Screening for brain metastases in patients with stage III non-small cell lung carcinoma (NSCLC), MRI or CT? A prospective study
Oncology, infection and vascular disease (English)Introduction: Non-small cell lung cancer (NSCLC) guidelines advise to screen stage III NSCLC patients for brain metastases (BM), preferably by magnetic resonance imaging (MRI) or, when contra-indicated or not accessible a dedicated contrast-enhanced computed tomogram (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: Observational prospective multicentre study (NTR3628). Inclusion:stage III NSCLC patients with a dCE-CT of the brain incorporated in the 18FDG-PET and an additional MRI of the brain. Primary endpoint: percentage of patients with BM on MRI without suspect lesions on dCE-CT. Secondary endpoints: percentage of patients with BM on dCE-CT and percentage of patients with BM ≤1 year of a negative staging MRI.
Results: 16 (7%) patients with extracranial stage III had BM on dCE-CT and were excluded. 149 patients were enrolled.7/149 (4.7%) had BM on MRI without suspect lesions on dCE-CT. 118 patients had a follow-up of at least 1 year (4 with BM on baseline MRI); 8 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 BM were detected on staging dCE-CT, MRI brain detected BM in an additional 4.7% which we consider clinically relevant. Within 1 year after a negative staging MRI, 7% developed BM.