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Review
. 2023 Jul 1;93(1):50-59.
doi: 10.1227/neu.0000000000002372. Epub 2023 Feb 1.

Extended Survival in Patients With Non-Small-Cell Lung Cancer-Associated Brain Metastases in the Modern Era

Assaf Berger  1 , Reed Mullen  1 , Kenneth Bernstein  2 , Juan Diego Alzate  1 , Joshua S Silverman  2 , Erik P Sulman  2 , Bernadine R Donahue  2 , Abraham Chachoua  3 , Elaine Shum  3 , Vamsidhar Velcheti  3 , Joshua Sabari  3 , John G Golfinos  1 , Douglas Kondziolka  1
Affiliations
Review

Extended Survival in Patients With Non-Small-Cell Lung Cancer-Associated Brain Metastases in the Modern Era

Assaf Berger et al. Neurosurgery. .

Abstract

Background: 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, has enabled improvements in overall and progression-free (PFS) survival.

Objective: 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 to 2020, 606 patients with NSCLC 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: The median overall survival was 17 months (95% CI, 13-40). Predictors of increased survival in a multivariable analysis included age <65 years ( P < .001), KPS ≥80 ( P < .001), absence of extracranial metastases ( P < .001), fewer BM at first SRS (≤3, P = .003), and targeted therapy ( P = .005), whereas chemotherapy alone was associated with shorter survival ( P = .04). 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%.

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