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Dr Imran Farooq
Dr Aakif Ullah Khan
Dr Abbas Ilyas
Dr Sami Ullah
Dr Noor Ul Ain
Dr Asad Zamir
Dr Zainab Jan
Dr Naheed Akhtar
Dr Sana Ullah


Temozolomide, Whole brain radiotherapy, Brain metastases.



  • To assess the Improvement in Signs and symptoms.

  • To assess 90 days progression free survival

  • To assess the Radiological response at day 30 and 90 with MRI brain.

Materials and Methods:  In this Randomized control trial, total of 4o patients were enrolled.

The enrolled patients were divided into two groups. Group A patients were treated with WBRT alone while Group B patients were treated with WBRT and TMZ. The radiologic response at Day 30 and the 90-day progression-free survival of the BM served as the main efficacy indicators.

Results: In our 40 patient study, 20 patients underwent RT alone and 20 received WBRT and

TMZ. No statistically significant differences were found between the both groups. In 30 days response 2 (10.0%) patients shows complete response and 6 (30%) shows partial response in each group. 8 (40.0%) patients shows stable disease condition in group A while 9 (45.0%) patients shows progressive disease condition in group B patients. At 90 days, the radiologic response was assessed and it was noted that there was no statistically significant difference between the groups. Conclusion: Concurrent treatment of RT and TMZ was well tolerated and improved BM's 90day progression-free survival rate considerably. These findings indicate that TMZ might enhance local BM management, but caution should be exercised.

Abstract 36 | PDF Downloads 23


1. Sacks P, Rahman M. Epidemiology of brain metastases. Neurosurgery Clinics. 2020;31(4):481- 8.
2. Chamberlain MC, Baik CS, Gadi VK, Bhatia S, Chow LQ. Systemic therapy of brain metastases: non–small cell lung cancer, breast cancer, and melanoma. Neuro-oncology. 2017;19(1):i1-i24.
3. Barlesi F, Gervais R, Lena H, Hureaux J, Berard H, Paillotin D, et al. Pemetrexed and cisplatin as first-line chemotherapy for advanced non-small-cell lung cancer (NSCLC) with asymptomatic inoperable brain metastases: a multicenter phase II trial (GFPC 07-01). Annals of oncology. 2011;22(11):2466-70.
4. Salkeld AL, Hau EK, Nahar N, Sykes JR, Wang W, Thwaites DI. Changes in brain metastasis during radiosurgical planning. International Journal of Radiation Oncology* Biology* Physics. 2018;102(4):727-33.
5. Kim I-Y, Jung S, Jung T-Y, Moon K-S, Jang W-Y, Park J-Y, et al. Repeat stereotactic radiosurgery for recurred metastatic brain tumors. Journal of Korean Neurosurgical Society. 2018;61(5):633-9.
6. Patil CG, Pricola K, Sarmiento JM, Garg SK, Bryant A, Black KL. Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases. Cochrane Database of Systematic Reviews. 2017(9).
7. Cortot A, Geriniere L, Robinet G, Breton JL, Corre R, Falchero L, et al. Phase II trial of temozolomide and cisplatin followed by whole brain radiotherapy in non-small-cell lung cancer patients with brain metastases: a GLOT-GFPC study. Annals of oncology. 2006;17(9):1412-7.
8. Parrish K, Sarkaria J, Elmquist WF. Improving drug delivery to primary and metastatic brain tumors: strategies to overcome the blood– brain barrier. Clinical Pharmacology & Therapeutics. 2015;97(4):336-46.
9. Moravan MJ, Fecci PE, Anders CK, Clarke JM, Salama AK, Adamson JD, et al. Current multidisciplinary management of brain metastases. Cancer. 2020;126(7):1390-406.
10. Yao Y, Chen Z-L, Norris EH, Strickland S. Astrocytic laminin regulates pericyte differentiation and maintains blood brain barrier integrity. Nature communications. 2014;5(1):3413. 11. Chang L, Su J, Jia X, Ren H. Treating malignant glioma in Chinese patients: update on temozolomide. OncoTargets and therapy. 2014:235-44.
12. Strobel H, Baisch T, Fitzel R, Schilberg K, Siegelin MD, Karpel-Massler G, et al. Temozolomide and other alkylating agents in glioblastoma therapy. Biomedicines. 2019;7(3):69.
13. Gilbar PJ, Pokharel K, Mangos HM. Temozolomide-induced aplastic anaemia: case report and review of the literature. Journal of Oncology Pharmacy Practice. 2021;27(5):1275-80.
14. Stupp R, Dietrich P-Y, Kraljevic SO, Pica A, Maillard I, Maeder P, et al. Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. Journal of Clinical Oncology. 2002;20(5):1375-82.
15. Margolin K, Atkins M, Thompson J, Ernstoff M, Weber J, Flaherty L, et al. Temozolomide and whole brain irradiation in melanoma metastatic to the brain: a phase II trial of the Cytokine Working Group. Journal of cancer research and clinical oncology. 2002;128:214-8.
16. Antonadou D, Paraskevaidis M, Sarris G, Coliarakis N, Economou I, Karageorgis P, et al. Phase II randomized trial of temozolomide and concurrent radiotherapy in patients with brain metastases. Journal of Clinical Oncology. 2002;20(17):3644-50.
17. Abrey LE, Olson JD, Raizer JJ, Mack M, Rodavitch A, Boutros DY, et al. A phase II trial of temozolomide for patients with recurrent or progressive brain metastases. Journal of neurooncology. 2001;53:259-65.
18. Antonadou D, Coliarakis N, Paraskevaidis M, Athanasiou H, Sarris G, Synodinou M, et al. Whole brain radiotherapy alone or in combination with temozolomide for brain metastases. A phase III study. International Journal of Radiation Oncology, Biology, Physics. 2002;54(2):93-4.
19. Shaw E, Scott C, Suh J, Kadish S, Stea B, Hackman J, et al. RSR13 plus cranial radiation therapy in patients with brain metastases: comparison with the Radiation Therapy Oncology Group Recursive Partitioning Analysis Brain Metastases Database. Journal of clinical oncology. 2003;21(12):2364-71.

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