Brain Metastases Common in Lung Cancer Patients

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By David Douglas

NEW YORK (Reuters Health) Apr 01 - There is a high risk of brain metastases in certain patients with non-small-cell-lung cancer (NSCLC), researchers report. Thus, Dr. Raphael Bueno told Reuters Health, "Patients with stage IIIA NSCLC and lung adenocarcinoma may benefit from prophylactic brain irradiation."

Dr. Bueno of Brigham and Women's Hospital, Boston, and colleagues reviewed their experience with 177 patients with surgically staged IIIA (N2) NSCLC, and report the findings in the March 1st issue of the Journal of Clinical Oncology.

Median survival from the time of surgery was 21 months. The 3-year overall survival was 34%.

The most common site of recurrence was in the brain. In 34% of patients this was the first site of failure and 40% developed such metastases as some point.

Moreover, in patients with non-squamous histology and residual nodal involvement after neoadjuvant therapy, the risk reached 53% at 3 years. However, with preoperative radiation there was a trend towards reduced metastases at 3 years (25% versus 39%). [1533,2,4]

Nodal downstaging (to N0) was associated with an improved outlook, and compared to preoperative chemotherapy alone, chemotherapy and radiation were strongly correlated with nodal downstaging..

In fact, concluded Dr. Bueno, "there is a subset of patients with stage IIIA lung cancer that can be cured with a combination of chemotherapy, radiation therapy and surgery."

Future studies, he and his colleagues add, will focus on the potentially beneficial effects "of prophylaxis of brain metastases."

J Clin Oncol 2005;23:1530-1537