M18-01: Whole brain radiotherapy and stereotactic radiosurgery for brain metastases from NSCLC

Frank J. Lagerwaard
2007 Journal of Thoracic Oncology  
Surgical resection is the standard approach for patients with early stage NSCLC. Even after complete resection, about half of these patients will relapse and die within 5 years. Cisplatin-based adjuvant chemotherapy has been proven to improve the prognosis for patients with resected stages II, IIIA and perhaps some IB 1 . In the LACE meta-analysis, the pooled hazard ratio was 0.89 (95% CI 0.82-0.96), translating into a 6% benefit in 5-year survival (from 43 to 49%) with adjuvant chemotherapy 2
more » ... Postoperative administration of Cisplatin-based chemotherapy, however, often results in substantial toxicity, especially after pneumonectomy, and quite some patients are not able to receive it because of co-morbidity or postoperative problems 3 . Effective and better tolerated adjuvant strategies are therefore most welcome. Cancer immunotherapy might be a good candidate to achieve this goal. In a broad sense, cancer immunotherapy is stimulation of the immune system to treat cancer. This can be supportive (non-specific enhancement of innate immune system), passive (supply immune response to the system by giving antibodies or cytotoxic T cells), or active by specific priming of the immune system to recognize the tumor as foreign. Only the last one is cancer vaccination in its true sense. Conditions for optimal cancer vaccination are: 1/ specificity (i.e. having a well defined target antigen in the tumour, not in other tissues); 2/ selectivity (i.e. used in the population expressing the target); 3/ interac-Brain metastases are a common complication of advanced stage nonsmall cell lung cancer (NSCLC), with an estimated incidence at initial diagnosis of 10-20%, increasing to up to 40% in the two years following diagnosis [Carolan 2005 ]. Palliative whole brain radiotherapy (WBRT) has been the mainstay of treatment for patients with multiple brain metastases, extending survival to 3-6 months. However, despite
doi:10.1097/01.jto.0000282980.11489.fa fatcat:2cngcdwy4fh4npnwnqchdy7vii