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Fadul CE, Sheehan JP, Silvestre J, Bonilla G, Bovi JA, Ahluwalia M, Soffietti R, Hui D, Anderson RT. Defining the quality of interdisciplinary care for patients with brain metastases: modified Delphi panel recommendations. Lancet Oncol 2024; 25:e432-e440. [PMID: 39214114 DOI: 10.1016/s1470-2045(24)00198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/21/2024] [Accepted: 04/04/2024] [Indexed: 09/04/2024]
Abstract
The value of interdisciplinary teams in improving outcomes and quality of care of patients with brain metastases remains uncertain, partly due to the lack of consensus on key indicators to evaluate interprofessional care. We aimed to obtain expert consensus across disciplines on indicators that evaluate the quality and value of brain metastases care. A steering committee of key opinion leaders curated relevant outcomes and process indicators from a literature review and a stakeholder needs assessment, and an international panel of physicians rated the outcomes and process indicators using a modified Delphi method. After three rounds, a consensus was reached on 29 indicators encompassing brain-directed oncological treatment, surgery, whole-brain radiotherapy, stereotactic radiosurgery, supportive or palliative care, and interdisciplinary team care. The Brain Metastases Quality-of-Care measure reflects the value and quality of brain metastases team-based care according to treatment modality and provides a benchmark of care for this under-studied patient population. The adoption, implementation, and sustainability of this set of indicators could help address the need expressed by patients with cancer, caregivers, and clinicians for more coordinated care across inpatient, outpatient, home, community, and tertiary academic settings.
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Affiliation(s)
- Camilo E Fadul
- Department of Neurology, Division of Neuro-Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Julio Silvestre
- Department of Palliative Care, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Gloribel Bonilla
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Joseph A Bovi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Manmeet Ahluwalia
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Riccardo Soffietti
- Department of Neuroscience, Division of Neuro-Oncology, University of Turin and City of Health and Science University Hospital, Turin, Italy
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roger T Anderson
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA; Department of Public Health, University of Virginia School of Medicine, Charlottesville, VA, USA
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Gong Z, Xu T, Peng N, Cheng X, Niu C, Wiestler B, Hong F, Li HB. A Multi-Center, Multi-Parametric MRI Dataset of Primary and Secondary Brain Tumors. Sci Data 2024; 11:789. [PMID: 39019912 PMCID: PMC11255278 DOI: 10.1038/s41597-024-03634-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 07/11/2024] [Indexed: 07/19/2024] Open
Abstract
Brain metastases (BMs) and high-grade gliomas (HGGs) are the most common and aggressive types of malignant brain tumors in adults, with often poor prognosis and short survival. As their clinical symptoms and image appearances on conventional magnetic resonance imaging (MRI) can be astonishingly similar, their accurate differentiation based solely on clinical and radiological information can be very challenging, particularly for "cancer of unknown primary", where no systemic malignancy is known or found. Non-invasive multiparametric MRI and radiomics offer the potential to identify these distinct biological properties, aiding in the characterization and differentiation of HGGs and BMs. However, there is a scarcity of publicly available multi-origin brain tumor imaging data for tumor characterization. In this paper, we introduce a multi-center, multi-origin brain tumor MRI (MOTUM) imaging dataset obtained from 67 patients: 29 with high-grade gliomas, 20 with lung metastases, 10 with breast metastases, 2 with gastric metastasis, 4 with ovarian metastasis, and 2 with melanoma metastasis. This dataset includes anonymized DICOM files alongside processed FLAIR, T1-weighted, contrast-enhanced T1-weighted, T2-weighted sequences images, segmentation masks of two tumor regions, and clinical data. Our data-sharing initiative is to support the benchmarking of automated tumor segmentation, multi-modal machine learning, and disease differentiation of multi-origin brain tumors in a multi-center setting.
