1
|
Jensen TSR, Olsen MH, Lelkaitis G, Kjaer A, Binderup T, Fugleholm K. Urokinase Plasminogen Activator Receptor: An Important Focal Player in Chronic Subdural Hematoma? Inflammation 2024; 47:1015-1027. [PMID: 38236383 PMCID: PMC11147925 DOI: 10.1007/s10753-023-01957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/18/2023] [Accepted: 12/23/2023] [Indexed: 01/19/2024]
Abstract
Chronic subdural hematoma (CSDH) development involves inflammatory, angiogenetic, and fibrinolytic mechanisms, several components of which are now unraveled through intensive research. The urokinase plasminogen activator receptor (uPAR) is part of the plasminogen activator system and possesses inflammatory, angiogenetic, and fibrinolytic capabilities. As a first, this study aims to identify uPAR in the hematoma fluid, hematoma membrane, dura mater, and systemic blood from patients with CSDH and, if present, to investigate if the uPAR level at the time of surgery may be a predictor for later developing recurrent CSDH. uPAR expression in the hematoma membrane and dura mater was analyzed using immunohistochemistry and presented as the H-score of the positive immunostaining. The uPAR levels in the hematoma fluid and systemic blood were determined using a multiplex antibody bead kit (Luminex). Samples were collected at the time of the first CSDH surgery, and in the case of recurrent CSDH within 90 days, the samples were again collected at reoperation. A comparison of uPAR expression between the hematoma membrane and dura mater, as well as uPAR levels in systemic blood and hematoma fluid, was performed using the Wilcoxon rank sum test. We included 112 patients, 26 of whom had recurrent CSDH. The median hematoma uPAR level was 22,125 (14,845-33,237) and significantly higher than the median systemic blood level of 789 pg/L (465-2,088) (p < 0.001). Similarly, the uPAR level of the hematoma membrane was 14.3 (7.54-44.8) and significantly higher than the dural uPAR level of 0.81 (0.3-1.98) (p < 0.001). For the first time, we identified uPAR in the subdural fluid, hematoma membrane, dura mater, and systemic blood from patients with CSDH. The high expression of uPAR in the subdural fluid and hematoma membrane indicates that the mechanisms of CSDH are predominantly in the subdural fluid collection and surrounding hematoma membrane.
Collapse
Affiliation(s)
- Thorbjørn Søren Rønn Jensen
- Department of Neurosurgery, The Neuroscience Center, Copenhagen University Hospital, Inge Lehmanns Vej 6, 2100, Rigshospitalet, Copenhagen, Denmark.
| | - Markus Harboe Olsen
- Department of Neuroanesthesiology, The Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | | | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine and PET & Cluster for Molecular Imaging, Copenhagen University Hospital-Rigshospitalet & Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Tina Binderup
- Department of Clinical Physiology, Nuclear Medicine and PET & Cluster for Molecular Imaging, Copenhagen University Hospital-Rigshospitalet & Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, The Neuroscience Center, Copenhagen University Hospital, Inge Lehmanns Vej 6, 2100, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
2
|
Moon JW, Hong BJ, Kim SK, Park MS, Lee H, Lee J, Kim MY. Systematic identification of a synthetic lethal interaction in brain-metastatic lung adenocarcinoma. Cancer Lett 2024; 588:216781. [PMID: 38494150 DOI: 10.1016/j.canlet.2024.216781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/15/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024]
Abstract
Metastatic lung adenocarcinoma (LuAC) presents a significant clinical challenge due to the short latency and the lack of efficient treatment options. Therefore, identification of molecular vulnerabilities in metastatic LuAC holds great importance in the development of therapeutic drugs against this disease. In this study, we performed a genome-wide siRNA screening using poorly and highly brain-metastatic LuAC cell lines. Using this approach, we discovered that compared to poorly metastatic LuAC (LuAC-Par) cells, brain-metastatic LuAC (LuAC-BrM) cells exhibited a significantly higher vulnerability to c-FLIP (an inhibitor of caspase-8)-depletion-induced apoptosis. Furthermore, in vivo studies demonstrated that c-FLIP knockdown specifically inhibited growth of LuAC-BrM, but not the LuAC-Par, tumors, suggesting the addiction of LuAC-BrM to the function of c-FLIP for their survival. Our in vitro and in vivo analyses also demonstrated that LuAC-BrM is more sensitive to c-FLIP-depletion due to ER stress-induced activation of the c-JUN and subsequent induction of stress genes including ATF4 and DDIT3. Finally, we found that c-JUN not only sensitized LuAC-BrM to c-FLIP-depletion-induced cell death but also promoted brain metastasis in vivo, providing strong evidence for c-JUN's function as a double-edged sword in LuAC-BrM. Collectively, our findings not only reveal a novel link between c-JUN, brain metastasis, and c-FLIP addiction in LuAC-BrM but also present an opportunity for potential therapeutic intervention.
Collapse
Affiliation(s)
- Jin Woo Moon
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | | | - Seon-Kyu Kim
- Personalized Genomic Medicine Research Center, Korea Research Institute of Bioscience & Biotechnology (KRIBB), Daejeon, South Korea
| | - Min-Seok Park
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Hohyeon Lee
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - JiWon Lee
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Mi-Young Kim
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea; KAIST Institute for the BioCentury, Cancer Metastasis Control Center, Daejeon, South Korea.
| |
Collapse
|
3
|
Halil E, Viteva E, Vasilev G, Shukerski K, Atanassova P. Atypical clinical and radiologic findings in a patient with brain metastatic lesions. Folia Med (Plovdiv) 2023; 65:844-848. [PMID: 38351770 DOI: 10.3897/folmed.65.e84810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/30/2022] [Indexed: 02/16/2024] Open
Abstract
We report the case of a 47-year-old man who was admitted to our clinic with an intractable headache, nausea, and sporadic vomiting, as well as speech difficulties and a 'floating' sensation. This man had no prior medical history. MRI of the brain showed evidence of over 20 supra- and infratentorial capsulated ring-enhancing lesions. All other paraclinical investigations done in our clinic were unremarkable and we excluded our first assumption of neurocysticercosis, as well as other parasitic infections. The patient was then referred to the Oral and Maxillofacial Surgery Clinic for an excisional biopsy of a submandibular formation, which was later verified to represent a lymph node metastasis from a poorly differentiated adenocarcinoma. A chest X-ray failed to demonstrate any significant pathology and the immunohistochemical constellation of the lymph node metastasis excluded the possibility of the primary tumor originating in the lung or the prostate. Due to the unresolved diagnostic query, a whole-body PET/CT was performed demonstrating a formation with malignant characteristics in the basal segment of the left lung, reaching the pleura and the left hilum, as well as solitary enlarged mesenteric and mediastinal lymph nodes. Following clinical consultations, it was determined that the patient was inoperable and chemotherapy and palliative CNS irradiation were recommended.
Collapse
Affiliation(s)
- Eray Halil
- St George University Hospital, Plovdiv, Bulgaria
| | | | | | | | | |
Collapse
|
4
|
Calderon B, Vazquez L, Belkacemi M, Pourel N. Stereotactic radiotherapy for brain metastases: predictive factors of radionecrosis. Eur J Med Res 2023; 28:233. [PMID: 37443046 DOI: 10.1186/s40001-023-01178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE Stereotactic radiotherapy (SRT) is a highly effective approach and represents the current standard of treatment for patients with limited number of brain metastasis (BM). SRT is generally well tolerated but can sometimes lead to radionecrosis (RN). The aim of this study was to identify predictive factors of radionecrosis related to SRT for brain metastasis. METHODS This retrospective observational cohort study included patients who underwent SRT in the Institut Sainte Catherine between January 1st, 2017 and December 31st, 2020 for the treatment of brain metastasis from any cancer. Individual data and particularly signs of radionecrosis (clinical, imaging, anatomopathological) were collected from electronic medical records. Radionecrosis was defined as the occurrence on MRI of contrast-enhancing necrotic lesions, surrounded by edema, occurring at least 6 months after SRT and localized within fields of irradiation. RESULTS 123 patients were included; median age was 66 years. 17 patients (11.8%) developed radionecrosis after a median follow up of 418.5 days [63;1498]. Predictive factors of radionecrosis in multivariate analysis were age under 66 years with a sensitivity of 77% and a specificity of 56%. No other factor as the presence of comorbidities, the number of irradiated metastases, the PTV volume or the volume of irradiated healthy brain were predictive of radionecrosis. CONCLUSION Age at treatment initiation and tumor location seems to be correlated with radionecrosis in patients with brain metastasis treated with SRT. These elements could be useful to adapted radiation therapy.
Collapse
Affiliation(s)
- Benoît Calderon
- Institut Sainte Catherine, 250 Chemin Des Baigne-Pieds, 84000, Avignon, France
| | - Léa Vazquez
- Institut Sainte Catherine, 250 Chemin Des Baigne-Pieds, 84000, Avignon, France.
| | | | - Nicolas Pourel
- Institut Sainte Catherine, 250 Chemin Des Baigne-Pieds, 84000, Avignon, France
| |
Collapse
|
5
|
Liang N, Sun S, Li Z, Wu T, Zhang C, Xin T. CCKAR is a biomarker for prognosis and asynchronous brain metastasis of non-small cell lung cancer. Front Oncol 2023; 12:1098728. [PMID: 36733361 PMCID: PMC9886659 DOI: 10.3389/fonc.2022.1098728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/22/2022] [Indexed: 01/18/2023] Open
Abstract
Background Non-small cell lung cancer (NSCLC) is the most common histological type of lung cancer, and brain metastasis (BM) is the most lethal complication of NSCLC. The predictive biomarkers and risk factors of asynchronous BM are still unknown. Materials and methods A total of 203 patients with NSCLC were enrolled into our cohort and followed up. The clinicopathological factors such as tumor size, T stage, lymphatic invasion, metastasis and asynchronous BM were investigated. CCKAR expression in NSCLC and resected BM was assessed by IHC, and CCKAR mRNAs in NSCLC and para-tumor tissues were estimated by qRT-PCR. The correlations between CCKAR expression, BM and other clinicopathological factors were assessed by chi-square test, and prognostic significance of CCKAR was estimated by univariate and multivariate analyses. Results CCKAR was highly expressed in NSCLC tissues compared with para-tumor tissues. CCKAR expression in NSCLC was significantly associated with asynchronous BM. The BM percentages for NSCLC patients with low and high CCKAR were surprisingly 5.2% and 66.6%, respectively. CCKAR expression and BM were unfavorable factors predicting unfavorable outcome of NSCLC. Moreover, CCKAR expression in NSCLC was an independent risk factor of asynchronous BM. Conclusions CCKAR is a prognostic biomarker of NSCLC. CCKAR expression in NSCLC is positively associated with asynchronous BM, and is a risk factor of asynchronous BM from NSCLC.
Collapse
Affiliation(s)
- Nan Liang
- Department of Neurosurgery, the Second Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Suohui Sun
- Department of Neurosurgery, the Second Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zheng Li
- Department of Neurosurgery, the Second Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Tao Wu
- Department of Neurosurgery, the Second Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Chunpu Zhang
- Department of Neurosurgery, the Second Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Tao Xin
- Department of Neurosurgery, the First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China,*Correspondence: Tao Xin, ,
| |
Collapse
|
6
|
Zhu LH, Fan XW, Sun L, Ni TT, Li YQ, Wu CY, Wu KL. New prognostic system specific for epidermal growth factor receptor-mutated lung cancer brain metastasis. Front Oncol 2023; 13:1093084. [PMID: 37020869 PMCID: PMC10067922 DOI: 10.3389/fonc.2023.1093084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/02/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction Brain metastases (BM) from lung cancer are heterogeneous, and accurate prognosis is required for effective treatment strategies. This study aimed to identify prognostic factors and develop a prognostic system exclusively for epidermal growth factor receptor (EGFR)-mutated lung cancer BM. Methods In total, 173 patients with EGFR-mutated lung cancer from two hospitals who developed BM and received tyrosine kinase inhibitor (TKI) and brain radiation therapy (RT) were included. Univariate and multivariate analyses were performed to identify significant EGFR-mutated BM prognostic factors to construct a new EGFR recursive partitioning analysis (RPA) prognostic index. The predictive discrimination of five prognostic scoring systems including RPA, diagnosis-specific prognostic factors indexes (DS-GPA), basic score for brain metastases (BS-BM), lung cancer using molecular markers (lung-mol GPA) and EGFR-RPA were analyzed using log-rank test, concordance index (C-index), and receiver operating characteristic curve (ROC). The potential predictive factors in the multivariable analysis to construct a prognostic index included Karnofsky performance status, BM at initial lung cancer diagnosis, BM progression after TKI, EGFR mutation type, uncontrolled primary tumors, and number of BM. Results and discussion In the log-rank test, indices of RPA, DS-GPA, lung-mol GPA, BS-BM, and EGFR-RPA were all significant predictors of overall survival (OS) (p ≤ 0.05). The C-indices of each prognostic score were 0.603, 0.569, 0.613, 0.595, and 0.671, respectively; The area under the curve (AUC) values predicting 1-year OS were 0.565 (p=0.215), 0.572 (p=0.174), 0.641 (p=0.007), 0.585 (p=0.106), and 0.781 (p=0.000), respectively. Furthermore, EGFR-RPA performed better in terms of calibration than other prognostic indices.BM progression after TKI and EGFR mutation type were specific prognostic factors for EGFR-mutated lung cancer BM. EGFR-RPA was more precise than other models, and useful for personal treatment.
