Research Progress on Risk Factors of Brain Metastasis in Non-small Cell Lung Cancer / 中国肺癌杂志

Brain metastasis of non-small cell lung cancer (NSCLC) is a common treatment failure mode, and the median survival time of NSCLC patients with brain metastasis is only 1 mon-2 mon. Prophylactic cranial irradiation (PCI) can delay the occurrence of brain metastasis, but the survival benefits of NSCLC patients are still controversial. It is particularly important to identify the patients who are most likely to benefit from PCI. This article reviews the high risk factors of brain metastasis in NSCLC.
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Descripción clínico-radiológica de un angiosarcoma cardiaco con metástasis cerebral que simula un quiste hidatídico / A radiological and clinical description of metastatic angiosarcoma simulating a hydatid cyst

RESUMEN Los angiosarcomas son sarcomas malignos que se originan en las células endoteliales vasculares. Su diagnóstico diferencial es muy amplio debido a su parecido con otras enfermedades, como las parasitarias, y usualmente es un diagnóstico por exclusión. La neurocisticercosis y la hidatidosis cerebral son parasitosis intestinales que pueden comprometer el sistema nervioso central y tienen mayor incidencia en los países suramericanos. El diagnóstico se establece a partir del perfil epidemiológico, el estudio parasitológico, la apariencia radiológica de las lesiones y el estudio de histopatología del espécimen. Se presenta el caso de una adolescente con factores de riesgo para parasitosis y neuroimágenes sugestivas de hidatidosis cerebral, cuyo diagnóstico definitivo fue angiosarcoma cardiaco metastásico.

ABSTRACT Angiosarcoma is the most malignant sarcoma originating in endothelial vascular cells. It has a wide differential diagnosis due to its similarities with other entities, such as parasitic diseases. More often, angiosarcoma is diagnosed by exclusion. Neurocysticercosis and hydatid disease, or echinococcosis, are parasitic infections that may involve the central nervous system and their incidence is higher in South American countries. Diagnosis is established based on the epidemiological profile, the parasitological examination, the radiological appearance of the lesions, and the histopathology analysis of specimens. We present the case of a female adolescent with parasitosis risk factors whose neuroimages suggested cerebral hydatid cysts and who was finally diagnosed with cardiac metastatic angiosarcoma.

Testicular mixed germ cell tumor presenting with seizure as the initial symptom: a case report and literature review

Abstract Most patients with testicular germ cell tumor present with a painless scrotal mass. We report a 19-year-old patient who presented with neurological complains. Rapid clinical progression to coma was noted during the staging work up. A diagnosis of testicular mixed germ cell tumor with multiorgan metastasis (lymph node, lung, liver and brain) was made. Patients with brain metastasis should receive chemotherapy alone or combined with surgery or radiotherapy. Because the clinical symptoms deteriorated quickly, surgery was used upfront followed by chemotherapy and radiotherapy for the brain tumor. After the first stage of treatment, the clinical symptoms, tumor markers and imaging findings were improved. The residual brain tumor was eliminated by chemotherapy, and only sparse degenerated tumor cells were noted in the brain tissue. Longer follow up is required to assess the impact of our treatment strategy.

Brain metastasis in papillary serous adenocarcinoma of the endometrium / Metástase cerebral do adenocarcinoma seroso-papilífero do endométrio

Abstract Background Most endometrial cancers (75%) are diagnosed in early stages (stages I and II), in which abnormal uterine bleeding is the most frequent clinical sign.When the diagnosis is performed in stage IV, the most common sites of metastasis are the lungs, liver and bones. Central nervous system (CNS)metastasis is a rare condition. The aim of this study is to describe a case of uterine papillary serous adenocarcinoma of the endometrium that progressed to brain and bone metastases. Case Report We present the case of a 56-year-old woman with abnormal uterine bleeding and endometrial thickened echo (1.8 cm). A hysteroscopy with biopsy was performed, which identified poor differentiated serous adenocarcinoma of the endometrium. A total abdominal hysterectomy, with pelvic and para-aortic lymphadenectomy, was performed. Analysis of the surgical specimen revealed a grade III uterine papillary serous adenocarcinoma. Adjuvant radio/chemotherapy (carboplatin and paclitaxel-six cycles) was indicated. Sixteen months after the surgery, the patient began to complain of headaches. Brain magnetic resonance imaging demonstrated an expansile mass in the right parietal lobe, suggesting a secondary hematogenous implant subsequently confirmed by biopsy. She underwent surgery for treatment of brain metastasis, followed by radiotherapy. She died 12 months after the brain metastasis diagnosis due to disease progression. Conclusion Uterine papillary serous adenocarcinoma of the endometrium has a low propensity to metastasize to the brain. To the best of our knowledge, this is the fifth documented case of uterine papillary serous adenocarcinoma of the endometrium with metastasis to the CNS.

