Yonsei Med J.  2015 Jan;56(1):103-111. 10.3349/ymj.2015.56.1.103.

Efficacy of Surgical Treatment for Brain Metastasis in Patients with Non-Small Cell Lung Cancer

• Kim SY
• Hong CK
• Kim TH
• Hong JB
• Park CH
• Chang YS
• Kim HJ
• Ahn CM
• Byun MK

• KMID: 2352795
• DOI: http://doi.org/10.3349/ymj.2015.56.1.103

Abstract

PURPOSE
Patients with non-small cell lung cancer (NSCLC) and simultaneously having brain metastases at the initial diagnosis, presenting symptoms related brain metastasis, survived shorter duration and showed poor quality of life. We analyzed our experiences on surgical treatment of brain metastasis in patients with NSCLC.
MATERIALS AND METHODS
We performed a single-center, retrospective review of 36 patients with NSCLC and synchronous brain metastases between April 2006 and December 2011. Patients were categorized according to the presence of neurological symptoms and having a brain surgery. As a result, 14 patients did not show neurological symptoms and 22 patients presented neurological symptoms. Symptomatic 22 patients were divided into two groups according to undergoing brain surgery (neurosurgery group; n=11, non-neurosurgery group; n=11). We analyzed overall surgery (OS), intracranial progression-free survival (PFS), and quality of life.
RESULTS
Survival analysis showed there was no difference between patients with neurosurgery (OS, 12.1 months) and non-neurosurgery (OS, 10.2 months; p=0.550). Likewise for intracranial PFS, there was no significant difference between patients with neurosurgery (PFS, 6.3 months) and non-neurosurgery (PFS, 5.3 months; p=0.666). Reliable neurological one month follow up by the Medical Research Council neurological function evaluation scale were performed in symptomatic 22 patients. The scale improved in eight (73%) patients in the neurosurgery group, but only in three (27%) patients in the non-neurosurgery group (p=0.0495).
CONCLUSION
Patients with NSCLC and synchronous brain metastases, presenting neurological symptoms showed no survival benefit from neurosurgical resection, although quality of life was improved due to early control of neurological symptoms.

Keyword

Non-small cell lung cancer; brain metastasis; neurosurgery; quality of life; treatment outcome

MeSH Terms

Adult
Aged
Aged, 80 and over
Brain Neoplasms/physiopathology/*secondary/*surgery
Carcinoma, Non-Small-Cell Lung/mortality/*pathology
Demography
Disease-Free Survival
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Lung Neoplasms/*pathology
Male
Middle Aged
Treatment Outcome

Figure

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  Fig. 1 Kaplan-Meier estimate curves of OS (A) and intracranial PFS (B) for NSR and non-NSR group patients. OS, overall survival; PFS, progression free survival; NSR, neurosurgical resection.

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  Fig. 2 Cumulative change of MRC neurological function scale at 1-month follow-up after therapy for brain metastasis. (A) NSR group (n=11). (B) Non-NSR group (n=11). p=0.0495. *Medical Research Council (MRC) neurological function scale. NSR, neurosurgical resection.

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