Epidemiological Characteristics and Management of Brain Metastases on Patients in the Clinical Hospital of the University of Chile (Hcuch) between 2012 and 2017| Biomed Grid

Introduction and Context: Brain metastases (BM) are the main neurological complication of cancer, affecting up to 30% of these patients (incidence = 8.3-14.3 x 100,000), and they are the most frequent intracranial tumors (IT) of the adult. They are 10 times more common than primary cerebral neoplasms (PCN), however, the number of publications about this pathology is only 25% of PCNs such as gliomas. In our country there is no national registry of brain tumors, so the actual incidence of these is unknown. Treatments include initial/palliative management with glucocorticoids (GC) and/or surgery (Cx), radiosurgery (RS) or Whole Brain Radiation Therapy (WBRT). The purpose of this study is to determine clinical and therapeutic characteristics of BM in patients taken care of in our institution and with this information we propose the improvement of the management of these patients. Material and Methods: In this cohort study we analyze the clinical records of patients treated in our hospital during the years 2012-2017 with a diagnosis of BM. The date of death was obtained from the National Identification Registry and Identification Service and calculated the median survival between diagnosis and death. We registered: sex, age at diagnosis, number of brain metastases, management and survival rate. Results: 54 CR were found with a diagnosis of BM, however, only 31 complied with Inclusion criteria (IC). Average age at diagnosis of symptomatic BM: 59 years (range: 29-86 years), men (n=13): 56.3 years and in women (n=18): 60.9 years. BM number: 14 patients (45,1%) had one BM; 11 (35,5%) had oligometastases (2 or 3); and 6 (19,4%) patients multiple BM (more than 3). Origin of primary tumor: 45.2% pulmonary; 12.9% colorectal; 12.9% renal; 9.7% breast; 3.2% ovary; 3.2% unknown; 12.9% other (Includes gastric, hepatic and thyroid). Only 38.7% of BM had BB, 25% were poorly differentiated lung carcinoma, 16.7% colon adenocarcinoma and 16.7% moderate/poorly differentiated breast carcinoma. Clinical Features (CF) highlights includes motor symptoms and signs in 54,8%, headache in 48,4% and gait apraxia in 38,7%. Location: 67.7% of patients had hemispheric tumors and 35.5% cerebellar. There were no brainstem tumors in our study. 12 (38.7%) patient received active treatment (surgery or radiosurgery),11 (35.5%) had surgery and only one (3.2%) received radiosurgery. All patients received palliative care, and 10 received WBRT. Survival: one patient was alive. For those who had a certified death, average survival time after diagnosis was 34.9 weeks (N=30). People who received active treatment, had an average survival time of 56.1 weeks after diagnosis and 54.5 weeks after treatment (N=12). Patients which did not receive an active treatment (N=18) had an average survival of 20.7 weeks. The hazard rates differ between those who had an active treatment and those who did not (log-rank test), z test = 2.25, p = 0.0246).The survival -in weeks- of patients who WBRT (N=10) versus those that were only managed with palliative care (GC) (N=8) was z test = 2.76, p = 0.00578. In the group of people who received active treatment, there was no difference between the ones that had unique BM vs those with 2 or 3 BM. In the group that received active treatment, 3(25%) patients died because of their BM but there was no difference with the palliative group.