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The prognostic factors of lung cancer patients with brain metastases treated with radiotherapy

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Abstract

Purpose: To analyze the prognostic factors of lung cancer with brain metastases (BM) and evaluate the role of cranial irradiation on survival. Methods and materials: From 1987 to 1994, 159 lung cancer patients with CT scan documented BM were reviewed. All of them underwent cranial irradiation (median radiation dose: 30 Gy). Chemotherapy and surgery of BM were performed in 21 and 10 cases, respectively. Results: Overall median survival was 3.5 months and one year survival rate was 10.69%. Univariate analysis showed that the significant factors were performance status, age, total radiation dose to brain, BM as the first metastasis, neurosurgery, symptoms of urine/stool incontinence, and synchronous BM. Multivariate analysis indicated that (1) performance status (p=0.0002), (2) total radiation dose (p=0.0032), (3) BM as the first metastasis (p=0.0449), (4) neurosurgery (p = 0.0233), (5) symptoms of urine/stool incontinence (p = 0.0002), and (6) the presence of a midline shift on cranial CT scans (p = 0.0063) were significant prognostic factors. Conclusion: The prognosis of BM in lung cancer patients is extremely poor. Radiotherapy appears as an effective means of palliation with 75% overall symptomatic response rate. Higher radiation dose (≥ 30 Gy) and neurosurgery are associated with longer survival. Good performance status, BM as the first metastasis, absence of sphincter dysfunction, and midline shift on CT scans are favorable prognostic predictors. The role of midline shift is very interesting and needs to be explored further.

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References

  1. Line DH, Deeley TJ: The necropsy findings in carcinoma of the bronchus. Br J Dis Chest 65: 238–242, 1971

    Google Scholar 

  2. Cox JD, Yesner R: Adenocarcinoma of the lung–recent results from VA Lung Group. Am Rev Resp Dis 120: 1025–1029, 1979

    Google Scholar 

  3. Chao JH, Philips R, Nickson JJ: Roentgen-ray therapy of cerebral metastases. Cancer 7: 682–689, 1954

    Google Scholar 

  4. Coia LR: The role of radiation therapy in the treatment of brain metastases. Int J Radiat Oncol Biol Phys 23: 229–238, 1992

    Google Scholar 

  5. Hoskin PJ, Crow J, Ford HT: The influence of extent and local management on the outcome of radiotherapy for brain metastases. Int J Radiat Oncol Biol Phys 19: 111–115, 1990

    Google Scholar 

  6. Li JC, Liu MT, Chang KH, Chung CH: Palliative radiotherapy of cerebral metastasis from lung cancer. J Formos Med Assoc 89(4): 281–285, 1990

    Google Scholar 

  7. Nieder C, Niewald M, Schnabel K: The radiotherapy of brain metastases in bronchial carcinoma. Strahlenther Onkol 170(6): 335–341, 1994

    Google Scholar 

  8. Sundaresan N, Galicich JH, Beattie EJ Jr: Surgical treatment of brain metastases from lung cancer. J Neurosurg 58 (5): 666–671, 1983

    Google Scholar 

  9. Ide Y, Oka K, Tsuchimochi H, Mizoguchi T, Fukushima T, Tomonaga M, Shirakusa T: Surgical results of brain metastasis from lung cancer–prognostic factors. Neurol Med Chir 31(1): 18–25, 1991

    Google Scholar 

  10. Wronski M, Arbit E, Burt M, Galicich JH: Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231patients treated between 1976 and 1991. J Neurosurg 83(4): 605–616, 1995

    Google Scholar 

  11. Nakagawa H, Miyawaki Y, Fujita T, Kubo S, Tokiyoshi K, Tsuruzono K, Kodama K, Higashiyama M, Doi O, Hayakawa T: Surgical treatment of brain metastases of lung cancer: retrospective analysis of 89 cases. J Neurol Neurosurg Psychiatry 57(8): 950–956, 1994

    Google Scholar 

  12. Wronski M: Surgical treatment of brain metastases from non-microcellular lung cancer. Neurol Neurochir Pol 26(6): 837–844, 1992

