Skip to main content
Erschienen in: Die Onkologie 7/2021

02.03.2021 | Zerebrale Metastasen | Leitthema

Sonderformen des CUP-Syndroms in Hirn und Wirbelsäule

verfasst von: Dr. med. D. Miller, Prof. Dr. med. K. Schmieder

Erschienen in: Die Onkologie | Ausgabe 7/2021

Einloggen, um Zugang zu erhalten

Zusammenfassung

Hintergrund

Neurologische Symptome sind nicht selten Erstmanifestation einer Krebserkrankung und führen schließlich zum Nachweis eines Tumors in Hirn oder Wirbelsäule. In den seltensten Fällen handelt es sich um eine Metastase eines CUP-Syndroms („cancer of unknown primary site“).

Ziel

Ziel der Arbeit war die Darstellung des aktuellen Wissensstands zu Epidemiologie, Diagnostik, Therapie und Prognose von Metastasen des CUP-Syndroms in Hirn und Wirbelsäule.

Methoden

Dazu erfolgte eine Medline-Literaturrecherche.

Ergebnisse

Es kann nur auf retrospektive Daten zurückgegriffen werden. Die Therapie unterscheidet sich nicht von der Metastasentherapie bei bekanntem Primarius und besteht aus einem interdisziplinären Therapieansatz, welcher insbesondere die neurologische Akutsymptomatik rasch behandeln sollte. Ein signifikanter Unterschied in der Prognose konnte bisher nicht gezeigt werden.