Collapse
Affiliation(s)
- Li-Hua Zhu
- Department of Radiation Oncology, The People’s Hospital Affiliated to Jiangsu University, Zhenjiang, China
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Xing-Wen Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- *Correspondence: Xing-Wen Fan, ; Chao-Yang Wu, ; Kai-Liang Wu,
| | - Lu Sun
- Department of Radiation Oncology, The People’s Hospital Affiliated to Jiangsu University, Zhenjiang, China
| | - Ting-ting Ni
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Ya-qi Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Chao-Yang Wu
- Department of Radiation Oncology, The People’s Hospital Affiliated to Jiangsu University, Zhenjiang, China
- *Correspondence: Xing-Wen Fan, ; Chao-Yang Wu, ; Kai-Liang Wu,
| | - Kai-Liang Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
- *Correspondence: Xing-Wen Fan, ; Chao-Yang Wu, ; Kai-Liang Wu,
| |
Collapse
|
7
|
Lee JE, Yang SH. Advances in Brain Metastasis Models. Brain Tumor Res Treat 2023; 11:16-21. [PMID: 36762804 PMCID: PMC9911715 DOI: 10.14791/btrt.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 02/05/2023] Open
Abstract
To obtain achievements in addressing the clinical challenges of brain metastasis, we need a clear understanding of its biological mechanisms. Brain metastasis research is challenged by many practical scientific barriers. Depending on the purpose of the study, experimental brain metastasis models in vivo can be used. It is now possible to re-create the architecture and physiology of human organs. Human organoids provide unique opportunities for the study of human disease and complement animal models. The translation of experimental findings to clinical application has several barriers in the development of treatment for brain metastasis. A variety of models have provided significant contributions to the knowledge of brain metastasis pathology and remain pivotal tools for examining novel therapeutic strategies.
Collapse
Affiliation(s)
- Jung Eun Lee
- Department of Neurosurgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Ho Yang
- Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
8
|
Deng H, Xiong B, Gao Y, Wu Y, Wang W. Stereotactic radiosurgery combined with immune checkpoint inhibitors for brain metastasis: A systematic review and meta-analysis. Asian J Surg 2022; 46:1917-1923. [PMID: 36207214 DOI: 10.1016/j.asjsur.2022.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/05/2022] [Accepted: 09/19/2022] [Indexed: 11/02/2022] Open
Abstract
Many studies have reported the combination of radiosurgery and immune checkpoint inhibitors (ICI) in the treatment of brain metastasis, but these studies have not reached a consistent conclusion. Therefore, we conducted this systematic review and meta-analysis to evaluate the effect of combination therapy compared with radiosurgery alone on the prognosis of patients with brain metastasis. The Pubmed-MEDLINE and Ovid-EMBASE databases were comprehensively searched to identify relevant articles until May 5, 2022. The search results were filtered by the inclusion and exclusion criteria described in this paper. The pooled hazard ratios (HR) with 95% confidence intervals (CI) were presented as estimates effect to reflect the effect of combined therapy on each outcome. A total of 17 eligible studies covering 2079 patients were included in this meta-analysis. The pooled results showed that the use of targeted drugs could significantly improve the overall survival (HR = 0.62, 95%CI: 0.51-0.76; P<0.01), reduce the risk of local recurrence (HR = 0.48, 95%CI: 0.38-0.62; P<0.01) and distant brain recurrence (HR = 0.70, 95%CI: 0.50-0.97; P<0.05). Overall, SRS combined with ICIs could significantly improve overall survival, local control, and distant brain control of patients with brain metastasis compared to SRS alone, but the effect varies for different pathological types. Our results verified the rationality of the current treatment strategy for brain metastasis which emphasizes the combination of local and systematic therapy.
Collapse
|
9
|
Li Z, Liang N, Wang N, Jia Y, Tian C. WDR5 is a prognostic biomarker of brain metastasis from non-small cell lung cancer. Front Oncol 2022; 12:1023776. [PMID: 36249032 PMCID: PMC9557102 DOI: 10.3389/fonc.2022.1023776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/13/2022] [Indexed: 12/09/2022] Open
Abstract
Background Lung cancer (LC) is the most frequent caner type and causes the most cancer-related death. Brain metastases (BM) are the deadliest complications of lung cancer, and the prognostic biomarkers of BM are urgently needed. Materials and methods In our study, we established an inception cohort including 122 patients with asynchronous BM from NSCLC, and further selected 70 patients who received surgical resection, which compromised the validation cohort. With immunohistochemistry, we investigated the expression of WDR5 in the cohort. By chi-square method, the correlations between WDR5 and clinicopathological factors were analyzed. The prognostic indicators were analyzed with the univariate analysis, and independent prognostic factors were identified by multivariate analysis with Cox-regression model. Results WDR5 is frequently expressed in the cytoplasm of BM from NSCLC. Patients with low or high expression of WDR5 account for 60% and 40% respectively. High expression of WDR5 indicates poor prognosis of BM from NSCLC (P=0.001). In addition to WDR5, KPS is also a prognostic factor of BM, and high KPS predicts favorable prognosis (P=0.006). WDR5 is an independent prognostic biomarker for poor prognosis of BM from NSCLC, with the cancer-related odds as 2.48. Conclusions High expression of WDR5 can predict the poor prognosis of BM, and WDR5 is an independent prognostic biomarker of BM from NSCLC. Patients with WDR5 overexpression are more high-risk to suffer BM-related death and should receive more intense post-operational supervision.
Collapse
Affiliation(s)
- Zheng Li
- Department of Neurosurgery, The Second Affiliated Hospital of Shandong First Medical University, Tai’an, China
| | - Nan Liang
- Department of Neurosurgery, The Second Affiliated Hospital of Shandong First Medical University, Tai’an, China
| | - Na Wang
- Department of Anesthesiology, The First People’s Hospital of Tai’an, Tai’an, China
| | - Yan Jia
- Department of Intensive Care Unit, Shandong Provincial Tai’shan Hospital, Tai’an, China
| | - Cui Tian
- Department of Intensive Care Unit, The Second Affiliated Hospital of Shandong First Medical University, Tai’an, China
- *Correspondence: Cui Tian,
| |
Collapse
|
10
|
Defibrotide suppresses brain metastasis by activating the adenosine A2A receptors. Anticancer Drugs 2022; 33:1081-1090. [PMID: 35946567 DOI: 10.1097/cad.0000000000001372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Brain metastasis is a devastating clinical condition globally as one of the most common central nervous system malignancies. The current study aimed to assess the effect of defibrotide, an Food and Drug Administration-approved drug, against brain metastasis and the underlying molecular mechanisms. Two tumor cell lines with high brain metastasis potential, PC-9 and 231-BR, were subjected to defibrotide treatment of increasing dosage. The metastasis capacity of the tumor cells was evaluated by cell invasion and migration assays. Western blotting was employed to determine the levels of tight junction proteins in the blood-brain barrier (BBB) including Occludin, Zo-1, and Claudin-5, as well as metastasis-related proteins including CXCR4, MMP-2, and MMP-9. The in-vitro observations were further verified in nude mice, by monitoring the growth of xenograft tumors, mouse survival and brain metastasis foci following defibrotide treatment. Defibrotide inhibited proliferation, migration, invasion, and promotes lactate dehydrogenase release of brain metastatic tumor cells, elevated the levels of BBB tight junction proteins and metastasis-related proteins. Such beneficial role of defibrotide was mediated by its inhibitory action on the SDF-1/CXCR4 signaling axis both in vitro and in vivo, as CXCR4 agonist SDF1α negated the anti-tumoral effect of defibrotide on mouse xenograft tumor growth, mouse survival and brain metastasis. Defibrotide inhibits brain metastasis through activating the adenosine A2A receptors, which in turn inhibits the SDF-1/CXCR4 signaling axis. Our study hereby proposes defibrotide as a new and promising candidate drug against brain metastasis of multiple organ origins.
Collapse
|
11
|
Folloso MC, Torres M, Ciocon SL, Ong JN, Flores JA, Catindig JA. Therapeutic role of memantine for the prevention of cognitive decline in cancer patients with brain metastasis receiving whole-brain radiotherapy: a narrative review. Dement Neuropsychol 2022; 16:270-275. [PMID: 36619840 PMCID: PMC9762383 DOI: 10.1590/1980-5764-dn-2021-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/12/2021] [Accepted: 01/05/2022] [Indexed: 02/01/2023] Open
Abstract
Brain metastases are the most common central nervous system tumors. The mainstay treatment for this tumor in low to middle income countries is whole brain radiation therapy. Irreversible cognitive decline is associated with the use of whole brain radiotherapy. Several pharmacologic and nonpharmacologic options have been employed in studies focusing on the prevention of cognitive decline following whole-brain radiation therapy. Memantine use has been shown to provide some benefit in reducing the rate of decline in cognitive function and time to cognitive failure. The objective of this review article is to provide a summary on available primary literature on the therapeutic role of memantine for the prevention of cognitive decline in cancer patients with brain metastasis receiving whole brain radiotherapy.
Collapse
Affiliation(s)
| | - Mazelle Torres
- Jose R. Reyes Memorial Medical Center, Department of Neurology,
Manila, Philippines
| | - Stephen Lowell Ciocon
- Jose R. Reyes Memorial Medical Center, Department of Radiotherapy,
Manila, Philippines
| | - Jed Noel Ong
- Jose R. Reyes Memorial Medical Center, Department of Neurology,
Manila, Philippines
| | | | - Joseree-Ann Catindig
- Jose R. Reyes Memorial Medical Center, Department of Neurology,
Manila, Philippines
| |
Collapse
|
12
|
Shah I, Razzak AN, Janardan A, Laing B, Zwagerman NT. A Rare Case of Neck Sarcomatoid Squamous Cell Carcinoma With Brain Metastases. Cureus 2022; 14:e26179. [PMID: 35891819 PMCID: PMC9304508 DOI: 10.7759/cureus.26179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/12/2022] Open
Abstract
Squamous cell carcinoma (SCC) is the second most prominent form of skin malignancy. It occurs most frequently in older males with fair skin complexion that have extensive sun exposure most commonly in their childhood. The metastatic presentation of SCC is rare and is most common in the lung. In this paper, we present the unique case of a 73-year-old patient with sarcomatoid squamous cell carcinoma in their posterior neck that metastasized to the brain.
Collapse
|
13
|
Bruzzaniti P, Lapolla P, D'Amico A, Zancana G, Katsev M, Relucenti M, Familiari G, Mingoli A, D'Andrea G, Frati A, Salvati M, Santoro A, Familiari P. En Bloc Resection of Solitary Brain Metastasis: The Role of Perilesional Edema. In Vivo 2022; 36:1274-1284. [PMID: 35478118 PMCID: PMC9087063 DOI: 10.21873/invivo.12827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The treatment of solitary brain metastasis is a challenging intervention since the incidence increases and prognosis is poor. This study investigated the role of perilesional edema in the overall mass effect of solitary brain metastasis. PATIENTS AND METHODS We conducted a retrospective analysis on 88 patients with single supratentorial brain metastasis and concomitant perilesional edema undergoing en bloc resection. Each patient was evaluated for perilesional brain edema grading. We stratified patients into three groups based on the size of the metastatic lesion and the extent of perilesional edema. RESULTS The grade of perilesional edema at 30 days after surgical removal did not correlate with the maximum diameter of the metastasis (Pearson's correlation 0.098, p=0.494). In patients with a maximal metastatic diameter ≤2 cm, the grade of perilesional edema before surgical treatment was 1.63 (STD 0.43), while 30 days after removal it was significantly reduced; 0.47 (STD 0.26), p<0.001. CONCLUSION The overall mass effect of solitary supratentorial brain metastases is not correlated to the size of the lesion and the grade of the associated perilesional edema should be considered. Surgical en bloc resection can be considered the first choice of treatment in the presence of solitary metastasis ≤2 cm in maximal diameter but with high-grade edema, since this treatment reduces the overall mass effect.
