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Title: Primary Tumour Histology Important in Determining Brain Metastasis Survival

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Onkologie, 2002; 25: 420-425. "Prognostic Factors for Patients with Microsurgically Resected Brain Metastases"
11/19/2002 11:34:55 AM
By Elda Hauschildt

Histology of the primary tumour is one of the most important factors in determining survival times in patients after microsurgical resection for brain metastases. Preoperative Kamofsky scale score, location of the metastasis and preoperative symptom duration are also important, German researchers report. "Microsurgical resection of one or more brain metastases followed by whole-brain radiation therapy (WBRT) is still a useful and efficient treatment in a carefully selected patient group to prolong survival and improve or stabilise performance status," concluded the investigators from the Universitatsklinikum der RWTH Aachen in Aachen. The retrospective review included data on 187 consecutive patients: 85 with lung cancer; 20 with gastrointestinal cancer, 19 with renal cell cancer, 17 with breast cancer, 8 with malignant melanoma and 38 others with various carcinomas or with unknown primary sites. Participants underwent microsurgical resection of brain metastases between July 1989 and September 1996. After tumour resection, 111 patients underwent WBRT, with a mean dose of 32 Gy. The researchers evaluated eight prognostic factors. These included the influence of the number, size and localisation of brain metastases as well as primary tumour histology, preoperative performance status, presence of extra-cranial system disease, time course and adjuvant radiation therapy. Early postoperative Kamofsky score improved in 59 percent of patients. It remained unchanged in 32 percent and was worse in 9 percent. The investigators say the median survival time was 9.8 months, with a range of 1 day to 5.3 years. Histology of the primary tumour significantly influenced survival time, predicting a negative outcome especially for patients with metastases from renal cell cancers and malignant melanomas. Breast cancer patients survived longer than other patients. "Survival varied significantly depending on location of the brain metastases, performance status at the time of craniotomy and duration of symptoms," the researchers note.

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