gms | German Medical Science

Objective: Brain metastases are the most common malignant brain tumors in adults. Among different malignant primaries, brain metastases are most frequently associated with lung cancer. Treatment options are microsurgery, radiotherapy and chemotherapy. However, the prognosis for patients with brain metastasis remains poor. Therefore we performed an in-depth analysis of these patients with regard to their clinical outcome to identify prognostic factors.

Method: A cohort of 134 patients with brain metastases from non-small-cell lung cancer (NSCLC), who had undergone surgery at our department between 2002 and 2013 was analyzed. Age, gender, type of treatment, presence of neurologic symptoms, Karnofsky performance status (KPS), smoking history, presence and localization of extracranial metastasis, number, localization and size of brain metastases and percentage of Ki67 positive cells were assessed and survival analysis was performed by using Kaplan-Meier method.

Results: Mean age was 61.8 years. 24 of 134 patients are still alive. Median overall survival time (OST) was 9.9 months. Statistically significant prognostic factors for the OST included the existence of extracranial metastases, postoperative whole brain radiation therapy (WBRT) and Ki67 positive cells of less than 60%. Patients, who had been diagnosed with brain metastases before the onset of neurologic symptoms also had a better OST (20.8 vs. 9.4 months, p<0.05). A KPS >70% was also associated with a better OST (5.7 vs. 11.8 months) although not significant (p: 0.25). Age, gender, the size and the number of intracranial metastases did not have significant impact on the OST. Five of 134 patients turned out to be long-term survivors (56.6 -75.1 months).

Conclusions: In the present study extracranial metastases, postoperative WBRT and the presentation of neurologic symptoms at diagnosis of brain metastases were the most important prognostic factors in NSCLC-patients suffering from brain metastases. Therefore early surgical treatment and postoperative WBRT might be important options to improve the overall survival time.