title: Analyses of prognostic factors in cases of non-small cell lung cancer with multiple brain metastases.
abstract: OBJECTIVE
  To observe the therapeutic efficacy and prognostic factors that influence survival rates in non-small cell lung cancer (NSCLC) patients with multiple brain metastases (BMs), (more than three and less than ten).
  
  
  METHODS
  Retrospective analyses were conducted on the clinical data of 209 NSCLC patients with multiple BMs and were admitted to our hospital between March 2007 and November 2012. All BM patients received whole-brain radiotherapy. Two hundred patients received combined chemotherapy during the treatment process; 99 received targeted drug therapy; and nine got only symptomatic and supportive treatment. Survival time was defined as the period from the start of BM therapy to the patient's death or end of the follow-up period. The Kaplan-Meier method was used to calculate the median survival time, and the 6-month, 1-, and 2-year cumulative survival rates, as well as to plot the survival curves. The patients' cultural background included their socioeconomic status, level of education, their understanding of the disease, and the degree of care and support they received from their family members. Log-rank test was employed to test the differences in the survival rates between the subgroups. Cox multivariate regression analyses were used to analyze the various factors influencing the prognoses of NSCLC with multiple BMs.
  
  
  RESULTS
  The follow-up duration was between 1 and 87 months. The median survival time for all BM patients was 12.1 months (95% confidence interval 9.37-14.83). The 6-month, 1-, and 2-year cumulative survival rates were 80%, 50.2%, and 10.7%, respectively. Univariate analyses revealed that the independent factors influencing survival prognoses included Karnofsky Performance Status score, control of the primary lung tumor, interval between the confirmed diagnoses of lung cancer and BM, presence of extracranial metastasis, number of chemotherapy cycles undergone, Graded Prognostic Assessment class, administration of combined targeted drug therapy, the pathological type, and the cultural backgrounds of the patients. Multivariate analyses indicated that the number of chemotherapy cycles, administration of combined drug therapy, and patients' cultural background were key independent factors influencing survival prognoses.
  
  
  CONCLUSIONS
  Active treatment of NSCLC with multiple BMs was beneficial, and the patients' cultural background had a strong influence on survival prognoses. Chemotherapy combined with targeted drug therapy could increase the patients' median and overall survival rates. The number of chemotherapy cycles undergone, administration of combined targeted drug therapy, and the cultural backgrounds of the patients had significant effects on the patients' survival prognoses.
authors.affiliation: Department of Radiation Oncology, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Gong
authors.affiliation: Department of Radiation Oncology, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Daoan
authors.initials: D
authors.lastname: Zhou
authors.affiliation: Department of Radiation Oncology, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Shixiong
authors.initials: S
authors.lastname: Liang
authors.affiliation: Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Caicun
authors.initials: C
authors.lastname: Zhou
keywords: brain tumor; cancer; cultural background; non-small cell lung cancer; targeted drug therapy; whole-brain radiotherapy