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<p>Advances in molecular biology have extended survival for lung cancer patients with brain metastases. However, radiotherapy and surgery remain standard for non-small cell lung cancer (NSCLC) brain metastases. Existing studies assess surgical and radiotherapeutic outcomes using outdated data and lack relevant subgroup analyses. We retrospectively analyzed 298 NSCLC patients with 1–3 brain metastases. Overall survival (OS) and median OS were compared across five treatments: surgery + postoperative radiotherapy, surgery + postoperative non-radiotherapy, whole brain radiotherapy, stereotactic radiosurgery (SRS), and whole brain radiotherapy + SRS. Univariate and multivariate Cox regression analyses were conducted. Significant survival differences were noted among treatments (<i>p</i> = 0.0041) for patients with 1–3 brain metastases, single metastasis (<i>p</i> = 0.0034), age &gt; 57 (<i>p</i> = 0.0001), wild-type EGFR/ALK (<i>p</i> = 0.0017), KPS ≥ 90 (<i>p</i> = 0.0379), tumor diameter ≤ 2.7&#xa0;cm (<i>p</i> = 0.0147), and no extracranial metastasis (<i>p</i> = 0.0014). Surgery + postoperative radiotherapy and SRS significantly improved OS and median OS. For KPS ≥ 90, surgery + postoperative radiotherapy improved OS. Multivariate analysis identified age ≤ 57 (HR: 1.89; <i>p</i> &lt; 0.001), surgery + postoperative radiotherapy (HR: 0.60; <i>p</i> = 0.017), and SRS (HR: 0.57; <i>p</i> = 0.01) as independent protective factors for OS. Surgery + postoperative radiotherapy and SRS enhance survival in NSCLC patients with 1–3 brain metastases, particularly those with wild-type EGFR/ALK, small metastases, and no extracranial metastases. For KPS ≥ 90, surgery followed by radiotherapy is recommended. SRS improves median OS in patients with KPS ≤ 80.</p>

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In the context of the era of targeted therapy: evaluation of the survival benefits of different local treatment modalities for patients with 1–3 brain metastases from non-small cell lung cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月11日

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  • Liang Sun,
  • Haibin Chen,
  • Zhi Yang,
  • Liwen Li,
  • Zhaohui ying,
  • Yuanyuan Qu,
  • Nanyang Tong,
  • Caixing Sun,
  • Liang Xia

摘要

Advances in molecular biology have extended survival for lung cancer patients with brain metastases. However, radiotherapy and surgery remain standard for non-small cell lung cancer (NSCLC) brain metastases. Existing studies assess surgical and radiotherapeutic outcomes using outdated data and lack relevant subgroup analyses. We retrospectively analyzed 298 NSCLC patients with 1–3 brain metastases. Overall survival (OS) and median OS were compared across five treatments: surgery + postoperative radiotherapy, surgery + postoperative non-radiotherapy, whole brain radiotherapy, stereotactic radiosurgery (SRS), and whole brain radiotherapy + SRS. Univariate and multivariate Cox regression analyses were conducted. Significant survival differences were noted among treatments (p = 0.0041) for patients with 1–3 brain metastases, single metastasis (p = 0.0034), age > 57 (p = 0.0001), wild-type EGFR/ALK (p = 0.0017), KPS ≥ 90 (p = 0.0379), tumor diameter ≤ 2.7 cm (p = 0.0147), and no extracranial metastasis (p = 0.0014). Surgery + postoperative radiotherapy and SRS significantly improved OS and median OS. For KPS ≥ 90, surgery + postoperative radiotherapy improved OS. Multivariate analysis identified age ≤ 57 (HR: 1.89; p < 0.001), surgery + postoperative radiotherapy (HR: 0.60; p = 0.017), and SRS (HR: 0.57; p = 0.01) as independent protective factors for OS. Surgery + postoperative radiotherapy and SRS enhance survival in NSCLC patients with 1–3 brain metastases, particularly those with wild-type EGFR/ALK, small metastases, and no extracranial metastases. For KPS ≥ 90, surgery followed by radiotherapy is recommended. SRS improves median OS in patients with KPS ≤ 80.