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de Godoy LL, Chen YJ, Chawla S, Viaene AN, Wang S, Loevner LA, Alonso-Basanta M, Poptani H, Mohan S. Prognostication of overall survival in patients with brain metastases using diffusion tensor imaging and dynamic susceptibility contrast-enhanced MRI. Br J Radiol 2022; 95:20220516. [PMID: 36354164 PMCID: PMC9733614 DOI: 10.1259/bjr.20220516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/23/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To investigate the prognostic utility of DTI and DSC-PWI perfusion-derived parameters in brain metastases patients. METHODS Retrospective analyses of DTI-derived parameters (MD, FA, CL, CP, and CS) and DSC-perfusion PWI-derived rCBVmax from 101 patients diagnosed with brain metastases prior to treatment were performed. Using semi-automated segmentation, DTI metrics and rCBVmax were quantified from enhancing areas of the dominant metastatic lesion. For each metric, patients were classified as short- and long-term survivors based on analysis of the best coefficient for each parameter and percentile to separate the groups. Kaplan-Meier analysis was used to compare mOS between these groups. Multivariate survival analysis was subsequently conducted. A correlative histopathologic analysis was performed in a subcohort (n = 10) with DTI metrics and rCBVmax on opposite ends of the spectrum. RESULTS Significant differences in mOS were observed for MDmin (p < 0.05), FA (p < 0.01), CL (p < 0.05), and CP (p < 0.01) and trend toward significance for rCBVmax (p = 0.07) between the two risk groups, in the univariate analysis. On multivariate analysis, the best predictive survival model was comprised of MDmin (p = 0.05), rCBVmax (p < 0.05), RPA (p < 0.0001), and number of lesions (p = 0.07). On histopathology, metastatic tumors showed significant differences in the amount of stroma depending on the combination of DTI metrics and rCBVmax values. Patients with high stromal content demonstrated poorer mOS. CONCLUSION Pretreatment DTI-derived parameters, notably MDmin and rCBVmax, are promising imaging markers for prognostication of OS in patients with brain metastases. Stromal cellularity may be a contributing factor to these differences. ADVANCES IN KNOWLEDGE The correlation of DTI-derived metrics and perfusion MRI with patient outcomes has not been investigated in patients with treatment naïve brain metastasis. DTI and DSC-PWI can aid in therapeutic decision-making by providing additional clinical guidance.
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Affiliation(s)
- Laiz Laura de Godoy
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States
| | - Yin Jie Chen
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States
| | - Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States
| | - Angela N Viaene
- Division of Anatomic Pathology, Children’s Hospital of Philadelphia, Philadelphia, United States
| | - Sumei Wang
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States
| | - Laurie A Loevner
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States
| | - Harish Poptani
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Suyash Mohan
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, United States
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152
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Hartford AC, Gill GS, Ravi D, Tosteson TD, Li Z, Russo G, Eskey CJ, Jarvis LA, Simmons NE, Evans LT, Williams BB, Gladstone DJ, Roberts DW, Buckey JC. Sensitizing brain metastases to stereotactic radiosurgery using hyperbaric oxygen: A proof-of-principle study. Radiother Oncol 2022; 177:179-184. [PMID: 36404528 PMCID: PMC10827304 DOI: 10.1016/j.radonc.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/30/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Increased oxygen levels may enhance the radiosensitivity of brain metastases treated with stereotactic radiosurgery (SRS). This project administered hyperbaric oxygen (HBO) prior to SRS to assess feasibility, safety, and response. METHODS 38 patients were studied, 19 with 25 brain metastases treated with HBO prior to SRS, and 19 historical controls with 27 metastases, matched for histology, GPA, resection status, and lesion size. Outcomes included time from HBO to SRS, quality-of-life (QOL) measures, local control, distant (brain) metastases, radionecrosis, and overall survival. RESULTS The average time from HBO chamber to SRS beam-on was 8.3 ± 1.7 minutes. Solicited adverse events (AEs) were comparable between HBO and control patients; no grade III or IV serious AEs were observed. Radionecrosis-free survival (RNFS), radionecrosis-free survival before whole-brain radiation therapy (WBRT) (RNBWFS), local recurrence-free survival before WBRT (LRBWFS), distant recurrence-free survival before WBRT (DRBWFS), and overall survival (OS) were not significantly different for HBO patients and controls on Kaplan-Meier analysis, though at 1-year estimated survival rates trended in favor of SRS + HBO: RNFS - 83% vs 60%; RNBWFS - 78% vs 60%; LRBWFS - 95% vs 78%; DRBWFS - 61% vs 57%; and OS - 73% vs 56%. Multivariate Cox models indicated no significant association between HBO treatment and hazards of RN, local or distant recurrence, or mortality; however, these did show statistically significant associations (p < 0.05) for: local recurrence with higher volume, radionecrosis with tumor resection, overall survival with resection, and overall survival with higher GPA. CONCLUSION Addition of HBO to SRS for brain metastases is feasible without evident decrement in radiation necrosis and other clinical outcomes.
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Affiliation(s)
- Alan C Hartford
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
| | - Gobind S Gill
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Divya Ravi
- Dartmouth Cancer Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Tor D Tosteson
- Dartmouth Cancer Center, One Medical Center Drive, Lebanon, NH 03756, USA.
| | - Zhongze Li
- Dartmouth Cancer Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Gregory Russo
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Clifford J Eskey
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Lesley A Jarvis
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Nathan E Simmons
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Linton T Evans
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Benjamin B Williams
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - David J Gladstone
- Dartmouth Cancer Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - David W Roberts
- Dartmouth Cancer Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Jay C Buckey
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
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Trikhirhisthit K, Setakornnukul J, Thephamongkhol K. Added survival benefit of whole brain radiotherapy in brain metastatic non-small cell lung cancer: Development and external validation of an individual prediction model. Front Oncol 2022; 12:911835. [PMID: 36591469 PMCID: PMC9796174 DOI: 10.3389/fonc.2022.911835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background The heterogeneous survival benefit of whole brain radiotherapy (WBRT) in brain metastatic non-small cell lung cancer (NSCLC) was prospectively evidenced in the Quality of Life after Treatment for Brain Metastases (QUARTZ) trial, resulting in inconsistent guideline recommendations and diverse clinical practices for giving WBRT. The objective of this study was to develop and externally validate an individual prediction model to demonstrate the added survival benefit of WBRT to assist decision making when giving WBRT is undetermined. Methods For model development, we collected 479 brain metastatic NSCLC patients unfit for surgery or stereotactic radiotherapy techniques at Siriraj Hospital. Potential predictors were age, sex, performance status, histology, genetic mutation, neurological symptoms, extracranial disease, previous systemic treatment, measurable lesions, further systemic treatment, and WBRT. Cox proportional hazard regression was used for survival analysis. We used multiple imputations to handle missing data and a backward selection method for predictor selection. Bootstrapping was used for internal validation, while model performance was assessed with discrimination (c-index) and calibration prediction accuracy. The final model was transformed into a nomogram and a web-based calculator. An independent cohort from Sawanpracharak Hospital was used for external validation. Results In total, 452 patients in the development cohort died. The median survival time was 4.4 (95% CI, 3.8-4.9) months, with 5.1 months for patients who received WBRT and 2.3 months for those treated with optimal supportive care (OSC). The final model contained favorable predictors: female sex, KPS > 70, receiving additional systemic treatment, and WBRT. Having active extracranial disease, experiencing neurological symptoms, and receiving previous systemic treatment were adverse predictors. After optimism correction, the apparent c-index dropped from 0.71 (95% CI, 0.69-0.74) to 0.70 (95% CI, 0.69-0.73). The predicted and observed values agreed well in all risk groups. Our model performed well in the external validation cohort, with a c-index of 0.66 (95% CI, 0.59-0.73) and an acceptable calibration. Conclusions This model (https://siriraj-brainmetscore.netlify.app/) predicted the added survival benefit of WBRT for individual brain metastatic NSCLC patients, with satisfactory performance in the development and validation cohorts. The results certify its value in aiding treatment decision-making when the administration of WBRT is unclear.
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Affiliation(s)
- Kyrhatii Trikhirhisthit
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand,Division of Radiation Oncology, Department of Radiology, Sawanpracharak Hospital, Nakhonsawan, Thailand
| | - Jiraporn Setakornnukul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kullathorn Thephamongkhol
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand,*Correspondence: Kullathorn Thephamongkhol,
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The Analysis of Trends in Survival for Patients with Melanoma Brain Metastases with Introduction of Novel Therapeutic Options before the Era of Combined Immunotherapy-Multicenter Italian-Polish Report. Cancers (Basel) 2022; 14:cancers14235763. [PMID: 36497248 PMCID: PMC9737166 DOI: 10.3390/cancers14235763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Stage IV melanoma patients develop melanoma brain metastases (MBM) in 50% of cases. Their prognosis is improving, and its understanding outside the context of clinical trials is relevant. We have retrospectively analyzed the clinical data, course of treatment, and outcomes of 531 subsequent stage IV melanoma patients with BM treated in five reference Italian and Polish melanoma centers between 2014 and 2021. Patients with MBM after 2017 had a better prognosis, with a significantly improved median of overall survival (OS) after 2017 in the worst mol-GPA prognostic groups (mol-GPA ≤ 2): a median OS >6 months and HR 0.76 vs. those treated before 2017 (CI: 0.60−0.97, p = 0.027). In our prognostic model, mol-GPA was highly predictive for survival, and symptoms without steroid use did not have prognostic significance. Local therapy significantly improved survival regardless of the year of diagnosis (treated before or after 2017), with median survival >12 months. Systemic therapy improved outcomes when it was combined with local therapy. Local surgery was associated with improved OS regardless of the timing related to treatment start (i.e., before or after 30 days from MBM diagnosis). Local and systemic treatment significantly prolong survival for the poorest mol-GPA prognosis. Use of modern treatment modalities is justified in all mol-GPA prognostic groups.
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155
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Tang C, Qin S, Li Q, Huang Y. Therapeutic effectiveness and safety of sequential ICIs with radiotherapy for symptomatic brain and bone metastases in NSCLC patients. Medicine (Baltimore) 2022; 101:e31665. [PMID: 36401404 PMCID: PMC9678514 DOI: 10.1097/md.0000000000031665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
In advanced non-small cell lung cancer (NSCLC), the brain and bones are common metastatic sites, and the disease seriously affects the survival time and quality of life. For metastatic lesions with symptoms, local treatment often precedes systemic treatment. However, in clinical trials, patients with symptomatic brain or bone metastases are often excluded. Therefore, limited data are available on the efficacy of immune checkpoint inhibitors (ICIs) in those patients. We aimed to evaluate the effectiveness and safety of local radiotherapy followed by ICIs in driver gene-negative NSCLC patients with symptomatic local metastasis in the brain and bone. This is a 29-month 2 centered retrospective cohort study performed in China between March 2019 and August 2021. A total of 22 patients with advanced NSCLC were included. All patients received radiotherapy in the brain or bone before the administration of ICIs. For all patients, the overall response rate was 59.09%, the median progression-free survival (PFS) was 7.5 months, the PFS rate at 6 months was 72.73%, and the PFS rate at 1 year was 13.64%. Waterfall plots showed that tumor size was mostly reduced compared with baseline. The spider map showed that the tumor continued to shrink. In terms of symptom improvement, 100% pain control and 83.33% improvement were observed in epilepsy and neurological function. Sequential ICIs with local radiotherapy is effective for the treatment of patients with symptomatic brain and bone metastases of driver gene-negative NSCLC, which will benefit patients and improve their symptoms.
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Affiliation(s)
- Cuiping Tang
- The Second Clinical College of Chongqing Medical University, Chongqing, China
- Department of Oncology, the second affiliated hospital of Chongqing Medical University, Chongqing, China
| | - Si Qin
- Department of Oncology, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Qian Li
- Department of Pathology, Southwest Hospital, Army Military Medical University, Chongqing, China
- * Correspondence: Yusheng Huang, Department of Oncology, the second affiliated hospital of Chongqing Medical University, 288 Tianwen Avenue, Nan ‘an District, Chongqing, 400010 China (e-mail: )
| | - Yusheng Huang
- Department of Oncology, the second affiliated hospital of Chongqing Medical University, Chongqing, China
- * Correspondence: Yusheng Huang, Department of Oncology, the second affiliated hospital of Chongqing Medical University, 288 Tianwen Avenue, Nan ‘an District, Chongqing, 400010 China (e-mail: )
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156
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Jalalifar SA, Soliman H, Sahgal A, Sadeghi‐Naini A. Predicting the outcome of radiotherapy in brain metastasis by integrating the clinical and MRI-based deep learning features. Med Phys 2022; 49:7167-7178. [PMID: 35727568 PMCID: PMC10083982 DOI: 10.1002/mp.15814] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A considerable proportion of metastatic brain tumors progress locally despite stereotactic radiation treatment, and it can take months before such local progression is evident on follow-up imaging. Prediction of radiotherapy outcome in terms of tumor local failure is crucial for these patients and can facilitate treatment adjustments or allow for early salvage therapies. PURPOSE In this work, a novel deep learning architecture is introduced to predict the outcome of local control/failure in brain metastasis treated with stereotactic radiation therapy using treatment-planning magnetic resonance imaging (MRI) and standard clinical attributes. METHODS At the core of the proposed architecture is an InceptionResentV2 network to extract distinct features from each MRI slice for local outcome prediction. A recurrent or transformer network is integrated into the architecture to incorporate spatial dependencies between MRI slices into the predictive modeling. A visualization method based on prediction difference analysis is coupled with the deep learning model to illustrate how different regions of each lesion on MRI contribute to the model's prediction. The model was trained and optimized using the data acquired from 99 patients (116 lesions) and evaluated on an independent test set of 25 patients (40 lesions). RESULTS The results demonstrate the promising potential of the MRI deep learning features for outcome prediction, outperforming standard clinical variables. The prediction model with only clinical variables demonstrated an area under the receiver operating characteristic curve (AUC) of 0.68. The MRI deep learning models resulted in AUCs in the range of 0.72 to 0.83 depending on the mechanism to integrate information from MRI slices of each lesion. The best prediction performance (AUC = 0.86) was associated with the model that combined the MRI deep learning features with clinical variables and incorporated the inter-slice dependencies using a long short-term memory recurrent network. The visualization results highlighted the importance of tumor/lesion margins in local outcome prediction for brain metastasis. CONCLUSIONS The promising results of this study show the possibility of early prediction of radiotherapy outcome for brain metastasis via deep learning of MRI and clinical attributes at pre-treatment and encourage future studies on larger groups of patients treated with other radiotherapy modalities.
