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Chambrelant I, Jarnet D, Le Fèvre C, Kuntz L, Jacob J, Jenny C, Noël G. Comparative study of dynamic conformal arc therapy and volumetric modulated arc therapy for treating single brain metastases: A retrospective analysis of dosimetric and clinical outcomes. Phys Imaging Radiat Oncol 2024; 30:100591. [PMID: 38832123 PMCID: PMC11145388 DOI: 10.1016/j.phro.2024.100591] [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: 12/04/2023] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024] Open
Abstract
Background and purpose Stereotactic radiation therapy (SRT) is commonly used to treat brain metastases (BMs). This retrospective study compared two SRT techniques, dynamic conformal arc therapy (DCAT) and volumetric modulated arc therapy (VMAT), for single BM treatments. Material and methods Data of patients treated between January 2010 and June 2020 were considered. Patients with multiple BMs, resected BMs, reirradiation, whole-brain radiation therapy and brainstem metastases were excluded. We focused our analysis on 97 patients who received 23.1 Gy in three fractions. Acute toxicities and follow-up outcomes were recorded. Dosimetric data were analyzed in two subgroups (PTV ≤ 10 cc and PTV > 10 cc). Results DCAT and VMAT were used in 70 (72.2 %) and 27 (27.8 %) patients, respectively. Acute toxicities were not significantly different between groups (p = 0.259), and no difference was detected in the incidence rate of radionecrosis, local recurrence and cerebral recurrence (p > 0.999, p > 0.999 and p = 0.682, respectively). PTV coverage was better with DCAT for small volumes (PTV ≤ 10 cc). Mean conformity index (CI) was significantly higher with VMAT and mean gradient index (GI) was significantly lower with DCAT whatever volume subgroups (p < 0.001). DCAT had more heterogeneous plans and VMAT required more monitor units. DCAT resulted in reduced low and intermediate doses, whereas VMAT led to decreased high doses. Conclusion DCAT and VMAT are two effective and safe SRT techniques for BMs treatment. In the era of re-irradiation, it is important to reduce the doses delivered to healthy tissues. Further prospective studies are needed to validate these findings.
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Affiliation(s)
- Isabelle Chambrelant
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France
| | - Delphine Jarnet
- Department of Medical Physics, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France
| | - Clara Le Fèvre
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France
| | - Laure Kuntz
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France
| | - Julian Jacob
- Department of Radiation Oncology, AP-HP. Sorbonne Université, Hôpitaux Universitaires Pitié-Salpêtrière, 47-83 Bd de l’Hôpital, 75651 Paris Cedex 13, France
| | - Catherine Jenny
- Department of Medical Physics, AP-HP. Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière, 47-83 Bd de l’Hôpital, 75651 Paris Cedex 13, France
| | - Georges Noël
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France
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2
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Bonert M, Berzins A, Begum H, Schittenhelm J, Lu JQ, Juergens RA, Swaminath A, Cutz JC, Naqvi AH. Neuroanatomical location of brain metastases from solid tumours based on pathology: An analysis of 511 patients with a comparison to the provided clinical history. PLoS One 2023; 18:e0294154. [PMID: 37943775 PMCID: PMC10635465 DOI: 10.1371/journal.pone.0294154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
Brain metastases are a frequent occurrence in neuropathology practices. The literature on their neuroanatomical location is frequently derived from radiological analyses. This work examines brain metastases through the lens of pathology specimens. All brain surgical pathology reports for cases accessioned 2011-2020 were retrieved from a laboratory. Specimens were classified by neuroanatomical location, diagnosis and diagnostic category with a hierarchical free text string-matching algorithm (HFTSMA) and also subsequently audited. All reports classified as probable metastasis were reviewed by a pathologist. The provided history was compared to the final categorization by a pathologist. The cohort had 4,625 cases. The HFTSMA identified 854 cases (including metastases from a definite primary, metastases from primary not known and improperly classified cases). 514/854 cases had one definite primary site per algorithm and on report review 538/854 cases were confirmed as such. The 538 cases originated from 511 patients. Primaries from breast, gynecologic tract, and gastrointestinal tract not otherwise specified were most frequently found in the cerebellum. Kidney metastases were most frequently found in the occipital lobe. Lung, metastatic melanoma and colorectal primaries were most commonly found in the frontal lobe. The provided clinical history predicted the primary in 206 cases (40.3%), was discordant in 17 cases (3.3%) and non-contributory in 280 cases (54.8%). The observed distribution of the metastatic tumours in the brain is dependent on the primary site. In the majority (54.8%) of cases, the provided clinical history was non-contributory; this suggests surgeon-pathologist communication may have the potential for optimization.
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Affiliation(s)
- Michael Bonert
- Anatomical Pathology, Pathology and Molecular Medicine, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Canada
| | - Alison Berzins
- Anatomical Pathology, Pathology and Molecular Medicine, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Canada
| | - Housne Begum
- McMaster University, Hamilton, and Health Services Management, Toronto Metropolitan University, Toronto, Canada
| | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tübingen, Germany
| | - Jian-Qiang Lu
- Neuropathology, Pathology and Molecular Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Rosalyn A. Juergens
- Medical Oncology, Oncology, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Anand Swaminath
- Radiation Oncology, Oncology, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Jean-Claude Cutz
- Anatomical Pathology, Pathology and Molecular Medicine, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Canada
| | - Asghar H. Naqvi
- Anatomical Pathology, Pathology and Molecular Medicine, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Canada
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3
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Voglis S, Padevit L, van Niftrik CHB, Kälin V, Beyersdorf B, Da Mutten R, Stumpo V, Bellomo J, Sarnthein J, Staartjes VE, Carretta A, Krayenbühl N, Regli L, Serra C. Safety of microneurosurgical interventions for superficial and deep-seated brain metastases: single-center cohort study of 637 consecutive cases. J Neurooncol 2023; 165:271-278. [PMID: 37945819 PMCID: PMC10689541 DOI: 10.1007/s11060-023-04478-1] [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: 09/03/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Microneurosurgical techniques have greatly improved over the past years due to the introduction of new technology and surgical concepts. To reevaluate the role of micro-neurosurgery in brain metastases (BM) resection in the era of new systemic and local treatment options, its safety profile needs to be reassessed. The aim of this study was to analyze the rate of adverse events (AEs) according to a systematic, comprehensive and reliably reproducible grading system after microneurosurgical BM resection in a large and modern microneurosurgical series with special emphasis on anatomical location. METHODS Prospectively collected cases of BM resection between 2013 and 2022 were retrospectively analyzed. Number of AEs, defined as any deviations from the expected postoperative course according to Clavien-Dindo-Grade (CDG) were evaluated. Patient, surgical, and lesion characteristics, including exact anatomic tumor locations, were analyzed using uni- and multivariate logistic regression and survival analysis to identify predictive factors for AEs. RESULTS We identified 664 eligible patients with lung cancer being the most common primary tumor (44%), followed by melanoma (25%) and breast cancer (11%). 29 patients (4%) underwent biopsy only whereas BM were resected in 637 (96%) of cases. The overall rate of AEs was 8% at discharge. However, severe AEs (≥ CDG 3a; requiring surgical intervention under local/general anesthesia or ICU treatment) occurred in only 1.9% (n = 12) of cases with a perioperative mortality of 0.6% (n = 4). Infratentorial tumor location (OR 5.46, 95% 2.31-13.8, p = .001), reoperation (OR 2.31, 95% 1.07-4.81, p = .033) and central region tumor location (OR 3.03, 95% 1.03-8.60) showed to be significant predictors in a multivariate analysis for major AEs (CDG ≥ 2 or new neurological deficits). Neither deep supratentorial nor central region tumors were associated with more major AEs compared to convexity lesions. CONCLUSIONS Modern microneurosurgical resection can be considered an excellent option in the management of BM in terms of safety, as the overall rate of major AEs are very rare even in eloquent and deep-seated lesions.
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Affiliation(s)
- Stefanos Voglis
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Luis Padevit
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Vincens Kälin
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Benjamin Beyersdorf
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Raffaele Da Mutten
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Vittorio Stumpo
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Jacopo Bellomo
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Johannes Sarnthein
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Victor Egon Staartjes
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Alessandro Carretta
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Niklaus Krayenbühl
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Roy JM, Bangash AH, Skandalakis GP, Bowers CA. Frailty indices in patients undergoing surgical resection of brain metastases: a systematic review. Neurosurg Rev 2023; 46:267. [PMID: 37815634 DOI: 10.1007/s10143-023-02174-2] [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: 08/18/2023] [Revised: 09/16/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
Brain metastases are a relatively common occurrence in patients with primary malignancies, with an incidence ranging from 9 to 17%. Their prevalence has increased due to treatment advancements that have led to improved survival in cancer patients. Frailty has demonstrated the ability to outperform greater patient age in surgical decision-making by predicting postoperative adverse events that include mortality, extended length of hospital stay, non-routine discharge disposition, and postoperative complications. Although predictive models based on frailty have been increasingly utilized in literature, their generalizability remains questionable due to inadequacies in model development and validation. Our systematic review describes development and validation cohorts of frailty indices used in patients undergoing surgical resection of brain metastases and serves as a guide to their incorporation in the outpatient clinical setting. A systematic review of literature was performed using PubMed and Google Scholar. Articles that reported outcomes using frailty indices in patients undergoing surgical resection of brain metastases were included. The Newcastle Ottawa Scale (NOS) was used to assess for risk of bias across individual studies. Studies with NOS > 5 were considered high quality. We identified 238 articles through our search strategy. After a title and abstract screen, followed by a full text review, 9 articles met criteria for inclusion. The 5- and 11-factor modified frailty indices were most frequently utilized (n = 4). Five studies utilized single-hospital databases, and four utilized nationwide databases. Six studies were considered high-quality based on the NOS. Although frailty indices have demonstrated the ability to predict outcomes in patients undergoing surgical resection of brain metastases, further validation of these indices is necessary prior to their incorporation in clinical practice.
