title: Risk of intracranial hemorrhage and cerebrovascular accidents in non-small cell lung cancer brain metastasis patients.
abstract: BACKGROUND
  Brain metastases confer significant morbidity and a poorer survival in non-small cell lung cancer (NSCLC). Vascular endothelial growth factor-targeted antiangiogenic therapies (AAT) have demonstrated benefit for patients with metastatic NSCLC and are expected to directly inhibit the pathophysiology and morbidity of brain metastases, yet patients with brain metastases have been excluded from most clinical trials of AAT for fear of intracranial hemorrhage (ICH). The underlying risk of ICH from NSCLC brain metastases is low, but needs to be quantitated to plan clinical trials of AAT for NSCLC brain metastases.
  
  
  METHODS
  Data from MD Anderson Cancer Center Tumor Registry and electronic medical records from January 1998 to March 2006 was interrogated. Two thousand one hundred forty-three patients with metastatic NSCLC registering from January 1998 to September 2005 were followed till March 2006. Seven hundred seventy-six patients with and 1,367 patients without brain metastases were followed till death, date of ICH, or last date of study, whichever occurred first.
  
  
  RESULTS
  The incidence of ICH seemed to be higher in those with brain metastasis compared with those without brain metastases, in whom they occurred as result of cerebrovascular accidents. However, the rates of symptomatic ICH were not significantly different. All ICH patients with brain metastasis had received radiation therapy for them and had been free of anticoagulation. Most of the brain metastasis-associated ICH's were asymptomatic, detected during increased radiologic surveillance. The rates of symptomatic ICH, or other cerebrovascular accidents in general were similar and not significantly different between the two groups.
  
  
  CONCLUSIONS
  In metastatic NSCLC patients, the incidence of spontaneous ICH appeared to be higher in those with brain metastases compared with those without, but was very low in both groups without a statistically significant difference. These data suggest a minimal risk of clinically significant ICH for NSCLC brain metastasis patients and proposes having more well designed prospective trail to see the role of AAT in this patient population.
authors.affiliation: Department of Medicine, The University of Arkansas for Medical Services, Little Rock, AR, USA.
authors.forename: Geetika
authors.initials: G
authors.lastname: Srivastava
authors.forename: Vishal
authors.initials: V
authors.lastname: Rana
authors.forename: Suzy
authors.initials: S
authors.lastname: Wallace
authors.forename: Sarah
authors.initials: S
authors.lastname: Taylor
authors.forename: Matthew
authors.initials: M
authors.lastname: Debnam
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.forename: Dima
authors.initials: D
authors.lastname: Suki
authors.forename: Daniel
authors.initials: D
authors.lastname: Karp
authors.forename: David
authors.initials: D
authors.lastname: Stewart
authors.forename: Yun
authors.initials: Y
authors.lastname: Oh
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000453:epidemiology* / Q000556:secondary* / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000453:epidemiology*; D008175:Lung Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D016019:Survival Analysis