1
|
Motallebnejad P, Rajesh VV, Azarin SM. Evaluating the Role of IL-1β in Transmigration of Triple Negative Breast Cancer Cells Across the Brain Endothelium. Cell Mol Bioeng 2022; 15:99-114. [PMID: 35096187 PMCID: PMC8761198 DOI: 10.1007/s12195-021-00710-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/28/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION In vivo, breast cancer cells spend on average 3-7 days adhered to the endothelial cells inside the vascular lumen before entering the brain. IL-1β is one of the highly upregulated molecules in brain-seeking triple negative breast cancer (TNBC) cells. In this study, the effect of IL-1β on the blood-brain barrier (BBB) and astrocytes and its role in transmigration of TNBC cells were evaluated. METHODS The effect of IL-1β on transendothelial electrical resistance, gene and protein expression of human induced pluripotent stem cell-derived brain-specific microvascular endothelial-like cells (iBMECs) was studied. Transport of IL-1β across the iBMEC layer was investigated and the effect of IL-1β treatment of astrocytes on their cytokine and chemokine secretome was evaluated with a cytokine membrane array. Using BBB-on-a-chip devices, transmigration of MDA-MB-231 cells and their brain-seeking variant (231BR) across the iBMECs was studied, and the effect of an IL-1β neutralizing antibody on TNBC cell transmigration was investigated. RESULTS We showed that IL-1β reduces BBB integrity and induces endothelial-to-mesenchymal transition in iBMECs. IL-1β crosses the iBMEC layer and induces secretion of multiple chemokines by astrocytes, which can enhance TNBC cell transmigration across the BBB. Transmigration assays in a BBB-on-a-chip device showed that 231BR cells have a higher rate of transmigration across the iBMECs compared to MDA-MB-231 cells, and IL-1β pretreatment of BBB-on-a-chip devices increases the number of transmigrated MDA-MB-231 cells. Finally, we demonstrated that neutralizing IL-1β reduces the rate of 231BR cell transmigration. CONCLUSION IL-1β plays a significant role in transmigration of brain-seeking TNBC cells across the BBB. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12195-021-00710-y.
Collapse
Affiliation(s)
- Pedram Motallebnejad
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, MN 55455 USA
| | - Vinayak V. Rajesh
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, MN 55455 USA
| | - Samira M. Azarin
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, MN 55455 USA
| |
Collapse
|
2
|
Yi Z, Long L, Zeng Y, Liu Z. Current Advances and Challenges in Radiomics of Brain Tumors. Front Oncol 2021; 11:732196. [PMID: 34722274 PMCID: PMC8551958 DOI: 10.3389/fonc.2021.732196] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/23/2021] [Indexed: 12/12/2022] Open
Abstract
Imaging diagnosis is crucial for early detection and monitoring of brain tumors. Radiomics enable the extraction of a large mass of quantitative features from complex clinical imaging arrays, and then transform them into high-dimensional data which can subsequently be mined to find their relevance with the tumor's histological features, which reflect underlying genetic mutations and malignancy, along with grade, progression, therapeutic effect, or even overall survival (OS). Compared to traditional brain imaging, radiomics provides quantitative information linked to meaningful biologic characteristics and application of deep learning which sheds light on the full automation of imaging diagnosis. Recent studies have shown that radiomics' application is broad in identifying primary tumor, differential diagnosis, grading, evaluation of mutation status and aggression, prediction of treatment response and recurrence in pituitary tumors, gliomas, and brain metastases. In this descriptive review, besides establishing a general understanding among protocols, results, and clinical significance of these studies, we further discuss the current limitations along with future development of radiomics.
Collapse
Affiliation(s)
- Zhenjie Yi
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,XiangYa School of Medicine, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lifu Long
- XiangYa School of Medicine, Central South University, Changsha, China
| | - Yu Zeng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
3
|
Ye C, Lin Q, Jin Z, Zheng C, Ma S. Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC. Open Med (Wars) 2021; 16:1265-1275. [PMID: 34514171 PMCID: PMC8395589 DOI: 10.1515/med-2021-0260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancer (NSCLC), a commonly diagnosed lung cancer, is characterized by a high incidence of metastatic spread to the brain, which adversely impacts prognosis. The present study aimed to assess the value of combined dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in predicting the treatment outcomes of whole-brain radiotherapy (WBRT) and gefitinib in brain metastases from non-small cell lung cancer (NSCLC) from the perspectives of response rate and short- and long-term efficacy. These results suggested that the indicators measured by DCE-MRI combined with DWI can be used as key imaging-derived markers that predicted the efficacy of WBRT combined with gefitinib in NSCLC patients with brain metastases. Specifically, patients with higher ΔADCmid and ΔADCpost values showed better treatment outcomes. ROC curve analysis indicated ADCpost, ΔADCpost, ΔADCpost (%), and tumor regression rate as the best predictors of efficacy of WBRT combined with gefitinib in these patients. The short-term and long-term effects noted were also significant. Taken together, the findings of this study reveal that tumor regression rate, ADCpost, ΔADCpost, and ΔADCpost (%) can be used as important imaging indicators that predict the therapeutic effect of WBRT combined with gefitinib in NSCLC patients with brain metastases.
Collapse
Affiliation(s)
- Chengyu Ye
- Department of Radiotherapy, Wenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou 325000, People’s Republic of China
- Zhejiang Chinese Medical University, Hangzhou 310053, People’s Republic of China
| | - Quanbing Lin
- Department of Radiotherapy, Wenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou 325000, People’s Republic of China
| | - Zhang Jin
- Department of Radiotherapy, Wenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou 325000, People’s Republic of China
| | - Cuiping Zheng
- Department of Haematology and Oncology, Wenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical University, No. 252, Eastern Baili Road, Lucheng District, Wenzhou 325000, Zhejiang Province, People’s Republic of China
| | - Shenglin Ma
- Department of Radiotherapy, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 216, Huansha Road, Shangcheng District, Hangzhou 310006, Zhejiang Province, People’s Republic of China
| |
Collapse
|
4
|
Han Y, Zhang L, Niu S, Chen S, Yang B, Chen H, Zheng F, Zang Y, Zhang H, Xin Y, Chen X. Differentiation Between Glioblastoma Multiforme and Metastasis From the Lungs and Other Sites Using Combined Clinical/Routine MRI Radiomics. Front Cell Dev Biol 2021; 9:710461. [PMID: 34513840 PMCID: PMC8427511 DOI: 10.3389/fcell.2021.710461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/09/2021] [Indexed: 01/17/2023] Open
Abstract
Background Differentiation between cerebral glioblastoma multiforme (GBM) and solitary brain metastasis (MET) is important. The existing radiomic differentiation method ignores the clinical and routine magnetic resonance imaging (MRI) features. Purpose To differentiate between GBM and MET and between METs from the lungs (MET-lung) and other sites (MET-other) through clinical and routine MRI, and radiomics analyses. Methods and Materials A total of 350 patients were collected from two institutions, including 182 patients with GBM and 168 patients with MET, which were all proven by pathology. The ROI of the tumor was obtained on axial postcontrast MRI which was performed before operation. Seven radiomic feature selection methods and four classification algorithms constituted 28 classifiers in two classification strategies, with the best classifier serving as the final radiomics model. The clinical and combination models were constructed using the nomograms developed. The performance of the nomograms was evaluated in terms of calibration, discrimination, and clinical usefulness. Student’s t-test or the chi-square test was used to assess the differences in the clinical and radiological characteristics between the training and internal validation cohorts. Receiver operating characteristic curve analysis was performed to assess the performance of developed models with the area under the curve (AUC). Results The classifier fisher_decision tree (fisher_DT) showed the best performance (AUC: 0.696, 95% CI:0.608-0.783) for distinguishing between GBM and MET in internal validation cohorts; the classifier reliefF_random forest (reliefF_RF) showed the best performance (AUC: 0.759, 95% CI: 0.613-0.904) for distinguishing between MET-lung and MET-other in internal validation cohorts. The combination models incorporating the radiomics signature and clinical-radiological characteristics were superior to the clinical-radiological models in the two classification strategies (AUC: 0.764 for differentiation between GBM in internal validation cohorts and MET and 0.759 or differentiation between MET-lung and MET-other in internal validation cohorts). The nomograms showed satisfactory performance and calibration and were considered clinically useful, as revealed in the decision curve analysis. Data Conclusion The combination of radiomic and non-radiomic features is helpful for the differentiation among GBM, MET-lung, and MET-other.
Collapse
Affiliation(s)
- Yuqi Han
- School of Life Sciences and Technology, Xidian University, Xi'an, China.,Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Lingling Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuzi Niu
- Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Shuguang Chen
- School of Mathematical Sciences, Nankai University, Tianjin, China
| | - Bo Yang
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hongyan Chen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fei Zheng
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuying Zang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongbo Zhang
- Department of Neurosurgery, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, China
| | - Yu Xin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuzhu Chen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Zhang L, Yao R, Gao J, Tan D, Yang X, Wen M, Wang J, Xie X, Liao R, Tang Y, Chen S, Li Y. An Integrated Radiomics Model Incorporating Diffusion-Weighted Imaging and 18F-FDG PET Imaging Improves the Performance of Differentiating Glioblastoma From Solitary Brain Metastases. Front Oncol 2021; 11:732704. [PMID: 34527594 PMCID: PMC8435895 DOI: 10.3389/fonc.2021.732704] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/06/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The effectiveness of conventional MRI (cMRI)-based radiomics in differentiating glioblastoma (GBM) from solitary brain metastases (SBM) is not satisfactory enough. Therefore, we aimed to develop an integrated radiomics model to improve the performance of differentiating GBM from SBM. METHODS One hundred patients with solitary brain tumors (50 with GBM, 50 with SBM) were retrospectively enrolled and randomly assigned to the training set (n = 80) or validation set (n = 20). A total of 4,424 radiomic features were obtained from contrast-enhanced T1-weighted imaging (CE-T1WI) with the contrast-enhancing and peri-enhancing edema region, T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI)-derived apparent diffusion coefficient (ADC), and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) images. The partial least squares (PLS) regression with fivefold cross-validation is used to analyze the correlation between different radiomic features and different modalities. The cross-validity analysis was performed to judge whether a new principal component or a new feature dimension can significantly improve the final prediction effect. The principal components with effective interpretation in all radiomic features were projected to a low-dimensional space (2D in this study). The effective features of the new projection mapping were then sent to the random forest classifier to predict the results. The performance of differentiating GBM from SBM was compared between the integrated radiomics model and other radiomics models or nonradiomics methods using the area under the receiver operating characteristics curve (AUC). RESULTS Through the cross-validity analysis of partial least squares, hundreds of radiomic features were projected into a new two-dimensional space to complete the construction of radiomics model. Compared with the combined radiomics model using DWI + 18F-FDG PET (AUC = 0.93, p = 0.014), cMRI + DWI (AUC = 0.89, p = 0.011), cMRI + 8F-FDG PET (AUC = 0.91, p = 0.015), and single radiomics model using cMRI (AUC = 0.85, p = 0.018), DWI (AUC = 0.84, p = 0.017), and 18F-FDG PET (AUC = 0.85, p = 0.421), the integrated radiomics model (AUC = 0.98) showed more efficient diagnostic performance. The integrated radiomics model (AUC = 0.98) also showed significantly better performance than any single ADC, SUV, or TBR parameter (AUC = 0.57-0.71, p < 0.05). The integrated radiomics model showed better performance in the training (AUC = 0.98) and validation (AUC = 0.93) sets than any other models and methods, demonstrating robustness. CONCLUSIONS We developed an integrated radiomics model incorporating DWI and 18F-FDG PET, which improved the performance of differentiating GBM from SBM greatly.
