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Epidemiology of Brain Metastases

  • Neuro-oncology (M Gilbert, Section Editor)
  • Published:
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Abstract

Brain metastases are one of the most common neurologic complications of cancer. The incidence is 9%–17% based on various studies, although the exact incidence is thought to be higher. The incidence is increasing with the availability of improved imaging techniques which aid early diagnosis, and effective systemic treatment regimens which prolong life, thus allowing cancer to disseminate to the brain. Lung cancer, breast cancer, and melanoma are the most frequent to develop brain metastases, and account for 67%–80% of all cancers. Most patients with brain metastases have synchronous extracerebral metastases. Some patients present with no known primary cancer diagnosis. In children, brain metastases are rare; germ cell tumors, sarcomas, and neuroblastoma are the common offenders.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. • DeAngelis LM, Posner JB. Intracranial metastases. In: DeAngelis LM, Posner JB, editors. Neurologic complications of cancer. New York: Oxford University Press; 2009. p. 141–193. This book is the most comprehensive review of neurologic complications of cancer, including intracranial metastases.

    Google Scholar 

  2. Johnson JD, Young B. Demographics of brain metastasis. Neurosurg Clin N Am. 1996;7:337–44.

    PubMed  CAS  Google Scholar 

  3. Barker 2nd FG. Craniotomy for the resection of metastatic brain tumors in the U.S., 1988–2000: decreasing mortality and the effect of provider caseload. Cancer. 2004;100:999–1007.

    Article  PubMed  Google Scholar 

  4. Percy AK, Elveback LR, Okazaki H, Kurland LT. Neoplasms of the central nervous system. Epidemiologic considerations. Neurology. 1972;22:40–8.

    PubMed  CAS  Google Scholar 

  5. Walker AE, Robins M, Weinfeld FD. Epidemiology of brain tumors: the national survey of intracranial neoplasms. Neurology. 1985;35:219–26.

    PubMed  CAS  Google Scholar 

  6. Counsell CE, Collie DA, Grant R. Incidence of intracranial tumours in the Lothian region of Scotland, 1989–90. J Neurol Neurosurg Psychiatry. 1996;61:143–50.

    Article  PubMed  CAS  Google Scholar 

  7. Schouten LJ, Rutten J, Huveneers HA, Twijnstra A. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer. 2002;94:2698–705.

    Article  PubMed  Google Scholar 

  8. Barnholtz-Sloan JS, Sloan AE, Davis FG, et al. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol. 2004;22:2865–72.

    Article  PubMed  Google Scholar 

  9. Posner JB, Chernik NL. Intracranial metastases from systemic cancer. Adv Neurol. 1978;19:579–92.

    PubMed  CAS  Google Scholar 

  10. Takakura K, Sano K, Hojo S, Hirano A. Metastatic tumors of the central nervous system. Tokyo: Igaku-Shoin; 1982.

    Google Scholar 

  11. Pickren JW, Lopez G, Tsukada Y, Lane WW. Brain metastases: an autopsy study. Cancer Treat Symp. 1983;2:295–313.

    Google Scholar 

  12. • Fabi A, Felici A, Metro G et al. Brain metastases from solid tumors: disease outcome according to type of treatment and therapeutic resources of the treating center. J Exp Clin Cancer Res. 2011;30:10. This survey provides recent data from four Italian cancer centers on brain metastases from solid tumors.

    Article  PubMed  Google Scholar 

  13. Clayton AJ, Danson S, Jolly S, et al. Incidence of cerebral metastases in patients treated with trastuzumab for metastatic breast cancer. Br J Cancer. 2004;91:639–43.

    PubMed  CAS  Google Scholar 

  14. Bendell JC, Domchek SM, Burstein HJ, et al. Central nervous system metastases in women who receive trastuzumab-based therapy for metastatic breast carcinoma. Cancer. 2003;97:2972–7.

    Article  PubMed  Google Scholar 

  15. Lin NU, Winer EP. Brain metastases: the HER2 paradigm. Clin Cancer Res. 2007;13:1648–55.

    Article  PubMed  CAS  Google Scholar 

  16. Stemmler HJ, Kahlert S, Siekiera W, et al. Characteristics of patients with brain metastases receiving trastuzumab for HER2 overexpressing metastatic breast cancer. Breast. 2006;15:219–25.

    Article  PubMed  CAS  Google Scholar 

  17. Yau T, Swanton C, Chua S, et al. Incidence, pattern and timing of brain metastases among patients with advanced breast cancer treated with trastuzumab. Acta Oncol. 2006;45:196–201.

