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Samanci Y, Ali Tepebasili M, Deniz Ardor G, Haluk Duzkalir A, Orbay Askeroglu M, Peker S. Efficacy of hypofractionated Gamma Knife radiosurgery in treating surgical beds of metastatic brain tumors. J Clin Neurosci 2024; 121:105-113. [PMID: 38387112 DOI: 10.1016/j.jocn.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE Surgery alone for metastatic brain tumors (METs) often results in local recurrence due to microscopic residual tumor tissue. While stereotactic radiosurgery (SRS) is commonly used post-surgery, hypofractionation may be required for large surgical beds. This study evaluated the efficacy and safety of hypofractionated Gamma Knife radiosurgery (hf-GKRS) for the first time as a post-operative adjuvant therapy. METHODS This retrospective study involved 24 patients (28 surgical beds) who underwent hf-GKRS within four weeks after surgery. The study primarily focused on local control (LC) rate and analyzed distant intracranial failure (DICF), intracranial progression-free survival (PFS), leptomeningeal disease (LMD), overall survival (OS), and radiation necrosis (RN). RESULTS During a median follow-up of 9 months, LC was achieved in 89.3 % of surgical beds. LC estimates at 6, 12, and 24 months were 96.4 %, 82.7 %, and 82.7 %, respectively. DICF was observed in 45.8 % of patients, and LMD was identified in two patients (8.3 %). At the end of the follow-up, 58.3 % of patients were alive, and the median OS was 20 months. RN occurred in only one surgical bed (3.6 %). No grade 5 toxicity was observed. The univariate analysis identified a longer interval to GKRS (HR 11.842, p = 0.042) and a larger treatment volume (HR 1.103, p = 0.037) as significant factors for local failure. CONCLUSIONS hf-GKRS shows potential as an effective and safe adjuvant treatment for surgical beds. It offers an alternative to SRS, SRT, or WBRT, particularly for larger volumes or tumors near critical structures. Further research is needed to confirm these results and optimize treatment approaches.
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Affiliation(s)
- Yavuz Samanci
- Koc University School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | | | - Gokce Deniz Ardor
- Koc University Hospital, Department of Neurosurgery, Gamma Knife Center, Istanbul, Turkey
| | - Ali Haluk Duzkalir
- Koc University Hospital, Department of Neurosurgery, Gamma Knife Center, Istanbul, Turkey
| | - M Orbay Askeroglu
- Koc University Hospital, Department of Neurosurgery, Gamma Knife Center, Istanbul, Turkey
| | - Selcuk Peker
- Koc University School of Medicine, Department of Neurosurgery, Istanbul, Turkey.
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Geng X, Kou C, Wang J. The association between graded prognostic assessment and the prognosis of brain metastases after whole brain radiotherapy: a meta-analysis. Front Oncol 2024; 13:1322262. [PMID: 38264750 PMCID: PMC10803601 DOI: 10.3389/fonc.2023.1322262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction This meta-analysis aims to provide evidence-based medical evidence for formulating rational treatment strategies and evaluating the prognosis of brain metastasis (BM) patients by assessing the effectiveness of the graded prognostic assessment (GPA) model in predicting the survival prognosis of patients with BM after whole-brain radiotherapy (WBRT). Methods A comprehensive search was conducted in multiple databases, including the China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), PubMed, Wanfang database, Cochrane Library, Web of Science, and Embase. Cohort studies that met the inclusion and exclusion criteria were selected. The quality of the included literature was evaluated using the Newcastle-Ottawa Scale, and all statistical analyses were performed with R version 4.2.2. The effect size (ES) was measured by the hazard ratio (HR) of overall survival (OS). The OS rates at 3, 6, 12, and 24 months of patients with BM were compared between those with GPAs of 1.5-2.5, 3.0, and 3.5-4.0 and those with GPAs of 0-1 after WBRT. Results A total of 1,797 participants who underwent WBRT were included in this study. The meta-analysis revealed a significant association between GPA and OS rates after WBRT: compared with BM patients with GPA of 0-1, 3-month OS rates after WBRT were significantly higher in BM patients with GPA of 1.5-2.5 (HR = 0.48; 95% CI: 0.40-0.59), GPA of 3 (HR = 0.38; 95% CI: 0.25-0.57), and GPA of 3.5-4 (HR = 0.28; 95% CI: 0.15-0.52); 6-month OS rates after WBRT were significantly higher in BM patients with GPA of 1.5-2.5 (HR = 0.48; 95% CI: 0.41-0.56), GPA of 3 (HR = 0.33; 95% CI: 0.24-0.45), and GPA of 3.5-4 (HR = 0.24; 95% CI: 0.16-0.35); 12-month OS rates after WBRT were significantly higher in BM patients with GPA of 1.5-2.5 (HR = 0.49; 95% CI: 0.41-0.58), GPA of 3 (HR = 0.48; 95% CI: 0.32-0.73), and GPA of 3.5-4 (HR = 0.31; 95% CI: 0.12-0.79); and 24-month OS rates after WBRT were significantly higher in BM patients with GPA of 1.5-2.5 (HR = 0.49; 95% CI: 0.42-0.58), GPA of 3 (HR = 0.49; 95% CI: 0.32-0.74), and GPA of 3.5-4 (HR = 0.38; 95% CI: 0.15-0.94). Conclusion BM patients with higher GPAs generally exhibited better prognoses and survival outcomes after WBRT compared to those with lower GPAs. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023422914.
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Affiliation(s)
- Xiaohan Geng
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Jianfeng Wang
- Department of Radiotherapy, China-Japan Union Hospital, Jilin University, Changchun, China
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Mehkri Y, Windermere SA, Still MEH, Yan SC, Goutnik M, Melnick K, Doonan B, Ghiaseddin AP, Rahman M. The Safety and Efficacy of Concurrent Immune Checkpoint Blockade and Stereotactic Radiosurgery Therapy with Practitioner and Researcher Recommendations. World Neurosurg 2024; 181:e133-e153. [PMID: 37739175 DOI: 10.1016/j.wneu.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have shown growing promise in the treatment of brain metastases, especially combined with stereotactic radiosurgery (SRS). The combination of ICIs with SRS has been studied for efficacy as well as increasing radiation necrosis risks. In this review, we compare clinical outcomes of radiation necrosis, intracranial control, and overall survival between patients with brain metastases treated with either SRS alone or SRS-ICI combination therapy. METHODS A literature search of PubMed, Scopus, Embase, Web of Science, and Cochrane was performed in May 2023 for articles comparing the safety and efficacy of SRS/ICI versus SRS-alone for treating brain metastases. RESULTS The search criteria identified 1961 articles, of which 48 met inclusion criteria. Combination therapy with SRS and ICI does not lead to significant increases in incidence of radiation necrosis either radiographically or symptomatically. Overall, no difference was found in intracranial control between SRS-alone and SRS-ICI combination therapy. Combination therapy is associated with increased median overall survival. Notably, some comparative studies observed decreased neurologic deaths, challenging presumptions that improved survival is due to greater systemic control. The literature supports SRS-ICI administration within 4 weeks of another for survival but remains inconclusive, requiring further study for other outcome measures. CONCLUSIONS Combination SRS-ICI therapy is associated with significant overall survival benefit for patients with brain metastases without significantly increasing radiation necrosis risks compared to SRS alone. Although intracranial control rates appear to be similar between the 2 groups, timing of treatment delivery may improve control rates and demands further study attention.
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Affiliation(s)
- Yusuf Mehkri
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | | | - Megan E H Still
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Sandra C Yan
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Michael Goutnik
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Kaitlyn Melnick
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Bently Doonan
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Ashley P Ghiaseddin
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Maryam Rahman
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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Di Cristofori A, Carone G, Rocca A, Rui CB, Trezza A, Carrabba G, Giussani C. Fluorescence and Intraoperative Ultrasound as Surgical Adjuncts for Brain Metastases Resection: What Do We Know? A Systematic Review of the Literature. Cancers (Basel) 2023; 15:cancers15072047. [PMID: 37046709 PMCID: PMC10092992 DOI: 10.3390/cancers15072047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: brain metastases (BMs) are the most common neoplasm of the central nervous system; despite the high incidence of this type of tumour, to date there is no universal consensus on the most effective treatment in patients with BMs, even if surgery still plays a primary role. Despite this, the adjunct systems that help to reach the GTR, which are well structured for other tumour forms such as ultrasound and fluorescence systems, are not yet well employed and standardised in surgical practice. The aim of this review is to provide a picture of the current state-of-art of the roles of iOUS and intraoperative fluorescence to better understand their potential roles as surgical tools. (2) Methods: to reach this goal, the PubMed database was searched using the following string as the keyword: (((Brain cerebral metastasis [MeSH Major Topic])OR (brain metastasis, [MeSH Major Topic])) AND ((5-ala, [MeSH Terms]) OR (Aminolevulinicacid [All fields]) OR (fluorescein, [MeSH Terms]) OR (contrast enhanced ultrasound [MeSH Terms])OR ((intraoperative ultrasound. [MeSH Terms]))) AND (english [Filter]) AND ((english [Filter]) AND (2010:2022 [pdat])) AND (english [Filter]). (3) Results: from our research, a total of 661 articles emerged; of these, 57 were selected. 21 of these included BMs generically as a secondary class for comparisons with gliomas, without going deeply into specific details. Therefore, for our purposes, 36 articles were considered. (4) Conclusions: with regard to BMs treatment and their surgical adjuncts, there is still much to be explored. This is mainly related to the heterogeneity of patients, the primary tumour histology and the extent of systemic disease; regardless, surgery plays a paramount role in obtaining a local disease control, and more standardised surgical protocols need to be made, with the aim of optimizing the use of the available surgical adjuncts and in order to increase the rate of GTR.
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Affiliation(s)
- Andrea Di Cristofori
- Division of Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi, 20900 Monza, Italy
- PhD Program in Neuroscience, University of Milano-Bicocca, Piazza Ateneo Nuovo 1, 20126 Milano, Italy
| | - Giovanni Carone
- Department of Neurosurgery, School of Medicine, Surgery Università degli Studi di Milano-Bicocca, Piazza Ateneo Nuovo 1, 20126 Milano, Italy
| | - Alessandra Rocca
- Department of Neurosurgery, School of Medicine, Surgery Università degli Studi di Milano-Bicocca, Piazza Ateneo Nuovo 1, 20126 Milano, Italy
| | - Chiara Benedetta Rui
- Department of Neurosurgery, School of Medicine, Surgery Università degli Studi di Milano-Bicocca, Piazza Ateneo Nuovo 1, 20126 Milano, Italy
| | - Andrea Trezza
- Division of Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi, 20900 Monza, Italy
| | - Giorgio Carrabba
- Division of Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi, 20900 Monza, Italy
- Department of Neurosurgery, School of Medicine, Surgery Università degli Studi di Milano-Bicocca, Piazza Ateneo Nuovo 1, 20126 Milano, Italy
| | - Carlo Giussani
- Division of Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Via GB Pergolesi, 20900 Monza, Italy
- Department of Neurosurgery, School of Medicine, Surgery Università degli Studi di Milano-Bicocca, Piazza Ateneo Nuovo 1, 20126 Milano, Italy
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Comparison of whole brain radiation therapy for synchronous brain metastases with irradiation protecting the hippocampus versus whole brain radiotherapy for sequential brain metastases to boost irradiation in the treatment of brain metastases from SCLC: study protocol for a randomized controlled trial. Trials 2022; 23:876. [PMID: 36242060 PMCID: PMC9569116 DOI: 10.1186/s13063-022-06826-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 10/05/2022] [Indexed: 12/04/2022] Open
Abstract
Background This study is in regard to the comparison of whole brain radiation therapy for synchronous brain metastases with irradiation protecting the hippocampus versus whole brain radiotherapy for sequential brain metastases to boost irradiation in the treatment of brain metastases from small cell lung cancer (SCLC). Therapeutically, they have notably varying dose distributions. Based on theoretical and model studies, it has long been speculated that these modes may result in different prognostic outcomes. We aim to assess the efficacy of tomotherapy in the treatment of SCLC brain metastases while protecting the key functional area, the hippocampus, and minimizing any neurocognitive impairments incurred by radiation. Methods This is a randomized, controlled, prospective study including 102 SCLC patients with brain metastases randomized (1:1) to the experimental (whole brain radiation therapy for synchronous brain metastases with irradiation to protect the hippocampus) or control (whole brain radiotherapy for sequential brain metastases to boost irradiation) group. The sample size is calculated through a single-sided test; 102 participants will be required for the main results to have statistical and clinical significance. We aim to provide clinical trial data support for better prognostic treatment options in patients with SCLC and brain metastases. The clinical trial data include both the primary and secondary outcomes; the primary outcome is the intracranial progression-free survival time after the new technology application. The secondary study outcomes include the assessment of neurological function, the quality of life, and the overall survival rate. Follow-up consultations will be conducted every 2 months. After the final patient completes follow-up, the Statistical Product and Service Solutions software will be used for scientific and rigorous data analysis. Version 1.0 of the protocol was implemented on January 1, 2021; the recruitment process for this clinical trial commenced on April 1, 2021, and will end on March 31, 2024. Discussion The study will provide high-quality clinical evidence to support the efficacy and safety of whole brain radiation therapy for synchronous brain metastases with dose irradiation protecting the hippocampus versus whole brain radiotherapy for sequential brain metastases with push volume irradiation for the treatment of patients who have lung cancer as well as brain metastases. This has not been previously reported. Trial registration This trial is registered with the Chinese Clinical Trial Registry (ChiCTR1900027539; November 17, 2019) (URL: https://www.chictr.org.cn/hvshowproject.aspx?id=20515).
