title: Chemotherapy is the cornerstone of the combined surgical treatment of lung cancer with synchronous brain metastases.
abstract: BACKGROUND
  Lung cancer accounts for about 50% of brain metastases, of which nearly 25% are eligible for neurosurgery, providing a neurological control rate of up to 70% when followed by whole brain radiation therapy. How to manage the primary lung carcinoma remains elusive.
  
  
  METHODS
  We undertook a retrospective study of consecutive patients who underwent surgical resection for synchronous brain metastases from non-small cell lung cancer in a single institution, to determine overall survival and prognostic factors, with particular attention to the treatment of the primary lung tumor.
  
  
  RESULTS
  Fifty-one patients underwent surgical resection of synchronous brain metastases from non-small cell lung cancer. Median survival was 13.2 months. Prognosis mainly depended of the treatment of the lung tumor, with a marked survival advantage in the 29 patients receiving a focal treatment (thoracic surgery or radiotherapy), compared to the 22 other patients: median, 1-year, and 2-year survival were 22.5 months, 69%, and 42%, versus 7.1 months, 33%, and 5%, respectively (p<0.001); response to pre-operative chemotherapy before focal treatment was the main favorable prognostic factor (p=0.023), and further identified patients who had benefit from resection of the lung tumor, with a significantly better outcome.
  
  
  CONCLUSIONS
  Chemotherapy, by its therapeutic and prognostic value, may be considered as the cornerstone of the combined medical and surgical therapeutic sequence whereby brain metastasectomy is followed by chemotherapy and further focal treatment of the primary lung tumor in responders to chemotherapy.
authors.affiliation: Department of Respiratory Medicine, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girard
authors.forename: Vincent
authors.initials: V
authors.lastname: Cottin
authors.forename: François
authors.initials: F
authors.lastname: Tronc
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Etienne-Mastroianni
authors.forename: Françoise
authors.initials: F
authors.lastname: Thivolet-Bejui
authors.forename: Jérôme
authors.initials: J
authors.lastname: Honnorat
authors.forename: Jacques
authors.initials: J
authors.lastname: Guyotat
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Souquet
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Cordier
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate