NCOG-53. Presenting and Therapy-Related Psychiatric Manifestations of Metastatic and Primary Brain Tumors. A Meta-Analysis and Systematic Review of Case Reports

INTRODUCTION Brain tumors range widely in histopathological characteristics and clinical severity. Presenting clinical cues of brain tumors range from focal neurological deficits to more insidious psychiatric symptoms. The purpose of this study is to describe the landscape of psychiatric manifestations of brain tumors. METHODS Datasets including Pubmed, MEDLINE, Scopus, Embase, PsychINFO, and Web of Science were queried for case reports between 1965-2025 using key terms for a variety of brain cancers and psychiatric symptomatology. Only case reports with adult patients with image and biopsy confirmed brain tumors with psychiatric symptoms were included. Duplicate deletion and abstract and full text screening was conducted with Rayyan.AI. RESULTS 16,480 total papers were extracted. 103 cases were included. The median age at presentation was 48 years (IQR: 35-60.5 years). The majority were male (n=58), had a mood disorder as the chief complaint (n=50), and had a tumor of the temporal lobe (n=25) or frontal lobe (n=24). There were marginally more left hemispheric tumors (n=21) than right hemispheric tumors (n=14). Almost all tumors were astrocytomas (n=32) or meningiomas (n=27). Only 4 were metastatic cancers. Surgery was the major therapy (n=67) with most psychiatric symptoms resolving after therapy (n=59). Demographic and pathologic characteristics were not associated significantly with the type of psychiatric manifestation. Type of tumor (p=0.04), therapeutic course (p<0.0001), and management of psychiatric symptoms (p=0.02) all had a significant impact on the resolution of symptoms. CONCLUSION The psychiatric manifestations of brain tumors remain heterogeneous across tumor types. However, type of tumor and surgery are important predictors of the complete resolution of symptoms post-treatment. Future research is needed to identify psychiatric symptoms as key characteristics of possibly insidious brain tumor progression.