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Affiliation(s)
- Joanna M Roy
- Topiwala National Medical College, Mumbai, India
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, 87122, USA
| | | | - Georgios P Skandalakis
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, 87131, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, 87122, USA.
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5
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Koyuncuer A. Role of intraoperative touch imprint cytology and immunohistochemistry in the diagnosis of metastatic malignancies in the central nervous system: Cyto-histomorphological findings and differential diagnosis. Diagn Cytopathol 2023; 51:612-628. [PMID: 37435815 DOI: 10.1002/dc.25192] [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: 05/31/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Brain metastases (BMs) are intracranial neoplasms that are more common in adults than primary brain tumors, causing significant mortality and morbidity in cancer patients. This study aimed to evaluate the definitive histopathological diagnosis using touch imprint cytology and the importance and use of immunohistochemistry in the diagnosis of primary origin. METHOD Cytological, paraffin section, and immunohistochemical study slides of all metastatic brain tumors consecutively consulted at the pathology department between 2018 and 2023 were evaluated. The sensitivity, specificity, and accuracy of patients' diagnostic results who underwent imprint cytology were compared based on the final diagnosis histopathological report. RESULTS A total of 45 patients with and without intraoperative consultation were included in the study. The definitive histopathologic diagnosis and the diagnostic accuracy rate of imprint cytology for distinguishing glial and metastatic tumors on paraffin sections was 100%. Immunohistochemistry was performed in all patients (except one patient; immediate exitus) and histological classification of the primary tumor was performed by analysis of clinical findings and biomarkers. The primary origins of metastatic tumors were often lung and breast, with adenocarcinoma subtype histomorphology, cerebral hemispheres, and discrete foci of metastasis. CONCLUSION TPs is a simple and rapid technique that supports diagnosis in intraoperative neuropathology and is a very cost-effective procedure. The pathologist's experience is the key factor in the diagnosis and reduces the need for a frozen section. In our series, the final histopathologic correlation of imprint cytology in the diagnosis of primary and metastatic tumors is 100%.
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Affiliation(s)
- Ali Koyuncuer
- Department of Pathology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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6
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He J, Jia L, Zhang Y, Tian Y, Hao P, Li T, Xiao Y, Peng L, Feng Y, Cheng X, Deng H, Wang P, Chong W, Hai Y, Chen L, You C, Fang F. Obesity Paradox for Postoperative Mortality in Young Chinese Patients Undergoing Craniotomy for Brain Tumor Resection. J Neurosurg Anesthesiol 2023:00008506-990000000-00076. [PMID: 37550895 DOI: 10.1097/ana.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 06/29/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND There is little evidence regarding the association of body mass index (BMI) with postoperative mortality after craniotomy, especially in the Asian population. Our study aimed to explore the association between BMI and postoperative 30-day mortality in Chinese patients undergoing craniotomy for brain tumor resection. METHODS This large retrospective cohort study, Supplemental Digital Content 9, http://links.lww.com/JNA/A634 collected data from 7519 patients who underwent craniotomy for brain tumor resection. On the basis of the World Health Organization obesity criteria for Asians, included patients were categorized as underweight (<18.5 kg/m2), normal weight (18.5 to 22.9 kg/m2), overweight (23to 24.9 kg/m2), obese I (25 to 29.9 kg/m2), and obese II (≥30 kg/m2). We used a multivariable logistic regression model to explore the association between different BMI categories and 30-day postoperative mortality. In addition, we also conducted stratified analyses based on age and sex. RESULTS Overweight (adjusted odds ratio 0.63, 95% CI 0.40-0.99) and obese I (adjusted odds ratio 0.44, 95% CI 0.28-0.72) were associated with decreased 30-day postoperative mortality compared with normal-weight counterparts. Such associations were prominent among younger (age younger than 65 y) patients but not older patients, and there was an interaction between age and overweight versus normal weight on mortality (P for interaction=0.04). CONCLUSIONS We found that among Chinese patients undergoing craniotomy for brain tumors, there was a J-shaped association between BMI and postoperative 30-day mortality, with lowest mortality at 27 kg/m². Moreover, in young patients, overweight and obese I were both associated with decreased risk of 30-day mortality.
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Affiliation(s)
- Jialing He
- Department of Neurosurgery, West China Hospital, Sichuan University
- Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong
| | - Lu Jia
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | | | - Yixin Tian
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Pengfei Hao
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Tiangui Li
- Department of Neurosurgery, Longquan Hospital, Chengdu, Sichuan
| | | | | | | | - Xin Cheng
- Department of Neurosurgery, West China Hospital, Sichuan University
| | | | - Peng Wang
- Affiliated Hospital of Chengdu University
| | | | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Lvlin Chen
- Affiliated Hospital of Chengdu University
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University
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7
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Chambrelant I, Jarnet D, Bou-Gharios J, Le Fèvre C, Kuntz L, Antoni D, Jenny C, Noël G. Stereotactic Radiation Therapy of Single Brain Metastases: A Literature Review of Dosimetric Studies. Cancers (Basel) 2023; 15:3937. [PMID: 37568753 PMCID: PMC10416831 DOI: 10.3390/cancers15153937] [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: 06/06/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Stereotactic radiotherapy (SRT) plays a major role in treating brain metastases (BMs) and can be delivered using various equipment and techniques. This review aims to identify the dosimetric factors of each technique to determine whether one should be preferred over another for single BMs treatment. A systematic literature review on articles published between January 2015 and January 2022 was conducted using the MEDLINE and ScienceDirect databases, following the PRISMA methodology, using the keywords "dosimetric comparison" and "brain metastases". The included articles compared two or more SRT techniques for treating single BM and considered at least two parameters among: conformity (CI), homogeneity (HI) and gradient (GI) indexes, delivery treatment time, and dose-volume of normal brain tissue. Eleven studies were analyzed. The heterogeneous lesions along with the different definitions of dosimetric indexes rendered the studied comparison almost unattainable. Gamma Knife (GK) and volumetric modulated arc therapy (VMAT) provide better CI and GI and ensure the sparing of healthy tissue. To conclude, it is crucial to optimize dosimetric indexes to minimize radiation exposure to healthy tissue, particularly in cases of reirradiation. Consequently, there is a need for future well-designed studies to establish guidelines for selecting the appropriate SRT technique based on the treated BMs' characteristics.
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Affiliation(s)
- Isabelle Chambrelant
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France; (I.C.); (C.L.F.); (L.K.); (D.A.)
| | - Delphine Jarnet
- Department of Medical Physics, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France;
| | - Jolie Bou-Gharios
- Radiobiology Laboratory, Institut de Cancérologie Strasbourg Europe (ICANS), Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France;
| | - Clara Le Fèvre
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France; (I.C.); (C.L.F.); (L.K.); (D.A.)
| | - Laure Kuntz
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France; (I.C.); (C.L.F.); (L.K.); (D.A.)
| | - Delphine Antoni
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France; (I.C.); (C.L.F.); (L.K.); (D.A.)
| | - Catherine Jenny
- Department of Medical Physics, AP-HP, Sorbonne Université, CEDEX 13, 75651 Paris, France;
| | - Georges Noël
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), UNICANCER, Paul Strauss Comprehensive Cancer Center, 67200 Strasbourg, France; (I.C.); (C.L.F.); (L.K.); (D.A.)
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8
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Diehl CD, Giordano FA, Grosu AL, Ille S, Kahl KH, Onken J, Rieken S, Sarria GR, Shiban E, Wagner A, Beck J, Brehmer S, Ganslandt O, Hamed M, Meyer B, Münter M, Raabe A, Rohde V, Schaller K, Schilling D, Schneider M, Sperk E, Thomé C, Vajkoczy P, Vatter H, Combs SE. Opportunities and Alternatives of Modern Radiation Oncology and Surgery for the Management of Resectable Brain Metastases. Cancers (Basel) 2023; 15:3670. [PMID: 37509330 PMCID: PMC10377800 DOI: 10.3390/cancers15143670] [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: 04/18/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Postsurgical radiotherapy (RT) has been early proven to prevent local tumor recurrence, initially performed with whole brain RT (WBRT). Subsequent to disadvantageous cognitive sequalae for the patient and the broad distribution of modern linear accelerators, focal irradiation of the tumor has omitted WBRT in most cases. In many studies, the effectiveness of local RT of the resection cavity, either as single-fraction stereotactic radiosurgery (SRS) or hypo-fractionated stereotactic RT (hFSRT), has been demonstrated to be effective and safe. However, whereas prospective high-level incidence is still lacking on which dose and fractionation scheme is the best choice for the patient, further ablative techniques have come into play. Neoadjuvant SRS (N-SRS) prior to resection combines straightforward target delineation with an accelerated post-surgical phase, allowing an earlier start of systemic treatment or rehabilitation as indicated. In addition, low-energy intraoperative RT (IORT) on the surgical bed has been introduced as another alternative to external beam RT, offering sterilization of the cavity surface with steep dose gradients towards the healthy brain. This consensus paper summarizes current local treatment strategies for resectable brain metastases regarding available data and patient-centered decision-making.
