Aggressive therapy for patients with non-small cell lung carcinoma and synchronous brain-only oligometastatic disease is associated with long-term survival

Phillip J. Gray, Raymond H. Mak, Beow Y. Yeap, Sarah K. Cryer, Nancy E. Pinnell, Laura W. Christianson, David J. Sher, Nils D. Arvold, Elizabeth H. Baldini, Aileen B. Chen, David E. Kozono, Scott J. Swanson, David M. Jackman, Brian M. Alexander

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Objectives: Optimal therapy for patients with non-small cell lung carcinoma (NSCLC) presenting with synchronous brain-only oligometastases (SBO) is not well defined. We sought to analyze the effect of differing therapeutic paradigms in this subpopulation. Materials and methods: We retrospectively analyzed NSCLC patients with 1-4 SBO diagnosed between 1/2000 and 1/2011 at our institution. Patients with T0 tumors or documented Karnofsky Performance Status <70 were excluded. Aggressive thoracic therapy (ATT) was defined as resection of the primary disease or chemoradiotherapy whose total radiation dose exceeded 45. Gy. Cox proportional hazards and competing risks models were used to analyze factors affecting survival and first recurrence in the brain. Results: Sixty-six patients were included. Median follow-up was 31.9 months. Intrathoracic disease extent included 9 stage I, 10 stage II and 47 stage III patients. Thirty-eight patients received ATT, 28 did not. Patients receiving ATT were younger (median age 55 vs. 60.5 years, p= 0.027) but were otherwise similar to those who did not. Receipt of ATT was associated with prolonged median overall survival (OS) (26.4 vs. 10.5 months; p< 0.001) with actuarial 2-year rates of 54% vs. 26%. ATT remained associated with OS after controlling for age, thoracic stage, performance status and initial brain therapy (HR 0.40, p= 0.009). On multivariate analysis, the risk of first failure in the brain was associated with receipt of ATT (HR 3.62, p= 0.032) and initial combined modality brain therapy (HR 0.34, p= 0.046). Conclusion: Aggressive management of thoracic disease in NSCLC patients with SBO is associated with improved survival. Careful management of brain disease remains important, especially for those treated aggressively.

Original languageEnglish (US)
Pages (from-to)239-244
Number of pages6
JournalLung Cancer
Volume85
Issue number2
DOIs
StatePublished - Jan 1 2014

Fingerprint

Non-Small Cell Lung Carcinoma
Thorax
Survival
Brain
Therapeutics
Thoracic Diseases
Karnofsky Performance Status
Combined Modality Therapy
Brain Diseases
Chemoradiotherapy
Therapeutic Uses
Statistical Factor Analysis
Multivariate Analysis
Radiation
Recurrence
Neoplasms

Keywords

  • Aggressive therapy
  • Brain metastases
  • Non-small cell lung cancer
  • Oligometastases
  • Radiation therapy
  • Stereotactic radiosurgery
  • Whole brain radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Aggressive therapy for patients with non-small cell lung carcinoma and synchronous brain-only oligometastatic disease is associated with long-term survival. / Gray, Phillip J.; Mak, Raymond H.; Yeap, Beow Y.; Cryer, Sarah K.; Pinnell, Nancy E.; Christianson, Laura W.; Sher, David J.; Arvold, Nils D.; Baldini, Elizabeth H.; Chen, Aileen B.; Kozono, David E.; Swanson, Scott J.; Jackman, David M.; Alexander, Brian M.

In: Lung Cancer, Vol. 85, No. 2, 01.01.2014, p. 239-244.

