1
|
Yuen CA, Bao S, Kong XT. A non-enhancing, T2 fluid-attenuated inversion recovery hyperintense, diffusion-restricting brainstem lesion in an EGFR tyrosine kinase inhibitor-treated non-small-cell lung cancer patient. Biomark Med 2024; 18:431-439. [PMID: 39007837 DOI: 10.1080/17520363.2024.2342231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/19/2024] [Indexed: 07/16/2024] Open
Abstract
Leptomeningeal metastasis (LM) is a devastating complication of malignancy. Diagnosis relies on both contrast enhancement on imaging and malignant cells in cerebral spinal fluid cytology. Though early detection and prompt intervention improves survival, the detection of LM is limited by false negatives. A rare brainstem imaging finding uncovered specifically in EGFR mutation-positive lung cancer patients may represent an early sign of LM. This sign demonstrates high signal on T2 fluid-attenuated inversion recovery and diffusion-weighted imaging sequences, but paradoxically lacks correlative contrast enhancement. Here we report a case of a 72-year-old female EGFR-positive lung cancer patient who developed this lesion following treatment with two first-generation EGFR tyrosine kinase inhibitors then showed subsequent response to osimertinib, an irreversible third-generation EGFR tyrosine kinase inhibitor.
Collapse
Affiliation(s)
- Carlen A Yuen
- Department of Neurology, Neuro-Oncology Division, University of California, Irvine, CA, 92780,USA
| | - Silin Bao
- Department of Internal Medicine, Neurosciences Division, Community Regional Medical Center, Fresno, CA 93721, USA
| | - Xiao-Tang Kong
- Department of Neurology, Neuro-Oncology Division, University of California, Irvine, CA, 92780,USA
| |
Collapse
|
2
|
Akindona FA, Frederico SC, Hancock JC, Gilbert MR. Exploring the origin of the cancer stem cell niche and its role in anti-angiogenic treatment for glioblastoma. Front Oncol 2022; 12:947634. [PMID: 36091174 PMCID: PMC9454306 DOI: 10.3389/fonc.2022.947634] [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: 05/19/2022] [Accepted: 07/08/2022] [Indexed: 11/21/2022] Open
Abstract
Cancer stem cells are thought to be the main drivers of tumorigenesis for malignancies such as glioblastoma (GBM). They are maintained through a close relationship with the tumor vasculature. Previous literature has well-characterized the components and signaling pathways for maintenance of this stem cell niche, but details on how the niche initially forms are limited. This review discusses development of the nonmalignant neural and hematopoietic stem cell niches in order to draw important parallels to the malignant environment. We then discuss what is known about the cancer stem cell niche, its relationship with angiogenesis, and provide a hypothesis for its development in GBM. A better understanding of the mechanisms of development of the tumor stem cell niche may provide new insights to potentially therapeutically exploit.
Collapse
Affiliation(s)
- Funto A. Akindona
- Neuro-Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD, United States
| | - Stephen C. Frederico
- Neuro-Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD, United States
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - John C. Hancock
- Neuro-Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD, United States
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Mark R. Gilbert
- Neuro-Oncology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Mark R. Gilbert,
| |
Collapse
|
3
|
Kozic D, Lasica N, Grujicic D, Raicevic S, Prvulovic Bunovic N, Nosek I, Boban J. Case Report: Atypical Solitary Brain Metastasis: The Role of MR Spectroscopy In Differential Diagnosis. Front Oncol 2022; 12:866622. [PMID: 35936687 PMCID: PMC9355509 DOI: 10.3389/fonc.2022.866622] [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: 01/31/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Metastatic brain tumors are typically located at the cerebral hemispheres or the cerebellum and most frequently originate from primary breast or lung tumors. Metastatic lesions are usually associated with blood–brain barrier disruption, solid or ring-like contrast enhancement, and perilesional vasogenic edema on brain imaging. Even in cases where metastases are predominantly cystic, enhancement of the minor solid component can be detected. In contrast, non-enhancing secondary brain tumors were only reported in a patient after antiangiogenic treatment with bevacizumab. Case report We report a case of a 54-year-old male who presented with left-sided weakness and multiple seizures. Brain magnetic resonance imaging revealed a T2-weighted heterogeneous solid tumor in the right frontoparietal parasagittal region, with no apparent enhancement on T1-weighted post-contrast images and no evident perilesional edema. Further MRS analysis revealed markedly increased choline and lipid peaks. The patient underwent craniotomy for tumor removal. Histopathology revealed findings consistent with metastatic non-microcellular neuroendocrine lung cancer. positron emission tomography/computed tomography (PET/CT) revealed a stellate lesion within the right upper lung lobe, compatible with primary lung cancer. Conclusion Non-enhancing brain metastatic tumors are rarely reported in the literature, usually following antiangiogenic treatment. Here, we report the first ever case of a non-enhancing metastatic brain tumor with no prior history of antiangiogenic treatment, with particular emphasis on the importance of MRS analysis in atypical brain lesions.
