57P - Non Small Cell Lung Carcinoma (NSCLC) Patients With Baseline Brain Imaging - A PROSPECTIVE OBSERVATIONAL STUDY

Date 05 April 2019
Event European Lung Cancer Congress 2019
Topics Imaging
Presenter Naresh Gundu
Citation Annals of Oncology (2019) 30 (suppl_2): ii20-ii21. 10.1093/annonc/mdz066
Authors N. Gundu1, P.S. Malik1, S. Khurana1, S. Pathy2, M. Yadav3, D. Jain4, H. Kancharla1
  • 1Medical Oncology, All India Institute of Medical Sciences, 110029 - New Delhi/IN
  • 2Radiation Oncology, All India Institute of Medical Sciences, 110029 - New Delhi/IN
  • 3Radiology, All India Institute of Medical Sciences, 110029 - New Delhi/IN
  • 4Pathology, All India Institute of Medical Sciences, 110029 - New Delhi/IN

Abstract

Background

Brain metastases in NSCLC patients is the major cause of the poor survival and quality of life. Symptomatic brain metastasis at baseline are present in 5-10% of NSCLC and over the time course about 40% patients develop brain metastasis. Screening for asymptomatic brain metastasis in advanced NSCLC is controversial. Here we present our initial experience of mandatory brain imaging of all NSCLC patients irrespective of CNS symptoms and stage.

Methods

It is a prospective observation study of NSCLC patients with mandatory baseline brain imaging. Data was analysed for patients enrolled in the study from Jan 2018- Nov 2018. All patients with histology proven NSCLC were incuded irrespective of stage. Brain imaging was performed by CECT. A comprehensive CNS examination was performed at diagnosis. All statistical analysis was done by STATA version 13.Univariate analysis was done by Cox regression model.

Results

There were 238 patients enrolled. Median age was 58yrs (range 26-83yrs) with male predominance (n = 183 , 76.9%). Smokers were 65.1% ( n = 153) and majority had ECOG PS 1&2 (82%). Most common histology was adenocarcinoma - 64.6% (n = 151) . EGFR mutation could be tested in 98 of adenocarcinoma patients and was positive in 32 (32.6%). ALK (IHC-D5F3) was tested in 78 patients and was positive in 11 (14.1%) . Majority patients had stage 4 disease, 74.8% (n = 176). There was upstaging to stage 4 after brain imaging in 8% (n = 20) patients. Brain metastases was present in 22.7% (n = 54) of which 52% (n = 28) were asymptomatic. Majority had solitary lesion - 48% (n = 26), predominatly located supratentorially - 66% (n = 36). Majority of these patients received chemotherapy - 46.2% (n = 25), TKI -27.7% (n = 15), WBRT -14.8%(n = 8), BSC -22.2% (n = 12). Univariate analyses was done for age, sex, histological subtype, EGFR and ALK status, out of which younger age (<40 yrs) and adenocarcinoma histology were found to be significant predictors for presence brain metastases.

Conclusions

Brain metastasis with mandatory baseline brain imaging (atleast CECT) were found in 22.7% patients in our study and resulted in upstaging of disease in 8%. Frequency of brain metastasis were significantly higher in adenocarcinoma histology and younger age (<40 yrs).

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

All India Institute of Medical Sciences.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.