Single brain metastases from unknown primary malignancies in CT-era

Area of Science:

• Neuro-oncology
• Medical oncology
• Surgical oncology

Background:

• Cerebral metastases constitute a significant proportion of intracranial neoplasms, often presenting as the initial indicator of systemic malignancy.
• Understanding the clinical course and outcomes for patients with solitary brain metastases from unknown primary tumors is crucial for treatment planning.

Purpose of the Study:

• To analyze the treatment experience and survival outcomes of 100 patients with solitary brain metastases originating from an unidentified primary cancer.
• To evaluate the impact of surgical intervention, radiotherapy, and chemotherapy on survival in this patient cohort.

Main Methods:

• Retrospective analysis of 100 patients diagnosed with solitary brain metastasis from unknown primary malignancies between 1976 and 1988.
• All patients underwent surgical treatment; 81 received adjuvant radiotherapy and chemotherapy.
• Data collected included treatment modalities, postoperative mortality, and survival duration.

Main Results:

• Postoperative mortality was 6%.
• Patients whose primary tumor remained unidentified during life had a mean survival of 31.6 months, compared to 15.3 months for those with identified primary tumors.
• The primary cause of death was the progression of systemic cancer.

Conclusions:

• Surgical management of solitary brain metastases from unknown primary tumors is associated with acceptable postoperative mortality.
• Identifying the primary tumor during life may be associated with poorer survival outcomes, highlighting the aggressive nature of these cancers.
• Systemic cancer progression remains the predominant cause of mortality, underscoring the need for effective systemic therapies.