Long-term survival with metastatic cancer to the brain

Metastatic cancer to the brain has a poor prognosis. The focus of this work was to determine the incidence of long-term ( greater than or equal to 2 y ) survival for patients with brain metastases from different primary cancer s and to identify prognostic variables associated with prolonged survival. A retrospective review of 740 patients with brain metastases treated over a 20 y period identified 51 that survived 2 or more years from the time of d iagnosis of the brain metastasis. Prognostic variables that were examined i ncluded age, sex, histology, tumor number and location, and treatment. In t he 51 patients, 35 (69%) had single lesions and 16 (31%) had multiple tumor s. For all tumor types (740 patients), the actuarial survival rate was 8.1% at 2 y, 4.8% at 3 y, and 2.4% at 5 y. At 2 y, patients with ovarian carcin oma had the highest survival rate (23.9%) and patients with small cell lung cancer (SCLC) had the lowest survival rate(1.7%). At 5 y, survival rates w ere 7.8% for ovarian carcinoma, 2.9% for non-SCLC, 2.3% for melanoma and re nal cell carcinoma, 1.3% for breast carcinoma and there were no survivors w ith SCLC, gastrointestinal, bladder, unknown primary, or prostate cancer. A ge, sex, histology, location for single tumors, systemic chemotherapy, and stereotactic radiosurgery did not significantly influence survival. The pre sence of a single lesion (P = 0.001, chi-square test), surgical resection ( P = 0.001), and WBRT (P = 0.009) were favorable prognostic variables for ex tended survival. Multiple bilateral metastases was a poor prognostic indica tor (P = 0.001). Multivariate analysis showed younger age (P < 0.05), singl e metastasis (P < 0.0001), surgical resection (P < 0.0001), whole brain rad iation therapy (P < 0.0001), and chemotherapy(P = 0.0288) were associated w ith prolonged survival. 29 patients (57%) died of systemic disease progress ion, 9 (18%) died of central nervous system progression, and the cause of d eath was unknown in 3 (6%). Patients with a single non-SCLC, breast, melano ma, renal cell, and ovarian carcinoma brain metastasis have the best chance for long-term survival if treated with surgical resection and WBRT.