1
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Winslow N, Boyle J, Miller W, Wang Y, Geoffroy F, Tsung AJ. Development of brain metastases in non-small-cell lung cancer: high-risk features. CNS Oncol 2024; 13:2395804. [PMID: 39264427 PMCID: PMC11404603 DOI: 10.1080/20450907.2024.2395804] [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: 03/18/2024] [Accepted: 08/20/2024] [Indexed: 09/13/2024] Open
Abstract
Aim: Brain metastases (BM) are a common site of disease progression and treatment failure in non-small-cell lung cancer (NSCLC) and can be identified in up to 30-50% of patients. Although they are common, there is no standardized screening protocol for development of BM in NSCLC. Multiple clinical variables predict increased BM occurrence, and, when present, should be used to initiate screening MRI.Materials & methods: We performed a single center retrospective review of NSCLC patients, examining BM development and overall survival. Available clinical, radiographic and molecular data were reviewed for association with BM and overall survival. A predictive model for BM development was created for multivariate analysis.Results: Risk factors for new BM development in NSCLC included younger age, larger primary lung tumor, Karnofsky performance score (KPS) <70, pre-existing liver or bone metastases, large cell histology and family history of cancer. Factors associated with decreased OS were larger primary lung tumor, extracranial metastases at time of diagnosis, large cell histology and poorly-differentiated carcinoma histology.Conclusion: There are multiple high risk features for developing BM in NSCLC. Each of these factors should routinely be investigated, and presence should prompt brain MRI to allow earlier diagnosis and treatment of BM.
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Affiliation(s)
- Nolan Winslow
- Department of Neurosurgery, OSF Saint Francis Medical Center, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA
| | - Jacqueline Boyle
- Department of Neurosurgery, OSF Saint Francis Medical Center, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA
| | - William Miller
- Department of Neurosurgery, OSF Saint Francis Medical Center, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA
| | - Yanzhi Wang
- Department of Statistics, University of Illinois College of Medicine, 1 Illini Drive, Peoria, IL 61605, USA
| | | | - Andrew J Tsung
- Department of Neurosurgery, OSF Saint Francis Medical Center, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA
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2
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Stember JN, Young RJ, Shalu H. Direct Evaluation of Treatment Response in Brain Metastatic Disease with Deep Neuroevolution. J Digit Imaging 2023; 36:536-546. [PMID: 36396839 PMCID: PMC10039135 DOI: 10.1007/s10278-022-00725-5] [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: 04/06/2022] [Revised: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
Cancer centers have an urgent and unmet clinical and research need for AI that can guide patient management. A core component of advancing cancer treatment research is assessing response to therapy. Doing so by hand, for example, as per RECIST or RANO criteria, is tedious and time-consuming, and can miss important tumor response information. Most notably, the prevalent response criteria often exclude lesions, the non-target lesions, altogether. We wish to assess change in a holistic fashion that includes all lesions, obtaining simple, informative, and automated assessments of tumor progression or regression. Because genetic sub-types of cancer can be fairly specific and patient enrollment in therapy trials is often limited in number and accrual rate, we wish to make response assessments with small training sets. Deep neuroevolution (DNE) is a novel radiology artificial intelligence (AI) optimization approach that performs well on small training sets. Here, we use a DNE parameter search to optimize a convolutional neural network (CNN) that predicts progression versus regression of metastatic brain disease. We analyzed 50 pairs of MRI contrast-enhanced images as our training set. Half of these pairs, separated in time, qualified as disease progression, while the other 25 image pairs constituted regression. We trained the parameters of a CNN via "mutations" that consisted of random CNN weight adjustments and evaluated mutation "fitness" as summed training set accuracy. We then incorporated the best mutations into the next generation's CNN, repeating this process for approximately 50,000 generations. We applied the CNNs to our training set, as well as a separate testing set with the same class balance of 25 progression and 25 regression cases. DNE achieved monotonic convergence to 100% training set accuracy. DNE also converged monotonically to 100% testing set accuracy. We have thus shown that DNE can accurately classify brain metastatic disease progression versus regression. Future work will extend the input from 2D image slices to full 3D volumes, and include the category of "no change." We believe that an approach such as ours can ultimately provide a useful and informative complement to RANO/RECIST assessment and volumetric AI analysis.
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Affiliation(s)
- Joseph N Stember
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY, NY, 10065, USA.
| | - Robert J Young
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY, NY, 10065, USA
| | - Hrithwik Shalu
- Indian Institute of Technology Madras, Madras, Chennai, 600036, India
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3
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Radiation therapy for melanoma brain metastases: a systematic review. Radiol Oncol 2022; 56:267-284. [PMID: 35962952 PMCID: PMC9400437 DOI: 10.2478/raon-2022-0032] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Radiation therapy (RT) for melanoma brain metastases, delivered either as whole brain radiation therapy (WBRT) or as stereotactic radiosurgery (SRS), is an established component of treatment for this condition. However, evidence allowing comparison of the outcomes, advantages and disadvantages of the two RT modalities is scant, with very few randomised controlled trials having been conducted. This has led to considerable uncertainty and inconsistent guideline recommendations. The present systematic review identified 112 studies reporting outcomes for patients with melanoma brain metastases treated with RT. Three were randomised controlled trials but only one was of sufficient size to be considered informative. Most of the evidence was from non-randomised studies, either specific treatment series or disease cohorts. Criteria for determining treatment choice were reported in only 32 studies and the quality of these studies was variable. From the time of diagnosis of brain metastasis, the median survival after WBRT alone was 3.5 months (IQR 2.4-4.0 months) and for SRS alone it was 7.5 months (IQR 6.7-9.0 months). Overall patient survival increased over time (pre-1989 to 2015) but this was not apparent within specific treatment groups. CONCLUSIONS These survival estimates provide a baseline for determining the incremental benefits of recently introduced systemic treatments using targeted therapy or immunotherapy for melanoma brain metastases.
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4
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Antúnez G, Merino T. Radiosurgery for brain oligometastases in lung cancer. Medwave 2021. [DOI: 10.5867/medwave.2021.11.8184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Brain metastases are a common problem in oncology patients, especially in lung cancer. The usual treatment for cerebral oligometastases is whole brain radiation therapy. Given the persistent poor prognosis of this disease, other therapeutic alternatives such as stereotactic radiosurgery have been considered. However, there is no clarity regarding the effectiveness of its addition. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified 17 systematic reviews including seven studies overall, of which four were randomized trials. All trials assessed patients with brain oligometastases, but none of them included exclusively lung cancer population. We concluded that it is not possible to clearly establish whether radiosurgery decreases neurological functionality, cognitive impairment, mortality or serious adverse effects, as the certainty of the existing evidence has been assessed as very low.
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Lai YL, Kang JH, Hsu CY, Lee JI, Cheng WF, Chen YL, Lee YY. Gamma Knife Radiosurgery-Based Combination Treatment Strategies Improve Survival in Patients With Central Nervous System Metastases From Epithelial Ovarian Cancer: A Retrospective Analysis of Two Academic Institutions in Korea and Taiwan. Front Oncol 2021; 11:719936. [PMID: 34513698 PMCID: PMC8429898 DOI: 10.3389/fonc.2021.719936] [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: 06/03/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
Central nervous system (CNS) metastases from epithelial ovarian cancer (EOC) are rare. We investigated the clinico-pathological prognostic factors of patients with CNS metastases from EOC and compared the outcomes of various treatment modalities. We retrospectively reviewed the records of patients with CNS metastases from EOC between 2000 and 2020. Information on the clinical and pathological characteristics, treatment, and outcomes of these patients was retrieved from Samsung Medical Center and National Taiwan University Hospital. A total of 94 patients with CNS metastases were identified among 6,300 cases of EOC, resulting in an incidence of 1.49%. Serous histological type [hazard ratio (HR): 0.49 (95% confidence interval [CI] 0.25-0.95), p=0.03], progressive disease [HR: 2.29 (95% CI 1.16-4.54), p=0.01], CNS involvement in first disease relapse [HR: 0.36 (95% CI 0.18-0.70), p=0.002], and gamma knife radiosurgery (GKS)-based combination treatment for EOC patients with CNS lesions [HR: 0.59 (95% CI 0.44-0.79), p<0.001] significantly impacted survival after diagnosis of CNS metastases. In a subgroup analysis, superior survival was observed in patients with CNS involvement not in first tumor recurrence who underwent GKS-based combination therapeutic regimens. The survival benefit of GKS-based treatment was not significant in patients with CNS involvement in first disease relapse, but a trend for longer survival was still observed. In conclusion, GKS-based combination treatment can be considered for the treatment of EOC patients with CNS metastases. The patients with CNS involvement not in first disease relapse could significantly benefit from GKS-based combination strategies.
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Affiliation(s)
- Yen-Ling Lai
- Department of Obstetrics and Gynecology, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan.,Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jun-Hyeok Kang
- Department of Obstetrics and Gynecology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, South Korea
| | - Che-Yu Hsu
- Division of Radiation oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Li Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yoo-Young Lee
- Division of Gynecologic oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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6
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Jung J, Tailor J, Dalton E, Glancz LJ, Roach J, Zakaria R, Lammy S, Chari A, Budohoski KP, Livermore LJ, Yu K, Jenkinson MD, Brennan PM, Brazil L, Bunce C, Bourmpaki E, Ashkan K, Vergani F. Management evaluation of metastasis in the brain (MEMBRAIN)-a United Kingdom and Ireland prospective, multicenter observational study. Neurooncol Pract 2020; 7:344-355. [PMID: 32537183 PMCID: PMC7274191 DOI: 10.1093/nop/npz063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In recent years an increasing number of patients with cerebral metastasis (CM) have been referred to the neuro-oncology multidisciplinary team (NMDT). Our aim was to obtain a national picture of CM referrals to assess referral volume and quality and factors affecting NMDT decision making. METHODS A prospective multicenter cohort study including all adult patients referred to NMDT with 1 or more CM was conducted. Data were collected in neurosurgical units from November 2017 to February 2018. Demographics, primary disease, KPS, imaging, and treatment recommendation were entered into an online database. RESULTS A total of 1048 patients were analyzed from 24 neurosurgical units. Median age was 65 years (range, 21-93 years) with a median number of 3 referrals (range, 1-17 referrals) per NMDT. The most common primary malignancies were lung (36.5%, n = 383), breast (18.4%, n = 193), and melanoma (12.0%, n = 126). A total of 51.6% (n = 541) of the referrals were for a solitary metastasis and resulted in specialist intervention being offered in 67.5% (n = 365) of cases. A total of 38.2% (n = 186) of patients being referred with multiple CMs were offered specialist treatment. NMDT decision making was associated with number of CMs, age, KPS, primary disease status, and extent of extracranial disease (univariate logistic regression, P < .001) as well as sentinel location and tumor histology (P < .05). A delay in reaching an NMDT decision was identified in 18.6% (n = 195) of cases. CONCLUSIONS This study demonstrates a changing landscape of metastasis management in the United Kingdom and Ireland, including a trend away from adjuvant whole-brain radiotherapy and specialist intervention being offered to a significant proportion of patients with multiple CMs. Poor quality or incomplete referrals cause delay in NMDT decision making.
