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Ishikawa Y, Teramura S, Nakano H, Ito K, Yamada T. Prognostic Factors and Impact of Therapeutic Intervention in Patients With Brain Metastases at the Initial Presentation. Cureus 2024; 16:e60368. [PMID: 38751406 PMCID: PMC11095982 DOI: 10.7759/cureus.60368] [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] [Accepted: 05/14/2024] [Indexed: 05/18/2024] Open
Abstract
Background Studies investigating the normative characteristics and prognosis of patients diagnosed with brain metastases (BMs) at the onset of cancer are scarce. Therefore, we analyzed real-world treatment options. Methodology This retrospective study enrolled 112 patients newly diagnosed with BM between May 2006 and October 2021. The variables examined included patients' age, sex, recurrence split analysis, Glasgow prognostic score (GPS), number of lesions, tumor size, peripheral brain tumor edema, targeted therapy, supportive care, chemotherapy, and date of onset. Prognostic factors were assessed using recursive partitioning analysis (RPA), graded prognostic assessment (GPA) scores, and GPS scoring, with magnetic resonance imaging (MRI) and computed tomography (CT) studies. Primary treatment comprised whole-brain radiotherapy (WBRT), with regular follow-up. Results Data from 112 survivors were analyzed, revealing a median overall survival time (MST) of 7.7 months, with some patients surviving beyond 24 months post-WBRT. Univariate analysis revealed associations between MST and RPA class, GPS, and treatment modalities (including targeted therapy and chemotherapy). RPA class 2, GPS of 0, and targeted therapy were identified as predictors of better prognosis in the multivariate analysis. In the subgroup not receiving chemotherapy, no significant difference in prognosis was seen between groups with or without WBRT. Conclusions Alongside RPA, scores indicating chronic inflammatory changes, including GPS, were confirmed as crucial prognostic factors. Moreover, treatment with molecularly targeted drugs correlated with favorable prognoses. The treatment-naïve group exhibited poorer prognoses, and WBRT was not deemed a significant prognostic factor in the chemotherapy group.
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Affiliation(s)
- Yojiro Ishikawa
- Division of Radiology, Tohoku Medical and Pharmaceutical University, Sendai, JPN
| | - Satoshi Teramura
- Division of Radiology, Tohoku Medical and Pharmaceutical University, Sendai, JPN
| | - Hiroshi Nakano
- Department of Radiation Oncology, Graduate School of Medicine, Tohoku University, Sendai, JPN
| | - Kengo Ito
- Division of Radiology, Tohoku Medical and Pharmaceutical University, Sendai, JPN
| | - Takayuki Yamada
- Division of Radiology, Tohoku Medical and Pharmaceutical University, Sendai, JPN
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Li C, Zheng H, Xiong J, Huang Y, Li H, Jin H, Ai S, Wang Y, Su T, Sun G, Xiao X, Fu T, Wang Y, Gao X, Liang P. miR-596-3p suppresses brain metastasis of non-small cell lung cancer by modulating YAP1 and IL-8. Cell Death Dis 2022; 13:699. [PMID: 35961957 PMCID: PMC9374706 DOI: 10.1038/s41419-022-05062-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/22/2022] [Accepted: 07/04/2022] [Indexed: 01/21/2023]
Abstract
Brain metastasis (BM) frequently occurs in advanced non-small cell lung cancer (NSCLC) and is associated with poor clinical prognosis. Due to the location of metastatic lesions, the surgical resection is limited and the chemotherapy is ineffective because of the existence of the blood brain barrier (BBB). Therefore, it is essential to enhance our understanding about the underlying mechanisms associated with brain metastasis in NSCLC. In the present study, we explored the RNA-Seq data of brain metastasis cells from the GEO database, and extracted RNA collected from primary NSCLC tumors as well as paired brain metastatic lesions followed by microRNA PCR array. Meanwhile, we improved the in vivo model and constructed a cancer stem cell-derived transplantation model of brain metastasis in mice. Our data indicated that the level of miR-596-3p is high in primary NSCLC tumors, but significantly downregulated in the brain metastatic lesion. The prediction target of microRNA suggested that miR-596-3p was considered to modulate two genes essential in the brain invasion process, YAP1 and IL-8 that restrain the invasion of cancer cells and permeability of BBB, respectively. Moreover, in vivo experiments suggested that our model mimics the clinical aspect of NSCLC and improves the success ratio of brain metastasis model. The results demonstrated that miR-596-3p significantly inhibited the capacity of NSCLC cells to metastasize to the brain. Furthermore, these finding elucidated that miR-596-3p exerts a critical role in brain metastasis of NSCLC by modulating the YAP1-IL8 network, and this miRNA axis may provide a potential therapeutic strategy for brain metastasis.
