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Journal of Neuro-Oncology

, Volume 48, Issue 3, pp 243–248 | Cite as

Asymptomatic Brain Metastases (BM) in Small Cell Lung Cancer (SCLC): MR-imaging is Useful at Initial Diagnosis

  • MMH Hochstenbag
  • A Twijnstra
  • JT Wilmink
  • EFM Wouters
  • GPM ten Velde
Article

Abstract

Purpose. In this study we evaluated the usefulness of MR-imaging in the detection of asymptomatic brain metastases (BM) at the initial diagnosis in patients with small cell lung cancer (SCLC) and studied the follow-up of these patients.

Patients and methods. One-hundred and twenty-five patients with SCLC were investigated with MR-imaging.

Results. In 112 patients with normal neurological findings, MR-imaging of the brain demonstrated BM in 17 patients (15%). Six of these 17 patients were therefore upgraded to extensive disease (ED). Two of these 17 patients died during chemotherapy because of progressive disease and 3 patients became neurologic symptomatic with progressive disease on MR-imaging of the brain. After completion of chemotherapy a repeated MR-imaging of the brain in the remaining 12 patients showed 1 complete remission, 4 partial remission and 7 progressive disease of the BM.

Conclusion. This study showed that at presentation an unexpectedly high percentage of SCLC patients had asymptomatic BM on MR-imaging. We propose that MR-imaging of the brain should be included in the staging of SCLC patients as well for staging, prognosis and therapy.