Collapse
Affiliation(s)
- Placido Bruzzaniti
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
- Neurosurgery Division of "Spaziani" Hospital, Frosinone, Italy
| | - Pierfrancesco Lapolla
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, U.K
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Alessia D'Amico
- Department of Experimental Medicine, Sapienza, University of Rome, Rome, Italy
- Unit of Rehabilitation, Istituto Neurotraumatologico Italiano, Division of Grottaferrata, Rome, Italy
| | - Giuseppa Zancana
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
| | - Michael Katsev
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
| | - Michela Relucenti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Familiari
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Andrea Mingoli
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | | | - Alessandro Frati
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
- Department of Neurosurgery, IRCCS Neuromed Pozzilli IS, Isernia, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico "Tor Vergata", University of Rome ''Tor Vergata", Rome, Italy
| | - Antonio Santoro
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
| | - Pietro Familiari
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza, University of Rome, Rome, Italy
| |
Collapse
|
14
|
Blazquez R, Proescholdt MA, Klauser M, Schebesch KM, Doenitz C, Heudobler D, Stange L, Riemenschneider MJ, Bumes E, Rosengarth K, Schicho A, Schmidt NO, Brawanski A, Pukrop T, Wendl C. Breakouts-A Radiological Sign of Poor Prognosis in Patients With Brain Metastases. Front Oncol 2022; 12:849880. [PMID: 35444944 PMCID: PMC9015662 DOI: 10.3389/fonc.2022.849880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Brain metastases (BM) can present a displacing or infiltrating growth pattern, independent of the primary tumor type. Previous studies have shown that tumor cell infiltration at the macro-metastasis/brain parenchyma interface (MMPI) is correlated with poor outcome. Therefore, a pre-therapeutic, non-invasive detection tool for potential metastatic cell infiltration at the MMPI would be desirable to help identify patients who may benefit from a more aggressive local treatment strategy. The aim of this study was to identify specific magnetic resonance imaging (MRI) patterns at the MMPI in patients with BM and to correlate these patterns with patient outcome. Patients and Methods In this retrospective analysis of a prospective BM registry, we categorized preoperative MR images of 261 patients with BM according to a prespecified analysis system, which consisted of four MRI contrast enhancement (CE) patterns: two with apparently regularly shaped borders (termed “rim-enhancing” and “spherical”) and two with irregular delineation (termed “breakout” and “diffuse”). The primary outcome parameter was overall survival (OS). Additionally analyzed prognostic parameters were the Karnofsky Performance Index, tumor size, edema formation, extent of resection, and RPA class. Results OS of patients with a breakout pattern was significantly worse than OS of all other groups. Conclusion Our data show that BM with a breakout pattern have a highly aggressive clinical course. Patients with such a pattern potentially require a more aggressive local and systemic treatment strategy.
Collapse
Affiliation(s)
- Raquel Blazquez
- Department of Internal Medicine III, Hematology and Medical Oncology, University Hospital Regensburg, Regensburg, Germany
| | | | - Marlene Klauser
- Institute of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Christian Doenitz
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | - Daniel Heudobler
- Department of Internal Medicine III, Hematology and Medical Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Lena Stange
- Department of Neuropathology, University Hospital Regensburg, Regensburg, Germany
| | | | - Elisabeth Bumes
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | | | - Andreas Schicho
- Institute of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Nils-Ole Schmidt
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | - Alexander Brawanski
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Pukrop
- Department of Internal Medicine III, Hematology and Medical Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Christina Wendl
- Institute of Radiology, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
15
|
Murphy KR, Aycock KN, Hay AN, Rossmeisl JH, Davalos RV, Dervisis NG. High-frequency irreversible electroporation brain tumor ablation: exploring the dynamics of cell death and recovery. Bioelectrochemistry 2022; 144:108001. [PMID: 34844040 PMCID: PMC8792323 DOI: 10.1016/j.bioelechem.2021.108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 11/02/2022]
Abstract
Improved therapeutics for malignant brain tumors are urgently needed. High-frequency irreversible electroporation (H-FIRE) is a minimally invasive, nonthermal tissue ablation technique, which utilizes high-frequency, bipolar electric pulses to precisely kill tumor cells. The mechanisms of H-FIRE-induced tumor cell death and potential for cellular recovery are incompletely characterized. We hypothesized that tumor cells treated with specific H-FIRE electric field doses can survive and retain proliferative capacity. F98 glioma and LL/2 Lewis lung carcinoma cell suspensions were treated with H-FIRE to model primary and metastatic brain cancer, respectively. Cell membrane permeability, apoptosis, metabolic viability, and proliferative capacity were temporally measured using exclusion dyes, condensed chromatin staining, WST-8 fluorescence, and clonogenic assays, respectively. Both tumor cell lines exhibited dose-dependent permeabilization, with 1,500 V/cm permitting and 3,000 V/cm inhibiting membrane recovery 24 h post-treatment. Cells treated with 1,500 V/cm demonstrated significant and progressive recovery of apoptosis and metabolic activity, in contrast to cells treated with higher H-FIRE doses. Cancer cells treated with recovery-permitting doses of H-FIRE maintained while those treated with recovery-inhibiting doses lost proliferative capacity. Taken together, our data suggest that H-FIRE induces reversible and irreversible cellular damage in a dose-dependent manner, and the presence of dose-dependent recovery mechanisms permits tumor cell proliferation.
Collapse
Affiliation(s)
- Kelsey R Murphy
- Department of Biomedical and Veterinary Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, United States.
| | - Kenneth N Aycock
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, United States.
| | - Alayna N Hay
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, United States.
| | - John H Rossmeisl
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, United States.
| | - Rafael V Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, United States; ICTAS Center for Engineered Health, Virginia Tech, Kelly Hall, Blacksburg, VA 24061, United States.
| | - Nikolaos G Dervisis
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, United States; Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, United States.
| |
Collapse
|
16
|
Tas ZA, Kulahci O. Histopathological Analysis of Central Nervous System Metastases: Six Years of Data From a Tertiary Center. Cureus 2022; 14:e22151. [PMID: 35308701 PMCID: PMC8920798 DOI: 10.7759/cureus.22151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction: The most common cause of neurological symptoms in patients with systemic malignant tumors is central nervous system (CNS) metastases, and CNS metastases are one of the important causes of morbidity and mortality in these patients. The most common metastatic tumors to the CNS are lung, breast, malignant melanoma, genitourinary, and gastrointestinal tumors. We aimed to analyze our data on patients with CNS metastases in our department, which belongs to a large archive in the field of neuropathology. Methods: The data of patients who had CNS metastases between January 2015 and August 2021 in our department were reviewed retrospectively. The patients were grouped in terms of demographic data, location, histopathological diagnosis, and primary origin characteristics, and their frequency and immunohistochemical staining characteristics were investigated. Results: There were 256 patients with CNS metastases in our study. The mean age was found to be 56.12. Of the patients, 30.5% were female and 69.5% were male. Astrocytic and oligodendral tumors (25.3%), followed by meningiomas (24.1%), and then CNS metastases (21.3%) were the most common CNS tumors. Among the CNS metastases, the most common primary sites were the lung (58%), breast (16%), tumors of unknown primary origin (TUP) (5%), colon (4%), and gynecologic tract (3.1%). Localization was found as cerebral (69.5%), cerebellar (28.1%), and spinal (2.3%). Conclusion: In CNS system metastases, an accurate histological diagnosis should be made by histomorphological evaluation supported by compatible immunohistochemical results in the presence of clinical history and radiological findings. Despite performing a larger immunohistochemical panel, it should be kept in mind that a primary site of origin cannot be found in a significant number of cases.
Collapse
|
17
|
Shen E, Van Swearingen AED, Price MJ, Bulsara K, Verhaak RGW, Baëta C, Painter BD, Reitman ZJ, Salama AKS, Clarke JM, Anders CK, Fecci PE, Goodwin CR, Walsh KM. A Need for More Molecular Profiling in Brain Metastases. Front Oncol 2022; 11:785064. [PMID: 35145903 PMCID: PMC8821807 DOI: 10.3389/fonc.2021.785064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
As local disease control improves, the public health impact of brain metastases (BrM) continues to grow. Molecular features are frequently different between primary and metastatic tumors as a result of clonal evolution during neoplasm migration, selective pressures imposed by systemic treatments, and differences in the local microenvironment. However, biomarker information in BrM is not routinely obtained despite emerging evidence of its clinical value. We review evidence of discordance in clinically actionable biomarkers between primary tumors, extracranial metastases, and BrM. Although BrM biopsy/resection imposes clinical risks, these risks must be weighed against the potential benefits of assessing biomarkers in BrM. First, new treatment targets unique to a patient's BrM may be identified. Second, as BrM may occur late in a patient's disease course, resistance to initial targeted therapies and/or loss of previously identified biomarkers can occur by the time of occult BrM, rendering initial and other targeted therapies ineffective. Thus, current biomarker data can inform real-time treatment options. Third, biomarker information in BrM may provide useful prognostic information for patients. Appreciating the importance of biomarker analyses in BrM tissue, including how it may identify specific drivers of BrM, is critical for the development of more effective treatment strategies to improve outcomes for this growing patient population.
Collapse
Affiliation(s)
- Erica Shen
- Division of Neurosurgery, Department of Surgery, University of Connecticut, Farmington, CT, United States
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
| | - Amanda E. D. Van Swearingen
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, United States
- Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Meghan J. Price
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States
| | - Ketan Bulsara
- Division of Neurosurgery, Department of Surgery, University of Connecticut, Farmington, CT, United States
| | - Roeland G. W. Verhaak
- Division of Neurosurgery, Department of Surgery, University of Connecticut, Farmington, CT, United States
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
- Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam Universitair Medische Centra (UMC), Vrije Universiteit Amsterdam (VU) University Medical Center (VUmc), Amsterdam, Netherlands
| | - César Baëta
- Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States
| | - Brice D. Painter
- Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States
| | - Zachary J. Reitman
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States
| | - April K. S. Salama
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, United States
- Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Jeffrey M. Clarke
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, United States
- Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Carey K. Anders
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, United States
- Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Peter E. Fecci
- Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States
| | - C. Rory Goodwin
- Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States
| | - Kyle M. Walsh
- Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States
| |
Collapse
|
18
|
Che W, Wang Y, Wang X, Lyu J. Midlife brain metastases in the United States: Is male at risk? Cancer Med 2022; 11:1202-1216. [PMID: 35019232 PMCID: PMC8855893 DOI: 10.1002/cam4.4499] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/08/2021] [Accepted: 11/29/2021] [Indexed: 01/07/2023] Open
Abstract
Background Population‐based estimates of the impact of gender throughout the whole course of brain metastases (BMs) at the time of diagnosis of systemic malignancies are insufficient. We aimed to discover the influence of gender on the presence of BMs in newly diagnosed malignancies and the survival of those patients on a population‐based level. Methods Midlife patients (40 years ≤ age ≤60 years) with newly diagnosed malignancies and BMs at the time of diagnosis were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. Clinical variables adjusted patient data. The LASSO regression was performed to exclude the possibility of collinearity. Univariable and multivariable logistic regression analyses were applied to find independent predictors for the presence of BMs, while univariable and multivariable Cox proportional hazard regression analyses were used to determine prognosticators of survival. K‐M curves were used to perform the survival analysis. Result 276,327 population‐based samples met inclusion criteria between 2014 and 2016, and 5747 (2.08%) patients were diagnosed with BMs at the time of diagnosis of systematic malignancies. Among all midlife patients with cancer, 44.02% (121,634) were male, while 51.68% (2970) were male among patients with BMs at the time of diagnosis. The most frequent tumor type was breast cancer (23.11%), and lung cancer had the highest incidence proportion of BMs among the entire cohort (19.34%). The multivariable logistic regression model suggested that female (vs. male, odds ratio [OR] 1.07, 95% CI: 1.01–1.14, p < 0.001) was associated with a higher risk of the presence of BMs at the time of diagnosis. Moreover, in the multivariable Cox model for all‐cause mortality in individuals with BMs at diagnosis, female (vs. male, hazard ratio [HR], 0.86, 95% CI, 0.80–0.92, p < 0.001) was shown to have a lower risk of decreased all‐cause mortality. Conclusion The middle‐aged females were at increased risk of developing BMs, while the middle‐aged males with BMs were at higher risk of having poorer survival.
Collapse
Affiliation(s)
- Wenqiang Che
- Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yujiao Wang
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiangyu Wang
- Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| |
Collapse
|
19
|
Singh M, Dahal A, Brastianos PK. Preclinical Solid Tumor Models to Study Novel Therapeutics in Brain Metastases. Curr Protoc 2021; 1:e284. [PMID: 34762346 PMCID: PMC8597918 DOI: 10.1002/cpz1.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Metastases are the most common malignancy of the adult central nervous system and are becoming an increasingly troubling problem in oncology largely due to the lack of successful therapeutic options. The limited selection of treatments is a result of the currently poor understanding of the biological mechanisms of metastatic development, which in turn is difficult to achieve because of limited preclinical models that can accurately represent the clinical progression of metastasis. Described in this article are in vitro and in vivo model systems that are used to enhance the understanding of metastasis and to identify new therapies for the treatment of brain metastasis. © 2021 Wiley Periodicals LLC.
Collapse
Affiliation(s)
- Mohini Singh
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ashish Dahal
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | |
Collapse
|
20
|
Zhang L, Yao J, Wei Y, Zhou Z, Li P, Qu J, Badu-Nkansah A, Yuan X, Huang YW, Fukumura K, Mao X, Chang WC, Saunus J, Lakhani S, Huse JT, Hung MC, Yu D. Blocking immunosuppressive neutrophils deters pY696-EZH2-driven brain metastases. Sci Transl Med 2021; 12:12/545/eaaz5387. [PMID: 32461334 DOI: 10.1126/scitranslmed.aaz5387] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/15/2020] [Indexed: 12/12/2022]
Abstract
The functions of immune cells in brain metastases are unclear because the brain has traditionally been considered "immune privileged." However, we found that a subgroup of immunosuppressive neutrophils is recruited into the brain, enabling brain metastasis development. In brain metastatic cells, enhancer of zeste homolog 2 (EZH2) is highly expressed and phosphorylated at tyrosine-696 (pY696)-EZH2 by nuclear-localized Src tyrosine kinase. Phosphorylation of EZH2 at Y696 changes its binding preference from histone H3 to RNA polymerase II, which consequently switches EZH2's function from a methyltransferase to a transcription factor that increases c-JUN expression. c-Jun up-regulates protumorigenic inflammatory cytokines, including granulocyte colony-stimulating factor (G-CSF), which recruits Arg1+- and PD-L1+ immunosuppressive neutrophils into the brain to drive metastasis outgrowth. G-CSF-blocking antibodies or immune checkpoint blockade therapies combined with Src inhibitors impeded brain metastasis in multiple mouse models. These findings indicate that pY696-EZH2 can function as a methyltransferase-independent transcription factor to facilitate the brain infiltration of immunosuppressive neutrophils, which could be clinically targeted for brain metastasis treatment.
