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V. Glushko



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    O20 - Staging and Advanced Disease (ID 102)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      O20.05 - Prognosis and outcome after surgical resection of solitary brain metastasis in 82 NSCLC patients: a single institution experience (ID 302)

      16:15 - 17:45  |  Author(s): V. Glushko

      • Abstract
      • Presentation
      • Slides

      Background
      The brain is one of the most frequent sites of distant metastasis in patients with lung cancer. Surgical resection of isolated brain metastases in NSCLC patients is not widely accepted and still a matter of debate. The study was aimed to evaluate the long-term results and prognosis after surgical resection of primary tumor and solitary brain metastasis in NSCLC patients.

      Methods
      In this retrospective study, the data of 82 patients who underwent lung resection for primary NSCLC and brain metastasectomy for solitary metastasis between 1991 and 2011 in our clinic were analyzed. There were 68 (82,9%) males and 14 (17,1%) females, median age – 59,6 years. The most common histologic type of lung cancer was adenocarcinoma (70,7%). Synchronous brain metastasis was detected in 21 (25,6%), metachronous – in 61 (74,4%) patients. The primary lung cancer was completely resected in all cases. Surgery included pneumonectomy – in 7 (8,5%), lobectomy – in 69 (85,4%) and wedge resection – in 5 (6,1%) patients. In all cases of synchronous brain metastasis, except one, we performed brain metastasectomy first followed by lung surgery in 4-6 weeks interval. Simultaneous lung resection and brain metastasectomy was performed only in one patient. Surgery in patients with metachronous brain metastasis depended on the time of detection and varied from 4 to 38 months.

      Results
      Postoperative complications were registered in 10 (12,2%) patients, mortality rate was 3,7% (3 patients). Overall 1, 3 and 5-year survival after brain metastasectomy was 52,0%, 29,0% and 25,6% respectively with median survival 18,6 months. The most important prognostic factors were N-status of primary lung cancer and synchronous or metachronous diagnosis of brain metastasis. Three and 5-year survival after brain metastasectomy in patients with N0 status was significantly better than in N+ patients: 56,8% and 34,8% versus 21,4% and 6,5% respectively (p<0,01). Median survival was 19,8 months in N0 group and only 12,4 months in patients with positive lymph nodes. Five-year survival in patients with metachronous brain metastases was 19,8% versus 10,0% in synchronous group (p<0,05). Eight patients are alive free of recurrence, 10 patients – with recurrence in the brain and 64 (78,0%) patients died of disease progression in the brain or other distant sites.

      Conclusion
      Surgery in NSCLC patients with operable solitary brain metastasis is justified especially in N0 cases and metachronous disease. Surgical resection improves long-term results and quality of life in patients with operable brain lung cancer metastasis.

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