Research output: Contribution to journalArticle

Gray, PJ, Mak, RH, Yeap, BY, Cryer, SK, Pinnell, NE, Christianson, LW, Sher, DJ, Arvold, ND, Baldini, EH, Chen, AB, Kozono, DE, Swanson, SJ, Jackman, DM & Alexander, BM 2014, 'Aggressive therapy for patients with non-small cell lung carcinoma and synchronous brain-only oligometastatic disease is associated with long-term survival', Lung Cancer, vol. 85, no. 2, pp. 239-244. https://doi.org/10.1016/j.lungcan.2014.06.001
Gray, Phillip J. ; Mak, Raymond H. ; Yeap, Beow Y. ; Cryer, Sarah K. ; Pinnell, Nancy E. ; Christianson, Laura W. ; Sher, David J. ; Arvold, Nils D. ; Baldini, Elizabeth H. ; Chen, Aileen B. ; Kozono, David E. ; Swanson, Scott J. ; Jackman, David M. ; Alexander, Brian M. / Aggressive therapy for patients with non-small cell lung carcinoma and synchronous brain-only oligometastatic disease is associated with long-term survival. In: Lung Cancer. 2014 ; Vol. 85, No. 2. pp. 239-244.
@article{ae8c6d307cfc4e61a8daccb75c7d5236,
title = "Aggressive therapy for patients with non-small cell lung carcinoma and synchronous brain-only oligometastatic disease is associated with long-term survival",
abstract = "Objectives: Optimal therapy for patients with non-small cell lung carcinoma (NSCLC) presenting with synchronous brain-only oligometastases (SBO) is not well defined. We sought to analyze the effect of differing therapeutic paradigms in this subpopulation. Materials and methods: We retrospectively analyzed NSCLC patients with 1-4 SBO diagnosed between 1/2000 and 1/2011 at our institution. Patients with T0 tumors or documented Karnofsky Performance Status <70 were excluded. Aggressive thoracic therapy (ATT) was defined as resection of the primary disease or chemoradiotherapy whose total radiation dose exceeded 45. Gy. Cox proportional hazards and competing risks models were used to analyze factors affecting survival and first recurrence in the brain. Results: Sixty-six patients were included. Median follow-up was 31.9 months. Intrathoracic disease extent included 9 stage I, 10 stage II and 47 stage III patients. Thirty-eight patients received ATT, 28 did not. Patients receiving ATT were younger (median age 55 vs. 60.5 years, p= 0.027) but were otherwise similar to those who did not. Receipt of ATT was associated with prolonged median overall survival (OS) (26.4 vs. 10.5 months; p< 0.001) with actuarial 2-year rates of 54{\%} vs. 26{\%}. ATT remained associated with OS after controlling for age, thoracic stage, performance status and initial brain therapy (HR 0.40, p= 0.009). On multivariate analysis, the risk of first failure in the brain was associated with receipt of ATT (HR 3.62, p= 0.032) and initial combined modality brain therapy (HR 0.34, p= 0.046). Conclusion: Aggressive management of thoracic disease in NSCLC patients with SBO is associated with improved survival. Careful management of brain disease remains important, especially for those treated aggressively.",
keywords = "Aggressive therapy, Brain metastases, Non-small cell lung cancer, Oligometastases, Radiation therapy, Stereotactic radiosurgery, Whole brain radiotherapy",
author = "Gray, {Phillip J.} and Mak, {Raymond H.} and Yeap, {Beow Y.} and Cryer, {Sarah K.} and Pinnell, {Nancy E.} and Christianson, {Laura W.} and Sher, {David J.} and Arvold, {Nils D.} and Baldini, {Elizabeth H.} and Chen, {Aileen B.} and Kozono, {David E.} and Swanson, {Scott J.} and Jackman, {David M.} and Alexander, {Brian M.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1016/j.lungcan.2014.06.001",
language = "English (US)",
volume = "85",
pages = "239--244",
journal = "Lung Cancer",
issn = "0169-5002",
publisher = "Elsevier Ireland Ltd",
number = "2",

}

TY - JOUR

T1 - Aggressive therapy for patients with non-small cell lung carcinoma and synchronous brain-only oligometastatic disease is associated with long-term survival

AU - Gray, Phillip J.

AU - Mak, Raymond H.

AU - Yeap, Beow Y.

AU - Cryer, Sarah K.

AU - Pinnell, Nancy E.

AU - Christianson, Laura W.

AU - Sher, David J.

AU - Arvold, Nils D.

AU - Baldini, Elizabeth H.

AU - Chen, Aileen B.

AU - Kozono, David E.

AU - Swanson, Scott J.

