Abstract
Background: Non-small cell lung carcinoma (NSCLC) is one of the most common types of cancer metastatic to brain. Several series report radiosurgery to have a median survival of six to 12 months after NSCLC brain metastasis. We report our experience and describe predictors of survival in NSCLC. In our study, one of the largest multicenter series of patients with NSCLC, we describe survival after stereotactic radiosurgery (SRS) and prognostic markers in patients with KPS≤70/ RPA III in contrast to patients with higher KPS. Methods: Patient records of 468 patients with complete data at Miami Neuroscience Center and Johns Hopkins Hospital were retrospectively reviewed for predictors of survival. The Kaplan-Meier survival analysis and log-rank test were performed to calculate and compare median survival from radiosurgery. Survival was compared between pre-radiosurgery Karnofsky performance status (KPS) >70 versus ≤70 using log-rank test. Further analysis using multivariate Cox regression identified predictors of survival in patients with KPS≤70. Results: Four hundred and seventeen (89.1%) patients died over a mean follow-up duration of 11.98-19.21 months with an overall median survival time of 7.14 months since treatment. Median survival differed by KPS (KPS≤70: 4.34 months; KPS>70: 7.89 months; (p=0.0003)). Overall factors associated with mortality included KPS score of 70 (hazard ratio 1.54, P<0.001), age above 65 years (hazard ratio 1.43, P<0.001), presence of more than three lesions (hazard ratio 1.51, p<0.0001), dose of or less than 18Gy (hazard ratio: 1.4, p=.005). Amongst patients with KPS≤ 70, none of the above factors were found to predict mortality, except with the diagnoses of brain metastases at the time of diagnoses of cancer (synchronicity) (Odds ratio 1.89). Patients with synchronous lesions had a median survival of 2.5 months while patients with metachronous lesions had a median survival rate of 6.09 months (p=0.0062). No significant difference was observed between survival of patients with KPS>70 (mortality: 87.7%, median survival: 7.89 months) and patients with metachronous lesions in KPS≤70 subgroup (Mortality: 91.3% & median survival: 6.09 months) p=0.38. Conclusions: Local control of radiosurgery and predictors of survival for patients with poor KPS differ from patients with good performance status. Patients with KPS≤70 and metachronous lesions may be candidates for aggressive treatment in patients with KPS>70.
Highlights
Non-small cell lung carcinoma (NSCLC) is one of the most common types of cancer that metastasize to the brain
Overall factors associated with mortality included Karnofsky performance scores (KPS) score of 70, age above 65 years, presence of more than three lesions, dose of or less than 18Gy
No significant difference was observed between survival of patients with KPS>70 and patients with metachronous lesions in KPS≤70 subgroup (Mortality: 91.3% & median survival: 6.09 months) p=0.38
Summary
Non-small cell lung carcinoma (NSCLC) is one of the most common types of cancer that metastasize to the brain. Several studies have demonstrated that radiosurgery enhances the survival to six to 12 months in patients with NSCLC [3,4,5] This efficacy, may not be observed in a subclass of patients with poor functional/performance status, often described as Karnofsky performance scores (KPS) ≤70. KPS is one of the most consistently observed predictors of poor survival and is a component of recursive partition analysis (RPA) classification, a most widely used parameter to select patients for aggressive treatment. Several series report radiosurgery to have a median survival of six to 12 months after NSCLC brain metastasis. One of the largest multicenter series of patients with NSCLC, we describe survival after stereotactic radiosurgery (SRS) and prognostic markers in patients with KPS≤70/ RPA III in contrast to patients with higher KPS
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