Outcome of Surgical Resection of Symptomatic Cerebral Lesions in Non-Small Cell Lung Cancer Patients with Multiple Brain Metastases

OBJECTIVE Patients with symptomatic brain metastases secondary to mass effect are often candidates for surgery. However, many of these surgical candidates are also found to have multiple asymptomatic tumors. This study aimed to determine the outcome of surgical resection of symptomatic brain metastases followed by chemotherapy or radiotherapy (RT) for the remnant asymptomatic lesions in non-small cell lung cancer (NSCLC) patients with multiple brain metastases. METHODS We conducted a retrospective review of the medical records of 51 NSCLC patients with symptomatic multiple brain metastases who underwent surgical resection, of whom 38 had one or more unresected asymptomatic lesions subsequently treated with chemotherapy and/or RT. Thirteen patients underwent resection of all metastatic lesions. RESULTS Median survival for overall patient population after surgical resection was 10.8 months. Median survival for patients with surgical resection of all brain metastases was not significantly different with patients who underwent surgical resection of only symptomatic lesions (6.5 months vs. 10.8 months; p=0.97). There was no statistically significant difference in survival according to the number of tumors (p=0.86, 0.16), or post-surgical treatment modalities (p=0.69). CONCLUSION The survival time of NSCLC patients with multiple brain metastases after surgery for only symptomatic brain metastases is similar to that of patients who underwent surgery for all brain metastases. The remaining asymptomatic lesions may be treated with chemotherapy or radiotherapy. The optimal treatment modality, however, needs to be defined in prospective trials with larger patient cohort.