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American Journal of Respiratory and Critical Care Medicine Vol 178. pp. 1090, (2008)
© 2008 American Thoracic Society

Correspondence

Carcinoma of the Lung and Metastatic Disease of the Central Nervous System

To the Editor:

We read with interest the article by Dr. Ost and colleagues, in which lung cancer–associated mortality after surgical resection for stage I non–small cell lung cancer (NSCLC) showed a strong correlation with tumor size; and for tumors 3 cm or larger, adenocarcinoma-associated mortality was greater than that of squamous cell carcinoma (1). We suggest that a major contribution to these results is likely to be metastatic disease to the central nervous system (CNS). Our group reported in 2007 for a cohort of 264 subjects with all stages of NSCLC an overall rate of 36% for CNS metastatic disease, and age-adjusted probability of CNS metastatic disease correlated with size of the primary tumor (P < 0.001) (2). Moreover, the prevalence of CNS metastatic disease was far greater for primary adenocarcinoma of the lung (43%) than for primary squamous cell carcinoma (13%) (P = 0.003), and the age-adjusted probabilities of a 2.0- and 6.0-cm node-negative adenocarcinoma of the lung spreading to the CNS were 0.14 and 0.72, respectively (P < 0.02). These results appear to dovetail nicely with those of Ost and colleagues and both lend strong support to the recently proposed revisions for the staging of lung cancer (3).

Because large adenocarcinomas of the lung especially tend to metastasize to the CNS, these patients may benefit more from adjuvant chemotherapy and prophylactic cranial irradiation than patients with smaller tumors (4). We suggest that randomized clinical trials of adjuvant therapy need to be adequately powered to address possible benefit to these subgroups.

John H. M. Austin, Amol Mujoomdar, Charles A. Powell, Gregory D. N. Pearson and Harry Raftopoulos

Columbia University Medical Center
New York, New York

FOOTNOTES

Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

  1. Ost D, Goldberg J, Rolnitzky L, Rom WN. Survival after surgery in stage IA and IB non–small cell lung cancer. Am J Respir Crit Care Med 2008;177:516–523.[Abstract/Free Full Text]
  2. Mujoomdar A, Austin JHM, Malhotra R, Powell CA, Pearson GDN, Shiau MC, Raftopoulos H. Clinical predictors of metastatic disease to the brain from non-small-cell lung carcinoma: primary tumor size, cell type, and lymph node metastasis. Radiology 2007;242:882–888.[Abstract/Free Full Text]
  3. Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, Postmus PE, Rusch V, Sobin L, on behalf of the International Association for the Study of Lung Cancer International Staging Committee and Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (7th) edition of the TNM classification of malignant tumors. J Thorac Oncol 2007;2:706–714.[CrossRef][Medline]
  4. Arriagada R, Le Péchoux C, Baeza R. Prophylactic cranial irradiation in high-risk non-small cell lung cancer patients. Lung Cancer 2003;32:S41–S45.



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