Abstract
BackgroundBrain metastases (BM) is one of the most common failures of locally advanced non-small cell lung cancer (LA-NSCLC) after combined-modality therapy. The outcome of trials on prophylactic cranial irradiation (PCI) has prompted us to identify the highest-risk subset most likely to benefit from PCI. Focusing on patients with completely resected pathological stage IIIA-N2 (pIIIA-N2) NSCLC, we aimed to assess risk factors of BM and to define the highest-risk subset.MethodsBetween 2003 and 2005, the records of 217 consecutive patients with pIIIA-N2 NSCLC in our institution were reviewed. The cumulative incidence of BM was estimated using the Kaplan–Meier method, and differences between the groups were analyzed using log-rank test. Multivariate Cox regression analysis was applied to assess risk factors of BM.ResultsFifty-three (24.4 %) patients developed BM at some point during their clinical course. On multivariate analysis, non-squamous cell cancer (relative risk [RR]: 4.13, 95 % CI: 1.86–9.19; P = 0.001) and the ratio of metastatic to examined nodes or lymph node ratio (LNR) ≥ 30 % (RR: 3.33, 95 % CI: 1.79–6.18; P = 0.000) were found to be associated with an increased risk of BM. In patients with non-squamous cell cancer and LNR ≥ 30 %, the 5-year actuarial risk of BM was 57.3 %.ConclusionsIn NSCLC, patients with completely resected pIIIA-N2 non-squamous cell cancer and LNR ≥ 30 % are at the highest risk for BM, and are most likely to benefit from PCI. Further studies are warranted to investigate the effect of PCI on this subset of patients.
Highlights
Brain metastases (BM) is one of the most common failures of locally advanced non-small cell lung cancer (LA-Non-small cell lung cancer (NSCLC)) after combined-modality therapy
Several studies have demonstrated that longer survival for patients with Locally advanced (LA)-NSCLC is associated with an increased incidence of BM, and that BM becomes a rising concern, detrimental to survival. [15,16] decreasing the risk of BM becomes increasingly significant for achieving prolonged survival
The outcome of RTOG 0214 in the modern era of combinedmodality therapy, which implies that not all patients with LA-NSCLC should receive prophylactic cranial irradiation (PCI), has prompted us to identify the subset, at the highest risk of BM, and most likely to benefit from PCI
Summary
Brain metastases (BM) is one of the most common failures of locally advanced non-small cell lung cancer (LA-NSCLC) after combined-modality therapy. The risk of developing brain metastases (BM) in patients with early stage NSCLC is 10 %.[1] the risk of BM after treatment for LA-NSCLC is much higher, approximately 30–50 %.[1,2,3,4,5,6] BM is a devastating issue with a striking impact on survival and quality of life. Recent studies employing multimodality therapy have reported median survival ranging from 20 to 43 months and 3-year survival rates of 34–63 % for LA-NSCLC.[7,8,9,10,11,12,13] chemotherapy has limited impact on BM because drugs do not penetrate the blood–brain barrier (BBB), which leaves the brain relatively undertreated.[5,14,15] The risk of BM increases as survival improves. Several studies have demonstrated that longer survival for patients with LA-NSCLC is associated with an increased incidence of BM, and that BM becomes a rising concern, detrimental to survival. [15,16] decreasing the risk of BM becomes increasingly significant for achieving prolonged survival
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