title: Combined treatment of non-small cell lung cancer with synchronous brain metastases: a single center experience.
abstract: OBJECTIVE
  The aim of this study was to analyze our experience with combined treatment of non-small cell lung cancer with synchronous brain metastases.
  
  
  METHODS
  Between 1992 and 2008, 31 patients were treated by performing neurosurgery (or stereotactic radiosurgery) and lung surgery. Patients were divided into two groups according to their preoperative mediastinal work-up: group A (CT scan) and group B (FDG-PET scan).
  
  
  RESULTS
  Twenty-six patients had one brain metastasis and five had two. Neurosurgery was performed in 10 patients, stereotactic radiosurgery in 20 and both approaches in 1. Seven patients underwent chemotherapy after cerebral procedure. Pulmonary resection was complete in 27 cases and incomplete in 4. Histological findings showed: adenocarcinoma in 19 cases, squamous cell carcinoma in 8 and large cell carcinoma in 4. All patients underwent adjuvant chemotherapy. Overall 1, 2 and 5-year survival rates were 83%, 47% and 21%, respectively. The median survival was 22 months. Univariate analysis showed a better prognosis for complete resection (P=0.008), adenocarcinomas (P=0.015), N0 disease (P=0.038), and Group B (P=0.045). Multivariate analysis showed that only the radicality of the resection (P=0.027) and Group B (P=0.047) were independent prognostic factors.
  
  
  CONCLUSIONS
  Our experience confirms that selected patients with non-small cell lung cancer and synchronous brain metastases may be effectively treated by combined therapy. Complete resection, adenocarcinoma histology and N0 disease were prognostic factors. The incorporation of FDG-PET scan into the preoperative work-up may translate into a survival benefit.
authors.affiliation: Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy. giulio.melloni@hsr.it
authors.forename: G
authors.initials: G
authors.lastname: Melloni
authors.forename: A
authors.initials: A
authors.lastname: Bandiera
authors.forename: V
authors.initials: V
authors.lastname: Gregorc
authors.forename: A
authors.initials: A
authors.lastname: Carretta
authors.forename: P
authors.initials: P
authors.lastname: Ciriaco
authors.forename: M
authors.initials: M
authors.lastname: Viganò
authors.forename: A
authors.initials: A
authors.lastname: Franzin
authors.forename: A
authors.initials: A
authors.lastname: Bolognesi
authors.forename: P
authors.initials: P
authors.lastname: Picozzi
authors.forename: P
authors.initials: P
authors.lastname: Zannini
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000401:mortality; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D049268:Positron-Emission Tomography; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18