J Korean Neurol Assoc.
1997 Apr;15(2):358-367.
Metastatic brain tumors: clinical aspects and prognosis
- Affiliations
-
- 1Department of Neurology, Yonsei University College of Medicine, Korea.
- 2Department of Oncology, Yonsei University College of Medicine, Korea.
- 3Department of Neurosurgery, Yonsei University College of Medicine, Korea.
Abstract
- Metastatic brain parenchymal tumors are among the most important cause of death in patients with cancer, but many physicians didn't have any efforts to treat of metastatic tumors because of their poor responses of treatment. With the recent development of MR techniques, we could diagnose and treat them earlier. Recently many reports for prognostic factors of metastatic brain parenchymal tumors led to assume a more active attitude toward the diagnosis and treatment. We analysed 250 cases of metastatic brain parenchymal tumors diagnosed with the brain CT scan or MRI scan at Yonsei University, Severance Hospital from January, 1992 to December, 1995 and following results were obtained. 1. Metastatic brain parenchymal tumors are found in 254 cases(38.5%) of all intracranial neoplasms. 2. The most common primary tumor is lung cancer(154 cases, 61.6%) followed by breast cancer (30 cases, 12%), GI cancer (15 cases, 5.6%) in the order and melanoma (11.9%), rectal cancer (11.3%), lung cancer (8.6%) exhibit relatively high rate of intraparenchymal metastasis in the order. 3. The most common presenting symptom and sign is headache(52.8%) followed by motor deficit (32.4%), nausea and vomiting(21.6%). 4. Metastatic brain parenchymal tumors are detected simultaneously (73 cases, 28.8%), precociously (9 cases, 3.6%), after (153 cases, 61.2%) diagnosis of the primary tumor. Interval between the diagnosis of primary tumor and development of intracerebral metastasis is short in lung cancer (15.2 month) and long in breast cancer (43.1 month), nasopharyngeal cancer (51 month). In radiologic findings, the lesions were located in supratentorial areas in 186 cases, and in infratentorial in 36 cases. Ring type(63.6%) in enhancement is more than nodular type (33.2%). 5. Hemorrhages are found in 15 cases (7.6%) and calcifications in 2 cases. Density of lesions are hypodense(72.8%) than hyperdense on CT scan and high signal intensity in T1, or T2 weighted image of MRI are 66.7% and 88.9%. 6. Treatments for metastatic brain parenchymal tumors are conventional adiation therapy(165 cases, 66%), surgery(22 cases, 8.8%), gamma knife surgery (19 cases, 7.6%) in the order and there were 36 cases(14.4%) who didn't have any treatment. There are 132 cases(58.2%) who alive and 118 cases(47.2%) who dead. 7. Good predilicting findings in prognosis of metastatic brain parenchymal tumors are single lesion and supratentorial location. However, there are no significant value between prognosis and interval primary-to-metastasis, age, type of primary cancer, type of presenting symptom, size of edema.
