Intracerebral metastases natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, patients with intracerebral metastases may progress to develop [[seizures]], altered mental status, [[hemiplegia]], focal neurological deficits, [[hemorrhage]], [[brain herniation]], [[coma]], and death.<ref name=symptomsofbrainmetastasis1>Clinical presentation of brain metastases. Dr Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases. Accessed on November 9, 2015</ref><ref name=historicalperspectiveofintracerebralmetastases>{{Cite journal | |||
| author = [[Andrew B. Lassman]] & [[Lisa M. DeAngelis]] | title = Brain metastases | journal = [[Neurologic clinics]] | volume = 21 | issue = 1 | pages = 1–23 | year = 2003 | month = February | pmid = 12690643}}</ref> Common complications of intracerebral metastases include [[brain herniation]], [[hemorrhage]], [[coma]], and [[stroke]]. Depending on the type of the [[Primary tumor|primary cancer]], the age of the patient, absence or presence of extracranial metastases, and the number of metastatic sites in the brain at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor. The median survival time of all patients with intracerebral metastases is 2.3 months.<ref name=prognosisofintracerebralmetastasis1>Prognosis of brain metastasis. Wikipedia 2015. https://en.wikipedia.org/wiki/Brain_metastasis. Accessed on November 9, 2015</ref><ref name="Khuntia2015">{{cite journal|last1=Khuntia|first1=Deepak|title=Contemporary Review of the Management of Brain Metastasis with Radiation|journal=Advances in Neuroscience|volume=2015|year=2015|pages=1–13|issn=2356-6787|doi=10.1155/2015/372856}}</ref> | |||
==Natural History== | ==Natural History== | ||
If left untreated, patients with intracerebral metastases may progress to develop [[seizures]], altered mental status, [[hemiplegia]], focal neurological deficits, [[hemorrhage]], [[brain herniation]], [[coma]], and death.<ref name=symptomsofbrainmetastasis1>Clinical presentation of brain metastases. Dr Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases. Accessed on November 9, 2015</ref><ref name=historicalperspectiveofintracerebralmetastases>{{Cite journal | |||
| author = [[Andrew B. Lassman]] & [[Lisa M. DeAngelis]] | title = Brain metastases | journal = [[Neurologic clinics]] | volume = 21 | issue = 1 | pages = 1–23 | year = 2003 | month = February | pmid = 12690643}}</ref> | |||
==Complications== | ==Complications== | ||
Common complications of intracerebral metastases include:<ref name=historicalperspectiveofintracerebralmetastases>{{Cite journal | |||
| author = [[Andrew B. Lassman]] & [[Lisa M. DeAngelis]] | title = Brain metastases | journal = [[Neurologic clinics]] | volume = 21 | issue = 1 | pages = 1–23 | year = 2003 | month = February | pmid = 12690643}}</ref> | |||
*[[Brain herniation]] | |||
*[[Hemorrhage]] | |||
*[[Coma]] | |||
*[[Stroke]] | |||
*[[Radiotherapy|Side effects of radiotherapy]] | |||
*[[Chemotherapy|Side effects of chemotherapy]] | |||
==Prognosis== | ==Prognosis== | ||
*Depending on the type of [[primary cancer]] | *Depending on the type of [[Primary tumor|primary cancer]]; the age of the patient; absence or presence of extracranial metastases; and the number of metastatic sites in the brain at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor.<ref name=prognosisofintracerebralmetastasis1>Prognosis of brain metastasis. Wikipedia 2015. https://en.wikipedia.org/wiki/Brain_metastasis. Accessed on November 9, 2015</ref><ref name="Khuntia2015">{{cite journal|last1=Khuntia|first1=Deepak|title=Contemporary Review of the Management of Brain Metastasis with Radiation|journal=Advances in Neuroscience|volume=2015|year=2015|pages=1–13|issn=2356-6787|doi=10.1155/2015/372856}}</ref> | ||
*The median survival time of all patients with intracerebral metastases is 2.3 months. | |||
*The primary tumor-specific median survival time of intracerebral metastases are tabulated below:<ref name="Khuntia2015">{{cite journal|last1=Khuntia|first1=Deepak|title=Contemporary Review of the Management of Brain Metastasis with Radiation|journal=Advances in Neuroscience|volume=2015|year=2015|pages=1–13|issn=2356-6787|doi=10.1155/2015/372856}}</ref> | |||
{| style="border: 0px; font-size: 90%; margin: 3px; width:1000px" | |||
|valign=top| | |||
|+ | |||
! style="background: #4479BA; width: 600px;" | {{fontcolor|#FFF|Primary}} | |||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Median survival (months)}} | |||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|95% C.I.}} | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |Non-small cell lung cancer | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|7 | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|6.53 - 7.50 | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |Small cell lung cancer | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|4.9 | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|4.30 - 6.20 | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |Melanoma | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|6.74 | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|5.90 - 7.57 | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |Renal cell carcinoma | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|9.63 | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|7.66 - 10.91 | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |Breast cancer | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|11.93 | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|9.69 - 12.85 | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |Gastrointestinal cancer | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|5.36 | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|4.30 - 6.30 | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |Unknown | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|6.37 | |||
