Metastatic brain tumors with dural extension

View More View Less
  • 1 Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and Departments of Biomathematics and Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

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.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

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.
  • 1.

    Arbit E, , Wrónski M, & Burt M, et al: The treatment of patients with recurrent brain metastases. A retrospective analysis of 109 patients with nonsmall cell lung cancer. Cancer 76:765773, 1995 Arbit E, Wrónski M, Burt M, et al: The treatment of patients with recurrent brain metastases. A retrospective analysis of 109 patients with nonsmall cell lung cancer. Cancer 76:765–773, 1995

    • Search Google Scholar
    • Export Citation
  • 2.

    Bindal RK, , Sawaya R, & Leavens ME, et al: Reoperation for recurrent metastatic brain tumors. J Neurosurg 83:600604, 1995 Bindal RK, Sawaya R, Leavens ME, et al: Reoperation for recurrent metastatic brain tumors. J Neurosurg 83:600–604, 1995

    • Search Google Scholar
    • Export Citation
  • 3.

    Bindal RK, , Sawaya R, & Leavens ME, et al: Surgical treatment of multiple brain metastases. J Neurosurg 79:210216, 1993 Bindal RK, Sawaya R, Leavens ME, et al: Surgical treatment of multiple brain metastases. J Neurosurg 79:210–216, 1993

    • Search Google Scholar
    • Export Citation
  • 4.

    Cox DR: Regression models and life tables. J R Stat Soc B 34:187220, 1972 Cox DR: Regression models and life tables. J R Stat Soc B 34:187–220, 1972

    • Search Google Scholar
    • Export Citation
  • 5.

    Fink LH: Metastasis of prostatic adenocarcinoma simulating a falx meningioma. Surg Neurol 12:253258, 1979 Fink LH: Metastasis of prostatic adenocarcinoma simulating a falx meningioma. Surg Neurol 12:253–258, 1979

    • Search Google Scholar
    • Export Citation
  • 6.

    France LH: Contribution to the study of 150 cases of cerebral metastases. II. Neuropathological study. J Neurosurg Sci 19:189210, 1975 France LH: Contribution to the study of 150 cases of cerebral metastases. II. Neuropathological study. J Neurosurg Sci 19:189–210, 1975

    • Search Google Scholar
    • Export Citation
  • 7.

    Gonzalez-Vitale JC, & Garcia-Bunuel R: Meningeal carcinomatosis. Cancer 37:29062911, 1976 Gonzalez-Vitale JC, Garcia-Bunuel R: Meningeal carcinomatosis. Cancer 37:2906–2911, 1976

    • Search Google Scholar
    • Export Citation
  • 8.

    Hojo S, & Hirano A: Pathology of metastases affecting the central nervous system, in Takakura K, , Sano K, & Hojo S, et al (eds): Metastatic Tumors of the Central Nervous System. Tokyo: Igaku-Shoin, 1982, pp 57 Hojo S, Hirano A: Pathology of metastases affecting the central nervous system, in Takakura K, Sano K, Hojo S, et al (eds): Metastatic Tumors of the Central Nervous System. Tokyo: Igaku-Shoin, 1982, pp 5–7

    • Search Google Scholar
    • Export Citation
  • 9.

    Huang PS, & Oz M: Malignant carcinoid tumor metastatic to the dura mater simulating a meningioma. Neurosurgery 29:449452, 1991 Huang PS, Oz M: Malignant carcinoid tumor metastatic to the dura mater simulating a meningioma. Neurosurgery 29:449–452, 1991

    • Search Google Scholar
    • Export Citation
  • 10.

    Irie K, , Austin E, & Morgenstern L: Solitary meningocerebral metastasis from squamous cell carcinoma of the esophagus. A case report. Cancer 42:24612465, 1978 Irie K, Austin E, Morgenstern L: Solitary meningocerebral metastasis from squamous cell carcinoma of the esophagus. A case report. Cancer 42:2461–2465, 1978

    • Search Google Scholar
    • Export Citation
  • 11.

    Kaplan EL, & Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457481, 1958 Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481, 1958

    • Search Google Scholar
    • Export Citation
  • 12.

    Karnofsky DA, & Burchenal JH: The clinical evaluation of chemotherapeutic agents in cancer, in MacLeod CM (ed): Evaluation of Chemotherapeutic Agents. New York: Columbia University Press, 1949, pp 191205 Karnofsky DA, Burchenal JH: The clinical evaluation of chemotherapeutic agents in cancer, in MacLeod CM (ed): Evaluation of Chemotherapeutic Agents. New York: Columbia University Press, 1949, pp 191–205

    • Search Google Scholar
    • Export Citation
  • 13.

    Le Chevalier T, , Smith FP, & Caille P, et al: Sites of primary malignancies in patients presenting with cerebral metastases. A review of 120 cases. Cancer 56:880882, 1985 Le Chevalier T, Smith FP, Caille P, et al: Sites of primary malignancies in patients presenting with cerebral metastases. A review of 120 cases. Cancer 56:880–882, 1985

    • Search Google Scholar
    • Export Citation
  • 14.

    McKenzie CR, , Rengachary SS, & McGregor DH, et al: Subdural hematoma associated with metastatic neoplasms. Neurosurgery 27:619625, 1990 McKenzie CR, Rengachary SS, McGregor DH, et al: Subdural hematoma associated with metastatic neoplasms. Neurosurgery 27:619–625, 1990

    • Search Google Scholar
    • Export Citation
  • 15.

    Muller HG, & Wang JL: Hazard rate estimation under random censoring with varying kernels and bandwidths. Biometrics 50:6176, 1994 Muller HG, Wang JL: Hazard rate estimation under random censoring with varying kernels and bandwidths. Biometrics 50:61–76, 1994

    • Search Google Scholar
    • Export Citation
  • 16.

