title: Brain metastases as the first symptom of lung cancer: a clinical study from an Asian medical center.
abstract: OBJECTIVE
  Brain metastasis as the first symptom of lung cancer is a unique clinical entity. We conducted a retrospective study to investigate the clinical characteristics and survival of patients with lung cancer whose first symptom was brain metastases in an Asian population.
  
  
  METHODS
  A retrospective study of 186 such patients who had been admitted to one institution in China between January 1, 2003 and December 30, 2008 was performed. The following data were collected and analyzed: manifesting signs and symptoms, imaging studies, extracerebral metastases, initial diagnosis, treatment, and patient survival.
  
  
  RESULTS
  This sample population exhibited high rates of misdiagnosis upon initial presentation (46.8 %). Fifty-seven (30.6 %) patients presented with silent extracerebral metastases. Pathologies among this cohort varied, and adenocarcinomas were most commonly observed. Most patients received surgical resection, and some patients had additional whole-brain radiotherapy or stereotactic radiosurgery. The median survival time for the entire cohort was 15 months (95 % confidence interval, 12.9-17.1 months). Survival rates for 1, 2, and 5 years were 58.2, 34.2, and 6.5 %, respectively. The median survival time was 15, 14, 19, and 7 months for the gross total resection, incomplete resection, surgery + whole-brain radiotherapy, and surgery + stereotactic radiosurgery groups, respectively.
  
  
  CONCLUSIONS
  Brain metastasis as the first symptom of lung cancer is a distinct clinical entity. Although overall survival was poor, combined treatments based on surgery for selected patients were reasonable with the exception of a minority who experienced long-term survival.
authors.affiliation: Department of Oncology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai 200040, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Jin
authors.forename: Xinli
authors.initials: X
authors.lastname: Zhou
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Liang
authors.forename: Ruofan
authors.initials: R
authors.lastname: Huang
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Chu
authors.forename: Jingwei
authors.initials: J
authors.lastname: Jiang
authors.forename: Qiong
authors.initials: Q
authors.lastname: Zhan
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality / Q000473:pathology*; D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality / Q000556:secondary*; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult