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Xiao H, Vaidya R, Hershman DL, Unger JM. Impact of Broadening Trial Eligibility Criteria on the Inclusion of Patients With Brain Metastases in Cancer Clinical Trials: Time Series Analyses for 2012-2022. J Clin Oncol 2024; 42:1953-1960. [PMID: 38537158 DOI: 10.1200/jco.23.01777] [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: 08/16/2023] [Revised: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 05/31/2024] Open
Abstract
PURPOSE In October 2017, an ASCO, Friends of Cancer Research (FoCR), and US Food and Drug Administration (ASCO/FoCR/FDA) task force recommended that common eligibility criteria be modified to make trials more inclusive. We examined whether patterns of exclusions regarding patients with brain metastases changed over time in relation to these recommendations. METHODS Trial eligibility criteria were abstracted from ClinicalTrials.gov for phase I-III US-based interventional clinical trials for patients with advanced breast, colorectal, lung, or melanoma cancers from January 2012 to December 2022. Trials were examined to determine whether patients with brain metastases were not excluded, conditionally excluded (ie, excluded in some circumstances), or wholly excluded. An interrupted time series analysis with multinomial logistic regression was used to determine whether the ASCO/FoCR/FDA recommendations were associated with changes in brain metastases criteria. RESULTS We evaluated N = 3,077 trials. Patients with brain metastases were not excluded in 506 trials (16.4%), conditionally excluded in 2,263 trials (73.5%), and wholly excluded in 308 trials (10.0%). In the postrecommendation period, we estimated a 68% increase in the odds of brain metastases not excluded compared with conditionally excluded (odds ratio, 1.68 [95% CI, 1.06 to 2.66], P = .03). The proportion of trials in which patients with brain metastases were not excluded increased (from 11.5% v 17.3%) and conditionally excluded decreased (from 82.3% to 75.2%, P = .03). We found no difference in the proportion of trials in which patients with brain metastases were wholly excluded (7.5% v 6.2%, P = .42). CONCLUSION The ASCO/FoCR/FDA task force recommendations were associated with a shift in patterns of brain metastases exclusion criteria from conditionally excluded to not excluded. These findings demonstrate that the cancer clinical trial community has begun to change the way trials are written to be more inclusive.
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Affiliation(s)
- Hong Xiao
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Riha Vaidya
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Joseph M Unger
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA
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Sharman Moser S, Apter L, Livnat I, Ginsburg R, Yarden A, Drori M, Drizon A, Chodick G, Siegelmann-Danieli N. Clinical Outcomes of Patients with HER2 Positive Metastatic Breast Cancer to the Brain, with First-Line Trastuzumab, Pertuzumab and Chemotherapy, in a Real-World Setting. BREAST CANCER (DOVE MEDICAL PRESS) 2024; 16:105-116. [PMID: 38464505 PMCID: PMC10924843 DOI: 10.2147/bctt.s439158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/25/2024] [Indexed: 03/12/2024]
Abstract
Background In this observational study, we analyzed the treatment patterns and clinical outcomes of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (mBC) who developed brain metastases during their disease in a 2.7 million-member public health-provider in Israel. Methods Newly diagnosed patients with mBC who initiated first-line treatment between January 2013 and June 2021 were identified. Time on treatment (ToT) and overall survival (OS) were assessed at a minimum of 6 months follow-up (cutoff: December 2021). Results We identified a total of 61 patients: 98.4% females, median age 50 years (IQR = 44-63), 85% invasive ductal tumors, 44% hormone receptor positive, 51% performance status 0-1. The median duration of follow-up was 6.2 years. All patients initiated a combination treatment of trastuzumab, pertuzumab, and chemotherapy (TPC), and 72% moved to second-line treatment during the study follow-up period (82% ado-trastuzumab emtansine). The median ToT for first-line and second-line treatments were 16.9 months (95% CI = 13.9-27.7) and 7.9 months (95% CI = 5.6-10.9), respectively. The median overall survival (OS) was 45.5 months (95% CI = 35.4-71.2) from the initiation of first-line treatment. When considering the timing of brain metastases, the median OS was 36.3 months (95% CI = 10.0-NR) for those diagnosed upfront (n = 15, 25%), 59.1 months (95% CI = 32.5-NR) for those diagnosed while on TPC (n = 25, 41%), and 40.8 months (95% CI = 35.4-NR) for those diagnosed at a later stage (n = 21, 34%). The median OS from brain metastases diagnosis was 25.1 months (95% CI = 17.0-34.6). Conclusion Patients with upfront brain involvement at the time of mBC diagnosis had shorter survival compared to those who started TPC without brain metastases. Nonetheless, the overall results from this study compare favorably with previous studies and contribute to understanding the value of traditional treatment options, which will serve as a baseline for future treatment strategies in the real-world setting.
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Affiliation(s)
- Sarah Sharman Moser
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, Tel Aviv, Israel
| | - Lior Apter
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Idit Livnat
- Medical Affairs, AstraZeneca, Kefar Sava, Israel
| | | | - Adva Yarden
- Medical Affairs, AstraZeneca, Kefar Sava, Israel
| | - Michal Drori
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, Tel Aviv, Israel
| | - Anat Drizon
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gabriel Chodick
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nava Siegelmann-Danieli
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Diagnostic Value of 18 F-FACBC PET/MRI in Brain Metastases. Clin Nucl Med 2022; 47:1030-1039. [PMID: 36241129 PMCID: PMC9653108 DOI: 10.1097/rlu.0000000000004435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The study aims to evaluate whether combined 18 F-FACBC PET/MRI could provide additional diagnostic information compared with MRI alone in brain metastases. PATIENTS AND METHODS Eighteen patients with newly diagnosed or suspected recurrence of brain metastases received dynamic 18 F-FACBC PET/MRI. Lesion detection was evaluated on PET and MRI scans in 2 groups depending on prior stereotactic radiosurgery (SRS group) or not (no-SRS group). SUVs, time-activity curves, and volumetric analyses of the lesions were performed. RESULTS In the no-SRS group, 29/29 brain lesions were defined as "MRI positive." With PET, 19/29 lesions were detected and had high tumor-to-background ratios (TBRs) (D max MR , ≥7 mm; SUV max , 1.2-8.4; TBR, 3.9-25.9), whereas 10/29 lesions were undetected (D max MR , ≤8 mm; SUV max , 0.3-1.2; TBR, 1.0-2.7). In the SRS group, 4/6 lesions were defined as "MRI positive," whereas 2/6 lesions were defined as "MRI negative" indicative of radiation necrosis. All 6 lesions were detected with PET (D max MR , ≥15 mm; SUV max , 1.4-4.2; TBR, 3.6-12.6). PET volumes correlated and were comparable in size with contrast-enhanced MRI volumes but were only partially congruent (mean DSC, 0.66). All time-activity curves had an early peak, followed by a plateau or a decreasing slope. CONCLUSIONS 18 F-FACBC PET demonstrated uptake in brain metastases from cancer of different origins (lung, gastrointestinal tract, breast, thyroid, and malignant melanoma). However, 18 F-FACBC PET/MRI did not improve detection of brain metastases compared with MRI but might detect tumor tissue beyond contrast enhancement on MRI. 18 F-FACBC PET should be further evaluated in recurrent brain metastases.
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Hamester F, Stürken C, Legler K, Eylmann K, Möller K, Roßberg M, Gorzelanny C, Bauer AT, Windhorst S, Schmalfeldt B, Laakmann E, Müller V, Witzel I, Oliveira-Ferrer L. Key Role of Hyaluronan Metabolism for the Development of Brain Metastases in Triple-Negative Breast Cancer. Cells 2022; 11:3275. [PMID: 36291142 PMCID: PMC9600690 DOI: 10.3390/cells11203275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 09/21/2023] Open
Abstract
Breast cancer (BC) is the second-most common cause of brain metastases (BM) and BCBM patients have a reduced quality of life and a poor prognosis. Hyaluronan (HA), and in particular the hyaluronidase Hyal-1, has been already linked to the development of BCBM, and therefore presents an interesting opportunity to develop new effective therapeutic options. HA metabolism was further discovered by the CRISPR/Cas9-mediated knockout of HYAL1 and the shRNA-mediated down-regulation of HA-receptor CD44 in the brain-seeking triple-negative breast cancer (TNBC) cell line MDA-MB-231-BR. Therefore, the impact of Hyal-1 on adhesion, disruption, and invasion through the brain endothelium, both in vitro and in vivo, was studied. Our analysis points out a key role of Hyal-1 and low-molecular-weight HA (LMW-HA) in the formation of a pericellular HA-coat in BC cells, which in turn promotes tumor cell adhesion, disruption, and migration through the brain endothelium in vitro as well as the extent of BM in vivo. CD44 knockdown in MDA-MB-231-BR significantly reduced the pericellular HA-coat on these cells, and, consequently, tumor cell adhesion and invasion through the brain endothelium. Thus, the interaction between Hyal-1-generated LMW-HA fragments and the HA-receptor CD44 might represent a potential target for future therapeutic options in BC patients with a high risk of cerebral metastases formation.
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Affiliation(s)
- Fabienne Hamester
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christine Stürken
- Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- MSH Medical School Hamburg, Faculty of Medicine, Medical University, 20251 Hamburg, Germany
| | - Karen Legler
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Kathrin Eylmann
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Katrin Möller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Maila Roßberg
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christian Gorzelanny
- Department of Dermatology and Venerology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Alexander T. Bauer
- Department of Dermatology and Venerology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Sabine Windhorst
- Department of Biochemistry and Signal Transduction, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Elena Laakmann
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Volkmar Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Isabell Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Leticia Oliveira-Ferrer
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Wu Q, He L, Luo J, Jin W, Xu Y, Wang C. Long‑term remission under Disitamab Vedotin (RC48) in HR‑positive/HER2‑positive metastatic breast cancer with brain meningeal, and bone marrow involvement: A case report. Oncol Lett 2022; 24:339. [PMID: 36039062 PMCID: PMC9404700 DOI: 10.3892/ol.2022.13459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Breast cancer (BC) with overexpression of human epidermal growth factor receptor 2 (HER2) is closely associated with an elevated risk of multiple distant metastases and unfavorable prognosis. Disitamab Vedotin (RC48) is a newly developed antibody-drug conjugate targeting HER2, which is comprised of hertuzumab coupled to monomethyl auristatin E via a cleavable linker. Pre-clinical studies indicated its strong anti-tumor activity in HER2-positive and low HER2 expression models of BC. The present study reported on the case of a 60-year-old postmenopausal female who suffered from fatigue and was diagnosed with a right-sided BC tumor. The diagnosis was stage IV (cT4N3M1) hormone receptor (HR)-positive and HER2-positive invasive ductal carcinoma with systemic metastases (brain included). The patient initially responded well to 26 cycles of the first-line anti-HER2 targeted therapy plus chemotherapy (trastuzumab+pertuzumab+nab-paclitaxel) combined with whole-brain radiotherapy. However, both extracranial and intracranial lesions achieved progressive disease (PD), which eventually occurred during 5 sequential cycles of maintenance therapy. Subsequently, 4 cycles of second-line treatment (trastuzumab + pyrotinib + capecitabin) were continued until the levels of blood tumor markers CEA, CA15-3 and CA125 were elevated, and systemic PD was able to be attained (the brain metastases were rated as stable disease). Finally, the patient received RC48 as the third-line therapy and achieved a durable and effective clinical response. To date, the patient has benefited from 12 cycles of RC48 without any severe adverse effects. The overall survival was >3 years. The present study showcased that RC48 was effective and tolerable for a patient with HR- and HER2-positive BMBC.
