Abstract
Between January 1985 and December 2000, 916 patients with brain metastases were treated with whole brain radiation therapy (WBRT) at the Department of Radiotherapy, University Hospital Freiburg. In 47 patients, a primary tumor could not be identified (cancer of unknown primary (CUP)). Sixteen patients had a solitary brain metastasis, 31 patients presented with multiple brain metastases. Surgical resection was performed in 15 patients, biopsy alone in 12 patients. WBRT was applied with daily fractions of 2 or 3Gy to a total dose of 50 or 30Gy, respectively. According to the recursive partitioning analysis (RPA) classes of the Radiation Therapy Oncology Group for patients with brain metastases none of the patients met the criteria for Class I, 23 for Class II, and 24 for Class III.
The median overall survival (OS) for all patients with brain metastases (n = 916) was 3.4 and 4.8 months for patients with CUP (p = 0.45). In patients with CUP (n = 47) the median OS for patients with a single brain metastasis was 7.3 versus 3.9 months for patients with multiple brain metastases (p = 0.05). Median OS for patients with a Karnofsky performance status (KPS) ≥70 was 6.3 months versus 3.2 months for KPS <70 (p = 0.01).
At multivariate analysis performance status and resection status could be identified as independent prognostic factors for the OS.
Similar content being viewed by others
References
Nussbaum E, Djalilian H, Cho K, Hall W: Brain metastases. Histology, multiplicity, surgery, and survival. Cancer 78: 1781–1788, 1996
Nguyen L, Maor M, Oswald M: Brain metastases as the only manifestation of an undetected primary tumor. Cancer 83: 2181–2184, 1998
Eapen L, Vachet M, Catton G, Danjoux C, McDermot R, Nair B, Girard A, Genest P, Stewart D, Gerig L: Brain metastases with an unknown primary: a clinical perspective. J Neuro-Oncol 6: 31–35, 1988
Salvati M, Cervoni L, Raco A: Single brain metastases from unknown primary malignancies in CT-era. J Neuro-Oncol 23: 75–80, 1995
Merchut M: Brain metastases from undiagnosed systemic neoplasms. Arch Intern Med 149: 1076–1080, 1989
Debevec M: Management of patients with brain metastases of unknown origin. Neoplasma 37: 601–606, 1990
Ruda R, Borgognone M, Benech F, Vasario E, Soffietti R: Brain metastases from unknownprimary tumour.Aprospective study. J Neurol 248: 394–398, 2001
Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna W, Byhardt R: Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trails. Int J Radiat Oncol Biol Phys 37: 745–751, 1997
Kaplan E, Meier P: Non-parametric estimation from incomplete observations. J Am Stat Assoc 53: 457–481, 1958
Cox D: Regression models and life tables. J R Statist Soc B 34: 187–220, 1972
Maesawa S, Konziolka D, Thompson T, Flickinger J, Lunsford L: Brain metastases in patients with no known primary tumor. The role of stereotactic radiosurgery. Cancer 89: 1095–1101, 2001
Lagerwaard F, Levendag P, Nowak P, Eijkenboom W, Hanssens P, Schmitz P: Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys 43: 795–803, 1999
Nieder C, Nestle U, Motaref B, Walter K, Niewald M, Schnabel K: Prognostic factors in brain metastases: should patients be selected for aggressive treatment according to recursive partitioning analysis (RPA) classes? Int J Radiat Oncol Biol Phys 46: 297–302, 2000
Mintz A, Kestle J, Rathbone M, Gaspar L, Hugenholtz H, Fisher B, Duncan G, Skingley P, Foster G, Levine M: A randomized trail to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis. Cancer 78: 1470–1476, 1996
Patchell R, Tibbs P, Walsch J, Dempsey R, Maruyama Y, Kryscio R, Markesbery W, MacDonald J, Young B: A randomized trail of surgery in the treatment of single metastases to the brain. NEJM 322: 494–500, 1990
Vecht C, Haaxma-Reiche H, Noordijk E, Padberg G, Voormolen J, Hoekstra F, Tans J, Lambooij N, Metsaars J, Wattendorff A: Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33: 583–590, 1993
Noordijk E, Vecht C, Haaxma R, Padberg G, Voormolen J, Hoekstra F, Tans J, Lambooij N, Metsaars J, Wattendorff A: The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 29: 711–717, 1994
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bartelt, S., Lutterbach, J. Brain Metastases in Patients with Cancer of Unknown Primary. J Neurooncol 64, 249–253 (2003). https://doi.org/10.1023/A:1025621819250
Issue Date:
DOI: https://doi.org/10.1023/A:1025621819250