Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991

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✓ The authors reviewed the records of 231 patients who underwent resection of brain metastases from nonsmall-cell lung cancer between 1976 and 1991. Data regarding the primary disease and the characteristics of brain metastasis were retrospectively collected. Median survival in the group from the time of first craniotomy was 11 months; postoperative mortality was 3%. Survival rates of 1, 2, 3, and 5 years were 46.3%, 24.2%, 14.7%, and 12.5%, respectively. One hundred twelve women survived significantly longer than 119 men (13.8 vs. 9.5 months, p < 0.02). Patients with single metastatic lesions (200 patients) survived longer than those (31 patients) with multiple metastases (11.1 vs. 8.5 months, p < 0.02). Patients with supratentorial tumors survived longer than patients with cerebellar lesions. A high Karnofsky performance scale score before surgery also indicated increased survival. In multivariate analyses, incomplete resection or no resection of primary lung tumor, male gender, infratentorial location, presence of systemic metastases, and age older than 60 years were significantly correlated with shorter survival. Approximately one-third of the patients died of neurological causes, one-third of systemic disease, and one-third of a combination of both. The results of this series confirm that the overall prognosis for patients with even a single resectable brain metastasis is poor, but that aggressive therapy can prolong life with quality of life preserved and can occasionally permit long-term survival.

Article Information

Address reprint requests to: Ehud Arbit, M.D., Neurosurgery Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graphs depicting overall and actuarial survival after surgical treatment of brain metastasis from nonsmall-cell lung cancer. Upper: Overall survival of 231 patients undergoing resection of brain metastases. Dotted curves with appropriate small symbols show lower and upper endpoint of the α-level 95% survival confidence interval for each survival curve. A 5-year survival is predicted. Lower: Actuarial survival of 112 women and 119 men from the time of craniotomy. Difference in survival is highly significant in both the log-rank test and Cox multivariate analysis.

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    Graphs showing actuarial survival from the time of craniotomy for brain metastasis from nonsmall-cell lung cancer. Dotted curves with appropriate small symbols show lower and upper endpoint of the α-level 95% survival confidence interval for each survival curve. Upper Left: Actuarial survival in patients with metachronous versus synchronous diagnoses of lung cancer and brain metastases. Difference in survival is significant in log-rank test but not in Cox multivariate analysis. Upper Right: Actuarial survival in patients who underwent resection for supratentorial versus infratentorial brain metastases. There is a significant difference in survival time, both in the log-rank test and Cox multivariate analysis favoring the group with supratentorial lesions. Lower: Actuarial survival in patients with single versus multiple brain metastases. Difference in survival is only significant in the log-rank test.

  • View in gallery

    Graphs depicting actuarial survival from the time of craniotomy in 231 patients with brain metastases from lung cancer. Dotted curves with appropriate small symbols show lower and upper endpoint of the α-level 95% survival confidence interval for each survival curve. Upper: Comparison based on surgical management of primary lung disease, that is, complete resection versus no resection. The second group includes patients who underwent partial resection, exploration and biopsy without resection, and no surgery. The difference in survival is highly significant in both the log-rank test and the Cox multivariate analysis favoring the group that underwent complete resection of the primary lung cancer. A 5-year survival time is predictive. Lower: Comparison according to patients who had “failed” whole-brain radiation therapy before surgery versus those who did not receive presurgical radiation therapy. The difference in survival is statistically significant in the log-rank test.

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