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- Title
Brain metastases in patients with no known primary tumor.
- Authors
Maesawa, Satoshi; Kondziolka, Douglas; Thompson, Todd P.; Flickinger, John C.; Lunsford, L. Dade; Maesawa, S; Kondziolka, D; Thompson, T P; Flickinger, J C; Dade, L
- Abstract
<bold>Background: </bold>The care of patients with a brain metastasis from unknown primary site is controversial. The authors reviewed the results of stereotactic radiosurgery in this group of patients to better define clinical expectations.<bold>Methods: </bold>During an 11-year interval, radiosurgery was performed in 421 patients with brain metastases at the University of Pittsburgh. Fifteen patients had solitary or multiple (< or = 5) brain metastases without a detectable primary site at the time of initial presentation. In five patients, a histologic diagnosis of cancer was obtained from extracranial metastatic sites. In 10 patients, a diagnosis was obtained from the brain. A total of 31 tumors with a mean volume of 4.3 mL (range, 0. 05-18.6 mL) underwent radiosurgery with a mean marginal dose of 16.2 Gray (Gy) (range, 12-20 Gy). Fourteen patients (93.3%) also received whole brain fractionated radiation therapy.<bold>Results: </bold>The median survival was 15 months after radiosurgery (range, 1-48 months) and 27 months after their initial diagnosis of cancer. In 4 patients (26. 7%), the primary tumor was discovered later (lung in 3 patients and liver in 1). Three of these four patients died due to progression of their primary tumor. Of the remaining 11 patients, 4 died of progression of extracranial metastases, 2 died of other systemic diseases, and 3 patients died because of progression of brain metastasis. Three patients (20%) were still living between 21-48 months after radiosurgery. The presence of active systemic disease and brain stem location both were associated with a poor outcome (P = 0.004 and 0.04). The actuarial imaging-defined local tumor control rate was 91.3 +/- 5.9% at 4 years.<bold>Conclusions: </bold>Radiosurgery was an effective strategy for patients with brain metastases from an unknown primary site. Disease progression outside of the brain was the usual cause for patient death.
- Subjects
RESEARCH; PATIENT selection; RESEARCH methodology; CANCER of unknown primary origin; EVALUATION research; MEDICAL cooperation; BRAIN tumors; TREATMENT effectiveness; COMPARATIVE studies; SURVIVAL analysis (Biometry); RESEARCH funding; RADIOSURGERY
- Publication
Cancer (0008543X), 2000, Vol 89, Issue 5, p1095
- ISSN
0008-543X
- Publication type
journal article
- DOI
10.1002/1097-0142(20000901)89:5<1095::AID-CNCR19>3.0.CO;2-H