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Year : 2014  |  Volume : 10  |  Issue : 4  |  Page : 915-921

Management of brain metastases from non-small cell lung cancer

1 Department of Medical Oncology, Sakarya University Training and Research Hospital, Sakarya, Turkey
2 Department of Neurosurgery, Gazi University Medical Faculty, Ankara, Turkey
3 Department of Medical Oncology, Gazi University Medical Faculty, Ankara, Turkey
4 Department of Medical Oncology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey

Correspondence Address:
Meltem Baykara
Department of Medical Oncology, Sakarya University Training and Research Hospital, Korucuk, Sakarya
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.137939

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Purpose: The purpose of the following study is to evaluate the treatment modalities, clinical status and prognostic factors affecting survival rates in patients with newly diagnosed brain metastasis from non-small cell lung cancer (NSCLC). Patients and Methods: NSCLC patients with a new diagnosis of one to four brain metastasis evaluated retrospectively for the effects of treatment regimens on local failure-relapse-free survival (LRFS) and overall survival (OS). The relationship between age, gender, performance status, recursive partitioning analysis (RPA) classification, the primary tumor under control, number of metastatic tumors in the brain and total volume of brain metastasis and prognosis is analyzed. Results: Out of a total of 138 (121 male and 17 female) patients, nearly 44.2% received only gamma-knife (GK); 24.6% were received both GK and whole brain radiotherapy (WBRT), 2.9% had GK and surgery, 3.6% received GK, surgery and WBRT, 10.9% had surgery and WBRT and 12.3% received only WBRT for treatment. Median LRFS of surgery plus WBRT group was significantly higher when compared with WBRT group (P < 0.0001). The OS was significantly longer for surgery plus WBRT group than the other treatment groups (P = 0.037). When median survival of WBRT-only group compared with surgery plus WBRT, it was significantly higher (29.6 months vs. 16.7 months, P = 0.006). Median OS of surgery plus WBRT group was significantly higher than GK plus WBRT group (29.6 months vs. 9.3 months, P = 0.007). Conclusion: WBRT is still the most effective treatment method following surgery in selected patients according to their age, performance status and spread of the primary disease with NSCLC had limited number brain metastasis. Adding WBRT treatment after surgery significantly improved OS and LRFS.

Abstract in Chinese

非小细胞肺癌脑转移的管理 摘要 目的:以下研究的目的旨在评估影响新诊断非小细胞肺癌(NSCLC)脑转移生存率的治疗方式,临床状态及预后因素。 患者和方法:对新诊断的有1到4个脑转移病灶的NSCLC患者回顾性分析了治疗方案对无局灶复发生存率(LRFS)和总生存(OS)的影响。对年龄、性别、表现状态,递归分割分析(RPA)分类,原发肿瘤控制,大脑转移灶数目和脑转移灶总体积,和预后的关系进行了分析。 结果:总共138(121名男性和17名女性)患者,近44.2%只接受伽玛刀(GK);24.6%接受伽玛刀和全脑放疗(WBRT),2.9%有伽玛刀和手术,3.6%行伽玛刀,外科手术和放疗,10.9%手术和伽玛刀,12.3%只接受伽玛刀治疗。中值LRFS的手术加全脑放疗组明显高于放疗组(P<0.0001)。总生存时间,手术加全脑放疗组较其他治疗组明显延长(P = 0.037)。全脑放疗组的中位生存时间与手术加全脑放疗组相比,明显延长(29.6个月vs 16.7个月,P = 0.006)。中位OS手术加全脑放疗组显著高于伽玛刀加全脑放疗组(29.6个月 vs 9.3个月,P = 0.007)。 结论:根据患者的年龄,身体状态,NSCLC原发疾病脑转移数量少的病灶来选择的病人,手术后全脑放疗仍是最有效的治疗方法。手术后全脑放疗显着改善OS和LRFS。 关键词:脑转移,非小细胞肺癌,递归分割分析,立体定向放射治疗,全脑放疗

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