The Outcome of Bifocal Surgical Resection in Non-Small Cell Lung Cancer with Synchronous Brain Metastases: Results of a Single Center Retrospective Study

Abstract

Background The reported median survival in patients with non-small cell lung cancer (NSCLC) metastases to the brain varies from 3 to 12 months with combined treatment modalities. Bifocal surgical resection of synchronous brain metastasis and primary NSCLC has not been reported widely, and there have been only a small number of articles published in the literature. The aim of this retrospective study was to evaluate the prognostic factors among patients undergoing bifocal surgical resection.

Materials and Methods We retrospectively analyzed 28 patients who had a solitary metastatic brain lesion at the time of diagnosis, and underwent synchronous surgical resection of the brain metastasis and primary lung tumor. Survival time was measured in all the patients from the date of craniotomy until death or the most recent date of follow-up for those still surviving.

Results Mean age was 53 years. The mean length of follow-up was 23.6 (4–69) months. The overall survival rates were 79, 42, and 8% at the 1st, 2nd, and 5th years, respectively. The median length of survival was 24 ± 3.8 months. The median survival was found to be statistically significantly lower for the stage T3 tumors when compared with both stage T1 and T2 tumors (p = 0.037).

Conclusion NSCLC patients with resectable solitary cranial metastasis, low locoregional stage (stages IA, IB, IIA) in which T3 status is counted out, with no mediastinal lymph node involvement or any other extrathoracic spread will mostly benefit from consecutive complete resection of both tumors and are supposed to have a better survival.

Keywords

lung cancer treatment - metastases/metastasectomy - brain - outcomes

• References

• 1 Andrews RJ, Gluck DS, Konchingeri RH. Surgical resection of brain metastases from lung cancer. Acta Neurochir (Wien) 1996; 138 (4) 382-389
• 2 Kelly K, Bunn Jr PA. Is it time to reevaluate our approach to the treatment of brain metastases in patients with non-small cell lung cancer?. Lung Cancer 1998; 20 (2) 85-91
• 3 Li B, Yu J, Suntharalingam M , et al. Comparison of three treatment options for single brain metastasis from lung cancer. Int J Cancer 2000; 90 (1) 37-45
• 4 Minniti G, Salvati M, Muni R , et al. Stereotactic radiosurgery plus whole-brain radiotherapy for treatment of multiple metastases from non-small cell lung cancer. Anticancer Res 2010; 30 (7) 3055-3061
• 5 Billing PS, Miller DL, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Surgical treatment of primary lung cancer with synchronous brain metastases. J Thorac Cardiovasc Surg 2001; 122 (3) 548-553
• 6 Bonnette P, Puyo P, Gabriel C , et al; Groupe Thorax. Surgical management of non-small cell lung cancer with synchronous brain metastases. Chest 2001; 119 (5) 1469-1475
• 7 Burt M, Wronski M, Arbit E, Galicich JH ; Memorial Sloan-Kettering Cancer Center Thoracic Surgical Staff. Resection of brain metastases from non-small-cell lung carcinoma. Results of therapy. J Thorac Cardiovasc Surg 1992; 103 (3) 399-410 , discussion 410–411
• 8 Granone P, Margaritora S, D'Andrilli A, Cesario A, Kawamukai K, Meacci E. Non-small cell lung cancer with single brain metastasis: the role of surgical treatment. Eur J Cardiothorac Surg 2001; 20 (2) 361-366
• 9 Hankins JR, Miller JE, Salcman M , et al. Surgical management of lung cancer with solitary cerebral metastasis. Ann Thorac Surg 1988; 46 (1) 24-28
• 10 Mussi A, Pistolesi M, Lucchi M , et al. Resection of single brain metastasis in non-small-cell lung cancer: prognostic factors. J Thorac Cardiovasc Surg 1996; 112 (1) 146-153
• 11 Rossi NP, Zavala DC, VanGilder JC. A combined surgical approach to non-oat-cell pulmonary carcinoma with single cerebral metastasis. Respiration 1987; 51 (3) 170-178
• 12 Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM, , ed. Evaluation of Chemotherapeutic Agents. New York: Columbia University Press; 1949: 196
• 13 Rami-Porta R, Crowley JJ, Goldstraw P. The revised TNM staging system for lung cancer. Ann Thorac Cardiovasc Surg 2009; 15 (1) 4-9
• 14 Torre M, Barbieri B, Bera E, Locicero S, Pieri Nerli F, Belloni PA. Surgical therapy in lung cancer with single brain metastasis. Eur J Cardiothorac Surg 1988; 2 (5) 336-339
• 15 Penel N, Brichet A, Prevost B , et al. Pronostic factors of synchronous brain metastases from lung cancer. Lung Cancer 2001; 33 (2-3) 143-154