Collapse
Affiliation(s)
- Liqiang Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Yao
- College of Computer & Information Science, Southwest University, Chongqing, China
| | - Jueni Gao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Duo Tan
- College of Computer & Information Science, Southwest University, Chongqing, China
| | - Xinyi Yang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ming Wen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangxian Xie
- Department of Radiology, Chongqing United Medical Imaging Center, Chongqing, China
| | - Ruikun Liao
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Yao Tang
- Department of Oncology, People’s Hospital of Chongqing Hechuan, Chongqing, China
| | - Shanxiong Chen
- College of Computer & Information Science, Southwest University, Chongqing, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
6
|
Dikaios N. Deep learning magnetic resonance spectroscopy fingerprints of brain tumours using quantum mechanically synthesised data. NMR IN BIOMEDICINE 2021; 34:e4479. [PMID: 33448078 DOI: 10.1002/nbm.4479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/24/2020] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
Metabolic fingerprints are valuable biomarkers for diseases that are associated with metabolic disorders. 1H magnetic resonance spectroscopy (MRS) is a unique noninvasive diagnostic tool that can depict the metabolic fingerprint based solely on the proton signal of different molecules present in the tissue. However, its performance is severely hindered by low SNR, field inhomogeneities and overlapping spectra of metabolites, which affect the quantification of metabolites. Consequently, MRS is rarely included in routine clinical protocols and has not been proven in multi-institutional trials. This work proposes an alternative approach, where instead of quantifying metabolites' concentration, deep learning (DL) is used to model the complex nonlinear relationship between diseases and their spectroscopic metabolic fingerprint (pattern). DL requires large training datasets, acquired (ideally) with the same protocol/scanner, which are very rarely available. To overcome this limitation, a novel method is proposed that can quantum mechanically synthesise MRS data for any scanner/acquisition protocol. The proposed methodology is applied to the challenging clinical problem of differentiating metastasis from glioblastoma brain tumours on data acquired across multiple institutions. DL algorithms were trained on the augmented synthetic spectra and tested on two independent datasets acquired by different scanners, achieving a receiver operating characteristic area under the curve of up to 0.96 and 0.97, respectively.
Collapse
Affiliation(s)
- Nikolaos Dikaios
- Mathematics Research Center, Academy of Athens, Athens, Greece
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK
| |
Collapse
|
7
|
De Martino M, Santini B, Cappelletti G, Mazzotta A, Rasi M, Bulgarelli G, Annicchiarico L, Marcocci A, Talacchi A. The quality of measurement properties of neurocognitive assessment in brain tumor clinical trials over the last 30 years: a COSMIN checklist-based approach. Neurol Sci 2020; 41:3105-3121. [PMID: 32656714 DOI: 10.1007/s10072-020-04477-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To provide an exhaustive review of the neuropsychological examination as conducted in brain tumor clinical trials over the last 30 years and to provide objective ratings about the reliability and suitability of such tests in neurooncological research and clinical practice. METHODS Methodologies and tools provided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) were exploited in order to assess the measurement properties of questionnaires and performance-based instruments used to evaluate cognitive functioning in brain tumor clinical trials from 1997 to 2017. RESULTS Twenty-six brain tumor clinical trials were analyzed and an overall set of 10 neuropsychological tests was identified. A list of 24 studies concerning the reliability of such tests was analyzed. Reliability and level of evidence scores for each study and for each test were obtained. The results revealed relevant faults about the quality of measurements and the suitability of the neurocognitive assessment batteries most commonly used in brain tumor clinical trials. CONCLUSION Our findings suggest that the cognitive assessment in brain tumor clinical trials should be implemented according to specific endpoints and should be addressed to investigate all the cognitive domains known to be affected by brain tumor and treatment.
Collapse
Affiliation(s)
- Maria De Martino
- Department of Political and Communication Sciences, University of Salerno, Via Giovanni Paolo II, 132, (SA), 84084, Fisciano, Italy.
| | - Barbara Santini
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Giovanna Cappelletti
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Annapina Mazzotta
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Matteo Rasi
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Giorgia Bulgarelli
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Luciano Annicchiarico
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Alessandro Marcocci
- Unit of Othorinolaringology, Merano Hospital, Via Rossini, 5, 39012, Merano (BZ), Italy
| | - Andrea Talacchi
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| |
Collapse
|
8
|
Kumthekar P, Tang SC, Brenner AJ, Kesari S, Piccioni DE, Anders C, Carrillo J, Chalasani P, Kabos P, Puhalla S, Tkaczuk K, Garcia AA, Ahluwalia MS, Wefel JS, Lakhani N, Ibrahim N. ANG1005, a Brain-Penetrating Peptide-Drug Conjugate, Shows Activity in Patients with Breast Cancer with Leptomeningeal Carcinomatosis and Recurrent Brain Metastases. Clin Cancer Res 2020; 26:2789-2799. [PMID: 31969331 DOI: 10.1158/1078-0432.ccr-19-3258] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/12/2019] [Accepted: 01/17/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE ANG1005, a novel taxane derivative, consists of three paclitaxel molecules covalently linked to Angiopep-2, designed to cross the blood-brain and blood-cerebrospinal barriers and to penetrate malignant cells via LRP1 transport system. Preclinical and clinical evidence of efficacy with ANG1005 has been previously shown. PATIENTS AND METHODS A multicenter, open-label phase II study in adult patients with measurable recurrent brain metastases from breast cancer (BCBM), with or without leptomeningeal carcinomatosis was conducted (n = 72 BCBM; n = 28 leptomeningeal carcinomatosis subset). ANG1005 was administered intravenously at 600 mg/m2 every 3 weeks. Tumor assessment was based on central nervous system (CNS) RECIST 1.1 for intracranial, and RECIST 1.1 for extracranial response. The primary endpoint was determination of intracranial objective response rate (iORR). RESULTS Median age was 47.5 years. Safety profile was similar to that of paclitaxel with myelosuppression as the predominating toxicity. Average number of prior CNS-directed therapies was 2.8 and 94% of the patients had prior taxane treatment. Patient benefit (stable disease or better) was seen in 77% (intracranial) and 86% (extracranial) of the evaluable patients, with iORR of 15% (investigator) or 8% (independent radiology facility [IRF] review). In the leptomeningeal carcinomatosis subset, 79% of the patients had intracranial disease control and estimated median overall survival of 8.0 months (95% CI, 5.4-9.4). CONCLUSIONS Even though the study preset rule for iORR per IRF was not met in this heavily pretreated population, a notable CNS and systemic treatment effect was seen in all patients including symptom improvement and prolonged overall survival compared to historical control for the subset of patients with leptomeningeal carcinomatosis (n = 28).
Collapse
Affiliation(s)
- Priya Kumthekar
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Shou-Ching Tang
- Cancer Center and Research Institute, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Santosh Kesari
- John Wayne Cancer Institute and Pacific Neuroscience Institute, Santa Monica, California
| | - David E Piccioni
- Department of Neurosciences, UC San Diego Moores Cancer Center, La Jolla, California
| | | | - Jose Carrillo
- John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California
| | | | - Peter Kabos
- University of Colorado, Anschutz Medical Campus, Greenwood Village, Colorado
| | - Shannon Puhalla
- University of Pittsburgh Magee Women's Cancer Program, Pittsburgh, Pennsylvania
| | - Katherine Tkaczuk
- University Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | | | - Manmeet S Ahluwalia
- Miller Family Endowed Chair in NeuroOncology; Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio
| | - Jeffrey S Wefel
- Departments of Neuro-Oncology and Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nehal Lakhani
- Cancer and Hematology Centers of Western Michigan, Grand Rapids, Michigan
| | - Nuhad Ibrahim
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center; Houston, Texas
| |
Collapse
|
9
|
Applications of radiomics and machine learning for radiotherapy of malignant brain tumors. Strahlenther Onkol 2020; 196:856-867. [PMID: 32394100 PMCID: PMC7498494 DOI: 10.1007/s00066-020-01626-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022]
Abstract
Background Magnetic resonance imaging (MRI) and amino acid positron-emission tomography (PET) of the brain contain a vast amount of structural and functional information that can be analyzed by machine learning algorithms and radiomics for the use of radiotherapy in patients with malignant brain tumors. Methods This study is based on comprehensive literature research on machine learning and radiomics analyses in neuroimaging and their potential application for radiotherapy in patients with malignant glioma or brain metastases. Results Feature-based radiomics and deep learning-based machine learning methods can be used to improve brain tumor diagnostics and automate various steps of radiotherapy planning. In glioma patients, important applications are the determination of WHO grade and molecular markers for integrated diagnosis in patients not eligible for biopsy or resection, automatic image segmentation for target volume planning, prediction of the location of tumor recurrence, and differentiation of pseudoprogression from actual tumor progression. In patients with brain metastases, radiomics is applied for additional detection of smaller brain metastases, accurate segmentation of multiple larger metastases, prediction of local response after radiosurgery, and differentiation of radiation injury from local brain metastasis relapse. Importantly, high diagnostic accuracies of 80–90% can be achieved by most approaches, despite a large variety in terms of applied imaging techniques and computational methods. Conclusion Clinical application of automated image analyses based on radiomics and artificial intelligence has a great potential for improving radiotherapy in patients with malignant brain tumors. However, a common problem associated with these techniques is the large variability and the lack of standardization of the methods applied.
Collapse
|
10
|
Lohmann P, Kocher M, Ruge MI, Visser-Vandewalle V, Shah NJ, Fink GR, Langen KJ, Galldiks N. PET/MRI Radiomics in Patients With Brain Metastases. Front Neurol 2020; 11:1. [PMID: 32116995 PMCID: PMC7020230 DOI: 10.3389/fneur.2020.00001] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022] Open
Abstract
Although a variety of imaging modalities are used or currently being investigated for patients with brain tumors including brain metastases, clinical image interpretation to date uses only a fraction of the underlying complex, high-dimensional digital information from routinely acquired imaging data. The growing availability of high-performance computing allows the extraction of quantitative imaging features from medical images that are usually beyond human perception. Using machine learning techniques and advanced statistical methods, subsets of such imaging features are used to generate mathematical models that represent characteristic signatures related to the underlying tumor biology and might be helpful for the assessment of prognosis or treatment response, or the identification of molecular markers. The identification of appropriate, characteristic image features as well as the generation of predictive or prognostic mathematical models is summarized under the term radiomics. This review summarizes the current status of radiomics in patients with brain metastases.
Collapse
Affiliation(s)
- Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3/-4/-11), Research Center Juelich, Jülich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Kocher
- Institute of Neuroscience and Medicine (INM-3/-4/-11), Research Center Juelich, Jülich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maximillian I Ruge
- Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine (INM-3/-4/-11), Research Center Juelich, Jülich, Germany.,JARA-BRAIN-Translational Medicine, Aachen, Germany.,Department of Neurology, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany
| | - Gereon R Fink
- Institute of Neuroscience and Medicine (INM-3/-4/-11), Research Center Juelich, Jülich, Germany.,Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3/-4/-11), Research Center Juelich, Jülich, Germany.,Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany.,Department of Nuclear Medicine, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3/-4/-11), Research Center Juelich, Jülich, Germany.,Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Cologne, Germany.,Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
11
|
Gerstenecker A, Gammon M, Marotta D, Fiveash J, Nabors B, Mulhauser K, Triebel K. Using cognition to predict the ability to understand medical treatment in brain and metastatic cancer. Psychooncology 2019; 29:406-412. [DOI: 10.1002/pon.5277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Adam Gerstenecker
- Department of Neurology, Division of Neuropsychology University of Alabama at Birmingham Birmingham Alabama
- Evelyn F. McKnight Brain Institute University of Alabama at Birmingham Birmingham Alabama
- Alzheimer's Disease Center University of Alabama at Birmingham Birmingham Alabama
| | - Meredith Gammon
- Department of Neurology, Division of Neuropsychology University of Alabama at Birmingham Birmingham Alabama
| | - Dario Marotta
- Department of Neurology, Division of Neuropsychology University of Alabama at Birmingham Birmingham Alabama
| | - John Fiveash
- O'Neal Comprehensive Cancer Center University of Alabama at Birmingham Birmingham Alabama
| | - Burt Nabors
- O'Neal Comprehensive Cancer Center University of Alabama at Birmingham Birmingham Alabama
| | - Kyler Mulhauser
- Department of Neurology, Division of Neuropsychology University of Alabama at Birmingham Birmingham Alabama
| | - Kristen Triebel
- Department of Neurology, Division of Neuropsychology University of Alabama at Birmingham Birmingham Alabama
- Evelyn F. McKnight Brain Institute University of Alabama at Birmingham Birmingham Alabama
- O'Neal Comprehensive Cancer Center University of Alabama at Birmingham Birmingham Alabama
| |
Collapse
|
12
|
Costa J, Haddad FG, Costa G, Harb A, Eid R, Kourie HR, Helou JE. Seizures in cancer patients: a vast spectrum of etiologies. FUTURE NEUROLOGY 2019. [DOI: 10.2217/fnl-2019-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: This study aims to recognize the distribution of different seizures etiologies in cancer patients, the most common primary tumors responsible for brain metastases, the most epileptogenic primary tumors and the therapeutic modalities. Methods: A retrospective study was conducted at Hotel-Dieu de France Hospital targeting patients admitted to hematology–oncology department between 2005 and 2016 who presented a seizure. Results: Of the 153 included patients, mean age was 57 years (standard deviation = 16 years) and a male predominance (66%). The majority of seizures were due to a primary tumor (49%) or brain metastases (32%). Other reversible (metabolic and drug) or nonreversible causes (carcinomatous meningitis, radiation and cardiovascular complications) formed the remaining causes. Regarding antiepileptic treatments, sodium valproate was mostly used, followed by levetiracetam and phenytoin. Conclusion: Numerous reversible causes are involved in the onset of epileptic seizures, including metabolic disorders, antibiotics and chemotherapies.
