title: Long-term survival in patients with synchronous, solitary brain metastasis from non-small-cell lung cancer treated with radiosurgery.
abstract: OBJECTIVE
  To report the outcome of patients with synchronous, solitary brain metastasis from non-small-cell lung cancer (NSCLC) treated with gamma knife stereotactic radiosurgery (GKSRS).
  
  
  METHODS
  Forty-two patients diagnosed with synchronous, solitary brain metastasis from NSCLC were treated with GKSRS between 1993 and 2006. The median Karnofsky performance status (KPS) was 90. Patients had thoracic Stage I-III disease (American Joint Committee on Cancer 2002 guidelines). Definitive thoracic therapy was delivered to 26/42 (62%) patients; 9 patients underwent chemotherapy and radiation, 12 patients had surgical resection, and 5 patients underwent preoperative chemoradiation and surgical resection.
  
  
  RESULTS
  The median overall survival (OS) was 18 months. The 1-, 2-, and 5-year actuarial OS rates were 71.3%, 34.1%, and 21%, respectively. For patients who underwent definitive thoracic therapy, the median OS was 26.4 months compared with 13.1 months for those who had nondefinitive therapy, and the 5-year actuarial OS was 34.6% vs. 0% (p < 0.0001). Median OS was significantly longer for patients with a KPS >or=90 vs. KPS < 90 (27.8 months vs. 13.1 months, p < 0.0001). The prognostic factors significant on multivariate analysis were definitive thoracic therapy (p = 0.020) and KPS (p = 0.001).
  
  
  CONCLUSIONS
  This is one of the largest series of patients diagnosed with synchronous, solitary brain metastasis from NSCLC treated with GKSRS. Definitive thoracic therapy and KPS significantly impacted OS. The 5-year OS of 21% demonstrates the potential for long-term survival in patients treated with GKSRS; therefore, patients with good KPS should be considered for definitive thoracic therapy.
authors.affiliation: Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Flannery
authors.forename: Mohan
authors.initials: M
authors.lastname: Suntharalingam
authors.forename: William F
authors.initials: WF
authors.lastname: Regine
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Chin
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Krasna
authors.forename: Michael K
authors.initials: MK
authors.lastname: Shehata
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Edelman
authors.forename: Marnie
authors.initials: M
authors.lastname: Kremer
authors.forename: Roy A
authors.initials: RA
authors.lastname: Patchell
authors.forename: Young
authors.initials: Y
authors.lastname: Kwok
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D006801:Humans; D017567:Karnofsky Performance Status; D007629:Kentucky; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008396:Maryland; D008875:Middle Aged; D009367:Neoplasm Staging; D016634:Radiosurgery / Q000401:mortality*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013534:Survival; D016896:Treatment Outcome