Clinical Analysis of 178 Metastatic Brain Tumors

ABSTRACT

OBJECTIVE: A retrospective clinical analysis for metastatic brain tumors was undertaken to understand demographic feature, to determine the survival rate, prognostic factors and to decide the role of surgery. PATIENTS AND METHODS: From 1987 to 1994, 178 patients with brain metastases were treated at our hospital. Data regarding the primary disease and characteristics of brain metastases were retrospectively collected. We used Kaplan-Meier method to assess survival rate, and log-rank test to compare survival rates between subgroups. RESULTS: The most common age at the time of diagnosis was sixth and seventh decade(62%). The male to female ratio was 9781. The supratentorial lesions were in 128(77%, n=67) and multiple lesions were in 84(55%, n=52). The most common primary cancer was lung cancer(80, 45%), and metastases of unknown origin(28, 16%), breast(27, 15%), head and neck(11, 6%), colorectal cancer(7, 4%), and stomach cancer(6, 3%). The time to metastasis was shortest in lung cancer(15 months), and longest in head and neck cancer(61 months). The overall 1 year survival rate(1YSR) was 25.4% and median survival time(MST) was 5.6 months. There was no statistically significant difference in MST and 1YSR between single and multiple metastases. The 1YSR of metastatic brain tumor from head and neck cancer was 62.5% and that from breast, lung, and GI tract was 37.7%, 25.7%, and 8.3% respectively. The overall 1YSR and MST of resected group in single metastasis(n=0, resection plus whole brain radiation therapy; WBRT) were 33.3% and 6.6 months, and those of non-resected group(n=5, WBRT) were 31.5% and 5.6 months. The 1YSR and MST of resected group in single metastasis from lung cancer(n=) were 37.5% and 8.4 months, and those of non-resected group(n=6) were 25% and 4.8 months. But there were no statistically significant differences. Karnofsky performance scale score was improved in 37% of resected group, compared with 24% of non-resected group. CONCLUSION: Surgical removal of metastatic brain tumor in selected patients results in increased survival time and better quality of life. For the statistical significance, multi-institutional well-designed prospective randomized study is needed.