Follow-up
Prognosis
- In summary, outcome factors associated with an improved prognosis are the following:
- High Karnofsky score (>70%)
- Age younger than 60 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 Studies
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[ CLOSE WINDOW ]Table
Group Karnofsky Performance Status Systemic Disease Median Survival (mo) 1 (age 65 y or younger) 70 or higher Controlled primary disease, no extracranial metastases 7.1; 13.5 for single metastasis, 6.0 for multiple metastases 2* Not group 1 or 3 Not group 1 or 3 4.2; 8.1 for single metastasis, 4.1 for multiple metastases 3 <70 2.3 * Patients in group 2 were those who did not meet the criteria for groups 1 and 3.Group Karnofsky Performance Status Systemic Disease Median Survival (mo) 1 (age 65 y or younger) 70 or higher Controlled primary disease, no extracranial metastases 7.1; 13.5 for single metastasis, 6.0 for multiple metastases 2* Not group 1 or 3 Not group 1 or 3 4.2; 8.1 for single metastasis, 4.1 for multiple metastases 3 <70 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.
- Median survival durations for resection, WBRT, and/or stereotactic radiosurgery are as follows:
- Surgical resection and WBRT - 36 months
- Surgical resection - 22 months
- Surgical resection and WBRT - 16 months
- Stereotactic radiosurgery - 11 months
- WBRT - 6 months
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 most commonly intracranial tumors.
- Because many of the widely used chemotherapeutic agents do not cross the BBB, the brain is a safe haven for tumor growth.
- Increasing incidence of brain metastasis is a result of the increasing age of the population (and thus an increase in the incidence of cancer overall) and improvements in treating systemic disease.
- 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, which may or may not apply to the needs of the individual patient.
More on Brain Metastasis |
| Overview: Brain Metastasis |
| Differential Diagnoses & Workup: Brain Metastasis |
| Treatment & Medication: Brain Metastasis |
 Follow-up: Brain Metastasis |
| Multimedia: Brain Metastasis |
| References |
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References
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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, Buatti JM, Chappell R, Friedman WA, 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].
Bindal AK, Bindal RK, Hess KR, Shiu A, Hassenbusch SJ, Shi WM, et al. Surgery versus radiosurgery in the treatment of brain metastasis. J Neurosurg. May 1996;84(5):748-54. [Medline].
DeAngelis LM, Mandell LR, Thaler HT, Kimmel DW, Galicich JH, Fuks Z, et al. The role of postoperative radiotherapy after resection of single brain metastases. Neurosurgery. Jun 1989;24(6):798-805. [Medline].
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].
Rusciano D, Burger MM. Mechanisms of metastases. In: Levine AJ, Schmidek HH, eds. In: Molecular Genetics of Nervous System Tumors. New York, NY: Wiley-Liss; 1993.
Further Reading
Keywords
metastatic tumor, central nervous system metastasis, CNS metastasis, CNS metastases, brain cancer, cerebral cancer, brain metastases, metastatic disease to the brain, brain metastasis
