Surgically Treated Patients With Brain Metastasis From Non-small Cell Lung Cancer

ObjectiveNon-Small Cell Lung Cancer(NSCLC)brain metastases is one of the most common intracranial malignancies in adults,ranging from 30% to 35% of intracranial tumors.Now,it is the severe clinical problems.With the emergence of modern effective systemic treatment and the frequency and quality of brain imaging and the recent rapid development of neurofemesis,more and more NSCLC brain metastases required active treatment than before.Surgical resection,stereotactic radiosurgery(SRS)and whole brain radiation therapy(WBRT)are the main local treatment regimen of NSCLC brain metastases.Because small cell lung cancer(SCLC)brain metastases have some sensitivity to radiotherapy and chemotherapy,surgery and SRS are not considered in this pathologic type,and whole brain radiation therapy is still a standard localized treatment for small cell lung cancer.Despite the surgical resection,stereotactic radiotherapy,whole brain radiation therapy and the emergence of new targeted drugs and biological therapy,the survival time of NSCLC brain metastases is still poor.Surgery for brain metastases is still controversial.The aim of our retrospective study was to evaluate prognostic factors and survival results in patients who underwent craniotomy for BMs from NSCLC.MethodsWe evaluated 122 consecutive patients of NSCLC who underwent surgical resection for BMs between 2001 and 2014 at Tianjin Medical University Cancer Institute and Hospital.Survival data were analyzed by the Kaplan-Meier method and log-rank test.The independent prognostic factors were identified by Cox' proportional hazard model.P<0.05 was considered as statistically significant.SPSS Statistics 20.0 was used.Results 1 General clinical data of the patientsAmong the 122 patients,73 were male and 49 were female.The median age of brain metastases was 56 years(31-81 years).There were 74 cases of adenocarcinoma,31 cases of squamous cell carcinoma,6 cases of adenosquamous carcinoma,7 cases of large cell lung cancer,4 cases of bronchioloalveolar lung cancer;39 cases with lung cancer operation,22 patients with chemotherapy and radiotherapy,66 cases without treatment;74 cases were located at supratentorial,12 cases were located at infratentorial,36 cases both located at supratentorial and infratentoria;83 patients had synchronous brain metastases,while 39 patients had metachronous brain metastases.Synchronous presentation was defined as diagnosis of brain metastases within 2 months of diagnosis of lung cancer;34 cases with extracranial metastasis,88 cases have no extracranial metastases;In 122 patients,144 lesions were resected.Complete resection of all BMs was achieved in 67(54.9%)patients,of which 52(42.6%)had a solitary lesion.Concerning multiple BMs,15(21.4%)had complete resection,the rest of them had at least one lesion resected.Completeness of resection was determined by contrast-enhanced MRI within 48 h after brain surgery.Therefore incomplete resection was either due to multiple metastases,where not all could be resected,or due to location and intraoperative considerations.Ninty patients received postoperative WBRT,while 14 patients received preoperative radiotherapy.Reoperation for recurrence was performed in ten patients,of which two patients received third craniotomy and radiosurgery was performed in13 patients.98 cases have preoperative neurological symptoms and signs,including 60 cases having headache symptoms,other symptoms include nausea and vomiting,decreased vision,lateral limb hemiplegia or sensory disturbances,ataxia and epilepsy and other symptoms.2 Analysis of postoperative survival and prognosis of patients 2.1 Improvement of neurological symptoms and signs98 patients had preoperative neurological symptoms and signs.After surgery,93.9% cases with neurological symptoms and signs had disappeared or improved,9.2% cases did not obviously improved.Nine patients died within 30 days after operation.2.2 Survival time and Survival rateOverall survival(OS)time was calculated as interval between the brain surgical time and death or the date of last follow up(November 14 th 2015)for patients.The median OS time was 10 months(mean,14.4months),with 18 patients surviving more than 24 months,6(4.9%)patients surviving more than 36 months.1,2 and three-year survival were 41%,18.6% and 8.2%,respectively.2.3 Analysis of prognostic factors affecting the survival of patients 2.3.1 Univariate analysis of the survival time of patientsThe results of univariate analysis showed that KPS score(P <0.001),number of brain metastases(P <0.001),radical treatment of the primary(P = 0.009),systemic disease control(P <0.001),the status of extracranial metastases(P = 0.007),postoperative whole brain radiotherapy(WBRT)(P <0.001),extent of resection(P <0.001),location of brain metastases(P = 0.013)had an effect on survival.In contrast,age,sex,smoking status,onset of BMs,and size of BMs,preoperative radiotherapy and histology subtypy of lung cancer had no influence on survival.2.3.2 Multivariate analysis of the survival time of patientsBy multivariate analysis,the variables of KPS,complete resection of BMs,postoperative WBRT and control of system disease independently affected patient survival.ConclusionIn most patients with solitary or multiple brain metastases from NSCLC,surgical resection is an effective treatment,and our study highly demonstrated that complete resection of BMs in NSCLC patients followed by WBRT improve survival;whereas for patients with a poor KPS,or who are not eligible for adjuvant WBRT are not likely to benefit from resection.In large lesions with mass effect,surgery will rapidly reduce tumor burden,therefore resolve neurological symptoms,and save time for postoperative adjuvant treatment.Besides,long-term survivors(?24months)were increasingly frequent than previous reports.