Tumor histology predicts patterns of failure and survival in patients with brain metastases from lung cancer treated with gamma knife radiosurgery

J. Griff Kuremsky, James J. Urbanic, W. Jeff Petty, James F. Lovato, J. Daniel Bourland, Stephen B. Tatter, Thomas L. Ellis, Kevin P. McMullen, Edward G. Shaw, Michael D. Chan

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

BACKGROUND:: We review our experience with lung cancer patients with newly diagnosed brain metastases treated with Gamma Knife radiosurgery (GKRS). OBJECTIVE:: To determine whether tumor histology predicts patient outcomes. METHODS:: Between July 1, 2000, and December 31, 2010, 271 patients with brain metastases from primary lung cancer were treated with GKRS at our institution. Included in our study were 44 squamous cell carcinoma (SCC), 31 small cell carcinoma (SCLC), and 138 adenocarcinoma (ACA) patients; 47 patients with insufficient pathology to determine subtype were excluded. No non-small cell lung cancer (NSCLC) patients received whole-brain radiation therapy (WBRT) before their GKRS, and SCLC patients were allowed to have prophylactic cranial irradiation, but no previously known brain metastases. A median of 2 lesions were treated per patient with median marginal dose of 20 Gy. RESULTS:: Median survival was 10.2 months for ACA, 5.9 months for SCLC, and 5.3 months for SCC patients (P = .008). The 1-year local control rates were 86%, 86%, and 54% for ACA, SCC, and SCLC, respectively (P = .027). The 1-year distant failure rates were 35%, 63%, and 65% for ACA, SCC, and SCLC, respectively (P = .057). The likelihood of dying of neurological death was 29%, 36%, and 55% for ACA, SCC, and SCLC, respectively (P = .027). The median time to WBRT was 11 months for SCC and 24 months for ACA patients (P = .04). Multivariate analysis confirmed SCLC histology as a significant predictor of worsened local control (hazard ratio [HR]: 6.46, P = .025) and distant failure (HR: 3.32, P = .0027). For NSCLC histologies, SCC predicted for earlier time to salvage WBRT (HR: 2.552, P = .01) and worsened overall survival (HR: 1.77, P <.0121). CONCLUSION:: Histological subtype of lung cancer appears to predict outcomes. Future trials and prognostic indices should take these histology-specific patterns into account.

Original languageEnglish (US)
Pages (from-to)641-647
Number of pages7
JournalNeurosurgery
Volume73
Issue number4
DOIs
StatePublished - Oct 2013
Externally publishedYes

Fingerprint

Radiosurgery
Lung Neoplasms
Small Cell Carcinoma
Histology
Neoplasm Metastasis
Squamous Cell Carcinoma
Survival
Brain
Adenocarcinoma
Neoplasms
Radiotherapy
Non-Small Cell Lung Carcinoma
Cranial Irradiation
Safety Management
Multivariate Analysis
Pathology

Keywords

  • Cranial metastases
  • Lung cancer
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Kuremsky, J. G., Urbanic, J. J., Petty, W. J., Lovato, J. F., Bourland, J. D., Tatter, S. B., ... Chan, M. D. (2013). Tumor histology predicts patterns of failure and survival in patients with brain metastases from lung cancer treated with gamma knife radiosurgery. Neurosurgery, 73(4), 641-647. https://doi.org/10.1227/NEU.0000000000000072

Tumor histology predicts patterns of failure and survival in patients with brain metastases from lung cancer treated with gamma knife radiosurgery. / Kuremsky, J. Griff; Urbanic, James J.; Petty, W. Jeff; Lovato, James F.; Bourland, J. Daniel; Tatter, Stephen B.; Ellis, Thomas L.; McMullen, Kevin P.; Shaw, Edward G.; Chan, Michael D.

In: Neurosurgery, Vol. 73, No. 4, 10.2013, p. 641-647.

