Display options
Share it on

MEDICC Rev. 2018 Jan;20(1):18. doi: 10.37757/MR2018.V20.N1.5. Epub 2018 Feb 10.

Brain Metastases in Havana Cancer Patients.

MEDICC review

Joel Caballero-García, Rosainerys Jiménez-Martínez, Adolfo M Giol-Álvarez, Mario de Jesús Caso-Cantero, Orlando Cruz-García, Diana de Los Ángeles García-López

Affiliations

  1. National Oncology and Radiobiology Institute (INOR), Havana, Cuba.
  2. Wilfredo Santana Rivas Polyclinic, Habana del Este, Havana, Cuba.
  3. Juan Manuel Márquez Pediatric Teaching Hospital, Havana, Cuba.
  4. Gregorio Valdés Cruz Polyclinic, Habana del Este, Havana, Cuba.
  5. Ramón González Coro University Maternity Hospital, Havana, Cuba.

PMID: 34229417 DOI: 10.37757/MR2018.V20.N1.5

Abstract

INTRODUCTION: Cancer is a major public health problem worldwide and in Cuba. Approximately one third of cancer patients develop a brain metastasis. Despite this, epidemiological studies are scarce, internationally and in Cuba; published research is mainly limited to autopsy studies and hospital case series.

OBJECTIVE: Characterize patients with brain metastases residing in Habana del Este Municipality, Havana, Cuba, with respect to demographics, metastasis location and primary tumor site.

METHODS: A retrospective descriptive study was carried out with data for all patients with histologically confirmed cancer diagnosed in 2014 and registered in primary health care in Habana del Este Municipality. Diagnostic reports from computed tomography and/or magnetic resonance imaging were used to identify patients with brain metastases. Study variables were age, sex, skin color, number and location of brain metastases, control of primary tumor, and presence of extracranial metastases. Percentages were calculated and presented in tables.

RESULTS: We identified 832 cancer patients in the Habana del Este population of 181,473 (prevalence 458.5 per 100,000 population). Among patients with cancer, 27.6% (230/832) had brain tumors, among which 83% (191/230) were brain metastases and 17% (39/230) primary tumors, a ratio of 4.9:1. Brain metastases appeared in 23% (191/832) of cancer patients (prevalence 105.2 per 100,000 population). Among patients with brain metastases, 48.2% (92/191) were aged 41-60 years and 61.3% (117/191) were female sex. The majority, 59.7% (114/191) had multiple metastases. The most frequent primary tumor location was the breast (40.8%, 78/191), followed by the lung (31.9%; 61/191); 46.8% (211/451) of brain metastases were in the parietal lobe.

CONCLUSIONS: Brain metastases are more prevalent in this Cuban municipality than reported in other countries, but they constitute a higher proportion of cancer cases than seen in other population-based studies. The study's results underline the importance of detecting brain metastasis early, to permit timely interventions to improve quality of life and survival.

CONTRIBUTION OF THIS RESEARCH: This is the first epidemiological study of brain metastases in Cuba and one of the few carried out internationally.

Keywords: Cancer; Cuba; epidemiology; neoplasm metastasis; prevalence; tumor metastasis/brain

