Title

Management and Prognosis in Synchronous Solitary Resected Brain Metastasis from Non–Small-Cell Lung Cancer

Authors

Alexander V. Louie, London Regional Cancer Program, London, ON
George Rodrigues, University of Western OntarioFollow
Brian Yaremko, University of Western OntarioFollow
Edward Yu, University of Western OntarioFollow
A. Rashid Dar, University of Western OntarioFollow
Brian Dingle, University of Western OntarioFollow
Mark Vincent, University of Western OntarioFollow
Michael Sanatani, University of Western OntarioFollow
Richard Malthaner, University of Western OntarioFollow
Richard Inculet, University of Western OntarioFollow

Document Type

Article

Publication Date

5-2009

Journal

Clinical Lung Cancer

Volume

10

Issue

3

First Page

174

Last Page

179

Abstract

Background: Reports in the medical literature have described cases of extended survival of patients with non-small-cell lung cancer (NSCLC) with solitary metastatic disease who have received aggressive treatment both to the brain metastasis and to the local/regional disease. The objective of this research is to analyze prognostic factors that predict for outcome in this unique patient population.

Patients and methods: A single-institution, retrospective chart review was performed on 35 patients with NSCLC and a synchronous solitary brain metastasis (SSBM) treated with craniotomy and whole-brain radiation therapy. Eight patients (22.9%) had chest surgery, 24 (68.6%) had chemotherapy, and 14 (40%) had thoracic radiation as part of their local management. Fourteen had stage I/II disease (42.9%), and 20 had stage III disease (57.1%). Mean age at diagnosis was 58.5 years. Eighteen patients (56.25%) had a brain metastasis < 3 cm, and 14 patients (43.75%) had a metastasis > 3 cm.

Results: Median survival was 7.8 months, and at last follow-up, 3 patients (8.6%) were alive and well, 6 patients (17.1%) were alive and with disease, 24 patients (68.6%) had died of disease, and 2 patients (5.7%) had died of other causes. Univariate analysis demonstrated that lung surgery (P = .0033), primary lung treatment > 8 weeks after brain surgery (P = .0128), and stage I/II disease (P = .0467) were predictive of overall survival.

Conclusion: Survival remains poor for patients with NSCLC with an SSBM. However, patients with thoracic disease amenable to local resection should be considered for such therapy because a survival advantage could exist compared with patients with more locally advanced disease.

Notes

Published in: Clinical Lung Cancer, Volume 10, Number 3, May 2009, Pages 174-179. doi: 10.3816/CLC.2009.n.024