Thursday, September 22, 2005
J of Clinical Oncology recently published a review of the management of brain metastases. It covers whole brain radiation, surgery, stereotactic radiosurgery, radiosensitizers, and future directions. As a non-oncologist I found it nicely informative & it would make good teaching material.
I found the following two sections particularly interesting:
The prognosis for patients with brain metastases is poor. Overall, median survival of brain metastases patients is about 4 months after whole-brain radiation therapy (WBRT), but it varies based on several prognostic variables. For example, in a study of 740 brain metastases patients, the actuarial 2-year survival rate was 8.1%, but it ranged from 1.7% for brain metastases patients with small-cell lung cancer to 23.9% for those with ovarian cancer. Factors that predict for better survival include good performance status, age younger than 65 years, successful control of the primary tumor, absence of extracranial metastases, favorable tumor histology, and presence of a solitary brain metastasis.
Patients with brain metastases exhibit significant neurologic and neurocognitive deficits. In a recent study of 401 brain metastases patients by Meyers et al that included careful neurocognitive testing of memory, verbal fluency, executive function, and fine motor control, 90.5% of patients were impaired in at least one neurocognitive domain at the time of diagnosis. In particular, memory, executive function, and fine motor control were affected. The degree of impairment correlated with tumor volume but not with the number of lesions, and it was an independent predictor of survival. [Here is the reference for the Meyers article: Meyers CA, Smith JA, Bezjak A, et al: Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: Results of a randomized phase III trial. J Clin Oncol 22:157-165, 2004 [Abstract/Free Full Text]