Long-term Survival with 18-Fluorodeoxyglucose Positron Emission Tomography-directed Therapy in Non-small Cell Lung Cancer with Synchronous Solitary Brain Metastasis
| Autor: | Phillip Tran, David Ball, Belinda A. Campbell, Gerard G Hanna, Michael MacManus, Neda Haghighi, Greg Wheeler, Shankar Siva, Steven David, Nikki Plumridge, Andrew Wirth, David L Kok, M. Shaw, Mathias Bressel, S.J. Newman, Claire Phillips, N. Bucknell |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Lung Neoplasms Gastroenterology 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Fluorodeoxyglucose F18 Internal medicine Carcinoma Non-Small-Cell Lung Positron Emission Tomography Computed Tomography medicine Carcinoma Humans Radiology Nuclear Medicine and imaging Lung cancer Aged Retrospective Studies Performance status business.industry Brain Neoplasms Hazard ratio Cancer Retrospective cohort study Middle Aged medicine.disease Prognosis Confidence interval Oncology 030220 oncology & carcinogenesis Positron-Emission Tomography Radiopharmaceuticals business Brain metastasis |
| Zdroj: | Clinical oncology (Royal College of Radiologists (Great Britain)). 33(3) |
| ISSN: | 1433-2981 |
| Popis: | At diagnosis,1% of patients with non-small cell lung cancer (NSCLC) have synchronous solitary brain metastasis (SSBM). In prior cohorts without 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) staging, definitive treatment to intracranial and intrathoracic disease showed a 5-year overall survival (OS) of 11-21%. We investigated the long-term survival outcomes for patients with SSBM NSCLC, diagnosed in the FDG-PET/CT era and treated definitively with local therapies to both intracranial and intrathoracic sites of disease.This retrospective study assessed patients staged with FDG-PET/CT who received definitive lung and SSBM treatment from February 1999 to December 2017. A lung-molecular graded prognostic assessment (lung-molGPA) score was assigned for each patient using age, performance status score, and, where carried out, molecular status. Overall survival and progression-free survival (PFS) were calculated using Kaplan-Meier methods. Cox proportional hazard models determined OS and PFS prognostic factors.Forty-nine patients newly diagnosed with NSCLC and SSBM had a median age of 63 years (range 34-76). The median follow-up of all patients was 3.9 years. Thirty-three patients (67%) had ≥T2 disease, 23 (47%) had ≥N2. At 2 years, 45% of first failures were intracranial only (95% confidence interval 30-59). At 3 and 5 years, OS was 45% (95% confidence interval 32-63) and 30% (95% confidence interval 18-51), respectively. In ≥N1 disease, 5-year OS was 34% (95% confidence interval 18-63). The 3- and 5-year PFS was 8% (95% confidence interval 3-22) and 0%, respectively. Higher lung-molGPA was associated with longer OS (hazard ratio 0.26, 95% confidence interval 0.11-0.61, P = 0.002). Higher lung-molGPA (hazard ratio 0.33, 95% confidence interval 0.15-0.71, P = 0.005) and lower N-stage (hazard ratio 1.56, 95% confidence interval 1.13-2.15, P = 0.007) were associated with longer PFS.Definitive treatment of patients with NSCLC and SSBM staged with FDG-PET/CT can result in 5-year survivors, including those with ≥N1 disease. |
| Databáze: | OpenAIRE |
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