Management of Non–Small-Cell Lung Cancer Patients Initially Diagnosed With 1 to 3 Synchronous Brain-Only Metastases: A Retrospective Study
The treatment options for newly diagnosed non–small-cell lung cancer (NSCLC) patients with 1 to 3 synchronous brain metastases (BM) remain controversial. The current study aimed to comprehensively analyze the characteristics, local treatment paradigms, and survival outcomes in these populations. A t...
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| Veröffentlicht in: | Clinical lung cancer 2021-01, Vol.22 (1), p.e25-e34 |
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| creator | Chen, Xin-ru Hou, Xue Li, De-lan Sai, Ke Dinglin, Xiao-xiao Chen, Jing Wang, Na Li, Mei-chen Wang, Kai-cheng Chen, Li-kun |
| description | The treatment options for newly diagnosed non–small-cell lung cancer (NSCLC) patients with 1 to 3 synchronous brain metastases (BM) remain controversial. The current study aimed to comprehensively analyze the characteristics, local treatment paradigms, and survival outcomes in these populations.
A total of 252 NSCLC patients initially diagnosed with 1 to 3 synchronous brain-only metastases were enrolled onto this study. Local therapy (LT) to primary lung tumors (PLT) and BM included surgery, radiotherapy, or both. Median overall survival (mOS) was measured among patients who received LT to both PLT and BM (all-LT group), patients who were treated with LT to either PLT or BM (part-LT group), and patients who did not receive any LT (non-LT group).
The mOS for all-LT (n = 70), part-LT (n = 113), and non-LT (n = 69) groups was 33.2, 18.5, and 16.8 months, respectively (P = .002). The OS rates at 5 years for the all-LT, part-LT, and non-LT groups were 25.5%, 16.2%, and 0, respectively. Multivariable analysis revealed that all-LT versus non-LT, pretreatment Karnofsky performance status > 70, histology of adenocarcinoma, thoracic stage I-II, EGFR mutation, ALK positive, and second-line systemic therapies were independent prognostic factors for improved mOS.
The current study showed that LT for both PLT and BM is associated with superior OS in appropriately selected NSCLC patients initially diagnosed with 1 to 3 synchronous BM. Prospective trials are urgently needed to confirm this finding.
The optimal initial treatment strategy in non–small-cell lung cancer patients initially diagnosed with 1 to 3 synchronous brain metastases remains unknown. A total of 252 patients were enrolled onto our study to conduct a comprehensive analysis. Patients in the all–local therapy (LT) group had a longer median overall survival than patients in the part-LT group and non-LT group. LT to both lung and brain lesions deserves consideration as an initial treatment strategy. |
| doi_str_mv | 10.1016/j.cllc.2020.07.011 |
| format | Article |
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A total of 252 NSCLC patients initially diagnosed with 1 to 3 synchronous brain-only metastases were enrolled onto this study. Local therapy (LT) to primary lung tumors (PLT) and BM included surgery, radiotherapy, or both. Median overall survival (mOS) was measured among patients who received LT to both PLT and BM (all-LT group), patients who were treated with LT to either PLT or BM (part-LT group), and patients who did not receive any LT (non-LT group).
The mOS for all-LT (n = 70), part-LT (n = 113), and non-LT (n = 69) groups was 33.2, 18.5, and 16.8 months, respectively (P = .002). The OS rates at 5 years for the all-LT, part-LT, and non-LT groups were 25.5%, 16.2%, and 0, respectively. Multivariable analysis revealed that all-LT versus non-LT, pretreatment Karnofsky performance status > 70, histology of adenocarcinoma, thoracic stage I-II, EGFR mutation, ALK positive, and second-line systemic therapies were independent prognostic factors for improved mOS.
The current study showed that LT for both PLT and BM is associated with superior OS in appropriately selected NSCLC patients initially diagnosed with 1 to 3 synchronous BM. Prospective trials are urgently needed to confirm this finding.
