Resection of symptomatic non–small cell lung cancer brain metastasis in the setting of multiple brain metastases

Abstract

OBJECTIVE Current guidelines primarily suggest resection of brain metastases (BMs) in patients with limited lesions. With a growing number of highly effective local and systemic treatment options, this view may be challenged. The purpose of this study was to evaluate the role of metastasectomy, disregarding BM count, in a comprehensive treatment setting. METHODS In this monocentric retrospective analysis, the authors included patients who underwent resection for at least 1 BM and collected demographic, clinical, and tumor-associated parameters. Prognostic factors for local control and overall survival (OS) were analyzed with the log-rank test and Cox proportional hazards analysis. RESULTS The authors analyzed 216 patients. One hundred twenty-nine (59.7%) patients were diagnosed with a single/solitary BM, whereas 64 (29.6%) patients had 2–3 BMs and the remaining 23 (10.6%) had more than 3 BMs. With resection of symptomatic BMs, a significant improvement in Karnofsky Performance Scale (KPS) was achieved (p < 0.001), thereby enabling adjuvant radiotherapy for 199 (92.1%) patients and systemic treatment for 119 (55.1%) patients. During follow-up, 83 (38.4%) patients experienced local recurrence. BM count did not significantly influence local control rates. By the time of analysis, 120 (55.6%) patients had died; the leading cause of death was systemic tumor progression. The mean (range) OS after surgery was 12.7 (0–88) months. In univariate analysis, the BM count did not influence OS (p = 0.844), but age < 65 years (p = 0.007), preoperative and postoperative KPS ≥ 70 (p = 0.002 and p = 0.005, respectively), systemic metastases other than BM (p = 0.004), adjuvant radiation therapy (p < 0.001), and adjuvant systemic treatment (p < 0.001) were prognostic factors. In regression analysis, the presence of extracranial metastases (HR 2.30, 95% CI 1.53–3.48, p < 0.001), adjuvant radiation therapy (HR 0.97, 95% CI 0.23–0.86, p = 0.016), and adjuvant systemic treatment (HR 0.37, 95% CI 0.25–0.55, p < 0.001) remained as independent factors for survival. CONCLUSIONS Surgery for symptomatic BM from non–small cell lung cancer may be indicated even for patients with multiple lesions in order to alleviate their neurological symptoms and to consequently facilitate further treatment.

Animal models of brain and spinal cord metastases of NSCLC established using a brain stereotactic instrument

“…Brain metastasis from lung cancer is the most prevalent intracranial metastatic malignancy [ 24 ]. Brain metastasis is the leading cause of death in lung cancer patients and one of the common causes of treatment failure [ 25 , 26 ], and the patients are often accompanied by neurological dysfunction caused by the occupancy of brain metastases and have inferior quality of life [ 27 , 28 ]. Spinal cord metastasis—also malignant metastasis—is characterized by rapid clinical progression and a poor prognosis [ [29] , [30] , [31] , [32] ].…”

Establishment of a prognostic risk prediction modelfor non-small cell lung cancer patients with brainmetastases: a retrospective study

“…Previous studies have identified that age, surgical treatment of the primary tumour, KPS, extracerebral metastasis, targeted therapy, NSE level, ALP level, and PLR are factors that influence the prognosis of NSCLC patients with BM ( Rodrigus, de Brouwer & Raaymakers, 2001 ; Sanchez de Cos et al, 2009 ; Fuchs et al, 2021 ; Junger et al, 2021 ; Yu et al, 2021 ; Jacot et al, 2001 ; Cho et al, 2021 ). In our model, five individual prognostic factors, namely NSE, PLR, ALP, intrathoracic metastasis, and targeted therapy, were identified.…”

Reduced Mortality and Radiation Necrosis After Surgery With Postoperative Stereotactic Radiation in Patients With Multiple Brain Metastases

“…19,20,[22][23][24]32,33,[37][38][39][40][41] However, these retrospective cohorts include few or no patients with multiple brain metastases. Additional reports on surgery in patients with multiple brain metastases [42][43][44][45][46][47] are often limited by a lack of nonsurgical comparison groups. Some studies also focus exclusively on a single tumor type or patients treated before advances in targeted therapy and immunotherapy.…”