Craniotomy and Thoracotomy for Non‐small Cell Carcinoma of the Lung With Cerebral Metastasis

Abstract

Twenty patients with non‐small cell carcinoma of the lung who had cerebral metastasis, were treated by craniotomy and thoracotomy. Eighteen of these patients had a solitary metastasis and all were treated as curable. Ten patients presented with synchronous lung and brain disease. Of the remaining 10, nine initially presented with the lung tumour, which was treated first. There was a zero operative mortality rate and median survival was 12 months with reasonable quality of life for this time.

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

“…2). In the curative intent group, median, 1-year, and 2-year survival (respectively 22.5 months, 69%, and 28%) compares favorably with the previously reported results of combined cerebral and thoracic surgery (respectively 12-27 months, 55-60%, and 25-30% [2,31]). This was observed not only in patients really undergoing combined surgery, but also in patients whose tumor responded to induction chemotherapy, as well as in all patients receiving induction chemotherapy, who had a 1-year and 2-year survival of 65% and 40%, respectively (Table 1).…”

“…However, the nodal involvement status did not appear as a significant factor in this situation, as previously reported (Fig. 2) [9,11,12,19,31,32]; thus, the recommendation to exclude patients with N2 or even N3 involvement from combined resection may be debated [41].…”

“…However, median, 1-year, and 2-year survival were somewhat higher in this cohort (respectively 13.2 months, 52%, and 28%) than in series of metastatic non-small cell lung cancer as a whole, (respectively about 8-9 months, 20-40%, and 5-12%) [39,40]. Although some recent studies reported a benefit from resection of synchronous brain metastases with further thoracic surgery [8,9,[26][27][28][29][30][31][32], little is known on the optimal treatment algorithm, especially regarding the place of chemotherapy. Actually, our results show that the prognosis of such patients mostly depends on the treatment of the primary lung tumor site, with brain metastasectomy leading to a survival benefit in patients whose primary lung tumor is resectable and/or responds to induction chemotherapy.…”

“…Previously reported series of patients with resected brain metastases from lung cancer are mostly based on selected groups [8][9][10][11][12][13][14][15][16], treated with various adjuvant modalities [9][10][11][12][13][14][15][16][17][18][19][20][21], at different times of the development of cancer [9,10,11,[22][23][24][25][26][27], and definite conclusions on prognostic factors and therapeutic options are thus difficult to assess. In contrast to the dogma that distant spread precludes thoracic surgery, a small number of patients with synchronous brain metastases may benefit from combined resection of both the primary and the metastatic site [9,11,12,20,[27][28][29][30][31][32].…”

Complete resection of non‐small‐cell lung cancer and oligo‐metastatic brain disease

“…There is a paucity of local data reporting survival after resection of NSCLC brain metastases in patients with controlled or controllable primary disease 14 . The present case series comprises the 5‐year experience using a multidisciplinary surgical approach to lung cancer with brain metastases in an Australian setting.…”