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Affiliation(s)
- Chenlong Li
- grid.412651.50000 0004 1808 3502Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, 150001 Heilongjiang China
| | - Hongshan Zheng
- grid.412651.50000 0004 1808 3502Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, 150001 Heilongjiang China
| | - Jinsheng Xiong
- grid.412651.50000 0004 1808 3502Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, 150001 Heilongjiang China
| | - Yuxin Huang
- Heilongjiang Tuomeng Technology Co.Ltd, Harbin, 150040 Heilongjiang China
| | - Haoyang Li
- grid.45672.320000 0001 1926 5090Computational Bioscience Research Center, King Abdullah University of Science and Technology (KAUST), Thuwal, 23955 Saudi Arabia ,grid.64924.3d0000 0004 1760 5735Cancer Systems Biology Center, the China-Japan Union Hospital, Jilin University, Changchun, 130001 Jilin China ,grid.64924.3d0000 0004 1760 5735College of Computer Science and Technology, Jilin University, Changchun, 130001 Jilin China
| | - Hua Jin
- grid.412651.50000 0004 1808 3502Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, 150001 Heilongjiang China
| | - Siqi Ai
- grid.412651.50000 0004 1808 3502Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, 150001 Heilongjiang China
| | - Yingjie Wang
- grid.412651.50000 0004 1808 3502Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, 150001 Heilongjiang China
| | - Tianqi Su
- grid.412651.50000 0004 1808 3502Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, 150001 Heilongjiang China
| | - Guiyin Sun
- grid.412651.50000 0004 1808 3502Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, 150001 Heilongjiang China
| | - Xu Xiao
- grid.412651.50000 0004 1808 3502Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, 150001 Heilongjiang China
| | - Tianjiao Fu
- grid.412651.50000 0004 1808 3502Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, 150001 Heilongjiang China
| | - Yujie Wang
- grid.412651.50000 0004 1808 3502Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, 150001 Heilongjiang China
| | - Xin Gao
- grid.45672.320000 0001 1926 5090Computational Bioscience Research Center, King Abdullah University of Science and Technology (KAUST), Thuwal, 23955 Saudi Arabia
| | - Peng Liang
- grid.412651.50000 0004 1808 3502Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, 150001 Heilongjiang China
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The Usefulness of Prognostic Tools in Breast Cancer Patients with Brain Metastases. Cancers (Basel) 2022; 14:cancers14051099. [PMID: 35267407 PMCID: PMC8909185 DOI: 10.3390/cancers14051099] [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: 01/25/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 12/09/2022] Open
Abstract
Simple Summary Due to the variability of an individual’s prognosis and the variety of treatment options available to breast cancer (BC) patients with brain metastases (BM), establishing the proper therapy is challenging. Since 1997, several prognostic tools for BC patients with BM have been proposed with variable precision in determining the overall survival. The majority of prognostic tools include the performance status, the age at BM diagnosis, the number of BM, the primary tumor phenotype/genotype and the extracranial metastases status as an outcome of systemic therapy efficacy. It is necessary to update the prognostic indices used by physicians as advances in local and systemic treatments develop and change the parameters of survival. Free access to prognostic tools online may increase their routine adoption in clinical practice. Clinical trials on BC patients with BM remains a broad field for the application of prognostic tools. Abstract Background: Determining the proper therapy is challenging in breast cancer (BC) patients with brain metastases (BM) due to the variability of an individual’s prognosis and the variety of treatment options available. Several prognostic tools for BC patients with BM have been proposed. Our review summarizes the current knowledge on this topic. Methods: We searched PubMed for prognostic tools concerning BC patients with BM, published from January 1997 (since the Radiation Therapy Oncology Group developed) to December 2021. Our criteria were limited to adults with newly diagnosed BM regardless of the presence or absence of any leptomeningeal metastases. Results: 31 prognostic tools were selected: 13 analyzed mixed cohorts with some BC cases and 18 exclusively analyzed BC prognostic tools. The majority of prognostic tools in BC patients with BM included: the performance status, the age at BM diagnosis, the number of BM (rarely the volume), the primary tumor phenotype/genotype and the extracranial metastasis status as a result of systemic therapy. The prognostic tools differed in their specific cut-off values. Conclusion: Prognostic tools have variable precision in determining the survival of BC patients with BM. Advances in local and systemic treatment significantly affect survival, therefore, it is necessary to update the survival indices used depending on the type and period of treatment.
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Owusuaa C, Dijkland SA, Nieboer D, van der Heide A, van der Rijt CCD. Predictors of Mortality in Patients with Advanced Cancer-A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:328. [PMID: 35053493 PMCID: PMC8774229 DOI: 10.3390/cancers14020328] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/31/2021] [Accepted: 01/07/2022] [Indexed: 02/01/2023] Open
Abstract
To timely initiate advance care planning in patients with advanced cancer, physicians should identify patients with limited life expectancy. We aimed to identify predictors of mortality. To identify the relevant literature, we searched Embase, MEDLINE, Cochrane Central, Web of Science, and PubMed databases between January 2000-April 2020. Identified studies were assessed on risk-of-bias with a modified QUIPS tool. The main outcomes were predictors and prediction models of mortality within a period of 3-24 months. We included predictors that were studied in ≥2 cancer types in a meta-analysis using a fixed or random-effects model and summarized the discriminative ability of models. We included 68 studies (ranging from 42 to 66,112 patients), of which 24 were low risk-of-bias, and 39 were included in the meta-analysis. Using a fixed-effects model, the predictors of mortality were: the surprise question, performance status, cognitive impairment, (sub)cutaneous metastases, body mass index, comorbidity, serum albumin, and hemoglobin. Using a random-effects model, predictors were: disease stage IV (hazard ratio [HR] 7.58; 95% confidence interval [CI] 4.00-14.36), lung cancer (HR 2.51; 95% CI 1.24-5.06), ECOG performance status 1+ (HR 2.03; 95% CI 1.44-2.86) and 2+ (HR 4.06; 95% CI 2.36-6.98), age (HR 1.20; 95% CI 1.05-1.38), male sex (HR 1.24; 95% CI 1.14-1.36), and Charlson comorbidity score 3+ (HR 1.60; 95% CI 1.11-2.32). Thirteen studies reported on prediction models consisting of different sets of predictors with mostly moderate discriminative ability. To conclude, we identified reasonably accurate non-tumor specific predictors of mortality. Those predictors could guide in developing a more accurate prediction model and in selecting patients for advance care planning.
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Affiliation(s)
- Catherine Owusuaa
- Department of Medical Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands;
| | - Simone A. Dijkland
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (S.A.D.); (D.N.); (A.v.d.H.)
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (S.A.D.); (D.N.); (A.v.d.H.)
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; (S.A.D.); (D.N.); (A.v.d.H.)
| | - Carin C. D. van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands;
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Gupta S, Singh S, Chophy A, Nair S, Ahuja R, Kusum K, Joseph D, Arora R, Gupta A, Gupta M. Analysis of prognostic factors in patients with brain metastases affecting survival. J Egypt Natl Canc Inst 2022; 34:45. [PMID: 36316594 PMCID: PMC9628477 DOI: 10.1186/s43046-022-00146-z] [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: 01/25/2022] [Accepted: 08/11/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Brain metastases (BM) are associated with dismal prognosis as they cause significant morbidity and affect the quality of life of patients. Management of BM depends on the following factors: age, patient performance, size and the number of lesions, location of the tumor, comorbidities, primary tumor type, and extracranial disease burden. In the present study, the pattern of occurrence, clinical characteristics, treatment outcome of brain metastases, and factors, tumor characteristics, and treatment that may impact BM patients' overall survival were analyzed. METHODS Retrospective analysis of medical records of 116 patients with histologically proven primary site solid tumors with brain metastases was done in the present study. Clinicoradiological and pathological parameters were documented. The relationship between variables and outcome was assessed by univariate analysis using the Cox proportional regression model to reach a significance of p < 0.05, to determine independent predictors of overall survival. RESULTS One hundred sixteen patients of BM from various solid malignancies were included. Age ranged from 18 to 81 years (median 53.5). One hundred four patients received WBRT with a dose range of 8-40Gy/1-15fr, 7 received SRS with a dose of 18-24Gy depending on the size of the metastatic lesion, and 2 received SRT 27-33Gy/3fr. At the time of final analysis, 47 patients with BM had expired, 60 were lost to follow-up, and 9 were alive. Median survival was 8.25 (0.5-32.5 months) months. Female gender (χ2 = 8.423; p = 0.015), RPA I (χ2 = 9.353; p = 0.05), and metachronous BM (χ2 = 3.793; p = 0.03) were associated with better survival. Patients with age 41-50 years, adenocarcinoma lung histology, and supratentorial location survived more than 2 years but did not show any statistical significance. CONCLUSION Brain metastases portend a very dismal prognosis. Certain clinicoradiological and pathologic factors have been identified to affect survival. More prospective multicentric trials, with a larger sample size, need to be conducted to assess the benefit of radiation in patients with limited life expectancy and identify prognostic and predictive factors for survival.