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Affiliation(s)
- Zhenyu Gong
- Department of Neurosurgery, Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tao Xu
- Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Nan Peng
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xing Cheng
- Department of Spine Surgery, Orthopedics Center of Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Spine Surgery, Orthopedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, China
| | - Chen Niu
- PET/CT center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fan Hong
- Department of Neurosurgery, Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China.
| | - Hongwei Bran Li
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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Ebaid NY, Ahmed RN, Assy MM, Amin MI, Alaa Eldin AM, Alsowey AM, Abdelhay RM. Diagnostic validity and reliability of BT-RADS in the management of recurrent high-grade glioma. J Neuroradiol 2024; 51:101190. [PMID: 38492800 DOI: 10.1016/j.neurad.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND AND PURPOSE BT-RADS is a new framework system for reporting the treatment response of brain tumors. The aim of the study was to assess the diagnostic performance and reliability of the BT-RADS in predicting the recurrence of high-grade glioma (HGG). MATERIALS AND METHODS This prospective single-center study recruited 81 cases with previously operated and pathologically proven HGG. The patients underwent baseline and follow-up contrast-enhanced MRI (CE-MRI). Two neuro-radiologists with ten years-experience in neuroimaging independently analyzed and interpreted the MRI images and assigned a BT-RADS category for each case. To assess the diagnostic accuracy of the BT-RADS for detecting recurrent HGG, the reference standard was the histopathology for BT-RADS categories 3 and 4, while neurological clinical examination and clinical follow up were used as a reference for BT-RADS categories 1 and 2. The inter-reader agreement was assessed using the Cohen's Kappa test. RESULTS The study included 81 cases of HGG, of which 42 were recurrent and 39 were non-recurrent HGG cases based on the reference test. BT-RADS 3B was the best cutoff for predicting recurrent HGG with a sensitivity of 90.5 % to 92.9 %, specificity of 76.9 % to 84.6 %, and accuracy of 83.9 % to 88.9 %, based on both readers. The BT-RADS showed a substantial inter-reader agreement with a K of 0.710 (P = 0.001). CONCLUSIONS The BT-RADS is a valid and reliable framework for predicting recurrent HGG. Moreover, BT-RADS can help neuro-oncologists make clinical decisions that can potentially improve the patient's outcome.
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Affiliation(s)
- Noha Yahia Ebaid
- Department of Radiology, Faculty of medicine, Zagazig University, Zagazig, Egypt; Negida academy LLC, Arlington, MA, USA
| | - Rasha Nadeem Ahmed
- Department of Surgery, College of medicine, Ninevah University, Mosul, Iraq
| | - Mostafa Mohamad Assy
- Department of Radiology, Faculty of medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Ibrahim Amin
- Department of Radiology, Faculty of medicine, Zagazig University, Zagazig, Egypt
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Fadul CE, Sarai G, Bovi JA, Thomas AA, Novicoff W, Anderson R, Amidon RF, Schuetz S, Singh R, Chang A, Gentzler RD, Gaughan EM, Sheehan JP. Relevance of the Updated Recursive Partitioning Analysis (U-RPA) Classification in the Contemporary Care of Patients with Brain Metastases. Cancers (Basel) 2023; 15:3255. [PMID: 37370865 DOI: 10.3390/cancers15123255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
Patients with brain metastases (BMETS) need information about the prognosis and potential value of treatment options to make informed therapeutic decisions, but tools to predict survival in contemporary practice are scarce. We propose an Updated Recursive Partitioning Analysis (U-RPA) instrument to predict survival and benefit from brain-directed treatment (BDT) of contemporary patients. This was a retrospective analysis of patients with BMETS treated between 2017 and 2019. With survival as the primary endpoint, we calculated the U-RPA and generated estimates using Kaplan-Meier curves and hazard ratios. Of 862 eligible patients, 752 received BDT and 110 received best supportive care (BSC). Median overall survival with BDT and BSC was 9.3 and 1.3 months, respectively. Patients in RPA class 1, 2A, 2B and 3 who underwent BDT had median survival of 28.1, 14.7, 7.6 and 3.3 months, respectively. The median survival for patients in RPA 3 who received BDT (n = 147), WBRT (n = 79) and SRS (n = 54) was 3.3, 2.9 and 4.1 months, respectively. The U-RPA defines prognosis estimates, independent of tumor type and treatment modality, which can assist to make value-based care treatment decisions. The prognosis for patients in U-RPA class 2B and 3 remains poor, with consideration for early palliative care involvement in these cases.