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Jain V, de Godoy LL, Mohan S, Chawla S, Learned K, Jain G, Wehrli FW, Alonso-Basanta M. Cerebral hemodynamic and metabolic dysregulation in the postradiation brain. J Neuroimaging 2022; 32:1027-1043. [PMID: 36156829 DOI: 10.1111/jon.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/28/2022] Open
Abstract
Technological advances in the delivery of radiation and other novel cancer therapies have significantly improved the 5-year survival rates over the last few decades. Although recent developments have helped to better manage the acute effects of radiation, the late effects such as impairment in cognition continue to remain of concern. Accruing data in the literature have implicated derangements in hemodynamic parameters and metabolic activity of the irradiated normal brain as predictive of cognitive impairment. Multiparametric imaging modalities have allowed us to precisely quantify functional and metabolic information, enhancing the anatomic and morphologic data provided by conventional MRI sequences, thereby contributing as noninvasive imaging-based biomarkers of radiation-induced brain injury. In this review, we have elaborated on the mechanisms of radiation-induced brain injury and discussed several novel imaging modalities, including MR spectroscopy, MR perfusion imaging, functional MR, SPECT, and PET that provide pathophysiological and functional insights into the postradiation brain, and its correlation with radiation dose as well as clinical neurocognitive outcomes. Additionally, we explored some innovative imaging modalities, such as quantitative blood oxygenation level-dependent imaging, susceptibility-based oxygenation measurement, and T2-based oxygenation measurement, that hold promise in delineating the potential mechanisms underlying deleterious neurocognitive changes seen in the postradiation setting. We aim that this comprehensive review of a range of imaging modalities will help elucidate the hemodynamic and metabolic injury mechanisms underlying cognitive impairment in the irradiated normal brain in order to optimize treatment regimens and improve the quality of life for these patients.
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Affiliation(s)
- Varsha Jain
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiation Oncology, Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
| | - Laiz Laura de Godoy
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Suyash Mohan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kim Learned
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gaurav Jain
- Department of Neurological Surgery, Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Felix W Wehrli
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Chen YH, Ho UC, Kuo LT. Oligometastatic Disease in Non-Small-Cell Lung Cancer: An Update. Cancers (Basel) 2022; 14:cancers14051350. [PMID: 35267658 PMCID: PMC8909159 DOI: 10.3390/cancers14051350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Approximately 7–50% of patients with non-small-cell lung cancer (NSCLC) develop oligometastases, which are new tumors found in another part of the body, arising from cancer cells of the original tumor that have travelled through the body. In recent years, these patients have been increasingly regarded as a distinct group that could benefit from treatment that intends to cure the disease, rather than palliative care, to achieve a better clinical outcome. Various treatment procedures have been developed for treating NSCLC patients with different oligometastatic sites. In addition, the newly proposed uniform definition for oligometastases as well as ongoing trials may lead to increased appropriate patient selection and evaluation of treatment effectiveness. The aim of this review article is to summarize the latest evidence regarding optimal management strategies for NSCLC patients with oligometastases. Abstract Oligometastatic non-small-cell lung cancer (NSCLC) is a distinct entity that is different from localized and disseminated diseases. The definition of oligometastatic NSCLC varies across studies in past decades owing to the use of different imaging modalities; however, a uniform definition of oligometastatic NSCLC has been proposed, and this may facilitate trial design and evaluation of certain interventions. Patients with oligometastatic NSCLC are candidates for curative-intent management, in which local ablative treatment, such as surgery or stereotactic radiosurgery, should be instituted to improve clinical outcomes. Although current guidelines recommend that local therapy for thoracic and metastatic lesions should be considered for patients with oligometastatic NSCLC with stable disease after systemic therapy, optimal management strategies for different oligometastatic sites have not been established. Additionally, the development of personalized therapies for individual patients with oligometastatic NSCLC to improve their quality of life and overall survival should also be addressed. Here, we review relevant articles on the management of patients with oligometastatic NSCLC and categorize the disease according to the site of metastases. Ongoing trials are also summarized to determine future directions and expectations for new treatment modalities to improve patient management.
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Affiliation(s)
- Yi-Hsing Chen
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yunlin Branch, Douliu 640, Taiwan; (Y.-H.C.); (U.-C.H.)
| | - Ue-Cheung Ho
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yunlin Branch, Douliu 640, Taiwan; (Y.-H.C.); (U.-C.H.)
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456
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Sas-Korczynska B, Rucinska M. WBRT for brain metastases from non-small cell lung cancer: for whom and when?-Contemporary point of view. J Thorac Dis 2021; 13:3246-3257. [PMID: 34164217 PMCID: PMC8182552 DOI: 10.21037/jtd-2019-rbmlc-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The incidence of brain metastases (BM) is estimated between 20% and 40% of patients with solid cancer. The most common cause of this failure is lung cancer, and in locally advanced non-small cell lung cancer (NSCLC) BM represent a common site of relapse in 30-55% cases. The basic criteria of therapeutic decision-making are based on the significant prognostic factors which are components of prognostic scores. The standard approach to treatment of BM from NSCLC include whole brain radiotherapy (WBRT) which is used as adjuvant modality after local therapy (surgery or stereotactic radiosurgery) or as primary treatment and it remains the primary modality of treatment for patients with multiple metastases. WBRT is also used in combination with systemic therapy. The aim of presented review of literature is trying to answer which patients with BM from NSCLC should receive WBRT and when it could be omitted. There were presented the aspects of application of WBRT in relation to (I) choice between WBRT or the best supportive care and (II) employment of WBRT in combination with local treatment modalities [surgical resection or stereotactic radio-surgery (SRS)] and/or with systemic therapy. According to data from literature we concluded that the most important factor that needs to be considered when assessing the suitability of a patient for WBRT is the patient's prognosis based on the Lung-molGPA score. WBRT should be applied in treatment of multiple BM from lung cancer in patients with favourable prognosis and in in patients with presence of EML4-ALK translocation before therapy with crizotinib. Whereas WBRT could be omitted in patients with poor prognosis and after primary SRS.
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Affiliation(s)
- Beata Sas-Korczynska
- Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland.,Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Monika Rucinska
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland.,Department of Oncology, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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9
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Samanci Y, Sisman U, Altintas A, Sarioglu S, Sharifi S, Atasoy Aİ, Bolukbasi Y, Peker S. Hypofractionated frameless gamma knife radiosurgery for large metastatic brain tumors. Clin Exp Metastasis 2021; 38:31-46. [PMID: 33389335 DOI: 10.1007/s10585-020-10068-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/29/2020] [Indexed: 12/30/2022]
Abstract
Hypofractionated stereotactic radiosurgery has become an alternative for metastatic brain tumors (METs). We aimed to analyze the efficacy and safety of frameless hypofractionated Gamma Knife radiosurgery (hfGKRS) in the management of unresected, large METs. All patients who were managed with hfGKRS for unresected, large METs (> 4 cm3) between June 2017 and June 2020 at a single center were reviewed in this retrospective study. Local control (LC), progression-free survival (PFS), overall survival (OS), and toxicities were investigated. A total of 58 patients and 76 METs with regular follow-up were analyzed. LC rate was 98.5% at six months, 96.0% at one year, and 90.6% at 2 years during a median follow-up of 12 months (range, 2-37). The log-rank test indicated no difference in the distribution of LC for any clinical or treatment variable. PFS was 86.7% at 6 months, 66.6% at 1 year, and 58.5% at 2 years. OS was 81% at 6 months, 63.6% at one year, and 50.7% at 2 years. On the log-rank test, clinical parameters such as control status of primary cancer, presence of extracranial metastases, RTOG-RPA class, GPA group, and ds-GPA group were significantly associated with PFS and OS. Patients presented with grade 1 (19.0%), grade 2 (3.5%) and grade 3 (5.2%) side effects. Radiation necrosis was not observed in any patients. Our current results suggest that frameless hfGKRS for unresected, large METs is a rational alternative in selected patients with promising results.
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Affiliation(s)
- Yavuz Samanci
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey
| | - Uluman Sisman
- School of Medicine, Koç University, Istanbul, Turkey
| | | | | | | | - Ali İhsan Atasoy
- Department of Radiation Oncology, Koç University Hospital, Istanbul, Turkey
| | - Yasemin Bolukbasi
- Department of Radiation Oncology, School of Medicine, Koç University, Istanbul, Turkey
| | - Selcuk Peker
- Department of Neurosurgery, School of Medicine, Koç University, Davutpasa Caddesi No:4, 34010, Zeytinburnu/İstanbul, Turkey.
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Sallabanda M, García-Berrocal MI, Romero J, García-Jarabo V, Expósito MJ, Rincón DF, Zapata I, Magallón MR. Brain metastases treated with radiosurgery or hypofractionated stereotactic radiotherapy: outcomes and predictors of survival. Clin Transl Oncol 2020; 22:1809-1817. [PMID: 32124243 DOI: 10.1007/s12094-020-02321-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/08/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To assess treatment outcome and prognostic factors associated with prolonged survival in patients with brain metastases (BM) treated with stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (HFSRT). METHODS/PATIENTS This study retrospectively reviewed 200 patients with 324 BM treated with one fraction (15-21 Gy) or 5-10 fractions (25-40 Gy) between January 2010 and August 2016. 26.5% of patients received whole brain radiotherapy (WBRT) and 25% initial surgery. Demographics, prognostic scales, systemic and local controls, patterns of relapse and rescue, toxicity, and cause of death were analyzed. A stratified analysis by primary tumor was done. RESULTS Median overall survival (OS) was 8 months from SRS/HFSRT. Breast cancer patients had a median OS of 17 months, followed by renal (11 months), lung (8 months), colorectal (5 months), and melanoma (4 months). The univariate analysis showed improved OS in females (p 0.004), RPA I-II (p < 0.001) initial surgery (p < 0.001), absence of extracranial disease (p 0.023), and good disease control (p 0.002). There were no differences in OS or local control between SRS and HFSRT or in patients receiving WBRT. Among 44% of brain recurrences, 11% were in field. 174 patients died, 10% from confirmed intracranial progression. CONCLUSIONS SRS and HSFRT are equally effective and safe for the treatment of BM, with no exceptions among different primary tumors. Disease control, surgery, age, and prognostic scales correlated with OS. However, the lack of survival benefit regarding WBRT might become logical evidence for its omission in a subset of patients.
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Affiliation(s)
- M Sallabanda
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain.
| | - M I García-Berrocal
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
| | - J Romero
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
| | - V García-Jarabo
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
| | - M J Expósito
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
| | - D F Rincón
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
| | - I Zapata
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
| | - M R Magallón
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
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11
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Nasrazadani A, Brufsky A. Neratinib: the emergence of a new player in the management of HER2+ breast cancer brain metastasis. Future Oncol 2020; 16:247-254. [PMID: 32057254 DOI: 10.2217/fon-2019-0719] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
HER2-positive (HER2+) breast cancer has become an effectively treatable disease in the era of targeted therapies, and outcomes have improved such that prognosis of this subtype is demonstrated to be superior to HER2-negative disease. Despite these advances, durable responses in HER2+ metastatic disease are challenged by the increased risk for brain metastasis. Neratinib is an irreversible pan-HER kinase inhibitor that has emerged as an effective agent when combined with capecitabine for the management of HER2+ metastatic breast cancer patients with brain metastasis. The randomized, Phase III, NALA trial compares neratinib plus capecitabine to a currently prevailing regimen of lapatinib plus capecitabine and is provided herein. Analysis of NALA portends meaningful changes on the horizon for the management of HER2+ metastatic breast cancer.