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Affiliation(s)
- Qifeng Wu
- School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Lina He
- Department of Oncology, Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200127, P.R. China
| | - Jing Luo
- Department of Oncology, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai 201100, P.R. China
| | - Wen Jin
- Department of Oncology, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai 201100, P.R. China
| | - Yingchun Xu
- Department of Oncology, Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200127, P.R. China
| | - Chen Wang
- Department of Oncology, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai 201100, P.R. China
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Colamaria A, Blagia M, Sacco M, Iodice S, Carbone F, Fochi NP, Leone A, Landriscina M, Coppola G, De Santis E, Giordano G. Solitary metastasis from renal cell carcinoma to the choroid plexus: A case illustration and review of the literature. Surg Neurol Int 2022; 13:227. [PMID: 35673668 PMCID: PMC9168291 DOI: 10.25259/sni_297_2022] [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: 03/29/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Metastatic renal cell carcinoma (RCC) of the choroid plexus is an exceedingly rare condition, with only 35 reported cases to date. Surgical resection of these tumors poses a unique challenge to neurosurgeons since evidence-based treatment guidelines are yet to be designed. Case Description: The authors describe the case of a 58-year-old woman presenting with progressive neurological deterioration 5 years after a right nephrectomy for a WHO 2016 Stage I RCC. A head, contrast-enhanced, and magnetic resonance revealed signs of obstructive hydrocephalus and a homogeneously contrast-enhancing 5 cm mass located in the trigone of the right lateral ventricle. Furthermore, a search of the literature was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After screening for duplicates, 35 publications met the eligibility criteria. Finally, 17 manuscripts were included for analysis. Moreover, a detailed description of an illustrative case is provided. The median age at diagnosis for intraventricular metastasis from RCC was 62.9 years, showing a slight female prevalence. The lateral ventricles were reported as the most frequent location with only one patient presenting with obstructive hydrocephalus caused by the obliteration of Monro foramen. Management options included either open craniotomy or radiosurgery. Conclusion: The management of choroid plexus metastasis from RCC is still controversial with various authors proposing different treatment strategies. In this article, in addition to an in-depth case description, a qualitative review of the literature on metastatic RCCs of the choroid plexus using the PRISMA is provided.
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Affiliation(s)
| | - Maria Blagia
- Division of Neurosurgery, Giovanni XXIII Hospital, Bari, Italy
| | - Matteo Sacco
- Department of Neurosurgery, Riuniti Hospital, Foggia, Italy
| | - Savino Iodice
- Department of Neurosurgery, Riuniti Hospital, Foggia, Italy
| | | | | | - Augusto Leone
- Department of Neurosurgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Matteo Landriscina
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giulia Coppola
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Elena De Santis
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Roma, Italy
| | - Guido Giordano
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Ahn SJ, Kwon H, Kim JW, Park G, Park M, Joo B, Suh SH, Chang YS, Lee JM. Hippocampal Metastasis Rate Based on Non-Small Lung Cancer TNM Stage and Molecular Markers. Front Oncol 2022; 12:781818. [PMID: 35619920 PMCID: PMC9127383 DOI: 10.3389/fonc.2022.781818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/04/2022] [Indexed: 01/18/2023] Open
Abstract
Hippocampal-avoidance whole-brain radiation therapy (HA-WBRT) is justified because of low hippocampal brain metastases (BM) rate and its prevention of cognitive decline. However, we hypothesize that the risk of developing BM in the hippocampal-avoidance region (HAR) may differ depending on the lung-cancer stage and molecular status. We retrospectively reviewed 123 patients with non-small cell lung cancer (NSCLC) at the initial diagnosis of BM. The number of BMs within the HAR (5 mm expansion) was counted. The cohort was divided into patients with and without BMs in the HAR, and their clinical variables, TNM stage, and epidermal growth factor receptor (EGFR) status were compared. The most influential variable predicting BMs in the HAR was determined using multi-variable logistic regression, classification and regression tree (CART) analyses, and gradient boosting method (GBM). The feasibility of HAR expansion was tested using generalized estimating equation marginal model. Patients with BMs in the HAR were more frequently non-smokers, and more likely to have extra-cranial metastases and EGFR mutations (p<0.05). Multi-variable analysis revealed that extra-cranial metastases were independently associated with the presence of BM in the HAR (odds ratio=8.75, p=0.04). CART analysis and GBM revealed that the existence of extra-cranial metastasis was the most influential variable predicting BM occurrence in the HAR (variable importance: 23% and relative influence: 37.38). The estmated BM incidence of patients without extra-cranial metastases in th extended HAR (7.5-mm and 10-mm expansion) did not differ significantly from that in the conventional HAR. In conclusion, NSCLC patients with extra-cranial metastases were more likely to have BMs in the HAR than those without extra-cranial metastases.
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Affiliation(s)
- Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Hyeokjin Kwon
- Department of Electronic Engineering, Hanyang University, Seoul, South Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Goeun Park
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Yoon Soo Chang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
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Menendez JA, Lupu R. Fatty acid synthase: A druggable driver of breast cancer brain metastasis. Expert Opin Ther Targets 2022; 26:427-444. [PMID: 35545806 DOI: 10.1080/14728222.2022.2077189] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Brain metastasis (BrM) is a key contributor to morbidity and mortality in breast cancer patients, especially among high-risk epidermal growth factor receptor 2-positive (HER2+) and triple-negative/basal-like molecular subtypes. Optimal management of BrM is focused on characterizing a "BrM dependency map" to prioritize targetable therapeutic vulnerabilities. AREAS COVERED We review recent studies addressing the targeting of BrM in the lipid-deprived brain environment, which selects for brain-tropic breast cancer cells capable of cell-autonomously generating fatty acids by upregulating de novo lipogenesis via fatty acid synthase (FASN). Disruption of FASN activity impairs breast cancer growth in the brain, but not extracranially, and mapping of the molecular causes of organ-specific patterns of metastasis has uncovered an enrichment of lipid metabolism signatures in brain metastasizing cells. Targeting SREBP1-the master regulator of lipogenic gene transcription-curtails the ability of breast cancer cells to survive in the brain microenvironment. EXPERT OPINION Targeting FASN represents a new therapeutic opportunity for patients with breast cancer and BrM. Delivery of brain-permeable FASN inhibitors and identifying strategies to target metabolic plasticity that might compensate for impaired brain FASN activity are two potential roadblocks that may hinder FASN-centered strategies against BrM.
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Affiliation(s)
- Javier A Menendez
- Metabolism and Cancer Group, Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology, 17007 Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain
| | - Ruth Lupu
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic, Rochester, MN 55905, USA.,Department of Biochemistry and Molecular Biology Laboratory, Mayo Clinic Minnesota, Rochester, MN 55905, USA.,Mayo Clinic Cancer Center, Rochester, MN 55905, USA
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Brain Metastases among Cancer Patients Diagnosed from 2010–2017 in Canada: Incidence Proportion at Diagnosis and Estimated Lifetime Incidence. Curr Oncol 2022; 29:2091-2105. [PMID: 35323369 PMCID: PMC8946963 DOI: 10.3390/curroncol29030169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
The incidence of BM among Canadian cancer patients is unknown. We aimed to estimate IP of BM at the time of cancer diagnosis and during the lifetime of patients with selected primary cancers. Data on BM at diagnosis from 2010–2017 was obtained from the CCR. Site-specific IPs of BM were estimated from provincial registries containing ≥90% complete data on BM. The CCR IP estimates and the IP estimates from literature were applied to the total diagnosed primary cancers to estimate the number of concurrent BM and lifetime BM from 2010–2017 in Canada, respectively. The annual average number of patients with BM at diagnosis from all cancer sites was approximately 3227. The site-specific IPs of BM at diagnosis were: lung (9.42%; 95% CI: 9.16–9.68%), esophageal (1.58%; 95% CI: 1.15–2.02%), kidney/renal pelvis (1.33%; 95% CI: 1.12–1.54%), skin melanoma (0.73%; 95% CI: 0.61–0.84%), colorectal (0.22%; 95% CI: 0.18–0.26%), and breast (0.21%; 95% CI: 0.17–0.24%). Approximately 76,546 lifetime BM cases (or 5.70% of selected fifteen primary cancers sites) were estimated to have occurred from the 2010–2017 cancer patient cohort. These findings reflect results of population analyses in the US and Denmark. We recommend improved standardization of the collection of BM data within the CCR.
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Insights into the Steps of Breast Cancer-Brain Metastases Development: Tumor Cell Interactions with the Blood-Brain Barrier. Int J Mol Sci 2022; 23:ijms23031900. [PMID: 35163822 PMCID: PMC8836543 DOI: 10.3390/ijms23031900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/01/2022] [Accepted: 02/05/2022] [Indexed: 02/07/2023] Open
Abstract
Brain metastases (BM) represent a growing problem for breast cancer (BC) patients. Recent studies have demonstrated a strong impact of the BC molecular subtype on the incidence of BM development. This study explores the interaction between BC cells of different molecular subtypes and the blood–brain barrier (BBB). We compared the ability of BC cells of different molecular subtypes to overcome several steps (adhesion to the brain endothelium, disruption of the BBB, and invasion through the endothelial layer) during cerebral metastases formation, in vitro as well as in vivo. Further, the impact of these cells on the BBB was deciphered at the molecular level by transcriptome analysis of the triple-negative (TNBC) cells themselves as well as of hBMECs after cocultivation with BC cell secretomes. Compared to luminal BC cells, TNBC cells have a greater ability to influence the BBB in vitro and consequently develop BM in vivo. The brain-seeking subline and parental TNBC cells behaved similarly in terms of adhesion, whereas the first showed a stronger impact on the brain endothelium integrity and increased invasive ability. The comparative transcriptome revealed potential brain-metastatic-specific key regulators involved in the aforementioned processes, e.g., the angiogenesis-related factors TNXIP and CXCL1. In addition, the transcriptomes of the two TNBC cell lines strongly differed in certain angiogenesis-associated factors and in several genes related to cell migration and invasion. Based on the present study, we hypothesize that the tumor cell’s ability to disrupt the BBB via angiogenesis activation, together with increased cellular motility, is required for BC cells to overcome the BBB and develop brain metastases.
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Mitchell D, Kwon HJ, Kubica PA, Huff WX, O’Regan R, Dey M. Brain metastases: An update on the multi-disciplinary approach of clinical management. Neurochirurgie 2022; 68:69-85. [PMID: 33864773 PMCID: PMC8514593 DOI: 10.1016/j.neuchi.2021.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/16/2021] [Accepted: 04/03/2021] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Brain metastasis (BM) is the most common malignant intracranial neoplasm in adults with over 100,000 new cases annually in the United States and outnumbering primary brain tumors 10:1. OBSERVATIONS The incidence of BM in adult cancer patients ranges from 10-40%, and is increasing with improved surveillance, effective systemic therapy, and an aging population. The overall prognosis of cancer patients is largely dependent on the presence or absence of brain metastasis, and therefore, a timely and accurate diagnosis is crucial for improving long-term outcomes, especially in the current era of significantly improved systemic therapy for many common cancers. BM should be suspected in any cancer patient who develops new neurological deficits or behavioral abnormalities. Gadolinium enhanced MRI is the preferred imaging technique and BM must be distinguished from other pathologies. Large, symptomatic lesion(s) in patients with good functional status are best treated with surgery and stereotactic radiosurgery (SRS). Due to neurocognitive side effects and improved overall survival of cancer patients, whole brain radiotherapy (WBRT) is reserved as salvage therapy for patients with multiple lesions or as palliation. Newer approaches including multi-lesion stereotactic surgery, targeted therapy, and immunotherapy are also being investigated to improve outcomes while preserving quality of life. CONCLUSION With the significant advancements in the systemic treatment for cancer patients, addressing BM effectively is critical for overall survival. In addition to patient's performance status, therapeutic approach should be based on the type of primary tumor and associated molecular profile as well as the size, number, and location of metastatic lesion(s).
