Brain imaging in lung cancer staging: A real-world, multi-centre study of prevalence of brain metastases, impact on treatment and re-modelling of the NICE health economic analysis

Brockelsby, Christopher; Maconachie, Ross; Navani, Neal; Prendecki, Ruth; Randles, Victoria; King, Jenny; Dildar, Babar; Lee, Xiang; Rice, Matthew; Al-Najjar, Haider; Atkins, Abby; Sundar, Ram; Brown, Louise; Sharma, Sumat; O’Dowd, Emma; Crisp, Elinor; Tufail, Muhammad; Vella, Claire; Grundy, Seamus; Evison, Matthew

doi:10.1016/j.lungcan.2023.02.012

Cited by 2 publications

(2 citation statements)

References 2 publications

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“…Despite existing protocols recommending brain MRI at initial LC diagnosis [ 7 , 8 ], practical challenges such as substantial cost, the time-consuming nature of conducting and interpreting scans, and limited accessibility contribute to variable compliance with these guidelines. For example, in the UK, adherence gaps are evidenced by the fact that 32% of stage III patients do not undergo the recommended pre-treatment imaging in alignment with NICE guidelines [ 9 ]. Also, there is a lack of guidance concerning regular surveillance with brain MRI in patients who do not initially present with BM.…”

Section: Introductionmentioning

confidence: 99%

Blood Neurofilament Light Chain and Glial Fibrillary Acidic Protein as Promising Screening Biomarkers for Brain Metastases in Patients with Lung Cancer

Kim,

Ahn,

Lee

et al. 2024

IJMS

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The diagnosis of brain metastases (BMs) in patients with lung cancer (LC) predominantly relies on magnetic resonance imaging (MRI), a method that is constrained by high costs and limited accessibility. This study explores the potential of serum neurofilament light chain (sNfL) and serum glial fibrillary acidic protein (sGFAP) as screening biomarkers for BMs in LC patients. We conducted a retrospective analysis of 700 LC cases at the National Cancer Center, Korea, from July 2020 to June 2022, measuring sNfL and sGFAP levels at initial LC diagnosis. The likelihood of BM was evaluated using multivariate analysis and a predictive nomogram. Additionally, we prospectively monitored 177 samples from 46 LC patients initially without BM. Patients with BMs (n= 135) had significantly higher median sNfL (52.5 pg/mL) and sGFAP (239.2 pg/mL) levels compared to those without BMs (n = 565), with medians of 17.8 pg/mL and 141.1 pg/mL, respectively (p < 0.001 for both). The nomogram, incorporating age, sNfL, and sGFAP, predicted BM with an area under the curve (AUC) of 0.877 (95% CI 0.84–0.914), showing 74.8% sensitivity and 83.5% specificity. Over nine months, 93% of samples from patients without BM remained below the cutoff, while all patients developing BMs showed increased levels at detection. A nomogram incorporating age, sNfL, and sGFAP provides a valuable tool for identifying LC patients at high risk for BM, thereby enabling targeted MRI screenings and enhancing diagnostic efficiency.

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Section: Introductionmentioning

confidence: 99%

Blood Neurofilament Light Chain and Glial Fibrillary Acidic Protein as Promising Screening Biomarkers for Brain Metastases in Patients with Lung Cancer

Kim,

Ahn,

Lee

et al. 2024

IJMS

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“…At least 40% of patients with non-smallcell lung cancer (NSCLC) are diagnosed with brain metastases (BMs) during the disease trajectory [3][4][5]. The incidence of BMs is increasing following more frequent screening [6], more accurate brain imaging with magnetic resonance imaging (MRI), and prolonged survival with new systemic treatment options [7]. Over time, standard-of-care treatment for NSCLC BMs has changed, with more use of stereotactic radiotherapy (SRT) and new systemic treatments.…”

Section: Introductionmentioning

confidence: 99%

Overall Survival after Radiotherapy for Brain Metastases According to ECOG Status—A Prospective Study of 294 NSCLC Patients

Karlsson,

Hjermstad,

Aass

et al. 2024

Cancers

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Up to 40% of non-smallcell lung cancer (NSCLC) patients develop brain metastases (BMs). The potential benefits of radiotherapy (RT) in patients with poor performance status (PS) are questionable, with considerable risk for futile treatment. We analyzed overall survival after initial radiotherapy in NSCLC patients with BMs, focusing on the relationship between PS and survival after RT. This study reports a prospective observational study including consecutive 294 NSCLC patients with first-time BMs. Overall survival (OS) was calculated from the start of RT to death or last follow-up (1 June 2023). Overall, in the 294 included patients (median age 69 years), the median OS was 4.6 months; 2.5 months after WBRT (N = 141), and 7.5 months after SRT (N = 153). After WBRT, mOS was equally poor for patients with ECOG 2 (1.9 months) and ECOG 3–4 (1.2 months). After SRT, mOS for patients with ECOG 2 was 4.1 months; for ECOG 3 patients, mOS was 4 1.6 months. For NSCLC patients with ECOG 2 diagnosed with BMs who are not candidates for surgery or SRT, WBRT should be questioned due to short survival.

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Brain imaging in lung cancer staging: A real-world, multi-centre study of prevalence of brain metastases, impact on treatment and re-modelling of the NICE health economic analysis

Cited by 2 publications

References 2 publications

Blood Neurofilament Light Chain and Glial Fibrillary Acidic Protein as Promising Screening Biomarkers for Brain Metastases in Patients with Lung Cancer

Blood Neurofilament Light Chain and Glial Fibrillary Acidic Protein as Promising Screening Biomarkers for Brain Metastases in Patients with Lung Cancer

Overall Survival after Radiotherapy for Brain Metastases According to ECOG Status—A Prospective Study of 294 NSCLC Patients

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