Author of

• 11001

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11045

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    P1.24-044 - Favorable Survival of Women with Non-Small Cell Lung Cancer (NSCLC) after Resection of Brain Metastases (BM) and Whole Brain Radiotherapy (WBRT) (ID 3092)

    09:30 - 09:30  |  Author(s): P.M. Putora
    • Abstract

    Background
    In NSCLC, BM are found in 20%-50% overall and 10-18% at initial presentation. Average survival of these patients (pts) is only 3–6 months. The selection of pts who may benefit from surgical resection of BM is challenging. Our goal was to distinguish which pts might benefit from surgical resection of BM.

    Methods
    We retrospectively reviewed all pts receiving surgical resection of BM from NSCLC at our institution between 2000 and 2011. Survival after Brain surgery was measured.

    Results
    A total of 52 pts were identified. Median age was 59 years (35-81). ECOG Performance status was 2 or less in 88%.Only 2 were never smokers, and 94% smoked until < 5 years before diagnosis. Nineteen (37%) were women, 29 (56%) had adenocarcinoma (AC), 14 (27%) squamous cell carcinoma (SCC) and 9 (17%) not otherwise specified NSCLC. In 35 pts (67%) single BM was present, 2 in 6 (12%), 3 in 5 (9 %) and 4 or more in 3 (6%) pts. The stage of the primary lung tumor was T1-3 in 40 (78%) and N0-1 in 25 (48%). Synchronous BM were resected within one month of diagnosis in 29 (56%) pts. Twenty-three (44%) had no other distant metastases at the time of diagnosis of the BM. Distribution of distant metastases was adrenal (21%), liver (19%), bone (15%), lung (13%) and other (19%). Median time from lung cancer diagnosis to resection of BM was 7.5 months (0-63 months). WBRT was applied to 45 (87%) pts post brain surgery and once before surgery. The primary tumor was resected in curative intent in 14 (27%) pts at diagnosis. Thirty four (65%) received first line platinum chemotherapy doublets. Second line systemic therapy was given to 19 (37%) pts. Only 8 pts received tyrosine kinase inhibitors, but no one was treated for longer than 4 months. Eight are still alive. Median survival was 9.1 months with only one patient (initially pT2 pN0) surviving more over 5 years. One year survival was 42%. Median survival for males was significantly shorter (6.7 vs. 14 months [p<0.005]). AC was associated with improved survival compared to SCC (10.6 vs. 6.7 months [p<0.05]) with no correlation between gender and histology. In a multivariate analysis, the use of TKI, age and WBRT were not associated with outcome. Thirteen (25%) died within 3 months after surgery including 4 (8%) within 1 month. Six (46%) of them had other metastatic sites involved. New brain lesions post-surgery were documented in 12 (23%) and 4 (8%) had local progression at the resection site.

    Conclusion
    Resection of BM followed by WBRT lead to good local control. Despite patient selction with almost one third being treated with surgery of the primary tumor "curative intent" as well, only one patient lived > 5 years. The relatively high death rate (25%) within 3 months of surgery indicate the need for further research to better select patients suitable for survery. Female gender and AC histology were associated with better survival after resection of BM. These pts may preferably be considered for resection.