Brain Metastases in Very Young Patients with Lung Cancer Are Still Brain Metastases

Abstract

In this issue of ONKOLOGIE, Nieder and colleagues retrospectively reviewed 149 patients treated with whole brain irradiation for lung cancer with subset evaluation of 9 patients under the age of 40 [1]. Five of the 9 patients had small cell lung cancer. Median survival was 7 months. Median Karnofsky performance score (KPS) was 70. Only one of 8 patients with complete follow-up information died as a direct result of CNS disease. In conclusion, the very young patients did not achieve a better outcome than intermediate age groups. Radiation provided durable CNS control in nearly all patients, while systemic failures remained the leading cause of death. The small percentage (6%) of very young patients in this study is consistent with the age distribution of lung cancer in the general population: less than 5% of patients with lung cancer are less than 40 years old [2–4]. Due to these small numbers, studies do not focus on prognosis and therapy of this particular age group. Standard therapy is based on treatment of patients with varying histologies, stage of disease and underlying comorbid conditions. Younger patients differ from older patients in terms of histology, genetic susceptibility, and gender distribution. Younger patients have a lower male/female ratio than older patients [3–5]. Lung cancer risk is higher in young patients with family history of smoking suggesting a genetic predisposition to lung cancer in patients with early onset of disease [5–7]. Contrary to the dominant small cell histology in the current study, younger patients tend to have a higher incidence of adenocarcinoma [3–5, 8]. In addition to differences in gender ratios, genetic predisposition and histological differences, patients ≤ 40 years may tolerate therapy better and be willing to accept a higher risk of toxicity than patients ≥ 65. These differences in younger versus older patients with lung cancer support the need to evaluate treatment and outcomes in very young patients separate from older lung cancer patients. Recursive partitioning analysis (RPA) of RTOG brain metas