Collapse
Affiliation(s)
- Lin Zhang
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, USA
| | - Jun Yao
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yongkun Wei
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Zhifen Zhou
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ping Li
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jingkun Qu
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Akosua Badu-Nkansah
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xiangliang Yuan
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yu-Wen Huang
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Center for Molecular Medicine, China Medical University, Taichung 40402, Taiwan
| | - Kazutaka Fukumura
- Department of Pathology and Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xizeng Mao
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Wei-Chao Chang
- Center for Molecular Medicine, China Medical University, Taichung 40402, Taiwan
| | - Jodi Saunus
- Faculty of Medicine, University of Queensland, St Lucia, QLD 4072, Australia
| | - Sunil Lakhani
- Faculty of Medicine, University of Queensland, St Lucia, QLD 4072, Australia.,Pathology Queensland, The Royal Brisbane & Women's Hospital, Herston, QLD 4029, Australia
| | - Jason T Huse
- Department of Pathology and Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mien-Chie Hung
- Center for Molecular Medicine, China Medical University, Taichung 40402, Taiwan
| | - Dihua Yu
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. .,MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX 77030, USA.,Center for Molecular Medicine, China Medical University, Taichung 40402, Taiwan
| |
Collapse
|
21
|
Dhawan S, Bartek J, Chen CC. Cost-effectiveness of stereotactic laser ablation (SLA) for brain tumors. Int J Hyperthermia 2021; 37:61-67. [PMID: 32672125 DOI: 10.1080/02656736.2020.1774084] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Stereotactic laser ablation(SLA) or laser interstitial thermal therapy (LITT) has been increasingly adopted as a treatment for primary and metastatic brain cancers. Here, we examined the published economic assessments of SLA, and review the current state of knowledge. METHODS The PubMed database was queried for articles investigating the cost-effectiveness of LITT. 3068 articles were screened. Two studies that met the inclusion criteria were included in this review. RESULTS Cost-effectiveness analysis(CEA) favored SLA(n = 8) relative to craniotomy (n = 92) for brain metastases (Mean difference [MD]=-US$6522; 95% confidence interval (CI) -$11,911 to -$1133; p = 0.02). SLA (n = 19) was found to be cost equivalent to craniotomy (n = 248) (MD=-US$1669; 95%(CI) -$8192 to $4854, p = 0.62) for primary brain tumors in general. CEA favored SLA for a subset of primary brain cancers. SLA was found to be cost-effective for difficult to access high-grade gliomas(HGG). When compared to 'other' existing treatments, the cost per life-years gained (LYG) through SLA was ∼$29,340, a threshold below that set for new technology adaptation in the U.S. Factors contributing to these cost-effectiveness were: (1) SLA of HGGs was associated with three-months prolongation in survival; (2) SLA of brain metastasis was associated with (i) shorter average length of stay (SLA: 2.3 days; craniotomy: 4.7 days), (ii) decreased discharge to inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), or home healthcare (SLA: 14.8%; craniotomy: 52%), (iii) lowered 30-day readmission (SLA: 0%; craniotomy: 14.1%). CONCLUSION There is limited data on the cost-effectiveness of SLA. In the available literature, SLA compared favorably to craniotomy in terms of cost-effectiveness as a treatment for primary and metastatic brain cancers.
Collapse
Affiliation(s)
- Sanjay Dhawan
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
22
|
Shoji Y, Furuhashi S, Kelly DF, Bilchik AJ, Hoon DSB, Bustos MA. Current status of gastrointestinal tract cancer brain metastasis and the use of blood-based cancer biomarker biopsy. Clin Exp Metastasis 2021; 39:61-69. [PMID: 33950411 DOI: 10.1007/s10585-021-10094-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/25/2021] [Indexed: 12/24/2022]
Abstract
Brain metastasis (BM) frequently occurs in patients with cutaneous melanoma, lung, and breast cancer; although, BM rarely arises from cancers of the gastrointestinal tract (GIT). The reported incidence of GIT cancer BM is less than 4%. In the last few years, effective systemic therapy has prolonged the survival of GIT patients and consequently, the incidence of developing BM is rising. Therefore, the epidemiology and biology of BM arising from GIT cancer requires a more comprehensive understanding. In spite of the development of new therapeutic agents for patients with metastatic GIT cancers, survival for patients with BM still remains poor, with a median survival after diagnosis of less than 4 months. Limited evidence suggests that early detection of isolated intra-cranial lesions will enable surgical resection plus systemic and/or radiation therapy, which may lead to an increase in overall survival. Novel diagnostic methods such as blood-based biomarker biopsies may play a crucial role in the early detection of BM. Circulating tumor cells and circulating cell-free nucleic acids are known to serve as blood biomarkers for early detection and treatment response monitoring of multiple cancers. Blood biopsy may improve early diagnosis and treatment monitoring of GIT cancers BM, thus prolonging patients' survivals.
Collapse
Affiliation(s)
- Yoshiaki Shoji
- Division of Molecular Oncology, Department of Translational Molecular Medicine, Saint John's Cancer Institute at Providence Saint John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Satoru Furuhashi
- Division of Molecular Oncology, Department of Translational Molecular Medicine, Saint John's Cancer Institute at Providence Saint John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Daniel F Kelly
- Pacific Neuroscience Institute, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Anton J Bilchik
- Department of Surgical Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Dave S B Hoon
- Division of Molecular Oncology, Department of Translational Molecular Medicine, Saint John's Cancer Institute at Providence Saint John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Matias A Bustos
- Division of Molecular Oncology, Department of Translational Molecular Medicine, Saint John's Cancer Institute at Providence Saint John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA.
| |
Collapse
|
23
|
Dankner M, Caron M, Al-Saadi T, Yu W, Ouellet V, Ezzeddine R, Maritan SM, Annis MG, Le PU, Nadaf J, Neubarth NS, Savage P, Zuo D, Couturier CP, Monlong J, Djambazian H, Altoukhi H, Bourque G, Ragoussis J, Diaz RJ, Park M, Guiot MC, Lam S, Petrecca K, Siegel PM. Invasive growth associated with Cold-Inducible RNA-Binding Protein expression drives recurrence of surgically resected brain metastases. Neuro Oncol 2021; 23:1470-1480. [PMID: 33433612 DOI: 10.1093/neuonc/noab002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Sixty percent of surgically resected brain metastases (BrM) recur within 1 year. These recurrences have long been thought to result from the dispersion of cancer cells during surgery. We tested the alternative hypothesis that invasion of cancer cells into the adjacent brain plays a significant role in local recurrence and shortened overall survival. METHODS We determined the invasion pattern of 164 surgically resected BrM and correlated with local recurrence and overall survival. We performed single-cell RNA sequencing (scRNAseq) of >15,000 cells from BrM and adjacent brain tissue. Validation of targets was performed with a novel cohort of BrM patient-derived xenografts (PDX) and patient tissues. RESULTS We demonstrate that invasion of metastatic cancer cells into the adjacent brain is associated with local recurrence and shortened overall survival. scRNAseq of paired tumor and adjacent brain samples confirmed the existence of invasive cancer cells in the tumor-adjacent brain. Analysis of these cells identified Cold-Inducible RNA-Binding Protein (CIRBP) overexpression in invasive cancer cells compared to cancer cells located within the metastases. Applying PDX models that recapitulate the invasion pattern observed in patients, we show that CIRBP is overexpressed in highly invasive BrM and is required for efficient invasive growth in the brain. CONCLUSIONS These data demonstrate peritumoral invasion as a driver of treatment failure in BrM that is functionally mediated by CIRBP. These findings improve our understanding of the biology underlying post-operative treatment failure and lay the groundwork for rational clinical trial development based upon invasion pattern in surgically resected brain metastases.
Collapse
Affiliation(s)
- Matthew Dankner
- Division of Experimental Medicine, Montréal, Québec, Canada.,Goodman Cancer Research Centre, Montréal, Québec, Canada.,McGill Faculty of Medicine, Montréal, Québec, Canada
| | - Maxime Caron
- McGill University Genome Centre, Department of Human Genetics, Montréal, Québec, Canada
| | - Tariq Al-Saadi
- McGill Faculty of Medicine, Montréal, Québec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, Montréal, Québec, Canada
| | - WenQing Yu
- McGill Faculty of Medicine, Montréal, Québec, Canada
| | - Veronique Ouellet
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Rima Ezzeddine
- Goodman Cancer Research Centre, Montréal, Québec, Canada.,Department of Biochemistry, University of Toronto, Toronto, Ontario, Canada
| | - Sarah M Maritan
- Division of Experimental Medicine, Montréal, Québec, Canada.,Goodman Cancer Research Centre, Montréal, Québec, Canada.,McGill Faculty of Medicine, Montréal, Québec, Canada
| | | | - Phuong Uyen Le
- McGill Faculty of Medicine, Montréal, Québec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, Montréal, Québec, Canada
| | - Javad Nadaf
- McGill University Genome Centre, Department of Human Genetics, Montréal, Québec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, Montréal, Québec, Canada
| | - Noah S Neubarth
- Goodman Cancer Research Centre, Montréal, Québec, Canada.,Department of Anatomy & Cell Biology, University of Toronto, Toronto, Ontario, Canada
| | - Paul Savage
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Dongmei Zuo
- Goodman Cancer Research Centre, Montréal, Québec, Canada
| | - Charles P Couturier
- McGill Faculty of Medicine, Montréal, Québec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, Montréal, Québec, Canada
| | - Jean Monlong
- McGill University Genome Centre, Department of Human Genetics, Montréal, Québec, Canada
| | - Haig Djambazian
- McGill University Genome Centre, Department of Human Genetics, Montréal, Québec, Canada
| | - Huda Altoukhi
- McGill Faculty of Medicine, Montréal, Québec, Canada.,Department of Radiation Oncology, McGill University, Montreal Quebec Canada
| | - Guillaume Bourque
- McGill University Genome Centre, Department of Human Genetics, Montréal, Québec, Canada
| | - Jiannis Ragoussis
- McGill University Genome Centre, Department of Human Genetics, Montréal, Québec, Canada
| | - Roberto J Diaz
- McGill Faculty of Medicine, Montréal, Québec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, Montréal, Québec, Canada
| | - Morag Park
- Division of Experimental Medicine, Montréal, Québec, Canada.,Goodman Cancer Research Centre, Montréal, Québec, Canada.,McGill Faculty of Medicine, Montréal, Québec, Canada.,Department of Biochemistry, University of Toronto, Toronto, Ontario, Canada.,Department of Pathology, McGill University, Montreal Quebec Canada
| | - Marie-Christine Guiot
- Goodman Cancer Research Centre, Montréal, Québec, Canada.,McGill Faculty of Medicine, Montréal, Québec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, Montréal, Québec, Canada.,Department of Pathology, McGill University, Montreal Quebec Canada
| | - Stephanie Lam
- McGill Faculty of Medicine, Montréal, Québec, Canada.,Department of Diagnostic Radiology, McGill University, Montreal Quebec Canada
| | - Kevin Petrecca
- McGill Faculty of Medicine, Montréal, Québec, Canada.,Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, Montréal, Québec, Canada
| | - Peter M Siegel
- Division of Experimental Medicine, Montréal, Québec, Canada.,Goodman Cancer Research Centre, Montréal, Québec, Canada.,McGill Faculty of Medicine, Montréal, Québec, Canada.,Department of Biochemistry, University of Toronto, Toronto, Ontario, Canada.,Department of Anatomy & Cell Biology, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, McGill University, Montreal Quebec Canada
| |
Collapse
|
24
|
Zhang J, Xu J, Jin S, Gao W, Guo R, Chen L. The development and validation of a nomogram for predicting brain metastases in lung squamous cell carcinoma patients: an analysis of the Surveillance, Epidemiology, and End Results (SEER) database. J Thorac Dis 2021; 13:270-281. [PMID: 33569207 PMCID: PMC7867817 DOI: 10.21037/jtd-20-3494] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The incidence of brain metastasis (BM) in patients suffering from lung squamous cell carcinoma (LUSC) is lower than that in patients suffering from non-squamous cell carcinoma (NSCC) and there are few studies on BM of LUSC. The purpose of this investigation was to ascertain the risk factors of LUSC, as well as to establish a nomogram prognostic model to predict the incidence of BM in patients with LUSC. Methods Patients diagnosed with LUSC between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database and the patient data were collated. All patients diagnosed from 2010–2012 were allocated into the training cohort, and the remaining patients diagnosed from 2013–2015 formed the test cohort. Using factors that were screened out through logistic regression analyses, the nomogram in the training cohort was established. It was then evaluated for discrimination and calibration using the test cohort. The performance of the nomogram was assessed by quantifying the area under the receiver operating characteristic (ROC) curve and evaluating the calibration curve. Results A total of 26,154 LUSC patients were included in the study. The training cohort consisted of 16,543 patients and there were 8611 patients in the test cohort. Age, marital status, insurance status, histological grade, tumor location, laterality, stage of the cancer, number of metastatic organs, chemotherapy, surgery, and radiotherapy were highly correlated with the incidence of BM. The area under the ROC curve (AUC) of the nomogram for the training cohort and the test cohort were 0.810 [95% confidence interval (CI): 0.796 to 0.823] and 0.805 (95% CI: 0.784 to 0.825), respectively. The slope of the calibration curve was close to 1. Conclusions The nomogram was able to accurately predict the incidence of BM. This may be beneficial for the early identification of high-risk LUSC patients and the establishment of individualized treatments.
