Performing brain MR imaging in asymptomatic patients with early stage, non-small cell lung cancer provides no prognostic benefit and is likely unnecessary, according to new research published Tuesday in Radiology.
The brain is the most affected organ outside of the chest among patients with this form of lung cancer. Upward of 20% of individuals present with disease that has metastasized into the head, which is strongly associated with poor prognosis, experts noted. Staging guidelines recommend routine brain MRI for advanced stages of non-small cell lung cancer. But there is no clinical consensus around whether to do so during early development of the disease.
South Korean scientists recently set out to explore this concern through a retrospective study incorporating 628 patients with early NSCLC. Among them, 53% underwent brain MRI, with no benefits derived in terms of metastasis-free and overall survival.
“These results indicate that the real-world adherence to the guideline-recommended staging work-up for NSCLC is variable among physicians,” corresponding author Hyungjin Kim, a professor with the Department of Radiology at the Seoul National University Hospital, and co-authors wrote March 8. “We assume that this variation in the staging process and overuse of brain imaging may be caused by a lack of confidence stemming from insufficient clinical evidence.”
Kim and colleagues used data from their institution for the study, incorporating patients who underwent surgical resection for primary lung cancer between 2009-2016, with several caveats. A total of 331 patients in the study population underwent staging brain MRI. Such exams showed no prognostic benefits for brain metastasis-free survival (hazard ratio of 1.06), time to brain metastasis (1.6) and overall survival (0.86).
In a corresponding editorial, experts said this study supports the evidence that contrast-enhanced MRI screening is unnecessary among patients with early-stage, non-small cell lung cancer. However, they cautioned that Kim et al. only explored the benefits of conventional MRI sequences.
“In future studies, the utility of adding diffusion MRI or even hybrid FDG PET/MRI to the imaging protocol should be tested,” Alberto Bizzi and Riccardo Pascuzzo, with the Carlo Besta Neurological Institute in Milan, Italy, wrote Tuesday. “Furthermore, the integration of advanced imaging modalities with modern artificial intelligence methods may reveal useful information for preoperative brain metastases detection that currently escape the human eye.”
Future studies could also explore the cost-effectiveness of staging brain MRI in this patient population and whether it may delay curative treatment for lung cancer, Kim and co-authors wrote.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.