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Affiliation(s)
- Josephine Jung
- Department of Neurosurgery, King’s College Hospital, London, UK
- Neurosciences Clinical Trials Unit, King’s College Hospital, London, UK
| | - Jignesh Tailor
- Department of Neurosurgery, St. George’s Hospital, London, UK
- The Hospital for Sick Children, Toronto, Canada
| | - Emma Dalton
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Laurence J Glancz
- Department of Neurosurgery, Queen’s Medical Centre, Nottingham University Hospital, UK
| | - Joy Roach
- Wessex Neurological Centre, University Hospitals Southampton, UK
| | - Rasheed Zakaria
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
- Institute of Integrative Biology, University of Liverpool, UK
| | - Simon Lammy
- Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Aswin Chari
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | | | | | - Kenny Yu
- Department of Neurosurgery, Salford Royal Hospital, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, UK
| | | | - Paul M Brennan
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Lucy Brazil
- Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Catey Bunce
- Department of Primary Care & Public Health Sciences, Kings College London, UK
| | - Elli Bourmpaki
- Department of Primary Care & Public Health Sciences, Kings College London, UK
| | - Keyoumars Ashkan
- Neurosciences Clinical Trials Unit, King’s College Hospital, London, UK
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7
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Nieder C, Yobuta R, Mannsåker B. LabBM Score and Extracranial Score As New Tools for Predicting Survival in Patients with Brain Metastases Treated with Focal Radiotherapy. Cureus 2020; 12:e7633. [PMID: 32399365 PMCID: PMC7213767 DOI: 10.7759/cureus.7633] [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] [Indexed: 11/05/2022] Open
Abstract
Background Two recently validated, untraditional prognostic scores include serum albumin and lactate dehydrogenase, among other parameters. The latter are hemoglobin, platelet counts, and C-reactive protein (three-tiered LabBM score), whereas the four-tiered extracranial score includes more than one extracranial site of metastatic involvement. Until now, head-to-head comparisons of these two scores in patients treated with focal radiotherapy for newly diagnosed brain metastases are not available. Methods This was a retrospective single-institution analysis of 51 patients, most of whom were managed with first-line stereotactic radiosurgery (SRS). Survival was stratified by the LabBM score and extracranial score. Results Both scores predicted survival, but the analyses were hampered by small subgroups. In particular, very few patients belonged to the unfavorable groups. Survival shorter than two months, which was recorded in 14%, was not well predicted by the LabBM score and extracranial score. Conclusions Very few patients treated with focal radiotherapy (largely SRS) had unfavorable prognostic features according to the two untraditional scores, which do not include the number of brain metastases and performance status. Additional research is needed to improve the tools that predict short survival because overtreatment during the terminal phase of metastatic disease continues to represent a relevant issue.
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8
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Nieder C, Dalhaug A, Pawinski A. External Validation of the LabBM Score in Patients With Brain Metastases. J Clin Med Res 2019; 11:321-325. [PMID: 31019625 PMCID: PMC6469893 DOI: 10.14740/jocmr3746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 03/16/2019] [Indexed: 01/16/2023] Open
Abstract
Background The aim of this study was to validate the prognostic impact of the recently introduced three-tiered LabBM score in patients with brain metastases. In contrast to the previous development and validation cohorts, the present cohort did not include patients treated with primary surgery and/or radiosurgery. The score is based on hemoglobin, platelet counts, albumin, C-reactive protein and lactate dehydrogenase. Methods This was a retrospective single institution analysis. Overall, 167 patients managed with first-line whole-brain radiotherapy (WBRT) were identified from a prospectively maintained database. Results The LabBM score significantly predicted overall survival (median 4.0, 2.9 and 1.5 months, respectively). Conclusions The LabBM score is also valid in a patient population that differs from the previously studied cohorts, that is patients who were judged to be better candidates for WBRT than surgery or radiosurgery. As these patients in general represent a less favorable subset, their median survival was shorter than reported in the development cohort (11, 7 and 3 months, respectively). Future studies should examine whether or not combinations of the LabBM and other scores, for example, lung-molGPA and melanoma-molGPA, improve the clinical value of single scores.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodo, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromso, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodo, Norway
| | - Adam Pawinski
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodo, Norway
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9
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Tanikawa S, Kato Y, Tanino M, Terasaka S, Kurokawa Y, Arai N, Nagashima K, Tanaka S. Autopsy report of a late delayed radiation injury after a period of 45 years. Neuropathology 2019; 39:106-110. [DOI: 10.1111/neup.12528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/02/2018] [Accepted: 11/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Satoshi Tanikawa
- Faculty of Cancer PathologyHokkaido University Graduate School of Medicine Sapporo Japan
| | - Yasutaka Kato
- Faculty of Cancer PathologyHokkaido University Graduate School of Medicine Sapporo Japan
| | - Mishie Tanino
- Faculty of Cancer PathologyHokkaido University Graduate School of Medicine Sapporo Japan
| | - Shunsuke Terasaka
- Faculty of NeurosurgeryHokkaido University Graduate School of Medicine Sapporo Japan
| | - Yasuo Kurokawa
- Department of PsychiatryIwamizawa Municipal General Hospital Iwamizawa Japan
| | - Nobutaka Arai
- Laboratory of NeuropathologyTokyo Metropolitan Institute of Medical Science Setagaya Japan
| | - Kazuo Nagashima
- Department of PathologySapporo Higashi‐Tokushukai Hospital Sapporo Japan
| | - Shinya Tanaka
- Faculty of Cancer PathologyHokkaido University Graduate School of Medicine Sapporo Japan
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10
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Dong Y, Zhang Y, Zhang T, Fan M, Zhu J, Li B, Huang W. Feasibility and Efficacy of Simultaneous Integrated Boost Intensity-modulated Radiation Therapy based on MRI-CT fusion in Patients with Brain Metastases of Non-small Cell Lung Cancer. J Cancer 2018; 9:4477-4483. [PMID: 30519353 PMCID: PMC6277651 DOI: 10.7150/jca.26547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 09/09/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose: To assess the feasibility and therapeutic effects of simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) based on the fusion imaging of magnetic resonance imaging (MRI) and computed tomography (CT) as a dose-intensive technique in patients with brain metastases (BM) of non-small cell lung cancer (NSCLC). Methods and materials: Forty-six NSCLC patients with 1 to 7 brain metastases were enrolled in this retrospective study between November, 2011 and February, 2017. Thirty-one patients (67.4%) had 1-3 metastases (oligometastases), otherwise, more than 3 metastases were seen in only 15 patients (32.6%). GTV (Gross tumor volume) contouring was based on the fusion imaging of MRI-CT, WBRT was prescribed in 37.5 Gy/15 fractions with a simultaneous boost in the metastatic lesions of 52.5 Gy/15 fractions. Results: The median overall survival (OS) and intracranial progression free survival (PFS) for all the patients were 20.0 months and 11.0 months, respectively. The 6-month and 1-year OS were 87.0% and 69.6% respectively, while the 6-month and 1-year PFS were 78.3% and 43.5% respectively. Until the end of the follow-up, 16 patients (34.8%) were alive. No evidence of intracranial progress or recurrence was found in 6 patients (13.0%) during the follow-up. Conclusion: SIB-IMRT with the dose/fractionation based on the fusion imaging of MRI-CT is feasible and safe. It is beneficial to the NSCLC patients with BM and can reduce the overall costs of treatment.
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Affiliation(s)
- Yinping Dong
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Yanke Zhang
- Department of Radiation Oncology, the General Hospital of Yan-zhou Mining Group, Jining, China
| | - Tianyi Zhang
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China
| | - Min Fan
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
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11
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Barillot I, Antoni D, Bellec J, Biau J, Giraud P, Jenny C, Lacornerie T, Lisbona A, Marchesi V, Mornex F, Supiot S, Thureau S, Noel G. Bases référentielles de la radiothérapie en conditions stéréotaxiques pour les tumeurs ou métastases bronchopulmonaires, hépatiques, prostatiques, des voies aérodigestives supérieures, cérébrales et osseuses. Cancer Radiother 2018; 22:660-681. [DOI: 10.1016/j.canrad.2018.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022]
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12
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Yoon BC, Saad AF, Rezaii P, Wintermark M, Zaharchuk G, Iv M. Evaluation of Thick-Slab Overlapping MIP Images of Contrast-Enhanced 3D T1-Weighted CUBE for Detection of Intracranial Metastases: A Pilot Study for Comparison of Lesion Detection, Interpretation Time, and Sensitivity with Nonoverlapping CUBE MIP, CUBE, and Inversion-Recovery-Prepared Fast-Spoiled Gradient Recalled Brain Volume. AJNR Am J Neuroradiol 2018; 39:1635-1642. [PMID: 30093483 DOI: 10.3174/ajnr.a5747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 06/16/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Early and accurate identification of cerebral metastases is important for prognostication and treatment planning although this process is often time consuming and labor intensive, especially with the hundreds of images associated with 3D volumetric imaging. This study aimed to evaluate the benefits of thick-slab overlapping MIPs constructed from contrast-enhanced T1-weighted CUBE (overlapping CUBE MIP) for the detection of brain metastases in comparison with traditional CUBE and inversion-recovery prepared fast-spoiled gradient recalled brain volume (IR-FSPGR-BRAVO) and nonoverlapping CUBE MIP. MATERIALS AND METHODS A retrospective review of 48 patients with cerebral metastases was performed at our institution from June 2016 to October 2017. Brain MRIs, which were acquired on multiple 3T scanners, included gadolinium-enhanced T1-weighted IR-FSPGR-BRAVO and CUBE, with subsequent generation of nonoverlapping CUBE MIP and overlapping CUBE MIP. Two blinded radiologists identified the total number and location of metastases on each image type. The Cohen κ was used to determine interrater agreement. Sensitivity, interpretation time, and lesion contrast-to-noise ratio were assessed. RESULTS Interrater agreement for identification of metastases was fair-to-moderate for all image types (κ = 0.222-0.598). The total number of metastases identified was not significantly different across the image types. Interpretation time for CUBE MIPs was significantly shorter than for CUBE and IR-FSPGR-BRAVO, saving at least 50 seconds per case on average (P < .001). The mean lesion contrast-to-noise ratio for both CUBE MIPs was higher than for IR-FSPGR-BRAVO. The mean contrast-to-noise ratio for small lesions (<4 mm) was lower for nonoverlapping CUBE MIP (1.55) than for overlapping CUBE MIP (2.35). For both readers, the sensitivity for lesion detection was high for all image types but highest for overlapping CUBE MIP and CUBE (0.93-0.97). CONCLUSIONS This study suggests that the use of overlapping CUBE MIP or nonoverlapping CUBE MIP for the detection of brain metastases can reduce interpretation time without sacrificing sensitivity, though the contrast-to-noise ratio of lesions is highest for overlapping CUBE MIP.
