Screening for Intracranial Disease in Patients With Lung Cancer Versus Breast Cancer
Posted: Tuesday, July 3, 2018
Compared with patients who have brain metastases secondary to breast cancer, those who have brain metastases secondary to non–small cell lung cancer (NSCLC) presented with less advanced disease and less frequently required whole-brain radiation therapy as initial management, according to Daniel N. Cagney, MD, of Dana-Farber/Brigham and Women’s Cancer Center, Boston, and colleagues. However, their study findings, which were published in a research letter in JAMA Oncology, demonstrate no differences between the two groups in terms of recurrence or salvage therapy–based outcomes after initial brain-directed therapy.
Patients with NSCLC and brain metastases are largely screened with brain MRI at diagnosis of systemic malignant neoplasm, as per recommendations from the NCCN for patients with stage III to IV NSCLC. However, patients with breast cancer and brain metastases are largely unscreened with brain MRI, although the findings from Dr. Cagney and colleagues support further investigation into the use of MRI screening of the brain in those with metastatic breast cancer.
Between January 2000 and December 2015 at Dana-Farber/Brigham and Women’s Cancer Center, 659 patients with newly diagnosed brain metastases secondary to NSCLC were compared with 349 patients with newly diagnosed brain metastases secondary to breast cancer. Nearly two-thirds of those with lung cancer had stage IV disease at initial diagnosis, and about 60% had neurologic symptoms (less than the 76% of those with breast cancer). In addition, patients with lung cancer were less likely than those with breast cancer to present with seizures, harbor brainstem involvement, have leptomeningeal disease at diagnosis, and receive whole-brain radiation therapy.
As for recurrence or treatment-based intracranial outcomes, there appeared to be no significant differences between the two groups after initial brain-directed therapy. There was, however, an apparent difference in terms of neurologic death, with it being less common in patients with NSCLC than in those with breast cancer.