Cerebral metastases in childhood malignancies

Taşdemiroğlu, Erol; Patchell, Roy A.

doi:10.1007/bf01844748

Cited by 28 publications

(8 citation statements)

References 20 publications

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“…In the pediatric population, brain seeding is common in patients with leukemia. On the other hand, brain metastasis from a solid extracranial primary tumor is uncommon, with reported frequencies of 1.5%-10% 1,8,14,22,27 from various clinical sources and 6%-13% from autopsy series. 7,24 Differences in frequency and patterns of occurrence between adults and children have been loosely linked to a number of factors, including but not limited to the different spectrum of primary cancer histologies seen between the 2 populations; physiological/biological differences between children and adults, such as a less mature blood-brain barrier in the former (enabling penetration of the drugs into the cerebral parenchyma); and the different treatment methodologies used.…”

Section: Discussionmentioning

confidence: 99%

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Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center

Suki¹,

Abdulla²,

Ding³

et al. 2014

PED

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Object Metastasis to the brain is frequent in adult cancer patients but rare among children. Advances in primary tumor treatment and the associated prolonged survival are said to have increased the frequency of brain metastasis in children. The authors present a series of cases of brain metastases in children diagnosed with a solid primary cancer, evaluate brain metastasis trends, and describe tumor type, patterns of occurrence, and prognosis. Methods Patients with brain metastases whose primary cancer was diagnosed during childhood were identified in the 1990–2012 Tumor Registry at The University of Texas M.D. Anderson Cancer Center. A review of their hospital records provided demographic data, history, and clinical data, including primary cancer sites, number and location of brain metastases, sites of extracranial metastases, treatments, and outcomes. Results Fifty-four pediatric patients (1.4%) had a brain metastasis from a solid primary tumor. Sarcomas were the most common (54%), followed by melanoma (15%). The patients' median ages at diagnosis of the primary cancer and the brain metastasis were 11.37 years and 15.03 years, respectively. The primary cancer was localized at diagnosis in 48% of patients and disseminated regionally in only 14%. The primary tumor and brain metastasis presented synchronously in 15% of patients, and other extracranial metastases were present when the primary cancer was diagnosed. The remaining patients were diagnosed with brain metastasis after initiation of primary cancer treatment, with a median presentation interval of 17 months after primary cancer diagnosis (range 2–77 months). At the time of diagnosis, the brain metastasis was the first site of systemic metastasis in only 4 (8%) of the 51 patients for whom data were available. Up to 70% of patients had lung metastases when brain metastases were found. Symptoms led to the brain metastasis diagnosis in 65% of cases. Brain metastases were single in 60% of cases and multiple in 35%; 6% had only leptomeningeal disease. The median Kaplan-Meier estimates of survival after diagnoses of primary cancer and brain metastasis were 29 months (95% CI 24–34 months) and 9 months (95% CI 6–11 months), respectively. Untreated patients survived for a median of 0.9 months after brain metastasis diagnosis (95% CI 0.3–1.5 months). Those receiving treatment survived for a median of 8 months after initiation of therapy (95% CI 6–11 months). Conclusions The results of this study challenge the current notion of an increased incidence of brain metastases among children with a solid primary cancer. The earlier diagnosis of the primary cancer, prior to its dissemination to distant sites (especially the brain), and initiation of presumably more effective treatments may support such an observation. However, although the actual number of cases may not be increasing, the prognosis after the diagnosis of a brain metastasis remains poor regardless of the management strategy.

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Section: Discussionmentioning

confidence: 99%

“…Owing to the absence of pulmonary metastasis in that disease, brain metastases from neuroblastoma are rarely parenchymal. 8,22 These lesions generally arise from the adjacent bone. Likewise, none of the 3 tumors from a neuroblastoma primary tumor in our series was parenchymal.…”

Section: Discussionmentioning

confidence: 99%

Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center

Suki¹,

Abdulla²,

Ding³

et al. 2014

PED

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“…The propensity of primary tumors to spread to the brain parenchyma ("neurotropism") differs, being high in melanoma (20-45 % of patients), small-cell lung cancer, choriocarcinoma and other germ cell tumors; intermediate in breast cancer, non small-cell lung cancers (being more frequent in adenocarcinomas than in squamous tumors) and renal cancer; low in cancers of the prostate, gastrointestinal tract, ovary, thyroid and sarcomas. Cerebral metastastic disease in children is less frequent than in adults (6-10 %) [16,54,123]. The commonest childhood solid tumors that metastatize to the brain are neuroblastomas and a variety of sarcomas, including rhabdomyosarcoma, Wilm's tumor, Ewing's sarcoma and osteogenic sarcoma.…”

Section: Epidemiology and Pathophysiologymentioning

confidence: 98%

Management of brain metastases

Soffietti¹,

Rudà²,

Mutani³

2002

Journal of Neurology

321

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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“…[3][4][5]9,15,17 We retrospectively reviewed our institution's neuropathological experience over a 30-year time frame to better characterize the incidence and distribution of solid CNS metastases in the pediatric population at a large regional children's hospital. Object.…”

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confidence: 99%

The pathological spectrum of solid CNS metastases in the pediatric population

Wiens

Hattab²

2014

PED

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Object Collectively, metastatic tumors are the most common malignancy encountered in the adult central nervous system (CNS), arising most often from lung, breast, skin, and gastrointestinal tract carcinomas. Limited information is available in the literature regarding solid nonhematopoietic CNS metastases in children. The authors carried out a retrospective study of pediatric metastatic neoplasms to the CNS treated in a 30-year period to characterize their frequency, common histological subtypes, and sites of origin. Methods The archival pathology files were searched (1981–2011) for metastatic tumors to the CNS in patients 21 years of age and younger. Pathology material was reviewed, tumors were classified by site of origin and histological subtype, and survival was evaluated. Results The authors identified 26 patients with solid nonhematopoietic CNS metastases out of 1135 pediatric CNS tumors diagnosed from 1981 to 2011. Patients ranged in age from 1.5 to 20.3 years and were equally divided between sexes. Most CNS metastases were supratentorial (85%) and solitary (65%). The mean interval from primary malignant diagnosis to CNS metastasis was 27 months. Sites of origin included kidney/adrenal, bone/soft tissue, gonads, head and neck, lung, and liver. Mean survival after CNS involvement was 36.6 months. Overall 1-year and 5-year survival rates were 52% and 16%, respectively. Conclusions In neuropathology practice, nonhematopoietic pediatric CNS metastases are far less common than are nonhematopoietic adult CNS metastases, accounting for approximately 2% of all pediatric CNS tumors. The most common tumors to exhibit CNS metastasis are of kidney/adrenal origin, followed by those from bone/soft tissue. As expected, prognosis is dismal, despite aggressive therapy.

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Cerebral metastases in childhood malignancies

Cited by 28 publications

References 20 publications

Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center

Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center

Management of brain metastases

The pathological spectrum of solid CNS metastases in the pediatric population

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