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Affiliation(s)
- Sweety Gupta
- Department of Radiation Oncology, AIIMS Rishikesh, Rishikesh, India
| | - Sumit Singh
- Department of Radiation Oncology, AIIMS Rishikesh, Rishikesh, India
| | - Atokali Chophy
- Department of Radiation Oncology, AIIMS Rishikesh, Rishikesh, India
| | - Sharanya Nair
- Department of Radiation Oncology, AIIMS Rishikesh, Rishikesh, India
| | - Rachit Ahuja
- Department of Radiation Oncology, AIIMS Rishikesh, Rishikesh, India
| | - K. Kusum
- College of Nursing, AIIMS Rishikesh, Rishikesh, India
| | - Deepa Joseph
- Department of Radiation Oncology, AIIMS Rishikesh, Rishikesh, India
| | - Rajnish Arora
- Department of Neurosurgery, AIIMS Rishikesh, Rishikesh, India
| | - Amit Gupta
- Department of Surgery, AIIMS Rishikesh, Rishikesh, India
| | - Manoj Gupta
- Department of Radiation Oncology, AIIMS Rishikesh, Rishikesh, India
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Sas-Korczynska B, Rucinska M. WBRT for brain metastases from non-small cell lung cancer: for whom and when?-Contemporary point of view. J Thorac Dis 2021; 13:3246-3257. [PMID: 34164217 PMCID: PMC8182552 DOI: 10.21037/jtd-2019-rbmlc-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The incidence of brain metastases (BM) is estimated between 20% and 40% of patients with solid cancer. The most common cause of this failure is lung cancer, and in locally advanced non-small cell lung cancer (NSCLC) BM represent a common site of relapse in 30-55% cases. The basic criteria of therapeutic decision-making are based on the significant prognostic factors which are components of prognostic scores. The standard approach to treatment of BM from NSCLC include whole brain radiotherapy (WBRT) which is used as adjuvant modality after local therapy (surgery or stereotactic radiosurgery) or as primary treatment and it remains the primary modality of treatment for patients with multiple metastases. WBRT is also used in combination with systemic therapy. The aim of presented review of literature is trying to answer which patients with BM from NSCLC should receive WBRT and when it could be omitted. There were presented the aspects of application of WBRT in relation to (I) choice between WBRT or the best supportive care and (II) employment of WBRT in combination with local treatment modalities [surgical resection or stereotactic radio-surgery (SRS)] and/or with systemic therapy. According to data from literature we concluded that the most important factor that needs to be considered when assessing the suitability of a patient for WBRT is the patient's prognosis based on the Lung-molGPA score. WBRT should be applied in treatment of multiple BM from lung cancer in patients with favourable prognosis and in in patients with presence of EML4-ALK translocation before therapy with crizotinib. Whereas WBRT could be omitted in patients with poor prognosis and after primary SRS.
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Affiliation(s)
- Beata Sas-Korczynska
- Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland.,Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Monika Rucinska
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland.,Department of Oncology, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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Toraih EA, Hussein MH, Zerfaoui M, Attia AS, Marzouk Ellythy A, Mostafa A, Ruiz EML, Shama MA, Russell JO, Randolph GW, Kandil E. Site-Specific Metastasis and Survival in Papillary Thyroid Cancer: The Importance of Brain and Multi-Organ Disease. Cancers (Basel) 2021; 13:cancers13071625. [PMID: 33915699 PMCID: PMC8037301 DOI: 10.3390/cancers13071625] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction-heterogeneity in clinical outcomes and survival was observed in patients with papillary thyroid cancer (PTC) and distant metastases. Here, we investigated the effect of distant metastases sites on survival in PTC patients. Methods-patients with a diagnosis of PTC and known metastases were identified using the Surveillance, Epidemiology, and End Results database (1975-2016). Univariate and multivariate Cox regression analyses were performed to analyze the effect of distant metastases sites on thyroid cancer-specific survival (TCSS) and overall survival (OS). Results-from 89,694 PTC patients, 1819 (2%) developed distant metastasis at the initial diagnosis, of whom 26.3% presented with the multiple-organ disease. The most common metastatic sites were lung (53.4%), followed by bone (28.1%), liver (8.3%), and brain (4.7%). In metastatic patients, thyroid cancer-specific death accounted for 73.2%. Kaplan-Meier curves showed decreased OS in patients with metastases to the brain (median OS = 5 months) and liver (median OS = 6 months) compared to lung (median OS = 10 months) and bone (median OS = 23 months). Moreover, multiple organ metastasis had a higher mortality rate (67.4%) compared to single organ metastasis (51.2%, p < 0.001). Using multivariate analysis, risk factors that significantly influence TCSS and OS were male gender (HR = 1.86, 95% CI = 1.17-2.94, p < 0.001, and HR = 1.90, 95% CI = 1.40-2.57, p = 0.009), higher tumor grade (HR = 7.31, 95% CI = 2.13-25.0, p < 0.001 and HR = 4.76, 95% CI = 3.93-5.76, p < 0.001), multiple organ involvement (HR = 6.52, 95% CI = 1.50-28.39, p = 0.026 and HR = 5.08, 95% CI = 1.21-21.30, p = 0.013), and brain metastasis (HR = 1.82, 95% CI = 1.15-2.89, p < 0.001 and HR = 4.21, 95% CI = 2.20-8.07, p = 0.010). Conclusion-the pattern of distant metastatic organ involvement was associated with variability in OS in PTC. Multi-organ metastasis and brain involvement are associated with lower survival rates in PTC. Knowledge of the patterns of distant metastasis is crucial to personalize the treatment and follow-up strategies.
