• Clayton M Spiceland, Kenneth R Olivier, and Aminah Jatoi.
• 1 Department of Medicine, Mayo Clinic , Rochester, Minnesota.
• J Palliat Med. 2015 Aug 1; 18 (8): 707-10.

BackgroundNumerous studies have focused on the treatment of non-small cell lung cancer patients with brain metastases. However, to our knowledge, few have sought to examine outcomes in patients who required whole brain radiation and developed radiation-refractory disease.MethodsThis study examined the medical records of all non-small cell lung cancer patients who developed brain metastases between 2004 and 2013, required whole brain radiation, and received their cancer treatment at the Mayo Clinic in Rochester, Minnesota.ResultsA total of 141 patients, most of whom were symptomatic, met the above criteria. Of these, 33 (23%) did not tolerate a corticosteroid taper and were therefore deemed to have radiation-refractory disease. The median survival of patients with and without radiation-refractory disease was 3.12 and 4.27 months, respectively, (hazard ratio [HR]: 0.65 [95% confidence interval (CI): 0.44-0.99]; p=0.04 by log rank test). In a subgroup analysis of patients with radiation-refractory disease (n=33) and radio-responsive disease (n=43), median survival was 3.12 and 5.94 months, respectively (HR: 0.43 [95% CI: 0.26-0.70]). Among patients with radiation-refractory disease, 12 received chemotherapy after radiation, and two received erlotinib. Systemic therapy was associated with improved symptoms in two patients but did not appear to improve survival.ConclusionNon-small cell lung cancer patients with radiation-refractory brain metastases represent a small subgroup who have a short survival and who appear to derive minimal benefit from systemic cancer therapy.

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