Louie Alexander V, Rodrigues George, Yaremko Brian, Yu Edward, Dar A Rashid, Dingle Brian, Vincent Mark, Sanatani Michael, Younus Jawaid, Malthaner Richard, Inculet Richard
Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada.
Clin Lung Cancer. 2009 May;10(3):174-9. doi: 10.3816/CLC.2009.n.024.
Reports in the medical literature have described cases of extended survival of patients with non-small-cell lung cancer (NSCLC) with solitary metastatic disease who have received aggressive treatment both to the brain metastasis and to the local/regional disease. The objective of this research is to analyze prognostic factors that predict for outcome in this unique patient population.
A single-institution, retrospective chart review was performed on 35 patients with NSCLC and a synchronous solitary brain metastasis (SSBM) treated with craniotomy and whole-brain radiation therapy. Eight patients (22.9%) had chest surgery, 24 (68.6%) had chemotherapy, and 14 (40%) had thoracic radiation as part of their local management. Fourteen had stage I/II disease (42.9%), and 20 had stage III disease (57.1%). Mean age at diagnosis was 58.5 years. Eighteen patients (56.25%) had a brain metastasis < 3 cm, and 14 patients (43.75%) had a metastasis > 3 cm.
Median survival was 7.8 months, and at last follow-up, 3 patients (8.6%) were alive and well, 6 patients (17.1%) were alive and with disease, 24 patients (68.6%) had died of disease, and 2 patients (5.7%) had died of other causes. Univariate analysis demonstrated that lung surgery (P = .0033), primary lung treatment > 8 weeks after brain surgery (P = .0128), and stage I/II disease (P = .0467) were predictive of overall survival.
Survival remains poor for patients with NSCLC with an SSBM. However, patients with thoracic disease amenable to local resection should be considered for such therapy because a survival advantage could exist compared with patients with more locally advanced disease.
医学文献中的报告描述了非小细胞肺癌（NSCLC）合并孤立性转移病灶的患者，在接受针对脑转移灶以及局部/区域疾病的积极治疗后生存期延长的病例。本研究的目的是分析可预测这一特殊患者群体预后的因素。
对35例接受开颅手术和全脑放射治疗的NSCLC合并同步孤立性脑转移（SSBM）患者进行了单机构回顾性病历审查。8例患者（22.9%）接受了胸部手术，24例（68.6%）接受了化疗，14例（40%）接受了胸部放疗作为局部治疗的一部分。14例为Ⅰ/Ⅱ期疾病（42.9%），20例为Ⅲ期疾病（57.1%）。诊断时的平均年龄为58.5岁。18例患者（56.25%）的脑转移灶<3 cm，14例患者（43.75%）的转移灶>3 cm。
中位生存期为7.8个月，在最后一次随访时，3例患者（8.6%）存活且情况良好，6例患者（17.1%）存活但患有疾病，24例患者（68.6%）死于疾病，2例患者（5.7%）死于其他原因。单因素分析表明，肺手术（P = .0033）、脑手术后原发性肺部治疗>8周（P = .0128）以及Ⅰ/Ⅱ期疾病（P = .0467）可预测总生存期。
NSCLC合并SSBM患者的生存期仍然较差。然而，对于适合局部切除的胸部疾病患者，应考虑进行此类治疗，因为与局部进展更严重的患者相比，可能存在生存优势。