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Affiliation(s)
- Camilo E Fadul
- Division of Neuro-Oncology, Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Guneet Sarai
- Division of Neuro-Oncology, Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Joseph A Bovi
- Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI 53222, USA
| | - Alissa A Thomas
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA
| | - Wendy Novicoff
- Department of Public Health Sciences and Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Roger Anderson
- Population Sciences, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Ryan F Amidon
- Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI 53222, USA
| | - Samantha Schuetz
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA
| | - Rohit Singh
- Division of Hematology and Oncology, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA
| | - Amy Chang
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT 05405, USA
| | - Ryan D Gentzler
- Division of Hematology and Oncology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Elizabeth M Gaughan
- Division of Hematology and Oncology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
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Winther RR, Skovlund E, Andreassen JS, Arvidsson L, Halvardson J, Solheim O, Bartek J, Kaasa S, Hjermstad MJ, Vik-Mo EO. Preoperative Prognostic Index for Patients with Brain Metastases-A Population-Based Multi-Centre Study. Cancers (Basel) 2023; 15:3174. [PMID: 37370784 DOI: 10.3390/cancers15123174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Brain metastases (BM) are common in cancer patients and are associated with high morbidity and mortality. Surgery is an option, but the optimal selection of patients for surgery is challenging and controversial. Current prognostication tools are not ideal for preoperative prognostication. By using a reference population (derivation data set) and two external populations (validation data set) of patients who underwent surgery for BM, we aimed to create and validate a preoperative prognostic index. METHODS The derivation data set consists of 590 patients who underwent surgery for BM (2011-2018) at Oslo University Hospital. We identified variables associated with survival and created a preoperative prognostic index with four prognostic groups, which was validated on patients who underwent surgery for BM at Karolinska University Hospital and St. Olavs University Hospital during the same time period. To reduce over-fitting, we adjusted the index in accordance with our findings. RESULTS 438 patients were included in the validation data set. The preoperative prognostic index correctly divided patients into four true prognostic groups. The two prognostic groups with the poorest survival outcomes overlapped, and these were merged to create the adjusted preoperative prognostic index. CONCLUSION We created a prognostic index for patients with BM that predicts overall survival preoperatively. This index might be valuable in supporting informed choice when considering surgery for BM.
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Affiliation(s)
- Rebecca Rootwelt Winther
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, 4956 Oslo, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7034 Trondheim, Norway
| | | | - Lisa Arvidsson
- Department of Neurosurgery, Karolinska University Hospital, 17164 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Jonathan Halvardson
- Department of Neurosurgery, Karolinska University Hospital, 17164 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Ole Solheim
- Department of Neurosurgery, St. Olavs University Hospital, 7030 Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, 7034 Trondheim, Norway
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, 17164 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, 4956 Oslo, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, 4956 Oslo, Norway
| | - Einar Osland Vik-Mo
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
- Vilhelm Magnus Laboratory, Department of Neurosurgery, Oslo University Hospital, 0372 Oslo, Norway
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6
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Anokwute MC, Preda V, Di Ieva A. Determining Contemporary Barriers to Effective Multidisciplinary Team Meetings in Neurological Surgery: A Review of the Literature. World Neurosurg 2023; 172:73-80. [PMID: 36754351 DOI: 10.1016/j.wneu.2023.01.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The integration of multidisciplinary team meetings (MDTMs) for neurosurgical care has been accepted worldwide. Our objective was to review the literature for the limiting factors to MDTMs that may introduce bias to patient care. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to perform a literature review of MDTMs for neuro-oncology, pituitary oncology, cerebrovascular surgery, and spine surgery and spine oncology. Limiting factors to productive MDTMs and factors that introduce bias were identified, as well as determining whether MDTMs led to improved patient outcomes. RESULTS We identified 1264 manuscripts from a PubMed and Ovid Medline search, of which 27 of 500 neuro-oncology, 4 of 279 pituitary, and 11 of 260 spine surgery articles met our inclusion criteria. Of 224 cerebrovascular manuscripts, none met the criteria. Factors for productive MDTMs included quaternary/tertiary referral centers, nonhierarchical environment, regularly scheduled meetings, concise inclusion of nonmedical factors at the same level of importance as patient clinical information, inclusion of nonclinical participants, and use of clinical guidelines and institutional protocols to provide recommendations. Our review did not identify literature that described the use of artificial intelligence to reduce bias and guide clinical care. CONCLUSIONS The continued implementation of MDTMs in neurosurgery should be recommended but cautioned by limiting bias.
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Affiliation(s)
- Miracle C Anokwute
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia; Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Veronica Preda
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Antonio Di Ieva
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia; Computational NeuroSurgery (CNS) Lab, Macquarie University, Sydney, New South Wales, Australia.
