Brain metastases in locally advanced nonsmall cell lung carcinoma after multimodality treatment: risk factors
Giovanni Luca Ceresoli1, Michele Reni, Giuseppe Chiesa
1Department of Radiochemotherapy, IRCCS San Raffaele, Via Olgettina 60, 02132 Milan, Italy. ceresoli.giovanni@hsr.it
Background:
Brain metastases (BM) are frequent sites of initial failure in patients with locally advanced nonsmall cell lung cancer (LAD-NSCLC) undergoing multimodality treatments (MMT). New treatment and follow-up strategies are needed to reduce the risk of BM and to diagnose them early enough for effective treatment.
Methods:
The incidence rate of BM as the first site of recurrence in 112 patients with LAD-NSCLC treated with the same MMT protocol was calculated. The influence of patient, disease, and treatment-related factors on the incidence of BM and on the time-to-brain recurrence (TBR) was analyzed.
Results:
BM as the first site of failure was observed in 25 cases (22% of the study population and 29% of all recurrences). In 18 of those cases, the brain was the exclusive site of recurrence. Median TBR was 9 months. The 2-year actuarial incidence of BM was 29%. Central nervous system (CNS) recurrence was more common in patients younger than 60 years (P = 0.006) and in whom bulky (> or = 2 cm) mediastinal lymph nodes were present (P = 0.02). TBR was influenced by age (P = 0.004) and by bulky lymph node disease (P = 0.003). Multivariate analysis confirmed the prognostic role of age, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance.
Conclusions:
Our study confirmed a high rate of BM in patients with LAD-NSCLC submitted to MMT. Most of these CNS recurrences were isolated and occurred within 2 years of initial diagnosis. Age younger than 60 years was associated with an increased risk of BM and reduced TBR, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance. Although our data require further validation in future studies, our results suggest that additional trials on prophylactic cranial irradiation and on intensive radiologic follow-up should focus on these high-risk populations.
Insights
Brain metastases are a common failure site in locally advanced non-small cell lung cancer patients. Younger patients (<60) and those with bulky lymph nodes face higher risks, suggesting targeted follow-up strategies.
Area of Science:
- Oncology
- Neurology
- Radiology
Background:
- Brain metastases (BM) are a frequent initial failure site in locally advanced non-small cell lung cancer (LAD-NSCLC) patients receiving multimodality treatments (MMT).
- Effective strategies for reducing BM risk and enabling early diagnosis are crucial for improved patient outcomes.
- Current treatment and follow-up protocols require refinement to address the challenge of brain recurrence.
Purpose of the Study:
- To calculate the incidence rate of BM as the first site of recurrence in LAD-NSCLC patients.
- To analyze patient, disease, and treatment-related factors influencing BM incidence and time-to-brain recurrence (TBR).
- To identify high-risk populations for targeted interventions.
Main Methods:
- Retrospective analysis of 112 LAD-NSCLC patients treated with a standardized MMT protocol.
- Calculation of BM incidence as the first site of recurrence.
- Statistical analysis of factors affecting BM incidence and TBR, including age and lymph node status.
Main Results:
- BM occurred as the first failure site in 22% of patients (29% of all recurrences), often as an isolated event.
- Median TBR was 9 months, with a 2-year actuarial BM incidence of 29%.
- Younger age (<60 years) and bulky mediastinal lymph nodes (> or = 2 cm) were significantly associated with increased CNS recurrence and reduced TBR.
Conclusions:
- A high rate of BM was confirmed in LAD-NSCLC patients undergoing MMT, with most recurrences isolated and occurring within 2 years.
- Younger age (<60) is a significant risk factor for BM and reduced TBR.
- Findings suggest further trials on prophylactic cranial irradiation and intensive follow-up for high-risk patient groups, including those with bulky mediastinal lymph nodes.