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Affiliation(s)
- Azadeh Nasrazadani
- UPMC Hillman Cancer Center, University of Pittsburgh, 5115 Centre Ave, Pittsburgh, PA 15232, USA
| | - Adam Brufsky
- UPMC Hillman Cancer Center, Magee Women's Hospital, Suite 4628, 300 Halket Street, Pittsburgh, PA 15213, USA
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12
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Verhaak E, Gehring K, Hanssens PEJ, Aaronson NK, Sitskoorn MM. Health-related quality of life in adult patients with brain metastases after stereotactic radiosurgery: a systematic, narrative review. Support Care Cancer 2020; 28:473-484. [PMID: 31792879 PMCID: PMC6954134 DOI: 10.1007/s00520-019-05136-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 10/16/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE A growing number of patients with brain metastases (BM) are being treated with stereotactic radiosurgery (SRS), and the importance of evaluating the impact of SRS on the health-related quality of life (HRQoL) in these patients has been increasingly acknowledged. This systematic review summarizes the current knowledge about the HRQoL of patients with BM after SRS. METHODS We searched EMBASE, Medline Ovid, Web-of-Science, the Cochrane Database, PsycINFO Ovid, and Google Scholar up to November 15, 2018. Studies in patients with BM in which HRQoL was assessed before and after SRS and analyzed over time were included. Studies including populations of several types of brain cancer and/or several types of treatments were included if the results for patients with BM and treatment with SRS alone were described separately. RESULTS Out of 3638 published articles, 9 studies met the eligibility criteria and were included. In 4 out of 7 studies on group results, overall HRQoL of patients with BM remained stable after SRS. In small study samples of longer-term survivors, overall HRQoL remained stable up to 12 months post-SRS. Contradictory results were reported for physical and general/global HRQoL, which might be explained by the different questionnaires that were used. CONCLUSIONS In general, SRS does not have significant negative effects on patients' overall HRQoL over time. Future research is needed to analyze different aspects of HRQoL, differences in individual changes in HRQoL after SRS, and factors that influence these changes. These studies should take into account several methodological issues as discussed in this review.
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Affiliation(s)
- Eline Verhaak
- Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - Karin Gehring
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
- Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands.
| | - Patrick E J Hanssens
- Gamma Knife Center, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Margriet M Sitskoorn
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
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13
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Pathologically confirmed brain metastases from primary uterine cervical tumors: two cases and a literature review. World J Surg Oncol 2019; 17:174. [PMID: 31672152 PMCID: PMC6824018 DOI: 10.1186/s12957-019-1720-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/03/2019] [Indexed: 12/26/2022] Open
Abstract
Background Pathologically confirmed brain metastasis from primary cervical cancer is extremely rare. Herein, we report two cases of intracranial metastasis from cervical cancer that were histopathologically confirmed after surgical excision. In addition, we conducted a literature review to characterize the clinical manifestation, pathogenesis, and treatment of these patients. Case summary Among the 1800 patients with primary cervical cancer who received therapy at our center from 2010 to 2018, two patients (0.1%) had definite histopathological evidence of brain metastasis. A 46-year-old female who had a history of poorly differentiated stage IIB cervical cancer with neuroendocrine differentiation presented with a solitary mass in the right occipital lobe 26 months after the initial diagnosis. She underwent surgery and chemotherapy but died of disease progression 9 months later. Another 55-year-old female diagnosed with poorly differentiated stage IVB cervical squamous cancer presented with a solitary mass in the right frontal lobe 16 months after simple hysterectomy. Twelve months later, multiple lesions were observed in the bilateral frontal-parietal lobe. The lesions were treated by surgery and stereotactic radiosurgery. The patient died of multiple organ failure 14 months later. Conclusion The pathogenesis and best management of brain metastasis from cervical cancer are not clear. Highly invasive subtypes or advanced cancer stages may be the key clinicopathological factors of brain metastasis. Surgical treatment is warranted in patients with a good health status and without metastasis to other sites.
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14
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Winograd E, Rivers CI, Fenstermaker R, Fabiano A, Plunkett R, Prasad D. The case for radiosurgery for brainstem metastases. J Neurooncol 2019; 143:585-595. [DOI: 10.1007/s11060-019-03195-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/11/2019] [Accepted: 05/16/2019] [Indexed: 11/30/2022]
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15
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Jiang A, Sun W, Zhao F, Wu Z, Shang D, Yu Q, Wang S, Zhu J, Yang F, Yuan S. Dosimetric evaluation of four whole brain radiation therapy approaches with hippocampus and inner ear avoidance and simultaneous integrated boost for limited brain metastases. Radiat Oncol 2019; 14:46. [PMID: 30876444 PMCID: PMC6419811 DOI: 10.1186/s13014-019-1255-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/07/2019] [Indexed: 01/31/2023] Open
Abstract
AIMS To perform a dosimetric evaluation of four different simultaneous integrated boost whole brain radiotherapy modalities with hippocampus and inner ear avoidance in the treatment of limited brain metastases. METHODS Computed tomography/magnetic resonance imaging data of 10 patients with limited (1-5) brain metastases were used to replan step-and-shoot intensity-modulated radiotherapy (sIMRT), dynamic intensity-modulated radiation therapy (dIMRT), volumetric-modulated arc therapy (VMAT), and helical tomotherapy (Tomo). The prescribed doses of 40-50 Gy in 10 fractions and 30 Gy in 10 fractions were simultaneously delivered to the metastatic lesions and the whole-brain volume, respectively. The hippocampal dose met the RTOG 0933 criteria for hippocampal avoidance (Dmax ≤17 Gy, D100% ≤10 Gy). The inner ear dose was restrained to Dmean ≤15 Gy. Target coverage (TC), homogeneity index (HI), conformity index (CI), maximum dose (Dmax), minimum dose (Dmin) and dose to organs at risk (OARs) were compared. RESULTS All plans met the indicated dose restrictions. The mean percentage of planning target volume of metastases (PTVmets) coverage ranged from 97.1 to 99.4%. For planning target volume of brain (PTVbrain), Tomo provided the lowest average D2% (37.5 ± 2.8 Gy), the highest average D98% (25.2 ± 2.0 Gy), and the best TC (92.6% ± 2.1%) and CI (0.79 ± 0.06). The two fixed gantry IMRT modalities (step and shot, dynamic) provided similar PTVbrain dose homogeneity (both 0.76). Significant differences across the four approaches were observed for the maximum and minimum doses to the hippocampus and the maximum doses to the eyes, lens and optic nerves. CONCLUSION All four radiotherapy modalities produced acceptable treatment plans with good avoidance of the hippocampus and inner ear. Tomo obtained satisfactory PTVbrain coverage and the best homogeneity index. TRIAL REGISTRATION Clinicaltrials.gov, NCT03414944 . Registered 29 January 2018.
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Affiliation(s)
- Aijun Jiang
- Shandong University, Jinan, 250117, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Weipeng Sun
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Fen Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Zhenxuan Wu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Dongping Shang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Qingxi Yu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Suzhen Wang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Jian Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Fengchang Yang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Shuanghu Yuan
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, 440 Jiyan Road, Jinan, 250117, Shandong, China.
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16
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Or M, Jayamanne D, Guo L, Stevens M, Parkinson J, Cook R, Little N, Back M. Focal radiation therapy for limited brain metastases is associated with high rates of local control and low subsequent whole brain radiation therapy. ANZ J Surg 2019; 89:418-422. [PMID: 30836451 DOI: 10.1111/ans.15040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/28/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Assess clinical outcomes of focal radiotherapy (RT) in patients with limited brain metastasis (LBM) with whole brain RT (WBRT) avoidance. METHODS Patients diagnosed with LBM were entered into a database between January 2010 and February 2017. Patients were recommended WBRT avoidance with focal therapy and three-monthly magnetic resonance imaging. The primary endpoint was overall survival. Secondary endpoints included progression-free survival, initial-site failure (ISF), distant brain relapse (DBF), leptomeningeal disease and rate of WBRT. Analysis involved Kaplan-Meier survival estimate with log-rank tests and Cox-regression analysis. RESULTS One hundred and sixty-six patients were managed with median follow-up of 13 months and median overall survival of 15 months (95% confidence interval (CI) 10.8-19.2). Eighty-three patients had central nervous system (CNS) relapse with median progression-free survival of 11 months (95% CI 6.7-15.3), of which most failures were DBF (83.1%) with 27 ISF (32.5%). Of the ISFs, 12 (43%) had surgery alone, six had chemotherapy alone and nine received RT. Surgery or chemotherapy alone compared with RT had a significantly higher incidence of ISF with a hazard ratio of 4.96 (P < 0.0001, 95% CI 2.10-11.83) and 6.54 (P = 0.001, 95% CI 2.26-18.87), respectively. WBRT was utilized in only 24 patients, with 83% patients free of WBRT at 12 months. On univariate analysis, number of metastases (P = 0.04), symptomatic extracranial disease (P = 0.04) and early CNS relapse within 6 months (P < 0.01) had worse survival. No grade 3-4 toxicity events were noted in 129 patients undergoing RT. CONCLUSION Focal RT has a low rate of ISF with low toxicity in patients with LBMs. CNS progression was mainly DBF with low rates of salvage WBRT.
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Affiliation(s)
- Michelle Or
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Dasantha Jayamanne
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Central Coast Cancer Centre, Gosford Hospital, Gosford, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Genesis Cancer Care, Sydney, New South Wales, Australia
| | - Lesley Guo
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Mark Stevens
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Central Coast Cancer Centre, Gosford Hospital, Gosford, New South Wales, Australia
| | - Jonathon Parkinson
- The Brain Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Neurosurgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Raymond Cook
- The Brain Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Neurosurgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Little
- The Brain Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Neurosurgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Central Coast Cancer Centre, Gosford Hospital, Gosford, New South Wales, Australia.,The Brain Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Genesis Cancer Care, Sydney, New South Wales, Australia
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Liu Q, Tong X, Wang J. Management of brain metastases: history and the present. Chin Neurosurg J 2019; 5:1. [PMID: 32922901 PMCID: PMC7398203 DOI: 10.1186/s41016-018-0149-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/13/2018] [Indexed: 12/28/2022] Open
Abstract
Brain metastases are significant causes of morbidity or mortality for patients with metastatic cancer. With the application of novel systematic therapy and improvement of overall survival, the prevalence of brain metastases is increasing. The paradigm of treatment for brain metastases evolved rapidly during the last 30 years due to the development of technology and emergence of novel therapy. Brain metastases used to be regarded as the terminal stage of cancer and left life expectancy to only 1 month. The application of whole brain radiotherapy for patients with brain metastases increased the life expectancy to 4–6 months in the 1980s. Following studies established surgical resection followed by the application of whole brain radiotherapy the standard treatment for patients with single metastasis and good systematic performance. With the development of stereotactic radiosurgery, stereotactic radiosurgery plus whole brain radiotherapy provides an alternative modality with superior neurocognitive protection at the cost of overall survival. In addition, stereotactic radiosurgery combined with whole brain radiotherapy may offer a promising modality for patients with numerous multiple brain metastases who are not eligible for surgical resection. With the advancing understanding of molecular pathway and biological behavior of oncogenesis and tumor metastasis, novel targeted therapy including tyrosine-kinase inhibitors and immunotherapy are applied to brain metastases. Clinical trials had revealed the efficacy of targeted therapy. Furthermore, the combination of targeted therapy and radiotherapy or chemotherapy is the highlight of current investigation. Advancement in this area may further change the treatment paradigm and offer better modality for patients who are not suitable for surgical resection or radiosurgery.