SCLC brain matastases neurologic asympotomatic MRI prophylactic radiotherapy 

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References

  1. 1.
    Viallet J, Ihde DC: Small cell carcinoma of the lung. Clinical and biologic aspects. Critical Reviews in Oncology/Hematology 11: 109-135, 1991Google Scholar
  2. 2.
    Greco FA, Oldman RK: Small-cell lung cancer. N Engl J Med 301: 355-358, 1979Google Scholar
  3. 3.
    Patchell RA: Brain metastases. Neurol Clin 9: 817-824, 1991Google Scholar
  4. 4.
    Nugent JL, Bunn PA, Mattew MJ, Ihde DC, Cohen MH, Gazdar A, Minna JD: CNS metastases in small cell bronchogenic carcinoma: increasing frequency and changing pattern with lengthening survival. Cancer 44: 1885-1893, 1979Google Scholar
  5. 5.
    Komaki R, Cox JD, Whitson W: Risk of brain metastasis in small cell lung carcinoma of the lung related to length of survival and prophylactic irradiation. Cancer Treat Rep 65: 811-814, 1981Google Scholar
  6. 6.
    Pedersen AG: Diagnosis of CNS metastases from SCLC. In: Hansen HH (ed) Lung Cancer: Basic and Clinical Aspects. Martinus Nijhoff Publishers, Boston, 1986, pp 153-182Google Scholar
  7. 7.
    Hazel van GA, Scott M, Eagan RT: The effect of CNS metastases on the survival of patients with small cell cancer of the lung. Cancer 51: 933-937, 1983Google Scholar
  8. 8.
    Giannone L, Johnson DH, Hande KR, Greco FA: Favourable prognosis of brain metastases in small cell lung cancer. Ann Intern Med 106: 386-389, 1987Google Scholar
  9. 9.
    Kochhar R, Frytak S, Shaw EG: Survival of patients with extensive small-cell lung cancer who have only brain metastases at initial diagnosis. Am J Clin Oncol 20: 125-127, 1997Google Scholar
  10. 10.
    Van de Pol M, van Oosterhout AGM, Wilmink JT, ten Velde GPM, Twijnstra A: MRI in detection of brain metastases at initial staging of small-cell lung cancer. Neuroradiology 38: 207-210, 1996Google Scholar
  11. 11.
    Hardy J, Smith I, Cherryman G, Vincent M, Judson I, Perren T, Williams M: The value of computed tomographic (CT) scan surveillance in the detection and management of brain metastases in patients with small cell lung cancer. Br J Cancer 62: 684-686, 1990Google Scholar
  12. 12.
    Hochstenbag MMH, Snoep G, Cobben NAM, Schols Am, Thunissen FB, Wouters EF, ten Velde GP: Detection of bone marrow metastases in small cell lung cancer. Comparison of magnetic resonance imaging with standard methods. Eur J Cancer 32A: 779-782, 1996Google Scholar
  13. 13.
    Kristensen CA, Kristjansen PEG, Hansen HH: Systemic chemotherapy of brain metastases from small cell lung cancer: a review. J Clin Oncol 10: 1498-1502, 1992Google Scholar
  14. 14.
    Postmus PE, Sleijfer DTH, Haaxma-Reiche H: Chemotherapy for central nervous system metastases from SCLC: a review. Lung Cancer 5: 254-263, 1989Google Scholar
  15. 15.
    Sorensen PS, Kristjansen PEG, Wagner A, Hansen HH: Comparison of clinical neurological function and CT response during chemotherapy for initial brain metastases from small cell lung cancer. Acta Neurol Scand 89: 372-377, 1994Google Scholar
  16. 16.
    Habets JM, van Oosterhout AG, ten Velde GP, Wilmink JT, Twijnstra A: Diagnostic value of CT in the detection of brain metastasis in small cell lung cancer patients. J Belge Radiol 75: 179-181, 1992Google Scholar
  17. 17.
    Johnson DH, Windham WW, Allen JH, Greco FA: Limited value of CT brain scans in staging of small cell lung cancer. ALR 140: 37-40, 1983Google Scholar
  18. 18.
    Crane J, Nelson M, Macdonald J: A comparison of computed tomography (CT) and radionuclide (RN) TC 99m scanning of the brain in small cell lung cancer. J Clin Oncol 2: 1017-1024, 1984Google Scholar
  19. 19.
    Hirsch FR, Paulson OB, Hansen HH, Larsen SO: Intracranial metastases in small cell carcinoma of the lung: prognostic aspects. Cancer 51: 529-533, 1983Google Scholar
  20. 20.
    Pederson AG, Kristjansen PEG, Hansen HH: Prophylactic cranial irradiation and small cell lung cancer. Cancer Treat Rev 15: 85-103, 1988Google Scholar
  21. 21.
    Baglan RJ, Marks JE: Comparison of symptomatic and prophylactic irradiation of brain metastases from oat cell carcinoma of the lung. Cancer 47: 41-45, 1981Google Scholar
  22. 22.
    Arriagada R, Le Chevalier T, Boire F, Riviere A, Chomy P, Monnet E, Tardivon A, Viader F, Tarayre M, Benhamou S: Prophylactic cranial irradiation for patients with small cell lung cancer in complete remission. J Natl Cancer Inst 87: 183-190, 1995Google Scholar
  23. 23.
    Gregor A, Cull A, Stephens RJ, Kirkpatrick JA, Yarnold JR, Girling DJ, Macbeth FR, Stout R, Machin D: Prophylactic cranial irradiation is indicated following complete response to induction therapy in small cell lung cancer: results of a multicentre randomised trial. Eur J Cancer 33: 1752-1758, 1997Google Scholar
  24. 24.
    Auperin A, Arriagada R, Pignon JP, Le Pechoux C, Gregor A, Stephens RJ, Kristjansen PE, Johnson BE, Ueoka H, Aisner J: Prophylactic cranial irradiation for patients with small cell lung cancer in complete remission: Prophylactic Cranial Irradiation Overview Collaborative Group. N Engl J Med 341: 476-484, 1999Google Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • MMH Hochstenbag
    • 1
  • A Twijnstra
    • 2
  • JT Wilmink
    • 3
  • EFM Wouters
    • 1
  • GPM ten Velde
    • 1
  1. 1.Department of PulmonologyUniversity Hospital MaastrichtThe Netherlands
  2. 2.Department of NeurologyUniversity Hospital MaastrichtThe Netherlands
  3. 3.Department of RadiologyUniversity Hospital MaastrichtThe Netherlands

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