SEOM-GEINO clinical guideline of systemic therapy and management of brain central nervous system metastases (2021)

Complexity of neuro-oncological in-hospital consultations: a multicentre study

INTRODUCTION

Oncological patients may require evaluation by a neurologist when they are admitted to hospital. The aim of our study was to determine the frequency and characteristics of hospital interconsultations (IC) received by the neurology department concerning oncology patients admitted to the hospital.

MATERIAL AND METHODS

A retrospective multicentre study analysing IC with neurology concerning onco-haematological patients admitted over 5 consecutive years (2016-2020) in 4 tertiary hospitals in Spain was carried out.

RESULTS

A total of 2091 IC from 1710 patients were analysed, most of them male (55.5%; 969/2091) with a median age of 60.5 years (range 15-92). Most of the ICs came from the medical oncology (43.2%; 904/2091) and hematology (42.2%; 882/2091) departments. Neuro-oncological ICs accounted for approximately 17% (2091/12 242) of the total number of ICs performed in the neurology department during the 5 years included in this study. The most frequent reasons for consultation were limb motor deficit (18.3%; 381/2077), confusional syndrome (14.1%; 292/2077), epileptic seizures (12.2%; 254/2077), and headache (8.1%; 169/2077). The most frequent associated tumours were lung cancer (18.3%; 383/2089), leukaemia (19%; 396/2089), lymphoma (17.1%; 357/2089), and primary brain tumor (12.1%; 353/2089). The majority (69.9%; 1460/2089) of patients were undergoing active or recent cancer treatment. Final neurological diagnoses included metabolic encephalopathy (11.2%; 234/2091), tumor progression (11%; 231/2091), cerebral vascular complications (10.1%%; 212/2091), metastases (9.1%%; 191/2091), and leptomeningeal dissemination (8.9%%; 186/2091). A total of 15.4% (323/2091) of the ICs were closed with an undetermined diagnosis. The median time that the ICs were open was 3 days (range, 1-152).

CONCLUSIONS

ICs concerning onco-haematological patients are heterogeneous, with an increasing incidence and complexity, requiring management by neurologists with experience in neuro-oncological patients.

Clinical, Radiologic, and Surgical Features of Brain Metastases in Colorectal Cancer. A Strong Correlation Between Surgical Patterns and Outcome

BACKGROUND

Brain metastases (BMs) from colorectal cancer (CRC) are a small percentage of metastatic patients and surgery is considered the best choice to improve survival. While most research has focused on the risk of CRC spreading to the brain, no studies have examined the characteristics of BMs in relation to surgery and outcome. In this study, we evaluate the clinical and radiologic features of BMs from CRC patients who underwent surgery and analyze their outcomes.

METHODS

The study is a retrospective observational analysis that included a cohort of 31 patients affected by CRC surgically-treated for their related BMs. For all patients, clinical and surgical data (number, site, side, tumor and edema volume, and morphology) were recorded.

RESULTS

Analysis found that synchronous diagnosis and lesion morphology, particularly cystic versus solid, had the most significant impact on survival (6 vs. 22 months, P = 0.04). To compare BMs with cystic morphology to those with solid morphology, a multivariate analysis was conducted. No significant differences were observed between the 2 groups in terms of age, sex, clinical onset, or performance status. The analysis revealed no significant differences in localization with regard to site, tumor and edema volume, biology, or complications rate.

CONCLUSIONS

BMs derived from CRC have a significantly different prognosis depending on whether they present as a solid or cystic pattern. Although solid pattern is more common, cystic BMs in this tumor type are less frequent and are associated with a poorer prognosis, regardless of molecular expression, location, size, and adjuvant treatment.