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Affiliation(s)
- Seyed Ali Jalalifar
- Department of Electrical Engineering and Computer ScienceLassonde School of EngineeringYork UniversityTorontoOntarioCanada
| | - Hany Soliman
- Department of Radiation OncologyOdette Cancer CentreSunnybrook Health Sciences CentreTorontoOntarioCanada
- Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
- Physical Sciences PlatformSunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Arjun Sahgal
- Department of Radiation OncologyOdette Cancer CentreSunnybrook Health Sciences CentreTorontoOntarioCanada
- Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
- Physical Sciences PlatformSunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Ali Sadeghi‐Naini
- Department of Electrical Engineering and Computer ScienceLassonde School of EngineeringYork UniversityTorontoOntarioCanada
- Department of Radiation OncologyOdette Cancer CentreSunnybrook Health Sciences CentreTorontoOntarioCanada
- Physical Sciences PlatformSunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
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157
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Prognostic Model for Intracranial Progression after Stereotactic Radiosurgery: A Multicenter Validation Study. Cancers (Basel) 2022; 14:cancers14215186. [PMID: 36358606 PMCID: PMC9657742 DOI: 10.3390/cancers14215186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
Stereotactic radiosurgery (SRS) is a standard of care for many patients with brain metastases. To optimize post-SRS surveillance, this study aimed to validate a previously published nomogram predicting post-SRS intracranial progression (IP). We identified consecutive patients completing an initial course of SRS across two institutions between July 2017 and December 2020. Patients were classified as low- or high-risk for post-SRS IP per a previously published nomogram. Overall survival (OS) and freedom from IP (FFIP) were assessed via the Kaplan−Meier method. Assessment of parameters impacting FFIP was performed with univariable and multivariable Cox proportional hazard models. Among 890 patients, median follow-up was 9.8 months (95% CI 9.1−11.2 months). In total, 47% had NSCLC primary tumors, and 47% had oligometastatic disease (defined as ≤5 metastastic foci) at the time of SRS. Per the IP nomogram, 53% of patients were deemed high-risk. For low- and high-risk patients, median FFIP was 13.9 months (95% CI 11.1−17.1 months) and 7.6 months (95% CI 6.4−9.3 months), respectively, and FFIP was superior in low-risk patients (p < 0.0001). This large multisite BM cohort supports the use of an IP nomogram as a quick and simple means of stratifying patients into low- and high-risk groups for post-SRS IP.
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158
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Impact of Tumour Segmentation Accuracy on Efficacy of Quantitative MRI Biomarkers of Radiotherapy Outcome in Brain Metastasis. Cancers (Basel) 2022; 14:cancers14205133. [PMID: 36291917 PMCID: PMC9601104 DOI: 10.3390/cancers14205133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Radiotherapy is a major treatment option for patients with brain metastasis. However, response to radiotherapy is highly varied among the patients, and it may take months before the response of brain metastasis to radiotherapy is apparent on standard follow-up imaging. This is not desirable, especially given the fact that patients diagnosed with brain metastasis suffer from a short median survival. Recent studies have shown the high potential of machine learning methods for analyzing quantitative imaging features (biomarkers) to predict the response of brain metastasis before or early after radiotherapy. However, these methods require manual delineation of individual tumours on imaging that is tedious and time-consuming, hindering further development and widespread application of these techniques. Here, we investigated the impact of using less accurate but automatically generated tumour outlines on the efficacy of the derived imaging biomarkers for radiotherapy response prediction. Our findings demonstrate that while the effect of tumour delineation accuracy is considerable for automatic contours with low accuracy, imaging biomarkers and prediction models are rather robust to imperfections in the produced tumour masks. The results of this study open the avenue to utilizing automatically generated tumour contours for discovering imaging biomarkers without sacrificing their accuracy. Abstract Significantly affecting patients’ clinical course and quality of life, a growing number of cancer cases are diagnosed with brain metastasis (BM) annually. Stereotactic radiotherapy is now a major treatment option for patients with BM. However, it may take months before the local response of BM to stereotactic radiation treatment is apparent on standard follow-up imaging. While machine learning in conjunction with radiomics has shown great promise in predicting the local response of BM before or early after radiotherapy, further development and widespread application of such techniques has been hindered by their dependency on manual tumour delineation. In this study, we explored the impact of using less-accurate automatically generated segmentation masks on the efficacy of radiomic features for radiotherapy outcome prediction in BM. The findings of this study demonstrate that while the effect of tumour delineation accuracy is substantial for segmentation models with lower dice scores (dice score ≤ 0.85), radiomic features and prediction models are rather resilient to imperfections in the produced tumour masks. Specifically, the selected radiomic features (six shared features out of seven) and performance of the prediction model (accuracy of 80% versus 80%, AUC of 0.81 versus 0.78) were fairly similar for the ground-truth and automatically generated segmentation masks, with dice scores close to 0.90. The positive outcome of this work paves the way for adopting high-throughput automatically generated tumour masks for discovering diagnostic and prognostic imaging biomarkers in BM without sacrificing accuracy.
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159
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Xie D, Xu F, Zhu W, Pu C, Huang S, Lou K, Wu Y, Huang D, He C, Hu H. Delta radiomics model for the prediction of progression-free survival time in advanced non-small-cell lung cancer patients after immunotherapy. Front Oncol 2022; 12:990608. [PMID: 36276082 PMCID: PMC9583844 DOI: 10.3389/fonc.2022.990608] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the validity of pre- and posttreatment computed tomography (CT)-based radiomics signatures and delta radiomics signatures for predicting progression-free survival (PFS) in stage III-IV non-small-cell lung cancer (NSCLC) patients after immune checkpoint inhibitor (ICI) therapy. Methods Quantitative image features of the largest primary lung tumours were extracted on CT-enhanced imaging at baseline (time point 0, TP0) and after the 2nd-3rd immunotherapy cycles (time point 1, TP1). The critical features were selected to construct TP0, TP1 and delta radiomics signatures for the risk stratification of patient survival after ICI treatment. In addition, a prediction model integrating the clinicopathologic risk characteristics and phenotypic signature was developed for the prediction of PFS. Results The C-index of TP0, TP1 and delta radiomics models in the training and validation cohort were 0.64, 0.75, 0.80, and 0.61, 0.68, 0.78, respectively. The delta radiomics score exhibited good accuracy for distinguishing patients with slow and rapid progression to ICI treatment. The predictive accuracy of the combined prediction model was higher than that of the clinical prediction model in both training and validation sets (P<0.05), with a C-index of 0.83 and 0.70, respectively. Additionally, the delta radiomics model (C-index of 0.86) had a higher predictive accuracy compared to PD-L1 expression (C-index of 0.50) (P<0.0001). Conclusions The combined prediction model including clinicopathologic characteristics (tumour anatomical classification and brain metastasis) and the delta radiomics signature could achieve the individualized prediction of PFS in ICIs-treated NSCLC patients.
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Affiliation(s)
- Dong Xie
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Radiology, Shaoxing Second Hospital, Shaoxing, China
| | - Fangyi Xu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenchao Zhu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cailing Pu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shaoyu Huang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Radiology, Ningbo Medical Center LiHuili Hospital, Ningbo, China
| | - Kaihua Lou
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Wu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dingpin Huang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cong He
- Department of Radiology, Shaoxing Second Hospital, Shaoxing, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Hongjie Hu,
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Goeckeritz J, Cerillo J, Sanghadia C, Hosseini M, Clark A, Pierre K, Lucke-Wold B. Principles of Lung Cancer Metastasis to Brain. JOURNAL OF SKELETON SYSTEM 2022; 1:https://www.mediresonline.org/article/principles-of-lung-cancer-metastasis-to-brain. [PMID: 36745145 PMCID: PMC9893877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung cancer is a disease associated with significant morbidity and mortality on a global setting. This form of cancer commonly gives raise to metastatic lesions the brain, which can further worsen outcomes. In this focused review, we discuss an overview of lung cancers that metastasize to the brain: known risk factors; means of detection and diagnosis; and options for treatment including a comparison between surgical resection, stereotactic radiosurgery, and whole-brain radiation therapy. These interventions are still being assessed by clinical trials and continue to be modified through evidence-based practice.
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Affiliation(s)
| | - John Cerillo
- College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL
| | | | | | - Alec Clark
- College of Medicine, University of Central Florida, Orlando, FL
| | - Kevin Pierre
- Department of Radiology, University of Florida, Gainesville, FL
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161
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Cho A, Hennenberg J, Untersteiner H, Hirschmann D, Gatterbauer B, Zöchbauer-Müller S, Hochmair MJ, Preusser M, Rössler K, Dorfer C, Frischer JM, Furtner J. Influence of temporal muscle thickness on the outcome of radiosurgically treated patients with brain metastases from non-small cell lung cancer. J Neurosurg 2022; 137:999-1005. [PMID: 35120324 DOI: 10.3171/2021.12.jns212193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/06/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the impact of temporal muscle thickness (TMT), a surrogate marker for sarcopenia, in radiosurgically treated patients with brain metastases (BMs) from non-small cell lung cancer (NSCLC). METHODS For 566 patients with BMs from NSCLC in the period between June 2012 and December 2019, TMT values were retrospectively measured on the planning brain magnetic resonance imaging (MRI) studies that had been obtained before their first Gamma Knife radiosurgery treatment (GKRS1). Predefined sex-specific TMT cutoff values were used to stratify the study cohort into patients at risk for sarcopenia and patients with normal muscle status. Cox regression models adjusted for other prognostic parameters were used to evaluate sarcopenia as an independent prognostic factor. RESULTS In sarcopenia patients with a TMT below the sex-specific cutoff values, the risk of death was significantly increased (HR 1.908, 95% CI 1.550-2.349, p < 0.001). In addition, sarcopenia was revealed as an independent prognostic factor even after adjusting for age groups, sex, number of BMs, presence of extracranial metastases, NSCLC subtypes, Karnofsky Performance Status groups, recursive partitioning analysis classes, and concomitant immunotherapy or targeted therapy (HR 1.680, 95% CI 1.347-2.095, p < 0.001). However, patients at risk for sarcopenia showed no significant differences in the estimated mean time until local BM progression after GKRS1, compared to patients with normal muscle status (p = 0.639). CONCLUSIONS TMT obtained from planning MRI studies is an independent prognostic marker in radiosurgically treated patients with BMs from NSCLC and may aid patient stratification in future clinical trials.
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Affiliation(s)
| | - Juliane Hennenberg
- 2Biomedical Imaging and Image-guided Therapy, Medical University of Vienna
| | | | | | | | | | - Maximilian J Hochmair
- 4Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Matthias Preusser
- 3Department of Internal Medicine I, Division of Oncology, Medical University of Vienna; and
| | | | | | | | - Julia Furtner
- 2Biomedical Imaging and Image-guided Therapy, Medical University of Vienna
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162
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Yoo J, Kim HJ, Kim SM, Park HH. Prognostic factors to predict the efficacy of surgical interventions against brain metastasis secondary to thyroid cancer. Eur Thyroid J 2022; 11:e220087. [PMID: 35900775 PMCID: PMC9346320 DOI: 10.1530/etj-22-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Brain metastasis in differentiated thyroid cancer (DTC) is rare (frequency < 1%) and has a poor prognosis. Treatment strategies for brain metastasis are not well established. Objectives We conducted a retrospective analysis to identify predictive factors for patient outcomes and verify surgical indications for patients with brain metastasis and DTC. Methods The study included 34 patients with pathologically confirmed DTC with brain metastasis from March 2008 to November 2020. The associations between overall survival (OS) and clinical factors were evaluated. Cox regression analysis was used to determine the relationship between clinical factors and OS. To assess the survival benefit of craniotomy, Kaplan-Meier survival analysis was performed for each variable whose statistical significance was determined by Cox regression analysis. Results The median OS of the entire patient sample was 11.4 months. Survival was affected by the presence of lung metastasis (P = 0.033) and the number of brain metastases (n > 3) (P = 0.039). Only the subgroup with the number of brain metastases ≤3 showed statistical significance in the subgroup analysis of survival benefit following craniotomy (P = 0.048). Conclusions The number of brain metastases and the existence of lung metastasis were regarded more essential than other clinical factors in patients with DTC in this study. Furthermore, craniotomies indicated a survival benefit only when the number of brain metastases was ≤3. This finding could be beneficial in determining surgical indications in thyroid cancer with brain metastasis.
