For patients with non-small cell lung cancer (NSCLC) presenting with brain oligometastases, the optimal treatment sequence of thoracic and metastatic treatment is not well-established. This study sought to evaluate long-term survival of patients with NSCLC with brain oligometastases who received initial treatment of the primary site lung tumor versus brain metastases.
Patients with cT1-4, N0-3, M1b-c NSCLC with synchronous limited metastatic disease isolated to the brain who received systemic therapy with radical treatment (surgery, brain stereotactic radiosurgery, or lung radiation) to both the primary site and metastases in the National Cancer Database from 2010–2019 were included. Patients who received whole brain radiation therapy or palliative treatment were excluded. Long-term overall survival of patients who received initial treatment to the brain versus lung was evaluated using Kaplan-Meier analysis, Cox proportional hazards modeling, and propensity score matching, on 15 common prognostic variables including comorbidities, clinical T/N status, and the specific type of treatment to each site.
Of the 1,044 patients diagnosed with NSCLC with brain oligometastases who met the study inclusion criteria, 893 (79.0%) received treatment of the brain metastases first, and 237 (21.0%) received treatment to the lung first. In unadjusted Kaplan-Meier analysis, overall survival was similar between patients who underwent initial treatment of brain metastases versus primary site. No significant difference in overall survival was found between the two groups after multivariable-adjusted Cox proportional hazards modeling (HR: 1.24, 95% CI: 0.91–1.70, p = 0.17). In a propensity score-matched analysis of 230 patients (115 in each arm), treatment sequence of brain metastases versus lung was not significantly associated with 5-year overall survival (Brain: 38.2% [95% CI: 27.5–34.4] vs Lung: 38.0% [95% CI: 29.9–44.7], p = 0.32).
The findings of this study suggest that for patients presenting with NSCLC with synchronous limited metastatic disease isolated to the brain who can tolerate aggressive treatment of the primary and metastatic sites, treatment sequence does not impact overall survival.
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