Collapse
Affiliation(s)
- Jad Costa
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fady Gh Haddad
- Hematology & Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Georges Costa
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ahmad Harb
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Roland Eid
- Hematology & Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Hampig Raphael Kourie
- Hematology & Oncology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jeanine El Helou
- Neurology Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| |
Collapse
|
13
|
Qian Z, Li Y, Wang Y, Li L, Li R, Wang K, Li S, Tang K, Zhang C, Fan X, Chen B, Li W. Differentiation of glioblastoma from solitary brain metastases using radiomic machine-learning classifiers. Cancer Lett 2019; 451:128-135. [DOI: 10.1016/j.canlet.2019.02.054] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/26/2019] [Accepted: 02/28/2019] [Indexed: 12/22/2022]
|
14
|
Mohammad AS, Adkins CE, Shah N, Aljammal R, Griffith JIG, Tallman RM, Jarrell KL, Lockman PR. Permeability changes and effect of chemotherapy in brain adjacent to tumor in an experimental model of metastatic brain tumor from breast cancer. BMC Cancer 2018; 18:1225. [PMID: 30526520 PMCID: PMC6286543 DOI: 10.1186/s12885-018-5115-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/20/2018] [Indexed: 02/07/2023] Open
Abstract
Background Brain tumor vasculature can be significantly compromised and leakier than that of normal brain blood vessels. Little is known if there are vascular permeability alterations in the brain adjacent to tumor (BAT). Changes in BAT permeability may also lead to increased drug permeation in the BAT, which may exert toxicity on cells of the central nervous system. Herein, we studied permeation changes in BAT using quantitative fluorescent microscopy and autoradiography, while the effect of chemotherapy within the BAT region was determined by staining for activated astrocytes. Methods Human metastatic breast cancer cells (MDA-MB-231Br) were injected into left ventricle of female NuNu mice. Metastases were allowed to grow for 28 days, after which animals were injected fluorescent tracers Texas Red (625 Da) or Texas Red dextran (3 kDa) or a chemotherapeutic agent 14C-paclitaxel. The accumulation of tracers and 14C-paclitaxel in BAT were determined by using quantitative fluorescent microscopy and autoradiography respectively. The effect of chemotherapy in BAT was determined by staining for activated astrocytes. Results The mean permeability of texas Red (625 Da) within BAT region increased 1.0 to 2.5-fold when compared to normal brain, whereas, Texas Red dextran (3 kDa) demonstrated mean permeability increase ranging from 1.0 to 1.8-fold compared to normal brain. The Kin values in the BAT for both Texas Red (625 Da) and Texas Red dextran (3 kDa) were found to be 4.32 ± 0.2 × 105 mL/s/g and 1.6 ± 1.4 × 105 mL/s/g respectively and found to be significantly higher than the normal brain. We also found that there is significant increase in accumulation of 14C-Paclitaxel in BAT compared to the normal brain. We also observed animals treated with chemotherapy (paclitaxel (10 mg/kg), erubilin (1.5 mg/kg) and docetaxel (10 mg/kg)) showed activated astrocytes in BAT. Conclusions Our data showed increased permeation of fluorescent tracers and 14C-paclitaxel in the BAT. This increased permeation lead to elevated levels of activated astrocytes in BAT region in the animals treated with chemotherapy.
Collapse
Affiliation(s)
- Afroz S Mohammad
- Department of Pharmaceutical Sciences, West Virginia University Health Sciences Center, School of Pharmacy, 1 Medical Center Drive, Morgantown, West Virginia, 26506-9050, USA
| | - Chris E Adkins
- Department of Pharmaceutical Sciences, West Virginia University Health Sciences Center, School of Pharmacy, 1 Medical Center Drive, Morgantown, West Virginia, 26506-9050, USA
| | - Neal Shah
- Department of Pharmaceutical Sciences, West Virginia University Health Sciences Center, School of Pharmacy, 1 Medical Center Drive, Morgantown, West Virginia, 26506-9050, USA
| | - Rawaa Aljammal
- Department of Pharmaceutical Sciences, West Virginia University Health Sciences Center, School of Pharmacy, 1 Medical Center Drive, Morgantown, West Virginia, 26506-9050, USA
| | - Jessica I G Griffith
- Department of Pharmaceutical Sciences, West Virginia University Health Sciences Center, School of Pharmacy, 1 Medical Center Drive, Morgantown, West Virginia, 26506-9050, USA
| | - Rachel M Tallman
- Department of Pharmaceutical Sciences, West Virginia University Health Sciences Center, School of Pharmacy, 1 Medical Center Drive, Morgantown, West Virginia, 26506-9050, USA
| | - Katherine L Jarrell
- Department of Pharmaceutical Sciences, West Virginia University Health Sciences Center, School of Pharmacy, 1 Medical Center Drive, Morgantown, West Virginia, 26506-9050, USA
| | - Paul R Lockman
- Department of Pharmaceutical Sciences, West Virginia University Health Sciences Center, School of Pharmacy, 1 Medical Center Drive, Morgantown, West Virginia, 26506-9050, USA.
| |
Collapse
|
15
|
Schimmel WC, Gehring K, Eekers DB, Hanssens PE, Sitskoorn MM. Cognitive effects of stereotactic radiosurgery in adult patients with brain metastases: A systematic review. Adv Radiat Oncol 2018; 3:568-581. [PMID: 30370357 PMCID: PMC6200877 DOI: 10.1016/j.adro.2018.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/20/2018] [Accepted: 06/25/2018] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Stereotactic radiation surgery (SRS) is increasingly applied in patients with brain metastases (BM) and is expected to have fewer adverse effects on cognitive functioning than whole brain radiation therapy (WBRT). Patients with BM are often confronted with a relatively short life expectancy, and the prevention or delay of cognitive decline to maintain quality of life is a clinically and highly relevant treatment goal. This review systematically and specifically evaluates the current literature on the cognitive effects of SRS in patients with BM. METHODS AND MATERIALS Published trials on SRS alone or in combination with WBRT, including objective assessment of cognitive functioning, were identified through a systematic search of the PubMed database up to March 2018. RESULTS Of the 241 records screened, 14 studies matched the selection criteria: 2 pilot studies, 7 single-group/observational trials (1 study update), and 5 randomized trials (1 secondary analysis). CONCLUSIONS In general, the results show little to no objective cognitive decline up to 4 months after SRS compared with WBRT. However, most trials suffered from methodologic limitations that hindered reliable conclusions. Most importantly, few studies investigated the specific cognitive effects of SRS alone or versus WBRT. Furthermore, disentangling the cognitive effects of SRS from the effects of the disease itself and from the effects of other treatments remains very difficult. By presenting this comprehensive review, we aim to encourage researchers to probe deeper into this area and to do so in a standardized and methodologically optimal manner. The ultimate objective of this line of research is to inform both doctors and patients more precisely about the cognitive effects they can expect from treatment. This study is expected to improve the quality of decision-making and maximize clinical outcomes for each individual patient.
Collapse
Affiliation(s)
- Wietske C.M. Schimmel
- Gamma Knife Center, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
| | - Karin Gehring
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Daniëlle B.P. Eekers
- Department of Radiation Oncology, GROW–School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands
| | - Patrick E.J. Hanssens
- Gamma Knife Center, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Margriet M. Sitskoorn
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, the Netherlands
| |
Collapse
|
16
|
Cacho-Díaz B, Spínola-Maroño H, González-Aguilar A, Arrieta O. Factors associated with long-term survival in central nervous system metastases. J Neurooncol 2018; 140:159-164. [PMID: 30003395 DOI: 10.1007/s11060-018-2946-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/05/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cancer is a leading cause of death worldwide; central nervous system metastases (CNSm) are amongst the most common complications of cancer and are associated with high morbidity and mortality. The aim of the study was to associate clinic and oncologic characteristics with the possibility of survival for ≥ 1 year. MATERIALS AND METHODS A prospective cohort in two referral centers recollected clinical and oncologic data from patients diagnosed with CNSm. Chronic metastases were defined as those patients that survived for ≥ 12 months after the diagnosis of CNSm. RESULTS Of 613 patients with CNSm, 554 had solid tumors as the primary cancer and were included; 405 (73%) were women, the most common primary cancer site were breast, lung and urologic. Chronic CNSm were found in 260 (47%) and were compared to those who did not. After multivariate logistic regression analysis, variables associated with good prognosis (living > 12 months) were: female sex (HR 0.55), single CNSm (HR 0.39), diagnosis of CNSm during initial extension studies or during presentation of cancer (HR 0.43), and occipital location (HR 0.62). CONCLUSIONS Long-term survival in patients with CNSm remains a topic of debate; their bad prognosis could be changing towards improvement. Clinical findings are typically overlooked in CNSm reports and prognostic scales. After our findings, we propose to include them in forthcoming studies to aid prognostic considerations. Factors associated with prolonged survival found in our study include female gender, timing of CNSm diagnosis, occipital lobe location, and single CNSm.
Collapse
Affiliation(s)
- Bernardo Cacho-Díaz
- Neuro-oncology Unit, Instituto Nacional de Cancerología, Av. San Fernando 22 Col Sección XVI, ZC 14050, Mexico City, México.
| | - Héctor Spínola-Maroño
- Neuro-oncology Unit, Instituto Nacional de Cancerología, Av. San Fernando 22 Col Sección XVI, ZC 14050, Mexico City, México
| | | | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, Mexico
| |
Collapse
|
17
|
Deike-Hofmann K, Thünemann D, Breckwoldt MO, Schwarz D, Radbruch A, Enk A, Bendszus M, Hassel J, Schlemmer HP, Bäumer P. Sensitivity of different MRI sequences in the early detection of melanoma brain metastases. PLoS One 2018; 13:e0193946. [PMID: 29596475 PMCID: PMC5875773 DOI: 10.1371/journal.pone.0193946] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND After the emergence of new MRI techniques such as susceptibility- and diffusion-weighted imaging (SWI and DWI) and because of specific imaging characteristics of melanoma brain metastases (MBM), it is unclear which MRI sequences are most beneficial for detection of MBM. This study was performed to investigate the sensitivity of six clinical MRI sequences in the early detection of MBM. METHODS Medical records of all melanoma patients referred to our center between November 2005 and December 2016 were reviewed for presence of MBM. Analysis encompassed six MRI sequences at the time of initial diagnosis of first or new MBM, including non-enhanced T1-weighted (T1w), contrast-enhanced T1w (ceT1w), T2-weighted (T2w), T2w-FLAIR, susceptibility-weighted (SWI) and diffusion-weighted (DWI) MRI. Each lesion was rated with respect to its conspicuity (score from 0-not detectable to 3-clearly visible). RESULTS Of 1210 patients, 217 with MBM were included in the analysis and up to 5 lesions per patient were evaluated. A total of 720 metastases were assessed and all six sequences were available for 425 MBM. Sensitivity (conspicuity ≥2) was 99.7% for ceT1w, 77.0% for FLAIR, 64.7% for SWI, 61.0% for T2w, 56.7% for T1w, and 48.4% for DWI. Thirty-one (7.3%) of 425 lesions were only detectable by ceT1w but no other sequence. CONCLUSIONS Contrast-enhanced T1-weighting is more sensitive than all other sequences for detection of MBM. Disruption of the blood-brain-barrier is consistently an earlier sign in MBM than perifocal edema, signal loss on SWI or diffusion restriction.
