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Rauschenbach L, Kolbe P, Engel A, Ahmadipour Y, Oppong MD, Santos AN, Kebir S, Dobersalske C, Scheffler B, Deuschl C, Dammann P, Wrede KH, Sure U, Jabbarli R. Predictors and surgical outcome of hemorrhagic metastatic brain malignancies. J Neurooncol 2024:10.1007/s11060-024-04714-2. [PMID: 38801490 DOI: 10.1007/s11060-024-04714-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Intracerebral metastases present a substantial risk of tumor-associated intracerebral hemorrhage (ICH). This study aimed to investigate the risk of hemorrhagic events in brain metastases (BM) from various primary tumor sites and evaluate the safety and outcomes of surgical tumor removal. METHODS A retrospective, single-center review of medical records was conducted for patients who underwent BM removal between January 2016 and December 2017. Patients with hemorrhagic BM were compared to those with non-hemorrhagic BM. Data on preoperative predictors, perioperative management, and postoperative outcomes were collected and analyzed. RESULTS A total of 229 patients met the inclusion criteria. Melanoma metastases were significantly associated with preoperative hemorrhage, even after adjusting for confounding factors (p = 0.001). Poor clinical status (p = 0.001), larger tumor volume (p = 0.020), and unfavorable prognosis (p = 0.001) independently predicted spontaneous hemorrhage. Importantly, preoperative use of anticoagulant medications was not linked to increased hemorrhagic risk (p = 0.592). Surgical removal of hemorrhagic BM, following cessation of blood-thinning medication, did not significantly affect intraoperative blood loss, surgical duration, or postoperative rebleeding risk (p > 0.096). However, intra-tumoral hemorrhage was associated with reduced overall survival (p = 0.001). CONCLUSION This study emphasizes the safety of anticoagulation in patients with BM and highlights the safety of neurosurgical treatment in patients with hemorrhagic BM when blood-thinning medication is temporarily paused. The presence of intra-tumoral hemorrhage negatively impacts survival, highlighting its prognostic significance in BM patients. Further research with larger cohorts is warranted to validate these findings and elucidate underlying mechanisms.
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Affiliation(s)
- Laurèl Rauschenbach
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
- DKFZ Division of Translational Neurooncology at the West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany.
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany.
| | - Pia Kolbe
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Adrian Engel
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alejandro N Santos
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Sied Kebir
- DKFZ Division of Translational Neurooncology at the West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, Germany
| | - Celia Dobersalske
- DKFZ Division of Translational Neurooncology at the West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, University of Duisburg-Essen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Björn Scheffler
- DKFZ Division of Translational Neurooncology at the West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, University of Duisburg-Essen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
- Center for Translational Neuroscience and Behavioral Science (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Risk factors for 30-day postoperative surgical site hematoma requiring evacuation after resection of brain metastases. Clin Neurol Neurosurg 2023; 226:107617. [PMID: 36753860 DOI: 10.1016/j.clineuro.2023.107617] [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: 01/08/2023] [Accepted: 02/04/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify the risk factors for a 30-day postoperative surgical site hematoma requiring evacuation (POH) after surgical resection of brain metastases. METHODS Patients who underwent surgical resection of brain metastases between 2011 and 2019 at our institution were included. Risk factors for a 30-day POH were identified using a multivariate logistic regression model. RESULTS A total of 158 patients were included in the analysis. The mean (SD) age of the study population was 59.3 (12.0) years, and 82 (53.2%) patients were female. The incidence of a 30-day POH was 8.2% (13 patients). There was no statistically significant association between the occurrence of a 30-day POH and overall mortality (p = 0.100). On multivariate analysis, there was a statistically significant association between a 30-day POH and younger age (OR=0.91; 95% CI=0.83, 0.99; p = 0.035), higher BMI (OR=1.61; 95% CI=1.16, 2.46; p = 0.010), and blood type AB (OR=21.7; 95% CI=1.66, 522; p = 0.031). On receiver operating characteristic analysis, a threshold BMI of 25.1 kg/m2 and threshold age of 57 gave the optimum balance of sensitivity and specificity in predicting the occurrence of a 30-day POH. CONCLUSIONS Patients below 57 years old, who have a BMI of above 25, and/or have blood type AB were at higher risk of developing a 30-day POH after surgical resection of brain metastases. Additional care in intraoperative hemostasis and postoperative monitoring may be indicated among patients who have these risk factors.
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Fecci PE, Rao G, Brastianos PK, Dunn GP, Anders CK. Editorial: It takes a village: The expanding multi-disciplinary approach to brain metastasis. Front Oncol 2022; 12:1054490. [PMID: 36338769 PMCID: PMC9627329 DOI: 10.3389/fonc.2022.1054490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter E. Fecci
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, United States
- Duke University School of Medicine, Duke Center for Brain and Spine Metastasis, Durham, NC, United States
- *Correspondence: Peter E. Fecci,
| | - Ganesh Rao
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Priscilla K. Brastianos
- Central Nervous System Metastasis Program, Massachusetts General Hospital, Boston, MA, United States
| | - Gavin P. Dunn
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
| | - Carey K. Anders
- Duke University School of Medicine, Duke Center for Brain and Spine Metastasis, Durham, NC, United States
- Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, United States
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Gao X, Chen M, Liu X, Shi Y, Liang H, Zhou Q, Zhao J, Pan R, Zhong W, Xu Y, Wang M. Prognostic Factors and Survival Benefits of Antitumor Treatments for Advanced Non-Small Cell Lung Cancer Patients With Central Nervous System Metastasis With or Without Driver Genes: A Chinese Single-Center Cohort Study. Front Oncol 2022; 12:879554. [PMID: 35558520 PMCID: PMC9090435 DOI: 10.3389/fonc.2022.879554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background The prognosis of non-small cell lung cancer (NSCLC) patients with central nervous system (CNS) metastasis is poor. The treatment for CNS metastasis could prolong the overall survival of NSCLC patients. We aimed to investigate the prognostic factors of Chinese NSCLC patients with CNS metastasis and the survival benefits of various treatments for CNS metastasis in NSCLC patients with or without driver genes. Methods Based on the CAPTRA-Lung database, NSCLC patients with CNS metastasis admitted at the Peking Union Medical College Hospital between January 2010 and October 2018 were enrolled in the study. The prognostic factors were analyzed using univariate and multivariate Cox regression analyses. Results Overall, 418 patients were enrolled in the study. A total of 206 patients (49.3%) had CNS metastasis with positive driver genes, while 97 patients (23.2%) had negative driver genes. The median survival time after CNS metastasis was 20.8 months. In the multivariable analysis, an Eastern Cooperative Oncology Group performance status of ≥2 (hazard ratio [HR]: 1.750, 95% confidence interval [CI]: 1.184-2.588, P=0.005), number of CNS metastases ≥5 (HR: 1.448, 95% CI: 1.084 -1.934, P=0.012), and CNS metastasis developed during treatment (HR: 1.619, 95% CI: 1.232-2.129, P=0.001) were independent risk factors for poor survival. Lung adenocarcinoma (HR: 0.490, 95% CI: 0.279-0.861, P=0.013) and driver gene positivity (HR: 0.464, 95% CI: 0.302-0.715, P=0.001) were independent predictors of prolonged survival. Radiotherapy for CNS metastasis showed a survival benefit in NSCLC patients in the entire groups (HR: 0.472, 95% CI: 0.360-0.619, P <0.001), and in patients with positive driver genes. Conclusion Performance status, number of CNS metastases, timing of CNS metastasis, histological subtype, and driver gene status are prognostic factors for NSCLC patients with CNS metastasis. Furthermore, radiotherapy improved the survival in NSCLC patients with CNS metastasis.
