Pattern of care and epidemiology of brain metastasis over past 10 years: A retrospective study from tertiary cancer center

Abstract

Background: In adults most common intracranial malignant lesion is brain metastasis, far outnumbering primary brain tumor. The most common primary site is lung cancer (18–64%), followed by breast (25–21%), malignant melanoma (4–16%), and colorectal cancer (2–12%). It is hypothesized that the incidence of brain metastasis might be increasing, as a result of increasing survival from recent advance in cancer treatment, more frequent brain screening for specific primary malignancy that known to have a higher prediction for brain metastasis and greater availability and use of magnetic resonance imaging (MRI) of brain. In clinical oncology, understanding brain metastasis is important, because it has profound effect on length of survival, quality of life, and in one-third to one-half of affected patients, they represent the direct cause of death despite current improvement in therapeutic approach. Epidemiological data of brain metastasis are lacking in India. Objectives: Aims of our retrospective analysis are to study epidemiology and pattern of care of brain metastasis over last one decade in Nil Ratan Sircar Medical College and Hospital, Kolkata. Materials and Methods: Between 2006 and December 2017, a total of 710 patients of brain metastasis treated in our department with palliative intent were analyzed retrospectively. New-onset neurological symptoms in a known case of cancer we always presumed that, symptoms were due to brain metastasis until proven otherwise. Hence, all patients presenting with acute neurological signs and symptoms underwent through clinical examination, contrast-enhanced (CE) computed tomography brain, and/or CEMRI of brain. Epidemiology, pattern of care, and outcome in the form of overall survival (OS) and disease-free survival were determined. Results: Fifty-seven percent patients were male. The median age was 62 years at the time of diagnosis. Lung carcinoma was most common primary site seen in 52% patients, followed by carcinoma breast second most common primary site, seen in 32% patients. Headache (73%) and motor weakness were most common presenting symptoms. Supratentorial location most common site, out of which parietal region is most common. The only small number of patients was offered best supportive care alone whereas majority of the patients were considered fit for palliative therapy. Treatment consisted of metastasectomy when possible and palliative whole-brain radiotherapy (WBRT) alone or followed by systemic therapy. Optimal supportive care in addition to chemotherapy or radiotherapy is given to all patients. A total of 254 patients were given blood product, erythropoietin, granulocyte-colony-stimulating factor following chemotherapy. Hospitalization required in 71% patients and tumor-related problem was most common cause (46%). Remaining patients were hospitalized for delivery WBRT or CCT. The median OS is 9 months. Patients with younger age and breast primary associated with better prognosis than lung primary. Conclusions: We can conclude that carcinoma lung in male and carcinoma breast in females was most common cause of brain metastasis. Because advance in palliative therapy, outcome of patients with brain metastasis has improved, and patients with brain metastasis benefit from palliative radiotherapy and chemotherapy and this treatment could be delivered easily on outpatients basis.