Treatment of brain metastases in patients with non-small cell lung cancer (NSCLC) by stereotactic linac-based radiosurgery: prognostic factors

A restrospective Study of patients with brain inetastases from non-small cell lung cancer (NSCLC) is performed to identify patients who benefit from radiosurgery and to determine prognostic factors for survival. Eighty-six Consecutive patients with a total of 110 brain metastases from NSCLC were treated with linac-based radiosurgery. Six patients with eight brain metastases who received radiosurgery as a focal boost to whole brain radiotherapy where excluded, Median age at treatment was 60 years. Median dose was 20 Gy/80%-isodose. A chi(2)-test was used to identify potential prognostic factors for local control of brain inetastases and survival of the patients. Median follow-up was 6 months (range 11/2-77 months) with 17/80 patients still alive. Median actuarial survival was significantly longer (P < 0.004) in patients with metachronous onset of brain metastases in comparison to synchronous onset (8.3 vs. 3.3 months). Survival,vas significantly increased after radiosurgery in the absence of extracranial tumor progression (P < 0.03), Eleven patients (14%) developed new brain metastases after radiosurgery after a latency of median 5 months. Actuarial local control rate was 96% after 3 months. Local control was significantly increased with a prescribed dose greater than or equal to18 Gy/80%-isodose (P < 0.01). We conclude that especially patients with poor prognostic factors and a limited number of brain inetastases may be palliatively treated with radiosurgery alone. This approach allows to effectively control CNS manifestation of the disease and can be integrated into chemotherapeutic protocols. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.