title: Comparison Between Surgical Resection and Stereotactic Radiosurgery in Patients with a Single Brain Metastasis from Non-Small Cell Lung Cancer.
abstract: BACKGROUND
  The management of patients with single brain metastasis (BM) from non-small cell lung cancer (NSCLC) is controversial. Surgical resection (SR) with adjuvant irradiation and stereotactic radiosurgery (SRS) are performed in the treatment of such lesions. This study compared both modalities in terms of tumor control and survival.
  
  
  METHODS
  During the period 2004-2011, 115 patients with single BM from NSCLC were treated with SR or SRS at our institution. Median patient age was 61 years. SR was performed in 43 patients, and SRS was performed in 72 patients. Most patients who underwent SR had adjuvant irradiation. Of patients, 63% in the SR group and 56% in the SRS group had synchronous presentation of BM and lung primary tumor. Thoracic disease was managed with curative intent in 60% of patients in the SR group compared with 50% of patients in the SRS group.
  
  
  RESULTS
  Median follow-up was 10.2 months. Local control was 72% in patients in the SR group and 79% in patients in the SRS group (P = 0.992). Median survival for patients in the SR group was 13.3 months, and median survival for patients in the SRS group was 7.8 months (P = 0.047). Multivariate analyses revealed aggressive treatment of the primary NSCLC as an independent factor associated with prolonged survival in patients undergoing SR. In the SRS group, patients with metachronous metastasis showed a better prognosis. Metachronous presentation was associated with more aggressive management of the primary tumor.
  
  
  CONCLUSIONS
  In this study, patients with single BM undergoing SR had a survival advantage. However, because SR and SRS achieved comparable local control of BM, patients receiving SRS should benefit from an equally aggressive treatment of the primary NSCLC, as thoracic management was the most important predictor of survival.
authors: Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada.
authors: Emilie
authors: E
authors: Bougie
authors: Department of Radiation Oncology, Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada.
authors: Laurence
authors: L
authors: Masson-Côté
authors: Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada. Electronic address: david.mathieu@usherbrooke.ca.
authors: David
authors: D
authors: Mathieu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Gamma Knife radiosurgery; Non–small cell lung cancer; Single brain metastasis; Stereotactic radiosurgery; Surgical resection