Collapse
Affiliation(s)
- Dusko Kozic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Oncology Institute of Vojvodina, Center for Diagnostic Imaging, Sremska Kamenica, Serbia
| | - Nebojsa Lasica
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic of Neurosurgery, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Danica Grujicic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Neuro-Oncology Department, Clinic of Neurosurgery Clinical Center of Serbia, Belgrade, Serbia
- Pediatric Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Savo Raicevic
- Department of Pathology, Clinical Center of Serbia, Belgrade, Serbia
| | - Natasa Prvulovic Bunovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Oncology Institute of Vojvodina, Center for Diagnostic Imaging, Sremska Kamenica, Serbia
| | - Igor Nosek
- Oncology Institute of Vojvodina, Center for Diagnostic Imaging, Sremska Kamenica, Serbia
| | - Jasmina Boban
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Oncology Institute of Vojvodina, Center for Diagnostic Imaging, Sremska Kamenica, Serbia
- *Correspondence: Jasmina Boban,
| |
Collapse
|
4
|
Advances in the Diagnosis and Treatment of Leptomeningeal Disease. Curr Neurol Neurosci Rep 2022; 22:413-425. [PMID: 35588045 DOI: 10.1007/s11910-022-01198-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Leptomeningeal disease (LMD) is a rare, late complication of systemic cancer and is associated with significant neurological morbidity and high mortality. Here we provide an overview of this condition, summarizing key recent research findings and clinical practice trends in its diagnosis and treatment. We also review current clinical trials for LMD. RECENT FINDINGS Improved molecular diagnostic tools are in development to enable more sensitive detection of LMD, including circulating tumor cells and circulating tumor DNA. The use of targeted and CNS-penetrant therapeutics has shown survival improvements with tyrosine kinase inhibitors, antibody-drug conjugates, and select chemotherapy. However, these studies have primarily been phase I/II and retrospective analyses. There remains a dearth of clinical trials that include LMD patients. The combination of patient-specific molecular information and novel therapeutic approaches holds significant promise for improving outcomes in patients with LMD.
Collapse
|
5
|
Mitsuya K, Nakasu Y, Deguchi S, Shirata K, Asakura K, Nakashima K, Endo M, Takahashi T, Hayashi N. FLAIR hyperintensity along the brainstem surface in leptomeningeal metastases: a case series and literature review. Cancer Imaging 2020; 20:84. [PMID: 33228799 PMCID: PMC7684742 DOI: 10.1186/s40644-020-00361-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 11/11/2020] [Indexed: 11/28/2022] Open
Abstract
Background The incidence of leptomeningeal metastasis (LM) is underestimated because of its non-specific signs and the low sensitivity of clinical diagnostic modalities. Cerebrospinal magnetic resonance (MR) imaging with and without contrast enhancement (CE) is a gold standard for the neuroradiological assessment of patients with suspected LM. Previous studies suggested that some LM cases show changes of the brainstem surface on non-contrast MR images without or before the appearance of abnormalities on CE images. We assessed the features of this non-contrast MR finding in a cohort of LM patients in this retrospective single-institution study. Methods We reviewed head MR images and clinical data of 142 consecutive patients in whom the final diagnosis was LM. Results We found that 11 of these 142 patients (7.7%) with LM had band-like hyperintensity on the brainstem surface on non-enhanced FLAIR images, which looked like bloomy rind on cheese. Three of seven patients who were examined using diffusion-weighted imaging showed restricted diffusion in the corresponding lesion site. The above-mentioned 11 patients included 10 women and 1 man, with a median age of 61 years. All 11 patients had primary lung adenocarcinoma. Seven patients had symptomatic hydrocephalus. Ten patients had EGFR-mutated and one had ALK-rearrangement adenocarcinomas. Before the diagnosis of LM, 10 patients had undergone systemic therapy with EGFR-TKI or pemetrexed, and 1 patient with ALK inhibitor and bevacizumab. Conclusions We present a series of patients with bloomy rind sign that is non-enhancing LM reliably detected by FLAIR hyperintensity on the brainstem surface. This finding is rare, but may reflect the spread of cancer cells in both the leptomeningeal membrane and the surface of the brain parenchyma specifically in patients with lung adenocarcinomas. Further study is needed to determine the clinical significance of this sign, and the pathophysiological factors associated with it may be clarified by analyzing serial MR images in a larger cohort of patients treated for LM.
Collapse
Affiliation(s)
- Koichi Mitsuya
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Shizuoka, 4118777, Japan.
| | - Yoko Nakasu
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Shizuoka, 4118777, Japan.,Division of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shoichi Deguchi
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Shizuoka, 4118777, Japan
| | - Kensei Shirata
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
| | - Koiku Asakura
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
| | - Kazuaki Nakashima
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
| | - Nakamasa Hayashi
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Shizuoka, 4118777, Japan
| |
Collapse
|
6
|
Dasgupta A, Moraes FY, Rawal S, Diamandis P, Shultz DB. Focal Leptomeningeal Disease with Perivascular Invasion in EGFR-Mutant Non-Small-Cell Lung Cancer. AJNR Am J Neuroradiol 2020; 41:1430-1433. [PMID: 32616581 DOI: 10.3174/ajnr.a6640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/07/2020] [Indexed: 11/07/2022]
Abstract
We report a previously undescribed pattern of brain metastases in patients with epidermal growth factor receptor-mutated non-small-cell lung cancer treated with tyrosine kinase inhibitors and radiation therapy. These highly distinct lesions appear to spread focally within the leptomeninges, with invasion along the perivascular spaces (FLIP). The survival of patients with FLIP was significantly better compared with patients with classic leptomeningeal disease (median survival, 21 versus 3 months; P = .003). It is unclear whether this pattern of growth is unique to epidermal growth factor receptor-mutated non-small-cell lung cancer.