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Affiliation(s)
- Christian D Diehl
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, 81675 München, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, 80336 München, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Anca-L Grosu
- Department of Radiation Oncology, University Medical Center, Medical Faculty, 79106 Freiburg, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Faculty of Medicine, Technical University of Munich, 81675 München, Germany
| | - Klaus-Henning Kahl
- Department of Radiation Oncology, University Medical Center Augsburg, 86156 Augsburg, Germany
| | - Julia Onken
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, 37075 Göttingen, Germany
- Comprehensive Cancer Center Niedersachsen (CCC-N), 37075 Göttingen, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Ehab Shiban
- Department of Neurosurgery, University Medical Center Augsburg, 86156 Augsburg, Germany
| | - Arthur Wagner
- Department of Neurosurgery, Faculty of Medicine, Technical University of Munich, 81675 München, Germany
| | - Jürgen Beck
- Department of Neurosurgery, University Hospital Freiburg, 79106 Freiburg, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Oliver Ganslandt
- Neurosurgical Clinic, Klinikum Stuttgart, 70174 Stuttgart, Germany
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Faculty of Medicine, Technical University of Munich, 81675 München, Germany
| | - Marc Münter
- Department of Radiation Oncology, Klinikum Stuttgart Katharinenhospital, 70174 Stuttgart, Germany
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Veit Rohde
- Department of Neurosurgery, Universitätsmedizin Göttingen, 37075 Göttingen, Germany
| | - Karl Schaller
- Department of Neurosurgery, University of Geneva Medical Center & Faculty of Medicine, 1211 Geneva, Switzerland
| | - Daniela Schilling
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, 81675 München, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Elena Sperk
- Mannheim Cancer Center, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, 81675 München, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, 80336 München, Germany
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9
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Kim SH, Lee YS, Lee SH, Sung YE, Lee A, Kang J, Park JS, Jeun SS, Lee YS. Single-center study on clinicopathological and typical molecular pathologic features of metastatic brain tumor. J Pathol Transl Med 2023; 57:217-231. [PMID: 37460396 PMCID: PMC10369139 DOI: 10.4132/jptm.2023.06.10] [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: 04/04/2023] [Accepted: 06/10/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The metastatic brain tumor is the most common brain tumor. The aim of this study was to demonstrate the clinicopathological and molecular pathologic features of brain metastases (BM). METHODS A total of 269 patients were diagnosed with BM through surgical resection at Seoul St. Mary's Hospital from January 2010 to March 2020. We reviewed the clinicopathological features and molecular status of primary and metastatic brain tissues using immunohistochemistry and molecular pathology results. RESULTS Among 269 patients, 139 males and 130 females were included. The median age of primary tumor was 58 years (range, 13 to 87 years) and 86 patients (32.0%) had BM at initial presentation. Median BM free interval was 28.0 months (range, 1 to 286 months). The most frequent primary site was lung 46.5% (125/269), and followed by breast 15.6% (42/269), colorectum 10.0% (27/269). Epidermal growth factor receptor (EGFR) mutation was found in 50.8% (32/63) and 58.0% (40/69) of lung primary and BM, respectively. In both breast primary and breast cancer with BM, luminal B was the most frequent subtype at 37.9% (11/29) and 42.9% (18/42), respectively, followed by human epidermal growth factor receptor 2 with 31.0% (9/29) and 33.3% (14/42). Triple-negative was 20.7% (6/29) and 16.7% (7/42), and luminal A was 10.3% (3/29) and 7.1% (3/42) of breast primary and BM, respectively. In colorectal primary and colorectal cancer with BM, KRAS mutation was found in 76.9% (10/13) and 66.7% (2/3), respectively. CONCLUSIONS We report the clinicopathological and molecular pathologic features of BM that can provide useful information for understanding the pathogenesis of metastasis and for clinical trials based on the tumor's molecular pathology.
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Affiliation(s)
- Su Hwa Kim
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Suk Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeoun Eun Sung
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ahwon Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Kang
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Sung Park
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sin Soo Jeun
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn Soo Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Sammaddar D, Basu A, Roy P, Chowdhury H. Incidence and clinical profile of brain metastasis treated with whole brain radiotherapy in a tertiary hospital in eastern India: A retrospective audit. Indian J Cancer 2023; 60:337-344. [PMID: 36861704 DOI: 10.4103/ijc.ijc_1211_20] [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] [Indexed: 11/05/2022]
Abstract
Introduction Management of brain metastases (BM) is witnessing marked advancement worldwide and modern technologies with better outcomes are gradually being adopted in developing countries. However, data regarding current practice in this field is lacking from the Indian subcontinent prompting us to plan the current study. Materials and Methods A retrospective, single institutional audit was performed on 112 patients with solid tumors metastasizing to the brain treated over the last 4 years at a tertiary care center in eastern India, of which 79 were ultimately evaluable. Demography, patterns of incidence, and overall survival (OS) were determined. Results The prevalence of BM was 5.65% among all patients with solid tumors. The median age was 55 years with a slight male preponderance. Lung followed by breast were the most common primary subsites. Multiple BM (54%), left-sided (61%), and frontal lobe lesions (54%) were the more common. Metachronous BM was found in 76% of patients. All patients received whole brain radiation therapy (WBRT). The median OS for the entire cohort was 7 months (95% confidence interval [CI]: 4 - 19 months). The median OS for lung and breast primaries were 6.5 and 8 months and for recursive partitioning analysis (RPA) classes I, II, and III the OS were 11.5, 7, and 3 months, respectively. Median OS did not differ by number of or other sites of metastases. Conclusions The outcomes from our series about BM from solid tumors in patients from eastern Indian are in congruence to those available in the literature. Patients with BM are still largely treated with WBRT in resource-limited settings.
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Affiliation(s)
- Debdeep Sammaddar
- Department of Radiation Oncology, R.G. Kar Medical College and Hospital, Kolkata, India
| | - Abhishek Basu
- Department of Radiation Oncology, Burdwan Medical College and Hospital, Purba Bardhaman, India
| | - Pritha Roy
- Department of Radiation Oncology, R.G. Kar Medical College and Hospital, Kolkata, India
| | - Hambir Chowdhury
- Department of Radiation Oncology, Medical College and Hospital, Kolkata, West Bengal, India
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11
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Telera S, Gazzeri R, Villani V, Raus L, Giordano FR, Costantino A, Delfinis CP, Piludu F, Sperduti I, Pace A. Surgical treatment of cerebellar metastases in elderly patients: A threshold that moves forward? World Neurosurg X 2023; 18:100164. [PMID: 36818737 PMCID: PMC9932212 DOI: 10.1016/j.wnsx.2023.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
The impact of surgery for cerebellar brain metastases in elderly population has been the object of limited studies in literature. Given the increasing burden of their chronic illnesses, the decision to recommend surgery remains difficult. All patients aged ≥65 years, who underwent surgical resection of a cerebellar brain metastasis from May 2000 and May 2021 at IRCCS National Cancer Institute "Regina Elena", were analyzed. The study cohort includes 48 patients with a mean age of 70.8 years. 7 patients belonged to the II Class according to the RPA classification, 41 to the III Class; the median GPA classification was 1.5. Median pre-operative and post-operative KPS was 60. Median Charlson Comorbidity Index (CCI) was 11; median 5-variable modified Frailty Index was 2. Overall, 14 patients (29%) presented perioperative neurologic and systemic complications. 34 patients (71%) were able to perform adjuvant therapies as RT and/or CHT after surgery. A higher CCI predicted complications occurrence (p = 0.044), while significant factors for a post-operative KPS ≥70, were i) hemispheric location of the metastasis, ii) higher pre-operative KPS, iii) RPA II classification. Median Overall Survival was 7 months. A post-operative KPS <70 (p = 0.004) and a short time interval between diagnosis of the primary tumor and cerebellar metastasis appearance, were predictive for a worse outcome (p = 0.012). Our study suggests that selected elderly patients with cerebellar metastases may benefit from microsurgery to continue their adjuvant therapies, although a high complications rate should be taken in account.
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Affiliation(s)
- Stefano Telera
- UOSD Neurosurgery, IRCCS National Cancer Institute Regina Elena, Rome, Italy,Corresponding author. Neurosurgery, IRCCS National Cancer Institute Regina Elena , Rome, Italy.
| | - Roberto Gazzeri
- UOSD Pain Therapy, San Giovanni Addolorata Hospital, Rome, Italy
| | - Veronica Villani
- UOSD Neuro-Oncology, IRCCS National Cancer Institute Regina Elena, Rome, Italy
| | - Laura Raus
- UOSD Neurosurgery, IRCCS National Cancer Institute Regina Elena, Rome, Italy
| | | | - Alessandra Costantino
- UOC Anesthesia and Intensive Care, IRCCS National Cancer Institute Regina Elena, Rome, Italy
| | | | - Francesca Piludu
- UOC Radiology and Diagnostic Imaging, IRCCS National Cancer Institute Regina Elena, Rome, Italy
| | - Isabella Sperduti
- UOC Biostatistics, IRCCS National Cancer Institute Regina Elena, Rome, Italy
| | - Andrea Pace
- UOSD Neuro-Oncology, IRCCS National Cancer Institute Regina Elena, Rome, Italy
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12
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Differentiating Primary Tumors for Brain Metastasis with Integrated Radiomics from Multiple Imaging Modalities. DISEASE MARKERS 2022; 2022:5147085. [PMID: 36199819 PMCID: PMC9529469 DOI: 10.1155/2022/5147085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/13/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022]
Abstract
Objectives. To differentiate the primary site of brain metastases (BMs) is of high clinical value for the successful management of patients with BM. The purpose of this study is to investigate a combined radiomics model with computer tomography (CT) and magnetic resonance imaging (MRI) images in differentiating BMs originated from lung and breast cancer. Methods. Pretreatment cerebral contrast enhanced CT and T1-weighted MRI images of 78 patients with 179 BMs from primary lung and breast cancer were retrospectively analyzed. Radiomic features were extracted from contoured BM lesions and selected using the Mann–Whitney
test and the least absolute shrinkage and selection operator (LASSO) logistic regression. Binary logistic regression (BLR) and support vector machine (SVM) models were built and evaluated based on selected radiomic features from CT alone, MRI alone, and combined images to differentiate BMs originated from lung and breast cancer. Results. A total of 10 and 6 optimal radiomic features were screened out of 1288 CT and 1197 MRI features, respectively. The mean area under the curves (AUCs) of the BLR and SVM models using fivefolds cross-validation were 0.703 vs. 0.751, 0.718 vs. 0.754, and 0.781 vs. 0.803 in the training dataset and 0.708 vs. 0.763, 0.715 vs. 0.717, and 0.771 vs. 0.805 in the testing dataset for models with CT alone, MRI alone, and combined CT and MRI radiomic features, respectively. Conclusions. Radiomics model based on combined CT and MRI features is feasible and accurate in the differentiation of the primary site of BMs from lung and breast cancer.
