Incidence and outcomes of brain metastases in patients with extra-pulmonary neuroendocrine neoplasms
Kapacee, Zainul Abedin Dawod, Mohammed Allison, Jennifer Frizziero, Melissa Chakrabarty, Bipasha Manoharan, Prakash McBain, Catherine A Mansoor, Was Lamarca, Angela Hubner, Richard A
Kapacee, Zainul Abedin
Dawod, Mohammed
Allison, Jennifer
Frizziero, Melissa
Chakrabarty, Bipasha
Manoharan, Prakash
McBain, Catherine A
Mansoor, Was
Lamarca, Angela
Hubner, Richard A
Citations
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Abstract
BACKGROUND: Brain metastases (BMs) incidence in patients with
extra-pulmonary neuroendocrine neoplasms (EP-NENs) is unclear, with no
available management recommendations. This study aimed to review the
clinical presentation, management and survival outcomes of patients with
EP-NENs and BMs at a European Centre of Excellence. METHODS: A
retrospective single-centre analysis of consecutive patients with EP-NENs
(Aug 2004-Feb 2020) was conducted. Median overall survival (OS)/survival
from BMs diagnosis were estimated (Kaplan Meier). RESULTS: Of
786 patients, 15 (1.9%) had BMs, median age 61y (range 15–77); 8 (53%)
male, primary NEN site: unknown 40%; oesophageal 13%; small bowel
13%; pancreas 13%; gastric 7%; cervix 7% and bladder 7%. Most patients
with BMs had grade 3 (G3) NENs (11, 73%), 3 (20%) were G2
and 1 (7%)G1. Eight (53%) had poorly-differentiated NENs, 6 welldifferentiated
and 1 not recorded. Two (13%) patients had synchronous
BMs at diagnosis, whilst 13 (87%) developed BMs metachronously. Median
time to development of BMs after initial NEN diagnosis: 15.9 months
(range 2.5–139.5). Five patients had a solitary BM, 4 had 2–9 lesions and
6 had >10 BMs. The most commonly affected sites were the cerebrum (13,
87%), cerebellum (6, 40%), leptomeninges (2, 13%) and orbit (1, 7%). The
most common presenting symptoms were limb weakness, headache, confusion,
visual disturbance (each n=3, 20%), seizures (2, 13%), word-finding
difficulty (2, 13%) and facial weakness/ptosis (1, 7%). Median OS from
initial NEN diagnosis was 23.6-months [95%-CI 15.2–31.3]; median time
to death from BMs diagnosis was 3.0-months [95%-CI 0.0–8.3]. Treatment
of BMs was surgery (n=3); radiotherapy (n=6); 5 had WBRT, one
localised radiotherapy (orbit). Six (40%) had best supportive care. CONCLUSION:
BMs in patients with EP-NENs are rare and predominantly
in G3 NENs, with diverse intracranial distribution. Although uncommon,
BMs from NENs behave aggressively and greater understanding is needed to improve therapeutic outcomes.
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Kapacee ZA, Dawod M, Allison J, Frizziero DM, Chakrabarty B, Manoharan P, et al. Ncmp-04. Incidence and Outcomes of Brain Metastases in Patients with Extra-Pulmonary Neuroendocrine Neoplasms. Neuro-Oncology. 2020;22(Supplement_2):ii123-ii4.