Intracerebral metastases in solid-tumor patients: natural history and results of treatment.
TLDR
Although the therapeutic goal in intracerebral metastases is generally palliative, it appears that there are categories of cases that may benefit from more aggressive treatment.Abstract:
In order to determine the natural history and results of treatment of intracerebral metastases in solid-tumor patients, the records of 191 patients with an antemortem diagnosis of intracerebral metastasis made during the period from August 1974 to November 1978 were reviewed. Malignancies included lung (122 patients), breast (26), unknown primary (16), melanoma (8), colorectal (6), hypernephroma (4), and others (12). Favorable prognostic factors included solitary brain metastasis (P less than 0.001), ambulatory performance status (P less than 0.001), symptoms of headache (P less than 0.001), or visual disturbances (P less than 0.02), and estrogen receptor positivity in breast cancer patients (P = 0.055). Poor prognostic factors included advanced age (P less than 0.04) and evidence of impaired consciousness, i.e., disorientation, lethargy, stupor, or coma (P less than 0.007). Median survival time after diagnosis of intracerebral metastasis was 3.7 months for the entire series. In those patients with a single intracerebral metastasis and minimal tumor burden, the type of treatment used had a significant impact on survival. Those cases treated with surgery and radiation had a median survival time of 9.7 months versus 3.7 months for those treated with radiation alone (P less than 0.02). When using a proportional hazard regression analysis to adjust for the three most important prognostic factors, treatment (surgery and radiation versus radiation alone) still appeared to be important. Intracerebral metastases were the immediate or contributing cause of death in 50% of the patients in this series. Patients at greater risk of dying of intracerebral metastases included those in whom the brain was the first site of distant metastasis, those with an intracerebral metastasis from an unknown primary site, and those whose presentation of malignancy was with symptoms of a brain metastasis. Although the therapeutic goal in intracerebral metastases is generally palliative, it appears that there are categories of cases that may benefit from more aggressive treatment.read more
Citations
More filters
Journal ArticleDOI
A Randomized Trial of Surgery in the Treatment of Single Metastases to the Brain
Roy A. Patchell,Phillip A. Tibbs,John W. Walsh,Robert J. Dempsey,Yosh Maruyama,Richard J. Kryscio,William R. Markesbery,John S. Macdonald,Byron Young +8 more
TL;DR: It is concluded that patients with cancer and a single metastasis to the brain who receive treatment with surgical resection plus radiotherapy live longer, have fewer recurrences of cancer in the brain, and have a better quality of life than similar patients treated with radiotherapy alone.
Journal ArticleDOI
Summary Report on the Graded Prognostic Assessment: An Accurate and Facile Diagnosis-Specific Tool to Estimate Survival for Patients With Brain Metastases
Paul W. Sperduto,Norbert Kased,David Roberge,Zhiyuan Xu,Ryan Shanley,Xianghua Luo,Penny K. Sneed,Samuel T. Chao,Robert J. Weil,John H. Suh,Amit Bhatt,Ashley W. Jensen,Paul D. Brown,Helen A. Shih,John P. Kirkpatrick,Laurie E. Gaspar,John B. Fiveash,Veronica Chiang,Jonathan P.S. Knisely,Christina Maria Sperduto,Nan Lin,Minesh P. Mehta +21 more
TL;DR: These indices and related worksheet provide an accurate and facile diagnosis-specific tool to estimate survival, potentially select appropriate treatment, and stratify clinical trials for patients with brain metastases.
Journal ArticleDOI
Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study
Masaaki Yamamoto,Toru Serizawa,Takashi Shuto,Atsuya Akabane,Yoshinori Higuchi,Jun Kawagishi,Kazuhiro Yamanaka,Yasunori Sato,Hidefumi Jokura,Shoji Yomo,Osamu Nagano,Hiroyuki Kenai,Akihito Moriki,Satoshi O. Suzuki,Yoshihisa Kida,Yoshiyasu Iwai,Motohiro Hayashi,Hiroaki Onishi,Masazumi Gondo,Mitsuya Sato,Tomohide Akimitsu,Kenji Kubo,Yasuhiro Kikuchi,Toru Shibasaki,Tomoaki Goto,Masami Takanashi,Yoshimasa Mori,Kintomo Takakura,Naokatsu Saeki,Etsuo Kunieda,Hidefumi Aoyama,Suketaka Momoshima,Kazuhiro Tsuchiya +32 more
TL;DR: The results suggest that stereotactic radiosurgery without WBRT in patients with five to ten brain metastases is non-inferior to that in Patients with two to four brain metastased.
Journal ArticleDOI
Treatment of single brain metastasis: Radiotherapy alone or combined with neurosurgery
Charles J. Vecht,H. Haaxma-Reiche,Evert M. Noordijk,George W. Padberg,J. H. C. Voormolen,F. H. Hoekstra,J. T. J. Tans,N. Lambooij,J. A. L. Metsaars,A. R. Wattendorff,Ronald Brand,Jo Hermans +11 more
TL;DR: It is coclude that patients with single brain metastasis and stable extracranial tumor activity should be treated with surgical excision and radiotherapy, and that radiotherapy alone appears to be sufficient.
Journal ArticleDOI
Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma.
TL;DR: The objective of this study was to report on the incidence of and factors related to the occurrence of central nervous system metastases in a cohort of patients who were diagnosed with colorectal, lung, breast, or kidney carcinoma or melanoma.
References
More filters
Journal ArticleDOI
A generalized Wilcoxon test for comparing arbitrarily singly-censored samples
TL;DR: Some comparisons are made for five cases of varying degrees of censoring and tying between probabilities from the exact test and those from the proposed test and these suggest the test is appropriate under certain conditions when the sample size is five in each group.
Journal ArticleDOI
Appraisal of methods for the study of chemotherapy of cancer in man: Comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide
Zubrod Cg,Marvin A. Schneiderman,Emil Frei,Clyde O. Brindley,G. Lennard Gold,Bruce I. Shnider,Raul G. Oviedo,John Gorman,Ralph Jones,Ulfar Jonsson,Jack Colsky,Thomas C. Chalmers,Bruce Ferguson,Margarida M. Dederick,James F. Holland,Oleg S. Selawry,William Regelson,Louis Lasagna,Albert H. Owens +18 more
TL;DR: A comparative study of triethylene thiophosphoramide and nitrogen mustard in cancer of the lung and breast, melanoma, and Hodgkin's disease concludes that thio-TEPA was less active than HN2 (in the doses used) in inducing remissions.
Journal ArticleDOI
The palliation of brain metastases: Final results of the first two studies by the radiation therapy oncology group
B.B. Borgelt,Richard D. Gelber,Simon Kramer,Luther W. Brady,Chu H. Chang,Lawrence W. Davis,Carlos A. Perez,Frank R. Hendrickson +7 more
TL;DR: Five schedules of whole brain irradiation ranging from 4000 rad/4 weeks to 2000 rad/ 1 week have been evaluated in two sequential phase III randomized Radiation Therapy Oncology Group (RTOG I studies) to determine palliative effectiveness in patients with metastatic brain disease.