[Diagnosis and treatment of metastatic brain tumor]

We presented an up-to date flow chart for the diagnosis and treatment of brain metastasis and described the characteristics of brain metastases from various organs in 390 patients with metastatic brain tumors treated at the Osaka Medical Center for Cancer & Cardiovascular Disease from 1977 to 1994. In the treatment of 287 brain metastases from lung cancer, the mean survival time (MST) was significantly longer in the surgical group and the chemotherapy group, compared with that in the non-surgical group and the non-chemotherapy group, while the radiation group did not show longer MST than the non-radiation group. Of 17 patients surviving longer than 2 years after the treatment of brain metastases from lung cancer, 11 patients had undergone brain surgery and chemotherapy, and all 5 patients who survived longer than 5 years had been treated with surgical excision and chemotherapy, mainly with CDDP. Fifty-seven patients with neither primary cancer nor extracranial cancer lesions survived the longest after brain surgery (Mean +/- SEM: 824 +/- 140 days). Data obtained in the analysis of brain metastases from lung cancer were also compared with the 20 reports of stereotactic radiosurgical treatment (SRT). The 1-year survival rate (mean, n: 26.7%, 3 reports) and survival time (mean, n: 7.4 months, 6 reports) in SRT without whole brain irradiation was similar to that in the direct surgical excision group (mean: 26.5%, 9.0 months). From these findings, we reached a consensus that SRT plays a part in direct surgical excision in cases of tumors less than 3.0 cm in diameter, and that brain metastases should be treated basically with SRT or direct surgical resection combined with systemic chemotherapy. If radiation therapy is added, small doses are preferred to prevent brain atrophy.