Does surgery for primary non-small cell lung cancer and cerebral metastasis have any impact on survival?

• Published in: Interactive cardiovascular and thoracic surgery 2009-04, Vol.8 (4), p.467-473
• Main Authors: Modi, Amit, Vohra, Hunaid A, Weeden, David F
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Benchmarking; Brain Neoplasms - mortality; Brain Neoplasms - secondary; Brain Neoplasms - surgery; Carcinoembryonic Antigen - blood; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Chemotherapy, Adjuvant; Craniotomy; Evidence-Based Medicine; Humans; Karnofsky Performance Status; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Neoadjuvant Therapy; Pneumonectomy; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2008.195776

Department of Thoracic Surgery, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK *Corresponding author. Tel.: [phone]; fax: [phone]. E-mail address : david.weeden{at}suht.swest.nhs.uk (D.F. Weeden). A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether surgical resection of non-small cell lung cancer (NSCLC) with cerebral metastasis prolongs survival. Altogether 153 relevant papers were identified using the below mentioned search, 11 papers represented the best evidence to answer the question. The author, date, journal, country of publication, study type, patient group studied, relevant outcomes, results and study weaknesses were tabulated. A vast majority of patients with synchronous presentation underwent cerebral metastasectomy prior to lung resection which led to a rapid regression of neurological symptoms. In these studies, the median survival for the curative intent groups (bifocal therapy±adjuvant treatment) ranged from 19 to 27 months (mean 23.12±3.3 months) and at 1, 2 and 5 years from 56% to 69% (mean=63.9±5.6%), 28% to 54% (mean=38.7±11%) and 11% to 24% (mean=18±5.7%), respectively. In comparison, the median and 1-year survival of the palliative groups were 7.1–12.9 months (mean=10.3±2.9 months) and 33–39.7% (mean=35.3±3.8%), respectively. We conclude that in the absence of mediastinal lymph node involvement, surgical resection of NSCLC with complete resection of the brain metastasis improves prognosis. Further, adenocarcinoma, low CEA levels at presentation, response to preoperative chemotherapy before focal treatment and a high Karnofsky performance score (KPS) may have a positive prognostic value. Key Words: Cerebral metastasis; Metastatectomy; Lung cancer; Evidence-based medicine