Clinical Predictors of Metastatic Disease to the Brain from Non–Small Cell Lung Carcinoma: Primary Tumor Size, Cell Type, and Lymph Node Metastases

Mujoomdar, Amol; Austin, John; Malhotra, Rohin; Powell, Charles A.; Pearson, Gregory; Shiau, Maria C.; Raftopoulos, H.

doi:10.1148/radiol.2423051707

Cited by 199 publications

(149 citation statements)

References 35 publications

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“…36 Similarly, in a study of 264 NSCLC patients at all stages (31% with stage I-II disease), Mujumoor and colleagues showed that the probability of developing metastases to the brain was significantly increased with increasing clinical tumor size. 38 In contrast, other studies have shown that for resected stage IIIA patients, pathologic T classification was not significantly associated with incidence of brain metasteses. 33,34 …”

Section: Clinical and Pathologic Risk Factorsmentioning

confidence: 86%

“…Mujumoor et al also found an increased risk of developing brain metastases with increasing lymph-node status. 38 Similarly, results from the Lung Cancer Study Group found that increasing T and N classifications were associated with a higher risk of developing isolated brain metasetases. 22 Several other studies have confirmed this finding.…”

Section: Original Article 5042mentioning

confidence: 95%

“…45 Histology was not a statistically significant factor in our series (P ¼ .14). Nonsquamous histology, adenocarcinoma in particular, has been associated with an increased risk of developing brain metastases in some, 33,34,38,39,46 but not all, [35][36][37] studies.…”

Section: Original Article 5042mentioning

confidence: 99%

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Factors associated with the development of brain metastases

Hubbs

Boyd

Hollis

et al. 2010

Cancer

120

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BACKGROUND The risk of developing brain metastases after definitive treatment of locally advanced nonsmall cell lung cancer (NSCLC) is approximately 30%-50%. The risk for patients with early stage disease is less defined. The authors sought to investigate this further and to study potential risk factors. METHODS The records of all patients who underwent surgery for T1-T2 N0-N1 NSCLC at Duke University between the years 1995 and 2005 were reviewed. The cumulative incidence of brain metastases and distant metastases was estimated by using the Kaplan-Meier method. A multivariate analysis assessed factors associated with the development of brain metastases. RESULTS Of 975 consecutive patients, 85% were stage I, and 15% were stage II. Adjuvant chemotherapy was given to 7%. The 5-year actuarial risk of developing brain metastases and distant metastases was 10%(95% confidence interval [CI], 8-13) and 34%(95% CI, 30-39), respectively. Of patients developing brain metastases, the brain was the sole site of failure in 43%. On multivariate analysis, younger age (hazard ratio [HR], 1.03 per year), larger tumor size (HR, 1.26 per cm), lymphovascular space invasion (HR, 1.87), and hilar lymph node involvement (HR, 1.18) were associated with an increased risk of developing brain metastases. CONCLUSIONS In this large series of patients treated surgically for early stage NSCLC, the 5-year actuarial risk of developing brain metastases was 10%. A better understanding of predictive factors and biological susceptibility is needed to identify the subset of patients with early stage NSCLC who are at particularly high risk. Cancer 2010;116:5038-46.

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Section: Clinical and Pathologic Risk Factorsmentioning

confidence: 86%

Section: Original Article 5042mentioning

confidence: 95%

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Factors associated with the development of brain metastases

Hubbs

Boyd

Hollis

et al. 2010

Cancer

120

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“…Earlier studies correlated the presence of BM with advanced stage, NSCLC histotypes, delay of lung radiotherapy, younger age, and large tumor size. [28][29][30][31][32] However, few studies assessed in this regard tobacco consumption, comorbidities, CT scanner tumor characteristics, or the presence of metastases other than BMs.…”

Section: Patients Who Are At High Risk Of Developing Bmmentioning

confidence: 99%

Prophylactic cranial irradiation in non-small cell lung cancer patients: who might be the candidates?