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Basile M, Di Brino E, Rumi F, Palmeri M, Cicchetti A. Analysis of the multidisciplinary approach for the management of patients affected by chronic myeloid leukaemia. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2020-000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BackgroundChronic myelogenous leukaemia (CML) is a pathological clinical condition with a yearly incidence between 10 and 15 cases per million people, 14 in Italy. Its incidence increases with age, reaching 20–25 yearly cases per million individuals in people over 70 years. A growing importance has been given to the need of a multidisciplinary approach (MDA) for the management of patients with CML.ObjectiveTo analyse the importance of MDA as compared with the current Italian standard of care for the management of CML patients based on the involvement of several health professional figures.MethodsA group of healthcare professionals from several healthcare structures were gathered in a first Advisory Board (AB) and divided into as many groups as the number of belonging health structures representative of the Italian provision of therapeutic approaches for CML. In a second AB, the results were validated by the same panel of experts.ResultsThe number of dedicated health professionals within the dedicated ward ranged from 1 to 13. Most structures rely on several professionals intervening only in case of necessity. Only one centre provides a booking service based on clinical needs to avoid waiting times. Most centres report there is basically no disagreement in the definition of the clinical pathway and there is a high adherence to national and international CML guidelines.ConclusionsThe development of forms of interorganisational and interprofessional coordination to improve the diagnosis and the treatment of CML patients have been for long on the agenda of policy makers, managers and professionals for more than 20 years. This analysis represents a starting reference to consider for the evaluation of an MDA in the Italian context.
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Moss NS, Beal K, Tabar V. Brain Metastasis-A Distinct Oncologic Disease Best Served by an Integrated Multidisciplinary Team Approach. JAMA Oncol 2022; 8:1252-1254. [PMID: 35862025 PMCID: PMC9984120 DOI: 10.1001/jamaoncol.2022.1928] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This Viewpoint discusses the identification and treatment of brain metastasis as a distinct disease and its management with a multidisciplinary approach to improve patient outcomes.
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Affiliation(s)
- Nelson S. Moss
- Memorial Sloan Kettering Cancer Center, Department of Neurosurgery and Brain Metastasis Center, New York, New York, USA
| | - Kathryn Beal
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology and Brain Metastasis Center, New York, New York, USA
| | - Viviane Tabar
- Memorial Sloan Kettering Cancer Center, Department of Neurosurgery and Brain Metastasis Center, New York, New York, USA
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Kim AE, Wang GM, Waite KA, Elder S, Fine A, Ahluwalia MS, Brat D, Mehta MP, Page R, Dunbar E, Calderone HM, Robins DS, DeVitto R, Willmarth NE, Barnholtz-Sloan JS, Brastianos PK. Cross-sectional survey of patients, caregivers, and physicians on diagnosis and treatment of brain metastases. Neurooncol Pract 2021; 8:662-673. [PMID: 34777835 PMCID: PMC8579087 DOI: 10.1093/nop/npab042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The development of brain metastases (BM) is one of the most feared complications of cancer due to the substantial neurocognitive morbidity and a grim prognosis. In the past decade, targeted therapies and checkpoint inhibitors have demonstrated promising intracranial response rates for tumors of multiple histologies. As overall survival for these patients improves, there is a growing need to identify issues surrounding patient survivorship and to standardize physician practice patterns for these patients. To date, there has not been an adequate study to specifically explore these questions of survivorship and practice standardization for patients with advanced cancer and BM. METHODS Here, we present results from a cross-sectional survey in which we analyze responses from 237 patients, 209 caregivers, and 239 physicians to identify areas of improvement in the clinical care of BM. RESULTS In comparing physician and patient/caregiver responses, we found a disparity in the perceived discussion of topics pertaining to important aspects of BM clinical care. We identified variability in practice patterns for this patient population between private practice and academic physicians. Many physicians continue to have patients with BM excluded from clinical trials. Finally, we obtained patient/physician recommendations on high-yield areas for federal funding to improve patient quality of life. CONCLUSION By identifying potential areas of unmet need, we anticipate this wealth of actionable information will translate into tangible benefits for both patients and caregivers. Future studies are needed to validate our findings.
