Brain Tumor Res Treat.  2022 Jul;10(3):172-182. 10.14791/btrt.2022.0016.

Survival Outcomes and Predictors for Recurrence of Surgically Treated Brain Metastasis From Non-Small Cell Lung Cancer

• Byun J
• Kim JH
• Kim M
• Lee S
• Kim YH
• Hong CK
• Kim JH

• KMID: 2532251
• DOI: http://doi.org/10.14791/btrt.2022.0016

Abstract

Background
There are numerous factors to consider in deciding whether to undergo surgical treatment for brain metastasis from lung cancer. Herein, we aimed to analyze the survival outcome and predictors of recurrence of surgically treated brain metastasis from non-small cell lung cancer (NSCLC).
Methods
A total of 197 patients with brain metastasis from NSCLC who underwent microsurgery were included in this study.
Results
A total of 114 (57.9%) male and 83 (42.1%) female patients with a median age of 59 years (range, 27–79) was included in this study. The median follow-up period was 22.7 (range, 1–126) months. The 1-year and 2-year overall survival (OS) rates of patients with brain metastasis secondary to NSCLC were 59% and 43%, respectively. The 6-month and 1-year progression-free survival (PFS) rates of local recurrence were 80% and 73%, respectively, whereas those of distant recurrence were 84% and 63%, respectively. En-bloc resection of tumor resulted in better PFS for local recurrence (1-year PFS: 79% vs. 62%, p=0.02). Ventricular opening and direct contact between the tumor and the subarachnoid space were not associated with distal recurrence and leptomeningeal seeding. The difference in PFS of local recurrence according to adjuvant resection bed irradiation was not significant. Moreover, postoperative whole-brain irradiation did not show a significant difference in PFS of distant recurrence. In multivariate analysis, only En-bloc resection was a favorable prognostic factor for local recurrence. Contrastingly, multiple metastasis was a poor prognostic factor for distant recurrence.
Conclusion
En-bloc resection may reduce local recurrence after surgical resection. Ventricular opening and contact between the tumor and subarachnoid space did not show a statistically significant result for distant recurrence and leptomeningeal seeding. Multiple metastasis was only meaningful factor for distant recurrence.

Keyword

Lung cancer; Brain metastases; Surgery; Recurrence; Survival

Figure

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  Fig. 1 Representative radiological findings for brain metastasis from lung cancer. A and D: A 52-year-old male patient with non-small cell lung cancer (NSCLC)-squamous cell carcinoma. A large right frontal lobe tumor was resected to relieve intracranial hypertension. Other lesions were treated by gamma knife radiosurgery. B and E: A 70-year-old male patient with NSCLC adenocarcinoma. The single left occipital solid and the cystic tumor were resected. Postoperative homonymous hemianopsia occurred. The patient did not receive adjuvant therapy. C and F: A 79-year-old male patient with NSCLC squamous cell carcinoma. A large cystic cerebellar tumor was resected to relieve obstructive hydrocephalus. Postoperatively, the fourth ventricle was decompressed, and the hydrocephalus was relieved.

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  Fig. 2 Kaplan-Meier survival analysis of the enrolled patients. A: Overall survival (OS) of all patients with brain metastasis from non-small cell lung cancer (NSCLC). B: Progression-free survival (PFS) of local recurrence of all the surgically treated patients with NSCLC brain metastasis. C: PFS of distant recurrence of all the surgically treated patients with NSCLC brain metastasis.

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  Fig. 3 The Kaplan-Meier survival analysis of the enrolled patients. A: The difference of the progression-free survival (PFS) for local recurrence for en-bloc resection and piecemeal resection in the NSCLC group. The difference was statistically significant (p=0.02). B: The difference of PFS for distant recurrence for en-bloc resection and piecemeal resection in the NSCLC group. The difference showed marginal statistical significance (p=0.06).

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  Fig. 4 The Kaplan-Meier survival analysis of the enrolled patients. A: Progression-free survival (PFS) difference for distant recurrence according to intraoperative ventricle opening. There was no significant difference in PFS for distant recurrence. B: PFS difference for leptomeningeal seeding according to intraoperative ventricle opening. There was no significant difference in PFS for leptomeningeal seeding. C: PFS difference for distant recurrence according to tumor contacting cerebrospinal fluid (CSF) space. There was no significant difference in PFS for distant recurrence. D: PFS difference for leptomeningeal seeding according to tumor contacting CSF space. There was no significant difference in PFS for leptomeningeal seeding.

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  Fig. 5 The Kaplan-Meier survival analysis of the enrolled patients. A: Progression-free survival (PFS) for local recurrence according to the resection bed irradiation. There was no significant difference in PFS for local recurrence. B: PFS for distantl recurrence according to the whole brain irradiation. There was no significant difference in PFS for distant recurrence.

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