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Affiliation(s)
- Eman A. Toraih
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
- Genetics Unit, Department of Histology and Cell Biology, Suez Canal University, Ismailia 41522, Egypt
- Correspondence: (E.A.T.); (E.K.); Tel.: +1-504-988-7407 (E.A.T.); Fax: +1-504-988-4762 (E.A.T.)
| | - Mohammad H. Hussein
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
| | - Mourad Zerfaoui
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
| | - Abdallah S. Attia
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
| | | | - Arwa Mostafa
- Tulane University School of Medicine, New Orleans, LA 70112, USA; (A.M.E.); (A.M.)
| | - Emmanuelle M. L. Ruiz
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
| | - Mohamed Ahmed Shama
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
| | - Jonathon O. Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, MD 21287, USA;
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA 02115, USA;
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
- Correspondence: (E.A.T.); (E.K.); Tel.: +1-504-988-7407 (E.A.T.); Fax: +1-504-988-4762 (E.A.T.)
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Patil R, Pandit P, Palwe V, Kate S, Gandhe S, Patil R, Ramesh YV, Nagarkar R. Evaluation of Prognostic Factors that Affect Survival Outcomes of Breast Cancer Patients with Brain Metastases: A Single Institutional Experience. Eur J Breast Health 2020; 17:62-67. [PMID: 33796832 DOI: 10.4274/ejbh.2020.5969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022]
Abstract
Objective This study aimed to evaluate various prognostic factors that play a vital role in stratifying and guiding tailored treatment strategies and survival outcome in breast cancer patients with brain metastases (BM). Materials and Methods Data regarding demography, clinical presentation, molecular subtypes, risk-stratification, treatment details, and outcomes were retrieved from medical records. All time-to-event (survival) outcomes were analyzed by Kaplan-Meir method and compared using log-rank test. Univariate and multivariate analysis of relevant prognostic factors were performed and p-values ≤0.05 were considered statistically significant. Results A total of 88 patients (median age: 50 years) were included for this study. The median follow-up time of all surviving patients was ~20 months. During the follow-up, 82 (93.1%) patients died. The median survival of all patients was 12 months, with 1-year and 2-year overall survival (OS) rate of 51% and 22%, respectively. Based on univariate analysis, statistically significant prognostic factors for OS were molecular subtypes, number of BM, and Karnofsky Performance Status (KPS); however, number of BM and KPS emerged as independent predictors of survival based on multivariate analysis. Conclusion We conclude that, there are other important prognostic factor, such as number of BM, which may affect the OS of these patients, in addition to variables included in the diagnosis-specific graded prognostic assessment score. Prospective studies evaluating these factors are necessary to further refine the stratification of patients, which will aid the initiation of appropriate treatment to improve the OS of patients.
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Affiliation(s)
- Roshankumar Patil
- Department of Radiation Oncology, HCG Manavata Cancer Centre, Maharashtra, India
| | - Prakash Pandit
- Department of Radiation Oncology, HCG Manavata Cancer Centre, Maharashtra, India
| | - Vijay Palwe
- Department of Radiation Oncology, HCG Manavata Cancer Centre, Maharashtra, India
| | - Shruti Kate
- Department of Medical Oncology, HCG Manavata Cancer Centre, Maharashtra, India
| | - Sucheta Gandhe
- Department of Pathology, HCG Manavata Cancer Centre, Maharashtra, India
| | - Rahul Patil
- Department of Pathology, HCG Manavata Cancer Centre, Maharashtra, India
| | | | - Raj Nagarkar
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Maharashtra, India
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Ding W, Ruan G, Zhu J, Tu C, Li Z. Metastatic site discriminates survival benefit of primary tumor surgery for differentiated thyroid cancer with distant metastases: A real-world observational study. Medicine (Baltimore) 2020; 99:e23132. [PMID: 33235073 PMCID: PMC7710227 DOI: 10.1097/md.0000000000023132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The role of primary tumor surgery in the management of differentiated thyroid cancer (DTC) with distant metastases (DM) remains controversial. We aimed to explore the survival benefit of primary tumor surgery in patients with different metastatic sites.A retrospective cohort study based on the SEER database was conducted to identify DTC patients with DM diagnosed between 2010 and 2016. Patients were divided into following 2 groups: surgery and non-surgery group. Propensity score weighting was employed to balance clinicopathologic factors between the 2 groups.Of 3537 DTC patients with DM, 956 (66.0%) patients underwent primary tumor surgery while 493 (34.0%) patients did not. There were 798 all-cause deaths and 704 DTC-specific deaths over a median follow-up of 22 months. The weighted 3-year overall survival (OS) for the surgery group was 55.2%, compared to 27.8% (P < .001) for the non-surgery group. The magnitude of the survival difference of surgery was significantly correlated with metastatic sites (Pinteraction <.001). Significant survival improvements in surgery group compared with non-surgery group were observed in patients with lung-only metastasis (adjusted HR = 0.45, P < .001), bone-only metastasis (adjusted HR = 0.40, P < .001), and liver-only metastasis (adjusted HR = 0.27, P < .001), whereas no survival improvement of surgery was found for patients with brain-only metastasis (adjusted HR = 0.57, P = .059) or multiply organ distant metastases (adjusted HR = 0.81, P = .099).The survival benefit from primary tumor surgery for DTC patients with DM varies by metastatic sites. Decisions for primary tumor surgery of DTC patients with DM should be tailored according to metastatic sites.