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Affiliation(s)
- Albert E Kim
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gi-Ming Wang
- Case Comprehensive Cancer Center and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kristin A Waite
- Case Comprehensive Cancer Center and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Scott Elder
- Penn, Schoen, and Berland (PSB) Research, Washington, DC, USA
| | - Avery Fine
- Penn, Schoen, and Berland (PSB) Research, Washington, DC, USA
| | - Manmeet S Ahluwalia
- Burkhardt Brain Tumor Neuro-Oncology Center, Neurological Institute, Taussig Cancer Center Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Brat
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Robin Page
- American Brain Tumor Association, Chicago, Illinois, USA
| | - Erin Dunbar
- Piedmont Brain Tumor Center, Piedmont Cancer Institute, Atlanta, Georgia, USA
| | | | | | - Ralph DeVitto
- American Brain Tumor Association, Chicago, Illinois, USA
| | | | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Case Comprehensive Cancer Center, University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Priscilla K Brastianos
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
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10
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Surgical Treatment of Cerebellar Metastases: Survival Benefits, Complications and Timing Issues. Cancers (Basel) 2021; 13:cancers13215263. [PMID: 34771427 PMCID: PMC8582465 DOI: 10.3390/cancers13215263] [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: 09/07/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Cerebellar metastases are often considered to have a poor prognosis. This retrospective study investigated the clinical course and functional outcome of 73 patients who underwent surgical treatment for cerebellar metastases. Median overall survival was 9.2 months which compares favorably with the more recent literature. Prognosis varied strikingly between individuals. This suggests a policy of individualized decision-making which includes offering surgery also in selected cases with adverse prognostic parameters. The presence of extracerebral metastases did not significantly influence survival which may justify expedited surgery in selected cases prior to the oncological work-up. Systemic therapy was associated with substantially better survival indicating that recent advances in medical oncology might amplify any survival benefit derived from surgery. Surgery was found to carry significant morbidity and even mortality. Major complications often precluded adjuvant treatment and correlated with markedly reduced survival. Complication avoidance is therefore of utmost importance. Abstract We retrospectively studied 73 consecutive patients who underwent surgery 2015–2020 for removal of cerebellar metastases (CM). Median overall survival (medOS) varied widely between patients and compared favorably with the more recent literature (9.2, 25–75% IQR: 3.2–21.7 months vs. 5–8 months). Prognostic factors included clinical (but not radiological) hydrocephalus (medOS 11.3 vs. 5.2 months, p = 0.0374). Of note, a third of the patients with a KPI <70% or multiple metastases survived >12 months. Chemotherapy played a prominent prognostic role (medOS 15.5 vs. 2.3, p < 0.0001) possibly reflecting advances in treating systemic vis-à-vis controlled CNS disease. Major neurological (≥30 days), surgical and medical complications (CTCAE III–V) were observed in 8.2%, 13.7%, and 9.6%, respectively. The occurrence of a major complication markedly reduced survival (10.7 vs. 2.5 months, p = 0.020). The presence of extracerebral metastases did not significantly influence OS. Postponing staging was not associated with more complications or shorter survival. Together these data argue for individualized decision making which includes offering surgery in selected cases with a presumably adverse prognosis and also occasional urgent operations in cases without a preoperative oncological work-up. Complication avoidance is of utmost importance.
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Proescholdt MA, Schödel P, Doenitz C, Pukrop T, Höhne J, Schmidt NO, Schebesch KM. The Management of Brain Metastases-Systematic Review of Neurosurgical Aspects. Cancers (Basel) 2021; 13:1616. [PMID: 33807384 PMCID: PMC8036330 DOI: 10.3390/cancers13071616] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023] Open
Abstract
The multidisciplinary management of patients with brain metastases (BM) consists of surgical resection, different radiation treatment modalities, cytotoxic chemotherapy, and targeted molecular treatment. This review presents the current state of neurosurgical technology applied to achieve maximal resection with minimal morbidity as a treatment paradigm in patients with BM. In addition, we discuss the contribution of neurosurgical resection on functional outcome, advanced systemic treatment strategies, and enhanced understanding of the tumor biology.
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Affiliation(s)
- Martin A. Proescholdt
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.A.P.); (P.S.); (C.D.); (J.H.); (N.O.S.)
- Wilhelm Sander Neuro-Oncology Unit, University Hospital Regensburg, 93053 Regensbur, Germany;
| | - Petra Schödel
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.A.P.); (P.S.); (C.D.); (J.H.); (N.O.S.)