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Affiliation(s)
- Xiaoxing Gao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjiang Chen
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyan Liu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuequan Shi
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongge Liang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Zhou
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Zhao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruili Pan
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhong
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Xu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Price M, Howell EP, Dalton T, Ramirez L, Howell C, Williamson T, Fecci PE, Anders CK, Check DK, Kamal AH, Goodwin CR. Inpatient palliative care utilization for patients with brain metastases. Neurooncol Pract 2021; 8:441-450. [PMID: 34277022 DOI: 10.1093/nop/npab016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction Given the high symptom burden and complex clinical decision making associated with a diagnosis of brain metastases (BM), specialty palliative care (PC) can meaningfully improve patient quality of life. However, no prior study has formally evaluated patient-specific factors associated with PC consultation among BM patients. Methods We examined the rates of PC consults in a cohort of 1303 patients with BM admitted to three tertiary medical centers from October 2015 to December 2018. Patient demographics, surgical status, 30-day readmission, and death data were collected via retrospective chart review. PC utilization was assessed by identifying encounters for which an inpatient consult to PC was placed. Statistical analyses were performed to compare characteristics and outcomes between patients who did and did not receive PC consults. Results We analyzed 1303 patients admitted to the hospital with BM. The average overall rate of inpatient PC consultation was 19.6%. Rates of PC utilization differed significantly by patient race (17.5% in White/Caucasian vs 26.0% in Black/African American patients, P = .0014). Patients who received surgery during their admission had significantly lower rates of PC consultation (3.9% vs 22.4%, P < .0001). Patients who either died during their admission or were discharged to hospice had significantly higher rates of PC than those who were discharged home or to rehabilitation (P < .0001). Conclusions In our dataset, PC consultation rates varied by patient demographic, surgical status, discharging service, and practice setting. Further work is needed to identify the specific barriers to optimally utilizing specialty PC in this population.
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Affiliation(s)
- Meghan Price
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth P Howell
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Tara Dalton
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Luis Ramirez
- Duke Center for Brain and Spine Metastasis, Duke University Medical Center, Durham, North Carolina, USA
| | - Claire Howell
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Theresa Williamson
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Peter E Fecci
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Carey K Anders
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Devon K Check
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Arif H Kamal
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.,Fuqua School of Business, Duke University, Durham, North Carolina, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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Li XM, Jin LB. Perioperative mortality of metastatic spinal disease with unknown primary: A case report and review of literature. World J Clin Cases 2021; 9:379-388. [PMID: 33521105 PMCID: PMC7812883 DOI: 10.12998/wjcc.v9.i2.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spinal metastases are common in patients with malignancies, but studies on those metastasized from unknown primaries are scarce due to the difficulty in treatment and the relatively poor prognosis. Knowledge of surgical complications, particularly perioperative mortality, in patients with spinal metastases from unidentified sources is still insufficient.
CASE SUMMARY A 54-year-old man with chest-back pain was diagnosed with spinal metastasis in the seventh thoracic vertebra (T7). Radiographic examinations, as well as needle biopsy and immunohistochemical tests were performed to verify the characteristics of the lesion, resulting in an inconclusive diagnosis of poorly differentiated cancer from an unknown primary lesion. Therefore, spinal surgery was performed using the posterior approach to relieve symptoms and verify the diagnosis. Postoperative histologic examination indicated that this poorly differentiated metastatic cancer was possibly sarcomatoid carcinoma. As the patient experienced unexpectedly fast progression of the disease and died 16 d after surgery, the origin of this metastasis was undetermined. We discuss this case with respect to reported perioperative mortality in similar cases.
CONCLUSION A comprehensive assessment prior to surgical decision-making is essential to reduce perioperative mortality risk in patients with spinal metastases from an unknown origin.
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Affiliation(s)
- Xiu-Mao Li
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Li-Bin Jin
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
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Chen XR, Hou X, Li DL, Sai K, Dinglin XX, Chen J, Wang N, Li MC, Wang KC, Chen LK. Management of Non-Small-Cell Lung Cancer Patients Initially Diagnosed With 1 to 3 Synchronous Brain-Only Metastases: A Retrospective Study. Clin Lung Cancer 2020; 22:e25-e34. [PMID: 32839132 DOI: 10.1016/j.cllc.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/17/2020] [Accepted: 07/25/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The treatment options for newly diagnosed non-small-cell lung cancer (NSCLC) patients with 1 to 3 synchronous brain metastases (BM) remain controversial. The current study aimed to comprehensively analyze the characteristics, local treatment paradigms, and survival outcomes in these populations. PATIENTS AND METHODS A total of 252 NSCLC patients initially diagnosed with 1 to 3 synchronous brain-only metastases were enrolled onto this study. Local therapy (LT) to primary lung tumors (PLT) and BM included surgery, radiotherapy, or both. Median overall survival (mOS) was measured among patients who received LT to both PLT and BM (all-LT group), patients who were treated with LT to either PLT or BM (part-LT group), and patients who did not receive any LT (non-LT group). RESULTS The mOS for all-LT (n = 70), part-LT (n = 113), and non-LT (n = 69) groups was 33.2, 18.5, and 16.8 months, respectively (P = .002). The OS rates at 5 years for the all-LT, part-LT, and non-LT groups were 25.5%, 16.2%, and 0, respectively. Multivariable analysis revealed that all-LT versus non-LT, pretreatment Karnofsky performance status > 70, histology of adenocarcinoma, thoracic stage I-II, EGFR mutation, ALK positive, and second-line systemic therapies were independent prognostic factors for improved mOS. CONCLUSIONS The current study showed that LT for both PLT and BM is associated with superior OS in appropriately selected NSCLC patients initially diagnosed with 1 to 3 synchronous BM. Prospective trials are urgently needed to confirm this finding.
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Affiliation(s)
- Xin-Ru Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Xue Hou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - De-Lan Li
- Department of Chemotherapy, Zhongshan City People's Hospital, Zhongshan, PR China
| | - Ke Sai
- Department of Neurosurgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Xiao-Xiao Dinglin
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, PR China
| | - Jing Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Na Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Mei-Chen Li
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Kai-Cheng Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Li-Kun Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China.
