P3.04-007 Detection of Brain Metastasis in Resected Lung Cancer with the New Postoperative Follow-Up Program: Topic: Miscellaneous I

Abstract

In our previous study, follow-up brain MRI for the detection of early brain metastasis was examined every 2 months during the first 6 months after operation until 1995. In the study, asymptomatic brain metastases were found at the frequency of 2.3%. After that, the follow-up program was changed as follows; brain MRI performed on a postoperative patient at two points of 2-3 months (early check time) and 5-6 months (late check time) after operation. We reviewed the detection rate of brain metastasis in the new program. Between January 1996 and December 2009, 954 patients with primary lung cancer underwent complete surgical resection. Of 954 cases, 712 received brain MRI in accordance with the new follow-up program. The frequency, the point of brain metastases detection, treatment for brain metastases, and prognosis were reviewed. Of total 712 cases, 24 (3.4%) patients with brain metastases were detected as initial recurrence lesion with follow-up MRI. Seven of these 24 cases were detected at the point of early check time (early group). The remaining 17 cases were detected at the point of late check time (late group). In the early group, 3 patients had a single metastasis and 1 had three lesions. The remaining 3 had more than four lesions. On the other hand, 10 of 17 late group had a single metastasis and 5 had two or three lesions, and the remaining 2 had more than four lesions. In early group, the pathological stagings were 2 stage 1, 3 stage 2, 2 stage 3. All cases of solitary metastasis and 1case of three metastatic lesions were treated with stereotactic radiosurgery (SRS). Two cases with more than four lesions were treated with whole brain radiotherapy (WBRT). In late group, the pathological stagings were 5 stage 1, 5 stage 2, 7 stage 3. All but 2 cases were treated with SRS. The overall median survival time from thoracic surgery was 17 months in early group and 20 months in late group. Two cases from the late group were recurrence free for 104 and 81 months. In early group, they frequently had multiple brain metastases and were treated with WBRT. On the other hand, in late group, a single metastasis was discovered in many patients and was treated with SRS. Among them, some patients had long recurrence-free survival. From these results, we changed postoperative follow-up program for detection of the brain metastasis to check at only one point of 5-6 months after operation.