Survival Benefits of Radiotherapy and Surgery in Lung Cancer Brain Metastases with Poor Prognosis Factors

Lun Liang; Zhenning Wang; Hao Duan; Zhenqiang He; Jie Lu; Xiaobing Jiang; Hongrong Hu; Chang Li; Chengwei Yu; Sheng Zhong; Run Cui; Xiaoyu Guo; Meiling Deng; Yuanyuan Chen; Xiaojing Du; Shaoxiong Wu; Likun Chen; Yonggao Mou

doi:10.3390/curroncol30020172

Survival Benefits of Radiotherapy and Surgery in Lung Cancer Brain Metastases with Poor Prognosis Factors

Curr Oncol. 2023 Feb 13;30(2):2227-2236. doi: 10.3390/curroncol30020172.

Authors

Lun Liang¹, Zhenning Wang^{1

2}, Hao Duan¹, Zhenqiang He¹, Jie Lu¹, Xiaobing Jiang¹, Hongrong Hu¹, Chang Li¹, Chengwei Yu¹, Sheng Zhong¹, Run Cui¹, Xiaoyu Guo³, Meiling Deng⁴, Yuanyuan Chen⁴, Xiaojing Du⁴, Shaoxiong Wu⁴, Likun Chen⁵, Yonggao Mou¹

Affiliations

¹ Department of Neurosurgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
² Department of Neurosurgery, Dongguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan 523058, China.
³ Department of Neurosurgery, The First Affiliated Hospital of Ji'nan University, Guangzhou 518053, China.
⁴ Department of Radiotherapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
⁵ Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.

Abstract

Background: Radiotherapy and surgery are the standard local treatments for lung cancer brain metastases (BMs). However, limited studies focused on the effects of radiotherapy and surgery in lung cancer BMs with poor prognosis factors.

Methods: We retrospectively analyzed 714 patients with lung cancer BMs. Analyses of overall survival (OS) and risk factors for OS were assessed by the log-rank test and Cox proportional hazard model.

Results: Age ≥ 65 years, a Karnofsky Performance Scale (KPS) score ≤ 70, anaplastic large-cell lymphoma kinase (ALK)/epidermal growth factor receptor (EGFR) wild type, and extracranial metastases were related to poor prognosis. Patients were stratified according to these poor prognosis factors. In patients with the ALK/EGFR wild type, whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and surgery improved the OS of patients. WBRT and SRS were the independent protective factors for OS. In patients with extracranial metastases, patients who received WBRT plus SRS or WBRT alone had longer OS than those who did not receive radiotherapy. WBRT plus SRS and WBRT were the independent protective factors for OS.

Conclusions: Radiotherapy and surgery are associated with improved survival for lung cancer BMs with the ALK/EGFR wild type. Radiotherapy is associated with improved survival in lung cancer BMs with extracranial metastases.

Keywords: lung cancer brain metastases; poor prognosis; radiotherapy; surgery.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Brain Neoplasms* / secondary
ErbB Receptors
Humans
Lung Neoplasms* / pathology
Prognosis
Retrospective Studies

Substances

ErbB Receptors

Grants and funding

This study was supported by the National Natural Science Foundation of China (Grant Number 81872324) and Medical Scientific Research Foundation of Guangdong Province of China (A2020149).