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Affiliation(s)
- D Mitchell
- Department of Neurosurgery, Indiana University School of Medicine, Indiana University Purdue University Indianapolis, IN, USA
| | - HJ Kwon
- Department of Neurosurgery, Indiana University School of Medicine, Indiana University Purdue University Indianapolis, IN, USA
| | - PA Kubica
- Department of Neurosurgery, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, USA
| | - WX Huff
- Department of Neurosurgery, Indiana University School of Medicine, Indiana University Purdue University Indianapolis, IN, USA
| | - R O’Regan
- Department of Medicine/Hematology Oncology, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, USA
| | - M Dey
- Department of Neurosurgery, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, USA,Correspondence Should Be Addressed To: Mahua Dey, MD, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI 53792; Tel: 317-274-2601;
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12
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Sun MS, Liu YH, Ye JM, Liu Q, Cheng YJ, Xin L, Xu L. A nomogram for predicting brain metastasis in patients with de novo stage IV breast cancer. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:853. [PMID: 34164487 PMCID: PMC8184439 DOI: 10.21037/atm-21-1808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Brain metastasis (BM) is a very serious event in patients with breast cancer. The aim of this study was to establish a nomogram to predict the risk of BM in patients with de novo stage IV breast cancer. Methods We gathered female patients diagnosed with de novo stage IV breast cancer between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. After randomly allocating the patients to the training set and verification set, we used univariate and multivariate logistic regression to analyze the relationship between BM and clinicopathological features. Finally, we developed a nomogram which was validated by the analysis of calibration curve and receiver operating characteristic curve. Results Of 7,154 patients with de novo stage IV breast cancer, 422 developed BM. Age, tumor size, subtype, and the degree of lung involvement were significantly correlated with BM. The nomogram had discriminatory ability with an area under curve (AUC) of 0.640 [95% confidence interval (CI): 0.607 to 0.673] in the training set, and 0.644 (95% CI: 0.595 to 0.693) in the validation set. Conclusions Our study developed a nomogram to predict BM for de novo stage IV breast cancer, thus helping clinicians to identify patients at high-risk of BM and implement early preventive interventions to improve their prognoses.
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Affiliation(s)
- Ming-Shuai Sun
- Breast Disease Center, Peking University First Hospital, Beijing, China
| | - Yin-Hua Liu
- Breast Disease Center, Peking University First Hospital, Beijing, China
| | - Jing-Ming Ye
- Breast Disease Center, Peking University First Hospital, Beijing, China
| | - Qian Liu
- Breast Disease Center, Peking University First Hospital, Beijing, China
| | - Yuan-Jia Cheng
- Breast Disease Center, Peking University First Hospital, Beijing, China
| | - Ling Xin
- Breast Disease Center, Peking University First Hospital, Beijing, China
| | - Ling Xu
- Breast Disease Center, Peking University First Hospital, Beijing, China
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13
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Ruiz-Rodado V, Brender JR, Cherukuri MK, Gilbert MR, Larion M. Magnetic resonance spectroscopy for the study of cns malignancies. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2021; 122:23-41. [PMID: 33632416 PMCID: PMC7910526 DOI: 10.1016/j.pnmrs.2020.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 05/04/2023]
Abstract
Despite intensive research, brain tumors are amongst the malignancies with the worst prognosis; therefore, a prompt diagnosis and thoughtful assessment of the disease is required. The resistance of brain tumors to most forms of conventional therapy has led researchers to explore the underlying biology in search of new vulnerabilities and biomarkers. The unique metabolism of brain tumors represents one potential vulnerability and the basis for a system of classification. Profiling this aberrant metabolism requires a method to accurately measure and report differences in metabolite concentrations. Magnetic resonance-based techniques provide a framework for examining tumor tissue and the evolution of disease. Nuclear Magnetic Resonance (NMR) analysis of biofluids collected from patients suffering from brain cancer can provide biological information about disease status. In particular, urine and plasma can serve to monitor the evolution of disease through the changes observed in the metabolic profiles. Moreover, cerebrospinal fluid can be utilized as a direct reporter of cerebral activity since it carries the chemicals exchanged with the brain tissue and the tumor mass. Metabolic reprogramming has recently been included as one of the hallmarks of cancer. Accordingly, the metabolic rewiring experienced by these tumors to sustain rapid growth and proliferation can also serve as a potential therapeutic target. The combination of 13C tracing approaches with the utilization of different NMR spectral modalities has allowed investigations of the upregulation of glycolysis in the aggressive forms of brain tumors, including glioblastomas, and the discovery of the utilization of acetate as an alternative cellular fuel in brain metastasis and gliomas. One of the major contributions of magnetic resonance to the assessment of brain tumors has been the non-invasive determination of 2-hydroxyglutarate (2HG) in tumors harboring a mutation in isocitrate dehydrogenase 1 (IDH1). The mutational status of this enzyme already serves as a key feature in the clinical classification of brain neoplasia in routine clinical practice and pilot studies have established the use of in vivo magnetic resonance spectroscopy (MRS) for monitoring disease progression and treatment response in IDH mutant gliomas. However, the development of bespoke methods for 2HG detection by MRS has been required, and this has prevented the wider implementation of MRS methodology into the clinic. One of the main challenges for improving the management of the disease is to obtain an accurate insight into the response to treatment, so that the patient can be promptly diverted into a new therapy if resistant or maintained on the original therapy if responsive. The implementation of 13C hyperpolarized magnetic resonance spectroscopic imaging (MRSI) has allowed detection of changes in tumor metabolism associated with a treatment, and as such has been revealed as a remarkable tool for monitoring response to therapeutic strategies. In summary, the application of magnetic resonance-based methodologies to the diagnosis and management of brain tumor patients, in addition to its utilization in the investigation of its tumor-associated metabolic rewiring, is helping to unravel the biological basis of malignancies of the central nervous system.
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Affiliation(s)
- Victor Ruiz-Rodado
- Neuro-Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institute of Health, Bethesda, United States.
| | - Jeffery R Brender
- Radiation Biology Branch, Center for Cancer Research, National Institute of Health, Bethesda, United States
| | - Murali K Cherukuri
- Radiation Biology Branch, Center for Cancer Research, National Institute of Health, Bethesda, United States
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institute of Health, Bethesda, United States
| | - Mioara Larion
- Neuro-Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institute of Health, Bethesda, United States.
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14
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Kwon H, Kim JW, Park M, Kim JW, Kim M, Suh SH, Chang YS, Ahn SJ, Lee JM. Brain Metastases From Lung Adenocarcinoma May Preferentially Involve the Distal Middle Cerebral Artery Territory and Cerebellum. Front Oncol 2020; 10:1664. [PMID: 32984041 PMCID: PMC7484698 DOI: 10.3389/fonc.2020.01664] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Although whole-brain radiation therapy (WBRT) is the mainstay of treatment for brain metastases (BMs), the concept of saving eloquent cortical lesions has been promoted. If BMs from lung cancer are spatially biased to certain regions, this approach can be justified more. We evaluated whether BMs from lung cancer show a preference for certain brain regions and if their distribution pattern differs according to the histologic subtype of the primary lung cancer. In this retrospective study, 562 BMs in 80 patients were analyzed (107 BMs from small cell carcinoma, 432 from adenocarcinoma, and 23 from squamous cell carcinoma). Kernel density estimation was performed to investigate whether BM spatial patterns differed among lung cancer subtypes. Further, we explored more detailed subregions where BMs from adenocarcinomas occur frequently using one-way analysis of variance. Finally, we divided our cohort into those with fewer (≤10) and more (>10) BMs and evaluated whether this biased pattern was maintained across limited and extensive stages. For small cell carcinoma, BMs were biased to the cerebellum, but this did not reach statistical significance. For adenocarcinoma, BMs were found more frequently near the distal middle cerebral artery (MCA) territory and cerebellum than in other arterial territories (p < 0.01). The precentral and postcentral gyri were the most significant subregions within the distal anterior cerebral artery (ACA) and MCA territories (p < 0.01). Crus I and Lobule VI were significant regions within the cerebellum (p < 0.01). Regardless of the number of BMs, the affinity to the distal MCA territory and cerebellum was maintained. The present data confirm that BMs from lung adenocarcinoma may preferentially involve the distal MCA territory and cerebellum.
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Affiliation(s)
- Hyeokjin Kwon
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Jin Woo Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Minseo Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Yoon Soo Chang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
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15
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Hepatocellular Carcinoma Brain Metastases: A Single-Institution Experience. World Neurosurg 2020; 140:e27-e32. [DOI: 10.1016/j.wneu.2020.03.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 01/10/2023]
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16
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Ahn SJ, Kwon H, Yang JJ, Park M, Cha YJ, Suh SH, Lee JM. Contrast-enhanced T1-weighted image radiomics of brain metastases may predict EGFR mutation status in primary lung cancer. Sci Rep 2020; 10:8905. [PMID: 32483122 PMCID: PMC7264319 DOI: 10.1038/s41598-020-65470-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 04/30/2020] [Indexed: 01/01/2023] Open
Abstract
Identification of EGFR mutations is critical to the treatment of primary lung cancer and brain metastases (BMs). Here, we explored whether radiomic features of contrast-enhanced T1-weighted images (T1WIs) of BMs predict EGFR mutation status in primary lung cancer cases. In total, 1209 features were extracted from the contrast-enhanced T1WIs of 61 patients with 210 measurable BMs. Feature selection and classification were optimized using several machine learning algorithms. Ten-fold cross-validation was applied to the T1WI BM dataset (189 BMs for training and 21 BMs for the test set). Area under receiver operating characteristic curves (AUC), accuracy, sensitivity, and specificity were calculated. Subgroup analyses were also performed according to metastasis size. For all measurable BMs, random forest (RF) classification with RF selection demonstrated the highest diagnostic performance for identifying EGFR mutation (AUC: 86.81). Support vector machine and AdaBoost were comparable to RF classification. Subgroup analyses revealed that small BMs had the highest AUC (89.09). The diagnostic performance for large BMs was lower than that for small BMs (the highest AUC: 78.22). Contrast-enhanced T1-weighted image radiomics of brain metastases predicted the EGFR mutation status of lung cancer BMs with good diagnostic performance. However, further study is necessary to apply this algorithm more widely and to larger BMs.
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Affiliation(s)
- Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea
| | - Hyeokjin Kwon
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Jin-Ju Yang
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea
| | - Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea.