Collapse
Affiliation(s)
- A Dasgupta
- From the Department of Radiation Oncology (A.D., F.Y.M., D.B.S.), Division of Neuroimaging, Joint Department of Medical Imaging (S.R.), and Department of Neuropathology (P.D.), Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada
| | - F Y Moraes
- From the Department of Radiation Oncology (A.D., F.Y.M., D.B.S.), Division of Neuroimaging, Joint Department of Medical Imaging (S.R.), and Department of Neuropathology (P.D.), Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada
| | - S Rawal
- From the Department of Radiation Oncology (A.D., F.Y.M., D.B.S.), Division of Neuroimaging, Joint Department of Medical Imaging (S.R.), and Department of Neuropathology (P.D.), Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada
| | - P Diamandis
- From the Department of Radiation Oncology (A.D., F.Y.M., D.B.S.), Division of Neuroimaging, Joint Department of Medical Imaging (S.R.), and Department of Neuropathology (P.D.), Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada
| | - D B Shultz
- From the Department of Radiation Oncology (A.D., F.Y.M., D.B.S.), Division of Neuroimaging, Joint Department of Medical Imaging (S.R.), and Department of Neuropathology (P.D.), Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada.
| |
Collapse
|
7
|
Tripathi M, Ahuja CK, Mukherjee KK, Kumar N, Dhandapani S, Dutta P, Kaur R, Rekhapalli R, Batish A, Gurnani J, Kamboj P, Agrahari A, Kataria K. The Safety and Efficacy of Bevacizumab for Radiosurgery - Induced Steroid - Resistant Brain Edema; Not the Last Part in the Ship of Theseus. Neurol India 2020; 67:1292-1302. [PMID: 31744962 DOI: 10.4103/0028-3886.271242] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Radiation-induced brain edema (RIBE) is a serious complication of radiation therapy. It may result in dramatic clinico-radiological deterioration. At present, there are no definite guidelines for management of the complication. Corticosteroids are the usual first line of treatment, which frequently fails to provide long-term efficacy in view of its adverse complication profile. Bevacizumab has been reported to show improvement in cases of steroid-resistant radiation injury. The objective of this study is to evaluate the role of Bevacizumab in post-radiosurgery RIBE. Material and Methods Since 2012, 189 out of 1241 patients who underwent radiosurgery at our institution developed post-radiosurgery RIBE, 17 of which did not respond to high-dose corticosteroids. We systematically reviewed these 17 patients of various intracranial pathologies with clinic-radiological evidence of RIBE following gamma knife radiosurgery (GKRS). All patients received protocol-based Bevacizumab therapy. The peer-reviewed literature was evaluated. Results 82 percent of the patients showed improvement after starting Bevacizumab. The majority began to improve after the third cycle started improvement after the third cycle of Bevacizumab. Clinical improvement preceded radiological improvement by an average of eight weeks. The first dose was 5 mg/kg followed by 7.5-10 mg/kg at with two-week intervals. Bevacizumab needs to be administered for an average of seven cycles (range 5-27, median 7) for best response. Steroid therapy could be tapered in most patients by the first follow-up. One patient did not respond to Bevacizumab and needed surgical decompression for palliative care. One noncompliant patient died due to radiation injury. Conclusion Bevacizumab is a effective and safe for treatment of RIBE after GKRS. A protocol-based dose schedule in addition to frequent clinical and radiological evaluations are required. Bevacizumab should be considered as an early treatment option for RIBE.
Collapse
Affiliation(s)
- Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag K Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanchan K Mukherjee
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narendra Kumar
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupinder Kaur
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajashekhar Rekhapalli
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Batish
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jenil Gurnani
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parwinder Kamboj
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhinav Agrahari
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ketan Kataria
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
8
|
Vessel co-option and resistance to anti-angiogenic therapy. Angiogenesis 2019; 23:55-74. [PMID: 31865479 DOI: 10.1007/s10456-019-09698-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/22/2019] [Indexed: 12/20/2022]
Abstract
Vessel co-option is a non-angiogenic mechanism of tumour vascularisation in which cancer cells utilise pre-existing blood vessels instead of inducing new blood vessel formation. Vessel co-option has been observed across a range of different tumour types, in both primary cancers and metastatic disease. Importantly, vessel co-option is now implicated as a major mechanism that mediates resistance to conventional anti-angiogenic drugs and this may help to explain the limited efficacy of this therapeutic approach in certain clinical settings. This includes the use of anti-angiogenic drugs to treat advanced-stage/metastatic disease, treatment in the adjuvant setting and the treatment of primary disease. In this article, we review the available evidence linking vessel co-option with resistance to anti-angiogenic therapy in numerous tumour types, including breast, colorectal, lung and pancreatic cancer, glioblastoma, melanoma, hepatocellular carcinoma, and renal cell carcinoma. The finding that vessel co-option is a significant mechanism of resistance to anti-angiogenic therapy may have important implications for the future of anti-cancer therapy, including (a) predicting response to anti-angiogenic drugs, (b) the need to develop therapies that target both angiogenesis and vessel co-option in tumours, and (c) predicting the response to other therapeutic modalities, including immunotherapy.
Collapse
|
9
|
Kuczynski EA, Vermeulen PB, Pezzella F, Kerbel RS, Reynolds AR. Vessel co-option in cancer. Nat Rev Clin Oncol 2019; 16:469-493. [PMID: 30816337 DOI: 10.1038/s41571-019-0181-9] [Citation(s) in RCA: 262] [Impact Index Per Article: 52.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
All solid tumours require a vascular supply in order to progress. Although the ability to induce angiogenesis (new blood vessel growth) has long been regarded as essential to this purpose, thus far, anti-angiogenic therapies have shown only modest efficacy in patients. Importantly, overshadowed by the literature on tumour angiogenesis is a long-standing, but continually emerging, body of research indicating that tumours can grow instead by hijacking pre-existing blood vessels of the surrounding nonmalignant tissue. This process, termed vessel co-option, is a frequently overlooked mechanism of tumour vascularization that can influence disease progression, metastasis and response to treatment. In this Review, we describe the evidence that tumours located at numerous anatomical sites can exploit vessel co-option. We also discuss the proposed molecular mechanisms involved and the multifaceted implications of vessel co-option for patient outcomes.