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Affiliation(s)
- Jihwan Yoo
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Seoul, Republic of Korea
- College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hee Jun Kim
- Department of Surgery, CHA Ilsan Medical Center, Cha University School of Medicine, Goyang-si, Republic of Korea
| | - Seok Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hun Ho Park
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Seoul, Republic of Korea
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Uto M, Torizuka D, Mizowaki T. Single isocenter stereotactic irradiation for multiple brain metastases: current situation and prospects. Jpn J Radiol 2022; 40:987-994. [PMID: 36057071 PMCID: PMC9529683 DOI: 10.1007/s11604-022-01333-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/24/2022] [Indexed: 10/29/2022]
Abstract
The prognosis of patients with brain metastases has dramatically improved, and long-term tumor control and reduction of the risk of late toxicities, including neurocognitive dysfunction, are important for patient quality of life. Stereotactic irradiation for multiple brain metastases, rather than whole-brain radiotherapy, can result in high local control rate with low incidence of neurocognitive deterioration and leukoencephalopathy. Recent advances in radiotherapy devices, treatment-planning systems, and image-guided radiotherapy can realize single isocenter stereotactic irradiation for multiple brain metastases (SI-STI-MBM), in which only one isocenter is sufficient to treat multiple brain metastases simultaneously. SI-STI-MBM has expanded the indications for linear accelerator-based stereotactic irradiation and considerably reduced patient burden. This review summarizes the background, methods, clinical outcomes, and specific consideration points of SI-STI-MBM. In addition, the prospects of SI-STI-MBM are addressed.
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Affiliation(s)
- Megumi Uto
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Daichi Torizuka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
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164
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Li Z, Liang N, Wang N, Jia Y, Tian C. WDR5 is a prognostic biomarker of brain metastasis from non-small cell lung cancer. Front Oncol 2022; 12:1023776. [PMID: 36249032 PMCID: PMC9557102 DOI: 10.3389/fonc.2022.1023776] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/13/2022] [Indexed: 12/09/2022] Open
Abstract
Background Lung cancer (LC) is the most frequent caner type and causes the most cancer-related death. Brain metastases (BM) are the deadliest complications of lung cancer, and the prognostic biomarkers of BM are urgently needed. Materials and methods In our study, we established an inception cohort including 122 patients with asynchronous BM from NSCLC, and further selected 70 patients who received surgical resection, which compromised the validation cohort. With immunohistochemistry, we investigated the expression of WDR5 in the cohort. By chi-square method, the correlations between WDR5 and clinicopathological factors were analyzed. The prognostic indicators were analyzed with the univariate analysis, and independent prognostic factors were identified by multivariate analysis with Cox-regression model. Results WDR5 is frequently expressed in the cytoplasm of BM from NSCLC. Patients with low or high expression of WDR5 account for 60% and 40% respectively. High expression of WDR5 indicates poor prognosis of BM from NSCLC (P=0.001). In addition to WDR5, KPS is also a prognostic factor of BM, and high KPS predicts favorable prognosis (P=0.006). WDR5 is an independent prognostic biomarker for poor prognosis of BM from NSCLC, with the cancer-related odds as 2.48. Conclusions High expression of WDR5 can predict the poor prognosis of BM, and WDR5 is an independent prognostic biomarker of BM from NSCLC. Patients with WDR5 overexpression are more high-risk to suffer BM-related death and should receive more intense post-operational supervision.
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Affiliation(s)
- Zheng Li
- Department of Neurosurgery, The Second Affiliated Hospital of Shandong First Medical University, Tai’an, China
| | - Nan Liang
- Department of Neurosurgery, The Second Affiliated Hospital of Shandong First Medical University, Tai’an, China
| | - Na Wang
- Department of Anesthesiology, The First People’s Hospital of Tai’an, Tai’an, China
| | - Yan Jia
- Department of Intensive Care Unit, Shandong Provincial Tai’shan Hospital, Tai’an, China
| | - Cui Tian
- Department of Intensive Care Unit, The Second Affiliated Hospital of Shandong First Medical University, Tai’an, China
- *Correspondence: Cui Tian,
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165
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Differentiating Primary Tumors for Brain Metastasis with Integrated Radiomics from Multiple Imaging Modalities. DISEASE MARKERS 2022; 2022:5147085. [PMID: 36199819 PMCID: PMC9529469 DOI: 10.1155/2022/5147085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/13/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022]
Abstract
Objectives. To differentiate the primary site of brain metastases (BMs) is of high clinical value for the successful management of patients with BM. The purpose of this study is to investigate a combined radiomics model with computer tomography (CT) and magnetic resonance imaging (MRI) images in differentiating BMs originated from lung and breast cancer. Methods. Pretreatment cerebral contrast enhanced CT and T1-weighted MRI images of 78 patients with 179 BMs from primary lung and breast cancer were retrospectively analyzed. Radiomic features were extracted from contoured BM lesions and selected using the Mann–Whitney
test and the least absolute shrinkage and selection operator (LASSO) logistic regression. Binary logistic regression (BLR) and support vector machine (SVM) models were built and evaluated based on selected radiomic features from CT alone, MRI alone, and combined images to differentiate BMs originated from lung and breast cancer. Results. A total of 10 and 6 optimal radiomic features were screened out of 1288 CT and 1197 MRI features, respectively. The mean area under the curves (AUCs) of the BLR and SVM models using fivefolds cross-validation were 0.703 vs. 0.751, 0.718 vs. 0.754, and 0.781 vs. 0.803 in the training dataset and 0.708 vs. 0.763, 0.715 vs. 0.717, and 0.771 vs. 0.805 in the testing dataset for models with CT alone, MRI alone, and combined CT and MRI radiomic features, respectively. Conclusions. Radiomics model based on combined CT and MRI features is feasible and accurate in the differentiation of the primary site of BMs from lung and breast cancer.
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166
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Yoo J, Joo B, Park J, Park HH, Park M, Ahn SJ, Suh SH, Kim JJ, Oh J. Delirium-related factors and their prognostic value in patients undergoing craniotomy for brain metastasis. Front Neurol 2022; 13:988293. [PMID: 36226079 PMCID: PMC9548882 DOI: 10.3389/fneur.2022.988293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Delirium is characterized by acute brain dysfunction. Although delirium significantly affects the quality of life of patients with brain metastases, little is known about delirium in patients who undergo craniotomy for brain metastases. This study aimed to identify the factors influencing the occurrence of delirium following craniotomy for brain metastases and determine its impact on patient prognosis. Method A total of 153 patients who underwent craniotomy for brain metastases between March 2013 and December 2020 were evaluated for clinical and radiological factors related to the occurrence of delirium. Statistical analysis was conducted by dividing the patients into two groups based on the presence of delirium, and statistical significance was confirmed by adjusting the clinical characteristics of the patients with brain metastases using propensity score matching (PSM). The effect of delirium on patient survival was subsequently evaluated using Kaplan-Meier analysis. Results Of 153 patients, 14 (9.2%) had delirium. Age (P = 0.002), sex (P = 0.007), and presence of postoperative hematoma (P = 0.001) were significantly different between the delirium and non-delirium groups. When the matched patients (14 patients in each group) were compared using PSM, postoperative hematoma showed a statistically significant difference (P = 0.036) between the delirium and non-delirium groups. Kaplan-Meier survival analysis revealed that the delirium group had poorer prognosis (log-rank score of 0.0032) than the non-delirium group. Conclusion In addition to the previously identified factors, postoperative hematoma was identified as a strong predictor of postoperative delirium. Also, the negative impact of delirium on patient prognosis including low survival rate was confirmed.
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Affiliation(s)
- Jihwan Yoo
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Juyeong Park
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hun Ho Park
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae-Jin Kim
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jooyoung Oh
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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167
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Oishi T, Ito M, Koizumi S, Horikawa M, Yamamoto T, Yamagishi S, Yamasaki T, Sameshima T, Suzuki T, Sugimura H, Namba H, Kurozumi K. Efficacy of HSV-TK/GCV system suicide gene therapy using SHED expressing modified HSV-TK against lung cancer brain metastases. Mol Ther Methods Clin Dev 2022; 26:253-265. [PMID: 35892087 PMCID: PMC9307584 DOI: 10.1016/j.omtm.2022.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022]
Abstract
Lung cancer is one of the most common cancers, and the number of patients with intracranial metastases is increasing. Previously, we developed an enzyme prodrug suicide gene therapy based on the herpes simplex virus thymidine kinase (HSV-TK)/ganciclovir (GCV) system using various mesenchymal stem cells to induce apoptosis in malignant gliomas through bystander killing effects. Here, we describe stem cells from human exfoliated deciduous teeth (SHED) as gene vehicles of the TK/GCV system against a brain metastasis model of non-small cell lung cancer (NSCLC). We introduced the A168H mutant TK (TKA168H) into SHED to establish the therapeutic cells because of the latent toxicity of wild type. SHED expressing TKA168H (SHED-TK) exhibited chemotaxis to the conditioned medium of NSCLC and migrated toward implanted NSCLC in vivo. SHED-TK demonstrated a strong bystander effect in vitro and in vivo and completely eradicated H1299 NSCLC in the brain. SHED-TK cells implanted intratumorally followed by GCV administration significantly suppressed the growth of H1299 and improved survival time. These results indicate that the TKA168H variant is suitable for establishing therapeutic cells and that intratumoral injection of SHED-TK followed by GCV administration may be a useful strategy for therapeutic approaches.
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Affiliation(s)
- Tomoya Oishi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masahiko Ito
- Department of Virology and Parasitology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shinichiro Koizumi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Makoto Horikawa
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Taisuke Yamamoto
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Satoru Yamagishi
- Department of Organ and Tissue Anatomy, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Preeminent Medical Photonics Education and Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Yamasaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tetsuro Sameshima
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tetsuro Suzuki
- Department of Virology and Parasitology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Haruhiko Sugimura
- Department of Tumor Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Namba
- Department of Neurosurgery, Enshu Hospital, Hamamatsu, Japan
| | - Kazuhiko Kurozumi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Association between Temporal Muscle Thickness and Overall Survival in Non-Small Cell Lung Cancer Patients with Brain Metastasis. Curr Oncol 2022; 29:6463-6471. [PMID: 36135077 PMCID: PMC9497949 DOI: 10.3390/curroncol29090508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 12/01/2022] Open
Abstract
Temporal muscle thickness (TMT) has recently been suggested as a novel biomarker of sarcopenia in head and neck malignancies. However, few studies have evaluated TMT as a prognostic marker in patients with brain metastasis. This study investigated the association of TMT with overall survival (OS) in non-small cell lung cancer (NSCLC) patients with brain metastasis. The records of all NSCLC patients with brain metastasis between 2009 and 2018 at St. Vincent’s Hospital were reviewed retrospectively. A total of 221 patients met our eligibility criteria. In the group with TMT thicker than the median, OS was longer than the group with TMT thinner than the median (240 days versus 139 days, p = 0.014). In multivariate analysis, the thicker TMT group had longer survival (HR 0.73 CI 0.56−0.96, p = 0.024). Male (HR 1.58 CI 1.19−2.09, p = 0.002) and older age (≥65 years) (HR 2.05 CI 1.53−2.74, p < 0.001) also showed statistical significance. We also performed subgroup analysis in older patients (≥65 years). In this subgroup of 107 patients, the thicker TMT group also showed longer OS than the thinner TMT group (209 days versus 82 days, p = 0.009). Our findings suggest that TMT can be a useful biomarker for OS in NSCLC patients with brain metastasis.
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169
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The Lung Graded Prognostic Assessment: Continued Evolution of Brain Metastases Prognostication. Int J Radiat Oncol Biol Phys 2022; 114:75-77. [PMID: 35964633 DOI: 10.1016/j.ijrobp.2022.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/15/2022] [Accepted: 05/28/2022] [Indexed: 11/24/2022]
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170
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Hulsbergen AFC, Lo YT, Awakimjan I, Kavouridis VK, Phillips JG, Smith TR, Verhoeff JJC, Yu KH, Broekman MLD, Arnaout O. Survival Prediction After Neurosurgical Resection of Brain Metastases: A Machine Learning Approach. Neurosurgery 2022; 91:381-388. [PMID: 35608378 PMCID: PMC10553019 DOI: 10.1227/neu.0000000000002037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Current prognostic models for brain metastases (BMs) have been constructed and validated almost entirely with data from patients receiving up-front radiotherapy, leaving uncertainty about surgical patients. OBJECTIVE To build and validate a model predicting 6-month survival after BM resection using different machine learning algorithms. METHODS An institutional database of 1062 patients who underwent resection for BM was split into an 80:20 training and testing set. Seven different machine learning algorithms were trained and assessed for performance; an established prognostic model for patients with BM undergoing radiotherapy, the diagnosis-specific graded prognostic assessment, was also evaluated. Model performance was assessed using area under the curve (AUC) and calibration. RESULTS The logistic regression showed the best performance with an AUC of 0.71 in the hold-out test set, a calibration slope of 0.76, and a calibration intercept of 0.03. The diagnosis-specific graded prognostic assessment had an AUC of 0.66. Patients were stratified into regular-risk, high-risk and very high-risk groups for death at 6 months; these strata strongly predicted both 6-month and longitudinal overall survival ( P < .0005). The model was implemented into a web application that can be accessed through http://brainmets.morethanml.com . CONCLUSION We developed and internally validated a prediction model that accurately predicts 6-month survival after neurosurgical resection for BM and allows for meaningful risk stratification. Future efforts should focus on external validation of our model.