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17
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Lee SR, Roh TH, Jeong DH, You N, Jang AH, Seo MR, Choung JH, Park B, Kim SH. A Simple and Practical Scoring System for Radiosurgical Treatment in Patients with Brain Metastases. Stereotact Funct Neurosurg 2020; 98:278-285. [PMID: 32408303 DOI: 10.1159/000507338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The study aimed to investigate the prognostic factors for patients with brain metastases undergoing radiosurgical treatment and to introduce a simple and practical scoring system for the prediction of survival time. METHODS We retrospectively analyzed data for 311 patients treated with Gamma Knife radiosurgery at a single institute. The mean age at time of treatment was 60 years (range 23-86 years), and the median Karnofsky performance status (KPS) score was 90 (range 60-100). Using a new prognostic index, the prognostic index for brain metastases (PIBM), the patients were categorized into 3 groups according to the primary tumor status and KPS score. We performed survival analysis and compared the prognostic ability of the PIBM with other published indices. RESULTS During the median follow-up duration of 8.2 months (range 0.1-109 months), the median overall survival time was 9.1 months. Stable primary tumor status (hazard ratio [HR] 0.497, 95% confidence interval [CI] 0.321-0.769, p = 0.002) and KPS score ≥90 (HR 1.407, 95% CI 1.018-1.946, p = 0.039) significantly predicted longer overall survival. The PIBM showed the lowest Akaike information criterion value and the highest integrated area under the curve value compared with other prognostic indices. CONCLUSIONS The PIBM may be a more accurate prognostic indicator than other published indices. Although this new and practical prognostic index requires further validation in larger cohort studies, we suggest that the PIBM could be useful to predict survival time and inform appropriate management of patients with brain metastases.
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Affiliation(s)
- Sang Ryul Lee
- Gamma Knife Center, Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Tae Hoon Roh
- Gamma Knife Center, Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dong Hwan Jeong
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwasung, Republic of Korea
| | - Namkyu You
- Gamma Knife Center, Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ae Hwa Jang
- Gamma Knife Center, Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Mi Ra Seo
- Gamma Knife Center, Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Hee Choung
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.,Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.,Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Se-Hyuk Kim
- Gamma Knife Center, Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea,
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18
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Zhang M, Young GS, Chen H, Li J, Qin L, McFaline-Figueroa JR, Reardon DA, Cao X, Wu X, Xu X. Deep-Learning Detection of Cancer Metastases to the Brain on MRI. J Magn Reson Imaging 2020; 52:1227-1236. [PMID: 32167652 DOI: 10.1002/jmri.27129] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Approximately one-fourth of all cancer metastases are found in the brain. MRI is the primary technique for detection of brain metastasis, planning of radiotherapy, and the monitoring of treatment response. Progress in tumor treatment now requires detection of new or growing metastases at the small subcentimeter size, when these therapies are most effective. PURPOSE To develop a deep-learning-based approach for finding brain metastasis on MRI. STUDY TYPE Retrospective. SEQUENCE Axial postcontrast 3D T1 -weighted imaging. FIELD STRENGTH 1.5T and 3T. POPULATION A total of 361 scans of 121 patients were used to train and test the Faster region-based convolutional neural network (Faster R-CNN): 1565 lesions in 270 scans of 73 patients for training; 488 lesions in 91 scans of 48 patients for testing. From the 48 outputs of Faster R-CNN, 212 lesions in 46 scans of 18 patients were used for training the RUSBoost algorithm (MatLab) and 276 lesions in 45 scans of 30 patients for testing. ASSESSMENT Two radiologists diagnosed and supervised annotation of metastases on brain MRI as ground truth. This data were used to produce a 2-step pipeline consisting of a Faster R-CNN for detecting abnormal hyperintensity that may represent brain metastasis and a RUSBoost classifier to reduce the number of false-positive foci detected. STATISTICAL TESTS The performance of the algorithm was evaluated by using sensitivity, false-positive rate, and receiver's operating characteristic (ROC) curves. The detection performance was assessed both per-metastases and per-slice. RESULTS Testing on held-out brain MRI data demonstrated 96% sensitivity and 20 false-positive metastases per scan. The results showed an 87.1% sensitivity and 0.24 false-positive metastases per slice. The area under the ROC curve was 0.79. CONCLUSION Our results showed that deep-learning-based computer-aided detection (CAD) had the potential of detecting brain metastases with high sensitivity and reasonable specificity. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:1227-1236.
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Affiliation(s)
- Min Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Geoffrey S Young
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Huai Chen
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jing Li
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, The Affiliated Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan, China
| | - Lei Qin
- Department of Radiology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - David A Reardon
- Department of Radiology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Xinhua Cao
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Xian Wu
- Department of Computer Science and Technology, Tsing-hua University, Beijing, China
| | - Xiaoyin Xu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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19
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Bhambhvani HP, Greenberg DR, Srinivas S, Hayden Gephart M. Prostate Cancer Brain Metastases: A Single-Institution Experience. World Neurosurg 2020; 138:e445-e449. [PMID: 32147556 DOI: 10.1016/j.wneu.2020.02.152] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Brain metastases from prostate cancer are rare and poorly described. We sought to assess the proportion of brain metastases arising from prostate cancer and to detail clinical characteristics, treatment modalities, and survival outcomes. METHODS We retrospectively identified and reviewed the charts of 31 patients with intraparenchymal brain metastases from prostate adenocarcinoma seen at our institution from 2008 to 2018. RESULTS Among all patients with brain metastases, the proportion originating from prostate adenocarcinoma was 0.86%. The median age at the time of brain metastasis diagnosis was 69 (range, 57-90). The median original Gleason score was 8 (range, 6-10), and the median prostate-specific antigen at the time of brain metastasis was 60 ng/mL (range, 0.34-4600). The median months from initial cancer diagnosis to brain metastasis was 81 (range, 3-195). The median number of brain metastases was 2 (range, 1-5). Patients had concurrent metastases to bone (100%), lung (48%), and liver (35%). Median overall survival was 3 months (range, 0.4-25.0). Treatment of the brain metastases was correlated with an increase in median survival from 1.2 months to 4.6 months with radiosurgery (hazard ratio = 0.11, P = 0.001) and surgical resection plus radiotherapy to 13 months (hazard ratio = 0.05, P < 0.001). All patients died of advanced, systemic disease and not of their intracranial disease. CONCLUSIONS Brain metastasis from prostate cancer constitutes a small fraction of total brain metastases, but is associated with poor prognosis and is seen in the setting of advanced, castrate resistant disease. These data enable treating physicians to appropriately counsel their patients with prostate adenocarcinoma brain metastasis.
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Affiliation(s)
- Hriday P Bhambhvani
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Daniel R Greenberg
- Department of Urology, Stanford University Medical Center, Stanford, California, USA
| | - Sandy Srinivas
- Division of Medical Oncology, Stanford University Medical Center, Stanford, California, USA
| | - Melanie Hayden Gephart
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
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20
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Leone JP, Duda DG, Hu J, Barry WT, Trippa L, Gerstner ER, Jain RK, Tan S, Lawler E, Winer EP, Lin NU, Tolaney SM. A phase II study of cabozantinib alone or in combination with trastuzumab in breast cancer patients with brain metastases. Breast Cancer Res Treat 2019; 179:113-123. [PMID: 31541381 DOI: 10.1007/s10549-019-05445-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To analyze the efficacy and tolerability of cabozantinib-a small molecule inhibitor of MET and VEGFR2-alone or with trastuzumab in patients with breast cancer brain metastases (BCBM). METHODS This single-arm phase II study enrolled patients with new or progressive measurable BCBM into 3 cohorts: Cohort 1 (HER2-positive), Cohort 2 (hormone receptor-positive/HER2-negative), and Cohort 3 (triple-negative). Patients received cabozantinib 60-mg daily on a 21-day cycle. Cohort 1 added trastuzumab every 3 weeks and had a primary objective of central nervous system (CNS) objective response rate (ORR) by RECIST 1.1. Secondary objectives for all cohorts were progression-free survival, overall survival, toxicity, and changes in vascular parameters and circulating biomarkers. Cohorts 2 and 3 also had CNS ORR as a secondary objective. RESULTS Thirty-six BCBM patients enrolled (cohort 1, n = 21; cohort 2, n = 7; cohort 3, n = 8), with a median age of 50. Patients had a median of 3 prior lines for metastatic disease (range 1-9). Treatments prior to enrollment included craniotomy (n = 4), whole brain radiation (n = 24) and stereotactic radiosurgery (n = 11). CNS ORR was 5% in cohort 1, 14% in cohort 2, and 0% in cohort 3. Most common grade 3/4 adverse events included elevations in lipase (11%), AST (8%), ALT (6%), hyponatremia (8%), and hypertension (6%). Cabozantinib increased plasma concentrations of CA-IX, soluble (s)MET, PlGF, sTIE-2, VEGF, and VEGF-D, and decreased sVEGFR2 and TNF-α and total tumor blood volume. CONCLUSIONS Cabozantinib had insufficient activity in heavily pretreated BCBM patients. Biomarker analysis showed that cabozantinib had antiangiogenic activity and increased tissue hypoxia. TRIAL REGISTRATION Clinicaltrial.gov registration: NCT02260531.
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Affiliation(s)
- José Pablo Leone
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Dan G Duda
- Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Jiani Hu
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - William T Barry
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lorenzo Trippa
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Rakesh K Jain
- Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Sally Tan
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Elizabeth Lawler
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Eric P Winer
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nancy U Lin
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Sara M Tolaney
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
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21
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Liu Y, Chongsathidkiet P, Crawford BM, Odion R, Dechant CA, Kemeny HR, Cui X, Maccarini PF, Lascola CD, Fecci PE, Vo-Dinh T. Plasmonic gold nanostar-mediated photothermal immunotherapy for brain tumor ablation and immunologic memory. Immunotherapy 2019; 11:1293-1302. [PMID: 31530200 DOI: 10.2217/imt-2019-0023] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Brain tumors present unique therapeutic challenges and they include glioblastoma (GBM) and metastases from cancers of other organs. Current treatment options are limited and include surgical resection, radiation therapy, laser interstitial thermal therapy and chemotherapy. Although much research has been done on the development of immune-based treatment platforms, only limited success has been demonstrated. Herein, we demonstrate a novel treatment of GBM through the use of plasmonic gold nanostars (GNS) as photothermal inducers for synergistic immuno photothermal nanotherapy (SYMPHONY), which combines treatments using gold nanostar and laser-induced photothermal therapy with checkpoint blockade immunotherapy. In the treatment of a murine flank tumor model with the CT-2A glioma cell line, SYMPHONY demonstrated the capability of producing long-term survivors that rejects rechallenge with cancer cells, heralding the successful emergence of immunologic memory. This study is the first to investigate the use of this novel therapy for the treatment of GBM in a murine model.
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Affiliation(s)
- Yang Liu
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.,Department of Chemistry, Duke University, Durham, NC 27708, USA.,Fitzpatrick Institute of Photonics, Duke University, Durham, NC 27708, USA
| | - Pakawat Chongsathidkiet
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.,Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Bridget M Crawford
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.,Fitzpatrick Institute of Photonics, Duke University, Durham, NC 27708, USA
| | - Ren Odion
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.,Fitzpatrick Institute of Photonics, Duke University, Durham, NC 27708, USA
| | - Cosette A Dechant
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Hanna R Kemeny
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Xiuyu Cui
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Paolo F Maccarini
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.,Fitzpatrick Institute of Photonics, Duke University, Durham, NC 27708, USA
| | - Christopher D Lascola
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.,Department of Neurobiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Peter E Fecci
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.,Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
| | - Tuan Vo-Dinh
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.,Department of Chemistry, Duke University, Durham, NC 27708, USA.,Fitzpatrick Institute of Photonics, Duke University, Durham, NC 27708, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
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22
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Fares J, Kanojia D, Rashidi A, Ahmed AU, Balyasnikova IV, Lesniak MS. Diagnostic Clinical Trials in Breast Cancer Brain Metastases: Barriers and Innovations. Clin Breast Cancer 2019; 19:383-391. [PMID: 31262686 DOI: 10.1016/j.clbc.2019.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/08/2019] [Accepted: 05/27/2019] [Indexed: 01/05/2023]
Abstract
Optimal treatment of breast cancer brain metastases (BCBM) is often hampered by limitations in diagnostic abilities. Developing innovative tools for BCBM diagnosis is vital for early detection and effective treatment. In this study we explored the advances in trial for the diagnosis of BCBM, with review of the literature. On May 8, 2019, we searched ClinicalTrials.gov for interventional and diagnostic clinical trials involving BCBM, without limiting for date or location. Information on trial characteristics, experimental interventions, results, and publications were collected and analyzed. In addition, a systematic review of the literature was conducted to explore published studies related to BCBM diagnosis. Only 9 diagnostic trials explored BCBM. Of these, 1 trial was withdrawn because of low accrual numbers. Three trials were completed; however, none had published results. Modalities in trial for BCBM diagnosis entailed magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), PET-CT, nanobodies, and circulating tumor cells (CTCs), along with a collection of novel tracers and imaging biomarkers. MRI continues to be the diagnostic modality of choice, whereas CT is best suited for acute settings. Advances in PET and PET-CT allow the collection of metabolic and functional information related to BCBM. CTC characterization can help reflect on the molecular foundations of BCBM, whereas cell-free DNA offers new genetic material for further exploration in trials. The integration of machine learning in BCBM diagnosis seems inevitable as we continue to aim for rapid and accurate detection and better patient outcomes.
