Brain Metastasis Differential Diagnoses

  • Author: Victor Tse, MD, PhD; Chief Editor: Nicholas Lorenzo, MD   more...
 
Updated: Oct 7, 2011
 
 

Differential Diagnoses

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Contributor Information and Disclosures
Author

Victor Tse, MD, PhD  Associate Professor, Department of Neurosurgery, Stanford University Medical Center, Santa Clara Valley Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Amy A Pruitt, MD  Associate Professor of Neurology, University of Pennsylvania School of Medicine; Attending Neurologist, Hospital of the University of Pennsylvania

Amy A Pruitt, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jorge C Kattah, MD  Head, Associate Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria

Jorge C Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and New York Academy of Sciences

Disclosure: Biogen Honoraria Consulting; Bayer Corporation Honoraria Consulting

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Nicholas Lorenzo, MD  Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and American College of Physician Executives

Disclosure: Nothing to disclose.

References

  1. Nussbaum ES, Djalilian HR, Cho KH, Hall WA. Brain metastases. Histology, multiplicity, surgery, and survival. Cancer. Oct 15 1996;78(8):1781-8. [Medline].

  2. Santarelli JG, Sarkissian V, Hou LC, Veeravagu A, Tse V. Molecular events of brain metastasis. Neurosurg Focus. Mar 15 2007;22(3):E1. [Medline].

  3. Rusciano D, Burger MM. Mechanisms of Metastases. In: levine AJ, Schmidek HH (eds). In Molecular Genetics of Nervous System Tumors. New York: John Wiley & Son; 1993.

  4. Kaplan RN, Riba RD, Zacharoulis S, Bramley AH, Vincent L, Costa C. VEGFR1-positive haematopoietic bone marrow progenitors initiate the pre-metastatic niche. Nature. Dec 8 2005;438(7069):820-7. [Medline].

  5. Hanssens P, Karlsson B, Yeo TT, Chou N, Beute G. Detection of brain micrometastases by high-resolution stereotactic magnetic resonance imaging and its impact on the timing of and risk for distant recurrences. J Neurosurg. Sep 2011;115(3):499-504. [Medline].

  6. Tien RD, Felsberg GJ, Friedman H, Brown M, MacFall J. MR imaging of high-grade cerebral gliomas: value of diffusion-weighted echoplanar pulse sequences. AJR Am J Roentgenol. Mar 1994;162(3):671-7. [Medline].

  7. Galicich JH, French LA. Use of dexamethasone in the treatment of cerebral edema resulting from brain tumors and brain surgery. Am Pract Dig Treat. Mar 1961;12:169-74. [Medline].

  8. Debinski W, Tatter SB. Convection-enhanced delivery for the treatment of brain tumors. Expert Rev Neurother. Oct 2009;9(10):1519-27. [Medline].

  9. DeAngelis LM, Mandell LR, Thaler HT, et al. The role of postoperative radiotherapy after resection of single brain metastases. Neurosurgery. Jun 1989;24(6):798-805. [Medline].

  10. Jensen CA, Chan MD, McCoy TP, et al. Cavity-directed radiosurgery as adjuvant therapy after resection of a brain metastasis. J Neurosurg. Jun 2011;114(6):1585-91. [Medline].

  11. Kocher M, Soffietti R, Abacioglu U, et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol. Jan 10 2011;29(2):134-41. [Medline].

  12. Bindal RK, Sawaya R, Leavens ME, Lee JJ. Surgical treatment of multiple brain metastases. J Neurosurg. Aug 1993;79(2):210-6. [Medline].

  13. Bindal AK, Bindal RK, Hess KR, et al. Surgery versus radiosurgery in the treatment of brain metastasis. J Neurosurg. May 1996;84(5):748-54. [Medline].

  14. Cho KH, Hall WA, Lee AK. Stereotactic radiosurgery for patients with single brain metastasis. J Radiol. 1998;1:79-85.

  15. Auchter RM, Lamond JP, Alexander E, et al. A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys. Apr 1 1996;35(1):27-35. [Medline].

  16. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, 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. Mar 1 1997;37(4):745-51. [Medline].

  17. Rusciano D, Burger MM. Mechanisms of metastases. In: Levine AJ, Schmidek HH, eds. Molecular Genetics of Nervous System Tumors. New York, NY: Wiley-Liss; 1993.

 
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Management of recurrent metastasis.
Multiple brain metastasis in a patient with known non-small cell lung adenocarcinoma. There was also systemic disease in the liver.
Table 1. Sources of Primary Tumor in Brain Metastases
Primary Tumor SitePercentage (%)
Lung21
Breast9
Melanoma40
Lymphoma, mainly non-Hodgkin1
GI tract3
Genitourinary tract11
Osteosarcoma10
Head and neck6
Table 2. Overview of RPA Data from RTOG Studies[16]
GroupKarnofsky Performance StatusSystemic DiseaseMedian Survival (mo)
Age ≤ 65 y≥ 70Controlled primary disease, no extracranial metastases7.1; 13.5 for single metastasis, 6.0 for multiple metastases
Age ≥ 65 y≥ 70Controlled systemic disease, with extracranial metastasis4.2; 8.1 for single metastasis, 4.1 for multiple metastases
Any ageAnyAny2.3
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