Chemotherapy is the cornerstone of the combined surgical treatment of lung cancer with synchronous brain metastases

Non-small cell lung cancer and silent brain metastasis

“…Regrettably, only 10-15% of patients are deemed fit for such surgery [11]. Neurosurgery is normally successful in controlling metastasis in the majority of these patients and long-term survival is achieved when, in addition, such patients respond well to treatment of the primary tumor by chemotherapy [16]. In our group, 11 out of 80 patients (13.7%) underwent neurosurgery, and they had a Statistical significance at p < 0.05. b TNM stage without consideration of possible brain involvement.…”

Time for reappraisal of extracranial treatment options?

“…4,9,10,14,[18][19][20] (Most studies reported that the prognosis of patients undergoing surgical resection for a synchronous BM from NSCLC mainly depended on the treatment of the lung tumor, with a survival advantage seen in patients receiving radical treatment (surgery or radiotherapy). 12,14,21 After SRS for solitary synchronous BM from NSCLC, a significantly longer OS (26.4 months) was similarly seen in patients who underwent radical thoracic treatment (surgery or chemoradiotherapy) than those undergoing palliative treatment (13.1 months). 7 In our study, survival in patients receiving aggressive treatment of synchronous BM was also significantly associated with thoracic stage, with a less advanced stage incurring a better prognosis.…”

“…Some reports suggest that survival in such patients is influenced by the treatment modality used for an intrathoracic tumor, with radical treatment strategies (surgery or high-dose thoracic radiotherapy) effecting extended survival. [9][10][11][12][13][14][15] However, such data are mainly limited to retrospective analyses of small numbers of patients with a single brain metastasis and no extracranial metastases (oligometastatic disease). As the majority of patients with NSCLC present with multiple brain metastases and/or extensive extracranial disease, they are ineligible for such treatment.…”

The elderly with synchronous non-small cell lung cancer and solitary brain metastasis: Does palliative thoracic radiotherapy have a useful role?

“…Their observation of a 22% long-term (>36 months) survival rate suggests that there may be a favorable subset of patients who could benefit from aggressive (a combination of treatments) rather than palliative therapy. Girard et al [27] examined their experience of 51 patients with resected simultaneous brain metastases from NSCLC (including an analysis of survival determinants pertaining to the treatment strategy of the primary lung tumor); gain in survival was compared between the 29 people managed with a curative intent (median survival of 22.5 months and 2-year survival rate of 42%) and the 22 individuals treated with a palliative design (median survival of 7.1 months and a 2-year survival rate of 5%). Because of their observations, they proposed that in cases of synchronous, resectable brain metastases from NSCLC, a multimodality management approach may now include chemotherapy because it could help identify those patients who might respond to induction chemotherapy and consequently live longer.…”