Collapse
Affiliation(s)
- Jingya Zhang
- Nanjing Medical University, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiali Xu
- First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shidai Jin
- First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen Gao
- First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Renhua Guo
- Nanjing Medical University, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang Chen
- First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
25
|
Zheng H, Li C, Li Z, Zhu K, Bao H, Xiong J, Liang P. HOXB9 enhances the ability of lung cancer cells to penetrate the blood-brain barrier. Aging (Albany NY) 2020; 13:4999-5019. [PMID: 33411683 PMCID: PMC7950248 DOI: 10.18632/aging.202324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 12/21/2022]
Abstract
Even after multimodal therapy, the prognosis is dismal for patients with brain metastases from non-small cell lung cancer (NSCLC). Although the blood-brain barrier (BBB) limits tumor cell penetration into the brain parenchyma, some nevertheless colonize brain tissue through mechanisms that are not fully clear. Here we show that homeobox B9 (HOXB9), which is commonly overexpressed in NSCLC, promotes epithelial-to-mesenchymal transition (EMT) and tumor migration and invasion. Animal experiments showed that HOXB9 expression correlates positively with the brain metastatic potential of human NSCLC cells, while brain metastatic cells derived through in vivo selection showed greater HOXB9 expression than their cells of origin. Comparable results were obtained after immunohistochemical analysis of clinical primary NSCLC and matched brain metastasis samples obtained after surgery. Using an in vitro BBB model, knockdown and overexpression experiments showed that HOXB9-dependent expression of MMP9 in NSCLC cells leads to reduced expression of junctional proteins in cultured human vascular endothelial cells and enhanced transmigration of tumor cells. These data indicate that HOXB9 enables NSCLC cells to break away from the primary tumor by inducing EMT, and promotes brain metastasis by driving MMP9 production and degradation of intercellular adhesion proteins in endothelial cells comprising the BBB.
Collapse
Affiliation(s)
- HongShan Zheng
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin 150001, Heilongjiang, P.R. China
| | - ChenLong Li
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin 150001, Heilongjiang, P.R. China
| | - ZhenZhe Li
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin 150001, Heilongjiang, P.R. China
| | - KaiBin Zhu
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin 150001, Heilongjiang, P.R. China
| | - HongBo Bao
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin 150001, Heilongjiang, P.R. China
| | - JinSheng Xiong
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin 150001, Heilongjiang, P.R. China
| | - Peng Liang
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin 150001, Heilongjiang, P.R. China
| |
Collapse
|
26
|
Khan M, Arooj S, Li R, Tian Y, Zhang J, Lin J, Liang Y, Xu A, Zheng R, Liu M, Yuan Y. Tumor Primary Site and Histology Subtypes Role in Radiotherapeutic Management of Brain Metastases. Front Oncol 2020; 10:781. [PMID: 32733787 PMCID: PMC7358601 DOI: 10.3389/fonc.2020.00781] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 04/22/2020] [Indexed: 12/12/2022] Open
Abstract
Randomized controlled trials have failed to report any survival advantage for WBRT combined with SRS in the management of brain metastases, despite the enhanced local and distant control in comparison to each treatment alone. Literature review have revealed important role of primary histology of the tumor when dealing with brain metastases. NSCLC responds better to combined approach even when there was only single brain metastasis present while breast cancer has registered better survival with SRS alone probably due to better response of primary tumor to advancement in surgical and chemotherapeutic agents. Furthermore, mutation status (EGFR/ALK) in lung cancer and receptor status (ER/PR/HER2) in breast cancer also exhibit diversity in their response to radiotherapy. Radioresistant tumors like renal cell carcinoma and melanoma brain metastases have achieved better results when treated with SRS alone. Secondly, single brain metastasis may benefit from local and distant brain control achieved with combined treatment. These diverse outcomes suggest a primary histology-based analysis of the radiotherapy regimens (WBRT, SRS, or their combination) would more ideally establish the role of radiotherapy in the management of brain metastases. Molecularly targeted therapeutic and immunotherapeutic agents have revealed synergism with radiation therapy particularly SRS in treating cancer patients with brain metastases. Clinical updates in this regard have also been reviewed.
Collapse
Affiliation(s)
- Muhammad Khan
- Department of Radiation Oncology, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.,Department of Oncology, First affiliated Hospital of Anhui Medical University, Hefei, China
| | - Sumbal Arooj
- Department of Radiation Oncology, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.,Department of Oncology, First affiliated Hospital of Anhui Medical University, Hefei, China.,Department of Biochemistry, University of Sialkot, Sialkot, Pakistan
| | - Rong Li
- Department of Radiation Oncology, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yunhong Tian
- Department of Radiation Oncology, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Jian Zhang
- Department of Radiation Oncology, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Jie Lin
- Department of Radiation Oncology, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yingying Liang
- Department of Radiation Oncology, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Anan Xu
- Department of Radiation Oncology, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Ronghui Zheng
- Department of Radiation Oncology, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Mengzhong Liu
- Department of Radiation Oncology, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yawei Yuan
- Department of Radiation Oncology, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
27
|
Vilariño N, Bruna J, Bosch-Barrera J, Valiente M, Nadal E. Immunotherapy in NSCLC patients with brain metastases. Understanding brain tumor microenvironment and dissecting outcomes from immune checkpoint blockade in the clinic. Cancer Treat Rev 2020; 89:102067. [PMID: 32682248 DOI: 10.1016/j.ctrv.2020.102067] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/01/2020] [Accepted: 06/26/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Brain metastases are frequent complications in patients with non-small-cell lung cancer (NSCLC) associated with significant morbidity and poor prognosis. Our goal is to give a global overlook on clinical efficacy from immune checkpoint inhibitors in this setting and to review the role of biomarkers and molecular interactions in brain metastases from patients with NSCLC. METHODS We reviewed clinical trials reporting clinical outcomes of patients with NSCLC with brain metastases as well as publications assessing the tumor microenvironment and the complex molecular interactions of tumor cells with immune and resident cells in brain metastases from NSCLC biopsies or preclinical models. RESULTS Although limited data are available on immunotherapy in patients with brain metastases, immune checkpoint inhibitors alone or in combination with chemotherapy have shown promising intracranial efficacy and safety results. The underlying mechanism of action of immune checkpoint inhibitors in the brain niche and their influence on tumor microenvironment are still not known. Lower PD-L1 expression and less T CD8+ infiltration were found in brain metastases compared with matched NSCLC primary tumors, suggesting an immunosuppressive microenvironment in the brain. Reactive astrocytes and tumor associated macrophages are paramount in NSCLC brain metastases and play a role in promoting tumor progression and immune evasion. CONCLUSIONS Discordances in the immune profile between primary tumours and brain metastases underscore differences in the tumour microenvironment and immune system interactions within the lung and brain niche. The characterization of immune phenotype of brain metastases and dissecting the interplay among immune cells and resident stromal cells along with cancer cells is crucial to unravel effective immunotherapeutic approaches in patients with NSCLC and brain metastases.
Collapse
Affiliation(s)
- N Vilariño
- Department of Medical Oncology, Catalan Institute of Oncology, Hospital Duran i Reynals, Avinguda de la Gran Via de l'Hospitalet, 199-203, L'Hospitalet de Llobregat, Barcelona, Spain; Clinical Research in Solid Tumors (CReST) Group, Molecular Mechanisms and Experimental Therapeutics in Cancer (Oncobell). IDIBELL, Avinguda de la Gran Via de l'Hospitalet, 199-203, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - J Bruna
- Neuro-Oncology Unit, Bellvitge University Hospital-ICO (IDIBELL), Avinguda de la Gran Via de l'Hospitalet, 199-203, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - J Bosch-Barrera
- Department of Medical Oncology, Catalan Institute of Oncology, Doctor Josep Trueta University Hospital, Avinguda França-Sant Ponç, 0, 17007 Girona, Spain.
| | - M Valiente
- Brain Metastases Group, Spanish National Cancer Research Centre (CNIO), Calle Melchor Fernández Almagro, 3, 28029 Madrid, Spain.
| | - E Nadal
- Department of Medical Oncology, Catalan Institute of Oncology, Hospital Duran i Reynals, Avinguda de la Gran Via de l'Hospitalet, 199-203, L'Hospitalet de Llobregat, Barcelona, Spain; Clinical Research in Solid Tumors (CReST) Group, Molecular Mechanisms and Experimental Therapeutics in Cancer (Oncobell). IDIBELL, Avinguda de la Gran Via de l'Hospitalet, 199-203, L'Hospitalet de Llobregat, Barcelona, Spain.
| |
Collapse
|
28
|
Guo JH, Wang YY, Zhang JW, Liu PM, Hao YJ, Duan HR. Clinical effects of apatinib mesylate for treatment of multiple brain micrometastases: Two case reports. World J Clin Cases 2020; 8:1326-1336. [PMID: 32337210 PMCID: PMC7176611 DOI: 10.12998/wjcc.v8.i7.1326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Apatinib is a small-molecule multitargeted tyrosine kinase inhibitor. Apatinib has demonstrated encouraging antitumor activities. This study aimed to observe the efficacy and safety of apatinib for the treatment of multiple brain micrometastases.
CASE SUMMARY We report two patients with multiple brain micrometastases after failure of second-line treatment. Both patients had extracerebral metastases. When the patients took 250 mg/d apatinib orally, the intracerebral lesions disappeared. The extracerebral lesions were partially alleviated. Both patients had a progression-free survival of more than 12 mo and were still stable. The safety was good. The main adverse events (AEs) were mild hypertension and proteinuria, which could be controlled.
CONCLUSION Apatinib has clear efficacy and good tolerance in patients with multiple brain micrometastases after failure of second-line treatment.
Collapse
Affiliation(s)
- Jun-Hui Guo
- Department of Oncology, The Second Affiliated Hospital of Henan University of Chinese Medicine, Henan Province Hospital of TCM, Zhengzhou 450002, Henan Province, China
| | - Yuan-Yuan Wang
- Department of Oncology, The Second Affiliated Hospital of Henan University of Chinese Medicine, Henan Province Hospital of TCM, Zhengzhou 450002, Henan Province, China
| | - Jiang-Wei Zhang
- Department of Oncology, The Second Affiliated Hospital of Henan University of Chinese Medicine, Henan Province Hospital of TCM, Zhengzhou 450002, Henan Province, China
| | - Pei-Min Liu
- Department of Oncology, The Second Affiliated Hospital of Henan University of Chinese Medicine, Henan Province Hospital of TCM, Zhengzhou 450002, Henan Province, China
| | - Yan-Jun Hao
- Department of Oncology, The Second Affiliated Hospital of Henan University of Chinese Medicine, Henan Province Hospital of TCM, Zhengzhou 450002, Henan Province, China
| | - Hai-Rui Duan
- Department of Oncology, The Second Affiliated Hospital of Henan University of Chinese Medicine, Henan Province Hospital of TCM, Zhengzhou 450002, Henan Province, China
| |
Collapse
|
29
|
Sikpa D, Whittingstall L, Fouquet JP, Radulska A, Tremblay L, Lebel R, Paquette B, Lepage M. Cerebrovascular inflammation promotes the formation of brain metastases. Int J Cancer 2020; 147:244-255. [PMID: 32011730 DOI: 10.1002/ijc.32902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/18/2019] [Accepted: 01/23/2020] [Indexed: 12/24/2022]
Abstract
Brain metastases are the most prevalent intracranial malignancy. Patient outcome is poor and treatment options are limited. Hence, new avenues must be explored to identify potential therapeutic targets. Inflammation is a known critical component of cancer progression. Intratumoral inflammation drives progression and leads to the release of circulating tumor cells (CTCs). Inflammation at distant sites promotes adhesion of CTCs to the activated endothelium and then initiates the formation of metastases. These interactions mostly involve cell adhesion molecules expressed by activated endothelial cells. For example, the vascular cell adhesion molecule-1 (VCAM-1) is known to promote transendothelial migration of cancer cells in different organs. However, it is unclear whether a similar mechanism occurs within the specialized environment of the brain. Our objective was therefore to use molecular imaging to assess the potential role of VCAM-1 in promoting the entry of CTCs into the brain. First, magnetic resonance imaging (MRI) and histological analyses revealed that cerebrovascular inflammation induced by intracranial injection of lipopolysaccharide significantly increased the expression of VCAM-1 in the Balb/c mouse brain. Next, intracardiac injection of 4T1 mammary carcinoma cancer cells in animals with cerebrovascular inflammation yielded a higher brain metastasis burden than in the control animals. Finally, blocking VCAM-1 prior to 4T1 cells injection prevented this increased metastatic burden. Here, we demonstrated that by contributing to CTCs adhesion to the activated cerebrovascular endothelium, VCAM-1 improves the capacity of CTCs to form metastatic foci in the brain.
