EvoluciÓn de pacientes con metástasis cerebral sincrÓnica de carcinoma de pulmÓn no células pequeñas

Objective: to determine and compare median (MS) and overall (OS) survivals of a group of patients with NSCLC and synchronic brain metastasis treated with multimodal therapy (MM) -neurosurgery + radio-chemotherapy-bimodal therapy (BM) -radio-chemotherapy- or radiotherapy alone (RT) Patients and methods: pts. with simultaneous diagnosis of NSCLC and brain metastasis were included. They were evaluated with toraco-abdominal CT scan, bone scintigraphy and brain CT scan. The work-up of pts. eligible for neurosurgery included a brain MRI. Those pts. with one brain metastasis and adequate local (candidates to surgery) tumors were treated with MM. Pts. with multiple brain metastasis or inadequate local tumors were treated with BM or RT. Neurosurgery was adequated to metastasis location. Radiotherapy consisted in holocraneal 5,040 cGys and there were used two chemotherapy schemes (cisplatin 75 mgs-sqm on day 1, vinorelbine 20 mgs-sqm on days 1 and 8 and etoposide 60 mgs-sqm on days 1,2 and 3 or carboplatin AUC 6 and paclitaxel 200 mgs-sqm on day 1). The association of radio-chemotherapy was developed concurrently with the first cycle. MS and I year OS with Kaplan Meier method were determined. Results: from 388 patients with NSCLC treated between 1990 and 1999, 31 were included in the present study. Histology: adeno: 14 pts., squamous: 13 pts. Undifferenciated: 2 pts., Large Cells: 1 pt. Median follow-up for the entire group was 9.8 months. 16/31 pts. had one brain metastasis. 6 were treated with MM and 10 with BM. For pts. with MM, median age was 52.16 (r: 39-54) and MS and OS were 11.66 months and 12% respectively. For pts. with BM, median age was 64.4 (r: 43-78) and MS and OS were 2.8 months and 0% respectively. 15/31 pts. had multiple brain metastasis. 12 pts. received BM and 3 RT. For the first group, median age was 53 (r: 32-71), OS and MS were 4 months and 0% respectively and for the second median age was 54 (r: 38-63), OS and MS were 2.33 months and 0% respectively. One Brain Multiple Brain metastasis metastasis Treatment MM BM BM XRT Median Age 52.16 64.4 53 54.3 MS 11.6 m 2.8 m 3.18 m 2.33 m 1 year OS 12% 0% 0% 0% Conclusions: pts. with brain metastasis of NSCLC had worst MS and OS than those with other metastatic localizations. This rates seems better when it is possible adding surgery to treatment.