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

Abstract

The authors reviewed the records of 231 patients who underwent resection of brain metastases from nonsmall-cell lung cancer between 1976 and 1991. Data regarding the primary disease and the characteristics of brain metastasis were retrospectively collected. Median survival in the group from the time of first craniotomy was 11 months; post-operative mortality was 3%. Survival rates of 1, 2, 3, and 5 years were 46.3%, 24.2%, 14.7%, and 12.5%, respectively. One hundred twelve women survived significantly longer than 119 men (13.8 vs. 9.5 months, p < 0.02). Patients with single metastatic lesions (200 patients) survived longer than those (31 patients) with multiple metastases (11.1 vs. 8.5 months, p < 0.02). Patients with supratentorial tumors survived longer than patients with cerebellar lesions. A high Karnofsky performance scale score before surgery also indicated increased survival. In multivariate analyses, incomplete resection or no resection of primary lung tumor, male gender, infratentorial location, presence of systemic metastases, and age older than 60 years were significantly correlated with shorter survival. Approximately one-third of the patients died of neurological causes, one-third of systemic disease, and one-third of a combination of both. The results of this series confirm that the overall prognosis for patients with even a single resectable brain metastasis is poor, but that aggressive therapy can prolong life with quality of life preserved and can occasionally permit long-term survival.

Surgical Treatment of Extrapulmonary Oligometastatic Non-small Cell Lung Cancer

“…A subgroup of patients with oligometastatic disease may benefit from surgical resection of the primary tumor and metastasis, but only very limited data are available to date. Several studies have documented a benefit of surgical resection of the primary tumor and a single metastasis in the brain or the adrenal gland, but the benefit of this treatment is not well documented for oligometastatic NSCLC to other metastatic sites [8][9][10]. Recently, Salah et al reviewed 51 case reports of patients with oligometastatic, extracranial, and extra-adrenal NSCLC and tried to identify parameters that predict outcome [11].…”

“…These patients may benefit from surgical resection of the primary tumor and its metastasis. Several retrospective case studies have documented an improved outcome in patients treated surgically, but most studies reported only on isolated metastasis of the brain or adrenal gland [7][8][9][10]. Therefore, it is unknown whether patients with an isolated metastasis in other locations also benefit from this aggressive approach.…”

“…Therefore, it is unknown whether patients with an isolated metastasis in other locations also benefit from this aggressive approach. Recently, Salah et al reviewed 51 cases to analyze the outcome of extrapulmonary, extracerebral, and extraadrenal oligometastatic NSCLC [7][8][9][10][11]. The 5-year overall survival rate was 50 %, which implies a high publication bias.…”

Brain metastasis from prostate carcinoma

“…In the current series, infratentorial metastasis was not associated with a shorter median survival. Wronski et al [15][16][17][18][19] found that infratentorial location was an independent, negative predictive factor for survival in patients with brain metastases from melanoma, colon carcinoma, nonsmall cell lung carcinoma, and renal carcinoma but not in patients with breast carcinoma. The median survival in this series of untreated patients and treated patients was similar to the survival reported in other large series in which the median survival was between 3 months and 4 months.…”

Isolated brain metastasis as a late recurrence of completely resected non-small cell lung cancer

“…Patients with lung cancer have been shown to develop brain metastasis at an early stage, usually within the first 2 years following the diagnosis of the primary tumor (3,4). It has been reported that 25-40% of patients with non-small cell lung cancer (NSCLC) develop brain metastasis during the course of their disease (5).…”