Collapse
Affiliation(s)
| | - Daniel Thünemann
- Department of Radiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Michael O. Breckwoldt
- Department of Radiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Daniel Schwarz
- Department of Radiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Alexander Radbruch
- Department of Radiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, National Center for Tumor Diseases, NCT, University of Heidelberg Medical Center Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Jessica Hassel
- Department of Dermatology, National Center for Tumor Diseases, NCT, University of Heidelberg Medical Center Heidelberg, Germany
| | | | - Philipp Bäumer
- Department of Radiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
- * E-mail:
| |
Collapse
|
18
|
Schimmel WCM, Verhaak E, Hanssens PEJ, Gehring K, Sitskoorn MM. A randomised trial to compare cognitive outcome after gamma knife radiosurgery versus whole brain radiation therapy in patients with multiple brain metastases: research protocol CAR-study B. BMC Cancer 2018; 18:218. [PMID: 29466961 PMCID: PMC5822552 DOI: 10.1186/s12885-018-4106-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/08/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Gamma Knife radiosurgery (GKRS) is increasingly applied in patients with multiple brain metastases and is expected to have less adverse effects in cognitive functioning than whole brain radiation therapy (WBRT). Effective treatment with the least negative cognitive side effects is increasingly becoming important, as more patients with brain metastases live longer due to more and better systemic treatment options. There are no published randomized trials yet directly comparing GKRS to WBRT in patients with multiple brain metastases that include objective neuropsychological testing. METHODS CAR-Study B is a prospective randomised trial comparing cognitive outcome after GKRS or WBRT in adult patients with 11-20 newly diagnosed brain metastases on a contrast-enhanced MRI-scan, KPS ≥70 and life expectancy of at least 3 months. Randomisation by the method of minimization, is stratified by the cumulative tumour volume in the brain, systemic treatment, KPS, histology, baseline cognitive functioning and age. The primary endpoint is the between-group difference in the percentage of patients with significant memory decline at 3 months. Secondary endpoints include overall survival, local control, development of new brain metastases, cognitive functioning over time, quality of life, depression, anxiety and fatigue. Cognitive functioning is assessed by a standardised neuropsychological test battery. Assessments (cognitive testing, questionnaires and MRI-scans) are scheduled at baseline and at 3, 6, 9, 12 and 15 months after treatment. DISCUSSION Knowledge gained from this trial may be used to inform individual patients with BM more precisely about the cognitive effects they can expect from treatment, and to assist both doctors and patients in making (shared) individual treatment decisions. This trial is currently recruiting. Target accrual: 23 patients at 3-months follow-up in both groups. TRIAL REGISTRATION The Netherlands Trials Register number NTR5463. ClinicalTrials.gov registration number NCT02953717 , first received October 27, 2016, 8 patients were enrolled in this study on 31 July 2017.
Collapse
Affiliation(s)
- Wietske C. M. Schimmel
- Gamma Knife Centre Tilburg, Elisabeth TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
| | - Eline Verhaak
- Gamma Knife Centre Tilburg, 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 Centre Tilburg, Elisabeth TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
- Department Neurosurgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Karin Gehring
- Gamma Knife Centre Tilburg, Elisabeth TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
- Department Neurosurgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
| | - Margriet M. Sitskoorn
- Department Neurosurgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
| |
Collapse
|
19
|
Radiation injury vs. recurrent brain metastasis: combining textural feature radiomics analysis and standard parameters may increase 18F-FET PET accuracy without dynamic scans. Eur Radiol 2016; 27:2916-2927. [PMID: 27853813 DOI: 10.1007/s00330-016-4638-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/29/2016] [Accepted: 10/07/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We investigated the potential of textural feature analysis of O-(2-[18F]fluoroethyl)-L-tyrosine (18F-FET) PET to differentiate radiation injury from brain metastasis recurrence. METHODS Forty-seven patients with contrast-enhancing brain lesions (n = 54) on MRI after radiotherapy of brain metastases underwent dynamic 18F-FET PET. Tumour-to-brain ratios (TBRs) of 18F-FET uptake and 62 textural parameters were determined on summed images 20-40 min post-injection. Tracer uptake kinetics, i.e., time-to-peak (TTP) and patterns of time-activity curves (TAC) were evaluated on dynamic PET data from 0-50 min post-injection. Diagnostic accuracy of investigated parameters and combinations thereof to discriminate between brain metastasis recurrence and radiation injury was compared. RESULTS Diagnostic accuracy increased from 81 % for TBRmean alone to 85 % when combined with the textural parameter Coarseness or Short-zone emphasis. The accuracy of TBRmax alone was 83 % and increased to 85 % after combination with the textural parameters Coarseness, Short-zone emphasis, or Correlation. Analysis of TACs resulted in an accuracy of 70 % for kinetic pattern alone and increased to 83 % when combined with TBRmax. CONCLUSIONS Textural feature analysis in combination with TBRs may have the potential to increase diagnostic accuracy for discrimination between brain metastasis recurrence and radiation injury, without the need for dynamic 18F-FET PET scans. KEY POINTS • Textural feature analysis provides quantitative information about tumour heterogeneity • Textural features help improve discrimination between brain metastasis recurrence and radiation injury • Textural features might be helpful to further understand tumour heterogeneity • Analysis does not require a more time consuming dynamic PET acquisition.
Collapse
|
20
|
Kotecha R, Vogel S, Suh JH, Barnett GH, Murphy ES, Reddy CA, Parsons M, Vogelbaum MA, Angelov L, Mohammadi AM, Stevens GHJ, Peereboom DM, Ahluwalia MS, Chao ST. A cure is possible: a study of 10-year survivors of brain metastases. J Neurooncol 2016; 129:545-555. [DOI: 10.1007/s11060-016-2208-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/06/2016] [Indexed: 11/29/2022]
|
21
|
Fogarty GB, Hong A, Gondi V, Burmeister B, Jacobsen K, Lo S, Paton E, Shivalingam B, Thompson JF. Debate: adjuvant whole brain radiotherapy or not? More data is the wiser choice. BMC Cancer 2016; 16:372. [PMID: 27370683 PMCID: PMC4930567 DOI: 10.1186/s12885-016-2433-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 06/27/2016] [Indexed: 11/10/2022] Open
Abstract
Every year 170,000 patients are diagnosed with brain metastases (BMs) in the United States. Traditionally, adjuvant whole brain radiotherapy (AWBRT) has been offered following local therapy with neurosurgery (NSx) and/or stereotactic radiosurgery (SRS) to BMs. The aim is to increase intracranial control, thereby decreasing symptoms from intracranial progression and a neurological death. There is a rapidly evolving change in the radiation treatment of BMs happening around the world. AWBRT is now being passed over in favour of repeat scanning at regular intervals and more local therapies as more BMs appear radiologically, BMs that may never become symptomatic. This change has happened after the American Society for Radiation Oncology (ASTRO) in Item 5 of its “Choosing Wisely 2014” list recommended: “Don't routinely add adjuvant whole brain radiation therapy to SRS for limited brain metastases”. The guidelines are supposed to be based on the highest evidence to hand at the time. This article debates that the randomised controlled trials (RCTs) published prior to this recommendation consistently showed AWBRT significantly increases intracranial control, and avoids a neurological death, what it is meant to do. It also points out that, despite the enormity of the problem, only 774 patients in total had been randomised over more than three decades. These trials were heterogeneous in many respects. This data can, at best, be regarded as preliminary. In particular, there are no single histology AWBRT trials yet completed. A phase two trial investigating hippocampal avoiding AWBRT (HAWBRT) showed significantly less NCF decline compared to historical controls. We now need more randomised data to confirm the benefit of adjuvant HAWBRT. However, the ASTRO Guideline has particularly impacted accrual to trials investigating this, especially the international ANZMTG 01.07 WBRTMel trial. This is an RCT investigating AWBRT following local treatment in patients with one to three BMs from melanoma. WBRTMel has accrued 196 of a required 220 to date but accrual has slowed. HAWBRT may now never be tested in a randomised setting. Encouraging more data in AWBRT is the wiser choice.
Collapse
Affiliation(s)
- Gerald B Fogarty
- Melanoma Institute Australia, Poche Centre, North Sydney, Australia. .,Sydney Medical School, The University of Sydney, Sydney, Australia. .,Australia and New Zealand Melanoma Trials Group (ANZMTG), North Sydney, Australia. .,Trans-Tasman Radiation Oncology Group (TROG), Newcastle, Australia. .,Mater Sydney Radiation Oncology, PO Box 1003, Crows Nest, 1585, Australia.
| | - Angela Hong
- Melanoma Institute Australia, Poche Centre, North Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia.,Australia and New Zealand Melanoma Trials Group (ANZMTG), North Sydney, Australia
| | - Vinai Gondi
- Central Dupage Hospital Cancer Center, Warrenville, IL, USA.,University of Wisconsin Comprehensive Cancer Center, Madison, WI, USA
| | - Bryan Burmeister
- Australia and New Zealand Melanoma Trials Group (ANZMTG), North Sydney, Australia.,Trans-Tasman Radiation Oncology Group (TROG), Newcastle, Australia.,Princess Alexandra Hospital, Brisbane, Australia
| | - Kari Jacobsen
- Oslo University Hospital HF, The Norwegian Radium Hospital, Oslo, Norway
| | - Serigne Lo
- Melanoma Institute Australia, Poche Centre, North Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia.,Australia and New Zealand Melanoma Trials Group (ANZMTG), North Sydney, Australia
| | - Elizabeth Paton
- Sydney Medical School, The University of Sydney, Sydney, Australia.,Australia and New Zealand Melanoma Trials Group (ANZMTG), North Sydney, Australia
| | | | - John F Thompson
- Melanoma Institute Australia, Poche Centre, North Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia.,Australia and New Zealand Melanoma Trials Group (ANZMTG), North Sydney, Australia
| |
Collapse
|
22
|
Pérez-Ramírez Ú, Arana E, Moratal D. Brain metastases detection on MR by means of three-dimensional tumor-appearance template matching. J Magn Reson Imaging 2016; 44:642-52. [DOI: 10.1002/jmri.25207] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 02/09/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Úrsula Pérez-Ramírez
- Center for Biomaterials and Tissue Engineering; Universitat Politècnica de València; Valencia Spain
| | - Estanislao Arana
- Department of Radiology; Fundación Instituto Valenciano de Oncología; Valencia Spain
| | - David Moratal
- Center for Biomaterials and Tissue Engineering; Universitat Politècnica de València; Valencia Spain
| |
Collapse
|
23
|
Perez-Ramirez U, Arana E, Moratal D. Computer-aided detection of brain metastases using a three-dimensional template-based matching algorithm. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:2384-7. [PMID: 25570469 DOI: 10.1109/embc.2014.6944101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this work was to develop an algorithm for detecting brain metastases in magnetic resonance imaging (MRI), emphasizing the reduction of false positives. Firstly, three-dimensional templates were cross-correlated with the brain volume. Afterwards, each lesion candidate was segmented in the three orthogonal views as a previous step to remove elongated structures such as blood vessels. In a database containing 19 patients and 62 brain metastases, detection algorithm showed a sensitivity of 93.55%. After applying the method for false positive reduction, encouraging results were obtained: false positive rate per slice decreased from 0.64 to 0.15 and only one metastasis was removed, leading to a sensitivity of 91.94%.
Collapse
|
24
|
Triebel KL, Gerstenecker A, Meneses K, Fiveash JB, Meyers CA, Cutter G, Marson DC, Martin RC, Eakin A, Watts O, Nabors LB. Capacity of patients with brain metastases to make treatment decisions. Psychooncology 2015; 24:1448-55. [PMID: 25613039 PMCID: PMC4512930 DOI: 10.1002/pon.3753] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/21/2014] [Accepted: 12/18/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate medical decision-making capacity (MDC) in patients with brain metastases. METHODS Participants were 41 adults with brain metastases with Karnofsky Performance Status scores of ≥70 who were recruited from an academic medical center and 41 demographically matched controls recruited from the community. We evaluated MDC using the Capacity to Consent to Treatment Instrument and its four clinically relevant consent standards (expressing a treatment choice, appreciation, reasoning, and understanding). Capacity impairment ratings (no impairment, mild/moderate impairment, and severe impairment) on the consent standards were also assigned to each participant with brain metastasis using cutoff scores derived statistically from the performance of the control group. RESULTS The brain metastasis patient group performed significantly below controls on consent standards of understanding and reasoning. Capacity compromise was defined as performance ≤1.5 standard deviations below the control group mean. Using this definition, approximately 60% of the participants with brain metastases demonstrated capacity compromise on at least one MDC standard. CONCLUSION When defining capacity compromise as performance ≤1.5 standard deviation below the control group mean, over half of patients with brain metastases have reduced capacity to make treatment decisions. This impairment is demonstrated shortly after initial diagnosis of brain metastases and highlights the importance of routine clinical assessment of MDC following diagnosis of brain metastasis. These results also indicate a need for the development and investigation of interventions to support or improve MDC in this patient population.