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Affiliation(s)
- Alexander F. C. Hulsbergen
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
- Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Yu Tung Lo
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
- Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Ilia Awakimjan
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
| | - Vasileios K. Kavouridis
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
| | - John G. Phillips
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
- Radiation Oncology, Tennessee Oncology, Nashville, Tennessee, USA
| | - Timothy R. Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
| | - Joost J. C. Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands
| | - Kun-Hsing Yu
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA;
| | - Marike L. D. Broekman
- Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Leiden University, Leiden, The Netherlands
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Omar Arnaout
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
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Sperduto PW, De B, Li J, Carpenter D, Kirkpatrick J, Milligan M, Shih HA, Kutuk T, Kotecha R, Higaki H, Otsuka M, Aoyama H, Bourgoin M, Roberge D, Dajani S, Sachdev S, Gainey J, Buatti JM, Breen W, Brown PD, Ni L, Braunstein S, Gallitto M, Wang TJC, Shanley R, Lou E, Shiao J, Gaspar LE, Tanabe S, Nakano T, An Y, Chiang V, Zeng L, Soliman H, Elhalawani H, Cagney D, Thomas E, Boggs DH, Ahluwalia MS, Mehta MP. Graded Prognostic Assessment (GPA) for Patients With Lung Cancer and Brain Metastases: Initial Report of the Small Cell Lung Cancer GPA and Update of the Non-Small Cell Lung Cancer GPA Including the Effect of Programmed Death Ligand 1 and Other Prognostic Factors. Int J Radiat Oncol Biol Phys 2022; 114:60-74. [PMID: 35331827 PMCID: PMC9378572 DOI: 10.1016/j.ijrobp.2022.03.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/02/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Patients with lung cancer and brain metastases represent a markedly heterogeneous population. Accurate prognosis is essential to optimally individualize care. In prior publications, we described the graded prognostic assessment (GPA), but a GPA for patients with small cell lung cancer (SCLC) has never been reported, and in non-small cell lung cancer (NSCLC), the effect of programmed death ligand 1 (PD-L1) was unknown. The 3-fold purpose of this work is to provide the initial report of an SCLC GPA, to evaluate the effect of PD-L1 on survival in patients with NSCLC, and to update the Lung GPA accordingly. METHODS AND MATERIALS A multivariable analysis of prognostic factors and treatments associated with survival was performed on 4183 patients with lung cancer (3002 adenocarcinoma, 611 nonadenocarcinoma, 570 SCLC) with newly diagnosed brain metastases between January 1, 2015, and December 31, 2020, using a multi-institutional retrospective database. Significant variables were used to update the Lung GPA. RESULTS Overall median survival for lung adenocarcinoma, SCLC, and nonadenocarcinoma was 17, 10, and 8 months, respectively, but varied widely by GPA from 2 to 52 months. In SCLC, the significant prognostic factors were age, performance status, extracranial metastases, and number of brain metastases. In NSCLC, the distribution of molecular markers among patients with lung adenocarcinoma and known primary tumor molecular status revealed alterations/expression in PD-L1 50% to 100%, PD-L1 1% to 49%, epidermal growth factor receptor, and anaplastic lymphoma kinase in 32%, 31%, 30%, and 7%, respectively. Median survival of patients with lung adenocarcinoma and brain metastases with 0, 1% to 49%, and ≥50% PD-L1 expression was 17, 19, and 24 months, respectively (P < .01), confirming PD-L1 is a prognostic factor. Previously identified prognostic factors for NSCLC (epidermal growth factor receptor and anaplastic lymphoma kinase status, performance status, age, number of brain metastases, and extracranial metastases) were reaffirmed. These factors were incorporated into the updated Lung GPA with robust separation between subgroups for all histologies. CONCLUSIONS Survival for patients with lung cancer and brain metastases has improved but varies widely. The initial report of a GPA for SCLC is presented. For patients with NSCLC-adenocarcinoma and brain metastases, PD-L1 is a newly identified significant prognostic factor, and the previously identified factors were reaffirmed. The updated indices establish unique criteria for SCLC, NSCLC-nonadenocarcinoma, and NSCLC-adenocarcinoma (incorporating PD-L1). The updated Lung GPA, available for free at brainmetgpa.com, provides an accurate tool to estimate survival, individualize treatment, and stratify clinical trials.
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Affiliation(s)
| | - Brian De
- MD Anderson Cancer Center, Houston, Texas
| | - Jing Li
- MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Helen A Shih
- Massachusetts General Hospital, Boston, Massachusetts
| | - Tugce Kutuk
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Rupesh Kotecha
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | | | | | - Hidefumi Aoyama
- Hokkaido Cancer Center, Hokkaido, Japan; Hokkaido University, Sapporo, Japan
| | - Malie Bourgoin
- Centre Hospitalier de l' Université de Montreal, Montreal, Quebec, Canada
| | - David Roberge
- Centre Hospitalier de l' Université de Montreal, Montreal, Quebec, Canada
| | | | | | | | | | | | | | - Lisa Ni
- University of California, San Francisco, California
| | | | | | | | | | - Emil Lou
- University of Minnesota, Minneapolis, Minnesota
| | - Jay Shiao
- University of Colorado Denver, Denver, Colorado
| | - Laurie E Gaspar
- University of Colorado Denver, Denver, Colorado; Banner MD Anderson Cancer Center, Loveland, Colorado
| | | | | | - Yi An
- Yale University, New Haven, Connecticut
| | | | - Liang Zeng
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hany Soliman
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Evan Thomas
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Minesh P Mehta
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
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Safety and efficacy of pralsetinib in RET fusion-positive non-small cell lung cancer including as first-line therapy: update from the ARROW trial. Ann Oncol 2022; 33:1168-1178. [PMID: 35973665 DOI: 10.1016/j.annonc.2022.08.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND RET fusions are present in 1%-2% of non-small cell lung cancer (NSCLC). Pralsetinib, a highly potent, oral, central nervous system-penetrant, selective RET inhibitor, previously demonstrated clinical activity in patients with RET fusion-positive NSCLC in the phase I/II ARROW study, including among treatment-naïve patients. We report an updated analysis from the ARROW study. PATIENTS AND METHODS ARROW is a multi-cohort, open-label, phase I/II study. Eligible patients were ≥18 years of age with locally advanced or metastatic solid tumours and an Eastern Cooperative Oncology Group performance status 0-2 (later 0-1). Patients initiated pralsetinib at the recommended phase II dose of 400 mg once-daily (QD) until disease progression, intolerance, consent withdrawal, or investigator's decision. The co-primary endpoints (phase II) were overall response rate (ORR) by blinded independent central review and safety. RESULTS Between 17 March 2017 and 06 November 2020 (data cutoff), 281 patients with RET fusion-positive NSCLC were enrolled. The ORR was 72% (54/75; 95% CI, 60-82) for treatment-naïve patients and 59% (80/136; 95% CI, 50-67) for patients with prior platinum-based chemotherapy (enrolment cutoff for efficacy analysis: 22 May 2020); median duration of response was not reached for treatment-naïve patients and 22.3 months for prior platinum-based chemotherapy patients. Tumour shrinkage was observed in all treatment-naïve patients and in 97% of patients with prior platinum-based chemotherapy; median progression-free survival was 13.0 and 16.5 months, respectively. In patients with measurable intracranial metastases, the intracranial response rate was 70% (7/10; 95% CI, 35-93); all had received prior systemic treatment. In treatment-naïve patients with RET fusion-positive NSCLC who initiated pralsetinib by the data cutoff (n = 116), the most common Grade 3-4 treatment-related adverse events (TRAEs) were neutropenia (18%), hypertension (10%), increased blood creatine phosphokinase (9%), and lymphopenia (9%). Overall, 7% (20/281) discontinued due to TRAEs. CONCLUSIONS Pralsetinib treatment produced robust efficacy and was generally well tolerated in treatment-naïve patients with advanced RET fusion-positive NSCLC. Results from the confirmatory phase III AcceleRET Lung study (NCT04222972) of pralsetinib versus standard of care in the first-line setting are pending.
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Kim TW, Lee KM, Lee SH. Capmatinib in MET Exon 14 Skipping Mutation-Positive Lung Adenocarcinoma with Extensive Central Nervous System Metastasis. Onco Targets Ther 2022; 15:941-946. [PMID: 36072511 PMCID: PMC9441579 DOI: 10.2147/ott.s382722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Tae Woo Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Seung Hyeun Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, South Korea
- Correspondence: Seung Hyeun Lee, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Kyungheedae-ro 23, Dongdaemun-gu, Seoul, 02447, South Korea, Tel +82 2 958 8511, Fax +82 2 968 1848, Email
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Retrospective study of hypofractionated stereotactic radiotherapy combined with whole brain radiotherapy for patients with brain metastases. Radiat Oncol 2022; 17:132. [PMID: 35883147 PMCID: PMC9327356 DOI: 10.1186/s13014-022-02096-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 11/14/2022] Open
Abstract
Background and purpose To evaluate the clinical outcomes of hypofractionated stereotactic radiotherapy (HFSRT) combined with whole brain radiotherapy (WBRT) in patients with brain metastases (BMs). Materials and methods From May 2018 to July 2020, 50 patients (111 lesions) received HFSRT (18 Gy/3F) + WBRT (40 Gy/20F). The RECIST 1.1 and RANO-BM criteria were used to evaluate treatment efficacy. Five prognostic indexes (RPA, GPA, SIR, BS-BM, and GGS) were applied. The primary endpoint was intracranial local control (iLC). Secondary endpoints were overall survival (OS) and the safety of treatment. Results Intracranial objective response rates (iORR) using the RECIST 1.1 and RANO-BM criteria were 62.1% and 58.6%, respectively. The iLC rate was 93.1%, the 6- and 12-month iLC rates were 90.8% and 57.4%, respectively. The median intracranial progression-free survival (iPFS) was not reached (range 0–23 months). The 6-, 12-, and 24-month OS rates were 74.2%, 58.2%, and 22.9%, respectively. The KPS score showed statistical significance in univariate analysis of survival. The 6, 12, and 24 month OS rates for patients with KPS ≥ 70 were 83.8%, 70.5%, and 29.7%, respectively. The median survival time (MST) for all patients and for patients with KPS ≥ 70 were 13.6 and 16.5 months, respectively. Sex, KPS score, and gross tumor volume were significant factors in the multivariate analysis of survival. OS was significantly associated with RPA, SIR, BS-BM, and GGS classes. No acute toxicities of grade 3 or higher were noted. Conclusion HFSRT combined with WBRT is a safe and effective local treatment modality for BM patients.
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Wang Q, Li J, Liang X, Zhan Q. Improved Survival With Surgical Treatment of Primary Lung Lesions in Non-Small Cell Lung Cancer With Brain Metastases: A Propensity‐Matched Analysis of Surveillance, Epidemiology, and End Results Database. Front Oncol 2022; 12:888999. [PMID: 35936705 PMCID: PMC9354689 DOI: 10.3389/fonc.2022.888999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesNon-small cell lung cancer (NSCLC) with Brain metastases (BM) is an advanced disease with poor prognosis and low survival rate. Our study evaluated the survival benefit of primary lung resection with mediastinal lymph node dissection in NSCLC patients with BM using Surveillance, Epidemiology, and End-result (SEER) databases.MethodsAll cases analyzed were from Surveillance, Epidemiology, and End Results database. The data of the patients with BM of NSCLC from 2010 to 2016 was retrospectively analyzed. Patients (N=203) patients who underwent radical surgical treatment for primary lung lesions and patients (N=15500) who did not undergo surgery were compared. We successfully analyzed patients using propensity score matching (PSM). Kaplan‐Meier and Cox‐ regression analyses were applied to assess prognosis.ResultsThe median survival in the surgery group was longer than in the control group (27 months vs 5 months; P < 0.001) in the overall sample, 21 months longer compared to the control group (27 months vs 6 months; P<0.001) in a PSM cohort. Cox regression analysis showed that underwent surgery patients in the propensity-matched sample had a significantly lower risk of mortality (HR:0.243, 95%CI: 0.162-0.365, P < 0.001) compared with untreated patients. Multivariate analysis identified the following as independent risk factors for NSCLC with BM: no primary resection surgery, age >65 years, worse differentiation, squamous cell carcinoma, lymphatic metastasis, no systemic therapy. Subgroup analysis revealed that radical resection of the primary lung provided a survival benefit regardless of marital status, tumor size, tumor grade, tumor T stage, and mediastinal lymph node metastasis after PSM.ConclusionRadical resection of primary lung can improve the survival of NSCLC patients with BM. Male, age>65years, poorly differentiated tumor, tumor size>5cm, and mediastinal lymph node metastasis were factors for poor survival.
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Efficacy and Safety of EGFR Tyrosine Kinase Inhibitors Combined with Cranial Radiotherapy for Brain Metastases from Non-Small-Cell Lung Cancer: A Protocol for a Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6531748. [PMID: 35872868 PMCID: PMC9301690 DOI: 10.1155/2022/6531748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/18/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
Introduction. Brain metastases (BMs) are common in non-small-cell lung cancer (NSCLC), which leads to a poor prognosis. As the two most effective strategies available, the use of combination of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and radiotherapy (RT) is still controversial. This protocol proposes a methodology for carrying out a systematic review and meta-analysis that is aimed at (1) focusing on the efficacy and safety role of EGFR-TKIs combined with RT for BMs from NSCLC and (2) displaying the difference in efficacy of EGFR-TKIs owing to the sites and number of BMs, different types of RT, EGFR mutation status, and the subtypes of EGFR mutations by subgroup analysis. Methods and Analysis. Electronic databases including PubMed, Embase, CENTRAL, Web of Science, CBM, CNKI, Wanfang database, and VIP database will be searched from their inception until May 2022. Only randomized controlled trials evaluating the clinical efficacy and safety of EGFR-TKIs combined with RT on BMs of NSCLC will be included. Two reviewers will select the articles, assess the risk of bias, and extract data independently and in duplicate. The RoB 2 tool will be used to assess the quality of included studies. The meta-analysis of data synthesis will be performed with Stata 16. Publication bias will be assessed with the funnel plot method and the Egger test. Quality of the evidence will be evaluated by the GRADE system. Discussion. The approval of an ethical committee is not required. All the included trials will comply with the current ethical standards and the Declaration of Helsinki. Given the ongoing controversies regarding the optimal sequencing of the available and expanding treatment options for EGFR-TKIs in NSCLC with BMs, a synthesis of available, high-quality clinical research evidence is essential to advance our understanding in the treatment of this complex and common disease. This systematic review will evaluate available evidence, will try to provide optimized advice in the applications of EGFR-TKIs, and will be published in a high-quality journal. This study is registered with PROSPERO registration number CRD42021291509.
