Survival benefit of radiotherapy and surgery in lung cancer brain metastases with poor prognosis factors

Purpose: Radiotherapy and surgery are the standard local treatments for lung cancer brain metastases (BMs). This study aimed to evaluate the effects of radiotherapy and surgery in lung cancer BMs with poor prognosis factors. Methods We analyzed retrospectively 714 patients with lung cancer BMs. Analyses of overall survival (OS) and risk factors for OS were assessed by log-rank test and Cox proportional hazard model. Results Age ≥ 65 years, Karnofsky Performance Scale (KPS) score ≤ 70, anaplastic large-cell lymphoma kinase (ALK)/epidermal growth factor receptor (EGFR) wild type and extracranial metastases were related to poor prognosis. Patients were stratified according to these poor prognosis factors. In patients with ALK/EGFR wild type, whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and surgery improved the OS of patients ( p =  0.028, p =  0.044, p =  0.014). WBRT (hazard ratio [HR]: 0.67; 95% confidence interval [CI]: 0.49–0.92; p  = 0.01) and SRS (HR: 0.65; 95% CI: 0.43–0.99; p  = 0.04) were the independent protective factors for OS in the multivariate analyses. In patients with extracranial metastases, patients who received WBRT plus SRS or WBRT alone had longer OS than those who did not receive radiotherapy ( p =  0.019, p =  0.024). WBRT plus SRS (HR: 0.50; 95% CI: 0.29–0.87; p  = 0.01) and WBRT (HR: 0.74; 95% CI: 0.58–0.95; p  = 0.02) were the independent protective factors for OS in the multivariate analyses. Conclusions Radiotherapy and surgery provide survival benefits for lung cancer BMs with ALK/EGFR wild type, suggesting local treatments may be alternatives to targeted therapy for patients with ALK/EGFR wild type.