Outcomes of Non-Small-Cell Lung Cancer Resection in Patients With Synchronous Brain Metastases

Abstract

Objectives: To report on the outcomes in a single-centre cohort of patients who underwent resection of their primary lung tumour along with radical treatment of their synchronous brain metastases.

Materials and methods: Between 2005 and 2024, 86 patients (35 females and 51 males) with 113 events with a median age of 59 years (range: 52-67) were treated. The most common histological subtype was adenocarcinoma (71 patients, 82.6%). In 70 patients (81.4%), the local treatment for brain metastases was prioritised. This included neurosurgery (N = 50), gamma knife radiosurgery (N = 32), or radiotherapy (N = 4). Lung surgeries consisted of lobectomy (N = 77), pneumonectomy or bilobectomy (N = 6), and sublobar resection (N = 3). Related to lung surgery, systemic therapy was administered preoperatively in 48 patients (55.8%), perioperatively in 13 (15.1%) and postoperatively in 16 (18.6%).

Results: Ninety-day mortality was 4.6%. The 5-year overall and disease-free survival rates were 43.4% (95% CI, 33.8%-55.6%) and 32.9% (95% CI, 23.6%-45.8%), respectively. Cox regression analysis identified several preoperative variables associated with long-term overall mortality: age (years) (HR, 1.04; 95% CI, 1.01-1.07; P = .016), Eastern Cooperative Oncology Group performance status > 1 (HR, 4.81; 95% CI, 1.99-11.6; P = .002), FEV1 ppo (%) (HR, 0.98; 95% CI, 0.96-1; P = .034), local lung vs brain consolidative treatment first (HR, 2.05; 95% CI, 1.04-4.04; P = .048), and absence of systemic therapy (HR, 2.94; 95% CI, 1.30-6.65; P = .018).

Conclusions: Curative-intent treatment in selected patients with oligometastatic brain involvement can be performed safely and may result in substantial long-term survival, especially in fit young patients with good pulmonary function.

Keywords: brain metastases; non–small-cell lung carcinoma; oligometastases.