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13
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Shah I, Razzak AN, Janardan A, Laing B, Zwagerman NT. A Rare Case of Neck Sarcomatoid Squamous Cell Carcinoma With Brain Metastases. Cureus 2022; 14:e26179. [PMID: 35891819 PMCID: PMC9304508 DOI: 10.7759/cureus.26179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/12/2022] Open
Abstract
Squamous cell carcinoma (SCC) is the second most prominent form of skin malignancy. It occurs most frequently in older males with fair skin complexion that have extensive sun exposure most commonly in their childhood. The metastatic presentation of SCC is rare and is most common in the lung. In this paper, we present the unique case of a 73-year-old patient with sarcomatoid squamous cell carcinoma in their posterior neck that metastasized to the brain.
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14
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The Clinical Frailty Scale as useful tool in patients with brain metastases. J Neurooncol 2022; 158:51-57. [PMID: 35419752 PMCID: PMC9166853 DOI: 10.1007/s11060-022-04008-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE The Clinical Frailty Scale (CFS) evaluates patients' level of frailty on a scale from 1 to 9 and is commonly used in geriatric medicine, intensive care and orthopedics. The aim of our study was to reveal whether the CFS allows a reliable prediction of overall survival (OS) in patients after surgical treatment of brain metastases (BM) compared to the Karnofsky Performance Score (KPS). METHODS Patients operated for BM were included. CFS and KPS were retrospectively assessed pre- and postoperatively and at follow-up 3-6 months after resection. RESULTS 205 patients with a follow-up of 22.8 months (95% CI 18.4-27.1) were evaluated. CFS showed a median of 3 ("managing well"; IqR 2-4) at all 3 assessment-points. Median KPS was 80 preoperatively (IqR 80-90) and 90 postoperatively (IqR 80-100) as well as at follow-up after 3-6 months. CFS correlated with KPS both preoperatively (r = - 0.92; p < 0.001), postoperatively (r = - 0.85; p < 0.001) and at follow-up (r = - 0.93; p < 0.001). The CFS predicted the expected reduction of OS more reliably than the KPS at all 3 assessments. A one-point increase (worsening) of the preoperative CFS translated into a 30% additional hazard to decease (HR 1.30, 95% CI 1.15-1.46; p < 0.001). A one-point increase in postoperative and at follow-up CFS represents a 39% (HR 1.39, 95% CI 1.25-1.54; p < 0.001) and of 42% risk (HR 1.42, 95% CI 1.27-1.59; p < 0.001). CONCLUSION The CFS is a feasible, simple and reliable scoring system in patients undergoing resection of brain metastasis. The CFS 3-6 months after surgery specifies the expected OS more accurately than the KPS.
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15
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Winther RR, Hjermstad MJ, Skovlund E, Aass N, Helseth E, Kaasa S, Yri OE, Vik-Mo EO. Surgery for brain metastases-impact of the extent of resection. Acta Neurochir (Wien) 2022; 164:2773-2780. [PMID: 35080651 PMCID: PMC9519668 DOI: 10.1007/s00701-021-05104-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/23/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Surgical resection of brain metastases improves symptoms and survival in selected patients. The benefit of gross total resection is disputed, as most patients are believed to succumb from their non-CNS tumor burden. We investigated the association between overall survival and residual tumor after surgery for single brain metastases. METHODS We reviewed adults who underwent surgery for a single brain metastasis at a regional referral center (2011-2018). Gross total resection was defined as no visible residual tumor on cerebral MRI 12-48 h postoperatively. RESULTS We included 373 patients. The most common primary tumors were lung cancer (36%) and melanoma (24%). We identified gross total resection in 238 patients (64%). Median overall survival was 11.0 months, 8.0 (6.2-9.8) months for patients with subtotal resection and 13.0 (9.7-16.3) months for patients with gross total resection. In a multivariate regression analysis including preoperative prognostic factors, gross total resection was associated with longer overall survival (HR: 0.66, p = 0.003). Postoperative radiotherapy administered within 6 weeks did not significantly alter the hazard ratio estimates for grade of resection. CONCLUSIONS Our study suggests improved survival with gross total resection compared to subtotal resection. The importance of extent of resection in surgery for brain metastases should not be discarded.
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Affiliation(s)
- Rebecca Rootwelt Winther
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eva Skovlund
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Nina Aass
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,Department of Neurosurgery, OUH, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav Erich Yri
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Einar Osland Vik-Mo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,Department of Neurosurgery, OUH, Oslo, Norway
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16
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Abstract
Brain metastasis continues to be a devastating complication of systemic malignancy, affecting approximately 20% of all patients suffering from cancer. Despite being a major source of morbidity and mortality for this patient population, a nationwide, systematic mechanism for reporting of brain metastases does not exist. Better understanding the epidemiology of brain metastases will help identify individuals who are at greatest risk of developing them and guide clinicians in selecting patients who are most likely to benefit from brain metastasis surveillance and prophylaxis.
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Affiliation(s)
- Patricia Sacks
- Lillian S. Wells Department of Neurosurgery, UF Brain Tumor Immunotherapy Program, University of Florida, PO Box 100265, Gainesville, FL 32610, USA
| | - Maryam Rahman
- Lillian S. Wells Department of Neurosurgery, UF Brain Tumor Immunotherapy Program, University of Florida, PO Box 100265, Gainesville, FL 32610, USA.
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17
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Pudsey LMM, Cutajar D, Wallace A, Saba A, Schmidt L, Bece A, Clark C, Yamada Y, Biasi G, Rosenfeld A, Poder J. The use of collimator angle optimization and jaw tracking for VMAT-based single-isocenter multiple-target stereotactic radiosurgery for up to six targets in the Varian Eclipse treatment planning system. J Appl Clin Med Phys 2021; 22:171-182. [PMID: 34288376 PMCID: PMC8425912 DOI: 10.1002/acm2.13360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Island blocking occurs in single-isocenter multiple-target (SIMT) stereotactic radiotherapy (SRS) whenever targets share multi-leaf collimator (MLC) leaf pairs. This study investigated the effect on plan quality and delivery, of reducing island blocking through collimator angle optimization (CAO). In addition, the effect of jaw tracking in this context was also investigated. METHODS For CAO, an algorithm was created that selects the collimator angle resulting in the lowest level of island blocking, for each beam in any given plan. Then, four volume-modulated arc therapy (VMAT) SIMT SRS plans each were generated for 10 retrospective patients: two CAO plans, with and without jaw tracking, and two plans with manually selected collimator angles, with and without jaw tracking. Plans were then assessed and compared using typical quality assurance procedures. RESULTS There were no substantial differences between plans with and without CAO. Jaw tracking produced statistically significant reduction in low-dose level parameters; healthy brain V10% and mean dose were reduced by 9.66% and 15.58%, respectively. However, quantitative values (108 cc for V10% and 0.35 Gy for mean dose) were relatively small in relation to clinical relevance. Though there were no statistically significant changes in plan deliverability, there was a notable trend of plans with jaw tracking having lower gamma analysis pass rates. CONCLUSION These findings suggest that CAO has limited benefit in VMAT SIMT SRS of 2-6 targets when using a low-dose penalty to the healthy brain during plan optimization in Eclipse. As clinical benefits of jaw tracking were found to be minimal and plan deliverability was potentially reduced, a cautious approach would be to exclude jaw tracking in SIMT SRS plans.
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Affiliation(s)
- Lauren M M Pudsey
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Dean Cutajar
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.,St George Hospital Cancer Care Centre, Kogarah, NSW, Australia
| | - Alex Wallace
- St George Hospital Cancer Care Centre, Kogarah, NSW, Australia
| | - Anastasia Saba
- St George Hospital Cancer Care Centre, Kogarah, NSW, Australia
| | - Laurel Schmidt
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Andrej Bece
- St George Hospital Cancer Care Centre, Kogarah, NSW, Australia
| | - Catherine Clark
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Giordano Biasi
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Joel Poder
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.,St George Hospital Cancer Care Centre, Kogarah, NSW, Australia
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The Management of Brain Metastases-Systematic Review of Neurosurgical Aspects. Cancers (Basel) 2021; 13:cancers13071616. [PMID: 33807384 PMCID: PMC8036330 DOI: 10.3390/cancers13071616] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary In this comprehensive review, we focused on the neurosurgical treatment as an integrative part of the challenging multidisciplinary management of cerebral metastases, a neuro-oncologic entity, which has been observed to have an increased incidence over the last years. In selected cases, the surgical removal of the space-occupying mass reduces the intracranial pressure, normalizes the metabolic environment, reduces the symptom burden, and allows for the intensification of local and systemic adjuvant treatment. In detail, we discuss the incidence of brain metastases, the role of surgical resection, as well as the evolution of current neurosurgical techniques, the surgical morbidity and mortality of single and multiple lesions, and we enlighten the role of surgery for recurrent tumors. Abstract The multidisciplinary management of patients with brain metastases (BM) consists of surgical resection, different radiation treatment modalities, cytotoxic chemotherapy, and targeted molecular treatment. This review presents the current state of neurosurgical technology applied to achieve maximal resection with minimal morbidity as a treatment paradigm in patients with BM. In addition, we discuss the contribution of neurosurgical resection on functional outcome, advanced systemic treatment strategies, and enhanced understanding of the tumor biology.
