Results of Treatment of Patients with Non-Small Cell Lung Cancer with Metastatic Brain Lesions
Introduction. The brain is one of the most common areas for metastasis in non-small cell lung cancer (NSCLC). The presence of metastases in the brain is associated with a poor prognosis, being a life-threatening condition that requires an immediate decision on treatment tactics. The purpose of our study was to study the results of treatment of patients with NSCLC with metastatic brain lesions, depending on prognostic factors. Materials and methods. This is a retrospective study that included 111 consecutive cases of morphologically verified NSCLC living in the Minsk region with diagnosed metastatic brain lesions for the period from 2018 to 2020. The results of treatment in 2 groups of patients were analyzed: 1 - with primary metastatic brain lesion (n=46); 2 - with progression to the brain after previous treatment (n=65). Results. In the first group, the one-year overall survival rate was 22±6%, the median overall survival rate was 4 months. Multivariate analysis data indicate that the presence of multiple brain metastases and the absence of local treatment increase the risk of death by 6.75 times (p=0.0001). The presence of extracranial metastases negatively affects the prognosis by a 2.18-fold increase in the risk of death in patients with metastatic brain lesions (p=0.0294). In the second group, the median time to progression to the brain was 1.08 years. The risk of progression to the brain was significantly higher in patients with locally advanced and metastatic lung cancer who received palliative treatment (p=0.0012). The median overall survival after the onset of brain metastases was 6 months. The group of patients who received conditionally radical treatment was characterized by the best survival rates (p=0.0173). Half of the patients receiving targeted therapy survived 1 year. Conclusions: 1. Given the high incidence of metastatic brain lesions in NSCLC, it is advisable to examine the brain in all patients subject to radical treatment, with the exception of stage IA. 2. Since the life expectancy of patients is primarily determined by metastatic brain lesions, and irradiation of the whole brain is characterized by low efficiency, the possibility of radical treatment (surgical removal, radiosurgery, and their combination) should always be considered, even in patients with extracranial metastases. 3. In patients with metastatic adenocarcinoma of the lung, including those with brain damage, it is necessary to conduct a molecular genetic study of the tumor. When detecting activating mutations, consider the appointment of targeted therapy, since today in the arsenal of oncologists there are drugs that penetrate well through the blood-brain barrier and are characterized by high efficiency in metastatic brain lesions even without local treatment.