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Affiliation(s)
- Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Deepak Kanojia
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Aida Rashidi
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Atique U Ahmed
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Irina V Balyasnikova
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Maciej S Lesniak
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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23
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Mehrabian H, Detsky J, Soliman H, Sahgal A, Stanisz GJ. Advanced Magnetic Resonance Imaging Techniques in Management of Brain Metastases. Front Oncol 2019; 9:440. [PMID: 31214496 PMCID: PMC6558019 DOI: 10.3389/fonc.2019.00440] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 05/08/2019] [Indexed: 01/18/2023] Open
Abstract
Brain metastases are the most common intracranial tumors and occur in 20–40% of all cancer patients. Lung cancer, breast cancer, and melanoma are the most frequent primary cancers to develop brain metastases. Treatment options include surgical resection, whole brain radiotherapy, stereotactic radiosurgery, and systemic treatment such as targeted or immune therapy. Anatomical magnetic resonance imaging (MRI) of the tumor (in particular post-Gadolinium T1-weighted and T2-weighted FLAIR) provide information about lesion morphology and structure, and are routinely used in clinical practice for both detection and treatment response evaluation for brain metastases. Advanced MRI biomarkers that characterize the cellular, biophysical, micro-structural and metabolic features of tumors have the potential to improve the management of brain metastases from early detection and diagnosis, to evaluating treatment response. Magnetic resonance spectroscopy (MRS), chemical exchange saturation transfer (CEST), quantitative magnetization transfer (qMT), diffusion-based tissue microstructure imaging, trans-membrane water exchange mapping, and magnetic susceptibility weighted imaging (SWI) are advanced MRI techniques that will be reviewed in this article as they pertain to brain metastases.
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Affiliation(s)
- Hatef Mehrabian
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.,Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, CA, United States
| | - Jay Detsky
- Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Hany Soliman
- Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Arjun Sahgal
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.,Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Greg J Stanisz
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Neurosurgery and Pediatric Neurosurgery, Medical University, Lublin, Poland
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25
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Moroney MR, Wheeler LJ, Corr BR. Clinical presentation of brain metastases from endometrial carcinoma: A case series. Gynecol Oncol Rep 2019; 28:79-83. [PMID: 30963086 PMCID: PMC6434091 DOI: 10.1016/j.gore.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/08/2022] Open
Abstract
Brain metastases from endometrial carcinoma are rare, however they do occur, and they are associated with an especially poor prognosis. There is evidence demonstrating improved outcomes with early diagnosis and subsequent multimodal treatment. This study therefore aims to review cases of brain metastases from endometrial carcinoma with specific focus on clinical presentation and disease history. This retrospective case series evaluated all cases of brain metastases from endometrial carcinoma at a single institution over a seven-year period. A medical records search was performed using ICD codes for endometrial cancer, brain lesions and brain imaging. Analysis of patient and disease characteristics was performed with descriptive statistics. Twelve cases were identified. The majority of cases had intermediate or high-grade histology (97.7%), advanced stage disease (58.3%), and at least one prior disease recurrence (66.7%). Eleven of 12 cases (91.7%) had lung metastases diagnosed prior to brain metastases. All 12 cases had neurologic signs and symptoms present at time of brain metastases diagnosis; 14 different types of neurologic deficits were noted. Headache was the most common neurologic symptom (5/12, 41.7%), followed by focal weakness (3/12, 25.0%) and aphasia (3/12, 25.0%). In conclusion, clinical presentation at time of diagnosis of brain metastases consistently includes neurologic signs and symptoms with persistent headache being the most common. Endometrial cancer patients that present with new neurologic complaints or exam findings should be evaluated for brain metastases. Brain metastases from endometrial cancer are rare Most cases occur in high grade, advanced stage disease with other metastatic sites Patients with brain metastases present with neurologic symptoms Common neurologic symptoms on presentation are headache, focal weakness and aphasia Persistent neurologic symptoms warrant evaluation for brain metastases
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Affiliation(s)
- Marisa R Moroney
- University of Colorado Denver, Department of Obstetrics and Gynecology, Aurora, CO, United States
| | - Lindsay J Wheeler
- University of Colorado Denver, Department of Obstetrics and Gynecology, Aurora, CO, United States
| | - Bradley R Corr
- University of Colorado Denver, Department of Obstetrics and Gynecology, Aurora, CO, United States
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26
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Wang H, Liu X, Jiang X, Song Y, Wang X, Wang J, Dong Y, Li F, Wu Z, Zhang Y, Yuan Z. Cystic brain metastases had slower speed of tumor shrinkage but similar prognosis compared with solid tumors that underwent radiosurgery treatment. Cancer Manag Res 2019; 11:1753-1763. [PMID: 30858728 PMCID: PMC6387614 DOI: 10.2147/cmar.s188674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Traditionally, radiosurgery was considered less effective for patients with cystic brain metastases. However, comparisons of prognosis between cystic and solid brain metastases in cancer patients have been seldom reported. We aimed to compare the survival between cystic and solid brain metastases and assess risk factors for overall survival after brain metastases (BMOS) in patients who underwent radiosurgery treatment. Patients and methods The Kaplan-Meier method and multivariate Cox regression analysis were used to compare survival time and evaluate risk factors for BMOS. Results A total of 356 patients (including 498 brain metastases) were analyzed in our study, including 67 patients (67/356, 18.8%) with 75 cystic brain metastases. There is no statistical significance in BMOS between patients with cystic (17 months, range: 3-64 months) and solid (17.5 months, range: 1-65 months) brain metastases (P=0.148). However, the volume of cystic brain metastases decreased more slowly than solid brain metastases (P<0.05). The results indicated that high recursive partitioning analysis classification (P=0.006), large volume of brain metastases (P=0.006), and different primary lesion (especially gastrointestinal tract tumor) (P=0.001) were associated with poor prognosis in patients with brain metastases. Conclusion There is no difference in prognosis and local control between patients with cystic and solid brain metastases who underwent radiosurgery. However, the rate and speed of tumor shrinkage were lower in cystic brain metastases after radiotherapy. Patients with larger brain metastases had shorter survival time, regardless of cystic or solid brain metastases.
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Affiliation(s)
- Hui Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Xiaoye Liu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Xuechao Jiang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Yongchun Song
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Xiaoguang Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Jingsheng Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Yang Dong
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Fengtong Li
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Zhiqiang Wu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Yuhan Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
| | - Zhiyong Yuan
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China,
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Apparent diffusion coefficient histogram in breast cancer brain metastases may predict their biological subtype and progression. Sci Rep 2018; 8:9947. [PMID: 29967409 PMCID: PMC6028481 DOI: 10.1038/s41598-018-28315-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/19/2018] [Indexed: 01/07/2023] Open
Abstract
Our aims for this study were to investigate the relationship between diffusion weighted image (DWI) parameters of brain metastases (BMs) and biological markers of breast cancer, and moreover, to assess whether DWI parameters accurately predict patient outcomes. DWI data for 34 patients with BMs from breast cancer were retrospectively reviewed. Apparent diffusion coefficient (ADC) histogram parameters were calculated from all measurable BMs. Two region of interest (ROI) methods are used for the analysis: from the largest BM or from all measurable BMs per one patient. ADC histogram parameters were compared between positive and negative groups depending on ER/PR and HER2 statuses. Overall survival analysis after BM (OSBM) and BM-specific progression-free survival (BMPFS) was analyzed with ADC parameters. Regardless of ROI methods, 25th percentile of ADC histogram was significantly lower in the ER/PR-positive group than in the ER/PR-negative group (P < 0.05). Using ROIs from all measurable BMs, Peak location, 50th percentile, 75th percentile, and mean value of ADC histogram were also significantly lower in the ER/PR-positive group than in the ER/PR-negative group (P < 0.05). However, there was no significant difference between HER2-postive and negative group. On univariate analysis, using ROIs from all measurable BMs, lower 25th percentile, 50th percentile and mean of ADC were significant predictors for poor BMPFS. ADC histogram analysis may have a prognostic value over ER/PR status as well as BMPFS.
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28
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Noh T, Walbert T. Brain metastasis: clinical manifestations, symptom management, and palliative care. HANDBOOK OF CLINICAL NEUROLOGY 2018; 149:75-88. [PMID: 29307363 DOI: 10.1016/b978-0-12-811161-1.00006-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Patients who have brain metastases can suffer from a medley of symptoms, including headaches, seizures, cognitive impairment, fatigue, and focal deficits. As therapies have evolved, so has the management of these symptoms as patients survive longer. This chapter focuses on the clinical presentation of brain metastases, the treatment of those symptoms, and palliation in end-of-life management. Brain metastases are the most common cerebral malignancy. They can present with various symptoms, which can have significant impact on patients' quality of life throughout the course of their disease. Most of these symptoms are related to direct brain compression from the tumor or from edema. The location of the metastases will determine the focal deficits incurred and most patients will be on a course of steroids tapered according to their clinical status. The chapter includes a list of potential side-effects and considerations for management. Palliative care is an essential and important part of approaching patients with metastases. Early and clear communication about end-of-life decision making is encouraged with multiple easily accessible tools. For patients near the end of life, comfort is the ultimate goal in providing a good quality of life.
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Affiliation(s)
- Thomas Noh
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, United States
| | - Tobias Walbert
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, United States; Department of Neurology, Henry Ford Health System, Detroit, MI, United States.
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29
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Klimov S, Rida PC, Aleskandarany MA, Green AR, Ellis IO, Janssen EA, Rakha EA, Aneja R. Novel immunohistochemistry-based signatures to predict metastatic site of triple-negative breast cancers. Br J Cancer 2017; 117:826-834. [PMID: 28720841 PMCID: PMC5589983 DOI: 10.1038/bjc.2017.224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/23/2017] [Accepted: 06/21/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although distant metastasis (DM) in breast cancer (BC) is the most lethal form of recurrence and the most common underlying cause of cancer related deaths, the outcome following the development of DM is related to the site of metastasis. Triple negative BC (TNBC) is an aggressive form of BC characterised by early recurrences and high mortality. Athough multiple variables can be used to predict the risk of metastasis, few markers can predict the specific site of metastasis. This study aimed at identifying a biomarker signature to predict particular sites of DM in TNBC. METHODS A clinically annotated series of 322 TNBC were immunohistochemically stained with 133 biomarkers relevant to BC, to develop multibiomarker models for predicting metastasis to the bone, liver, lung and brain. Patients who experienced metastasis to each site were compared with those who did not, by gradually filtering the biomarker set via a two-tailed t-test and Cox univariate analyses. Biomarker combinations were finally ranked based on statistical significance, and evaluated in multivariable analyses. RESULTS Our final models were able to stratify TNBC patients into high risk groups that showed over 5, 6, 7 and 8 times higher risk of developing metastasis to the bone, liver, lung and brain, respectively, than low-risk subgroups. These models for predicting site-specific metastasis retained significance following adjustment for tumour size, patient age and chemotherapy status. CONCLUSIONS Our novel IHC-based biomarkers signatures, when assessed in primary TNBC tumours, enable prediction of specific sites of metastasis, and potentially unravel biomarkers previously unknown in site tropism.
