Cerebral metastases as first symptom of bronchogenic carcinoma. A prospective study of 37 cases

Abstract

Among the patients showing evidence of cerebral metastases without previously known cancer history, lung cancer has been found 37 times as the primary tumor in our institution. There were 34 men and three women and all but two were heavy smokers. Only one presented at diagnosis with thoracic symptoms but the chest radiograph was abnormal in 34. The histologic type of the primary tumor was obtained in 32 cases as a result of thoracic investigations and in five cases from metastatic tumor tissue. The primary tumor appeared to be non-small cell lung carcinoma in 26 cases and small cell lung carcinoma in 11 cases. These results show that patients treated with surgery (20 cases) have a better survival (median 10 months versus 4.5) than the others, and among surgically treated patients only those treated with bifocal resection (eight patients) are long-term survivors. Also, in four of six patients, objective regression of the neurologic symptoms was seen after radiation therapy alone. Central nervous system relapse was seen in 12 patients, but in none of the patients treated with postoperative radiation therapy. Conventional chemotherapy (11 patients) induced objective responses only in the small cell type and proved to be too toxic when used simultaneously with radiation therapy in inoperable patients.

Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991

“…The impact of gender on survival has not been an issue until recently because reported case material until the late 1980s was dominated by men. 55,67,70 In our series, the number of men and women was similar (ratio 1:1) and women survived longer by 4.3 months. Similarly, in most published series of patients who have undergone surgical treatment of primary lung cancer, women have had a better prognosis than men.…”

“…Others have reported similar findings. 5,32,69,70 In general, the median interval between the diagnosis of lung cancer and the discovery of brain metastases is 6 months, but 10% of our patients with adenocarcinoma did not receive a diagnosis of brain metastasis until more than 2 years after diagnosis of their primary tumor. For five patients, the interval was even longer-more than 5 years-a time period that was also reported by Komaki and colleagues.…”

Brain metastases from unknown primary tumour

“…Patients with single brain metastasis who underwent a gross total resection and WBRT displayed survival patterns similar to those reported by most authors for patients with single brain metastasis both from unknown and known primary tumour treated by surgery and radiotherapy. These had a median survival of 9-14 months with 30-53 % alive at 1 year and up to 20-25 % alive at 2 years [5,15,18,21,22,25,26,28,29,31,33]. Le Chevalier et al [14] and Eapen et al [8] reported a poorer prognosis with a median survival of 6 months, 18-20 % alive at 1 year and 5,4 % at 2 years, but half of the patients had not received surgery [14] or only incomplete surgery [8].…”

A study of immunohistochemical differential expression in pulmonary and mammary carcinomas

“…30 The squamous differentiation (metaplasia) can be accentuated in the metastatic site, which may lead to the erroneous diagnosis of primary bronchogenic squamous cell carcinoma. 31 In addition, both mammary and pulmonary adenocarcinomas have a similar predilection for distant metastasis to the bone, liver, brain, and adrenal glands, 15,19,32,33 and metastasis of mammary carcinomas can clinically and radiographically present as a solitary lung mass with metastasis in any of the above-mentioned organs, a condition that can be interpreted as a lung cancer with distant metastasis.…”