Clinical effectiveness of routine brain imaging in the management of lung cancer prior to curative treatments
Lee, X. Nagarajan, T. Evison, M. Grundy, S. Al-Najjar, H. Brockelsby, C. Randles, V. Rice, M. Dildar, B. King, J.
Lee, X.
Nagarajan, T.
Evison, M.
Grundy, S.
Al-Najjar, H.
Brockelsby, C.
Randles, V.
Rice, M.
Dildar, B.
King, J.
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Abstract
Introduction: The aim of this study is to compare the current
practice within the Greater Manchester Cancer Network against
the NICE recommendations in 2019 on brain imaging for patients
with lung cancer. We focused on the effectiveness of brain imaging
in detecting metastasis in asymptomatic patients prior to curative
therapies for their lung cancers.
Methods: Six hospitals participated in this retrospective study.
Medical notes were reviewed for patients who were eligible for
curative treatments for their early-stage lung cancer in 2018. Their
brain imaging was examined to assess if the presence of brain
metastasis would alter their treatments.
Results: Brain imaging was performed in 184 patients diagnosed
with stage 1 to stage 3 lung cancer, who were eligible for curative
treatments. 98 were males, 86 were females. Median age was 69
years old (IQR 64–76). 155 had non-small cell lung cancer. 162
patients had MRI brain, whilst 22 had CT brain. Median time for brain
imaging from request to report is 9 days (IQR 6–14). 8 patients were
found to have brain metastasis and all of them were stage 3 cancer
patients. Four of them proceeded with initial curative treatment,
whilst four had treatments changed to palliative intent after brain
metastasis were found (Table 1). All 12 patients with stage 1 disease
and 32 with stage 2 disease had normal brain imaging.
Conclusion: Based on our study, the prevalence of occult brain
metastasis in asymptomatic patients with radically treatable stage 3
lung cancer is 5.7%, which is comparable to the evidence reviewed in
NICE guidelines (1.5–21.4%). In stage 1 and 2 cancer the prevalence
was 0%. There is a need for a more robust evidence base to support or
refute NICE guidelines on brain imaging for asymptomatic patients.
Imaging stage 2 patients will have significant resource impact and
may lead to an unnecessary delay to treatment.
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Lee X, Nagarajan T, Evison M, Grundy S, Al-Najjar H, Brockelsby C, et al. Clinical effectiveness of routine brain imaging in the management of lung cancer prior to curative treatments. Lung Cancer. 2020;139:S17-S