Factors associated with the development of brain metastases |
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Authors: | Jessica L Hubbs MS Jessamy A Boyd MD Donna Hollis MS Junzo P Chino MD Mert Saynak MD Chris R Kelsey MD |
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Institution: | 1. Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina;2. Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina;3. Duke Cancer Center Biostatistics, Duke University Medical Center, Durham, North Carolina;4. Department of Radiation Oncology, Trakya University Hospital, Edirne, Turkey;5. Department of Radiation Oncology, Duke University Medical Center, Durham, North CarolinaFax: (919) 668‐7345 |
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Abstract: | BACKGROUND The risk of developing brain metastases after definitive treatment of locally advanced nonsmall cell lung cancer (NSCLC) is approximately 30%‐50%. The risk for patients with early stage disease is less defined. The authors sought to investigate this further and to study potential risk factors. METHODS The records of all patients who underwent surgery for T1‐T2 N0‐N1 NSCLC at Duke University between the years 1995 and 2005 were reviewed. The cumulative incidence of brain metastases and distant metastases was estimated by using the Kaplan‐Meier method. A multivariate analysis assessed factors associated with the development of brain metastases. RESULTS Of 975 consecutive patients, 85% were stage I, and 15% were stage II. Adjuvant chemotherapy was given to 7%. The 5‐year actuarial risk of developing brain metastases and distant metastases was 10%(95% confidence interval CI], 8‐13) and 34%(95% CI, 30‐39), respectively. Of patients developing brain metastases, the brain was the sole site of failure in 43%. On multivariate analysis, younger age (hazard ratio HR], 1.03 per year), larger tumor size (HR, 1.26 per cm), lymphovascular space invasion (HR, 1.87), and hilar lymph node involvement (HR, 1.18) were associated with an increased risk of developing brain metastases. CONCLUSIONS In this large series of patients treated surgically for early stage NSCLC, the 5‐year actuarial risk of developing brain metastases was 10%. A better understanding of predictive factors and biological susceptibility is needed to identify the subset of patients with early stage NSCLC who are at particularly high risk. Cancer 2010. © 2010 American Cancer Society. |
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Keywords: | nonsmall cell lung cancer brain metastases patterns of failure prophylactic cranial irradiation |
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