Development of symptomatic brain metastases after chemoradiotherapy for stage III non-small cell lung cancer: Does the type of chemotherapy regimen matter?

Lizza E. L. Hendriks*, Anita J. W. M. Brouns, Mohammad Amini, Wilma Uyterlinde, Robin Wijsman, Jan Bussink, Bonne Biesma, S. Bing Oei, Jos A. Stigt, Gerben P. Bootsma, Jose S. A. Belderbos, Dirk K. M. De Ruysscher, Michel M. Van den Heuvel, Anne-Marie C. Dingemans

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objectives: Symptomatic brain metastases (BM) occur frequently after chemoradiotherapy (CRT) for stage III NSCLC. Aim of the current study was to determine whether the specific chemotherapy used in a CRT regimen influences BM development. Materials and methods: Retrospective multicenter study including all consecutive stage III NSCLC who completed CRT. Primary endpoints: symptomatic BM development, whether this was the only site of first relapse. Differences between regimens were assessed with a logistic regression model including known BM risk factors and the specific chemotherapy: concurrent versus sequential (cCRT/sCRT), within cCRT: daily low dose cisplatin (LDC)-cyclic dose polychemotherapy; LDC-(non-)taxane cyclic dose; LDC-polychemotherapy subgroups of >= 50 patients. Results: Between January 2006 and June 2014, 838 patients were eligible (737 cCRT, 101 5CRT). 18.2% developed symptomatic BM, 8.0% had BM as only site of first relapse. BM patients were significantly younger, female, had more advanced N-stage and had adenocarcinoma histology. In both cCRT and sCRT BM were found in 18% (p=0.904). In cyclic dose cCRT (N=346) and LDC (N=391) BM were found in 18.8% and 17.9%, respectively (p=0.757). In 7.2% and 8.7%, respectively, BM were the only site of first relapse (p = 0.463). The chemotherapy used (cCRT versus SCRT) had no influence on BM development, not for all brain relapses nor as only site of first relapse (OR 0.88 (p= 0.669), OR 0.93 (p = 0.855), respectively). LDC versus cyclic dose cCRT was not significantly different: neither for all brain relapses nor as only site of first relapse (OR 0.96 (p = 0.819), OR 1.21 (p= 0.498), respectively).Comparable results were found for LDC versus cyclic dose non-taxane (N = 277) and cyclic dose taxane regimens (N = 69) and for cCRT regimens with >= 50 patients (LDC versus cisplatin/etoposide (N=188), cisplatin/vinorelbin (N= 65), weekly cisplatin/docetaxel (N= 60)). Conclusion: approximately 18% developed symptomatic BM after stage III diagnosis, not dependent on type of chemotherapy regimen used within a CRT treatment.
Original languageEnglish
Pages (from-to)68-75
JournalLung Cancer
Publication statusPublished - Nov 2016


  • Stage III
  • Chemoradiation
  • Chemotherapy
  • Symptomatic brain metastases

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