Primary unknown solitary brain metastasis: Brain recurrence alone

Year 2007, Volume: 22 Issue: 2, 82 - 87, 01.03.2007

Gülden Bayır Angın Mert Saynak Zafer Koçak Alaattin Özen Ruşen Coşar Alas Vuslat Yürüt Çaloğlu Füsun Tokatlı Murat Çaloğlu Cem Uzal

Abstract

A 53-year-old male patient presented with complaints of headache and paresis in left arm. Cranial computerized tomography and magnetic resonance imaging (MRI) demonstrated a mass in the right parietal region. The solitary tumor was removed by craniotomy. Histological examination showed that it was a squamous cell carcinoma metastasis. The patient subsequently underwent whole brain radiotherapy for a total dose of 30 Gy in 10 fractions and conventional external-beam boost irradiation of 10 Gy in 5 fractions to the tumor margins. He remained disease free until 23 months later. He returned to our clinic with left arm paresis after 24 months. In the left parietal lobe a new lesion was determined on his MRI scan. Partial brain reirradiation at a dose of 25 Gy in 10 fractions was performed. There was a partial regression of symptoms after radiotherapy. In the light of this patient, we reviewed the literature and discussed the treatment strategies of patients with solitary brainmetastasis.

Keywords

Middle Aged, Male, Magnetic Resonance Imaging, Neoplasm Metastasis, Brain Neoplasms, Tomography, Carcinoma, Squamous Cell

Primeri bilinmeyen tek beyin metastazı: Yalnız beyin nüksü

Abstract

Elli üç yaşında erkek olgu baş ağrısı, sol kolda güçsüzlük yakınmalarıyla başvurdu. Kranyal tomografi ve manyetik rezonans (MR) incelemede sağ parietal bölgede lezyon belirlendi ve eksize edildi. Histopatolojik inceleme sonucu lezyonun skuamöz hücreli karsinom metastazı olduğu belirlendi. Olguya 30 Gy / 10 fr tüm beyin ışınlaması yapıldı ve ardından lezyon bölgesine 10 Gy / 5 fr ek doz uygulandı. Sol kolda güçsüzlük şikayeti ile 24 ay sonra tekrar servisimize başvuran olgunun MR tetkikinde sol parietal lob yerleşimli yeni lezyon belirlendi. İkinci seri 25 Gy / 10 fr parsiyel beyin radyoterapisi uygulanan olgunun nörolojik şikayetlerinde kısmi palyasyon sağlandı. Bu olgu ışığında tek beyin metastazlı hastalardaki tedavi seçenekleri tartışıldı ve literatür özetlendi.

Keywords

Soliter beyin metastazı, cerrahi, radyocerrahi, primeri bilinmeyen tümör, tüm beyin ışınlaması

