Tumor Histology Predicts Patterns of Failure and Survival in Patients With Brain Metastases From Lung Cancer Treated With Gamma Knife Radiosurgery

Tumor Histology Predicts Patterns of Failure and Survival in Patients With Brain Metastases From Lung Cancer Treated With Gamma Knife Radiosurgery

Abstract BACKGROUND: We review our experience with lung cancer patients with newly diagnosed brain metastases treated with Gamma Knife radiosurgery (GKRS). OBJECTIVE: To determine whether tumor histology predicts patient outcomes. METHODS: Between July 1, 2000, and December 31, 2010, 271 patients wi...

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Bibliographic Details
Published in:Neurosurgery Vol. 73; no. 4; pp. 641 - 647
Main Authors: Kuremsky, J. Griff, Urbanic, James J., Petty, W. Jeff, Lovato, James F., Bourland, J. Daniel, Tatter, Stephen B., Ellis, Thomas L., McMullen, Kevin P., Shaw, Edward G., Chan, Michael D.
Format: Journal Article
Language:English
Published: United States Oxford University Press 01-10-2013
Copyright by the Congress of Neurological Surgeons
Wolters Kluwer Health, Inc
Subjects:
Adenocarcinoma - mortality
Adenocarcinoma - secondary
Adenocarcinoma - surgery
Aged
Brain cancer
Brain Neoplasms - mortality
Brain Neoplasms - secondary
Brain Neoplasms - surgery
Carcinoma, Small Cell - mortality
Carcinoma, Small Cell - secondary
Carcinoma, Small Cell - surgery
Carcinoma, Squamous Cell - mortality
Carcinoma, Squamous Cell - secondary
Carcinoma, Squamous Cell - surgery
Female
Histology
Humans
Lung cancer
Lung Neoplasms - mortality
Lung Neoplasms - pathology
Lung Neoplasms - surgery
Male
Metastasis
Middle Aged
Neurosurgery
Patients
Radiosurgery
Retrospective Studies
Toxicity
Treatment Outcome
Stereotactic radiosurgery
Cranial metastases
Lung cancer
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Summary:Abstract BACKGROUND: We review our experience with lung cancer patients with newly diagnosed brain metastases treated with Gamma Knife radiosurgery (GKRS). OBJECTIVE: To determine whether tumor histology predicts patient outcomes. METHODS: Between July 1, 2000, and December 31, 2010, 271 patients with brain metastases from primary lung cancer were treated with GKRS at our institution. Included in our study were 44 squamous cell carcinoma (SCC), 31 small cell carcinoma (SCLC), and 138 adenocarcinoma (ACA) patients; 47 patients with insufficient pathology to determine subtype were excluded. No non-small cell lung cancer (NSCLC) patients received whole-brain radiation therapy (WBRT) before their GKRS, and SCLC patients were allowed to have prophylactic cranial irradiation, but no previously known brain metastases. A median of 2 lesions were treated per patient with median marginal dose of 20 Gy. RESULTS: Median survival was 10.2 months for ACA, 5.9 months for SCLC, and 5.3 months for SCC patients (P = .008). The 1-year local control rates were 86%, 86%, and 54% for ACA, SCC, and SCLC, respectively (P = .027). The 1-year distant failure rates were 35%, 63%, and 65% for ACA, SCC, and SCLC, respectively (P = .057). The likelihood of dying of neurological death was 29%, 36%, and 55% for ACA, SCC, and SCLC, respectively (P = .027). The median time to WBRT was 11 months for SCC and 24 months for ACA patients (P = .04). Multivariate analysis confirmed SCLC histology as a significant predictor of worsened local control (hazard ratio [HR]: 6.46, P = .025) and distant failure (HR: 3.32, P = .0027). For NSCLC histologies, SCC predicted for earlier time to salvage WBRT (HR: 2.552, P = .01) and worsened overall survival (HR: 1.77, P < .0121). CONCLUSION: Histological subtype of lung cancer appears to predict outcomes. Future trials and prognostic indices should take these histology-specific patterns into account.
Bibliography:Deceased
ISSN:0148-396X
1524-4040
DOI:10.1227/NEU.0000000000000072