Intracerebral metastases in solid-tumor patients: Natural history and results of 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.

Efaproxiral red blood cell concentration predicts efficacy in patients with brain metastases

“…Whole-brain radiation therapy (WBRT) is a standard treatment for brain metastases (Zimm et al, 1981;Egawa et al, 1986); however, patients may not achieve maximum benefit from WBRT owing to tumour hypoxia, which decreases radiation sensitivity of solid tumours (Rampling et al, 1994;De Santis et al, 1998). Efaproxiral (Efaproxynt, RSR13) is a synthetic allosteric modifier of haemoglobin (Hb), which binds noncovalently in the central water cavity of the Hb tetramer (Wireko et al, 1991;Safo et al, 2001), thereby reducing the Hb-oxygen (O 2 ) binding affinity to facilitate the release of O 2 from Hb to the tissues (Randad et al, 1991;Khandelwal et al, 1993;Kunert et al, 1996;Watson et al, 1997;Steffen, 1998;Eichelbronner et al, 1999).…”

Antidepressant use and risk of central nervous system metastasis

“…Metastatic CNS tumors should be in the differential diagnosis if a cancer patient reports neurological symptoms such as headaches, nausea, cognitive problems, seizures, dysphasia, motor weakness, or sensory disturbances, since these metastases are usually symptomatic [139,145,153,[156][157][158]. CNS metastasis symptoms can either be generalized or focal.…”

“…One of the most common symptoms of brain metastasis is a headache, developing in about 23% to 38% of patients [153,[156][157][158]. These headaches generally transpire in patients with multiple metastases or metastasis located in the posterior fossa [4].…”

“…Of these patients, 5% to 10% will never receive a definite cancer diagnosis, even with thorough workups [4,157,163]. The primary cancer may appear later or a diagnosis can be confirmed by autopsy, and is usually diagnosed as metastatic lung cancer [4,158]. Identified in a series of patients from 1987 to 1996, patients with unknown primary tumors were primarily male and with a median age of 51.…”

“…Patients with single lesions, and surgery on those lesions, had longer survival than patients with multiple lesions or patients who did not have surgery on their singular lesions [157,158]. Nussbaum et al [157] conducted a multivariate analysis to determine which variables were important predictors of survival in patients with a single brain metastasis.…”