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Brain metastases in patients with no known primary tumor
Author(s) -
Maesawa Satoshi,
Kondziolka Douglas,
Thompson Todd P.,
Flickinger John C.,
Lunsford L. Dade
Publication year - 2000
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20000901)89:5<1095::aid-cncr19>3.0.co;2-h
Subject(s) - medicine , radiosurgery , brain metastasis , primary tumor , radiation therapy , metastasis , cancer , lung cancer , tumor progression , radiology , surgery
BACKGROUND 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. METHODS 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 (≤ 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. RESULTS 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. CONCLUSIONS 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. Cancer 2000;89:1095–1101. © 2000 American Cancer Society.