Lung cancer and brain metastases: treatment choice of oncologists in a cancer center

Takeshi Kondoh1, Toshinori Soejima2, Kohei Ohta3, Kensaku Yasuo3, Hisahiko Suzuki3, Yoshiyuki Takaishi3, Satoshi Matsumoto4

1Kobe, Japan 2Hyogo Cancer Center 3Shinsuma General Hospital 4The Japan Spina Bifida & Hydrocephalus Research Foundation

Keywords: gamma knife, radiosurgery, lung cancer, radiotherapy, outcome

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     The treatment choice for the metastatic brain tumors has been argued by radiologists, oncologists and neurosurgeons. Patient selection for radiosurgery may be varied among the specialities. 
     We report the realities of treatment for lung cancer with brain metastasis in a cancer center where the indications for Gamma Knife radiosurgery (GKS) are determined from the view point of oncologists but not of radiologists nor neurosurgeons.
     298 patients of lung caner with brain metastases were treated between 2004 and 2009 in a prefectural cancer center. The median age was 63.5 years (27 to 89 years). There were 62 small cell lung cancer (SCLC) and 236 non-small cell lung cancer (NSCLC) patients. The median observation period was 332 days.
      The treatment method was divided into four subgroups; only a single GKS (GKS), only whole-brain irradiation (WBRT), combination of GKS(s) and WBRT (“combined”) and surgery with radiotherapy (“ope”).
     The treatment choice was WBRT(73%) > “combined” (23%) in SCLC and WBRT (43%) > GKS (27%) > combined (24%) > “ope” (6%) in NSCLC. The 1-year survival rate and the median survival time in SCLC were 43% and 253 days in “combined”, followed by WBRT (24% and 203 days). In NSCLC, the 1-year survival rate and the median survival time were 73% and 617 days in “combined”, followed by GKS (40% and 309 days) and WBRT (25% and 146 days). On multivariate analysis, survival statistically favored patients with NSCLC, good performance score, “combined” treatment and no extracranial lesion.
     This was a retrospective series.
     Age and number of metastases were not significant for survival. In comparison of the first 3 years with the following 3 years, number of GKS-treated patients increased and the 1-year survival rate was improved from 40 % to 53 % in NSCLC.
     The following factors were important for survival: NSCLC, good performance score, “combined” treatment and no extracranial lesion.


Project Roles:

T. Kondoh (), T. Soejima (), K. Ohta (), K. Yasuo (), H. Suzuki (), Y. Takaishi (), S. Matsumoto ()