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Affiliation(s)
- B C Yoon
- From the Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, California
| | - A F Saad
- From the Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, California
| | - P Rezaii
- From the Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, California
| | - M Wintermark
- From the Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, California
| | - G Zaharchuk
- From the Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, California
| | - M Iv
- From the Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, California.
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13
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Brosnan EM, Anders CK. Understanding patterns of brain metastasis in breast cancer and designing rational therapeutic strategies. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:163. [PMID: 29911111 PMCID: PMC5985267 DOI: 10.21037/atm.2018.04.35] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/06/2018] [Indexed: 01/28/2023]
Abstract
One of the most feared sequelae after a diagnosis of advanced breast cancer is development of metastases to the brain as this diagnosis can affect physical function, independence, relationships, quality of life, personality, and ultimately one's sense of self. The propensity to develop breast cancer brain metastases (BCBMs) varies by subtype, occurring in up to one half of those with triple negative breast cancer (TNBC), approximately a third of HER+ breast cancers and 14% in hormone positive disease. Median survival after BCBM diagnosis can be as short as 5 months in TNBC and 10-18 months in the other subtypes. Here, we review the biology of BCBMs and how it informs the rational design of new therapeutic approaches and agents. We discuss application of novel targeted and immunotherapies by breast cancer subtype. It is noteworthy that there are no U.S. Food and Drug Administration (FDA)-approved treatments specifically for BCBMs currently. Nevertheless, there are legitimate grounds for hope as patients with BCBMs are now being included in clinical trials of systemic therapies and a better understanding of the biology and genetic underpinning of BCBMs is driving an increased range of options for patients.
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Affiliation(s)
- Evelyn M Brosnan
- Division of Hematology/Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Carey K Anders
- Division of Hematology/Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Khan M, Lin J, Liao G, Li R, Wang B, Xie G, Zheng J, Yuan Y. Comparison of WBRT alone, SRS alone, and their combination in the treatment of one or more brain metastases: Review and meta-analysis. Tumour Biol 2017; 39:1010428317702903. [PMID: 28675121 DOI: 10.1177/1010428317702903] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Whole brain radiotherapy has been a standard treatment of brain metastases. Stereotactic radiosurgery provides more focal and aggressive radiation and normal tissue sparing but worse local and distant control. This meta-analysis was performed to assess and compare the effectiveness of whole brain radiotherapy alone, stereotactic radiosurgery alone, and their combination in the treatment of brain metastases based on randomized controlled trial studies. Electronic databases (PubMed, MEDLINE, Embase, and Cochrane Library) were searched to identify randomized controlled trial studies that compared treatment outcome of whole brain radiotherapy and stereotactic radiosurgery. This meta-analysis was performed using the Review Manager (RevMan) software (version 5.2) that is provided by the Cochrane Collaboration. The data used were hazard ratios with 95% confidence intervals calculated for time-to-event data extracted from survival curves and local tumor control rate curves. Odds ratio with 95% confidence intervals were calculated for dichotomous data, while mean differences with 95% confidence intervals were calculated for continuous data. Fixed-effects or random-effects models were adopted according to heterogeneity. Five studies (n = 763) were included in this meta-analysis meeting the inclusion criteria. All the included studies were randomized controlled trials. The sample size ranged from 27 to 331. In total 202 (26%) patients with whole brain radiotherapy alone, 196 (26%) patients receiving stereotactic radiosurgery alone, and 365 (48%) patients were in whole brain radiotherapy plus stereotactic radiosurgery group. No significant survival benefit was observed for any treatment approach; hazard ratio was 1.19 (95% confidence interval: 0.96-1.43, p = 0.12) based on three randomized controlled trials for whole brain radiotherapy only compared to whole brain radiotherapy plus stereotactic radiosurgery and hazard ratio was 1.03 (95% confidence interval: 0.82-1.29, p = 0.81) for stereotactic radiosurgery only compared to combined approach. Local control was best achieved when whole brain radiotherapy was combined with stereotactic radiosurgery. Hazard ratio 2.05 (95% confidence interval: 1.36-3.09, p = 0.0006) and hazard ratio 1.84 (95% confidence interval: 1.26-2.70, p = 0.002) were obtained from comparing whole brain radiotherapy only and stereotactic radiosurgery only to whole brain radiotherapy + stereotactic radiosurgery, respectively. No difference in adverse events for treatment difference; odds ratio 1.16 (95% confidence interval: 0.77-1.76, p = 0.48) and odds ratio 0.92 (95% confidence interval: 0.59-1.42, p = 71) for whole brain radiotherapy + stereotactic radiosurgery versus whole brain radiotherapy only and whole brain radiotherapy + stereotactic radiosurgery versus stereotactic radiosurgery only, respectively. Adding stereotactic radiosurgery to whole brain radiotherapy provides better local control as compared to whole brain radiotherapy only and stereotactic radiosurgery only with no difference in radiation related toxicities.
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Affiliation(s)
- Muhammad Khan
- 1 Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China, 510515
| | - Jie Lin
- 2 Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China, 510095
| | - Guixiang Liao
- 3 Department of Radiation Oncology, Shenzhen People's Hospital, Second Clinical Medicine College of Jinan University, China, 518020
| | - Rong Li
- 2 Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China, 510095
| | - Baiyao Wang
- 1 Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China, 510515
| | - Guozhu Xie
- 1 Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China, 510515
| | - Jieling Zheng
- 1 Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China, 510515
| | - Yawei Yuan
- 1 Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China, 510515.,2 Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China, 510095
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Examination of the predictive factors of the response to whole brain radiotherapy for brain metastases from lung cancer using MRI. Oncol Lett 2017; 14:1073-1079. [PMID: 28693276 DOI: 10.3892/ol.2017.6264] [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: 06/21/2016] [Accepted: 03/09/2017] [Indexed: 11/05/2022] Open
Abstract
Previous studies have been conducted on the prognostic factors for overall survival in patients with brain metastases (BMs) following whole brain radiotherapy (WBRT). However, there have been a small number of studies regarding the prognostic factors for the response of tumor to WBRT. The aim of the present study was to identify the predictive factors for the response to WBRT from the point of view of reduction of tumor using magnetic resonance imaging. A retrospective analysis of 62 patients with BMs from primary lung cancer treated with WBRT was undertaken. The effects of the following factors on the response to WBRT were evaluated: Age; sex; performance status; lactate dehydrogenase; pathology; existence of extracranial metastases; activity of extracranial disease; chemo-history; chest radiotherapy history; treatment term; γ-knife radiotherapy; diffusion weighted image signal intensity; tumor diameter; extent of edema and the edema/tumor (E/T) ratio. The association between the reduction of tumors and clinical factors was evaluated using logistic regression analysis. P<0.05 was considered to indicate a statistically significant difference. The overall response ratio of this cohort was 54.8%. In the univariate analysis, the response of tumors was associated with the presence of small cell lung carcinoma (SCLC; P=0.0007), an E/T ratio of ≥1.5 (P=0.048), and a median tumor diameter of <20 mm (P=0.014). In the multivariate analysis, the presence of SCLC [P=0.001; odds ratio (OR), 17.152), an E/T ratio of ≥1.5 (P=0.019; OR, 9.526), and the presence of extracranial metastases (P=0.031; OR, 4.875) were revealed to be independent predictive factors for the reduction of tumor. The following 3 factors were significantly associated with the response of tumors to WBRT: The presence of SCLC; an E/T ratio of ≥1.5; and the presence of extracranial metastases. The E/T ratio is a novel index that provides a simple and easy predictive method for use in a clinical setting.
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Gu X, Zhao Y, Xu F. [Whole Brain Irradiation and Hypo-fractionation Radiotherapy for the Metastases in Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:224-9. [PMID: 27118651 PMCID: PMC5999817 DOI: 10.3779/j.issn.1009-3419.2016.04.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Up to 40% non-small cell lung cancer patients developed brain metastasis during progression. Multiple brain metastases are common in non-small cell lung cancer. The prognosis of brain metastasis is poor with median survival of less than 1 year. Radio therapy for brain metastases has gradually developed from whole brain radiotherapy (WBRT) to various radiation strategies. WBRT, surgery+WBRT, stereotactic radiotherapy+WBRT or WBRT with simultaneous integrated boost (SIB), etc. have better overall survival than those untreated patients. The damage of the cognitive function from WBRT has been realized recently, however, options of radiation strategies for long expected survival patients remain controversial. This paper will discuss different WBRT strategies and treatment side effects of non-small cell lung cancer with brain metastases.