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Branco V, Pimentel J, Brito MA, Carvalho C. Thioredoxin, Glutathione and Related Molecules in Tumors of the Nervous System. Curr Med Chem 2020; 27:1878-1900. [PMID: 30706774 DOI: 10.2174/0929867326666190201113004] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 09/14/2018] [Accepted: 11/28/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Central Nervous System (CNS) tumors have a poor survival prognosis due to their invasive and heterogeneous nature, in addition to the resistance to multiple treatments. OBJECTIVE In this paper, the main aspects of brain tumor biology and pathogenesis are reviewed both for primary tumors of the brain, (i.e., gliomas) and for metastasis from other malignant tumors, namely lung cancer, breast cancer and malignant melanoma which account for a high percentage of overall malignant brain tumors. We review the role of antioxidant systems, namely the thioredoxin and glutathione systems, in the genesis and/or progression of brain tumors. METHODS Although overexpression of Thioredoxin Reductase (TrxR) and Thioredoxin (Trx) is often linked to increased malignancy rate of brain tumors, and higher expression of Glutathione (GSH) and Glutathione S-Transferases (GST) are associated to resistance to therapy, several knowledge gaps still exist regarding for example, the role of Peroxiredoxins (Prx), and Glutaredoxins (Grx). CONCLUSION Due to their central role in redox homeostasis and ROS scavenging, redox systems are potential targets for new antitumorals and examples of innovative therapeutics aiming at improving success rates in brain tumor treatment are discussed.
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Affiliation(s)
- Vasco Branco
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - José Pimentel
- Laboratory of Neuropathology, Department of Neurology, Hospital de Santa Maria (CHLN), Av. Prof. Egas Moniz, 1649-036 Lisboa, Portugal.,Faculty of Medicine, Lisbon University, Av. Prof. Egas Moniz, 1649-036 Lisboa, Portugal
| | - Maria Alexandra Brito
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Cristina Carvalho
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal
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Amelot A, Terrier LM, Cristini J, Buffenoir K, Pascal-Moussellard H, Carpentier A, Bonaccorsi R, Le Nail LR, Mathon B. Spinal metastases from lung cancer: Survival depends only on genotype, neurological and personal status, scarcely of surgical resection. Surg Oncol 2020; 34:51-56. [PMID: 32891353 DOI: 10.1016/j.suronc.2020.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 01/30/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND For patients with non-small cell lung cancer (NSCLC), the spinal column is the most common site for bone metastasis. Studies that assess survival prognostic factors associated with specific lung spinal metastases (SpM) are weak and required the incorporation of genotype mutations. METHODS A prospective French national multicenter database of patients treated for SpM between January 2014 and 2017.818 lung SpM were diagnosed over the course or at the time of diagnosis of 210 consecutive patients with NSCLC. RESULTS Median overall survival (OS) time for all patients from the lung SpM event was 5.9 months (SD 0.609). For 122 patients (61%), lung tumor and SpM were diagnosed synchronously. In univariate analysis, good World Health Organisation (WHO) status (p < 0.0001), ambulatory status (Frankel score) (p < 0.0001), the absence of spine epiduritis (p < 0.0001), immunotherapy after SpM diagnosis (p < 0.0001), ALK gene rearrangement (p < 0.0001) and EGFR mutation (p < 0.0001) were associated with longer survival, whereas spine surgery showed no association (0.141). Cox multivariate proportional hazard model identified that EGFR + status (HR: 0.339, 95% CI 0.166-0.693; p = 0.003), good WHO status (p < 0.0001) and good neurological status (Frankel E; p < 0.001 and D; p = 0.018) were associated with higher median OS. Whereas the other factors, including ALK + status, epiduritis and immunotherapy were not independent prognostic factors of survival. CONCLUSION Survival in SpM must be prognosticated from general health performance status: clinical (WHO) and neurological (Frankel) as well as the EGFR mutation status. Immunotherapy, surgery and epiduritis have not demonstrated prognostic value. Therefore, surgical prognostic scoring algorithms should incorporate genotype subtypes in NSCLC cancers to adapt surgical treatment.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, La Pitié Salpétrière Hospital, Paris, France.
| | | | - Joseph Cristini
- Department of Neurosurgery/Neurotraumatology, Hotel-Dieu Hospital, Nantes, France
| | - Kévin Buffenoir
- Department of Neurosurgery/Neurotraumatology, Hotel-Dieu Hospital, Nantes, France
| | | | | | - Raphael Bonaccorsi
- Department of Orthopaedic Surgery, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Bertrand Mathon
- Department of Neurosurgery, La Pitié Salpétrière Hospital, Paris, France
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10
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Amelot A, Terrier LM, Cristini J, Buffenoir K, Pascal-Moussellard H, Carpentier A, Bonaccorsi R, Le Nail LR, Mathon B. Survival in breast cancer patients with spine metastases: Prognostic assessment involving molecular markers. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 46:1021-1027. [PMID: 31899046 DOI: 10.1016/j.ejso.2019.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/30/2019] [Accepted: 12/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND To clarify and update the prognostic assessment for heterogeneous population of patients with breast cancer and spine metastases (SpM), using molecular markers. METHODS The patient data used in this study was obtained from a French national multi-center database of patients treated for breast cancer with SpM between 2014 and 2017. 556 SpM cases were diagnosed. RESULTS Median overall survival (OS) time for all patients following the SpM event was 43.9 months. First, we confirmed 3 previously known significant prognostic factors for survival of patients with SpM: young age [HR: 2.019, 95% CI 1.343-3.037; p = 0.001], good WHO status [ Status 0 HR: 2.823, 95% CI 1.231-3.345; p < 0.0001] or [ Status 1 HR: 1.956, 95% CI 0.768-2.874; p = 0.001] and no-ambulatory neurological status: Frankel A-C [HR: 0.438, 95% CI 0.248-0.772; p = 0.004]. Secondly, we determined the effect of gene mutations on survival in patients with SpM, and we identified that HER2+ cancer subtype [HR: 1.567, 95% CI 0.946-2.557; p = 0.008] was an independent predictor of longer survival, whereas basal cancer subtype [HR: 0.496, 95% CI 0.353-0.699; p < 0.0001] was associated with a poorer prognosis. Other factors including the number of SpM, surgery, extraspinal metastases, synchrone metastases, metastasis-free survival, and SpM recurrence were not identified as prognostically relevant to survival. CONCLUSION Survival and our ability to estimate it in breast cancer patients with SpM has improved significantly. Therefore, SpM prognostic scoring algorithms should be updated and incorporate genotypic data on subtypes to make treatment more adaptive.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, La Pitié Salpétrière Hospital, Paris, France.
