Lung cancer with brain metastasis, like Gloria Maria’s, occurs in up to 40% of cases

This Thursday (2), journalist Glória Maria had her death confirmed three years after the diagnosis of lung cancer that progressed to brain metastases.

Solid tumors, such as lung and breast cancer, are associated with a high incidence of brain metastases in later stages of the disease.

According to the oncologist at the Reference Center for Lung and Thorax Tumors at AC Camargo Hospital, Helano Freitas, it is important to keep in mind that patients diagnosed with one of these types of cancer can – and should – be examined for brain metastases at all stages of the disease. illness.

“Everyone who has been diagnosed with some types of cancer, and lung cancer is one of them, needs to investigate brain metastasis. And the sooner this diagnosis is made, the better in terms of treatment”, he explains.

Lung cancer, according to Freitas, is divided into three main types: small cell tumors, which are more aggressive and account for about 13% of cases of lung cancer; non-small cell tumors (non-small cell lung cancer, in English), less aggressive; and, among them, the most common is the adenocarcinoma type, which can have an incidence of up to 40% in the development of brain metastases. The other type of non-small cell lung cancer is squamous cell carcinoma.

What are brain metastases

Metastases are foci of tumor cells that can spread throughout the body, from the point of origin (in this case, the initial tumor) and continue to replicate, causing new foci of the disease in other organs. Metastases in patients with lung cancer most often occur in the brain, liver, adrenal glands (formerly called adrenals), or bones.

According to the clinical oncologist at INCA (National Cancer Institute), Luiz Henrique Araújo, lung cancer is one of the cancers with the highest incidence of brain metastases, reaching up to half of patients, and about 10% of new cases that are diagnosed already have the metastatic stage in the brain.

The causes, according to the doctor, are biology and the type of tumor, and are not linked to risk factors such as age, sex and comorbidities. The longer since the onset of cancer, however, the greater the risk of metastatic foci, he explains.

“When we discover lung cancer at a very early stage, with tumors still very localized in the lungs, the chance of cure is up to 90%, but as it becomes more advanced and metastatic, the treatment itself becomes more complex. “, evaluates.

According to INCA estimates, for the three-year period 2023 to 2025, 32,560 new cases of lung cancer are expected, 18,020 in men and 14,540 in women. Lung cancer ranks first in cancer deaths in both men and women (in women, it ties with breast cancer), with a mortality rate of about 11.7%. The incidence of brain metastases, however, has not been described as it varies according to the subtype of lung cancer, says Araújo.

Treatment

There are also molecular differences due to the mutation suffered in certain genes that lead to subtypes of adenocarcinoma. “Knowing the subtype, it is possible to carry out a more targeted, specialized treatment, with targeted therapies. But, invariably, patients with lung cancer with brain metastasis must undergo radiotherapy treatment”, emphasizes Freitas, from AC Camargo.

Traditionally, brain metastases are treated with total skull radiotherapy, but this technique, as it applies radiotherapy to the entire brain, needs to use much lower doses so as not to cause damage to the brain tissue.

In the last 15 years, however, a type of high-precision radiotherapy called stereotactic (or stereotactic) fractional cranial radiotherapy has progressed. This procedure uses a high dose of localized radiotherapy and can treat the focus of metastasis without damage to the rest of the brain.

“However, when the advance of metastases is so great that there are 10, 15, 20 nodules, then it is not possible to perform stereotactic treatment and it is necessary to apply total radiotherapy”, explains the doctor.

Another alternative is treatment with surgery, when you have detailed knowledge of tumor cells, but even surgery is not a guarantee of cure, as it is common for cases of recurrence to occur.

“What was adopted as a protocol is to perform the surgery and then the stereotactic radiotherapy or, then, to start the treatment with immunotherapy [conjunto de medicamentos voltados para a defesa do sistema imune contra as células tumorais] and then go for radiotherapy. But always one and the other, “she says.

Target therapies

More recently, in the last ten years, the discovery of targeted therapy treatments for some subtypes of adenocarcinoma has also grown, which increases the survival of patients, says Araújo.

“Today we have an increasing percentage of patients alive five years after diagnosis, thanks to targeted therapies. This is a different survival time from the cured patient, we know that the disease is dormant, but it is in remission thanks to the treatment . And target therapy and immunotherapy have a duration [do benefício] much greater than chemotherapy”, he explains.

Doctors stress that early diagnosis is still the main key to reducing the incidence of metastases and achieving success in treatment to control nodules and increase survival.

“Unfortunately, there is a very large inequality of access. And, to diagnose and monitor brain metastases, equipment such as magnetic resonance imaging and computed tomography is needed. If we manage to expand access, we will certainly reduce the number of cases diagnosed at an advanced stage “, ends.