Collapse
Affiliation(s)
- Kristen L. Triebel
- Department of Neurology, UAB, Birmingham, AL
- Comprehensive Cancer Center, UAB, Birmingham, AL
| | | | - Karen Meneses
- Comprehensive Cancer Center, UAB, Birmingham, AL
- School of Nursing, UAB, Birmingham, AL
| | - John B. Fiveash
- Comprehensive Cancer Center, UAB, Birmingham, AL
- Department of Radiation Oncology, UAB, Birmingham, AL
| | - Christina A. Meyers
- Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, TX (retired)
| | - Gary Cutter
- Department of Biostatistics, School of Public Health, UAB, Birmingham, AL
| | | | | | | | - Olivia Watts
- Department of Psychology, Boston University, Boston, MA
| | - Louis B. Nabors
- Department of Neurology, UAB, Birmingham, AL
- Comprehensive Cancer Center, UAB, Birmingham, AL
| |
Collapse
|
25
|
Habets EJJ, Dirven L, Wiggenraad RG, Verbeek-de Kanter A, Lycklama À Nijeholt GJ, Zwinkels H, Klein M, Taphoorn MJB. Neurocognitive functioning and health-related quality of life in patients treated with stereotactic radiotherapy for brain metastases: a prospective study. Neuro Oncol 2015; 18:435-44. [PMID: 26385615 DOI: 10.1093/neuonc/nov186] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/06/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stereotactic radiotherapy (SRT) is expected to have a less detrimental effect on neurocognitive functioning and health-related quality of life (HRQoL) than whole-brain radiotherapy. To evaluate the impact of brain metastases and SRT on neurocognitive functioning and HRQoL, we performed a prospective study. METHODS Neurocognitive functioning and HRQoL of 97 patients with brain metastases were measured before SRT and 1, 3, and 6 months after SRT. Seven cognitive domains were assessed. HRQoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and BN20 questionnaires. Neurocognitive functioning and HRQoL over time were analyzed with linear mixed models and stratified for baseline Karnofsky performance status (KPS), total metastatic volume, and systemic disease. RESULTS Median overall survival of patients was 7.7 months. Before SRT, neurocognitive domain and HRQoL scores were lower in patients than in healthy controls. At group level, patients worsened in physical functioning and fatigue at 6 months, while other outcome parameters of HRQoL and cognition remained stable. KPS < 90 and tumor volume >12.6 cm(3) were both associated with worse information processing speed and lower HRQoL scores over 6 months time. Intracranial tumor progression was associated with worsening of executive functioning and motor function. CONCLUSIONS Prior to SRT, neurocognitive functioning and HRQoL are moderately impaired in patients with brain metastases. Lower baseline KPS and larger tumor volume are associated with worse functioning. Over time, SRT does not have an additional detrimental effect on neurocognitive functioning and HRQoL, suggesting that SRT may be preferred over whole-brain radiotherapy.
Collapse
Affiliation(s)
- Esther J J Habets
- Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.)
| | - Linda Dirven
- Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.)
| | - Ruud G Wiggenraad
- Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.)
| | - Antoinette Verbeek-de Kanter
- Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.)
| | - Geert J Lycklama À Nijeholt
- Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.)
| | - Hanneke Zwinkels
- Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.)
| | - Martin Klein
- Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.)
| | - Martin J B Taphoorn
- Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.)
| |
Collapse
|
26
|
Gerstenecker A, Duff K, Meneses K, Fiveash JB, Nabors LB, Triebel KL. Cognitive Predictors of Reasoning through Treatment Decisions in Patients with Newly Diagnosed Brain Metastases. J Int Neuropsychol Soc 2015; 21:412-8. [PMID: 26149751 PMCID: PMC4707649 DOI: 10.1017/s1355617715000478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To examine the association between reasoning through medical treatment decisions and cognition in a sample of patients with brain metastasis. The association between reasoning and cognition was examined using data from 41 patients with diagnosed brain metastasis. All diagnoses were made by a board-certified radiation oncologist and were verified histologically. In total, 41 demographically matched, cognitively healthy controls were also included to aid in classifying patients with brain metastasis according to reasoning status (i.e., intact or impaired). Results indicate that measures of episodic memory and processing speed were associated with reasoning. Using these two predictors, actuarial equations were constructed that can be used to help screen for impaired reasoning ability in patients' with brain metastasis. The equations presented in this study have clinical significance as they can be used to help identify patients at risk for possessing a diminished ability to reason through medical treatment decisions and, thus, are in need of a more comprehensive evaluation of their medical decision-making capacity.
Collapse
Affiliation(s)
- Adam Gerstenecker
- Department of Neurology, Division of Neuropsychology, UAB, Birmingham, AL
| | - Kevin Duff
- Department of Neurology, University of Utah, Salt Lake City, UT
| | - Karen Meneses
- Comprehensive Cancer Center, UAB, Birmingham, AL
- School of Nursing, UAB, Birmingham, AL
| | - John B. Fiveash
- Comprehensive Cancer Center, UAB, Birmingham, AL
- Department of Radiation Oncology, UAB, Birmingham, AL
| | - Louis B. Nabors
- Comprehensive Cancer Center, UAB, Birmingham, AL
- Department of Neurology, Division of Neuro-oncology, UAB, Birmingham, AL
| | - Kristen L. Triebel
- Department of Neurology, Division of Neuropsychology, UAB, Birmingham, AL
- Comprehensive Cancer Center, UAB, Birmingham, AL
| |
Collapse
|
27
|
Puhalla S, Elmquist W, Freyer D, Kleinberg L, Adkins C, Lockman P, McGregor J, Muldoon L, Nesbit G, Peereboom D, Smith Q, Walker S, Neuwelt E. Unsanctifying the sanctuary: challenges and opportunities with brain metastases. Neuro Oncol 2015; 17:639-51. [PMID: 25846288 PMCID: PMC4482864 DOI: 10.1093/neuonc/nov023] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/18/2015] [Indexed: 12/22/2022] Open
Abstract
While the use of targeted therapies, particularly radiosurgery, has broadened therapeutic options for CNS metastases, patients respond minimally and prognosis remains poor. The inability of many systemic chemotherapeutic agents to penetrate the blood-brain barrier (BBB) has limited their use and allowed brain metastases to become a burgeoning clinical challenge. Adequate preclinical models that appropriately mimic the metastatic process, the BBB, and blood-tumor barriers (BTB) are needed to better evaluate therapies that have the ability to enhance delivery through or penetrate into these barriers and to understand the mechanisms of resistance to therapy. The heterogeneity among and within different solid tumors and subtypes of solid tumors further adds to the difficulties in determining the most appropriate treatment approaches and methods of laboratory and clinical studies. This review article discusses therapies focused on prevention and treatment of CNS metastases, particularly regarding the BBB, and the challenges and opportunities these therapies present.
Collapse
Affiliation(s)
- Shannon Puhalla
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - William Elmquist
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - David Freyer
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Lawrence Kleinberg
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Chris Adkins
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Paul Lockman
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - John McGregor
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Leslie Muldoon
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Gary Nesbit
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - David Peereboom
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Quentin Smith
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Sara Walker
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| | - Edward Neuwelt
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania (S.P.); Department of Pharmaceutics, University of Minnesota, Minneapolis, Minnesota (W.E.); Department of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California (D.F.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (L.K.); Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas (C.A.); Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University and the Mary Babb Randolph Cancer Center, Morgantown, West Virginia (P.L.); Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio (J.M.); Blood Brain-Barrier Program, Oregon Health & Science University, Portland, Oregon (L.M., E.N.); Dotter Radiology/Neuroradiology, Oregon Health & Science University, Portland, Oregon (G.N.); Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio (D.P.); School of Pharmacy, Texas Tech University, Health Sciences Center, Amarillo, Texas (Q.S.); Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (S.W.); Portland Veterans Affairs Medical Center, Portland, Oregon (E.N.)
| |
Collapse
|
28
|
Krizbai IA, Gasparics Á, Nagyőszi P, Fazakas C, Molnár J, Wilhelm I, Bencs R, Rosivall L, Sebe A. Endothelial-mesenchymal transition of brain endothelial cells: possible role during metastatic extravasation. PLoS One 2015; 10:e0119655. [PMID: 25742314 PMCID: PMC4350839 DOI: 10.1371/journal.pone.0119655] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/20/2015] [Indexed: 12/24/2022] Open
Abstract
Cancer progression towards metastasis follows a defined sequence of events described as the metastatic cascade. For extravasation and transendothelial migration metastatic cells interact first with endothelial cells. Yet the role of endothelial cells during the process of metastasis formation and extravasation is still unclear, and the interaction between metastatic and endothelial cells during transendothelial migration is poorly understood. Since tumor cells are well known to express TGF-β, and the compact endothelial layer undergoes a series of changes during metastatic extravasation (cell contact disruption, cytoskeletal reorganization, enhanced contractility), we hypothesized that an EndMT may be necessary for metastatic extravasation. We demonstrate that primary cultured rat brain endothelial cells (BEC) undergo EndMT upon TGF-β1 treatment, characterized by the loss of tight and adherens junction proteins, expression of fibronectin, β1-integrin, calponin and α-smooth muscle actin (SMA). B16/F10 cell line conditioned and activated medium (ACM) had similar effects: claudin-5 down-regulation, fibronectin and SMA expression. Inhibition of TGF-β signaling during B16/F10 ACM stimulation using SB-431542 maintained claudin-5 levels and mitigated fibronectin and SMA expression. B16/F10 ACM stimulation of BECs led to phosphorylation of Smad2 and Smad3. SB-431542 prevented SMA up-regulation upon stimulation of BECs with A2058, MCF-7 and MDA-MB231 ACM as well. Moreover, B16/F10 ACM caused a reduction in transendothelial electrical resistance, enhanced the number of melanoma cells adhering to and transmigrating through the endothelial layer, in a TGF-β-dependent manner. These effects were not confined to BECs: HUVECs showed TGF-β-dependent SMA expression when stimulated with breast cancer cell line ACM. Our results indicate that an EndMT may be necessary for metastatic transendothelial migration, and this transition may be one of the potential mechanisms occurring during the complex phenomenon known as metastatic extravasation.