| | | | - Joseph Cristini
- Department of Neurosurgery/Neurotraumatology, Hotel-Dieu Hospital, Nantes, France
| | - Kévin Buffenoir
- Department of Neurosurgery/Neurotraumatology, Hotel-Dieu Hospital, Nantes, France
| | | | | | - Raphael Bonaccorsi
- Department of Orthopaedic Surgery, La Pitié-Salpêtrière Hospital, Paris, France
| | | | - Bertrand Mathon
- Department of Neurosurgery, La Pitié Salpétrière Hospital, Paris, France
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11
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Sankey EW, Tsvankin V, Grabowski MM, Nayar G, Batich KA, Risman A, Champion CD, Salama AKS, Goodwin CR, Fecci PE. Operative and peri-operative considerations in the management of brain metastasis. Cancer Med 2019; 8:6809-6831. [PMID: 31568689 PMCID: PMC6853809 DOI: 10.1002/cam4.2577] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 12/24/2022] Open
Abstract
The number of patients who develop metastatic brain lesions is increasing as the diagnosis and treatment of systemic cancers continues to improve, resulting in longer patient survival. The role of surgery in the management of brain metastasis (BM), particularly multiple and recurrent metastases, remains controversial and continues to evolve. However, with appropriate patient selection, outcomes after surgery are typically favorable. In addition, surgery is the only means to obtain a tissue diagnosis and is the only effective treatment modality to quickly relieve neurological complications or life‐threatening symptoms related to significant mass effect, CSF obstruction, and peritumoral edema. As such, a thorough understanding of the role of surgery in patients with metastatic brain lesions, as well as the factors associated with surgical outcomes, is essential for the effective management of this unique and growing patient population.
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Affiliation(s)
- Eric W Sankey
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Vadim Tsvankin
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | | | - Gautam Nayar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kristen A Batich
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Aida Risman
- School of Medicine, Medical College of Georgia, Augusta, GA, USA
| | - Cosette D Champion
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - April K S Salama
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Peter E Fecci
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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12
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Ziu M. Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Use of Stereotactic Radiosurgery in the Treatment of Adults With Metastatic Brain Tumors. Neurosurgery 2019; 84:E171-E172. [DOI: 10.1093/neuros/nyy599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 11/16/2018] [Indexed: 11/13/2022] Open
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13
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She C, Wang R, Lu C, Sun Z, Li P, Yin Q, Liu Q, Wang P, Li W. Prognostic factors and outcome of surgically treated patients with brain metastases of non-small cell lung cancer. Thorac Cancer 2018; 10:137-142. [PMID: 30485664 PMCID: PMC6360214 DOI: 10.1111/1759-7714.12913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/13/2018] [Accepted: 10/13/2018] [Indexed: 02/06/2023] Open
Abstract
Background Brain metastases (BM) are a common consequence of lung cancer and surgery is effective; however, the factors affecting survival after surgery are unclear. The aim of this study was to identify the outcomes and prognoses of post‐metastasectomy patients with BM from non‐small cell lung cancer (NSCLC) at a single institution over a 15‐year period. Methods NSCLC patients who had undergone BM surgery were retrospectively identified. Survival was analyzed using the Kaplan–Meier curve, and univariate and multivariate factors associated with survival were identified using the Cox proportional hazards model. Results The median overall survival was 9.8 months, 18 (14.8%) patients survived > 24 months, and 6 (4.9%) > 36 months. The one and two‐year survival rates were 41% and 18.6%, respectively. Univariate analysis revealed that recursive partitioning analysis (RPA) classification, Karnofsky Performance Scale (KPS) scores, BM number, extracranial metastasis status, different lesion locations, resection extent, postoperative treatment, and salvage therapy after recurrence significantly influenced patient survival. The different treatment modalities for primary lesions also affected postoperative survival. KPS ≥ 70, RPA class I/II, and postoperative chemotherapy were independent factors that decreased the risk of death from BM. Interestingly, the initial onset of intracranial lesions could increase the risk of death from BM. Conclusion A KPS score ≥ 70, RPA class I/II, and postoperative chemotherapy could benefit post‐metastasectomy patients with BM from NSCLC. Conversely, the initial onset of intracranial lesions is an unfavorable factor that increases the risk of death. These findings support the use of personalized therapy for patients with BM from NSCLC.
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Affiliation(s)
- Chunhua She
- Department of Neurosurgery and Neuro-Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ruixia Wang
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Changhong Lu
- Ultrasound Department, Binzhou People's Hospital, Binzhou, China
| | - Zengfeng Sun
- Department of Neurosurgery and Neuro-Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Peng Li
- Department of Neurosurgery and Neuro-Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Qiang Yin
- Department of Neurosurgery and Neuro-Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Qun Liu
- Department of Neurosurgery and Neuro-Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Peng Wang
- Department of Neurosurgery and Neuro-Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Wenliang Li
- Department of Neurosurgery and Neuro-Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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14
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Cheng H, Chen H, Lv Y, Chen Z, Li CSR. Prospective memory impairment following whole brain radiotherapy in patients with metastatic brain cancer. Cancer Med 2018; 7:5315-5321. [PMID: 30259694 PMCID: PMC6198199 DOI: 10.1002/cam4.1784] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the prospective memory (PM) impairment following whole brain radiotherapy (WBRT) in cancer patients with brain metastases. METHOD Eighty-one patients with metastatic brain cancer, agreeing to undergo WBRT, were enrolled and subjected to a battery of cognitive neuropsychological tests, including the mini-mental state examination (MMSE), verbal fluency test (VFT), digit span test (DST), and event-based and time-based prospective memory (EBPM and TBPM) tasks, before and after radiotherapy. RESULTS The patients with metastatic brain cancer after WBRT exhibited a significant decrease in the MMSE, DST, VFT, and EBPM scores (t = 6.258, 10.192, 5.361, -5.892, P < 0.01), but nonsignificant decrease in the TBPM scores (t = -1.172, P > 0.05). CONCLUSION There is significant EBPM impairment in cancer patients with brain metastases after WBRT, whereas that in the TBPM remained relatively unaffected. The result suggests that EBPM impairment may be as an early cognitive impairment marker in patients with BM who undergo WBRT.
