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Poster Discussion session - Non-metastatic NSCLC and other thoracic malignancies

5172 - Screening for brain metastases (BM) in patients (pts) with stage III non-small cell lung cancer (NSCLC), magnetic resonance imaging (MRI) or dedicated contrast-enhanced computed tomography (dCE-CT)? A prospective observational study


21 Oct 2018


Poster Discussion session - Non-metastatic NSCLC and other thoracic malignancies


Staging and Imaging

Tumour Site


Janna Schoenmaekers


Annals of Oncology (2018) 29 (suppl_8): viii488-viii492. 10.1093/annonc/mdy291


J.J.A.O. Schoenmaekers1, P. Hofman2, G. Bootsma3, M. Westenend4, M. De Booij5, W. Schreurs6, R. Houben7, D. De Ruysscher8, A.C. Dingemans9, L. Hendriks10

Author affiliations

  • 1 Pulmonology, Academisch Ziekenhuis Maastricht (AZM), 6229 HX - Maastricht/NL
  • 2 Radiology, MUMC, 6229hx - Maastricht/NL
  • 3 Pulmonary Diseases, Zuyderland Medical Center - Heerlen, 6419 PC - Heerlen/NL
  • 4 Pulmonology, Viercurie hospital Venlo, 5912bl - Venlo/NL
  • 5 Radiology, Zuyderland Medical Center - Heerlen, 6419 PC - Heerlen/NL
  • 6 Nuclear Medicine, Zuyderland hospital Heerlen, 6419pc - Heerlen/NL
  • 7 Radiotherapy, Maastro, 6229et - Maastricht/NL
  • 8 Radiation oncology (maastro Clinic), Maastricht University Medical Centre (MUMC)-MAASTRO clinic, 6229 ET - Maastricht/NL
  • 9 Pulmonology, Maastricht University Medical Center (MUMC), 6202 AZ - Maastricht/NL
  • 10 Pulmonary Diseases, Maastricht University Medical Center (MUMC), 6202 AZ - Maastricht/NL


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Abstract 5172


In all NSCLC guidelines it is advised to screen stage III pts eligible for therapy (tx) with curative intent for BM, preferably by MRI, or otherwise a dCE-CT. However, MRI access can be problematic. dCE-CT brain is frequently incorporated in the staging 18Fluodeoxoglucose-positron-emission-tomography (18FDG-PET)-CE-CT scan. The additive value of a brain MRI after a dCE-CT brain is unknown.


Observational prospective multicentre study (3 Dutch centers, (NTR3628). Inclusion: all consecutive neurologically asymptomatic stage III (based on 18FDG-PET) NSCLC pts with a dCE-CT brain incorporated in the 18FDG-PET and an additional brain MRI. Demographics, brain imaging results and development of BM in follow-up (FU) were collected. Both MRI and 18FDG-PET-CE-CT were reviewed by an experienced neuroradiologist. Primary endpoint: % pts with BM on MRI without suspect lesions on dCE-CT. 118 pts were needed to show a clinically relevant considered difference of 2%. Secondary endpoints: % of pts with BM on dCE-CT, % of pts with BM ≤ 1 year of a negative staging MRI.


118 pts were enrolled between 12-‘12 until 12-‘16, and were followed until 12-’17. During the year of FU 30 extra pts were included. In total 148 pts were included: 59% male; mean age 68 years, 84% WHO PS 0-1 and 44% adenocarcinoma. Median time (range) between 18FDG-PET-CE-CT and MRI was 13 (0 -57) days. 5 of the first 118 pts (4.2%) had a solitary BM on MRI despite no suspect brain lesions on dCE-CT. In total 7/154 pts (4.5%) had a BM on MRI without suspect lesions on dCE-CT. In retrospect, in one of these 7 pts a solitary BM could be identified on the 18FDG-PET–CE-CT. 16 (7%) of the screened pts with extracranial stage III were excluded because BM were already detected on dCE-CT brain. Of the 118 pts with a FU of 1 year, 10 (8.5%) developed BM ≤ 1 year after a negative staging brain MRI.


Although in 7% of stage III NSCLC pts BM were detected on staging dCE-CT, MRI brain detected BM in an additional 4.5% of pts which we consider clinically relevant in this pt population. Within 1 year after a negative staging MRI, 8.5% of pts developed BM.

Clinical trial identification


Legal entity responsible for the study

Academic hospital Maastricht.


Has not received any funding.

Editorial Acknowledgement


L. Hendriks: Outside the current abstract: Research funding: Roche; Advisory board: Boehringer, BMS; Travel reimbursement: Roche, BMS. A-M.C. Dingemans: Advisory board: BMS, MSD, Roche. D. De Ruysscher: Outside the current abstract: Advisory board: BMS, Roche/Genentech, Merck/ Pfizer, Celgene, AstraZeneca, Noxxon, Mologen. All financial income is going to Maastro Clinic. All other authors have declared no conflicts of interest.

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