Fellow NYU Langone Health New York City, New York, United States
Introduction: Brain metastases (BM) have long been considered a terminal diagnosis with management mainly aimed at palliation and little hope for extended survival. Use of brain stereotactic radiosurgery (SRS) and/or resection, in addition to novel systemic therapies have enabled improvements in overall (OS) and progression free (PFS) survival. This study aimed to explore the possibility of extended survival in patients with non-small cell lung cancer (NSCLC) BM in the current era.
Methods: During the years 2008-2020, 606 NSCLC patients underwent their first gamma knife SRS for BM at our institution with point-of-care data collection. We reviewed clinical, molecular, imaging and treatment parameters to explore the relationship of such factors with survival.
Results: Median OS was 17 months (95% Confidence Interval, CI, 13-40). Predictors of increased survival in a multivariable analysis included age < 67 (p < 0.001), KPS ≥80 (p < 0.001), absence of extracranial metastases (p < 0.001), fewer BM at first SRS (≤ 3, p=0.003) and targeted therapy (p=0.004), while chemotherapy alone was associated with shorter survival (p=0.03). In a subgroup of patients managed before 2016 (n=264), 38 (14%) were long-term survivors (≥5 years), of which 16% required no active cancer treatment (systemic or brain) for ≥3 years by the end of their follow-up.
Conclusion : Long-term survival in patients with brain metastases from NSCLC is feasible in the current era of SRS when combined with the use of effective targeted therapeutics. Of those living ≥5 years, the chance for living with stable disease without the need for active treatment for ≥3 years was 16%.
