Abstract
Background: In 30% of patients with brain metastasis (BM), neurological symptoms are the first clinical manifestation of systemic malignancy, referred to as BM from cancer of unknown primary site (BM-CUPS). Here, we define the diagnostic value of 18F-fluordesoxyglucose positron emission tomography (FDG-PET/CT) in the workup of BM-CUPS. Methods: We screened 565 patients operated for BM at the University Hospital Zurich and identified 64 patients with BM-CUPS with data on both FDG-PET/CT and contrast-enhanced chest/abdomen computed tomography (CT) available at BM diagnosis. A cohort of 125 patients with BM-CUPS from Lille and Vienna was used for validation. Results: FDG-PET/CT was not superior to chest/abdomen CT in localising the primary lesion in the discovery cohort, presumably because most primary tumours were lung cancers. However, FDG-PET/CT identified additional lesions suspicious of extracranial metastases in 27 of 64 patients (42%). The inclusion of FDG-PET/CT findings shifted the graded prognostic assessment (GPA) score from 3 with CT alone to 2.5 for PET/CT (p = 3.8 × 10−5, Wilcoxon's test), resulting in a predicted survival of 5.3 versus 3.8 months (p = 6.1 × 10−5; Wilcoxon's test). All observations were confirmed in the validation cohort. Conclusions: Lung cancers are the most common primary tumour in BM-CUPS; accordingly, CT alone shows similar overall sensitivity for detecting the primary tumour as FDG-PET/CT. Yet, FDG-PET/CT improves the accuracy of staging by detecting more metastases, reflected by decreased GPA scores and decreased predicted survival. Therefore, randomised trials on patients with BM should standardise methods of staging, notably when stratifying for GPA.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 64-72 |
| Number of pages | 9 |
| Journal | European Journal of Cancer |
| Volume | 96 |
| DOIs | |
| State | Published - Jun 2018 |
Funding
FW has received travel support from Roche. MW has received research grants from Acceleron, Actelion, Bayer, Isarna, MSD, Merck EMD, Novocure, Piqur and Roche and honoraria for lectures or advisory board participation or consultation from Celldex, Immunocellular Therapeutics, Isarna, Magforce, MSD, Merck EMD, Novocure, Pfizer, Roche and Teva. ASB has received travel support from Amgen, Roche and Bristol-Myers Squibb and honoraria for lectures or advisory board participation from Roche. RS has served on advisory boards and institution received honoraria from Celgene, Ipsen, Merck KGaA, MSD/Merck & Co, Novartis, Pfizer and Roche. RD receives research funding from Astra Zeneca, Novartis, Merck Sharp & Dhome, Bristol-Myers Squibb, Roche, GlaxoSmithKline and Bayer and has a consultant or advisory board relationship with Astra Zeneca, Novartis, Merck Sharp & Dhome, Bayer, Roche, Bristol-Myers Squibb, GlaxoSmithKline, Amgen and Takeda. TF has received honoraria for lectures from Bayer and for speakers' bureau from GE. PR has received honoraria for advisory board participation and lectures from Bristol-Myers Squibb, Molecular Partners, MSD, Novartis and Roche. MP has received research support from Böhringer-Ingelheim, GlaxoSmithKline, Merck Sharp & Dome and Roche and honoraria for lectures, consultation or advisory board participation from Bristol-Myers Squibb, Novartis, CMC Contrast, GlaxoSmithKline, Mundipharma and Roche. ELR has received research support from Mundipharma and Amgen and travel support or honoraria from Mundipharma and Novartis. The rest of the authors have no conflicts of interest to declare.
Keywords
- Brain metastasis
- CUPS
- FDG-PET/CT
- GPA
ASJC Scopus subject areas
- Oncology
- Cancer Research
