Management of Non-small-cell Lung Cancer Patients Initially Diagnosed with 1 to 3 Synchronous Brain-only Metastases: A Retrospective Study

Abstract Background The treatment options for newly diagnosed non-small-cell lung cancer (NSCLC) patients with 1 to 3 synchronous brain metastases (BM) remain controversial. The current study aimed to comprehensively analyze the characteristics, local treatment paradigms and survival outcomes in these subpopulations. Patients and Methods A total of 252 NSCLC patients initially diagnosed with 1 to 3 synchronous brain-only metastases were enrolled in this study. Local therapy (LT) to primary lung tumors (PLT) and BM included surgery, radiotherapy and both. Median overall survival (mOS) was measured among patients who received LT to both PLT and BM (all-LT group), patients who were treated with LT to either PLT or BM (part-LT group) and patients who did not receive any LT (non-LT group). Results The mOS for all-LT (n = 70), part-LT (n = 113), non-LT (n = 69) groups was 33.2 months, 18.5 months, 16.8 months, respectively (p = 0.002). OS rate at 5 years for all-LT, part-LT, and non-LT groups was 25.5%, 16.2%, and 0%, respectively. The multivariable analysis revealed that all-LT versus non-LT, pretreatment Karnofsky Performance Status (KPS) > 70, histology of adenocarcinoma, thoracic stage I-II, epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) positive and second-line systemic therapies were independent prognostic factors for improved mOS. Conclusion The current study showed that the use of LT to both PLT and BM is associated with superior OS in appropriately selected NSCLC patients initially diagnosed with 1 to 3 synchronous BM. Prospective trials are urgently needed to confirm this finding.