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document
Treatment of brain metastases of small-cell lung cancer : comparing teniposide and teniposide with whole-brain radiotherapy -- a phase III study of the European Organization for the Research and Treatment of Cancer Lung Cancer Cooperative Group . PURPOSE Approximately 60 % of patients with small-cell lung cancer ( SCLC ) develop brain metastases . Whole-brain radiotherapy ( WBRT ) gives symptomatic improvement in more than 50 % of these patients . Because brain metastases are a sign of systemic progression , and chemotherapy was found to be effective as well , it becomes questionable whether WBRT is the only appropriate therapy in this situation . PATIENTS AND METHODS In a phase III study , SCLC patients with brain metastases were randomized to receive teniposide with or without WBRT . Teniposide 120 mg/m ( 2 ) was given intravenously three times a week , every 3 weeks . WBRT ( 10 fractions of 3 Gy ) had to start within 3 weeks from the start of chemotherapy . Response was measured clinically and by computed tomography of the brain . RESULTS One hundred twenty eligible patients were randomized . A 57 % response rate was seen in the combined-modality arm ( 95 % confidence interval [ CI ] , 43 % to 69 % ) , and a 22 % response rate was seen in the teniposide-alone arm ( 95 % CI , 12 % to 34 % ) ( P < .001 ) . Time to progression in the brain was longer in the combined-modality group ( P=.005 ) . Clinical response and response outside the brain were not different . The median survival time was 3.5 months in the combined-modality arm and 3.2 months in the teniposide-alone arm . Overall survival in both groups was not different ( P=.087 ) . CONCLUSION Adding WBRT to teniposide results in a much higher response rate of brain metastases and in a longer time to progression of brain metastases than teniposide alone . Survival was poor in both groups and not significantly different .
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Intervention_Pharmacological
teniposide
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Intervention_Pharmacological
teniposide
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Intervention_Physical
with whole-brain radiotherapy
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Intervention_Physical
Whole-brain radiotherapy ( WBRT )
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Intervention_Physical
WBRT
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Intervention_Pharmacological
teniposide
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Intervention_Physical
WBRT
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Intervention_Pharmacological
Teniposide
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Intervention_Physical
WBRT
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Intervention_Pharmacological
chemotherapy
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Intervention_Pharmacological
teniposide-alone
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Intervention_Pharmacological
teniposide-alone
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Intervention_Physical
WBRT
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Intervention_Pharmacological
teniposide
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Outcome_Other
clinically
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Outcome_Other
computed tomography of the brain
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Outcome_Other
response rate
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Outcome_Other
response rate
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Outcome_Physical
Time to progression
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Outcome_Other
in the brain
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Outcome_Other
longer
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Outcome_Other
Clinical response
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Outcome_Mortality
median survival time
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Outcome_Other
response rate
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Outcome_Mortality
Survival
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Participant_Condition
patients with small-cell lung cancer ( SCLC )
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Participant_Condition
One hundred twenty eligible patients