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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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The fading relevance of the quantity of brain metastases in patients with non-small cell lung cancer

Die abklingende Relevanz der Anzahl von Hirnmetastasen bei Patienten mit nicht-kleinzelligen Bronchialkarzinom

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  • presenting/speaker David Reinecke - Universitätsklinikum Köln, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Stephanie T. Jünger - Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
  • Martin Kocher - Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
  • Lucia Nogova - Universitätsklinikum Köln, Klinik für Innere Medizin I - Onkologie, Köln, Deutschland
  • Marie-Lisa Eich - Universitätsklinikum Köln, Klinik für Pathologie, Köln, Deutschland
  • Maximilian I. Ruge - Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
  • Daniel Rueß - Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
  • Roland Goldbrunner - Universitätsklinikum Köln, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Stefan Grau - Universitätsklinikum Köln, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV164

doi: 10.3205/22dgnc160, urn:nbn:de:0183-22dgnc1607

Published: May 25, 2022

© 2022 Reinecke et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: That the number of brain metastases (BM) is included in prognostic assessment models for patients with non-small cell lung cancer (NSCLC). However, the underlying data were generated in an era with limited systemic treatment options. With rapidly changing treatment modalities based on a growing number of targeted driver mutations, the importance of the mere BM count is questionable.

Methods: We retrospectively analysed NSCLC patients treated for BM between 2010 and 2020. Demographics, baseline characteristics and tumor-associated parameters were retrieved from an electronic database. Prognostic factors for LC and OS were identified using log rank test and Cox regression analysis.

Results: We included 343 patients with BM (male n=187, female n=156; median age 61 (range 32-87 years)). Histological subtypes were adenocarcinoma (n=283), squamous-cell carcinoma (n=42) and large cell neuroendocrine carcinoma (n=18). The number of BM was singular/solitary in 189, oligometastatic (2-3) in 110, and multiple (>4) in 44 patients. Local treatment comprised surgical resection followed by radiotherapy (n=218) or stereotactic radiosurgery (n=125). Additive systemic therapy was initiated in 203 patients. The median LC was 11 months (95%CI 8.5 – 13.5) and the median OS was 16 months (95%CI 12.8 – 19.2) for all patients. The number of BM neither influenced LC nor OS rates (p=.234 and p=.210, respectively). Controlled systemic disease (HR0.42; 95%CI 0.284-0.633; p=.001), Karnofsky Performance Status >70 (HR0.41; 95%CI 0.265-0.661; p=.001), and additive systemic therapy (HR0.38; 95%CI 0.279-0.530; p=.001) were independent prognostic factors for LC and OS.

Conclusion: The quantity of brain metastases alone is not a prognostic factor for LC and OS in NSCLC patients anymore in a multimodal treatment setting.