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Affiliation(s)
- Qi Liu
- Department of neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Southern 4th Street, No.119, Beijing, 100071 China
| | - Xuezhi Tong
- Department of neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Southern 4th Street, No.119, Beijing, 100071 China
| | - Jiangfei Wang
- Department of neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Southern 4th Street, No.119, Beijing, 100071 China
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18
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Joshi RS, Hirshman BR, Ali MA, Alattar A, Carroll K, Nagano O, Aiyama H, Serizawa T, Yamamoto M, Chen CC. Prognostic Importance of Cumulative Intracranial Tumor Volume in Patients with Gastrointestinal Brain Metastasis Treated with Stereotactic Radiosurgery. World Neurosurg 2019; 121:e747-e754. [DOI: 10.1016/j.wneu.2018.09.209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022]
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19
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Yang L, He W, Xie Q, Liu S, Kong P, Jiang C, Zhang B, Xia L. Brain metastases in newly diagnosed colorectal cancer: a population-based study. Cancer Manag Res 2018; 10:5649-5658. [PMID: 30532587 PMCID: PMC6245349 DOI: 10.2147/cmar.s180173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Population-based incidence evaluations and prognosis assessments of brain metastasis (BM) at diagnosis of colorectal cancer (CRC) are lacking. Our study sought to determine the incidence of BM in CRC patients, median survival of patients with BM, and the risk factors of BM in CRC. Patients and methods Patients diagnosed with CRC were identified using the Surveillance, Epidemiology, and End Results database. Multivariable logistic and Cox regression analyses were performed to identify predictors of the presence of BM at CRC diagnosis and the factors associated with poor survival. Kaplan–Meier analysis was used to estimate the survival difference between subgroups. Results We identified 170,793 adult patients diagnosed with CRC between 2010 and 2013. From these patients, we identified 401 patients with BM at the time of CRC diagnosis, which represents 0.23% of the entire patient CRC cohort and 1.3% of the patients with metastatic disease to any site. Median survival of patients with BM was 7.0 months, and the survival could increase to 15.59 months if there was no metastasis to other organs. We found that extracranial metastases number, tumor site, and pathology type were associated with BM at CRC diagnosis. Conclusion The findings of this study indicate the incidence and prognosis for patients with BM at the time of CRC diagnosis. Our findings lend support for positive treatment for BM without metastasis to other organs.
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Affiliation(s)
- Lin Yang
- Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,State Key Laboratory of Oncology in Southern China, Guangzhou, China, ; .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Wenzhuo He
- Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,State Key Laboratory of Oncology in Southern China, Guangzhou, China, ; .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Qiankun Xie
- Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,State Key Laboratory of Oncology in Southern China, Guangzhou, China, ; .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Shousheng Liu
- Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,State Key Laboratory of Oncology in Southern China, Guangzhou, China, ; .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Pengfei Kong
- Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,State Key Laboratory of Oncology in Southern China, Guangzhou, China, ; .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Chang Jiang
- Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,State Key Laboratory of Oncology in Southern China, Guangzhou, China, ; .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Bei Zhang
- Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,State Key Laboratory of Oncology in Southern China, Guangzhou, China, ; .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
| | - Liangping Xia
- Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China, ; .,State Key Laboratory of Oncology in Southern China, Guangzhou, China, ; .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China, ;
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Masucci GL. Hypofractionated Radiation Therapy for Large Brain Metastases. Front Oncol 2018; 8:379. [PMID: 30333955 PMCID: PMC6176274 DOI: 10.3389/fonc.2018.00379] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/23/2018] [Indexed: 12/21/2022] Open
Abstract
Single fraction radiosurgery (SRS) treatment is an effective and recognized alternative to whole brain radiation for brain metastasis. However, SRS is not always possible, especially in tumors of a larger diameter where the administration of high dose in a single fraction is limited by the possibility of acute and late side effects and the dose to the surrounding organs at risk. Hypofractionated radiation therapy allows the delivery of high doses of radiation per fraction while minimizing adverse events, all the while maintaining good local control of lesions. The optimal dose fractionation has however not been established. This overwiew presents available evidence and rationale supporting usage of hypofractionated radiation therapy in the treatment of large brain metastases.
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Affiliation(s)
- Giuseppina Laura Masucci
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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21
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Hatiboglu MA, Akdur K, Sawaya R. Neurosurgical management of patients with brain metastasis. Neurosurg Rev 2018; 43:483-495. [DOI: 10.1007/s10143-018-1013-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/19/2018] [Accepted: 07/15/2018] [Indexed: 12/18/2022]
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22
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Franchino F, Rudà R, Soffietti R. Mechanisms and Therapy for Cancer Metastasis to the Brain. Front Oncol 2018; 8:161. [PMID: 29881714 PMCID: PMC5976742 DOI: 10.3389/fonc.2018.00161] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/30/2018] [Indexed: 12/12/2022] Open
Abstract
Advances in chemotherapy and targeted therapies have improved survival in cancer patients with an increase of the incidence of newly diagnosed brain metastases (BMs). Intracranial metastases are symptomatic in 60–70% of patients. Magnetic resonance imaging (MRI) with gadolinium is more sensitive than computed tomography and advanced neuroimaging techniques have been increasingly used in the detection, treatment planning, and follow-up of BM. Apart from the morphological analysis, the most effective tool for characterizing BM is immunohistochemistry. Molecular alterations not always reflect those of the primary tumor. More sophisticated methods of tumor analysis detecting circulating biomarkers in fluids (liquid biopsy), including circulating DNA, circulating tumor cells, and extracellular vesicles, containing tumor DNA and macromolecules (microRNA), have shown promise regarding tumor treatment response and progression. The choice of therapeutic approaches is guided by prognostic scores (Recursive Partitioning Analysis and diagnostic-specific Graded Prognostic Assessment-DS-GPA). The survival benefit of surgical resection seems limited to the subgroup of patients with controlled systemic disease and good performance status. Leptomeningeal disease (LMD) can be a complication, especially in posterior fossa metastases undergoing a “piecemeal” resection. Radiosurgery of the resection cavity may offer comparable survival and local control as postoperative whole-brain radiotherapy (WBRT). WBRT alone is now the treatment of choice only for patients with single or multiple BMs not amenable to surgery or radiosurgery, or with poor prognostic factors. To reduce the neurocognitive sequelae of WBRT intensity modulated radiotherapy with hippocampal sparing, and pharmacological approaches (memantine and donepezil) have been investigated. In the last decade, a multitude of molecular abnormalities have been discovered. Approximately 33% of patients with non-small cell lung cancer (NSCLC) tumors and epidermal growth factor receptor mutations develop BMs, which are targetable with different generations of tyrosine kinase inhibitors (TKIs: gefitinib, erlotinib, afatinib, icotinib, and osimertinib). Other “druggable” alterations seen in up to 5% of NSCLC patients are the rearrangements of the “anaplastic lymphoma kinase” gene TKI (crizotinib, ceritinib, alectinib, brigatinib, and lorlatinib). In human epidermal growth factor receptor 2-positive, breast cancer targeted therapies have been widely used (trastuzumab, trastuzumab-emtansine, lapatinib-capecitabine, and neratinib). Novel targeted and immunotherapeutic agents have also revolutionized the systemic management of melanoma (ipilimumab, nivolumab, pembrolizumab, and BRAF inhibitors dabrafenib and vemurafenib).
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Affiliation(s)
- Federica Franchino
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
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23
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Jin J, Gao Y, Zhang J, Wang L, Wang B, Cao J, Shao Z, Wang Z. Incidence, pattern and prognosis of brain metastases in patients with metastatic triple negative breast cancer. BMC Cancer 2018; 18:446. [PMID: 29673325 PMCID: PMC5909254 DOI: 10.1186/s12885-018-4371-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 04/15/2018] [Indexed: 12/14/2022] Open
Abstract
Background To identify the incidence, recurrence pattern and prognosis of brain metastases (BM) among women with metastatic triple negative breast cancer (mTNBC) treated consecutively at a single institution during a 7-year period. Methods Patients with histologically confirmed mTNBC were retrospectively identified. The incidence of BM as first site of recurrence and the cumulative BM incidence were computed. We used the Cox proportional hazards model to identify the univariate and multivariate factors associated with survival. Results Four hundred thirty three patients were included with a median overall survival (OS) of 21.6 months after median follow-up for 48.1 months. BM was found in 29% (127/433) of the patients and about a quarter (32/127) of BM was first recurrence. The cumulative incidence of BM at 1 and 2 years was 17 and 25%, respectively. The median time from the diagnosis of extracranial metastases to BM was 10 months. Median OS following a diagnosis of BM was 7.3 months. The longer median OS from time of first recurrent BM was noted compared with those of subsequent recurrent (17.3 vs 6.3 months, p = 0.008). However, patients with first recurrent BM were associated with shorter OS compared with those without BM (17.3 vs 22.1 months, p = 0.006). The independent factors that increased BM death risk were > 3 brain lesions, no BM-directed treatment, subsequent recurrent BM, symptomatic BM and uncontrolled extracranial metastasis. Conclusions Patients with mTNBC have a high incidence of early BM with subsequent poor survival. The findings lend support to consideration of screening imaging of the brain for mTNBC patients.
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Affiliation(s)
- Jia Jin
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yu Gao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Jian Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Leiping Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Biyun Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Jun Cao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Zhimin Shao
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Zhonghua Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China. .,, Shanghai, People's Republic of China.
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24
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van der Meer PB, Habets EJJ, Wiggenraad RG, Verbeek-de Kanter A, Lycklama À Nijeholt GJ, Zwinkels H, Klein M, Dirven L, Taphoorn MJB. Individual changes in neurocognitive functioning and health-related quality of life in patients with brain oligometastases treated with stereotactic radiotherapy. J Neurooncol 2018; 139:359-368. [PMID: 29663172 PMCID: PMC6096889 DOI: 10.1007/s11060-018-2868-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/08/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recently, it has been shown that at group level, patients with limited brain metastases treated with stereotactic radiotherapy (SRT) maintain their pre-treatment levels of neurocognitive functioning (NCF) and health-related quality of life (HRQoL). The aim of this study was to evaluate NCF and HRQoL changes over time at the individual patient level. METHODS NCF (seven domains assessed with a standardized test battery) and HRQoL (eight predetermined scales assessed with the EORTC QLQ-C30 and BN20 questionnaires) were measured prior to SRT and at 3 and/or 6 months follow-up. Changes in NCF and HRQoL were evaluated at (1) a domain/scale level and (2) patient level. RESULTS A total of 55 patients were examined, of which the majority showed stable NCF 3 months after SRT, on both the domain level (78-100% of patients) and patient level (67% of patients). This was different for HRQoL, where deterioration in the different scales was observed in 12-61% of patients, stable scores in 20-71%, and improvement in 16-40%, 3 months after SRT. At patient level, most patients (64%) showed both improvement and deterioration in different HRQoL scales. Results were similar between 3 and 6 months after SRT. CONCLUSION In line with results at group level, most brain oligometastases patients with ≥ 6 months follow-up and treated with SRT maintained their pre-treatment level of NCF during this period. By contrast, changes in HRQoL scores differed considerably at domain and patient level, despite stable HRQoL scores at group level.
