Factors Affecting 2-Year Survival in Patients With Non-Small Cell Lung Cancer Brain Metastases: Evidence from Indonesia's National Cancer Center, Jakarta, Indonesia

Overview

Journal Clin Med Insights Oncol

Publisher Sage Publications

Specialty Oncology

Date 2023 Jun 26

PMID 37359276

Authors

Rini Andriani

Joice Rosewitasari

Muhammad Alfin Hanif

Achmad Mulawarman

Sri Agustini Kurniawati

Achmad Fachri

Affiliations

Soon will be listed here.

Abstract

Background: Brain metastases are a common complication in a wide range of cancers but are ubiquitous among patients with lung cancer. Limited data are available on the survival of patients with lung cancer and brain metastases in Indonesia. In this study, we aimed to identify the factors that might contribute to and predict survival in patients with non-small cell lung cancer (NSCLC) that resulted in brain metastases.

Methods: This retrospective study on patients with NSCLC and brain metastases was conducted using data available from the medical records of the Dharmais National Cancer Hospital, Jakarta, Indonesia. The study outcome was survival time, which was associated with sex, age, smoking status, body mass index, number of brain metastases, tumor location, systemic therapy, and other therapies. Descriptive statistics, median survival, Kaplan-Meier graphs, and Cox regression were analyzed using SPSS version 27.

Results: We included 111 patients with NSCLC and brain metastases in this study. The median patient age was 58 years. Long survivorship was observed among women (median: 95.4 weeks; < .0003), patients with epidermal growth factor receptor (EGFR) mutations (median: 41.8 weeks; < .0492), those who received chemotherapy (median: 58 weeks; < .000), and those who received a combination of surgery and whole brain radiotherapy (WBRT; median: 64.7 weeks; = .0174). Multivariate analysis showed consistent results for the following factors: sex, EGFR mutations, systemic therapy, and surgery plus WBRT.

Conclusions: Female sex and EGFR mutations in patients with NSCLC and brain metastases are associated with a high survival rate. Patients who have NSCLC with brain metastases will benefit from treatment with EGFR tyrosine kinase inhibitors, chemotherapy, and surgery plus WBRT.

References

Myall N, Yu H, Soltys S, Wakelee H, Pollom E . Management of brain metastases in lung cancer: evolving roles for radiation and systemic treatment in the era of targeted and immune therapies. Neurooncol Adv. 2021; 3(Suppl 5):v52-v62. PMC: 8633733. DOI: 10.1093/noajnl/vdab106. View

Ortuzar W, Hanna N, Pennella E, Peng G, Langer C, Monberg M . Brain metastases as the primary site of relapse in two randomized phase III pemetrexed trials in advanced non-small-cell lung cancer. Clin Lung Cancer. 2011; 13(1):24-30. DOI: 10.1016/j.cllc.2011.05.007. View

Patchell R, Tibbs P, Walsh J, Dempsey R, Maruyama Y, Kryscio R . A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990; 322(8):494-500. DOI: 10.1056/NEJM199002223220802. View

Getman V, Devyatko E, Dunkler D, Eckersberger F, End A, Klepetko W . Prognosis of patients with non-small cell lung cancer with isolated brain metastases undergoing combined surgical treatment. Eur J Cardiothorac Surg. 2004; 25(6):1107-13. DOI: 10.1016/j.ejcts.2004.02.021. View

Gupta S, Singh S, Chophy A, Nair S, Ahuja R, Kusum K . Analysis of prognostic factors in patients with brain metastases affecting survival. J Egypt Natl Canc Inst. 2022; 34(1):45. PMC: 9628477. DOI: 10.1186/s43046-022-00146-z. View

Schouten L, Rutten J, Huveneers H, Twijnstra A . Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer. 2002; 94(10):2698-705. DOI: 10.1002/cncr.10541. View