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Siegl F, Vecera M, Roskova I, Smrcka M, Jancalek R, Kazda T, Slaby O, Sana J. The Significance of MicroRNAs in the Molecular Pathology of Brain Metastases. Cancers (Basel) 2022; 14:cancers14143386. [PMID: 35884446 PMCID: PMC9322877 DOI: 10.3390/cancers14143386] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 12/07/2022] Open
Abstract
Brain metastases are the most frequent intracranial tumors in adults and the cause of death in almost one-fourth of cases. The incidence of brain metastases is steadily increasing. The main reason for this increase could be the introduction of new and more efficient therapeutic strategies that lead to longer survival but, at the same time, cause a higher risk of brain parenchyma infiltration. In addition, the advances in imaging methodology, which provide earlier identification of brain metastases, may also be a reason for the higher recorded number of patients with these tumors. Metastasis is a complex biological process that is still largely unexplored, influenced by many factors and involving many molecules. A deeper understanding of the process will allow the discovery of more effective diagnostic and therapeutic approaches that could improve the quality and length of patient survival. Recent studies have shown that microRNAs (miRNAs) are essential molecules that are involved in specific steps of the metastatic cascade. MiRNAs are endogenously expressed small non-coding RNAs that act as post-transcriptional regulators of gene expression and thus regulate most cellular processes. The dysregulation of these molecules has been implicated in many cancers, including brain metastases. Therefore, miRNAs represent promising diagnostic molecules and therapeutic targets in brain metastases. This review summarizes the current knowledge on the importance of miRNAs in brain metastasis, focusing on their involvement in the metastatic cascade and their potential clinical implications.
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Affiliation(s)
- Frantisek Siegl
- Central European Institute of Technology, Masaryk University, 625 00 Brno, Czech Republic; (F.S.); (M.V.); (O.S.)
| | - Marek Vecera
- Central European Institute of Technology, Masaryk University, 625 00 Brno, Czech Republic; (F.S.); (M.V.); (O.S.)
| | - Ivana Roskova
- Department of Neurosurgery, University Hospital Brno and Faculty of Medicine of Masaryk University, 625 00 Brno, Czech Republic; (I.R.); (M.S.)
| | - Martin Smrcka
- Department of Neurosurgery, University Hospital Brno and Faculty of Medicine of Masaryk University, 625 00 Brno, Czech Republic; (I.R.); (M.S.)
| | - Radim Jancalek
- Department of Neurosurgery, St. Annes University Hospital Brno and Faculty of Medicine of Masaryk University, 656 91 Brno, Czech Republic;
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute and Faculty of Medicine of Masaryk University, 656 53 Brno, Czech Republic;
| | - Ondrej Slaby
- Central European Institute of Technology, Masaryk University, 625 00 Brno, Czech Republic; (F.S.); (M.V.); (O.S.)
- Department of Biology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Jiri Sana
- Central European Institute of Technology, Masaryk University, 625 00 Brno, Czech Republic; (F.S.); (M.V.); (O.S.)
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute and Faculty of Medicine of Masaryk University, 656 53 Brno, Czech Republic
- Department of Pathology, University Hospital Brno, 625 00 Brno, Czech Republic
- Correspondence: ; Tel.: +420-549-495-246
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Gondi V, Bauman G, Bradfield L, Burri SH, Cabrera AR, Cunningham DA, Eaton BR, Hattangadi-Gluth JA, Kim MM, Kotecha R, Kraemer L, Li J, Nagpal S, Rusthoven CG, Suh JH, Tomé WA, Wang TJC, Zimmer AS, Ziu M, Brown PD. Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2022; 12:265-282. [PMID: 35534352 DOI: 10.1016/j.prro.2022.02.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE This guideline provides updated evidence-based recommendations addressing recent developments in the management of patients with brain metastases, including advanced radiation therapy techniques such as stereotactic radiosurgery (SRS) and hippocampal avoidance whole brain radiation therapy and the emergence of systemic therapies with central nervous system activity. METHODS The American Society for Radiation Oncology convened a task force to address 4 key questions focused on the radiotherapeutic management of intact and resected brain metastases from nonhematologic solid tumors. The guideline is based on a systematic review provided by the Agency for Healthcare Research and Quality. Recommendations were created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS Strong recommendations are made for SRS for patients with limited brain metastases and Eastern Cooperative Oncology Group performance status 0 to 2. Multidisciplinary discussion with neurosurgery is conditionally recommended to consider surgical resection for all tumors causing mass effect and/or that are greater than 4 cm. For patients with symptomatic brain metastases, upfront local therapy is strongly recommended. For patients with asymptomatic brain metastases eligible for central nervous system-active systemic therapy, multidisciplinary and patient-centered decision-making to determine whether local therapy may be safely deferred is conditionally recommended. For patients with resected brain metastases, SRS is strongly recommended to improve local control. For patients with favorable prognosis and brain metastases receiving whole brain radiation therapy, hippocampal avoidance and memantine are strongly recommended. For patients with poor prognosis, early introduction of palliative care for symptom management and caregiver support are strongly recommended. CONCLUSIONS The task force has proposed recommendations to inform best clinical practices on the use of radiation therapy for brain metastases with strong emphasis on multidisciplinary care.
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Affiliation(s)
- Vinai Gondi
- Department of Radiation Oncology, Northwestern Medicine Cancer Center and Proton Center, Warrenville, Illinois.
| | - Glenn Bauman
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre & Western University, London, Ontario, Canada
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Stuart H Burri
- Department of Radiation Oncology, Atrium Health, Charlotte, North Carolina
| | - Alvin R Cabrera
- Department of Radiation Oncology, Kaiser Permanente, Seattle, Washington
| | | | - Bree R Eaton
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | | | - Michelle M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | | | - Jing Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seema Nagpal
- Division of Neuro-oncology, Department of Neurology, Stanford University, Stanford, California
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado
| | - John H Suh
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Wolfgang A Tomé
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University, New York, New York
| | - Alexandra S Zimmer
- Women's Malignancies Branch, National Institutes of Health/National Cancer Institute, Bethesda, Maryland
| | - Mateo Ziu
- Department of Neurosciences, INOVA Neuroscience and INOVA Schar Cancer Institute, Falls Church, Virginia
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Yoo J, Park HH, Kang SG, Chang JH. Recent Update on Neurosurgical Management of Brain Metastasis. Brain Tumor Res Treat 2022; 10:164-171. [PMID: 35929114 PMCID: PMC9353165 DOI: 10.14791/btrt.2022.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 11/20/2022] Open
Abstract
Brain metastasis (BM), classified as a secondary brain tumor, is the most common malignant central nervous system tumor whose median overall survival is approximately 6 months. However, the survival rate of patients with BMs has increased with recent advancements in immunotherapy and targeted therapy. This means that clinicians should take a more active position in the treatment paradigm that passively treats BMs. Because patients with BM are treated in a variety of clinical settings, treatment planning requires a more sophisticated decision-making process than that for other primary malignancies. Therefore, an accurate prognostic prediction is essential, for which a graded prognostic assessment that reflects next-generation sequencing can be helpful. It is also essential to understand the indications for various treatment modalities, such as surgical resection, stereotactic radiosurgery, and whole-brain radiotherapy and consider their advantages and disadvantages when choosing a treatment plan. Surgical resection serves a limited auxiliary function in BM, but it can be an essential therapeutic approach for increasing the survival rate of specific patients; therefore, this must be thoroughly recognized during the treatment process. The ultimate goal of surgical resection is maximal safe resection; to this end, neuronavigation, intraoperative neuro-electrophysiologic assessment including evoked potential, and the use of fluorescent materials could be helpful. In this review, we summarize the considerations for neurosurgical treatment in a rapidly changing treatment environment.
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Affiliation(s)
- Jihwan Yoo
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hun Ho Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Konopka-Filippow M, Hempel D, Sierko E. Actual, Personalized Approaches to Preserve Cognitive Functions in Brain Metastases Breast Cancer Patients. Cancers (Basel) 2022; 14:3119. [PMID: 35804894 PMCID: PMC9265102 DOI: 10.3390/cancers14133119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022] Open
Abstract
Breast cancer (BC) is the most often diagnosed cancer among women worldwide and second most common cause of brain metastases (BMs) among solid malignancies being responsible for 10-16% of all BMs in oncological patients. Moreover, BMs are associated with worse prognosis than systemic metastases. The quality of life (QoL) among brain metastases breast cancer (BMBC) patients is significantly influenced by cognitive functions. Cancer-related cognitive deficits and the underlying neural deficits in BMBC patients can be caused via BMs per se, chemotherapy administration, brain irradiation, postmenopausal status, or comorbidities. Brain RT often leads to cognitive function impairment by damage of neural progenitor cells of the hippocampus and hence decreased QoL. Sparing the hippocampal region of the brain during RT provides protective covering of the centrally located hippocampi according to the patient's clinical requirements. This article discusses the personalized strategies for treatment options to protect cognitive functions in BMBC patients, with special emphasis on the innovative techniques of radiation therapy.
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Affiliation(s)
- Monika Konopka-Filippow
- Department of Oncology, Medical University of Bialystok, 15-274 Bialystok, Poland; (M.K.-F.); (D.H.)
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Bialystok, Poland
| | - Dominika Hempel
- Department of Oncology, Medical University of Bialystok, 15-274 Bialystok, Poland; (M.K.-F.); (D.H.)
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Bialystok, Poland
| | - Ewa Sierko
- Department of Oncology, Medical University of Bialystok, 15-274 Bialystok, Poland; (M.K.-F.); (D.H.)
- Department of Radiotherapy I, Maria Sklodowska-Curie Bialystok Oncology Centre, 15-027 Bialystok, Poland
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Shen F, Liang N, Fan Z, Zhao M, Kang J, Wang X, Hu Q, Mu Y, Wang K, Yuan M, Chen R, Guo W, Dong G, Zhao J, Bai J. Genomic Alterations Identification and Resistance Mechanisms Exploration of NSCLC With Central Nervous System Metastases Using Liquid Biopsy of Cerebrospinal Fluid: A Real-World Study. Front Oncol 2022; 12:889591. [PMID: 35814426 PMCID: PMC9259993 DOI: 10.3389/fonc.2022.889591] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Genomic profiling of cerebrospinal fluid (CSF) can be used to detect actionable mutations and guide clinical treatment of non-small cell lung cancer (NSCLC) patients with central nervous system (CNS) metastases. Examining the performance of CSF samples in real-world settings can confirm the potential of CSF genotyping for guiding therapy in clinical practice. Patients and Methods We included 1,396 samples from 970 NSCLC patients with CNS metastases in real-world settings. All samples underwent targeted next-generation sequencing of 1,021 cancer-relevant genes. In total, 100 CSF samples from 77 patients who had previously received targeted treatment were retrospectively analyzed to explore the mechanisms of TKI-resistance. Results For NSCLC patients with CNS metastases, CSF samples were slightly more often used for genomic sequencing in treated patients with only distant CNS metastases compared to other patients (10.96% vs. 0.81–9.61%). Alteration rates in CSF samples were significantly higher than those in plasma, especially for copy number variants (CNV). The MSAFs of CSF samples were significantly higher than those of plasma and tumor tissues (all p <0.001). Remarkably, detection rates of all actionable mutations and EGFR in CSF were higher than those in plasma samples of treated patients (all p <0.0001). For concordance between paired CSF and plasma samples that were simultaneously tested, the MSAF of the CSF was significantly higher than that of matched plasma cfDNA (p <0.001). From multiple comparisons, it can be seen that CSF better detects alterations compared to plasma, especially CNV and structural variant (SV) alterations. CSF cfDNA in identifying mutations can confer the reason for the limited efficacy of EGFR-TKIs for 56 patients (78.87%, 56/71). Conclusions This real-world large cohort study confirmed that CSF had higher sensitivity than plasma in identifying actionable mutations and showed high potential in exploring underlying resistance mechanisms. CSF can be used in genomics profiling to facilitate the broad exploration of potential resistance mechanisms for NSCLC patients with CNS metastases.
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Affiliation(s)
- Fangfang Shen
- Department of Respiratory Medicine, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Naixin Liang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zaiwen Fan
- Department of Medical Oncology, Air Force Medical Center, Chinese People's Liberation Army (PLA), Beijing, China
| | - Min Zhao
- Department of Oncology, Hebei Chest Hospital, Research Center of Hebei Lung Cancer Prevention and Treatment, Shijiazhuang, China
| | - Jing Kang
- Department of Oncology, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Xifang Wang
- Department of Medical Oncology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Qun Hu
- Department of Oncology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yongping Mu
- Department of Clinical Laboratory Center, The Affiliated People’s Hospital of Inner Mongolia Medical University, Inner Mongolia Autonomous Region Cancer Hospital, Hohhot, China
| | - Kai Wang
- Medical Center, Geneplus-Beijing, Beijing, China
| | | | | | - Wei Guo
- Department of Respiratory Medicine, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
- *Correspondence: Jun Bai, ; Jun Zhao, ; Guilan Dong, ; Wei Guo,
| | - Guilan Dong
- Department of Medical Oncology, Tangshan People’s Hospital, Tangshan, China
- *Correspondence: Jun Bai, ; Jun Zhao, ; Guilan Dong, ; Wei Guo,
| | - Jun Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department I of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing, China
- *Correspondence: Jun Bai, ; Jun Zhao, ; Guilan Dong, ; Wei Guo,
| | - Jun Bai
- Department of Medical Oncology, Shaanxi Provincial People’s Hospital, Xi’an, China
- *Correspondence: Jun Bai, ; Jun Zhao, ; Guilan Dong, ; Wei Guo,
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Chee LYS, Sia J, Milne RL, Foroudi F, Millar JL, Ong WL. Variations in whole brain radiation therapy fractionation for brain metastases in Victoria. J Med Imaging Radiat Oncol 2022; 66:1106-1114. [PMID: 35726760 PMCID: PMC10084193 DOI: 10.1111/1754-9485.13447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/05/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We aim to evaluate the use of different whole brain radiation therapy (WBRT) fractionation schedules for brain metastases (BM) in Victoria, and the factors associated with it. METHODS This is a population-based cohort of patients who received radiation therapy for BM between 2012 and 2017, as captured in the Victorian Radiotherapy Minimum Dataset. We excluded patients with primary brain tumour and those who had 'prophylactic' intent treatment. The Cochran-Armitage test was used to evaluate changing trend in WBRT fractionation. Multivariate multinomial logistic regressions were used to evaluate factors associated with WBRT fractionation. RESULTS Of the 3111 patients who had WBRT, 1048 (45%), 1291 (42%) and 312 (13%) had ≤5, 6-10 and >10 fractions WBRT respectively. There was progressive increase in ≤5 fractions WBRT use over time, from 37% in 2012 to 50% in 2017 (P-trend < 0.001). In multivariate analyses, increasing age, patients with gastrointestinal cancer, patients living in remote/regional areas and more recent treatment were associated with the use of shorter WBRT fractionation (≤5 fractions), while patients who had WBRT plus stereotactic radiosurgery, and those treated in private institutions were associated with the use of prolonged WBRT fractionation (≥6 fractions). Three hundred eighty-nine (13%) patients died within 30 days of WBRT, of which 241 (64%), 119 (32%) and 17 (5%) had ≤5, 6-10 and > 10 fractions WBRT respectively. CONCLUSION We observed large variations in WBRT fractionation that are associated with patient, tumour, treatment and institutional factors. It is important to continuously monitor and benchmark our practice in order to reduce potentially unwarranted variations.