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Affiliation(s)
- Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands.
| | - Esther J J Habets
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Ruud G Wiggenraad
- Department of Radiotherapy, Haaglanden Medical Center, The Hague, The Netherlands
| | | | | | - Hanneke Zwinkels
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Martin Klein
- Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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25
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Kim H, Rajagopalan M, Beriwal S, Smith K. Cost-effectiveness Analysis of Stereotactic Radiosurgery Alone Versus Stereotactic Radiosurgery with Upfront Whole Brain Radiation Therapy for Brain Metastases. Clin Oncol (R Coll Radiol) 2017; 29:e157-e164. [DOI: 10.1016/j.clon.2017.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/18/2017] [Accepted: 04/27/2017] [Indexed: 10/19/2022]
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26
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An J, Wang L, Zhao Y, Hao Q, Zhang Y, Zhang J, Yang C, Liu L, Wang W, Fang D, Lu T, Gao Y. Effects of FSTL1 on cell proliferation in breast cancer cell line MDA‑MB‑231 and its brain metastatic variant MDA‑MB‑231‑BR. Oncol Rep 2017; 38:3001-3010. [PMID: 29048681 PMCID: PMC5780039 DOI: 10.3892/or.2017.6004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 09/04/2017] [Indexed: 12/23/2022] Open
Abstract
In the past decades, altered Follistatin-like 1 (FSTL1) expression has been documented in a variety of cancers, while its functional roles are poorly understood. Particularly in breast cancer, the expression of FSTL1 and its signaling pathway remain to be determined. In the present study, an elevated FSTL1 expression and a supressed cell proliferation were detected in a specific brain metastatic cell line MDA-MB-231-BR (231-BR), compared with its parental cell line MDA-MB-231. However, this protein was hardly detected in the other three breast cancer cell lines. Next, lentiviral vectors encoding FSTL1 or FSTL1 specific shRNAs were used to overexpress or knock down FSTL1 in MDA-MB-231 or 231-BR, respectively (MDA-MB-231FSTL1 or 231-BRsh FSTL1). Results showed that overexpression of FSTL1 inhibited MDA-MB-231 cell proliferation, while knockdown of FSTL1 in 231-BR cells promotes cell proliferation, compared with their corresponding control groups. These results were further confirmed in nude mouse xenografts. The tumor volume in 231-BR cell-bearing mice was significantly smaller than that of MDA-MB-231 group, and reduction of tumor volume was detected in MDA-MB-231FSTL1 cell-bearing mice compared with the control group. Previous studies revealed that TGF-β-Smad2/3 signaling pathway was activated in 231-BR and MDA-MB-231FSTL1 cells, which may contribute to the inhibited cell proliferation. In addition, Smad3 knockdown could restore the inhibition of cell proliferation induced by FSTL1 overexpression in MDA-MB-231FSTL1 cells, indicating that the anti-proliferative effect of FSTL1 overexpression may be associated with Smad3 involved TGF-β signaling pathway regulation. This study identified FSTL1 as an inhibitor of cell proliferation in MDA-MB-231 and 231-BR cell lines, which may provide new insights into the development and management of breast cancer.
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Affiliation(s)
- Jiaqiang An
- Department of Human Anatomy, Capital Medical University, Beijing 100069, P.R. China
| | - Lulu Wang
- Department of Human Anatomy, Capital Medical University, Beijing 100069, P.R. China
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100069, P.R. China
| | - Qiang Hao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100069, P.R. China
| | - Ying Zhang
- Department of Human Anatomy, Capital Medical University, Beijing 100069, P.R. China
| | - Jingyi Zhang
- Department of Human Anatomy, Capital Medical University, Beijing 100069, P.R. China
| | - Chun Yang
- Department of Human Anatomy, Capital Medical University, Beijing 100069, P.R. China
| | - Li Liu
- Department of Human Anatomy, Capital Medical University, Beijing 100069, P.R. China
| | - Wenjuan Wang
- Department of Human Anatomy, Capital Medical University, Beijing 100069, P.R. China
| | - Dongliang Fang
- Department of Human Anatomy, Capital Medical University, Beijing 100069, P.R. China
| | - Tao Lu
- Department of Human Anatomy, Capital Medical University, Beijing 100069, P.R. China
| | - Yan Gao
- Department of Human Anatomy, Capital Medical University, Beijing 100069, P.R. China
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27
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Soffietti R, Abacioglu U, Baumert B, Combs SE, Kinhult S, Kros JM, Marosi C, Metellus P, Radbruch A, Villa Freixa SS, Brada M, Carapella CM, Preusser M, Le Rhun E, Rudà R, Tonn JC, Weber DC, Weller M. Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO). Neuro Oncol 2017; 19:162-174. [PMID: 28391295 DOI: 10.1093/neuonc/now241] [Citation(s) in RCA: 296] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The management of patients with brain metastases has become a major issue due to the increasing frequency and complexity of the diagnostic and therapeutic approaches. In 2014, the European Association of Neuro-Oncology (EANO) created a multidisciplinary Task Force to draw evidence-based guidelines for patients with brain metastases from solid tumors. Here, we present these guidelines, which provide a consensus review of evidence and recommendations for diagnosis by neuroimaging and neuropathology, staging, prognostic factors, and different treatment options. Specifically, we addressed options such as surgery, stereotactic radiosurgery/stereotactic fractionated radiotherapy, whole-brain radiotherapy, chemotherapy and targeted therapy (with particular attention to brain metastases from non-small cell lung cancer, melanoma and breast and renal cancer), and supportive care.
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Affiliation(s)
- Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Ufuk Abacioglu
- Department of Radiation Oncology, Neolife Medical Center, Istanbul, Turkey
| | - Brigitta Baumert
- Department of Radiation-Oncology, MediClin Robert-Janker-Klinik, Bonn, Germany
| | - Stephanie E Combs
- Department of Innovative Radiation Oncology and Radiation Sciences, Munich, Germany
| | - Sara Kinhult
- Department of Oncology, Skane University Hospital, Lund, Sweden
| | - Johan M Kros
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Christine Marosi
- Department of Internal Medicine, Division of Oncology, Medical University, Vienna, Austria
| | - Philippe Metellus
- Department of Internal Medicine, Division of Oncology, Medical University, Vienna, Austria.,Department of Neurosurgery, Clairval Hospital Center, Generale de Santé, Marseille, France
| | - Alexander Radbruch
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Salvador S Villa Freixa
- Department of Radiation Oncology, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Michael Brada
- Department of Molecular and Clinical Cancer Medicine & Radiation Oncology, Liverpool, United Kingdom
| | - Carmine M Carapella
- Department of Neuroscience, Division of Neurosurgery, Regina Elena Nat Cancer Institute, Rome, Italy
| | - Matthias Preusser
- Department of Medicine I and Comprehensive Cancer Center CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - Emilie Le Rhun
- Department of Neurosurgery, Neuro-oncology, University Hospital, Lille, France
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Joerg C Tonn
- Department of Neurosurgery, University of Munich LMU, Munich, Germany
| | - Damien C Weber
- Centre for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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28
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Clinical outcomes of patients with limited brain metastases treated with hypofractionated (5×6Gy) conformal radiotherapy. Radiother Oncol 2017; 123:203-208. [PMID: 28390657 DOI: 10.1016/j.radonc.2017.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/22/2017] [Accepted: 03/22/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Hypofractionated conformal radiotherapy (hfCRT) is used for larger brain metastases or metastases near critical structures. We investigated hfCRT outcomes for newly diagnosed brain metastases. MATERIALS AND METHODS We identified 195 patients with 1-3 brain metastases who underwent 5×6Gy hfCRT for 231 lesions from 2007 to 2013. Associations among clinical factors, local control (LC), distant brain control (DC) and overall survival (OS) were tested using univariate and multivariate (MVA) Cox regression analysis and Kaplan-Meier method. RESULTS Median follow-up was 12.8months. One hundred forty-three (62%) lesions were treated with hfCRT post-operatively, and 88 (38%) with definitive hfCRT. LC for all lesions was 83% at 1year. For lesions treated with post-operative hfCRT, tumor size (HR=4.7, p=0.04) and subtotal resection (HR=2.7, p=0.02) were predictive of local failure on MVA. For lesions ≥2.8cm in size, LC was 61% at 12months for lesions status-post subtotal resection, compared to 84% status-post gross total resection (p=0.004). Extracranial disease presence was associated with worse DC (HR=1.8, p=0.008) and OS (HR=3.1, p<0.001). CONCLUSIONS We showed 5×6Gy hfCRT provides acceptable LC at 1year for limited brain metastases. For large lesions not grossly resected, more aggressive strategies can be considered to improve LC.
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29
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Efficacy and safety of antitumor agents plus radiotherapy compared with radiotherapy alone for brain metastases from lung cancer. Mol Clin Oncol 2017; 6:296-306. [PMID: 28451402 PMCID: PMC5403574 DOI: 10.3892/mco.2017.1152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/27/2016] [Indexed: 12/26/2022] Open
Abstract
The present study aimed to investigate the efficacy and safety of different therapeutic regimens for brain metastases (BMs) from lung cancer (LC). A total of 13 controlled trials (1,783 cases) involving chemotherapy, tyrosine kinase inhibitors or endostatin plus radiotherapy (combination group) vs. radiotherapy alone group were identified from PubMed. Compared with the radiotherapy alone group, the combination group resulted in a significant benefit for objective response rate (ORR) [risk ratio (RR), 1.38; 95% confidence interval (CI), 1.19–1.60; P<0.0001], notably prolonged the time to central nervous system progression [CNS-TTP; hazard ratio (HR), 0.71; 95% CI, 0.57–0.90; P=0.004] and progression-free survival (PFS; HR, 0.60; 95% CI, 0.44–0.83; P=0.002); however, failed in prolonging the overall survival (OS; HR, 0.80; 95% CI, 0.61–1.05; P=0.11) with a higher overall severe adverse events (AEs, Grade ≥3; RR, 2.57; 95% CI, 1.24–5.35; P=0.01). Notably, subgroup analysis demonstrated that targeted therapy plus radiotherapy possessed a superior OS compared with radiotherapy alone (HR, 0.58; 95% CI, 0.37–0.90; P=0.01) with mild non-hematological toxicity and without severe hematotoxicity. The present study demonstrated that targeted agents plus radiotherapy possessed desirable effects with mild adverse events. Secondary to best, chemoradiotherapy is an alternative option for patients without suitable molecular targets.
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30
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Peyrl A, Frischer J, Hainfellner JA, Preusser M, Dieckmann K, Marosi C. Brain tumors - other treatment modalities. HANDBOOK OF CLINICAL NEUROLOGY 2017; 145:547-560. [PMID: 28987193 DOI: 10.1016/b978-0-12-802395-2.00034-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Management of tumors of the central nervous system is challenging for clinicians for various reasons, including complex diagnostic procedures, limited penetration of drugs into brain tissue, and the prerequisite to preserve brain function in any case of therapeutic intervention. Therapeutic success is dependent on the efforts, skills, and cooperation of involved specialists and disciplines. Knowledge and ability to apply adequate therapeutic modalities in an interdisciplinary approach in due time are crucial, necessitating coordination of diagnostic procedures and therapeutic interventions by means of multidisciplinary brain tumor boards. In this chapter we present in brief the essential current standards and future perspectives for therapy modalities that complement surgery of brain tumors.
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Affiliation(s)
- Andreas Peyrl
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Josa Frischer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - Johannes A Hainfellner
- Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria; Institute of Neurology, Medical University of Vienna, Vienna, Austria.
| | - Matthias Preusser
- Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria; Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria
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31
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Azimi P, Shahzadi S, Bitaraf MA, Azar M, Alikhani M, Zali A, Sadeghi S, Montazeri A. Brain metastases in cancer patients attending a Gamma Knife Center: A study from a single institute in Iran. Asian J Neurosurg 2017; 12:529-533. [PMID: 28761536 PMCID: PMC5532943 DOI: 10.4103/1793-5482.145564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: This study was aimed to explore data on brain metastases in cancer patients attending the Iranian Gamma Knife Center. Meterials and Methods: This was a retrospective study. In all 5216 case records of patients who referred to the Iranian Gamma Knife Center for treatment of brain tumors during year 2003-2011 were reviewed. Data were explored to identify patients who developed brain metastases due to cancer and assessed the information as applied to cancer patients including survival analysis. Results: Two hundred and twenty patients were identified as having brain metastases due to cancer. The mean age of patients was 54.0 (standard deviation [SD] =12.7) years. Patients were followed for an average of 7 months after treatment with gamma-knife. The median survival time for different the Graded Prognostic Assessment (GPA) was: GPA: 0-1, 4.0 ± 0.4 months; GPA: 1.5-2.5, 6.0 ± 0.7 months; GPA: 3, 9.0 ± 0.9 months; and GPA: 3.5-4.0, 12.0 ± 1.8 months and the overall median survival was 7.0 (SD = 0.6) months. Conclusion: The findings suggest that many cancer patients in Iran might develop brain metastasis. Although, this is not a very high incidence compared with the existing statistics from other countries, there is an urgent need to explore the issue further.
