Survival outcomes following craniotomy for intracranial metastases from an unknown primary

Abstract

Introduction Management of patients with intracranial metastases from an unknown primary tumor (CUP) varies compared to those with metastases of known primary tumor origin (CKP). The National Institute for Health and Care Excellence (NICE) recognizes the current lack of research to support the management of CUP patients with brain metastases. The primary aim was to compare survival outcomes of CKP and CUP patients undergoing early resection of intracranial metastases to understand the efficacy of surgery for patients with CUP. Methods A retrospective study was performed, wherein patients were identified using a pathology database. Data was collected from patient notes and trust information services. Surgically managed patients during a 10-year period aged over 18 years, with a histological diagnosis of intracranial metastasis, were included. Results 298 patients were identified, including 243 (82.0%) CKP patients and 55 (18.0%) CUP patients. Median survival for CKP patients was 9 months (95%CI 7.475-10.525); and 6 months for CUP patients (95%CI 4.263-7.737, p = 0.113). Cox regression analyses suggest absence of other metastases (p = 0.016), age (p = 0.005), and performance status (p = 0.001) were positive prognostic factors for improved survival in cases of CUP. The eventual determination of the primary malignancy did not affect overall survival for CUP patients. Conclusions There was no significant difference in overall survival between the two groups. Surgical management of patients with CUP brain metastases is an appropriate treatment option. Current diagnostic pathways specifying a thorough search for the primary tumor pre-operatively may not improve patient outcomes.

Retrospective analysis of survival in patients with brain metastases from an unknown primary tumor

“…Gough et al reported the results of 298 subjects with brain metastases (343-82% patients with known primary and 55-18% patients with unknown primary) (6). The median survival of subjects with known primary was 9 months, and for subjects with unknown primary, median survival was 6 months, which did not differ for patients with known and unknown primary tumors.…”

“…Neurological symptoms of brain tumors can be the first sign of an undiagnosed metastatic disease (2). The National Institute for Health and Care Excellence (NICE) also highlighted the scarcity of data regarding brain metastases of unknown primary (6).…”

“…Brain metastasis from unknown primary cancers is a relatively rare phenomenon; therefore, only a limited number of cases have been reported. In 2018, The National Institute for Health and Care Excellence reported a series of 298 patients with brain metastasis in which 55 subjects categorized as brain metastasis from unknown primary (6). In another study, Rotta et al reported 71 subjects (11).…”

Brain Metastasis from Unknown Primary Tumour: Moving from Old Retrospective Studies to Clinical Trials on Targeted Agents

“…The prognosis of BM-CUP in comparison with BM from known primaries is debated. Although the majority of studies did not report significant differences in survival between patients with BM of known or unknown origin [ 8 , 14 , 17 , 19 , 21 , 22 , 25 , 30 , 66 , 67 ], older studies reported a better overall outcome in BM-CUP ascribed to the lack of a significant extracranial tumour burden [ 10 , 18 ]. In a recent study by Füreder et al [ 24 ], patients with BM-CUP showed a better survival when the primary was identified (after a latency of > 3 months).…”

Prognostic Factors among Patients with Brain Metastases from Cancer of Unknown Primary

“…4 Lastly, the survival estimates of our Dutch cohort seem to be in line with published prospects for untreated BM-CUP patients whose median survival is only 1-2 months. 13 To our knowledge, this is the largest cohort study on BM-CUP with only two earlier studies that particularly assessed BM-CUP 4,5 , of which the largest included 127 patients. In addition, analyses were based on data from a near-complete cancer registry that includes cases noti ed by pathology reports and clinical diagnoses.…”