Collapse
Affiliation(s)
- István A. Krizbai
- Institute of Biophysics, Biological Research Centre, Hungarian Academy of Sciences, Temesvári krt. 62, 6726, Szeged, Hungary
- Institute of Life Sciences, Vasile Goldis Western University of Arad, Liviu Rebreanu Str. 86, 310414, Arad, Romania
| | - Ákos Gasparics
- Department of Pathophysiology, Semmelweis University, Nagyvárad Square 4, 1089, Budapest, Hungary
| | - Péter Nagyőszi
- Institute of Biophysics, Biological Research Centre, Hungarian Academy of Sciences, Temesvári krt. 62, 6726, Szeged, Hungary
| | - Csilla Fazakas
- Institute of Biophysics, Biological Research Centre, Hungarian Academy of Sciences, Temesvári krt. 62, 6726, Szeged, Hungary
| | - Judit Molnár
- Institute of Biophysics, Biological Research Centre, Hungarian Academy of Sciences, Temesvári krt. 62, 6726, Szeged, Hungary
| | - Imola Wilhelm
- Institute of Biophysics, Biological Research Centre, Hungarian Academy of Sciences, Temesvári krt. 62, 6726, Szeged, Hungary
| | - Rita Bencs
- Department of Pathophysiology, Semmelweis University, Nagyvárad Square 4, 1089, Budapest, Hungary
| | - László Rosivall
- Department of Pathophysiology, Semmelweis University, Nagyvárad Square 4, 1089, Budapest, Hungary
- Pediatrics and Nephrology Research Group, Hungarian Academy of Sciences and Semmelweis University, Nagyvárad Square 4, 1089, Budapest, Hungary
| | - Attila Sebe
- Department of Pathophysiology, Semmelweis University, Nagyvárad Square 4, 1089, Budapest, Hungary
- * E-mail:
| |
Collapse
|
29
|
Gerstenecker A, Meneses K, Duff K, Fiveash JB, Marson DC, Triebel KL. Cognitive predictors of understanding treatment decisions in patients with newly diagnosed brain metastasis. Cancer 2015; 121:2013-9. [PMID: 25735262 DOI: 10.1002/cncr.29326] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/02/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Medical decision-making capacity is a higher-order functional skill that refers to a patient's ability to make informed, sound decisions related to care and treatment. In a medical context, understanding is the most cognitively demanding consent standard and refers to a patient's ability to comprehend information to the extent that informed decisions can be made. METHODS The association between reasoning and cognition was examined using data from 41 patients with diagnosed brain metastasis. All diagnoses were made by a board-certified radiation oncologist and were verified histologically. In total, 41 demographically matched, cognitively healthy controls were also included to aid in classifying patients with brain metastasis according to reasoning status (ie, intact or impaired). RESULTS Results indicate that measures of simple attention, verbal fluency, verbal memory, processing speed, and executive functioning were all associated with understanding, and that verbal memory and phonemic fluency were the primary cognitive predictors. Using these two primary predictors, equations can be constructed to predict the ability to understand treatment decisions in patients with brain metastasis. CONCLUSIONS Although preliminary, these data demonstrate how cognitive measures can estimate understanding as it relates to medical decision-making capacities in these patients. Clinically, these findings suggest that poor verbal memory and expressive language function could serve as "red flags" for reduced consent capacity in this patient population, thus signaling that a more comprehensive medical decision-making capacity evaluation is warranted.
Collapse
Affiliation(s)
- Adam Gerstenecker
- Department of Neurology, Division of Neuropsychology, UAB, Birmingham, Alabama
| | - Karen Meneses
- Comprehensive Cancer Center, UAB, Birmingham, Alabama.,School of Nursing, UAB, Birmingham, Alabama
| | - Kevin Duff
- Department of Neurology, University of Utah, Salt Lake City, Utah
| | - John B Fiveash
- Comprehensive Cancer Center, UAB, Birmingham, Alabama.,Department of Radiation Oncology, UAB, Birmingham, Alabama
| | - Daniel C Marson
- Department of Neurology, Division of Neuropsychology, UAB, Birmingham, Alabama
| | - Kristen L Triebel
- Department of Neurology, Division of Neuropsychology, UAB, Birmingham, Alabama.,Comprehensive Cancer Center, UAB, Birmingham, Alabama
| |
Collapse
|
30
|
Gerstenecker A, Nabors LB, Meneses K, Fiveash JB, Marson DC, Cutter G, Martin RC, Meyers CA, Triebel KL. Cognition in patients with newly diagnosed brain metastasis: profiles and implications. J Neurooncol 2014; 120:179-85. [PMID: 25035099 PMCID: PMC4295820 DOI: 10.1007/s11060-014-1543-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/06/2014] [Indexed: 10/25/2022]
Abstract
Cognitive impairment is a common symptom in patients with brain metastasis, and significant cognitive dysfunction is prevalent in a majority of patients who are still able to engage in basic self-care activities. In the current study, the neurocognitive performance of 32 patients with brain metastasis and 32 demographically-matched controls was examined using a battery of standardized neuropsychological tests, with the goal of comprehensively examining the cognitive functioning of newly diagnosed brain metastasis patients. The cognition of all patients was assessed within 1 week of beginning treatment for brain metastasis. Results indicated impairments in verbal memory, attention, executive functioning, and language in relation to healthy controls. Performance in relation to appropriate normative groups was also examined. Overall, cognitive deficits were prevalent and memory was the most common impairment. Given that cognitive dysfunction was present in this cohort of patients with largely minimal functional impairment, these results have implications for patients, caregivers and health care providers treating patients with brain metastasis.
Collapse
|
31
|
Kim SW, Choi HJ, Lee HJ, He J, Wu Q, Langley RR, Fidler IJ, Kim SJ. Role of the endothelin axis in astrocyte- and endothelial cell-mediated chemoprotection of cancer cells. Neuro Oncol 2014; 16:1585-98. [PMID: 25008093 DOI: 10.1093/neuonc/nou128] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent evidence suggests that astrocytes protect cancer cells from chemotherapy by stimulating upregulation of anti-apoptotic genes in those cells. We investigated the possibility that activation of the endothelin axis orchestrates survival gene expression and chemoprotection in MDA-MB-231 breast cancer cells and H226 lung cancer cells. METHODS Cancer cells, murine astrocytes, and murine fibroblasts were grown in isolation, and expression of endothelin (ET) peptides and ET receptors (ETAR and ETBR) compared with expression on cancer cells and astrocytes (or cancer cells and fibroblasts) that were co-incubated for 48 hours. Type-specific endothelin receptor antagonists were used to evaluate the contribution of ETAR and ETBR to astrocyte-induced activation of the protein kinase B (AKT)/mitogen-activated protein kinase (MAPK) signal transduction pathways, anti-apoptotic gene expression, and chemoprotection of cancer cells. We also investigated the chemoprotective potential of brain endothelial cells and microglial cells. RESULTS Gap junction signaling between MDA-MB-231 cancer cells and astrocytes stimulates upregulation of interleukin 6 (IL-6) and IL-8 expression in cancer cells, which increases ET-1 production from astrocytes and ET receptor expression on cancer cells. ET-1 signals for activation of AKT/MAPK and upregulation of survival proteins that protect cancer cells from taxol. Brain endothelial cell-mediated chemoprotection of cancer cells also involves endothelin signaling. Dual antagonism of ETAR and ETBR is required to abolish astrocyte- and endothelial cell-mediated chemoprotection. CONCLUSIONS Bidirectional signaling between astrocytes and cancer cells involves upregulation and activation of the endothelin axis, which protects cancer cells from cytotoxicity induced by chemotherapeutic drugs.
Collapse
Affiliation(s)
- Seung Wook Kim
- Department of Cancer Biology, Metastasis Research Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.W.K., H.J.C., H.-J.L., J.H., Q.W., R.R.L., I.J.F., S.-J.K.)
| | - Hyun Jin Choi
- Department of Cancer Biology, Metastasis Research Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.W.K., H.J.C., H.-J.L., J.H., Q.W., R.R.L., I.J.F., S.-J.K.)
| | - Ho-Jeong Lee
- Department of Cancer Biology, Metastasis Research Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.W.K., H.J.C., H.-J.L., J.H., Q.W., R.R.L., I.J.F., S.-J.K.)
| | - Junqin He
- Department of Cancer Biology, Metastasis Research Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.W.K., H.J.C., H.-J.L., J.H., Q.W., R.R.L., I.J.F., S.-J.K.)
| | - Qiuyu Wu
- Department of Cancer Biology, Metastasis Research Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.W.K., H.J.C., H.-J.L., J.H., Q.W., R.R.L., I.J.F., S.-J.K.)
| | - Robert R Langley
- Department of Cancer Biology, Metastasis Research Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.W.K., H.J.C., H.-J.L., J.H., Q.W., R.R.L., I.J.F., S.-J.K.)
| | - Isaiah J Fidler
- Department of Cancer Biology, Metastasis Research Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.W.K., H.J.C., H.-J.L., J.H., Q.W., R.R.L., I.J.F., S.-J.K.)
| | - Sun-Jin Kim
- Department of Cancer Biology, Metastasis Research Laboratory, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.W.K., H.J.C., H.-J.L., J.H., Q.W., R.R.L., I.J.F., S.-J.K.)
| |
Collapse
|
32
|
Esmaeilzadeh M, Majlesara A, Faridar A, Hafezi M, Hong B, Esmaeilnia-Shirvani H, Neyazi B, Mehrabi A, Nakamura M. Brain metastasis from gastrointestinal cancers: a systematic review. Int J Clin Pract 2014; 68:890-9. [PMID: 24666726 DOI: 10.1111/ijcp.12395] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Brain metastases (BM) from the gastrointestinal tract (GIT) cancers are relatively rare. Despite those advances in diagnostic and treatment options, life expectancy and quality of life in these patients are still poor. In this review, we present an overview of the studies which have been previously performed as well as a comprehensive strategy for the assessment and treatment of BM from the GIT cancers. METHOD To obtain information on brain metastases from GIT, we performed a systematic review of Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). The collected data included patient characteristics, primary tumor data and brain metastases data. RESULT In our search of the literature, we found 74 studies between 1980 and 2011, which included 2538 patients with brain metastases originated from gastrointestinal cancer. Analysis of available data showed that among 2538 patients who had brain metastases from GIT, a total of 116 patients (4.57%) had esophageal cancer, 148 patients (5.83%) had gastric cancer, 233 patients (9.18%) had liver cancer, 13 patients had pancreas cancer (0.52%) and 2028 patients (79.90%) had colorectal cancer. The total median age of the patients was 58.9 years. CONCLUSION Brain metastases have been considered the most common structural neurological complication of systemic cancer. Due to poor prognosis they influence the survival rate as well as the quality of life of the patients. The treatment of cerebral metastasis depends on the patients' situation and the decisions of the treating physicians. The early awareness of a probable metastasis from GI to the brain will have a great influence on treatment outcomes as well as the survival rate and the quality-of-life of the patients.
Collapse
Affiliation(s)
- M Esmaeilzadeh
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Soon YY, Tham IWK, Lim KH, Koh WY, Lu JJ. Surgery or radiosurgery plus whole brain radiotherapy versus surgery or radiosurgery alone for brain metastases. Cochrane Database Syst Rev 2014; 2014:CD009454. [PMID: 24585087 PMCID: PMC6457788 DOI: 10.1002/14651858.cd009454.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The benefits of adding upfront whole-brain radiotherapy (WBRT) to surgery or stereotactic radiosurgery (SRS) when compared to surgery or SRS alone for treatment of brain metastases are unclear. OBJECTIVES To compare the efficacy and safety of surgery or SRS plus WBRT with that of surgery or SRS alone for treatment of brain metastases in patients with systemic cancer. SEARCH METHODS We searched MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials (CENTRAL) up to May 2013 and annual meeting proceedings of ASCO and ASTRO up to September 2012 for relevant studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing surgery or SRS plus WBRT with surgery or SRS alone for treatment of brain metastases. DATA COLLECTION AND ANALYSIS Two review authors undertook the quality assessment and data extraction. The primary outcome was overall survival (OS). Secondary outcomes include progression free survival (PFS), local and distant intracranial disease progression, neurocognitive function (NF), health related quality of life (HRQL) and neurological adverse events. Hazard ratios (HR), risk ratio (RR), confidence intervals (CI), P-values (P) were estimated with random effects models using Revman 5.1 MAIN RESULTS: We identified five RCTs including 663 patients with one to four brain metastases. The risk of bias associated with lack of blinding was high and impacted to a greater or lesser extent on the quality of evidence for all of the outcomes. Adding upfront WBRT decreased the relative risk of any intracranial disease progression at one year by 53% (RR 0.47, 95% CI 0.34 to 0.66, P value < 0.0001, I(2) =34%, Chi(2) P value = 0.21, low quality evidence) but there was no clear evidence of a difference in OS (HR 1.11, 95% CI 0.83 to 1.48, P value = 0.47, I(2) = 52%, Chi(2) P value = 0.08, low quality evidence) and PFS (HR 0.76, 95% CI 0.53 to 1.10, P value = 0.14, I(2) = 16%, Chi(2) P value = 0.28, low quality evidence). Subgroup analyses showed that the effects on overall survival were similar regardless of types of focal therapy used, number of brain metastases, dose and sequence of WBRT. The evaluation of the impact of upfront WBRT on NF, HRQL and neurological adverse events was limited by the unclear and high risk of reporting, performance and detection bias, and inconsistency in the instruments and methods used to measure and report results across studies. AUTHORS' CONCLUSIONS There is low quality evidence that adding upfront WBRT to surgery or SRS decreases any intracranial disease progression at one year. There was no clear evidence of an effect on overall and progression free survival. The impact of upfront WBRT on neurocognitive function, health related quality of life and neurological adverse events was undetermined due to the high risk of performance and detection bias, and inconsistency in the instruments and methods used to measure and report results across studies.