References

  1. Horton S, Gauvreau CL. Cancer in Low- and Middle-Income Countries: An Economic Overview. In: Gelband H, Jha P, Sankaranarayanan R, Horton S, editors. Cancer: Disease Control Priorities. Vol 3. 3rd ed. Washington, D.C.: The International Bank for Reconstruction and Development / The World Bank; 2015 Nov 1 [updated 2016 Jul 31; cited 2017 Feb 1]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK343620/ - PubMed
  2. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1459–544. - PubMed
  3. Grossman R, Mukherjee D, Chang DC, Purtell M, Lim M, Brem H, et al. Predictors of inpatient death and complications among postoperative elderly patients with metastatic brain tumors. Ann Surg Oncol. 2011 Feb;18(2):521–8. - PubMed
  4. Stanford J, Gardner S, Schwartz M, Davey P. Does the surgical resection of a brain metastasis alter the planning and subsequent local control achieved with radiosurgery prescribed for recurrence at the operated site? Br J Neurosurg. 2011 Aug;25(4):488–91. - PubMed
  5. Tabouret E, Bauchet L, Carpentier AF. Brain metastases epidemiology and biology. Bull Cancer. 2013;100(1):57–62. - PubMed
  6. Nieder C, Spanne O, Mehta MP, Grosu AL, Geinitz H. Presentation, patterns of care and survival in patients with brain metastases: what has changed in the last 20 years? Cancer. 2011 Jun 1;117(11):2505–12. - PubMed
  7. Platta CS, Khuntia D, Mehta MP, Suh JH. Current treatment strategies for brain metastasis and complications from therapeutic techniques: a review of current literature. Am J Clin Oncol. 2010 Aug;33(4):398–407. - PubMed
  8. Niibe Y, Chang JY. Novel Insights of Oligometastases and Oligo-Recurrence and Review of the Literature. Pulmonary Med [Internet]. 2012 Jul [cited 2014 Dec 21];2012(Art 261096):1–5. Available from: http://www.hindawi.com/journals/pm/2012/261096/cta/ - PubMed
  9. Kienast Y, von Baumgarten L, Fuhrmann M, Klinkert WE, Goldbrunner R, Herms J, et al. Real-time imaging reveals the single steps of brain metastasis formation. Nat Med. 2010 Jan;16(1):116–22. - PubMed
  10. Davies MA, Liu P, McIntyre S, Kim KB, Papadopoulos N, Hwu WJ, et al. Prognostic factors for survival in melanoma patients with brain metastases. Cancer. 2011 Apr 15;117(8):1687–96. - PubMed
  11. National Health Statistics and Medical Records Division (CU). Anuario Estadístico de Salud 2016 [Internet]. Havana: Ministry of Public Health (CU); 2017 [cited 2017 May 20]. 206 p. Available from: http://files.sld.cu/dne/files/2017/05/Anuario_Estad%C3%ADstico_de_Salud_e_2016_edici%C3%B3n_2017.pdf. Spanish. - PubMed
  12. Ministry of Public Health (CU). Registro Nacional del Cáncer [Internet]. Havana: National Medical Sciences Information Center (CU); c1999–2017 [updated 2016 Apr 2; cited 2017 May 2]. Available from: http://instituciones.sld.cu/sicc/registro-nacional-del-cancer/. Spanish. - PubMed
  13. Cruz García O, Caballero García J, Salas Rubio JH. Para cambiar la percepción ante las metástasis encefálicas en Cuba. Rev Cubana Neurol Neurocir. 2014;4(2):103–4. Spanish. - PubMed
  14. Caballero García J, Felipe Morán A, Toledo Valdés C, Pérez La O P, Morales Pérez I. Conside-raciones anatomopatológicas y demográficas de la metástasis intracraneal. Rev Cubana Neurol Neurocir. 2012;2(1):23–7. Spanish. - PubMed
  15. Caballero García J, de Mendoza Amat JH, Cruz García O, Montero González TJ, Felipe Morán A. Características de la metástasis intracraneal en 14 321 autopsias realizadas en el Hospital “Dr. Luis Díaz Soto”, La Habana (1962–2011). Rev Cubana Neurol Neurocir. 2013 Jul–Dec;3(2):132–8. Spanish. - PubMed
