Non-Small Cell Lung Cancer Patients with Brain Metastases and Limited Access to Systemic Therapy

We aimed to identify prognostic factors associated with overall survival in patients with brain metastases from non-small cell lung cancer (BM-NSCLC) who had limited access to systemic therapy.

We retrospectively analyzed 83 patients with BM-NSCLC. Data collected included age, sex, performance status, histology, neurologic symptoms, extracranial metastasis (ECM), and receipt of whole-brain radiotherapy (WBRT) and systemic treatment. Associations between these factors and time to death were assessed using Cox proportional hazards regression analysis.

The mean age of the patients was 63.1±8.9 years. Approximately 30% of patients had ECM, whereas 14% received systemic treatment. Three-quarters of the cohort underwent WBRT. The median survival time was 2.7 months [95% confidence interval (CI): 2.2-4.1 months]. The 6-month and 1-year survival probabilities were 26.5% (95% CI: 17.6%-36.3%) and 9.6% (95% CI: 4.5%-17.1%), respectively. Multivariable analysis demonstrated that ECM was significantly associated with an increased risk of death [adjusted hazard ratio (aHR): 4.22, 95% CI: 1.27-14.0, P = 0.019, for newly diagnosed lung cancer; aHR: 6.33, 95% CI: 1.62-24.79, P = 0.008, for controlled primary lung cancer with ECM; and aHR: 11.32, 95% CI: 2.89-56.1, P = 0.003, for uncontrolled primary lung cancer and ECM]. Receipt of systemic treatment was significantly associated with a lower risk of death (aHR: 0.39, 95% CI: 0.18-0.80, P = 0.011). WBRT was not significantly associated with improved survival (aHR: 0.79, 95% CI: 0.43-1.44, P = 0.441).

The presence of ECM and the absence of systemic treatment were significantly associated with shorter survival in patients with BM-NSCLC.