Intracranial dural metastases

• Published in: Cancer Vol. 115; no. 9; pp. 1947 - 1953
• Main Authors: Nayak, Lakshmi, Abrey, Lauren E., Iwamoto, Fabio M.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.05.2009; Wiley-Blackwell
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; central nervous system; Child; Disease-Free Survival; Dura Mater; Female; Humans; intracranial neoplasms; Magnetic Resonance Imaging; Male; Medical sciences; Meningeal Neoplasms - diagnosis; Meningeal Neoplasms - secondary; Meningeal Neoplasms - therapy; Meningioma - diagnosis; Meningioma - secondary; Meningioma - therapy; Middle Aged; neoplasm metastases; Prognosis; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Tumors; Young Adult; Intracranial; Cancerology; Central nervous system; Dura mater; Malignant tumor; Metastasis; neoplasm metastases; intracranial neoplasms; Cancer
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.24203

BACKGROUND: Intracranial dural metastases (IDM) are found at autopsy in 9% of patients with advanced systemic cancer. However, to the authors' knowledge, IDM have not been studied systematically in the modern neuroimaging era. The objective of the current study was to evaluate the demographics, clinical presentation, imaging, treatment, and prognosis of patients with IDM. METHODS: The current study was a retrospective review of 122 patients with IDM diagnosed at Memorial Sloan‐Kettering Cancer Center between 1999 and 2006. Patients with concurrent brain or leptomeningeal metastases were excluded. RESULTS: Sixty‐one percent of the patients were women; the median age at diagnosis was 59 years, the median Karnofsky performance scale (KPS) at diagnosis was 80, and the median time to IDM diagnosis from initial cancer diagnosis was 37 months. Breast (34%) and prostate (17%) cancers were the most frequent primary tumors associated with IDM. Fifty‐six percent of patients had a single dural metastasis. On imaging, 70% had metastases of the overlying skull, 44% had dural tail metastases, 53% had vasogenic edema, and 34% had brain invasion. Direct extension from skull metastases was the most common mode of spread. Eighty‐three percent of patients had active systemic disease at the time of IDM diagnosis. A lower KPS and lung cancer were associated with worse overall survival. Surgical resection and chemotherapy improved progression‐free survival, but only resection was found to be associated with improved overall survival. CONCLUSIONS: IDM affect a significant proportion of cancer patients. KPS and status of systemic cancer should guide treatment decisions. Cancer 2009. © 2009 American Cancer Society. The authors retrospectively reviewed 122 patients with intracranial dural metastases (IDM) and most common primary tumors were breast, prostate, and lung cancer. Most IDM patients had active systemic cancer; poor performance status and lung cancer were associated with worse survival.