Survival prognostic factors for patients with synchronous brain oligometastatic non-small-cell lung carcinoma receiving local therapy

Abstract

IntroductionClinical evidence for patients with synchronous brain oligometastatic non-small-cell lung carcinoma is limited. We aimed to summarize the clinical data of these patients to explore the survival prognostic factors for this population.MethodsFrom September 1995 to July 2011, patients with 1–3 synchronous brain oligometastases, who were treated with stereotactic radiosurgery (SRS) or surgical resection as the primary treatment, were identified at Shanghai Chest Hospital.ResultsA total of 76 patients (22 patients underwent brain surgery as primary treatment and 54 patients received SRS) were available for survival analysis. The overall survival (OS) for patients treated with SRS and brain surgery as the primary treatment were 12.6 months (95% confidence interval [CI] 10.3–14.9) and 16.4 months (95% CI 8.8–24.1), respectively (adjusted hazard ratio =0.59, 95% CI 0.33–1.07, P=0.08). Among 76 patients treated with SRS or brain surgery, 21 patients who underwent primary tumor resection did not experience a significantly improved OS (16.4 months, 95% CI 9.6–23.2), compared with those who did not undergo resection (11.9 months, 95% CI 9.7–14.0; adjusted hazard ratio =0.81, 95% CI 0.46–1.44, P=0.46). Factors associated with survival benefits included stage I–II of primary lung tumor and solitary brain metastasis.ConclusionThere was no significant difference in OS for patients with synchronous brain oligometastasis receiving SRS or surgical resection. Among this population, the number of brain metastases and stage of primary lung disease were the factors associated with a survival benefit.

Association of Brain Metastases With Survival in Patients With Limited or Stable Extracranial Disease

“…The literature search identified 1067 unique studies, of which 68 studies met eligibility criteria (Figure 1; eTable 3 in Supplement 1). Among included studies, there were 58 retrospective cohort studies, 7 prospective cohort studies, and 3 RCTs. Thirty-four reported on non–small cell lung cancer (NSCLC), 3 on breast cancer, 2 on small-cell lung cancer, 1 on melanoma, and 1 reported multiple lung cancers.…”

“…Abbreviations: ECD, extracranial disease; IMD-PE, intracranial metastatic disease in the setting of progressive ECD; IMD-SE, intracranial metastatic disease in the setting of stable ECD; iPFS, intracranial progression-free survival; OS, overall survival; PFS, progression-free survival. a Data are from 49 studies b Data are from 4 studies …”

“…Of note, 9 studies did not report a median follow-up. 20,34,39,55,59,60,63,73,80 In patients with IMD-SE secondary to breast cancer 20,60 and NSCLC, 27,36,39,[41][42][43][44]59,63,66,73,81,85 differences between cancer type (P = .84). Subgroup analysis similarly did not show significant differences among studies with high vs low risk of bias as determined by AHRQ ratings.…”

Factors Affecting the Survival of Patients with Oligometastatic Non-Small-Cell Lung Cancer: A Meta-Analysis

“…Then, 21 articles were full reviewed, 15 articles were excluded because the subjects in 8 articles were not only NSCLC, and outcomes in 7 articles were not shown. Finally, 6 studies [9, 15–17, 22, 23] were included and analyzed in this study.…”

From Whole-Brain Radiotherapy to Immunotherapy: A Multidisciplinary Approach for Patients with Brain Metastases from NSCLC

“…According to a recent analysis of the Metropolitan Detroit Surveillance, Epidemiology and End Results (SEER) registry, the incidence of BMs in nonmetastatic NSCLC is 9% [9] and there is an increased incidence with more advanced stages of disease [10]. Moreover, the majority of BMs of unknown origin are eventually found to have a lung primary lesion [11, 12]. One out of four patients with anaplastic lymphoma kinase- (ALK-) rearrangement and epidermal growth factor receptor (EGFR) mutation diagnosed at an advanced stage present with BMs and prevalence increases with time [13, 14].…”