Various Prognostic Factors in Metastatic Brain Tumours: A Cross-sectional Study

Abstract

Introduction: The most common type of intracranial neoplasms seen in neurosurgical practice is metastatic brain tumours. Adults with cancer have an 8-10% lifetime risk of developing symptomatic metastases. Breast cancer and lung cancer are the commonest to give brain metastases. However, the number of reported cases in India is still a portion of the true prevalence of brain metastases. In order to better understand the clinical presentation of brain metastases, their distribution, and other variables that impact their survival, this research was planned and conducted. Aim: To analyse the distribution of metastatic brain tumours, their primary source, characteristics of imaging, the different modalities of treatment and the factors which affect their survival like Karnofsky’s performance score, time interval between diagnosis of primary and metastasis, treatment method adopted. Materials and Methods: The cross-sectional study was carried out in a tertiary care hospital in Chennai, Tamil Nadu, India during the period from June 2018-May 2021 and included 102 metastatic brain tumour patients with proven biopsy of either of the primary or secondary lesions. Individuals who neither had the main nor the secondary lesion verified by biopsy are excluded. Among these patients, the parameters studied were incidence of various primary tumours, demographic profile, clinical features, imaging characteristics, performance status of the patient, treatment options, patient survival in relation to performance status, pathology, time interval between diagnosis of primary malignancy and the onset of secondary lesions. The results were analysed for the factors which affect survival like nature of systemic disease, source of primary, number of metastatic lesions, treatment methods adopted. Results: The commonest age group involved was 40-69 years (81, 79.41%). Female to male ratio of 4:1 in the age group of less than 40 years and the overall male to female ratio was 1:1.04. Lungs being the commonest primary source (42%) followed by breast and unknown primary. Ring lesion was the commonest appearance of metastasis (51, 50%), followed by cystic lesions (8, 7.84%) and haemorrhagic secondaries (3, 2.94%). Breast primary had a survival rate of 58.3% with better prognosis. Good karnofsky performance score, longer interval between diagnosis of primary and secondaries brain, combining surgery along with radiotherapy were also found to have good prognosis. Conclusion: Metastatic brain tumours are the commonest intracranial tumours. The favourable prognostic factors are the breast primary, younger age patients with good karnofsky’s score. Surgery along with radiation shows promising results than radiation alone even in poor grade patients