Abstract
Brain metastases occur in about 20-40% of patients with non-small-cell lung carcinoma (NSCLC), and are usually associated with a poor outcome. Whole brain radiotherapy (WBRT) is widely used but increasingly, more aggressive local treatments such as surgery or stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) are being employed. In our study we aimed to describe the various factors affecting outcomes in NSCLC patients receiving local therapy for brain metastases. The case records of 125 patients with NSCLC and brain metastases consecutively treated with radiotherapy at two tertiary centres from January 2006 to June 2012 were analysed for patient, tumour and treatment-related prognostic factors. Patients receiving SRS/SRT were treated using Cyberknife. Variables were examined in univariate and multivariate testing. Overall median survival was 3.4 months (95%CI: 1.7-5.1). Median survival for patients with multiple metastases receiving WBRT was 1.5 months, 1-3 metastases receiving WBRT was 3.6 months and 1-3 metastases receiving surgery or SRS/SRT was 8.9 months. ECOG score (≤2 vs >2, p=0.001), presence of seizure (yes versus no, p=0.031), treatment modality according to number of brain metastases (1-3 metastases+surgery or SRS/SRT±WBRT vs 1-3 metastases+WBRT only vs multiple metastases+WBRT only, p=0.007) and the use of post-therapy systemic treatment (yes versus no, p=0.001) emerged as significant on univariate analysis. All four factors remained statistically significant on multivariate analysis. ECOG ≤2, presence of seizures, oligometastatic disease treated with aggressive local therapy (surgery or SRS/SRT) and the use of post-therapy systemic treatment are favourable prognostic factors in NSCLC patients with brain metastases.
Highlights
Patients with non-small cell lung carcinoma (NSCLC) develop brain metastases (BM) in about 20-40% of cases (Law et al, 2001; Ceresoli et al, 2002)
Eastern Cooperative Oncology Group (ECOG) ≤2, presence of seizures, oligometastatic disease treated with aggressive local therapy and the use of post-therapy systemic treatment are favourable prognostic factors in non-small-cell lung carcinoma (NSCLC) patients with brain metastases
Both Recursive Partitioning Analysis (RPA) score (p=0.033) and Graded Prognostic Assessment (GPA) index (p=0.001) demonstrated survival differences according to known prognostic groupings (Table 3 and Figure 2a-b). To our knowledge this is the first data to emerge from the South East Asian Region (ASEAN) to describe factors involved in the survival of patients with NSCLC cancer and BM
Summary
Patients with non-small cell lung carcinoma (NSCLC) develop brain metastases (BM) in about 20-40% of cases (Law et al, 2001; Ceresoli et al, 2002). There is accumulating evidence to suggest that SRS/SRT offers improved local control and quality of life and in some clinical situations better survival (Patil et al, 2012). These aggressive local therapies are not without risks, patient selection is vital to ensure suitable patients are considered for the treatment to achieve potential improved outcome. Conclusions: ECOG ≤2, presence of seizures, oligometastatic disease treated with aggressive local therapy (surgery or SRS/SRT) and the use of post-therapy systemic treatment are favourable prognostic factors in NSCLC patients with brain metastases
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