Abstract
Simple SummaryIn order to clarify whether an early development of brain metastases from non-small cell lung cancer represents a poor prognostic factor for further survival we analyzed 377 patients with brain metastases, treated by radiosurgery or surgery at two German institutions. Our results show that an early appearance of brain metastasis does not influence further survival in a comprehensive treatment setting.Objective: We attempted to analyze whether early presentation with brain metastases (BM) represents a poor prognostic factor in patients with non-small cell lung cancer (NSCLC), which should guide the treatment team towards less intensified therapy. Patients and methods: In a retrospective bi-centric analysis, we identified patients receiving surgical treatment for NSCLC BM. We collected demographic-, tumor-, and treatment-related parameters and analyzed their influence on further survival. Results: We included 377 patients. Development of BM was precocious in 99 (26.3%), synchronous in 152 (40.3%), and metachronous in 126 (33.4%) patients. The groups were comparable in terms of age (p = 0.76) and number of metastases (p = 0.11), and histology (p = 0.1); however, mutational status significantly differed (p = 0.002). The precocious group showed the worst clinical status as assessed by Karnofsky performance score (KPS) upon presentation (p < 0.0001). Resection followed by postoperative radiotherapy was the predominant treatment modality for precocious BM, while in syn- and metachronous BM surgical and radio-surgical treatment was balanced. Overall survival (OS) did not differ between the groups (p = 0.76). A good postoperative clinical status (KPS ≥ 70) and the application of any kind of adjuvant systemic therapy were independent predictive factors for OS. Conclusion: Early BM presentation was not associated with worse OS in NSCLC BM patients.
Highlights
Lung cancers represent the most frequent cancer type seeding to the brain [1,2]
We identified 438 patients, who received treatment for brain metastases from lung cancer between
We queried our institutional databases for adult patients who underwent surgery and stereotactic radiosurgery (SRS) for brain metastases (BM) from lung cancer between 2010 and 2019 and identified demographic and clinical parameters
Summary
Lung cancers represent the most frequent cancer type seeding to the brain [1,2]. While some patients may develop brain metastases (BM) during or after initial treatment for the primary tumors, others show early development of brain disease, sometimes even before the primary cancer is detected.In accordance, the pattern of appearance is termed synchronous (i.e., within three months of diagnosis) or metachronous (i.e., later than three months after diagnosis) and precocious (i.e., prior to diagnosis of the primary tumor) [3,4,5].While precocious and most synchronous metastases are frequently treatment-naive compared to metachronous tumors, a different oncological course for these patients has been reported, with a rather dismal prognosis for patients with precocious tumors, possibly resulting in differing treatment decisions [6].As (radio-)oncological treatment patterns have changed substantially over recent decades due to the substances available and frequency of treatment, and with postoperative treatment options advancing over the past two decades [7], the aim of this study was to evaluate the treatment course of patients with symptomatic brain metastases from non-small cell lung cancers (NSCLC) in relation to their time of appearance in the setting of comprehensive oncological treatment. While precocious and most synchronous metastases are frequently treatment-naive compared to metachronous tumors, a different oncological course for these patients has been reported, with a rather dismal prognosis for patients with precocious tumors, possibly resulting in differing treatment decisions [6]. As (radio-)oncological treatment patterns have changed substantially over recent decades due to the substances available and frequency of treatment, and with postoperative treatment options advancing over the past two decades [7], the aim of this study was to evaluate the treatment course of patients with symptomatic brain metastases from non-small cell lung cancers (NSCLC) in relation to their time of appearance in the setting of comprehensive oncological treatment
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