Abstract
PurposeWhole brain irradiation (WBRT) either with or without resection has historically been the treatment for brain metastases from non-small cell lung cancer (NSCLC). The effect of gamma knife (GK) radiosurgery, chemotherapy, or the combination remains incompletely defined. In this study, we assessed the outcome of brain metastases from non-small cell lung cancer treated by WBRT followed by GK, gefitinib, or the combination of GK and gefitinib.Material and methodsWe retrieved the records of NSCLC patients with brain metastases from the National Health Insurance Research Database (NHIRD) of Taiwan from 2004 to 2010. WBRT either with or without resection was the first line treatment for nearly all patients. The decision to add GK and/or gefitinib treatment was at the discretion of the treating physician and based upon a patient’s medical records and imaging data. These patients were classified into four groups including WBRT, WBRT + gefitinib, WBRT + GK, WBRT + gefitinib + GK. These data was evaluated for difference in survival and factors that portended an extended survival from the time of brain metastasis diagnosis.ResultsOf the 60194 patients with newly diagnosed NSCLC, 23874 (39.6 %) developed brain metastases. The distribution of patients for the groups was WBRT for 20241, WBRT + gefitinib for 3379, WBRT + GK for 155, and WBRT+ gefitinib + GK for 99 patients. The median survival for the time of brain metastasis diagnosis for WBRT, WBRT+ gefitinib, WBRT+ GK, WBRT+ gefitinib + GK groups was 0.53, 1.01, 1.46, and 2.25 years, respectively (p < 0.0001). The hazard ratio (95 % CI) for survival was 1, 0.56, 0.43, and 0.40, respectively (p < 0.001). The adjusted hazard ratio (95 % CI) by age, sex and Charlson comorbidity index (CCI) was 1, 0.73, 0.49, and 0.42, respectively (p < 0.001).ConclusionPatients with brain metastases from NSCLC receiving GK or gefitinib demonstrated extended survival. The improved survival seen with GK and gefitinib suggests a survival benefit in selected patients receiving the combined treatment. Further Phase II study should be conducted to assessment these influence.
Highlights
Lung cancer harbored the highest incidence of brain metastasis in relation to all malignancies
Data analyzed in this study were retrieved from the Taiwan National Health Insurance Research Database (NHIRD), which is managed by the Taiwan National Health Research Institute (NHRI)
We found that addition of gefitinib or gamma knife (GK) to Whole brain irradiation (WBRT) prolonged the median survival of non-small cell lung cancer (NSCLC) patients
Summary
Lung cancer harbored the highest incidence of brain metastasis in relation to all malignancies. 40 % of all patients with non-small cell lung cancer (NSCLC) will develop brain metastasis during the course of their disease [1]. Subset analysis of a randomized trial demonstrated improved survival with the addition of SRS to WBRT in patients with single brain metastases and in patients younger than 65 with good performance status, controlled primary tumor, and no extracranial metastases compared to those receiving WBRT alone [7]. Another study showed worsened overall survival and neurocognition at 4 months after WBRT compared to treatment with SRS alone [10]. National Comprehensive Cancer Network (NCCN) guidelines recommend consideration of SRS for patients with 1–3 brain metastases with newly diagnosed or stable systemic disease or for those with reasonable systemic treatment options
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