Long-Term Survival in Patients With Synchronous, Solitary Brain Metastasis From Non–Small-Cell Lung Cancer Treated With Radiosurgery

Flannery, Todd W.; Suntharalingam, Mohan; Regine, William F.; Chin, Lawrence S.; Krasna, Mark J.; Shehata, Michael K.; Edelman, Martin J.; Kremer, Marnie; Patchell, Roy A.; Kwok, Young

doi:10.1016/j.ijrobp.2007.12.031

« Previous Next »International Journal of Radiation Oncology * Biology * Physics
Volume 72, Issue 1 , Pages 19-23, 1 September 2008

Long-Term Survival in Patients With Synchronous, Solitary Brain Metastasis From Non–Small-Cell Lung Cancer Treated With Radiosurgery

Todd W. Flannery, M.D.
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
Mohan Suntharalingam, M.D.
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
William F. Regine, M.D.
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
Lawrence S. Chin, M.D.
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD
Mark J. Krasna, M.D.
- Department of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD
Michael K. Shehata, M.D.
- Department of Radiation Oncology, University of Kentucky School of Medicine, Lexington, KY
Martin J. Edelman, M.D.
- Department of Medical Oncology, University of Maryland School of Medicine, Baltimore, MD
Marnie Kremer, B.A.
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
Roy A. Patchell, M.D.
- Department of Neurosurgery, University of Kentucky School of Medicine, Lexington, KY
Young Kwok, M.D.
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
- Reprint requests to: Young Kwok, M.D., Department of Radiation Oncology, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201. Tel: (410) 328-9134; Fax: (410) 328-5279

Received 8 November 2007; received in revised form 6 December 2007; accepted 11 December 2007. published online 15 February 2008.

Purpose

To report the outcome of patients with synchronous, solitary brain metastasis from non–small-cell lung cancer (NSCLC) treated with gamma knife stereotactic radiosurgery (GKSRS).

Patients and Methods

Forty-two patients diagnosed with synchronous, solitary brain metastasis from NSCLC were treated with GKSRS between 1993 and 2006. The median Karnofsky performance status (KPS) was 90. Patients had thoracic Stage I-III disease (American Joint Committee on Cancer 2002 guidelines). Definitive thoracic therapy was delivered to 26/42 (62%) patients; 9 patients underwent chemotherapy and radiation, 12 patients had surgical resection, and 5 patients underwent preoperative chemoradiation and surgical resection.

Results

The median overall survival (OS) was 18 months. The 1-, 2-, and 5-year actuarial OS rates were 71.3%, 34.1%, and 21%, respectively. For patients who underwent definitive thoracic therapy, the median OS was 26.4 months compared with 13.1 months for those who had nondefinitive therapy, and the 5-year actuarial OS was 34.6% vs. 0% (p < 0.0001). Median OS was significantly longer for patients with a KPS ≥90 vs. KPS < 90 (27.8 months vs. 13.1 months, p < 0.0001). The prognostic factors significant on multivariate analysis were definitive thoracic therapy (p = 0.020) and KPS (p = 0.001).

Conclusions

This is one of the largest series of patients diagnosed with synchronous, solitary brain metastasis from NSCLC treated with GKSRS. Definitive thoracic therapy and KPS significantly impacted OS. The 5-year OS of 21% demonstrates the potential for long-term survival in patients treated with GKSRS; therefore, patients with good KPS should be considered for definitive thoracic therapy.

Synchronous brain metastasis, Solitary brain metastasis, Non-small cell lung cancer, gamma knife radiosurgery