Epidemiology, Clinical Presentation, Diagnosis, Prognosis

Chapter 8 - Management of CNS Metastases

The most common primary tumours causing central nervous system (CNS) metastases are lung cancer, breast cancer and melanoma. 

CNS metastases are the most common intracranial tumours and are approximately 10 times more common than primary brain tumours.

The incidence of CNS metastases is increasing due to novel therapies improving the survival time of cancer patients and the increasing availability of neuroimaging.

CNS metastases may cause symptoms and signs of increased intracranial pressure (headache, nausea/ vomiting), seizures and focal deficits.

Epidemiology Clinical Presentation Diagnosis Prognosis Figure 2

Courtesy J. Furtner, Medical University of Vienna, Vienna

The method of choice for the detection of CNS metastases is contrast-enhanced magnetic resonance imaging (MRI).

CNS metastases typically present as single or multiple contrast-enhancing space-occupying lesions, often with surrounding brain oedema.

The prognosis of CNS metastases is limited, with median overall survival times ranging from a few weeks to months.

Epidemiology Clinical Presentation Diagnosis Prognosis Figure 3

Courtesy A. Berhghoff, Medical University of Vienna, Vienna

The most important clinical prognostic parameters are patient age, Karnofsky Performance Status, number of brain metastases and extracranial tumour status.

Long-term survivors exist, with patients with brain metastases of HER2-positive breast cancer showing the most favourable median survival times.

Revision Questions

  1. CNS metastases occur most frequently with which tumour types?
  2. What is the method of choice for the detection of CNS metastases?
  3. Name the important clinical prognostic parameters for patients with brain metastases.

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Last update: 18 September 2017