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Newman J, Leelatian N, Liang J. Characterization of pediatric non-hematopoietic tumor metastases to the central nervous system: A single institution review. J Neuropathol Exp Neurol 2024; 83:268-275. [PMID: 38350468 DOI: 10.1093/jnen/nlae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Central nervous system (CNS) metastases represent a small portion of pediatric CNS neoplasms and data surrounding this condition with high morbidity is scarce. Single institutional archival institutional pathology records between 1999 and 2022 were searched for patients over 21 years old and younger with CNS, dura, cranial nerve, CSF, or leptomeningeal metastases; 41 cases were identified. We documented primary tumor types and locations, metastasis locations, types of invasion (direct extension vs distant metastasis), times from imaging or pathologic diagnosis to CNS involvement, and outcomes. Distant metastasis was the most common mechanism of metastasis (n = 32, 78%). Interval times to CNS metastasis varied by both tumor type and primary tumor location. In this cohort, osteosarcoma portended the shortest survival following CNS metastasis. This study highlights the diverse mechanisms and locations of CNS involvement in pediatric CNS metastases and illuminates a need for varied monitoring strategies when considering primary tumor type and anatomic location.
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Affiliation(s)
- John Newman
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nalin Leelatian
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jiancong Liang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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2
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Doval DC, Chacko M, Sinha R, Choudhury KD, Sharma A, Rao A, Jaggi RS, Mehta A. A rare case of brain metastasis in a patient with osteosarcoma. South Asian J Cancer 2020; 6:36-37. [PMID: 28413797 PMCID: PMC5379894 DOI: 10.4103/2278-330x.202572] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Dinesh Chandra Doval
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.,Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Mithun Chacko
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rupal Sinha
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | | | - Ajay Sharma
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Avinash Rao
- Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - R S Jaggi
- Department of Neurosurgery, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anurag Mehta
- Department of Laboratory Services, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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3
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Hu H, Zhang W, Huang D, Wang Y, Zhang Y, Yi Y, Liu A, Li J. Clinical characteristics, treatment and prognosis of paediatric patients with metastatic neuroblastoma to the brain. Clin Neurol Neurosurg 2019; 184:105372. [PMID: 31155296 DOI: 10.1016/j.clineuro.2019.105372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 05/07/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Neuroblastoma (NB) is the most common extracranial solid malignancy in children. Metastatic involvement of brain is rare in NB. This study was established to evaluate the clinical characteristics, treatment and prognosis of NB patients with brain metastases. PATIENTS AND METHODS From September 2005 to December 2016, the clinical data of 15 cases with brain metastases among 264 NB patients admitted to Beijing Tongren Hospital, Capital Medical University were collected and retrospectively analysed. The clinical features of the 15 patients were summarised, and the patients were grouped according to different treatment methods and followed up for a median time of 41 months. The survival curves were plotted, and the Log-rank test was performed to compare the effect of different treatment methods on the prognosis. RESULTS The proportion of brain metastases in NB patients in our hospital is 5.68% (15/264). For the prognosis of 15 NB cases, the survival time of combined radiotherapy and/or autologous peripheral blood stem cell transplantation group was longer than that of simple operation and chemotherapy group (61.79 ± 9.59 vs. 30.00 ± 5.99 months, P = 0.03). Among the 15 patients, 4 cases underwent intracranial tumor resection, 4 cases received craniospinal irradiation, and the rest received maintenance chemotherapy. The 2-year survival rate was 82.2%, and the 5-year survival rate was 19.9%. The survival time of combined intracranial surgery and/or radiotherapy group was significantly longer than that of the chemotherapy group (46.67 ± 6.69 vs. 16.42 ± 1.42 months, P = 0.003). CONCLUSIONS The incidence of brain metastases NB in children is relatively small, but the prognosis is very poor. Active chemotherapy, radiotherapy and surgery-based comprehensive treatment can prolong the survival time.
