Brain Metastatic Lesions
Section snippets
EPIDEMIOLOGIC FEATURES
A 1972 Mayo Clinic study demonstrated the annual incidence of brain metastases to be 11.1 per 100,000 population, an approximation of the incidence of primary brain tumors.5 A study published about a decade later found similar results; incidence figures for primary and secondary brain tumors were almost identical.6 In 1978, Posner and Chernik2 published a study of 2,375 patients with cancer who underwent autopsy at Memorial Sloan-Kettering Cancer Center. Of those patients, 15% had brain and
BIOLOGIC PROCESSES
More than 25% of all autopsy-proven brain metastases have a pulmonary source; those from breast cancer are second most common, and those from cutaneous melanoma are third.2 Thus, malignant melanoma, which represents only 1% of all cancers, has the highest propensity of all systemic malignant tumors to metastasize to the brain. In an autopsy study, almost 40% of patients with melanoma harbored brain metastases.8 Furthermore, striking differences in incidence of metastasis also occur among
PATHOLOGIC INVOLVEMENT
Brain metastasis tends to occur at the gray-white matter junction of the brain, characteristic of an embolic event.9 Metastases are multiple in approximately 50% of patients and typically are well demarcated and solid.10 Occasionally, they may be cystic, necrotic, and hemorrhagic. Brain metastases are characterized by severe peritumoral edema, which often contributes to neurologic symptoms.13 The distribution of brain metastases roughly parallels brain weight and cerebral blood flow.14
CLINICAL FINDINGS
Most brain metastases manifest with a combination of focal and generalized symptoms and signs. Since the development of modern neuroimaging with computed tomography (CT) and magnetic resonance imaging (MRI), the initial findings of brain metastases have changed. Cairncross and Posner3 reviewed the initial symptoms and signs in a large group of patients with brain tumors before and after the availability of CT. In the post-CT era, headaches were less frequent and mental change was more common
TREATMENT
Several factors affect the optimal management of a patient with brain metastases, including the patient's neurologic, functional, and overall performance status; the extent of the primary tumor and other sites of systemic disease; the number and site of brain metastases; and the radiosensitivity or chemosensitivity (or both) of the patient's disease.3 Therapeutic options might include (1) no treatment in moribund patients with widespread disease, (2) emergency treatment such as relief of
CONCLUSION
Recent literature has confirmed independent prognostic variables in patients with brain metastases. In a “good-risk” population, surgical intervention followed by radiation therapy is superior to only irradiation for patients with solitary metastases. Stereotactic radiosurgical treatment is feasible in the same select patient population, but questions about the extent of delayed toxicity, tumor response, and effect on quality of life and longevity remain to be answered. For patients with
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What's the clinical significance of adding diffusion and perfusion MRI in the differentiation of glioblastoma multiforme and solitary brain metastasis?
2017, Egyptian Journal of Radiology and Nuclear MedicineCitation Excerpt :Patients with GBM usually do not require systemic work-up, because tumor spread outside of the central nervous system is exceedingly rare. On the other hand, any patient with suspected brain metastasis without a previous history of systemic cancer should undergo comprehensive systemic staging to determine the site of the primary carcinoma and evidence of distant metastasis and the most suitable site of biopsy [1,3]. The ability to differentiate GBM from single brain metastasis on anatomic MR imaging alone remains challenging because of their similar imaging appearance. [4,5].
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