Brain Tumor Res Treat.  2013 Oct;1(2):64-70. 10.14791/btrt.2013.1.2.64.

Outcome of Surgical Resection of Symptomatic Cerebral Lesions in Non-Small Cell Lung Cancer Patients with Multiple Brain Metastases

• Hong N
• Yoo H
• Gwak HS
• Shin SH
• Lee SH

• KMID: 2048477
• DOI: http://doi.org/10.14791/btrt.2013.1.2.64

Abstract

OBJECTIVE
Patients with symptomatic brain metastases secondary to mass effect are often candidates for surgery. However, many of these surgical candidates are also found to have multiple asymptomatic tumors. This study aimed to determine the outcome of surgical resection of symptomatic brain metastases followed by chemotherapy or radiotherapy (RT) for the remnant asymptomatic lesions in non-small cell lung cancer (NSCLC) patients with multiple brain metastases.
METHODS
We conducted a retrospective review of the medical records of 51 NSCLC patients with symptomatic multiple brain metastases who underwent surgical resection, of whom 38 had one or more unresected asymptomatic lesions subsequently treated with chemotherapy and/or RT. Thirteen patients underwent resection of all metastatic lesions.
RESULTS
Median survival for overall patient population after surgical resection was 10.8 months. Median survival for patients with surgical resection of all brain metastases was not significantly different with patients who underwent surgical resection of only symptomatic lesions (6.5 months vs. 10.8 months; p=0.97). There was no statistically significant difference in survival according to the number of tumors (p=0.86, 0.16), or post-surgical treatment modalities (p=0.69).
CONCLUSION
The survival time of NSCLC patients with multiple brain metastases after surgery for only symptomatic brain metastases is similar to that of patients who underwent surgery for all brain metastases. The remaining asymptomatic lesions may be treated with chemotherapy or radiotherapy. The optimal treatment modality, however, needs to be defined in prospective trials with larger patient cohort.

Keyword

Surgery; Multiple; Brain metastasis; Survival; Lung cancer

MeSH Terms

Brain*
Carcinoma, Non-Small-Cell Lung*
Cohort Studies
Drug Therapy
Humans
Lung Neoplasms
Medical Records
Neoplasm Metastasis*
Radiotherapy
Retrospective Studies

Figure

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  Fig. 1 Survival curve for multiple brain metastases according to types of lesion resection.

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  Fig. 2 Differences in survival according to the status of primary disease in multiple brain metastases.

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  Fig. 3 Differences in survival difference according to recursive partitioning analysis class in multiple brain metastases.

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  Fig. 4 Comparison of survival according to the number of tumors.

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  Fig. 5 Comparison of survival according to additional treatments modalities in multiple metastases. RT: radiotherapy, CTx: chemotherapy.

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  Fig. 6 Comparison of survival between single and multiple brain metastases.

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