The optimal initial treatment strategy in non–small-cell lung cancer patients initially diagnosed with 1 to 3 synchronous brain metastases remains unknown. A total of 252 patients were enrolled onto our study to conduct a comprehensive analysis. Patients in the all–local therapy (LT) group had a longer median overall survival than patients in the part-LT group and non-LT group. LT to both lung and brain lesions deserves consideration as an initial treatment strategy.</description><identifier>ISSN: 1525-7304</identifier><identifier>EISSN: 1938-0690</identifier><identifier>DOI: 10.1016/j.cllc.2020.07.011</identifier><identifier>PMID: 32839132</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adenocarcinoma of Lung - pathology ; Adenocarcinoma of Lung - therapy ; Adult ; Aged ; Aged, 80 and over ; Brain ; Brain Neoplasms - secondary ; Brain Neoplasms - therapy ; Carcinoma, Non-Small-Cell Lung - pathology ; Carcinoma, Non-Small-Cell Lung - therapy ; Carcinoma, Squamous Cell - pathology ; Carcinoma, Squamous Cell - therapy ; Combined Modality Therapy ; Disease Management ; Female ; Follow-Up Studies ; Humans ; Local therapy ; Lung Neoplasms - pathology ; Lung Neoplasms - therapy ; Male ; Middle Aged ; Neoplasms, Multiple Primary - secondary ; Neoplasms, Multiple Primary - therapy ; Oligometastases ; Prognosis ; Prognostic factors ; Retrospective Studies ; Survival ; Survival Rate ; Young Adult</subject><ispartof>Clinical lung cancer, 2021-01, Vol.22 (1), p.e25-e34</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-525dccd247243f396d6503aa800ba8238badb053c63fe1ecddd391045043b3cf3</citedby><cites>FETCH-LOGICAL-c400t-525dccd247243f396d6503aa800ba8238badb053c63fe1ecddd391045043b3cf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.cllc.2020.07.011$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32839132$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, Xin-ru</creatorcontrib><creatorcontrib>Hou, Xue</creatorcontrib><creatorcontrib>Li, De-lan</creatorcontrib><creatorcontrib>Sai, Ke</creatorcontrib><creatorcontrib>Dinglin, Xiao-xiao</creatorcontrib><creatorcontrib>Chen, Jing</creatorcontrib><creatorcontrib>Wang, Na</creatorcontrib><creatorcontrib>Li, Mei-chen</creatorcontrib><creatorcontrib>Wang, Kai-cheng</creatorcontrib><creatorcontrib>Chen, Li-kun</creatorcontrib><title>Management of Non–Small-Cell Lung Cancer Patients Initially Diagnosed With 1 to 3 Synchronous Brain-Only Metastases: A Retrospective Study</title><title>Clinical lung cancer</title><addtitle>Clin Lung Cancer</addtitle><description>The treatment options for newly diagnosed non–small-cell lung cancer (NSCLC) patients with 1 to 3 synchronous brain metastases (BM) remain controversial. The current study aimed to comprehensively analyze the characteristics, local treatment paradigms, and survival outcomes in these populations.
A total of 252 NSCLC patients initially diagnosed with 1 to 3 synchronous brain-only metastases were enrolled onto this study. Local therapy (LT) to primary lung tumors (PLT) and BM included surgery, radiotherapy, or both. Median overall survival (mOS) was measured among patients who received LT to both PLT and BM (all-LT group), patients who were treated with LT to either PLT or BM (part-LT group), and patients who did not receive any LT (non-LT group).
The mOS for all-LT (n = 70), part-LT (n = 113), and non-LT (n = 69) groups was 33.2, 18.5, and 16.8 months, respectively (P = .002). The OS rates at 5 years for the all-LT, part-LT, and non-LT groups were 25.5%, 16.2%, and 0, respectively. Multivariable analysis revealed that all-LT versus non-LT, pretreatment Karnofsky performance status > 70, histology of adenocarcinoma, thoracic stage I-II, EGFR mutation, ALK positive, and second-line systemic therapies were independent prognostic factors for improved mOS.
The current study showed that LT for both PLT and BM is associated with superior OS in appropriately selected NSCLC patients initially diagnosed with 1 to 3 synchronous BM. Prospective trials are urgently needed to confirm this finding.
