From the Guidelines
Approximately 25% of patients with stage IV non-small cell lung cancer (NSCLC) have a brain metastasis, as reported in the American College of Chest Physicians evidence-based clinical practice guidelines 1.
Frequency of Brain Metastasis
The frequency of brain metastasis in NSCLC is a significant concern, with approximately 25% of patients with stage IV disease having a brain metastasis 1. This highlights the importance of considering brain metastasis in the management of NSCLC, particularly in patients with advanced disease.
Factors Influencing Brain Metastasis
Several factors influence the likelihood of brain metastasis in NSCLC, including:
- Adenocarcinoma histology, which is associated with a higher likelihood of brain metastases 1
- Advanced disease stage
- Specific molecular alterations, such as EGFR mutations and ALK rearrangements
- Younger age
- Good performance status
Management of Brain Metastasis
The management of brain metastasis in NSCLC depends on various factors, including the number and location of metastases, the patient's performance status, and the presence of other sites of disease. Aggressive curative-intent treatment of a brain metastasis may involve either surgical resection of the metastasis or ablation of the metastasis by radiosurgery, as discussed in the American College of Chest Physicians guidelines 1. Whole-brain radiotherapy (WBRT) may also be considered for palliative intent or prophylactically to prevent or delay the appearance of further brain metastases.
From the Research
Frequency of Brain Metastasis in Non-Small Cell Carcinoma
- The frequency of brain metastasis in non-small cell carcinoma (NSCLC) can range from 20% to 50% of patients during the course of the disease 2, 3.
- Approximately 10.4% of patients with NSCLC present with brain metastases at diagnosis, with a higher prevalence (26%) in patients with stage IV disease at presentation 4.
- The risk of brain metastases at presentation can be calculated based on clinical variables such as younger age, adenocarcinoma or large cell histology, tumor size > 3 cm, tumor grade ≥ II, and node-positive disease 4.
Factors Influencing Brain Metastasis
- The improvement in diagnostic tools and screening, as well as the use of new systemic therapies, have contributed to a more precise diagnosis and prolonged survival of lung cancer patients, allowing more time for brain metastases to develop 3.
- The blood-brain barrier poses a substantial challenge in the treatment of brain metastases, restricting the penetration of many anticancer agents 5.
- Novel immunotherapy, such as immune checkpoint inhibitors (ICIs), have emerged as promising treatments for NSCLC and its associated brain metastases 6, 5.
Treatment and Outcomes
- Surgery, radiotherapy, and systemic therapies have each played a role in the management of brain metastases in NSCLC patients, with stereotactic radiosurgery being a significant advancement 2.
- The combination of stereotactic radiotherapy and systemic treatments, such as chemotherapy, TKIs, and immunotherapy, remains a subject of ongoing investigation 3.
- Selected patients with brain metastases at presentation may achieve prolonged benefit, with a 3-year overall survival rate of 36.2% in those with T1/2 and N0/1 undergoing surgery for the primary site 4.