Risk of brain metastases in T1-3N0 NSCLC: a population-based analysis

Michael T Milano; James E Bates; Justin Budnik; Haoming Qiu; Sara Hardy; Michael A Cummings; Megan A Baumgart; Ronald J Maggiore; Deborah A Mulford; Kenneth Y Usuki

doi:10.2217/lmt-2019-0010

Risk of brain metastases in T1-3N0 NSCLC: a population-based analysis

Lung Cancer Manag. 2020 Feb 25;9(1):LMT25. doi: 10.2217/lmt-2019-0010.

Affiliations

¹ Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA.
² Department of Radiation Oncology, University of Florida, Gainesville, FL 32610, USA.

Abstract

Aim: Several consensus guidelines recommend against routine brain imaging at diagnosis of T1-3N0 non-small cell lung cancer (NSCLC).

Methods: From the Surveillance, Epidemiology and End Results registry, patients with pathologically confirmed T1-3N0 NSCLC were identified. Risks of brain metastases at time of initial diagnosis were analyzed.

Results: Patients selected to not undergo primary NSCLC resection had approximately tenfold greater incidence of brain metastases versus those who did. Younger age, adenocarcinoma histology, higher tumor stage and higher histologic grade were all significantly (p < 0.0001) associated with greater likelihood of presenting with brain metastases.

Conclusion: Given the morbidity and mortality of brain metastases, routine brain screening after NSCLC diagnosis (particularly adenocarcinoma) may be justifiable, though more refined cost-benefit analyses are warranted.

Keywords: NSCLC; adenocarcinoma; brain metastases; squamous cell carcinoma.