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Affiliation(s)
- Parisa Azimi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Shahzadi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Maziar Azar
- Department of Neurosurgery, Tehran University of Medical Science, Tehran, Iran
| | | | - Alireza Zali
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Sadeghi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Montazeri
- Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
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32
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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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Baliga S, Garg MK, Fox J, Kalnicki S, Lasala PA, Welch MR, Tomé WA, Ohri N. Fractionated stereotactic radiation therapy for brain metastases: a systematic review with tumour control probability modelling. Br J Radiol 2016; 90:20160666. [PMID: 27936894 DOI: 10.1259/bjr.20160666] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Fractionated stereotactic radiotherapy (FSRT) is a relatively new option for the treatment of brain metastases. We performed a quantitative systematic review to determine if local control (LC) following is affected by FSRT dosing regimen. METHODS We reviewed articles describing LC following FSRT for brain metastases. LC data from each study were extracted from actuarial survival curves and aggregated to form a single data set. LC curves were generated using the Kaplan-Meier method. Log-rank testing and Cox proportional hazards modelling were utilized to test for associations between the biologically effective dose (BED) and LC. Tumour control probability modelling was performed to illustrate the relationship between the BED and the likelihood of LC after FSRT. RESULTS 10 studies (720 metastases) met inclusion criteria. Prescription doses ranged from 18 to 42 Gy, delivered in 3-12 fractions (BED range: 29-100 Gy10). 1- and 2-year actuarial LC rates were 80% and 69%, respectively. Increasing BED was associated with improved LC (HR = 0.77 per increase of 10 Gy10, p = 0.009). Tumour control probability models demonstrated that the BEDs of 40, 50 and 60 Gy10 yield predicted 1-year LC rates of 73%, 78% and 84%, respectively. The BEDs of 40, 50 and 60 Gy10 yield 2-year LC rates of 62%, 69% and 81%, respectively. CONCLUSION FSRT provides high rates of LC for patients with brain metastases. We found evidence for a dose-response relationship that should be explored in prospective trials. Advances in knowledge: This review identified a dose-response relationship for LC in patients treated with FSRT for brain metastases.
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Affiliation(s)
- Sujith Baliga
- 1 Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Madhur K Garg
- 1 Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Jana Fox
- 1 Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Shalom Kalnicki
- 1 Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Patrick A Lasala
- 2 Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Mary R Welch
- 3 Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Wolfgang A Tomé
- 1 Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Nitin Ohri
- 1 Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
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Evaluation of Dose-Staged Gamma Knife Radiosurgical Treatment Method for High-Risk Brain Metastases. World Neurosurg 2016; 94:352-359. [DOI: 10.1016/j.wneu.2016.07.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/11/2016] [Accepted: 07/11/2016] [Indexed: 11/20/2022]
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Hanibuchi M, Kim SJ, Fidler IJ, Nishioka Y. The molecular biology of lung cancer brain metastasis: an overview of current comprehensions and future perspectives. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 61:241-53. [PMID: 25264041 DOI: 10.2152/jmi.61.241] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Brain metastases occur in 20-40% of patients with advanced malignancies and lung cancer is one of the most common causes of brain metastases. The occurrence of brain metastases is associated with poor prognosis and high morbidity in patients with advanced lung cancer, even after intensive multimodal therapy. Progress in treating brain metastases has been hampered by a lack of model systems, a lack of human tissue samples, and the exclusion of brain metastatic patients from many clinical trials. While the biology of brain metastasis is still poorly understood, it is encouraging to see more efforts are beginning to be directed toward the study of brain metastasis. During the multi-step process of metastasis, functional significance of gene expressions, changes in brain vasculature, abnormal secretion of soluble factors and activation of autocrine/paracrine signaling are considered to contribute to the brain metastasis development. A better understanding of the mechanism of this disease will help us to identify the appropriate therapeutic strategies, which leads to circumvent brain metastases. Recent findings on the biology of lung cancer brain metastases and translational leads identified by molecular studies are discussed in this review.
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Affiliation(s)
- Masaki Hanibuchi
- Department of Respiratory Medicine and Rheumatology, Institute of Health Biosciences, The University of Tokushima Graduate School
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Borghetti P, Pedretti S, Spiazzi L, Avitabile R, Urpis M, Foscarini F, Tesini G, Trevisan F, Ghirardelli P, Pandini SA, Triggiani L, Magrini SM, Buglione M. Whole brain radiotherapy with adjuvant or concomitant boost in brain metastasis: dosimetric comparison between helical and volumetric IMRT technique. Radiat Oncol 2016; 11:59. [PMID: 27094398 PMCID: PMC4837558 DOI: 10.1186/s13014-016-0634-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 04/12/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND To compare and evaluate the possible advantages related to the use of VMAT and helical IMRT and two different modalities of boost delivering, adjuvant stereotactic boost (SRS) or simultaneous integrated boost (SIB), in the treatment of brain metastasis (BM) in RPA classes I-II patients. METHODS Ten patients were treated with helical IMRT, 5 of them with SRS after whole brain radiotherapy (WBRT) and 5 with SIB. MRI co-registration with planning CT was mandatory and prescribed doses were 30 Gy in 10 fractions (fr) for WBRT and 15Gy/1fr or 45Gy/10fr in SRS or SIB, respectively. For each patient, 4 "treatment plans" (VMAT SRS and SIB, helical IMRT SRS and SIB) were calculated and accepted if PTV boost was included in 95 % isodose and dose constraints of the main organs at risk were respected without major deviations. Homogeneity Index (HI), Conformal Index (CI) and Conformal Number (CN) were considered to compare the different plans. Moreover, time of treatment delivery was calculated and considered in the analysis. RESULTS Volume of brain metastasis ranged between 1.43 and 51.01 cc (mean 12.89 ± 6.37 ml) and 3 patients had double lesions. V95% resulted over 95 % in the average for each kind of technique, but the "target coverage" was inadequate for VMAT planning with two sites. The HI resulted close to the ideal value of zero in all cases; VMAT-SIB, VMAT-SRS, Helical IMRT-SIB and Helical IMRT-SRS showed mean CI of 2.15, 2.10, 2.44 and 1.66, respectively (optimal range: 1.5-2.0). Helical IMRT-SRS was related to the best and reliable finding of CN (0.66). The mean of treatment time was 210 s, 467 s, 440 s, 1598 s, respectively, for VMAT-SIB, VMAT-SRS, Helical IMRT-SIB and Helical IMRT-SRS. CONCLUSIONS This dosimetric comparison show that helical IMRT obtain better target coverage and respect of CI and CN; VMAT could be acceptable in solitary metastasis. SIB modality can be considered as a good choice for clinical and logistic compliance; literature's preliminary data are confirming also a radiobiological benefit for SIB. Helical IMRT-SRS seems less effective for the long time of treatment compared to other techniques.
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Affiliation(s)
- Paolo Borghetti
- Radiation Oncology Department, University and Spedali Civili Brescia, P.le Spedali Civili 1, Brescia, Italy.
| | - Sara Pedretti
- Radiation Oncology Department, University and Spedali Civili Brescia, P.le Spedali Civili 1, Brescia, Italy
| | - Luigi Spiazzi
- Medical Physics Department, Spedali Civili Brescia, P.le Spedali Civili 1, Brescia, Italy
| | - Rossella Avitabile
- Medical Physics Department, Spedali Civili Brescia, P.le Spedali Civili 1, Brescia, Italy
| | - Mauro Urpis
- Radiation Oncology Department, University and Spedali Civili Brescia, P.le Spedali Civili 1, Brescia, Italy
| | - Federica Foscarini
- Radiation Oncology Department, University and Spedali Civili Brescia, P.le Spedali Civili 1, Brescia, Italy
| | - Giulia Tesini
- Medical Physics Department, Spedali Civili Brescia, P.le Spedali Civili 1, Brescia, Italy
| | - Francesca Trevisan
- Radiation Oncology Department, University and Spedali Civili Brescia, P.le Spedali Civili 1, Brescia, Italy
| | - Paolo Ghirardelli
- Radiation Oncology Department, University and Spedali Civili Brescia, P.le Spedali Civili 1, Brescia, Italy
| | - Sara Angela Pandini
- Radiation Oncology Department, University and Spedali Civili Brescia, P.le Spedali Civili 1, Brescia, Italy
| | - Luca Triggiani
- Radiation Oncology Department, University and Spedali Civili Brescia, P.le Spedali Civili 1, Brescia, Italy
| | - Stefano Maria Magrini
- Radiation Oncology Department, University and Spedali Civili Brescia, P.le Spedali Civili 1, Brescia, Italy
| | - Michela Buglione
- Radiation Oncology Department, University and Spedali Civili Brescia, P.le Spedali Civili 1, Brescia, Italy
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Liu J, Xing L, Meng X, Yue J, Meng X, Xie P, Li X, Kong L, Yu J. Risk of brain metastasis reduced after erlotinib treatment in advanced pulmonary adenocarcinoma patients with sensitive EGFR mutation. Onco Targets Ther 2016; 9:671-9. [PMID: 26917973 PMCID: PMC4751907 DOI: 10.2147/ott.s100105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose Brain metastasis (BM) is associated with impaired quality of life and increased mortality. The study aimed to compare BM risk after erlotinib administration and chemotherapy in stage IIIB/IV pulmonary adenocarcinoma patients harboring epidermal growth factor receptor (EGFR) mutation. Patients and methods Eligible patients underwent match pair process with matching factors, including age, sex, performance status score, first-line or second-line treatment, first-line chemotherapy regimen (for the second-line treatment subgroup), stage IIIB or IV, and genotypes of EGFR mutation. BM and mortality risk of both groups were recorded and compared. Results In total 129 matched pairs were included for analysis. During a median follow-up of 21.5 months, time to BM risk was longer and incidences of BM within 2 years were lower in patients who received erlotinib than chemotherapy in total population, as well as subgroups of first-line treatment, second-line treatment, stage IIIB, stage IV, exon 19 deletion mutation, and exon 21 L858R mutation. Similar overall survival time and 2-year survival rates were seen in two groups totally or in any subgroup. Multivariate analysis showed that BM was retarded in patients who received erlotinib administration (hazard ratio, 1.695; P=0.001) and in patients who were in stage IIIB (hazard ratio, 1.751; P=0.001). Conclusion Erlotinib administration decreases BM risk in advanced pulmonary adenocarcinoma patients harboring sensitive EGFR mutations.
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Affiliation(s)
- Jing Liu
- Department of Radiation Oncology, Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China
| | - Jinbo Yue
- Department of Radiation Oncology, Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China
| | - Xiangjiao Meng
- Department of Radiation Oncology, Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China
| | - Peng Xie
- Department of Radiation Oncology, Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China
| | - Xiaolin Li
- Department of Radiation Oncology, Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China
| | - Li Kong
- Department of Radiation Oncology, Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, People's Republic of China
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Kim B, Kim K, Im KH, Kim JH, Lee JH, Jeon P, Byun H. Multiparametric MR imaging of tumor response to intraarterial chemotherapy in orthotopic xenograft models of human metastatic brain tumor. J Neurooncol 2016; 127:243-51. [PMID: 26746691 DOI: 10.1007/s11060-015-2041-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/28/2015] [Indexed: 01/18/2023]
Abstract
The purpose of our study was to investigate the therapeutic efficacy of intraarterial (IA) chemotherapy via multiparametric magnetic resonance imaging (MRI) analysis in orthotopic mouse brain tumor models. Stereotactic-guided intracranial inoculation of MDA-MB-231 cells was performed in nude mice. Thirty tumor bearing mice were randomized into three groups, and each group received either IA docetaxel administration (n = 10), intravenous (IV) docetaxel administration (n = 10), or IA solvent injection (n = 10) as control. Treatment response was monitored by diffusion-weighted imaging and dynamic contrast enhanced-MRI obtained 1 day before and 8 days after therapy initiation. Imaging results were correlated with histopathology. In the results, IA chemotherapy showed a significant decrease in tumor volume (86.5 ± 15.6 %) compared to the IV chemotherapy (121.1 ± 39.6%) and control (126.2 ± 22.0%) 8 days after therapy (p < 0.05). Furthermore, IA chemotherapy resulted in a significant increase in mean tumor apparent diffusion coefficient (ADC) values (116.8 ± 44.9%); in contrary IV chemotherapy (66.6 ± 26.9%) and control (69.1 ± 29.5%) showed a significant decrease in ADC values corresponding to further tumor growth (p < 0.05). However, there was no significant difference in perfusion parameters including initial area under the curve, K(trans), K(ep), and V(e) between the groups (p > 0.05). Histopathology confirmed necrosis and necroptosis in the tumors after IA chemotherapy. In conclusion, IA chemotherapy may lead to effective inhibition of tumor cell proliferation and offer potential benefit of inducing higher degree of treatment response than IV chemotherapy.