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Affiliation(s)
- Lessandra Yan Shan Chee
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Joseph Sia
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
| | - Jeremy L Millar
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Wee Loon Ong
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Chow LQM, Barlesi F, Bertino EM, van den Bent MJ, Wakelee HA, Wen PY, Chiu CH, Orlov S, Chiari R, Majem M, McKeage M, Yu CJ, Garrido P, Hurtado FK, Arratia PC, Song Y, Branle F, Shi M, Kim DW. ASCEND-7: Efficacy and Safety of Ceritinib Treatment in Patients with ALK-Positive Non-Small Cell Lung Cancer Metastatic to the Brain and/or Leptomeninges. Clin Cancer Res 2022; 28:2506-2516. [PMID: 35091443 DOI: 10.1158/1078-0432.ccr-21-1838] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/25/2021] [Accepted: 01/25/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Central nervous system metastases are a prominent cause of morbidity and mortality in patients with ALK-positive (ALK+) non-small cell lung cancer (NSCLC). The phase II ASCEND-7 (NCT02336451) study was specifically designed to assess the efficacy and safety of the ALK inhibitor (ALKi) ceritinib in patients with ALK+ NSCLC metastatic to the brain and/or leptomeninges. PATIENTS AND METHODS Patients with active brain metastases were allocated to study arms 1 to 4 based on prior exposure to an ALKi and/or prior brain radiation (arm 1: prior radiotherapy/ALKi-pretreated; arm 2: no radiotherapy/ALKi-pretreated; arm 3: prior radiotherapy/ALKi-naïve; arm 4: no radiotherapy/ALKi-naïve). Arm 5 included patients with leptomeningeal carcinomatosis. Patients received ceritinib 750 mg once daily (fasted condition). Primary endpoint was investigator-assessed whole-body overall response rate (ORR) per RECIST v1.1. Secondary endpoints included disease control rate (DCR) and intracranial/extracranial responses. RESULTS Per investigator assessment, in arms 1 (n = 42), 2 (n = 40), 3 (n = 12), and 4 (n = 44), respectively: whole-body ORRs [95% confidence interval (CI)] were 35.7% (21.6-52.0), 30.0% (16.6-46.5), 50.0% (21.1-78.9), and 59.1% (43.2-73.7); whole-body DCR (95% CI): 66.7% (50.5-80.4), 82.5% (67.2-92.7), 66.7% (34.9-90.1), and 70.5% (54.8-83.2); intracranial ORRs (95% CI): 39.3% (21.5-59.4), 27.6% (12.7-47.2), 28.6% (3.7-71.0), and 51.5% (33.5-69.2). In arm 5 (n = 18), whole-body ORR was 16.7% (95% CI, 3.6-41.4) and DCR was 66.7% (95% CI, 41.0-86.7). Paired cerebrospinal fluid and plasma sampling revealed that ceritinib penetrated the human blood-brain barrier. CONCLUSIONS Ceritinib showed antitumor activity in patients with ALK+ NSCLC with active brain metastases and/or leptomeningeal disease, and could be considered in the management of intracranial disease. See related commentary by Murciano-Goroff et al., p. 2477.
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Affiliation(s)
- Laura Q M Chow
- University of Washington, Seattle, Washington and University of Texas at Austin, Dell Medical School, Department of Oncology, Austin, Texas
| | - Fabrice Barlesi
- Aix-Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| | - Erin M Bertino
- The Ohio State University Comprehensive Cancer Centre, Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio
| | - Martin J van den Bent
- Department of Neurology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Patrick Y Wen
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Chao-Hua Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Sergey Orlov
- State Pavlov Medical University, St. Petersburg, Russia
| | - Rita Chiari
- Department of Oncology, AULSS6 Euganea, Padova, Italy
| | | | | | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pilar Garrido
- Department of Medical Oncology, Hospital Universitario Ramon Y Cajal, Madrid, Spain
| | | | | | - Yuanbo Song
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Michael Shi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
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184
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Wang Y, Lang J, Zuo JZ, Dong Y, Hu Z, Xu X, Zhang Y, Wang Q, Yang L, Wong STC, Wang H, Li H. The radiomic-clinical model using the SHAP method for assessing the treatment response of whole-brain radiotherapy: a multicentric study. Eur Radiol 2022; 32:8737-8747. [PMID: 35678859 DOI: 10.1007/s00330-022-08887-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop and validate a pretreatment magnetic resonance imaging (MRI)-based radiomic-clinical model to assess the treatment response of whole-brain radiotherapy (WBRT) by using SHapley Additive exPlanations (SHAP), which is derived from game theory, and can explain the output of different machine learning models. METHODS We retrospectively enrolled 228 patients with brain metastases from two medical centers (184 in the training cohort and 44 in the validation cohort). Treatment responses of patients were categorized as a non-responding group vs. a responding group according to the Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria. For each tumor, 960 features were extracted from the MRI sequence. The least absolute shrinkage and selection operator (LASSO) was used for feature selection. A support vector machine (SVM) model incorporating clinical factors and radiomic features wase used to construct the radiomic-clinical model. SHAP method explained the SVM model by prioritizing the importance of features, in terms of assessment contribution. RESULTS Three radiomic features and three clinical factors were identified to build the model. Radiomic-clinical model yielded AUCs of 0.928 (95%CI 0.901-0.949) and 0.851 (95%CI 0.816-0.886) for assessing the treatment response in the training cohort and validation cohort, respectively. SHAP summary plot illustrated the feature's value affected the feature's impact attributed to model, and SHAP force plot showed the integration of features' impact attributed to individual response. CONCLUSION The radiomic-clinical model with the SHAP method can be useful for assessing the treatment response of WBRT and may assist clinicians in directing personalized WBRT strategies in an understandable manner. KEY POINTS • Radiomic-clinical model can be useful for assessing the treatment response of WBRT. • SHAP could explain and visualize radiomic-clinical machine learning model in a clinician-friendly way.
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Affiliation(s)
- Yixin Wang
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China.,University of Science and Technology of China, Hefei, 230026, People's Republic of China.,Department of Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China
| | - Jinwei Lang
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China.,University of Science and Technology of China, Hefei, 230026, People's Republic of China
| | - Joey Zhaoyu Zuo
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China.,University of Science and Technology of China, Hefei, 230026, People's Republic of China
| | - Yaqin Dong
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People's Republic of China
| | - Zongtao Hu
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China.,Department of Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China
| | - Xiuli Xu
- Department of Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China
| | - Yongkang Zhang
- Department of Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China
| | - Qinjie Wang
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China.,University of Science and Technology of China, Hefei, 230026, People's Republic of China
| | - Lizhuang Yang
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China.,University of Science and Technology of China, Hefei, 230026, People's Republic of China.,Department of Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China
| | - Stephen T C Wong
- Department of Systems Medicine and Bioengineering, Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX, 77030, USA
| | - Hongzhi Wang
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China. .,University of Science and Technology of China, Hefei, 230026, People's Republic of China. .,Department of Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China.
| | - Hai Li
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China. .,University of Science and Technology of China, Hefei, 230026, People's Republic of China. .,Department of Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, 230031, People's Republic of China.
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185
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Michel A, Dinger TF, Santos AN, Pierscianek D, Darkwah Oppong M, Ahmadipour Y, Dammann P, Wrede KH, Hense J, Pöttgen C, Iannaccone A, Kimmig R, Sure U, Jabbarli R. Time interval between the diagnosis of breast cancer and brain metastases impacts prognosis after metastasis surgery. J Neurooncol 2022; 159:53-63. [PMID: 35672530 PMCID: PMC9325855 DOI: 10.1007/s11060-022-04043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/21/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Purpose
Breast cancer (BC) is the most frequently diagnosed tumor entity in women. Occurring at different time intervals (TI) after BC diagnosis, brain metastases (BM) are associated with poor prognosis. We aimed to identify the risk factors related to and the clinical impact of timing on overall survival (OS) after BM surgery.
Methods
We included 93 female patients who underwent BC BM surgery in our institution (2008–2019). Various clinical, radiographic, and histopathologic markers were analyzed with respect to TI and OS.
Results
The median TI was 45.0 months (range: 9–334.0 months). Fifteen individuals (16.1%) showed late occurrence of BM (TI ≥ 10 years), which was independently related to invasive lobular BC [adjusted odds ratio (aOR) 9.49, 95% confidence interval (CI) 1.47–61.39, p = 0.018] and adjuvant breast radiation (aOR 0.12, 95% CI 0.02–0.67, p = 0.016). Shorter TI (< 5 years, aOR 4.28, 95% CI 1.46–12.53, p = 0.008) was independently associated with postoperative survival and independently associated with the Union for International Cancer Control stage (UICC) III–IV of BC (aOR 4.82, 95% CI 1.10–21.17, p = 0.037), midline brain shift in preoperative imaging (aOR10.35, 95% CI 1.09–98.33, p = 0.042) and identic estrogen receptor status in BM (aOR 4.56, 95% CI 1.35–15.40, p = 0.015).
Conclusions
Several factors seem to influence the period between BC and BM. Occurrence of BM within five years is independently associated with poorer prognosis after BM surgery. Patients with invasive lobular BC and without adjuvant breast radiation are more likely to develop BM after a long progression-free survival necessitating more prolonged cancer aftercare of these individuals.
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Affiliation(s)
- Anna Michel
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany.
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany.
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Thiemo Florin Dinger
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Alejandro N Santos
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Daniela Pierscianek
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Jörg Hense
- Department of Medical Oncology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Antonella Iannaccone
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Rainer Kimmig
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, 45147, Essen, Germany
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ADC textural features in patients with single brain metastases improve clinical risk models. Clin Exp Metastasis 2022; 39:459-466. [PMID: 35394585 PMCID: PMC9117356 DOI: 10.1007/s10585-022-10160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 02/28/2022] [Indexed: 11/03/2022]
Abstract
AIMS In this retrospective study we performed a quantitative textural analysis of apparant diffusion coefficient (ADC) images derived from diffusion weighted MRI (DW-MRI) of single brain metastases (BM) patients from different primary tumors and tested whether these imaging parameters may improve established clinical risk models. METHODS We identified 87 patients with single BM who had a DW-MRI at initial diagnosis. Applying image segmentation, volumes of contrast-enhanced lesions in T1 sequences, hyperintense T2 lesions (peritumoral border zone (T2PZ)) and tumor-free gray and white matter compartment (GMWMC) were generated and registered to corresponding ADC maps. ADC textural parameters were generated and a linear backward regression model was applied selecting imaging features in association with survival. A cox proportional hazard model with backward regression was fitted for the clinical prognostic models (diagnosis-specific graded prognostic assessment score (DS-GPA) and the recursive partitioning analysis (RPA)) including these imaging features. RESULTS Thirty ADC textural parameters were generated and linear backward regression identified eight independent imaging parameters which in combination predicted survival. Five ADC texture features derived from T2PZ, the volume of the T2PZ, the normalized mean ADC of the GMWMC as well as the mean ADC slope of T2PZ. A cox backward regression including the DS-GPA, RPA and these eight parameters identified two MRI features which improved the two risk scores (HR = 1.14 [1.05;1.24] for normalized mean ADC GMWMC and HR = 0.87 [0.77;0.97]) for ADC 3D kurtosis of the T2PZ.) CONCLUSIONS: Textural analysis of ADC maps in patients with single brain metastases improved established clinical risk models. These findings may aid to better understand the pathogenesis of BM and may allow selection of patients for new treatment options.