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Affiliation(s)
- Sergey Klimov
- Department of Biology, Georgia State University, Atlanta, GA 30303 USA
| | | | - Mohammed A Aleskandarany
- Department of Cellular Pathology, University of Nottingham and Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham NG5 1PB, UK
| | - Andrew R Green
- Department of Cellular Pathology, University of Nottingham and Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham NG5 1PB, UK
| | - Ian O Ellis
- Department of Cellular Pathology, University of Nottingham and Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham NG5 1PB, UK
| | - Emiel Am Janssen
- Department of Pathology, Stavanger University Hospital, Stavanger N-4011, Norway
| | - Emad A Rakha
- Department of Cellular Pathology, University of Nottingham and Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham NG5 1PB, UK
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA 30303 USA
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30
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Roehrig AT, Ferrel EA, Benincosa DA, MacKay AR, Ling BC, Carlson JD, Demakas JJ, Wagner A, Lamoreaux WT, Fairbanks RK, Call JA, Cooke BS, Peressini B, Lee CM. Pretreatment clinical prognostic factors for brain metastases from breast cancer treated with Gamma Knife radiosurgery. Surg Neurol Int 2016; 7:S830-S836. [PMID: 27990315 PMCID: PMC5134111 DOI: 10.4103/2152-7806.194065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 08/08/2016] [Indexed: 11/18/2022] Open
Abstract
Background: Brain metastases significantly affect morbidity and mortality rates for patients with metastatic breast cancer. Treatment for brain metastases lengthens survival, and options such as stereotactic radiosurgery (SRS) can increase survival to 12 months or longer. This study retrospectively analyzes the prognostic factors for overall survival (OS) for patients with one or multiple brain metastases from breast cancer treated with SRS. Methods: Between December 2001 and May 2015, 111 patients with brain metastases from breast cancer were grouped by potential prognostic factors including age at diagnosis, Karnofsky Performance Status (KPS) score, number of brain metastases, and whether or not they received adjuvant treatments such as whole brain radiotherapy (WBRT) or surgical resection. Survival rates were determined for all groups, and hazard ratios were calculated using univariate and multivariate analyses to compare differences in OS. Results: Median OS was 16.8 ± 4.22 months. Univariate analysis of patients with a KPS ≤60 and multivariate analysis of KPS 70–80 showed significantly shorter survival than those with KPS 90–100 (5.9 ± 1.22 months, 21.3 ± 11.69 months, and 22.00 ± 12.56 months, P = 0.024 and < 0.001). Other results such as age ≥65 years and higher number of brain metastases trended toward shorter survival but were not statistically significant. No difference in survival was found for patients who had received WBRT in addition to SRS (P = 0.779). Conclusion: SRS has been shown to be safe and effective in treating brain metastases from breast cancer. We found our median survival to be 16.8 ± 4.22 months, an increase from other clinical reports. In addition, 38.4% of our population was alive at 2 years and 15.6% survived 5 years. Significant prognostic factors can help inform clinical treatment decisions. This study found that KPS was a significant prognostic indicator of OS in these patients.
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Affiliation(s)
- Andrew T Roehrig
- Gamma Knife of Spokane, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA; University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Ethan A Ferrel
- Gamma Knife of Spokane, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA; University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Devon A Benincosa
- Gamma Knife of Spokane, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA; Cancer Care Northwest, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA
| | | | - Benjamin C Ling
- Inland Neurosurgery and Spine Associates, 105 W 8 Ave, Suite 200, Spokane, WA 99204, USA
| | - Jonathan D Carlson
- Gamma Knife of Spokane, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA; Inland Neurosurgery and Spine Associates, 105 W 8 Ave, Suite 200, Spokane, WA 99204, USA
| | - John J Demakas
- Gamma Knife of Spokane, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA; Department of Neurosurgery, Rockwood Clinic, 801 W 5 Ave, Suite 525, Spokane, WA 99204, USA
| | - Aaron Wagner
- Gamma Knife of Spokane, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA; Cancer Care Northwest, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA
| | - Wayne T Lamoreaux
- Gamma Knife of Spokane, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA; Cancer Care Northwest, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA
| | - Robert K Fairbanks
- Gamma Knife of Spokane, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA; Cancer Care Northwest, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA
| | - Jason A Call
- Cancer Care Northwest, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA
| | - Barton S Cooke
- Gamma Knife of Spokane, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA
| | - Ben Peressini
- DataWorks Analytics, LLC, 3952 N Magnuson St, Coeur D'Alene, ID 83815, USA
| | - Christopher M Lee
- Gamma Knife of Spokane, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA; Cancer Care Northwest, 910 W 5 Ave, Suite 102, Spokane, WA 99204, USA
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Larkin JR, Dickens AM, Claridge TDW, Bristow C, Andreou K, Anthony DC, Sibson NR. Early Diagnosis of Brain Metastases Using a Biofluids-Metabolomics Approach in Mice. Theranostics 2016; 6:2161-2169. [PMID: 27924154 PMCID: PMC5135440 DOI: 10.7150/thno.16538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 12/25/2022] Open
Abstract
Over 20% of cancer patients will develop brain metastases. Prognosis is currently extremely poor, largely owing to late-stage diagnosis. We hypothesized that biofluid metabolomics could detect tumours at the micrometastatic stage, prior to the current clinical gold-standard of blood-brain barrier breakdown. Metastatic mammary carcinoma cells (4T1-GFP) were injected into BALB/c mice via intracerebral, intracardiac or intravenous routes to induce differing cerebral and systemic tumour burdens. B16F10 melanoma and MDA231BR-GFP human breast carcinoma cells were used for additional modelling. Urine metabolite composition was analysed by 1H NMR spectroscopy. Statistical pattern recognition and modelling was applied to identify differences or commonalities indicative of brain metastasis burden. Significant metabolic profile separations were found between control cohorts and animals with tumour burdens at all time-points for the intracerebral 4T1-GFP time-course. Models became stronger, with higher sensitivity and specificity, as the time-course progressed indicating a more severe tumour burden. Sensitivity and specificity for predicting a blinded testing set were 0.89 and 0.82, respectively, at day 5, both rising to 1.00 at day 35. Significant separations were also found between control and all 4T1-GFP injected mice irrespective of route. Likewise, significant separations were observed in B16F10 and MDA231BR-GFP cell line models. Metabolites underpinning each separation were identified. These findings demonstrate that brain metastases can be diagnosed in an animal model based on urinary metabolomics from micrometastatic stages. Furthermore, it is possible to separate differing systemic and CNS tumour burdens, suggesting a metabolite fingerprint specific to brain metastasis. This method has strong potential for clinical translation.
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Affiliation(s)
- James R. Larkin
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Alex M. Dickens
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
- Department of Pharmacology, University of Oxford, Oxford, UK
| | | | - Claire Bristow
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Kleopatra Andreou
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | | | - Nicola R. Sibson
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
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Ma W, Li N, An Y, Zhou C, Bo C, Zhang G. Effects of Temozolomide and Radiotherapy on Brain Metastatic Tumor: A Systematic Review and Meta-Analysis. World Neurosurg 2016; 92:197-205. [DOI: 10.1016/j.wneu.2016.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 11/28/2022]
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Development of a new tri-block copolymer with a functional end and its feasibility for treatment of metastatic breast cancer. Colloids Surf B Biointerfaces 2016; 144:73-80. [DOI: 10.1016/j.colsurfb.2016.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/29/2016] [Accepted: 04/01/2016] [Indexed: 11/18/2022]
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Golanov AV, Banov SM, Il'yalov SR, Trunin YY, Maryashev SA, Vetlova ER, Osinov IK, Kostyuchenko VV, Dalechina AV, Durgaryan AA. [Overall survival and intracranial relapse in patients with brain metastases after gamma knife radiosurgery alone]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2016; 80:35-46. [PMID: 27070256 DOI: 10.17116/neiro201680235-46] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
UNLABELLED The study purpose was to evaluate the impact of gamma knife radiosurgery (GKRS) alone on the overall survival and rate of intracranial recurrences in brain metastasis patients. MATERIAL AND METHODS Treatment outcomes in 502 patients (211 males and 291 females with 2782 brain metastases (BMs)) were retrospectively reviewed. Most patients (n=142; 28.2%) were diagnosed with breast cancer. Multiple BMs were detected in 259 patients (51.6%). The median of the total tumor volume and ВM number was 5.9 cm3 (0.09-44.5 cm3) and 4 (1-36), respectively. The mean marginal radiation dose was 21 Gy (15-24 Gy). The mean follow-up period was 10.6 months (0.2-47.2 months). RESULTS The overall survival rate for 12 and 24 months was 37.6 and 19.1%, respectively. The median overall survival after GKRS was 8.6 months (95% confidence interval (CI) 7.0-10.0). Local control of metastatic lesions was achieved in 78.8% of patients. The median local recurrence-free survival was 6.8 months after radiosurgery. The development of new (distant) metastases was observed in 49.5% of patients. The median distant metastasis-free time was 8.8 months. The Karnofsky performance score (KPS) of ≥80 (HR 0.3935, 95% CI 0.2429-0.6376; p=0.0002), BM number of <3 (HR 0.6138, 95% CI 0.3993-0.9943; p=0.0269), and BMs of breast and lung cancers (HR 0.5442, 95% CI 0.3642-0.8071; p=0.0027) are predictors of better survival. In the case of intracranial metastasis recurrence, repeated radiosurgery provides the median overall survival of 19.6 months versus 9.6 months in patients without radiosurgery (HR 0.4026, 95% CI 0.2381-0.6809). CONCLUSION Radiosurgical treatment of patients with multiple BMs provides the median overall survival of 8.6 months. A good functional status, non-extensive metastasis of the brain, and radiosensitive morphology of the primary tumor are the predictors of better survival. Repeated radiosurgical treatment for intracranial recurrences provides longer overall survival compared to that in patients without repeated radiosurgical treatment.
