THORACIC SURGERY Results of surgical treatment of primary lung cancer with synchronous brain metastases

Abstract

IntroductionThe surgical treatment of non-small cell lung cancer (NSCLC) with synchronous brain matastases is more effective than other therapeutic options, but this management is still controversial.The aim of the studyThe aim of the study was to evaluate the survival of patients after pulmonary resection NSCLC preceded by resection of brain metastases.Material and methodsFrom 2007 to 2012, 645 patients underwent pulmonary resection for NSCLC at our department. In 25 of them (3.87%) thoracic surgery was preceded by resection of a single brain metastasis of NSCLC and a PET CT scan. No signs of nodal involvement or distant metastases were detected.ResultsThe group consisted of 18 men (72%) and 7 women (28%). Average age was 57.62 years (46-70). In all cases, whole brain radiotherapy (5 × 4 Gy) was performed. The average interval between excision of brain metastasis and lung resection was 31.4 days (27-41). Pneumonectomy was performed in 1, lobectomy/bilobectomy in 17 and wedge resection in 7 cases. Pathological stage N0 was diagnosed in 17, N1 in 5 and N2 in 3 patients. Average survival was 18.68 months (4-74). Survival at 1, 2 and 5 years was 64%, 28% and 28% respectively. Average disease-free survival was 17.52 months. Histological type (p = 0.57) and G (p = 0.82) have no influence on survival. All the patients with hilar lymph node involvement died within 26 months and with mediastinal one within 12 months.ConclusionsSurgical treatment of patients with NSCLC with synchronous brain metastases may prove beneficial in selected patients after excluding other distant metastases and lymph node involvement.

Multimodal treatment of oligometastatic non-small cell lung cancer

“…This latter aspect leads criticisms due to sometimes discordant reports. Bella et al ,23 in a retrospective study involving 645 NSCLC patients and 25 of those with M1-brain disease, reported no significant differences in prognosis when histotype is considered (p=0.57).…”

Results of surgical resection in lung cancer with synchronous brain metastasis

“…There are several studies suggesting mediastinoscopy to meet this goal. [18,19] Therefore, we performed standard cervical mediastinoscopy in all patients to evaluate the status of the mediastinal lymph nodes before pulmonary resection. We completed the lung resections, when the frozen-section examinations of lymph nodes resulted negative.…”

Bevacizumab and gefitinib enhanced whole-brain radiation therapy for brain metastases due to non-small-cell lung cancer

“…Although surgical excision has been considered an effective approach for managing BM resulting from NSCLC, the median survival time for patients who experience such a disease progression is less than 3 months ( 24 ). As a standard treatment for BM caused by NSCLC, WBRT has improved the median survival time to approximately 5 months ( 25 ).…”