Schlussfolgerung

Prospektive multizentrische Studien sind notwendig, um das Verständnis und die Therapie des CUP-Syndroms mit Metastasen in Hirn und Wirbelsäule zu verbessern.
Literatur
1.
Zurück zum Zitat Bartelt S, Lutterbach J (2003) Brain metastases in patients with cancer of unknown primary. J Neurooncol 64(3):249–253CrossRef Bartelt S, Lutterbach J (2003) Brain metastases in patients with cancer of unknown primary. J Neurooncol 64(3):249–253CrossRef
2.
Zurück zum Zitat Bollen L, van der Linden YM, Pondaag W, Fiocco M, Pattynama BP, Marijnen CA, Nelissen RG, Peul WC, Dijkstra PD (2014) Prognostic factors associated with survival in patients with symptomatic spinal bone metastases: a retrospective cohort study of 1,043 patients. Neuro Oncol 16(7):991–998CrossRef Bollen L, van der Linden YM, Pondaag W, Fiocco M, Pattynama BP, Marijnen CA, Nelissen RG, Peul WC, Dijkstra PD (2014) Prognostic factors associated with survival in patients with symptomatic spinal bone metastases: a retrospective cohort study of 1,043 patients. Neuro Oncol 16(7):991–998CrossRef
3.
Zurück zum Zitat Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, Greenspoon J, Parney IF, Laack NNI, Ashman JB, Bahary JP, Hadjipanayis CG, Urbanic JJ, Barker FG 2nd, Farace E, Khuntia D, Giannini C, Buckner JC, Galanis E, Roberge D (2017) Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 18(8):1049–1060CrossRef Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, Greenspoon J, Parney IF, Laack NNI, Ashman JB, Bahary JP, Hadjipanayis CG, Urbanic JJ, Barker FG 2nd, Farace E, Khuntia D, Giannini C, Buckner JC, Galanis E, Roberge D (2017) Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 18(8):1049–1060CrossRef
4.
Zurück zum Zitat D’Ambrosio AL, Agazzi S (2007) Prognosis in patients presenting with brain metastasis from an undiagnosed primary tumor. Neurosurg Focus 22(3):E7PubMed D’Ambrosio AL, Agazzi S (2007) Prognosis in patients presenting with brain metastasis from an undiagnosed primary tumor. Neurosurg Focus 22(3):E7PubMed
5.
Zurück zum Zitat Douglas S, Huttenlocher S, Bajrovic A, Rudat V, Schild SE, Rades D (2012) Prognostic factors for different outcomes in patients with metastatic spinal cord compression from cancer of unknown primary. BMC Cancer 12:261CrossRef Douglas S, Huttenlocher S, Bajrovic A, Rudat V, Schild SE, Rades D (2012) Prognostic factors for different outcomes in patients with metastatic spinal cord compression from cancer of unknown primary. BMC Cancer 12:261CrossRef
6.
Zurück zum Zitat Douglas S, Schild SE, Rades D (2012) Metastatic spinal cord compression in patients with cancer of unknown primary. Estimating the survival prognosis with a validated score. Strahlenther Onkol 188(11):1048–1051CrossRef Douglas S, Schild SE, Rades D (2012) Metastatic spinal cord compression in patients with cancer of unknown primary. Estimating the survival prognosis with a validated score. Strahlenther Onkol 188(11):1048–1051CrossRef
7.
Zurück zum Zitat Enkaoua EA, Doursounian L, Chatellier G, Mabesoone F, Aimard T, Saillant G (1997) Vertebral metastases: a critical appreciation of the preoperative prognostic tokuhashi score in a series of 71 cases. Spine 22(19):2293–2298CrossRef Enkaoua EA, Doursounian L, Chatellier G, Mabesoone F, Aimard T, Saillant G (1997) Vertebral metastases: a critical appreciation of the preoperative prognostic tokuhashi score in a series of 71 cases. Spine 22(19):2293–2298CrossRef
8.
Zurück zum Zitat Fizazi K, Greco FA, Pavlidis N, Daugaard G, Oien K, Pentheroudakis G (2015) ESMO guidelines committee. Cancers of unknown primary site: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(5):v133–8CrossRef Fizazi K, Greco FA, Pavlidis N, Daugaard G, Oien K, Pentheroudakis G (2015) ESMO guidelines committee. Cancers of unknown primary site: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(5):v133–8CrossRef
9.
Zurück zum Zitat Füreder LM, Widhalm G, Gatterbauer B, Dieckmann K, Hainfellner JA, Bartsch R, Zielinski CC, Preusser M, Berghoff AS (2018) Brain metastases as first manifestation of advanced cancer: exploratory analysis of 459 patients at a tertiary care center. Clin Exp Metastasis 35(8):727–738CrossRef Füreder LM, Widhalm G, Gatterbauer B, Dieckmann K, Hainfellner JA, Bartsch R, Zielinski CC, Preusser M, Berghoff AS (2018) Brain metastases as first manifestation of advanced cancer: exploratory analysis of 459 patients at a tertiary care center. Clin Exp Metastasis 35(8):727–738CrossRef