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Affiliation(s)
- Huimin Hu
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, West South road 2, Yizhuang Economic and Technological Development Zone, Beijing, 100176, PR China
| | - Weiling Zhang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, West South road 2, Yizhuang Economic and Technological Development Zone, Beijing, 100176, PR China
| | - Dongsheng Huang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, West South road 2, Yizhuang Economic and Technological Development Zone, Beijing, 100176, PR China.
| | - Yizhuo Wang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, West South road 2, Yizhuang Economic and Technological Development Zone, Beijing, 100176, PR China
| | - Yi Zhang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, West South road 2, Yizhuang Economic and Technological Development Zone, Beijing, 100176, PR China
| | - You Yi
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, West South road 2, Yizhuang Economic and Technological Development Zone, Beijing, 100176, PR China
| | - Aiping Liu
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, West South road 2, Yizhuang Economic and Technological Development Zone, Beijing, 100176, PR China
| | - Jing Li
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, West South road 2, Yizhuang Economic and Technological Development Zone, Beijing, 100176, PR China
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Brain Metastases in a 12-Year-Old Girl with Osteosarcoma: A Case Report. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.89629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chaigneau L, Patrikidou A, Ray-Coquard I, Valentin T, Linassier C, Bay JO, Moureau Zabotto L, Bompas E, Piperno-Neumann S, Penel N, Alcindor T, Laigre M, Guillemet C, Salas S, Hugli A, Domont J, Sunyach MP, Lecesne A, Blay JY, Nerich V, Isambert N. Brain Metastases from Adult Sarcoma: Prognostic Factors and Impact of Treatment. A Retrospective Analysis from the French Sarcoma Group (GSF/GETO). Oncologist 2018; 23:948-955. [PMID: 29934413 DOI: 10.1634/theoncologist.2017-0136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/09/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Brain metastases (BM) from adult soft tissue or bone sarcomas are rare, and sparse data exist on their prognostic factors and management. SUBJECTS, MATERIALS AND METHODS A retrospective study was conducted in 15 centers of the French Sarcoma Group, plus one Canadian and one Swiss center, to report on clinical, histological, and treatment characteristics and to identify predictive factors of outcome. RESULTS Between 1992 and 2012, 246 patients with a median age of 50 years (range: 16-86) were managed for BM. BM included 221 cerebral and cerebellar metastases and 40 cases of meningeal sarcomatosis. The most frequent histopathological subtype was leiomyosarcoma (18.7%). Histological grade was high in 118 (48%) cases. Surgery of BM was carried out for 38 (15.5%) patients. Radiotherapy and chemotherapy were administered in 168 (68.3%) and 91 (37.0%) patients, respectively. Irrespective of treatment modality, BM were controlled in 113 patients (45.9%), including 31 partial responses (12.6%) and 18 complete responses (7.3%). The median overall survival from diagnosis of brain metastasis was 2.7 months (range: 0-133). In the multivariate analysis, the following parameters influenced overall survival: chemotherapy (hazard ratio [HR] = 0.38; 95% confidence interval [CI]: 0.26-0.48), surgery (HR = 0.40; 95% CI: 0.22-0.72), stereotactic radiotherapy (HR = 0.41; 95% CI: 0.19-0.90), whole-brain radiotherapy (HR = 0.51; 95% CI: 0.35-0.76), and grade (HR = 0.65; 95% CI: 0.43-0.98). CONCLUSION BM of sarcomas are rare and associated with a dismal outcome. Multidisciplinary management with chemotherapy, radiation therapy, and surgery is associated with a better survival. IMPLICATIONS FOR PRACTICE The incidence of brain and meningeal metastasis in bone and soft tissue sarcomas is estimated between 1% and 8%. Published data are derived from small retrospective case series, often in the pediatric population. A prognostic index is important to guide both clinical decision-making and outcomes research, but one such is lacking for adult sarcoma patients with brain metastases. The current study describes brain metastasis in a large cohort of sarcoma patients. This study, conducted within the French Sarcoma Group, describes the natural history of sarcoma brain metastasis and enables the proposal of strategic recommendations for subsequent clinical trials and for the management of such patients.
