Abstract
ObjectiveThis retrospective study evaluated the survival advantage of local treatment targeted to brain metastases, relative to systemic therapy, as the first option for brain metastases of non-small cell lung cancer (NSCLC).MethodsFirst reviewed were 291 cases of NSCLC brain metastases from two centers. All patients were at least 18 years old, with histologically confirmed NSCLC, and required and underwent both local (radiotherapy or brain surgery) and systemic treatment (chemotherapy and tyrosine kinase inhibitor [TKI] medication). Demographics, clinical characteristics, and treatment-related variables were collected.ResultsThe final population comprised 160 patients. Overall, the multivariate analysis suggested that the following were associated with better survival: >3 cycles of chemotherapy; stereotactic radiosurgery; and TKI medication (all, P = 0.000). Local treatment that began within 1 week of the diagnosis of brain metastases was associated with poorer survival (P = 0.006). Among the 111 patients with symptomatic brain metastases, the multivariate analysis indicated that better survival was associated with >3 cycles of chemotherapy (P = 0.000), radiation dose >40 Gy (P = 0.001), stereotactic radiosurgery (P = 0.000), and TKI medication (P = 0.000), while local treatment that began within 1 week after the diagnosis of brain metastases was associated with poorer survival (P = 0.015).ConclusionsFor patients with NSCLC brain metastases, regardless of the presence of clinical symptoms associated with brain metastases, systemic treatment before local may be better for survival. Even when used to relieve clinical symptoms, local treatment should be within a setting of sufficient systemic treatment.
Highlights
IntroductionThe incidence of lung cancer metastasized to the brain is about 30% to 50% and seriously threatens the life of patients [3]
Lung cancer is the deadliest malignancy in both China and the United States [1, 2]
The results of this study suggest that local treatment within 1 week of diagnosis of non-small cell lung cancer (NSCLC) brain metastases, prior to systemic treatment, leads to a shorter survival
Summary
The incidence of lung cancer metastasized to the brain is about 30% to 50% and seriously threatens the life of patients [3]. The median overall survival (OS) time of patients with lung cancer brain metastases is 3 to 6 months, or even less [4]. With rapid developments in medicine, the median survival time has become about 16 months [5]. The treatment of lung cancer brain metastases involves both local (surgery and radiation) and systemic therapies (molecularly targeted agents, chemotherapy, and immunotherapy) [6, 7], depending on whether patients are symptomatic or asymptomatic. Chinese and American guidelines generally recommend that patients with symptomatic brain metastases receive both local and systemic treatment, especially for intracranial masses. Patients who are asymptomatic receive systemic treatment, and local treatment is applied as necessary [8, 9]
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