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Affiliation(s)
- Xingting Gu
- Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yaqin Zhao
- Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Feng Xu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
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Ferro M, Chiesa S, Macchia G, Cilla S, Bertini F, Frezza G, Farioli A, Cammelli S, Balducci M, Ianiro A, Angelini AL, Compagnone G, Valentini V, Deodato F, Morganti AG. Intensity Modulated Radiation Therapy With Simultaneous Integrated Boost in Patients With Brain Oligometastases: A Phase 1 Study (ISIDE-BM-1). Int J Radiat Oncol Biol Phys 2017; 97:82-90. [PMID: 27843034 DOI: 10.1016/j.ijrobp.2016.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/13/2016] [Accepted: 09/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the maximum tolerated dose of intensity modulated radiation therapy simultaneous integrated boost whole-brain radiation therapy for palliative treatment of patients with <5 brain metastases using a standard linear accelerator. MATERIALS AND METHODS The whole brain plus 3-mm margin was defined as the planning target volume (PTVwb), whereas each brain metastasis, defined as the contrast-enhancing tumor on MRI T1 scans, plus a 3-mm isotropic margin, was defined as metastases PTV (PTVm). Radiation therapy was delivered in 10 daily fractions (2 weeks). Only the dose to PTVm was progressively increased in the patient cohorts (35 Gy, 40 Gy, 45 Gy, 50 Gy), whereas the PTVwb was always treated with 30 Gy (3 Gy per fraction) in all patients. The dose-limiting toxicity was evaluated providing that 3 months of follow-up had occurred after the treatment of a 6-patient cohort. RESULTS Thirty patients were enrolled in the study (dose PTVm: 35 Gy, 8 patients; 40 Gy, 6 patients; 45 Gy, 6 patients; 50 Gy, 10 patients). The number of treated brain metastases was 1 in 18 patients, 2 in 5 patients, 3 in 6 patients, and 4 in 1 patient. Three patients experienced dose-limiting toxicity: 1 patient at dose level 2 presented grade 3 (G3) skin toxicity; 1 patient at dose level 4 presented G3 neurologic toxicity; and 1 patient at the same level showed brain hemorrhage. Most patients showed G1 to 2 acute toxicity, in most cases skin (n=19) or neurologic (n=10). Twenty-seven were evaluable for response: 6 (22%) stable disease, 18 (67%) partial response, and 3 (11%) complete response. Median survival and 1-year overall survival were 12 months and 53%, respectively. No patient showed late toxicity. CONCLUSIONS In this first prospective trial on the use of intensity modulated radiation therapy simultaneous integrated boost delivered with a standard linear accelerator in patients with brain oligometastases, a boost dose up to 50 Gy in 10 fractions was tolerable according to the study design.
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Affiliation(s)
- Marica Ferro
- Radiotherapy Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II," Catholic University of Sacred Heart, Campobasso, Italy
| | - Silvia Chiesa
- Department of Radiotherapy, Fondazione Policlinico Universitario "A. Gemelli," Catholic University of Sacred Heart, Rome, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II," Catholic University of Sacred Heart, Campobasso, Italy.
| | - Savino Cilla
- Medical Physics Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II," Catholic University of Sacred Heart, Campobasso, Italy
| | - Federica Bertini
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Andrea Farioli
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mario Balducci
- Department of Radiotherapy, Fondazione Policlinico Universitario "A. Gemelli," Catholic University of Sacred Heart, Rome, Italy
| | - Anna Ianiro
- Medical Physics Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II," Catholic University of Sacred Heart, Campobasso, Italy
| | | | | | - Vincenzo Valentini
- Department of Radiotherapy, Fondazione Policlinico Universitario "A. Gemelli," Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II," Catholic University of Sacred Heart, Campobasso, Italy
| | - Alessio G Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Wang SJ, Choi M, Fuller CD, Salter BJ, Fuss M. Intensity-Modulated Radiosurgery for Patients with Brain Metastases: A Mature Outcomes Analysis. Technol Cancer Res Treat 2016; 6:161-8. [PMID: 17535023 DOI: 10.1177/153303460700600302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to evaluate the outcomes of patients with brain metastases treated by tomotherapeutic Intensity-modulated Radiosurgery (IMRS). Using retrospective chart review, we analyzed the outcomes of 78 patients (age 33–83 years, median 57 years) who underwent 111 sessions of IMRS (1 to 7 sessions per patient, median 1) for brain metastases (1 to 4 targets per IMRS session, median 1) treated between 2000 and 2005 using a serial tomotherapeutic intensity-modulated radiotherapy treatment (IMRT) planning and delivery system (Peacock, Nomos Corp., Cranberry Township, PA). Treatment planning was performed using an inverse treatment planning optimization algorithm that was optimized for IMRS. A median prescription dose of 15 Gy in combination with WBI, and median 20 Gy for IMRS alone was delivered using 2–4 couch angles over 4–24 rotational arcs. Overall survival was calculated using Kaplan-Meier analysis. To determine the effects of prognostic variables on survival, univariate and multivariate analyses using proportional hazards were performed to assess the effects of age, tumor size, the combination with whole brain irradiation, presence of multiple brain metastases, and presence of extracranial disease. The median overall survival was 6.5 months (95% CI, 5.5–7.9). One- and two-year survival rates were 24% and 10%. In multivariate analyses, age greater than 60 years was the only statistically significant variable that affected survival (hazard rate 1.29, p=0.049). We conclude that tomotherapeutic IMRS is safe and effective to treat patients with brain metastases.
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Affiliation(s)
- Samuel J Wang
- Department of Radiation Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, MC L337, Portland, Oregon 97239, USA.
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Rodin D, Banihashemi B, Wang L, Lau A, Harris S, Levin W, Dinniwell R, Millar BA, Chung C, Laperriere N, Bezjak A, Wong RKS. The Brain Metastases Symptom Checklist as a novel tool for symptom measurement in patients with brain metastases undergoing whole-brain radiotherapy. ACTA ACUST UNITED AC 2016; 23:e239-47. [PMID: 27330360 DOI: 10.3747/co.23.2936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE We evaluated the feasibility, reliability, and validity of the Brain Metastases Symptom Checklist (bmsc), a novel self-report measure of common symptoms experienced by patients with brain metastases. METHODS Patients with first-presentation symptomatic brain metastases (n = 137) referred for whole-brain radiotherapy (wbrt) completed the bmsc at time points before and after treatment. Their caregivers (n = 48) provided proxy ratings twice on the day of consultation to assess reliability, and at week 4 after wbrt to assess responsiveness to change. Correlations with 4 other validated assessment tools were evaluated. RESULTS The symptoms reported on the bmsc were largely mild to moderate, with tiredness (71%) and difficulties with balance (61%) reported most commonly at baseline. Test-retest reliability for individual symptoms had a median intraclass correlation of 0.59 (range: 0.23-0.85). Caregiver proxy and patient responses had a median intraclass correlation of 0.52. Correlation of absolute scores on the bmsc and other symptom assessment tools was low, but consistency in the direction of symptom change was observed. At week 4, change in symptoms was variable, with improvements in weight gain and sleep of 42% and 41% respectively, and worsening of tiredness and drowsiness of 62% and 59% respectively. CONCLUSIONS The bmsc captures a wide range of symptoms experienced by patients with brain metastases, and it is sensitive to change. It demonstrated adequate test-retest reliability and face validity in terms of its responsiveness to change. Future research is needed to determine whether modifications to the bmsc itself or correlation with more symptom-specific measures will enhance validity.
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Affiliation(s)
- D Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - B Banihashemi
- Department of Radiation Oncology, Lakeridge Health Corporation, Oshawa, ON
| | - L Wang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON
| | - A Lau
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON
| | - S Harris
- Palliative Radiation Oncology Program, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - W Levin
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - R Dinniwell
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - B A Millar
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - C Chung
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - N Laperriere
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - A Bezjak
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - R K S Wong
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
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20
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Zeng YC, Wu R, Xing R, Chi F, Wang SL, Chen XD, Xuan Y, Wu LN, Duan QY, Tang MY, Niu N, Sun YN, Fan GL, Wang HM. Radiation-enhancing effect of sodium glycididazole in patients suffering from non-small cell lung cancer with multiple brain metastases: A randomized, placebo-controlled study. Cancer Radiother 2016; 20:187-92. [PMID: 27052296 DOI: 10.1016/j.canrad.2016.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/05/2016] [Accepted: 02/14/2016] [Indexed: 01/06/2023]
Abstract
PURPOSE Median survival of patients with brain metastases from non-small cell lung cancer is poor. This study was to investigate the radiation-enhancing effect of sodium glycididazole combined with whole-brain radiotherapy of multiple brain metastases from non-small cell lung cancer. PATIENTS AND METHODS Sixty-four patients with multiple brain metastases from non-small cell lung cancer were included: the study group (n=32) received whole-brain radiotherapy combined with sodium glycididazole at a dose of 700mg/m(2) intravenous infusion 30minutes before radiotherapy, three times a week; the control group (n=32) only received whole-brain radiotherapy. The primary end point was central nervous system (CNS) progression-free survival and overall survival. The treatment-related toxicity was also recorded. RESULTS The CNS disease control rate was better (90.6% vs 65.6%, P=0.016) in the study group than in the control group at 3 month of follow-up. The median CNS progression-free survival time was longer in the study group than in the control group (7.0 months vs 4.0 months, P=0.038). There was no significant difference of the median overall survival time between the study group and the control group (11.0 months vs 9.0 months, P=0.418). On the other hand, the treatment-related toxicity showed no statistically significant difference between these two groups (P>0.05). CONCLUSIONS The study indicated that sodium glycididazole was an effective, promising radiation-enhancing agent that improved CNS disease control rate, extended the median CNS progression-free survival time and was well tolerated in patients suffering from non-small cell lung cancer with multiple brain metastases.
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Affiliation(s)
- Y C Zeng
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - R Wu
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China.
| | - R Xing
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - F Chi
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - S L Wang
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - X D Chen
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - Y Xuan
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - L N Wu
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - Q Y Duan
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - M Y Tang
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - N Niu
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - Y N Sun
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - G L Fan
- Department of Otorhinolaryngology, Harbin First Hospital, 151, Diduan Street, Harbin 150010, China
| | - H M Wang
- Department of Radiation Oncology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China
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Mackillop WJ, Kong W. Estimating the Need for Palliative Radiation Therapy: A Benchmarking Approach. Int J Radiat Oncol Biol Phys 2016; 94:51-59. [DOI: 10.1016/j.ijrobp.2015.09.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/24/2015] [Accepted: 09/18/2015] [Indexed: 12/25/2022]
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Reddy JP, Dawood S, Mitchell M, Debeb BG, Bloom E, Gonzalez-Angulo AM, Sulman EP, Buchholz TA, Woodward WA. Antiepileptic drug use improves overall survival in breast cancer patients with brain metastases in the setting of whole brain radiotherapy. Radiother Oncol 2015; 117:308-14. [PMID: 26482599 DOI: 10.1016/j.radonc.2015.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE There is mounting evidence that histone deacetylase (HDAC) inhibitors, e.g. valproic acid (VPA), synergize with radiation to improve outcomes in several cancers. This study was conducted to ascertain whether VPA affected outcomes in breast cancer patients with brain metastases treated with whole brain radiotherapy (WBRT). MATERIALS AND METHODS Records from 253 breast cancer patients with brain metastases treated with WBRT were reviewed. Data regarding use of all antiepileptic drugs (AEDs) were extracted. Kaplan-Meier survival times were calculated using the date of brain involvement as time zero. Cox proportional hazard models were used to determine the association between patient and tumor characteristics and overall survival (OS). RESULTS Median OS for the entire patient cohort was 6 months. Patients receiving VPA (n=20) had a median OS of 11 months versus 5 months for those not receiving VPA (p=0.028). Median OS was 9 months for patients taking any AED (n=101) versus 4 months for those not taking AEDs (p=0.0003). On multivariate analysis both VPA and AED use were associated with improved OS (HR 0.61, p=0.0419; HR 0.59, p=0.0002, respectively). CONCLUSIONS This study suggests the use of AEDs, including VPA, is associated with improved OS in breast cancer patients with brain metastases following WBRT.
