Surgery of Primary Lung Cancer with Oligometastatic M1b Synchronous Single Brain Metastasis: Analysis of 37 Cases
02. Dezember 2013
01. April 2014
19. August 2014 (online)
Background At the time of diagnosis, lung cancer has often metastasized already. Brain metastases, however, are associated with a poor prognosis (median survival of less than 1 year). We evaluated the changes of the median survival after resection of the cerebral metastases and primary non-small cell lung cancer (NSCLC).
Materials and Methods Between January 1999 and December 2009, 37 patients (22 men, 15 women; median age: 55.64 years; age range: 38–72 years) underwent surgery for primary NSCLC after craniotomy and removal of the synchronous single brain metastasis. The overall survival was evaluated and risk factors identified.
Results Mediastinal lymph node involvement was excluded with mediastinoscopy in 26 of the 37 patients. Postoperative N-stage was N0, N1, and N2 in 16 (43%), 10 (27%), and 11 (30%) patients, respectively. Histology was squamous cell carcinoma in 10 (27%), adenocarcinoma in 20 (54%), and large cell carcinoma in 7 (19%). The employed type of resection was anatomical segmentectomy in 6 and lobectomy in 31 patients. The 30-day mortality was 0% and postoperative complications occurred in 12 patients only (32%). The overall 1 and 2 years survival were 62 and 24%, respectively. None of the factors age, sex, tumor histology, primary location of the tumor, type of resection, adjuvant chemotherapy, or nodal status affected survival in the univariate analysis.
Conclusions The oncologic lung resection of NSCLC after the resection of a single brain metastasis can be implemented without an increased risk of complications or mortality. Despite the stage IV disease, the median survival appears encouraging.
- 1 Ochi N, Yamane H, Yamagishi T, Takigawa N. Continuous pemetrexed treatment for brain metastasis in non-small cell lung cancer—a report of two cases. Lung Cancer 2013; 80 (1) 111-113
- 2 Kawabe T, Phi JH, Yamamoto M, Kim DG, Barfod BE, Urakawa Y. Treatment of brain metastasis from lung cancer. Prog Neurol Surg 2012; 25: 148-155
- 3 Billing PS, Miller DL, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Surgical treatment of primary lung cancer with synchronous brain metastases. J Thorac Cardiovasc Surg 2001; 122 (3) 548-553
- 4 Knights Jr EM. Metastatic tumors of the brain and their relation to primary and secondary pulmonary cancer. Cancer 1954; 7 (2) 259-265
- 5 Figlin RA, Piantadosi S, Feld R. Intracranial recurrence of carcinoma after complete surgical resection of stage I, II, and III non-small-cell lung cancer. N Engl J Med 1988; 318 (20) 1300-1305
- 6 Magilligan Jr DJ, Duvernoy C, Malik G, Lewis Jr JW, Knighton R, Ausman JI. Surgical approach to lung cancer with solitary cerebral metastasis: twenty-five years' experience. Ann Thorac Surg 1986; 42 (4) 360-364
- 7 Patchell RA, Tibbs PA, Walsh JW , et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990; 322 (8) 494-500
- 8 Ruderman NB, Hall TC. Use of glucocorticoids in the palliative treatment of metastatic brain tumors. Cancer 1965; 18: 298-306
- 9 Patchell RA, Tibbs PA, Regine WF , et al. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 1998; 280 (17) 1485-1489
- 10 Vecht CJ, Haaxma-Reiche H, Noordijk EM , et al. Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery?. Ann Neurol 1993; 33 (6) 583-590
- 11 Lévy A, Chargari C, Lamproglou I, Mazeron JJ, Krzisch C, Assouline A. Whole brain radiation with supplementary boost for patients for unique brain metastasis from a primitive lung cancer [in French]. Cancer Radiother 2011; 15 (5) 426-429
- 12 Burt M, Wronski M, Arbit E, Galicich JH ; Memorial Sloan-Kettering Cancer Center Thoracic Surgical Staff. Resection of brain metastases from non-small-cell lung carcinoma. Results of therapy. J Thorac Cardiovasc Surg 1992; 103 (3) 399-410 , discussion 410–411
- 13 Rossi NP, Zavala DC, VanGilder JC. A combined surgical approach to non-oat-cell pulmonary carcinoma with single cerebral metastasis. Respiration 1987; 51 (3) 170-178
- 14 Read RC, Boop WC, Yoder G, Schaefer R. Management of nonsmall cell lung carcinoma with solitary brain metastasis. J Thorac Cardiovasc Surg 1989; 98 (5 Pt 2) 884-890 , discussion 890–891
- 15 Richards P, McKISSOCK W. Intracranial metastases. BMJ 1963; 1 (5322) 15-18
- 16 Griffioen GH, Toguri D, Dahele M , et al. Radical treatment of synchronous oligometastatic non-small cell lung carcinoma (NSCLC): patient outcomes and prognostic factors. Lung Cancer 2013; 82 (1) 95-102