Collapse
Affiliation(s)
- Dina Sikpa
- Centre d'Imagerie Moléculaire de Sherbrooke, Département de Médecine Nucléaire et Radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Lisa Whittingstall
- Centre d'Imagerie Moléculaire de Sherbrooke, Département de Médecine Nucléaire et Radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jérémie P Fouquet
- Centre d'Imagerie Moléculaire de Sherbrooke, Département de Médecine Nucléaire et Radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Adrianna Radulska
- Centre d'Imagerie Moléculaire de Sherbrooke, Département de Médecine Nucléaire et Radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Luc Tremblay
- Centre d'Imagerie Moléculaire de Sherbrooke, Département de Médecine Nucléaire et Radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Réjean Lebel
- Centre d'Imagerie Moléculaire de Sherbrooke, Département de Médecine Nucléaire et Radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Benoit Paquette
- Centre de Recherche en Radiothérapie, Département de Médecine Nucléaire et Radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Martin Lepage
- Centre d'Imagerie Moléculaire de Sherbrooke, Département de Médecine Nucléaire et Radiobiologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| |
Collapse
|
30
|
Chen L, Li L, Zhou C, Chen X, Cao Y. Adenosine A2A receptor activation reduces brain metastasis via SDF-1/CXCR4 axis and protecting blood-brain barrier. Mol Carcinog 2020; 59:390-398. [PMID: 32037613 DOI: 10.1002/mc.23161] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 12/16/2022]
Abstract
Brain metastasis is a leading cause of death worldwide, but the mechanism involved remains unclear. Stromal cell-derived factor-1 (SDF-1)/C-X-C motif chemokine receptor 4 (CXCR4) signaling has been reported to induce the directed metastasis of cancers, and adenosine A2A receptor activation suppresses the SDF-1/CXCR4 interaction. However, whether A2A receptor activation implicates the SDF-1/CXCR4 signaling pathway and thus modulates brain metastasis remains unclear. In this study, Western blot was performed to evaluate the protein levels. Cell invasion and migration assays were used to estimate the metastasis ability of PC-9 cells. The viability of cells was demonstrated by lactate dehydrogenase and cell proliferation assays. And the findings in vitro were further identified in nude mice. Notably, adenosine A2A receptor activation inhibited the proliferation and viability of PC-9 cells and thus suppressed the brain metastasis. A2A receptor stimulation protected the function of blood-brain barrier (BBB). The suppression of brain metastasis and the protection of BBB by A2A receptor relied on SDF-1/CXCR4 signaling, and treatment using A2A receptor agonist and CXCR4 antagonist protected the nude mice from malignancy metastasis in vivo. Adenosine A2A receptor activation suppressed the brain metastasis by implicating the SDF-1/CXCR4 axis and protecting the BBB.
Collapse
Affiliation(s)
- Lei Chen
- Department of Neurosurgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liangdong Li
- Department of Neurosurgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Changshuai Zhou
- Department of Neurosurgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Chen
- Department of Neurosurgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yiqun Cao
- Department of Neurosurgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| |
Collapse
|
31
|
Yang SH, Hong CT, Tsai FY, Chen WY, Chen CY, Chan WP. Anatomical relationships between medullary veins and three types of deep-seated malignant brain tumors as detected by susceptibility-weighted imaging. J Chin Med Assoc 2020; 83:164-169. [PMID: 31834025 DOI: 10.1097/jcma.0000000000000235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Deep-seated brain tumors can be difficult to differentiate. Three tumor types (primary central nervous system lymphoma [PCNSL], high-grade glioma, and metastatic brain tumors), identified by susceptibility-weighted imaging, have different relationships with small medullary veins, and these relationships can be used to enhance diagnostic accuracy. METHODS Records of patients with pathology confirmed malignant brain tumors who received susceptibility-weighted imaging between 2009 and 2015 were reviewed. A total of 29 patients with deep-seated malignant brain tumors in the territory of small medullary veins were enrolled in this study. The sensitivity, specificity, and diagnostic accuracy of medullary vein blockage (MVB), defined as a small medullary vein terminating at the margin of the tumor, for indicating malignant brain tumors were analyzed. RESULTS Of 11 patients with PCNSLs, 5 with high-grade gliomas, and 13 with metastases, only the latter presented MVBs. The sensitivity, specificity, and accuracy of using MVBs for diagnosing metastatic tumors were 76.9%, 100%, and 89.7%, respectively. CONCLUSION An MVB is an accurate sign for differentiating metastatic brain tumors from two other common malignancies and thus provides a useful tool for preoperative planning.
Collapse
Affiliation(s)
- Shih-Hung Yang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chien-Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Fong Y Tsai
- Department of Radiological Sciences, University of California Irvine, Irvine California, USA
- Imaging Research Center, Taipei Medical University, Taipei, Taiwan, ROC
| | - Wei-Yu Chen
- Department of Pathology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chia-Yuen Chen
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| |
Collapse
|
32
|
Yang SH, Kim HY, Lee SI, Jin SJ. The Effect of Epidermal Growth Factor Receptor Mutation on Intracranial Progression-Free Survival of Non-Small Cell Lung Cancer Patients with Brain Metastasis Underwent Gamma Knife Radiosurgery. Brain Tumor Res Treat 2020; 8:103-108. [PMID: 33118342 PMCID: PMC7595855 DOI: 10.14791/btrt.2020.8.e15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/22/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to survey prognostic factors, particularly those focusing on epidermal growth factor receptor (EGFR) mutations, of patients with non-small cell lung cancer (NSCLC) after Gamma Knife Radiosurgery (GKRS) for metastatic brain tumors. METHODS We retrospectively reviewed the medical records of 98 patients with NSCLC who underwent GKRS for brain metastases from August 2010 to July 2017. The primary endpoint was progression-free survival (PFS) of the intracranial disease. We analyzed variables such as age, sex, Karnofsky Performance Status, recursive partitioning analysis (RPA) class, smoking status, primary cancer pathology, EGFR mutations, and time to brain metastases as prognostic factors. RESULTS The median overall survival (OS) of the patients was 16 months [95% confidence interval (CI), 13-21 months]. Median systemic PFS and intracranial PFS were 9 months (95% CI, 8-11 months) and 11 months (95% CI, 7-14 months), respectively. Kaplan-Meier survival analysis revealed that the patients with EGFR mutations had longer intracranial PFS than those without EGFR mutation (median intracranial PFS: 19 vs. 10 months with p=0.01) while they had no benefits in OS and systemic PFS. Furthermore, the patients harboring adenocarcinoma had longer OS (p<0.01) and intracranial PFS (p<0.01) and the patients with lower RPA class had longer OS (p=0.02) and intracranial PFS (p=0.03). CONCLUSION EGFR mutations, primary cancer pathology, and RPA class may be proposed as prognostic factors for intracranial PFS in NSCLC patients after GKRS for brain metastasis in this study.
Collapse
Affiliation(s)
- Seung Hyeon Yang
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hae Yu Kim
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.,Department of Neurosurgery, Gamma Knife Center, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
| | - Sun Il Lee
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.,Department of Neurosurgery, Gamma Knife Center, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seong Jin Jin
- Department of Neurosurgery, Gamma Knife Center, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
33
|
Chikani M, Okpara S, Mathew M, Onuh A, Okwor V, Mezue W. Preliminary findings on metastatic brain tumors in Enugu, Southeast Nigeria. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_86_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
34
|
Zheng Y, Ding Y, Wang Q, Sun Y, Teng X, Gao Q, Zhong W, Lou X, Xiao C, Chen C, Xu Q, Xu N. 90-gene signature assay for tissue origin diagnosis of brain metastases. J Transl Med 2019; 17:331. [PMID: 31570099 PMCID: PMC6771090 DOI: 10.1186/s12967-019-2082-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 09/23/2019] [Indexed: 12/27/2022] Open
Abstract
Background Brain metastases (BM) are the most common intracranial tumors. 2–14% of BM patients present with unknown primary site despite intensive evaluations. This study aims to evaluate the performance of a 90-gene expression signature in determining the primary sites for BM samples. Methods The sequence-based gene expression profiles of 708 primary brain tumors (PBT) collected from The Cancer Genome Atlas (TCGA) database were analyzed by the 90-gene expression signature, with a similarity score for each of 21 common tumor types. We then used Optimal Binning algorithm to generate a threshold for separating PBT from BM. Eighteen PBT samples were analyzed to substantiate the reliability of the threshold. In addition, the performance of the 90-gene expression signature for molecular classification of metastatic brain tumors was validated in a cohort of 48 BM samples with the known origin. For each BM sample, the tumor type with the highest similarity score was considered tissue of origin. When a sample was diagnosed as PBT, but the similarity score below the threshold, the second prediction was considered as the primary site. Results A threshold of the similarity score, 70, was identified to discriminate PBT from BM (PBT: > 70, BM: ≤ 70) with an accuracy of 99% (703/708, 95% CI 98–100%). The 90-gene expression signature was further validated with 18 PBT and 44 BM samples. The results of 18 PBT samples matched reference diagnosis with a concordance rate of 100%, and all similarity scores were above the threshold. Of 44 BM samples, the 90-gene expression signature accurately predicted primary sites in 89% (39/44, 95% CI 75–96%) of the cases. Conclusions Our findings demonstrated the potential that the 90-gene expression signature could serve as a powerful tool for accurately identifying the primary sites of metastatic brain tumors.
Collapse
Affiliation(s)
- Yulong Zheng
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yongfeng Ding
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qifeng Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yifeng Sun
- Canhelp Genomics Co., Ltd., Hangzhou, Zhejiang, China
| | - Xiaodong Teng
- Department of Pathology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiqi Gao
- Department of Pathology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weixiang Zhong
- Department of Pathology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaofeng Lou
- Department of Surgical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Cheng Xiao
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chengshu Chen
- Canhelp Genomics Co., Ltd., Hangzhou, Zhejiang, China
| | - Qinghua Xu
- Canhelp Genomics Co., Ltd., Hangzhou, Zhejiang, China.
| | - Nong Xu
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| |
Collapse
|
35
|
Gilbride L, Siker M, Bovi J, Gore E, Schultz C, Hall WA. Current Predictive Indices and Nomograms To Enable Personalization of Radiation Therapy for Patients With Secondary Malignant Neoplasms of the Central Nervous System: A Review. Neurosurgery 2019; 82:595-603. [PMID: 29669114 DOI: 10.1093/neuros/nyx631] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 02/16/2018] [Indexed: 01/03/2023] Open
Abstract
The proper treatment of brain metastases continues to be a challenge for oncologists given the variability of individual patients' prognoses and the variety of treatment options available to address brain metasteses. There have been efforts since the 1990s to develop prognostic indices and nomograms to help clinicians determine the best approach for individuals with secondary malignant neoplasms of the central nervous system. A literature search was performed to identify the existing prognostic tools published between January 1995 and January 2017. While there have been several reported indices, many are limited by the number of patients analyzed or lack of generalizability. The most robust prognostic tools available are the Disease Specific Graded Prognostic Assessment and the Barnholtz-Sloan nomogram, both of which have online tools available to help clinicians. While these tools are helpful in stratifying different patients' outcomes, they are limited by their retrospective nature and likely underestimate survival in the modern era, where there is a rapidly growing arsenal of systemic agents available to patients with metastatic disease.
Collapse
Affiliation(s)
- Lucas Gilbride
- Medical College of Wisconsin, Department of Radiation Oncology
| | - Malika Siker
- Medical College of Wisconsin, Department of Radiation Oncology
| | - Joseph Bovi
- Medical College of Wisconsin, Department of Radiation Oncology
| | - Elizabeth Gore
- Medical College of Wisconsin, Department of Radiation Oncology.,Clement J. Zablocki, VA Medical Center
| | | | - William A Hall
- Medical College of Wisconsin, Department of Radiation Oncology.,Clement J. Zablocki, VA Medical Center
| |
Collapse
|
36
|
Sánchez-Martín V, Jiménez-García L, Herranz S, Luque A, Acebo P, Amesty Á, Estévez-Braun A, de Las Heras B, Hortelano S. α-Hispanolol Induces Apoptosis and Suppresses Migration and Invasion of Glioblastoma Cells Likely via Downregulation of MMP-2/9 Expression and p38MAPK Attenuation. Front Pharmacol 2019; 10:935. [PMID: 31551765 PMCID: PMC6733979 DOI: 10.3389/fphar.2019.00935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/22/2019] [Indexed: 12/14/2022] Open
Abstract
α-Hispanolol (α-H) is a labdane diterpenoid that has been shown to induce apoptosis in several human cancer cells. However, the effect of α-H in human glioblastoma cells has not been described. In the present work, we have investigated the effects of α-H on apoptosis, migration, and invasion of human glioblastoma cells with the aim of identifying the molecular targets underlying its mechanism of action. The results revealed that α-H showed significant cytotoxicity against human glioma cancer cell lines U87 and U373 in a concentration- and time-dependent manner. This effect was higher in U87 cells and linked to apoptosis, as revealed the increased percentage of sub-G1 population by cell cycle analysis and acquisition of typical features of apoptotic cell morphology. Apoptosis was also confirmed by significant presence of annexin V-positive cells and caspase activation. Pretreatment with caspase inhibitors diminishes the activities of caspase 8, 9, and 3 and maintains the percentage of viable glioblastoma cells, indicating that α-H induced cell apoptosis through both the extrinsic and the intrinsic pathways. Moreover, we also found that α-H downregulated the anti-apoptotic Bcl-2 and Bcl-xL proteins and activated the pro-apoptotic Bid and Bax proteins. On the other hand, α-H exhibited inhibitory effects on the migration and invasion of U87 cells in a concentration-dependent manner. Furthermore, additional experiments showed that α-H treatment reduced the enzymatic activities and protein levels of matrix metalloproteinase MMP-2 and MMP-9 and increased the expression of TIMP-1 inhibitor, probably via p38MAPK regulation. Finally, xenograft assays confirmed the anti-glioma efficacy of α-H. Taken together, these findings suggest that α-H may exert anti-tumoral effects in vitro and in vivo through the inhibition of cell proliferation and invasion as well as by the induction of apoptosis in human glioblastoma cells. This research describes α-H as a new drug that may improve the therapeutic efficacy against glioblastoma tumors.
