Surgical therapy in lung cancer with single brain metastasis

Abstract

From January 1975 to April 1987, 27 patients underwent surgical resection of non oat cell lung cancer and a single brain metastasis. There were 25 men and 2 women ranging in age from 37 to 70 years. In 21 cases the brain metastasis was synchronous while in 6 cases the onset was metachronous. In 17 cases, the site of the brain metastasis was supratentorial and in 10 cases it was located in the posterior fossa. The chest X-ray confirmed the primary lung tumour in 24 cases. In 3 cases, only bronchoscopy and cytology revealed the primary focus of the tumour. The lung cancer was located in the upper lobe in 25 patients. Upper lobectomy was performed in 23 patients, pneumonectomy in 3, and lower lobectomy in 1. There were no operative deaths. The cell type was adenocarcinoma in 19 cases, squamous cell carcinoma in 4 patients and large cell carcinoma in 4. Only the tumour and nodes were used for staging at thoracotomy. The classification was: 12 patients in stage I, 2 in stage II, and 13 in stage III. At conclusion of the study the longest survival was 68 months after thoracotomy. There was no significant difference in the duration of survival in patients over or under 50 years old. Better results were obtained in patients without node metastases at thoracotomy (median survival of 30 months and an overall 5-year survival of 35%), and in patients with supratentorial metastases (median survival of 22 months and an overall 5-year survival of 23.4%). Our experience confirms that combined surgery prolongs survival and improves the quality of life.

Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991

“…Others have reported similar findings. 5,32,69,70 In general, the median interval between the diagnosis of lung cancer and the discovery of brain metastases is 6 months, but 10% of our patients with adenocarcinoma did not receive a diagnosis of brain metastasis until more than 2 years after diagnosis of their primary tumor. For five patients, the interval was even longer-more than 5 years-a time period that was also reported by Komaki and colleagues.…”

Metastatectomy for extra-cranial extra-adrenal non-small cell lung cancer solitary metastases: Systematic review and analysis of reported cases

“…The prognosis of NSCLC is poor because metastasis develops early, and most patients present as advanced stage with metastasis to other organs. To date, multiple studies have showed a significant survival benefit from resection of a solitary metastatic lesion in the brain or the adrenal gland, and this practice is becoming the standard of care, especially if the primary lung tumor is in the early stages and resectable [3][4][5][6][7][8][9][10][11]. In some studies, the 5-year survival rate reaches the historical survival of patients with the same intra-thoracic stage NSCLC without metastasis [3][4][5][6][7][8].…”

“…In several series, 5-year survival rates of 15-35% had been reported after resection of solitary brain metastasis [3][4][5][6][7]. Likewise, other studies had shown that resection of isolated adrenal gland metastasis can result in long term survival (up to 26% at 5 years, and a median survival of 11-31 months) [8][9][10][11].…”

“…In these reports, predictive factors of survival following resection of solitary metastases to the brain or adrenal gland from NSCLC primary have been identified [4][5][6][7][8][9][10]. The prognostic factors of interest commonly included mode of presentation (synchronous vs. metachronous), histology and T and N stage of the primary tumor.…”

Oligometastatic Non-Small Cell Lung Cancer: A Significant Entity outside of Specialized Cancer Centers?

“…It has long been recognized that patients with a solitary brain metastasis and limited thoracic disease might experience favorable long-term survival after effective local therapy [ 4 ]. Historically, cohort studies published during the 1980s with treatment dating back to even earlier decades already described the concept of surgical treatment in NSCLC with a solitary brain metastasis, which resulted in variable rates of 5-year survival [ 5 ]. Later on, stereotactic radiosurgery was used for some patients with brain metastases, and more recently, the introduction of extracranial stereotactic ablative radiotherapy has enabled us to provide noninvasive highly efficacious local therapy to different sites of oligometastases [ 6 ].…”