Objectives: Published series on the synchronous
combined resection of brain metastases and primary non-small cell lung
cancer are small and scarce. We therefore undertook a multicenter
retrospective study to determine long-term survival and identify
potential prognostic factors.
Design: Our series
includes 103 patients who were operated on between 1985 and 1998 for
the following tumors: adenocarcinomas (74); squamous cell carcinomas
(20); and large cell carcinomas (9). Three patients had two brain
metastases, and one patient had three metastases; the remaining
patients had a single metastasis. Ninety-three patients presented with
neurologic signs that regressed completely after resection in 60
patients and partially, in 26 patients. Neurosurgical resection was
incomplete in six patients. Seventy-five patients received
postoperative brain radiotherapy. The time interval between the brain
operation and the lung resection was < 4 months. Pulmonary resection
was incomplete in eight patients.
survival calculated from the date of the first operation was 56% at 1
year, 28% at 2 years, and 11% at 5 years. Univariate analysis showed
a better prognosis for adenocarcinomas (p = 0.019) and a trend toward
a better prognosis for patients with small pulmonary tumors (T1 vs T3,
p = 0.068), N0 stage disease (N0 vs N+, p = 0.069), and complete
pulmonary resection (p = 0.057). In a multivariate analysis,
adenocarcinoma histology also affected the survival rate
(p = 0.03).
Conclusions: It seems legitimate to
proceed with lung resection after complete resection of a single brain
metastasis, at least in patients with an adenocarcinoma and a small
lung tumor and without abnormal mediastinal lymph nodes seen on the CT
scan or during mediastinoscopy.