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Affiliation(s)
- Loïc Chaigneau
- Department of Medical Oncology, University Hospital Jean Minjoz, Besançon, France
| | - Anna Patrikidou
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | | | | | - Claude Linassier
- Department of Medical Oncology, University Hospital, Tours, France
| | - Jacques Olivier Bay
- Department of Medical Oncology, University Hospital, Clermont-Ferrand, France
| | | | - Emmanuelle Bompas
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | | | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Thierry Alcindor
- Departments of Oncology and Medicine, McGill University, Montreal, Quebec, Canada
| | - Maryline Laigre
- Department of Oncology, Centre Val D'Aurelle II, Montpelier, France
| | - Cecile Guillemet
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Sebastien Salas
- Department of Medical Oncology, CH La Timone, Marseille, France
| | | | - Julien Domont
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | | | - Axel Lecesne
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Jean Yves Blay
- Department of Medical Oncology, Centre Leon Berard, Lyon, France
| | - Virginie Nerich
- Department of Pharmacy, University Hospital Jean Minjoz, Besançon, France
| | - Nicolas Isambert
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
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Suki D, Khoury Abdulla R, Ding M, Khatua S, Sawaya R. Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center. J Neurosurg Pediatr 2014; 14:372-85. [PMID: 25127097 DOI: 10.3171/2014.7.peds13318] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Metastasis to the brain is frequent in adult cancer patients but rare among children. Advances in primary tumor treatment and the associated prolonged survival are said to have increased the frequency of brain metastasis in children. The authors present a series of cases of brain metastases in children diagnosed with a solid primary cancer, evaluate brain metastasis trends, and describe tumor type, patterns of occurrence, and prognosis. METHODS Patients with brain metastases whose primary cancer was diagnosed during childhood were identified in the 1990-2012 Tumor Registry at The University of Texas M.D. Anderson Cancer Center. A review of their hospital records provided demographic data, history, and clinical data, including primary cancer sites, number and location of brain metastases, sites of extracranial metastases, treatments, and outcomes. RESULTS Fifty-four pediatric patients (1.4%) had a brain metastasis from a solid primary tumor. Sarcomas were the most common (54%), followed by melanoma (15%). The patients' median ages at diagnosis of the primary cancer and the brain metastasis were 11.37 years and 15.03 years, respectively. The primary cancer was localized at diagnosis in 48% of patients and disseminated regionally in only 14%. The primary tumor and brain metastasis presented synchronously in 15% of patients, and other extracranial metastases were present when the primary cancer was diagnosed. The remaining patients were diagnosed with brain metastasis after initiation of primary cancer treatment, with a median presentation interval of 17 months after primary cancer diagnosis (range 2-77 months). At the time of diagnosis, the brain metastasis was the first site of systemic metastasis in only 4 (8%) of the 51 patients for whom data were available. Up to 70% of patients had lung metastases when brain metastases were found. Symptoms led to the brain metastasis diagnosis in 65% of cases. Brain metastases were single in 60% of cases and multiple in 35%; 6% had only leptomeningeal disease. The median Kaplan-Meier estimates of survival after diagnoses of primary cancer and brain metastasis were 29 months (95% CI 24-34 months) and 9 months (95% CI 6-11 months), respectively. Untreated patients survived for a median of 0.9 months after brain metastasis diagnosis (95% CI 0.3-1.5 months). Those receiving treatment survived for a median of 8 months after initiation of therapy (95% CI 6-11 months). CONCLUSIONS The results of this study challenge the current notion of an increased incidence of brain metastases among children with a solid primary cancer. The earlier diagnosis of the primary cancer, prior to its dissemination to distant sites (especially the brain), and initiation of presumably more effective treatments may support such an observation. However, although the actual number of cases may not be increasing, the prognosis after the diagnosis of a brain metastasis remains poor regardless of the management strategy.
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Shweikeh F, Bukavina L, Saeed K, Sarkis R, Suneja A, Sweiss F, Drazin D. Brain metastasis in bone and soft tissue cancers: a review of incidence, interventions, and outcomes. Sarcoma 2014; 2014:475175. [PMID: 24757391 PMCID: PMC3976890 DOI: 10.1155/2014/475175] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/19/2014] [Accepted: 01/22/2014] [Indexed: 12/15/2022] Open
Abstract
Bone and soft tissue malignancies account for a small portion of brain metastases. In this review, we characterize their incidence, treatments, and prognosis. Most of the data in the literature is based on case reports and small case series. Less than 5% of brain metastases are from bone and soft tissue sarcomas, occurring most commonly in Ewing's sarcoma, malignant fibrous tumors, and osteosarcoma. Mean interval from initial cancer diagnosis to brain metastasis is in the range of 20-30 months, with most being detected before 24 months (osteosarcoma, Ewing sarcoma, chordoma, angiosarcoma, and rhabdomyosarcoma), some at 24-36 months (malignant fibrous tumors, malignant peripheral nerve sheath tumors, and alveolar soft part sarcoma), and a few after 36 months (chondrosarcoma and liposarcoma). Overall mean survival ranges between 7 and 16 months, with the majority surviving < 12 months (Ewing's sarcoma, liposarcoma, malignant fibrous tumors, malignant peripheral nerve sheath tumors, angiosarcoma and chordomas). Management is heterogeneous involving surgery, radiosurgery, radiotherapy, and chemotherapy. While a survival advantage may exist for those given aggressive treatment involving surgical resection, such patients tended to have a favorable preoperative performance status and minimal systemic disease.
