SURVIVAL AFTER SURGICAL-TREATMENT OF BRAIN METASTASES FROM LUNG-CANCER - A FOLLOW-UP-STUDY OF 231 PATIENTS TREATED BETWEEN 1976 AND 1991

The authors reviewed the records of 231 patients who underwent resecti on of brain metastases from nonsmall-cell lung cancer between 1976 and 1991. Data regarding the primary disease and the characteristics of b rain metastasis were retrospectively collected. Median survival in the group from the time of first craniotomy was 11 months; postoperative mortality was 3%. Survival rates of 1, 2, 3, and 5 years were 46.3%, 2 4.2%, 14.7%, and 12.5%, respective ly, One hundred twelve women surviv ed significantly longer than 119 men (13.8 vs. 9.5 months, p < 0.02). Patients with single metastatic lesions (200 patients) survived longer than those (31 patients) with multiple metastases (11.1 vs. 8.5 month s, p < 0.02). Patients with supratentorial tumors survived Longer than patients with cerebellar lesions. A high Karnofsky performance scale score before surgery also indicated increased survival. In multivariat e analyses, incomplete resection or no resection of primary lung tumor , male gender, infratentorial location, presence of systemic metastase s, and age older than 60 years were significantly correlated with shor ter survival. Approximately one-third of the patients died of neurolog ical causes, one-third of systemic disease, and one-third of a combina tion of both. The results of this series confirm that the overall prog nosis for patients with even a single resectable brain metastasis is p oor, but that aggressive therapy can prolong life with quality of life preserved and can occasionally permit long-term survival.