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Kaya I, Cingoz ID, Gursoy M, Atar M, Guvenc G, Uzunoglu I, Sahin MC, Yuceer N. Edema-mass Ratio Based On Magnetic Resonance Imaging As A Preoperative Diagnostic Factor For Posterior Fossa Metastasis. Curr Med Imaging 2021; 17:762-766. [PMID: 33655873 DOI: 10.2174/1573405617666210303105006] [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: 12/28/2020] [Revised: 01/21/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Peritumoral edema of primary brain tumors is an important cause of morbidity and mortality. The number of studies currently available on the prognostic role of peritumoral brain edema in the posterior fossa is extremely limited. OBJECTIVE Based on the known importance of magnetic resonance imaging in diagnosing supratentorial metastases, this study aimed to investigate the effects of peritumoral edema on survival of patients with posterior fossa metastases and the preoperative diagnostic value of MRI. METHODS Edema and mass volumes of 49 patients with posterior fossa metastasis, who underwent surgery during 2012-2016, were measured using magnetic resonance imaging. The edema/mass indices were retrospectively calculated and interpreted by evaluating the demographic, clinical, and survival data. RESULTS The study consisted of 32 (65.3%) male and 17 (34.7%) female participants, with the mean age ± standard deviation of 47.25±29.25 (17-81) years. Among the 49 patients with posterior fossa metastases, 34 (69.4%) had carcinoma, while 15 (30.6%) had non-carcinoma metastases. The edema/mass indices of patients with carcinoma and non-carcinoma metastases were found to be 14.55±9.64 and 1.34±1.08, respectively, and the difference was statistically significant (p<0.001). The mean survival of patients with carcinoma and non-carcinoma metastases was found to be 642±11.52 days and 726±9.32 days, respectively; however, this difference was not statistically significant (p=0.787). CONCLUSION The edema/mass ratio was found to be a significant diagnostic factor for the prediction of posterior fossa metastases. Further detailed studies are warranted to investigate the effect of edema/mass ratio on survival rate.
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Affiliation(s)
- Ismail Kaya
- Department of Neurosurgery, Kutahya Health Science University, Medical Faculty, Kutahya, Turkey
| | - Ilker Deniz Cingoz
- Department of Neurosurgery, Kutahya Health Science University, Medical Faculty, Kutahya, Turkey
| | - Merve Gursoy
- Department of Radiology, Izmir Democracy University, Medical Faculty, Izmir, Turkey
| | - Murat Atar
- Department of Neurosurgery, ISAH Sample Training and Research Hospital, Istanbul, Turkey
| | - Gonul Guvenc
- Department of Neurosurgery, Katip Celebi University, Medical Faculty, Izmir, Turkey
| | - Inan Uzunoglu
- Department of Neurosurgery, Katip Celebi University, Medical Faculty, Izmir, Turkey
| | - Meryem Cansu Sahin
- Training and Research Center, Kutahya Health Science University, Kutahya, Turkey
| | - Nurullah Yuceer
- Department of Neurosurgery, Katip Celebi University, Medical Faculty, Izmir, Turkey
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20
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Brain Metastases in Elderly Patients-The Role of Surgery in the Context of Systemic Treatment. Brain Sci 2021; 11:brainsci11010123. [PMID: 33477588 PMCID: PMC7831306 DOI: 10.3390/brainsci11010123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/25/2020] [Accepted: 01/11/2021] [Indexed: 12/15/2022] Open
Abstract
In patients with brain metastases (BM), advanced age is considered a negative prognostic factor. To address the potential reasons for that, we assessed 807 patients who had undergone BM resection; 315 patients aged at least 65 years (group A) were compared with 492 younger patients (group B). We analyzed the impact of the pre- and postoperative Karnofsky performance status (KPS), postoperative treatment structure and post-treatment survival. BM resection significantly improved KPS scores in both groups (p = 0.0001). Median survival after BM resection differed significantly between the groups (A: 5.81 vs. B: 8.12 months; p = 0.0015). In both groups, patients who received postoperative systemic treatment showed significantly longer overall survival (p = 0.00001). However, elderly patients less frequently received systemic treatment (p = 0.0001) and the subgroup of elderly patients receiving such therapies had a significantly higher postsurgical KPS score (p = 0.0007). In all patients receiving systemic treatment, age was no longer a negative prognostic factor. Resection of BM improves the functional status of elderly patients, thus enhancing the likeliness to receive systemic treatment, which, in turn, leads to longer overall survival. In the context of such a treatment structure, age alone is no longer a prognostic factor for survival.
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21
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Yang Y, Zeitlberger AM, Neidert MC, Staartjes VE, Broggi M, Zattra CM, Vasella F, Velz J, Bartek J, Fletcher-Sandersjöö A, Förander P, Kalasauskas D, Renovanz M, Ringel F, Brawanski KR, Kerschbaumer J, Freyschlag CF, Jakola AS, Sjåvik K, Solheim O, Schatlo B, Sachkova A, Bock HC, Hussein A, Rohde V, Broekman ML, Nogarede CO, Lemmens CM, Kernbach JM, Neuloh G, Krayenbühl N, Ferroli P, Regli L, Bozinov O, Stienen MN. The association of patient age with postoperative morbidity and mortality following resection of intracranial tumors. BRAIN AND SPINE 2021; 1:100304. [PMID: 36247402 PMCID: PMC9560674 DOI: 10.1016/j.bas.2021.100304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022]
Abstract
Introduction The postoperative functional status of patients with intracranial tumors is influenced by patient-specific factors, including age. Research question This study aimed to elucidate the association between age and postoperative morbidity or mortality following the resection of brain tumors. Material and methods A multicenter database was retrospectively reviewed. Functional status was assessed before and 3–6 months after tumor resection by the Karnofsky Performance Scale (KPS). Uni- and multivariable linear regression were used to estimate the association of age with postoperative change in KPS. Logistic regression models for a ≥10-point decline in KPS or mortality were built for patients ≥75 years. Results The total sample of 4864 patients had a mean age of 56.4 ± 14.4 years. The mean change in pre-to postoperative KPS was −1.43. For each 1-year increase in patient age, the adjusted change in postoperative KPS was −0.11 (95% CI -0.14 - - 0.07). In multivariable analysis, patients ≥75 years had an odds ratio of 1.51 to experience postoperative functional decline (95%CI 1.21–1.88) and an odds ratio of 2.04 to die (95%CI 1.33–3.13), compared to younger patients. Discussion Patients with intracranial tumors treated surgically showed a minor decline in their postoperative functional status. Age was associated with this decline in function, but only to a small extent. Conclusion Patients ≥75 years were more likely to experience a clinically meaningful decline in function and about two times as likely to die within the first 6 months after surgery, compared to younger patients. A multicenter database of patients with intracranial tumors is analyzed in this study. Age is associated with a minor decline in the postoperative functional status & mortality. Patients ≥75 years are more likely to experience a clinically meaningful decline in function and to die.
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Zidan MA, Hassan RS, El-Noueam KI, Zakaria YM. Brain metastases assessment by FDG-PET/CT: can it eliminate the necessity for dedicated brain imaging? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00342-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Brain metastases (BM) are the most common intracranial tumors in adults outnumbering all other intracranial neoplasms. Positron emission tomography combined with computed tomography (PET/CT) is a widely used imaging modality in oncology with a unique combination of cross-sectional anatomic information provided by CT and the metabolic information provided by PET using the [18F]-2-fluoro-2-deoxy-d-glucose (FDG) as a tracer. The aim of the study is to assess the role and diagnostic performance of brain-included whole-body PET/CT in detection and evaluation of BM and when further imaging is considered necessary. The study was conducted over a period of 12 months on 420 patients suffering from extra-cranial malignancies utilizing brain-included whole-body PET/CT.
Results
Thirty patients with 71 brain lesions were detected, 18 patients (60%) had BM of unknown origin while 12 patients (40%) presented with known primary tumors. After brain-included whole-body FDG-PET/CT examination, the unknown primaries turned out to be bronchogenic carcinoma in 10 patients (33.3%), renal cell carcinoma in 2 patients (6.7%), and lymphoma in 2 patients (6.7%), yet the primary tumors remained unknown in 4 patients (13.3%). In 61 lesions (85.9%), the max SUV ranged from 0.2- < 10, while in 10 lesions (14.1%) the max SUV ranged from 10 to 20. Hypometabolic lesions were reported in 41 (57.7%) lesions, hypermetabolic in 3 lesions (4.2%), whereas 27 lesions (38.0%) showed similar FDG uptake to the corresponding contralateral brain matter. PET/CT overall sensitivity, specificity, positive and negative predictive, and accuracy values were 78.1, 92.6, 83.3, 90, and 88% respectively.
Conclusion
Brain-included whole-body FDG-PET/CT provides valuable complementary information in the evaluation of patients with suspected BM. However, the diagnostic performance of brain PET-CT carries the possibility of false-negative results with consequent false sense of security. The clinicians should learn about the possible pitfalls of PET/CT interpretation to direct patients with persistent neurological symptoms or high suspicion for BM for further dedicated CNS imaging.
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Eid R, Hage S, Antonios I, Moussa R, Khoury M, Haddad FG, Kourie HR, Kesrouani C, Ghorra C, Abadjian G, Kattan J. Epidemiologic and histologic characteristics of CNS lesions: a 20-year experience of a tertiary center in Lebanon. CNS Oncol 2020; 9:CNS55. [PMID: 32603607 PMCID: PMC7341156 DOI: 10.2217/cns-2020-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: Report the epidemiologic and histologic characteristics of CNS lesions in the Lebanese population. Methods: We conducted a retrospective study evaluating 2025 CNS lesions diagnosed between 1998 and 2017 in the pathology laboratory of a Lebanese tertiary center. Results: 52.2% of patients were men with a median age of 50 years. The most frequent symptoms were epilepsy (22.5%), headache (20.6%) and motor impairment (19.9%). 90.7% of tumors were primary. Lung (35.6%) and breast (16.5%) were the most frequent primaries of metastases. 46.2% of primary CNS tumors were glial, predominantly astrocytic (56.4%), and (42.5%) were nonglial, predominantly meningeal tumors (58%). Conclusion: Compared with Western literature, the Lebanese population is characterized by a younger age of onset of brain tumors, a lower rate of meningiomas and a higher rate of gliomas.
