Metastatic Non-small Cell Lung Cancer

Radiosurgery Case History #1 - Metastatic Non-small Cell Lung Cancer

A 58 year old man with new lesions after whole brain radiotherapy and chemotherapy.



Ten months following radiosurgery, (20Gy to 50%) the lesions have almost completely resolved.

The problem. Lung cancer is the most frequent source of metastatic lesions of the brain, with a median survival of only 7 weeks without treatment and 5 months with whole brain radiotherapy (WBRT). Surgical resection increases survival to 11 months for patients with single lesions, but surgery is not feasible for all patients and often impractical for with mulitple lesions.

The question. Does the local tumor control provided by radiosurgery translate into a survival benefit or to better quality of life?

The studies. Many large studies document the efficacy of radiosurgery for metastatic lung cancer. For example:

• A report of 191 patients showed a median survival of 14 months and a local control rate of 91% at 12 months^1.
• A report of 504 patients showed a median survival of 14.5 months, a local control rate of 94% at 16 months and good quality of life indices².
• The recent randomized prospective RTOG 9805 trial showed that adding radiosurgrey to WBRT conferred better local control, longer median survival (6.5 vs. 4.9 months) in patients with solitary metastatic lesions, and better functional status³.

Advantages of radiosurgery. Because radiosurgery is non-invasive, it is suitable for patients unable to undergo a craniotomy and for surgically difficult lesions that are deep or multiple. Radiosurgery can be repeated for new and recurrent lesions.

Risks of radiosurgery. The risk of radionecrosis is usually less than 5 percent. Radiosurgery induced malignancies have been reported but are extremely rare and occur years following treatment.

The role of radiosurgery vs. WBRT. Although radiosurgery plus WBRT has advantages over WBRT alone, comparison to radiosurgery remains an important question because many patients choose radiosurgery alone out of fear that WBRT will produce cognitive decline. However, partial results of a new randomized phase III trial argue in favor of combined therapy because the risk of new lesions decreases from 45 percent to 15 percent when WBRT is added to radiosurgery⁴.

Conclusion.Radiosurgery for metastatic lung cancer of the brain confers improved survival, local control and quality of life. Morbidity is low. Optimal therapy may be a combination of radiosurgery and WBRT.

1. Pan HC et al Journal of Neurosurgery 2005
2. Gerosa et al Journal of Neurosurgery 2005
3. Andrews et al Lancet, 2004
4. Jawahar, et al AANS conference, New Orleans, 2005

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Radiosurgery Case History #2 - Intracranial Meningiomas