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Natural history of lung squamous cell brain metastases in patients treated with radiosurgery: a thirty-year experience at a tertiary medical center

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Abstract

Purpose

In this study we report our 30-year experience in stereotactic radiosurgery (SRS) treatment of lung squamous cell carcinoma (LUSC) brain metastases (BMs). It will serve to provide detailed longitudinal outcomes and predictors of efficacy in treating LUSC-BMs with SRS.

Method

We retrospectively reviewed 51 patients and 109 tumors treated with SRS at our center between 1993 and 2022. Patient demographics, PDL1 genotype, immunotherapy use and mortality cause were recorded. Radiological and clinical outcomes were followed at 1-3-month intervals post-SRS. Cox-regression analysis and Kaplan-Meier survival curves were performed in statistical analysis.

Results

We included 37 male and 14 female patients (median age 62.7 years at BM diagnosis). Median overall survival (OS) time was 6.9 months, 6-month OS rate was 62.1%, and Karnofsky performance scale (KPS) was the only independent predictor. Median time for local control maintenance was 7.6 months, 6-month local control rate was 69.1%, with TKI as the only independent predictor. Median time to distant failure was 5.13 months, 6-month distant failure rate was 51.1%, and factors with significant impact included gender (p = 0.002), presence of extracranial metastases (p < 0.001), use of immunotherapy(p < 0.001), PDL1 genotype (p = 0.034), and total intracranial metastases number (p = 0.008). However, no definitive benefits of immunotherapy were identified in patients with higher PDL1 mutational tumors.

Conclusion

In this study we defined the natural history of disease progression and outcomes in SRS-treated LUSC-BM patients. We also identified predictors of OS and tumor control among these patients. The findings of this study will serve as a guide when counseling these patients for SRS.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AC:

adenocarcinoma

ARE:

adverse radiation effects

BM:

brain metastasis

KPS:

Karnofsky performance scale

LUSC-BM:

lung squamous cell carcinoma with brain metastases

OS:

overall survival

QoL:

quality of life

SRS:

stereotactic radiosurgery

SqCC:

squamous cell carcinoma

TKIs:

tyrosine kinase inhibitors

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Funding

This work was financially supported by the Ministry of Science and Technology, Taiwan, under the project MOST 110-2314-B-075-038 -MY2 and MOST 111-2314-b-075-066.

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Authors and Affiliations

  1. Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

    Yu-Chi Chen, Huai-Che Yang, Wen-Yuh Chung, David Hung-Chi Pan & Cheng-Chia Lee

  2. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Hsiu-Mei Wu, Yong-Sin Hu, Chung-Jung Lin & Wan-Yuo Guo

  3. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Huai-Che Yang, Chi-Lu Chiang, Chia-I Shen, Hsiu-Mei Wu, Yung-Hung Luo, Yong-Sin Hu, Chung-Jung Lin, Wen-Yuh Chung, Cheng-Ying Shiau, Wan-Yuo Guo & Cheng-Chia Lee

  4. Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan

    Cheng-Ying Shiau

  5. Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Chi-Lu Chiang, Chia-I Shen & Yung-Hung Luo

  6. Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Cheng-Chia Lee

  7. Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

    David Hung-Chi Pan

  8. Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Chi-Lu Chiang

  9. Department of Neurosurgery, The University of Texas Health Science Center, Houston, TX, USA

    Ching-Jen Chen

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The first draft of this manuscript was written by Yu-Chi Chen and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Cheng-Chia Lee.

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Chen, YC., Yang, HC., Chiang, CL. et al. Natural history of lung squamous cell brain metastases in patients treated with radiosurgery: a thirty-year experience at a tertiary medical center. J Neurooncol 161, 135–146 (2023). https://doi.org/10.1007/s11060-022-04153-x

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