    Google Scholar 

  13. Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53: 457–481, 1958

    Google Scholar 

  14. Cox DR: Regression models and life-tables. J R Stat Soc 34: 187–220, 1972

    Google Scholar 

  15. Sheline GE, Brady LW: Radiation therapy for brain metastases. J Neuro-Oncol 4: 219–225, 1987

    Google Scholar 

  16. Wright DC, Delaney TF: Treatment of metastatic cancer to the brain. In: Devita L (ed) Cancer: Principles and Practice of Oncology. J.B. Lippincott Co., Philadelphia, Pennsylvania 2245–2260, 1989

    Google Scholar 

  17. Zimm S, Wampler GL, Stablein D, Hazra T, Young HF: Intracerebral metastases in solid-tumor patients: natural history and results of treatment. Cancer 48: 384–394, 1981

    Google Scholar 

  18. Egawa S, Tukiyama I, Akine Y, Kajiura Y, Yanagawa S, Watai K, Nomura K: Radiotherapy of brain metastases. Int J Radiat Oncol Biol Phys 12(9): 1261–1265, 1986

    Google Scholar 

  19. Ryan GF, Ball DL, Smith JG: Treatment of brain metastases from primary lung cancer. Int J Radiat Oncol Biol Phys 31 (2): 273–278, 1995

    Google Scholar 

  20. Diener-West M, Dobbins TW, Phillips TL, Nelson DF: Identification of an optimal subgroup for treatment evaluation of patients with brain metastases using RTOG study 796. Int J Radiat Oncol Biol Phys 16: 669–673, 1989

    Google Scholar 

  21. Boogerd W, Vos VW, Hart AAM, Baris G: Brain metastases in breast cancer, natural history, prognostic factors and outcome. J Neuro-Oncol 15: 165–174, 1993

    Google Scholar 

  22. Noordijk EM, Vecht CJ, Reiche-Haaxma H, Padberg GW, Voormolen JHC, Hoekstra FH, Tans JTJ, Lambooij N, Metsaars JAL, Wattendorff AR, Brand R, Hermans J: The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 29 (4): 711–717, 1994

    Google Scholar 

  23. Shcherbenko OI: The efficacy of gamma teletherapy of malignant metastases to the brain and certain prognostic factors. Vopr Onkol 35(5): 565–569, 1989

    Google Scholar 

  24. Swift PS, Phillips T, Martz K, Wara W, Mohiuddin M, Chang CH, Asbell SO: CT characteristics of patients with brain metastases treated in RTOG study 79-16. Int J Radiat Oncol Biol Phys 25: 209–214, 1993

    Google Scholar 

  25. Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesbery WR, MacDonald JS, Young B: A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322: 494–500, 1990

    Google Scholar 

  26. Loeffler JS, Shrieve DC: What is appropriate therapy for a patient with a single brain metastasis? Int J Radiat Oncol Biol Phys 29: 915–917, 1994

    Google Scholar 

  27. Mehta MP, Rozental JM, Levin AB, Mackie TR, Kubsad SS, Gehring MA, Kinsella TJ: Defining the role of radiosurgery in the management of brain metastases. Int J Radiat Oncol Biol Phys 24: 619–625, 1992

    Google Scholar 

  28. Flickinger JC, Kondziolka D: Radiosurgery instead of resection for solitary brain metastasis: the gold standard redefined. Int J Radiat Oncol Biol Phys 35(1): 185–186, 1996

    Google Scholar 

  29. Auchter RM, Lamond JP, Alexander EA, Buatti JM, Chappel R, Friedman WA, Kinsella TJ, Levin AB, Noyes WR, Schultz CJ, Loeffler JS, Mehta MP: A multi-institutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 35: 27–35, 1996

    Google Scholar 

  30. Flickinger JC, Kondziolka D, Lunsford LD, Coffey RJ. Goodman ML, Shaw EG, Hudgins WR, Weiner R, Harsh GR, Sneed PS, Larson DA: A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 28 (4): 797–802, 1994

    Google Scholar 

  31. Hendrickson FR, Lee MS, Larson M, Gelber RD: The influence of surgery and radiation therapy on patients with brain metastases. Int J Radiat Oncol Biol Phys 9: 623–627, 1983

