Brain metastases in patients with no known primary tumor

Maesawa, Satoshi; Kondziolka, Douglas; Thompson, Todd P.; Flickinger, John C.; Lunsford, L. Dade

doi:10.1002/1097-0142(20000901)89:5<1095::aid-cncr19>3.0.co;2-h

Cited by 54 publications

(26 citation statements)

References 18 publications

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“…WBRT is delivered during the course of several weeks, causes alopecia and fatigue, can lead to long-term cognitive problems, and may delay the delivery of other treatments for extracranial cancer. Many investigators have reported the efficacy of radiosurgery as a minimally invasive alternative to surgical resection to obtain local tumor control (2,8,14,16,18,21,24,25,36,37). Radiosurgery has several advantages over surgical resection.…”

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confidence: 99%

Brain Metastases Treated with Radiosurgery Alone: An Alternative to Whole Brain Radiotherapy?

et al. 2003

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Brain Metastases Treated with Radiosurgery Alone: An Alternative to Whole Brain Radiotherapy?

et al. 2003

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“…The incidence of brain metastases of unknown primary origin is decreasing owing to the improvements of imaging technology. However, only a few studies have reported results about the outcome of patients with unknown primary brain metastases, and the results are discrepant [7891011]. …”

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confidence: 99%

“…However, the outcome of patients with brain metastases of unknown primary origin is still controversial [7891011]. …”

Section: Introductionmentioning

confidence: 99%

Optimal Treatment Decision for Brain Metastases of Unknown Primary Origin: The Role and Timing of Radiosurgery

Han

Chang

Jung

et al. 2016

Brain Tumor Res Treat

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BackgroundUp to 15% of all patients with brain metastases have no clearly detected primary site despite intensive evaluation, and this incidence has decreased with the use of improved imaging technology. Radiosurgery has been evaluated as one of the treatment modality for patients with limited brain metastases. In this study, we evaluated the effectiveness of radiosurgery for brain metastases from unknown primary tumors.MethodsWe retrospectively evaluated 540 patients who underwent gamma knife radiosurgery (GKRS) for brain metastases radiologically diagnosed between August 1992 and September 2007 in our institution. First, the brain metastases were grouped into metachronous, synchronous, and precocious presentations according to the timing of diagnosis of the brain metastases. Then, synchronous and precocious brain metastases were further grouped into 1) unknown primary; 2) delayed known primary; and 3) synchronous metastases according to the timing of diagnosis of the primary origin. We analyzed the survival time and time to new brain metastasis in each group.ResultsOf the 540 patients, 29 (5.4%) presented precocious or synchronous metastases (34 GKRS procedures for 174 lesions). The primary tumor was not found even after intensive and repeated systemic evaluation in 10 patients (unknown primary, 34.5%); found after 8 months in 3 patients (delayed known primary, 1.2%); and diagnosed at the same time as the brain metastases in 16 patients (synchronous metastasis, 55.2%). No statistically significant differences in survival time and time to new brain metastasis were found among the three groups.ConclusionIdentification of a primary tumor before GKRS did not affect the patient outcomes. If other possible differential diagnoses were completely excluded, early GKRS can be an effective treatment option for brain metastases from unknown primary tumor.

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“…In 12 of 31 patients, the primary was eventually discovered, most commonly in the lung. Median survival in such patients is in the range of 13 to 15 months [23,24]. Patients in these studies died of both intracranial and extracranial disease progression.…”

Section: Tumor Subtypesmentioning

confidence: 91%

Brain metastases

Ewend

Carey

Morris

et al. 2001

Curr. Treat. Options in Oncol.

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Metastatic tumors to the brain are an increasing cause of morbidity and mortality in patients with systemic cancers. Many new therapies used to treat systemic cancers do not penetrate the central nervous system (CNS) and do not protect patients from the development of brain metastases. Surgery, radiosurgery, and radiation therapy are all used to treat brain metastases. It is in our opinion a mistake to use only one or two of these modalities to the exclusion of other(s). The role of systemic chemotherapy is still limited, due to both the issues of drug delivery caused by the blood brain barrier and to the relative resistance of many of these tumors to chemotherapy. Traditionally, brain metastases have been grouped together regardless of the origin of the tumor and have been treated with a single algorithm. As we encounter more patients for whom treatment of the brain metastases is an important determinant of survival, we must tailor our treatment strategies to individual tumor types. Also, we must recognize differences in each tumor's sensitivity to chemotherapy and radiotherapy and differences in their biology.

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Brain metastases in patients with no known primary tumor

Cited by 54 publications

References 18 publications

Brain Metastases Treated with Radiosurgery Alone: An Alternative to Whole Brain Radiotherapy?

Brain Metastases Treated with Radiosurgery Alone: An Alternative to Whole Brain Radiotherapy?

Optimal Treatment Decision for Brain Metastases of Unknown Primary Origin: The Role and Timing of Radiosurgery

Brain metastases

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