    Article  PubMed  CAS  Google Scholar 

  18. Stark AM, Stohring C, Hedderich J, et al. Surgical treatment for brain metastases: Prognostic factors and survival in 309 patients with regard to patient age. J Clin Neurosci. 2011;18:34–8.

    Article  PubMed  CAS  Google Scholar 

  19. Nussbaum ES, Djalilian HR, Cho KH, Hall WA. Brain metastases. Histology, multiplicity, surgery, and survival. Cancer. 1996;78:1781–8.

    Article  PubMed  CAS  Google Scholar 

  20. Delattre JY, Krol G, Thaler HT, Posner JB. Distribution of brain metastases. Arch Neurol. 1988;45:741–4.

    Article  PubMed  CAS  Google Scholar 

  21. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322:494–500.

    Article  PubMed  CAS  Google Scholar 

  22. Graf AH, Buchberger W, Langmayr H, Schmid KW. Site preference of metastatic tumours of the brain. Virchows Arch A Pathol Anat Histopathol. 1988;412:493–8.

    Article  PubMed  CAS  Google Scholar 

  23. Lagerwaard FJ, Levendag PC, Nowak PJ, et al. Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys. 1999;43:795–803.

    Article  PubMed  CAS  Google Scholar 

  24. Ruda R, Borgognone M, Benech F, et al. Brain metastases from unknown primary tumour: a prospective study. J Neurol. 2001;248:394–8.

    Article  PubMed  CAS  Google Scholar 

  25. Mavrakis AN, Halpern EF, Barker 2nd FG, et al. Diagnostic evaluation of patients with a brain mass as the presenting manifestation of cancer. Neurology. 2005;65:908–11.

    Article  PubMed  CAS  Google Scholar 

  26. • Vuong DA, Rades D, Vo SQ, Busse R. Extracranial metastatic patterns on occurrence of brain metastases. J Neurooncol. 2011. This study evaluates a large number of patients with brain metastases and provides data on the pattern of metastases outside the brain.

  27. • Hubbs JL, Boyd JA, Hollis D et al. Factors associated with the development of brain metastases: analysis of 975 patients with early stage nonsmall cell lung cancer. Cancer. 2010;116:5038–5046. This is a recent retrospective review evaluating the risk factors in patients with NSCLC in the development of brain metastases.

    Article  PubMed  Google Scholar 

  28. Shi AA, Digumarthy SR, Temel JS, et al. Does initial staging or tumor histology better identify asymptomatic brain metastases in patients with non-small cell lung cancer? J Thorac Oncol. 2006;1:205–10.

    PubMed  Google Scholar 

  29. Chen AM, Jahan TM, Jablons DM, et al. Risk of cerebral metastases and neurological death after pathological complete response to neoadjuvant therapy for locally advanced nonsmall-cell lung cancer: clinical implications for the subsequent management of the brain. Cancer. 2007;109:1668–75.

    Article  PubMed  Google Scholar 

  30. Hung JJ, Jeng WJ, Hsu WH, et al. Prognostic factors of postrecurrence survival in completely resected stage I non-small cell lung cancer with distant metastasis. Thorax. 2010;65:241–5.

    Article  PubMed  Google Scholar 

  31. Tomlinson BE, Perry RH, Stewart-Wynne EG. Influence of site of origin of lung carcinomas on clinical presentation and central nervous system metastases. J Neurol Neurosurg Psychiatry. 1979;42:82–8.

    Article  PubMed  CAS  Google Scholar 

  32. Yawn BP, Wollan PC, Schroeder C, et al. Temporal and gender-related trends in brain metastases from lung and breast cancer. Minn Med. 2003;86:32–7.

    PubMed  Google Scholar 

  33. Heon S, Yeap BY, Britt GJ, et al. Development of central nervous system metastases in patients with advanced non-small cell lung cancer and somatic EGFR mutations treated with gefitinib or erlotinib. Clin Cancer Res. 2010;16:5873–82.

    Article  PubMed  CAS  Google Scholar 

  34. Seute T, Leffers P, Wilmink JT, et al. Response of asymptomatic brain metastases from small-cell lung cancer to systemic first-line chemotherapy. J Clin Oncol. 2006;24:2079–83.

    Article  PubMed  CAS  Google Scholar 

  35. Greenspoon JN, Evans WK, Cai W, Wright JR. Selecting patients with extensive-stage small cell lung cancer for prophylactic cranial irradiation by predicting brain metastases. J Thorac Oncol. 2011;6:808–12.

