NSCLC brain mets: no benefit for surgery before stereotactic radiosurgery

  • Lung Cancer

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Patients with large NSCLC brain metastases who received multifraction stereotactic radiosurgery (mfSRS) alone had similar OS and local control (LC) rates as patients who underwent surgery plus mfSRS, with lower rates of radiation-induced brain necrosis (RN) and leptomeningeal spread of disease.

Why this matters

  • Approximately one-third of patients with NSCLC develop brain metastases.

Study design

  • 222 patients with 241 NSCLC brain metastases (2-4 cm) were included, who underwent surgery followed by postoperative mfSRS (3×9 Gy) to the resection cavity (n=95) or mfSRS alone for at least 1 metastasis (n=127).
  • Median follow-up of 13 months.
  • Funding: None.

Key results

  • No significant difference in local control rates between groups.
  • Surgery+mfSRS and mfSRS alone yielded similar median OS (13.5 vs 15.2 months) and 1-year survival (59% vs 68%; P=.2).
  • 18 patients receiving surgery+mfSRS and 17 receiving mfSRS alone had local recurrence (P=.2).
  • 12-month RN rates were 5% with mfSRS alone and 11% with surgery plus mfSRS (P=.03).
  • mfSRS-alone yielded significantly lower rate of leptomeningeal disease vs surgery+mfSRS (0% vs 7%; P=.01).

Limitations

  • Retrospective study.