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

Time for reappraisal of extracranial treatment options?

“…Some studies have found locoregional stage to have no significant effect on survival, 4,7 whereas other studies report significantly longer survival in patients with stage I or II disease, as compared with stage III disease. 13,14 Similarly, some studies found no survival difference according to nodal status, 5,20 whereas other studies demonstrate longer survival in lymph node negative patients compared with lymph node positive patients. 9,10 In this study age was also significant for survival in patients undergoing treatment of their brain metastases.…”

“…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.…”

Whole Brain Radiotherapy Plus Chemotherapy in the Treatment of Brain Metastases from Lung Cancer: A Meta-analysis of 19 Randomized Controlled Trails

“…Brain is one of the most common sites of metastases, and it is often accompanied by extracranial metastasis to other organs. The incidence of BM is 20% -30% in patients with non-small cell lung cancer (Louie et al, 2009), while is greater than 50% in small cell lung cancer patients (Jo et al, 2011). BM often show symptoms of intracranial hypertension, which is often the direct cause of death.…”

Efficacy of Surgical Treatment for Brain Metastasis in Patients With Non-small Cell Lung Cancer

“…3 Studies have been performed on the effect of neurosurgery for brain metastasis in the patients with neurological symptoms on diagnosis; however, their results were limited to patients with a solitary metastasis. [13][14][15][16] We performed early surgical treatment of brain metastasis (including multiple metastases) in patients with lowered performance status (i.e., KPS <70 or RPA class II or III) (Table 1). Early surgical treatment controlled the progression of brain metastasis and improved neurologic symptoms, and was followed by better performance status that enabled systemic chemotherapy (Fig.…”