    Article  PubMed  Google Scholar 

  36. Slotman B, Faivre-Finn C, Kramer G, et al. Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med. 2007;357:664–72.

    Article  PubMed  CAS  Google Scholar 

  37. Stemmler HJ, Heinemann V. Central nervous system metastases in HER-2-overexpressing metastatic breast cancer: a treatment challenge. Oncologist. 2008;13:739–50.

    Article  PubMed  Google Scholar 

  38. Pestalozzi BC, Zahrieh D, Price KN, et al. Identifying breast cancer patients at risk for Central Nervous System (CNS) metastases in trials of the International Breast Cancer Study Group (IBCSG). Ann Oncol. 2006;17:935–44.

    Article  PubMed  CAS  Google Scholar 

  39. Gonzalez-Angulo AM, Cristofanilli M, Strom EA, et al. Central nervous system metastases in patients with high-risk breast carcinoma after multimodality treatment. Cancer. 2004;101:1760–6.

    Article  PubMed  Google Scholar 

  40. Lin NU, Bellon JR, Winer EP. CNS metastases in breast cancer. J Clin Oncol. 2004;22:3608–17.

    Article  PubMed  Google Scholar 

  41. Dawood S, Broglio K, Esteva FJ, et al. Survival among women with triple receptor-negative breast cancer and brain metastases. Ann Oncol. 2009;20:621–7.

    Article  PubMed  CAS  Google Scholar 

  42. Anders CK, Deal AM, Miller CR, et al. The prognostic contribution of clinical breast cancer subtype, age, and race among patients with breast cancer brain metastases. Cancer. 2011;117:1602–11.

    Article  PubMed  Google Scholar 

  43. Albiges L, Andre F, Balleyguier C, et al. Spectrum of breast cancer metastasis in BRCA1 mutation carriers: highly increased incidence of brain metastases. Ann Oncol. 2005;16:1846–7.

    Article  PubMed  CAS  Google Scholar 

  44. Gabos Z, Sinha R, Hanson J, et al. Prognostic significance of human epidermal growth factor receptor positivity for the development of brain metastasis after newly diagnosed breast cancer. J Clin Oncol. 2006;24:5658–63.

    Article  PubMed  CAS  Google Scholar 

  45. • Musolino A, Ciccolallo L, Panebianco M et al. Multifactorial central nervous system recurrence susceptibility in patients with HER2-positive breast cancer: epidemiological and clinical data from a population-based cancer registry study. Cancer. 2011;117:1837–1846. This is the first population-based study evaluating the relationship of HER2-positive patients and use of trastuzumab in the development of brain metastases.

    Article  PubMed  Google Scholar 

  46. Leyland-Jones B. Human epidermal growth factor receptor 2-positive breast cancer and central nervous system metastases. J Clin Oncol. 2009;27:5278–86.

    Article  PubMed  Google Scholar 

  47. Smith I, Procter M, Gelber RD, et al. 2-year follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer: a randomised controlled trial. Lancet. 2007;369:29–36.

    Article  PubMed  CAS  Google Scholar 

  48. Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005;353:1673–84.

    Article  PubMed  CAS  Google Scholar 

  49. • Bria E, Cuppone F, Fornier M et al. Cardiotoxicity and incidence of brain metastases after adjuvant trastuzumab for early breast cancer: the dark side of the moon? A meta-analysis of the randomized trials. Breast Cancer Res Treat. 2008;109:231–239. This provides a review of the three major randomized phase 3 trials using trastuzumab and a meta-analysis of those trials.

    Article  PubMed  CAS  Google Scholar 

  50. Sul J, Posner JB. Brain metastases: epidemiology and pathophysiology. Cancer Treat Res. 2007;136:1–21.

    Article  PubMed  Google Scholar 

  51. Dasgupta T, Brasfield R. Metastatic melanoma. A clinicopathological study. Cancer. 1964;17:1323–39.

    Article  PubMed  CAS  Google Scholar 

  52. Patel JK, Didolkar MS, Pickren JW, Moore RH. Metastatic pattern of malignant melanoma. A study of 216 autopsy cases. Am J Surg. 1978;135:807–10.

    Article  PubMed  CAS  Google Scholar 

  53. de la Monte SM, Moore GW, Hutchins GM. Patterned distribution of metastases from malignant melanoma in humans. Cancer Res. 1983;43:3427–33.

