In Spite of Curative Radical Pulmonary Procedures, Lesser Pulmonary Resection Shows More Favorable Prognosis in Surgically Treated NSCLC With Synchronous Isolated Cranial Oligometastases

Abstract

Oligometastatic disease in lung cancer is not a rare condition as previously thought. Among 812 non-small cell lung cancer patients treated surgically with lung resection between October 2011 and October 2018 at the Department of Thoracic Surgery, Florence Nightingale Hospitals, Turkey, 28 patients (3.4%) had synchronous cranial metastases. We analyzed synchronous isolated cranial metastases patients treated by locally ablative treatments (surgery, radiotherapy, or both). Metastases existing at the diagnosis of primary cancer were considered as synchronous, and their treatment was performed before (at least 1 month) or after (for maximum 1 month) surgery of the primary lung lesion. Prognostic factors affecting survival are evaluated retrospectively to identify clinical factors predicting survival in an effort to better select patients for surgery. Patients having T1-T2 primary lung tumors, no mediastinal lymph node metastasis, receiving minor anatomical lung resection, receiving neoadjuvant chemotherapy, having single cranial metastasis, and receiving surgical cranial metastasectomy were found to have better survival. According to tumor histology, having adenocarcinoma, and not having lymphovascular or visceral pleura invasion correlated with better survival. Average survival time was 52.1 months and median survival was 32 months. The last mortality during the follow-up was at 24 months; cumulative survival was 48.3% at that time. Our study was designed to define the criteria for patients with oligometastatic disease who may benefit from lung resection.

Association of Brain Metastases With Survival in Patients With Limited or Stable Extracranial Disease

“…The literature search identified 1067 unique studies, of which 68 studies met eligibility criteria (Figure 1; eTable 3 in Supplement 1). Among included studies, there were 58 retrospective cohort studies, 7 prospective cohort studies, and 3 RCTs. Thirty-four reported on non–small cell lung cancer (NSCLC), 3 on breast cancer, 2 on small-cell lung cancer, 1 on melanoma, and 1 reported multiple lung cancers.…”

“…Of note, 9 studies did not report a median follow-up. 20,34,39,55,59,60,63,73,80 In patients with IMD-SE secondary to breast cancer 20,60 and NSCLC, 27,36,39,[41][42][43][44]59,63,66,73,81,85 differences between cancer type (P = .84). Subgroup analysis similarly did not show significant differences among studies with high vs low risk of bias as determined by AHRQ ratings.…”

Prognostic value of thoracic tumor staging and volume parameters in non-small cell lung cancer patients with synchronous solitary bone metastasis

“…The 8th edition lung cancer stage classification categorizes a single distant metastatic lesion under the M1b classification, which is indicative of the rational definitions for an "oligometastatic disease subset" in NSCLC (1,19,20). A growing body of evidence has shown that NSCLC patients with solitary metastasis could achieve long-term survival, with some even approaching the 5-year survival rates achievable by patients with early-stage NSCLC without metastasis (3)(4)(5)(6). In this study, patients in group I in the cTN stage also had a favorable prognosis.…”

“…The prognosis of patients with M1b disease was similar to that of patients with M1a disease, with a median survival of 11.4 months, and the 5-year survival rate of stage IVA patients, which includes the M1a and M1b categories, was 10% (1,2). However, in recent years, a large number of retrospective studies have found that the 5-year survival rate in some non-small cell lung cancer (NSCLC) patients with solitary metastasis could exceed 30%, even reaching 50% in some cases, which was close to the 5-year survival rate of NSCLC patients without metastatic disease (3)(4)(5)(6). These data show that there is significant heterogeneity among NSCLC patients with solitary metastasis, but the stratification and treatment of such patients currently mainly depend on the subjective preferences of doctors, as no standardized regimen is available.…”

Editorial: Bench Research Behind Lung Cancer Surgery

“…Patients with T1–T2 primary lung tumours, no mediastinal lymph node metastasis, minor anatomical lung resection, neoadjuvant chemotherapy, single cranial metastasis, and surgical cranial metastasectomy were better survival. According to tumour histology, they had adenocarcinoma and not having lymphovascular or visceral pleura invasion correlated with better survival ( 6 ).…”