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Affiliation(s)
- Faris Shweikeh
- College of Medicine, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, OH 44272, USA
| | - Laura Bukavina
- Department of Medicine, Summa Health System, Akron, OH 44303, USA
- Johns Hopkins School of Public Health, Baltimore, MD 21205, USA
| | - Kashif Saeed
- Department of Physical Medicine and Rehabilitation, Rush University Medical Center, Chicago, IL 60612, USA
| | - Reem Sarkis
- College of Medicine, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, OH 44272, USA
| | - Aarushi Suneja
- College of Medicine, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, OH 44272, USA
| | - Fadi Sweiss
- Department of Neurosurgery, George Washington University, Washington, DC 20037, USA
| | - Doniel Drazin
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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The role of surgery, radiosurgery and whole brain radiation therapy in the management of patients with metastatic brain tumors. Int J Surg Oncol 2011; 2012:952345. [PMID: 22312545 PMCID: PMC3263703 DOI: 10.1155/2012/952345] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 10/03/2011] [Indexed: 01/30/2023] Open
Abstract
Brain tumors constitute the most common intracranial tumor. Management of brain metastases has become increasingly complex as patients with brain metastases are living longer and more treatment options develop. The goal of this paper is to review the role of stereotactic radiosurgery (SRS), whole brain radiation therapy (WBRT), and surgery, in isolation and in combination, in the contemporary treatment of brain metastases. Surgery and SRS both offer management options that may help to optimize therapy in selected patients. WBRT is another option but can lead to late toxicity and suboptimal local control in longer term survivors. Improved prognostic indices will be critical for selecting the best therapies. Further prospective trials are necessary to continue to elucidate factors that will help triage patients to the proper brain-directed therapy for their cancer.
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Osawa SI, Kumabe T, Saito R, Sonoda Y, Niizuma H, Watanabe M, Tominaga T. Infratentorial brain metastases of pediatric non-epithelial malignant tumors: three case reports. Brain Tumor Pathol 2011; 28:167-74. [DOI: 10.1007/s10014-010-0014-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
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OKURA H, YATOMI K, SAITO Y, KASUGA C, ISHII H, KARAGIOZOV K, MIYAJIMA M, ARAI H. Unexpected Intraparenchymal Hematoma Caused by Brain Metastasis in a Patient With Neuroblastoma -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:784-8. [DOI: 10.2176/nmc.51.784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hidehiro OKURA
- Department of Neurosurgery, Juntendo University School of Medicine
| | - Kenji YATOMI
- Department of Neurosurgery, Juntendo University School of Medicine
| | - Youhei SAITO
- Department of Pediatrics, Juntendo University School of Medicine
| | - Chinatsu KASUGA
- Department of Neurosurgery, Juntendo University School of Medicine
| | - Hisato ISHII
- Department of Neurosurgery, Juntendo University School of Medicine
| | | | | | - Hajime ARAI
- Department of Neurosurgery, Juntendo University School of Medicine
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Goldman S, Echevarría ME, Fangusaro J. Pediatric brain metastasis from extraneural malignancies: a review. Cancer Treat Res 2007; 136:143-168. [PMID: 18078269 DOI: 10.1007/978-0-387-69222-7_8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Stewart Goldman
- Children's Memorial Hospital, Division of Hematology/Oncology and Stem Cell Transplantation, Chicago, IL 60611, USA
