Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991

1995 ◽  
Vol 83 (4) ◽  
pp. 605-616 ◽  
Author(s):  
Marek Wroński ◽  
Ehud Arbit ◽  
Michael Burt ◽  
Joseph H. Galicich
Keyword(s):  
Lung Cancer ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Lung Tumor ◽  
Systemic Disease ◽  
Postoperative Mortality ◽  
Nonsmall Cell Lung Cancer ◽  
Karnofsky Performance Scale ◽  
Incomplete Resection ◽  
Term Survival

✓ The authors reviewed the records of 231 patients who underwent resection of brain metastases from nonsmall-cell lung cancer between 1976 and 1991. Data regarding the primary disease and the characteristics of brain metastasis were retrospectively collected. Median survival in the group from the time of first craniotomy was 11 months; postoperative mortality was 3%. Survival rates of 1, 2, 3, and 5 years were 46.3%, 24.2%, 14.7%, and 12.5%, respectively. One hundred twelve women survived significantly longer than 119 men (13.8 vs. 9.5 months, p < 0.02). Patients with single metastatic lesions (200 patients) survived longer than those (31 patients) with multiple metastases (11.1 vs. 8.5 months, p < 0.02). Patients with supratentorial tumors survived longer than patients with cerebellar lesions. A high Karnofsky performance scale score before surgery also indicated increased survival. In multivariate analyses, incomplete resection or no resection of primary lung tumor, male gender, infratentorial location, presence of systemic metastases, and age older than 60 years were significantly correlated with shorter survival. Approximately one-third of the patients died of neurological causes, one-third of systemic disease, and one-third of a combination of both. The results of this series confirm that the overall prognosis for patients with even a single resectable brain metastasis is poor, but that aggressive therapy can prolong life with quality of life preserved and can occasionally permit long-term survival.

The Role of Postoperative Radiotherapy after Resection of Single Brain Metastases

Neurosurgery ◽  
1989 ◽  
Vol 24 (6) ◽  
pp. 798-805 ◽  
Author(s):  
Lisa M. DeAngelis ◽  
Lynda R. Mandell ◽  
H. Tzvi Thaler ◽  
David W. Kimmel ◽  
Joseph H. Galicich ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Postoperative Radiotherapy ◽  
Systemic Disease ◽  
Whole Brain Radiotherapy ◽  
Complete Resection ◽  
Term Survival ◽  
Single Brain Metastasis ◽  
Group A ◽  
Group B

ABSTRACT To assess the value of whole brain radiotherapy (WBRT) after complete resection of a single brain metastasis we reviewed the records of 98 patients who had elective craniotomy between 1978 and 1985. Seventy-nine patients received postoperative WBRT (Group A) and 19 patients no radiotherapy (RT) (Group B). Neurological relapse was designated as local (i.e., at the site of the original metastasis) or distant (i.e., elsewhere in the brain). Postoperative WBRT significantly prolonged the time to any neurological relapse (P = 0.034) with a 1-year recurrence rate of 22% in Group A and 46% in Group B patients; however, it did not specifically control either local or distant cerebral recurrence. Recurrence of metastatic brain disease was not affected by location of the original lesion; however, meningeal relapse occurred in 38% of cerebellar lesions, but only in 4.7% of supratentorial metastases (P = 0.003). The total radiation dose or fractionation scheme of RT did not affect survival nor time to neurological relapse. The median survival was 20.6 and 14.4 months for Groups A and B, respectively (not statistically different). Forty-eight percent of Group A and 47% of Group B patients survived for 1 year or longer; however, 11% of patients who had received RT and survived 1 year developed severe radiation-induced dementia. All patients with radiation-related cerebral damage received hypo-fractionated RT with high daily fractions as commonly designed for rapid palliation of macroscopic brain metastases. Thus, postoperative WBRT may be an important adjunct to complete resection of a single brain metastasis, particularly in patients with limited or no systemic disease who have the potential for long-term survival or even cure, but it carries a substantial risk of late neurological toxicity when hypofractionated RT schedules are used. For these good-risk patients, postoperative WBRT should be administered by standard fractionation schemes of 180 to 200 cGy/day to a total of 4000 to 4500 cGy, or hyperfractionation, which provides even lower doses/fraction to minimize potential neurotoxicity while delivering a maximally efficacious total dose, should be considered.