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Affiliation(s)
- Roland Eid
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Stephanie Hage
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ingrid Antonios
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Rita Moussa
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Makram Khoury
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fady Ghassan Haddad
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Hampig Raphael Kourie
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Carole Kesrouani
- Department of Pathology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Claude Ghorra
- Department of Pathology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Gerard Abadjian
- Department of Pathology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kattan
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Shi DD, Arnaout O, Bi WL, Buchbinder EI, Cagney DN, Insco ML, Liu D, Schoenfeld JD, Aizer AA. Severe Radiation Necrosis Refractory to Surgical Resection in Patients with Melanoma and Brain Metastases Managed with Ipilimumab/Nivolumab and Brain-Directed Stereotactic Radiation Therapy. World Neurosurg 2020; 139:226-231. [PMID: 32330622 DOI: 10.1016/j.wneu.2020.04.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of targeted therapies and immune checkpoint inhibitors has drastically changed the management of patients with melanoma and brain metastases. Specifically, combination therapy with ipilimumab, a cytotoxic T-lymphocyte antigen 4 inhibitor, and nivolumab, a programmed cell death protein 1 inhibitor, has become a preferred systemic therapy option for patients with melanoma and asymptomatic brain metastases. However, the efficacy and toxicity profile of these agents in combination with brain-directed radiation therapy is not well described. CASE DESCRIPTION In this case series, we highlight a series of patients with melanoma demonstrating severe radiation necrosis immediately refractory to surgical resection following brain-directed stereotactic radiation therapy with concurrent ipilimumab and nivolumab. Three patients described in this series each received stereotactic radiation therapy to a dose of 30 Gy in 5 fractions to a melanoma brain metastasis. These areas developed radiographic evidence of necrosis, which was managed surgically and progressed immediately and rapidly after resection. Re-resection, bevacizumab, steroids, and/or discontinuation of nivolumab was used to mitigate further necrosis with varying efficacy. CONCLUSIONS Patients with metastatic melanoma receiving brain-directed radiation therapy with concurrent ipilimumab and nivolumab are at risk for developing severe, surgically refractory radiation necrosis and should be closely followed clinically and with imaging. The exact mechanism for such severe necrosis is unknown, and future studies are needed to better understand this pathophysiology and identify optimal treatment strategies.
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Affiliation(s)
- Diana D Shi
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wenya L Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth I Buchbinder
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel N Cagney
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan L Insco
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - David Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ayal A Aizer
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Mapping distribution of brain metastases: does the primary tumor matter? J Neurooncol 2020; 147:229-235. [PMID: 32065345 PMCID: PMC7075842 DOI: 10.1007/s11060-020-03419-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 01/30/2020] [Indexed: 01/22/2023]
Abstract
Purpose Prior reports on the location and sizes of brain metastases almost entirely focus on patients with primary breast and pulmonary cancer. This is the first study comparing multiple other types of cancer that metastasize to the brain. Methods This monocentric retrospective study includes 369 untreated patients with 3313 intraaxial brain metastases. Following semi-manual segmentation of metastases on post-contrast T1WI, cumulative spatial probability distribution maps of brain metastases were created for the whole group and for all primary tumors. Furthermore, mixed effects logistic regression model analysis was performed to determine if the primary tumor, patient age, and patient sex influence lesion location. Results The cerebellum as location of brain metastases was proportionally overrepresented. Breast and pulmonary cancer caused higher number of brain metastases to what would normally be expected. Multivariate analyses revealed a significant accumulation of brain metastases from skin cancer in a frontal and from breast and gastrointestinal cancer in a cerebellar location. Conclusion Distribution of brain metastases is very heterogeneous for the distinct primaries, possibly reflecting the diversity of mechanisms involved in brain metastases formation. In daily clinical practice distribution patters may be beneficial to predict the primary cancer site, if unknown. Electronic supplementary material The online version of this article (10.1007/s11060-020-03419-6) contains supplementary material, which is available to authorized users.
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Risk factors for in-brain local progression in elderly patients after resection of cerebral metastases. Sci Rep 2019; 9:7431. [PMID: 31092876 PMCID: PMC6520351 DOI: 10.1038/s41598-019-43942-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/02/2019] [Indexed: 12/26/2022] Open
Abstract
Intracranial metastases are the most frequent brain tumor with recurrence rates after treatment of around 40–60%. Age is still considered a determinant of treatment and prognosis in this pathology. Recent studies analyzing the impact of metastasectomy in elderly patients focused on reporting perioperative mortality and morbidity rates but not on the evaluation of oncological outcome parameters. Aim of this study is to determine risk factors for in-brain local recurrence after brain surgery in this sub-population. From October 2009 until September 2016 all patients aged 65 years and above with histopathologically confirmed metastasis after surgical resection were retrospectively studied. Clinical, radiological and perioperative information was collected and statistically analysed. Follow-up consisted of clinical and radiological assessment every 3-months following surgery. 78 patients were included, of these 50% were female (39 patients). Median age was 71 years (66–83). Early postoperative-MRI verified a complete surgical resection in 41 patients (52.6%) and showed a tumor-remnant in 15 patients (19.2%). In 22 patients the MRI result was inconclusive (28.2%). None of the patients experienced severe complications due to surgery. The median postoperative NIHSS was adequate 1 ± 1.4 (0–6), nonetheless, insignificantly improved in comparison to the preoperative NIHSS (p = 0.16). A total of 20 patients (25.6%) presented local recurrence. The only statistically significant factor for development of local in-brain recurrence after resection of cerebral metastases in patients above 65 years of age was a tumor-remnant in the early postoperative MRI (p = 0.00005). Median overall survival was 13 months. Local in-brain recurrence after surgical resection of a cerebral metastasis in patients above 65 years of age was 25.6%. In our analysis, tumor-remnant in early postoperative MRI is the only risk factor for local in-brain recurrence. Oncological parameters in the present cohort do not seem to differ from recent phase III studies with non-geriatric patients. Nevertheless, controlled studies on the impact of metastasectomy in elderly patients delivering high quality reliable data are required.
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Nahed BV, Alvarez-Breckenridge C, Brastianos PK, Shih H, Sloan A, Ammirati M, Kuo JS, Ryken TC, Kalkanis SN, Olson JJ. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Surgery in the Management of Adults With Metastatic Brain Tumors. Neurosurgery 2019; 84:E152-E155. [PMID: 30629227 DOI: 10.1093/neuros/nyy542] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/18/2018] [Indexed: 11/13/2022] Open
Abstract
Please see the full-text version of this guideline https://www.cns.org/guidelines/guidelines-treatment-adults-metastatic-brain-tumors/chapter_2) for the target population of each recommendation listed below. SURGERY FOR METASTATIC BRAIN TUMORS AT NEW DIAGNOSIS QUESTION: Should patients with newly diagnosed metastatic brain tumors undergo surgery, stereotactic radiosurgery (SRS), or whole brain radiotherapy (WBRT)? RECOMMENDATIONS Level 1: Surgery + WBRT is recommended as first-line treatment in patients with single brain metastases with favorable performance status and limited extracranial disease to extend overall survival, median survival, and local control. Level 3: Surgery plus SRS is recommended to provide survival benefit in patients with metastatic brain tumors Level 3: Multimodal treatments including either surgery + WBRT + SRS boost or surgery + WBRT are recommended as alternatives to WBRT + SRS in terms of providing overall survival and local control benefits. SURGERY AND RADIATION FOR METASTATIC BRAIN TUMORS QUESTION: Should patients with newly diagnosed metastatic brain tumors undergo surgical resection followed by WBRT, SRS, or another combination of these modalities? RECOMMENDATIONS Level 1: Surgery + WBRT is recommended as superior treatment to WBRT alone in patients with single brain metastases. Level 3: Surgery + SRS is recommended as an alternative to treatment with SRS alone to benefit overall survival. Level 3: It is recommended that SRS alone be considered equivalent to surgery + WBRT. SURGERY FOR RECURRENT METASTATIC BRAIN TUMORS QUESTION: Should patients with recurrent metastatic brain tumors undergo surgical resection? RECOMMENDATIONS Level 3: Craniotomy is recommended as a treatment for intracranial recurrence after initial surgery or SRS. SURGICAL TECHNIQUE AND RECURRENCE QUESTION A: Does the surgical technique (en bloc resection or piecemeal resection) affect recurrence? RECOMMENDATION Level 3: En bloc tumor resection, as opposed to piecemeal resection, is recommended to decrease the risk of postoperative leptomeningeal disease when resecting single brain metastases. QUESTION B Does the extent of surgical resection (gross total resection or subtotal resection) affect recurrence? RECOMMENDATION Level 3: Gross total resection is recommended over subtotal resection in recursive partitioning analysis class I patients to improve overall survival and prolong time to recurrence. The full guideline can be found at https://www.cns.org/guidelines/guidelines-treatment-adults-metastatic-brain-tumors/chapter_2.
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Affiliation(s)
- Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Helen Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew Sloan
- Department of Neurosurgery, Case Western Reserve University, Cleveland, Ohio
| | - Mario Ammirati
- Department of Neurosurgery, St. Rita Medical Center, Lima, Ohio.,Department of Biology, College of Science and Technology and Sbarro Health Research Organization, Temple University, Philadelphia, Pennsylvania
| | - John S Kuo
- Department of Neurosurgery and Mulva Clinic for the Neurosciences, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Timothy C Ryken
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Steven N Kalkanis
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
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Abstract
Brain metastases (BM) are the most commonly diagnosed type of central nervous system tumor in the United States. Estimates of the frequency of BM vary significantly, as there is no nationwide reporting system for metastases. BM may be the first sign of a previously undiagnosed cancer, or occur years or decades after the primary cancer was diagnosed. Incidence of BM varies significantly by primary cancer site. Lung, breast, and melanoma continue to be the leading cause of BM. These tumors are increasingly more common as new therapeutics, advanced imaging, and improved screening have led to lengthened survival after primary diagnosis for cancer patients. BM are difficult to treat, and for most individuals the diagnosis of BM generally portends a poor prognosis.