Resumo Fundamentos A maioria dos cânceres de endométrio (75%) é diagnosticada em estágios iniciais (estágios I e II), nos quais o sangramento uterino anormal é o sinalclínico mais frequente. Quando o diagnóstico é realizado no estágio IV, os locais mais comuns de metástase são os pulmões, o fígado e os ossos. A metástase para o sistema nervoso central (SNC) é uma condição rara. O objetivo deste estudo é descrever um caso de adenocarcinoma seroso-papilífero do endométrio que progrediu para metástases cerebral e óssea. Relato de Caso Apresentamos o caso de uma mulher de 56 anos com sangramento uterino anormal e eco endometrial espessado (1,8 cm). Foi realizada histeroscopia com biópsia que identificou adenocarcinoma seroso-papilífero pouco diferenciado do endométrio. Uma histerectomia abdominal total, com linfadenectomia pélvica e para-aórtica, foi realizada. A análise da peça cirúrgica revelou adenocarcinoma seroso-papilífero do endométrio grau III. Radioterapia adjuvante/quimioterapia (carboplatina e paclitaxel- seis ciclos) foi indicada.Dezesseismeses após a cirurgia, a paciente começou a se queixar de dores de cabeça. A ressonância magnética cerebral demonstrou uma massa expansiva no lobo parietal direito, sugerindo um implante hematogênico secundário posteriormente confirmado por biópsia. A paciente foi submetida a cirurgia para tratamento de metástase cerebral, seguida de radioterapia. A paciente morreu 12 meses após o diagnóstico de metástase cerebral devido à progressão da doença. Conclusão O adenocarcinoma seroso-papilífero do endométrio tem uma baixa propensão a metastizar para o cérebro. Até onde sabemos, este é o quinto caso documentado de adenocacinoma seroso-papilífero do endométrio com metástase para o SNC.

Fulvestrant-induced toxic epidermal necrolysis

Abstract Toxic epidermal necrolysis is a condition with massive keratinocyte apoptosis, and it is associated with high mortality rates. Fulvestrant, an estrogen receptor antagonist, is indicated in the treatment of estrogen receptor-positive metastatic breast cancer in postmenopausal women. To our knowledge, this is the first described case of toxic epidermal necrolysis due to fulvestrant. A 56-year-old woman received 500 mg of intramuscular fulvestrant monthly for metastatic ductal carcinoma of the breast. Five days after the first dose, the patient presented with a maculopapular rash that evolved to blisters, and a detachment of the epidermis in over 30% of the total body surface area. Histological analysis was compatible with toxic epidermal necrolysis. Fulvestrant was discontinued, topical management and supportive care were initiated.

Primary cardiac angiosarcoma with rare presenting feature and successful surgical treatment

Abstract Primary angiosarcoma is a rare clinical entity, it's typically located within the right atrium and known to be rapidly fatal. A 37-year-old female was presented with a history of recurrent facial paralysis and left hemiparesis. A cranial mass was identified at cranial magnetic resonance imaging and she underwent neurosurgery operation. The immunohistochemical examination was determined as metastatic cardiac angiosarcoma. The tumor, as well as part of the right pericardium, were resected. A piece of bovine pericardium was used to reconstruct the right atrial wall. Tricuspid valve was reconstructed with ring annuloplasty. Due to resection of right coronary artery with the tumor, coronary bypass surgery was performed successfully. The patient is currently healthful without any recurrence and complaint 12 months after the diagnosis as followed up.