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Affiliation(s)
- Huaidong Cheng
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Haijun Chen
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yue Lv
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhendong Chen
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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15
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Single fraction spine stereotactic ablative body radiotherapy with volumetric modulated arc therapy. J Neurooncol 2017; 133:165-172. [DOI: 10.1007/s11060-017-2428-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/11/2017] [Indexed: 12/25/2022]
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16
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Goodwin CR, Schoenfeld AJ, Abu-Bonsrah NA, Garzon-Muvdi T, Sankey EW, Harris MB, Sciubba DM. Reliability of a spinal metastasis prognostic score to model 1-year survival. Spine J 2016; 16:1102-8. [PMID: 27080411 DOI: 10.1016/j.spinee.2016.04.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/04/2016] [Accepted: 04/07/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Predicting survival after surgery for patients with metastatic spine disease can be challenging, with multiple variables that can influence a patient's overall survival. Predictive models have been developed to assist clinicians in providing a prognosis for patients. Recently, Ghori et al. reported a composite model taking into account a modified Bauer score, preoperative albumin, and ambulatory status of patients with spinal metastasis. Using an independent cohort, we sought to assess the reliability and validity of this composite model to predict 1-year survival in patients diagnosed with metastatic cancer to the spine. PURPOSE This study aimed to assess the reliability and validity of the Ghori et al. composite model to predict 1-year survival in patients diagnosed with metastatic cancer to the spine, using an independent cohort. STUDY DESIGN/SETTING A retrospective study was carried out. PATIENT SAMPLE The sample comprised 161 patients with spinal metastasis undergoing surgery. OUTCOME MEASURES Patients' modified Bauer score, preoperative albumin, and ambulatory status were assessed. METHODS This study used a retrospective analysis of 161 patients with spinal metastasis who underwent surgical management from 2007 to 2013. The ability of this composite model to predict 1-year survival was compared with actual patient survival using multivariable logistic regression to control for confounders, as well as post-regression diagnostics. RESULTS Our analysis revealed significantly lower 1-year mortality among patients with higher composite scores as compared with those with lower scores. Strong associations between scores and survival were appreciated in unadjusted analysis. The final model was able to account for 80% of the variation in the 1-year survival, and there was no evidence of lack of fit. CONCLUSION This study demonstrates, in an independent cohort of spinal metastases patients, that a composite model taking into account the ambulatory status, serum albumin, and modified Bauer score is able to better predict postoperative survival. These data serve to validate the use of this predictive model in determining the prognosis of patients with spinal metastasis.
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Affiliation(s)
- C Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Nancy A Abu-Bonsrah
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Eric W Sankey
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Mitchel B Harris
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
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17
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Pre-treatment factors associated with detecting additional brain metastases at stereotactic radiosurgery. J Neurooncol 2016; 128:251-7. [PMID: 26966096 DOI: 10.1007/s11060-016-2103-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/06/2016] [Indexed: 10/22/2022]
Abstract
The number of brain metastases identified on diagnostic magnetic resonance imaging (MRI) is a key factor in consideration of stereotactic radiosurgery (SRS). However, additional lesions are often detected on high-resolution SRS-planning MRI. We investigated pre-treatment clinical characteristics that are associated with finding additional metastases at SRS. Patients treated with SRS for brain metastases between the years of 2009-2014 comprised the study cohort. All patients underwent frame-fixed, 1 mm thick MRI on the day of SRS. Patient, tumor, and treatment characteristics were analyzed for an association with increase in number of metastases identified on SRS-planning MRI. 289 consecutive SRS cases were analyzed. 725 metastases were identified on pre-treatment MRI and 1062 metastases were identified on SRS-planning MRI. An increase in the number of metastases occurred in 34 % of the cases. On univariate analysis, more than four metastases and the diameter of the largest lesion were significantly associated with an increase in number of metastases on SRS-planning MRI. When stratified by the diameter of the largest lesion into <2, 2-3, or ≥3 cm, additional metastases were identified in 37, 29, and 18 %, respectively. While this increase in the number of metastases is largely due to the difference in imaging technique, the number and size of the metastases were also associated with finding additional lesions. These clinical factors may be considered when determining treatment options for brain metastases.
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18
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Goodwin CR, Sankey EW, Liu A, Abu-Bonsrah N, Elder BD, Rhee J, Kosztowski T, Bydon A, Witham TF, Wolinsky JP, Gokaslan ZL, Sciubba DM. Primary lesion location influences postoperative survival in patients with metastatic colorectal spinal lesions. J Clin Neurosci 2016; 25:84-9. [PMID: 26777084 DOI: 10.1016/j.jocn.2015.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/11/2015] [Indexed: 01/05/2023]
Abstract
Spinal metastasis from colorectal cancer occurs rarely. However, with increasing incidence of colorectal cancer in the setting of improved therapies, physicians are more likely to encounter such patients. We performed a retrospective review of patients who underwent spine surgery for metastatic colorectal cancer from 2005-2011. Preoperative, operative and postoperative factors; functional outcome as determined by Karnofsky Performance Status (KPS) and modified Rankin scale (mRS); and survival were recorded. Univariate analysis was performed, with patients stratified into two groups based on the position of the primary cancer, either proximal (colon) or distal (rectum) to the rectosigmoid junction. Fourteen patients, with a median age of 52 (interquartile range [IQR] 48-66)years, underwent 21 spine surgeries for metastatic colorectal cancer. Pain was the common presenting symptom (n=11, 79%), followed by motor weakness (n=8, 57%). Twenty-seven postoperative complications occurred in 11 (52%) patients. Baseline KPS and mRS remained stable in four (29%), improved in two (14%), worsened in six (43%), and was unknown in two (14%) at last follow-up. Patients with spinal metastasis from a rectal primary (n=6) had a significantly longer survival compared to those with a colon primary (n=8), with a median survival of 84 (IQR 56-103) versus 26 (IQR 19-44)months after primary diagnosis (p=0.002), 19 (IQR 13-27) versus five (IQR 3-9)months after spine metastasis diagnosis (p=0.010), and six (IQR 4-14) versus three (IQR 2-4)months after surgery (p=0.030). Patients with spinal metastasis arising from rectal primary lesions display longer survival compared to colon lesions. Consideration of these factors is essential to appropriately assess surgical candidacy.
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Affiliation(s)
- C Rory Goodwin
- Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Eric W Sankey
- Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Ann Liu
- Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Nancy Abu-Bonsrah
- Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Benjamin D Elder
- Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Jay Rhee
- Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Thomas Kosztowski
- Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Ali Bydon
- Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Timothy F Witham
- Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Jean-Paul Wolinsky
- Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Ziya L Gokaslan
- Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA
| | - Daniel M Sciubba
- Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
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Goodwin CR, Sankey EW, Liu A, Elder BD, Kosztowski T, Lo SFL, Fisher CG, Clarke MJ, Gokaslan ZL, Sciubba DM. A systematic review of clinical outcomes for patients diagnosed with skin cancer spinal metastases. J Neurosurg Spine 2015; 24:837-49. [PMID: 26544595 DOI: 10.3171/2015.4.spine15239] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Surgical procedures and/or adjuvant therapies are effective modalities for the treatment of symptomatic spinal metastases. However, clinical results specific to the skin cancer spinal metastasis cohort are generally lacking. The purpose of this study was to systematically review the literature for treatments, clinical outcomes, and survival following the diagnosis of a skin cancer spinal metastasis and evaluate prognostic factors in the context of spinal skin cancer metastases stratified by tumor subtype. METHODS The authors performed a literature review using PubMed, Embase, CINAHL, and Web of Science to identify articles since 1950 that reported survival, clinical outcomes, and/or prognostic factors for the skin cancer patient population with spinal metastases. The methodological quality of reviews was assessed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) tool. RESULTS Sixty-five studies met the preset criteria and were included in the analysis. Of these studies, a total of 25, 40, 25, and 12 studies included patients who underwent some form of surgery, radiotherapy, chemotherapy, or observation alone, respectively. Sixty-three of the 65 included studies were retrospective in nature (Class of Evidence [CoE] IV), and the 2 prospective studies were CoE II. Based on the studies analyzed, the median overall survival for a patient with a spinal metastasis from a primary skin malignancy is 4.0 months; survival by tumor subtype is 12.5 months for patients with basal cell carcinoma (BCC), 4.0 months for those with melanoma, 4.0 months for those with squamous cell carcinoma, 3.0 months for those with pilomatrix carcinoma, and 1.5 months for those with Merkel cell carcinoma (p < 0.0001). The overall percentage of known continued disease progression after spine metastasis diagnosis was 40.1% (n = 244/608, range 25.0%-88.9%), the rate of known recurrence of the primary skin cancer lesion was 3.5% (n = 21/608, range 0.2%-100.0%), and the rate of known spine metastasis recurrence despite treatment for all skin malignancies was 2.8% (n = 17/608, range 0.0%-33.3%). Age greater than 65 years, sacral spinal involvement, presence of a neurological deficit, and nonambulatory status were associated with decreased survival in patients diagnosed with a primary skin cancer spinal metastasis. All other clinical or prognostic parameters were of low or insufficient strength. CONCLUSIONS Patients diagnosed with a primary skin cancer metastasis to the spine have poor overall survival with the exception of those with BCC. The median duration of survival for patients who received surgical intervention alone, medical management (chemotherapy and/or radiation) alone, or the combination of therapies was similar across interventions. Age, spinal region, and neurological status may be associated with poor survival following surgery.
