In the context of the era of targeted therapy: evaluation of the survival benefits of different local treatment modalities for patients with 1-3 brain metastases from non-small cell lung cancer.

Advances in molecular biology have extended survival for lung cancer patients with brain metastases. However, radiotherapy and surgery remain standard for non-small cell lung cancer (NSCLC) brain metastases. Existing studies assess surgical and radiotherapeutic outcomes using outdated data and lack relevant subgroup analyses. We retrospectively analyzed 298 NSCLC patients with 1-3 brain metastases. Overall survival (OS) and median OS were compared across five treatments: surgery + postoperative radiotherapy, surgery + postoperative non-radiotherapy, whole brain radiotherapy, stereotactic radiosurgery (SRS), and whole brain radiotherapy + SRS. Univariate and multivariate Cox regression analyses were conducted. Significant survival differences were noted among treatments (p = 0.0041) for patients with 1-3 brain metastases, single metastasis (p = 0.0034), age > 57 (p = 0.0001), wild-type EGFR/ALK (p = 0.0017), KPS ≥ 90 (p = 0.0379), tumor diameter ≤ 2.7 cm (p = 0.0147), and no extracranial metastasis (p = 0.0014). Surgery + postoperative radiotherapy and SRS significantly improved OS and median OS. For KPS ≥ 90, surgery + postoperative radiotherapy improved OS. Multivariate analysis identified age ≤ 57 (HR: 1.89; p < 0.001), surgery + postoperative radiotherapy (HR: 0.60; p = 0.017), and SRS (HR: 0.57; p = 0.01) as independent protective factors for OS. Surgery + postoperative radiotherapy and SRS enhance survival in NSCLC patients with 1-3 brain metastases, particularly those with wild-type EGFR/ALK, small metastases, and no extracranial metastases. For KPS ≥ 90, surgery followed by radiotherapy is recommended. SRS improves median OS in patients with KPS ≤ 80.