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Affiliation(s)
- Byungjun Kim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Keonha Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
| | - Keun Ho Im
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea
| | - Jae-Hoon Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea
| | - Jung Hee Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea
| | - Pyoung Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea
| | - Hongsik Byun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea
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Aktan M, Koc M, Kanyilmaz G, Tezcan Y. Outcomes of reirradiation in the treatment of patients with multiple brain metastases of solid tumors: a retrospective analysis. ANNALS OF TRANSLATIONAL MEDICINE 2016; 3:325. [PMID: 26734635 DOI: 10.3978/j.issn.2305-5839.2015.12.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Patients with multiple brain metastases are often treated with whole brain radiation therapy (WBRT). Second course of WBRT is an important treatment option for patients with clinical or radiological intracranial disease progression. This study examines the outcomes in patients with multiple brain metastases who underwent reirradiation. METHODS We examined the medical records of 34 patients with multiple brain metastases who were treated WBRT. The median dose for the first course of WBRT was 30 Gy (range, 25-30 Gy) and for the second course 25 Gy (range, 20-30 Gy). Statistical analyses were performed with using Cox regression analyses, log-rank test and Kaplan-Meier method. RESULTS The median Karnofsky performance status (KPS) was 80 (range, 50-100) before reirradiation. Patients with KPS of >70 had a median survival of 11.4 months, compared to 2.2 months with KPS of ≤70 (P=0.012) and patients who have severe symptoms at the time of reirradiation with median survival 2.2 months while those with mild symptoms had a median of 4.8 months survival (P=0.08). The median overall survival for all patients after diagnosis of metastases was 24.7 months, after the re-irradiation WBRT (re-WBRT) it was 5.3 months (95% CI, 4.08-6.62) and from the diagnosis of primary tumor was 27.1 months (95% CI, 17.75-37.04). CONCLUSIONS In select patients who have good performance status and who do not have severe symptoms might benefit from re-WBRT and re-WBRT seems to be associated with minimal toxicity in patients treated with lower palliation doses.
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Affiliation(s)
- Meryem Aktan
- Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Koc
- Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gul Kanyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Yilmaz Tezcan
- Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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Adkins CE, Nounou MI, Hye T, Mohammad AS, Terrell-Hall T, Mohan NK, Eldon MA, Hoch U, Lockman PR. NKTR-102 Efficacy versus irinotecan in a mouse model of brain metastases of breast cancer. BMC Cancer 2015; 15:685. [PMID: 26463521 PMCID: PMC4604629 DOI: 10.1186/s12885-015-1672-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 10/01/2015] [Indexed: 02/07/2023] Open
Abstract
Background Brain metastases are an increasing problem in women with invasive breast cancer. Strategies designed to treat brain metastases of breast cancer, particularly chemotherapeutics such as irinotecan, demonstrate limited efficacy. Conventional irinotecan distributes poorly to brain metastases; therefore, NKTR-102, a PEGylated irinotecan conjugate should enhance irinotecan and its active metabolite SN38 exposure in brain metastases leading to brain tumor cytotoxicity. Methods Female nude mice were intracranially or intracardially implanted with human brain seeking breast cancer cells (MDA-MB-231Br) and dosed with irinotecan or NKTR-102 to determine plasma and tumor pharmacokinetics of irinotecan and SN38. Tumor burden and survival were evaluated in mice treated with vehicle, irinotecan (50 mg/kg), or NKTR-102 low and high doses (10 mg/kg, 50 mg/kg respectively). Results NKTR-102 penetrates the blood-tumor barrier and distributes to brain metastases. NKTR-102 increased and prolonged SN38 exposure (>20 ng/g for 168 h) versus conventional irinotecan (>1 ng/g for 4 h). Treatment with NKTR-102 extended survival time (from 35 days to 74 days) and increased overall survival for NKTR-102 low dose (30 % mice) and NKTR-102 high dose (50 % mice). Tumor burden decreased (37 % with 10 mg/kg NKTR-102 and 96 % with 50 mg/kg) and lesion sizes decreased (33 % with 10 mg/kg NKTR-102 and 83 % with 50 mg/kg NKTR-102) compared to conventional irinotecan treated animals. Conclusions Elevated and prolonged tumor SN38 exposure after NKTR-102 administration appears responsible for increased survival in this model of breast cancer brain metastasis. Further, SN38 concentrations observed in this study are clinically achieved with 145 mg/m2 NKTR-102, such as those used in the BEACON trial, underlining translational relevance of these results. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1672-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chris E Adkins
- Department of Basic Pharmaceutical Sciences, West Virginia University Health Sciences Center, 1 Medical Center Drive, Morgantown, WV, 26506-905, USA. .,School of Pharmacy, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, 79106, USA.
| | - Mohamed I Nounou
- School of Pharmacy, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, 79106, USA. .,Faculty of Pharmacy, Department of Pharmaceutics, Alexandria University, Alexandria, Egypt.
| | - Tanvirul Hye
- School of Pharmacy, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, 79106, USA.
| | - Afroz S Mohammad
- Department of Basic Pharmaceutical Sciences, West Virginia University Health Sciences Center, 1 Medical Center Drive, Morgantown, WV, 26506-905, USA. .,School of Pharmacy, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, 79106, USA.
| | - Tori Terrell-Hall
- Department of Basic Pharmaceutical Sciences, West Virginia University Health Sciences Center, 1 Medical Center Drive, Morgantown, WV, 26506-905, USA. .,School of Pharmacy, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, 79106, USA.
| | - Neel K Mohan
- Nektar Therapeutics, San Francisco, CA, 94158, USA.
| | | | - Ute Hoch
- Nektar Therapeutics, San Francisco, CA, 94158, USA.
| | - Paul R Lockman
- Department of Basic Pharmaceutical Sciences, West Virginia University Health Sciences Center, 1 Medical Center Drive, Morgantown, WV, 26506-905, USA. .,School of Pharmacy, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, 79106, USA.
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Tan Y, Wang XC, Zhang H, Wang J, Qin JB, Wu XF, Zhang L, Wang L. Differentiation of high-grade-astrocytomas from solitary-brain-metastases: Comparing diffusion kurtosis imaging and diffusion tensor imaging. Eur J Radiol 2015; 84:2618-24. [PMID: 26482747 DOI: 10.1016/j.ejrad.2015.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/24/2015] [Accepted: 10/05/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the value of MRI diffusion kurtosis imaging (DKI) and diffusion tensor imaging (DTI) in differentiating high-grade-astrocytomas from solitary-brain-metastases. METHODS Thirty-one high-grade-astrocytomas and twenty solitary-brain-metastases were retrospectively identified. DKI parameters [mean kurtosis (MK), radial kurtosis (Kr), and axial kurtosis (Ka)] and DTI parameters [fractional anisotropy (FA) and mean diffusivity (MD)] values with and without correction by contralateral normal-appearing white matter (NAWM) in the tumoral solid part and peritumoral edema, were compared using the t-test. Receiver operating characteristic (ROC) curves were used to test for the best parameters. RESULTS The DKI values (MK, Kr, and Ka) and DTI values (FA and MD) in tumoral solid parts did not show significant differences between the two groups. Corrected and uncorrected MK, Kr, and Ka values in peritumoral edema were significantly higher in high-grade-astrocytomas than solitary-brain-metastases, and MD values without correction were lower in high-grade astrocytomas than solitary-brain-metastases. The areas under curve (AUC) of corrected Ka (1.000), MK (0.889), and Kr (0.880) values were significantly higher than those of MD (0.793) and FA (0.472) values. The optimal thresholds for corrected MK, Kr, Ka, and MD were 0.369, 0.405, 0.483, and 2.067, respectively. CONCLUSION DKI and directional analysis could lead to improved differentiation with better sensitivity and directional specificity than DTI.
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Affiliation(s)
- Yan Tan
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001 Shanxi Province, China
| | - Xiao-Chun Wang
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, 030001 Shanxi Province, China
| | - Hui Zhang
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001 Shanxi Province, China.
| | - Jun Wang
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, 030001 Shanxi Province, China.
| | - Jiang-Bo Qin
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001 Shanxi Province, China
| | - Xiao-Feng Wu
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001 Shanxi Province, China
| | - Lei Zhang
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001 Shanxi Province, China
| | - Le Wang
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, 030001 Shanxi Province, China
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Duregon E, Senetta R, Pittaro A, Verdun di Cantogno L, Stella G, De Blasi P, Zorzetto M, Mantovani C, Papotti M, Cassoni P. CAVEOLIN-1 expression in brain metastasis from lung cancer predicts worse outcome and radioresistance, irrespective of tumor histotype. Oncotarget 2015; 6:29626-36. [PMID: 26315660 PMCID: PMC4745751 DOI: 10.18632/oncotarget.4988] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/16/2015] [Indexed: 02/02/2023] Open
Abstract
Brain metastases develop in one-third of patients with non-small-cell lung cancer and are associated with a dismal prognosis, irrespective of surgery or chemo-radiotherapy. Pathological markers for predicting outcomes after surgical resection and radiotherapy responsiveness are still lacking. Caveolin 1 has been associated with chemo- and radioresistance in various tumors, including non-small-cell lung cancer. Here, caveolin 1 expression was assessed in a series of 69 brain metastases from non-small-cell lung cancer and matched primary tumors to determine its role in predicting survival and radiotherapy responsiveness. Only caveolin 1 expression in brain metastasis was associated with poor prognosis and an increased risk of death (log rank test, p = 0.015). Moreover, in the younger patients (median age of <54 years), caveolin 1 expression neutralized the favorable effect of young age on survival compared with the older patients. Among the radiotherapy-treated patients, an increased risk of death was detected in the group with caveolin 1-positive brain metastasis (14 out of 22 patients, HR=6.839, 95% CI 1.849 to 25.301, Wald test p = 0.004). Overall, caveolin 1 expression in brain metastasis from non-small-cell lung cancer is independently predictive of worse outcome and radioresistance and could become an additional tool for personalized therapy in the critical subset of brain-metastatic non-small-cell lung cancer patients.
