title: Prognostic factors in patients with non-small cell lung carcinoma and brain metastases: a Malaysian perspective.
abstract: BACKGROUND
  Brain metastases occur in about 20-40% of patients with non-small-cell lung carcinoma (NSCLC), and are usually associated with a poor outcome. Whole brain radiotherapy (WBRT) is widely used but increasingly, more aggressive local treatments such as surgery or stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) are being employed. In our study we aimed to describe the various factors affecting outcomes in NSCLC patients receiving local therapy for brain metastases.
  
  
  METHODS
  The case records of 125 patients with NSCLC and brain metastases consecutively treated with radiotherapy at two tertiary centres from January 2006 to June 2012 were analysed for patient, tumour and treatment-related prognostic factors. Patients receiving SRS/SRT were treated using Cyberknife. Variables were examined in univariate and multivariate testing.
  
  
  RESULTS
  Overall median survival was 3.4 months (95%CI: 1.7-5.1). Median survival for patients with multiple metastases receiving WBRT was 1.5 months, 1-3 metastases receiving WBRT was 3.6 months and 1-3 metastases receiving surgery or SRS/SRT was 8.9 months. ECOG score (≤2 vs >2, p=0.001), presence of seizure (yes versus no, p=0.031), treatment modality according to number of brain metastases (1-3 metastases+surgery or SRS/SRT±WBRT vs 1-3 metastases+WBRT only vs multiple metastases+WBRT only, p=0.007) and the use of post-therapy systemic treatment (yes versus no, p=0.001) emerged as significant on univariate analysis. All four factors remained statistically significant on multivariate analysis.
  
  
  CONCLUSIONS
  ECOG ≤2, presence of seizures, oligometastatic disease treated with aggressive local therapy (surgery or SRS/SRT) and the use of post-therapy systemic treatment are favourable prognostic factors in NSCLC patients with brain metastases.
authors.affiliation: Clinical Oncology Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia E-mail : tangwengheng@ummc.edu.my.
authors.forename: Weng Heng
authors.initials: WH
authors.lastname: Tang
authors.forename: Adlinda
authors.initials: A
authors.lastname: Alip
authors.forename: Marniza
authors.initials: M
authors.lastname: Saad
authors.forename: Vincent Chee Ee
authors.initials: VC
authors.lastname: Phua
authors.forename: Hari
authors.initials: H
authors.lastname: Chandran
authors.forename: Yi Hang
authors.initials: YH
authors.lastname: Tan
authors.forename: Yan Yin
authors.initials: YY
authors.lastname: Tan
authors.forename: Voon Fong
authors.initials: VF
authors.lastname: Kua
authors.forename: Mohamed Ibrahim
authors.initials: MI
authors.lastname: Wahid
authors.forename: Lye Mun
authors.initials: LM
authors.lastname: Tho
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008296:Malaysia; D008297:Male; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome