Title: Clinical Profile of Metastatic Cancer to the Brain in a Tertiary Care Hospital

Authors: Kannan Jayaraman, Ramya Rangarajan

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.73

Abstract

Introduction                                     

Metastatic cancer to the brain is associated with a very grave prognosis. Secondaries brain is the most common adult intracranial neoplasm(1).  Around 10% of cancer patients can develop brain metastases at some point during their lifetime(2,3). The incidence of brain metastases seems to be on the rise due to better treatment of primary disease, longer survival of cancer patients due to effective treatment modalities and advanced imaging technologies.

Certain primary cancers like lung, breast, renal cell cancer and melanoma have an increased propensity to metastasise to the brain. Lung cancer is the most common malignancy to metastasise to the brain accounting for 40-50%(4) of brain metastases followed by breast cancer (15-25%), melanoma (5-25%) and renal cell cancer (5-10%). Synchronous metastases in other sites are commonly seen with brain metastases. Isolated brain metastases in the absence of other systemic sites are rare. Isolated metastasis in the brain without a detectable primary cancer is seen in about 5 – 10%(5).

The most common site of metastases is in the supratentorial region. 80% of metastases occur in the cerebral hemispheres(4,6). Cerebellum and brainstem account for 15% and 5% of metastatic sites. Patients commonly present with headache, vomiting, blurring of vision, seizures and neurologic deficits. The median survival of patients with brain metastases without treatment is 1 month.

In this study, we analysed the clinical profile of brain metastases patients who presented to department of oncology from May 2013 to May 2015.

Materials and Methods

We analysed the case records of brain metastases patients who attended the department of oncology between May 2013 and May 2015. Age, gender, clinical presentation, primary site, histopathology of primary, median duration from diagnosis of cancer to brain metastases, site of metastases, treatment given were recorded.

References

  1. Sawaya R, Ligon BL, Bindal RK. Management of metastatic brain tumors. Ann Surg Oncol. 1994;1:169–78
  2. Barnholtz-Sloan JS, Sloan AE, Davis FG, et al. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol 2004;22:2865-2872.
  3. Schouten LJ, Rutten J, Huveneers HA, et al. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer 2002;94:2698-2705.
  4. Delattre JY, Krol G, Thaler HT, Posner JB. Distribution of brain metastases. Arch Neurol. 1988;45:741–4.
  5. Lagerwaard FJ, Levendag PC, Nowak PJ, Eijkenboom WM, Hanssens PE, Schmitz PI. Identification of prognostic factors in patients with brain metastases: A review of 1292 patients. Int J Radiat Oncol Biol Phys. 1999;43:795–803.
  6. Ewing J Ewing J. Metastasis. In: Ewing J, editor. Neoplastic Diseases: A Treastise on Tumours. Philadelphia: Saunders; 1940. p. 62-74.
  7. GasparL, ScottC, RotmanM, et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 1997;37:745-751.
  8. LagerwaardFJ, LevendagPC, NowakPJ, et al. Identification of prognostic factors in patients with brain metastases: A review of 1292 patients. Int J Radiat Oncol Biol Phys 1999;43:795-803.
  9. YatesJW, ChalmerB, McKegneyFP. Evaluation of patients with advanced cancer using the Karnofsky performance status. Cancer 1980;45:2220-2224.
  10. FifeKM, ColmanMH, StevensGN, et al. Determinants of outcome in melanoma patients with cerebral metastases. J Clin Oncol 2004;22:1293-1300.
  11. AgboolaO, BenoitB, CrossP, et al. Prognostic factors derived from recursive partition analysis (RPA) of Radiation Therapy Oncology Group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastatic cases. Int J Radiat Oncol Biol Phys 1998;42:155-159.
  12. Fabi A, Felici A, Metro G, et al (2011). Brain metastases from solid tumors: disease outcome according to type of treatment and therapeutic resources of the treating center. J Exp Clin Cancer Res, 30, 10.
  13. Saha A, Ghosh SK, Roy C, et al (2013). Demographic and clinical profile of patients with brain metastases: A retrospective study. Asian J Neurosurg, 8, 157-61.
  14. Ali Akhavan, Fariba Binesh, Samaneh Heidari. Survival of Brain Metastatic Patients in Yazd, Iran Asian Pacific Journal of Cancer Prevention. 2014;15:3571-3574.
  15. Victor TS. Brain metastasis. Medscape reference. [Last updated on 2011 Oct 7]. Available from:http://www. emedicine.medscape.com/article
  16. Debnath H, Barua KK, Hossain MA, Khair MA, Islam MA. Outcome and prognosis of metastatic brain tumour: A study of 35 cases. Bangladesh J Neurosci. 2008;24:17-23
  17. Jin J, Zhou X, Liang X, et al (2011). A study of patients with brain metastases as the initial manifestation of their systemic cancer in a Chinese population. J Neurooncol, 103, 649-55.
  18. Delattre JY, Krol G, Thaler HT, et al (1988). Distribution of brain metastases. Arch Neurol, 45, 741 -4.
  19. Lassman AB, DeAngelis LM. Brain metastases. Neurol Clin. 2003;21:1-23.
  20. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt RInt J Radiat Oncol Biol Phys. 1997 Mar 1; 37(4):745-51.

Corresponding Author

Kannan Jayaraman