10.
Zurück zum Zitat Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37(4):745–751CrossRef Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37(4):745–751CrossRef
11.
Zurück zum Zitat Giordana MT, Cordera S, Boghi A (2000) Cerebral metastases as first symptom of cancer: a clinico-pathologic study. J Neurooncol 50(3):265–273CrossRef Giordana MT, Cordera S, Boghi A (2000) Cerebral metastases as first symptom of cancer: a clinico-pathologic study. J Neurooncol 50(3):265–273CrossRef
12.
Zurück zum Zitat Gough M, Nielsen M, Coulter IC, Holliman D (2020) Survival outcomes following craniotomy for intracranial metastases from an unknown primary. Int J Clin Oncol 25(8):1475–1482CrossRef Gough M, Nielsen M, Coulter IC, Holliman D (2020) Survival outcomes following craniotomy for intracranial metastases from an unknown primary. Int J Clin Oncol 25(8):1475–1482CrossRef
13.
Zurück zum Zitat Lechapt Zalcman E, Bazille C, Rousseau A, Burel-Vandenbos F, Pierga JY (2015) Analyse histologique et moléculaire des métastases cérébrales. Cancer Radiother 19(1):10–15CrossRef Lechapt Zalcman E, Bazille C, Rousseau A, Burel-Vandenbos F, Pierga JY (2015) Analyse histologique et moléculaire des métastases cérébrales. Cancer Radiother 19(1):10–15CrossRef
14.
Zurück zum Zitat Ma Y, He S, Liu T, Yang X, Zhao J, Yu H, Feng J, Xu W, Xiao J (2017) Quality of life of patients with spinal metastasis from cancer of unknown primary origin: a longitudinal study of surgical management combined with postoperative radiation therapy. J Bone Joint Surg Am 99(19):1629–1639CrossRef Ma Y, He S, Liu T, Yang X, Zhao J, Yu H, Feng J, Xu W, Xiao J (2017) Quality of life of patients with spinal metastasis from cancer of unknown primary origin: a longitudinal study of surgical management combined with postoperative radiation therapy. J Bone Joint Surg Am 99(19):1629–1639CrossRef
15.
Zurück zum Zitat Matsunaga S, Shuto T, Kobayashi N (2019) Gamma knife radiosurgery for metastatic brain tumors from cancer of unknown primary. World Neurosurg 122:e1465–e1471CrossRef Matsunaga S, Shuto T, Kobayashi N (2019) Gamma knife radiosurgery for metastatic brain tumors from cancer of unknown primary. World Neurosurg 122:e1465–e1471CrossRef
16.
Zurück zum Zitat Mueller WC, Spector Y, Edmonston TB, St Cyr B, Jaeger D, Lass U, Aharonov R, Rosenwald S, Chajut A (2011) Accurate classification of metastatic brain tumors using a novel microRNA-based test. Oncologist 16(2):165–174CrossRef Mueller WC, Spector Y, Edmonston TB, St Cyr B, Jaeger D, Lass U, Aharonov R, Rosenwald S, Chajut A (2011) Accurate classification of metastatic brain tumors using a novel microRNA-based test. Oncologist 16(2):165–174CrossRef
17.
Zurück zum Zitat Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366(9486):643–648CrossRef Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366(9486):643–648CrossRef
18.
Zurück zum Zitat Pavlidis N, Fizazi K (2009) Carcinoma of unknown primary (CUP). Crit Rev Oncol Hematol 69(3):271–278CrossRef Pavlidis N, Fizazi K (2009) Carcinoma of unknown primary (CUP). Crit Rev Oncol Hematol 69(3):271–278CrossRef
19.
Zurück zum Zitat Quraishi NA, Ramoutar D, Sureshkumar D, Manoharan SR, Spencer A, Arealis G, Edwards KL, Boszczyk BM (2014) Metastatic spinal cord compression as a result of the unknown primary tumour. Eur Spine J 23(7):1502–1507CrossRef Quraishi NA, Ramoutar D, Sureshkumar D, Manoharan SR, Spencer A, Arealis G, Edwards KL, Boszczyk BM (2014) Metastatic spinal cord compression as a result of the unknown primary tumour. Eur Spine J 23(7):1502–1507CrossRef
20.
Zurück zum Zitat Rades D, Conde-Moreno AJ, Garcia R, Veninga T, Schild SE (2015) A tool to estimate survival of elderly patients presenting with metastatic epidural spinal cord compression (MESCC) from cancer of unknown primary. Anticancer Res 35(11):6219–6222PubMed Rades D, Conde-Moreno AJ, Garcia R, Veninga T, Schild SE (2015) A tool to estimate survival of elderly patients presenting with metastatic epidural spinal cord compression (MESCC) from cancer of unknown primary. Anticancer Res 35(11):6219–6222PubMed
21.
