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Radiosurgery for patients with recurrent small cell lung
carcinoma metastatic to the brain: outcomes and prognostic factors
Sheehan J, Kondziolka D, Flickinger J, Lunsford LD
Department of Neurological Surgery, University of Virginia, Charlottesville,
Virginia 22908, USA. jps2f@virginia.edu
Object. Lung carcinoma is the leading cause of death from cancer.
More than
50% of those with small cell lung cancer develop a brain metastasis.
Corticosteroid agents, radiotherapy, and resection have been the mainstays
of treatment.
Nonetheless, median survival for patients with small cell lung
carcinoma metastasis is approximately 4 to 5 months after cranial
irradiation.
In this study the authors examine the efficacy of gamma knife
surgery for treating recurrent small cell lung carcinoma metastases to the
brain following tumor growth in patients who have previously undergone
radiation therapy, and they evaluate factors affecting survival.
Methods. A
retrospective review of 27 patients (47 recurrent small cell lung cancer
brain metastases) undergoing radiosurgery was performed.
Clinical and
radiographic data obtained during a 14-year treatment period were collected.
Multivariate analysis was utilized to determine significant prognostic
factors influencing survival.
The overall median survival was 18 months
after the diagnosis of brain metastases.
In multivariate analysis, factors
significantly affecting survival included: 1) tumor volume (p = 0.0042); 2)
preoperative Karnofsky Performance Scale score (p = 0.0035); and 3) time
between initial lung cancer diagnosis and development of brain metastasis (p
= 0.0127).
Postradiosurgical imaging of the brain metastases revealed that
62% decreased, 19% remained stable, and 19% eventually increased in size.
One patient later underwent a craniotomy and tumor resection for a tumor
refractory to radiosurgery and radiation therapy.
In three patients new
brain metastases were demonstrating on follow-up imaging.
Conclusions.
Stereotactic radiosurgery for recurrent small cell lung carcinoma metastases
provided effective local tumor control in the majority of patients.
Early
detection of brain metastases, aggressive treatment of systemic disease, and
a therapeutic strategy including radiosurgery can extend survival.
PMID: 15662819 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15662819
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