Abstract
Simple SummaryIn non-small cell lung cancer patients with brain metastases, combined Gamma Knife radiosurgery and immunotherapy or targeted therapy showed an increase in overall survival. The combination of Gamma Knife radiosurgery and immunotherapy or targeted therapy did not increase complications related to radiosurgery. Therefore, the combined treatment seems to be a safe and powerful treatment option for non-small cell lung cancer patients with brain metastases.The combination of Gamma Knife radiosurgery (GKRS) and systemic immunotherapy (IT) or targeted therapy (TT) is a novel treatment method for brain metastases (BMs) in non-small cell lung cancer (NSCLC). To elucidate the safety and efficacy of concomitant IT or TT on the outcome after GKRS, 496 NSCLC patients with BMs, who were treated with GKRS were retrospectively reviewed. The median time between the initial lung cancer diagnosis and the diagnosis of brain metastases was one month. The survival after the initial BM diagnosis was significantly longer than the survival predicted by prognostic BM scores. After the first Gamma Knife radiosurgery treatment (GKRS1), the estimated median survival was 9.9 months (95% CI = 8.3–11.4). Patients with concurrent IT or TT presented with a significantly longer survival after GKRS1 than patients without IT or TT (p < 0.001). These significant differences in the survival were also apparent among the four treatment groups and remained significant after adjustment for Karnofsky performance status scale (KPS), recursive partitioning analysis (RPA) class, sex, and multiple BMs. About half of all our patients (46%) developed new distant BMs after GKRS1. Of note, no statistically significant differences in the occurrence of radiation reaction, radiation necrosis, or intralesional hemorrhage in association with IT or TT at or after GKRS1 were observed. In NSCLC-BM patients, the concomitant use of GKRS and IT or TT showed an increase in overall survival without increased complications related to GKRS. Therefore, the combined treatment with GKRS and IT or TT seems to be a safe and powerful treatment option and emphasizes the role of radiosurgery in modern BM treatment.
Highlights
In non-small cell lung cancer (NSCLC) patients, brain metastases (BMs) occur in up to 60% of patients, representing the most common cause of brain metastasis (BM) [1]
At brain metastasis (BM) diagnosis, 321/496 (65%) of patients had already been diagnosed with extracranial metastases
The estimated median overall survival was 19.6 months (95% confidence interval (CI) = 16.8–22.5) after the initial diagnosis of NSCLC, 12.5 months after the initial diagnosis of BMs, and 9.9 months after the first Gamma Knife treatment (GKRS1)
Summary
In non-small cell lung cancer (NSCLC) patients, brain metastases (BMs) occur in up to 60% of patients, representing the most common cause of BMs [1]. Depending on the number and location of the BMs, surgery, stereotactic radiosurgery (SRS), and whole-brain irradiation (WBRT) are used as local treatments. As compared with WBRT, Gamma Knife radiosurgery (GKRS) enables the delivery of a high radiation dose to the selected target with a rapid radiation fall-off to the surrounding brain parenchyma. A novel treatment method for BMs in NSCLC patients is the combination of GKRS and immunotherapy (IT) or targeted therapy (TT) [5]. Recent preliminary studies have suggested that this new form of combination therapy might amplify the immune response to malignant cells, and thereby improve the overall survival of patients with BMs [6,7]. Only inadequate data on the safety and efficacy of the concomitant use of SRS and systemic treatment with either IT or TT exist
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