Zurück zum Zitat Rades D, Dziggel L, Janssen S, Khoa MT, Duong VN, Khiem VH, Gebauer N, Bartscht T, Schild SE (2018) Predictive factors for local control and survival in patients with cancer of unknown primary (CUP) irradiated for cerebral metastases. Anticancer Res 38(4):2415–2418PubMed Rades D, Dziggel L, Janssen S, Khoa MT, Duong VN, Khiem VH, Gebauer N, Bartscht T, Schild SE (2018) Predictive factors for local control and survival in patients with cancer of unknown primary (CUP) irradiated for cerebral metastases. Anticancer Res 38(4):2415–2418PubMed
22.
Zurück zum Zitat Rades D, Fehlauer F, Veninga T, Stalpers LJ, Basic H, Hoskin PJ, Rudat V, Karstens JH, Schild SE, Dunst J (2007) Functional outcome and survival after radiotherapy of metastatic spinal cord compression in patients with cancer of unknown primary. Int J Radiat Oncol Biol Phys 67(2):532–537CrossRef Rades D, Fehlauer F, Veninga T, Stalpers LJ, Basic H, Hoskin PJ, Rudat V, Karstens JH, Schild SE, Dunst J (2007) Functional outcome and survival after radiotherapy of metastatic spinal cord compression in patients with cancer of unknown primary. Int J Radiat Oncol Biol Phys 67(2):532–537CrossRef
23.
Zurück zum Zitat Schmieder K, Keilholz U, Combs S (2016) The interdisciplinary management of brain metastases. Dtsch Arztebl Int 113(24):415–421PubMedPubMedCentral Schmieder K, Keilholz U, Combs S (2016) The interdisciplinary management of brain metastases. Dtsch Arztebl Int 113(24):415–421PubMedPubMedCentral
25.
Zurück zum Zitat Soffietti R, Abacioglu U, Baumert B, Combs SE, Kinhult S, Kros JM, Marosi C, Metellus P, Radbruch A, Villa Freixa SS, Brada M, Carapella CM, Preusser M, Le Rhun E, Rudà R, Tonn JC, Weber DC, Weller M (2017) Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European association of neuro-oncology (EANO). Neuro Oncol 19(2):162–174CrossRef Soffietti R, Abacioglu U, Baumert B, Combs SE, Kinhult S, Kros JM, Marosi C, Metellus P, Radbruch A, Villa Freixa SS, Brada M, Carapella CM, Preusser M, Le Rhun E, Rudà R, Tonn JC, Weber DC, Weller M (2017) Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European association of neuro-oncology (EANO). Neuro Oncol 19(2):162–174CrossRef
26.
Zurück zum Zitat Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W (2008) A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys 70(2):510–514CrossRef Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W (2008) A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys 70(2):510–514CrossRef
27.
Zurück zum Zitat Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine 26(3):298–306CrossRef Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine 26(3):298–306CrossRef
28.
Zurück zum Zitat Weiss LM, Chu P, Schroeder BE, Singh V, Zhang Y, Erlander MG, Schnabel CA (2013) Blinded comparator study of immunohistochemical analysis versus a 92-gene cancer classifier in the diagnosis of the primary site in metastatic tumors. J Mol Diagn 15(2):263–269CrossRef Weiss LM, Chu P, Schroeder BE, Singh V, Zhang Y, Erlander MG, Schnabel CA (2013) Blinded comparator study of immunohistochemical analysis versus a 92-gene cancer classifier in the diagnosis of the primary site in metastatic tumors. J Mol Diagn 15(2):263–269CrossRef
29.
Zurück zum Zitat Wolpert F, Weller M, Berghoff AS, Rushing E, Füreder LM, Petyt G, Leske H, Andratschke N, Regli L, Neidert MC, Stupp R, Stahel R, Dummer R, Frauenfelder T, Roth P, Reyns N, Kaufmann PA, Preusser M, Le Rhun E (2018) Diagnostic value of 18F‑fluordesoxyglucose positron emission tomography for patients with brain metastasis from unknown primary site. Eur J Cancer 96:64–72CrossRef Wolpert F, Weller M, Berghoff AS, Rushing E, Füreder LM, Petyt G, Leske H, Andratschke N, Regli L, Neidert MC, Stupp R, Stahel R, Dummer R, Frauenfelder T, Roth P, Reyns N, Kaufmann PA, Preusser M, Le Rhun E (2018) Diagnostic value of 18F‑fluordesoxyglucose positron emission tomography for patients with brain metastasis from unknown primary site. Eur J Cancer 96:64–72CrossRef
Metadaten
Titel
Sonderformen des CUP-Syndroms in Hirn und Wirbelsäule
verfasst von
Dr. med. D. Miller
Prof. Dr. med. K. Schmieder
Publikationsdatum
02.03.2021
Verlag
Springer Medizin
Erschienen in
Die Onkologie / Ausgabe 7/2021
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-021-00919-6

Weitere Artikel der Ausgabe 7/2021

Die Onkologie 7/2021 Zur Ausgabe

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.