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187
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Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative Review. Cancers (Basel) 2022; 14:cancers14112736. [PMID: 35681716 PMCID: PMC9179311 DOI: 10.3390/cancers14112736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Decline in cognitive function is a major problem for patients undergoing whole-brain radiotherapy (WBRT). Scientific interest has increased due to the high dropout rate of patients in the first months after WBRT and the early onset of cognitive decline. Therefore, the study of antiglutamatergic pharmacological prophylaxis and hippocampal-sparing WBRT techniques has been deepened based on the knowledge of the mechanisms of hyperglutamatergic neurotoxicity and the role of some hippocampal areas in cognitive decline. In order to provide a summary of the evidence in this field, and to foster future research in this setting, this literature review presents current evidence on the prevention of radiation-induced cognitive decline and particularly on the role of memantine. Abstract Preserving cognitive functions is a priority for most patients with brain metastases. Knowing the mechanisms of hyperglutamatergic neurotoxicity and the role of some hippocampal areas in cognitive decline (CD) led to testing both the antiglutamatergic pharmacological prophylaxis and hippocampal-sparing whole-brain radiotherapy (WBRT) techniques. These studies showed a relative reduction in CD four to six months after WBRT. However, the failure to achieve statistical significance in one study that tested memantine alone (RTOG 0614) led to widespread skepticism about this drug in the WBRT setting. Moreover, interest grew in the reasons for the strong patient dropout rates in the first few months after WBRT and for early CD onset. In fact, the latter can only partially be explained by subclinical tumor progression. An emerging interpretation of the (not only) cognitive impairment during and immediately after WBRT is the dysfunction of the limbic and hypothalamic system with its immune and hormonal consequences. This new understanding of WBRT-induced toxicity may represent the basis for further innovative trials. These studies should aim to: (i) evaluate in greater detail the cognitive effects and, more generally, the quality of life impairment during and immediately after WBRT; (ii) study the mechanisms producing these early effects; (iii) test in clinical studies, the modern and advanced WBRT techniques based on both hippocampal-sparing and hypothalamic-pituitary-sparing, currently evaluated only in planning studies; (iv) test new timings of antiglutamatergic drugs administration aimed at preventing not only late toxicity but also acute effects.
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Gao X, Chen M, Liu X, Shi Y, Liang H, Zhou Q, Zhao J, Pan R, Zhong W, Xu Y, Wang M. Prognostic Factors and Survival Benefits of Antitumor Treatments for Advanced Non-Small Cell Lung Cancer Patients With Central Nervous System Metastasis With or Without Driver Genes: A Chinese Single-Center Cohort Study. Front Oncol 2022; 12:879554. [PMID: 35558520 PMCID: PMC9090435 DOI: 10.3389/fonc.2022.879554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background The prognosis of non-small cell lung cancer (NSCLC) patients with central nervous system (CNS) metastasis is poor. The treatment for CNS metastasis could prolong the overall survival of NSCLC patients. We aimed to investigate the prognostic factors of Chinese NSCLC patients with CNS metastasis and the survival benefits of various treatments for CNS metastasis in NSCLC patients with or without driver genes. Methods Based on the CAPTRA-Lung database, NSCLC patients with CNS metastasis admitted at the Peking Union Medical College Hospital between January 2010 and October 2018 were enrolled in the study. The prognostic factors were analyzed using univariate and multivariate Cox regression analyses. Results Overall, 418 patients were enrolled in the study. A total of 206 patients (49.3%) had CNS metastasis with positive driver genes, while 97 patients (23.2%) had negative driver genes. The median survival time after CNS metastasis was 20.8 months. In the multivariable analysis, an Eastern Cooperative Oncology Group performance status of ≥2 (hazard ratio [HR]: 1.750, 95% confidence interval [CI]: 1.184-2.588, P=0.005), number of CNS metastases ≥5 (HR: 1.448, 95% CI: 1.084 -1.934, P=0.012), and CNS metastasis developed during treatment (HR: 1.619, 95% CI: 1.232-2.129, P=0.001) were independent risk factors for poor survival. Lung adenocarcinoma (HR: 0.490, 95% CI: 0.279-0.861, P=0.013) and driver gene positivity (HR: 0.464, 95% CI: 0.302-0.715, P=0.001) were independent predictors of prolonged survival. Radiotherapy for CNS metastasis showed a survival benefit in NSCLC patients in the entire groups (HR: 0.472, 95% CI: 0.360-0.619, P <0.001), and in patients with positive driver genes. Conclusion Performance status, number of CNS metastases, timing of CNS metastasis, histological subtype, and driver gene status are prognostic factors for NSCLC patients with CNS metastasis. Furthermore, radiotherapy improved the survival in NSCLC patients with CNS metastasis.
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Affiliation(s)
- Xiaoxing Gao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjiang Chen
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyan Liu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuequan Shi
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongge Liang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Zhou
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Zhao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruili Pan
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhong
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Xu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Alvarez-Breckenridge C, Remon J, Piña Y, Nieblas-Bedolla E, Forsyth P, Hendriks L, Brastianos PK. Emerging Systemic Treatment Perspectives on Brain Metastases: Moving Toward a Better Outlook for Patients. Am Soc Clin Oncol Educ Book 2022; 42:1-19. [PMID: 35522917 DOI: 10.1200/edbk_352320] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The diagnosis of brain metastases has historically been a dreaded, end-stage complication of systemic disease. Additionally, with the increasing effectiveness of systemic therapies that prolong life expectancy and improved imaging tools, the incidence of intracranial progression is becoming more common. Within this context, there has been increasing attention directed at understanding the molecular underpinnings of intracranial progression. Exploring the unique features of brain metastases compared with their extracranial counterparts to identify aberrant signaling pathways, which can be targeted pharmacologically, may help lead to new treatments for this patient population. Additionally, critical discoveries outside the sphere of the central nervous system are increasingly being applied to brain metastases with the emergence of immune checkpoint inhibition, becoming a prevalent treatment option for patients with brain metastases across multiple histologies. As novel treatment strategies are considered, they require thoughtful incorporation of agents that can cross the blood-brain barrier and can synergize with pre-existing agents through rational combinations. Lastly, as clinicians and scientists continue to understand key molecular features of these tumors, they will continue to influence the treatment algorithms that are developing for the management of these patients. Due to the complexity of treatment decisions for patients with brain metastases, an emerging tool is the utilization of multidisciplinary brain metastasis tumor boards to ensure optimal treatment decisions are made and that patients are provided access to applicable clinical trials. Looking to the future, the collective effort to understand the various tumor-intrinsic and tumor-extrinsic factors that promote central nervous system seeding and propagation will have the potential to change the clinical trajectory for these patients.
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Affiliation(s)
| | - Jordi Remon
- Department of Medical Oncology, HM CIOCC Barcelona (Centro Integral Oncológico Clara Campal), Hospital HM Delfos, HM Hospitales, Barcelona, Spain
| | - Yolanda Piña
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL
| | | | - Peter Forsyth
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL
| | - Lizza Hendriks
- Department of Pulmonary Diseases - GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, Netherlands
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190
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Gaebe K, Li AY, Park A, Parmar A, Lok BH, Sahgal A, Chan KKW, Erickson AW, Das S. Stereotactic radiosurgery versus whole brain radiotherapy in patients with intracranial metastatic disease and small-cell lung cancer: a systematic review and meta-analysis. Lancet Oncol 2022; 23:931-939. [DOI: 10.1016/s1470-2045(22)00271-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 12/14/2022]
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191
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Katano A, Yamashita H. Brain metastasis: Recent treatment modalities and future‑perspectives (Review). Oncol Lett 2022; 23:191. [DOI: 10.3892/ol.2022.13311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/12/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Atsuto Katano
- Department of Radiology, University of Tokyo Hospital, Bunkyo, Tokyo 113‑8655, Japan
| | - Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, Bunkyo, Tokyo 113‑8655, Japan
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192
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Otto-Vollaard L, Quint S, de Pree IMN, Steinvoort IN, Tims OJL, Nuyttens JJ. Brain Metastases: Patient-Reported Outcome and Quality of Life After Whole-Brain Radiotherapy. J Palliat Med 2022; 25:1533-1539. [PMID: 35482284 DOI: 10.1089/jpm.2021.0533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim of this prospective cohort study was to determine the outcome and quality of life (QoL) for patients with brain metastases treated with whole-brain radiotherapy (WBRT). Materials and Methods: WBRT was given to 162 patients. Treatment outcome was reported through telephone consultation at four and eight weeks after the last fraction of the treatment. Treatment outcome was scored as a benefit when patients reported positively on the question whether radiotherapy of the whole brain did relieve their complaints. Patients who scored the treatment as beneficial were categorized as responders. The European Organization for Research and Treatment of Cancer (EORTC) questionnaire QLQ-C15-PAL was scored at day 0 and eight weeks after the last fraction of WBRT. Results: Patients who were alive after 2 months and reported benefit from treatment had a median survival of 8.1 months compared with 2.9 months for patients who reported no benefit. Forty-three patients died within two months (27%). Median overall survival was 3.5 months. Improvement of neurological symptoms was the most commonly reported benefit of the treatment. The responders had significantly better sleep (p = 0.032) and were less tense (p = 0.014). The nonresponders were also less tense (p = 0.042), but had less appetite (p = 0.023), felt weaker (p = 0.011), and experienced more fatigue (p = 0.001). Conclusions: WBRT is effective in a selected group of patients. Forty-nine percent of the patients surviving two months reported benefit from the treatment, resulting in a significantly increased survival rate for this group. However, 27% of patients died within two months. QoL increased in responders, but decreased in nonresponders.
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Affiliation(s)
| | - Sandra Quint
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ilse M N de Pree
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Illona N Steinvoort
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Olijn J L Tims
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joost J Nuyttens
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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193
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Coelho JC, de Souza Carvalho G, Chaves F, de Marchi P, de Castro G, Baldotto C, Mascarenhas E, Pacheco P, Gomes R, Werutsky G, Araujo LH. Non-Small-Cell Lung Cancer With CNS Metastasis: Disparities From a Real-World Analysis (GBOT-LACOG 0417). JCO Glob Oncol 2022; 8:e2100333. [PMID: 35467932 PMCID: PMC9067364 DOI: 10.1200/go.21.00333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite the advances in the approach to non–small-cell lung cancer (NSCLC) with CNS metastasis, access to timely diagnosis and treatment may not be optimal in many instances. Our main objective was to describe a cohort of patients with NSCLC with brain metastases from public and private cancer centers, and the differences between patients' presentation, treatment, and outcomes. Worse survival in lung cancer patients with brain metastasis from public institutions.![]()
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Affiliation(s)
| | | | | | - Pedro de Marchi
- Fundação Pio XII-Hospital de Câncer de Barretos, Barretos, Brazil
| | - Gilberto de Castro
- Grupo Brasileiro de Oncologia Torácica, Porto Alegre, Brazil.,Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Clarissa Baldotto
- Grupo Brasileiro de Oncologia Torácica, Porto Alegre, Brazil.,Instituto COI, Rio De Janeiro, Brazil
| | - Eldsamira Mascarenhas
- Grupo Brasileiro de Oncologia Torácica, Porto Alegre, Brazil.,Núcleo de Oncologia da Bahia (NOB), Salvador, Brazil
| | | | - Rafaela Gomes
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | | | - Luiz H Araujo
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil.,Grupo Brasileiro de Oncologia Torácica, Porto Alegre, Brazil.,Instituto COI, Rio De Janeiro, Brazil
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194
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The Clinical Frailty Scale as useful tool in patients with brain metastases. J Neurooncol 2022; 158:51-57. [PMID: 35419752 PMCID: PMC9166853 DOI: 10.1007/s11060-022-04008-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE The Clinical Frailty Scale (CFS) evaluates patients' level of frailty on a scale from 1 to 9 and is commonly used in geriatric medicine, intensive care and orthopedics. The aim of our study was to reveal whether the CFS allows a reliable prediction of overall survival (OS) in patients after surgical treatment of brain metastases (BM) compared to the Karnofsky Performance Score (KPS). METHODS Patients operated for BM were included. CFS and KPS were retrospectively assessed pre- and postoperatively and at follow-up 3-6 months after resection. RESULTS 205 patients with a follow-up of 22.8 months (95% CI 18.4-27.1) were evaluated. CFS showed a median of 3 ("managing well"; IqR 2-4) at all 3 assessment-points. Median KPS was 80 preoperatively (IqR 80-90) and 90 postoperatively (IqR 80-100) as well as at follow-up after 3-6 months. CFS correlated with KPS both preoperatively (r = - 0.92; p < 0.001), postoperatively (r = - 0.85; p < 0.001) and at follow-up (r = - 0.93; p < 0.001). The CFS predicted the expected reduction of OS more reliably than the KPS at all 3 assessments. A one-point increase (worsening) of the preoperative CFS translated into a 30% additional hazard to decease (HR 1.30, 95% CI 1.15-1.46; p < 0.001). A one-point increase in postoperative and at follow-up CFS represents a 39% (HR 1.39, 95% CI 1.25-1.54; p < 0.001) and of 42% risk (HR 1.42, 95% CI 1.27-1.59; p < 0.001). CONCLUSION The CFS is a feasible, simple and reliable scoring system in patients undergoing resection of brain metastasis. The CFS 3-6 months after surgery specifies the expected OS more accurately than the KPS.
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195
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Frisk G, Helde Frankling M, Warnqvist A, Björkhem-Bergman L, Hedman M. Evaluation of Whole Brain Radiotherapy among Lung Cancer Patients with Brain Metastases in Relation to Health Care Level and Survival. Life (Basel) 2022; 12:life12040525. [PMID: 35455016 PMCID: PMC9031780 DOI: 10.3390/life12040525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/15/2022] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Whole-brain radiotherapy (WBRT) as a treatment for brain metastases has been questioned over the last years. This study aimed to evaluate health care levels and survival after WBRT in a cohort of lung cancer patients with brain metastases receiving WBRT in Stockholm, Sweden, from 2008 to 2019 (n = 384). If the patients were able to come home again was estimated using logistic regression and odds ratios (OR) and survival by using Cox regression. The median age in the cohort was 65.6 years, the median survival following WBRT was 2.4 months (interquartile range (IQR) 1.2–6.2 months), and 84 (22%) patients were not able to come home after treatment. Significantly more males could come home again after WBRT compared to women (OR = 0.37, 95%CI 0.20–0.68). Patients with performance status scores WHO 3–4 had a median survival of 1.0 months, hazard ratio (HR) = 4.69 (95%CI 3.31–6.64) versus WHO score 0–1. Patients admitted to a palliative ward before WBRT had a median survival of 0.85 months, HR = 2.26 (95%CI 1.53–3.34) versus being at home. In conclusion, patients treated with WBRT had a short median survival and 20% could not be discharged from the hospital following treatment. Significantly more women did not come home again.
