Patients with Single Brain Metastasis from Non-Small Cell Lung Cancer Equally Benefit from Stereotactic Radiosurgery and Surgery: A Systematic Review

Abstract

BackgroundThe appropriate treatment of non-small cell lung cancer (NSCLC) with single brain metastasis (SBM) is still controversial. A systematic review was designed to evaluate the effectiveness of neurosurgery and stereotactic radiosurgery (SRS) in patients with SBM from NSCLC.Material/MethodsPUBMED, EMBASE, the Cochrane Library, Web of Knowledge, Current Controlled Trials, Clinical Trials, and 2 conference websites were searched to select NSCLC patients with only SBM who received brain surgery or SRS. SPSS 18.0 software was used to analyze the mean median survival time (MST) and Stata 11.0 software was used to calculate the overall survival (OS).ResultsA total of 18 trials including 713 patients were systematically reviewed. The MST of the patients was 12.7 months in surgery group and 14.85 months in SRS group, respectively. The 1, 2, and 5 years OS of the patients were 59%, 33%, and 19% in surgery group, and 62%, 33%, and 14% in SRS group, respectively. Furthermore, in the surgery group, the 1 and 3 years OS were 68% and 15% in patients with controlled primary tumors, and 50% and 13% in the other patients with uncontrolled primary tumors, respectively. Interestingly, the 5-year OS was up to 21% in patients with controlled primary tumors.ConclusionsThere was no significant difference in MST or OS between patients treated with neurosurgery and SRS. Patients with resectable lung tumors and SBM may benefit from the resection of both primary lesions and metastasis.

CAVEOLIN-1 expression in brain metastasis from lung cancer predicts worse outcome and radioresistance, irrespective of tumor histotype

“…According to current guidelines [ 23 , 24 ], resection of solitary brain metastasis is a valuable treatment option, resulting in a five-year survival rate of 20-25% if radical surgery of the primary tumor is also performed [ 25 ]. In agreement with a recent systematic review [ 26 ], survival improves when both the primary lung tumor and brain metastasis are resected; thus, removal of the primary site and single brain metastasis appears to be an effective treatment for long-term survival. However, effective tools for selecting patients who may benefit from surgical resection of brain metastasis remain to be identified.…”

Survival prognostic factors for patients with synchronous brain oligometastatic non-small-cell lung carcinoma receiving local therapy

“…Recently, a system review summarized the clinical evidence in patients with single brain metastasis from NSCLC who underwent surgical resection and SRS. 19 The results were consistent with those of the present study, which demonstrated comparable local control of brain metastases and OS benefits.…”

Effect of metastatic site on survival in patients with neuroendocrine neoplasms (NENs). An analysis of SEER data from 2010 to 2014

“…A study in two major institutions [27] in carcinoid patients with bone and/or liver metastases confirmed that coexistence of bone and liver metastasis was indicative of worse prognosis with a significant difference in overall survival -the small total numbers of patients (691) might have made it more difficult to obtain statistical significance in other histologies. The poor prognosis of brain metastases is not unexpected and is consistent across different tumor types, such as breast [28,29], lung [30], gastrointestinal [31] and ovarian [32]. It is usually measured in matters of months and may reflect the virulence of the tumor, the severity of CNS dysfunction or the inability of most current therapies to cross the blood brain barrier.…”