Collapse
Affiliation(s)
- Elizabeth A Kuczynski
- Bioscience, Oncology, IMED Biotech Unit, AstraZeneca, Cambridge, UK. .,Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.
| | - Peter B Vermeulen
- HistoGeneX, Antwerp, Belgium.,Translational Cancer Research Unit, GZA Hospitals St Augustinus, University of Antwerp, Wilrijk-Antwerp, Belgium.,Tumour Biology Team, Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Francesco Pezzella
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Robert S Kerbel
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Andrew R Reynolds
- Tumour Biology Team, Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK. .,Oncology Translational Medicine Unit, IMED Biotech Unit, AstraZeneca, Cambridge, UK.
| |
Collapse
|
10
|
Turkaj A, Morelli AM, Vavalà T, Novello S. Management of Leptomeningeal Metastases in Non-oncogene Addicted Non-small Cell Lung Cancer. Front Oncol 2018; 8:278. [PMID: 30140655 PMCID: PMC6094962 DOI: 10.3389/fonc.2018.00278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/04/2018] [Indexed: 12/13/2022] Open
Abstract
Brain metastases in non-small cell lung cancer (NSCLC) patients are more often detected due to imaging modalities improvements but also emerge because of improved treatments of the primary tumor which lead to a longer survival. In this context, development of leptomeningeal metastases (LM) is a devastating complication and its prognosis remains poor despite advances in systemic and local approaches. Histology characterization of NSCLC and molecular expression influence LM management. For those with “oncogene addiction,” new generation epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) were developed to strongly penetrate the blood-brain barrier (BBB) with the aim to prevent central nervous system cancer dissemination, eventually impacting on LM appearance and its subsequent management. Systemic chemotherapy, often combined with intrathecal chemotherapy (when possible), was one of common indications for lung cancer patients affected by LM, without driver mutations and a good performance status but currently, with the advent of innovative systemic approaches treatment solutions in this subgroup of patients are rapidly evolving. Whole brain radiation therapy (WBRT) is the conventional treatment for patients with brain metastases. Furthermore, modern radiation techniques, as stereotactic radiotherapy (SRT), improve outcomes in those cases with a limited number of lesions. However, LM represent a minority of CNS metastases and few literature data are available to drive the radiotherapy approach. Considering all relevant progress made in this setting, after a literature review, the aim of this paper is to discuss about recent developments and therapeutic options in LM management of non-oncogene addicted NSCLC.
Collapse
Affiliation(s)
- Ana Turkaj
- Department of Oncology, University of Torino, Ospedale San Luigi Gonzaga, Orbassano, Italy
| | - Anna M Morelli
- Department of Oncology, University of Torino, Ospedale San Luigi Gonzaga, Orbassano, Italy
| | - Tiziana Vavalà
- SC of Oncology, ASL CN1, Ospedale Civile di Saluzzo, Saluzzo, Italy
| | - Silvia Novello
- Department of Oncology, University of Torino, Ospedale San Luigi Gonzaga, Orbassano, Italy
| |
Collapse
|
11
|
Goyal P, Tenenbaum M, Gupta S, Kochar PS, Bhatt AA, Mangla M, Kumar Y, Mangla R. Survival prediction based on qualitative MRI diffusion signature in patients with recurrent high grade glioma treated with bevacizumab. Quant Imaging Med Surg 2018; 8:268-279. [PMID: 29774180 DOI: 10.21037/qims.2018.04.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Bevacizumab was approved by the FDA for the treatment of recurrent or progressive glioblastoma (GBM). Imaging responses are typically assessed by gadolinium-enhanced MRI. We sought to determine the significance of qualitative diffusion signature (manifest as variable degree of dark signal) on ADC maps in recurrent gliomas after treatment with bevacizumab. Methods We performed an institutional review board (IRB) approved retrospective study on patients who underwent MRI of the brain after 8 weeks of receiving bevacizumab for recurrent glioma. Patients were divided into three groups based on qualitative diffusion signature: (I) lesion not bright on diffusion weighted imaging (DWI) suggestive of no restricted diffusion (FDR0); (II) lesion bright on DWI with corresponding homogenous dark signal on apparent diffusion coefficient (ADC) maps suggestive of focal restricted diffusion likely due to bevacizumab induced necrosis (FDRn); and (III) lesion bright on DWI with corresponding homogenous faint dark signal on ADC maps suggestive of focal restricted diffusion likely due to viable tumor or heterogeneous spectrum of dark and faint dark signals on ADC maps suggestive of focal restricted diffusion likely due to viable tumor surrounding the bevacizumab induced necrosis (FDRt). Results Based on the qualitative signal on diffusion weighted sequences after bevacizumab therapy, total number of patients in group (I) were 14 (36%), in group (II) were 17 (44%); and in group (III) were 8 (20%). The median overall survival (OS) from the time of recurrence in patients belonging to group (II) was 364 days vs. 183 days for those with group (I) vs. 298 days for group (III). On simultaneous comparison of survival differences in all three groups by Kaplan-Meier analysis, group (II) was significant in predicting survival with P values for the log-rank tests <0.033. Conclusions In patients with recurrent glioma treated with bevacizumab, the presence of homogenous dark signal (FDRn) on ADC maps at 8 weeks follow-up MRI correlated with a longer survival. Thus, use of this qualitative diffusion signature in adjunct to contrast enhanced MRI may have the widest potential impact on routine clinical care for patients with recurrent high-grade gliomas. However, prospective studies analysing its predictive value are warranted.
