Treatment of metastatic brain lesion

Objective. Increasing survival in patients with secondary brain damage, and identifying the factors of favorable and adverse prognosis.

Material and method. In P. A. Hertsen Moscow Oncology Research Institute from 2007 to 2013 there were treated 268 patients with brain metastases. The mean age was 55.8 years (from 24 to 81 years). Metastases of colorectal cancer identified in 7.8%, cases of lung cancer in 34%, melanoma 9.3 %, breast cancer in 26%, kidney cancer in 11%, with non-identified primary tumor in 4.5%, other tumors accounted for 6.7%. Solitary metastasis was diagnosed in 164 (61,19%) patients, oligometastasis (2-3) - 72 (26,87%) patients with polymetastasis (more than 3) – 32 (11,94%) patients. In 106 (39,55%) of patients with brain metastases it was the only manifestation of the generalization process. To control the radical removal of the tumor in 93 (34,7%) patients we used the method of fluorescence navigation (FN) with the drug Alasens. In 66 (24,6%) patients intraoperatively was held a session of photodynamic therapy (PDT). In 212 (79,1%) cases, the removal of metastasis performed totally, 55 (20,9%) patients stated Subtotal removal.

Results. The observation period for the patients ranged from 3 to 79 months. Survival median among the entire group of patients with metastatic brain lesion was 12 months. Overall survival was significantly dependent on RPA class, the volume of postoperative treatment, histological type of primary tumor, number of intracerebral metastases and the timing of the relapse-free period.

Conclusions. Factors that affects the overall survival are the features of the histology of the primary lesion, multiplicity of metastatic lesions, RPA class and the synchronous nature of the metastasis. The median of overall survival of patients who did not receive after surgical treatment of a particular type of therapy was only 4 months. If to use the combined treatment (surgical treatment with the irradiation of the whole brain) median survival was 9-10,5 months (depending on the method of irradiation). When you use drug treatment the median overall survival was 11 months. In the complex treatment survival rates were highest 12 months.

brain metastases, central nervous system metastases, intracranial metastases

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