Management of Cerebral Metastasis: Review of 106 Patients

FCS Wong, KK Yuen, SH Lo, TY Ng, KC Lee, WK Sze, SK O

Hong Kong J Radiol 2005;8:87-92

Objective: To identify prognostic factors that could predict the outcomes of patients with cerebral metastasis and to study the application of the factors in management decisions.

Patients and Methods: The outcomes of 106 consecutive patients with radiological documentation of newly diagnosed cerebral metastasis in 2003 were reviewed. Seven patients had undergone surgery for solitary brain metastasis. Ninety patients received whole-brain radiotherapy and 100 patients received corticosteroid therapy. Patients who were treated without surgery were further divided into 3 groups depending on whether they were older than 60 years, had a Karnofsky Performance Status of less than 70, and had active extracranial disease. Patients with at most 1, any 2, or all 3 of these factors were classified as group 1, group 2, and group 3, respectively.

Results: The median survival time of the whole group was 62 days. Patients with good performance status (Karnofsky Performance Status ≥70) [p < 0.0001], surgical treatment (p = 0.002), any primary site of malignancy other than the lung (p = 0.036), and female sex (p = 0.047) had significantly increased survival times. In a multivariate analysis, surgical treatment (p = 0.01) and performance status (p < 0.001) remained as independent significant prognostic factors. The median survival times of patients in group 1, group 2, and group 3 were 146 days, 69 days, and 30 days, respectively (p < 0.0001).

Conclusions: The proposed system classifies patients into 3 groups with different prognoses, and may be useful in making management decisions. Further study to reliably identify patients who have a short life expectancy to avoid whole-brain radiotherapy is eagerly awaited.