[Studies on the factors affecting the prognosis of patients with metastatic brain tumors]

The factors affecting the prognosis of 85 patients with brain metastases from August 1973 to August 1992 were analyzed. The following specific factors were reviewed; (1) patient age, (2) primary site, (3) disease free interval, (4) presence or absence of disseminated disease, (5) initial neurological symptoms (focal signs or IICP signs), (6) single or multiple metastases, and (7) treatment (surgery, chemotherapy, radiotherapy, locally injected chemotherapy). Statistical evaluation of the various prognostic factors was performed on the basis of the mean survival time and the survival rate after brain metastasis. The overall mean survival time after brain metastasis was 8.2 months. Regarding the cause of death, only 35% of nonsurvivors died of the brain lesion itself, while 38% died because of systemic cancer. The group with focal signs as the initial neurological symptoms had a mean survival time of 11.9 months versus 5.2 months for the IICP signs group. The focal signs group also had a significantly better survival rate compared to the IICP group (p < 0.01). Evaluation of the prognosis in relation to therapy showed that locally injected chemotherapy and intravenous chemotherapy tended to prolong survival, but did not significantly increase the survival rate. However, surgery and radiotherapy achieved a longer survival time and significantly improved the survival rate (p < 0.05 for surgery and p < 0.01 for radiotherapy). It is concluded that the significantly favorable prognostic variables were focal signs as the initial neurological symptoms, surgical treatment, and radiotherapy.