Hillas¹,

Dimitropoulos²,

Nikolakopoulou³

et al. 2011

CMAR

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Objectives: Brain metastases (BMs) often advance the course of non-small cell lung cancer (NSCLC). We performed an observational study in order to investigate the possible correlation of selected clinical and epidemiological factors with BM appearance in patients suffering from different histological subtypes of NSCLC stage I-IV. Methods: The study included 161 consecutive patients with NSCLC. Analyzed data included patient-and tumor-related characteristics. Results: Thirty-nine patients (24.2%) presented BMs within 12 (0-36) weeks of diagnosis. BMs decreased the mean overall survival significantly (15.6 versus 50.7 weeks, P , 0.001), with hazard ratio (95% confidence interval) 3.60 (2.42-5.35). The age of the patients with BM was significantly lower than that of the patients without BM (60.8 ± 8.9 versus 66.5 ± 8.5, P , 0.001). Patients with BM had significantly higher pack-years consumption (75.9 ± 23.9 versus 58.9 ± 31.9, P = 0.003) and larger tumor size compared with patients without BM (size in mm: 55.1 ± 20.1 versus 45.9 ± 19.3, P = 0.012). The presence of BM was also correlated with the absence of lung (P , 0.001), bone (P = 0.005), and adrenal (P = 0.046) metastases. Conclusion: Younger NSCLC patients with high tobacco consumption, large tumor size, and absence of metastases in other organs (lung, bones, adrenal metastases) are at high risk of BM appearance during the course of NSCLC and are candidates for prophylactic cranial irradiation early in the course of the disease.

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“…The rate of brain metastasis has been reported up to 43% (1,2). In general, brain metastases (BM) affect treatment strategy in patients with NSCLC.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic impact of integrated 18F-FDG PET/MRI in cerebral staging of patients with non-small cell lung cancer

et al. 2016

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Background: Integrated positron emission tomography/magnetic resonance imaging (PET/MRI) systems are increasingly being available and used for staging examinations. Brain metastases (BM) are frequent in patients with non-small cell lung cancer (NSCLC) and decisive for treatment strategy. Purpose: To assess the diagnostic value of integrated 18F-2-fluoro-2-deoxy-D glucose (18F-FDG) PET/MRI in initial staging in patients with NSCLC for BM in comparison to MRI alone. Material and Methods: Eighty-three patients were prospectively enrolled for an integrated 18F-FDG PET/MRI examination. The 3 T MRI protocol included a fluid-attenuated inversion-recovery sequence (FLAIR) and a contrast-enhanced three-dimensional magnetization prepared rapid acquisition GRE sequence (MPRAGE). Two neuroradiologists evaluated the datasets in consensus regarding: (i) present lesions; (ii) size of lesions; and (iii) number of lesions detected in MRI alone, compared to the PET component when reading the 18F-FDG PET/MRI. Results: Based on MRI alone, BM were detected in 15 out of the 83 patients, comprising a total of 39 metastases. Based on PET alone, six patients out of the 83 patients were rated positive for metastatic disease, revealing a total of 15 metastases. PET detected no additional BM. The size of the BM correlated positively with sensitivity of detection in PET. Conclusion: The sensitivity of PET in detection of BM depends on their size. 18F-FDG PET/MRI does not lead to an improvement in diagnostic accuracy in cerebral staging of NSCLC patients, as MRI alone remains the gold standard.

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Clinical Predictors of Metastatic Disease to the Brain from Non–Small Cell Lung Carcinoma: Primary Tumor Size, Cell Type, and Lymph Node Metastases

Abstract: The probability of metastatic disease to the brain from primary NSCLC is correlated with size of the primary tumor, cell type, and intrathoracic lymph node stage.

Cited by 199 publications

References 35 publications

Factors associated with the development of brain metastases

Factors associated with the development of brain metastases

Prophylactic cranial irradiation in non-small cell lung cancer patients: who might be the candidates?

Diagnostic impact of integrated 18F-FDG PET/MRI in cerebral staging of patients with non-small cell lung cancer

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