title: Time for reappraisal of extracranial treatment options? Synchronous brain metastases from nonsmall cell lung cancer.
abstract: BACKGROUND
  The optimal treatment of the primary tumor in patients with brain metastases (BM) from newly diagnosed nonsmall cell lung cancer (NSCLC) remains unclear. The authors aimed to identify patient groups with synchronous BM for whom radical treatment of the primary site may be appropriate.
  
  
  METHODS
  The medical records of 167 patients treated at our center between November 2000 and June 2009 for newly diagnosed NSCLC and synchronous BM were reviewed. All patients underwent surgery/radiosurgery (n = 86) or whole-brain radiotherapy (WBRT; n = 81) for BM. Univariate and multivariate analyses assessed prognostic factors significant for overall survival (OS).
  
  
  RESULTS
  Median OS of patients undergoing surgery/radiosurgery for BM was 12.1 months. Those undergoing "radical" thoracic treatment (n = 24) had a longer median OS (28.4 months) than those undergoing chemotherapy (n = 74; 12.1 months) or supportive therapy (n = 69; 5.6 months, P < .01). Patients with stage I thoracic disease (n = 23) had a longer median OS (18.5 months) than those with stage III (n = 43; 9.4 months) or with intra/extra-thoracic metastases other than BM (stage IV; n = 20; 2.7 months, P < .01). Median OS of WBRT patients was 3.7 months. One patient underwent radical thoracic treatment. Patients undergoing chemotherapy (n = 42) had a longer median OS (5.7 months) than patients undergoing supportive therapy only (n = 38; 1.6 months, P < .01). Performance status and age were also associated with OS.
  
  
  CONCLUSIONS
  Radical thoracic treatments may be justified in selected patients <65-years-old, eligible to undergo surgery/radiosurgery for synchronous BM from NSCLC, even when stage III thoracic disease is present.
authors.affiliation: Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Joline S W
authors.initials: JS
authors.lastname: Lind
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Lagerwaard
authors.forename: Egbert F
authors.initials: EF
authors.lastname: Smit
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Postmus
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Slotman
authors.forename: Suresh
authors.initials: S
authors.lastname: Senan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery*; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D014916:Whole-Body Irradiation