Collapse
Affiliation(s)
- Yu Yang Soon
- National University Cancer Institute SingaporeRadiation Oncology1E Kent Ridge RoadNUHS Tower Block, Level 7SingaporeSingapore119228
| | - Ivan Weng Keong Tham
- National University Cancer InstituteRadiation Oncology1E Kent Ridge RoadNUHS Tower Block, Level 7SingaporeSingapore119228
| | - Keith H Lim
- National University Cancer InstituteRadiation Oncology1E Kent Ridge RoadNUHS Tower Block, Level 7SingaporeSingapore119228
| | - Wee Yao Koh
- National University Cancer InstituteRadiation Oncology1E Kent Ridge RoadNUHS Tower Block, Level 7SingaporeSingapore119228
| | - Jiade J Lu
- Shanghai Proton and Heavy Ion Center (SPHIC)4365 Kang Xin RoadPudong New DistrictShanghaiChina201321
| | | |
Collapse
|
34
|
Jia W, Lu R, Martin TA, Jiang WG. The role of claudin-5 in blood-brain barrier (BBB) and brain metastases (review). Mol Med Rep 2013; 9:779-85. [PMID: 24366267 DOI: 10.3892/mmr.2013.1875] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 11/19/2013] [Indexed: 11/05/2022] Open
Abstract
Metastatic brain tumours are frequently observed in patients with lung, breast and malignant melanoma and a severe complication of metastatic cancers. With improved primary cancer treatments, including surgery, radiation therapy and chemotherapy, patients are now living longer following initial treatment, compared with previous treatments. Brain metastasis (BM) remains a significant clinical issue. Since BM represents a major therapeutic challenge, it is vital that the mechanisms of interaction between tumour cells and the blood‑brain barrier (BBB), as well as the method by which tumour cells establish metastatic tumours in the brain, are understood. A key step in BM is the interaction and penetration of the BBB by cancer cells. The BBB consists of endothelial cells, pericytes, astrocytes and a number of molecular structures between these cells. The BBB relies on the tight junctions (TJs) that are present between the endothelial cells of the brain capillaries to provide a closed environment for the brain. TJs comprise a number of proteins, including occludin, claudins and junctional adhesion molecules (JAMs). Among them, claudins are the key integral proteins that regulate BBB permeability. It has previously been shown that claudin‑5, not only regulates paracellular ionic selectivity, but also plays a role in the regulation of tumour cell motility, suggesting that TJs and claudin‑5 contribute to the control of BM. This study reviews the role of claudin‑5 in the regulation of BBB permeability during the brain metastatic process.
Collapse
Affiliation(s)
- Wang Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Runchun Lu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Tracey A Martin
- Cardiff University‑Capital Medical University Joint Centre for Biomedical Research, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - Wen G Jiang
- Cardiff University‑Capital Medical University Joint Centre for Biomedical Research, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| |
Collapse
|
35
|
McDuff SGR, Taich ZJ, Lawson JD, Sanghvi P, Wong ET, Barker FG, Hochberg FH, Loeffler JS, Warnke PC, Murphy KT, Mundt AJ, Carter BS, McDonald CR, Chen CC. Neurocognitive assessment following whole brain radiation therapy and radiosurgery for patients with cerebral metastases. J Neurol Neurosurg Psychiatry 2013; 84:1384-91. [PMID: 23715918 DOI: 10.1136/jnnp-2013-305166] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The treatment of metastatic brain lesions remains a central challenge in oncology. Because most chemotherapeutic agents do not effectively cross the blood-brain barrier, it is widely accepted that radiation remains the primary modality of treatment. The mode by which radiation should be delivered has, however, become a source of intense controversy in recent years. The controversy involves whether patients with a limited number of brain metastases should undergo whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) delivered only to the radiographically visible tumours. Survival is comparable for patients treated with either modality. Instead, the controversy involves the neurocognitive function (NCF) of radiating cerebrum that appeared radiographically normal relative to effects of the growth from micro-metastatic foci. A fundamental question in this debate involves quantifying the effect of WBRT in patients with cerebral metastasis. To disentangle the effects of WBRT on neurocognition from the effects inherent to the underlying disease, we analysed the results from randomised controlled studies of prophylactic cranial irradiation in oncology patients as well as studies where patients with limited cerebral metastasis were randomised to SRS versus SRS+WBRT. In aggregate, these results suggest deleterious effects of WBRT in select neurocognitive domains. However, there are insufficient data to resolve the controversy of upfront WBRT versus SRS in the management of patients with limited cerebral metastases.
Collapse
Affiliation(s)
- Susan G R McDuff
- Center for Theoretical and Applied Neuro-Oncology, University of California, , La Jolla, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
de Azambuja E, Zardavas D, Lemort M, Rossari J, Moulin C, Buttice A, D'Hondt V, Lebrun F, Lalami Y, Cardoso F, Sotiriou C, Gil T, Devriendt D, Paesmans M, Piccart-Gebhart M, Awada A. Phase I trial combining temozolomide plus lapatinib for the treatment of brain metastases in patients with HER2-positive metastatic breast cancer: the LAPTEM trial. Ann Oncol 2013; 24:2985-9. [PMID: 24013582 DOI: 10.1093/annonc/mdt359] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Brain metastases (BMs) pose a clinical challenge in breast cancer (BC). Lapatinib or temozolomide showed activity in BM. Our study assessed the combination of both drugs as treatment for patients with HER2-positive BC and BM. METHODS Eighteen patients were enrolled, with sixteen of them having recurrent or progressive BM. Any type of previous therapy was allowed, and disease was assessed by gadolinium (Gd)-enhanced magnetic resonance imaging (MRI). The primary end points were the evaluation of the dose-limiting toxicities (DLTs) and the determination of the maximum-tolerated dose (MTD). The secondary end points included objective response rate, clinical benefit and duration of response. RESULTS The lapatinib-temozolomide regimen showed a favorable toxicity profile because the MTD could not be reached. The most common adverse events (AEs) were fatigue, diarrhea and constipation. Disease stabilization was achieved in 10 out of 15 assessable patients. The estimated median survival time for the 16 patients with BM reached 10.94 months (95% CI: 1.09-20.79), whereas the median progression-free survival time was 2.60 months [95% confidence interval (CI): 1.82-3.37]. CONCLUSIONS The lapatinib-temozolomide combination is well tolerated. Preliminary evidence of clinical activity was observed in a heavily pretreated population, as indicated by the volumetric reductions occurring in brain lesions.
Collapse
Affiliation(s)
- E de Azambuja
- Breast Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Kamson DO, Mittal S, Buth A, Muzik O, Kupsky WJ, Robinette NL, Barger GR, Juhász C. Differentiation of Glioblastomas from Metastatic Brain Tumors by Tryptophan Uptake and Kinetic Analysis: A Positron Emission Tomographic Study with Magnetic Resonance Imaging Comparison. Mol Imaging 2013. [DOI: 10.2310/7290.2013.00048] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- David O. Kamson
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Sandeep Mittal
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Amy Buth
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Otto Muzik
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - William J. Kupsky
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Natasha L. Robinette
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Geoffrey R. Barger
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Csaba Juhász
- From the PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, and the Departments of Neurosurgery, Pediatrics, Radiology, Pathology, and Neurology and The Karmanos Cancer Institute, Wayne State University, Detroit, MI
| |
Collapse
|
38
|
Hickey MJ, Malone CC, Erickson KL, Lin A, Soto H, Ha ET, Kamijima S, Inagaki A, Takahashi M, Kato Y, Kasahara N, Mueller BM, Kruse CA. Combined alloreactive CTL cellular therapy with prodrug activator gene therapy in a model of breast cancer metastatic to the brain. Clin Cancer Res 2013; 19:4137-48. [PMID: 23780889 DOI: 10.1158/1078-0432.ccr-12-3735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Individual or combined strategies of cellular therapy with alloreactive CTLs (alloCTL) and gene therapy using retroviral replicating vectors (RRV) encoding a suicide prodrug activating gene were explored for the treatment of breast tumors metastatic to the brain. EXPERIMENTAL DESIGN AlloCTL, sensitized to the HLA of MDA-MB-231 breast cancer cells, were examined in vitro for antitumor functionality toward breast cancer targets. RRV encoding the yeast cytosine deaminase (CD) gene was tested in vivo for virus spread, ability to infect, and kill breast cancer targets when exposed to 5-fluorocytosine (5-FC). Individual and combination treatments were tested in subcutaneous and intracranial xenograft models with 231BR, a brain tropic variant. RESULTS AlloCTL preparations were cytotoxic, proliferated, and produced IFN-γ when coincubated with target cells displaying relevant HLA. In vivo, intratumorally placed alloCTL trafficked through one established intracranial 231BR focus to another in contralateral brain and induced tumor cell apoptosis. RRV-CD efficiently spread in vivo, infected 231BR and induced their apoptosis upon 5-FC exposure. Subcutaneous tumor volumes were significantly reduced in alloCTL and/or gene therapy-treated groups compared to control groups. Mice with established intracranial 231BR tumors treated with combined alloCTL and RRV-CD had a median survival of 97.5 days compared with single modalities (50-83 days); all experimental treatment groups survived significantly longer than sham-treated groups (median survivals 31.5 or 40 days) and exhibited good safety/toxicity profiles. CONCLUSION The results indicate combining cellular and suicide gene therapies is a viable strategy for the treatment of established breast tumors in the brain.
Collapse
Affiliation(s)
- Michelle J Hickey
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Kader I, Strong M, George M. Skull destruction from intracranial metastasis arising from pulmonary squamous cell carcinoma: a case report. J Med Case Rep 2013; 7:28. [PMID: 23347506 PMCID: PMC3568724 DOI: 10.1186/1752-1947-7-28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 11/22/2012] [Indexed: 01/21/2023] Open
Abstract
Introduction Squamous cell carcinoma of the lung represents 30% of all non-small cell lung carcinomas. It arises from dysplasia of squamous epithelium of the bronchi and is strongly associated with cigarette smoking. Squamous cell carcinoma of the lung is known to produce metastases in the brain parenchyma. Case presentation We present the case of an 80-year-old indigenous Australian man with an unusual presentation of metastatic carcinoma of the lung. The case demonstrated a squamous cell carcinoma of the lung with an intracranial metastatic lesion destroying the parietal bone and extending into the extracranial soft tissue. A visible deformity as a result of the metastasis was evident on physical examination and computed tomography demonstrated extensive bone destruction. Conclusion The authors were unable to find a case of this occurring from a squamous cell carcinoma of the lung anywhere in the world literature. The case report demonstrates an unusual disease presentation with a rare intracranial metastasis invading through the skull.
Collapse
Affiliation(s)
- Imran Kader
- University of Newcastle Bachelor of Medicine Program, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | | | | |
Collapse
|
40
|
Role of the blood-brain barrier in the formation of brain metastases. Int J Mol Sci 2013; 14:1383-411. [PMID: 23344048 PMCID: PMC3565326 DOI: 10.3390/ijms14011383] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/12/2012] [Accepted: 12/14/2012] [Indexed: 01/11/2023] Open
Abstract
The majority of brain metastases originate from lung cancer, breast cancer and malignant melanoma. In order to reach the brain, parenchyma metastatic cells have to transmigrate through the endothelial cell layer of brain capillaries, which forms the morphological basis of the blood-brain barrier (BBB). The BBB has a dual role in brain metastasis formation: it forms a tight barrier protecting the central nervous system from entering cancer cells, but it is also actively involved in protecting metastatic cells during extravasation and proliferation in the brain. The mechanisms of interaction of cancer cells and cerebral endothelial cells are largely uncharacterized. Here, we provide a comprehensive review on our current knowledge about the role of junctional and adhesion molecules, soluble factors, proteolytic enzymes and signaling pathways mediating the attachment of tumor cells to brain endothelial cells and the transendothelial migration of metastatic cells. Since brain metastases represent a great therapeutic challenge, it is indispensable to understand the mechanisms of the interaction of tumor cells with the BBB in order to find targets of prevention of brain metastasis formation.
