Skip to main content
PMC home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1990 Oct;62(4):684–686. doi: 10.1038/bjc.1990.357

The value of computed tomographic (CT) scan surveillance in the detection and management of brain metastases in patients with small cell lung cancer.

J Hardy 1, I Smith 1, G Cherryman 1, M Vincent 1, I Judson 1, T Perren 1, M Williams 1
PMCID: PMC1971490  PMID: 2171623

Abstract

One hundred and twenty-seven consecutive patients presenting with small cell lung cancer were entered into a whole-brain CT scan surveillance study, starting at presentation and repeating at 3-monthly intervals for 2 years as an alternative to prophylactic cranial irradiation (PCI). The aim of the study was to detect CNS metastases at an early asymptomatic stage in the hope that prompt CNS radiotherapy could achieve long-term control; at the same time unnecessary PCI with its potential long-term morbidity could be avoided. CNS metastases were found in 56 patients (44%) including 16 (13%) at diagnosis and 40 at a median of 4 months (range 1-27 months) after completing chemotherapy. No patient developed CNS disease while on chemotherapy. Thirty-six patients were asymptomatic at diagnosis (group A) but 20 developed clinical CNS relapse between scans (group B) (interval relapse). Despite prompt radiotherapy 56% of patients in group A and 60% of patients in group B died with active CNS disease. Likewise, there was no survival difference between patients in group A, group B or those who never developed CNS disease. Regular 3-month CT scan surveillance is therefore not an effective substitute for PCI.

