Brain Metastasis from Pancreatic Cancer: Our Experience and Systematic Review

The goal of this study was to systematically review the existing literature on neurosurgical management and outcomes of brain metastasis from pancreatic cancer in comparison to our institutional experience of this patient cohort. Following the PRISMA guidelines, a systematic literature review was performed using PubMed, Ovid Embase, Scopus, and Web of Science databases from date of database inception to March 2022. Studies were selected based on predetermined inclusion and exclusion criteria. Simulteanously, a retrospective analysis was conducted on patients who underwent neurosurgical evaluation and treatment for intracranial metastatic lesions from pancreatic origin at a single institution. Of the total 292 articles in the original literature search, 17 studies were ultimately selected. A total of 23 patients with brain metastases of pancreatic origin were included. Median overall survival from primary diagnosis of pancreatic cancer was 22 months (3-84) and 3 months (1-36) after diagnosis of brain metastasis. In our institution’s cohort, 4 patients were identified with a median overall survival of 30.5 months (2-108). Our institutional cohort experienced a prolonged median overall survival (3 vs 30.5 months, p=0.03) in comparison to the literature. Brain metastasis is a rare and fatal outcome of pancreatic cancer that carries a poor survival. However, based on the data presented in this review, there are patient-specific and treatment-related factors that could signal better prognosis. Further studies are needed to elucidate multimodal therapy and survival to suggest a more personalized decision-making process.