Impact of aggressive therapy in patients with non-small cell lung carcinoma presenting with brain-only oligometastatic disease.

Abstract

8069 Background: Optimal therapy for patients with non-small cell lung carcinoma (NSCLC) presenting with synchronous brain metastases as their only metastatic site is not well defined. We investigated whether aggressive therapy directed to the primary site or whole-brain radiotherapy (WBRT) were associated with improved outcomes in this subset of patients. Methods: We conducted a retrospective analysis of patients seen at the Dana-Farber Cancer Institute between 1/2000 and 1/2011. Patients with NSCLC, 1-4 synchronous brain metastases and no other sites of metastatic disease confirmed by CT or PET scan were included. Patients with poor performance status were excluded. Aggressive thoracic therapy (ATT) was defined as surgical resection of the primary disease or radiotherapy to a dose of greater than 45 Gy. A Cox proportional hazards model was used to analyze effects on survival and a competing risks model was constructed to analyze the risk of recurrence in the brain. Results: 66 patients met the study criteria. Median follow-up for survivors was 32.3 months. Excluding the metastatic disease, 9 patients had stage I disease, 10 stage II and 47 stage III. 38 patients received ATT. Patients receiving ATT were significantly younger (median age 55 vs. 60.5 years) but otherwise had a similar distribution of sex, performance status and number of brain metastases. Receipt of ATT was associated with significantly prolonged overall survival (OS) (median 26.8 vs. 10.9 months; p<0.001). Actuarial 5-year survival was 28% for those who received ATT vs. 0%. ATT remained significantly associated with OS after controlling for age, stage, performance status and receipt of WBRT (HR 0.42, p=0.016). On multivariate analysis, receipt of ATT (HR 3.14, p=0.048) and WBRT (HR 0.10, p=0.005) were the only factors predictive of first failure in the brain. Receipt of initial WBRT did not improve OS. Conclusions: Patients with NSCLC presenting with synchronous brain-only metastases may still benefit from aggressive therapy directed to the thoracic primary site. Use of WBRT for this subgroup does not improve OS but significantly reduces future brain recurrences.