Collapse
Affiliation(s)
- Pradeep Goyal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Mary Tenenbaum
- Department of Radiology, UMMS-Baystate Regional Campus, Springfield, MA, USA.,Department of Radiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Sonali Gupta
- Department of Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Puneet S Kochar
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Alok A Bhatt
- Department of Radiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Manisha Mangla
- Department of Public Health, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Yogesh Kumar
- Department of Radiology, Columbia University at Bassett Healthcare, Cooperstown, NY, USA
| | - Rajiv Mangla
- Department of Radiology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, USA
| |
Collapse
|
12
|
Thomas A, Rosenblum M, Karimi S, DeAngelis LM, Omuro A, Kaley TJ. Radiographic patterns of recurrence and pathologic correlation in malignant gliomas treated with bevacizumab. CNS Oncol 2018; 7:7-13. [PMID: 29388793 PMCID: PMC6001559 DOI: 10.2217/cns-2017-0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Interpretation of MRI abnormalities in patients with malignant gliomas (MG) treated with bevacizumab is challenging. Recent reports describe quantitative analyses of diffusion-weighted imaging abnormalities not available in standard clinical settings, to differentiate tumor recurrence from treatment necrosis. We retrospectively reviewed bevacizumab treated MG patients who underwent surgery or autopsy to correlate radiographic recurrence patterns with pathologic findings. 32 patients with MG (26 glioblastoma, three anaplastic astrocytoma and three anaplastic oligodendroglioma) were identified. Recurrence patterns: local enhancing (n = 23), distant enhancing (n = 1), nonenhancing (n = 7) and leptomeningeal (n = 1). Histology: tumor (n = 25), mixed tumor/necrosis (n = 5) and all necrosis (n = 2). On diffusion-weighted imaging, 5/32 had restricted diffusion (three mixed and two necrosis). Irrespective of radiographic recurrence pattern, tumor was found in 94% of cases. Restricted diffusion correlated with necrosis.
Collapse
Affiliation(s)
- Alissa Thomas
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.,Department of Neurology, University of Vermont, 11 Colchester Avenue, Burlington, VT 05401, USA
| | - Marc Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Sasan Karimi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Antonio Omuro
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Thomas J Kaley
- Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| |
Collapse
|
13
|
Abstract
OPINION STATEMENT Treatment options for leptomeningeal metastases are expanding with greater tolerability and efficacy than in the past. Improved knowledge of molecular subtypes of some cancers can guide in choosing more effective therapeutic options; however, physicians should be mindful that these molecular types can be different in the central nervous system compared to the rest of the body. This is particularly true in breast and lung cancer, in which some patients now can live for many months or even years after diagnosis of leptomeningeal metastases. Options for intrathecal therapies are expanding, but physicians should be mindful that this is a passive delivery system that relies on normal CSF flow, so therapies will not penetrate bulky or parenchymal disease sites, especially in the presence of abnormal CSF flow. When chemotherapeutic options are lacking or unsuccessful, focal radiosurgery which can provide symptomatic relief and proton craniospinal radiation remain effective options. Hopefully more formal studies will be conducted in the future to verify which treatments are indeed most effective for particular types of cancer.
Collapse
Affiliation(s)
- Jerome J Graber
- Department of Neurology, Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, Swedish Neuroscience Institute, Seattle, WA, 98122-4470, USA.
| | - Santosh Kesari
- Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, CA, 90404, USA.
| |
Collapse
|
14
|
Nayar G, Ejikeme T, Chongsathidkiet P, Elsamadicy AA, Blackwell KL, Clarke JM, Lad SP, Fecci PE. Leptomeningeal disease: current diagnostic and therapeutic strategies. Oncotarget 2017; 8:73312-73328. [PMID: 29069871 PMCID: PMC5641214 DOI: 10.18632/oncotarget.20272] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/20/2017] [Indexed: 12/28/2022] Open
Abstract
Leptomeningeal disease has become increasingly prevalent as novel therapeutic interventions extend the survival of cancer patients. Although a majority of leptomeningeal spread occurs secondary to breast cancer, lung cancer, and melanoma, a wide variety of malignancies have been reported as primary sources. Symptoms on presentation are equally diverse, often involving a combination of neurological deficits with the possibility of obstructive hydrocephalus. Diagnosis is definitively made via cerebrospinal fluid cytology for malignant cells, but neuro-imaging with high quality T1-weighted magnetic resonance imaging can aid diagnosis and localization. While leptomeningeal disease is still a terminal, late-stage complication, a variety of treatment modalities, such as intrathecal chemotherapeutics and radiation therapy, have improved median survival from 4–6 weeks to 3–6 months. Positive prognosticative factors for survival include younger age, high performance scores, and controlled systemic disease. In looking to the future, diagnostics that improve early detection and chemotherapeutics tailored to the primary malignancy will likely be the most significant advances in improving survival.
