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Stereotactic radiosurgery for brain metastasis in non-small cell lung cancer
Yong Kyun Won1, Ja Young Lee2, Young Nam Kang1
1Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
Purpose:
Stereotactic radiosurgery (SRS) has been introduced for small-sized single and oligo-metastases in the brain. The aim of this study is to assess treatment outcome, efficacy, and prognostic variables associated with survival and intracranial recurrence.
Materials And Methods:
This study retrospectively reviewed 123 targets in 64 patients with non-small cell lung cancer (NSCLC) treated with SRS between January 2006 and December 2012. Treatment responses were evaluated using magnetic resonance imaging. Overall survival (OS) and intracranial progression-free survival (IPFS) were determined.
Results:
The median follow-up was 13.9 months. The median OS and IPFS were 14.1 and 8.9 months, respectively. Fifty-seven patients died during the follow-up period. The 5-year local control rate was achieved in 85% of 108 evaluated targets. The 1- and 2-year OS rates were 55% and 28%, respectively. On univariate analysis, primary disease control (p < 0.001), the Eastern Cooperative Oncology Group (ECOG) performance status (0-1 vs. 2; p = 0.002), recursive partitioning analysis class (1 vs. 2; p = 0.001), and age (<65 vs. ≥65 years; p = 0.036) were significant predictive factors for OS. Primary disease control (p = 0.041) and ECOG status (p = 0.017) were the significant prognostic factors for IPFS. Four patients experienced radiation necrosis.
Conclusion:
SRS is a safe and effective local treatment for brain metastases in patients with NSCLC. Uncontrolled primary lung disease and ECOG status were significant predictors of OS and intracranial failure. SRS might be a tailored treatment option along with careful follow-up of the intracranial and primary lung disease status.
Insights
Stereotactic radiosurgery (SRS) effectively treats brain metastases in non-small cell lung cancer (NSCLC). Primary disease control and ECOG status significantly impact survival and intracranial recurrence in NSCLC patients receiving SRS.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Medical Oncology
Background:
- Stereotactic radiosurgery (SRS) is increasingly used for limited brain metastases.
- Assessing SRS outcomes in non-small cell lung cancer (NSCLC) is crucial.
Purpose of the Study:
- To evaluate the efficacy and safety of SRS for brain metastases in NSCLC patients.
- To identify prognostic factors for overall survival (OS) and intracranial progression-free survival (IPFS).
Main Methods:
- Retrospective review of 123 targets in 64 NSCLC patients treated with SRS (2006-2012).
- Magnetic resonance imaging (MRI) used for response assessment.
- Analysis of OS and IPFS.
Main Results:
- Median OS was 14.1 months, median IPFS was 8.9 months.
- 5-year local control rate of 85%.
- Significant predictors for OS included primary disease control, ECOG status, RPA class, and age. Primary disease control and ECOG status predicted IPFS.
Conclusions:
- SRS is a safe and effective local treatment for NSCLC brain metastases.
- Uncontrolled primary disease and ECOG performance status are key predictors of outcomes.
- Tailored SRS treatment with close monitoring of both intracranial and primary disease is recommended.