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Affiliation(s)
- Gabriella Frisk
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, 141 83 Huddinge, Sweden; (M.H.F.); (L.B.-B.)
- ASIH Stockholm Södra, Palliative Home Care and Specialized Palliative Ward, 125 59 Älvsjö, Sweden
- Correspondence:
| | - Maria Helde Frankling
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, 141 83 Huddinge, Sweden; (M.H.F.); (L.B.-B.)
- Karolinska University Hospital, Thoracic Oncology Center, Theme Cancer, 171 64 Solna, Sweden
| | - Anna Warnqvist
- Department of Environmental Medicine, Division of Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Linda Björkhem-Bergman
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, 141 83 Huddinge, Sweden; (M.H.F.); (L.B.-B.)
| | - Mattias Hedman
- Department of Oncology-Pathology, Karolinska Institute, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden;
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196
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Xiao L, Lin Q, Hu M, Wang Y, Hui Z, Wu F, Wang J. Could intracranial tumor volume predict prognosis of patients with brain metastases from esophageal carcinoma? Thorac Cancer 2022; 13:1193-1198. [PMID: 35289101 PMCID: PMC9013658 DOI: 10.1111/1759-7714.14384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE A previous study demonstrated that intracranial tumor volume had some correlation with gastrointestinal cancer patients' outcome. The aim of this study was to analyze patients with esophageal carcinoma (EC) and brain metastases to investigate if intracranial tumor volume would be a predictor of these patients' survival. METHODS A total of 52 patients with brain metastases from esophageal squamous cell carcinoma or esophageal adenocarcinoma were retrospectively reviewed. Patients without images of brain metastases in the hospital information system were eliminated. RESULTS The median follow-up time duration was 8.4 months (interquartile range 4.0-15.2). The median overall survival (OS) from time of brain metastases diagnosis was 8.0 months for all cases. Median OS of patients with small and large cumulative intracranial tumor volume (CITV) (<6.65 cm3 , ≥6.65 cm3 ) was 11.23 and 7.4 months, respectively. Median OS of patients with large and small largest intracranial tumor volume (LITV) (≥7.75 cm3 , <7.75 cm3 ) was 6.4 and 10.6 months, respectively. Univariate analysis demonstrated that CITV (hazard ratio [HR] 1.255, 95% confidence interval [CI] 0.673-2.342, p = 0.475) or LITV (HR 1.037, 95% CI 0.570-1.887, p = 0.904) was not significantly associated with improved OS. Multivariate analysis demonstrated that CITV and LITV were not significantly associated with improved OS. CONCLUSION EC patients with small intracranial tumor volume may have longer OS than those with large intracranial tumor volume, but this difference did not reach statistical difference. Future studies with a larger sample size may validate the correlation of intracranial tumor volume and patient survival.
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Affiliation(s)
- Linlin Xiao
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qiang Lin
- Department of Oncology, North China Petroleum Bureau General Hospital, Hebei Medical University, Renqiu, China
| | - Mengzhu Hu
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yi Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhouguang Hui
- Department of Radiotherapy, Cancer Institute & Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Fengpeng Wu
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jun Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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197
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Gibson AJW, Box A, Cheung WY, Dean ML, Elegbede AA, Hao D, Pabani A, Sangha R, Bebb DG. Real-World Management and Outcomes of Crizotinib-Treated ROS1-Rearranged NSCLC: A Retrospective Canadian Cohort. Curr Oncol 2022; 29:1967-1982. [PMID: 35323360 PMCID: PMC8947433 DOI: 10.3390/curroncol29030160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
The use, safety and effectiveness of crizotinib as part of the management of ROS1-rearranged NSCLC patients in a real-world Canadian clinical cohort was the focus of this retrospective review. Twenty-one ROS1-rearranged patients with advanced/metastatic disease receiving crizotinib between 2014-2020 were identified; crizotinib demonstrated tolerability and effectiveness in this population where outcomes were similar to those described in other crizotinib-treated real-world cohorts, but lower than those of the PROFILE 1001 clinical trial population. Systemic anti-cancer therapy prior to crizotinib initiation occurred in half of the study cohort, with platin-pemetrexed and immune checkpoint inhibitors being most common. Platin-pemetrexed showed good effectiveness in this cohort, but despite high prevalence of upregulated PD-L1 expression, immune checkpoint inhibitors showed poor effectiveness in his cohort. Among all systemic therapies received, crizotinib showed the most effective disease control, although longer intervals between diagnosis and crizotinib initiation were more common among those showing a lack of clinical response to crizotinib, and patients with brain metastases at the time of crizotinib initiation also showed increased diagnosis to crizotinib initiation intervals and decreased clinical response to crizotinib. This study reveals crizotinib has clinical benefit, but timely identification of ROS1-rearrangements and initiation targeted therapies appears important to maximize outcome in this population.
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Affiliation(s)
- Amanda J. W. Gibson
- Department of Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.J.W.G.); (A.B.); (W.Y.C.); (M.L.D.); (A.A.E.); (D.H.); (A.P.)
| | - Adrian Box
- Department of Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.J.W.G.); (A.B.); (W.Y.C.); (M.L.D.); (A.A.E.); (D.H.); (A.P.)
- Alberta Precision Laboratories, Molecular Pathology Laboratory, 3535 Research Road NW, Calgary, AB T2L 2K8, Canada
| | - Winson Y. Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.J.W.G.); (A.B.); (W.Y.C.); (M.L.D.); (A.A.E.); (D.H.); (A.P.)
- Tom Baker Cancer Centre, Alberta Health Services, 1331 29th Street NW, Calgary, AB T2N 4N2, Canada
| | - Michelle L. Dean
- Department of Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.J.W.G.); (A.B.); (W.Y.C.); (M.L.D.); (A.A.E.); (D.H.); (A.P.)
| | - Anifat A. Elegbede
- Department of Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.J.W.G.); (A.B.); (W.Y.C.); (M.L.D.); (A.A.E.); (D.H.); (A.P.)
| | - Desiree Hao
- Department of Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.J.W.G.); (A.B.); (W.Y.C.); (M.L.D.); (A.A.E.); (D.H.); (A.P.)
- Tom Baker Cancer Centre, Alberta Health Services, 1331 29th Street NW, Calgary, AB T2N 4N2, Canada
| | - Aliyah Pabani
- Department of Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.J.W.G.); (A.B.); (W.Y.C.); (M.L.D.); (A.A.E.); (D.H.); (A.P.)
- Tom Baker Cancer Centre, Alberta Health Services, 1331 29th Street NW, Calgary, AB T2N 4N2, Canada
| | - Randeep Sangha
- Faculty of Medicine and Dentistry, University of Alberta, 8440 112 Street, Edmonton, AB T6G 2R7, Canada;
- Cross Cancer Institute, Alberta Health Services, 11560 University Avenue, Edmonton, AB T6G 1Z2, Canada
| | - Dafydd Gwyn Bebb
- Department of Oncology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; (A.J.W.G.); (A.B.); (W.Y.C.); (M.L.D.); (A.A.E.); (D.H.); (A.P.)
- Tom Baker Cancer Centre, Alberta Health Services, 1331 29th Street NW, Calgary, AB T2N 4N2, Canada
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198
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Michel A, Darkwah Oppong M, Rauschenbach L, Dinger TF, Barthel L, Pierscianek D, Wrede KH, Hense J, Pöttgen C, Junker A, Schmidt T, Iannaccone A, Kimmig R, Sure U, Jabbarli R. Prediction of Short and Long Survival after Surgery for Breast Cancer Brain Metastases. Cancers (Basel) 2022; 14:cancers14061437. [PMID: 35326590 PMCID: PMC8946189 DOI: 10.3390/cancers14061437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/02/2022] [Indexed: 12/09/2022] Open
Abstract
Background: Brain metastases requiring surgical treatment determine the prognosis of patients with breast cancer. We aimed to develop the scores for the prediction of short (<6 months) and long (≥3 years) survival after BCBM surgery. Methods: Female patients with BCBM surgery between 2008 and 2019 were included. The new scores were constructed upon independent predictors for short and long postoperative survival. Results: In the final cohort (n = 95), 18 (18.9%) and 22 (23.2%) patients experienced short and long postoperative survival, respectively. Breast-preserving surgery, presence of multiple brain metastases and age ≥ 65 years at breast cancer diagnosis were identified as independent predictors of short postoperative survival. In turn, positive HER2 receptor status in brain metastases, time interval ≥ 3 years between breast cancer and brain metastases diagnosis and KPS ≥ 90% independently predicted long survival. The appropriate short and long survival scores showed higher diagnostic accuracy for the prediction of short (AUC = 0.773) and long (AUC = 0.775) survival than the breast Graded Prognostic Assessment score (AUC = 0.498/0.615). A cumulative survival score (total score) showed significant association with overall survival (p = 0.001). Conclusion: We identified predictors independently impacting the prognosis after BCBM surgery. After external validation, the presented scores might become useful tools for the selection of proper candidates for BCBM surgery.
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Affiliation(s)
- Anna Michel
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
- Correspondence: ; Tel.: +49-201-723-1230; Fax: +49-201-723-1220
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Laurèl Rauschenbach
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Thiemo Florin Dinger
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Lennart Barthel
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Daniela Pierscianek
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Karsten H. Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Jörg Hense
- Department of Medical Oncology, University Hospital Essen, 45147 Essen, Germany;
| | - Christoph Pöttgen
- Department of Radiotherapy, University Hospital Essen, 45147 Essen, Germany;
| | - Andreas Junker
- Department of Neuropathology, University Hospital Essen, 45147 Essen, Germany;
| | - Teresa Schmidt
- Department of Neurooncology, University Hospital Essen, 45147 Essen, Germany;
| | - Antonella Iannaccone
- Department of Obstetrics and Gynecology, University Hospital Essen, 45147 Essen, Germany; (A.I.); (R.K.)
| | - Rainer Kimmig
- Department of Obstetrics and Gynecology, University Hospital Essen, 45147 Essen, Germany; (A.I.); (R.K.)
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147 Essen, Germany; (M.D.O.); (L.R.); (T.F.D.); (L.B.); (D.P.); (K.H.W.); (U.S.); (R.J.)
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Liu J, Xu J, Ye W, Zhong W, Zhang X, Mao J, Wu D. Whole-Brain Radiotherapy Combined With Anlotinib for Multiple Brain Metastases From Non-small Cell Lung Cancer Without Targetable Driver Mutation: A Single-Arm, Phase II Study. Clin Med Insights Oncol 2022; 16:11795549221079185. [PMID: 35250325 PMCID: PMC8891900 DOI: 10.1177/11795549221079185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/20/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Existing evidence demonstrates that radiotherapy and antiangiogenic drugs have synergistic antitumour effects and may be a promising treatment option for patients with solid tumour. Thus, we performed a phase II trial to evaluate the efficacy and safety of whole-brain radiotherapy (WBRT) combined with anlotinib for multiple brain metastases (BMs) from non-small cell lung cancer (NSCLC) without targetable driver mutations. Methods: Patients with multiple BMs (⩾3) from NSCLC without targetable driver mutations who failed to respond to at least first-line chemotherapy were enrolled. Eligible patients received WBRT (30 Gy/10 f, 5 f/week) and anlotinib (12 mg/day, day 1-14 of 21 days per cycle, 2 cycles) until disease progression or treatment intolerance. The primary endpoint was intracranial objective response rate (iORR) and secondary endpoints included intracranial progression-free survival (iPFS), disease control rate (DCR), overall survival (OS), and safety. Results: Between April 2019 and March 2021, 21 patients were enrolled in the trial, of which 12 were aged ⩾60 years (57.1%), 13 were men (61.9%), 7 had an Eastern Cooperative Oncology Group Performance Status score of 0 to 1 (81.0%), 18 had adenocarcinoma (85.7%), and 11 had ⩾6 BMs (52.4%). Of the 21 evaluable patients, the iORR was 66.7% (1 complete response + 13 partial response [PR]), and 28.6% (7PR) had extracerebral lesions. The DCRs for intracerebral and extracerebral lesions were 90.5% and 81.0%, respectively. The iPFS and OS were 10.3 months (95% confidence interval [CI]: 0-24.8 months) and 13.4 months (95% CI: 0-27.9 months), respectively. The most frequently observed toxicities were loss of appetite (61.9%), hypertension (52.4%), fatigue (47.6%), diarrhoea (28.6%), vomiting (19.0%), dizziness (42.9%), and headache (33.3%). None of the patients developed grade 4 or higher grade adverse reactions. Conclusions: Anlotinib combined with WBRT is effective and well tolerated in patients with multiple BMs (⩾3) from NSCLC without targetable driver mutations. Therefore, further validation studies are required. Clinical trial registration number: ChiCTR 1900027769
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Affiliation(s)
- Jianjiang Liu
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Jun Xu
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Wanli Ye
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Wangyan Zhong
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Xiaoyu Zhang
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Jiwei Mao
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Dongping Wu
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
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Palmer JD, Prasad RN, Fabian D, Wei L, Yildiz VO, Tan Y, Grecula J, Welliver M, Williams T, Elder JB, Raval R, Blakaj D, Haglund K, Bazan J, Kendra K, Arnett A, Beyer S, Liebner D, Giglio P, Puduvalli V, Chakravarti A, Wuthrick E. Phase I study of trametinib in combination with whole brain radiation therapy for brain metastases. Radiother Oncol 2022; 170:21-26. [DOI: 10.1016/j.radonc.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
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