Time for Reappraisal of Extracranial Treatment Options? Synchronous Brain Metastases From Nonsmall Cell Lung Cancer
Time for Reappraisal of Extracranial Treatment Options? Synchronous Brain Metastases From Nonsmall Cell Lung Cancer
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DOI：
10.1002/cncr.25416
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发表时间：
2011-02-01
期刊：
影响因子：
6.2
通讯作者：
Senan, Suresh
中科院分区：
文献类型：
--
作者：
Lind, Joline S. W.;Lagerwaard, Frank J.;Senan, Suresh
背景。新诊断的非小细胞肺癌（NSCLC）脑转移（BM）患者原发肿瘤的最佳治疗方案仍不清楚。作者旨在确定患有同步 BM 的患者群体，对这些患者群体可能适合对原发部位进行根治性治疗。方法。回顾了 2000 年 11 月至 2009 年 6 月期间在我中心治疗的 167 例新诊断 NSCLC 和同步 BM 患者的病历。所有患者均接受手术/放射外科手术 (n = 86) 或全脑放疗 (WBRT; n = 81) 进行 BM。单变量和多变量分析评估了对总生存期 (OS) 具有重要意义的预后因素。结果。接受 BM 手术/放射外科手术的患者的中位 OS 为 12.1 个月。接受“根治”胸部治疗的患者 (n = 24) 的中位 OS (28.4 个月) 比接受化疗 (n = 74; 12.1 个月) 或支持治疗 (n = 69; 5.6 个月, P < .01) 的患者更长。 I 期胸部疾病患者 (n = 23) 的中位 OS (18.5 个月) 比 III 期患者 (n = 43；9.4 个月) 或除 BM 以外的胸内/胸外转移患者 (IV 期；n = 20；2.7 个月，P < .01) 更长。 WBRT 患者的中位 OS 为 3.7 个月。一名患者接受了根治性胸部治疗。接受化疗的患者 (n = 42) 比仅接受支持治疗的患者 (n = 38; 1.6 个月，P < .01) 具有更长的中位 OS (5.7 个月)。体能状态和年龄也与 OS 相关。结论。对于选定的患者，根治性胸部治疗可能是合理的
BACKGROUND. The optimal treatment of the primary tumor in patients with brain metastases (BM) from newly diagnosed nonsmall cell lung cancer (NSCLC) remains unclear. The authors aimed to identify patient groups with synchronous BM for whom radical treatment of the primary site may be appropriate. METHODS. The medical records of 167 patients treated at our center between November 2000 and June 2009 for newly diagnosed NSCLC and synchronous BM were reviewed. All patients underwent surgery/radiosurgery (n = 86) or whole-brain radiotherapy (WBRT; n = 81) for BM. Univariate and multivariate analyses assessed prognostic factors significant for overall survival (OS). RESULTS. Median OS of patients undergoing surgery/radiosurgery for BM was 12.1 months. Those undergoing "radical" thoracic treatment (n = 24) had a longer median OS (28.4 months) than those undergoing chemotherapy (n = 74; 12.1 months) or supportive therapy (n = 69; 5.6 months, P < .01). Patients with stage I thoracic disease (n = 23) had a longer median OS (18.5 months) than those with stage III (n = 43; 9.4 months) or with intra/extra-thoracic metastases other than BM (stage IV; n = 20; 2.7 months, P < .01). Median OS of WBRT patients was 3.7 months. One patient underwent radical thoracic treatment. Patients undergoing chemotherapy (n = 42) had a longer median OS (5.7 months) than patients undergoing supportive therapy only (n = 38; 1.6 months, P < .01). Performance status and age were also associated with OS. CONCLUSIONS. Radical thoracic treatments may be justified in selected patients