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Affiliation(s)
- Quinn T Ostrom
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Christina Huang Wright
- Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, United States
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
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Roux A, Botella C, Still M, Zanello M, Dhermain F, Metellus P, Pallud J. Posterior Fossa Metastasis-Associated Obstructive Hydrocephalus in Adult Patients: Literature Review and Practical Considerations from the Neuro-Oncology Club of the French Society of Neurosurgery. World Neurosurg 2018; 117:271-279. [PMID: 29935321 DOI: 10.1016/j.wneu.2018.06.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is no consensus concerning the management of adult patients with posterior fossa metastasis-associated obstructive hydrocephalus, especially regarding surgical procedures. A literature review was performed to assess the surgical strategy in the management of patients with metastatic brain tumor. METHODS A literature search was conducted of PubMed in November 2017 to identify all studies concerning brain metastases and obstructive hydrocephalus in English. All studies (except case reports and pediatric studies) between December 1953 and November 2017 that were about posterior fossa metastasis-associated obstructive hydrocephalus in adult patients were eligible. Eligible studies were classified by level of evidence. We assessed epidemiology, clinical and imaging findings, neurosurgical management, and prognosis of adult patients with posterior fossa metastasis-associated obstructive hydrocephalus. We suggest some practical considerations and a management decision tree on behalf of the Neuro-oncology Club of the French Society of Neurosurgery, with evidence-based analysis. RESULTS Direct surgical resection could be considered for patients with asymptomatic obstructive hydrocephalus, and endoscopic third ventriculostomy seems to be a reasonable procedure for patients with symptomatic obstructive hydrocephalus. A ventriculoperitoneal or atrial shunt seems to be a valid alternative when patients have a history of central nervous system infection or ventricular hemorrhage, leptomeningeal carcinomatosis, or unfavorable anatomy for an endoscopic third ventriculostomy to be performed. CONCLUSIONS The Neuro-oncology Club of the French Society of Neurosurgery suggests a prospective assessment of these neurosurgical procedures to compare their safety and efficacy.
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Affiliation(s)
- Alexandre Roux
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Céline Botella
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Neurosurgery, Henri-Mondor Hospital, Créteil, France
| | - Megan Still
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marc Zanello
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Frédéric Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - Philippe Metellus
- Department of Neurosurgery, Clairval Private Hospital, Ramsay-Générale de Santé, Marseille, France
| | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France.
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Frati A, Pesce A, Palmieri M, Celniku M, Raco A, Salvati M. Surgical Treatment of the Septuagenarian Patients Suffering From Brain Metastases: A Large Retrospective Observational Analytic Cohort-Comparison Study. World Neurosurg 2018; 114:e565-e572. [DOI: 10.1016/j.wneu.2018.03.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/24/2022]
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Wolf A, Kvint S, Chachoua A, Pavlick A, Wilson M, Donahue B, Golfinos JG, Silverman J, Kondziolka D. Toward the complete control of brain metastases using surveillance screening and stereotactic radiosurgery. J Neurosurg 2018; 128:23-31. [DOI: 10.3171/2016.10.jns161036] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe incidence of brain metastases is increasing with improved systemic therapies, many of which have a limited impact on intracranial disease. Stereotactic radiosurgery (SRS) is a first-line management option for brain metastases. The purpose of this study was to determine if there is a threshold tumor size below which local control (LC) rates approach 100%, and to relate these findings to the use of routine surveillance brain imaging.METHODSFrom a prospective registry, 200 patients with 1237 brain metastases were identified who underwent SRS between December 2012 and May 2015. The median imaging follow-up duration was 7.9 months, and the median margin dose was 18 Gy. The maximal diameter and volume of tumors were measured. Histological analysis included 96 patients with non–small cell lung cancers (NSCLCs), 40 with melanoma, 35 with breast cancer, and 29 with other histologies.RESULTSAlmost 50% of brain metastases were NSCLCs and commonly measured less than 6 mm in maximal diameter or 70 mm3 in volume. Thirty-three of 1237 tumors had local progression at a median of 8.8 months. The 1- and 2-year actuarial LC rates were 97% and 93%, respectively. LC of 100% was achieved for all intracranial metastases less than 100 mm3 in volume or 6 mm in diameter. Patients whose tumors at first SRS were less than 10 mm maximal diameter or a volume of 250 mm3 had improved overall survival.CONCLUSIONSSRS can achieve LC rates approaching 100% for subcentimeter metastases. The earlier initial detection and prompt treatment of small intracranial metastases may prevent the development of neurological symptoms and the need for resection, and improve overall survival. To identify tumors when they are small, routine surveillance brain imaging should be considered as part of the standard of care for lung, breast, and melanoma metastases.■ CLASSIFICATION OF EVIDENCE Type of question: prognostic; study design: retrospective cohort; evidence: Class II.
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Affiliation(s)
| | | | | | | | | | - Bernadine Donahue
- 3Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York University, New York, New York
| | | | - Joshua Silverman
- 3Radiation Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York University, New York, New York
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Siqueira EMP, Diccini S. Complicações pós-operatórias em neurocirurgia eletiva e não eletiva. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Avaliar a incidência de complicações pós-operatorias e mortalidade entre pacientes submetidos a neurocirurcia eletiva e não eletiva. Metodos Estudo de coorte prospectivo com pacientes adultos, acompanhados desde o período pré-operatório até a alta hospitalar ou óbito. Resultados Foram incluídos 127 pacientes no grupo cirúrgico eletivo e 75 pacientes no grupo cirúrgico não eletivo. O grupo eletivo teve mais vômitos (p=0,010) e dor (p<0,001) e o grupo não eletivo apresentou mais hipertensão intracraniana (p=0,001), anisocoria (p=0,002), vasoespasmo cerebral (p=0,043), pupilas não fotorreagentes (p=0,006) e reoperação (p=0,046). A taxa de mortalidade foi de 5,5% no grupo de cirurgia eletiva e 26,7% no grupo de cirurgia não eletiva (p<0,001). Conclusão Os procedimentos eletivos em neurocirurgia estão relacionados a maior frequência de complicações sistêmicas, enquanto as cirurgias não eletivas tiveram taxas significativamente mais altas de complicações neurológicas e mortalidade.
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Goncalves PH, Peterson S, Vigneau FD, Shore RD, Quarshie WO, Islam K, Schwartz AG, Wozniak A, Gadgeel SM. Risk of brain metastases in patients with nonmetastatic lung cancer: Analysis of the Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER) data. Cancer 2016; 122:1921-7. [PMID: 27062154 PMCID: PMC4892979 DOI: 10.1002/cncr.30000] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/10/2016] [Accepted: 03/01/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Brain metastases (BM) remain an important cause of morbidity and mortality in patients with lung cancer. The current study evaluated population-based incidence and outcomes of BM in patients with nonmetastatic lung cancer. METHODS Patients diagnosed with nonmetastatic first primary lung cancer between 1973 and 2011 in the Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER) registry were used for the current analysis. Age-adjusted odds ratios of developing BM based on various demographic characteristics and histology were calculated with 95% confidence intervals. Adjusted Cox proportional hazard ratios and log-rank tests of Kaplan-Meier survival curves were calculated to evaluate survival differences for non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). RESULTS The incidence of BM in patients with nonmetastatic NSCLC and SCLC was 9% and 18%, respectively. There was variation in the incidence of BM according to NCSLC histology. The incidence of BM was higher in patients aged <60 years for both NSCLC and SCLC, but there were no differences noted by race for either histological group. Female patients with NSCLC were more likely to have BM than male patients. There was variation in the proportion of BM in both patients with NSCLC and SCLC over the three 13-year periods of diagnosis. The risk of death (hazard ratio) was found to be significantly higher for patients with NSCLC with BM, but was not significantly higher in patients with SCLC with BM. CONCLUSIONS The incidence of BM in patients with nonmetastatic lung cancer varies according to histology, age, and sex. BM are associated with worse survival for patients with NSCLC but not those with SCLC. Cancer 2016;122:1921-7. © 2016 American Cancer Society.
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Affiliation(s)
- Priscila H. Goncalves
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, 48201
| | - Stephanie Peterson
- Wayne State University, Department of Internal Medicine, Detroit, MI, 48201
| | - Fawn D. Vigneau
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, 48201
| | - Ronald D Shore
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, 48201
| | | | - Khairul Islam
- Texas A&M University, Department of Mathematics, Kingsville, TX, 78363
| | - Ann G. Schwartz
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, 48201
| | - Antoinette Wozniak
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, 48201
| | - Shirish M. Gadgeel
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, 48201
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Xu Z, Elsharkawy M, Schlesinger D, Sheehan J. Gamma Knife Radiosurgery for Resectable Brain Metastasis. World Neurosurg 2013; 80:351-8. [DOI: 10.1016/j.wneu.2012.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 02/02/2012] [Accepted: 03/29/2012] [Indexed: 11/25/2022]
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Konglund A, Helseth R, Lund-Johansen M, Helseth E, Meling TR. Surgery for high-grade gliomas in the aging. Acta Neurol Scand 2013; 128:185-93. [PMID: 23432636 DOI: 10.1111/ane.12105] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE High-grade glioma (HGG) is the commonest primary brain tumor in adults. We prospectively assessed outcome following surgery and adjuvant treatment for HGG in older patients. MATERIALS AND METHODS Patients ≥ 60 years undergoing craniotomies for gliomas WHO grade 3 and 4 at Oslo and Haukeland University Hospitals 2008-2009 were included (n = 80). Outcome was assessed at six months, and overall mortality evaluated at two years. RESULTS Forty-two males and 38 females of median age 68.5 (60-83) years were included, 35% attended a follow-up appointment at six months. Surgical mortality was 1.3%. Surgical morbidity included neurological sequela (10%), post-operative hematomas (3.8%) and hydrocephalus (1.3%). Median overall survival was 8.4 months and significantly increased by adjuvant radiochemotherapy. In univariate survival analyses, age ≥ 80 years, subtotal resection, American Society of Anesthesiology (ASA) scores 3-4, Karnofsky performance scale (KPS) < 70, and mini-mental state examination (MMSE) score < 25 significantly reduced survival. CONCLUSIONS Surgical treatment of HGG carries low mortality and acceptable morbidity in patients aged ≥ 60 years. There is improved survival following bimodal adjuvant treatment. Maximum tumor resection should be attempted. Treatment might be less beneficial in patients aged ≥ 80 years and in those with poor pre-operative function.