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Affiliation(s)
- A V Golanov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - Yu Yu Trunin
- Burdenko Neurosurgical Institute, Moscow, Russia
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Lam JC, Robinson SR, Schell A, Vaughan S. Pulmonary neuroendocrine carcinoma mimicking neurocysticercosis: a case report. J Med Case Rep 2016; 10:144. [PMID: 27250121 PMCID: PMC4890325 DOI: 10.1186/s13256-016-0910-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background Neurocysticercosis occurs when the eggs of the pork tapeworm (Taenia solium) migrate and hatch into larvae within the central nervous system. Neurocysticercosis is the most common cause of seizures in the developing world and is characterized on brain imaging by cysts in different stages of evolution. In Canada, cases of neurocysticercosis are rare and most of these patients acquire the disease outside of Canada. We report the case of a patient with multiple intracranial lesions whose history and diagnostic imaging were consistent with neurocysticercosis. Pathological investigations ultimately demonstrated that her brain lesions were secondary to malignancy. Brain metastases are considered to be the most common cause of intracranial cystic lesions. Case presentation We present the case of a 60-year-old Canadian-born Caucasian woman with a subacute history of ataxia, lower extremity hyper-reflexia, and otalgia who resided near a pig farm for most of her childhood. Computed tomography and magnetic resonance imaging showed that she had multiple heterogeneous intracranial cysts, suggestive of neurocysticercosis. Despite a heavy burden of disease, serological tests for cysticercosis were negative. This result and a lack of the central scolices on neuroimaging that are pathognomonic of neurocysticercosis prompted whole-body computed tomography imaging to identify another etiology. The whole-body computed tomography revealed right hilar lymphadenopathy associated with soft tissue nodules in her chest wall and abdomen. A biopsy of an anterior chest wall nodule demonstrated high-grade poorly differentiated carcinoma with necrosis, which stained strongly positive for thyroid transcription factor-1 and synaptophysin on immunohistochemistry. A diagnosis of stage 4 metastatic small cell neuroendocrine carcinoma was made and our patient was referred for oncological palliative treatment. Conclusions This case illustrates the importance of the diagnostic approach to intracranial lesions. Our patient’s diagnosis of neuroendocrine carcinoma was delayed because of her nontraditional presentation. Despite extensive metastatic burden, the lack of perilesional edema and the identification of lesions appearing to be in various stages of development led to a pursuit of neurocysticercosis as the diagnosis. The absence of constitutional symptoms should not discount the possibility of malignancy from the differential diagnosis.
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Affiliation(s)
- John C Lam
- Department of Medicine, The University of Calgary, Calgary, AB, T2N 2T9, Canada.
| | - Stephen R Robinson
- Department of Medicine, The University of Calgary, Calgary, AB, T2N 2T9, Canada
| | - Andrew Schell
- Department of Pathology and Laboratory Medicine, The University of Calgary, Calgary, AB, T2N 2T9, Canada
| | - Stephen Vaughan
- Department of Medicine, The University of Calgary, Calgary, AB, T2N 2T9, Canada.,Department of Infectious Disease, The University of Calgary, Calgary, AB, T2N 2T9, Canada.,Foothills Medical Center, The University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
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Estabrook NC, Lutz ST, Johnson CS, Lo SS, Henderson MA. Does Graded Prognostic Assessment outperform Recursive Partitioning Analysis in patients with moderate prognosis brain metastases? CNS Oncol 2016; 5:69-76. [PMID: 26985694 DOI: 10.2217/cns.15.45] [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] [Indexed: 11/21/2022] Open
Abstract
AIM To compare the clinical utility of the Recursive Partitioning Analysis (RPA) and Graded Prognostic Assessment (GPA) in predicting outcomes for moderate prognosis patients with brain metastases. METHODS & MATERIALS We reviewed 101 whole brain radiotherapy cases. RPA and GPA were calculated. Overall survival was compared. RESULTS Sixty-eight patients had moderate prognosis. RPA patient characteristics for increased death hazard were ≤10 WBRT fractions or no surgery/radiosurgery. GPA patients had increased death risk with no surgery/radiosurgery or lower Karnofsky Performance Status. CONCLUSION The indices have similar predicted survival. Patients scored by RPA with longer radiation schedules had longer survival; patients scored by GPA did not. This indicates GPA is more clinically useful, leaving less room for subjective treatment choices.
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Affiliation(s)
- Neil C Estabrook
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stephen T Lutz
- Blanchard Valley Regional Cancer Center, Findlay, OH, USA
| | - Cynthia S Johnson
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Simon S Lo
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Mark A Henderson
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
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Leone JP, Leone BA. Breast cancer brain metastases: the last frontier. Exp Hematol Oncol 2015; 4:33. [PMID: 26605131 PMCID: PMC4657380 DOI: 10.1186/s40164-015-0028-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/09/2015] [Indexed: 01/16/2023] Open
Abstract
Breast cancer is a common cause of brain metastases, with metastases occurring in at least 10–16 % of patients. Longer survival of patients with metastatic breast cancer and the use of better imaging techniques are associated with an increased incidence of brain metastases. Unfortunately, patients who develop brain metastases tend to have poor prognosis with short overall survival. In addition, brain metastases are a major cause of morbidity, associated with progressive neurologic deficits that result in a reduced quality of life. Tumor subtypes play a key role in prognosis and treatment selection. Current therapies include surgery, whole-brain radiation therapy, stereotactic radiosurgery, chemotherapy and targeted therapies. However, the timing and appropriate use of these therapies is controversial and careful patient selection by using available prognostic tools is extremely important. This review will focus on current treatment options, novel therapies, future approaches and ongoing clinical trials for patients with breast cancer brain metastases.
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Affiliation(s)
- José Pablo Leone
- University of Iowa Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, C32 GH, 200 Hawkins Drive, Iowa City, IA 52242 USA
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Saria M, Piccioni D, Carter J, Orosco H, Turpin T, Kesari S. Current Perspectives in the Management of Brain Metastases. Clin J Oncol Nurs 2015. [DOI: 10.1188/15.cjon.475-478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Salvage whole brain radiotherapy or stereotactic radiosurgery after initial stereotactic radiosurgery for 1–4 brain metastases. J Neurooncol 2015; 124:429-37. [DOI: 10.1007/s11060-015-1855-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/21/2015] [Indexed: 11/27/2022]
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Bedard G, Ray S, Zhang L, Zeng L, Cella D, Wong E, Danjoux C, Tsao M, Barnes E, Sahgal A, Holden L, Lauzon N, Chow E. Validation of the Brain Symptom and Impact Questionnaire (BASIQ) to assess symptom and quality of life in brain metastases. CNS Oncol 2015; 3:275-85. [PMID: 25286039 DOI: 10.2217/cns.14.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To validate the Brain Symptom and Impact Questionnaire (BASIQ) version 1.0 for brain metastases. METHODS Patients with brain metastases and their healthcare professionals (HCPs) assessed the relevance of the BASIQ on a 0-10 scale with 10 as extremely relevant. RESULTS A total of 52 patients and 20 HCPs participated in this study. In total, 95% of HCPs and 85% of patients found all items relevant. Balance and walking ability were rated relevant by 100% of patients and HCPs. Headache, nausea, energy, memory and ability to do housework were also rated relevant by 100% of HCPs. Over 95% of patients determined the items of ability to do housework, tiredness, energy, vision, memory and putting ideas into words as relevant. There were no items rated below 7 by patients or below 5 by HCPs. CONCLUSION This study indicates that BASIQ version 1.0 has valid content items encompassing disease-related symptom and impact on daily living.
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Affiliation(s)
- Gillian Bedard
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Jiang XD, Qiao Y. Updating advances on recombinant human endostatin combined with radiotherapy for non-small cell lung cancer with brain metastasis. Transl Lung Cancer Res 2015; 1:84-8. [PMID: 25806159 DOI: 10.3978/j.issn.2218-6751.2011.12.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 12/22/2011] [Indexed: 11/14/2022]
Abstract
Brain metastases (BM) heavily affects the prognosis of advanced non-small cell lung cancer (NSCLC). Although whole-brain radiotherapy remains the mainstream therapy for BM caused by NSCLC, the effectiveness is unsatisfactory. Endostar, a recombinant human endostatin (RHES), has shown certain therapeutic effect on advanced NSCLC. This article reviews the feasibility of Endostar combined with radiotherapy in the treatment of BM caused by NSCLC.
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Affiliation(s)
- Xiao-Dong Jiang
- Department of Radiation Oncology, Lianyungang First People's Hospital, Affiliated to Xuzhou Medical College, Lianyungang, China
| | - Yun Qiao
- Department of Radiation Oncology, Lianyungang First People's Hospital, Affiliated to Xuzhou Medical College, Lianyungang, China
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Tamari K, Suzuki O, Hashimoto N, Kagawa N, Fujiwara M, Sumida I, Seo Y, Isohashi F, Yoshioka Y, Yoshimine T, Ogawa K. Treatment outcomes using CyberKnife for brain metastases from lung cancer. JOURNAL OF RADIATION RESEARCH 2015; 56:151-158. [PMID: 25344929 PMCID: PMC4572587 DOI: 10.1093/jrr/rru092] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/03/2014] [Accepted: 09/10/2014] [Indexed: 06/04/2023]
Abstract
We investigated the clinical outcomes following treatment using stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) for brain metastases from lung cancer. A total of 67 patients with 109 brain metastases from lung cancer treated using CyberKnife between 1998 and 2011 were retrospectively analyzed. SRS (median dose, 24 Gy) was used to treat 79 lesions, and 3-fraction SRT (median dose, 30 Gy) was used to treat 30 lesions. The median follow-up time was 9.4 months (range, 0.4-125 months). The 1-year local control rate was 83.3%, and the 1-year distant brain failure rate was 30.1%. The median survival time was 13.1 months, and the 1- and 3-year overall survival (OS) rates were 54.8% and 25.9%, respectively. On multivariate analysis, three factors were found to be statistically significant predictors of OS: (i) presence of uncontrolled primary disease [hazard ratio (HR) = 3.04; P = 0.002]; (ii) Brinkman index (BI) ≥ 1000 (HR = 2.75; P = 0.007); and (iii) pulmonary metastases (HR = 3.54; P = 0.009). Radionecrosis and worsening of neurocognitive function after radiosurgery were observed in 5 (7%) and 3 (4%) patients, respectively. Our results indicated that SRS/SRT for brain metastases from lung cancer was effective. Uncontrolled primary disease, high BI, and pulmonary metastases at treatment were significant risk factors for OS.
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Affiliation(s)
- Keisuke Tamari
- Department of Radiation Oncology, Osaka University, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Osamu Suzuki
- Department of Radiation Oncology, Osaka University, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Osaka University, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Naoki Kagawa
- Department of Neurosurgery, Osaka University, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Masateru Fujiwara
- Department of Radiation Oncology, Osaka University, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Iori Sumida
- Department of Radiation Oncology, Osaka University, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yuji Seo
- Department of Radiation Oncology, Osaka University, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Osaka University, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Osaka University, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Toshiki Yoshimine
- Department of Neurosurgery, Osaka University, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University, 2-2 (D10) Yamadaoka, Suita, Osaka 565-0871, Japan
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Abstract
Brain metastases are less common than bone or visceral metastases in patients with breast cancer. The overall prognosis of breast cancer patients with brain metastases remains poor, and these metastases are less responsive to systemic therapies. Brain metastasis is associated with a reduced quality of life due to progressive neurologic impairments. Recently, a trend of increased incidence of brain metastases in breast cancer has been noted. Reasons for this increased incidence include the more frequent use of sensitive detection methods such as contrast-enhanced magnetic resonance imaging and increased awareness of brain metastasis among patients and clinicians. Adjuvant and systemic therapy with drugs that have a low blood-brain barrier penetrance can lead to an increased risk of brain metastases in breast cancer patients. Molecular subtype is a predictive factor for overall survival after developing brain metastases. Patients who do not have a poor prognosis based on previously identified prognostic factors should be treated with radiation therapy to control symptoms. Whole-brain radiation therapy, stereotactic irradiation and surgery are tools for the local treatment of brain metastases. Novel molecular target therapy, including HER2-targeted therapy, has demonstrated an antitumor effect on brain metastases. In this review, we provide a practical algorithm for the treatment of breast cancer brain metastases. This review provides an overview of the incidence, risk factors, diagnosis, prognostic factors and current and potential future management strategies of breast cancer brain metastases.