Collapse
Affiliation(s)
- Vanesa Sánchez-Martín
- Unidad de Terapias Farmacológicas, Área de Genética Humana, Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Farmacología, Farmacognosia y Botánica, Facultad de Farmacia, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Lidia Jiménez-García
- Unidad de Terapias Farmacológicas, Área de Genética Humana, Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, Madrid, Spain
| | - Sandra Herranz
- Unidad de Terapias Farmacológicas, Área de Genética Humana, Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, Madrid, Spain
| | - Alfonso Luque
- Unidad de Terapias Farmacológicas, Área de Genética Humana, Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, Madrid, Spain
| | - Paloma Acebo
- Unidad de Terapias Farmacológicas, Área de Genética Humana, Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, Madrid, Spain
| | - Ángel Amesty
- Departamento de Química Orgánica, Instituto Universitario de Bio-Orgánica Antonio González, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Ana Estévez-Braun
- Departamento de Química Orgánica, Instituto Universitario de Bio-Orgánica Antonio González, Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Beatriz de Las Heras
- Departamento de Farmacología, Farmacognosia y Botánica, Facultad de Farmacia, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Sonsoles Hortelano
- Unidad de Terapias Farmacológicas, Área de Genética Humana, Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
37
|
Zhang L, Li Y, Meng W, Ni Y, Gao Y. Dynamic urinary proteomic analysis in a Walker 256 intracerebral tumor model. Cancer Med 2019; 8:3553-3565. [PMID: 31090175 PMCID: PMC6601583 DOI: 10.1002/cam4.2240] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 03/17/2019] [Accepted: 04/19/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with primary and metastatic brain cancer have an extremely poor prognosis, mostly due to the late diagnosis of disease. Urine, which lacks homeostatic mechanisms, is an ideal biomarker source that accumulates early and highly sensitive changes to provide information about the early stage of disease. METHODS A rat model mimicking the local tumor growth process in the brain was established with intracerebral Walker 256 (W256) cell injection. Urine samples were collected on days 3, 5, and 8 after injection, and then analyzed by liquid chromatography coupled with tandem mass spectrometry. RESULTS In the intracerebral W256 model, no obvious clinical manifestations or abnormal magnetic resonance imaging (MRI) signals were found on days 3 or 5; at these time points, 9 proteins were changed significantly in the urine of all eight tumor rats. On day 8, when tumors were detected by MRI, 25 differential proteins were identified, including 10 that have been reported to be closely related to brain metastasis or primary tumors. The differential urinary proteome was compared with those from the subcutaneous W256 model and the intracerebral C6 model. Few differential proteins overlapped, and specific differential protein patterns were observed among the three models. CONCLUSIONS These findings demonstrate that early changes in the urine proteome can be detected in the intracerebral W256 model. The urinary proteome can reflect the difference when tumor cells with different growth characteristics are inoculated into the brain and when identical tumor cells are inoculated into different areas, specifically, the subcutis and the brain.
Collapse
Affiliation(s)
- Linpei Zhang
- Department of Biochemistry and Molecular BiologyBeijing Normal University, Gene Engineering Drug and Biotechnology Beijing Key LaboratoryBeijingChina
- BiobankThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Yuqiu Li
- Department of Biochemistry and Molecular BiologyBeijing Normal University, Gene Engineering Drug and Biotechnology Beijing Key LaboratoryBeijingChina
| | - Wenshu Meng
- Department of Biochemistry and Molecular BiologyBeijing Normal University, Gene Engineering Drug and Biotechnology Beijing Key LaboratoryBeijingChina
| | - Yanying Ni
- Department of PathologyAviation General Hospital of China Medical UniversityBeijingChina
| | - Youhe Gao
- Department of Biochemistry and Molecular BiologyBeijing Normal University, Gene Engineering Drug and Biotechnology Beijing Key LaboratoryBeijingChina
| |
Collapse
|
38
|
Bentley R, O'Cathail M, Aznar-Garcia L, Crosby V, Wilcock A, Christian J. Defining patterns of care in the management of patients with brain metastases in a large oncology centre: A single-centre retrospective audit of 236 cases. Eur J Cancer Care (Engl) 2019; 28:e13059. [PMID: 30993779 DOI: 10.1111/ecc.13059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/16/2019] [Accepted: 03/25/2019] [Indexed: 12/25/2022]
Abstract
AIMS The role of selected treatments for brain metastases (BM) is well documented; however, the prevalence of these is not. We report on the patterns of care in the management of BM in a large oncology centre. MATERIALS AND METHODS We retrospectively audited 236 cases of newly diagnosed BM from January 2016 to December 2017 by looking at 2 years of radiology reports and gathered data on primary site, survival, treatment received, palliative care input and brain metastases-related admissions. RESULTS Eighty-two per cent of cases were related to lung, breast and melanoma primaries. Half of patients received a form of treatment with the other half receiving best supportive care. Of these, whole-brain radiotherapy (39%) and stereotactic radiosurgery (40%) were the most common treatment modalities. Most common reasons for admissions were headaches, seizures, weakness and confusion. CONCLUSION This is the first study in the UK that gives an in-depth overview of the real-world management of brain metastases. We have demonstrated the prevalence of treatment across the spectrum of brain metastases patients. Radiotherapy is the mainstay of treatment in nearly 80% of cases; however, care needs to be taken in ensuring that SRS is offered to those who are suitable.
Collapse
Affiliation(s)
- Rebecca Bentley
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Micheal O'Cathail
- Department of Oncology and Radiotherapy, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Luis Aznar-Garcia
- Department of Oncology and Radiotherapy, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Vincent Crosby
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Wilcock
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Judith Christian
- Department of Oncology and Radiotherapy, Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
39
|
Izraely S, Ben-Menachem S, Sagi-Assif O, Telerman A, Zubrilov I, Ashkenazi O, Meshel T, Maman S, Orozco JI, Salomon MP, Marzese DM, Pasmanik-Chor M, Pikarski E, Ehrlich M, Hoon DS, Witz IP. The metastatic microenvironment: Melanoma-microglia cross-talk promotes the malignant phenotype of melanoma cells. Int J Cancer 2018; 144:802-817. [DOI: 10.1002/ijc.31745] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/24/2018] [Accepted: 06/27/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Sivan Izraely
- Department of Cell Research and Immunology, George S. Wise Faculty of Life Sciences; Tel Aviv University; Tel Aviv Israel
| | - Shlomit Ben-Menachem
- Department of Cell Research and Immunology, George S. Wise Faculty of Life Sciences; Tel Aviv University; Tel Aviv Israel
| | - Orit Sagi-Assif
- Department of Cell Research and Immunology, George S. Wise Faculty of Life Sciences; Tel Aviv University; Tel Aviv Israel
| | - Alona Telerman
- Department of Cell Research and Immunology, George S. Wise Faculty of Life Sciences; Tel Aviv University; Tel Aviv Israel
| | - Inna Zubrilov
- Department of Cell Research and Immunology, George S. Wise Faculty of Life Sciences; Tel Aviv University; Tel Aviv Israel
| | - Ofir Ashkenazi
- Department of Cell Research and Immunology, George S. Wise Faculty of Life Sciences; Tel Aviv University; Tel Aviv Israel
| | - Tsipi Meshel
- Department of Cell Research and Immunology, George S. Wise Faculty of Life Sciences; Tel Aviv University; Tel Aviv Israel
| | - Shelly Maman
- Department of Cell Research and Immunology, George S. Wise Faculty of Life Sciences; Tel Aviv University; Tel Aviv Israel
| | - Javier I.J. Orozco
- Department of Translational Molecular Medicine; John Wayne Cancer Institute at Providence Saint John's Health Center; Santa Monica CA
| | - Matthew P. Salomon
- Department of Translational Molecular Medicine; John Wayne Cancer Institute at Providence Saint John's Health Center; Santa Monica CA
| | - Diego M. Marzese
- Department of Translational Molecular Medicine; John Wayne Cancer Institute at Providence Saint John's Health Center; Santa Monica CA
| | - Metsada Pasmanik-Chor
- Bioinforamatics Unit, The George S. Wise Faculty of Life Science; Tel Aviv University; Tel-Aviv Israel
| | - Eli Pikarski
- The Lautenberg Center for Immunology and Cancer Research; Institute for Medical Research Israel Canada (IMRIC), Hebrew University-Hadassah Medical School; Jerusalem Israel
| | - Marcelo Ehrlich
- Department of Cell Research and Immunology, George S. Wise Faculty of Life Sciences; Tel Aviv University; Tel Aviv Israel
| | - Dave S.B. Hoon
- Department of Translational Molecular Medicine; John Wayne Cancer Institute at Providence Saint John's Health Center; Santa Monica CA
| | - Isaac P. Witz
- Department of Cell Research and Immunology, George S. Wise Faculty of Life Sciences; Tel Aviv University; Tel Aviv Israel
| |
Collapse
|
40
|
Mathis T, Jardel P, Loria O, Delaunay B, Nguyen AM, Lanza F, Mosci C, Caujolle JP, Kodjikian L, Thariat J. New concepts in the diagnosis and management of choroidal metastases. Prog Retin Eye Res 2018; 68:144-176. [PMID: 30240895 DOI: 10.1016/j.preteyeres.2018.09.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 12/17/2022]
Abstract
The most frequent site of ocular metastasis is the choroid. The occurrence of choroidal metastases has increased steadily due to the longer survival of metastatic patients and the improvement of diagnostic tools. Fundoscopy, ultrasonography, and fluorescein angiography are now complemented by indocyanine green angiography and optical coherence tomography. Choroidal tumor biopsy may also confirm the metastatic nature of the tumor and help to determine the site of the primary malignancy. There is currently no consensus on the treatment strategy. Most patients have a limited life expectancy and for these complex treatments are generally not recommended. However, recent advances in systemic therapy have significantly improved survival of certain patients who may benefit from an aggressive ocular approach that could preserve vision. Although external beam radiation therapy is the most widely used treatment, more advanced forms of radiotherapy that are associated with fewer side effects can be proposed in select cases. In patients with a shorter life expectancy, systemic therapies such as those targeting oncogenic drivers, or immunotherapy can induce a regression of the choroidal metastases, and may be sufficient to temporarily decrease visual symptoms. However, they often acquire resistance to systemic treatment and ocular relapse usually requires radiotherapy for durable control. Less invasive office-based treatments, such as photodynamic therapy and intravitreal injection of anti-VEGF, may also help to preserve vision while reducing time spent in medical settings for patients in palliative care. The aim of this review is to summarize the current knowledge on choroidal metastases, with emphasis on the most recent findings in epidemiology, pathogenesis, diagnosis and treatment.
Collapse
Affiliation(s)
- Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Pauline Jardel
- Department of Radiation Oncology, Chicoutimi Hospital, Saguenay, QC, Canada
| | - Olivier Loria
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Benoit Delaunay
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Anh-Minh Nguyen
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Francesco Lanza
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | - Carlo Mosci
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | | | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Juliette Thariat
- Department of Radiation Therapy, Centre François Baclesse - ARCHADE, Unicaen - Normandie University, 14000, Caen, France.
| |
Collapse
|
41
|
Meng Y, Suppiah S, Surendrakumar S, Bigioni L, Lipsman N. Low-Intensity MR-Guided Focused Ultrasound Mediated Disruption of the Blood-Brain Barrier for Intracranial Metastatic Diseases. Front Oncol 2018; 8:338. [PMID: 30211117 PMCID: PMC6121246 DOI: 10.3389/fonc.2018.00338] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/03/2018] [Indexed: 12/19/2022] Open
Abstract
Low-intensity MR-guided focused ultrasound in combination with intravenously injected microbubbles is a promising platform for drug delivery to the central nervous system past the blood-brain barrier. The blood-brain barrier is a key bottleneck for cancer therapeutics via limited inter- and intracellular transport. Further, drugs that cross the blood-brain barrier when delivered in a spatially nonspecific way, result in adverse effects on normal brain tissue, or at high concentrations, result in increasing risks to peripheral organs. As such, various anti-cancer drugs that have been developed or to be developed in the future would benefit from a noninvasive, temporary, and repeatable method of targeted opening of the blood-brain barrier to treat metastatic brain diseases. MR-guided focused ultrasound is a potential solution to these design requirements. The safety, feasibility and preliminary efficacy of MRgFUS aided delivery have been demonstrated in various animal models. In this review, we discuss this preclinical evidence, mechanisms of focused ultrasound mediated blood-brain barrier opening, and translational efforts to neuro-oncology patients.
