Brain imaging in lung cancer staging: A real-world, multi-centre study of prevalence of brain metastases, impact on treatment and re-modelling of the NICE health economic analysis

被引：5

作者：

Brockelsby, Christopher ^{[1
]}

Maconachie, Ross ^{[2
]}

Navani, Neal ^{[3
]}

Prendecki, Ruth ^{[3
]}

Randles, Victoria ^{[4
,5
]}

King, Jenny ^{[1
]}

Dildar, Babar ^{[1
]}

Lee, Xiang ^{[6
]}

Nagarajan, Thapas ^{[6
]}

Rice, Matthew ^{[7
]}

Al-Najjar, Haider ^{[7
]}

Atkins, Abby ^{[8
]}

Sundar, Ram ^{[8
]}

Brown, Louise ^{[9
]}

Sharma, Sumat ^{[10
]}

O'Dowd, Emma ^{[11
]}

Crisp, Elinor

Tufail, Muhammad ^{[12
]}

Vella, Claire ^{[12
]}

Grundy, Seamus ^{[13
]}

Evison, Matthew ^{[1
]}

机构：

[1] Manchester Univ NHS Fdn Trust, Wythenshawe Hosp, Lung Canc & Thorac Surg Directorate, Southmoor Rd, Manchester M23 9LT, England

[2] Natl Inst Hlth & Care Excellence, NICE Ctr Guidelines, London, England

[3] UCL, Lungs Living Res Ctr, UCL Respirator, London, England

[4] Midcheshire Hosp NHS Fdn Trust, Leighton Hosp Middlewich Rd, Crewe CW1 4QJ, England

[5] Univ Coll London Hosp, Dept Thorac Med, London, England

[6] Macclesfield Hosp, East Cheshire NHS Trust, Victoria Rd, Macclesfield SK10 3BL, Ches, England

[7] Manchester Univ NHS Fdn Trust, Manchester Royal Infirm, Oxford Rd, Manchester M13 9WL, England

[8] Royal Albert Edward Infirm, Wigan & Leigh NHS Fdn Trust, Wigan Lane, Wigan WN1 2NN, England

[9] North Manchester Gen Hosp, Pennine Acute Hosp NHS Trust, Manchester M8 5RB, England

[10] Univ Hosp Derby, Burton NHS Fdn Trust, Uttoxeter Rd, Derby DE22 3NE, England

[11] Nottingham City Hosp, Nottingham Univ Hosp NHS Trust, Hucknall Rd, Nottingham NG5 1PB, England

[12] Univ Hosp Leicester NHS Trust, Glenfield Hosp, Groby Rd, Leicester LE3 9QP, England

[13] Salford Royal Hosp, Stott Lane, Salford M6 8HD, England

来源：

LUNG CANCER | 2023年 / 178卷

关键词：

Non-small cell lung cancer; Brain imaging; Economic analysis; Magnetic resonance imaging; Diagnostic Imaging;

D O I：

10.1016/j.lungcan.2023.02.012

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Introduction: In 2019, the National Institute for Health and Care Excellence (NICE) updated their recommendations with respect to brain imaging in the staging of non-small cell lung cancer (NSCLC) based on an analytic cost-effectiveness model using published data and modelling assumptions from committee experts. In this study, we aimed to re-run this model using real-world multi-centre UK data.Materials and Methods: Retrospective data was collected on consecutive patients with radically treatable clinical stage II and III lung cancer from eleven acute NHS Trusts during the calendar year 01/01/2018 to 31/12/2018. Following a written application to the NICE lung cancer guideline committee, we were granted access to the NG122 brain imaging economic model for the purpose of updating the input parameters in line with the realworld findings from this study.Results: A total of 444 patients had data for analysis. The combined prevalence of occult brain metastases was 6.2% (10/165) in stage II and 6% (17/283) in stage III, compared to 9.5% and 9.3% used in the NICE economic model. 30% of patients with clinical stage III NSCLC and occult BMs on pre-treatment imaging went onto complete the planned curative intent treatment of extracranial disease, 60% completed SRS to the brain and 30% completed WBRT. This compares to 0%, 10% and 0% in the NICE assumptions. The health economic analysis concluded that brain imaging was no longer cost-effective in stage II disease (ICERs 50,023- pound 115,785) pound whilst brain imaging remained cost-effective for stage III patients (ICERs 17,000-22,173) pound, with MRI being the most cost-effective strategy. Conclusion: This re-running of the NICE health economic model with real-world data strongly supports the NICE guideline recommendation for brain imaging prior to curative-intent treatment in stage III lung cancer but questions the cost-effectiveness of CT brain imaging prior to curative-intent treatment in stage II lung cancer.

引用

页码：145 / 150

页数：6

共 7 条

[1] [Anonymous], 2019, LUNG CANC UPD B EV R
[2] BRAIN IMAGING IN THE MANAGEMENT OF PEOPLE WITH LUNG CANCER PRIOR TO THERAPY WITH CURATIVE INTENT: MULTI-CENTRE REVIEW OF THE ASSUMPTIONS MADE IN THE NICE GUIDELINE NG122 EVIDENCE REVIEW
Brockelsby, C.
Randles, V.
King, J.
Dildar, B.
Lee, X.
Nagarajan, T.
Rice, M.
Al-Najjar, H.
Atkins, A.
Sundar, R.
Brown, L.
Sharma, S.
Navani, N.
Prendecki, R.
O'Dowd, E.
Crisp, E.
Tufail, M.
Vella, C.
Grundy, S.
Evison, M.
[J]. THORAX, 2021, 76 : A45 - A46
[3] Brain metastases following radical surgical treatment of non-small cell lung cancer: Is preoperative brain imaging important?
O'Dowd, Emma L.
Kumaran, Maruti
Anwar, Sadia
Palomo, Begona
Baldwin, David R.
[J]. LUNG CANCER, 2014, 86 (02) : 185 - 189
[4] Royal College of Physicians, 2018, National Lung Cancer Audit (NLCA) annual report
[5] Schoenmaekers J., 2018, J THORAC DIS, V10
[6] Brain Metastases at Presentation in Patients With Non-Small Cell Lung Cancer
Waqar, Saiama N.
Waqar, Sadaf H.
Trinkaus, Kathryn
Gadea, Carlos A.
Robinson, Cliff G.
Bradley, Jeffrey
Watson, Mark A.
Puri, Varun
Govindan, Ramaswamy
Morgensztern, Daniel
[J]. AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS, 2018, 41 (01): : 36 - 40
[7] US

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