Surgery Versus Stereotactic Radiosurgery for Single Synchronous Brain Metastasis from Non-Small Cell Lung Cancer

Objective:The aim of this study is to compare the effectiveness of surgery with stereotactic radiosurgery(SRS) for patients with a single synchronous brain metastasis from successfully treated non-small cell lung cancer. Methods:Between 1995 and 2002,53 patients underwent resection of both primary non-small cell lung cancer and the associated single brain metastasis. There were 33 men and 20 women with a mean age of 57 years(range,32-85 years). At the time of diagnosis,42 patients experienced lung cancer related symptoms,whereas 11 patients experienced brain metastases-related symptoms. 42 patients had received thoracic surgery first,and 11 patients had undergone neurosurgery or radiosurgery first. Pneumonectomy was performed in 9 out of 42 patients(21.4%),lobectomies in 30(71.4%),and wedge resection in 3(7.2%). 48 patients(90.5%) underwent complete lymphadenectomy. 35 patients underwent brain metastasectomy. 18 underwent SRS. Results:There was no postoperative mortality and severe complications after either lung or brain surgery. Histology showed 34 adenocarcinomas,16 squamous cell carcinomas,and 3 large cell lung cancers. 15 patients(28.3%) had no evidence of lymph node metastases(N0),20 patients(37.7%) had hilar metastases(N1),and 18 patients(34%) had mediastinal metastases(N2). The 1-,2-,3-and 5-year overall survival rates were 49%,19%,10%,and 5%,respectively. The corresponding data for neurosurgery group were 55%,17%,11%,and 6%,respectively. The median survival time was 13 months. For SRS group the corresponding data were 44.8%,20.9% 10.5%,and 2%,respectively. The median survival time was 14 months. The differences between the two groups were not significant(P>0.05). In lymph node negative patients(N0),the overall 5-year survival rate was 10%,as compared with a 1% survival rate in patients with lymph node metastases(N1-2). The difference was significant(P<0.01). For adenocarcinomas,the 5-year survival rate was 5%. The correspondent data for squamous cell lung cancers was 3%. The difference was not significant(P>0.05). Conclusion:Although the overall survival rate for patients who have brain metastases from NSCLC is poor,surgical resection or radiosurgery may be beneficial in a select group of patients with synchronous brain metastases and lung cancer without lymph node metastases.