  16. Chi Ramírez D, Forteza Sáez M, Galán Álvarez Y, Chon Rivas I, Ortiz Reyes RM, Caballero García J. Mortalidad por metástasis encefálica (La Habana, 2006–2008). Rev Cubana Neurol Neurocir. 2014 Jul–Dec;4(2):109–16. Spanish. - PubMed
  17. Caballero García J, Cruz García O, Morales Pérez I, Pérez La O P, Hernández Díaz Z, Salazar Rodríguez S. Características clínicas y de neuroimagen de las metástasis cerebrales. Rev Cubana Neurol Neurocir. 2015 Jan–Jun;5(1):5–12. Spanish. - PubMed
  18. Lacerda Gallardo AJ, Borroto Pacheco R. Metástasis cerebral: estudio clínico-quirúrgico y anatomopatológico. Rev Cubana Cir. 2000 Aug [cited 2015 Jan 22];39(2):103–7. Available from: http://neuroc99.sld.cu/text/metastasis.htm#up. Spanish. - PubMed
  19. Pascual Piazuelo MC, Bestué M, Serrano Ponz M, Montori-Lasilla M. Estudio epidemiológico de las metástasis cerebrales en Aragón y La Rioja. Rev Neurol. 2002 May 1–15;34(9):897–8. - PubMed
  20. Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol. 2004 Jul 15;22(14):2865–72. - PubMed
  21. Schouten LJ, Rutten J, Huveneers HA, Twijnstra A. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer. 2002 May 15;94(10):2698–705. - PubMed
  22. Sánchez Jacas I. La planeación estratégica en el Sistema Nacional de Salud cubano. MEDISAN. 2017 May;21(5):635–41. Spanish. - PubMed
  23. Jackson JE, Burmeister BH, Burmeister EA, Foote MC, Thomas JM, Meakin JA, et al. Melanoma brain metastases: the impact of nodal disease. Clin Exp Metastasis. 2014 Jan;31(1):81–5. - PubMed
  24. Hauswald H, Dittmar JO, Habermehl D, Rieken S, Sterzing F, Debus J, et al. Efficacy and toxicity of whole brain radiotherapy in patients with multiple cerebral metastases from malignant melanoma. Radiat Oncol. 2012 Aug 2;7:130. - PubMed
  25. Vermeulen L, de Sousa e Melo F, Richel DJ, Medema JP. The developing cancer stem-cell model: clinical challenges and opportunities. Lancet Oncol. 2012 Feb;13(2):e83–9. - PubMed
  26. Kondziolka D, Kalkanis SN, Mehta MP, Ahluwalia M, Loeffler JS. It is time to reevaluate the management of patients with brain metastases. Neurosurgery. 2014 Jul;75(1):1–9. - PubMed
  27. Dziggel L, Segedin B, Podvrsnik NH, Oblak I, Schild SE, Rades D. A survival score for patients with brain metastases from less radiosensitive tumors treated with whole-brain radiotherapy alone. Strahlentherap und Onkolog. 2014 Jan;190(1):54–8. - PubMed
  28. Murrell DH, Foster PJ, Chambers AF. Brain metastases from breast cancer: lessons from experimental magnetic resonance imaging studies and clinical implications. J Mol Med. 2014 Jan;92(1):5–12. - PubMed
  29. Jenkinson MD, Haylock B, Shenoy A, Husband D, Javadpour M. Management of cerebral metastasis: Evidence-based approach for surgery, stereotactic radiosurgery and radiotherapy. Eur J Cancer. 2011 Mar;47(5):649–55. - PubMed
  30. Carlson JA, Nooruddin Z, Rusthoven C, Elias A, Borges VF, Diamond JR, et al. Trastuzumab emtansine and stereotactic radiosurgery: an unexpected increase in clinically significant brain edema. Neuro Oncol. 2014 Jul;16(7):1006–9. - PubMed
  31. Senkus E, Cardoso F, Pagani O. Time for more optimism in metastatic breast cancer? Cancer Treat Rev. 2014 Mar;40(2):220–8. - PubMed
  32. Marchetti M, Milanesi I, Falcone C, De Santis M, Fumagalli L, Brait L, et al. Hypofractionated stereotactic radiotherapy for oligometastases in the brain: a single-institution experience. Neurol Sci. 2011 Jun;32(3):393–9. - PubMed
  33. - PubMed

Publication Types