Lung cancer with synchronous solitary brain metastasispalliative or radical treatment?

Resumen

Carcinoma of the lung is the malignancy that most commonly metastasizes to the brain. It is not uncommon for patients to have brain metastasis at the time of initial presentation with non-small cell lung cancer (NSCLC). The optimum treatment for the patients presenting with NSCLC and synchronous solitary brain metastasis has been controversial but with clear evidence of benefit in selected patients when in receipt of radical treatment for both, the lung tumor and the cerebral metastasis. Nevertheless, this treatment is not always offered to patients who are potential candidates, despite the evidence in the literature. We undertook a review of literature to assess the benefit of aggressive therapy, and which patients would benefit from it, and what constitutes the most appropriate treatment. We conclude that, in selected patients, the potentially-curative dual resection of the primary tumour and the brain metastasis can achieve improvements in survival rate and quality-of-life. However, identification of reliable prognostic factors to select appropriate patients is needed. To date there is no clear evidence regarding what should be the radical treatment for cerebral metastasis (surgery, radio-surgery, total cranial radiotherapy following either of these...)