Chamberlain M, Baik C, Gadi V, Bhatia S, Chow L . Systemic therapy of brain metastases: non-small cell lung cancer, breast cancer, and melanoma. Neuro Oncol. 2016; 19(1):i1-i24. PMC: 5193029. DOI: 10.1093/neuonc/now197. View

Bajard A, Westeel V, Dubiez A, Jacoulet P, Pernet D, Dalphin J . Multivariate analysis of factors predictive of brain metastases in localised non-small cell lung carcinoma. Lung Cancer. 2004; 45(3):317-23. DOI: 10.1016/j.lungcan.2004.01.025. View

Guerrieri M, Wong K, Ryan G, Millward M, Quong G, Ball D . A randomised phase III study of palliative radiation with concomitant carboplatin for brain metastases from non-small cell carcinoma of the lung. Lung Cancer. 2004; 46(1):107-11. DOI: 10.1016/j.lungcan.2004.02.019. View

10.

Lin J, Cardarella S, Lydon C, Dahlberg S, Jackman D, Janne P . Five-Year Survival in EGFR-Mutant Metastatic Lung Adenocarcinoma Treated with EGFR-TKIs. J Thorac Oncol. 2016; 11(4):556-65. PMC: 4979601. DOI: 10.1016/j.jtho.2015.12.103. View

11.

Chua D, Krzakowski M, Chouaid C, Pallotta M, Martinez J, Gottfried M . Whole-brain radiation therapy plus concomitant temozolomide for the treatment of brain metastases from non-small-cell lung cancer: a randomized, open-label phase II study. Clin Lung Cancer. 2010; 11(3):176-81. DOI: 10.3816/CLC.2010.n.022. View

12.

Govindan R, Page N, Morgensztern D, Read W, Tierney R, Vlahiotis A . Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol. 2006; 24(28):4539-44. DOI: 10.1200/JCO.2005.04.4859. View

13.

Ali A, Goffin J, Arnold A, Ellis P . Survival of patients with non-small-cell lung cancer after a diagnosis of brain metastases. Curr Oncol. 2013; 20(4):e300-6. PMC: 3728058. DOI: 10.3747/co.20.1481. View

14.

Barnholtz-Sloan J, Sloan A, Davis F, Vigneau F, Lai P, Sawaya R . Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol. 2004; 22(14):2865-72. DOI: 10.1200/JCO.2004.12.149. View

15.

Yen C, Wu W, Chen Y, Chang W, Yang S, Shen S . Surgical resection of brain metastases prolongs overall survival in non-small-cell lung cancer. Am J Cancer Res. 2022; 11(12):6160-6172. PMC: 8727818. View

16.

Andratschke N, Kraft J, Nieder C, Tay R, Califano R, Soffietti R . Optimal management of brain metastases in oncogenic-driven non-small cell lung cancer (NSCLC). Lung Cancer. 2019; 129:63-71. DOI: 10.1016/j.lungcan.2018.12.009. View

17.

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M . Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2014; 136(5):E359-86. DOI: 10.1002/ijc.29210. View

18.

Rick J, Shahin M, Chandra A, Dalle Ore C, Yue J, Nguyen A . Systemic therapy for brain metastases. Crit Rev Oncol Hematol. 2019; 142:44-50. PMC: 6746616. DOI: 10.1016/j.critrevonc.2019.07.012. View

19.

Kim S, Uhm J, Lee J, Sun J, Sohn I, Kim S . Randomized phase II study of gefitinib versus erlotinib in patients with advanced non-small cell lung cancer who failed previous chemotherapy. Lung Cancer. 2011; 75(1):82-8. DOI: 10.1016/j.lungcan.2011.05.022. View

20.

Sun D, Hu L, Cai Y, Li X, Ye L, Hou H . A systematic review of risk factors for brain metastases and value of prophylactic cranial irradiation in non-small cell lung cancer. Asian Pac J Cancer Prev. 2014; 15(3):1233-9. DOI: 10.7314/apjcp.2014.15.3.1233. View