Screening for brain metastases in patients with stage III non–small-cell lung cancer, magnetic resonance imaging or computed tomography? A prospective study

Janna Schoenmaekers, Paul Hofman, Gerben Bootsma, Marcel Westenend, Machiel de Booij, Wendy Schreurs, Ruud Houben, Dirk De Ruysscher, Anne Marie Dingemans, Lizza E.L. Hendriks*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

24 Citations (Scopus)

Abstract

Introduction:

Non–small-cell lung cancer (NSCLC) guidelines advise to screen stage III NSCLC patients for brain metastases (BMs), preferably by magnetic resonance imaging (MRI) or when contraindicated or not accessible a dedicated contrast enhanced–computed tomography (dCE-CT), which can be incorporated in the staging 18Fluodeoxoglucose–positron emission tomography (18FDG-PET-CE-CT). In daily practice, often a dCE-CT is performed instead of a MRI. The aim of the current study is to evaluate the additive value of MRI after dCE-CT, incorporated in the 18FDG-PET-CE-CT. 

Patients and methods: 

It is an observational prospective multicentre study (NTR3628). Inclusion criteria included stage III NSCLC patients with a dCE-CT of the brain incorporated in the 18FDG-PET and an additional MRI of the brain. Primary end-point is percentage of patients with BM on MRI without suspect lesions on dCE-CT. Secondary end-points are percentage of patients with BM on dCE-CT and percentage of patients with BM ≤ 1 year of a negative staging MRI. 

Results: 

Sixteen (7%) patients with extracranial stage III had BM on dCE-CT and were excluded. One hundred forty-nine patients were enrolled. 7/149 (4.7%) had BM on MRI without suspect lesions on dCE-CT. One hundred eighteen patients had a follow-up of at least 1 year (four with BM on baseline MRI); eight of the remaining 114 (7%) patients developed BM ≤ 1 year after a negative staging brain MRI. 

Conclusion: 

Although in 7% of otherwise stage III NSCLC patients, BMs were detected on staging dCE-CT, MRI brain detected BMs in an additional 4.7%, which we consider clinically relevant. Within 1 year after a negative staging MRI, 7% developed BM.

Original languageEnglish
Pages (from-to)88-96
Number of pages9
JournalEuropean Journal of Cancer
Volume115
DOIs
Publication statusPublished - Jul 2019
Externally publishedYes

Bibliographical note

Funding Information:
L.H. has none related to current manuscript, and outside of current manuscript, L.H. received research funding from Roche and Boehringer Ingelheim (both institution) and is in advisory board of Boehringer and BMS (both institution, BMS also self) and received travel reimbursement from Roche, BMS (self), took part mentorship program with key opinion leaders funded by AstraZeneca and received fees for educational webinars: Quadia (self). All other authors have none to declare.

Publisher Copyright:
© 2019 Elsevier Ltd

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