• Assaf Berger, Reed Mullen, Kenneth Bernstein, Juan Diego Alzate, Joshua S Silverman, Erik P Sulman, Bernadine R Donahue, Abraham Chachoua, Elaine Shum, Vamsidhar Velcheti, Joshua Sabari, John G Golfinos, and Douglas Kondziolka.
• Department of Neurological Surgery, NYU Langone Health Medical Center, New York University, New York, New York, USA.
• Neurosurgery. 2023 Jul 1; 93 (1): 505950-59.

BackgroundBrain metastases (BM) have long been considered a terminal diagnosis with management mainly aimed at palliation and little hope for extended survival. Use of brain stereotactic radiosurgery (SRS) and/or resection, in addition to novel systemic therapies, has enabled improvements in overall and progression-free (PFS) survival.ObjectiveTo explore the possibility of extended survival in patients with non-small-cell lung cancer (NSCLC) BM in the current era.MethodsDuring the years 2008 to 2020, 606 patients with NSCLC underwent their first Gamma Knife SRS for BM at our institution with point-of-care data collection. We reviewed clinical, molecular, imaging, and treatment parameters to explore the relationship of such factors with survival.ResultsThe median overall survival was 17 months (95% CI, 13-40). Predictors of increased survival in a multivariable analysis included age <65 years ( P < .001), KPS ≥80 ( P < .001), absence of extracranial metastases ( P < .001), fewer BM at first SRS (≤3, P = .003), and targeted therapy ( P = .005), whereas chemotherapy alone was associated with shorter survival ( P = .04). In a subgroup of patients managed before 2016 (n = 264), 38 (14%) were long-term survivors (≥5 years), of which 16% required no active cancer treatment (systemic or brain) for ≥3 years by the end of their follow-up.ConclusionLong-term survival in patients with brain metastases from NSCLC is feasible in the current era of SRS when combined with the use of effective targeted therapeutics. Of those living ≥5 years, the chance for living with stable disease without the need for active treatment for ≥3 years was 16%.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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