References

• 1. Ewend MG, Carey LA, Morris DE, Harvey RD, Hensing TA. Brain metastases. Curr Treat Options Oncol 2001;2(6):537-47.
• 2. Nussbaum ES, Djalilian HR, Cho KH, Hall WA. Brain metastases. Histology, multiplicity, surgery, and survival. Cancer 1996;78(8):1781-8.
• 3. Cascino TL. Neurologic complications of systemic cancer. Med Clin North Am 1993;77(1):265-78.
• 4. Özkök S. ‹leri evre akci¤er kanserlerinde palyatif tedavi yaklafl›mlar›; palyatif radyoterapi. Solunum Dergisi 2001;3(2):190-3.
• 5. Coia LR. The role of radiation therapy in the treatment of brain metastases. Int J Radiat Oncol Biol Phys 1992;23(1):229-38.
• 6. Sundstrom JT, Minn H, Lertola KK, Nordman E. Prognosis of patients treated for intracranial metastases with whole-brain irradiation. Ann Med 1998;30(3):296-9.
• 7. Posner JB. Management of brain metastases. Rev Neurol (Paris) 1992;148(6-7):477-87.
• 8. Borgelt B, Gelber R, Kramer S, Brady LW, Chang CH, Davis LW, et al. The palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 1980;6(1):1-9.
• 9. Cairncross JG, Kim JH, Posner JB. Radiation therapy for brain metastases. Ann Neurol 1980;7(6):529-41.
• 10. Delattre JY, Krol G, Thaler HT, Posner JB. Distribution of brain metastases. Arch Neurol 1988;45(7):741-4.
• 11. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, et al. Recursive partitioning analysis ( R PA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 1997;37(4):745- 51.
• 12. Tsao MN, Lloyd NS, Wong RK, Rakovitch E, Chow E, Laperriere N; Supportive Care Guidelines Group of Cancer Care Ontario's Program in Evidence-based Care. Radiotherapeutic management of brain metastases: a systematic review and meta-analysis. Cancer Treat Rev 2005;31(4):256-73.
• 13. Noordijk EM, Vecht CJ, Haaxma-Reiche H, Padberg GW, Voormolen JH, Hoekstra FH, et al. The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 1994;29(4):711-7.
• 14. Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990;322(8):494-500.
• 15. Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, et al. Whole brain radiation therapy with or without stereotactic radiosurg e r y boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 2004;363(9422):1665-72.
• 16.Roos DE, Wirth A, Burmeister BH, Spry NA, Drummond KJ, Beresford JA, et al. Whole brain irradiation following surgery or radiosurgery for solitary brain metastases: mature results of a prematurely closed randomized Trans-Tasman Radiation Oncology Group trial (TROG 98.05). Radiother Oncol 2006;80(3):318-22.
• 17. Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 2006;295(21):2483- 91.
• 18. Polyzoidis KS, Miliaras G, Pavlidis N. Brain metastasis of unknown primary: a diagnostic and therapeutic dilemma. Cancer Treat Rev 2005;31(4):247-55.
• 19.Rades D, Raabe A, Bajrovic A, Alberti W. Treatment of solitary brain metastasis. Resection followed by whole brain radiation therapy (WBRT) and a radiation boost to the metastatic site. Strahlenther Onkol 2004;180(3):144-7.
• 20. Schueller P, Schroeder J, Micke O, Moustakis C, Willich N. 9 years tumor free survival after resection, intraoperative radiotherapy (IORT) and whole brain radiotherapy of a solitary brain metastasis of nonsmall cell lung cancer. Acta Oncol 2006;45(2):224-5.
• 21. Sawada M, Inagaki M, Ozaki M, Yamasaki M, Nakagawa H, Inoue T, et al. Long-term survival after brain metastasis from endometrial cancer. Jpn J Clin Oncol 1990;20(3):312-5.
• 22.Rodrigus P, de Brouwer P, Raaymakers E. Brain metastases and non-small cell lung cancer. Prognostic factors and correlation with survival after irradiation. Lung Cancer 2001;32(2):129-36.
• 23. Gutzeit A, Antoch G, Kuhl H, Egelhof T, Fischer M, Hauth E, et al. Unknown primary tumors: detection with dual-modality PET/CT--initial experience. Radiology 2005;234(1):227-34.
• 24. Salvati M, Cervoni L, Raco A. Single brain metastases from unknown primary malignancies in CT-era. J Neurooncol 1995;23(1):75-80.
• 25. Merchut MP. Brain metastases from undiagnosed systemic neoplasms. Arch Intern Med 1989;149(5):1076- 80.
• 26. Le Cesne A, Le Chevalier T, Caille P, Cvitkovic E, Contesso G, Spielmann M, et al. Metastases from cancers of unknown primary site. Data from 302 autopsies. [Article in French] Presse Med 1991;20(29):1369-73. [Abstract]
• 27.Cooper JS, Steinfeld AD, Lerch IA. Cerebral metastases: value of reirradiation in selected patients. Radiology 1990;174(3 Pt 1):883-5.
• 28. Wong WW, Schild SE, Sawyer TE, Shaw EG. Analysis of outcome in patients reirradiated for brain metastases. Int J Radiat Oncol Biol Phys 1996;34(3):585-90.