STEREOTAXIC RADIOSURGERY FOR PATIENTS WITH NONSMALL CELL LUNG-CARCINOMA METASTATIC TO THE BRAIN

BACKGROUND. A retrospective study of patients undergoing stereotactic radiosurgery for one to four brain metastases from nonsmall lung cell carcinoma (NSCLC) was performed to document outcomes and risks. METHOD S. Seventy-seven patients underwent radiosurgery during a 7-year inter val; 71 also underwent whole brain radiation therapy. Univariate and m ultivariate analyses were used to determine significant prognostic fac tors affecting survival. RESULTS. The overall median survival was 10 m onths after radiosurgery, and 15 months from the diagnosis of brain me tastases. Five factors significantly affected survival: extent of syst emic disease, presence of a neurologic deficit, size of the intracrani al tumor, initial imaging appearance of intratumoral necrosis, and ini tial resection of the primary tumor of the chest. Median survival time was 26 months in a subgroup of patients with no extracranial metastas es, no neurologic deficits, and a small tumor without necrosis. The au thors evaluated 91 tumors with imaging. Local tumor control was achiev ed in 77 lesions (85%) and tumoral radiation necrosis developed in 4 l esions (4.4%). Nineteen new metastatic tumors developed during the obs ervation interval. CONCLUSIONS. Stereotactic radiosurgery for NSCLC br ain metastases is effective and is associated with few complications. The early detection of brain metastases and treatment with radiosurger y combined with radiation therapy provide the opportunity for extended high quality survival. (C) 1997 American Cancer Society.