Surgical Management Of Non-small Cell Lung Cancer With Synchronous Brain Metastases

Background Lung cancer is one of the most common malignant tumors, itsincidence rate and mortality rate account for the first of all malignant cases in the west developed countries.Because of smoking, passive smoking and envrionment pollution, the incidence of lung cancer enhanced year after year, not only in cities but in countris, presently its incidence rate and mortality rate account for the first of all malignant cases in china. The first symptom of lung cancer is not obvious, before the diagnoses of disease was sure, it was too late, because some patients had metastasized other important organs.Brain metastasis from non-small cell lung cancer is the symptom of late stage in hematogenic metastasis, prognosis is very poor, which used to be not operable, but whole brain radiotherapy and/or chemotherapy post-operative can not improve the prognosis.Presently it is reported that surgical resection may prove beneficial in a select group of patients with synchronous brain metastases and lungcancer without lymph node metastases. Methods The clinical date of 41 patientswho underwent combined resection of brain metastases and the primary tumor between January 1999 and October 2004 was retrospectively reviewed. Resection of primary lung cancer and metachronous brain metastases and pallative radiotheryand/or chemotherapy post-operation, received either adjuvant or neo-adjuvant chemotherapy. Data analysis includes descriptive statistics, Wilcoxon test, Kaplan-Meier method and Cox's proportional hazards model. To clarify the efficacy of surgical management and evaluate factors affecting survival time for non-small celllung cancer (NSCLC) with synchronous brain metastases. Results The group comprised 27 men and 14 women. Median age was 52.7 years (range 32-68 years). The study group comprised of patients with lung cancer in the following stages: 13 patients in stage I (4 patient in stage IA, 9 patients in stage IB), 21 patients in stage II (13patients in stage IIA, 8 patients in stage IIB), 7 patients in stage IIIA. Craniotomy was performed first in 30 patients with neurologic symptoms, and thoracic surgery was performed first in another 11 patients without neurologic symptoms. Median time between craniotomy and thoracotomy was 14.6 days (range 7~32 days).37 patients was performed Craniotomy, the other 4 patients with noisolation brain metastases was performed Y -radiosurgery. Left pneumonectomy was performed in 1 patient, bilobectomy in 6, and lobectomy in 34. Complete pulmonary resection and lymph node dissection were performed in all patients. 28 patients had no evidence of lymph node metastases (No), 6 had N1 and 7 had N2. histological type including: adenocarcinoma in 23(56.1%), squama carcinoma in 13(37.7%), large-cell lung cancer in 5(12.2%). All 41 patients received four to six courses of chemotherapy after the second operation, and 11 of the 41 patients received whole brain radiation (WBR). Follow-up was complete in all patients. Median survival was 25.1 months (range 4-82 months). Estimated survival rates by Kaplan-Meier method after both procedures operation, the overall survival at 1, 2, 3, and 5 years was 73.1%, 60.9%, 43.9% and 24.4%, respectively. Multivariate analysis revealed: The presence of lymph node metastases (N1 or N2) significantly affected survival(P=0.001). But none of the following variables had effect on survival: sex, age, T stage of the tumour, histological type, nodal status, the modality of treatment. Postoperative WBR significantly reduced tumor recurrence inthe brain (P=0.04)but failed to prolong survival time(P=0.172). Conclusions Combined surgery on brain metastases and the primary lung tumor may prolongsurvival time in the selected cases with NSCLC and synchronous brain metastases, especially, in those patients with No disease.