Outcome of Patients with Non-Small Cell Lung Cancer (NSCLC) and Brain Metastases: Egyptian Experience

Background: Lung cancer remains the most common primary tumor responsible for brain metastases making up to 40% to 50% of cases. Brain metastases from NSCLC is associated with poor prognosis. Aim: The aim of this study is to analyze the risk factors and treatment outcome of patients with NSCLC who developed brain metastases; and to identify which subgroup of these patients is associated with better survival outcome. Methods: We analyzed all patients with NSCLC presented to Kasralainy Center of Clinical Oncology and Nuclear Medicine (NEMROCK) during the period between January 2006 and December 2012. Seven hundred and fourteen patients were found, from which 132 had clinical evidence of brain metastases. Results: The median time to development of brain metastases (TTBM) was 6 months. Factors associated with longer TTBM were good PS (1-2) (P=0.004), early stages at presentation (stage II good PS (1&2) at development of brain metastases (P<0.0001), controlled lung primary (P<0.0001), absence of extracranial metastases (P=0.019), the use of chemotherapy after development of brain metastases (P<0.0001) and whole brain irradiation (P=0.001). Controlled lung primary and administration of chemotherapy were independent prognostic factors associated with higher OS (P= 0.006 and 0.02 respectively). Conclusion: After development of brain metastases; patients with good PS(1-2), controlled lung primary and absence of extracranial metastases are associated with better outcome than other cases.