Non small cell lung cancer (NSCLC) with single brain metastasis: The role of surgical treatment

The prognosis of NSCLC is very poor, with mean survival rate below 6 months, even if treated with palliative radio and/or chemotherapy. From 1/1/89 to 31/12/96, 24 patients (14 males and 10 females; mean age: 55 yrs) with NSCLC and single brain metastasis underwent radical surgery of both primary lung cancer and secondary cerebral lesion. Patients (pts) were divided into 2 major groups. In group 1 (G1) 16 pts (14 males and 2 females) presented a synchronous brain metastasis. In group 2 (G2) 8 pts(6 males and 2 females) presented a metachronous brain metastasis during the follow-up period (range 3-24 months since the primary tumour). Patients selected in G1 had T1-2, NO-1 clinical staging, good "performance status" (ECOG: 0-1; Karnofsky index > 70%), age < 75 yrs. Craniotomy has always been the first approach. In G2 also patients with locally advanced rumours (T3 and/or N2) were included. Whole brain radiotherapy and/or poli-chemotherapy has been the post-operative treatment. Hystologic findings showed : adenocarcinoma in 12 cases (8 in G1 and 4 inG2), squamous cell carcinoma in 10 cases (7 in G1 and 3 in G2) and large cell carcinoma in 2 (1 in G1 and 1 in G2). Actuarial survival (Kaplan-Meier method) analysis shows a global value of 81,3% at 1 year, 25,8% at 2 years and 15,5% at 3 years. Median survival is 16 months; mean survival 19,9 months (23,8 months in G1 and 12,2 months in G2) According to univariate analysis (Cox model) prognosis is definitely better in NO tumours compared to N1-2 tumours (p<0.05). We can conclude that combined surgical therapy is, nowadays, the treatment of choice for this kind of patients, even though restricted to selected cases.