Brain Metastases

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Brain Metastases

BACKGROUND

Brain metastases, unfortunately are very common and grave condition in the natural history of patients with cancer. It is estimated that approximately 250,000 patients with cancer will develop brain metastasis in the United States each years. Autopsy data have shown that up to 50% of patients who die with cancer have evidence of spread to the central nervous system, with approximately 40% of these patients having a solitary or single metastasis . (Solitary means that this metastasis is the only evidence of cancer in the whole body, whereas single means that there are other deposits of cancer outside the brain).

Tumors more prone to brain dissemination are: Lung, breast, melanoma, renal cell carcinoma, colorectal, sarcoma.

The temporal pattern of presentation is of interest:

  1. Precocious (occult primary). Some authors state that up to one-third of patients who present with brain metastasis do not have previous cancer history, and in 16-35% of these patients a systemic cancer is never found
  2. Synchronous
  3. Metachronous (81%) Usually tertiary event: Short intervals (Lung, melanoma, renal CC). Long intervals (Breast, Colon, Sarcomas)