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Affiliation(s)
- Wu Ding
- Department of Oncological Surgery, Shaoxing Second Hospital
- Department of Clinical Medicine, Shaoxing University School of Medicine, Shaoxing
| | - Guodong Ruan
- Department of Oncological Surgery, Shaoxing Second Hospital
| | - Jianming Zhu
- Department of Oncological Surgery, Shaoxing Second Hospital
| | - Chuanjian Tu
- Department of Neurosurgery, Shaoxing Central Hospital
- Department of Clinical Medicine, Shaoxing University School of Medicine, Shaoxing
| | - Zhian Li
- Department of Oncological Surgery, Shaoxing Second Hospital
- Department of Clinical Medicine, Shaoxing University School of Medicine, Shaoxing
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10
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Tsakonas G, Kamali C, De Petris L, Friesland S, Lewensohn R, Ekman S. ALK-Brain Prognostic Index-Preliminary Study of a Prognostic Tool for Patients with ALK-Rearranged, Non-small Cell Lung Cancer and Brain Metastases. Cancers (Basel) 2020; 12:cancers12071804. [PMID: 32640547 PMCID: PMC7408161 DOI: 10.3390/cancers12071804] [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: 05/25/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Disease-specific Graded Prognostic Assessment (DS-GPA) is the most validated prognostic tool for patients with brain metastasized lung cancer. The Lung-molGPA scoring system was recently introduced for oncogenic-driven brain metastasized lung cancer, but has not yet been validated in cohorts including only ALK-translocated tumors. Methods: We designed a retrospective cohort study consisting of 44 patients with brain metastasized ALK-positive, non-small cell lung cancer (NSCLC) who were treated between January 2009 and November 2019 at Karolinska University Hospital in Stockholm, Sweden. Information about demographics and clinicopathological parameters were collected. Predictors of overall survival (OS) were identified by Cox regression analyses. A bootstrap validation with 1000 samples was performed in order to compare the different prognostic scores. Results: The variables found to independently influence OS in the multivariate analysis, i.e., PS, sex and brain metastases at diagnosis, were used as prognostic variables in our new prognostic index (ALK-BPI). Patients were divided into two prognostic groups. The median OS was 65.7 months for the good prognostic group and 22.7 months for the poor prognostic group (p = 0.0068). In the univariate analysis of the different prognostic scores, ALK-BPI performed better than the others (HR = 3.6; 95% CI: 1.3–9.9). The mean C-statistics of the different prognostic scores were compared to each other, and no significant difference was observed. Conclusion: We propose the ALK-BPI score as a new prognostic tool that can easily be applied for ALK-positive lung cancer patients with brain metastases in daily clinical practice, as it has at least the same prognostic value as Lung-molGPA.
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Affiliation(s)
- Georgios Tsakonas
- Theme Cancer, Medical Unit Head & Neck, Lung and Skin Cancer, Karolinska University Hospital, 17176 Stockholm, Sweden; (C.K.); (L.D.P.); (S.F.); (R.L.); (S.E.)
- Department of Oncology-Pathology, Karolinska Institutet, 17176 Stockholm, Sweden
- Correspondence: ; Tel.: +46-(0)-762129941
| | - Caroline Kamali
- Theme Cancer, Medical Unit Head & Neck, Lung and Skin Cancer, Karolinska University Hospital, 17176 Stockholm, Sweden; (C.K.); (L.D.P.); (S.F.); (R.L.); (S.E.)
- Department of Oncology-Pathology, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Luigi De Petris
- Theme Cancer, Medical Unit Head & Neck, Lung and Skin Cancer, Karolinska University Hospital, 17176 Stockholm, Sweden; (C.K.); (L.D.P.); (S.F.); (R.L.); (S.E.)
- Department of Oncology-Pathology, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Signe Friesland
- Theme Cancer, Medical Unit Head & Neck, Lung and Skin Cancer, Karolinska University Hospital, 17176 Stockholm, Sweden; (C.K.); (L.D.P.); (S.F.); (R.L.); (S.E.)
- Department of Oncology-Pathology, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Rolf Lewensohn
- Theme Cancer, Medical Unit Head & Neck, Lung and Skin Cancer, Karolinska University Hospital, 17176 Stockholm, Sweden; (C.K.); (L.D.P.); (S.F.); (R.L.); (S.E.)
- Department of Oncology-Pathology, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Simon Ekman
- Theme Cancer, Medical Unit Head & Neck, Lung and Skin Cancer, Karolinska University Hospital, 17176 Stockholm, Sweden; (C.K.); (L.D.P.); (S.F.); (R.L.); (S.E.)
- Department of Oncology-Pathology, Karolinska Institutet, 17176 Stockholm, Sweden
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11
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Sperduto PW, Mesko S, Li J, Cagney D, Aizer A, Lin NU, Nesbit E, Kruser TJ, Chan J, Braunstein S, Lee J, Kirkpatrick JP, Breen W, Brown PD, Shi D, Shih HA, Soliman H, Sahgal A, Shanley R, Sperduto W, Lou E, Everett A, Boggs DH, Masucci L, Roberge D, Remick J, Plichta K, Buatti JM, Jain S, Gaspar LE, Wu CC, Wang TJC, Bryant J, Chuong M, Yu J, Chiang V, Nakano T, Aoyama H, Mehta MP. Beyond an Updated Graded Prognostic Assessment (Breast GPA): A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 to Today. Int J Radiat Oncol Biol Phys 2020; 107:334-343. [PMID: 32084525 PMCID: PMC7276246 DOI: 10.1016/j.ijrobp.2020.01.051] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Brain metastases are a common sequelae of breast cancer. Survival varies widely based on diagnosis-specific prognostic factors (PF). We previously published a prognostic index (Graded Prognostic Assessment [GPA]) for patients with breast cancer with brain metastases (BCBM), based on cohort A (1985-2007, n = 642), then updated it, reporting the effect of tumor subtype in cohort B (1993-2010, n = 400). The purpose of this study is to update the Breast GPA with a larger contemporary cohort (C) and compare treatment and survival across the 3 cohorts. METHODS AND MATERIALS A multi-institutional (19), multinational (3), retrospective database of 2473 patients with breast cancer with newly diagnosed brain metastases (BCBM) diagnosed from January 1, 2006, to December 31, 2017, was created and compared with prior cohorts. Associations of PF and treatment with survival were analyzed. Kaplan-Meier survival estimates were compared with log-rank tests. PF were weighted and the Breast GPA was updated such that a GPA of 0 and 4.0 correlate with the worst and best prognoses, respectively. RESULTS Median survival (MS) for cohorts A, B, and C improved over time (from 11, to 14 to 16 months, respectively; P < .01), despite the subtype distribution becoming less favorable. PF significant for survival were tumor subtype, Karnofsky Performance Status, age, number of BCBMs, and extracranial metastases (all P < .01). MS for GPA 0 to 1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0 was 6, 13, 24, and 36 months, respectively. Between cohorts B and C, the proportion of human epidermal receptor 2 + subtype decreased from 31% to 18% (P < .01) and MS in this subtype increased from 18 to 25 months (P < .01). CONCLUSIONS MS has improved modestly but varies widely by diagnosis-specific PF. New PF are identified and incorporated into an updated Breast GPA (free online calculator available at brainmetgpa.com). The Breast GPA facilitates clinical decision-making and will be useful for stratification of future clinical trials. Furthermore, these data suggest human epidermal receptor 2-targeted therapies improve clinical outcomes in some patients with BCBM.