    PubMed  Google Scholar 

  54. Sampson JH, Carter Jr JH, Friedman AH, Seigler HF. Demographics, prognosis, and therapy in 702 patients with brain metastases from malignant melanoma. J Neurosurg. 1998;88:11–20.

    Article  PubMed  CAS  Google Scholar 

  55. Zakrzewski J, Geraghty LN, Rose AE, et al. Clinical variables and primary tumor characteristics predictive of the development of melanoma brain metastases and post-brain metastases survival. Cancer. 2011;117:1711–20.

    Article  PubMed  Google Scholar 

  56. Daryanani D, Plukker JT, de Jong MA, et al. Increased incidence of brain metastases in cutaneous head and neck melanoma. Melanoma Res. 2005;15:119–124.57.

    Article  PubMed  Google Scholar 

  57. Raizer JJ, Hwu WJ, Panageas KS, et al. Brain and leptomeningeal metastases from cutaneous melanoma: survival outcomes based on clinical features. Neuro Oncol. 2008;10:199–207.

    Article  PubMed  Google Scholar 

  58. Wronski M, Arbit E. Surgical treatment of brain metastases from melanoma: a retrospective study of 91 patients. J Neurosurg. 2000;93:9–18.

    Article  PubMed  CAS  Google Scholar 

  59. Liew DN, Kano H, Kondziolka D, et al. Outcome predictors of Gamma Knife surgery for melanoma brain metastases. Clinical article. J Neurosurg. 2011;114:769–79.

    Article  PubMed  Google Scholar 

  60. Miyao N, Naito S, Ozono S, et al. Late recurrence of renal cell carcinoma: retrospective and collaborative study of the Japanese Society of Renal Cancer. Urology. 2011;77:379–84.

    Article  PubMed  Google Scholar 

  61. Wronski M, Arbit E, Russo P, Galicich JH. Surgical resection of brain metastases from renal cell carcinoma in 50 patients. Urology. 1996;47:187–93.

    Article  PubMed  CAS  Google Scholar 

  62. Mongan JP, Fadul CE, Cole BF, et al. Brain metastases from colorectal cancer: risk factors, incidence, and the possible role of chemokines. Clin Colorectal Cancer. 2009;8:100–5.

    Article  CAS  Google Scholar 

  63. Kruser TJ, Chao ST, Elson P, et al. Multidisciplinary management of colorectal brain metastases: a retrospective study. Cancer. 2008;113:158–65.

    Article  PubMed  Google Scholar 

  64. Nieder C, Pawinski A, Balteskard L. Colorectal cancer metastatic to the brain: time trends in presentation and outcome. Oncology. 2009;76:369–74.

    Article  PubMed  Google Scholar 

  65. Giordana MT, Cordera S, Boghi A. Cerebral metastases as first symptom of cancer: a clinico-pathologic study. J Neurooncol. 2000;50:265–73.

    Article  PubMed  CAS  Google Scholar 

  66. Bouffet E, Doumi N, Thiesse P, et al. Brain metastases in children with solid tumors. Cancer. 1997;79:403–10.

    Article  PubMed  CAS  Google Scholar 

  67. Kebudi R, Ayan I, Gorgun O, et al. Brain metastasis in pediatric extracranial solid tumors: survey and literature review. J Neurooncol. 2005;71:43–8.

    Article  PubMed  Google Scholar 

  68. Graus F, Walker RW, Allen JC. Brain metastases in children. J Pediatr. 1983;103:558–61.

    Article  PubMed  CAS  Google Scholar 

  69. Curless RG, Toledano SR, Ragheb J, et al. Hematogenous brain metastasis in children. Pediatr Neurol. 2002;26:219–21.

    Article  PubMed  Google Scholar 

  70. Kramer K, Kushner B, Heller G, Cheung NK. Neuroblastoma metastatic to the central nervous system. The Memorial Sloan-kettering Cancer Center experience and a literature review. Cancer. 2001;91:1510–9.

    Article  PubMed  CAS  Google Scholar 

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Disclosure

L. Nayak: none; E. Q. Lee: board membership for Novartis and Genentech; P. Y. Wen: consultant to Novartis and Genzyme.

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Correspondence to Patrick Y. Wen.

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Nayak, L., Lee, E.Q. & Wen, P.Y. Epidemiology of Brain Metastases. Curr Oncol Rep 14, 48–54 (2012). https://doi.org/10.1007/s11912-011-0203-y

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