- Wilhelm Sander Neuro-Oncology Unit, University Hospital Regensburg, 93053 Regensbur, Germany;
| | - Christian Doenitz
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.A.P.); (P.S.); (C.D.); (J.H.); (N.O.S.)
- Wilhelm Sander Neuro-Oncology Unit, University Hospital Regensburg, 93053 Regensbur, Germany;
| | - Tobias Pukrop
- Wilhelm Sander Neuro-Oncology Unit, University Hospital Regensburg, 93053 Regensbur, Germany;
- Department of Medical Oncology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Julius Höhne
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.A.P.); (P.S.); (C.D.); (J.H.); (N.O.S.)
- Wilhelm Sander Neuro-Oncology Unit, University Hospital Regensburg, 93053 Regensbur, Germany;
| | - Nils Ole Schmidt
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.A.P.); (P.S.); (C.D.); (J.H.); (N.O.S.)
- Wilhelm Sander Neuro-Oncology Unit, University Hospital Regensburg, 93053 Regensbur, Germany;
| | - Karl-Michael Schebesch
- Department of Neurosurgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.A.P.); (P.S.); (C.D.); (J.H.); (N.O.S.)
- Wilhelm Sander Neuro-Oncology Unit, University Hospital Regensburg, 93053 Regensbur, Germany;
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12
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Foundations of Neuro-Oncology: A Multidisciplinary Approach. World Neurosurg 2021; 151:392-401. [PMID: 33618043 DOI: 10.1016/j.wneu.2021.02.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/24/2022]
Abstract
Neuro-oncology is a branch of medicine focused on the diagnosis and treatment of primary and secondary tumors of the nervous system as well as the neurologic complications of cancer and cancer treatments. In practice, neuro-oncologists require an intimate knowledge of the neurologic presentation and management of central nervous system tumors, including gliomas, meningiomas, primary central nervous system lymphoma, metastases to the nervous system, and others. The mainstays of treatment for most nervous system tumors include surgical intervention, radiation therapy, and medical treatment with chemotherapy, immunotherapy, and/or targeted therapy. Interdisciplinary collaboration is thus critical to neuro-oncology. The prognosis for many central nervous system tumors, including gliomas and brain metastases, is often poor despite the advent of novel medical therapies. Efforts to develop more effective therapies are ongoing, and patient enrollment in clinical trials assessing the efficacy of new treatments is crucial to improve outcomes.
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13
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Incidence, risk factors and survival of patients with brain metastases at initial metastatic breast cancer diagnosis in China. Breast 2020; 55:30-36. [PMID: 33310633 PMCID: PMC7736978 DOI: 10.1016/j.breast.2020.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose To characterize the incidence, risk factors and survival of patients with brain metastases at initial diagnosis of metastatic breast cancer (MBC) in China. Methods The China National Cancer Center database was used to identify 2087 MBC patients diagnosed between 2003 and 2015. Clinicopathological features, treatment and survival information were extracted. Multivariable logistic and Cox regression were performed to determine factors predictive of brain metastases at MBC diagnosis and survival, respectively. Results Brain metastases occurred in ninety patients (4.3%) at MBC diagnosis, and in 27 patients (2.5%), 42 patients (7.2%) and 21 patients (5.2%) with hormone receptor positive, human epidermal growth factor receptor 2 negative (HR + HER2-), HER2-positive and triple negative breast cancer (TNBC), respectively. HER2-positive subtype (OR = 2.38; 95% CI 1.40–4.04; p < 0.0001), TNBC subtype (OR = 1.89; 95% CI 1.02–3.51; p = 0.005), and metastases to all three sites of bone, liver and lungs (OR = 3.23; 95% CI 1.52–6.87; p = 0.002) were shown to increase the risk of BM at MBC diagnosis. Median survival after BM was 23.7 months. First-line tyrosine kinase inhibitors (TKI) improved survival compared to trastuzumab-based regimen (44.9 vs 35.4 months, p = 0.09). Factors that independently decreased BM death risk were ECOG<2, brain metastases only and multidisciplinary treatment. Conclusion HER2-positive and TNBC subtypes have a higher incidence of BM at initial MBC diagnosis. Brain screening might be considered in patients with HER2-positive disease at MBC diagnosis, and further prospective randomized study is warranted. Large retrospective analysis focusing on patients with BM at initial MBC diagnosis. HER2-positive subtype presented with the highest incidence of BM at initial MBC diagnosis. Patients with brain metastases only and receiving multidisciplinary treatment have a superior OS. Brain screening might be considered in HER2-positive patients with BM at MBC diagnosis.
