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Real-world risk of brain metastases in stage III non-small cell lung cancer in the era of PET and MRI staging

OBJECTIVE: The 2-year incidence of brain metastases (BrMs) in stage III non-small lung cell cancer (NSCLC) has been estimated to be around 30%. However, recent clinical trials have demonstrated considerably lower BrMs rates in this patient population. In this study, we aimed to review the real-world...

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Autores principales: Alhusaini, Saud, Lanman, Tyler A., Ko, Ryan B., Therkelsen, Kate E., Eyben, Rie Von, Diehn, Maximilian, Soltys, Scott G., Pollom, Erqi L., Chin, Alexander, Vitzthum, Lucas, Wakelee, Heather A., Padda, Sukhmani K., Ramchandran, Kavitha, Loo, Billy W., Neal, Joel W., Nagpal, Seema
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10080021/
https://www.ncbi.nlm.nih.gov/pubmed/37035171
http://dx.doi.org/10.3389/fonc.2023.1139940
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author Alhusaini, Saud
Lanman, Tyler A.
Ko, Ryan B.
Therkelsen, Kate E.
Eyben, Rie Von
Diehn, Maximilian
Soltys, Scott G.
Pollom, Erqi L.
Chin, Alexander
Vitzthum, Lucas
Wakelee, Heather A.
Padda, Sukhmani K.
Ramchandran, Kavitha
Loo, Billy W.
Neal, Joel W.
Nagpal, Seema
author_facet Alhusaini, Saud
Lanman, Tyler A.
Ko, Ryan B.
Therkelsen, Kate E.
Eyben, Rie Von
Diehn, Maximilian
Soltys, Scott G.
Pollom, Erqi L.
Chin, Alexander
Vitzthum, Lucas
Wakelee, Heather A.
Padda, Sukhmani K.
Ramchandran, Kavitha
Loo, Billy W.
Neal, Joel W.
Nagpal, Seema
author_sort Alhusaini, Saud
collection PubMed
description OBJECTIVE: The 2-year incidence of brain metastases (BrMs) in stage III non-small lung cell cancer (NSCLC) has been estimated to be around 30%. However, recent clinical trials have demonstrated considerably lower BrMs rates in this patient population. In this study, we aimed to review the real-world incidence, surveillance, and treatment patterns of BrMs in stage III NSCLC. MATERIALS AND METHODS: Using a retrospective single-center study design, we identified patients with stage III NSCLC who received radiation with curative intent over a 10-year period. Outcome variables included BrMs incidence, overall survival (OS), and survival from date of BrMs. Additionally, we assessed patterns of BrMs surveillance in stage III NSCLC and treatment. RESULTS: We identified a total of 279 stage III NSCLC patients, of which 160 with adequate records were included in the final analyses [adenocarcinoma (n = 96), squamous cell carcinoma (n = 53), other histology subtype (n = 11)]. The median OS for the entire cohort was 41 months (95% CI, 28-53), while the median time from BrMs to death was 19 months (95% CI, 9-21). Twenty-three patients (14.4%) received planned surveillance brain MRIs at 6, 12, and 24 months after completion of treatment. The remaining 137 patients (85.6%) received brain MRIs at systemic recurrence (restaging) or when neurologically symptomatic. A total of 37 patients (23%) developed BrMs, with a 2-year cumulative BrMs incidence of 17% (95% CI, 11-23). A higher incidence of BrMs was identified in patients with adenocarcinoma relative to those with squamous cell carcinoma (p < 0.01). Similarly, a higher 2-year BrMs incidence was observed in patients who received planned surveillance brain MRI relative to those who did not, although statistical significance was not reached. Stereotactic radiosurgery (SRS) treated 29 of BrMs patients (78.4%) and was preferred over WBRT, which treated only 3 patients (8.1%). CONCLUSIONS: At our center, BrMs incidence in stage III NSCLC patients was lower than historically reported but notably higher than the incidence described in recent clinical trials. Routine BrMs surveillance potentially allows earlier detection of asymptomatic BrMs. However, asymptomatic BrMs were mostly detected on restaging MRI at the time of recurrence.