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Affiliation(s)
- Paul W Sperduto
- Minneapolis Radiation Oncology & University of Minnesota Gamma Knife Center, Minneapolis, Minnesota.
| | | | - Jing Li
- MD Anderson Cancer Center, Houston, Texas
| | | | - Ayal Aizer
- Dana Farber Cancer Institute, Boston, Massachusetts
| | - Nancy U Lin
- Dana Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Jason Chan
- University of California San Francisco, San Francisco, California
| | - Steve Braunstein
- University of California San Francisco, San Francisco, California
| | | | | | | | | | - Diana Shi
- Massachusetts General Hospital, Massachusetts, Boston, Massachusetts
| | - Helen A Shih
- Massachusetts General Hospital, Massachusetts, Boston, Massachusetts
| | - Hany Soliman
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - Arjun Sahgal
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | | | | | - Emil Lou
- University of Minnesota, Minneapolis, Minnesota
| | | | | | - Laura Masucci
- Centre Hospitalier de l' Université de Montréal, Montreal, Quebec, Canada
| | - David Roberge
- Centre Hospitalier de l' Université de Montréal, Montreal, Quebec, Canada
| | | | | | | | | | | | | | | | | | | | - James Yu
- Yale University, New Haven, Connecticut
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12
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Survival and prognostic factors in surgically treated brain metastases. J Neurooncol 2019; 143:359-367. [DOI: 10.1007/s11060-019-03171-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/09/2019] [Indexed: 12/26/2022]
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13
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Gao HX, Huang SG, Du JF, Zhang XC, Jiang N, Kang WX, Mao J, Zhao Q. Comparison of Prognostic Indices in NSCLC Patients with Brain Metastases after Radiosurgery. Int J Biol Sci 2018; 14:2065-2072. [PMID: 30585269 PMCID: PMC6299364 DOI: 10.7150/ijbs.28608] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/05/2018] [Indexed: 11/05/2022] Open
Abstract
Prognostic indices are commonly used in the context of brain metastases radiotherapy to guide patient decision-making and clinical trial stratification. This study is to choose an appropriate prognostic index (PI) for non-small cell lung cancer (NSCLC) patients with brain metastases (BM) who underwent radiosurgery. A total of 103 patients with BM from NSCLC receiving radiosurgery were analyzed retrospectively. There are six prognostic factors were analyzed, including age, primary tumor control, extracranial metastasis, KPS score, number of lesions, max lesion volume; and four prognostic indices were compared, include Recursive Partitioning Analysis (RPA),Graded Prognostic Assessment (GPA), Score Index for Radiosurgery (SIR), Basic Score for Brain Metastases (BSBM). Survival curves were estimated with the Kaplan-Meier method and compared with a log-rank test stratified according to the PIs. Univariate and multivariate analysis was performed using the Cox regression analysis. The PI's predictive capacity was compared in terms of Akaike information criterion (AIC), Log-rank × 2, Concordance index (C-index) and calibration curve. The median survival time was 8 months, and the 6-months and 12-months survival rate were 61% and 26% respectively. All four prognostic indices were correlated with prognosis (P<0.005).The AIC for BSBM (686.317) was the minimum in the four PIs(range,686.317-739.113).The Log-rank × 2 value for BSBM (77.62) was the maximum in the four PIs (range,23.32-77.62).The C-index for BSBM (0.758)was superior than the other PIs predictive capacity (range,0.611-0.758). The calibration curve showed that the BSBM was able to predict 6-months and 12-months overall survival accurately. In conclusion, the BSBM may be the most accurate prognostic index for patients with BM from NSCLC who underwent radiosurgery.
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Affiliation(s)
- Hong Xiang Gao
- Department of Radiotherapy Oncology, Chang An Hospital, Xi'an, Shaan Xi, China.,Radiotherapy Department, 323 Hospital of People's Liberation Army, Xi'an, Shaan Xi, China
| | - Shi Gao Huang
- Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China
| | - Jian Fei Du
- Department of Radiotherapy Oncology, Chang An Hospital, Xi'an, Shaan Xi, China
| | - Xue Cheng Zhang
- Department of Radiotherapy Oncology, Chang An Hospital, Xi'an, Shaan Xi, China
| | - Nan Jiang
- Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China
| | - Wen Xing Kang
- Radiotherapy Department, 323 Hospital of People's Liberation Army, Xi'an, Shaan Xi, China
| | - Jian Mao
- Department of Radiotherapy Oncology, Chang An Hospital, Xi'an, Shaan Xi, China
| | - Qi Zhao
- Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China
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Cacho-Díaz B, Lorenzana-Mendoza NA, Chávez-Hernandez JD, González-Aguilar A, Reyes-Soto G, Herrera-Gómez Á. Clinical manifestations and location of brain metastases as prognostic markers. Curr Probl Cancer 2018; 43:312-323. [PMID: 30001820 DOI: 10.1016/j.currproblcancer.2018.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/22/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Brain metastases (BM) are a frequent complication of cancer and are regularly seen in clinical practice. New treatment modalities are improving survival after diagnosis of BM. However, symptoms are rarely reported and their significance is not well established. The aim of the present study was to investigate neurologic indicators as prognostic markers in patients with brain metastases. PATIENTS AND METHODS A prospectively acquired database from 2 referral centers was analyzed. All patients had had at least 2 neuro-oncologic consultations and magnetic resonance imaging to confirm the diagnosis. Patients were classified according to universally used prognostic scores, gender, primary tumor, localization of BM, and clinical complaints. Univariate and multivariate analysis was used to evaluate associations. RESULTS A total of 570 patients were included; 71% were female, and 91% had solid tumors. Median survival was 11 months (95% confidence interval 9.4-12.6). Of 1322 parenchymal lesions, 78% were supratentorial, and were most commonly in the frontal lobe. The most common symptoms were headache, vision changes, and weakness. Brain metastases in the brainstem were associated with a worse prognosis (P = 0.04). Visual complaints (P = 0.005), altered mental status, (P < 0.0001) and cranial neuropathy (P 0.001) were also associated with a poor outcome, as were poor performance status, more than 1 brain metastases, meningeal carcinomatosis, and uncontrolled primary cancer. CONCLUSIONS Both presenting symptoms and the location of brain metastases have prognostic significance and should be further studied, both as independent prognostic predictors and in conjunction with other factors used in prognostic scores.