Research output: Contribution to journalArticle

Kuremsky, JG, Urbanic, JJ, Petty, WJ, Lovato, JF, Bourland, JD, Tatter, SB, Ellis, TL, McMullen, KP, Shaw, EG & Chan, MD 2013, 'Tumor histology predicts patterns of failure and survival in patients with brain metastases from lung cancer treated with gamma knife radiosurgery', Neurosurgery, vol. 73, no. 4, pp. 641-647. https://doi.org/10.1227/NEU.0000000000000072
Kuremsky, J. Griff ; Urbanic, James J. ; Petty, W. Jeff ; Lovato, James F. ; Bourland, J. Daniel ; Tatter, Stephen B. ; Ellis, Thomas L. ; McMullen, Kevin P. ; Shaw, Edward G. ; Chan, Michael D. / Tumor histology predicts patterns of failure and survival in patients with brain metastases from lung cancer treated with gamma knife radiosurgery. In: Neurosurgery. 2013 ; Vol. 73, No. 4. pp. 641-647.
@article{6c2e56fec21a4baaa0b219b74c088779,
title = "Tumor histology predicts patterns of failure and survival in patients with brain metastases from lung cancer treated with gamma knife radiosurgery",
abstract = "BACKGROUND:: We review our experience with lung cancer patients with newly diagnosed brain metastases treated with Gamma Knife radiosurgery (GKRS). OBJECTIVE:: To determine whether tumor histology predicts patient outcomes. METHODS:: Between July 1, 2000, and December 31, 2010, 271 patients with brain metastases from primary lung cancer were treated with GKRS at our institution. Included in our study were 44 squamous cell carcinoma (SCC), 31 small cell carcinoma (SCLC), and 138 adenocarcinoma (ACA) patients; 47 patients with insufficient pathology to determine subtype were excluded. No non-small cell lung cancer (NSCLC) patients received whole-brain radiation therapy (WBRT) before their GKRS, and SCLC patients were allowed to have prophylactic cranial irradiation, but no previously known brain metastases. A median of 2 lesions were treated per patient with median marginal dose of 20 Gy. RESULTS:: Median survival was 10.2 months for ACA, 5.9 months for SCLC, and 5.3 months for SCC patients (P = .008). The 1-year local control rates were 86{\%}, 86{\%}, and 54{\%} for ACA, SCC, and SCLC, respectively (P = .027). The 1-year distant failure rates were 35{\%}, 63{\%}, and 65{\%} for ACA, SCC, and SCLC, respectively (P = .057). The likelihood of dying of neurological death was 29{\%}, 36{\%}, and 55{\%} for ACA, SCC, and SCLC, respectively (P = .027). The median time to WBRT was 11 months for SCC and 24 months for ACA patients (P = .04). Multivariate analysis confirmed SCLC histology as a significant predictor of worsened local control (hazard ratio [HR]: 6.46, P = .025) and distant failure (HR: 3.32, P = .0027). For NSCLC histologies, SCC predicted for earlier time to salvage WBRT (HR: 2.552, P = .01) and worsened overall survival (HR: 1.77, P <.0121). CONCLUSION:: Histological subtype of lung cancer appears to predict outcomes. Future trials and prognostic indices should take these histology-specific patterns into account.",
keywords = "Cranial metastases, Lung cancer, Stereotactic radiosurgery",
author = "Kuremsky, {J. Griff} and Urbanic, {James J.} and Petty, {W. Jeff} and Lovato, {James F.} and Bourland, {J. Daniel} and Tatter, {Stephen B.} and Ellis, {Thomas L.} and McMullen, {Kevin P.} and Shaw, {Edward G.} and Chan, {Michael D.}",
year = "2013",
month = "10",
doi = "10.1227/NEU.0000000000000072",
language = "English (US)",
volume = "73",
pages = "641--647",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Tumor histology predicts patterns of failure and survival in patients with brain metastases from lung cancer treated with gamma knife radiosurgery

AU - Kuremsky, J. Griff

AU - Urbanic, James J.

AU - Petty, W. Jeff

AU - Lovato, James F.

AU - Bourland, J. Daniel

AU - Tatter, Stephen B.

AU - Ellis, Thomas L.

AU - McMullen, Kevin P.

AU - Shaw, Edward G.

AU - Chan, Michael D.

