Carcinoid metastasis to the brain

Authors

  • Roman Hlatky M.D.,

    1. Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Dima Suki Ph.D.,

    1. Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Raymond Sawaya M.D.

    Corresponding author
    1. Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    • Department of Neurosurgery and the Brain Tumor Center, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 442, Houston, TX 77030
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    • Fax: (713) 794-4950


Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

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