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Carcinoid metastasis to the brain
Article first published online: 19 OCT 2004
Copyright © 2004 American Cancer Society
Volume 101, Issue 11, pages 2605–2613, 1 December 2004
How to Cite
Hlatky, R., Suki, D. and Sawaya, R. (2004), Carcinoid metastasis to the brain. Cancer, 101: 2605–2613. doi: 10.1002/cncr.20659
- Issue published online: 16 NOV 2004
- Article first published online: 19 OCT 2004
- Manuscript Revised: 11 AUG 2004
- Manuscript Accepted: 11 AUG 2004
- Manuscript Received: 26 MAR 2004
- brain metastasis;
- whole-brain radiotherapy
Carcinoid tumors rarely metastasize to the brain. The objectives of the current study were to assess the frequency of brain metastasis from carcinoid tumors, determine correlates of survival, and describe treatment modalities and their outcomes.
Between January 1977 and December 2003, 1633 patients with a carcinoid tumor were registered at The University of Texas M. D. Anderson Cancer Center. Of those, 24 patients (1.5%) had a diagnosis of brain metastasis. The authors collected demographic and clinical data and performed a statistical analysis.
The median age at the time patients were diagnosed with brain metastasis was 60 years. The metastases were treated with whole-brain radiotherapy (WBRT) alone in 7 patients (29%), and 12 patients (50%) underwent surgical resection, 7 of whom (29%) also received WBRT. The median survival time for the entire cohort after diagnosis of the primary tumor was 2.3 years (95% confidence interval [CI], 0.5–4.1 years), and the median survival time after the diagnosis of brain metastasis was 10.0 months (95% CI, 4.0–16.0 months). The longest median survival observed after the diagnosis of brain metastasis (3.2 years) occurred in patients who underwent resection and received WBRT. In the multivariate analysis, the adjusted rate ratio for comparison of all treatments versus combination of neurosurgical intervention and WBRT was 5.7 (95% CI, 1.3–26.1; P = 0.024). A positive effect of surgery followed by WBRT on the duration of survival was detected in patients with a single metastasis (P = 0.084) as well as in those with multiple metastases (P = 0.018).
Prolonged survival was observed in patients < 65 years old as well as in those who underwent surgery and received WBRT in comparison with other treatments. Whenever feasible, neurosurgical resection followed by WBRT seems to be the indicated treatment in patients with brain metastases from carcinoid tumors. Cancer 2004. © 2004 American Cancer Society.