Surgical treatment of primary lung cancer with synchronous brain metastases

Objectives: The role of surgical resection for brain metastases from non-sm all cell lung cancer is evolving. Although resection of primary lung cancer and metachronous brain metastases is superior to other treatment modalitie s in prolonging survival and disease-free interval, resection of the primar y non-small cell lung cancer and synchronous brain metastases is controvers ial. Methods: From January 1975 to December 1997, 220 patients underwent surgica l treatment for brain metastases from non-small cell lung cancer at our ins titution. Twenty-eight (12.7%) of these patients underwent surgical resecti on of synchronous brain metastases and the primary non-small cell lung canc er. Results: The group comprised 18 men and 10 women. Median age was 57 years ( range 35-71 years). Twenty-two (78.6%) patients had neurologic symptoms. Cr aniotomy was performed first in all 28 patients. Median time between cranio tomy and thoracotomy was 14 days (range 4-840 days). Pneumonectomy was perf ormed in 4 patients, bilobectomy in 4, lobectomy in 18, and wedge excision in 2. Postoperative complications developed in 6 (21.4%) patients. Cell typ e was adenocarcinoma in 11 patients, squamous cell carcinoma in 9, and larg e cell carcinoma in 8. After pulmonary resection, 17 patients had no eviden ce of lymph node metastases (NO), 5 had hilar metastases (N1), and 6 had me diastinal metastases (N2). Twenty-four (85.7%) patients received postoperat ive adjuvant therapy. Follow-up was complete in all patients for a median o f 24 months (range 2-104 months). Median survival was 24 months (range 2-10 4). Survival at 1, 2, and 5 years was 64.3%, 54.0%, and 21.4%, respectively . The presence of thoracic lymph node metastases (N1 or N2) significantly a ffected 5-year survival (P =.001). Conclusion: Although the overall survival for patients who have brain metas tases from non-small cell lung cancer is poor, surgical resection may prove beneficial in a select group of patients with synchronous brain metastases and lung cancer without lymph node metastases.