Does the incidence and outcome of brain metastases in locally advanced non-small cell lung cancer justify prophylactic cranial irradiation or early detection?

Carolan, Hannah; Sun, Alexander; Bezjak, Andrea; Yi, Qijian; Payne, David G.; Kane, Gabrielle; Waldron, John; Leighl, Natasha B.; Feld, Ronald; Burkes, Ronald L.; Keshavjee, Shaf; Shepherd, Frances A.

doi:10.1016/j.lungcan.2004.12.004

Cited by 73 publications

(66 citation statements)

References 29 publications

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“…Brain metastases in long-term NSCLC survivors have been widely reported and have been the focus of several studies (Carolan et al, 2005;Gaspar et al, 2005). As we observed that SPC occurs just as frequently, long-term survivors require vigilant follow-up to detect SPC at the earliest possible stage.…”

Section: Discussionmentioning

confidence: 75%

Second primary cancer in survivors following concurrent chemoradiation for locally advanced non-small-cell lung cancer

et al. 2006

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Section: Discussionmentioning

confidence: 75%

Second primary cancer in survivors following concurrent chemoradiation for locally advanced non-small-cell lung cancer

et al. 2006

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“…Although several clinical and pathologic factors have been associated with the development of brain metastases in locally advanced disease, [31][32][33][34][35] few studies have evaluated risk factors in early stage disease (Table 3). On multivariate analysis, we identified 4 factors that were independently associated with a higher risk of developing brain metastases.…”

Section: Clinical and Pathologic Risk Factorsmentioning

confidence: 99%

“…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%

“…This is consistent with other studies in which the median time was 7.5-12.5 months. 34,35,48,63 However, not all patients had CT or MRI imaging of the brain at the time of diagnosis, and it is possible that some patients had asymptomatic intracranial disease at the time of surgery. Interestingly, patients who subsequently developed brain metastases were actually more likely to have had a negative staging CT or MRI of the brain compared with patients who did not develop brain metastases, reflecting the finding that brain imaging was performed more commonly in patients with N1 disease.…”

Section: Study Limitationsmentioning

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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“…Although knowledge regarding modifiable risk factors is scarce, several nonmodifiable risk factors are known to influence the cumulative incidence of brain metastasis. Brain metastasis are more common in younger cancer patients than older cancer patients in breast cancer and melanoma [8,9,153,185,[187][188][189][190][191][192][193][194]. The risk of brain metastasis appears to increase until 40 to 49 years of age and then decline thereafter [131].…”

Section: Risk Factorsmentioning

confidence: 99%