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UNC scientists report that in early stage, asymptomatic non-small cell lung cancer, early brain recurrences are potentially detectable prior to surgery and recommend that physicians consider including a routine pre-operative staging brain MRI. In addition, patients whose tumors are determined to be higher risk based on the findings at surgery, should consider post-operative MRI to offer early treatment of unrecognized metastasis.

The UNC group reported their findings in a letter published in the September 23, 2011 online issue of the journal Clinical Oncology.

At present, practice guidelines do not recommend a preoperative brain MRI for early stage cancer (Stage 1A), but recently the clinical practice group, the National Comprehensive Cancer Network, has added a brain MRI for early stage cancer (Stage 1B).

Neil Hayes, MD, MPH, and colleagues completed a retrospective study of 174 UNC patients with lung adenocarcinoma, the type of lung cancer that arises in peripheral lung tissue. As expected, they found that patients with Stage II and III disease developed more brain metastases compared to Stage 1.

Hayes writes, “Survival analysis of our study population showed that about 60 percent of stage 1 patients with early brain recurrence were still alive at five years, implying that some patients with brain metastases can have long-term, positive outcomes. Thus, even though stage 1 patients are at lower risk of developing brain recurrence, there is a significant incentive to diagnose them as early as possible.” Hayes is associate professor of medicine and a faculty member of UNC Lineberger Comprehensive Cancer Center.

The UNC group recommends consideration of routine preoperative staging brain MRI in patients with adenocarcinomas of the lung, including stage 1A, and postoperative scans if the pathological state is high.