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Surgical Management of Non-small Cell Lung Cancer With Synchronous Brain Metastases^*

Pierre Bonnette, MD; Philippe Puyo, MD; Christophe Gabriel, MD; Roger Giudicelli, MD; Jean-François Regnard, MD; Marc Riquet, MD; Pierre-Yves Brichon, MD and nd the Groupe Thorax

^* From the Department of Thoracic Surgery (Drs. Bonnette and Puyo) and the Department of Statistics (Dr. Gabriel), Hôpital Foch, Suresnes, France; the Department of Thoracic Surgery (Dr. Giudicelli), Hôpital Ste-Marguerite, Marseille, France; the Department of Thoracic Surgery (Dr. Regnard), Hôpital Marie Lannelongue, Le Plessis-Robinson, France; the Department of Thoracic Surgery (Dr. Riquet), Hôpital Laënnec, Paris, France; and the Department of Thoracic Surgery (Dr. Brichon), Hôpital La Tronche, Grenoble, France. A complete list of Groupe Thorax investigators and participating centers is located in the ^Appendix.

Correspondence to: Pierre Bonnette, MD, Service de Chirurgie Thoracique, Hôpital Foch, BP 36, 40 rue Worth, 92151 Suresnes, France; e-mail: pierre.bonnette{at}wanadoo.fr

Objectives: Published series on the synchronous combined resection of brain metastases and primary non-small cell lung cancer are small and scarce. We therefore undertook a multicenter retrospective study to determine long-term survival and identify potential prognostic factors.

Design: Our series includes 103 patients who were operated on between 1985 and 1998 for the following tumors: adenocarcinomas (74); squamous cell carcinomas (20); and large cell carcinomas (9). Three patients had two brain metastases, and one patient had three metastases; the remaining patients had a single metastasis. Ninety-three patients presented with neurologic signs that regressed completely after resection in 60 patients and partially, in 26 patients. Neurosurgical resection was incomplete in six patients. Seventy-five patients received postoperative brain radiotherapy. The time interval between the brain operation and the lung resection was < 4 months. Pulmonary resection was incomplete in eight patients.

Results: The survival calculated from the date of the first operation was 56% at 1 year, 28% at 2 years, and 11% at 5 years. Univariate analysis showed a better prognosis for adenocarcinomas (p = 0.019) and a trend toward a better prognosis for patients with small pulmonary tumors (T1 vs T3, p = 0.068), N0 stage disease (N0 vs N+, p = 0.069), and complete pulmonary resection (p = 0.057). In a multivariate analysis, adenocarcinoma histology also affected the survival rate (p = 0.03).

Conclusions: It seems legitimate to proceed with lung resection after complete resection of a single brain metastasis, at least in patients with an adenocarcinoma and a small lung tumor and without abnormal mediastinal lymph nodes seen on the CT scan or during mediastinoscopy.

Key Words: brain neoplasms • lung neoplasms • neoplasm metastasis • neurosurgery • survival rate • thoracic surgery

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