    Google Scholar 

  32. Patchell RA, Cirrincione C, Thaler HT, Galicich JH, Kim JH, Posner JB: Single brain metastases: surgery plus radiation or radiation alone. Neurology 36: 447–453, 1986

    Google Scholar 

  33. Mandell L, Hilaris B, Sullivan M, Sundaresan N, Nori D, Kim JH, Martini N, Fuks Z: The treatment of single brain metastases from non-oat cell lung carcinoma. Surgery and radiation versus radiation therapy alone. Cancer 58(3): 641–649, 1986

    Google Scholar 

  34. Mussi A, Janni A, Pistolesi M, Ravelli V, Buonaguidi R, Angeletti CA: Surgical treatment of primary lung cancer and solitary brain metastasis. Thorax 40(3): 191–193, 1985

    Google Scholar 

  35. Sundaresan N, Galicich JH: Surgical treatment of single brain metastases from non-small-cell lung cancer. Cancer Invest 3(2): 107–113, 1985

    Google Scholar 

  36. Rizzi A, Tondini M, Rocco G, Rossi G, Robustellini M, Radaelli F, Della Pona C: Lung cancer with a single brain metastasis: therapeutic options. Tumori 76(6): 579–581, 1990

    Google Scholar 

  37. Armornmarn R, Prempree T, Ostrowski ML, Nguyen T: Long-term survival of lung cancer with brain metastasis. J Fla Med Assoc 77(7): 659–662, 1990

    Google Scholar 

  38. Read RC, Boop WC, Yoder G, Schaefer R: Management of nonsmall cell lung carcinoma with solitary brain metastasis. J Thorac Cardiovasc Surg 98: 884–891, 1989

    Google Scholar 

  39. Pladdet I, Boven E, Nauta J, Pinedo HM: Palliative care for brain metastases of solid tumour types. Neth J Med 34: 10–21, 1989

    Google Scholar 

  40. Catinella FP, Kittle CF, Faber LP, Milloy FJ, Warren WH, Von Roenn KA: Surgical treatment of primary lung cancer and solitary intracranial metastasis. Chest 95(5): 972–975, 1989

    Google Scholar 

  41. Torre M, Barbieri B, Bera E, Locicero S, Pieri Nerli F, Belloni PA: Surgical therapy in lung cancer with single brain metastasis. Eur J Cardiothorac Surg 2(5): 336–339, 1988

    Google Scholar 

  42. Sarma DP, Weilbaecher TG: Long-term survival after brain metastasis from lung cancer. Cancer 58(6): 1366–1370, 1986

    Google Scholar 

  43. Magilligan DJ Jr, Duvernoy C, Malik G, Lewis JW Jr, Knighton R, Ausman JI: Surgical approach to lung cancer with solitary cerebral metastasis: twenty-five years' experience. Ann Thorac Surg 42(4): 360–364, 1986

    Google Scholar 

  44. Vecht CJ, Haaxma-Reiche H, Noordijk EM, Padberg GW, Voormolen JH, Hoekstra FH, Tans JT, Lambooij N, Metsaars JA, Wattendorff AR, Brand R, Hermans J: Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33(6): 583–590, 1993

    Google Scholar 

  45. Sause WT, Crowley JJ, Morantz R, Rotman M, Mowry PA, Bouzaglou A, Borst JR, Selin H: Solitary brain metastasis: results of an RTOG/SWOG protocol evaluation surgery + RT verse RT alone. Am J Clin Oncol 13(5): 427–432, 1990

    Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Chang Gung Memorial Hospital-, Kaohsiung, Taiwan

    Ching-Yeh Hsiung, Stephen Wan Leung, Chong-Jong Wang, Hui-Chun Chen, Li-Min Sun & Fu-Min Fang

  2. Faculty of Health and Behavioural Sciences, Deakin University, Burwood, Australia

    Sing-Kai Lo

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Hsiung, CY., Leung, S.W., Wang, CJ. et al. The prognostic factors of lung cancer patients with brain metastases treated with radiotherapy. J Neurooncol 36, 71–77 (1998). https://doi.org/10.1023/A:1005775029983

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