Early detection of brain metastasis by routine brain scanning in selected cancer patients doubles survival and increases quality of life.

Keywords: Imaging, gamma knife, brain metastasis, outcome, radiosurgery

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     According to the literature 20-40% of cancer patients develop brain metastases (BM). Increasing efficacy of contemporary treatment of the primary tumor with attendant longer survival times and failure of chemotherapy to cross the blood brain barrier (BBB) allow for a relative increase of metastatic disease to the brain. Even so, due to oncological tradition and imaging costs, follow-up protocols for lung and breast cancer patients frequently do not include brain scanning. Particularly breast cancer patients have improved survival due to radio-chemosensibility of their tumors. HER-2 positive tumors have better extracranial disease control with Trastuzumab, which does not cross BBB, with higher percentages of BM (50-60%) after one year from diagnosis. Mean prognosis for patients at diagnosis of BM is 2-4 months; single or combined treatments may increase survival up to 12-15 months.
     Our purpose was to demonstrate that routine brain scanning, at least in selected cancer patients, could improve survival outcomes after brain metastasis detection.
     Among our 5381 Gamma Knife (GK) cases, malignant tumors represents 45%, almost all metastases (n = 2219).
       Lung (n = 1144) and breast (n= 377) cancer are the most common primary tumors. We reviewed our cases to evaluate percentage of patient referred that could effectively undergo to GK treatment, outcome, survival and causes of death.
     The overall survival of patients coming from Centers adopting cerebral follow-up is almost double (97 weeks vs. 53), 56% are still alive at 24 months and 25% at 5 years from BM diagnosis and, after six moth, quality of life (Karnofsky) is high, most of patients are free from neurological symptoms and the death for brain causes is exceptional.
     This was a retrospective study.
     Early diagnosis allows avoidance of palliative options and offer the most efficient treatments. Oncological Centers who have adequate routine brain imaging for their breast cancer patients present most correct indications to RS and have better results.
     This means also significantly lower costs for the health care system, which should taken into account in the financial analysis of protocols allowing early BM diagnosis.


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