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Affiliation(s)
- C Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric W Sankey
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ann Liu
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Benjamin D Elder
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas Kosztowski
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sheng-Fu L Lo
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles G Fisher
- Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada; and
| | | | - Ziya L Gokaslan
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Goodwin CR, Khattab MH, Sankey EW, Elder BD, Kosztowski TA, Sarabia-Estrada R, Bydon A, Witham TF, Wolinsky JP, Gokaslan ZL, Sciubba DM. Factors Associated with Life Expectancy in Patients with Metastatic Spine Disease from Adenocarcinoma of the Lung. Global Spine J 2015; 5:417-24. [PMID: 26430597 PMCID: PMC4577314 DOI: 10.1055/s-0035-1554778] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/16/2015] [Indexed: 01/15/2023] Open
Abstract
Study Design Retrospective study. Objective Our objective was to identify preoperative prognostic factors associated with survival in patients with spinal metastasis from lung carcinoma. Methods A retrospective analysis of 26 patients diagnosed with lung carcinoma metastatic to the spinal column was performed to determine factors associated with survival. We used 3 months survival as the clinical cutoff for whether surgical intervention should be performed. We analyzed patients who survived less than 3 months compared with those who survived more than 3 months. Demographic, preoperative, operative, and postoperative factors including functional scores were collected for analysis. Results The median survival for all patients in our study was 3.5 months. We found a statistically significant difference between the group that survived less than 3 months and the group that survived greater than 3 months in terms of extrathoracic metastasis, visceral metastasis, and average postoperative modified Rankin score. Conclusion Determining which patients with lung cancer spinal metastases will benefit from surgical intervention is often dictated by the patient's predicted life expectancy. Factors associated with poorer prognosis include age, functional status, visceral metastases, and extrathoracic metastases. Although the prognosis for patients with lung cancer spinal metastases is poor, some patients may experience long-term benefit from surgical intervention.
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Affiliation(s)
- C. Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Mohamed H. Khattab
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Eric W. Sankey
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Benjamin D. Elder
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Thomas A. Kosztowski
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Rachel Sarabia-Estrada
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Ali Bydon
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Timothy F. Witham
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Jean-Paul Wolinsky
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Ziya L. Gokaslan
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Daniel M. Sciubba
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, United States,Address for correspondence Daniel M. Sciubba, MD Department of Neurosurgery, Johns Hopkins University School of Medicine600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287United States
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Saunus JM, Quinn MCJ, Patch AM, Pearson JV, Bailey PJ, Nones K, McCart Reed AE, Miller D, Wilson PJ, Al-Ejeh F, Mariasegaram M, Lau Q, Withers T, Jeffree RL, Reid LE, Da Silva L, Matsika A, Niland CM, Cummings MC, Bruxner TJC, Christ AN, Harliwong I, Idrisoglu S, Manning S, Nourse C, Nourbakhsh E, Wani S, Anderson MJ, Fink JL, Holmes O, Kazakoff S, Leonard C, Newell F, Taylor D, Waddell N, Wood S, Xu Q, Kassahn KS, Narayanan V, Taib NA, Teo SH, Chow YP, kConFab, Jat PS, Brandner S, Flanagan AM, Khanna KK, Chenevix-Trench G, Grimmond SM, Simpson PT, Waddell N, Lakhani SR. Integrated genomic and transcriptomic analysis of human brain metastases identifies alterations of potential clinical significance. J Pathol 2015; 237:363-78. [DOI: 10.1002/path.4583] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/26/2015] [Accepted: 07/01/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Jodi M Saunus
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | - Michael CJ Quinn
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Ann-Marie Patch
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - John V Pearson
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Peter J Bailey
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences; University of Glasgow; UK
| | - Katia Nones
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Amy E McCart Reed
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | - David Miller
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
- Kinghorn Centre for Clinical Genomics; Garvan Institute of Medical Research; Darlinghurst NSW Australia
| | - Peter J Wilson
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Fares Al-Ejeh
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | - Mythily Mariasegaram
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | - Queenie Lau
- Pathology Queensland; Gold Coast Hospital; Southport Queensland Australia
| | - Teresa Withers
- Department of Neurosurgery; Gold Coast Hospital; Southport Queensland Australia
| | - Rosalind L Jeffree
- Kenneth G Jamieson Department of Neurosurgery; Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Lynne E Reid
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | - Leonard Da Silva
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- University of Queensland School of Medicine; Herston Queensland Australia
| | - Admire Matsika
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- Pathology Queensland; Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Colleen M Niland
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | - Margaret C Cummings
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- University of Queensland School of Medicine; Herston Queensland Australia
- Pathology Queensland; Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Timothy JC Bruxner
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Angelika N Christ
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Ivon Harliwong
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Senel Idrisoglu
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Suzanne Manning
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Craig Nourse
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences; University of Glasgow; UK
| | - Ehsan Nourbakhsh
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Shivangi Wani
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Matthew J Anderson
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - J Lynn Fink
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Oliver Holmes
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Stephen Kazakoff
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Conrad Leonard
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Felicity Newell
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Darrin Taylor
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Nick Waddell
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Scott Wood
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Qinying Xu
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Karin S Kassahn
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
- Genetic and Molecular Pathology, SA Pathology; Women's and Children's Hospital; North Adelaide South Australia Australia
- School of Molecular and Biomedical Science; University of Adelaide; South Australia Australia
| | - Vairavan Narayanan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Nur Aishah Taib