The optimal initial treatment strategy in non–small-cell lung cancer patients initially diagnosed with 1 to 3 synchronous brain metastases remains unknown. A total of 252 patients were enrolled onto our study to conduct a comprehensive analysis. Patients in the all–local therapy (LT) group had a longer median overall survival than patients in the part-LT group and non-LT group. LT to both lung and brain lesions deserves consideration as an initial treatment strategy.</description><subject>Adenocarcinoma of Lung - pathology</subject><subject>Adenocarcinoma of Lung - therapy</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Brain</subject><subject>Brain Neoplasms - secondary</subject><subject>Brain Neoplasms - therapy</subject><subject>Carcinoma, Non-Small-Cell Lung - pathology</subject><subject>Carcinoma, Non-Small-Cell Lung - therapy</subject><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Carcinoma, Squamous Cell - therapy</subject><subject>Combined Modality Therapy</subject><subject>Disease Management</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Local therapy</subject><subject>Lung Neoplasms - pathology</subject><subject>Lung Neoplasms - therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasms, Multiple Primary - secondary</subject><subject>Neoplasms, Multiple Primary - therapy</subject><subject>Oligometastases</subject><subject>Prognosis</subject><subject>Prognostic factors</subject><subject>Retrospective Studies</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Young Adult</subject><issn>1525-7304</issn><issn>1938-0690</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1uFDEQhVuIiPzABVggL9l0U7b7F7EJA4FIE4IYEEvLbVdPPOq2B9sdaXYcIDtuyEnwaEKWkSyVF1891Xsvy15SKCjQ-s2mUOOoCgYMCmgKoPRJdkI73uZQd_A0_StW5Q2H8jg7DWEDwGpO2bPsmLOWd5Szk-zuSlq5xgltJG4gX5z9-_vPapLjmC9wHMlytmuykFahJ19lNIkL5NKaaBKyIx-MXFsXUJOfJt4QSqIjnKx2Vt14Z90cyHsvjc2vbYKvMMqQHoa35Jx8w-hd2KKK5hbJKs569zw7GuQY8MX9PMt-XHz8vvicL68_XS7Ol7kqAWKeXGmlNCsbVvKBd7WuK-BStgC9bBlve6l7qLiq-YAUldY6uYWygpL3XA38LHt90N1692vGEMVkgkp2pcV0s0iyDaVNV7YJZQdUpWODx0FsvZmk3wkKYt-C2Ih9C2LfgoBGpBbS0qt7_bmfUD-s_I89Ae8OACaXtwa9CCpFq1AbnwIR2pnH9P8Bk_uaPQ</recordid><startdate>202101</startdate><enddate>202101</enddate><creator>Chen, Xin-ru</creator><creator>Hou, Xue</creator><creator>Li, De-lan</creator><creator>Sai, Ke</creator><creator>Dinglin, Xiao-xiao</creator><creator>Chen, Jing</creator><creator>Wang, Na</creator><creator>Li, Mei-chen</creator><creator>Wang, Kai-cheng</creator><creator>Chen, Li-kun</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202101</creationdate><title>Management of Non–Small-Cell Lung Cancer Patients Initially Diagnosed With 1 to 3 Synchronous Brain-Only Metastases: A Retrospective Study</title><author>Chen, Xin-ru ; Hou, Xue ; Li, De-lan ; Sai, Ke ; Dinglin, Xiao-xiao ; Chen, Jing ; Wang, Na ; Li, Mei-chen ; Wang, Kai-cheng ; Chen, Li-kun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-525dccd247243f396d6503aa800ba8238badb053c63fe1ecddd391045043b3cf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adenocarcinoma of Lung - pathology</topic><topic>Adenocarcinoma of Lung - therapy</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Brain</topic><topic>Brain Neoplasms - secondary</topic><topic>Brain Neoplasms - therapy</topic><topic>Carcinoma, Non-Small-Cell Lung - pathology</topic><topic>Carcinoma, Non-Small-Cell Lung - therapy</topic><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Carcinoma, Squamous Cell - therapy</topic><topic>Combined Modality Therapy</topic><topic>Disease Management</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Local therapy</topic><topic>Lung Neoplasms - pathology</topic><topic>Lung Neoplasms - therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasms, Multiple Primary - secondary</topic><topic>Neoplasms, Multiple Primary - therapy</topic><topic>Oligometastases</topic><topic>Prognosis</topic><topic>Prognostic factors</topic><topic>Retrospective