BRAIN METASTASES IN CHILDREN WITH SOLID TUMORS

BACKGROUND. Brain metastases are uncommon among children with solid tu mors. However, improvements in survival have increased the period of t ime during which children are at risk for developing these metastases. The authors reviewed brain metastases in children with solid tumors t reated at the Centre Leon Berard during the 9 years between 1987 and 1 995. METHODS. Among 486 patients with solid tumors, 162 eventually dev eloped distant metastases in their disease process, including 12 brain metastases detected by imaging. The tumor type, clinical setting, ima ging characteristics, treatment modalities, and outcome were assessed for each patient. RESULTS. The most common tumors causing brain metast ases were Ewing's sarcoma (in three patients), neuroblastoma (in three patients), and osteogenic sarcoma (in three patients). At the time of initial diagnosis, 9 of the 12 patients had metastatic disease. All b ut one patient initially received intensive multiagent chemotherapy, i ncluding high dose chemotherapy with bone marrow rescue in six patient s. The median time from initial diagnosis to the detection of brain me tastases was 15 months. These metastases were clinically detectable in 10 patients and subclinical in 2 patients. Brain metastases were pres ent at the time of first relapse in five patients. In two patients, th e brain was the only site of relapse. Ail other patients had extensive systemic disease. Seven patients had multiple brain metastases. Two c hildren underwent surgical resection of solitary metastases, and eight were irradiated. One child achieved complete remission following chem otherapy and irradiation. Ail other children died, mostly of their sys temic disease, within a median period of 3 months. CONCLUSIONS. The in troduction of effective systemic chemotherapy has changed the patterns of brain metastases in children. The increasing incidence of these me tastases in patients with sarcoma and neuroblastoma suggests that the brain is a pharmacologically protected site in patients initially diag nosed with metastatic disease. (C) 1997 American Cancer Society.