Brain metastasis: Clinical characteristics and prognosis

Lee, Jae Lyun; Shin, Chang Jin; Kang, Hee Jeong; Oh, Hyun Ah; Lee, Gu; Choi, Jae Hyuk; Bae, Sung Hwa; Lee, Kyung Hee; Hyun, Myung Soo; Shin, Sei One; Ryoo, Hyun Mo

Abstract

BACKGROUND
Brain metastasis is a common complication in cancer patients. We evaluated the clinical characteristics, treatment outcome and prognostic factors for patients with metastatic brain tumor.
METHODS
The records of 97 patients with metastatic brain tumor during the period from January 1991 to November 1997 were reviewed retrospectively.
RESULTS
The most common primary tumor is lung cancer (61 cases, 63%) followed by metastatic cancer unknown primary site (15 cases, 16%), gastrointestinal cancer (13 cases, 13%), breast cancer (6 cases, 6%) and renal cancer (2 cases, 2%). There were 44 patients with a single brain metastasis and 53 patients with multiple brain metastases. The median survival was 3.0 months and one-year survival rate was 8% irrespective of treatment. Favorable prognostic factors which affect survival were ambulatory status (p<0.01) and functional neurologic class 1, 2 (p<0.01). Median survival was 3.7 months for patients with steroid therapy and 1.1 months with no therapy (p<0.01). Median survival was 4.8 months for patients with steroid therapy plus whole brain radiotherapy (WBRT) and 2.2 months with steroid therapy alone (p<0.01). Additional chemotherapy did not appear to affect the survival. The patients treated with surgery had median survival time of 8.8 months compared with 2.5 months for patients treated with steroid therapy plus WBRT (p<0.05).
CONCLUSION
In present study, we confirmed that whole brain irradiation and corticosteroid administration are effective palliative treatment for patients with metastatic brain tumor. Initial performance status and neurological function were identified as important prognostic factors. Although confounded by the limitations of retrospective study, more aggressive treatments including surgery and chemotherapy could be regarded to have a significant role to achieve better treatment outcome in some selected cases.