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Affiliation(s)
- Bernardo Cacho-Díaz
- Unidad de Neurociencias, Instituto Nacional de Cancerología, Mexico City, Mexico.
| | | | | | - Alberto González-Aguilar
- Neuro-oncología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Gervith Reyes-Soto
- Unidad de Neurociencias, Instituto Nacional de Cancerología, Mexico City, Mexico
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15
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Tsakonas G, Hellman F, Gubanski M, Friesland S, Tendler S, Lewensohn R, Ekman S, de Petris L. Prognostic factors affecting survival after whole brain radiotherapy in patients with brain metastasized lung cancer. Acta Oncol 2018; 57:231-238. [PMID: 28984492 DOI: 10.1080/0284186x.2017.1386799] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Whole-brain radiotherapy (WBRT) has been the standard of care for multiple NSCLC brain metastases but due to its toxicity and lack of survival benefit, its use in the palliative setting is being questioned. PATIENT AND METHODS This was a single institution cohort study including brain metastasized lung cancer patients who received WBRT at Karolinska University Hospital. Information about Recursive Partitioning Analysis (RPA) and Graded Prognostic Assessment (GPA) scores, demographics, histopathological results and received oncological therapy were collected. Predictors of overall survival (OS) from the time of received WBRT were identified by Cox regression analyses. OS between GPA and RPA classes were compared by pairwise log rank test. A subgroup OS analysis was performed stratified by RPA class. RESULTS The cohort consisted of 280 patients. RPA 1 and 2 classes had better OS compared to class 3, patients with GPA <1.5 points had better OS compared to GPA≥ 1.5 points and age >70 years was associated with worse OS (p< .0001 for all comparisons). In RPA class 2 subgroup analysis GPA ≥1.5 points, age ≤70 years and CNS surgery before salvage WBRT were independent positive prognostic factors. CONCLUSIONS RPA class 3 patients should not receive WBRT, whereas RPA class 1 patients should receive WBRT if clinically indicated. RPA class 2 patients with age ≤70 years and GPA ≥1.5 points should be treated as RPA 1. WBRT should be omitted in RPA 2 patients with age >70. In RPA 2 patients with age ≤70 years and GPA <1.5 points WBRT could be a reasonable option.
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Affiliation(s)
- Georgios Tsakonas
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Fatou Hellman
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Gubanski
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Signe Friesland
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Salomon Tendler
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Lewensohn
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Simon Ekman
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Luigi de Petris
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
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16
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Validation of the Disease-Specific GPA for Patients With 1 to 3 Synchronous Brain Metastases in Newly Diagnosed NSCLC. Clin Lung Cancer 2017; 19:e141-e147. [PMID: 28739316 DOI: 10.1016/j.cllc.2017.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/27/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The disease-specific graded prognostic assessment (DS-GPA) for brain metastases is a powerful prognostic tool but has not been validated for patients with synchronous brain metastases (SBM) in newly diagnosed non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS We identified patients with newly diagnosed NSCLC with 1 to 3 SBM treated with stereotactic radiosurgery (SRS) between 1997 and 2012. We included patients whose brain metastases were treated with SRS alone or combined SRS and whole-brain radiotherapy (WBRT). Patients were stratified according to NSCLC DS-GPA to evaluate the accuracy of survival estimates. RESULTS One hundred sixty-four patients were treated with either SRS alone (n = 85; 52%) or SRS and WBRT (n = 79; 48%). Median overall survival (OS) stratified according to DS-GPA of 0 to 1, 1.5 to 2, 2.5 to 3, and 3.5 to 4 were 2.8, 6.7, 9.8, and 13.2 months, respectively, consistent with OS reported for brain metastases in NSCLC DS-GPA (3.0, 6.5, 11.3, and 14.8 months, respectively). No difference in median progression-free survival or OS was noted with combined use of SRS and WBRT: 6.0 versus 6.1 months (P = .81) and 8.5 versus 9.1 months (P = .093), respectively. In multivariable analysis, Karnofsky performance status (hazard ratio [HR], 0.98; P = .008), extracranial metastases (HR, 0.498; P = .0003), squamous histology (HR, 1.81; P = .02), and number of brain metastases (2 vs. 1; HR, 1.504; P = .04, and 3 vs. 1; HR, 1.66; P = .05) were significant predictors of OS. CONCLUSION The DS-GPA accurately estimates the prognosis of patients with SBM in newly diagnosed NSCLC. Patients with synchronous brain metastasis in newly diagnosed NSCLC should be carefully stratified for consideration of aggressive therapy.
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Azimi P, Shahzadi S, Bitaraf MA, Azar M, Alikhani M, Zali A, Sadeghi S, Montazeri A. Brain metastases in cancer patients attending a Gamma Knife Center: A study from a single institute in Iran. Asian J Neurosurg 2017; 12:529-533. [PMID: 28761536 PMCID: PMC5532943 DOI: 10.4103/1793-5482.145564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: This study was aimed to explore data on brain metastases in cancer patients attending the Iranian Gamma Knife Center. Meterials and Methods: This was a retrospective study. In all 5216 case records of patients who referred to the Iranian Gamma Knife Center for treatment of brain tumors during year 2003-2011 were reviewed. Data were explored to identify patients who developed brain metastases due to cancer and assessed the information as applied to cancer patients including survival analysis. Results: Two hundred and twenty patients were identified as having brain metastases due to cancer. The mean age of patients was 54.0 (standard deviation [SD] =12.7) years. Patients were followed for an average of 7 months after treatment with gamma-knife. The median survival time for different the Graded Prognostic Assessment (GPA) was: GPA: 0-1, 4.0 ± 0.4 months; GPA: 1.5-2.5, 6.0 ± 0.7 months; GPA: 3, 9.0 ± 0.9 months; and GPA: 3.5-4.0, 12.0 ± 1.8 months and the overall median survival was 7.0 (SD = 0.6) months. Conclusion: The findings suggest that many cancer patients in Iran might develop brain metastasis. Although, this is not a very high incidence compared with the existing statistics from other countries, there is an urgent need to explore the issue further.
