Metastatic Disease of the Nervous System

David Schiff, M J Van den Bent

• Publisher: Elsevier
• Year: 2018
• Print ISBN: 9780128111611
• eBook ISBN: 9780444638793
• Topic: Medicine
• Subtopic: Neurology

Metastatic Disease of the Nervous System, Volume 149, begins with an overview of the impact and range of direct neoplastic involvement of the central and peripheral nervous system, comprehensively reviewing all aspects of brain metastases, from clinical, radiological and neuropathological manifestations, to the roles of surgery, radiation, systemic and palliative therapy in their management, and the complications of these interventions. The clinical manifestations, diagnosis and treatment of leptomeningeal, dural, spinal epidural and plexus metastases are also covered in detail.- Covers all aspects of brain metastases, from clinical, radiological and neuropathological manifestations, to the roles of surgery, radiation, systemic and palliative therapy- Presents a multidisciplinary review of the evidence regarding accuracy of diagnostic testing and evidence-based reviews of therapies- Addresses metastatic diseases of the nervous system for residents, fellows and clinicians in neurology and oncology

Section II

Brain metastases

Chapter 2

Brain metastases: epidemiology

Quinn T. Ostrom¹; Christina Huang Wright²; Jill S. Barnholtz-Sloan^1,* ¹ Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
² Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, United States
^* Correspondence to: Jill S. Barnholtz-Sloan, Ph.D., Case Comprehensive Cancer Center, CWRU School of Medicine, 11100 Euclid Ave, Wearn 152, Cleveland OH 44106, United States. Tel: + 1-216-368-1506 email address: [email protected]

Abstract

Brain metastases (BM) are the most commonly diagnosed type of central nervous system tumor in the United States. Estimates of the frequency of BM vary significantly, as there is no nationwide reporting system for metastases. BM may be the first sign of a previously undiagnosed cancer, or occur years or decades after the primary cancer was diagnosed. Incidence of BM varies significantly by primary cancer site. Lung, breast, and melanoma continue to be the leading cause of BM. These tumors are increasingly more common as new therapeutics, advanced imaging, and improved screening have led to lengthened survival after primary diagnosis for cancer patients. BM are difficult to treat, and for most individuals the diagnosis of BM generally portends a poor prognosis.

Keywords

brain metastases; incidence; survival; epidemiology

Introduction

Intracranial or brain metastases (BM) are the most commonly diagnosed central nervous system (CNS) tumor in the United States, and cause significant morbidity and mortality (Kaal et al., 2005; Nayak et al., 2012). These tumors are estimated to occur as much as 10 times more frequently than primary malignant brain tumors (Gavrilovic and Posner, 2005; Kaal et al., 2005; Nathoo et al., 2005; Fox et al., 2011; Davis et al., 2012; Nayak et al., 2012; Feng et al., 2015; Villano et al., 2015). Estimates for the frequency of these tumors vary significantly, but previous studies have reported that they occur in 9–10% of all cancer diagnoses (Schouten et al., 2002; Barnholtz-Sloan et al., 2004).

Incidence of brain metastases

Autopsy studies

Early studies that attempted to estimate the frequency of BM were based on autopsy data collected at single centers. These studies estimated the overall frequency of BM in persons who die of cancer to be approximately 25% (Posner and Chernik, 1978; Takakura, 1982). These estimates varied significantly by cancer histology (Table 2.1), with the highest reported frequencies in melanoma and lung cancer. There are many limitations to autopsy studies for estimating frequency of BM. These studies are often conducted at a single institution, and thus largely reflect the experience of a single large tertiary referral center only. Most of these studies are over 20 years old, and since this time period, the proportion of individuals receiving autopsy after death has declined significantly.

Table 2.1

Incidence proportions (IP%) of brain metastases by primary cancer from autopsy studies

Primary site (reference)	Autopsies	IP%
Breast (Takakura, 1982)	526	21%
Breast (Tsukada et al., 1983)	1,044	18%
Lung (Galluzzi and Payne, 1956)	647	26%
Lung (Takakura, 1982)	747	36%
Lung (Cox and Komaki, 1986)	2,380	32%
Lung (Newman and Hansen, 1974)	247	23%
Lung (adenocarcinoma) (Sorensen et al., 1988)	87	44%
Lung (adenocarcinoma) (Cox and Komaki, 1986)	129	13%
Lung (large cell) (Cox and Komaki, 1986)	54	52%
Lung (small cell) (Cox and Komaki, 1986)	82	45%
Lung (squamous) (Cox and Komaki, 1986)	123	13%
Melanoma (Takakura, 1982)	49	49%
Melanoma (Amer et al., 1978)	53	68%
Melanoma (de la Monte et al., 1983)	56	64%
Melanoma (Lee, 1980)	553	46%
Renal (Saitoh et al., 1982)	1828	10%
Renal (Takakura, 1982)	199	17%

Population-based studies

Precise incidence or prevalence of BM is difficult to calculate, as it is not possible to use the same methodologies that are most often used for primary cancers. It is mandatory in the United States for all newly diagnosed primary malignancies to be reported to state central cancer registries (Cancer Registries Amendment Act, 1992), but BM are not included under this reporting mandate. As a result, there are no nationally representative systematically collected data on these tumors from which incidence or prevalence can be accurately estimated. There have been a few attempts to estimate incidence of BM from population-based samples, but incidence estimated by these studies has varied (Table 2.2). A study conducted from 1935 to 1968 in Rochester, MN, estimated the incidence rate of BM to be 11.1 per 100,000 (Percy et al., 1972), while investigators from the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) estimated that 17,380 cases occur annually in the United States (incidence rate of 8.3 per 100,000) (Walker et al., 1985). A regional study in Scotland estimated annual crude incidence as 14.3 per 100,000 (Counsell et al., 1996). Other studies have attempted to estimate the total percentage of primary cancer diagnoses that eventually metastasize to the brain. One study in the Netherlands estimated that this amount is 8.5% (Schouten et al., 2002), while a study of the Detroit Surveillance, Epidemiology and End Results registry estimated this to be 9.6% (Barnholtz-Sloan et al., 2004). Davis and colleagues (2012) estimated the overall incidence of BM to be 5.6% and the total number of BM occurring in 1 year to be 69,325 based on incidence proportions reported by prior studies and national primary incidence data (Fig. 2.1).

Fig. 2.1 Average annual age-adjusted incidence and expected total brain metastases occurring from 1 year of diagnosis (based on estimates from Davis et al. (2012)) by primary cancer. (Incidence data from Centers for Disease Control and Prevention National Center for Health Statistics (2016), 2009–2013.)

Table 2.2

...

Incidence, incidence proportions, and prevalence of brain metastases by primary cancer (based on recent studies, 1985 and forward)

Primary site (reference)	Data type	Years	IP%	Incidence		Prevalence
				Cases	Rate per 100,000 (95% CI)	Cases	Rate per 100,000 (95% CI)
All (Walker et al., 1985)	National survey (US)	1973–1974	–	17,380	8.3	–	–
All (Counsell et al., 1996)	Hospital records (Scotland)	1989–1990	–	214	14.3 (12.4–16.3)	–	–
Breast (Pelletier et al., 2008)	Insurance claims database (US)	2002–2004	–	779	9.15 (8.53–9.78)	995	11.68 (11.0–12.36)
Breast (male and female) (Barnholtz-Sloan et al., 2004)	Cancer registry (US)	1973–2001	5.1%	–	–	–	–
Colorectal (Mongan et al., 2009)	Case series (US)	1984–2006	2.3%	–	–	–	–
Endometrium (Uccella et al., 2016)	Case series (US)	1984–2001	0.86%	–	–	–	–
Esophageal (Weinberg et al., 2003)	Case series (US)	1993–2001	1.7%	–	–	–	–
Esophageal (Gabrielsen et al., 1995)	Case series (US)	1984–1993	3.6%	–	–	–	–
Liver (HCC) (Choi et al., 2009)	Case series (Korea)	1995–2006	0.9%	–	–	–	–
Lung (all types) (Barnholtz-Sloan et al., 2004)	Cancer registry (US)	1973–2001	19.9%	–	–	–	–
Lung (NSCLC) (Goncalves et al., 2016)	Cancer registry (US)	1973–2011	9.0%	–	–	–	–
Lung (SCLC) (Goncalves et al., 2016)	Cancer registry (US)	1973–2011	18.0%	–	–	–	–
Melanoma (Barnholtz-Sloan et al., 2004)	Cancer registry (US)	1973–2001	6.9%	–	–	–	–
Melanoma (Ernst et al., 2016)	Cancer registry (Canada)	2011–2013	10.4%	–	–	–	–
Non-Hodgkin lymphoma (Hollender et al., 2002)	Case series (Norway)	1980–1996	4.2%	–	–	–	–
Renal (Gore et al., 2011)	Clinical trial (global)	2005–2007	7.0%	–	–	–	–
Stomach (York et al., 1999)	Case series (US)	1957–1997	0.7%	–	–

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Handbook of Clinical Neurology 3rd Series
• Foreword
• Preface
• Contributors
• Section I: Overview
• Section II: Brain metastases
• Section III: Other nervous system metastases
• Index