Title: Incidence of Brain Metastases in Wahidin Sudirohusodo and Hasanuddin

University Hospital: A Retrospective Study

Article type: Literature Review
Keywords: Brain metastases, incidence, characteristics
Authors' name:
Djoko Widodo1
Kevin Jonathan Sjukur1
James Otniel1
Nailul Humam1
Affiliation:
1
Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas
Hasanuddin
Corresponding author: Djoko Widodo
Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas
Hasanuddin
Jl. Perintis Kemerdekaan KM 10 Tamalanrea Indah, Makassar
E-mail: djokwid@yahoo.co.id
Tel.: +62811449394; Postal code: 92211
Fax: +62(0411)-591331

Declaration of Competing Interest

The authors state there is no conflict of interest in writing this article.
Funding
This manuscript did not receive any funding.
Author Contribution
All authors have equal contributions in writing this article. All authors read and approved
the final manuscript.
Acknowledgment
None.
Retrospective study
Incidence of Brain Metastase in Wahidin Sudirohusodo and Hasanuddin
University Hospital : A Retrospective study.

ABSTRACT
Brain metastases are the most common intracranial tumors that occur in 10-30% of
adults and 6-10% of children. Almost 50% of brain neoplasms are metastatic, 30–40%
present with a single metastasis. Collecting data is needed as initial data on the
treatment of metastatic brain tumors to improve the service system and share with the
handling of the other centers. A retrospective multi-center study was performed on brain
metastase patients within collaboration data from multidisciplinary research conducted
between 2013 and 2023. Between 2013 and 2023, ? patients treated for newly
diagnosed brain metastases at our hospital via our database. The most common
symptom was ? (%), age was ? (%), gender was ? (%), symptoms (%), location (%),
primary tumor (%), and the most common histological subtypes were ? (%). This study
is still initial reports of brain metastasis cases which have been observed at Wahidin
Sudirohusodo Central Hospital and University Hasanuddin Hospital besides we do not
know whether the cases are recurence or not therefore we need further study to collect
more data on incidences of brain metastases at this hospital.

INTRODUCTION
Brain metastases, which are the most frequent intracranial tumors in adults and
affect 10% to 30% of adult [1] and 6–10% of pediatric cancer patients, are a significant
cause of morbidity and death. The American Cancer Society estimates that each year
170,000 cancer patients in the United States develop brain metastases. According to
recent estimates, there may be as many as 200,000 cases of brain metastases in the
United States alone per year. [2] Of individuals with systemic cancer, 20–40% develop
brain metastases; 30–40% only show single metastasis at a time. [3]
Based on a cross-sectional study carried out in the Neurology Unit at Dr.
Soetomo Hospital in Surabaya, Indonesia from August 2018 to July 2019, a total of 22
subjects with brain metastases were involved; 14 (63.6%) were male, and 13 (59.1%)
were aged ≥50 years. The most common clinical symptom reported by 78.2% of
patients was headache; the majority of patients (63.3%) had an MMSE score of ≤ 23;
CT-scan and MRI imaging suggested that multiple lesions were the most common, with
57.8% and 71.4%, respectively; the most common location of brain tumors was in the
parietal and temporal lobes (CT-scan imaging) and the temporal and cerebellar lobes
based on MRI; the most common source of brain metastases was lung tumors (50%),
followed by nasopharynx cancers (13.6% each); 9% had unknown sources. [4]
Brain parenchyma, leptomeninges, dura mater, and calvaria are possible sites for
brain metastase emergence. Historically, brain metastases have been associated with a
poor prognosis and have frequently led to neurologic deficits such as paralysis,
seizures, and cognitive loss. These deficiencies can severely impair a patient's quality
of life and make it more difficult for them to get additional therapy or to enroll in clinical
trials. [5] These patients had significant neurological problems that resulted in morbidity
and fatality. It seems that the majority of individuals who have more than three cerebral
metastases die young. Therefore, it's critical to determine the precise quantity of these
lesions. It is possible to find small brain metastases with magnetic resonance imaging
(MRI) [1].

METHODS
This research is a retrospective study design. The research was conducted at
Wahidin Sudirohusodo General Hospital and University Hasanuddin Hospital, one of the
largest central and eastern region hospitals in Indonesia, and also the main Teaching
Hospital in South Sulawesi Province, Indonesia. The population in this study consists of
all patients with brain metastases who were confirmed by histopathological examination
and treated at Wahidin Sudirohusodo General Hospital and University Hasanuddin
Hospital, with a sample size of 21 respondents whose data were collected from 2013 to
2017 and may progress until 2024. Sampling was conducted using consecutive
sampling.

The inclusion criteria for the study are all patients with brain metastasis who were
confirmed by histopathological examination and treated at Wahidin Sudirohusoso
General Hospital and University Hasanuddin Hospital. The characteristics in this study
will be informed by the components of age, gender, symptoms, tumor location, and
histopathological examination.

RESULT
21 participants whose information was gathered between 2013 and 2017. There
were? (?%) male respondents and? (?%) female respondents based on gender
characteristics. In this survey, the majority of responders were men. According to the
age group characteristics, the largest group in this study is made up of adolescents
(aged 12 to 25), with a total of? respondents (?%). Next in size is the adult (aged 26 to
45), followed by the elderly (aged 46 to 65), children (aged 6 to 12), and the least
represented group is the old (age above 65), with? respondents (?%).
The clinical symptoms in this study include headache, seizures, consciousness
decline, visual disturbance, and asymptomatic. The primary mechanism causing brain
injuries in this study is motor vehicle crashes, accounting for 36 cases (90%), followed
by falls with 3 cases (7.5%), and sports injuries with 1 case (2.5%). From the research
we conducted, it is known that the most frequent cases of cerebral edema based on CT
scan findings are grade 2, with a total of 11 cases (27.5%), followed by grade 1 with 10
cases (25%), grade 3 with 9 cases (22.5%), grade 0 with 7 cases (17.5%), and the least
frequent is grade 4 with 3 cases (7.5%).

