Chapter 46 - Neurological complications of solid tumors
Introduction
Patients with cancer suffer from a variety of systemic effects of their primary malignancy. Neurological complications of solid tumors can arise from either metastatic disease or nonmetastatic disease. The former can result in brain metastases, epidural spinal metastases, and leptomeningeal metastases, whereas paraneoplastic syndromes can be seen in the latter. By assessing the prognosis of the patient, the appropriate treatment options to minimize additional morbidity and maximize the patient's quality of life may be selected. These treatment options range from palliative measures, such as radiation therapy and systemic treatment, to curative resection; the type of treatment must be individualized for each patient.
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Epidemiology
As the treatment of systemic malignancy has improved, patients with cancer are living longer and the incidence of brain metastasis has risen. In addition, improvements in imaging modalities such as magnetic resonance imaging (MRI) have enhanced the rate of detection of small metastatic deposits. Brain metastases occur in 10–30% of adult cancer patients (Wen and Loeffler, 1999). A variety of prognostic factors, including the type of primary lesion and the extent of systemic disease, must be
Epidemiology and prognosis
Metastatic epidural spinal cord compression (ESCC) is a devastating complication that occurs when cancer metastasizes to the vertebral (spinal) column and secondarily compresses the spinal cord or cauda equina. It usually results from cancer invading the vertebrae, paravertebral (paraspinal) tissue, or the epidural space itself. Although it is a relatively common complication, the magnitude of the problem of spinal epidural metastases is usually underestimated. The best evidence suggests that
Epidemiology
Cancer arising outside the CNS can metastasize to any intracranial structure including the leptomeninges. The leptomeninges are defined anatomically as the pia mater and the arachnoid mater, and are tissue envelopes that encase the brain and spinal cord. The subarachnoid space lies between these two layers and contains the cerebrospinal fluid (CSF). Invasion of the leptomeninges or the CSF by cancer is termed leptomeningeal metastasis (LMM) and represents a devastating complication of
General concepts
Paraneoplastic neurological syndromes (PNSs) are rare disorders caused by the secondary effects of cancer. These syndromes include paraneoplastic limbic encephalitis, paraneoplastic subacute cerebellar degeneration, opsoclonus–myoclonus, subacute sensory neuropathy, Lambert–Eaton myasthenic syndrome, and paraneoplastic encephalomyelitis. PNSs affect women twice as frequently as men. Most paraneoplastic syndromes are multifocal and are commonly mistaken for vascular, inflammatory or degenerative
References (294)
- et al.
Recurrent adenocarcinoma of the endometrium: a clinical and histopathological study of 379 patients
Gynecol Oncol
(1984) - et al.
Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomized trial
Lancet
(2004) - et al.
Clinical decision making in brain metastases
Neurosurg Clin N Am
(1996) - et al.
A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis
Int J Radiat Oncol Biol Phys
(1996) - et al.
Metastases from transitional cell carcinoma of urinary bladder
Urology
(1980) - et al.
The treatment of brain metastases in melanoma patients
Cancer Treat Rev
(2004) - et al.
Medical management of cerebral metastases
Neurosurg Clin N Am
(1996) Methotrexate: clinical pharmacology, current status and therapeutic guidelines
Cancer Treat Rev
(1977)- et al.
Surgical management of non-small cell lung cancer with synchronous brain metastases
Chest
(2001) - et al.
The relevance of intraventricular chemotherapy for leptomeningeal metastasis in breast cancer: a randomized study
Eur J Cancer
(2004)