Brain imaging in lung cancer patients without symptoms of brain metastases: a national survey of current practice in England

Hudson, Benjamin; Crawford, Michael; Curtin, John J.

doi:10.1016/j.crad.2015.02.007

Cited by 13 publications

(14 citation statements)

References 5 publications

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“…There is guidance on brain imaging as part of the pre-operative work up from many international groups. However, it is acknowledged that within the UK individual centre practice is very variable [1]. …”

Section: Introductionmentioning

confidence: 99%

Brain imaging before primary lung cancer resection: a controversial topic

Hudson¹,

Internullo²,

Edey³

et al. 2017

ecancer

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ObjectiveInternational and national recommendations for brain imaging in patients planned to undergo potentially curative resection of non-small-cell lung cancer (NSCLC) are variably implemented throughout the United Kingdom [Hudson BJ, Crawford MB, and Curtin J et al (2015) Brain imaging in lung cancer patients without symptoms of brain metastases: a national survey of current practice in England Clin Radiol https://doi.org/10.1016/j.crad.2015.02.007]. However, the recommendations are not based on high-quality evidence and do not take into account cost implications and local resources. Our aim was to determine local practice based on historic outcomes in this patient cohort.MethodsThis retrospective study took place in a regional thoracic surgical centre in the United Kingdom. Pathology records for all patients who had undergone lung resection with curative intent during the time period January 2012–December 2014 were analysed in October 2015. Electronic pathology and radiology reports were accessed for each patient and data collected about their histological findings, TNM stage, resection margins, and the presence of brain metastases on either pre-operative or post-operative imaging. From the dates given on imaging, we calculated the number of days post-resection that the brain metastases were detected.Results585 patients were identified who had undergone resection of their lung cancer. Of these, 471 had accessible electronic radiology records to assess for the radiological evidence of brain metastases. When their electronic records were evaluated, 25/471 (5.3%) patients had radiological evidence of brain metastasis. Of these, five patients had been diagnosed with a brain metastasis at initial presentation and had undergone primary resection of the brain metastasis followed by resection of the lung primary. One patient had been diagnosed with both a primary lung and a primary bowel adenocarcinoma; on review of the case, it was felt that the brain metastasis was more likely to have originated from the bowel cancer. One had been clinically diagnosed with a cerebral abscess while the radiology had been reported as showing a metastatic deposit. Of the remaining 18/471 (3.8%) patients who presented with brain metastases after their surgical resection, 12 patients had adenocarcinoma, four patients had squamous cell carcinoma, one had basaloid, and one had large-cell neuroendocrine. The mean number of days post-resection that the brain metastases were identified was 371 days, range 14–1032 days, median 295 days (date of metastases not available for two patients).ConclusionThe rate of brain metastases identified in this study was similar to previous studies. This would suggest that preoperative staging of the central nervous system may change the management pathway in a small group of patients. However, for this group of patients, the change would be significant either sparing them non-curative surgery or allowing aggressive management of oligometastatic disease. Therefore, we would recommend pre-operative brain imagin...

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Section: Introductionmentioning

confidence: 99%

Brain imaging before primary lung cancer resection: a controversial topic

Hudson¹,

Internullo²,

Edey³

et al. 2017

ecancer

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“…They revealed a variation in treatment patterns in the Dutch health care system, which could not be explained solely by annual case volume and hospital teaching status. Moreover, Hudson et al [26] conducted a survey among British lung cancer clinicians regarding cerebral imaging in newly diagnosed NSCLC patients with no neurologic symptoms. The questionnaire included changes in clinical practice after the publication of the 2011 National Institute for Health and Care Excellence (NICE) guidelines.…”

Section: Discussionmentioning

confidence: 99%

Lung cancer guidelines in Sweden, Denmark, Norway and Finland: a comparison

et al. 2017

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Background: The Nordic countries are similar in terms of demographics and health care organization. Yet there are marked differences in lung cancer mortality, for which Denmark historically has had the poorest outcome. One of several possible reasons for these differences could have to do with how lung cancer is diagnosed and treated in the different Nordic countries. However, among the four most populous Nordic countries: Sweden, Denmark, Norway and Finland, there is a paucity of knowledge about differences and similarities in recommendations in the national guidelines for non-small cell lung cancer (NSCLC) and the methodology by which the guidelines are developed. Methods: We identified and evaluated the development and content of the available clinical care guidelines for NSCLC in the four countries. Moreover, we compared the integrated cancer pathways in these countries. We have used case examples to illustrate areas with clear differences in clinical care recommendations.Results: There are notable differences in the methodology by which the guidelines are developed, published and updated to comply with international recommendations. The Norwegian guidelines are developed and updated according to the most rigorous methodology and have so far been updated most frequently. We found that on the basis of recommendations patients with NSCLC are treated differently with regard to bevacizumab therapy and radiation dosing regimens. Cerebral imaging practices in patients with locally advanced NSCLC also differ. There is, moreover, a marked difference with regard to efforts to help patients to quit smoking. All except Finland have integrated cancer pathways for fast track diagnosis and treatment. Guidelines for follow-up of lung cancer patients also differ, with the Danish follow-up regimen as the most comprehensive. To obtain consensus on optimal clinical care, areas with differences in recommendations or where recommendations are based on a low level of evidence should be subjected to further studies. ARTICLE HISTORY

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“…Although MRI is more sensitive than a CE-CT, in daily practice CE-CT is often used because of contra-indications to MRI or poor MRI accessibility (14,15). Screening patients for BM is important, as a diagnosis of BM will change the treatment plan for a patient with otherwise early stage disease: either the treatment with radical intent is abandoned and systemic treatment (with/without local treatment for the BM) is initiated, or both the thoracic disease and the BM (when few in number) are treated with radical intent.…”

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confidence: 99%