Collapse
Affiliation(s)
- Ying Meng
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Suganth Suppiah
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Shanan Surendrakumar
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Luca Bigioni
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| |
Collapse
|
42
|
Abstract
Brain metastases (BM) are the most commonly diagnosed type of central nervous system tumor in the United States. Estimates of the frequency of BM vary significantly, as there is no nationwide reporting system for metastases. BM may be the first sign of a previously undiagnosed cancer, or occur years or decades after the primary cancer was diagnosed. Incidence of BM varies significantly by primary cancer site. Lung, breast, and melanoma continue to be the leading cause of BM. These tumors are increasingly more common as new therapeutics, advanced imaging, and improved screening have led to lengthened survival after primary diagnosis for cancer patients. BM are difficult to treat, and for most individuals the diagnosis of BM generally portends a poor prognosis.
Collapse
Affiliation(s)
- Quinn T Ostrom
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Christina Huang Wright
- Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, United States
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
| |
Collapse
|
43
|
Roux A, Botella C, Still M, Zanello M, Dhermain F, Metellus P, Pallud J. Posterior Fossa Metastasis-Associated Obstructive Hydrocephalus in Adult Patients: Literature Review and Practical Considerations from the Neuro-Oncology Club of the French Society of Neurosurgery. World Neurosurg 2018; 117:271-279. [PMID: 29935321 DOI: 10.1016/j.wneu.2018.06.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is no consensus concerning the management of adult patients with posterior fossa metastasis-associated obstructive hydrocephalus, especially regarding surgical procedures. A literature review was performed to assess the surgical strategy in the management of patients with metastatic brain tumor. METHODS A literature search was conducted of PubMed in November 2017 to identify all studies concerning brain metastases and obstructive hydrocephalus in English. All studies (except case reports and pediatric studies) between December 1953 and November 2017 that were about posterior fossa metastasis-associated obstructive hydrocephalus in adult patients were eligible. Eligible studies were classified by level of evidence. We assessed epidemiology, clinical and imaging findings, neurosurgical management, and prognosis of adult patients with posterior fossa metastasis-associated obstructive hydrocephalus. We suggest some practical considerations and a management decision tree on behalf of the Neuro-oncology Club of the French Society of Neurosurgery, with evidence-based analysis. RESULTS Direct surgical resection could be considered for patients with asymptomatic obstructive hydrocephalus, and endoscopic third ventriculostomy seems to be a reasonable procedure for patients with symptomatic obstructive hydrocephalus. A ventriculoperitoneal or atrial shunt seems to be a valid alternative when patients have a history of central nervous system infection or ventricular hemorrhage, leptomeningeal carcinomatosis, or unfavorable anatomy for an endoscopic third ventriculostomy to be performed. CONCLUSIONS The Neuro-oncology Club of the French Society of Neurosurgery suggests a prospective assessment of these neurosurgical procedures to compare their safety and efficacy.
Collapse
Affiliation(s)
- Alexandre Roux
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Céline Botella
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Neurosurgery, Henri-Mondor Hospital, Créteil, France
| | - Megan Still
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marc Zanello
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Frédéric Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - Philippe Metellus
- Department of Neurosurgery, Clairval Private Hospital, Ramsay-Générale de Santé, Marseille, France
| | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France.
| |
Collapse
|
44
|
Barrett TF, Gill CM, Miles BA, Iloreta AMC, Bakst RL, Fowkes M, Brastianos PK, Bederson JB, Shrivastava RK. Brain metastasis from squamous cell carcinoma of the head and neck: a review of the literature in the genomic era. Neurosurg Focus 2018; 44:E11. [DOI: 10.3171/2018.2.focus17761] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Squamous cell carcinoma of the head and neck (HNSCC) affects nearly 500,000 individuals globally each year. With the rise of human papillomavirus (HPV) in the general population, clinicians are seeing a concomitant rise in HPV-related HNSCC. Notably, a hallmark of HPV-related HNSCC is a predilection for unique biological and clinical features, which portend a tendency for hematogenous metastasis to distant locations, such as the brain. Despite the classic belief that HNSCC is restricted to local spread via passive lymphatic drainage, brain metastases (BMs) are a rare complication that occurs in less than 1% of all HNSCC cases. Time between initial diagnosis of HNSCC and BM development can vary considerably. Some patients experience more than a decade of disease-free survival, whereas others present with definitive neurological symptoms that precede primary tumor detection. The authors systematically review the current literature on HNSCC BMs and discuss the current understanding of the effect of HPV status on the risk of developing BMs in the modern genomic era.
Collapse
Affiliation(s)
| | | | | | | | | | - Mary Fowkes
- 4Pathology, Mount Sinai Medical Center, New York, New York; and
| | - Priscilla K. Brastianos
- 5Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
| | | | | |
Collapse
|
45
|
Lin CY, Cho CF, Bai ST, Liu JP, Kuo TT, Wang LJ, Lin YS, Lin CC, Lai LC, Lu TP, Hsieh CY, Chu CN, Cheng DC, Sher YP. ADAM9 promotes lung cancer progression through vascular remodeling by VEGFA, ANGPT2, and PLAT. Sci Rep 2017; 7:15108. [PMID: 29118335 PMCID: PMC5678093 DOI: 10.1038/s41598-017-15159-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 10/23/2017] [Indexed: 12/27/2022] Open
Abstract
Lung cancer has a very high prevalence of brain metastasis, which results in a poor clinical outcome. Up-regulation of a disintegrin and metalloproteinase 9 (ADAM9) in lung cancer cells is correlated with metastasis to the brain. However, the molecular mechanism underlying this correlation remains to be elucidated. Since angiogenesis is an essential step for brain metastasis, microarray experiments were used to explore ADAM9-regulated genes that function in vascular remodeling. The results showed that the expression levels of vascular endothelial growth factor A (VEGFA), angiopoietin-2 (ANGPT2), and tissue plasminogen activator (PLAT) were suppressed in ADAM9-silenced cells, which in turn leads to decreases in angiogenesis, vascular remodeling, and tumor growth in vivo. Furthermore, simultaneous high expression of ADAM9 and VEGFA or of ADAM9 and ANGPT2 was correlated with poor prognosis in a clinical dataset. These findings suggest that ADAM9 promotes tumorigenesis through vascular remodeling, particularly by increasing the function of VEGFA, ANGPT2, and PLAT.
Collapse
Affiliation(s)
- Chen-Yuan Lin
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, 404, Taiwan.,Center for Molecular Medicine, China Medical University Hospital, Taichung, 404, Taiwan.,Division of Hematology and Oncology, China Medical University Hospital, Taichung, 404, Taiwan
| | - Chia-Fong Cho
- Center for Molecular Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Shih-Ting Bai
- Center for Molecular Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Jing-Pei Liu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, 404, Taiwan
| | - Ting-Ting Kuo
- Center for Molecular Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Li-Ju Wang
- Center for Molecular Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Yu-Sen Lin
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, 404, Taiwan.,Division of Thoracic Surgery, China Medical University Hospital, Taichung, 404, Taiwan
| | - Ching-Chan Lin
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, 404, Taiwan.,Division of Hematology and Oncology, China Medical University Hospital, Taichung, 404, Taiwan
| | - Liang-Chuan Lai
- Graduate Institute of Physiology, National Taiwan University, Taipei, 106, Taiwan
| | - Tzu-Pin Lu
- Department of Public Health, National Taiwan University, Taipei, 106, Taiwan
| | - Chih-Ying Hsieh
- Center for Molecular Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Chin-Nan Chu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, 404, Taiwan.,Department of Radiation Oncology, China Medical University Hospital, Taichung, 404, Taiwan
| | - Da-Chuan Cheng
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, 404, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, 404, Taiwan
| | - Yuh-Pyng Sher
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, 404, Taiwan. .,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, 404, Taiwan. .,Center for Molecular Medicine, China Medical University Hospital, Taichung, 404, Taiwan.
| |
Collapse
|
46
|
Waters JD, Hoshide R, Jandial R. Historical perspectives on the biology of brain metastasis. Clin Exp Metastasis 2017; 34:365-367. [DOI: 10.1007/s10585-017-9859-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
|
47
|
Estimating the annual frequency of synchronous brain metastasis in the United States 2010–2013: a population-based study. J Neurooncol 2017; 134:55-64. [DOI: 10.1007/s11060-017-2516-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/25/2017] [Indexed: 01/20/2023]
|
48
|
Li QX, Zhou X, Huang TT, Tang Y, Liu B, Peng P, Sun L, Wang YH, Yuan XL. The Thr300Ala variant of ATG16L1 is associated with decreased risk of brain metastasis in patients with non-small cell lung cancer. Autophagy 2017; 13:1053-1063. [PMID: 28441070 DOI: 10.1080/15548627.2017.1308997] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) often metastasizes to the brain, but identifying which patients will develop brain metastases (BM) is difficult. Macroautophagy/autophagy is critical for cancer initiation and progression. We hypothesized that genetic variants of autophagy-related genes may affect brain metastases (BM) in NSCLC patients. We genotyped 16 single nucleotide polymorphisms (SNPs) in 7 autophagy-related (ATG) genes (ATG3, ATG5, ATG7, ATG10, ATG12, ATG16L1, and MAP1LC3/LC3) by using DNA from blood samples of 323 NSCLC patients. Further, we evaluated the potential associations of these genes with subsequent BM development. Lung cancer cell lines stably transfected with ATG16L1: rs2241880 (T300A) were established. Mouse models of brain metastasis were developed using cells transfected with ATG16L1-300T or ATG16L1-300A. ATG10: rs10036653 and ATG16L1: rs2241880 were significantly associated with a decreased risk of BM (respective hazard ratios [HRs]=0.596, 95% confidence interval [CI] 0.398-0.894, P = 0.012; and HR = 0. 655, 95% CI 0.438-0.978, P = 0.039, respectively). ATG12: rs26532 was significantly associated with an increased risk of BM (HR=1.644, 95% CI 1.049-2.576, P = 0.030). Invasion and migration assays indicated that transfection with ATG16L1-300T (vs. 300A) stimulated the migration of A549 cells. An in vivo metastasis assay revealed that transfection with ATG16L1-300T (vs. 300A) significantly increased brain metastasis. Our results indicate that genetic variations in autophagy-related genes can predict BM and that genome analysis would facilitate stratification of patients for BM prevention trials.
Collapse
Affiliation(s)
- Qian-Xia Li
- a Department of Oncology , Tongji Hospital, Huazhong University of Science and Technology , Wuhan , Hubei Province , China
| | - Xiao Zhou
- a Department of Oncology , Tongji Hospital, Huazhong University of Science and Technology , Wuhan , Hubei Province , China
| | - Ting-Ting Huang
- a Department of Oncology , Tongji Hospital, Huazhong University of Science and Technology , Wuhan , Hubei Province , China
| | - Yang Tang
- a Department of Oncology , Tongji Hospital, Huazhong University of Science and Technology , Wuhan , Hubei Province , China
| | - Bo Liu
- a Department of Oncology , Tongji Hospital, Huazhong University of Science and Technology , Wuhan , Hubei Province , China
| | - Ping Peng
- a Department of Oncology , Tongji Hospital, Huazhong University of Science and Technology , Wuhan , Hubei Province , China
| | - Li Sun
- a Department of Oncology , Tongji Hospital, Huazhong University of Science and Technology , Wuhan , Hubei Province , China
| | - Yi-Hua Wang
- b Biological Sciences , Faculty of Natural & Environmental Sciences, University of Southampton , Southampton , UK
| | - Xiang-Lin Yuan
- a Department of Oncology , Tongji Hospital, Huazhong University of Science and Technology , Wuhan , Hubei Province , China
| |
Collapse
|
49
|
Clinical outcome and molecular characterization of brain metastases from esophageal and gastric cancer: a systematic review. Med Oncol 2017; 34:62. [DOI: 10.1007/s12032-017-0919-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/13/2017] [Indexed: 01/07/2023]
|
50
|
Lowery FJ, Yu D. Brain metastasis: Unique challenges and open opportunities. Biochim Biophys Acta Rev Cancer 2016; 1867:49-57. [PMID: 27939792 DOI: 10.1016/j.bbcan.2016.12.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/03/2016] [Accepted: 12/05/2016] [Indexed: 12/29/2022]
Abstract
The metastasis of cancer to the central nervous system (CNS) remains a devastating clinical reality, carrying an estimated survival time of less than one year in spite of recent therapeutic breakthroughs for other disease contexts. Advances in brain metastasis research are hindered by a number of factors, including its complicated nature and the difficulty of modeling metastatic cancer growth in the unique brain microenvironment. In this review, we will discuss the clinical challenge, and compare the merits and limitations of the available models for brain metastasis research. Additionally, we will specifically address current knowledge on how brain metastases take advantage of the unique brain environment to benefit their own growth. Finally, we will explore the distinctive metabolic and chemical characteristics of the brain and how these paradoxically represent barriers to establishment of brain metastasis, but also provide ample supplies for metastatic cells' growth in the brain. We envision that multi-disciplinary innovative approaches will open opportunities for the field to make breakthroughs in tackling unique challenges of brain metastasis.
Collapse
Affiliation(s)
- Frank J Lowery
- Department of Molecular and Cellular Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Dihua Yu
- Department of Molecular and Cellular Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
| |
Collapse
|