Brain chemotherapy improves survival after lung metastasis
Intraventricular chemotherapy, in which the drugs are injected directly into the ventricles of the brain, improved symptom response rate and overall survival among persons with leptomeningeal carcinomatosis (LMC) that developed from non-small cell lung cancer (NSCLC).
Lung cancer is one of the most common primary cancers to cause LMC, in which cancer metastasizes to the membranes surrounding the spinal cord and brain. With treatment advances improving survival rates for persons with lung cancer, cases of LMC have increased, according to a statement from the International Association for the Study of Lung Cancer (IASLC).
Researchers conducted a retrospective analysis of the medical records of 105 persons with LMC from NSCLC who had undergone intraventricular chemotherapy. The patients, aged 31 to 75 years (median age 56 years), had received 1 to 49 rounds of intraventricular chemotherapy (median five rounds).
The most common presenting symptom was headache (in 77% of patients), with nausea or vomiting; this showed the highest response rate to intraventricular chemotherapy, at 42%. Altered mentality, cranial neuropathy, and cauda equina symptoms were associated with a symptom response of 10% or less.
Median overall survival was 3.0 months (range 0.5 to 21.5 months). Age of 60 years or older, high functional impairment as indicated by a Karnofsky Performance Status score of less than 70, and uncontrolled intracranial pressure were unfavorable prognostic factors for patient survival.
Among the 54 patients with increased intracranial pressure at the start of treatment, 20 achieved normal pressure after undergoing intraventricular chemotherapy, not including three patients who received a ventriculo-peritoneal shunt. However, 15 of 51 patients with normal intracranial pressure at the start of treatment showed increased pressure during the course of therapy, which remained uncontrolled. The total increased intracranial pressure control rate of intraventricular chemotherapy was thus 29%, or 20 of 69 patients.
In the multivariate analysis, a greater amount of intraventricular chemotherapy and concurrent systemic chemotherapy significantly improved overall survival.
As investigators Ho-Shin Gwak and colleagues from the National Cancer Center in Goyang, Korea, concluded in the IASLC's Journal of Thoracic Oncology (2013;8:599-605), intraventricular chemotherapy for patients with LMC from NSCLC could palliate associated symptoms and prolong survival. The group recommended careful selection of patients for this treatment, with aggressive intracranial pressure control and concurrent systemic chemotherapy.