Outcomes of non–small cell lung cancer resection in patients with synchronous brain metastases

OBJECTIVES To report on the outcomes in a single centre cohort of patients who underwent resection of their primary lung tumour along with radical treatment of their synchronous brain metastases. Materials and Methods Between 2005 and 2024, 86 patients (35 females and 51 males) with 113 events with a median age of 59 years (range: 52–67) were treated. The most common histological subtype was adenocarcinoma (71 patients, 82.6%). In 70 patients (81.4%), the local treatment for brain metastases was prioritised. This included neurosurgery (N = 50), Gamma Knife radiosurgery (N = 32), or radiotherapy (N = 4). Lung surgeries consisted of lobectomy (N = 77), pneumonectomy or bilobectomy (N = 6), and sublobar resection (N = 3). Related to lung surgery, systemic therapy was administered preoperatively in 48 patients (55.8%), perioperatively in 13 (15.1%) and postoperatively in 16 (18.6%). RESULTS 90-day mortality was 4.6%. The 5-year overall and disease-free survival rates were 43.4% (95% CI: 33.8%–55.6%), and 32.9% (95% CI: 23.6%–45.8%), respectively. Cox regression analysis identified several preoperative variables associated with long-term overall mortality: age (years) (HR = 1.04; 95% CI: 1.01–1.07; p = 0.016), ECOG performance status > 1 (HR = 4.81; 95% CI: 1.99–11.6; p = 0.002), FEV1 ppo (%) (HR = 0.98; 95% CI: 0.96–1; p = 0.034), local lung vs brain consolidative treatment first (HR = 2.05; 95% CI: 1.04–4.04; p = 0.048), and absence of systemic therapy (HR = 2.94; 95% CI: 1.30–6.65; p = 0.018). CONCLUSIONS Curative-intent treatment in selected patients with oligometastatic brain involvement can be performed safely and may result in substantial long-term survival, especially in fit young patients with a good pulmonary function.