[Multimodal Treatment of Non-Small Cell Lung Cancer with Cerebral Metastases]

The role of surgical treatment of lung cancer with brain metastases remains controversial. The aim of this study was to determine the long-term outcome and to identify potential prognostic factors in patients with cerebral metastatic non-small cell lung cancer (NSCLC).

The data of patients who underwent a resection of oligometastatic NSCLC with brain metastases from January 1999 to December 2012 were investigated retrospectively at a single institution. Multimodal treatment included resection or radiation surgery of the brain metastases at first, followed by systemic chemotherapy and the surgical treatment of the lung cancer finally. Survival, potential prognostic factors, response to chemotherapy as well as morbidity and mortality were investigated.

A total of 105 patients with primary NSCLC and brain metastases was identified. Out of these, 26 patients (18 males, 8 females) were included in the study. Morbidity and mortality rates were 15 and 0 %, respectively. Lobectomies were performed in 15 patients, pneumonectomy in 5 and sleeve lobectomy in 6 patients, respectively. The brain metastases were treated individually by resection (n = 12), stereotactic radiotherapy (n = 11) or whole brain radiotherapy in several combinations. Histological response to chemotherapy was proven in 9.1 %. The 2-year survival rate was 50 % (median survival [MS], 26 months). There were no significant differences of the survival depending on the patients' age, gender, presence of lymph node metastases, number of the brain metastases, type of chemotherapy or response to chemotherapy. Adenocarcinoma as histology of the primary tumour showed a significantly better survival compared to squamous cell carcinoma (MS: 26 vs. 8 months; p = 0.034). Treatment of the brain metastases without any additional whole brain radiation was associated with inferior survival compared to patients with whole brain radiation (mean survival: 17 vs. 73 months; p = 0.005).

Long-term survival is achievable in highly selected patients with NSCLC and cerebral metastasis by multimodal treatment including resection of the primary lung cancer. Patients with squamous cell carcinoma should be selected carefully for multimodal treatment. Treatment of the brain metastases without whole brain radiation should be avoided.