Detection of brain metastases from small cell lung cancer

Abstract

BACKGROUNDThe aims of this study were to show 1) the effect of changing from computed tomography (CT) to magnetic resonance imaging (MRI) on the prevalence of detected brain metastases (BM) in patients with newly diagnosed small cell lung cancer (SCLC); 2) the difference in survival between patients with single and multiple BM; and 3) the effect of the change in patient labeling on eligibility for prophylactic brain irradiation.METHODSFrom 1980 to 2004, 481 consecutive patients with SCLC were enrolled. Brain imaging was routinely performed after diagnosis of SCLC. At the start of 1991, MRI replaced CT in almost all patients. All patients were regularly examined by a neurologist.RESULTSThe prevalence of detected BM was 10% in the CT era and 24% in the MRI era. In the CT era, all detected BM were symptomatic, whereas in the MRI era, 11% were asymptomatic. In both periods, patients labeled as single BM survived longer than those labeled as multiple BM. For patients labeled as single BM or multiple BM, survival was longer in the MRI era than in the CT era. The proportion of patients who were eligible for prophylactic cranial irradiation was lower in the MRI era.CONCLUSIONSThe estimated prevalence of BM increases when MRI is used instead of CT. Patients with a detected single BM survive longer than patients with multiple BM. The apparently increased survival in the MRI era can be attributed to the “Will Rogers phenomenon”. The use of MRI makes fewer patients eligible for prophylactic cranial irradiation. Cancer 2008. ©2008 American Cancer Society.

Surgery in Small-Cell Lung Cancer: Past, Present and Future

“…In one report, the prevalence of brain metastases was 10% with CT and 24% with MRI. In this series all CT-detected brain metastases were symptomatic, whereas 11% of those detected by MRI were asymptomatic [Seute et al, 2008]. Chest CT scan, abdominal CT scan, brain MRI and bone scintigraphy are mandatory in the evaluation of patients amenable to surgery [Koletsis et al, 2009].…”

A Review of Current Radiation Therapies for the Treatment of Metastatic Brain Tumors

“…and allowed higher daily doses of radiation to be given without exacerbation of intracranial edema, etc. [7,8]. Although palliative care was provided, neurocognitive and other neurological/behavioral disorders still existed [9].…”

“…NCCN guidelines still support its use [7,8,23,24]. However, due to the associated neurodegeneration, there is a trend to only treat the brain with radiation, if lesions are detected [23].…”

Antidepressant use and risk of central nervous system metastasis

“…Interestingly, since the implementation of MRI, brain metastasis found upon autopsy significantly decreased from 53% in the CT era to 15% in the MRI era (p=0.027) [164].…”

“…Replacing CT scans, MRIs only became the standard for brain imaging in the 1990's, which allows for detection of smaller metastases [148]. For example, asymptomatic small cell lung cancers can now be detected [164]. Although MRI is more useful in identifying brain metastasis, some patients cannot receive MRI due to certain medical conditions, such as a pacemaker; consequently, these patients must undergo CT.…”