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14
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Silvestre J, Gosse T, Read P, Gentzler R, Purow B, Asthagiri A, Gaughan E, Dillon PM, Larner JM, Anderson RT, Sheehan JP, Fadul CE. Genesis of Quality Measurements to Improve the Care Delivered to Patients With Brain Metastases. JCO Oncol Pract 2020; 17:e397-e405. [PMID: 32780641 DOI: 10.1200/op.20.00233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE High-value and high-quality health care requires outcome measurements to inform treatment decisions, but, to our knowledge, no standardized measurements exist to evaluate brain metastases (BMs) care. We propose a set of measurements and report on their implementation in the care of patients with BMs. METHODS On the basis of a stakeholders' needs assessment and review of the literature, we identified outcome and process measurements to assess the care of patients with BMs according to treatment modality. Retrospectively, we applied these indicators of care to all patients diagnosed and treated at our institution over 2 years. RESULTS We ascertained 5 outcome and 6 process measurements of relevance in the care of BMs. When applied to 209 patients (89.7%) who received cancer treatment, 77% were alive > 90 days after diagnosis. The proportion alive at 90 days after surgery, whole-brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS) was 82%, 59%, and 81%, respectively. Other performance measurements included 30-day postoperative readmission rate (6%), SRS within 30 days of surgery (79%), use of memantine with WBRT (41%), advance directives within 6 months of diagnosis (53%), and palliative care consultation for patients with poor prognosis or receiving WBRT (45%). Measurements for the 24 patients (10.3%) receiving best supportive care were advance directives documentation (67%) and referral to palliative or hospice care (83%). CONCLUSION We propose a set of measurements to apprise quality improvement efforts, inform treatment decision-making, and to use in evaluation of the performance of interdisciplinary BMs programs. Their refinement can potentially enhance the quality and value of care delivered to patients with BMs.
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Affiliation(s)
- Julio Silvestre
- Department of Medicine, Palliative Care Medicine Section, University of Virginia Health System, Charlottesville, VA
| | - Tracey Gosse
- Department of Neurology, Division of Neuro-Oncology, University of Virginia Health System, Charlottesville, VA
| | - Paul Read
- Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA
| | - Ryan Gentzler
- Department of Medicine, Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA
| | - Benjamin Purow
- Department of Neurology, Division of Neuro-Oncology, University of Virginia Health System, Charlottesville, VA
| | - Ashok Asthagiri
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA
| | - Elizabeth Gaughan
- Department of Medicine, Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA
| | - Patrick M Dillon
- Department of Medicine, Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA
| | - James M Larner
- Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA
| | - Camilo E Fadul
- Department of Neurology, Division of Neuro-Oncology, University of Virginia Health System, Charlottesville, VA
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15
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Jung J, Tailor J, Dalton E, Glancz LJ, Roach J, Zakaria R, Lammy S, Chari A, Budohoski KP, Livermore LJ, Yu K, Jenkinson MD, Brennan PM, Brazil L, Bunce C, Bourmpaki E, Ashkan K, Vergani F. Management evaluation of metastasis in the brain (MEMBRAIN)-a United Kingdom and Ireland prospective, multicenter observational study. Neurooncol Pract 2020; 7:344-355. [PMID: 32537183 PMCID: PMC7274191 DOI: 10.1093/nop/npz063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In recent years an increasing number of patients with cerebral metastasis (CM) have been referred to the neuro-oncology multidisciplinary team (NMDT). Our aim was to obtain a national picture of CM referrals to assess referral volume and quality and factors affecting NMDT decision making. METHODS A prospective multicenter cohort study including all adult patients referred to NMDT with 1 or more CM was conducted. Data were collected in neurosurgical units from November 2017 to February 2018. Demographics, primary disease, KPS, imaging, and treatment recommendation were entered into an online database. RESULTS A total of 1048 patients were analyzed from 24 neurosurgical units. Median age was 65 years (range, 21-93 years) with a median number of 3 referrals (range, 1-17 referrals) per NMDT. The most common primary malignancies were lung (36.5%, n = 383), breast (18.4%, n = 193), and melanoma (12.0%, n = 126). A total of 51.6% (n = 541) of the referrals were for a solitary metastasis and resulted in specialist intervention being offered in 67.5% (n = 365) of cases. A total of 38.2% (n = 186) of patients being referred with multiple CMs were offered specialist treatment. NMDT decision making was associated with number of CMs, age, KPS, primary disease status, and extent of extracranial disease (univariate logistic regression, P < .001) as well as sentinel location and tumor histology (P < .05). A delay in reaching an NMDT decision was identified in 18.6% (n = 195) of cases. CONCLUSIONS This study demonstrates a changing landscape of metastasis management in the United Kingdom and Ireland, including a trend away from adjuvant whole-brain radiotherapy and specialist intervention being offered to a significant proportion of patients with multiple CMs. Poor quality or incomplete referrals cause delay in NMDT decision making.