scholarly journals Long-Term Survival of a Patient with Brainstem and Recurrent Brain Metastasis from Stage IV Nonsmall Cell Lung Cancer Treated with Multiple Gamma Knife Radiosurgeries and Craniotomies: A Case Report and Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Andrew F. Lamm ◽  
Ameer L. Elaimy ◽  
Alexander R. Mackay ◽  
Robert K. Fairbanks ◽  
John J. Demakas ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Metastasis ◽  
Gamma Knife ◽  
Cell Lung Cancer ◽  
Gamma Knife Radiosurgery ◽  
Stage Iv ◽  
Nonsmall Cell Lung Cancer ◽  
Term Survival ◽  
The Right

The prognosis of patients diagnosed with stage IV nonsmall cell lung cancer that have brain and brainstem metastasis is very poor, with less than a third surviving a year past their initial date of diagnosis. We present the rare case of a 57-year-old man who is a long-term survivor of brainstem and recurrent brain metastasis, after aggressive treatment. He is now five and a half years out from diagnosis and continues to live a highly functional life without evidence of disease. Four separate Gamma Knife stereotactic radiosurgeries in conjunction with two craniotomies were utilized since his initial diagnosis to treat recurrent brain metastasis while chemoradiation therapy and thoracic surgery were used to treat his primary disease in the right upper lung. In his situation, Gamma Knife radiosurgery proved to be a valuable, safe, and effective tool for the treatment of multiply recurrent brain metastases within critical normal structures.

The results of resection after stereotactic radiosurgery for brain metastases

2009 ◽  
Vol 111 (4) ◽  
pp. 825-831 ◽  
Author(s):  
Hideyuki Kano ◽  
Douglas Kondziolka ◽  
Oscar Zorro ◽  
Javier Lobato-Polo ◽  
John C. Flickinger ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Surgical Navigation ◽  
Systemic Disease ◽  
Univariate Analysis ◽  
Tumor Control ◽  
Karnofsky Performance Scale ◽  
Surgical Removal ◽  
Local Progression

Object Radiosurgery for brain metastasis fails in some patients, who require further surgical care. In this paper the authors' goal was to evaluate prognostic factors that correlate with the survival of patients who require a resection of a brain metastasis after stereotactic radiosurgery (SRS). Methods During the last 14 years when surgical navigation systems were routinely available, the authors identified 58 patients who required resection for various brain metastases after SRS. The median patient age was 54 years. Prior adjuvant treatment included whole-brain radiation therapy alone (17 patients), chemotherapy alone (9 patients), both radiotherapy and chemotherapy (10 patients), and prior resection before SRS (8 patients). The median target volumes at the time of SRS and resection were 7.7 cm3 (range 0.5–24.9 cm3) and 15.5 cm3 (range 1.3–81.2 cm3), respectively. Results At a median follow-up of 7.6 months, 8 patients (14%) were living and 50 patients (86%) had died. The survival after surgical removal was 65, 30, and 16% at 6, 12, and 24 months, respectively (median survival after resection 7.7 months). The local tumor control rate after resection was 71, 62, and 43% at 6, 12, and 24 months, respectively. A univariate analysis revealed that patient preoperative recursive partitioning analysis classification, Karnofsky Performance Scale status, systemic disease status, and the interval between SRS and resection were factors associated with patient survival. The mortality and morbidity rates of resection were 1.7 and 6.9%, respectively. Conclusions In patients with symptomatic mass effect after radiosurgery, resection may be warranted. Patients who had delayed local progression after SRS (> 3 months) had the best outcomes after resection.

scholarly journals Long Term Survival of a Patient with Brain Metastases from Lung Cancer: A Case Report

2020 ◽  
pp. 15-21
Author(s):  
Tahseen Alrubai ◽  
Arwa Mohsun Khalil ◽  
Samaa AL Tabbah ◽  
Rasha Zaki
Keyword(s):  
Lung Cancer ◽  
Case Report ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Primary Cancer ◽  
Term Survival ◽  
Long Term Survival ◽  
Whole Brain Radiation ◽  
Brain Radiation

