Brain Metastasis Follow-up

Updated: May 23, 2017
  • Author: Victor Tse, MD, PhD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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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 Studies [22] (Open Table in a new window)

Group Karnofsky Performance Status Systemic Disease Median Survival, mo
Age 65 y or younger 70 or higher Controlled primary disease; no extracranial metastases 7.1 overall; 13.5 for single metastasis, 6 for multiple metastases
Age 65 y or older 70 or higher Uncontrolled systemic disease; extracranial metastasis 4.2 overall; 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.

To date, treatment options for metastatic disease to the brain are mainly palliative, but this is changing. With newer chemotherapeutic agents, the repetitive use of stereotactic radiosurgery, and the growing trend in developing comprehensive cancer centers and integrative medicine to address emotional, nutritional, and cognitive/social issues of cancer patients, physicians and auxiliary staffs caring for cancer patients are more equipped to meet the personal needs of the patients.

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Patient Education

For excellent patient education resources, visit eMedicineHealth's Cancer Center. Also, see eMedicineHealth's patient education article Brain Cancer.

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