Stage III XXXX and metachronous brain metastases.

@entity1 @entity1149 @entity5
OBJECTIVES: This study was undertaken to identify management strategies that maximize survival of @entity1 with @entity5 and metachronous brain metastases and to determine whether any apparent improved survival was due to treatment or simply to @entity1 selection. METHODS: Treatment evaluations of both primary @entity1149 and brain metastases were performed in 91 @entity1 . Optimal treatment was identified by multivariable analysis. Propensity scoring and multivariable analysis were used to separate treatment benefit from @entity1 selection. RESULTS: Risk-unadjusted median, 12-, and 24-month survivals were 5.2 months, 22%, and 10%, respectively. Younger age (P =.006), good performance status (P =.003), stage IIIA (P =.001), lung resection (P =.02), no other systemic metastases at time of diagnosis of brain metastases (P =.02), and either metastasectomy (P <.001) or stereotactic radiosurgery (P <.001) predicted best survival. However, metastasectomy or stereotactic radiosurgery was more common after lung resection (P =.02) and in @entity1 with good performance status (P =.006), no other systemic metastases at time of diagnosis of brain metastases (P =.01), and fewer brain metastases (P <.001), suggesting that the @entity1 with the best risk profile were selected for aggressive therapy of both lung primary and brain metastases. Despite this selection, analysis of propensity-matched @entity1 demonstrated the benefit of lung resection and metastasectomy or stereotactic radiosurgery (P <.001). CONCLUSIONS: Younger @entity1 with resected stage IIIA @entity1149 who have isolated metachronous brain metastases and good performance status do best when treated with metastasectomy or stereotactic radiosurgery. This survival benefit is a brain treatment effect, not the result of selecting the best @entity1 for aggressive therapy.
