THE PROGNOSTIC FACTORS OF LUNG-CANCER PATIENTS WITH BRAIN METASTASES TREATED WITH RADIOTHERAPY

Purpose: To analyze the prognostic factors of lung cancer with brain m etastases (BM) and evaluate the role of cranial irradiation on surviva l. Methods and materials: From 1987 to 1994, 159 lung cancer patients with CT scan documented BM were reviewed. All of them underwent crania l irradiation (median radiation dose: 30 Gy). Chemotherapy and surgery of BM were performed in 21 and 10 cases, respectively. Results: Overa ll median survival was 3.5 months and one year survival rate was 10.69 %. Univariate analysis showed that the significant factors were perfor mance status, age, total radiation dose to brain, BM as the first meta stasis, neurosurgery, symptoms of urine/stool incontinence, and synchr onous BM. Multivariate analysis indicated that (1) performance status (p = 0.0002), (2) total radiation dose (p = 0.0032), (3) BM as the fir st metastasis (p = 0.0449), (4) neurosurgery (p = 0.0233), (5) symptom s of urine/stool incontinence (p = 0.0002), and (6) the presence of a midline shift on cranial CT scans (p = 0.0063) were significant progno stic factors. Conclusion: The prognosis of BM in lung cancer patients is extremely poor. Radiotherapy appears as an effective means of palli ation with 75% overall symptomatic response rate. Higher radiation dos e (2 30 Gy) and neurosurgery are associated with longer survival. Good performance status, BM as the first metastasis, absence of sphincter dysfunction, and midline shift on CT scans are favorable prognostic pr edictors. The role of midline shift is very interesting and needs to b e explored further.