Introduction: Currently, there is no evidence-based guideline that describes the ideal time from surgery to adjuvant radiotherapy in patients with brain metastases from the lung.
Methods: We retrospectively analyzed 28 patients (median age 62 years, 29% male) who had a craniotomy for cerebral metastases followed by adjuvant radiotherapy at our institution from 2001 to 2016. We categorized patients into one of two groups: 1) early adjuvant radiotherapy (< 6 weeks after surgery) or delayed adjuvant radiotherapy (= 6 weeks after surgery). Our main outcome measures included overall survival and progression-free survival.
Results: Twenty patients had early adjuvant radiotherapy (median time 3.71 weeks). Eight patients had delayed adjuvant radiotherapy (median time 8.57 weeks). The most common reasons for a delay in adjuvant radiation included a complicated postoperative course (n = 3, 38%) and poor postoperative functional status (n = 2, 25%). However, there were no significant differences between groups in the rate of postoperative complications or functional statuses. Overall survival was greater for patients in the early versus delayed adjuvant radiotherapy groups (28 months vs 7 months, P = 0.01). The median clinical follow-up duration was 8 months.
Conclusions: Our results suggest that early adjuvant radiotherapy (less than 6 weeks after surgery for brain metastases) in patients with lung cancer is associated with improved survival. Delayed adjuvant RT with SRI 6 weeks is associated with shorter expected survival of up to 21 post-operative months. However, our study is limited by its retrospective nature, limited sample size, and limited follow-up. Refined studies are needed to more conclusively delineate optimal timing of adjuvant RT after surgical resection of intracranial lung cancer metastases, ideally involving well-powered randomized trials
Patient Care: Our results suggest that patients radiated earlier then their counterparts may be associated with increased survival. Further reserach with larger cohorts may be more conclusive.
Learning Objectives: To investigate if early adjuvant radiotherapy, after surgical resection of cerebral metastases, affects survival outcomes in patients with lung cancer.