Introduction: Brain metastasis (BM) commonly occurs in patients with advanced lung cancer and is associated with poor prognosis and short survival periods. In some cases, select patients survive several years which is rare. Presentation of case: This case report highlights the long-term survival of a 55-year-old patient who was diagnosed with brain metastases from lung cancer three years ago and is currently alive following treatment with chemotherapy for the primary cancer and whole-brain radiation therapy and chemotherapy for the brain metastases. Since the diagnosis of brain metastases three years ago, the patient’s primary cancer has remained controlled and she is living a disease-free, functional life. Discussion: Literature review identified female gender, performance status, number of metastatic sites, the presence of a solitary lesion or single lesion, brain metastases later in their illness, adenocarcinoma histology, younger age, and patients with EGFR and ALK alterations, to be all as favorable prognostic factors associated with long term survival in patients with brain metastasis secondary to lung cancer. Conclusion: Further studies should be designed to investigate the factors that may relate to long term survival in patients with brain metastasis secondary to lung cancer. This should help further understand the treatment outcomes in these patients. Keywords: Brain Metastasis; Chemotherapy; Carboplatin; Gemcitabine; Whole-brain radiation; Non-small-cell lung cancer

scholarly journals Intracranial Response of Brain Metastases to Osimertinib With or Without Upfront Stereotactic Radiosurgery in TKI-Naïve Nonsmall Cell Lung Cancer Patients

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Michael Chuwei Jin ◽  
Elisa K Liu ◽  
Charles W Macaulay ◽  
Amanda Gian ◽  
Siyu Shi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Disease Progression ◽  
Stereotactic Radiosurgery ◽  
Cell Lung Cancer ◽  
Brain Mri ◽  
Nonsmall Cell Lung Cancer ◽  
Nsclc Patients ◽  
Serial Brain

Abstract INTRODUCTION Stereotactic radiosurgery (SRS) is an accepted standard of care for the treatment of brain metastases. However, the benefit of upfront SRS in combination with osimertinib, which has excellent intracranial penetrance, for patients with EGFR-mutant nonsmall cell lung cancer (NSCLC) is unknown. Improved understanding of brain metastasis dynamics in patients treated with osimertinib without intracranial radiotherapy (icRT) could provide insight into the additive benefit of upfront SRS. METHODS This retrospective cohort study included TKI-naïve NSCLC patients with brain metastases treated with osimertinib between 2017 and 2019 at Stanford University. Mutation status was determined by next generation sequencing (NGS), digital droplet polymerase chain reaction (PCR), or EGFR sequencing. Serial brain magnetic resonance imaging (MRIs) were interrogated for intracranial progression and metastasis response. RESULTS A total of 32 patients with 204 brain metastases were identified. A total of 16 patients received osimertinib with upfront icRT (15 SRS) while 16 received osimertinib alone. EGFR mutations were identified, with 17 patients receiving targeted NGS. Initial sizes of measurable brain metastases were similar in patients treated with icRT compared to those receiving osimertinib alone (median 4.5 mm vs 5.0 mm, P = .3813). Number of measurable brain metastases were similar (median 3.5 vs 5.5, P = .2322). A total of 11 (34.4%) patients experienced disease progression on osimertinib (8 [25%] intracranial, 7 [21.9%] extracranial). Changes in brain metastasis size of patients receiving osimertinib alone were assembled based on serial brain MRI. Although changes in metastasis size were not evident in the first MRI after starting osimertinib (Pscan1 = 0.4928), subsequent scans demonstrated increased stratification (Pscan2 = 0.0043 and Pscan3 = 0.0131). CONCLUSION TKI-naïve NSCLC patients receiving osimertinib demonstrate good intracranial response. Understanding the dynamics of metastasis growth could help identify patients at risk for disease progression and those most likely to benefit from icRT.

Tumor recurrence and survival following gamma knife surgery for brain metastases

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 287-288 ◽  
Author(s):  
Thomas Mindermann
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Tumor Recurrence ◽  
Patient Survival ◽  
Gamma Knife Surgery ◽  
Recurrence Rates ◽  
Term Survival ◽  
Content Type ◽  
Fine Print

Object. The authors evaluated prognostic factors for tumor recurrence and patient survival following gamma knife surgery (GKS) for brain metastasis. Methods. A retrospective review of 101 patient charts was undertaken for those patients treated with GKS for brain metastases from 1994 to 2001. Recurrence rates of brain metastasis following GKS depended on the duration of patient survival. Long-term survival was associated with a higher risk of tumor recurrence and shorter-term survival was associated with a lower risk. The duration of survival following GKS for brain metastases seems to be characteristic of the primary disease rather than the cerebral disease. Conclusions. Recurrence rates of brain metastasis following GKS are related to duration of survival, which is in turn mostly dependent on the nature and course of the primary tumor.

scholarly journals SURG-26. READMISSION FOLLOWING RESECTION FOR PATIENTS WITH BRAIN METASTASES IN THE UNITED STATES

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi245-vi245
Author(s):  
Rupesh Kotecha ◽  
Muni Rubens ◽  
Sergio Gonzalez-Arias ◽  
Vitaly Siomin ◽  
Matthew Hall ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Systemic Disease ◽  
Significant Proportion ◽  
The United States ◽  
Patient Specific ◽  
Unplanned Readmission ◽  
Readmission Rates ◽  
Operative Care ◽  
Nationally Representative