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spelling pubmed-100800212023-04-08 Real-world risk of brain metastases in stage III non-small cell lung cancer in the era of PET and MRI staging Alhusaini, Saud Lanman, Tyler A. Ko, Ryan B. Therkelsen, Kate E. Eyben, Rie Von Diehn, Maximilian Soltys, Scott G. Pollom, Erqi L. Chin, Alexander Vitzthum, Lucas Wakelee, Heather A. Padda, Sukhmani K. Ramchandran, Kavitha Loo, Billy W. Neal, Joel W. Nagpal, Seema Front Oncol Oncology OBJECTIVE: The 2-year incidence of brain metastases (BrMs) in stage III non-small lung cell cancer (NSCLC) has been estimated to be around 30%. However, recent clinical trials have demonstrated considerably lower BrMs rates in this patient population. In this study, we aimed to review the real-world incidence, surveillance, and treatment patterns of BrMs in stage III NSCLC. MATERIALS AND METHODS: Using a retrospective single-center study design, we identified patients with stage III NSCLC who received radiation with curative intent over a 10-year period. Outcome variables included BrMs incidence, overall survival (OS), and survival from date of BrMs. Additionally, we assessed patterns of BrMs surveillance in stage III NSCLC and treatment. RESULTS: We identified a total of 279 stage III NSCLC patients, of which 160 with adequate records were included in the final analyses [adenocarcinoma (n = 96), squamous cell carcinoma (n = 53), other histology subtype (n = 11)]. The median OS for the entire cohort was 41 months (95% CI, 28-53), while the median time from BrMs to death was 19 months (95% CI, 9-21). Twenty-three patients (14.4%) received planned surveillance brain MRIs at 6, 12, and 24 months after completion of treatment. The remaining 137 patients (85.6%) received brain MRIs at systemic recurrence (restaging) or when neurologically symptomatic. A total of 37 patients (23%) developed BrMs, with a 2-year cumulative BrMs incidence of 17% (95% CI, 11-23). A higher incidence of BrMs was identified in patients with adenocarcinoma relative to those with squamous cell carcinoma (p < 0.01). Similarly, a higher 2-year BrMs incidence was observed in patients who received planned surveillance brain MRI relative to those who did not, although statistical significance was not reached. Stereotactic radiosurgery (SRS) treated 29 of BrMs patients (78.4%) and was preferred over WBRT, which treated only 3 patients (8.1%). CONCLUSIONS: At our center, BrMs incidence in stage III NSCLC patients was lower than historically reported but notably higher than the incidence described in recent clinical trials. Routine BrMs surveillance potentially allows earlier detection of asymptomatic BrMs. However, asymptomatic BrMs were mostly detected on restaging MRI at the time of recurrence. Frontiers Media S.A. 2023-03-24 /pmc/articles/PMC10080021/ /pubmed/37035171 http://dx.doi.org/10.3389/fonc.2023.1139940 Text en Copyright © 2023 Alhusaini, Lanman, Ko, Therkelsen, Eyben, Diehn, Soltys, Pollom, Chin, Vitzthum, Wakelee, Padda, Ramchandran, Loo, Neal and Nagpal https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Alhusaini, Saud
Lanman, Tyler A.
Ko, Ryan B.
Therkelsen, Kate E.
Eyben, Rie Von
Diehn, Maximilian
Soltys, Scott G.
Pollom, Erqi L.
Chin, Alexander
Vitzthum, Lucas
Wakelee, Heather A.
Padda, Sukhmani K.
Ramchandran, Kavitha
Loo, Billy W.
Neal, Joel W.
Nagpal, Seema
Real-world risk of brain metastases in stage III non-small cell lung cancer in the era of PET and MRI staging
title Real-world risk of brain metastases in stage III non-small cell lung cancer in the era of PET and MRI staging
title_full Real-world risk of brain metastases in stage III non-small cell lung cancer in the era of PET and MRI staging
title_fullStr Real-world risk of brain metastases in stage III non-small cell lung cancer in the era of PET and MRI staging
title_full_unstemmed Real-world risk of brain metastases in stage III non-small cell lung cancer in the era of PET and MRI staging
title_short Real-world risk of brain metastases in stage III non-small cell lung cancer in the era of PET and MRI staging
title_sort real-world risk of brain metastases in stage iii non-small cell lung cancer in the era of pet and mri staging
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10080021/
https://www.ncbi.nlm.nih.gov/pubmed/37035171
http://dx.doi.org/10.3389/fonc.2023.1139940
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