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Affiliation(s)
- Jay P Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Shaheenah Dawood
- Department of Medical Oncology, Dubai Hospital, United Arab Emirates
| | - Melissa Mitchell
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Bisrat G Debeb
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Elizabeth Bloom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Ana M Gonzalez-Angulo
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Erik P Sulman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Thomas A Buchholz
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Wendy A Woodward
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
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Kim HJ, Kim WS, Kwon DH, Cho YH, Choi CM. Effects of an Epithelial Growth Factor Receptor-Tyrosine Kinase Inhibitor Add-on in Stereotactic Radiosurgery for Brain Metastases Originating from Non-Small-Cell Lung Cancer. J Korean Neurosurg Soc 2015; 58:205-10. [PMID: 26539262 PMCID: PMC4630350 DOI: 10.3340/jkns.2015.58.3.205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/24/2015] [Accepted: 05/06/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study was aimed at optimizing the treatment of non-small-cell lung cancer (NSCLC) patients who are candidates for stereotactic radiosurgery (SRS) for brain metastases and harbor activating epithelial growth factor receptor (EGFR) mutations. METHODS We retrospectively reviewed the medical records from 2005 to 2010 of NSCLC patients with brain metastases harboring an activating EGFR mutation. Patients who received a combination therapy of SRS and EGFR-tyrosine kinase inhibitor (TKI) for brain metastases and those who received SRS without EGFR-TKI were compared. The primary endpoint was progression-free survival (PFS) of the brain metastases. RESULTS Thirty-one patients were eligible for enrolment in this study (SRS with TKI, 18; SRS without TKI, 13). Twenty-two patients (71.0%) were women and the median overall age was 56.0 years. PFS of brain lesions was not significantly prolonged in SRS with TKI treatment group than in SRS without TKI group (17.0 months vs. 9.0 months, p=0.45). Local tumor control rate was 83.3% in the combination therapy group, and 61.5% in the SRS monotherapy group (p=0.23). There were no severe adverse events related with treatment in both groups. CONCLUSIONS Therapeutic outcome of concurrent SRS and TKI treatment was not superior to SRS monotherapy, however, there was no additive adverse events related with combined treatment.
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Affiliation(s)
- Hyun Jung Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Sung Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kwon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hyun Cho
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Christ SM, Mahadevan A, Floyd SR, Lam FC, Chen CC, Wong ET, Kasper EM. Stereotactic radiosurgery for brain metastases from malignant melanoma. Surg Neurol Int 2015; 6:S355-65. [PMID: 26392919 PMCID: PMC4553636 DOI: 10.4103/2152-7806.163315] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 04/22/2015] [Indexed: 01/21/2023] Open
Abstract
Background: Surgical resection and stereotactic radiosurgery (SRS) are well-established treatment methods for patients with brain metastases, yet their respective roles in the management of brain metastases remain incompletely defined. Methods: To report on the role of SRS in the treatment of patients with brain metastases from malignant melanoma, a retrospective analysis of 381 intracranial melanoma metastases in 103 consecutive patients who underwent SRS between 2005 and 2011 at Beth Israel Deaconess Medical Center was conducted. The Cyberknife® SRS system was used to treat all patients. Clinical, technical, and radiographic data were recorded at presentation and on follow-up. Results: The patient cohort consisted of 40 female (39%) and 63 male (61%) patients with a median age of 57 years. The median overall survival from the time of radiosurgery for the entire patient cohort was 7.6 months. The local control rate at 1-year was 72% for the patients who received surgery followed by SRS and 55% for the entire patient population. Surgery followed by SRS was associated with significantly improved overall survival compared with SRS alone or whole-brain radiation therapy followed by salvage SRS (P < 0.0057). Conclusions: Both surgery plus SRS and SRS provide comparable local control. Despite the difference in lesion size in the subgroups who received surgery plus SRS and radiosurgery alone, similar outcomes were achieved in both groups, suggesting that surgical treatment of larger lesions can yield results that are not significantly different from small lesions treated by SRS alone.
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Affiliation(s)
- Sebastian M Christ
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA 02215, USA
| | - Anand Mahadevan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
| | - Scott R Floyd
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA ; Koch Institute for Integrative Cancer Biology, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA 02139, USA
| | - Fred C Lam
- Koch Institute for Integrative Cancer Biology, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA 02139, USA
| | - Clark C Chen
- Division of Neurosurgery, University of California Sand Diego, 200 West Arbor Drive, San Diego, CA 92103, USA
| | - Eric T Wong
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
| | - Ekkehard M Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA 02215, USA
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Results of a Phase II Study of Short-Course Accelerated Radiation Therapy (SHARON) for Multiple Brain Metastases. Am J Clin Oncol 2015. [DOI: 10.1097/coc.0b013e3182a0e826] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goyal S, Silk AW, Tian S, Mehnert J, Danish S, Ranjan S, Kaufman HL. Clinical Management of Multiple Melanoma Brain Metastases: A Systematic Review. JAMA Oncol 2015; 1:668-76. [PMID: 26181286 PMCID: PMC5726801 DOI: 10.1001/jamaoncol.2015.1206] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
IMPORTANCE The treatment of multiple brain metastases (MBM) from melanoma is controversial and includes surgical resection, stereotactic radiosurgery (SRS), and whole-brain radiation therapy (WBRT). Several new classes of agents have revolutionized the treatment of metastatic melanoma, allowing some subsets of patients to have long-term survival. Given this, management of MBM from melanoma is continually evolving. OBJECTIVE To review the current evidence regarding the treatment of MBM from melanoma. EVIDENCE REVIEW The PubMed database was searched using combinations of search terms and synonyms for melanoma, brain metastases, radiation, chemotherapy, immunotherapy, and targeted therapy published between January 1, 1995, and January 1, 2015. Articles were selected for inclusion on the basis of targeted keyword searches, manual review of bibliographies, and whether the article was a clinical trial, large observational study, or retrospective study focusing on melanoma brain metastases. Of 2243 articles initially identified, 110 were selected for full review. Of these, the most pertinent 73 articles were included. FINDINGS Patients with newly diagnosed MBM can be treated with various modalities, either alone or in combination. Level 1 evidence supports the use of SRS alone, WBRT, and SRS with WBRT. Although the addition of WBRT to SRS improves the overall brain relapse rate, WBRT has no significant impact on overall survival and has detrimental neurocognitive outcomes. Cytotoxic chemotherapy has largely been ineffective; targeted therapies and immunotherapies have been reported to have high response rates and deserve further attention in larger clinical trials. Further studies are needed to fully evaluate the efficacy of these novel regimens in combination with radiation therapy. CONCLUSIONS AND RELEVANCE At this time, the standard management for patients with MBM from melanoma includes SRS, WBRT, or a combination of both. Emerging data exist to support the notion that SRS in combination with targeted therapies or immune therapy may obviate the need for WBRT; prospective studies are required to fully evaluate the efficacy of these novel regimens in combination with radiation therapy.
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Affiliation(s)
- Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School
| | - Ann W. Silk
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School
| | - Sibo Tian
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School
| | - Janice Mehnert
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School
| | - Shabbar Danish
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School
| | - Sinthu Ranjan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School
| | - Howard L. Kaufman
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School
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Bedard G, Ray S, Zhang L, Zeng L, Cella D, Wong E, Danjoux C, Tsao M, Barnes E, Sahgal A, Holden L, Lauzon N, Chow E. Validation of the Brain Symptom and Impact Questionnaire (BASIQ) to assess symptom and quality of life in brain metastases. CNS Oncol 2015; 3:275-85. [PMID: 25286039 DOI: 10.2217/cns.14.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To validate the Brain Symptom and Impact Questionnaire (BASIQ) version 1.0 for brain metastases. METHODS Patients with brain metastases and their healthcare professionals (HCPs) assessed the relevance of the BASIQ on a 0-10 scale with 10 as extremely relevant. RESULTS A total of 52 patients and 20 HCPs participated in this study. In total, 95% of HCPs and 85% of patients found all items relevant. Balance and walking ability were rated relevant by 100% of patients and HCPs. Headache, nausea, energy, memory and ability to do housework were also rated relevant by 100% of HCPs. Over 95% of patients determined the items of ability to do housework, tiredness, energy, vision, memory and putting ideas into words as relevant. There were no items rated below 7 by patients or below 5 by HCPs. CONCLUSION This study indicates that BASIQ version 1.0 has valid content items encompassing disease-related symptom and impact on daily living.
