Risk factors affecting survival after brain metastases from non-small celllung carcinoma: a follow-up study of 70 patients

Object. The authors present their experience with the treatment of brain me tastases from non-small cell lung carcinoma (NSCLC). Methods. A retrospective review was conducted in which records from 74 pati ents treated at the authors' institution between 1994 and 1999 were assesse d. Survival and functional outcome were reviewed relative to individual pat ient variables. The median survival time was 12.9 months, with 1-, 2-, and 5-year survival milestones reached by 52.2%, 30.7%, and 18.1% of patients, respectively. Patients were stratified into groups composed of those with s ynchronous brain metastases (tumors diagnosed within 3 months of NSCLC) and metachronous brain metastases (tumors diagnosed 3 months after NSCLC). The median survival time and 5-year survival rate were 18 months and 28.9% for metachronous, compared with 9.9 months and 0% for synchronous brain metast ases. In univariate analyses, the stage of brain metastases, an initial Kar nofsky Performance Scale (KPS) score of 90 or less, and conservative therap y for NSCLC were associated with worse outcomes (p < 0.05). In analyses in which tumors were stratified by synchronous compared with metachronous brai n metastases, a preoperative KPS score of 90 or less and radiation therapy (RT) alone for brain metastases were associated with worse outcomes in pati ents with metachronous brain metastases but not with synchronous tumors (p < 0.05). When stratified by preoperative KPS score, the synchronous brain m etastases stage or treatment of brain metastases with RT alone were associa ted with worse outcome in patients with KPS scores of 100, but had no disce rnible effect on patients with KPS scores of 90 or less (p < 0.05). Conclusions. The tumor stage and preoperative KPS score were significantly associated with survival. Craniotomy plus RT significantly improved the pro gnosis in patients with metachronous brain metastases or those with a preop erative KPS score of 100.