The impact of brain MRI screening on stage IV NSCLC patients: A real world look at guidelines based care

Brain metastases frequently occur in patients with non-small cell lung cancer (NSCLC) and are associated with poor prognosis and shortened overall survival, despite the advances in both imaging and therapeutic fields. Data are scarce regarding the utility of brain magnetic resonance imaging (MRI) screening in NSCLC patients. We aimed to characterize the impact of brain MRI screening on stage IV NSCLC patients and their survival.

A retrospective analysis was performed in 609 newly-diagnosed patients with stage IV NSCLC treated at our center during 2019-2020. Patients with neurological symptoms at presentation were excluded (n = 230). The remaining 379 patients comprised the study group and were divided into two groups - those who underwent brain MRI screening within 12 weeks of diagnosis (n = 170), and those who did not (n = 209). The clinical data retrieved from patients' medical files included demographics, performance status (PS), brain metastases during follow-up, tumor molecular profiling, and oncology treatment.

Median survival among patients who underwent brain MRI screening was 24 months from diagnosis, versus 18 months for those who did not (p = 0.003). Among patients with good PS (ECOG 0-2), median OS was longer among patients who underwent screening MRI (25 months), versus those who did not (21 months) (p = 0.025). Among patients with low PS (ECOG 3-4), the between-group difference for OS did not reach statistical significance.

Our study supports the use of brain MRI screening among good PS patients diagnosed with stage IV NSCLC lung cancer. Brain MRI screening correlated with better survival among patients with good functional status in this patient population.