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Affiliation(s)
- Gillian Bedard
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Kim W, Kim HY, Woo J, Rhim HJ, Kang BR, Lee YD, Kim S, Kim JY, Choi EJ, Kim KS, Kim DJ, Kim Y. Real-Time Imaging Reveals Glioblastoma Suppression Effects of Curcumin in Mouse Brains. B KOREAN CHEM SOC 2015. [DOI: 10.1002/bkcs.10273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Woong Kim
- Centers for Neuro-Medicine, Neuroscience and Theragnosis; Korea Institute of Science and Technology (KIST); Seoul 136-791 Republic of Korea
- Biological Chemistry Program; Korea University of Science and Technology (UST); Daejeon 305-350 Republic of Korea
| | - Hye Yun Kim
- Centers for Neuro-Medicine, Neuroscience and Theragnosis; Korea Institute of Science and Technology (KIST); Seoul 136-791 Republic of Korea
- Department of Biochemistry and Biomedical Sciences; Seoul National University College of Medicine; Seoul 110-799 Republic of Korea
| | - Jiwan Woo
- Centers for Neuro-Medicine, Neuroscience and Theragnosis; Korea Institute of Science and Technology (KIST); Seoul 136-791 Republic of Korea
- Department of Life Sciences; Korea University; Seoul 136-701 Republic of Korea
| | - Hoo Jung Rhim
- Centers for Neuro-Medicine, Neuroscience and Theragnosis; Korea Institute of Science and Technology (KIST); Seoul 136-791 Republic of Korea
- Yonsei University Wonju College of Medicine; Gangwon-do 220-701 Republic of Korea
| | - Bo Ram Kang
- Centers for Neuro-Medicine, Neuroscience and Theragnosis; Korea Institute of Science and Technology (KIST); Seoul 136-791 Republic of Korea
- Biological Chemistry Program; Korea University of Science and Technology (UST); Daejeon 305-350 Republic of Korea
| | - Yong-Deok Lee
- Centers for Neuro-Medicine, Neuroscience and Theragnosis; Korea Institute of Science and Technology (KIST); Seoul 136-791 Republic of Korea
| | - Sehoon Kim
- Centers for Neuro-Medicine, Neuroscience and Theragnosis; Korea Institute of Science and Technology (KIST); Seoul 136-791 Republic of Korea
| | - Jung Young Kim
- Molecular Imaging Research Center; Korea Institute of Radiological & Medical Sciences (KIRAMS); Seoul 139-706 Republic of Korea
| | - Eun-Ju Choi
- Department of Life Sciences; Korea University; Seoul 136-701 Republic of Korea
| | - Key-Sun Kim
- Centers for Neuro-Medicine, Neuroscience and Theragnosis; Korea Institute of Science and Technology (KIST); Seoul 136-791 Republic of Korea
| | - Dong Jin Kim
- Centers for Neuro-Medicine, Neuroscience and Theragnosis; Korea Institute of Science and Technology (KIST); Seoul 136-791 Republic of Korea
| | - YoungSoo Kim
- Centers for Neuro-Medicine, Neuroscience and Theragnosis; Korea Institute of Science and Technology (KIST); Seoul 136-791 Republic of Korea
- Biological Chemistry Program; Korea University of Science and Technology (UST); Daejeon 305-350 Republic of Korea
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Kim W, Kang BR, Kim HY, Cho SM, Lee YD, Kim S, Kim JY, Kim DJ, Kim Y. Real-time imaging of glioblastoma using bioluminescence in a U-87 MG xenograft model mouse. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13765-015-0037-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Kong W, Jarvis C, Mackillop W. Estimating the Need for Palliative Radiotherapy for Brain Metastasis: A Benchmarking Approach. Clin Oncol (R Coll Radiol) 2015; 27:83-91. [DOI: 10.1016/j.clon.2014.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 11/03/2014] [Indexed: 11/30/2022]
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Gao Y, Gao F, Ma JL, Zhao DL. Palliative whole-brain radiotherapy and health- related quality of life for patients with brain metastasis in cancer. Neuropsychiatr Dis Treat 2015; 11:2185-90. [PMID: 26346192 PMCID: PMC4552255 DOI: 10.2147/ndt.s87109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the use of palliative whole-brain radiotherapy (WBRT) in the treatment of brain metastases (BMs) and to evaluate the health-related quality of life (HRQOL) of these patients. MATERIALS AND METHODS We conducted a retrospective study of 46 patients with BMs who were treated with WBRT at the First Affiliated Hospital of Xi'an Jiaotong University between January 2013 and January 2015. External beam radiotherapy techniques were used to deliver 40 Gy in 20 fractions or 30 Gy in ten fractions with a 10 MV photon beam from a linear accelerator to the whole brain. Data were stored and analyzed using SPSS version 17.0. RESULTS Of the 46 patients, the survival time of patients in our study was 10.8±0.55 months: 11.8±0.46 months in patients with WBRT, 11.75±1.00 in patients with WBRT + chemotherapy, and 3±0.79 months in patients with supportive care, respectively (P<0.01). The HRQOL scores of all the patients were 70±1.16 (before therapy) and 76.83±1.04 (after therapy) (P<0.01). The HRQOL scores of the patients with WBRT were 72.23±0.88 (before therapy) and 78.49±0.87 (after therapy) (P<0.01). There was no central nervous system toxicity; only two (4.3%) patients were found to have BM hemorrhage. Radiation necrosis happened in one patient (2.2%). CONCLUSION Effective treatment options for patients with BMs are important. WBRT was evaluated to ensure survival outcomes and QOL were enhanced after therapy for patients with BMs.
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Affiliation(s)
- Ying Gao
- Department of Radiotherapy Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Fei Gao
- Department of Neurology, First Affiliated Hospital of Xi'an Medical University, Xi'an, People's Republic of China
| | - Jin-Lu Ma
- Department of Radiotherapy Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Dong-Li Zhao
- Department of Radiotherapy Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
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Kraszkiewicz M, Wydmanski J. Brain metastases from stomach cancer - The role of different treatment modalities and efficacy of palliative radiotherapy. Rep Pract Oncol Radiother 2014; 20:32-7. [PMID: 25535582 DOI: 10.1016/j.rpor.2014.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/17/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022] Open
Abstract
AIM To evaluate different treatment modalities, sequences, and prognostic factors in patients with brain metastases from stomach cancer. BACKGROUND Brain metastases from gastric cancer are rare and late manifestation of the disease, occurring in less than 1% of gastric cancer patients. The prognosis is poor and median overall survival is 1.3-2.4 months. The standard treatment scheme has not yet been described. Most studies present small sample sizes. The choice of treatment scheme is individually based on performance status, number, location and size of metastases, the status of primary tumor and the presence of other metastases. MATERIALS AND METHODS Sixteen patients diagnosed with brain metastases from gastric cancer in Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch. Patients, mostly men (69%) aged 51-75 years, (median 68.5 years). Thirteen (81.25%) had treatment of primary tumor before diagnosis of brain metastases. Primary metastatic gastric cancer was diagnosed in 6 patients (37.5%), in 3 cases (18.75%) brain was the site of those metastases. Treatment schemes were individually based. RESULTS We identified prognostic factors influencing OS: performance status, number of brain metastases, type of treatment. Median OS was 2.8 months. Median time to brain metastases was 12.3 months and it was shorter in patients with pretreatment metastases to other organs. Patients treated with combined treatment had median survival of 12.3 months. CONCLUSIONS Aggressive treatment schemes are needed to improve the outcome. Prognostic factors such as performance status, number of metastases, dissemination to other organs are helpful in considering the best treatment options.
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Affiliation(s)
- Malgorzata Kraszkiewicz
- Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, ul. Wybrzeże AK 15, 44-101 Gliwice, Poland
| | - Jerzy Wydmanski
- Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, ul. Wybrzeże AK 15, 44-101 Gliwice, Poland
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Abstract
OBJECT Collectively, metastatic tumors are the most common malignancy encountered in the adult central nervous system (CNS), arising most often from lung, breast, skin, and gastrointestinal tract carcinomas. Limited information is available in the literature regarding solid nonhematopoietic CNS metastases in children. The authors carried out a retrospective study of pediatric metastatic neoplasms to the CNS treated in a 30-year period to characterize their frequency, common histological subtypes, and sites of origin. METHODS The archival pathology files were searched (1981-2011) for metastatic tumors to the CNS in patients 21 years of age and younger. Pathology material was reviewed, tumors were classified by site of origin and histological subtype, and survival was evaluated. RESULTS The authors identified 26 patients with solid nonhematopoietic CNS metastases out of 1135 pediatric CNS tumors diagnosed from 1981 to 2011. Patients ranged in age from 1.5 to 20.3 years and were equally divided between sexes. Most CNS metastases were supratentorial (85%) and solitary (65%). The mean interval from primary malignant diagnosis to CNS metastasis was 27 months. Sites of origin included kidney/adrenal, bone/soft tissue, gonads, head and neck, lung, and liver. Mean survival after CNS involvement was 36.6 months. Overall 1-year and 5-year survival rates were 52% and 16%, respectively. CONCLUSIONS In neuropathology practice, nonhematopoietic pediatric CNS metastases are far less common than are nonhematopoietic adult CNS metastases, accounting for approximately 2% of all pediatric CNS tumors. The most common tumors to exhibit CNS metastasis are of kidney/adrenal origin, followed by those from bone/soft tissue. As expected, prognosis is dismal, despite aggressive therapy.
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Affiliation(s)
- Andrea L Wiens
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Change in postsurgical cavity size within the first 30 days correlates with extent of surrounding edema: consequences for postoperative radiosurgery. J Comput Assist Tomogr 2014; 38:457-60. [PMID: 24681852 DOI: 10.1097/rct.0000000000000058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Resection cavity diameter of less than 40 mm is required to be eligible for stereotactic radiosurgery (SRS), after gross total resection of brain metastasis at our institution. Our study evaluates the correlation between vasogenic edema and change in cavity size for 30 days. METHODS Cavity size was measured on the postoperative and follow-up magnetic resonance imaging. Vasogenic edema was quantified as the largest axial measurement of T2 hyperintensity surrounding the resection cavity (postoperative magnetic resonance imaging). RESULTS Thirty-nine resection cavities (37 patients) were reviewed. There was a statistically significant (Pearson coefficient = -0.35; P = 0.02) negative correlation between edema and change in cavity size. An arbitrary cutoff value of a 15-mm edema yielded a sensitivity of 96% and a specificity of 65% (P < 0.001) to predict 10% decrease in cavity size. CONCLUSIONS In patients with cavity size close to the size cutoff for SRS, rescanning closer to the date of SRS should be considered, especially if there is significant edema surrounding the cavity.
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Park YM, Park JH, Lee SU, Lee JS. Metastatic breast cancer presenting as a subconjunctival mass. J Breast Cancer 2014; 17:88-90. [PMID: 24744803 PMCID: PMC3988349 DOI: 10.4048/jbc.2014.17.1.88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 01/06/2014] [Indexed: 11/30/2022] Open
Abstract
Breast cancer is the most common primary source of orbital metastasis. Metastasis occurs through hematogenous spread and predominantly involves the choroid. We present a case of a metastatic subconjunctival mass associated with primary breast cancer. To our knowledge, this is the first reported case of its kind. A 41-year-old woman presented with complaints of conjunctival injection and a foreign body sensation in the left eye. She had a history of breast cancer and had been treated 2 years previously with modified radical mastectomy followed by adjuvant radiotherapy and chemotherapy. Slit-lamp examination showed a cystic mass under the temporal bulbar conjunctiva, associated with dilated overlying conjunctival vessels. An excisional biopsy revealed a poorly differentiated adenocarcinoma. Positron emission tomography examination for systemic malignancy revealed multiple systemic metastasis. Metastatic disease should be considered in the differential diagnosis of subconjunctival lesions, and ophthalmic manifestations can play an important role in the detection of metastatic spread of a known primary breast cancer.
