Brain metastases in XXXX : prognostic factors and management.

@entity1 @entity0 @entity3
BACKGROUND: The purpose of this retrospective study was to analyze the overall survival of @entity1 with brain metastases due to @entity0 and to identify prognostic factors that affect clinical outcome. METHODS: Of the 7,872 @entity0 @entity1 histologically diagnosed with @entity0 between January 1990 and July 2006 at the Asan Medical Center, 198 @entity1 with solitary or multiple brain metastases were included in this retrospective study. Central nervous system (CNS) lesions were diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI). @entity1 with leptomeningeal or dural metastases without co-existent parenchymal metastatic lesions were excluded in this study. We reviewed the medical records and pathologic data of these 198 @entity1 to characterize the clinical features and outcomes. RESULTS: The median age of the @entity1 at the diagnosis of brain metastases was 45 years (range 26-78 years). Fifty-five @entity1 (28%) had a single brain @entity3 , whereas 143 (72%) had more than two metastases. A total of 157 (79.2%) @entity1 received whole-brain radiation therapy (WBRT). A total of 7 (3.6%) @entity1 underwent resection of solitary brain metastases, 22 (11%) @entity1 underwent gamma-knife surgery, three @entity1 underwent intrathecal chemotherapy (1.5%) and 9 (4.6%) @entity1 received no treatment. The overall median survival time was 5.6 months (95% confidence interval (CI), 4.7-6.5 months) and 23.1% of the @entity1 survived for more than 1 year. The median overall survival time was 5.4 months for @entity1 treated with WBRT, 14.9 months for @entity1 treated with surgery or gamma-knife surgery only, and 2.1 months for @entity1 who received no treatment (P < 0.001). Multivariate analysis demonstrated that Eastern Cooperative Oncology Group (ECOG) performance status (relative risk (RR) = 0.704, 95% CI 0.482-1.028, P = 0.069), number of brain metastases (RR = 0.682, 95% CI 0.459-1.014, P = 0.058), treatment modalities (RR = 1.686, 95% CI 1.022-2.781, P = 0.041), and systemic chemotherapy after brain metastases (RR = 1.871, 95% CI 1.353-2.586, P < 0.001) were independent factors associated with survival. CONCLUSION: Although survival of @entity0 @entity1 with brain metastases was generally short, the performance status, number of brain metastases, treatment modalities and systemic chemotherapy after brain metastases were significantly associated with survival. @entity1 with single-brain @entity3 and good performance status deserve aggressive treatment. The characteristics of initial primary breast lesions did not affect survival after brain @entity3 .