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Affiliation(s)
- Naoki Niikura
- Department of Target Therapy Oncology, Kyoto University Graduate School of Medicine, Kyoto Departments of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa
| | - Shigehira Saji
- Department of Target Therapy Oncology, Kyoto University Graduate School of Medicine, Kyoto Department of Medical Oncology, Fukushima Medical University, Fukushima
| | - Yutaka Tokuda
- Departments of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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Niikura N, Hayashi N, Masuda N, Takashima S, Nakamura R, Watanabe KI, Kanbayashi C, Ishida M, Hozumi Y, Tsuneizumi M, Kondo N, Naito Y, Honda Y, Matsui A, Fujisawa T, Oshitanai R, Yasojima H, Tokuda Y, Saji S, Iwata H. Treatment outcomes and prognostic factors for patients with brain metastases from breast cancer of each subtype: a multicenter retrospective analysis. Breast Cancer Res Treat 2014; 147:103-12. [PMID: 25106661 DOI: 10.1007/s10549-014-3090-8] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/29/2014] [Indexed: 12/20/2022]
Abstract
To define prognostic factors for breast cancer patients with brain metastases, compare their clinical courses and prognoses according to breast cancer subtypes, and analyze the causes of death in such patients. We retrospectively analyzed 1,466 patients diagnosed with brain metastases between April 1, 2001 and December 31, 2012, from 24 institutions of the Japan Clinical Oncology Group. Overall, 1,256 patients with brain metastases were included. The median overall survival (OS) was 8.7 months (95 % confidence interval [CI] 7.8-9.6 months). Univariate and multivariate analyses revealed that patients diagnosed with brain metastasis within 6 months of metastatic breast cancer diagnoses, asymptomatic brain disease, or HER2-positive/estrogen receptor-positive tumors had increased OS. Median OS after the development of brain metastases was 9.3 months (95 % CI 7.2-11.3) for the luminal type, 16.5 months (95 % CI 11.9-21.1) for the luminal-HER2 type, 11.5 months (95 % CI 9.1-13.8) for the HER2 type, and 4.9 months (95 % CI 3.9-5.9) for the triple-negative type. Luminal-HER2 type patients had significantly longer OS than patients with the luminal type (hazard ratio [HR] = 1.50, P < 0.0001) and triple-negative type (HR = 1.97, P < 0.0001); no significant differences were noted compared to HER2-type patients (HR = 1.19, P = 0.117). The prognosis and clinical course of patients with brain metastasis from breast cancer before and after developing brain metastases vary according to subtype. Focusing on the subtypes of breast cancer can optimize the prevention, early detection, and improved treatment of brain metastases.
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Affiliation(s)
- Naoki Niikura
- Department of Breast and Endocrine Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan,
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Shapira Y, Hadelsberg UP, Kanner AA, Ram Z, Roth J. The ventricular system and choroid plexus as a primary site for renal cell carcinoma metastasis. Acta Neurochir (Wien) 2014; 156:1469-74. [PMID: 24809532 DOI: 10.1007/s00701-014-2108-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 04/19/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Brain metastases (BM) are the most common intracranial tumours amongst adults. Ten to 40 % of patients with cancer will develop BM. In this study, we observed a high affinity of renal cell carcinoma (RCC) to the ventricular system, with close association to the choroid plexus. METHODS This is a retrospective study evaluating data of our prospectively maintained brain tumour database, focusing on consecutive BM patients, who were treated at our center between March 2003 and December 2011. Data collected included primary pathologies, anatomical distribution of the brain metastasis according to neuroimaging, and treatment modalities. RESULTS We identified 614 patients with BM, of whom 24 (3.9 %) were diagnosed with RCC, harboring 33 lesions. Nine of the 24 patients (37.5 %) presented with an intraventricular location (10 of 33 RCC BM lesions). Of the remaining 590 patients with non-RCC pathologies, five patients (0.8 %) were diagnosed with intraventricular lesions (p < 0.0001). CONCLUSION In this unselected, consecutive treated BM patient cohort we observed a high affinity of RCC BM to the ventricular system with close association to the choroid plexus. The reason for this affinity is unknown. Surgical approaches for resection of these lesions should be planned to include early control on the vascular supply from the choroidal vessels.
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Affiliation(s)
- Yuval Shapira
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University School of Medicine, 6 Weizman Street, Tel Aviv, 64239, Israel
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Abstract
OBJECT Collectively, metastatic tumors are the most common malignancy encountered in the adult central nervous system (CNS), arising most often from lung, breast, skin, and gastrointestinal tract carcinomas. Limited information is available in the literature regarding solid nonhematopoietic CNS metastases in children. The authors carried out a retrospective study of pediatric metastatic neoplasms to the CNS treated in a 30-year period to characterize their frequency, common histological subtypes, and sites of origin. METHODS The archival pathology files were searched (1981-2011) for metastatic tumors to the CNS in patients 21 years of age and younger. Pathology material was reviewed, tumors were classified by site of origin and histological subtype, and survival was evaluated. RESULTS The authors identified 26 patients with solid nonhematopoietic CNS metastases out of 1135 pediatric CNS tumors diagnosed from 1981 to 2011. Patients ranged in age from 1.5 to 20.3 years and were equally divided between sexes. Most CNS metastases were supratentorial (85%) and solitary (65%). The mean interval from primary malignant diagnosis to CNS metastasis was 27 months. Sites of origin included kidney/adrenal, bone/soft tissue, gonads, head and neck, lung, and liver. Mean survival after CNS involvement was 36.6 months. Overall 1-year and 5-year survival rates were 52% and 16%, respectively. CONCLUSIONS In neuropathology practice, nonhematopoietic pediatric CNS metastases are far less common than are nonhematopoietic adult CNS metastases, accounting for approximately 2% of all pediatric CNS tumors. The most common tumors to exhibit CNS metastasis are of kidney/adrenal origin, followed by those from bone/soft tissue. As expected, prognosis is dismal, despite aggressive therapy.
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Affiliation(s)
- Andrea L Wiens
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Jiang XD, Ding MH, Qiao Y, Liu Y, Liu L. Study on lung cancer cells expressing VEGFR2 and the impact on the effect of RHES combined with radiotherapy in the treatment of brain metastases. Clin Lung Cancer 2013; 15:e23-9. [PMID: 24374073 DOI: 10.1016/j.cllc.2013.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 11/10/2013] [Accepted: 11/17/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Brain metastases are often accompanied by edema. Endostatin therapy can prevent tumor tissue edema. Therefore, we investigated the therapeutic effects of endostatin combined with radiotherapy in the treatment of brain metastases of non-small cell lung cancer (NSCLC) and assessed the relations between the effect and vascular endothelial growth factor receptor 2 (VEGFR2) expression. PATIENTS AND METHODS Eighty patients with brain metastases of NSCLC were randomly divided into a combination therapy group and a radiotherapy-alone group, each group with 40 patients. The short-term effective rate, overall survival time, cerebral edema index, and adverse reactions were observed, and the expressions of VEGFR2 protein and KDR gene in primary lesions were detected via immunohistochemical methods and fluorescence in-situ hybridization (FISH) in all patients. RESULTS Compared with the radiotherapy-alone group, brain edema was significantly relieved (P = .003) and there were no marked adverse reactions in the combination therapy group. Regarding the short-term effective rate, there was no statistical significance in the total population (n = 80, 90% vs. 75%, P = .07), but there was statistical significance in cases of positive VEGFR2 (93% vs. 67.7%, P = .012) or positive KDR gene (94.4% vs. 47.3%, P = .002) in both groups. For overall survival time, there was no statistical significance in total population (n = 80, P = .35), positive VEGFR2 patients (P = .109), and positive KDR gene patients (P = .147). CONCLUSION Compared with radiotherapy alone, endostatin combined with radiotherapy can relieve brain edema in patients with brain metastases of NSCLC and can obtain a better short-term effective rate in patients with positive VEGFR2 or positive KDR gene, but endostatin therapy does not significantly improve overall survival time.
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Affiliation(s)
- Xiao-dong Jiang
- Department of Radiation Oncology, Lianyungang First People's Hospital, Lianyungang, China.
| | - Man-hua Ding
- Department of Radiation Oncology, Lianyungang First People's Hospital, Lianyungang, China
| | - Yun Qiao
- Department of Radiation Oncology, Lianyungang First People's Hospital, Lianyungang, China
| | - Yi Liu
- Department of Radiation Oncology, Lianyungang First People's Hospital, Lianyungang, China
| | - Liang Liu
- Department of Radiation Oncology, Lianyungang First People's Hospital, Lianyungang, China
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Rojas-Puentes LL, Gonzalez-Pinedo M, Crismatt A, Ortega-Gomez A, Gamboa-Vignolle C, Nuñez-Gomez R, Dorantes-Gallareta Y, Arce-Salinas C, Arrieta O. Phase II randomized, double-blind, placebo-controlled study of whole-brain irradiation with concomitant chloroquine for brain metastases. Radiat Oncol 2013; 8:209. [PMID: 24010771 PMCID: PMC3848663 DOI: 10.1186/1748-717x-8-209] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/03/2013] [Indexed: 12/16/2022] Open
Abstract
Background and purpose Chloroquine (CLQ), an antimalarial drug, has a lysosomotropic effect associated with increased radiationsensibility, which is mediated by the leakage of hydrolytic enzymes, increased apoptosis, autophagy and increased oxidative stress in vitro. In this phase II study, we evaluated the efficacy and safety of radiosensibilization using CLQ concomitant with 30 Gray (Gy) of whole-brain irradiation (WBI) to treat patients with brain metastases (BM) from solid tumors. Methods Seventy-three eligible patients were randomized. Thirty-nine patients received WBI (30 Gy in 10 fractions over 2 weeks) concomitant with 150 mg of CLQ for 4 weeks (the CLQ arm). Thirty-four patients received the same schedule of WBI concomitant with a placebo for 4 weeks (the control arm). All the patients were evaluated for quality of life (QoL) using the EORTC Quality of Life (QoL) Questionnaire (EORTC QLQ-C30) (Mexican version) before beginning radiotherapy and one month later. Results The overall response rate (ORR) was 54% for the CLQ arm and 55% for the control arm (p=0.92). The progression-free survival of brain metastases (BMPFS) rates at one year were 83.9% (95% CI 69.4-98.4) for the CLQ arm and 55.1% (95% CI 33.6-77.6) for the control arm. Treatment with CLQ was independently associated with increased BMPFS (RR 0.31,95% CI [0.1-0.9], p=0.046).The only factor that was independently associated with increased overall survival (OS) was the presence of< 4 brain metastases (RR 1.9, 95% CI [1.12-3.3], p=0.017). WBI was associated with improvements in cognitive and emotional function but also with worsened nausea in both patients groups. No differences in QoL or toxicity were found between the study arms. Conclusion Treatment with CLQ plus WBI improved the control of BM (compared with the control arm) with no increase in toxicity; however, CLQ did not improve the RR or OS. A phase III clinical trial is warranted to confirm these findings.
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Affiliation(s)
- Luis L Rojas-Puentes
- Medical Oncology Department, Instituto Nacional de Cancerología de México(INCan), San Fernando N22 Colonia Sección XVI, Tlalpan Mexico City, Mexico.
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Clarke E, Brock J, Soldà F, Gupta S, Brada M. The impact of brain metastases on the clinical service in a cancer center. J Palliat Med 2013; 16:836-7. [PMID: 23767954 DOI: 10.1089/jpm.2013.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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