Brain metastases with an unknown primary: a clinical perspective

Abstract

A review of 43 patients with cerebral metastases, an unknown primary, and no other sites of metastases is presented. 27/43 (62.7%) had solitary metastases and 37.2% (16/43) had multiple metastases. Surgical treatment involved complete resection in 30.2%, subtotal resection in 37.2% and biopsy alone or no surgical procedure in the remainder. 39/43 patients underwent whole brain irradiation with the majority receiving 3,000-4,000 rads/10-20 fractions. Overall survival was 52% at six months and 20% at one year, and was significantly better in patients with solitary as opposed to multiple metastases (p less than 0.03). A failure analysis including autopsy data demonstrates that (28/41) 68.3% of patients died of progressive intracranial disease without extracerebral metastases. Implications for treatment strategies are discussed.

Brain metastases as the only manifestation of an undetected primary tumor

“…Other reports may have included patients with incomplete workup or extracranial metastases or patients whose tumors were diagnosed by a nuclear brain scan. 4,7,8 Nevertheless, the demographics and clinical presentations of patients in previous studies and those in the current study were similar. The predominant metastasis histology in all studies was adenocarcinoma, consistent with its recognized aggressive metastatic potential.…”

“…The prognosis of patients with brain metastases only generally is considered to be poor; thus, most treatment is palliative. 4 The objective of this study was to evaluate retrospectively the experience with this presentation at The University of Texas M. D. Anderson Cancer Center. Because the workup and evaluation of this group of patients has improved vastly with the advent of computed tomography (CT) scanning, we restricted our study to only the years after CT was introduced to the M. D. Anderson Cancer Center.…”

Brain metastases from unknown primary tumour

“…All studies are retrospective and deal with a small number of patients over a long time period: 17 patients over 20 years [13]; 7 patients over 10 years [15]; 34 patients over 12 years [8]; 28 patients over 13 years [25]; 39 patients over 19 years [18]. This study (33 patients over 10 years) was prospective.…”

“…1 Survival curves for patients with single brain metastasis receiving gross total resection plus whole-brain radiotherapy (Single GTR + WBRT), multiple brain metastases receiving whole-brain radiotherapy alone (WBRT) and multiple brain metastases receiving gross total resection of the symptomatic lesions plus wholebrain radiotherapy (Multiple GTR + WBRT). According to the largest series [8,13,15,23,30], among patients with precocious brain metastases, the underlying primary tumour is discovered during life in 64-84 % (82 % in this series). It may remain unknown even at autopsy: our value of 3 % is in line with those reported in the literature, ranging between 1.6 % [13] and 3.5 % [15].…”

“…The reports in the literature on patients with brain metastases from an unknown primary tumour are all retrospective, including patients of both pre-CT and CT eras [8,9,13]. They may also group together patients in whom the brain metastases were the first symptom of therapy and followed with serial CT until death.…”