Collapse
Affiliation(s)
- Gautam Nayar
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Tiffany Ejikeme
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Pakawat Chongsathidkiet
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Aladine A Elsamadicy
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Kimberly L Blackwell
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey M Clarke
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Peter E Fecci
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,Department of Pathology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
15
|
Little Influence of Bevacizumab in Diagnosis of Leptomeningeal Metastases in Current Study. J Thorac Oncol 2017; 12:e5-e6. [DOI: 10.1016/j.jtho.2016.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/01/2016] [Indexed: 11/19/2022]
|
16
|
False-Negative MRI Findings for Leptomeningeal Metastases with Use of Bevacizumab. J Thorac Oncol 2017; 12:e5. [PMID: 27988101 DOI: 10.1016/j.jtho.2016.09.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 09/18/2016] [Indexed: 11/24/2022]
|
17
|
Hatzoglou V, Karimi S, Diamond EL, Lis E, Krol G, Holodny AI, Young RJ. Nonenhancing Leptomeningeal Metastases: Imaging Characteristics and Potential Causative Factors. Neurohospitalist 2016; 6:24-8. [PMID: 26753054 DOI: 10.1177/1941874415591702] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The diagnosis of leptomeningeal metastasis (LM) has increased in frequency, as new therapies have lengthened the survival of patients with cancer. Early diagnosis and intervention help improve quality of life and prevent further neurological deterioration in LM. The detection of LM is often established by magnetic resonance imaging examinations, cerebrospinal fluid analysis, or both. We present a series of cases where LM was identified on fluid-attenuated inversion recovery or T2-weighted image but was nonenhancing on the traditionally more sensitive postcontrast T1-weighted sequences. Nonenhancing LM is unusual and not yet fully understood but should be considered in the appropriate clinical context and may become more common with increased utilization of antiangiogenic therapies.
Collapse
Affiliation(s)
- Vaios Hatzoglou
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Sasan Karimi
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Eric Lis
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - George Krol
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Robert J Young
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
18
|
Yomo S, Hayashi M. Salvage stereotactic radiosurgery with adjuvant use of bevacizumab for heavily treated recurrent brain metastases: a preliminary report. J Neurooncol 2015; 127:119-26. [DOI: 10.1007/s11060-015-2019-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
|
19
|
Faivre G, Pentsova E, Demopoulos A, Taillibert S, Rosenblum M, Omuro A. Clinical Reasoning: Worsening neurologic symptoms in a brain tumor patient. Neurology 2015; 85:e57-61. [PMID: 26283762 DOI: 10.1212/wnl.0000000000001848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Geraldine Faivre
- From Memorial Sloan Kettering Cancer Center (G.F., E.P., M.R., A.O.), New York; North Shore University Hospital (A.D.), Manhasset, NY; and Groupe Hospitalier Pitié-Salpêtrière (S.T.), Paris, France
| | - Elena Pentsova
- From Memorial Sloan Kettering Cancer Center (G.F., E.P., M.R., A.O.), New York; North Shore University Hospital (A.D.), Manhasset, NY; and Groupe Hospitalier Pitié-Salpêtrière (S.T.), Paris, France
| | - Alexis Demopoulos
- From Memorial Sloan Kettering Cancer Center (G.F., E.P., M.R., A.O.), New York; North Shore University Hospital (A.D.), Manhasset, NY; and Groupe Hospitalier Pitié-Salpêtrière (S.T.), Paris, France
| | - Sophie Taillibert
- From Memorial Sloan Kettering Cancer Center (G.F., E.P., M.R., A.O.), New York; North Shore University Hospital (A.D.), Manhasset, NY; and Groupe Hospitalier Pitié-Salpêtrière (S.T.), Paris, France
| | - Marc Rosenblum
- From Memorial Sloan Kettering Cancer Center (G.F., E.P., M.R., A.O.), New York; North Shore University Hospital (A.D.), Manhasset, NY; and Groupe Hospitalier Pitié-Salpêtrière (S.T.), Paris, France
| | - Antonio Omuro
- From Memorial Sloan Kettering Cancer Center (G.F., E.P., M.R., A.O.), New York; North Shore University Hospital (A.D.), Manhasset, NY; and Groupe Hospitalier Pitié-Salpêtrière (S.T.), Paris, France.
| |
Collapse
|
20
|
Zhang M, Gulotta B, Thomas A, Kaley T, Karimi S, Gavrilovic I, Woo KM, Zhang Z, Arevalo-Perez J, Holodny AI, Rosenblum M, Young RJ. Large-volume low apparent diffusion coefficient lesions predict poor survival in bevacizumab-treated glioblastoma patients. Neuro Oncol 2015; 18:735-43. [PMID: 26538618 DOI: 10.1093/neuonc/nov268] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 10/01/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Glioblastomas treated with bevacizumab may develop low-signal apparent diffusion coefficient (low-ADC) lesions, which may reflect increased tumor cellularity or atypical necrosis. The purpose of this study was to examine the relationship between low-ADC lesions and overall survival (OS). We hypothesized that growing low-ADC lesions would be associated with shorter OS. METHODS We retrospectively identified 52 patients treated with bevacizumab for the first (n = 42, 81%) or later recurrence of primary glioblastoma, who had low-ADC lesions and 2 post-bevacizumab scans ≤90 days apart. Low-ADC lesion volumes were measured, and normalized 5th percentile histogram low-ADC values were recorded. Using OS as the primary endpoint, semiparametric Cox models were fitted to ascertain univariate and multivariate hazard ratios (HRs) with significance at P = .05. RESULTS Median OS was 9.1 months (95% CI = 7.2-14.3). At the second post-bevacizumab scan, the volume of the low-ADC lesion (median: 12.94 cm(3)) was inversely associated with OS, with larger volumes predicting shorter OS (HR = 1.014 [95% CI = 1.003-1.025], P = .009). The percent change in low-ADC volume (median: 6.8%) trended toward increased risk of death with growing volumes (P = .08). Normalized 5th percentile low-ADC value and its percent change were not associated with OS (P > .51). Also correlated with shorter OS were the pre-bevacizumab nonenhancing volume (P = .025), the first post-bevacizumab enhancing volume (P = .040), and the second post-bevacizumab enhancing volume (P = .004). CONCLUSIONS The volume of low-ADC lesions at the second post-bevacizumab scan predicted shorter OS. This suggests that low-ADC lesions may be considered important imaging markers and included in treatment decision algorithms.