Studies</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Xin-ru</creatorcontrib><creatorcontrib>Hou, Xue</creatorcontrib><creatorcontrib>Li, De-lan</creatorcontrib><creatorcontrib>Sai, Ke</creatorcontrib><creatorcontrib>Dinglin, Xiao-xiao</creatorcontrib><creatorcontrib>Chen, Jing</creatorcontrib><creatorcontrib>Wang, Na</creatorcontrib><creatorcontrib>Li, Mei-chen</creatorcontrib><creatorcontrib>Wang, Kai-cheng</creatorcontrib><creatorcontrib>Chen, Li-kun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical lung cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Xin-ru</au><au>Hou, Xue</au><au>Li, De-lan</au><au>Sai, Ke</au><au>Dinglin, Xiao-xiao</au><au>Chen, Jing</au><au>Wang, Na</au><au>Li, Mei-chen</au><au>Wang, Kai-cheng</au><au>Chen, Li-kun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management of Non–Small-Cell Lung Cancer Patients Initially Diagnosed With 1 to 3 Synchronous Brain-Only Metastases: A Retrospective Study</atitle><jtitle>Clinical lung cancer</jtitle><addtitle>Clin Lung Cancer</addtitle><date>2021-01</date><risdate>2021</risdate><volume>22</volume><issue>1</issue><spage>e25</spage><epage>e34</epage><pages>e25-e34</pages><issn>1525-7304</issn><eissn>1938-0690</eissn><abstract>The treatment options for newly diagnosed non–small-cell lung cancer (NSCLC) patients with 1 to 3 synchronous brain metastases (BM) remain controversial. The current study aimed to comprehensively analyze the characteristics, local treatment paradigms, and survival outcomes in these populations.
A total of 252 NSCLC patients initially diagnosed with 1 to 3 synchronous brain-only metastases were enrolled onto this study. Local therapy (LT) to primary lung tumors (PLT) and BM included surgery, radiotherapy, or both. Median overall survival (mOS) was measured among patients who received LT to both PLT and BM (all-LT group), patients who were treated with LT to either PLT or BM (part-LT group), and patients who did not receive any LT (non-LT group).
The mOS for all-LT (n = 70), part-LT (n = 113), and non-LT (n = 69) groups was 33.2, 18.5, and 16.8 months, respectively (P = .002). The OS rates at 5 years for the all-LT, part-LT, and non-LT groups were 25.5%, 16.2%, and 0, respectively. Multivariable analysis revealed that all-LT versus non-LT, pretreatment Karnofsky performance status > 70, histology of adenocarcinoma, thoracic stage I-II, EGFR mutation, ALK positive, and second-line systemic therapies were independent prognostic factors for improved mOS.
The current study showed that LT for both PLT and BM is associated with superior OS in appropriately selected NSCLC patients initially diagnosed with 1 to 3 synchronous BM. Prospective trials are urgently needed to confirm this finding.
The optimal initial treatment strategy in non–small-cell lung cancer patients initially diagnosed with 1 to 3 synchronous brain metastases remains unknown. A total of 252 patients were enrolled onto our study to conduct a comprehensive analysis. Patients in the all–local therapy (LT) group had a longer median overall survival than patients in the part-LT group and non-LT group. LT to both lung and brain lesions deserves consideration as an initial treatment strategy.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32839132</pmid><doi>10.1016/j.cllc.2020.07.011</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adenocarcinoma of Lung - pathology Adenocarcinoma of Lung - therapy Adult Aged Aged, 80 and over Brain Brain Neoplasms - secondary Brain Neoplasms - therapy Carcinoma, Non-Small-Cell Lung - pathology Carcinoma, Non-Small-Cell Lung - therapy Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - therapy Combined Modality Therapy Disease Management Female Follow-Up Studies Humans Local therapy Lung Neoplasms - pathology Lung Neoplasms - therapy Male Middle Aged Neoplasms, Multiple Primary - secondary Neoplasms, Multiple Primary - therapy Oligometastases Prognosis Prognostic factors Retrospective Studies Survival Survival Rate Young Adult |
| title | Management of Non–Small-Cell Lung Cancer Patients Initially Diagnosed With 1 to 3 Synchronous Brain-Only Metastases: A Retrospective Study |
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