Brain Metastasis from Lung Cancer-Treatment and Prognosis-.

Park, Bong Jin; Lim, Young Jin; Kim, Tae Sung; Rhee, Bong Arm; Leem, Won; Kim, Gook Ki

Original Article

Journal of Korean Neurosurgical Society 1998;27(1): 53-58.

Bong Jin Park, Young Jin Lim, Tae Sung Kim, Bong Arm Rhee, Won Leem, Gook Ki Kim

Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea.

ABSTRACT

The treatment of brain tumors metastasizing from lung cancer though the outcome has been unsatisfactory. Through an examination of the prognosis in patients treated with varying modalities, this study aims to determine which gives the best results. We analyzed 110 of 124 cases, histologically diagnosed between 1985 and 1994, in which lung cancer had meta-stasized to the brain. Radiotherapy, chemotherapy and conservative management had been implemented. The patients' mean age was 58(range 23 to 76) years: the M: F ratio was 74: 36. The histological diagnosis was squamous cell carcinoma in 25 cases, adenocarcinoma in 50, small cell carcinoma in 24, and large cell carcinoma in 11. The median metastatic period between the lung cancer and metastatic tumor was 11.5 months: the longest duration was 42 months(one case). In 63 cases primary lung cancer and brain metastasis were diagnosed simultaneously. Of the total cases, 47 involved solitary metastasis and 63, multiple. The chief complaints were headache in 38 cases, hemiparesis in 48, cognitive function defect in 16, and seizure in eight. Metastasis to other organs at the time of diagnosis was as follow: adrenal gland, 6: bone, 9: liver, 4: lung, 3: leptomeninges, 1. Four patients had undergone craniotomy, two, only chemotherapy; and 41, radiotherapy. Seven patients underwent gamma knife radiosurgery: 43 were treated with a single modality: and 53, by combined therapy. The median survival period in cases of surgery alone, radiotherapy, chemotherapy and gamma knife radiosurgery was 17 months, 5.7 months, 3.5 months and 8.0 months, respectively. In cases of combined therapy, this period was 19.2 months for conventional surgery and gamma knife radiosurgery, 14.0 months for surgery and radiotherapy, and 7.0 months for radiotherapy and chemotherapy. For those with adenocarcinoma, the median survival period was 7.7 months: those with large cell carcinoma had the shortest median survival period(4.6 months). Combined therapy proved most effective, but survival periods did not lengthen.

Key Words: Brain metastasis; Gamma knife radiosurgery