Collapse
Affiliation(s)
- Myron Zhang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York (M.Z., B.G., S.K., J.A.-P., A.I.H., R.J.Y.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.T., T.K., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (M.R.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (T.K., S.K., I.G., A.I.H., M.R., R.J.Y.)
| | - Bryanna Gulotta
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York (M.Z., B.G., S.K., J.A.-P., A.I.H., R.J.Y.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.T., T.K., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (M.R.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (T.K., S.K., I.G., A.I.H., M.R., R.J.Y.)
| | - Alissa Thomas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York (M.Z., B.G., S.K., J.A.-P., A.I.H., R.J.Y.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.T., T.K., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (M.R.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (T.K., S.K., I.G., A.I.H., M.R., R.J.Y.)
| | - Thomas Kaley
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York (M.Z., B.G., S.K., J.A.-P., A.I.H., R.J.Y.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.T., T.K., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (M.R.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (T.K., S.K., I.G., A.I.H., M.R., R.J.Y.)
| | - Sasan Karimi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York (M.Z., B.G., S.K., J.A.-P., A.I.H., R.J.Y.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.T., T.K., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (M.R.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (T.K., S.K., I.G., A.I.H., M.R., R.J.Y.)
| | - Igor Gavrilovic
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York (M.Z., B.G., S.K., J.A.-P., A.I.H., R.J.Y.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.T., T.K., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (M.R.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (T.K., S.K., I.G., A.I.H., M.R., R.J.Y.)
| | - Kaitlin M Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York (M.Z., B.G., S.K., J.A.-P., A.I.H., R.J.Y.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.T., T.K., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (M.R.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (T.K., S.K., I.G., A.I.H., M.R., R.J.Y.)
| | - Zhigang Zhang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York (M.Z., B.G., S.K., J.A.-P., A.I.H., R.J.Y.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.T., T.K., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (M.R.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (T.K., S.K., I.G., A.I.H., M.R., R.J.Y.)
| | - Julio Arevalo-Perez
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York (M.Z., B.G., S.K., J.A.-P., A.I.H., R.J.Y.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.T., T.K., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (M.R.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (T.K., S.K., I.G., A.I.H., M.R., R.J.Y.)
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York (M.Z., B.G., S.K., J.A.-P., A.I.H., R.J.Y.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.T., T.K., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (M.R.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (T.K., S.K., I.G., A.I.H., M.R., R.J.Y.)
| | - Marc Rosenblum
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York (M.Z., B.G., S.K., J.A.-P., A.I.H., R.J.Y.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.T., T.K., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (M.R.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (T.K., S.K., I.G., A.I.H., M.R., R.J.Y.)
| | - Robert J Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York (M.Z., B.G., S.K., J.A.-P., A.I.H., R.J.Y.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.T., T.K., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (M.R.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (T.K., S.K., I.G., A.I.H., M.R., R.J.Y.)
| |
Collapse
|
21
|
Lumboperitoneal shunt for the treatment of leptomeningeal metastasis. Med Hypotheses 2015; 84:506-8. [DOI: 10.1016/j.mehy.2015.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 02/04/2015] [Accepted: 02/19/2015] [Indexed: 01/18/2023]
|
22
|
Nayak L, Fleisher M, Gonzalez-Espinoza R, Lin O, Panageas K, Reiner A, Liu CM, Deangelis LM, Omuro A. Rare cell capture technology for the diagnosis of leptomeningeal metastasis in solid tumors. Neurology 2013; 80:1598-605; discussion 1603. [PMID: 23553479 DOI: 10.1212/wnl.0b013e31828f183f] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the utility of rare cell capture technology (RCCT) in the diagnosis of leptomeningeal metastasis (LM) from solid tumors through identification of circulating tumor cells (CTCs) in the CSF. METHODS In this pilot study, CSF samples from 60 patients were analyzed. The main patient cohort consisted of 51 patients with solid tumors undergoing lumbar puncture for clinical suspicion of LM. Those patients underwent initial MRI evaluation and had CSF analyzed through conventional cytology and for the presence of CTCs using RCCT, based on immunomagnetic platform enrichment utilizing anti-epithelial cell adhesion molecule antibody-covered magnetic nanoparticles. An additional 9 patients with CSF pleocytosis but without solid tumors were separately analyzed to ensure accurate differentiation between CTCs and leukocytes. RESULTS Among the 51 patients with solid tumors, 15 patients fulfilled criteria for LM. CSF CTCs were found in 16 patients (median 20.7 CTCs/mL, range 0.13 to >150), achieving a sensitivity of 100% as compared with 66.7% for conventional cytology and 73.3% for MRI. One patient had a false-positive CSF CTC result (specificity = 97.2%); however, that patient eventually met LM criteria 6 months after the tap. CSF CTCs were not found in any of the additional 9 patients with CSF pleocytosis. CONCLUSION RCCT is an accurate, novel method for the detection of LM in solid tumors, potentially providing earlier diagnostic confirmation and sparing patients from repeat lumbar punctures.