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Affiliation(s)
- Josephine Jung
- Department of Neurosurgery, King’s College Hospital, London, UK
- Neurosciences Clinical Trials Unit, King’s College Hospital, London, UK
| | - Jignesh Tailor
- Department of Neurosurgery, St. George’s Hospital, London, UK
- The Hospital for Sick Children, Toronto, Canada
| | - Emma Dalton
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Laurence J Glancz
- Department of Neurosurgery, Queen’s Medical Centre, Nottingham University Hospital, UK
| | - Joy Roach
- Wessex Neurological Centre, University Hospitals Southampton, UK
| | - Rasheed Zakaria
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
- Institute of Integrative Biology, University of Liverpool, UK
| | - Simon Lammy
- Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Aswin Chari
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | | | | | - Kenny Yu
- Department of Neurosurgery, Salford Royal Hospital, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, UK
| | | | - Paul M Brennan
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Lucy Brazil
- Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Catey Bunce
- Department of Primary Care & Public Health Sciences, Kings College London, UK
| | - Elli Bourmpaki
- Department of Primary Care & Public Health Sciences, Kings College London, UK
| | - Keyoumars Ashkan
- Neurosciences Clinical Trials Unit, King’s College Hospital, London, UK
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Kwee RM, Kwee TC. Dynamic susceptibility MR perfusion in diagnosing recurrent brain metastases after radiotherapy: A systematic review and meta-analysis. J Magn Reson Imaging 2019; 51:524-534. [PMID: 31150144 PMCID: PMC7004193 DOI: 10.1002/jmri.26812] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/17/2019] [Indexed: 01/18/2023] Open
Abstract
Background The diagnostic performance of dynamic susceptibility contrast (DSC) MR perfusion in discriminating treatment‐related changes from recurrence in irradiated brain metastases is currently not completely clear. Purpose To systematically review the accuracy of DSC MR perfusion in diagnosing recurrent brain metastases after radiotherapy. Study Type Systematic review and meta‐analysis. Subjects MEDLINE and Embase were searched for original studies investigating the accuracy of DSC MR perfusion in diagnosing recurrent brain metastases after radiotherapy. Ten studies, comprising a total of more than 271 metastases, were included. Field Strength/Sequence 1.5T or 3.0T, DSC MR perfusion. Assessment Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. Statistical Tests Sensitivity and specificity were pooled with a bivariate random‐effects model. Heterogeneity was assessed by a chi‐squared test. Potential sources for heterogeneity were explored by subgroup analyses. Results In seven studies the diagnostic criterion was not prespecified. In eight studies it was unclear whether the reference standard was interpreted blindly. In seven studies it was unclear whether DSC MR perfusion results influenced which reference standard was used. Pooled sensitivity and specificity were 81.6% (95% confidence interval [CI]: 70.6%, 89.1%) and 80.6% (95% CI: 64.2%, 90.6%), respectively. There was significant heterogeneity in both sensitivity (P = 0.005) and specificity (P < 0.001). There were no significant differences in relative diagnostic odds ratio according to publication year, country of origin, study size, and DSC MR perfusion interpretation method (visual analysis of cerebral blood volume [CBV] map vs. relative CBV measurement) (P > 0.2). Due to insufficiently detailed reporting, it was not possible to investigate the influence of primary tumor origin on accuracy. Data Conclusion Our results suggest that the accuracy of DSC MR perfusion in diagnosing recurrent brain metastases after radiotherapy is fairly high. However, these findings should be interpreted with caution because of methodological quality concerns and heterogeneity between studies. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:524–534.
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Affiliation(s)
- Robert M Kwee
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
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