Stage III non–small cell lung cancer and metachronous brain metastases

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Presentation transcript:

Stage III non–small cell lung cancer and metachronous brain metastases Nader Moazami, MDa, Thomas W. Rice, MDa, Lisa A. Rybicki, MSb, David J. Adelstein, MDc, Sudish C. Murthy, MD, PhDa, Malcolm M. DeCamp, MDa, Gene H. Barnett, MDd, Mark A. Chidel, MDe, John H. Suh, MDe, Eugene H. Blackstone, MDa,b The Journal of Thoracic and Cardiovascular Surgery Volume 124, Issue 1, Pages 113-122 (July 2002) DOI: 10.1067/mtc.2002.121678 Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Risk-unadjusted survival. Vertical bars represent patients alive at last follow-up. Survival estimates ± SE and numbers of patients remaining at risk at 6, 12, and 24 months were 45% ± 5.3% (n = 40), 22% ± 4.4% (n = 19), and 10% ± 3.3% (n = 8), respectively. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 113-122DOI: (10.1067/mtc.2002.121678) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 Survival according to treatment of metachronous brain metastases. Figure format as in Figure 1. Survival estimates ± SE and numbers of patients remaining at risk at 6, 12, and 24 months were as follows: for metastasectomy (MET, solid line, n = 23), 77% ± 8.9% (n = 17), 39% ± 10.6% (n = 8), and 29% ± 10.0% (n = 6), respectively; for stereotactic radiosurgery (SRS, dashed line, n = 24), 65% ± 9.9% (n = 15), 39% ± 10.2% (n = 9), and 13% ± 7.0% (n = 3), respectively; and for palliation (unevenly broken line, n = 44), 18% ± 5.8% (n = 8), 5% ± 3.1% (n = 2), and 0% (n = 0), respectively. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 113-122DOI: (10.1067/mtc.2002.121678) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Comparison of metastasectomy or stereotactic radiosurgery (MET/SRS) with palliation in patients with characteristics predictive of good survival (A) and poor survival (B). A, 45-year-old patient with stage IIIA NSCLC treated by pneumonectomy. At diagnosis of metachronous brain metastases, this patient has ECOG 0 to 1 status with no other systemic metastases. B, 65-year-old patient with stage IIIB NSCLC not resected. At diagnosis of metachronous brain metastases, this patient has ECOG 2 status with other systemic metastases. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 113-122DOI: (10.1067/mtc.2002.121678) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Survival of propensity-matched patients stratified by treatment of metachronous brain metastases. Figure format as in Figure 1. A, Group 1, patients at good risk. Survival estimates and numbers of patients remaining at risk at 6, 12, and 24 months were as follows: for metastasectomy and stereotactic radiosurgery (MET/SRS, solid line, n = 40), 74% ± 7.0% (n = 29), 40% ± 8.0% (n = 15), and 21% ± 6.7% (n = 7), respectively; and for palliation (broken line, n = 6), 17% ± 15% (n = 1), 0% (n = 0), and 0% (n = 0), respectively. B, Group 2, patients at poor risk. Survival estimates and numbers of patients remaining at risk at 6, 12, and 24 months were as follows: for metastasectomy and stereotactic radiosurgery (MET/SRS, solid line, n = 7), 50% ± 20% (n = 3), 33% ± 19% (n = 2), and 17% ± 15% (n = 1), respectively; and for palliation (broken line, n = 38), 18% ± 6.3% (n = 7), 5% ± 3.6% (n = 2), and 0% (n = 0), respectively. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 113-122DOI: (10.1067/mtc.2002.121678) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Appendix Figure A. Predicted 1-year survival according to age of patient having undergone pneumonectomy, with ECOG 0 to 1 and no other systemic metastases at time of diagnosis of metachronous brain metastases. Multivariable equation has been solved for either metastasectomy or stereotactic radiosurgery (MET/SRS) or palliation. Dashed lines represent 68% confidence intervals. A, Stage IIIA NSCLC. B, Stage IIIB NSCLC. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 113-122DOI: (10.1067/mtc.2002.121678) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions