METASTASES TO THE NERVOUS-SYSTEM

  • 1 January 1985
    • journal article
    • research article
    • Vol. 56  (8) , 410-416
Abstract
Over a period of 13 years, 353 cases of metastases in the brain, spinal canal or peripheral nerves were treated in 14,350 inpatients. In 79.6% of the cases, the metastases were localized intracranially, in 14.7% spinally, in 2.6% peripherally and in 3.1% in several of these sites. Solitary tumors predominated (65.7%). Of 420 intracranial metastases, 336 were located supratentorially (80%) with a slight preponderance on the left side (54.5%), 15% cerebellar, and 5% in the brainstem. Of the spinal metastases, 80% were located in the thoracic spinal cord. Almost 60% of the cases also displayed metastases outside the nervous system, mainly in the skeletal system and the lungs. The most frequent primary tumor was bronchial carcinoma (26.6%) followed by breast cancer (19.5%) and unknown primary tumor (17.6%), which was also not found on autopsy in 0.8%. Rare primary tumors were parotid and pancreatic carcinomas, testicular and bladder tumors. There are correlations between the primary tumor and the location of the metastases in the nervous system in general and in the brain in particular. The latency between diagnosis of the primary tumor and that of the metastasis was 1-3 years. In one out of three cases, the metastasis in the nervous system was the first sign of the tumor condition. In six cases, the metastasis was removed before the primary tumor and two possible kinds of primary tumors were found in seven cases. Compared to intracranial hypertension focal deficit manifestations including focal convulsions occured twice as frequently in cerebral metastases. Spinal metastases led to CSF blockade in 20%. It was possible to demonstrate the tumor on the basis of the CSF cytology in 15%, and the CSF was normal in 25%. Spinal metastases derived mainly from prostate carcinoma and intracranial metastases from melanoblastoma. Intracranial metastases (2.9 months) had the shortest survival times, followed by spinal metastases (3,3 months) and peripheral metastases (5.5 months). Therapy resulted in a prolongation of the survival time by 2.5 months. The cases with intracranial and spinal metastases profited from therapy to a greater extent than cases with peripheral metastases.

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