Collapse
|
41
|
Addeo R, Sperlongano P, Montella L, Vincenzi B, Carraturo M, Iodice P, Russo P, Parlato C, Salzano A, Cennamo G, Lombardi A, Sperlongano R, Prete SD, Caraglia M. Protracted low dose of oral vinorelbine and temozolomide with whole-brain radiotherapy in the treatment for breast cancer patients with brain metastases. Cancer Chemother Pharmacol 2012; 70:603-9. [DOI: 10.1007/s00280-012-1945-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 07/24/2012] [Indexed: 01/28/2023]
|
42
|
Tatar Z, Thivat E, Planchat E, Gimbergues P, Gadea E, Abrial C, Durando X. Temozolomide and unusual indications: review of literature. Cancer Treat Rev 2012; 39:125-35. [PMID: 22818211 DOI: 10.1016/j.ctrv.2012.06.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 06/04/2012] [Accepted: 06/09/2012] [Indexed: 01/15/2023]
Abstract
Temozolomide (TMZ) was first known to be useful as a radiosensitiser in both primary brain tumours like glioblastoma multiforme and oligodendroglioma. Later, TMZ proved its efficacy in the treatment of melanoma. Multiple publications have demonstrated the benefit of TMZ in terms of efficacy and tolerance (used as mono-therapy or as adjuvant chemotherapy) compared to the "gold standard" treatment of this kind of tumours. Furthermore, several recent clinical trials have shown the particular importance of TMZ in other types of cancer. This publication deals with the use of TMZ in cancers which are not formal indications for TMZ (excluding glioblastoma multiforme, oligodendroglioma and melanoma). It also includes a necessary review of recent literature about the role of TMZ in the treatment of brain metastases, lymphomas, refractory leukaemia, neuroendocrine tumours, pituitary tumours, Ewing's sarcoma, primitive neuroectodermal tumours, lung cancer and other tumours.
Collapse
Affiliation(s)
- Zuzana Tatar
- Oncology Department, Centre Jean Perrin, Clermont-Ferrand F-63011, France.
| | | | | | | | | | | | | |
Collapse
|
43
|
Fitzgerald DP, Subramanian P, Deshpande M, Graves C, Gordon I, Qian Y, Snitkovsky Y, Liewehr DJ, Steinberg SM, Paltán-Ortiz JD, Herman MM, Camphausen K, Palmieri D, Becerra SP, Steeg PS. Opposing effects of pigment epithelium-derived factor on breast cancer cell versus neuronal survival: implication for brain metastasis and metastasis-induced brain damage. Cancer Res 2012; 72:144-53. [PMID: 22215693 DOI: 10.1158/0008-5472.can-11-1904] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brain metastases are a significant cause of morbidity and mortality for patients with cancer, yet preventative and therapeutic options remain an unmet need. The cytokine pigment epithelium-derived factor (PEDF) is downregulated in resected human brain metastases of breast cancer compared with primary breast tumors, suggesting that restoring its expression might limit metastatic spread. Here, we show that outgrowth of large experimental brain metastases from human 231-BR or murine 4T1-BR breast cancer cells was suppressed by PEDF expression, as supported by in vitro analyses as well as direct intracranial implantation. Notably, the suppressive effects of PEDF were not only rapid but independent of the effects of this factor on angiogenesis. Paralleling its cytotoxic effects on breast cancer cells, PEDF also exerted a prosurvival effect on neurons that shielded the brain from tumor-induced damage, as indicated by a relative 3.5-fold reduction in the number of dying neurons adjacent to tumors expressing PEDF. Our findings establish PEDF as both a metastatic suppressor and a neuroprotectant in the brain, highlighting its role as a double agent in limiting brain metastasis and its local consequences.
Collapse
Affiliation(s)
- Daniel P Fitzgerald
- Women's Cancer's Section, Laboratory of Molecular Pharmacology, Center for Cancer Research, National Cancer Institute, National Institute of Mental Health, Bethesda, Maryland 20892, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Amiri-Kordestani L, Basseville A, Kurdziel K, Fojo AT, Bates SE. Targeting MDR in breast and lung cancer: discriminating its potential importance from the failure of drug resistance reversal studies. Drug Resist Updat 2012; 15:50-61. [PMID: 22464282 PMCID: PMC3680361 DOI: 10.1016/j.drup.2012.02.002] [Citation(s) in RCA: 163] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This special issue of Drug Resistance Updates is dedicated to multidrug resistance protein 1 (MDR-1), 35 years after its discovery. While enormous progress has been made and our understanding of drug resistance has become more sophisticated and nuanced, after 35 years the role of MDR-1 in clinical oncology remains a work in progress. Despite clear in vitro evidence that P-glycoprotein (Pgp), encoded by MDR-1, is able to dramatically reduce drug concentrations in cultured cells, and that drug accumulation can be increased by small molecule inhibitors, clinical trials testing this paradigm have mostly failed. Some have argued that it is no longer worthy of study. However, repeated analyses have demonstrated MDR-1 expression in a tumor is a poor prognostic indicator leading some to conclude MDR-1 is a marker of a more aggressive phenotype, rather than a mechanism of drug resistance. In this review we will re-evaluate the MDR-1 story in light of our new understanding of molecular targeted therapy, using breast and lung cancer as examples. In the end we will reconcile the data available and the knowledge gained in support of a thesis that we understand far more than we realize, and that we can use this knowledge to improve future therapies.
Collapse
Affiliation(s)
- Laleh Amiri-Kordestani
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD 20892, United States
| | | | | | | | | |
Collapse
|
45
|
Kurzrock R, Gabrail N, Chandhasin C, Moulder S, Smith C, Brenner A, Sankhala K, Mita A, Elian K, Bouchard D, Sarantopoulos J. Safety, Pharmacokinetics, and Activity of GRN1005, a Novel Conjugate of Angiopep-2, a Peptide Facilitating Brain Penetration, and Paclitaxel, in Patients with Advanced Solid Tumors. Mol Cancer Ther 2011; 11:308-16. [DOI: 10.1158/1535-7163.mct-11-0566] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
46
|
Nieder C, Andratschke NH, Spanne O, Geinitz H, Grosu AL. Does overall treatment time impact on survival after whole-brain radiotherapy for brain metastases? Clin Transl Oncol 2011; 13:885-8. [PMID: 22126732 DOI: 10.1007/s12094-011-0750-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate whether reduced overall treatment time (OTT), i.e., administration of more than 5 fractions per week, or uncompensated treatment interruption resulting in increased OTT influences survival of patients treated with whole-brain radiotherapy (WBRT) for brain metastases. METHODS Retrospective multi-institutional intention-to-treat study including 233 patients treated with primary WBRT (prescribed dose 10 fractions of 3 Gy; no previous SRS or surgery) administered over 10-38 days. Four groups were studied: OTT 10-11 vs. 12 days, 13-15 or >15 days. RESULTS Fourteen patients (6%) failed to complete WBRT and received 3-9 fractions (median 7). Their median survival was 0.5 months as compared to 3 months in patients who completed WBRT. No significant impact of OTT on survival was found. Median survival was 1.5, 2.9, 3.0 and 3.1 months in the four groups mentioned above. CONCLUSIONS Compensation for unintended treatment interruption is generally recommended but might not always be feasible. Depending on histological tumour type or expected repopulation, prognostic factors and neurological status, it might be acceptable to complete an interrupted course of WBRT without compensation in selected patients. While survival might be largely independent from OTT, it should also be evaluated whether this parameter has any impact on quality of life and duration of palliation.
Collapse
Affiliation(s)
- C Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodo, Norway.
| | | | | | | | | |
Collapse
|
47
|
Xu Z, Marko NF, Angelov L, Barnett GH, Chao ST, Vogelbaum MA, Suh JH, Weil RJ. Impact of preexisting tumor necrosis on the efficacy of stereotactic radiosurgery in the treatment of brain metastases in women with breast cancer. Cancer 2011; 118:1323-33. [PMID: 22009460 DOI: 10.1002/cncr.26314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 03/29/2011] [Accepted: 05/03/2011] [Indexed: 01/28/2023]
Abstract
BACKGROUND Breast cancer is the second most common source of brain metastasis. Stereotactic radiosurgery (SRS) can be an effective treatment for some patients with brain metastasis (BM). Necrosis is a common feature of many brain tumors, including BM; however, the influence of tumor necrosis on treatment efficacy of SRS in women with breast cancer metastatic to the brain is unknown. METHODS A cohort of 147 women with breast cancer and BM treated consecutively with SRS over 10 years were studied. Of these, 80 (54.4%) had necrosis identified on pretreatment magnetic resonance images and 67 (46.4%) did not. Survival times were computed using the Kaplan-Meier method. Log-rank tests were used to compare groups with respect to survival times, Cox proportional hazards regression models were used to perform univariate and multivariate analyses, and chi-square and Fisher exact tests were used to compare clinicopathologic covariates. RESULTS Neurological survival (NS) and survival after SRS were decreased in BM patients with necrosis at the time of SRS compared with patients without necrosis by 32% and 27%, respectively (NS median survival, 25 vs 17 months [log-rank test, P = .006]; SRS median survival, 15 vs 11 months [log-rank test, P = .045]). On multivariate analysis, HER2 amplification status and necrosis influenced NS and SRS after adjusting for standard clinical features, including BM number, size, and volume as well as Karnofsky performance status. CONCLUSION Neuroimaging evidence of necrosis at the time of SRS significantly diminished the efficacy of therapy and was a potent prognostic marker.
Collapse
Affiliation(s)
- Zhiyuan Xu
- Brain Tumor & Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Moravan MJ, Olschowka JA, Williams JP, O'Banion MK. Cranial irradiation leads to acute and persistent neuroinflammation with delayed increases in T-cell infiltration and CD11c expression in C57BL/6 mouse brain. Radiat Res 2011; 176:459-73. [PMID: 21787181 DOI: 10.1667/rr2587.1] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Radiotherapy is commonly employed to treat cancers of the head and neck and is increasingly used to treat other central nervous system (CNS) disorders. Exceeding the radiation tolerance of normal CNS tissues can result in sequelae contributing to patient morbidity and mortality. Animal studies and clinical experience suggest that neuroinflammation plays a role in the etiology of these effects; however, detailed characterization of this response has been lacking. Therefore, a dose-time investigation of the neuroinflammatory response after single-dose cranial irradiation was performed using C57BL/6 mice. Consistent with previous reports, cranial irradiation resulted in multiphasic inflammatory changes exemplified by increased transcript levels of inflammatory cytokines, along with glial and endothelial cell activation. Cranial irradiation also resulted in acute infiltration of neutrophils and a delayed increase in T cells, MHC II-positive cells, and CD11c-positive cells seen first at 1 month with doses ≥ 15 Gy. CD11c-positive cells were found almost exclusively in white matter and expressed MHC II, suggesting a "mature" dendritic cell phenotype that remained elevated out to 1 year postirradiation. Our results indicate that cranial irradiation leads to persistent neuroinflammatory changes in the C57BL/6 mouse brain that includes unique immunomodulatory cell populations.
Collapse
Affiliation(s)
- Michael J Moravan
- Department of Neurobiology and Anatomy and, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | | | | |
Collapse
|
49
|
Topology and dynamics of the interaction between 5-nitroimidazole radiosensitizers and duplex DNA studied by a combination of docking, molecular dynamic simulations and NMR spectroscopy. J Mol Struct 2011. [DOI: 10.1016/j.molstruc.2011.02.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
50
|
Decoding melanoma metastasis. Cancers (Basel) 2010; 3:126-63. [PMID: 24212610 PMCID: PMC3756353 DOI: 10.3390/cancers3010126] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 12/22/2010] [Accepted: 12/23/2010] [Indexed: 12/18/2022] Open
Abstract
Metastasis accounts for the vast majority of morbidity and mortality associated with melanoma. Evidence suggests melanoma has a predilection for metastasis to particular organs. Experimental analyses have begun to shed light on the mechanisms regulating melanoma metastasis and organ specificity, but these analyses are complicated by observations of metastatic dormancy and dissemination of melanocytes that are not yet fully malignant. Additionally, tumor extrinsic factors in the microenvironment, both at the site of the primary tumor and the site of metastasis, play important roles in mediating the metastatic process. As metastasis research moves forward, paradigms explaining melanoma metastasis as a step-wise process must also reflect the temporal complexity and heterogeneity in progression of this disease. Genetic drivers of melanoma as well as extrinsic regulators of disease spread, particularly those that mediate metastasis to specific organs, must also be incorporated into newer models of melanoma metastasis.
Collapse
|