Follow-up
Prognosis
In summary, outcome factors associated with an improved prognosis are the following:
- High Karnofsky score (>70%)
- Age younger than 70 years
- No systemic disease or systemic disease controlled
- No systemic metastases within 1 year of diagnosis of primary lesion
- Female patients
Generalizing median survival data for resection, WBRT, and/or stereotactic radiosurgery from available study reports is difficult.
Median survival after any therapy must be judged by means of recursive partitioning analysis (RPA) of the patients' data and by evaluating the tumor type included in the study groups. Table 2 provides an overview of data from several RTOG studies.
Table 2. Overview of RPA Data from RTOG Studies13
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Table
| Group | Karnofsky Performance Status | Systemic Disease | Median Survival (mo) |
|---|---|---|---|
| Age £ 65 y | ³ 70 | Controlled primary disease, no extracranial metastases | 7.1; 13.5 for single metastasis, 6.0 for multiple metastases |
| Age ³ 65 y | ³ 70 | Controlled systemic disease, with extracranial metastasis | 4.2; 8.1 for single metastasis, 4.1 for multiple metastases |
| Any age | Any | Any | 2.3 |
| Group | Karnofsky Performance Status | Systemic Disease | Median Survival (mo) |
|---|---|---|---|
| Age £ 65 y | ³ 70 | Controlled primary disease, no extracranial metastases | 7.1; 13.5 for single metastasis, 6.0 for multiple metastases |
| Age ³ 65 y | ³ 70 | Controlled systemic disease, with extracranial metastasis | 4.2; 8.1 for single metastasis, 4.1 for multiple metastases |
| Any age | Any | Any | 2.3 |
Surgery and WBRT remain the standard of care.
- Emerging data suggest that WBRT and radiosurgery is as promising as surgery and WBRT, especially in patients with more than 1 lesion in the brain.
- Furthermore, no significant difference has been observed between stereotactic radiosurgery and combined WBRT and radiosurgery in this population of patients.
- Hence, patients of RAP 2 or 3 may not have any survival advantage with aggressive and prolonged treatment, and radiosurgery alone may be a more sensible therapeutic option.
Patient Education
For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education article Brain Cancer.
Miscellaneous
Special Concerns
- Metastatic brain tumors are the most commonly found intracranial tumors.
- To date, treatment options for metastatic disease to the brain are mainly palliative, but 20% of the total yearly cost of cancer treatment in the United States is for patients with primary or secondary cancer of the CNS.
- A good proportion of this money is used for comfort and supportive care; the latter includes counseling for both patients and their families, which is an essential element in comprehensive care for this population of patients.
- Given the increasing cost of treating cancer patients, specialists must justify their practice patterns on the basis of outcome analysis, and they must base their management plans on published guidelines. Fortunately, with the growing trend in developing comprehensive cancer centers and integrative medicine, physicians and auxiliary staffs caring for cancer patients can be more equipped to meet the personal needs of their patients in more cost-effective ways.
More on Brain Metastasis |
| Overview: Brain Metastasis |
| Differential Diagnoses & Workup: Brain Metastasis |
| Treatment & Medication: Brain Metastasis |
 Follow-up: Brain Metastasis |
| Multimedia: Brain Metastasis |
| References |
| Further Reading |
| « Previous Page | Next Page » |
References
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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].
Cho KH, Hall WA, Lee AK. Stereotactic radiosurgery for patients with single brain metastasis. J Radiol. 1998;1:79-85.
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].
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].
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Keywords
metastatic tumor, central nervous system metastasis, CNS metastasis, CNS metastases, brain cancer, cerebral cancer, brain metastases, metastatic disease to the brain, brain metastasis
