Pronostic factors of synchronous brain metastases from lung cancer

Background: The prognosis of brain metastases (BM) from lung cancer is poor . The management of lung cancer with BM is not clear. This retrospective st udy attempts to determine their prognostic factors, and to better define th e role of different treatments, Methods: We reviewed the clinical character istics of 271 consecutive patients with synchronous brain metastases (SBM) from lung cancer (small-cell lung cancers and non-small-cell lung cancers), collected between January 1985 and May 1993. Data were available for all p atients as well as follow-up information on all patients through to death. Patients had all undergone heterogeneous treatments. Each physician had cho sen the appropriate treatment after collegiate discussion. Survival curves were compared using the log-rank test in univariate analysis, and Cox's Reg ression model in multivariate analysis. Statistical significance was define d as P < 0.05. Results: 249 patients were assessable. Treatments included: neurosurgical resection in 56 cases, brain irradiation in 87 cases, and che motherapy in 126 cases. Median overall survival time from the date of histo logical diagnosis of SBM was 103 days (range, 1-1699). In multivariate anal ysis, prognostic factors for longer overall survival times were: absence of adrenal metastases (P = 0.007), neurosurgical resection (P = 0.028), chemo therapy (P = 0.032) and brain irradiation (P = 0.008). Moreover, risk facto rs of intracranial hypertension as cause of death were number of SBM and ab sence of neurosurgical resection. Conclusions: These results and others sug gest that patients with SBM from lung cancer be considered for carcinologic treatment, and not only for best supportive care. However, further studies are necessary to evaluate quality of life with or without carcinologic tre atment. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.