    Pak MW, , Mak HKF, & Ku PKM, et al: Dural metastasis at medulla oblongata: a rare cause of vocal fold paralysis. J Laryngol Otol 110:884886, 1996 Pak MW, Mak HKF, Ku PKM, et al: Dural metastasis at medulla oblongata: a rare cause of vocal fold paralysis. J Laryngol Otol 110:884–886, 1996

    • Search Google Scholar
    • Export Citation
  • 17.

    Patchell RA, & Posner JB: Neurologic complications of systemic cancer. Neurol Clin 3:729750, 1985 Patchell RA, Posner JB: Neurologic complications of systemic cancer. Neurol Clin 3:729–750, 1985

    • Search Google Scholar
    • Export Citation
  • 18.

    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 322:494500, 1990 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 322:494–500, 1990

    • Search Google Scholar
    • Export Citation
  • 19.

    Perry JR, & Bilbao JM: Metastatic alveolar soft part sarcoma presenting as a dural-based cerebral mass. Neurosurgery 34:168170, 1994 Perry JR, Bilbao JM: Metastatic alveolar soft part sarcoma presenting as a dural-based cerebral mass. Neurosurgery 34:168–170, 1994

    • Search Google Scholar
    • Export Citation
  • 20.

    Posner JB: Diagnosis and treatment of metastases to the brain. Clin Bull 4:4757, 1974 Posner JB: Diagnosis and treatment of metastases to the brain. Clin Bull 4:47–57, 1974

    • Search Google Scholar
    • Export Citation
  • 21.

    Posner JB: Management of central nervous system metastases. Semin Oncol 4:8191, 1977 Posner JB: Management of central nervous system metastases. Semin Oncol 4:81–91, 1977

    • Search Google Scholar
    • Export Citation
  • 22.

    Rouah E, , Goodman JC, & Harper RL: Acute subdural hematoma and metastatic seminoma. Neurology 36:418420, 1986 Rouah E, Goodman JC, Harper RL: Acute subdural hematoma and metastatic seminoma. Neurology 36:418–420, 1986

    • Search Google Scholar
    • Export Citation
  • 23.

    Senegor M: Prominent meningeal “tail sign” in a patient with a metastatic tumor. Neurosurgery 29:294296, 1991 Senegor M: Prominent meningeal “tail sign” in a patient with a metastatic tumor. Neurosurgery 29:294–296, 1991

    • Search Google Scholar
    • Export Citation
  • 24.

    Statistical Sciences: S-PLUS for Windows User's Manual, Version 3.3. Seattle: Statistical Sciences, Inc., 1995 Statistical Sciences: S-PLUS for Windows User's Manual, Version 3.3. Seattle: Statistical Sciences, Inc., 1995

    • Search Google Scholar
    • Export Citation
  • 25.

    Sundaresan N, & Galicich JH: Surgical treatment of brain metastases. Clinical and computerized tomography evaluation of the results of treatment. Cancer 55:13821388, 1985 Sundaresan N, Galicich JH: Surgical treatment of brain metastases. Clinical and computerized tomography evaluation of the results of treatment. Cancer 55:1382–1388, 1985

    • Search Google Scholar
    • Export Citation
  • 26.

    Toye R, & Jeffree MA: Metastatic bronchial adenocarcinoma showing the “meningeal sign”: case note. Neuroradiology 35:272273, 1993 Toye R, Jeffree MA: Metastatic bronchial adenocarcinoma showing the “meningeal sign”: case note. Neuroradiology 35:272–273, 1993

    • Search Google Scholar
    • Export Citation
  • 27.

    Tsukada Y, , Fouad A, & Pickren JW, et al: Central nervous system metastasis from breast carcinoma. Autopsy study. Cancer 52:23492354, 1983 Tsukada Y, Fouad A, Pickren JW, et al: Central nervous system metastasis from breast carcinoma. Autopsy study. Cancer 52:2349–2354, 1983

    • Search Google Scholar
    • Export Citation
  • 28.

    Turner DM, & Graf CJ: Nontraumatic subdural hematoma secondary to dural metastasis: case report and review of the literature. Neurosurgery 11:678680, 1982 Turner DM, Graf CJ: Nontraumatic subdural hematoma secondary to dural metastasis: case report and review of the literature. Neurosurgery 11:678–680, 1982

    • Search Google Scholar
    • Export Citation
  • 29.

    Vecht CJ, , Haaxma-Reiche H, & Noordijk EM, et al: Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33:583590, 1993 Vecht CJ, Haaxma-Reiche H, Noordijk EM, et al: Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33:583–590, 1993

    • Search Google Scholar
    • Export Citation
  • 30.

    Vonofakos D, , Zieger A, & Marcu H: Subdural hematoma associated with dural metastatic tumor. Neuroradiology 20:213218, 1980 Vonofakos D, Zieger A, Marcu H: Subdural hematoma associated with dural metastatic tumor. Neuroradiology 20:213–218, 1980

    • Search Google Scholar
    • Export Citation
  • 31.

    Wasserstrom WR, , Glass JP, & Posner JB: Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients. Cancer 49:759772, 1982 Wasserstrom WR, Glass JP, Posner JB: Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients. Cancer 49:759–772, 1982

    • Search Google Scholar
    • Export Citation
  • 32.

    Wrónski M, , Arbit E, & Burt M, et al: Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991. J Neurosurg 83:605616, 1995 Wrónski M, Arbit E, Burt M, et al: Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991. J Neurosurg 83:605–616, 1995

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 573 169 15
Full Text Views 108 5 0
PDF Downloads 91 1 0
EPUB Downloads 0 0 0