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Affiliation(s)
- Young Min Park
- Department of Ophthalmology, Pusan National University School of Medicine, and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jong Ho Park
- Department of Ophthalmology, Pusan National University School of Medicine, and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Seung Uk Lee
- Department of Ophthalmology, Institute of Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jong Soo Lee
- Department of Ophthalmology, Pusan National University School of Medicine, and Medical Research Institute, Pusan National University Hospital, Busan, Korea
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First assessment of whole-brain radiation therapy combined with pemetrexed-based chemotherapy in non-small-cell lung carcinoma: data on safety and efficacy. Anticancer Drugs 2014; 24:736-42. [PMID: 23542752 DOI: 10.1097/cad.0b013e328360974d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The folate antimetabolite pemetrexed was approved for the treatment of patients with metastatic nonsquamous non-small-cell lung carcinoma. Its activity on brain metastases makes pemetrexed attractive in combination with whole-brain radiation therapy (WBRT), but it could also potentially increase toxicity. We examined the medical records of 43 consecutive patients with brain metastases from non-small-cell lung carcinoma. Patients received pemetrexed-based chemotherapy at a dose of 500 mg/m. The median total number of pemetrexed-based chemotherapy cycles was 4 (range: 1-28). During the course of chemotherapy, patients received WBRT delivering 30 Gy in 10 fractions (n=34) or 20 Gy in five fractions (n=9). The median follow-up time was 30.5 weeks (range: 1-79 weeks). Intracranial progression was a cause of death in nine patients (20.9%). Clinical benefit of WBRT was reported in 30 patients (69.8%). The best radiological response was a complete response in eight patients (18.6%), a partial response in 16 patients (37.2%), stable disease in 11 patients (25.6%), and progression in four patients (9.3%). A stable intracranial disease until the last follow-up was observed in 26 patients (60.5%). The median estimated overall survival was 31 weeks (95% CI: 24-37 weeks). Most WBRT-related toxicities were low and 21 patients (48.9%) had no reported acute neurological toxicity. One patient developed unexplained encephalopathy 5 weeks after WBRT completion in the context of progressive diffuse brain metastases. The combination of pemetrexed with WBRT led to considerable clinical improvement and tumor responses in most patients. Overall neurological toxicity was rather low. A clinical trial is essential for better analysis of the potential synergistic effects of a drug with radiation and evaluation of neurological toxicity.
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Cyberknife stereotactic radiosurgery for the re-irradiation of brain lesions: a single-centre experience. Radiol Med 2014; 119:721-6. [PMID: 24469988 DOI: 10.1007/s11547-014-0383-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/22/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of our study was to retrospectively evaluate the feasibility and clinical benefit of cyberknife stereotactic radiosurgery (CSRS) in patients treated at Florence University for recurrent, pre-irradiated brain lesions. MATERIALS AND METHODS Thirteen patients were retreated with cyberknife. Mean age was 47.1 years (range 33-77 years). Karnofsky performance status ranged from 60 to 100 (median 80). Eleven (84.6%) out of 13 patients had metastatic lesions: four (36.4%) had primary lung, three (27.2%) had primary breast cancer and four (36.4%) other types of solid malignancies. Two (15.4%) out of 13 patients had recurrent of glioblastoma. RESULTS In terms of compliance with CSRS, the majority of patients did not develop any acute side effects. However, two (15.4%) out of 13 patients developed acute grade 2 toxicity requiring an increase of steroid medication. At the time of the last follow-up, response rates were as follows: complete response in one case (16.6%), partial response in three (50%) and stable disease in two (33.4%). CONCLUSIONS Re-irradiation with CSRS is a feasible and effective option for pre-irradiated, recurrent brain lesions to obtain clinical benefit without excessive acute toxicity.
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Cramarossa G, Zeng L, Zhang L, Tseng LM, Hou MF, Fairchild A, Vassiliou V, Jesus-Garcia R, Alm El-Din MA, Kumar A, Forges F, Chie WC, Sahgal A, Lam H, Pulenzas N, Chow E. Predictive factors of overall quality of life in advanced cancer patients using EORTC QLQ-C30. Expert Rev Pharmacoecon Outcomes Res 2013; 14:139-46. [PMID: 24325545 DOI: 10.1586/14737167.2014.864560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To identify which domains/symptoms from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were predictive of overall quality of life (QoL) in advanced cancer patients. METHODS Four hundred and forty seven patients with brain metastases or bone metastases from seven countries were enrolled with regression analysis to determine the predictive value of the QLQ-C30 functional/symptom scores for patient reported overall QoL (question 30), overall health (question 29) and the global health status domain (questions 29 and 30). RESULTS Worse role functioning, social functioning, fatigue and financial problems were the most significant predictive factors for worse QoL. In the bone metastases subgroup (n = 400), role functioning, fatigue and financial problems were the most significant predictors. In patients with brain metastases (n = 47), none of the EORTC domains significantly predicted worse QOL. CONCLUSION Deterioration of certain QLQ-C30 functional/symptom scores significantly contributes to worse QoL, overall health and global health status.
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Affiliation(s)
- Gemma Cramarossa
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada
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Lee YW, Cho HJ, Lee WH, Sonntag WE. Whole brain radiation-induced cognitive impairment: pathophysiological mechanisms and therapeutic targets. Biomol Ther (Seoul) 2013; 20:357-70. [PMID: 24009822 PMCID: PMC3762274 DOI: 10.4062/biomolther.2012.20.4.357] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 07/04/2012] [Indexed: 12/19/2022] Open
Abstract
Radiation therapy, the most commonly used for the treatment of brain tumors, has been shown to be of major significance in tu-mor control and survival rate of brain tumor patients. About 200,000 patients with brain tumor are treated with either partial large field or whole brain radiation every year in the United States. The use of radiation therapy for treatment of brain tumors, however, may lead to devastating functional deficits in brain several months to years after treatment. In particular, whole brain radiation therapy results in a significant reduction in learning and memory in brain tumor patients as long-term consequences of treatment. Although a number of in vitro and in vivo studies have demonstrated the pathogenesis of radiation-mediated brain injury, the cel-lular and molecular mechanisms by which radiation induces damage to normal tissue in brain remain largely unknown. Therefore, this review focuses on the pathophysiological mechanisms of whole brain radiation-induced cognitive impairment and the iden-tification of novel therapeutic targets. Specifically, we review the current knowledge about the effects of whole brain radiation on pro-oxidative and pro-inflammatory pathways, matrix metalloproteinases (MMPs)/tissue inhibitors of metalloproteinases (TIMPs) system and extracellular matrix (ECM), and physiological angiogenesis in brain. These studies may provide a foundation for defin-ing a new cellular and molecular basis related to the etiology of cognitive impairment that occurs among patients in response to whole brain radiation therapy. It may also lead to new opportunities for therapeutic interventions for brain tumor patients who are undergoing whole brain radiation therapy.
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Affiliation(s)
- Yong Woo Lee
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, Blacksburg, VA 24061, USA ; School of Biomedical Engineering and Sciences, Virginia Tech, Blacksburg, VA 24061, USA
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Stereotactic radiosurgery in the treatment of brain metastases: the current evidence. Cancer Treat Rev 2013; 40:48-59. [PMID: 23810288 DOI: 10.1016/j.ctrv.2013.05.002] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 11/22/2022]
Abstract
Chemotherapy has made substantial progress in the therapy of systemic cancer, but the pharmacological efficacy is insufficient in the treatment of brain metastases. Fractionated whole brain radiotherapy (WBRT) has been a standard treatment of brain metastases, but provides limited local tumor control and often unsatisfactory clinical results. Stereotactic radiosurgery using Gamma Knife, Linac or Cyberknife has overcome several of these limitations, which has influenced recent treatment recommendations. This present review summarizes the current literature of single session radiosurgery concerning survival and quality of life, specific responses, tumor volumes and numbers, about potential treatment combinations and radioresistant metastases. Gamma Knife and Linac based radiosurgery provide consistent results with a reproducible local tumor control in both single and multiple brain metastases. Ideally minimum doses of ≥18Gy are applied. Reported local control rates were 90-94% for breast cancer metastases and 81-98% for brain metastases of lung cancer. Local tumor control rates after radiosurgery of otherwise radioresistant brain metastases were 73-90% for melanoma and 83-96% for renal cell cancer. Currently, there is a tendency to treat a larger number of brain metastases in a single radiosurgical session, since numerous studies document high local tumor control after radiosurgical treatment of >3 brain metastases. New remote brain metastases are reported in 33-42% after WBRT and in 39-52% after radiosurgery, but while WBRT is generally applied only once, radiosurgery can be used repeatedly for remote recurrences or new metastases after WBRT. Larger metastases (>8-10cc) should be removed surgically, but for smaller metastases Gamma Knife radiosurgery appears to be equally effective as surgical tumor resection (level I evidence). Radiosurgery avoids the impairments in cognition and quality of life that can be a consequence of WBRT (level I evidence). High local efficacy, preservation of cerebral functions, short hospitalization and the option to continue a systemic chemotherapy are factors in favor of a minimally invasive approach with stereotactic radiosurgery.
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Poli GL, Bianchi C, Virotta G, Bettini A, Moretti R, Trachsel E, Elia G, Giovannoni L, Neri D, Bruno A. Radretumab radioimmunotherapy in patients with brain metastasis: a 124I-L19SIP dosimetric PET study. Cancer Immunol Res 2013; 1:134-43. [PMID: 24777501 DOI: 10.1158/2326-6066.cir-13-0007] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radioimmunotherapy (RIT) with (131)I-labeled L19SIP (radretumab; a small immunoprotein format antibody directed against the ED-B domain of fibronectin; ∼ 80 kDa molecular weight) has been investigated in several clinical trials. Here, we describe the use of immuno-PET imaging with iodine-124 ((124)I)-labeled L19SIP to predict doses delivered to tumor lesions and healthy organs by a subsequent radretumab RIT in patients with brain metastases from solid cancer. Bone marrow doses were evaluated both during the diagnostic phase and posttherapy, measuring activities in blood (germanium detector) and whole body (lanthanum bromide detector). Expected doses for radretumab administration (4,107 MBq/m(2)) were calculated from data obtained after administration of an average of 167 MBq (124)I-L19SIP to 6 patients. To assess lesion average doses, the positron emission tomography (PET) scanner was calibrated for the use of (124)I with an International Electrotechnical Commission (IEC) Body Phantom and recovery coefficients were calculated. The average dose to bone red marrow was 0.21 Gy/GBq, with high correlation between provisional and actual posttherapy doses. Although the fraction of injected activity in normal organs was similar in different patients, the antibody uptake in the neoplastic lesions varied by as much as a factor of 60. Immuno-PET with (124)I-labeled L19SIP offers significant advantages over conventional (131)I imaging, in particular accuracy of dosimetric results. Furthermore, the study indicates that antibody uptake can be highly variable even in different lesions of the same patient and that immuno-PET procedures may guide product development with armed antibodies.
