Neuraxis Metastases Of Primary Central Nervous System Tumors: A Review Of Clinicopathological And Radiographic Characters Of 198 Cases In A Single Center

• Main Authors: Liu H, Zhang J, Liu Y, Sun Y, Li C, Gu C, Wang H, Zhang H, Yu C, Zhang M
• Format: Article
• Language: English
• Published: Dove Medical Press 2019-11-01
• Series: Cancer Management and Research
• Subjects: neuraxis metastases; survival; mri; classification; operation
• Online Access: https://www.dovepress.com/neuraxis-metastases-of-primary-central-nervous-system-tumors-a-review--peer-reviewed-article-CMAR
• ISSN: 1179-1322

Hailong Liu,1,2 Junping Zhang,1 Yongqiang Liu,3 Youliang Sun,4 Cheng Li,1 Chunyu Gu,1 Haoran Wang,1 Hongwei Zhang,1 Chunjiang Yu,1 Mingshan Zhang1 1Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University, Beijing 100093, People’s Republic of China; 2Department of Neurosurgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing 100853, People’s Republic of China; 3Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou 510405, People’s Republic of China; 4School of Basic Medical Science, Capital Medical University, Beijing 100069, People’s Republic of ChinaCorrespondence: Mingshan ZhangDepartment of Neurosurgery, Sanbo Brain Hospital Capital Medical University, No. 50 Yi-Ke-Song Road, Xiangshan Ave, Beijing 100093, People’s Republic of ChinaTel [phone]Fax [phone]Email [e-mail]: Neuraxis metastases (NM) from systemic and central nervous system (CNS) tumors have become increasingly common. However, a lack of systematic information restricts the development of the accurate diagnosis and treatment. The aim of this study is to facilitate the understanding of NM arising from CNS tumors in the largest cohort.Methods: Based on the clinicopathological and neuroimaging findings, we retrospectively analyze the epidemiological characters, radiographic classification, therapeutic strategies and prognostic factors.Results: A total of 198 cases are enrolled and the most common primary tumor is medulloblastoma (34.34%). The median age is 15.0 years and the majority of NM (79.29%) occur in the children and young adult groups. One hundred and forty-nine (75.25%) cases suffer from intracranial metastases, and 169 (85.35%) have intraspinal NM. The whole leptomeninges and cauda equine are the most preferential disseminated sites. Upon MRI parameters, the massive and miliary subgroup occurs most frequently in the intracranial and intraspinal NM, respectively. Treatment includes surgery (21.71%), chemotherapy alone (19.19%), radiation alone (10.10%) and combined therapy (55.56%). Operations are performed in order to identify pathology and relive masses, as well as the triple chemotherapeutic scheme consisting of ifosfamide, carboplatin and etoposide is recommended for most of NM. The median overall survival is 11.6 months. Younger age, coexistence of NM with primary tumors, shorter interval from primaries to metastases, glioma, leptomeningeal seeding and nodal subtype on MRI significantly correlate with poor prognosis.Conclusion: In spite of controversial therapies and poor outcomes, the neuroimaging classification and comprehensive treatment contribute to the efficient administration of NM.Keywords: neuraxis metastases, survival, MRI, classification, operation