Analysis of survival in patients with brain metastases treated surgically: Impact of age, gender, oncologic status, chemotherapy, radiotherapy, number and localization of lesions, and primary cancer site

SUMMARY OBJECTIVE To evaluate the survival of patients with brain metastases treated surgically according to the potentially involved factors. METHODS 71 patients treated surgically were analyzed with the diagnosis of brain metastases during the period from January 2011 to November 2014, totaling 47 months of follow-up. The Kaplan-Meier curve method was used for survival analysis. Results We evaluated 71 patients with brain metastases treated surgically, 44 female and 27 male, mean age of 60.1 years. According to the Karnofsky scale, 44 patients were classified with Karnofsky greater than or equal to 70 and 27 patients with Karnofsky inferior to 70. Lung was the primary site most commonly found. Death occurred in twenty patients (28%), and lung tumors were responsible for the most deaths. Twelve patients had supra and infratentorial metastases, fifty-nine only had supratentorial lesions, and lesions were multiple in twenty-eight patients and single in forty-three. Thirty patients were also treated with chemotherapy, eighteen with chemotherapy and radiation therapy, while only three received just radiotherapy. Survival analysis by Kaplan-Meier curve showed no statistical significance regarding age, histological type, location, Karnofsky, chemotherapy, and radiotherapy. There was statistical significance regarding gender. CONCLUSION The factors analyzed did not change survival rates, except for gender. This fact may probably be explained due to the systemic and diffuse behavior of cancer.

RESUMO OBJETIVO Avaliar a sobrevivência de pacientes com metástases cerebrais tratados cirurgicamente de acordo com os fatores potencialmente envolvidos. Métodos 71 pacientes tratados cirurgicamente foram analisados com o diagnóstico de metástases cerebrais durante o período de janeiro de 2011 a novembro de 2014, totalizando 47 meses de seguimento. A curva de Kaplan-Meier foi utilizada para análise de sobrevivência. Resultados Avaliamos 71 pacientes com metástases cerebrais atendidas cirurgicamente, 44 do sexo feminino e 27 do sexo masculino, idade média de 60,1 anos. De acordo com a escala de Karnofsky, 44 pacientes foram classificados com Karnofsky maior ou igual a 70 e 27 pacientes com Karnofsky com menos de 70. O pulmão era o local mais comum. A morte ocorreu em 20 pacientes (28%) e os tumores pulmonares são responsáveis pela maioria das mortes. Doze pacientes apresentavam metástases supra e infratentoriais, 59 apresentavam apenas lesões supratentoriais, e as lesões eram múltiplas em 28 pacientes e isoladas em 43. Trinta pacientes também foram tratados com quimioterapia, 18 foram tratados com quimioterapia e radioterapia, enquanto que apenas três receberam apenas radioterapia. A análise de sobrevivência pela curva de Kaplan-Meier não mostrou significância estatística de acordo com a idade, tipo histológico, localização, Karnofsky, quimioterapia e radioterapia. Houve significância estatística em relação ao gênero. Conclusão Os fatores analisados não alteraram a sobrevivência, exceto o gênero. Este fato provavelmente pode ser explicado devido ao comportamento sistêmico e difuso do câncer.

Prolonged survival after surgical resection of cerebral metastasis from melanoma with multisystemic metastasis already present: a case report and literature review

ABSTRACT CONTEXT: Malignant melanoma is the third most common cause of cerebral metastases after breast and lung cancer. Despite advances in therapeutic options, the prognosis for patients with cerebral metastases from melanoma remains poor, with a median survival time of six months after diagnosis. CASE REPORT: A 65-year-old woman was diagnosed with a malignant melanoma on the third toe of her left foot.The tumorous spot was excised surgically. However, the melanoma reappeared after one year and skin biopsy confirmed recurrence of malignant melanoma. Investigations showed metastasis to the left pelvic region, left lobe of the liver and right lobe of the lung.The patient then received chemotherapy. Subsequently, the patient was brought to the emergency department with an altered level of consciousness (Glasgow coma scale: 9) and hemiplegia on the right side of her body. Computed tomography scans of the brain revealed hemorrhagic lesions in the parieto-occipital lobes of the brain. Urgent surgical evacuation was done to remove the lesion, following which the patient showed improvement in her score on the Glasgow coma scale and a concomitant decrease in weakness. She was discharged from hospital with full consciousness.The patient died of acute renal failure 14 months after the brain surgery and approximately 4 years after the initial presentation of the case. CONCLUSION: This case outcome is rare and shows the effectiveness of surgery to treat cerebral metastasis from malignant melanoma in a situation with multisystem metastasis already present.