AU - Jackman, David M.

AU - Alexander, Brian M.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Objectives: Optimal therapy for patients with non-small cell lung carcinoma (NSCLC) presenting with synchronous brain-only oligometastases (SBO) is not well defined. We sought to analyze the effect of differing therapeutic paradigms in this subpopulation. Materials and methods: We retrospectively analyzed NSCLC patients with 1-4 SBO diagnosed between 1/2000 and 1/2011 at our institution. Patients with T0 tumors or documented Karnofsky Performance Status <70 were excluded. Aggressive thoracic therapy (ATT) was defined as resection of the primary disease or chemoradiotherapy whose total radiation dose exceeded 45. Gy. Cox proportional hazards and competing risks models were used to analyze factors affecting survival and first recurrence in the brain. Results: Sixty-six patients were included. Median follow-up was 31.9 months. Intrathoracic disease extent included 9 stage I, 10 stage II and 47 stage III patients. Thirty-eight patients received ATT, 28 did not. Patients receiving ATT were younger (median age 55 vs. 60.5 years, p= 0.027) but were otherwise similar to those who did not. Receipt of ATT was associated with prolonged median overall survival (OS) (26.4 vs. 10.5 months; p< 0.001) with actuarial 2-year rates of 54% vs. 26%. ATT remained associated with OS after controlling for age, thoracic stage, performance status and initial brain therapy (HR 0.40, p= 0.009). On multivariate analysis, the risk of first failure in the brain was associated with receipt of ATT (HR 3.62, p= 0.032) and initial combined modality brain therapy (HR 0.34, p= 0.046). Conclusion: Aggressive management of thoracic disease in NSCLC patients with SBO is associated with improved survival. Careful management of brain disease remains important, especially for those treated aggressively.

AB - Objectives: Optimal therapy for patients with non-small cell lung carcinoma (NSCLC) presenting with synchronous brain-only oligometastases (SBO) is not well defined. We sought to analyze the effect of differing therapeutic paradigms in this subpopulation. Materials and methods: We retrospectively analyzed NSCLC patients with 1-4 SBO diagnosed between 1/2000 and 1/2011 at our institution. Patients with T0 tumors or documented Karnofsky Performance Status <70 were excluded. Aggressive thoracic therapy (ATT) was defined as resection of the primary disease or chemoradiotherapy whose total radiation dose exceeded 45. Gy. Cox proportional hazards and competing risks models were used to analyze factors affecting survival and first recurrence in the brain. Results: Sixty-six patients were included. Median follow-up was 31.9 months. Intrathoracic disease extent included 9 stage I, 10 stage II and 47 stage III patients. Thirty-eight patients received ATT, 28 did not. Patients receiving ATT were younger (median age 55 vs. 60.5 years, p= 0.027) but were otherwise similar to those who did not. Receipt of ATT was associated with prolonged median overall survival (OS) (26.4 vs. 10.5 months; p< 0.001) with actuarial 2-year rates of 54% vs. 26%. ATT remained associated with OS after controlling for age, thoracic stage, performance status and initial brain therapy (HR 0.40, p= 0.009). On multivariate analysis, the risk of first failure in the brain was associated with receipt of ATT (HR 3.62, p= 0.032) and initial combined modality brain therapy (HR 0.34, p= 0.046). Conclusion: Aggressive management of thoracic disease in NSCLC patients with SBO is associated with improved survival. Careful management of brain disease remains important, especially for those treated aggressively.

KW - Aggressive therapy

KW - Brain metastases

KW - Non-small cell lung cancer

KW - Oligometastases

KW - Radiation therapy

KW - Stereotactic radiosurgery

KW - Whole brain radiotherapy

UR - http://www.scopus.com/inward/record.url?scp=84904127784&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84904127784&partnerID=8YFLogxK

U2 - 10.1016/j.lungcan.2014.06.001

DO - 10.1016/j.lungcan.2014.06.001

M3 - Article

VL - 85

SP - 239

EP - 244

JO - Lung Cancer

JF - Lung Cancer

SN - 0169-5002

IS - 2

ER -