Brain carcinoid metastases: outcomes and prognostic factors

Clinical article

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Object

Carcinoid tumors are rare and have generally been regarded as indolent neoplasms. Systemic disease is often incurable; however, patients may live years with this disease. Furthermore, metastatic brain lesions are extremely uncommon. As such, few series have examined outcomes and prognostic factors in those with brain involvement.

Methods

The authors performed a retrospective review of patients who underwent primary treatment at Mayo Clinic in Rochester, Minnesota, for metastatic carcinoid tumors to the brain between 1986 and 2011. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier statistics. Cox proportional hazards were used to determine predictors of survival.

Results

Fifteen patients underwent primary treatment for metastatic carcinoid tumors to the brain between 1986 and 2011. Their mean age was 58 ± 12 years. Eighty percent (n = 12) of patients underwent surgery, whereas 2 received stereotactic radiosurgery and 1 had whole-brain radiation therapy (WBRT) as the primary treatment. The median follow-up duration was 19 months (maximum 124 months). Systemic disease progression occurred in 73% and was the leading cause of death in known cases, while intracranial disease recurred in 40%. The median PFS and OS were 21 and 19 months, respectively. The use of adjuvant WBRT correlated with improved PFS (HR 0.15, CI 0.0074–0.95, p = 0.044). Those who underwent surgery as primary modalities trended toward longer progression-free intervals (p = 0.095), although this did not reach significance.

Conclusions

Metastatic carcinoid disease to the brain appears to have a worse prognosis than that of other extracranial metastases. Although there was a trend toward a survival advantage in patients who underwent surgery and WBRT, further study is needed to establish definitive treatment recommendations.

Abbreviations used in this paper:GKS = Gamma Knife surgery; KPS = Karnofsky Performance Scale; PFS = progression-free survival; OS = overall survival; WBRT = whole brain radiation therapy.

Article Information

Address correspondence to: Ian F. Parney, M.D., Ph.D., Mayo Clinic Rochester, 201 First Street SW, Rochester, Minnesota 55905. email: parney.ian@mayo.edu.

Please include this information when citing this paper: published online February 8, 2013; DOI: 10.3171/2013.1.JNS121556.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Treatment algorithms in 15 patients with carcinoid brain metastases. Asterisk indicates chemotherapy (chemo) with cisplatin and etoposide. Otherwise chemotherapy consisted of somatostatin analogs. GK = Gamma Knife.

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    Preoperative (A [T1-weighted, Gd-enhanced] and B [T2-weighted]) and postoperative (C [T1-weighted, Gd-enhanced]) MR images in a 73-year-old man with a right-sided insular metastasis presenting with a mild left hemiparesis and homonymous hemianopia. The postoperative image (C) shows gross-total resection.

  • View in gallery

    Graphs showing PFS (upper) and OS (lower) in 15 patients who underwent treatment for intracranial neuroendocrine metastases. Recurrences were noted in 6 patients with a median recurrence time of 21 months (upper), and median overall survival for the cohort was 19 months.

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