Brain metastases in adenocarcinoma of the lung: frequency, risk groups, and prognosis.

Abstract

A consecutive group of 259 patients with inoperable adenocarcinoma of the lung (ACL) were observed to define risk groups for and frequency of brain metastases together with prognosis. All patients received chemotherapy in a three-armed randomized trial. Brain metastases were diagnosed in 25 patients before protocol entry and in 37 during treatment. Brain autopsy was performed in 87 patients and was positive in 38 (44%). Eleven of these (29%) were not diagnosed clinically. Patients younger than 60 years had a somewhat higher overall frequency of brain metastases than older patients. Patients with initial performance status above 60% and patients responding to chemotherapy had higher risk for developing brain metastasis during treatment than other patients, probably because of the increasing cumulated risk for this complication with prolonged survival. Median survival after onset of brain metastases was 73 days and survival was significantly shorter for these patients than for patients without this complication at days 0, 90, 180, and 365 after protocol entry. Thus, brain metastases is a frequent complication in ACL and the frequency increases with prolonged survival. Survival after development of brain metastases is short and it is questionable whether the inclusion of this subgroup of ACL patients into experimental cytostatic treatments is justified.

Frequency and clinicopathological features of metastasis to liver, lung, bone, and brain from gastric cancer: A SEER‐based study

“…The internal mechanism of this distribution remains unknown. Primary lung cancer frequently metastasizes to bone as well as brain 28, 29, 30, 31. Some studies had suggested that there was cross‐talk among lung tumor cells, bone microenvironment, and immune system, which led to bone metastasis formation in primary non‐small cell lung cancer patients 32.…”

Intracarotid delivery of oncolytic HSV vector G47Δ to metastatic breast cancer in the brain

“…10 In lung cancer, brain metastases are common with about 10% of patients presenting with small-cell lung cancer having brain metastases and rising to B40% at autopsy. 11 Other cancers metastasizing to the brain include breast with 10-20% of patients, 12 followed by renal and colorectal. 13 The percentage of patients where their primary tumor metastasizes to the brain has been increasing over the last two decades, related in part to the increased efficacy of current treatments for primary disease and the associated increased survival.…”

Time for reappraisal of extracranial treatment options?

“…1,2 Approximately 10%-20% of patients present with synchronous brain metastases at the time of diagnosis, and the optimal treatment strategy for this group of patients remains poorly defined. Some reports suggest that survival is worse in patients presenting with a synchronous BM from NSCLC, as opposed to a metachronous presentation.…”