Brain Metastases in Lung Cancer: The Results of Radiosurgery in 238 Consecutive Patients

Diana Stripp, MD
University of Pennsylvania Cancer Center
Last Modified: November 7, 2001

Presenter: B.E. Amendola
Presenter's Affiliation: Radiosurgery Department, Miami Neuroscience Center, Coral Gables, FL
Type of Session: Scientific

Background

Lung cancer is the leading cause of cancer death in this country.

50% of all brain metastases have lung primary tumors

Stereotactic radiosurgery is udergoing continued evaluation in the treatment of brain metastasis.

Materials and Methods

231 lung cancer pts with brain metastases were treated with Gamma Knife radiosurgery either alone or after failure of whole brain irradiation treatment (WBRT).

The mean Karnosfsky Performance Status (KPS) was 80. The mean dose was 17 Gy and the mean number of isocenters was 6.

Results

25 of 231 (11%) patients are alive.

For those who died, 9% died of brain metastases and 91% died of non brain mets related death.

5% developed brain necrosis.

The local control rate was 97%.

The overall actuarial survival for all patients was 56% at 6 months, 33% at 1 year, 11% at 2 years and 8% at 3 years. The overall five-year survival was 6%.

Age, initial number of lesions, and KPS were statistically significant factors associated with survival.

13/185 (7%) evaluated patients succumbed to progression of brain metastases and 4/13 had one lesion at initial presentation.

Author's Conclusions

Prolonged survival and excellent control can be achieved in patients treated with radiosurgery independent of the status of the primary site.

Multiple brain metastases from lung cancer may warrant an aggressive treatment.

Clinical/Scientific Implications
Aggressive treatment for brain metastases from lung cancer may be considered in selected patients. The treatment of multiple brain metastasis with stereotactic radiosurgery has not been shown to improve outcome in prospective randomized trials. Radiosurgical treatment of solitary brain metastasis remains under investigation and the results of a recent RTOG trial should shed light on this subject.

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