Factores pronósticos en pacientes con cáncer de mama y metástasis cerebral como primer sitio de recurrencia / Prognostic factors in patients with breast cáncer and brain metastasis as the first site of recurrence

Resumen: Objetivo: Evaluar los factores pronósticos (características clínico-patológicas y tratamientos) en las pacientes con cáncer de mama y metástasis al sistema nervioso central (SNC) como primer sitio de afección. Material y métodos: Cohorte retrospectiva, formada por 125 pacientes con cáncer de mama atendidas en el Instituto Nacional de Cancerología durante 2007-2015, quienes presentaron afección en el SNC como primer sitio de metástasis. A través del método Kaplan-Meier y tablas de vida se estimó la supervivencia global. El modelo de riesgos proporcionales de Cox fue utilizado para determinar los factores pronósticos. Resultados: La mediana de supervivencia global fue de 14.2 meses (IC95% 11.8-26.9). Pacientes clasificadas por inmunohistoquímica como triple negativo (TN) presentaron tiempos de supervivencia más cortos (p<0.004) y con dos veces más riesgo de fallecer, en comparación con los otros inmunofenotipos (HR= 2.77; IC95% 1.10-6.99); asimismo, se identificó que un grado intermedio en la escala Scarff-Bloom-Richardson incrementa el riesgo de morir en pacientes con metástasis (HR=2.76; IC95% 1.17-6.51). Conclusiones: La metástasis al SNC continúa siendo un factor de mal pronóstico que reduce la supervivencia y afecta la calidad de vida. Se recomienda vigilar puntualmente la presencia de manifestaciones clínicas neurológicas durante el seguimiento, para una rápida intervención. Las pacientes TN tienen peor pronóstico, y las HER2+ (es decir, con resultado positivo para el receptor 2 del factor de crecimiento humano epidérmico), mejor control a mediano plazo.

Abstract: Objective: To evaluate the prognostic factors (clinical-pathological characteristics and treatments) in patients with breast cancer and metastasis to central nervous system (CNS) as the first site of the disease. Materials and methods: Kaplan-Meier method and life tables were used to estimate overall survival time over a retrospective cohort of 125 breast cancer patients treated at the Instituto Nacional de Cancerología (INCan) during 2007-2015, who presented metastasis to the CNS as the first site of extension of the disease. The cox proportional hazards model was used to determine the prognosis factors. Result: The median overall survival time was 14.2 months (IC95%: 11.83-26.93). Patients with triple negative (TN), according to inmunohistochemistry analysis classification, had lower survival times (p=0.0004) and had a risk of dying two times (p=0.037) higher than patients with a different immunophenotype (HR: 2.77. 95%CI: 1.10-6.99). The degree of intermediate SBR increases the risk of dying in patients with metastasis (HR 2.76, 95% CI: 1.17-6.51). Conclusion: CNS metastasis continues to be a poor prognostic factor that reduces survival and affects quality of life. It is recommended to monitor the early presence of clinical neurological manifestations during follow-up for prompt treatment. TN patients have worse prognosis and HER2+ a better control.

Metástasis intraorbitárias de cáncer de mama / Breast cancer orbital metastasis

Objetivo: Describir un caso raro de una paciente previamente diagnosticada con cáncer de mama que evolucionó después de algunos años con metástasis intraorbitaria. Métodos: Relato del caso y revisión de literatura. Resultados: La correlación del diagnóstico previo de neoplasia de mama y la presencia de múltiples lesiones en la órbita y regiones adjacentes ha permitido concluir que la paciente presentaba enfermedad metastásica. Las metástasis se presentan como manifestaciones cada vez más frecuentes en enfermos oncológicos. La órbita y estruturas próximas constituyen topografías poco usuales de diseminaciónde células neoplásicas y manifestaciones iniciales pueden mimetizar otras condiciones, retrasando el diagnóstico. Como se trataban de pequeñas lesiones, se ha optado por radioterapia como tratamiento único. Después del término la paciente evolucionó con regresión de sintomatología. Conclusiones: Aunque infrecuentes, manifestaciones oculares pueden ocurrir en enfermos oncológicos y la investigación de enfermedad metastático de la órbita es esencial para el seguimiento adecuado.

Objective: Description a rare case of a patient with previous diagnosis of breast cancer that evolved years after with orbital metastasis. Method: Case report and literature review. Results: The relation between the previous diagnosis of breast cancer and the presence of multiple orbital and adjacent lesions allowed concluding that the patient presented metastatic disease. Metastasis presented as a common manifestation in oncological patients. Orbit and neighboring structures constitute unusualsite of neoplastic cells dissemination and initial manifestations could mimic other conditions, which can slow diagnosis. As they were small lesions that are close to noble structures, it was opted by performing exclusive radiotherapy. After the end of treatment, the patient referred improvement of her symptoms. Conclusions: Although unusual, ocular manifestations could occur in oncological patients and orbit metastatic disease investigation is essential to the proper follow.