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Affiliation(s)
- Eleonora Duregon
- Department of Oncology, University of Torino at San Luigi Hospital, Orbassano, Turin, Italy
| | | | | | | | - Giulia Stella
- Laboratory of Biochemistry and Genetics, Pneumology Unit, Department of Molecular Medicine University and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Michele Zorzetto
- Laboratory of Biochemistry and Genetics, Pneumology Unit, Department of Molecular Medicine University and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Mauro Papotti
- Department of Oncology, University of Torino at San Luigi Hospital, Orbassano, Turin, Italy
| | - Paola Cassoni
- Department of Medical Sciences, University of Torino, Italy
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Saunus JM, Quinn MCJ, Patch AM, Pearson JV, Bailey PJ, Nones K, McCart Reed AE, Miller D, Wilson PJ, Al-Ejeh F, Mariasegaram M, Lau Q, Withers T, Jeffree RL, Reid LE, Da Silva L, Matsika A, Niland CM, Cummings MC, Bruxner TJC, Christ AN, Harliwong I, Idrisoglu S, Manning S, Nourse C, Nourbakhsh E, Wani S, Anderson MJ, Fink JL, Holmes O, Kazakoff S, Leonard C, Newell F, Taylor D, Waddell N, Wood S, Xu Q, Kassahn KS, Narayanan V, Taib NA, Teo SH, Chow YP, kConFab, Jat PS, Brandner S, Flanagan AM, Khanna KK, Chenevix-Trench G, Grimmond SM, Simpson PT, Waddell N, Lakhani SR. Integrated genomic and transcriptomic analysis of human brain metastases identifies alterations of potential clinical significance. J Pathol 2015; 237:363-78. [DOI: 10.1002/path.4583] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/26/2015] [Accepted: 07/01/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Jodi M Saunus
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | - Michael CJ Quinn
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Ann-Marie Patch
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - John V Pearson
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Peter J Bailey
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences; University of Glasgow; UK
| | - Katia Nones
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Amy E McCart Reed
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | - David Miller
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
- Kinghorn Centre for Clinical Genomics; Garvan Institute of Medical Research; Darlinghurst NSW Australia
| | - Peter J Wilson
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Fares Al-Ejeh
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | - Mythily Mariasegaram
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | - Queenie Lau
- Pathology Queensland; Gold Coast Hospital; Southport Queensland Australia
| | - Teresa Withers
- Department of Neurosurgery; Gold Coast Hospital; Southport Queensland Australia
| | - Rosalind L Jeffree
- Kenneth G Jamieson Department of Neurosurgery; Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Lynne E Reid
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | - Leonard Da Silva
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- University of Queensland School of Medicine; Herston Queensland Australia
| | - Admire Matsika
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- Pathology Queensland; Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Colleen M Niland
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | - Margaret C Cummings
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- University of Queensland School of Medicine; Herston Queensland Australia
- Pathology Queensland; Royal Brisbane and Women's Hospital; Herston Queensland Australia
| | - Timothy JC Bruxner
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Angelika N Christ
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Ivon Harliwong
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Senel Idrisoglu
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Suzanne Manning
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Craig Nourse
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences; University of Glasgow; UK
| | - Ehsan Nourbakhsh
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Shivangi Wani
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Matthew J Anderson
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - J Lynn Fink
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Oliver Holmes
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Stephen Kazakoff
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Conrad Leonard
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Felicity Newell
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Darrin Taylor
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Nick Waddell
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Scott Wood
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Qinying Xu
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Karin S Kassahn
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
- Genetic and Molecular Pathology, SA Pathology; Women's and Children's Hospital; North Adelaide South Australia Australia
- School of Molecular and Biomedical Science; University of Adelaide; South Australia Australia
| | - Vairavan Narayanan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Nur Aishah Taib
- Breast Unit, Department of Surgery, Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
- University Malaya Cancer Research Institute; University of Malaya; Kuala Lumpur Malaysia
| | - Soo-Hwang Teo
- University Malaya Cancer Research Institute; University of Malaya; Kuala Lumpur Malaysia
- Cancer Research Initiatives Foundation; Sime Darby Medical Centre; Selangor Malaysia
| | - Yock Ping Chow
- Cancer Research Initiatives Foundation; Sime Darby Medical Centre; Selangor Malaysia
| | - kConFab
- Peter MacCallum Cancer Centre; University of Melbourne; Victoria Australia
| | - Parmjit S Jat
- Department of Neurodegenerative Disease and MRC Prion Unit; UCL Institute of Neurology; London UK
| | - Sebastian Brandner
- Division of Neuropathology and Department of Neurodegenerative Disease; UCL Institute of Neurology; London UK
| | - Adrienne M Flanagan
- Histopathology; Royal National Orthopaedic Hospital NHS Trust; Stanmore UK
- University College London Cancer Institute; London UK
| | - Kum Kum Khanna
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
| | | | - Sean M Grimmond
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences; University of Glasgow; UK
| | - Peter T Simpson
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- University of Queensland School of Medicine; Herston Queensland Australia
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute; Herston Queensland Australia
- Queensland Centre for Medical Genomics, IMB; University of Queensland; St Lucia Queensland Australia
| | - Sunil R Lakhani
- University of Queensland; UQ Centre for Clinical Research; Herston Queensland Australia
- University of Queensland School of Medicine; Herston Queensland Australia
- Pathology Queensland; Royal Brisbane and Women's Hospital; Herston Queensland Australia
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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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de la Fuente M, Beal K, Carvajal R, Kaley TJ. Whole-brain radiotherapy in patients with brain metastases from melanoma. CNS Oncol 2015; 3:401-6. [PMID: 25438811 DOI: 10.2217/cns.14.40] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AIMS To describe results of melanoma brain metastases (BM) treated with whole-brain radiation (WBRT). METHODS Retrospective review of patients with melanoma BM treated with WBRT divided into two groups based on the timing of WBRT (at BM diagnosis or recurrence). RESULTS We identified 61 patients with melanoma BM who received WBRT. For the group treated at diagnosis (n = 39): median overall survival was 3 months; best radiographic response included one partial response, ten stable disease, 18 progressive disease, and ten no follow-up imaging. For the group treated at recurrence (n = 22): median overall survival was 3 months; best radiographic response was three partial response, four stable disease, eight progressive disease, and seven no follow-up imaging. CONCLUSION WBRT activity was limited; however, its role in symptom palliation is unclear.
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Pangeni RP, Channathodiyil P, Huen DS, Eagles LW, Johal BK, Pasha D, Hadjistephanou N, Nevell O, Davies CL, Adewumi AI, Khanom H, Samra IS, Buzatto VC, Chandrasekaran P, Shinawi T, Dawson TP, Ashton KM, Davis C, Brodbelt AR, Jenkinson MD, Bièche I, Latif F, Darling JL, Warr TJ, Morris MR. The GALNT9, BNC1 and CCDC8 genes are frequently epigenetically dysregulated in breast tumours that metastasise to the brain. Clin Epigenetics 2015; 7:57. [PMID: 26052355 PMCID: PMC4457099 DOI: 10.1186/s13148-015-0089-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/11/2015] [Indexed: 01/12/2023] Open
Abstract
Background Tumour metastasis to the brain is a common and deadly development in certain cancers; 18–30 % of breast tumours metastasise to the brain. The contribution that gene silencing through epigenetic mechanisms plays in these metastatic tumours is not well understood. Results We have carried out a bioinformatic screen of genome-wide breast tumour methylation data available at The Cancer Genome Atlas (TCGA) and a broad literature review to identify candidate genes that may contribute to breast to brain metastasis (BBM). This analysis identified 82 candidates. We investigated the methylation status of these genes using Combined Bisulfite and Restriction Analysis (CoBRA) and identified 21 genes frequently methylated in BBM. We have identified three genes, GALNT9, CCDC8 and BNC1, that were frequently methylated (55, 73 and 71 %, respectively) and silenced in BBM and infrequently methylated in primary breast tumours. CCDC8 was commonly methylated in brain metastases and their associated primary tumours whereas GALNT9 and BNC1 were methylated and silenced only in brain metastases, but not in the associated primary breast tumours from individual patients. This suggests differing roles for these genes in the evolution of metastatic tumours; CCDC8 methylation occurs at an early stage of metastatic evolution whereas methylation of GANLT9 and BNC1 occurs at a later stage of tumour evolution. Knockdown of these genes by RNAi resulted in a significant increase in the migratory and invasive potential of breast cancer cell lines. Conclusions These findings indicate that GALNT9 (an initiator of O-glycosylation), CCDC8 (a regulator of microtubule dynamics) and BNC1 (a transcription factor with a broad range of targets) may play a role in the progression of primary breast tumours to brain metastases. These genes may be useful as prognostic markers and their products may provide novel therapeutic targets. Electronic supplementary material The online version of this article (doi:10.1186/s13148-015-0089-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rajendra P Pangeni
- Brain Tumour Research Centre, University of Wolverhampton, Wolverhampton, UK
| | | | - David S Huen
- School of Biology, Chemistry and Forensic Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Lawrence W Eagles
- Brain Tumour Research Centre, University of Wolverhampton, Wolverhampton, UK
| | - Balraj K Johal
- School of Biology, Chemistry and Forensic Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Dawar Pasha
- School of Biology, Chemistry and Forensic Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Natasa Hadjistephanou
- School of Biology, Chemistry and Forensic Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Oliver Nevell
- School of Biology, Chemistry and Forensic Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Claire L Davies
- School of Biology, Chemistry and Forensic Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Ayobami I Adewumi
- School of Biology, Chemistry and Forensic Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Hamida Khanom
- School of Biology, Chemistry and Forensic Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Ikroop S Samra
- School of Biology, Chemistry and Forensic Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Vanessa C Buzatto
- School of Biology, Chemistry and Forensic Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Preethi Chandrasekaran
- School of Biology, Chemistry and Forensic Sciences, University of Wolverhampton, Wolverhampton, UK
| | - Thoraia Shinawi
- Centre for Rare Diseases and Personalised Medicine, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Timothy P Dawson
- Department of Neurosciences, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Fulwood, Preston, UK
| | - Katherine M Ashton
- Department of Neurosciences, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Fulwood, Preston, UK
| | - Charles Davis
- Department of Neurosciences, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Fulwood, Preston, UK
| | | | | | - Ivan Bièche
- Department of Genetics, Institute Curie, Paris, France
| | - Farida Latif
- Centre for Rare Diseases and Personalised Medicine, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - John L Darling
- Brain Tumour Research Centre, University of Wolverhampton, Wolverhampton, UK
| | - Tracy J Warr
- Brain Tumour Research Centre, University of Wolverhampton, Wolverhampton, UK
| | - Mark R Morris
- Brain Tumour Research Centre, University of Wolverhampton, Wolverhampton, UK ; School of Biology, Chemistry and Forensic Sciences, University of Wolverhampton, Wolverhampton, UK ; Centre for Rare Diseases and Personalised Medicine, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
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Guérin A, Sasane M, Zhang J, Culver KW, Dea K, Nitulescu R, Wu EQ. Brain metastases in patients with ALK+ non-small cell lung cancer: clinical symptoms, treatment patterns and economic burden. J Med Econ 2015; 18:312-22. [PMID: 25565443 DOI: 10.3111/13696998.2014.1003644] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Brain metastases (BM) are highly prevalent among anaplastic lymphoma kinase positive (ALK+) non-small cell lung cancer (NSCLC) patients; yet little is known about their real-world treatment patterns and clinical and economic burdens. This study aimed to describe these patients' treatment patterns, symptoms, and costs. RESEARCH DESIGN AND METHODS Retrospective study pooling data from three large administrative databases in the US (08/2011-06/2013). ALK+ NSCLC patients with BM and continuous enrollment for ≥ 60 days before and ≥ 30 days after the first observed BM diagnosis were identified by pharmacy records for crizotinib among patients with lung cancer and BM diagnostic codes. MAIN OUTCOME MEASURES Treatment patterns, symptoms, healthcare resource utilization, and costs, before and after BM diagnosis. RESULTS Of the 213 crizotinib patients with BM diagnoses meeting the selection criteria, 23.0% had BM prior to NSCLC diagnosis; 47.4% had BM prior to crizotinib initiation; 19.2% during crizotinib treatment; and 10.3% post-crizotinib treatment. For those diagnosed with BM after NSCLC diagnosis, the median time between the NSCLC and BM diagnoses was 88 days. Following the first observed BM diagnosis, 88.7% used chemotherapy, 63.4% had radiotherapy, and 31.9% had stereotactic radiosurgery. The prevalence of BM-related symptoms substantially increased post-BM-diagnosis: fatigue (from 15% to 39%), headaches (from 5% to 24%), and depression (from 5% to 15%). Monthly costs per patient averaged $5983 before the BM diagnosis and $22,645 after diagnosis. Patients' resource utilization increased significantly post-BM-diagnosis, with a 3-fold increase in OP visits and a 6-fold increase in IP stays. Post-BM-diagnosis costs were driven by pharmacy (42.0%), inpatient (29.6%), and outpatient costs (26.0%). LIMITATIONS The study sample was limited to crizotinib-treated patients. CONCLUSIONS Post-BM-diagnosis, patients experience high symptom burden. Post-BM-diagnosis, treatment is highly variable and costly: average monthly costs per patient almost quadrupled post-BM-diagnosis.
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Ahmed Z, Balagamwala E, Murphy E, Angelov L, Suh J, Lo S, Chao S. Postoperative stereotactic radiosurgery for resected brain metastasis. CNS Oncol 2015; 3:199-207. [PMID: 25055128 DOI: 10.2217/cns.14.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Despite therapeutic advances in management, the prognosis of patients with brain metastasis remains dismal. Treatment options include surgical resection, whole brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS). Patients who undergo surgical resection typically receive WBRT as adjuvant therapy. However, several studies have demonstrated an association between WBRT and neurotoxicity. Thus, clinicians are increasingly delaying WBRT in favor of postoperative use of SRS. In this review, we will discuss the current literature exploring the efficacy and toxicity of postoperative SRS in the treatment of patients with resected brain metastasis.
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Affiliation(s)
- Zain Ahmed
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
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Cohen-Inbar O, Sheehan JP. Fighting Cancer on All Fronts: Stereotactic Radiosurgery and the Role for Aggressive Primary Treatment in Non-Small Cell Lung Cancer Patients with One Brain Metastasis. World Neurosurg 2015; 83:1015-6. [PMID: 25749580 DOI: 10.1016/j.wneu.2015.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Or Cohen-Inbar
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
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Management of Cerebral Brain Metastasis. CURRENT SURGERY REPORTS 2014. [DOI: 10.1007/s40137-014-0074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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