Because of Eric's post on iMRT I "ran into" information on proton beam therapy (got excited briefly) ......... and then 'stumbled onto' this old info dated: 1999
I guess it's all in where you focus your attention/research. This came as a surprize to me. Here it is:
<<Although, the results of chemotherapy for brain metastases have generally been disappointing, a number of uncontrolled studies have demonstrated favorable response rates of brain metastases from chemosensitive tumors such as breast cancer, small-cell lung cancer, and germ cell tumors.[1,114]
Brain Metastases From Breast Cancer—
Patients with metastatic breast cancer have been treated with chemotherapy since 1970. In the largest series to date, Rosner et al[116] treated 100 consecutive breast cancer patients with brain metastases with several chemotherapy regimens, including CFP (cyclophosphamide, fluorouracil, and prednisone) and CFPMV (CFP, methotrexate, and vincristine). Of note, these patients had not received prior chemotherapy for their systemic disease.
Overall, 50% of patients had an objective response (10% had a complete response and 40%, a partial response). In addition, disease stabilized in 9% of patients. The median duration of remission was 10 months for complete responders and 7 months for partial responders.
Rosner et al subsequently treated an additional 26 patients with progressive brain metastases from breast cancer with one of four chemotherapeutic regimens: (1) CFP, (2) CFPMV, (3) cyclophosphamide and doxorubicin, or (4) mitomycin (Mutamycin) and vinblastine.[117] Objective responses were seen in 61% of patients, while another 15% had stable disease. The median survival for responders was 12 months, as compared with 2.4 months for nonresponders. Interestingly, prior systemic chemotherapy did not affect the response of the brain metastases, arguing against the concept of the brain as a pharmacologic sanctuary.
Boogerd et al[118] treated 20 patients with brain metastases from breast cancer with CMF (cyclophosphamide, methotrexate, and fluorouracil) or CAF (cyclophosphamide, Adriamycin, and fluorouracil). Seven patients had developed recurrent disease after whole-brain radiation.
Objective tumor regression occurred in 76% of patients after two cycles of chemotherapy. The median duration of neurologic remission was 30 weeks, and the median survival was 25 weeks. When the results of these chemotherapy patients were compared to 29 historical controls treated with whole-brain radiation, the neurologic response rate, duration of response, and median survival were better in the patients treated with chemotherapy.
Several other small series have reported responses to a variety of regimens, including cisplatin (Platinol) plus etoposide[119]; and the TPDC-FuHu regimen, which combines lomustine (CCNU [CeeNu]) with various drugs designed to improve its efficacy, including thioguanine, procarbazine (Matulane), dibromodulcitol, fluorouracil, and hydroxyurea (Hydrea). [120]>>
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