PURPOSE: A retrospective study was performed to assess the features of operable and inoperable lung cancers with brain metastases.
METHODS: 152 patients with lung cancer and its cerebral metastases were divided into group S (surgical group) (n=65) where lung cancer and brain metastasis were removed surgically, and group C (conservative treatment) (n=87), where the pulmonary process could be treated with radiotherapy and/or chemotherapy and the cerebral metastases were operable only in 16%. The appearance of the brain metastasis was synchronous in 29% and 52% in group S and in group C, respectively. 69% of the patients in group S, and 33% of those in group C were free of complaints for lung cancer.
RESULTS: In group S, 66% of the tumours were in stage I or II, while 74% of the tumours in group C were in stage IIIA or IIIB. Types of the lung cancers are as follows: adenocarcinoma 63% and 37%, squamous cell carcinoma 20% and 41%, large cell lung cancer 14% and 1%, and small cell lung cancer 3% and 16% in group S and C, respectively. The 5-year survival rates were 24% and 20% (p=0.17) in group S and the 2 year survival rates were 7% and 9% (p=0.0008) in group C in synchronous and metachronous cases, respectively. The median survival time of patients without lung cancer related complaints was significantly better than that of the patients with complaints: group S: 19 vs. 12 months (p=0.05) and group C: 15 vs. 9 months (p=0.0015), respectively.
CONCLUSION: There was no significant difference in survival between the synchronous and metachronous cases in the operable cases, but there was longer survival in metachronous cases in the conservative treatment group. Complaint-free status is associated with a significantly longer survival in haematogenous metastases cases.
CLINICAL IMPLICATIONS: In cases involving operable lung cancer and removable brain metastasis, a combined surgical treatment is recommended. Patinets with inoperable lung cancer and synchronous brain metastasis had shortest survival.
DISCLOSURE: Jozsef Furak, None.