Presence of Brain Metastases at Initial Diagnosis of Cancer: Patient Characteristics and Outcome

Abstract

Objective To describe the characteristics of patients who present with brain metastases already at first diagnosis of cancer and to evaluate overall survival (OS) and long-term survival. Methods Retrospective uni- and multivariate analyses in a group of 84 patients treated with different approaches. Results With respect to primary cancer type, the largest entities were adenocarcinoma non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) (34.5 and 21.4%, respectively). The most common diagnostic setting was symptomatic brain metastases (64 patients, 76.2%). Median OS was 7.2 months (one-year survival rate 31%). Four patients survived for at least three years, all had solitary metastases. The best survival was observed in the group managed with neurosurgical resection, median 17.7 months. Systemic treatment was also associated with better survival (median 9.7 vs. 2.8 months, p = 0.0001). Multivariate analysis revealed two prognostic baseline factors for OS, Karnofsky performance status (KPS) and number of brain metastases. Neurologic cause of death was uncommon (n = 14, 17%). Conclusion Long-term survival was limited and observed exclusively in the setting of a solitary brain metastasis. In patients with good KPS and limited number of brain metastases, systemic treatment as well as effective local treatment, such as resection and/or radiotherapy with sufficiently high equivalent dose, is warranted.

Late Brain Oligometastases Diagnosed at Least 36 Months after Cancer Detection are Associated with Favorable Survival Outcome

“…We performed a retrospective study of all patients with maximum four parenchymal brain metastases from histologically confirmed extracranial primary tumors treated at our hospital, where we maintain and update a previously utilized database [3,5]. Patients with leptomeningeal metastases or extracranial distant metastases were excluded, resulting in 89 patients with brain-only oligometastases.…”

“…Only a small proportion of patients with brain metastases are diagnosed with brain-only oligometastatic disease [1][2][3]. Commonly, the development of extracranial metastatic sites precedes the development of brain metastases, or widespread intra-and extracranial metastases are detected simultaneously [4][5][6]. Paralleling the evolving treatment paradigms for liver and lung oligometastases, management of brain oligometastases has changed, too [7][8][9][10][11][12][13][14].…”

A systematic review of the impact of outpatient clinical pharmacy services on medication-related outcomes in patients receiving anticancer therapies

“…Pharmacy outpatient clinical services provided in relation to chemotherapeutics have been reported to contribute to accurate medication histories, reduced prescribing errors, improved patient adherence and satisfaction with the treatment process (17)(18)(19)(20)(21)(22)(23)(24). Similar benefits have been reported for patients undergoing radiotherapy however the evidence for these services in the radiotherapy clinics is less robust (25).…”

The association of health insurance with the survival of cancer patients with brain metastases at diagnosis

“…Approximately half of BMs originate from lung cancer, and the remaining half are derived from breast, melanoma, colorectal, and renal tumors [4] , [5] . Patients with BMs generally have poor morbidity and mortality related to mass effect or from treatment toxicities, with estimated overall survival (OS) ranging from three to fifteen months [6] , [7] , [8] , [9] , [10] . A subset of patients present with BMs at the time of primary cancer diagnosis, defined in this study as synchronous brain metastasis (SBM).…”