Abstract OBJECTIVE Up to 30% of cancer patients will develop brain metastasis during the course of their systemic disease with a significant proportion undergoing resection of at least one lesion. The objective of the present study was to characterize the rates, predictors, and costs of 30-day readmissions following craniotomy for brain metastases using a nationally representative database. METHODS This study was a retrospective analysis of data from the Nationwide Readmissions Database (NRD) from 2010–2014. We included patients who underwent craniotomy for brain metastasis, identified using ICD-9-CM diagnosis (198.3) and procedure (01.59) codes. The primary outcome of the study was unplanned 30-day all-cause readmission rates. Secondary outcomes included predictors and costs of readmissions. RESULTS During the study period, there were 44,846 index hospitalizations for patients who underwent resection of brain metastasis. Among this cohort, 17.8% (n=7,965) had unplanned readmissions within the first 30 days after discharge from the index hospitalization. The readmission rate did not change significantly during the study period (P=0.286). The odds of unplanned readmission were significantly greater in patients with thromboembolic complications (aOR, 1.53; 95% CI: 1.18–2.01), patients with Elixhauser comorbidities >3 (aOR, 1.35; 95% CI: 1.22–1.50), male patients (adjusted odds ratio [aOR], 1.29; 95% CI: 1.17–1.42), patients with an initial length of stay ≥5 days (aOR, 1.02; 95% CI: 1.01–1.03). The median per-patient cost for 30-day unplanned readmission was $11,109 and this accounted for a total cost of $132.1 million during the study period. CONCLUSIONS Unplanned readmissions after resection for brain metastases involve substantial healthcare expenditures. Though there have been many interventions for improving surgical quality, post-operative care, and cost metrics, unplanned readmission rates have not changed. Key patient-specific variables and high rates of comorbidities should be considered to focus our efforts on patient selection for resection, and for strengthening existing interventions for high-risk patients.

scholarly journals The structure of blood–tumor barrier and distribution of chemotherapeutic drugs in non-small cell lung cancer brain metastases

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ling-yun Ye ◽  
Li-xiang Sun ◽  
Xiu-hua Zhong ◽  
Xue-song Chen ◽  
Song Hu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Small Cell Lung Cancer ◽  
Blood Vessels ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Chemotherapeutic Drugs ◽  
Small Cell Lung ◽  
Metastatic Lesions

Abstract Background Brain metastasis is an important cause of increased mortality in patients with non-small cell lung cancer (NSCLC). In brain metastasis, the blood–brain barrier (BBB) is frequently impaired, forming blood–tumor barrier (BTB). The efficacy of chemotherapy is usually very poor. However, the characteristics of BTB and the impacts of BTB on chemotherapeutic drug delivery remain unclear. The present study investigated the structure of BTB, as well as the distribution of routine clinical chemotherapeutic drugs in both brain and peripheral tumors. Methods Bioluminescent image was used to monitor the tumor load after intracranial injection of lung cancer Lewis cells in mice. The permeability of BBB and BTB was measured by fluorescent tracers of evans blue and fluorescein sodium. Transmission electron microscopy (TEM), immunohistochemistry and immunofluorescence were performed to analyze structural differences between BBB and BTB. The concentrations of chemotherapeutic drugs (gemcitabine, paclitaxel and pemetrexed) in tissues were assayed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). Results Brain metastases exhibited increased BTB permeability compared with normal BBB detected by fluorescence tracers. TEM showed abnormal blood vessels, damaged endothelial cells, thick basement membranes, impaired intercellular endothelial tight junctions, as well as increased fenestrae and pinocytotic vesicles in metastatic lesions. Immunohistochemistry and immunofluorescence revealed that astrocytes were distributed surrounded the blood vessels both in normal brain and the tumor border, but no astrocytes were found in the inner metastatic lesions. By LC-MS/MS analysis, gemcitabine showed higher permeability in brain metastases. Conclusions Brain metastases of lung cancer disrupted the structure of BBB, and this disruption was heterogeneous. Chemotherapeutic drugs can cross the BTB of brain metastases of lung cancer but have difficulty crossing the normal BBB. Among the three commonly used chemotherapy drugs, gemcitabine has the highest distribution in brain metastases. The permeability of chemotherapeutic agents is related to their molecular weight and liposolubility.

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