Collapse
Affiliation(s)
- Lakshmi Nayak
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Martins SJ, Azevedo CRASD, Chinen LTD, Cruz MRS, Peterlevitz MA, Gimenes DL. Meningeal carcinomatosis in solid tumors. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 69:973-80. [PMID: 22297890 DOI: 10.1590/s0004-282x2011000700024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 07/01/2011] [Indexed: 02/06/2023]
Abstract
The involvement of the leptomeninges by metastatic tumors can be observed in solid tumors, in which case it is termed meningeal carcinomatosis (MC), and in lymphoproliferative malignant disease. It is more common in breast and lung cancer, as well as melanoma, with adenocarcinoma being the most frequent histological type. MC is usually a late event, with disseminated and progressive disease already present and, it is characterized by multifocal neurological signs and symptoms. Diagnosis is based on the evaluation of clinical presentation, cerebrospinal fluid and neuroimaging studies. The better systemic disease control is observed with new therapeutic agents, and the development of neuroimaging methods is responsible for the increasing incidence of such metastatic evolution. Intrathecal chemotherapy is generally the treatment of choice, although frequently palliative. Prognosis is guarded, although a higher performance status may indicate a subgroup of patients with a more favorable outcome.
Collapse
|
24
|
Gupta A, Young RJ, Karimi S, Sood S, Zhang Z, Mo Q, Gutin PH, Holodny AI, Lassman AB. Isolated diffusion restriction precedes the development of enhancing tumor in a subset of patients with glioblastoma. AJNR Am J Neuroradiol 2011; 32:1301-1306. [PMID: 21596805 DOI: 10.3174/ajnr.a2479] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Most response criteria for patients with glioblastoma rely on increases in the contrast enhancing abnormality to determine tumor progression. Our aim was to determine retrospectively in patients with glioblastoma whether diffusion restriction can predict the development of new enhancing mass lesions. MATERIALS AND METHODS We reviewed the brain MR imaging scans (including DWI and ADC maps) of 208 patients with glioblastoma. Patients with restricted diffusion in or adjacent to the tumor were identified, with further analysis only performed on those patients with low-ADC lesions without enhancement. These patients were followed to determine if new concordant enhancement developed at the site of the low-ADC lesion. A Wilcoxon signed rank test, competing risk analysis, and Kaplan-Meier curves were used to compare the mean drop in ADC values, assess enhancement-free survival, and determine overall survival, respectively. RESULTS In 67 of the 208 patients (32.2%), visibly detectable restricted diffusion was seen during treatment. The study cohort was formed by the 27 patients with low-ADC lesions and no corresponding enhancement. Twenty-three (85.2%) patients developed gadolinium-enhancing tumor at the site of restricted diffusion a median of 3.0 months later (95% CI, 2.6-4.1 months). The mean decrease in ADC was 22.9% from baseline (P < .001). The 3-month enhancement-free survival probability was 0.481 (95% CI, 0.288-0.675). The 12-month overall survival probability was 0.521 (95% CI, 0.345-0.788). Restricted diffusion predicted enhancement regardless of antiangiogenic therapy with bevacizumab. CONCLUSIONS In a subset of patients with glioblastoma, development of a new focus of restricted diffusion during treatment may precede the development of new enhancing tumor.
Collapse
Affiliation(s)
- A Gupta
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - R J Young
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - S Karimi
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - S Sood
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Z Zhang
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Q Mo
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - P H Gutin
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - A I Holodny
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - A B Lassman
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| |
Collapse
|
25
|
Vascular co-option in lung cancer metastatic to the eye after treatment with bevacizumab. J Ophthalmic Inflamm Infect 2010; 1:35-8. [PMID: 21475657 PMCID: PMC3062772 DOI: 10.1007/s12348-010-0013-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 10/26/2010] [Indexed: 12/04/2022] Open
Abstract
Background Chemotherapy with bevacizumab alters the angiogenic environment, and therefore, the growth and spread of metastases. We present a patient with metastatic lung adenocarcinoma to the eye with findings suggestive of retinal vascular co-option. Methods Case report. Results A 57-year-old male, receiving systemic bevacizumab for metastatic lung adenocarcinoma, presented with vitreous opacities and clumped deposits adherent to the retinal vessels. No choroidal metastases were present. Diagnostic vitrectomy yielded cellular evidence of adenocarcinoma, with thyroid transcription factor-1 staining confirming a lung primary. Conclusion The perivascular growth of small foci of metastatic vitreous cells suggests vascular co-option from the native retinal circulation. Similar modification of metastatic disease by bevacizumab has been observed in animal models and selected human cases.
Collapse
|
26
|
Abstract
Neoplastic meningitis (NM) occurs in 5% to 8% of cancer patients, commonly as an end-stage process in previously metastatic disease. As newer therapeutics extend patient survival by maintaining long-term control of systemic malignancies, the incidence of NM is likely to rise. This can be expected both because of a change in the natural history of the underlying disease and the generally poor penetrance of many newer anticancer drugs into the central nervous system, thereby creating a sanctuary site for malignant cells. Currently available treatments have provided limited benefit in overall survival in NM, although long-term survival does occur. Because of the morbidity occasionally associated with treatment, prognostic indicators are being analyzed to identify patients who may benefit from systemic and/or intrathecal therapy before making the decision to initiate treatment. Additionally, because of the relative insensitivity of traditional cerebrospinal fluid analysis, new markers of NM are being investigated. This endeavor is being aided by ongoing research into the underlying biology of the metastatic process.
Collapse
|