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Upfront Brain Treatments Followed by Lung Surgery Improves Survival for Stage IV Non-small Cell Lung Cancer Patients With Brain Metastases: A Large Cohort Analysis.

Authors :
He X
Yin S
Liu H
Lu R
Kernstine K
Gerber DE
Xie Y
Yang DM
Source :
Frontiers in surgery [Front Surg] 2021 Oct 13; Vol. 8, pp. 649531. Date of Electronic Publication: 2021 Oct 13 (Print Publication: 2021).
Publication Year :
2021

Abstract

Background: Current treatment guidelines for stage IV non-small cell lung cancer (NSCLC) with brain metastases recommend brain treatments, including surgical resection and radiotherapy (RT), in addition to resection of the primary lung tumor. Here, we investigate the less-studied impact of treatment sequence on the overall survival. Methods: The National Cancer Database was queried for NSCLC patients with brain metastases who underwent surgical resection of the primary lung tumor ( n = 776). Kaplan-Meier survival curves with log-rank test and propensity score stratified Cox regression with Wald test were used to evaluate the associations between various treatment plans and overall survival (OS). Results: Compared to patients who did not receive any brain treatment (median OS = 6.05 months), significantly better survival was observed for those who received brain surgery plus RT (median OS = 26.25 months, p < 0.0001) and for those who received brain RT alone (median OS = 14.49 months, p < 0.001). Patients who received one upfront brain treatment (surgery or RT) before lung surgery were associated with better survival than those who received lung surgery first ( p < 0.05). The best survival outcome (median OS 27.1 months) was associated with the sequence of brain surgery plus postoperative brain RT followed by lung surgery. Conclusions: This study shows the value of performing upfront brain treatments followed by primary lung tumor resection for NSCLC patients with brain metastases, especially the procedure of brain surgery plus postoperative brain RT followed by lung surgery.<br />Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.<br /> (Copyright © 2021 He, Yin, Liu, Lu, Kernstine, Gerber, Xie and Yang.)

Details

Language :
English
ISSN :
2296-875X
Volume :
8
Database :
MEDLINE
Journal :
Frontiers in surgery
Publication Type :
Academic Journal
Accession number :
34722619
Full Text :
https://doi.org/10.3389/fsurg.2021.649531