- Breast Unit, Department of Surgery, Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
- University Malaya Cancer Research Institute; University of Malaya; Kuala Lumpur Malaysia
| | - Soo-Hwang Teo
- University Malaya Cancer Research Institute; University of Malaya; Kuala Lumpur Malaysia
- Cancer Research Initiatives Foundation; Sime Darby Medical Centre; Selangor Malaysia
| | - Yock Ping Chow
- Cancer Research Initiatives Foundation; Sime Darby Medical Centre; Selangor Malaysia
| | - kConFab
- Peter MacCallum Cancer Centre; University of Melbourne; Victoria Australia
| | - Parmjit S Jat
- Department of Neurodegenerative Disease and MRC Prion Unit; UCL Institute of Neurology; London UK
| | - Sebastian Brandner
- Division of Neuropathology and Department of Neurodegenerative Disease; UCL Institute of Neurology; London UK
| | - Adrienne M Flanagan
- Histopathology; Royal National Orthopaedic Hospital NHS Trust; Stanmore UK
- University College London Cancer Institute; London UK
| | - Kum Kum Khanna
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | | | - Sean M Grimmond
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences; University of Glasgow; UK
| | - Peter T Simpson
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- University of Queensland School of Medicine; Herston Queensland Australia
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Sunil R Lakhani
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- University of Queensland School of Medicine; Herston Queensland Australia
- Pathology Queensland; Royal Brisbane and Women's Hospital; Herston Queensland Australia
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Cohen-Inbar O, Sheehan JP. Fighting Cancer on All Fronts: Stereotactic Radiosurgery and the Role for Aggressive Primary Treatment in Non-Small Cell Lung Cancer Patients with One Brain Metastasis. World Neurosurg 2015; 83:1015-6. [PMID: 25749580 DOI: 10.1016/j.wneu.2015.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Or Cohen-Inbar
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
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Caruso JP, Moosa S, Fezeu F, Ramesh A, Sheehan JP. A cost comparative study of Gamma Knife radiosurgery versus open surgery for intracranial pathology. J Clin Neurosci 2014; 22:184-8. [PMID: 25444994 DOI: 10.1016/j.jocn.2014.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
Abstract
Resection is the traditional treatment for common intracranial pathologies including brain metastases, arteriovenous malformations (AVM), and acoustic neuromas. However, more recently Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden) has emerged as an effective, alternative treatment modality. There are limited data investigating the cost effectiveness of these two treatment modalities. In this study, we compare the costs of GKRS and open surgical excision. This was a retrospective study including all patients at a single-institution across a 3 year period with at least 12 months of post-resection follow-up for brain metastases, acoustic neuromas, or AVM. The costs of care were then totaled and compared to known average costs for GKRS at the same institution. The average 12 month costs of treating patients with brain metastases, acoustic neuromas, and AVM using open surgery were USD$55,938, $67,538, and $78,332, respectively. The average 12 month costs of treating brain metastases, acoustic neuromas, and AVM with GKRS were USD$23,069, $37,840, and $46,293, respectively. This shows that GKRS was on average 58.8%, 44.0%, and 40.9% of the cost of open surgery for brain metastases, acoustic neuromas, and AVM, respectively. GKRS is a cost effective, first-line, alternative to open surgery for treatment of brain metastatic lesions, acoustic neuromas, and AVM in selected patients. This result conforms to previous studies, which also demonstrate that radiosurgery is the more cost-effective treatment for brain metastases and acoustic neuromas when patients are well suited for either approach. Further prospective studies are needed to show that this result is valid at other institutions.
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Affiliation(s)
- James P Caruso
- Department of Neurological Surgery, University of Virginia Health System, P.O. Box 800212, Charlottesville, VA 22908, USA
| | - Shayan Moosa
- Department of Neurological Surgery, University of Virginia Health System, P.O. Box 800212, Charlottesville, VA 22908, USA
| | - Francis Fezeu
- Department of Neurological Surgery, University of Virginia Health System, P.O. Box 800212, Charlottesville, VA 22908, USA
| | - Arjun Ramesh
- Department of Neurological Surgery, University of Virginia Health System, P.O. Box 800212, Charlottesville, VA 22908, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, P.O. Box 800212, Charlottesville, VA 22908, USA; Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA, USA.
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24
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Abd-El-Barr MM, Chiocca EA. Who benefits from surgery for brain metastases? World Neurosurg 2014; 82:e115-6. [PMID: 24636934 DOI: 10.1016/j.wneu.2014.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 03/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Muhammad M Abd-El-Barr
- Department of Neurosurgery, Harvard Medical School, Institute for the Neurosciences at the Brigham and Women's/Faulkner Hospital, and Center for Neuro-oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Harvard Medical School, Institute for the Neurosciences at the Brigham and Women's/Faulkner Hospital, and Center for Neuro-oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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25
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Serres S, Martin CJ, Sarmiento Soto M, Bristow C, O'Brien ER, Connell JJ, Khrapitchev AA, Sibson NR. Structural and functional effects of metastases in rat brain determined by multimodal MRI. Int J Cancer 2014; 134:885-96. [PMID: 23913394 DOI: 10.1002/ijc.28406] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/10/2013] [Accepted: 07/18/2013] [Indexed: 01/04/2023]
Abstract
Metastasis to the brain results in significant impairment of brain function and poor patient survival. Currently, magnetic resonance imaging (MRI) is under-utilised in monitoring brain metastases and their effects on brain function. Here, we sought to establish a model of focal brain metastasis in the rat that enables serial multimodal structural and functional MRI studies, and to assess the sensitivity of these approaches to metastatic growth. Female Berlin-Druckrey-IX rats were injected intracerebrally with metastatic ENU1564 cells in the ventroposterior medial nucleus (VPM) of the thalamus, a relay node of the whisker-to-barrel cortex pathway. Animals underwent multimodal structural and vascular MRI, as well as functional MRI of the cortical blood oxygenation level dependent (BOLD) responses to whisker pad stimulation. T2 , diffusion, magnetisation transfer and perfusion weighted MRI enabled differentiation between a central area of more advanced metastatic growth and penumbral regions of co-optive perivascular micrometastatic growth, with magnetisation transfer MRI being the most sensitive to micrometastatic growth. Areas of cortical BOLD activation in response to whisker pad stimulation were significantly reduced in the hemisphere containing metastases in the VPM. The reduction in BOLD response correlated with metastatic burden in the thalamus, and was sensitive to the presence of smaller metastases than currently detectable clinically. Our findings suggest that multimodal MRI provides greater sensitivity to tumour heterogeneity and micrometastatic growth than single modality contrast-enhanced MRI. Understanding the relationships between these MRI parameters and the underlying pathology may greatly enhance the utility of MRI in diagnosis, staging and monitoring of brain metastasis.