| style="padding: 5px 5px; background: #DCDCDC;" align=center|5.22 - 7.49 | |||
|} | |||
*However, in some patients such as those with no extracranial metastases, the prognosis is much better with the median survival rate of upto 13.5 months.<ref name=prognosisofintracerebralmetastasis1>Prognosis of brain metastasis. Wikipedia 2015. https://en.wikipedia.org/wiki/Brain_metastasis. Accessed on November 9, 2015</ref> | |||
*Favorable prognostic factors (median survival time of 13.5 months) for intracerebral metastases include:<ref name=prognosisofintracerebralmetastasis1>Prognosis of brain metastasis. Wikipedia 2015. https://en.wikipedia.org/wiki/Brain_metastasis. Accessed on November 9, 2015</ref><ref name="FabiFelici2011">{{cite journal|last1=Fabi|first1=Alessandra|last2=Felici|first2=Alessandra|last3=Metro|first3=Giulio|last4=Mirri|first4=Alessandra|last5=Bria|first5=Emilio|last6=Telera|first6=Stefano|last7=Moscetti|first7=Luca|last8=Russillo|first8=Michelangelo|last9=Lanzetta|first9=Gaetano|last10=Mansueto|first10=Giovanni|last11=Pace|first11=Andrea|last12=Maschio|first12=Marta|last13=Vidiri|first13=Antonello|last14=Sperduti|first14=Isabella|last15=Cognetti|first15=Francesco|last16=Carapella|first16=Carmine M|title=Brain metastases from solid tumors: disease outcome according to type of treatment and therapeutic resources of the treating center|journal=Journal of Experimental & Clinical Cancer Research|volume=30|issue=1|year=2011|pages=10|issn=1756-9966|doi=10.1186/1756-9966-30-10}}</ref> | |||
:*No extracranial metastases | |||
:*Age less than 65 years | |||
:*Single site of [[metastasis]] in the brain | |||
:*Responsive to steroid treatment | |||
:*No impairment of neurocognitive function | |||
:*[[Supratentorial]] location | |||
:*Female gender | |||
==References== | ==References== | ||
Latest revision as of 15:18, 23 November 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
If left untreated, patients with intracerebral metastases may progress to develop seizures, altered mental status, hemiplegia, focal neurological deficits, hemorrhage, brain herniation, coma, and death.[1][2] Common complications of intracerebral metastases include brain herniation, hemorrhage, coma, and stroke. Depending on the type of the primary cancer, the age of the patient, absence or presence of extracranial metastases, and the number of metastatic sites in the brain at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor. The median survival time of all patients with intracerebral metastases is 2.3 months.[3][4]
Natural History
If left untreated, patients with intracerebral metastases may progress to develop seizures, altered mental status, hemiplegia, focal neurological deficits, hemorrhage, brain herniation, coma, and death.[1][2]
Complications
Common complications of intracerebral metastases include:[2]
Prognosis
- Depending on the type of primary cancer; the age of the patient; absence or presence of extracranial metastases; and the number of metastatic sites in the brain at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor.[3][4]
- The median survival time of all patients with intracerebral metastases is 2.3 months.
- The primary tumor-specific median survival time of intracerebral metastases are tabulated below:[4]
| Primary | Median survival (months) | 95% C.I. |
|---|---|---|
| Non-small cell lung cancer | 7 | 6.53 - 7.50 |
| Small cell lung cancer | 4.9 | 4.30 - 6.20 |
| Melanoma | 6.74 | 5.90 - 7.57 |
| Renal cell carcinoma | 9.63 | 7.66 - 10.91 |
| Breast cancer | 11.93 | 9.69 - 12.85 |
| Gastrointestinal cancer | 5.36 | 4.30 - 6.30 |
| Unknown | 6.37 | 5.22 - 7.49 |
- However, in some patients such as those with no extracranial metastases, the prognosis is much better with the median survival rate of upto 13.5 months.[3]
- Favorable prognostic factors (median survival time of 13.5 months) for intracerebral metastases include:[3][5]
- No extracranial metastases
- Age less than 65 years
- Single site of metastasis in the brain
- Responsive to steroid treatment
- No impairment of neurocognitive function
- Supratentorial location
- Female gender
References
- ↑ 1.0 1.1 Clinical presentation of brain metastases. Dr Bruno Di Muzio and Dr Trent Orton et al. Radiopaedia 2015. http://radiopaedia.org/articles/brain-metastases. Accessed on November 9, 2015
- ↑ 2.0 2.1 2.2 Andrew B. Lassman & Lisa M. DeAngelis (2003). "Brain metastases". Neurologic clinics. 21 (1): 1–23. PMID 12690643. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 3.2 3.3 Prognosis of brain metastasis. Wikipedia 2015. https://en.wikipedia.org/wiki/Brain_metastasis. Accessed on November 9, 2015
- ↑ 4.0 4.1 4.2 Khuntia, Deepak (2015). "Contemporary Review of the Management of Brain Metastasis with Radiation". Advances in Neuroscience. 2015: 1–13. doi:10.1155/2015/372856. ISSN 2356-6787.
- ↑ Fabi, Alessandra; Felici, Alessandra; Metro, Giulio; Mirri, Alessandra; Bria, Emilio; Telera, Stefano; Moscetti, Luca; Russillo, Michelangelo; Lanzetta, Gaetano; Mansueto, Giovanni; Pace, Andrea; Maschio, Marta; Vidiri, Antonello; Sperduti, Isabella; Cognetti, Francesco; Carapella, Carmine M (2011). "Brain metastases from solid tumors: disease outcome according to type of treatment and therapeutic resources of the treating center". Journal of Experimental & Clinical Cancer Research. 30 (1): 10. doi:10.1186/1756-9966-30-10. ISSN 1756-9966.