RT Book, Section
A1 Krasna, Mark J.
A2 Sugarbaker, David J.
A2 Bueno, Raphael
A2 Colson, Yolonda L.
A2 Jaklitsch, Michael T.
A2 Krasna, Mark J.
A2 Mentzer, Steven J.
A2 Williams, Marcia
A2 Adams, Ann
SR Print(0)
ID 1105842705
T1 Resection of Bronchogenic Carcinoma with Oligometastatic Disease
T2 Adult Chest Surgery, 2e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-178189-3
LK accesssurgery.mhmedical.com/content.aspx?aid=1105842705
RD 2024/04/19
AB The  development  of  brain  metastasis  in  a  patient  with  non–small-cell  lung  cancer  (NSCLC)  is  an  ominous  prognostic  sign.  About  30%  of  individuals  with  NSCLC  eventually  develop  brain  metastasis.1  This  number  increases  to  about  50%  in  autopsy  series.2  When  the  metastases  are  multiple,  palliative  treatment  in  the  form  of  radiation  therapy  is  recommended.  Solitary  brain  metastasis,  however,  can  be  approached  surgically.  The  proportion  of  NSCLC  patients  that  develops  brain  metastasis  amounts  to  approximately  40,000  patients  per  year.  The  magnitude  of  this  problem  can  be  appreciated  by  comparing  this  number  with  the  incidence  of  new  primary  cancers  of  the  pancreas  (n  =  27,000),  stomach  (n  =  24,000),  and  esophagus  (n  =  13,000).  The  median  survival  rate  of  untreated  lung  cancer  with  brain  metastasis  is  approximately  1  month.  Steroid  therapy  increases  the  median  survival  by  2  months.  Whole-brain  radiation  increases  survival  by  3  to  6  months.3  Recent  reports  indicate  longer  survivals  when  surgical  treatment  is  combined  with  whole-brain  radiation.4,5  The  experience  of  several  large  centers  that  offer  a  surgical  approach  to  lung  cancer  with  brain  metastasis  is  discussed  herein,  with  an  analysis  of  factors  underlying  prolonged  survival.