Surgical treatment of single brain metastases from non-small-cell lung cancer

We analyzed the results of surgical treatment of 50 patients with brain metastases from non-small-cell lung cancer who underwent craniotomy between the years 1978 through 1983. The onset of brain metastases was synchronous in 14 patients, occurred within 1 year of treatment of the primary tumor in 21 patients, and after 1 year in 15 patients. A total of 28 patients had undergone curative resection of the lung tumor; 15 patients had undergone palliative resection with or without radioactive implants, and 7 patients did not undergo surgical treatment of their primary tumor. At time of craniotomy, 31 patients were considered to have disease limited to the central nervous system. Following surgery, 34 patients received radiation therapy (30 whole brain radiation, 4 focal radiation); 15 patients had previously undergone whole brain radiation ("radiation failures"), and there was 1 postoperative death. The overall median survival in this series was 18 months. Favorable prognostic variables included (a) curative resection of the primary tumor (median 28 months), (b) disease limited to the central nervous system (median 24 months), and (c) negative mediastinal nodes at time of thoracotomy (median 28 months). The incidence of local recurrence of intracranial tumor at the original site was higher in those patients who had failed previous radiation (53%) compared to those who received postoperative radiation (12%). Although the overall degree of neurological palliation was 75%, patients who had failed radiation were less successfully palliated, and the majority continued to require steroid therapy following tumor resection. These results suggest that patients with single brain metastases from non-small-cell lung cancer who have undergone curative resection of their primary tumor have considerable potential for long-term survival, and surgical resection prior to radiation should be considered. Even in symptomatic patients with controlled or limited extracranial disease, such treatment provides rapid effective neurological palliation and can be accomplished currently with minimal mortality and morbidity.