Table 1. The characteristics of the study respondents

Grade Frequency (%)
Sex Men ? (?)
Women ? (?)
Children ? (?)
Age groups Teenagers ? (?)
Adults ? (?)
Elderly ? (?)
Old ? (?)
Clinical symptomps Headache ? (?)
 Seizure ? (?)
Consciousness decline ? (?)
Visual disturbance ? (?)
Asymptomatic ? (?)
Location of tumors Frontal ? (?)
Temporal ? (?)
Parietal ? (?)
Occipital ? (?)
Cerebellar ? (?)
Primary tumors Lung ? (?)
Breast ? (?)
Head and neck ? (?)
Prostate ? (?)
Unknown ? (?)

DISCUSSION
The most prevalent kind of brain tumor and a frequent side effect of cancer is
brain metastases. Brain metastases occur in between 10% and 26% of cancer patients
who pass away. Conventional therapy may not always be able to cure brain
metastasizing malignancies; however, patients may still experience minimal side effects
and long-term survival. As patient survival rates rise, neurocognition and quality of life
are becoming more widely acknowledged as critical outcomes. [6]
There were ? (?%) male respondents and ? (?%) female respondents based on
gender characteristics. In this survey, the majority of responders were men. The results
align with the ? et al investigation, which indicated a ? majority. ……
The study's age group characteristics indicate that, with a total of ? respondents
(?%), adolescents (aged 12–25) make up the ? group, followed by adults (aged 26–45)
with ? respondents (?%), the elderly (aged 46–65) with ? respondents (?%), children
(aged 6–12) with ? respondents (?%), and the old (age above 65) with ? respondent (?
%). These findings align with the research conducted by ? and colleagues, …….
When the blood-brain barrier is breached, metastatic cancer travels through the
bloodstream and enters the central nervous system. Following the local invasion,
 displacement, inflammation, and edema, clonal cells multiply. High blood flow regions
are more likely to have distribution throughout the central nervous system; yet, distinct
histological subtypes typically have distinct distributions of locations within the brain. [8]
In terms of location, the most common site for lesion development was the ? lobes,
followed by the ? and ?. These results are in line with the research conducted by Malik
Adam et al., the highest incidence was reported in the posterior of Sylvian fissure near
the region where the temporal, parietal, and occipital meet. Many metastases were
found to develop in the boundary area of substantia grisea and alba. [9]
Brain metastases are most common in primary malignancies such as
melanoma, lung, and breast cancers. Due to the significant risk of brain metastases
from small-cell lung cancer, cranial irradiation is recommended as a preventive
measure. Rarely do other tumors, such as head neck, and prostate cancers, spread to
the brain. Other than using tumor kind and subtype, it might be challenging to forecast
which patients would develop brain metastases. [7] In this study, the most common
primary tumors causing brain metastases are from the lung, accounting for? cases (?
%). These are followed by cases from the breast, head, and neck, with? cases (?%) and
prostate, with? cases (?%). This inquiry is consistent with the research conducted by?
et al. ……..

CONCLUSION
This study is still initial reports of brain metastasis cases which have been
observed at Wahidin Sudirohusodo Central Hospital and University Hasanuddin
Hospital beside we do not know whether the cases are recurence or not therefore we
need further study to collect more data of incidences of brain metastases at this
hospital.

BIBLIOGRAPHY
[1] J 1. Elisa Y Saito et all. Whole brain radiation therapy in management of brain metastasis: results
and prognostic factors. Radiation Oncology Journal. 2006. Vol (1) : 20.
[2] Zinat Miabi. Metastatic Brain Tumors: A Retrospective Review in East Azarbyjan
(Tabriz). Acta Medica Iranica. 2011. Vol (49) : 2.
[3] David W Andrews et all. 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 randomised trial. The Lancet Journal. 2004. Vol (363).
[4] Patricia Sacks, Maryam Rahman. Epidemiology of Brain Metastases. Neurosurg Clin N
Am. 2020. Vol 31 : 481–488
[5] Anandito, Nur Akbaryan. Ardiansyah, Djohan. Clinical and radiological profiles of
metastatic brain tumor in Indonesia: A study at Dr. Soetomo Hospital, Surabaya. Bali
Medical Journal. 2022. Vol. 11 No. 1.
[6] Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep. 2012
Feb;14(1):48-54
[7] Smedby KE, Brandt L, Bäcklund ML, Blomqvist P. Brain metastases admissions in
Sweden between 1987 and 2006. Br J Cancer. 2009 Dec 01;101(11):1919-24.
[8] Quattrocchi CC, Errante Y, Gaudino C, Mallio CA, Giona A, Santini D, Tonini G, Zobel
BB. Spatial brain distribution of intra-axial metastatic lesions in breast and lung cancer
patients. J Neurooncol. 2012 Oct;110(1):79-87.
[9] Sembiring IG. Characteristics of Patients with Metastatic Brain Tumors at H. Adam
Malik Hospital in 2014-2016. 2017.
 RESULTS

Primary
No. Sample Name Gender Age Symptom Location
Tumors
1 1