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Nam JG, Hong H, Choi SH, Park CM, Goo JM, Kim YT, Kim H. No Prognostic Impact of Staging Brain MRI in Patients with Stage IA Non-Small Cell Lung Cancer. Radiology 2022; 303:632-643. [PMID: 35258373 DOI: 10.1148/radiol.212101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Although various guidelines discourage performing brain MRI for staging purposes in asymptomatic patients with clinical stage IA non-small cell lung cancer (NSCLC), evidence regarding their postoperative survival is lacking. Purpose To investigate the survival benefit of performing brain MRI in asymptomatic patients with early-stage NSCLC. Materials and Methods Patients who underwent curative resection between February 2009 and March 2016 for clinical TNM stage T1N0M0 NSCLC were retrospectively included. Patient survival and development of brain metastasis during postoperative surveillance were documented. The cumulative survival rate and incidence of brain metastasis were compared between patients who underwent surgery with or without staging brain MRI by using Cox regression and a Fine-Gray subdistribution hazard model, respectively, for multivariable adjustment. Propensity score matching and inverse probability of treatment weighting were applied for confounder adjustment. Results A total of 628 patients (mean age, 64 years ± 10 [SD]; 319 men) were included, of whom 53% (331 of 628) underwent staging brain MRI. In the multivariable analyses, brain MRI did not show prognostic benefits for brain metastasis-free survival (hazard ratio [HR], 1.06; 95% CI: 0.69, 1.63; P = .79), time to brain metastasis (HR, 1.60; 95% CI: 0.70, 3.94; P = .29), and overall survival (HR, 0.86; 95% CI, 0.54, 1.37; P = .54). Consistent results were obtained after propensity score matching (brain metastasis-free survival [HR, 0.97; 95% CI: 0.60, 1.57; P = .91], time to brain metastasis [HR, 1.29; 95% CI: 0.50, 3.33; P = .60], and overall survival [HR, 0.89; 95% CI: 0.53, 1.51; P = .67]) and inverse probability of treatment weighting. Conclusion No difference was observed between asymptomatic patients with clinical stage IA non-small cell lung cancer who underwent staging brain MRI and those who did not in terms of brain metastasis-free survival, time to brain metastasis, and overall survival. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Bizzi and Pascuzzo in this issue.
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Affiliation(s)
- Ju G Nam
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Hyunsook Hong
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Seung Hong Choi
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Chang Min Park
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Jin Mo Goo
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Young Tae Kim
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Hyungjin Kim
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
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Schoenmaekers J, Hofman P, Bootsma G, Westenend M, de Booij M, Schreurs W, Houben R, De Ruysscher D, Dingemans AM, Hendriks LEL. Screening for brain metastases in patients with stage III non-small-cell lung cancer, magnetic resonance imaging or computed tomography? A prospective study. Eur J Cancer 2019; 115:88-96. [PMID: 31129385 DOI: 10.1016/j.ejca.2019.04.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/19/2019] [Accepted: 04/05/2019] [Indexed: 12/25/2022]
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.
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Affiliation(s)
- Janna Schoenmaekers
- Dept. of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Paul Hofman
- Dept. of Radiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Gerben Bootsma
- Dept. of Pulmonary Diseases, Zuyderland Hospital Heerlen, Heerlen, the Netherlands
| | - Marcel Westenend
- Dept. of Pulmonary Diseases, VieCuri Hospital, Venlo, the Netherlands
| | - Machiel de Booij
- Dept. of Radiology, Zuyderland Hospital Heerlen, Heerlen, the Netherlands
| | - Wendy Schreurs
- Dept. of Nuclear Medicine, Zuyderland Hospital Heerlen, Heerlen, the Netherlands
| | - Ruud Houben
- Dept. of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Dirk De Ruysscher
- Dept. of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Anne-Marie Dingemans
- Dept. of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Lizza E L Hendriks
- Dept. of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands.
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