Original article
General thoracic
Lung Cancer and Its Operable Brain Metastasis: Survival Rate and Staging Problems

Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.
https://doi.org/10.1016/j.athoracsur.2004.06.051Get rights and content

Background

We assessed the survival rates regarding different stages of operable lung cancers causing operable brain metastasis in patients with or without cancer-related symptoms. The correlation between survival rates and the disease-free interval between lung surgery and metastasectomy was studied.

Methods

Sixty-five patients were operated on for lung cancer and brain metastases. The disease-free interval was divided into 5 subgroups: 0–2 months, 3–5 months, 6–11 months, 12–23 months, and 24 months and beyond. The study group comprised of patients with lung cancer in the following stages: 17 patients in stage I (1 patient in stage IA, 16 patients in stage IB), 16 patients in stage II (2 patients in stage IIA, 14 patients in stage IIB), 9 patients in stage IIIA, 4 patients in stage IIIB, and 19 patients in stage IV. Forty-four patients were symptom-free for lung cancer and 21 patients manifested lung cancer related symptoms.

Results

The 5-year survival rates were as follows: stage I = 22%, stage II = 20%, stage IIIA = 22%, stage IIIB = 0%, and stage IV = 23% after lung resections. There were no significant differences in the 5-year survival rates regarding the disease-free interval subgroups after brain metastasectomies (p = 0.19): disease-free interval 0–2 months = 22% and disease-free interval 24 months and beyond = 23%. The 5-year survival rate after metastasectomy was significantly greater (26% vs 5%) in patients without lung cancer related symptoms (p = 0.05).

Conclusions

The 5-year survival rate in stage I, II, IIIA, and IV lung cancer with operable hematogenous brain metastases corresponds to that in the customary stage IIIA (23%). The disease-free interval exhibited no significant impact on the survival rate. The complaint-free status exhibits a significantly greater impact on the survival rate in hematogenic metastasis.

Section snippets

Patients and Methods

In this multicenter (three thoracic surgery departments in Hungary) retrospective study, the data of 65 patients who underwent lung resection for primary lung cancer and brain metastasectomy for metastasis of the primary lung cancer between 1992–2001 were analyzed. The patients were divided into two groups depending on whether they exhibited synchronous or metachronous metastases. A metastasis was considered as synchronous if it appeared within 2 months of the detection of lung cancer.

Patients and Lung Cancer Related Symptoms

The mortality rate was 1.5% after lung resection (1 patient expired), and 6.1% after brain metastasectomy (4 patients expired). The overall mortality rate was 7.7% (5 out of 65 patients). Forty-four patients (67.7%) were symptom-free for lung cancer and only 21 patients (32.3%) experienced some symptoms that could be related to lung cancer. The stage distribution of lung cancer in patients with or without symptoms for lung cancer is indicated in Table 3. There were no significant differences

Comment

Similar to instances of lung metastasis from other organs [9], it was examined whether DFI is an important prognostic value after metastasectomy or not. Granone and associates indicated that their DFI ranged between 3–24 months [12] and there were no significant differences in survival rates between synchronous and metachronous patients. Burt and associates indicated that 60% of the distant metastases developed within patients 2 years after lung surgery [13]. Neoadjuvant treatment reduced the

References (17)

There are more references available in the full text version of this article.

Cited by (62)

  • Long-term outcomes of surgical resection for stage IV non-small-cell lung cancer: A national analysis

    2018, Lung Cancer
    Citation Excerpt :

    However, aggressive local therapy may be appropriate for selected patients with limited-site oligometastatic disease and otherwise early-stage local disease [3–5]. Retrospective studies of small sample sizes, ranging from 12 to 144 patients, have shown reasonable long-term outcomes when pulmonary resection is utilized in patients who have single brain or adrenal metastases but an otherwise early-stage primary tumor, with 5-year survival of approximately 10–20% for patients with oligometastases disease to the brain [7,8,27–29] and 5-year survival of approximately 25% for patients with isolated metastasis to the adrenal gland [14,17]. As such, the NCCN guidelines consider surgical resection of the lung primary along with local treatment of the metastasis in combination with systemic chemotherapy to be an acceptable treatment in these patients.

  • Role of Local Ablative Therapy in Patients with Oligometastatic and Oligoprogressive Non–Small Cell Lung Cancer

    2017, Journal of Thoracic Oncology
    Citation Excerpt :

    Similarly, in a randomized study of 333 patients with one to three brain metastases (64% of patients with NSCLC), stereotactic radiosurgery (SRS) plus WBRT improved functional autonomy and OS for patients with a single unresectable brain metastasis when compared with WBRT alone.39 Retrospective case series of patients with NSCLC and isolated CNS disease have also shown that this subgroup of patients has a relatively good prognosis and may achieve long-term survival after LAT for the primary tumor and metastatic lesions.40,41,51 Taken together, these findings support the role of LAT in the treatment of intracranial oligometastatic disease.50

View all citing articles on Scopus
View full text