Full text

PDF
684

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aroney R. S., Aisner J., Wesley M. N., Whitacre M. Y., Van Echo D. A., Slawson R. G., Wiernik P. H. Value of prophylactic cranial irradiation given at complete remission in small cell lung carcinoma. Cancer Treat Rep. 1983 Jul-Aug;67(7-8):675–682. [PubMed] [Google Scholar]
  2. Baglan R. J., Marks J. E. Comparison of symptomatic and prophylactic irradiation of brain metastases from oat cell carcinoma of the lung. Cancer. 1981 Jan 1;47(1):41–45. doi: 10.1002/1097-0142(19810101)47:1<41::aid-cncr2820470109>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  3. Cox J. D., Komaki R., Byhardt R. W., Kun L. E. Results of whole-brain irradiation for metastases from small cell carcinoma of the lung. Cancer Treat Rep. 1980 Aug-Sep;64(8-9):957–961. [PubMed] [Google Scholar]
  4. Crane J. M., Nelson M. J., Ihde D. C., Makuch R. W., Glatstein E., Zabell A., Johnston-Early A., Bates H. R., Saini N., Cohen M. H. A comparison of computed tomography and radionuclide scanning for detection of brain metastases in small cell lung cancer. J Clin Oncol. 1984 Sep;2(9):1017–1024. doi: 10.1200/JCO.1984.2.9.1017. [DOI] [PubMed] [Google Scholar]
  5. Felletti R., Souhami R. L., Spiro S. G., Geddes D. M., Tobias J. S., Mantell B. S., Harper P. G., Trask C. Social consequences of brain or liver relapse in small cell carcinoma of the bronchus. Radiother Oncol. 1985 Dec;4(4):335–339. doi: 10.1016/s0167-8140(85)80121-3. [DOI] [PubMed] [Google Scholar]
  6. Gallagher C. J., Cairnduff F., Smith I. E. High dose versus low dose medroxyprogesterone acetate: a randomized trial in advanced breast cancer. Eur J Cancer Clin Oncol. 1987 Dec;23(12):1895–1900. doi: 10.1016/0277-5379(87)90056-3. [DOI] [PubMed] [Google Scholar]
  7. Hirsch F. R., Paulson O. B., Hansen H. H., Larsen S. O. Intracranial metastases in small cell carcinoma of the lung. Prognostic aspects. Cancer. 1983 Feb 1;51(3):529–533. doi: 10.1002/1097-0142(19830201)51:3<529::aid-cncr2820510327>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  8. Johnson B. E., Becker B., Goff W. B., 2nd, Petronas N., Krehbiel M. A., Makuch R. W., McKenna G., Glatstein E., Ihde D. C. Neurologic, neuropsychologic, and computed cranial tomography scan abnormalities in 2- to 10-year survivors of small-cell lung cancer. J Clin Oncol. 1985 Dec;3(12):1659–1667. doi: 10.1200/JCO.1985.3.12.1659. [DOI] [PubMed] [Google Scholar]
  9. Kantarjian H., Farha P. A., Spitzer G., Murphy W. K., Valdivieso M. Systemic combination chemotherapy as primary treatment of brain metastasis from lung cancer. South Med J. 1984 Apr;77(4):426–430. doi: 10.1097/00007611-198404000-00005. [DOI] [PubMed] [Google Scholar]
  10. Komaki R., Cox J. D., Whitson W. Risk of brain metastasis from small cell carcinoma of the lung related to length of survival and prophylactic irradiation. Cancer Treat Rep. 1981 Sep-Oct;65(9-10):811–814. [PubMed] [Google Scholar]
  11. Kristjansen P. E., Hansen H. H. Brain metastases from small cell lung cancer treated with combination chemotherapy. Eur J Cancer Clin Oncol. 1988 Mar;24(3):545–549. doi: 10.1016/s0277-5379(98)90035-9. [DOI] [PubMed] [Google Scholar]
  12. Lee J. S., Umsawasdi T., Lee Y. Y., Barkley H. T., Jr, Murphy W. K., Welch S., Valdivieso M. Neurotoxicity in long-term survivors of small cell lung cancer. Int J Radiat Oncol Biol Phys. 1986 Mar;12(3):313–321. doi: 10.1016/0360-3016(86)90344-5. [DOI] [PubMed] [Google Scholar]
  13. Lucas C. F., Robinson B., Hoskin P. J., Yarnold J. R., Smith I. E., Ford H. T. Morbidity of cranial relapse in small cell lung cancer and the impact of radiation therapy. Cancer Treat Rep. 1986 May;70(5):565–570. [PubMed] [Google Scholar]
  14. Nugent J. L., Bunn P. A., Jr, Matthews M. J., Ihde D. C., Cohen M. H., Gazdar A., Minna J. D. CNS metastases in small cell bronchogenic carcinoma: increasing frequency and changing pattern with lengthening survival. Cancer. 1979 Nov;44(5):1885–1893. doi: 10.1002/1097-0142(197911)44:5<1885::aid-cncr2820440550>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
  15. Pedersen A. G., Karle A., Boysen G., Højgaard K., Dombernowsky P. Brain CT-scanning and neurological examination in small cell bronchogenic carcinoma. J Neurooncol. 1983;1(3):197–202. doi: 10.1007/BF00165603. [DOI] [PubMed] [Google Scholar]
  16. Pedersen A. G., Kristjansen P. E., Hansen H. H. Prophylactic cranial irradiation and small cell lung cancer. Cancer Treat Rev. 1988 Jun;15(2):85–103. doi: 10.1016/0305-7372(88)90019-9. [DOI] [PubMed] [Google Scholar]
  17. Twelves C. J., Souhami R. L., Harper P. G., Ash C. M., Spiro S. G., Earl H. M., Tobias J. S., Quinn H., Geddes D. M. The response of cerebral metastases in small cell lung cancer to systemic chemotherapy. Br J Cancer. 1990 Jan;61(1):147–150. doi: 10.1038/bjc.1990.30. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Twijnstra A., Boon P. J., Lormans A. C., ten Velde G. P. Neurotoxicity of prophylactic cranial irradiation in patients with small cell carcinoma of the lung. Eur J Cancer Clin Oncol. 1987 Jul;23(7):983–986. doi: 10.1016/0277-5379(87)90345-2. [DOI] [PubMed] [Google Scholar]
  19. Young D. F., Posner J. B., Chu F., Nisce L. Rapid-course radiation therapy of cerebral metastases: results and complications. Cancer. 1974 Oct;34(4):1069–1076. doi: 10.1002/1097-0142(197410)34:4<1069::aid-cncr2820340416>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES