Stereotactic radiosurgery for single brain metastases from non-small cell lung cancer: progression of extracranial disease correlates with distant intracranial failure.

Marie-Adele S Kress,Brian Collins,Eric Oermann,Huma Chaudhry,Riane B Hoffman,Matthew G Ewend

doi:10.1186/1748-717x-8-64

Abstract

BackgroundLimited data exist regarding management of patients with a single brain lesion with extracranial disease due to non-small cell lung cancer (NSCLC).MethodsEighty-eight consecutive patients with a single brain lesion from NSCLC in the presence of extracranial disease were treated with stereotactic radiosurgery (SRS) alone. Local control (LC), distant intracranial failure (DIF), overall survival (OS), and toxicity were assessed. The logrank test was used to identify prognostic variables.ResultsMedian OS was 10.6 months. One-year DIF was 61%; LC 89%. Treatments were delivered in 1-5 fractions to median BED10 = 60Gy. Five patients developed radionecrosis. Factors associated with shortened OS included poor performance status (PS) (p = 0.0002) and higher Recursive Partitioning Analysis class (p = 0.017). For patients with PS 0, median survival was 22 months. DIF was associated with systemic disease status (progressive vs. stable) (p = 0.0001), as was BED (p = 0.021) on univariate analysis, but only systemic disease (p = 0.0008) on multivariate analysis.ConclusionsThis study identifies a patient population that may have durable intracranial control after treatment with SRS alone. These data support the need for prospective studies to optimize patient selection for up-front SRS and to characterize the impact of DIF on patients’ quality of life.

Highlights

Limited data exist regarding management of patients with a single brain lesion with extracranial disease due to non-small cell lung cancer (NSCLC)
Brain metastases are common among patients with non-small cell lung cancer (NSCLC), even at the time of diagnosis, accounting for approximately 18-64% of all brain metastasis diagnoses [2]
To better define prognosis for patients with a single brain metastases from NSCLC and more effectively characterize which patients are at relatively high or low risk for distant intracranial recurrence, retrospective data from two institutions were pooled for evaluation of clinical outcomes and toxicity, as well as assessment of clinical prognostic variables. Patient selection This retrospective study was approved by the Institutional Review Boards of both Georgetown University and the University of North Carolina (UNC)

Summary

Introduction

Limited data exist regarding management of patients with a single brain lesion with extracranial disease due to non-small cell lung cancer (NSCLC). Brain metastases are common among patients with non-small cell lung cancer (NSCLC), even at the time of diagnosis, accounting for approximately 18-64% of all brain metastasis diagnoses [2]. Some of these patients will present with limited intracranial disease, with one or few metastatic lesions. Significant limitations still exist regarding optimizing patient selection for up-front SRS as a single modality, since these patients present with heterogeneous clinical circumstances

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