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Kebudi R, Ayan I, Görgün O, Ağaoğlu FY, Vural S, Darendeliler E. Brain metastasis in pediatric extracranial solid tumors: survey and literature review. J Neurooncol 2005; 71:43-8. [PMID: 15719274 DOI: 10.1007/s11060-004-4840-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Brain is a rare site of metastasis in most extracranial pediatric solid tumors. The aim of this study is to investigate the incidence, treatment, prognosis of brain metastasis in extracranial pediatric malignant tumors in a single institution and to review the literature. METHODS From September 1989 to December 2002, 1100 children <or=16 years of age with extracranial solid tumors including lymphomas were diagnosed and treated in the Division of Pediatric Oncology, Oncology Institute, Istanbul University. Patients with parenchymal metastases in the brain were assessed. RESULTS Sixteen (10 female, 6 male) of 1100 patients (1.45%) with extracranial solid tumors developed brain metastases. The median age of the patients was 10.5 (1-16) years. The diagnosis was sarcomas in 12 patients: 5 osteosarcomas, 4 Ewing's sarcoma family tumors, 1 rhabdomyosarcoma, 1 clear cell sarcoma of the soft tissue, 1 alveolar soft part sarcoma. Two patients had Wilms' tumor and two had germ cell tumors. Four patients (25%) had brain metastasis at diagnosis. Twelve (75%) developed brain metastasis during therapy or relapse at a median duration of 16 (1-70) months from initial diagnosis. All patients had metastases to various sites, mostly lung, at the time the brain metastases were detected. Treatment included surgery, followed by postoperative radiotherapy (RT) and chemotherapy (CT) in 1, S and RT in 1, S in 1, RT and CT in 6, RT in 1, CT in 1 and no treatment in 5. Only one patient with alveolar soft part sarcoma is alive with disease 20 months from diagnosis of brain metastasis. All other patients died at a median time of 2 months (2 days-6 months) from the time of brain metastasis. CONCLUSIONS Children with metastatic cancer who develop headaches or any other neurologic symptom should be investigated for possible brain metastasis. Although, the outcome for these patients is dismal in this series and in the literature; reports of long term survival in a few cases with Wilms' tumor, osteosarcoma and alveolar soft part sarcoma who had isolated brain metastasis, suggest that a subset of patients may benefit from therapy.
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Affiliation(s)
- Rejin Kebudi
- Division of Pediatric Oncology, Oncology Institute, Istanbul University, Capa, Istanbul, Turkey.
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Paulino AC, Nguyen TX, Barker JL. Brain metastasis in children with sarcoma, neuroblastoma, and Wilms' tumor. Int J Radiat Oncol Biol Phys 2003; 57:177-83. [PMID: 12909231 DOI: 10.1016/s0360-3016(03)00502-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the incidence and prognosis of children who develop brain metastasis. MATERIALS AND METHODS The medical and tumor registry records of 611 children treated at the University of Iowa Hospitals and Clinics between 1965 and 2000 for a sarcoma, neuroblastoma, or Wilms' tumor were reviewed. RESULTS Thirty children (4.9%) were found to have brain metastasis. Brain metastasis occurred in 9 of 113 (8%) neuroblastoma, 7 of 104 (6.7%) rhabdomyosarcoma, 6 of 105 (5.7%) Ewing's sarcoma, 5 of 106 (4.7%) osteosarcoma, 2 of 83 (2.4%) nonrhabdomyosarcoma soft-tissue sarcoma, and 1 of 100 (1%) Wilms' tumor patients. There were 22 male and 8 female patients, with a median age of 14 years at the time of diagnosis of brain metastasis (range 8 months-20 years). Four patients were diagnosed at autopsy, whereas five had brain metastasis at initial diagnosis. For the 25 children who did not have brain metastasis at initial presentation, the median interval from initial diagnosis to development of brain metastasis was 5 months (range 1-43 months). Twenty-nine (97%) had concurrent or prior history of distant metastasis. Eighteen (60%) had solitary brain metastasis. Treatment for the 26 non-autopsy-diagnosed children included surgery (S), followed by postoperative radiotherapy (RT) and chemotherapy (CT) in 2, S and postoperative RT in 1, RT and CT in 16, S alone in 2, CT alone in 2, RT alone in 1, and no treatment in 2. Median survival was 4 months after diagnosis of brain metastasis, with a 1-year survival rate of 11.5%. On multivariate analysis, only the use of RT was found to positively influence freedom from neurologic progression (p = 0.005). CONCLUSION Brain metastasis is uncommon in children with a diagnosis of sarcoma, neuroblastoma, or Wilms' tumor and is often accompanied by concurrent distant disease. Children treated with RT for brain metastasis had a better freedom from neurologic progression rate than those who did not receive radiotherapy.
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Affiliation(s)
- Arnold C Paulino
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA.
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