Exploration of spatial distribution of brain metastasis from small cell lung cancer and identification of metastatic risk level of brain regions: a multicenter, retrospective study

Abstract

Objectives This study aimed to explore the spatial distribution of brain metastases (BMs) from small cell lung cancer (SCLC) a homogenous sample, and to identify the metastatic risk levels in brain regions. Methods T1-enhanced magnetic resonance imaging (MRI) from SCLC patients were retrospectively reviewed from three medical institutions in China. All images were registered to the standard brain template provided by the Montreal Neurological Institute (MNI) 152 database, followed by transformation of the location of all BMs to the space of standard brain. The MNI structural atlas and Anatomical Automatic Labeling (AAL) atlas were then used to identify the anatomical brain regions, and the observed and expected rates of BMs were compared using 2-tailed proportional hypothesis testing. The locations and sizes of brain lesions were analyzed after image standardization. Results A total of 215 eligible patients with 1033 lesions were screened by MRI, including 157 (73%) males and 58 (27%) females. The incidence of crucial structures were as follows: hippocampus 0.68%, parahippocampal 0.97%, brainstem 2.05%, cauate 0.68%, putamen 0.68%, pallidum 0.2%, thalamus 1.36%. No BMs were found in the amygdala, pituitary gland, or pineal gland. The cumulative frequency of the important structures was 6.62%. Based on the results of MNI structural atlas, the cerebellum, deep white matter and brainstem was identified as a higher risk region than expected for BMs (P = 9.80 ×10−15, 9.04 ×10−6), whereas temporal lobe were low-risk regions (P = 1.65 ×10−4). More detailed AAL atlas revealed that the low-risk regions for BMs was inferior frontal gyrus (P = 6.971 ×10−4), while the high-risk regions for BMs was cerebellar hemispheres (P = 1.177 ×10−9). Conclusion Many crucial structures including the hippocampus, parahippocampus, pituitary gland and thalamus etc. have low frequency of brain metastases in a population of SCLC patients. This study provides the help to investigate the clinical feasibility of HA-WBRT and non-uniform dose of PCI in a population of SCLC patients.

Neuronal-Activity Dependent Mechanisms of Small Cell Lung Cancer Progression

“…Small cell lung cancer (SCLC) is a lethal high-grade neuroendocrine tumor that accounts for ~15% of all lung cancers, causes over 200,000 deaths worldwide annually 18,19 , and has a 60% chance of metastasis by the time of diagnosis, with a particular propensity to metastasize to the brain 20,21 . Experimental mouse models indicate that SCLC can originate from pulmonary neuroendocrine cells (PNECs) 22,23 , a lung epithelial cell type that resides in close proximity to nerve fibers and expresses neurotransmitter receptors [24][25][26] .…”

Predictive value of clinical characteristics on risk and prognosis of synchronous brain metastases in small‐cell lung cancer patients: A population‐based study

“…Interestingly, SCLC takes up less than 20% of lung cancer but accounts for 50% of all lung cancer brain metastases 7 . The most common sites for tumor brain metastasis are the frontal lobe, the cerebellum, the parietal lobe, and the temporal lobe 8 . The brain metastases will induce intracranial hypertension, meningeal irritation, motor/sensory disturbances, and epilepsy, leading to poor prognosis and impaired life quality.…”

“… 7 The most common sites for tumor brain metastasis are the frontal lobe, the cerebellum, the parietal lobe, and the temporal lobe. 8 The brain metastases will induce intracranial hypertension, meningeal irritation, motor/sensory disturbances, and epilepsy, leading to poor prognosis and impaired life quality. However, large sample data regarding the demographic features and management of SCLC patients with SBM is limited.…”

Untapped Neuroimaging Tools for Neuro-Oncology: Connectomics and Spatial Transcriptomics

“…Spatial mapping has shown that glioblastomas tend to occur in different locations according to their molecular subtypes [43]. Similar analyses identified brain areas favored by lung cancer metastases, as well as a relationship between their spatial distribution and epidermal growth factor receptor mutation status [44,45]. Pediatric postsurgical cerebellar lesion mapping was used to identify structures most strongly associated with cognitive affective syndrome [46].…”