Melanoma as a surprising solution to the puzzle of intestinal obstruction

Abstract We present a case of a 71-year-old man with an advanced melanoma of the right colon. The final diagnosis was determined based on histopathological examination of the material collected during urgent laparotomy performed due to ileus. Although we considered the tumor to be a disseminated primary melanoma of the colon, the possibility of unknown primary origin could not be excluded. Palliative chemotherapy and radiotherapy reduced symptoms associated with the disease and prolonged patient's survival.

Multiple cutaneous melanomas associated with gastric and brain metastases

Abstract The occurrence of multiple primary melanomas in a single individual is rare. Most commonly, malignant melanocytic lesions subsequent to the initial diagnosis of melanoma are secondary cutaneous metastases. We report a patient with gastrointestinal bleeding from gastric metastasis of cutaneous melanoma. During clinical evaluation and staging, we discovered a brain metastasis associated with 3 synchronous primary cutaneous melanomas. We suggest the research on the mutation in the cyclin-dependent kinase inhibitor 2A (CDKN2A) (INK4a) in such cases. We also emphasize the importance of clinical examination and dermoscopy of the entire tegument, even after a malignant melanocytic lesion is identified.

Melanoma patterns of distant relapse: a study of 108 cases from a South Brazilian center

Abstract Background: The incidence of cutaneous melanoma has increased over the last decades. Recurrences occur most frequently within the first 2-3 years after diagnosis but patients carry a lifelong risk of relapse. Nevertheless, there is no consensus in the literature on what screening tests patients should undergo. Objectives: To evaluate the most common melanoma metastasis sites among a South Brazilian population from a city with one of the highest melanoma rates, and establish the best screening method for these patients. Methods: A cross-sectional retrospective study of 108 consecutive melanoma patients followed up at a center from 2009 to 2013. Data were collected on demographic and tumoral characteristics, as well as the site of the first diagnosed metastasis. Results: Patients were divided into 3 groups for analytical purposes: Non-visceral metastases (48% of patients), visceral metastasis (39%) and brain metastasis (13%). We tried to correlate age, gender, mean Breslow thickness, mitosis and death rates with the aforementioned groups but none showed any statistically significant association. Conclusion: Melanoma patients must be monitored to detect early relapse and subsequent effective treatment but the best follow-up strategy remains to be established.

Angiosarcoma of the lung / Angiossarcoma pulmonar

Angiosarcoma is a rare malignant vascular tumor. Pulmonary involvement is usually attributable to metastasis from other primary sites, primary pulmonary angiosarcoma therefore being quite uncommon. We report a case of angiosarcoma with pulmonary involvement, probably primary to the lung, which had gone untreated for more than two years. We describe this rare neoplasm and its growth, as well as the extensive local invasion and hematogenous metastasis at presentation. We also discuss its poor prognosis.

O angiosarcoma é um tumor vascular maligno. O envolvimento pulmonar é geralmente atribuído à metástase de outros sítios primários, sendo o angiossarcoma pulmonar primário extremamente raro. Relatamos um caso de angiossarcoma com envolvimento pulmonar, provavelmente primário no pulmão com mais de dois anos de evolução. Descrevemos seu crescimento e sua extensa invasão local e hematogênica na apresentação. Documentamos ainda seu mau prognóstico.

Advances in diagnosis and treatment of metastatic cervical cancer / 부인종양

Cervical cancer is one of the most common cancers in women worldwide. The outcome of patients with metastatic cervical cancer is poor. We reviewed the relevant literature concerning the treatment and diagnosis of metastatic cervical cancer. There are two types of metastasis related to different treatments and survival rates: hematogenous metastasis and lymphatic metastasis. Patients with hematogenous metastasis have a higher risk of death than those with lymphatic metastasis. In terms of diagnosis, fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) and PET-computed tomography are effective tools for the evaluation of distant metastasis. Concurrent chemoradiotherapy and subsequent chemotherapy are well-tolerated and efficient for lymphatic metastasis. As for lung metastasis, chemotherapy and/or surgery are valuable treatments for resistant, recurrent metastatic cervical cancer and chemoradiotherapy may be the optimal choice for stage IVB cervical cancer. Chemotherapy and bone irradiation are promising for bone metastasis. A better survival is achieved with multimodal therapy. Craniotomy or stereotactic radiosurgery is an optimal choice combined with radiotherapy for solitary brain metastases. Chemotherapy and palliative brain radiation may be considered for multiple brain metastases and other organ metastases.

