Prognostic significance of histology after resection of brain metastases and whole brain radiotherapy in non-small cell lung cancer (NSCLC)

Abstract

Brain metastases from non-small cell lung cancer (NSCLC) are associated with a poor prognosis. In selected cases, surgical resection of brain metastases may be indicated, but the identification of patients suitable for surgery remains difficult. We collected data on patient and tumour characteristics known or suspected to be associated with survival by chart review. Data was merged with available data from the local cancer registry. We identified 64 NSCLC patients with resected brain metastases. Median overall survival after resection was 9.1 months with only two patients (3%) surviving more than 71 and 80 months. One and 2-year survival were 42 and 12.5%. Median survival for males and patients with more comorbidities was shorter (8 vs. 10 months [p = 0.11] and 6 vs. 9 months [p = 0.06]). Patients with squamous cell carcinomas (33% of the patients) had a significantly worse survival than patients with other histologies (7 vs. 10 months [p = 0.02]) with no patient living longer than 2 years. Squamous cell histology was associated with worse prognosis after resection of brain metastases in patients with non-small cell lung cancer. Histology, among other parameters, may also be taken into account when choosing the appropriate patients for resection of brain metastases.

Prognostic factors and outcome of surgically treated patients with brain metastases of non‐small cell lung cancer

“…The median OS, and one and two‐year survival rates in our study were 9.8 months, 41%, and 18.6%, respectively, consistent with the results of previous reports (approximately 8–9 months, 20–40%, and 5–12%, respectively) . Our results showed that RPA class I/II, KPS score > 70, solitary metastasis, no extracranial metastases, infratentorial lesions, complete resection, postoperative treatment, and recurrence treatment were associated with improved survival, whereas gender, age, smoking history, histological classification of metastases, the diameter of metastases, metastases onset, and preoperative prophylactic cranial irradiation were not associated with improved survival.…”

“…Adjuvant WBRT improves local tumor control and survival. 13,[24][25][26] Our results showed that WBRT prolonged survival by 3.5 months (12.1 vs. 8.6 months). Interestingly, chemotherapy increased the mean survival duration from 8.6 to 12.3 months, while chemotherapy combined with WBRT could prolong survival to 14.5 months.…”

“…Postoperative treatment includes WBRT, chemotherapy, and a combination of WBRT and chemotherapy. Adjuvant WBRT improves local tumor control and survival . Our results showed that WBRT prolonged survival by 3.5 months (12.1 vs. 8.6 months).…”

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

“…With respect to systemic therapy, tumor features, such as the histological subtype and molecular signature, play relevant prognostic and predictive roles because different NSCLC histologies have different treatment approaches and prognoses [ 27 ]. Surgical resection of brain metastasis from lung squamous cell carcinoma results in a significantly worse survival rate compared with other histotypes, whereas patients with adenocarcinoma live significantly longer [ 28 ]. Consistent with these findings, we found that the adenocarcinoma histotype is associated with prolonged survival, and advanced age is linked with poor prognosis.…”

The Interdisciplinary Management of Brain Metastases

“…and etoposide) do not cross the intact blood-brain barrier (32). Nonetheless, WBRT is still recommended as soon as chemotherapy has brought about a remission, because the risk of recurrent intracranial disease is otherwise high (5,31,33).…”