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INTRODUCTION: Patients with intracranial metastases from an unknown primary tumour (CUP) are often not put forward for the same treatment and benefits as those provided for patients with metastases of known primary tumour origin (CKP). NICE recognised, in their 2010 guidance, the current lack of national research strategy to address the needs of CUP patients with brain metastases. NICE has previously recommended increasing the collection of epidemiological data regarding these patients. AIM To compare survival of CKP patients undergoing resection of intracranial metastases with survival of CUP patients also undergoing resection. METHODS: A retrospective study was performed to compare survival between the two patient groups (CKP and CUP). Patients were sampled from a pathology database (age range 20 – 83; median age 61). Data was then collected from patient notes and trust information services using a proforma. INCLUSION CRITERIA: Surgically managed patients, aged over 18 years old, with a histological diagnosis of intracranial metastasis during the study period 01/01/2008 – 11/04/2018. RESULTS: 324 patients identified of whom 28 were censored (8.6%). This included 265 (81.8%) CKP patients of whom censored 24 (9.1%). 59 (18.2%) CUP patients of whom censored 4 (6.8%). Median survival for CKP patients was 10 months (95% CI 8.509 – 11.491); for CUP patients it was 6 months (95% CI 4.263 – 7.737). Log rank (Mantel-Cox) p = 0.747. CONCLUSION: The data reveal no statistically significant difference in survival outcome between the two groups. This is in keeping with the findings of the limited number of other studies in this area, and suggests that current diagnostic pathways specifying a thorough search for identification of primary tumours before surgery may not improve patient outcomes. Surgical management of CUP brain metastasis patients is therefore an appropriate treatment option in this patient group. |