Advances in diagnosis and treatment of metastatic cervical cancer / 부인종양

Cervical cancer is one of the most common cancers in women worldwide. The outcome of patients with metastatic cervical cancer is poor. We reviewed the relevant literature concerning the treatment and diagnosis of metastatic cervical cancer. There are two types of metastasis related to different treatments and survival rates: hematogenous metastasis and lymphatic metastasis. Patients with hematogenous metastasis have a higher risk of death than those with lymphatic metastasis. In terms of diagnosis, fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) and PET-computed tomography are effective tools for the evaluation of distant metastasis. Concurrent chemoradiotherapy and subsequent chemotherapy are well-tolerated and efficient for lymphatic metastasis. As for lung metastasis, chemotherapy and/or surgery are valuable treatments for resistant, recurrent metastatic cervical cancer and chemoradiotherapy may be the optimal choice for stage IVB cervical cancer. Chemotherapy and bone irradiation are promising for bone metastasis. A better survival is achieved with multimodal therapy. Craniotomy or stereotactic radiosurgery is an optimal choice combined with radiotherapy for solitary brain metastases. Chemotherapy and palliative brain radiation may be considered for multiple brain metastases and other organ metastases.

Tratamiento multimodal e individualizado a pacientes con metástasis encefálica / Multimodal and individualized treatment for patients with brain metastases

Introduction: The treatment of Brain Metastases is palliative and it is ignored the ideal therapeutic combination, constituting this a controversial topic. Objective: To determine the results of the treatment to patient with Brain Metastases according to different modalities. Method: It was carried out a prospective cohort study between april 2010 to april 2013 in the National Institute of Oncology and Radiobiology. It was designated as universe the total of patient with diagnosis of Brain Metastases of primary tumor assisted in consultation of Neurosurgery. The Fischer exact test was used to correlate qualitative variables and the Kaplan Meier curvesto estimate the survival. Results: It was obtained a sample of 42 patients and 84 lesions. The age average was of 53,1 years. The primary lesions prevailed in lung and breast. The used modalities were: Surgery-Whole Brain Radiation Therapy (20 lesions), Whole Brain Radiation Therapy alone (29 lesions), Radiosurgery alone (21 lesions) and Surgery alone (9 lesions). Conclusions: The combinations of Radiosurgery-Whole Brain Radiation Therapy and Surgery-Radiosurgery associated to a better local control. The treatment with Whole Brain Radiation Therapy didn't associate to a better distance control. The overall survival to the 6 months was of 91 percent and to the 12 months of 57 percent. A bigger survival was observed in patient with controlled primary illness and absence of extracraneal metastases. The Surgery presents the biggest number of complications.

Introducción: El tratamiento de la Metástasis Encefálica es paliativo y se desconoce la modalidad o combinación terapéutica óptima, constituyendo éste un tema controvertido. Objetivo: Determinar los resultados del tratamiento a pacientes con Metástasis Encefálica según diferentes modalidades. Método: Se realizó un estudio de cohorte prospectivo durante el período abril de 2010 a abril de 2013 en el Instituto Nacional de Oncología y Radiobiología. Se designó como universo el total de pacientes con diagnóstico de Metástasis Encefálica de neoplasia primaria conocida atendidos en consulta de Neurocirugía. Se utilizó el test exacto de Fischer para correlacionar variables cualitativas y las curvas de Kaplan Meier para estimar la supervivencia. Resultados: Se obtuvo una muestra de 42 pacientes y 84 lesiones. El promedio de edad fue de 53,1 años. Predominaron las lesiones primarias en pulmón y mama. Las modalidades más utilizadas fueron: Cirugía-Radioterapia Holocraneal (20 lesiones), Radioterapia Holocraneal sola (29 lesiones), Radiocirugía sola (21 lesiones) y la Cirugía sola (9 lesiones). Conclusiones: Las combinaciones de Radiocirugía-Radioterapia Holocraneal y Cirugía-Radiocirugía se asociaron a un mejor control local. El tratamiento con Radioterapia Holocraneal no se asoció a un mejor control a distancia. La supervivencia global a los 6 meses fue del 91 por ciento y a los 12 meses del 57 por ciento. Se observó una mayor supervivencia en pacientes con enfermedad primaria controlada y ausencia de metástasis extra craneal. La Cirugía presentó el mayor número de complicaciones.