Metastatic brain tumors with dural extension

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Object. Twenty-two patients who had solitary metastatic brain tumors with dural extension were treated surgically over a 3-year period. Their cases were reviewed to characterize these lesions and to compare the patients with a similar cohort in which there was no dural involvement.

Methods. The median age of the patients was 58 years (range 11–68 years) and the male/female ratio was 12:10. The median preoperative Karnofsky Performance Scale (KPS) score in the group was 90 (range 70–100). The most common histological diagnoses seen in these patients included breast cancer, adenocarcinoma and squamous cell carcinoma of the lung, and renal cell carcinoma. All patients underwent gross-total resection of the tumor and 86% received radiation therapy. The median patient survival time was 11 months, with a median time to recurrent intracranial disease of 19 months. Survival was related to the histological diagnosis. Recurrent disease occurred in 41% of cases. Leptomeningeal disease occurred in three patients (14%). The frequency and time course of development of recurrent disease was not affected by dural resection nor was survival.

These results for patients having metastatic brain tumors with dural extension were compared with those for a cohort of 26 patients in which there were similar histological diagnosis, age, gender, and preoperative KPS score were distributed similarly but in which each patient had a single subcortical metastatic lesion. Those patients had a median survival of 10 months and the median time to recurrence was not reached. Leptomeningeal disease occurred in one patient (4%).

Conclusions. To the authors' knowledge, this is the first reported series of patients with metastatic brain tumors with dural extension. Patients with this disease may be more likely to develop recurrences along the dura and leptomeningeal disease, but the overall survival time in these patients is not different from those patients with intraparenchymal lesions.

Article Information

Address reprint requests to: Raymond Sawaya, M.D., Department of Neurosurgery—64, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Representative gadolinium-enhanced T1-weighted magnetic resonance (MR) imaging performed in a patient with a metastatic brain tumor showing dural extension to the falx. Left: Preoperative coronal image showing tumor attached to the falx. Right: Coronal MR image obtained after tumor resection. The falx was not resected.

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    Kaplan—Meier survival curves for patients with dural-based or subcortical metastatic tumors. Survival probability (y axis) is plotted against follow-up time (x axis). Differences between the curves are not significant (p = 0.64).

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    Kaplan—Meier survival curves for patients with MTDE comparing patients who underwent resection of involved dura with patients in whom tumor cells were removed without dural resection. Axes are defined as in Fig. 2. Differences between the two curves are not significant (p = 0.68).

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    Graph depicting the freedom from recurrent disease in patients with metastatic dural-based or subcortical tumors. Probability of freedom from tumor recurrence (y axis) is plotted against follow-up time (x axis). Differences between the curves are not significant (p = 0.48).

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    Graph depicting the freedom from recurrent disease in patients with MTDE comparing patients who underwent a resection of involved dura with those who had macroscopic tumor removed without a dural resection. Axes are defined as in Fig. 4. Differences between the curves are not significant (p = 0.96).

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    Graph depicting the pattern of recurrent disease, showing the hazard rate of total, distant, local, and dural recurrences in relation to the time following surgery. The hazard rate (y axis), the instantaneous recurrence rate among patients remaining free from recurrence at a given time, is plotted against follow-up time (x axis).

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