WCLC 2025 - Posters & ePosters-P1.04.26 The Impact of Brain MRI Surveillance on Survival Outcomes in Initially CNS Metastasis-Free Non-Small Cell Lung Cancer

P1.04.26 The Impact of Brain MRI Surveillance on Survival Outcomes in Initially CNS Metastasis-Free Non-Small Cell Lung Cancer

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This retrospective observational study from Asan Medical Center, South Korea, evaluated the impact of brain MRI surveillance on survival in non-small cell lung cancer (NSCLC) patients initially without brain metastases. The cohort included 6,448 newly diagnosed NSCLC patients (2014–2019) who underwent baseline enhanced brain MRI showing no brain lesions. Patients were divided into a surveillance group (those undergoing subsequent brain MRI without neurological symptoms) and a non-surveillance group (no subsequent brain MRI). Propensity score matching accounted for confounders including stage, age, sex, smoking status, and actionable genetic alterations (AGAs such as EGFR, ALK, and ROS1 mutations), resulting in 3,564 patients for comparative analysis.<br /><br />Key findings revealed that 27.5% of the surveillance group developed brain metastases at a median of 20 months from diagnosis, with higher incidence in advanced stages (III and IV), adenocarcinoma histology, and presence of AGAs. Brain MRI surveillance was associated with significantly improved overall survival (OS) for stage IIIB/C and IV patients, with no OS difference observed in stages IA to IIIA. The surveillance group received more aggressive treatment, including greater use of stereotactic radiosurgery (Gamma Knife radiosurgery, GKRS) and longer durations of tyrosine kinase inhibitors (TKI), compared to the non-surveillance group.<br /><br />The study concludes that routine brain MRI surveillance in NSCLC patients without initial brain metastases—especially those with advanced disease and actionable mutations—enables earlier detection of brain metastases, facilitating timely intervention that improves survival outcomes. These findings support incorporation of brain MRI surveillance into clinical management for high-risk NSCLC patients lacking baseline brain metastases, addressing a gap where no established guidelines currently exist.<br /><br />In summary, brain MRI surveillance after initial diagnosis enhances survival by enabling earlier brain metastasis detection and subsequent targeted treatments in advanced NSCLC patients, highlighting its clinical significance.

Asset Subtitle

Seong-Eun Kim

Meta Tag

Speaker Seong-Eun Kim

Topic Screening and Early Detection

Keywords

non-small cell lung cancer

brain MRI surveillance

brain metastases

overall survival

advanced NSCLC

actionable genetic alterations

stereotactic radiosurgery

tyrosine kinase inhibitors

Asan Medical Center

propensity score matching