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Affiliation(s)
- Gian Luca Poli
- Authors' Affiliations: Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
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Rodrigues G, Bauman G, Palma D, Louie AV, Mocanu J, Senan S, Lagerwaard F. Systematic review of brain metastases prognostic indices. Pract Radiat Oncol 2013; 3:101-6. [DOI: 10.1016/j.prro.2012.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
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Salvetti DJ, Nagaraja TG, McNeill IT, Xu Z, Sheehan J. Gamma Knife surgery for the treatment of 5 to 15 metastases to the brain: clinical article. J Neurosurg 2013; 118:1250-7. [PMID: 23540265 DOI: 10.3171/2013.2.jns121213] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT It has been generally accepted that Gamma Knife surgery (GKS) is an effective primary or adjunct treatment for patients with 1-4 metastases to the brain. The number of studies detailing the use of GKS for 5 or more brain metastases, however, remains minimal. The aim of the current retrospective study was to elucidate the utility of GKS in patients with 5-15 brain metastases. METHODS Patients were chosen for GKS based on prior MRI of these metastatic lesions and a known primary cancer diagnosis. Magnetic resonance imaging was used post-GKS to assess tumor control; patients were also followed up clinically. Overall survival (OS) from the date of GKS was used as the primary end point. Statistical analysis was performed to identify prognostic factors related to OS. RESULTS Between 2003 and 2012, 96 patients were treated for a total of 704 metastatic brain lesions. The histology of these lesions varied among non-small cell lung cancer (NSCLC), breast cancer, melanoma, renal cancer, and other more rare carcinomas. At the initial treatment, 18 of the patients (18.8%) were categorized in Recursive Partitioning Analysis (RPA) Class 1 and 77 (80.2%) in RPA Class 2; none were in RPA Class 3. The median number of treated lesions was 7 (mean 7.13), and the median planned treatment volume was 6.12 cm(3) (range 0.42-57.83 cm(3)) per patient. The median clinical follow-up was 4.1 months (range 0.1-40.70 months). Actuarial tumor control was calculated to be 92.4% at 6 months, 84.8% at 12 months, and 74.9% at 24 months post-GKS. The median OS was found to be 4.73 months (range 0.4-41.8 months). Multivariate analysis demonstrated that RPA class was a significant predictor of death (HR = 2.263, p = 0.038). Number of lesions, tumor histology, Graded Prognostic Assessment score, prior whole-brain radiation therapy, prior resection, prior chemotherapy, patient age, patient sex, controlled primary tumor, extracranial metastases, and planned treatment volume were not significant predictors of OS. CONCLUSIONS In patients with 5-15 brain metastases at presentation, the number of lesions did not predict survival after GKS; however, the RPA class was predictive of OS in this group of patients. Gamma Knife surgery for such patients offers an excellent rate of local tumor control.
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Affiliation(s)
- David J Salvetti
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia 22908, USA
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Rodrigues G, Zindler J, Warner A, Lagerwaard F. Recursive partitioning analysis for the prediction of stereotactic radiosurgery brain metastases lesion control. Oncologist 2013; 18:330-5. [PMID: 23429647 DOI: 10.1634/theoncologist.2012-0316] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The objective of this investigation was to identify independent pretreatment factors that predict for control of local brain metastases (BM) in a large single-institution series of patients receiving stereotactic radiosurgery (SRS). Recursive partitioning analysis was used to potentially identify a class of patients with durable lesion control characteristics. METHODS A retrospective SRS database containing baseline characteristics, treatment details, and follow-up data of newly diagnosed patients with 1-3 BM (on magnetic resonance imaging) treated with linear accelerator-based SRS was created. Three study endpoints were used: time to progression (primary endpoint, individual lesion progression; n = 536), time to first progression (secondary endpoint, first lesion progression on an individual patient basis; n = 380), and overall survival (secondary endpoint; n = 380). Recursive partitioning analysis (RPA) was performed to identify predictors of time to progression. RESULTS Multivariable analysis demonstrated that lesion aspect/phenotype and radiotherapy schedule were independent factors associated with both progression outcomes. Presence of tumor necrosis was found to be associated with a significant hazard of progression (hazard ratio >3), whereas use of the most intense radiotherapy fractionation schedule (21 Gy in one fraction) was associated with significant reductions in progression (hazard ratio <0.3). RPA using SRS dose and lesion aspect/phenotype was created and described three distinct prognostic groups. CONCLUSIONS RPA of a large retrospective database of patients receiving SRS confirmed previous observations regarding the importance of SRS dose and lesion aspect/phenotype in lesion control and overall survival. The SRS lesion analysis may help to stratify future clinical trials and better define patient care options and prognosis.
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Affiliation(s)
- George Rodrigues
- Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.
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Luan P, Zhou HH, Zhang B, Liu AM, Yang LH, Weng XL, Tao EX, Liu J. Basic fibroblast growth factor protects C17.2 cells from radiation-induced injury through ERK1/2. CNS Neurosci Ther 2013; 18:767-72. [PMID: 22943143 DOI: 10.1111/j.1755-5949.2012.00365.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS To establish a radiation-induced neural injury model using C17.2 neural stem cells (NSCs) and to investigate whether basic fibroblast growth factor (bFGF) can protect the radiation-induced injury of C17.2 NSCs. Furthermore, we aim to identify the possible mechanisms involved in this model. METHODS C17.2 NSCs received a single exposure (3, 6, and 9 Gy, respectively) at a dose rate of 300 cGy/min with a control group receiving 0 Gy. Different concentrations of bFGF were added for 24 h, 5 min postirradiation. The MTS assay and flow cytometry were used to detect cytotoxicity and apoptosis. Expression of FGFR1, ERK1/2, and p-ERK1/2 proteins was detected with or without U0126 was pretreated prior to C17.2 NSCs receiving irradiation. RESULTS C17.2 NSCs showed a dose-dependent cell death as the dose of radiation was increased. Additionally, the rate of apoptosis in the C17.2 NSCs reached 31.2 ± 1.23% in the 6 Gy irradiation group, which was the most significant when compared to the other irradiation treated groups. bFGF showed protective effect on cell apoptosis in a dose-dependent manner. The mean percentage of apoptotic cells decreased to 7.83 ± 1.75% when 100 ng/mL bFGF was given. Furthermore, U0126 could block the protective effect of bFGF by inhibiting the phosphorylation of ERK1/2. CONCLUSIONS An in vitro cellular model of radiation-induced apoptosis of NSCs, in C17.2 NSCs, was developed successfully. Additionally, bFGF can protect neurons from radiation injury in vitro via the ERK1/2 signal transduction pathway.
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Affiliation(s)
- Ping Luan
- Medical School, Shenzhen University, China
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Predictive factors for overall quality of life in patients with advanced cancer. Support Care Cancer 2013; 21:1709-16. [DOI: 10.1007/s00520-013-1717-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 01/09/2013] [Indexed: 11/12/2022]
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Population-based outcomes after brain radiotherapy in patients with brain metastases from breast cancer in the Pre-Trastuzumab and Trastuzumab eras. Radiat Oncol 2013; 8:12. [PMID: 23302543 PMCID: PMC3582534 DOI: 10.1186/1748-717x-8-12] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/04/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the survival of patients with human epidermal growth factor receptor 2 (HER2) positive and negative metastatic breast cancer irradiated for brain metastases before and after the availability of trastuzumab (T). MATERIALS AND METHODS Women diagnosed with brain metastasis from breast cancer in two eras between 2000 and 2007 (T-era, n = 441) and 1986 to 1992 (PreT-era, n = 307), treated with whole brain radiotherapy (RT) were identified. In the T-era, HER2 testing was part of routine clinical practice, and in the preT-era 128/307 (42%) cases had HER2 testing performed retrospectively on tissue microarrays. Overall survival (OS) was estimated using the Kaplan-Meier method and comparisons between eras used log-rank tests. RESULTS In the preT- and T-era cohorts, the rate of HER2 positivity was 40% (176/441) and 26% (33/128) (p < 0.001). The median time from diagnosis to brain RT was longer in the preT-era (3.3 years versus 2.3 years, p < 0.001). Survival after brain RT was improved in the T-era compared to the preT-era (1-year OS 26% versus 12%, p < 0.001). The 1-year OS rate for HER2 negative patients was 20% in both eras (p = 0.97). Among HER2 positive patients, the 1-year OS in the preT-era was 5% compared to 40% in the T-era (p < 0.001). CONCLUSIONS Distinct from patients with HER2 negative disease in whom no difference in survival after brain RT was observed over time, patients with HER2 positive brain metastases experienced significantly improved survival subsequent to the availability of trastuzumab.
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Ruschin M, Komljenovic PT, Ansell S, Ménard C, Bootsma G, Cho YB, Chung C, Jaffray D. Cone Beam Computed Tomography Image Guidance System for a Dedicated Intracranial Radiosurgery Treatment Unit. Int J Radiat Oncol Biol Phys 2013; 85:243-50. [DOI: 10.1016/j.ijrobp.2012.03.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/12/2012] [Accepted: 03/13/2012] [Indexed: 10/27/2022]
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The Use of Palliative Whole Brain Radiotherapy in the Management of Brain Metastases. Clin Oncol (R Coll Radiol) 2012; 24:e149-58. [PMID: 23063070 DOI: 10.1016/j.clon.2012.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 11/20/2022]
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Khan L, Cramarossa G, Lemke M, Nguyen J, Zhang L, Chen E, Chow E. Symptom clusters using the Spitzer quality of life index in patients with brain metastases—a reanalysis comparing different statistical methods. Support Care Cancer 2012; 21:467-73. [DOI: 10.1007/s00520-012-1540-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 07/05/2012] [Indexed: 11/28/2022]
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