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Affiliation(s)
- A. Konglund
- Department of Neurosurgery; Oslo University Hospital; Oslo; Norway
| | - R. Helseth
- Department of Surgery; Buskerud Central Hospital; Drammen; Norway
| | - M. Lund-Johansen
- Department of Neurosurgery; Haukeland University Hospital; Bergen; Norway
| | | | - T. R. Meling
- Department of Neurosurgery; Oslo University Hospital; Oslo; Norway
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Dawood S, Gonzalez-Angulo AM. Progress in the biological understanding and management of breast cancer-associated central nervous system metastases. Oncologist 2013; 18:675-84. [PMID: 23740934 DOI: 10.1634/theoncologist.2012-0438] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Metastasis to the central nervous system (CNS) is a devastating neurological complication of systemic cancer. Brain metastases from breast cancer have been documented to occur in approximately 10%-16% of cases over the natural course of the disease with leptomeningeal metastases occurring in approximately 2%-5% of cases of breast cancer. CNS metastases among women with breast cancer tend to occur among those who are younger, have larger tumors, and have a more aggressive histological subtype such as the triple negative and HER2-positive subtypes. Treatment of CNS metastases involves various combinations of whole brain radiation therapy, surgery, stereotactic radiosurgery, and chemotherapy. We will discuss the progress made in the treatment and prevention of breast cancer-associated CNS metastases and will delve into the biological underpinnings of CNS metastases including evaluating the role of breast tumor subtype on the incidence, natural history, prognostic outcome, and impact of therapeutic efficacy.
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Affiliation(s)
- Shaheenah Dawood
- Departments of Breast Medical Oncology and Systems Biology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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Pekmezci M, Perry A. Neuropathology of brain metastases. Surg Neurol Int 2013; 4:S245-55. [PMID: 23717796 PMCID: PMC3656562 DOI: 10.4103/2152-7806.111302] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 03/18/2013] [Indexed: 11/29/2022] Open
Abstract
Metastatic tumors are the most common neoplasms encountered in the central nervous system (CNS), and continue to be major cause for mortality and morbidity. Macroscopic features and corresponding radiological findings can be diagnostic in majority of the cases, however, microscopic evaluation would be necessary when the differential diagnosis includes a primary CNS tumor, unknown primary tumor site, and when the resection of the tumor is either considered therapeutic or palliative. The first step in the diagnosis of a metastatic brain lesion is to exclude a primary CNS tumor, followed by verification or identification of the primary tumor and the site. Although general approach to a metastatic lesion from an unknown primary tumor is the same everywhere else, there are slight variations for the metastatic lesions in the CNS versus other regions. When morphological features are not enough to establish a definitive diagnosis, additional studies including immunohistochemical stains are applied. With the expending immunohistochemical armamentarium for pathologists, more accurate assessments are possible even in cases of unknown primary tumor. This review summarizes the diagnostic approach to CNS metastases, immunohistochemical assessment of neoplasm of unknown primary, and primary CNS lesions entering in the differential diagnosis of metastases.
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Affiliation(s)
- Melike Pekmezci
- Department of Pathology, University of California, Division of Neuropathology, 505 Parnassus Avenue, M551, San Francisco, California, USA
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Stelzer KJ. Epidemiology and prognosis of brain metastases. Surg Neurol Int 2013; 4:S192-202. [PMID: 23717790 PMCID: PMC3656565 DOI: 10.4103/2152-7806.111296] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 02/01/2013] [Indexed: 01/23/2023] Open
Abstract
A substantial, but uncertain, number of patients with cancer develop brain metastases. Risk of brain metastasis is recognized to vary with type of primary cancer. Within specific types of primary cancer, prognostic factors for development of brain metastases are being recognized. Recent data suggest that molecular biomarkers that relate to cellular function can predict risk of developing brain metastases. Such information could optimize surveillance standards and/or be used to select patients for preventive interventions. Though average survival for patients with brain metastases is typically less than 6 months, it is well-recognized that subgroups of patients have significant probability of longer survival. Multiple prognostic models have been proposed, validated, and compared without clearly demonstrating superiority of one model over another. However, some factors show consistency as predictive variables across models, and performance status is almost universally significant. Application of predictive models to specific treatments has been difficult. Tumor-specific prognostic models are evolving, and combinations of biological and clinical factors may be used to optimize models for particular primary tumor types.
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Affiliation(s)
- Keith J Stelzer
- Department of Radiation Oncology, Celilo Cancer Center, Mid-Columbia Medical Center, The Dalles, Oregon, USA
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Rogne SG, Rønning P, Helseth E, Johannesen TB, Langberg CW, Lote K, Scheie D, Meling TR. Craniotomy for brain metastases: a consecutive series of 316 patients. Acta Neurol Scand 2012; 126:23-31. [PMID: 21902675 DOI: 10.1111/j.1600-0404.2011.01590.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the incidence of craniotomy for brain metastases, overall survival (OS), surgical mortality, and prognostic factors in a large, contemporary, consecutive series from a well-defined catchment area. MATERIAL AND METHODS All patients ≥ 18 years who underwent craniotomies for intracranial metastases at Oslo University Hospital, Rikshospitalet and Ullevål, between 2005 and June 30, 2009 were included (n = 316). Patients were identified from our prospectively collected database and a thorough review of all charts to validate the entered data was performed. RESULTS The annual incidence of first-time craniotomy for a brain metastasis was 2.6/100,000 inhabitants. Patient age ranged from 25 to 87 years (median 64 years). The 30-day mortality rate was 3.8%. Median OS was 9.2 months. Recursive partitioning analysis was class I in 19.6%, class II in 59.2%, and class III in 21.2% with median OS of 16.2, 8.9, and 5.6 months, respectively (P < 0.001). Lung cancer and melanoma were associated with a higher risk (>1% per year) of developing brain metastases. Significant negative prognostic factors were age ≥ 65, a poor performance score, unstable extracranial disease, presence of extracranial metastases, multiplicity, metastasis in eloquent area, and no post-operative radiotherapy. CONCLUSIONS In this population study, the annual incidence of a first-time craniotomy for a brain metastasis was 2.6/100,000, the 30-day mortality rate was 3.8%, and median OS was 9.2 months. The well-known prognostic factors were confirmed.
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Affiliation(s)
- S G Rogne
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Lau D, Ziewacz JE, Siddiqi HK, Pelly A, Sullivan SE, El-Sayed AM. Cigarette smoking: a risk factor for postoperative morbidity and 1-year mortality following craniotomy for tumor resection. J Neurosurg 2012; 116:1204-14. [DOI: 10.3171/2012.3.jns111783] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Identifying risk factors for surgical morbidity and mortality might improve the safety and efficacy of neurosurgical intervention. Cigarette smoking is a relatively common practice and is associated with several adverse health outcomes. The authors examined the relationship between smoking and intraoperative blood loss, postoperative outcomes, and survival following craniotomy for tumor resection.
Methods
A consecutive population of patients undergoing craniotomy for tumor resection between 2006 and 2009 was identified. Using multivariable models and Cox proportional hazard regression analysis, the authors assessed the relation between smoking and operative outcomes including blood loss, complication rates, hospital length of stay, 30-day mortality, and 1-year survival among patients who underwent craniotomy for tumor resection.
Results
A total of 453 patients were included in this study: 237 patients never smoked, 54 quit smoking for at least 1 year, and 162 were current smokers. Current smoking status was an independent risk factor for higher intraoperative blood loss, complication risk, and lower 1-year survival following intervention relative to patients who never smoked. Patients who quit smoking had significantly higher mean blood loss, but did not carry a higher risk for other outcomes such as postoperative complications and 1-year mortality compared with patients who never smoked.
Conclusions
Current cigarette smoking is associated with poor surgical outcome and lower 1-year survival after undergoing craniotomy for tumor resection. However, quitting smoking and implementing strict smoking cessation programs may help mitigate these risks. Future research might investigate mechanisms underlying these associations.
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Affiliation(s)
- Darryl Lau
- 1University of Michigan Medical School and
| | - John E. Ziewacz
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Abdulrahman M. El-Sayed
- 3Department of Public Health, Oxford University, Oxford, United Kingdom; and
- 4Department of Epidemiology and
- 5College of Physicians and Surgeons, Columbia University, New York, New York
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Abstract
Brain metastases are one of the most common neurologic complications of cancer. The incidence is 9%-17% based on various studies, although the exact incidence is thought to be higher. The incidence is increasing with the availability of improved imaging techniques which aid early diagnosis, and effective systemic treatment regimens which prolong life, thus allowing cancer to disseminate to the brain. Lung cancer, breast cancer, and melanoma are the most frequent to develop brain metastases, and account for 67%-80% of all cancers. Most patients with brain metastases have synchronous extracerebral metastases. Some patients present with no known primary cancer diagnosis. In children, brain metastases are rare; germ cell tumors, sarcomas, and neuroblastoma are the common offenders.
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Affiliation(s)
- Lakshmi Nayak
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Division of Neuro-Oncology, Department of Neurology, Brigham and Women's Hospital, 450 Brookline Avenue, SW-430D, Boston, MA 02215, USA
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Stark AM. Neurosurgical treatment of breast cancer metastases to the neurocranium. PATHOLOGY RESEARCH INTERNATIONAL 2010; 2011:549847. [PMID: 21209717 PMCID: PMC3010687 DOI: 10.4061/2011/549847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 11/08/2010] [Indexed: 12/04/2022]
Abstract
Breast cancer metastases to the neurocranium might involve the bone, the dura, or the brain parenchyma. The latter location is the far most common. The annual incidence of brain metastases in patients with breast cancer is in the range of 4–11 per 100.000 persons per year. Symptoms and findings mainly result from the location of the lesion. The diagnostic method of choice is magnetic resonance imaging before and after administration of contrast material. Breast cancer brain metastases present as solid, cystic, or partially cystic lesions with marked contrast enhancement and perilesional edema. The therapeutic option of choice is microsurgical resection whenever possible. Adjuvant treatment includes radiotherapy, radiosurgery, and/or chemotherapy.
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Affiliation(s)
- Andreas M Stark
- Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Stra β e 3, 24105 Kiel, Germany
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