Characteristics and Screening of Brain Metastases in Breast Cancer and NSCLC

In a research letter published in JAMA Oncology, Cagney et al found that brain metastases were more advanced and more likely to be symptomatic in patients with breast cancer compared to patients with non–small cell lung cancer (NSCLC). Current guidelines recommend magnetic resonance imaging (MRI) screening of the brain in stage II–IV NSCLC, but not in breast cancer. The study was undertaken to ascertain the potential value of MRI screening in breast cancer.

Study Details

The study involved 349 patients with breast cancer and 659 with NSCLC treated for newly diagnosed brain metastases between January 2000 and December 2015 at Dana-Farber/Brigham and Women's Cancer Center. Overall, 84 breast cancer patients (24.0%) had been screened for brain metastases; some patients with NSCLC were not screened, including some diagnosed with NSCLC due to symptomatic brain metastases.

Comparison of Metastatic Disease

Compared with NSCLC patients, those with breast cancer presented with larger diameter metastases (median [interquartile range, IQR] = 17 [10–29] mm vs 14 [8–23] mm, P < .001) and a greater number of metastases (median [IQR] = 3 [1–8] vs 2 [1–4], P < .001). Patients with breast cancer were more likely to be symptomatic at presentation (75.9% vs 60.5%, P < .001), present with seizures (16.9% vs 11.4%, P = .01), have brainstem involvement (8.0% vs 4.2%, P = .02), have leptomeningeal disease at diagnosis (11.5% vs 14 2.1%, P < .001), and receive whole-brain radiation therapy (WBRT) as initial management (59.9% vs 42.9%, P < .001).

After initial brain-directed therapy, there were no differences between groups in recurrence or treatment-based intracranial outcomes. However, patients with breast cancer had higher risk for neurologic death (37.3% vs 19.9% of total deaths, P < .001) and reduced time to neurologic death (hazard ratio = 1.54, P = .01).

The investigators concluded, “Patients with breast cancer presented with more advanced intracranial disease than did patients with NSCLC and more frequently required WBRT as initial management… [Our findings suggest] that intracranial disease in patients with breast cancer was not more aggressive or resistant to treatment but rather was diagnosed at a later stage… Early identification of intracranial disease facilitates less invasive or less toxic approaches, such as stereotactic radiosurgery or careful use of promising systemic agents rather than WBRT or neurosurgical resection… [Despite its limitations], this study strongly supports further investigation into MRI screening of the brain among select patients with metastatic breast cancer.”

Daniel N. Cagney, MD, of the Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, is the corresponding author for the JAMA Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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