Transcript Brain imaging prior to lung cancer resection

BRAIN IMAGING PRIOR
TO LUNG CANCER
RESECTION
Dr Z Hudson
Dr A Addeo
Bristol Cancer Institute
Bristol 24/05/16
Background
1.3.26 Consider MRI or CT of the head in patients selected for treatment
with curative intent, especially in stage III disease. [new 2011]
1.3.27 Offer patients with features suggestive of intracranial pathology, CT
of the head followed by MRI if normal, or MRI as an initial test. [new 2011]
NICE 2011; Lung Cancer: Diagnosis and
Management CG121
Hudson et al; 2015; Clinical radiology; 610-613
Methods
• List of patients generated from pathology database
• Search of ICE, including OpenNet for brain imaging
• When patient out of area additional local searches
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undertaken in Bath, Cheltenham and Gloucester for brain
imaging
Documentation of whether brain metastases present
Documentation of date of radiological diagnosis with brain
metastases
Data subset created of patients with brain metastases
identified and further analysis undertaken
Data analysis using Microsoft Excel
Poster presentation at BTOG
Results (1)
• 585 patients underwent lung resection between Jan 2012
and December 2014
• 471 with accessible radiology records
• 25 patients had radiological evidence of brain metastases
• 5 diagnosed concurrently with primary tumour and treated radically
• 1 patient dual malignancies with brain metastases from bowel
cancer more likely
• 1 patient with clinical diagnosis of cerebral abscess
Results (2)
• 18 patients with radiological evidence of brain metastases
that presented after their primary lung surgery
• Appearance of brain metastases by days post resection
Mean
371 days
Range
14-1032 days
Median
295 days
• Date of metastases not available in two patients
Results (3)
• 4 presented within 6-12 months of resection
• 2 no evidence of systemic relapse
• 1 received SRS and is alive
• 1 no information available
• 2 local and nodal relapse
• Both died after palliative chemotherapy
• 5 presented within 6 months of resection
• 2 no evidence of systemic relapse
• 1 received SRS but died of pneumonia 1/12 later
• 1 no outcome available
• 3 no information available
• 2 died
• 1 alive
Results (4)
• Overall patients had 5.3% (25/471) chance of having
radiological evidence of brain metastases
• 3.8% (18/471) chance of having radiological evidence of
brain metastases after surgery
• 2% (9/471) of patients had radiological evidence of brain
metastases within 12 months of their surgery
• 1% (5/471) of patients had radiological evidence of brain
metastases within 6 months of their surgery
Brain metastases following radical surgical treatment of
non-small cell lung cancer: Is preoperative brain imaging
important?
Lung Cancer ,November 2014 Volume 86, Issue 2, Pages185–189
• Methods
• We performed a retrospective analysis of 646 patients who underwent surgery for lung
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cancer with curative intent at a regional thoracic surgical centre in the United Kingdom. We
identified those who developed brain metastases in the postoperative period and, by using
volume doubling times, estimated the size of the metastasis at the time of surgery. We then
determined the proportion of metastases that would have been seen on preoperative MR
brain at detection thresholds of 2 and 5 mm diameter.
Results
There was a 6.3% incidence of postoperative brain metastases, with the majority occurring
within 12 months of surgery. Those who developed metastases were more likely to have
adenocarcinoma and the majority had early stage malignancy (73% stage I or stage II).
We estimate that 71% of those who developed cerebral metastases might have been
detected had they undergone MR brain as part of their staging (4.4% of all patients).
Conclusion
Based on our findings we suggest that, in addition to standard staging investigations,
patients have brain imaging (MR or equivalent) prior to curative surgery in NSCLC regardless
of preoperative stage.
Discussion points
• Is it time for a change? y/n
• Which scan?
• MRI/CT?
• New PET-CT changes it?