Brain Metastases from Lung Cancer
A good friend of mine was recently diagnosed with brain metastases from his lung cancer, adenocarcinoma type. The neurosurgeon said to him that surgery is the treatment of choice for his case. He was also seen by a radiation oncologist who claimed that radiation therapy is just as effective as surgery. Could you help him?
Li Liu, MD, OncoLink Editorial Assistant, responds:
In general, treatment of brain metastases is based on the number and location of the brain metastases, status of disease in the rest of the body, patient age, and the overall condition of the patient. For most of the patients with brain metastases, radiation therapy is an appropriate treatment method. This can be delivered as a series of treatments daily for one week or more typically several weeks to the entire brain, or as a single treatment using high-dose stereotactic radiosurgery focused on treating only the sites of brain metastases seen on imaging.
For non-small cell lung cancer patients with a single metastasis to the brain who have good performance status, no other sites of disease outside of the chest, and controlled or limited disease in the chest, surgical resection plus radiotherapy can be used.
One study by Dr. Patchell reported a randomized trial comparing surgical resection plus post-operative radiation therapy versus radiation therapy alone in patients with single brain metastasis. This study was published in the New England Journal of Medicine on February 22, 1990. Patients who received treatment with surgical resection plus radiation therapy lived longer, had fewer recurrences of cancer in the brain, and had a better quality of life than patients treated with radiation therapy alone. A more recent study also from Dr. Patchell published in the Journal of American Medical Association on November 4, 1998 demonstrated that post-operative radiotherapy prevented tumor recurrence at the site of the original brain metastasis and at other sites in the brain. Patients receiving surgery and radiation therapy were less likely to die of neurologic causes than patients receiving surgery alone. However, there was no significant difference in the overall length of survival if radiation therapy was or was not added to surgery. For the patients with more than one metastasis in the brain, treatment decisions are made on an individual basis for each patient, but surgery is generally reserved for patients with very symptomatic brain lesions. Your friend should discuss his case with his oncologists.