Brain Metastases From Undiagnosed Systemic Neoplasms

Merchut, M P

doi:10.1001/archinte.1989.00390050066013

Cited by 83 publications

(34 citation statements)

References 14 publications

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“…As in most cases of brain metastases the primary tumor is located in the lung [67,82], a chest radiograph and chest CT are always recommended. CT of the abdomen occasionally shows an unsuspected cancer.…”

Section: Diagnosismentioning

confidence: 99%

Management of brain metastases

Soffietti¹,

Rudà²,

Mutani³

2002

Journal of Neurology

318

215

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Brain metastases occur in 20-40% of patients with cancer and their frequency has increased over time. Lung, breast and skin (melanoma) are the commonest sources of brain metastases, and in up to 15% of patients the primary site remains unknown. After the introduction of MRI, multiple lesions have outnumbered single lesions. Contrast-enhanced MRI is the gold standard for the diagnosis. There are no pathognomonic features on CT or MRI that distinguish brain metastases from primary malignant brain tumors or nonneoplastic conditions: therefore a tissue diagnosis by biopsy should be always obtained in patients with unknown primary tumor before undergoing radiotherapy and/or chemotherapy. Some factors are prognostically important: a high Performance Status, a solitary brain metastasis, an absence of systemic metastases, a controlled primary tumor and a younger age. Based on these factors, subgroups of patients with different prognosis have been identified (RPA class I, II, III). Symptomatic therapy includes corticosteroids to reduce vasogenic cerebral edema and anticonvulsants to control seizures. In patients with newly diagnosed brain metastases prophylactic anticonvulsants should not be used routinely. The combination of surgery and whole-brain radiotherapy (WBRT) is superior to WBRT alone for the treatment of single brain metastasis in patients with limited or absent systemic disease and good neurological condition. Complete surgical resection allows a relief of intracranial hypertension, seizures and focal neurological deficits. Radiosurgery, alone or in conjunction with WBRT, yields results which are comparable to those reported after surgery followed by WBRT, provided that lesion's diameter does not exceed 3-3.5 cm. Radiosurgery offers the potential of treating patients with surgically inaccessible metastases. Still controversial is the need for WBRT after surgery or radiosurgery: local control seems better with the combined approach, but overall survival does not improve. Late neurotoxicity in long surviving patients after WBRT is not negligible; to avoid this complication patients with favorable prognostic factors must be treated with conventional schedules of RT, and monitoring of cognitive functions is important. WBRT alone is the treatment of choice in patients with single brain metastasis not amenable to surgery or radiosurgery, and with an active systemic disease, and in patients with multiple brain metastases. A small subgroup of these latter may benefit from surgery. The response rate of brain metastases to chemotherapy is similar to the response rate of the primary tumor and extracranial metastases, some tumor types being more chemosensitive (small cell lung carcinoma, breast carcinoma, germ cell tumors). New radiosensitizers and cytotoxic or cytostatic agents, and innovative technique of drug delivery are being investigated.

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Section: Diagnosismentioning

confidence: 99%

Management of brain metastases

Soffietti¹,

Rudà²,

Mutani³

2002

Journal of Neurology

318

215

View full text Add to dashboard Cite

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“…There are only few cases documented in the literature of primary central nervous system lymphoma manifesting as a second primary tumor [12]. In pa- tients presenting with brain metastases the lung was found to be the primary in two thirds of the cases [13], but there was no evidence of lung tumor in this patient. Although in about 10% of patients with a history of extracranial primary cancer and solitary brain metastasis, the brain lesion proved to be a second primary tumor or an inflammatory process [14], the rate of false positive cases among patients with multiple brain metastases is probably much lower.…”

Section: Discussionmentioning

confidence: 79%

Complete Response of Multiple Melanoma Brain Metastases after Treatment with Temozolomide

Dvořák¹,

Melichar²,

Žižka³

et al. 2004

Oncol Res Treat

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Background: Inoperable melanoma brain metastases are usually uniformly fatal, and complete response after cytotoxic therapy is rare. Case report: A patient with multiple inoperable melanoma brain metastases was treated with 6 cycles of oral temozolomide (300 mg once daily over 5 days every 28 days). A complete response was documented by magnetic resonance. Conclusions: The present observation suggests that temozolomide may be an active and well tolerated treatment for malignant melanoma brain metastases.

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“…Metastatic brain lesions often present with headaches, weakness, or seizures, and are classically thought to be a very poor prognostic indicator. A survey of 56 patients (L40) presenting with symptomatic brain metastasis of unknown primary were found to have metastases from lung, gastrointestinal tract, bladder, thyroid, melanoma, and lymphoma, with a vast majority (68%) being from lung [40]. Cord compression is a common complication of such malignancy, presenting as spinal or radicular pain.…”

Section: Isolated Brain Metastasesmentioning

confidence: 99%