Brain metastases in lung cancer patients: unraveling clinical questions

Twenty-five to forty per cent of lung cancer patients are diagnosed with secondary tumours in the brain (brain metastases) during the course of their disease. These metastases are often associated with poorer quality of life and a shorter life expectancy. This dissertation shows that the MRI technique is better able to detect asymptomatic brain metastases in stage III non-small-cell lung cancer (NSCLC) compared to the CT technique. It also shows that specific chemotherapy given within the framework of chemoradiotherapy does not have any effect on the development of brain metastases. More than 10% of patients diagnosed with NSCLC without any brain metastases detected by MRI will develop symptomatic brain metastases within a year. The life expectancy following diagnosis of brain metastases is usually only a few months. Optimal supporting therapy is a good option for patients in poor physical condition, which is in line with the advice given by the Dutch guideline. However, this advice is not always followed. Patients with an EGFR mutation are not at increased risk of developing brain metastases.