CEREBRAL METASTASES FROM CARCINOMA OF THE LUNG

Because carcinoma of the lung is common, even its rarer manifestations are of clinical importance. Seven patients with carcinoma of the lung and cerebral metastases were examined in two general medical units over a period of seven months, and clinical details of these patients are reported. In all cases the symptoms of intracranial disease precipitated the patient's admission to hospital and, in four cases, this was also the initial presentation of pulmonary neoplasm. The symptoms of cerebral metastases do not differ from those of primary cerebral tumours but sometimes develop more rapidly than is usual with the latter. Mental changes are common and by mimicking primary psychiatric disorders sometimes tend to delay the diagnosis. X‐ray examination of the chest and cerebral scanning were the most useful investigations in the study of these patients. The more uncomfortable procedures of carotid angiography or air encephalography were required in only three cases. Although diagnosis was rapidly established for ail patients, the results of treatment were uniformly bad. The incidence of cerebral metastases from carcinoma of the lung is reviewed; this complication may be found in as many as one‐third of cases at autopsy. The results of surgical treatment of this condition are poor, partly because operative mortality is high. Radiotherapy offers good palliation to some patients, while systemically administered adrenocortical steroid hormones produce relief in some severely ill patients. Antineoplastic chemotherapy for cerebral metastases is briefly reviewed. While techniques of regional administration are relatively complex and have not yet found general acceptance, some patients with cerebral metastases from lung cancer have responded well to nitrogen mustard or cyclophosphamide systemically administered. Further investigation of this therapeutic approach is warranted.