PY - 2013/10

Y1 - 2013/10

N2 - BACKGROUND:: We review our experience with lung cancer patients with newly diagnosed brain metastases treated with Gamma Knife radiosurgery (GKRS). OBJECTIVE:: To determine whether tumor histology predicts patient outcomes. METHODS:: Between July 1, 2000, and December 31, 2010, 271 patients with brain metastases from primary lung cancer were treated with GKRS at our institution. Included in our study were 44 squamous cell carcinoma (SCC), 31 small cell carcinoma (SCLC), and 138 adenocarcinoma (ACA) patients; 47 patients with insufficient pathology to determine subtype were excluded. No non-small cell lung cancer (NSCLC) patients received whole-brain radiation therapy (WBRT) before their GKRS, and SCLC patients were allowed to have prophylactic cranial irradiation, but no previously known brain metastases. A median of 2 lesions were treated per patient with median marginal dose of 20 Gy. RESULTS:: Median survival was 10.2 months for ACA, 5.9 months for SCLC, and 5.3 months for SCC patients (P = .008). The 1-year local control rates were 86%, 86%, and 54% for ACA, SCC, and SCLC, respectively (P = .027). The 1-year distant failure rates were 35%, 63%, and 65% for ACA, SCC, and SCLC, respectively (P = .057). The likelihood of dying of neurological death was 29%, 36%, and 55% for ACA, SCC, and SCLC, respectively (P = .027). The median time to WBRT was 11 months for SCC and 24 months for ACA patients (P = .04). Multivariate analysis confirmed SCLC histology as a significant predictor of worsened local control (hazard ratio [HR]: 6.46, P = .025) and distant failure (HR: 3.32, P = .0027). For NSCLC histologies, SCC predicted for earlier time to salvage WBRT (HR: 2.552, P = .01) and worsened overall survival (HR: 1.77, P <.0121). CONCLUSION:: Histological subtype of lung cancer appears to predict outcomes. Future trials and prognostic indices should take these histology-specific patterns into account.

AB - BACKGROUND:: We review our experience with lung cancer patients with newly diagnosed brain metastases treated with Gamma Knife radiosurgery (GKRS). OBJECTIVE:: To determine whether tumor histology predicts patient outcomes. METHODS:: Between July 1, 2000, and December 31, 2010, 271 patients with brain metastases from primary lung cancer were treated with GKRS at our institution. Included in our study were 44 squamous cell carcinoma (SCC), 31 small cell carcinoma (SCLC), and 138 adenocarcinoma (ACA) patients; 47 patients with insufficient pathology to determine subtype were excluded. No non-small cell lung cancer (NSCLC) patients received whole-brain radiation therapy (WBRT) before their GKRS, and SCLC patients were allowed to have prophylactic cranial irradiation, but no previously known brain metastases. A median of 2 lesions were treated per patient with median marginal dose of 20 Gy. RESULTS:: Median survival was 10.2 months for ACA, 5.9 months for SCLC, and 5.3 months for SCC patients (P = .008). The 1-year local control rates were 86%, 86%, and 54% for ACA, SCC, and SCLC, respectively (P = .027). The 1-year distant failure rates were 35%, 63%, and 65% for ACA, SCC, and SCLC, respectively (P = .057). The likelihood of dying of neurological death was 29%, 36%, and 55% for ACA, SCC, and SCLC, respectively (P = .027). The median time to WBRT was 11 months for SCC and 24 months for ACA patients (P = .04). Multivariate analysis confirmed SCLC histology as a significant predictor of worsened local control (hazard ratio [HR]: 6.46, P = .025) and distant failure (HR: 3.32, P = .0027). For NSCLC histologies, SCC predicted for earlier time to salvage WBRT (HR: 2.552, P = .01) and worsened overall survival (HR: 1.77, P <.0121). CONCLUSION:: Histological subtype of lung cancer appears to predict outcomes. Future trials and prognostic indices should take these histology-specific patterns into account.

KW - Cranial metastases

KW - Lung cancer

KW - Stereotactic radiosurgery

UR - http://www.scopus.com/inward/record.url?scp=84885049210&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84885049210&partnerID=8YFLogxK

U2 - 10.1227/NEU.0000000000000072

DO - 10.1227/NEU.0000000000000072

M3 - Article

VL - 73

SP - 641

EP - 647

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 4

ER -