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Affiliation(s)
- Sébastien Serres
- CR-UK/MRC Gray Institute for Radiation Oncology and Biology, Department of Oncology, University of Oxford, Churchill Hospital, Oxford, OX3 7LJ, United Kingdom
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26
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Chaichana KL, Rao K, Gadkaree S, Dangelmajer S, Bettegowda C, Rigamonti D, Weingart J, Olivi A, Gallia GL, Brem H, Lim M, Quinones-Hinojosa A. Factors associated with survival and recurrence for patients undergoing surgery of cerebellar metastases. Neurol Res 2013; 36:13-25. [DOI: 10.1179/1743132813y.0000000260] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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27
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Identifying better surgical candidates among recursive partitioning analysis class 2 patients who underwent surgery for intracranial metastases. World Neurosurg 2013; 82:e267-75. [PMID: 24076052 DOI: 10.1016/j.wneu.2013.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 05/24/2013] [Accepted: 08/15/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The management of patients with brain metastases is typically dependent on their prognosis. Recursive partitioning analysis (RPA) is the most commonly used method for prognosticating survival, but has limitations for patients in the intermediate class. The aims of this study were to ascertain preoperative risk factors associated with survival, develop a preoperative prognostic grading system, and evaluate the utility of this system in predicting survival for RPA class 2 patients. METHODS Adult patient who underwent intracranial metastatic tumor surgery at an academic tertiary care institution from 1997 to 2011 were retrospectively reviewed. Multivariate proportional hazards regression analysis was used to identify preoperative factors associated with survival. The identified associations were then used to develop a grading system. Survival as a function of time was plotted using the Kaplan-Meier method, and survival rates were compared using log-rank analyses. RESULTS A total of 421 (59%) of 708 patients were RPA class 2. The preoperative factors found to be associated with poorer survival were: male gender (P < 0.0001), motor deficit (P = 0.0007), cognitive deficit (P = 0.0004), nonsolitary metastases (P = 0.002), and tumor size >2 cm (P = 0.003). Patients having 0-1, 2, and 3-5 of these variables were assigned a preoperative grade of A, B, and C, respectively. Patients with a preoperative grade of A, B, and C had a median survival of 17.0, 10.3, and 7.3 months, respectively. These grades had distinct survival times (P < 0.05). CONCLUSIONS The present study devised a preoperative grading system that may provide prognostic information for RPA class 2 patients, which may also guide medical and surgical therapies before any intervention is pursued.
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28
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Brem S, Meyers CA, Palmer G, Booth-Jones M, Jain S, Ewend MG. Preservation of neurocognitive function and local control of 1 to 3 brain metastases treated with surgery and carmustine wafers. Cancer 2013; 119:3830-8. [PMID: 24037801 PMCID: PMC4209121 DOI: 10.1002/cncr.28307] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 07/11/2013] [Indexed: 11/23/2022]
Abstract
Background Neurosurgical resection and whole-brain radiation therapy (WBRT) are accepted treatments for single and oligometastatic cancer to the brain. To avoid the decline in neurocognitive function (NCF) linked to WBRT, the authors conducted a prospective, multicenter, phase 2 study to determine whether surgery and carmustine wafers (CW), while deferring WBRT, could preserve NCF and achieve local control (LC). Methods NCF and LC were measured in 59 patients who underwent resection and received CW for a single (83%) or dominant (oligometastatic, 2 to 3 lesions) metastasis and received stereotactic radiosurgery (SRS) for tiny nodules not treated with resection plus CW. Preservation of NCF was defined as an improvement or a decline ≤1 standard deviation from baseline in 3 domains: memory, executive function, and fine motor skills, evaluated at 2-month intervals. Results Significant improvements in executive function and memory occurred throughout the 1-year follow-up. Preservation or improvement of NCF occurred in all 3 domains for the majority of patients at each of the 2-month intervals. NCF declined in only 1 patient. The chemowafers were well tolerated, and serious adverse events were reversible. There was local recurrence in 28% of the patients at 1-year follow-up. Conclusions Patients with brain metastases had improvements in their cognitive trajectory, especially memory and executive function, after treatment with resection plus CW. The rate of LC (78%) was comparable to historic rates of surgery with WBRT and superior to reports of WBRT alone. For patients who undergo resection for symptomatic or large-volume metastasis or for tissue diagnosis, the addition of CW can be considered as an option.
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Affiliation(s)
- Steven Brem
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, Florida; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania and the Abramson Cancer Center, Philadelphia, Pennsylvania
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29
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Chaichana KL, Flores M, Acharya S, Sampognaro P, Bettegowda C, Rigamonti D, Weingart JD, Olivi A, Gallia GL, Brem H, Lim M, Quinones-Hinojosa A. Survival and recurrence for patients undergoing surgery of skull base intracranial metastases. J Neurol Surg B Skull Base 2013; 74:228-35. [PMID: 24436917 DOI: 10.1055/s-0033-1342925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/28/2013] [Indexed: 10/27/2022] Open
Abstract
Objective Skull base metastases (SBMs) are rare lesions in close proximity to critical neural and vasculature structures. This rarity and complexity have led many to only offer nonsurgical therapies. The surgical outcomes for patients with SBM therefore remain unknown. Design Retrospective, comparison analyses. Setting Johns Hopkins Hospital. Participants All patients who underwent intracranial metastatic tumor surgery. Main Outcome Measure Survival and recurrence. Results Of the 708 patients who underwent intracranial metastatic tumor surgery, 29 (4%) had SBM: 3 (10%) involved the anterior skull base, 7 (24%) the sella, 6 (21%) the orbit, 2 (7%) the sphenoid wing, 3 (10%) the clivus, 4 (14%) the petrous bone, and 4 (14%) the paranasal sinuses. Following surgery, 6 (50%) had improvements in vision and 14 (88%) had improvement and/or maintenance of their cranial nerve symptoms. Three (10%), 0(0%), and 1(3%) developed a new motor, language, and vision deficit, respectively. There were no differences in median survival (10.0 versus 9.2 months, p = 0.48) and local progression-free survival (PFS) (p = 0.52), but there was improved distal PFS (p = 0.04) between patients with and without SBM. Conclusions Patients with SBM are relatively rare. These patients can tolerate surgery with minimal morbidity and mortality, and they have similar prognoses to patients without SBM.
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Affiliation(s)
- Kaisorn L Chaichana
- Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA ; Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
| | - Mariana Flores
- Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA ; Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
| | - Shami Acharya
- Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA ; Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
| | - Paul Sampognaro
- Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA ; Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
| | - Chetan Bettegowda
- Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA ; Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
| | - Daniele Rigamonti
- Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA ; Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
| | - Jon D Weingart
- Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA ; Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
| | - Alessandro Olivi
- Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA ; Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
| | - Gary L Gallia
- Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA ; Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
| | - Henry Brem
- Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA ; Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
| | - Michael Lim
- Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA ; Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
| | - Alfredo Quinones-Hinojosa
- Departments of Neurosurgery, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA ; Departments of Oncology, Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, Baltimore, Maryland, USA
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30
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Current world literature. Curr Opin Oncol 2012; 24:756-68. [PMID: 23079785 DOI: 10.1097/cco.0b013e32835a4c91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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