Surgical management of non-small cell lung cancer with synchronous brain metastases

Objectives: Published series on the synchronous combined resection of brain metastases and primary non-small cell lung cancer are small and scarce, We therefore undertook a multicenter retrospective study to determine long-term survival and identify potential prognostic factors. Design: Our series includes 103 patients who were operated on between 1985 and 1998 for the following tumors: adenocarcinomas (74); squamous cell carcinomas (20); and large cell carcinomas (9), Three patients had two brain metastases, and one patient had three metastases; the remaining patients had a single metastasis. Ninety-three patients presented with neurologic signs that regressed completely after resection in 60 patients and partially, in 26 patients. Neurosurgical resection was incomplete in six patients. Seventy-five patients received postoperative brain radiotherapy, The time interval between the brain operation and the lung resection was < 4 months. Pulmonary resection was incomplete in eight patients. Results: The survival calculated from the date of the first operation was 56% at 1 year, 28% at 2 years, and 11% at 5 years. Univariate analysis showed a better prognosis for adenocarcinomas (p = 0.019) and a trend toward a better prognosis for patients with small pulmonary tumors (TI vs T3, p = 0.068), NO stage disease (NO vs N+, p = 0,069), and complete pulmonary resection (p = 0.057). In a multivariate analysis, adenocarcinoma histology also affected the survival rate (p = 0.03). Conclusions: It seems legitimate to proceed with lung resection after complete resection of a single brain metastasis, at least in patients with an adenocarcinoma and a small lung tumor and without abnormal mediastinal lymph nodes seen on the CT scan or during mediastinoscopy.