title: Outcome appraisal of patients with limited brain metastases (BMs) from non small cell lung cancer (NSCLC) treated with different local therapeutic strategies: a single institute evaluation.
abstract: OBJECTIVE
  To evaluate the outcome of patients with non-small-cell lung cancer (NSCLC) with limited brain metastases (BMs) treated with local approaches omitting whole-brain radiation therapy (WBRT).
  
  
  METHODS
  Surgery was performed in case of a single, large BM, controlled extracranial disease and Karnofsky Performance Status (KPS) 90-100; stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiosurgery (HSRS) was performed in all other cases. The prescribed dose was 24 Gy/1 fraction for lesions <2.5 cm, and a median of 30 Gy (24-40 Gy) in 3-5 fractions for lesions >2.5 cm.
  
  
  RESULTS
  156 patients treated for 228 BMs were retrospectively evaluated. The median age was 62 years. The majority of patients had a KPS 90-100, recursive partitioning analysis Class II, diagnosis-specific graded prognostic assessment score 2.5-3 and 1-2 BMs. Surgical resection was performed in 18 cases, and SRS/HSRS was performed in 210 cases. The 1-2-year local control was 87.2 ± 3.0% and 72.8 ± 5.0%; the 1.2-year brain distant failure was 30.8 ± 4.0% and 58.1 ± 6.0%; the 1-2-year overall survival was 60.9 ± 3.9% and 31.4 ± 4.0%. On univariate and multivariate analysis, the following factors influenced survival: age (p = 0.01), the presence of lymph node involvement (p = 0.03), KPS (p << 0.01), the presence of extracranial metastases at the time of BM treatment (p < 0.01), the number of BMs (p = 0.02) and the treatment performed (p < 0.01).
  
  
  CONCLUSIONS
  The choice of an adequate local treatment can impact on survival in patients with limited BMs from NSCLC. A careful evaluation of prognostic and predictive factors is a pivotal additional aid. Advances in knowledge: Radiosurgery or surgery followed by radiosurgery on the tumour bed in place of WBRT proved to be an effective treatment influencing outcome. Surgical resection followed by SRS on the tumour bed has to be considered for lesions ≥15 mm, in patients with good KPS, age ≤70 years, adenocarcinoma histology and oligometastatic disease.
authors.affiliation: 1 Neurooncological Surgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pessina
authors.affiliation: 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.
authors.forename: Pierina
authors.initials: P
authors.lastname: Navarria
authors.affiliation: 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.|4 Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.affiliation: 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tomatis
authors.affiliation: 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Ascolese
authors.affiliation: 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Franzese
authors.affiliation: 3 Haematology and Oncology, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Toschi
authors.affiliation: 3 Haematology and Oncology, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.|4 Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
authors.affiliation: 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.
authors.forename: Fiorenza
authors.initials: F
authors.lastname: De Rose
authors.affiliation: 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Franceschini
authors.affiliation: 1 Neurooncological Surgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bello
authors.affiliation: 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.|4 Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000528:radiation effects / Q000601:surgery; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome