Comparison of clinical neurological function and CT response during chemotherapy for initial brain metastases from...

We compared the clinical neurological and functional response with changes in CT during systemic combination chemotherapy in 20 patients with initial brain metastases from small cell lung cancer (SCLC). Seven patients died within four weeks from start of chemotherapy, leaving 13 patients for evaluation of treatment response. Eight patients improved to or maintained a high neurological score, meaning no or insignificant neurological deficits or disability. Three patients had a stable neurological score, and 2 patients deteriorated. The median duration of the clinical response was 20 weeks. Based on changes in CT four patients had complete remission, six had partial remission, and two showed no change. One patient had a rapid deterioration of her clinical condition and died without CT control. Five patients with late CNS relapse were treated with second-line cranial irradiation inducing clinical improvement in three. Median survival was 11 weeks, and in assessable patients, excluding early deaths, 28 weeks. In conclusion initial brain metastases respond to systemic chemotherapy as readily as extracranial locations of SCLC, and in many patients prolonged neurological and CT remission can be achieved.