The elderly with synchronous non-small cell lung cancer and solitary brain metastasis: Does palliative thoracic radiotherapy have a useful role?

Ampil, Federico L.; Caldito, Gloria; Milligan, Shawn A.; Mills, Glenn; Nanda, Anil

doi:10.1016/j.lungcan.2007.02.006

Cited by 24 publications

(17 citation statements)

References 26 publications

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“…These findings are consistent with others reported in the literature [7,9,17]. The prognostic significance of the absence of neurologic signs and symptoms in patients with brain metastasis has received little attention.…”

Section: Discussionsupporting

confidence: 91%

“…The overall survival of patients with brain metastases is generally poor, ranging from about 3 to 6 months [6][7][8][9], although certain patients may benefit from active treatment and survive longer. Performance status, age <65 years, absence of extracranial metastasis and a primary tumor that can be controlled with treatment, and a single surgically accessible metastasis are well-known predictors of a good prognosis [6,7,10,11].…”

Section: Introductionmentioning

confidence: 99%

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Non-small cell lung cancer and silent brain metastasis

Cos

González

Montero³

et al. 2009

Lung Cancer

102

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Non-small cell lung cancer and silent brain metastasis

Cos

González

Montero³

et al. 2009

Lung Cancer

102

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“…This is supported by our data showing better control of the thoracic disease shifts the pattern of first failure to the brain. By comparison, for patients with NSCLC and SBO, Ampil et al reported that surgical resection of the brain metastases was the only factor associated with improved overall survival [26] and Chidel et al found that both initial WBRT and ATT were correlated with better overall survival [5]. Our analyses suggest that WBRT combined with focal therapy may be associated with a trend for improved survival in those receiving ATT.…”

Section: Discussionmentioning

confidence: 56%

Aggressive therapy for patients with non-small cell lung carcinoma and synchronous brain-only oligometastatic disease is associated with long-term survival

et al. 2014

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Objectives Optimal therapy for patients with non-small cell lung carcinoma (NSCLC) presenting with synchronous brain-only oligometastases (SBO) is not well defined. We sought to analyze the effect of differing therapeutic paradigms in this subpopulation. Materials and Methods We retrospectively analyzed NSCLC patients with 1-4 SBO diagnosed between 1/2000 and 1/2011 at our institution. Patients with T0 tumors or documented Karnofsky Performance Status <70 were excluded. Aggressive thoracic therapy (ATT) was defined as resection of the primary disease or chemoradiotherapy whose total radiation dose exceeded 45 Gy. Cox proportional hazards and competing risks models were used to analyze factors affecting survival and first recurrence in the brain. Results Sixty-six patients were included. Median follow-up was 31.9 months. Intrathoracic disease extent included 9 stage I, 10 stage II and 47 stage III patients. Thirty-eight patients received ATT, 28 did not. Patients receiving ATT were younger (median age 55 vs. 60.5 years, p=0.027) but were otherwise similar to those who did not. Receipt of ATT was associated with prolonged median overall survival (OS) (26.4 vs. 10.5 months; p<0.001) with actuarial 2-year rates of 54% vs. 26%. ATT remained associated with OS after controlling for age, thoracic stage, performance status and initial brain therapy (HR 0.40, p=0.009). On multivariate analysis, the risk of first failure in the brain was associated with receipt of ATT (HR 3.62, p=0.032) and initial combined modality brain therapy (HR 0.34, p=0.046). Conclusion Aggressive management of thoracic disease in NSCLC patients with SBO is associated with improved survival. Careful management of brain disease remains important, especially for those treated aggressively.

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“…29–31 This finding is supported by the clinical observation that the frequency of brain metastases increases with age. 32 Although a precise definition of elderly has not been determined, aged 65 years is the most accepted cutoff and is used in the Recursive Partitioning Analysis (RPA) classification. 33 …”

Section: Discussionmentioning

confidence: 99%

Predictors of Inpatient Death and Complications among Postoperative Elderly Patients with Metastatic Brain Tumors

et al. 2010

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Objective Risks of brain surgery in elderly patients with brain metastases are not well defined. This study was designed to quantify the postoperative risk for these patients after brain surgery for metastatic disease to the brain. Methods We performed a retrospective analysis of the Nationwide Inpatient Sample (1998–2005). Patients aged 65 years or older who underwent tumor resection of brain metastases were identified by ICD-9 coding. Primary outcome was inpatient death. Other outcomes included systemic postoperative complications, length of stay (LOS), and total charges. Results A total of 4,907 patients (53.6% men) were identified. Mean age was 72.1 years. Mean Charlson comorbidity score was 7.8. Inpatient mortality was 4%. The most common adverse events were pulmonary complications (3.4%). Mean length of stay was 9.2 days. Mean total charges were $57,596.39. In multivariate analysis, patients up to age 80 years had no significantly greater odds of inpatient death, relative to their 65- to 69-year-old counterparts. Each 1-point increase in Charlson score was associated with 12% increased odds of death, 0.52 days increased LOS, and $1,710.61 higher hospital charges. Postoperative pulmonary complications, stroke, or thromboembolic events increased LOS and total charges by up to 9.6 days and $57,664.42, respectively. These associations were statistically significant (P < 0.05). Conclusions Surgical resection of brain metastases among the elderly up to the ninth decade of life is feasible. Age older than 80 years and higher Charlson comorbidity scores were found to be important prognostic factors for inpatient outcome. Incorporating these factors into preoperative decision making may help to select appropriately those elderly candidates for neurosurgical intervention.

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The elderly with synchronous non-small cell lung cancer and solitary brain metastasis: Does palliative thoracic radiotherapy have a useful role?

Cited by 24 publications

References 26 publications

Non-small cell lung cancer and silent brain metastasis

Non-small cell lung cancer and silent brain metastasis

Aggressive therapy for patients with non-small cell lung carcinoma and synchronous brain-only oligometastatic disease is associated with long-term survival

Predictors of Inpatient Death and Complications among Postoperative Elderly Patients with Metastatic Brain Tumors

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