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Affiliation(s)
- Parisa Azimi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Shahzadi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Maziar Azar
- Department of Neurosurgery, Tehran University of Medical Science, Tehran, Iran
| | | | - Alireza Zali
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Sadeghi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Montazeri
- Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
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VRÁNA DAVID, ŠTUDENTOVÁ HANA, MATZENAUER MARCEL, VLACHOVÁ ZUZANA, CWIERTKA KAREL, GREMLICA DAVID, KALITA ONDŘEJ. Treatment of brain metastases of renal cell cancer with combined hypofractionated stereotactic radiotherapy and whole brain radiotherapy with hippocampal sparing. Oncol Lett 2016; 11:3777-3781. [PMID: 27313693 PMCID: PMC4888132 DOI: 10.3892/ol.2016.4440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 03/01/2016] [Indexed: 11/05/2022] Open
Abstract
Renal cell cancer patients with brain metastatic disease generally have poor prognosis. Treatment options include surgery, radiotherapy, targeted therapy or best supportive care with respect to disease burden, patient preference and performance status. In the present case report the radiotherapy technique combining whole brain radiotherapy with hippocampal sparing (hippocampal avoidance whole brain radiotherapy HA-WBRT) and hypofractionated stereotactic radiotherapy (SRT) of the brain metastases is performed in a patient with metastatic renal cell carcinoma. HA-WBRT was administered to 30 Gy in 10 fractions with sparing of the hippocampal structures and SRT of 21 Gy in 3 fractions to brain metastases which has preceded the HA-WBRT. Two single arc volumetric modulated arc radiotherapy (VMAT) plans were prepared using Monaco planning software. The HA-WBRT treatment plan achieved the following results: D2=33.91 Gy, D98=25.20 Gy, D100=14.18 Gy, D50=31.26 Gy. The homogeneity index was calculated as a deduction of the minimum dose in 2% and 98% of the planning target volume (PTV), divided by the minimum dose in 50% of the PTV. The maximum dose to the hippocampus was 17.50 Gy and mean dose was 11.59 Gy. The following doses to organs at risk (OAR) were achieved: Right opticus Dmax, 31.96 Gy; left opticus Dmax, 30.96 Gy; chiasma D max, 32,76 Gy. The volume of PTV for stereotactic radiotherapy was 3,736 cm3, with coverage D100=20.95 Gy and with only 0.11% of the PTV being irradiated to dose below the prescribed dose. HA-WBRT with SRT represents a feasible technique for radiotherapy of brain metastatic disease, however this technique is considerably demanding on departmental equipment and staff time/experience.
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Affiliation(s)
- DAVID VRÁNA
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, University Hospital in Olomouc, Olomouc 77900, Czech Republic
- Toxicogenomics Unit, National Institute of Public Health, Prague 10042, Czech Republic
| | - HANA ŠTUDENTOVÁ
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic
| | - MARCEL MATZENAUER
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic
| | - ZUZANA VLACHOVÁ
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic
| | - KAREL CWIERTKA
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic
| | - DAVID GREMLICA
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic
| | - ONDŘEJ KALITA
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic
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19
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Estabrook NC, Lutz ST, Johnson CS, Lo SS, Henderson MA. Does Graded Prognostic Assessment outperform Recursive Partitioning Analysis in patients with moderate prognosis brain metastases? CNS Oncol 2016; 5:69-76. [PMID: 26985694 DOI: 10.2217/cns.15.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To compare the clinical utility of the Recursive Partitioning Analysis (RPA) and Graded Prognostic Assessment (GPA) in predicting outcomes for moderate prognosis patients with brain metastases. METHODS & MATERIALS We reviewed 101 whole brain radiotherapy cases. RPA and GPA were calculated. Overall survival was compared. RESULTS Sixty-eight patients had moderate prognosis. RPA patient characteristics for increased death hazard were ≤10 WBRT fractions or no surgery/radiosurgery. GPA patients had increased death risk with no surgery/radiosurgery or lower Karnofsky Performance Status. CONCLUSION The indices have similar predicted survival. Patients scored by RPA with longer radiation schedules had longer survival; patients scored by GPA did not. This indicates GPA is more clinically useful, leaving less room for subjective treatment choices.
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Affiliation(s)
- Neil C Estabrook
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stephen T Lutz
- Blanchard Valley Regional Cancer Center, Findlay, OH, USA
| | - Cynthia S Johnson
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Simon S Lo
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Mark A Henderson
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
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20
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Pinkham MB, Whitfield GA, Brada M. New developments in intracranial stereotactic radiotherapy for metastases. Clin Oncol (R Coll Radiol) 2015; 27:316-23. [PMID: 25662094 DOI: 10.1016/j.clon.2015.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/16/2014] [Accepted: 01/22/2015] [Indexed: 11/19/2022]
Abstract
Brain metastases are common and the prognosis for patients with multiple brain metastases treated with whole brain radiotherapy is limited. As systemic disease control continues to improve, the expectations of radiotherapy for brain metastases are growing. Stereotactic radiosurgery (SRS) as a high precision localised irradiation given in a single fraction prolongs survival in patients with a single brain metastasis and functional independence in those with up to three brain metastases. SRS technology has become commonplace and is available in many radiation oncology and neurosurgery departments. With increasing use there is a need for appropriate patient selection, refinement of dose-fractionation and safe integration of SRS with other treatment modalities. We review the evidence for current practice and new developments in the field, with a specific focus on patient-relevant outcomes.
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Affiliation(s)
- M B Pinkham
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; School of Medicine, University of Queensland, Brisbane, Australia
| | - G A Whitfield
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - M Brada
- University of Liverpool, Department of Clinical and Molecular Cancer Medicine and Academic Radiotherapy Unit, Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK.
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Place de la chirurgie dans la prise en charge des métastases cérébrales. Cancer Radiother 2015; 19:20-4. [DOI: 10.1016/j.canrad.2014.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 11/18/2022]
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Gao Y, Gao F, Ma JL, Zhao DL. Palliative whole-brain radiotherapy and health- related quality of life for patients with brain metastasis in cancer. Neuropsychiatr Dis Treat 2015; 11:2185-90. [PMID: 26346192 PMCID: PMC4552255 DOI: 10.2147/ndt.s87109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the use of palliative whole-brain radiotherapy (WBRT) in the treatment of brain metastases (BMs) and to evaluate the health-related quality of life (HRQOL) of these patients. MATERIALS AND METHODS We conducted a retrospective study of 46 patients with BMs who were treated with WBRT at the First Affiliated Hospital of Xi'an Jiaotong University between January 2013 and January 2015. External beam radiotherapy techniques were used to deliver 40 Gy in 20 fractions or 30 Gy in ten fractions with a 10 MV photon beam from a linear accelerator to the whole brain. Data were stored and analyzed using SPSS version 17.0. RESULTS Of the 46 patients, the survival time of patients in our study was 10.8±0.55 months: 11.8±0.46 months in patients with WBRT, 11.75±1.00 in patients with WBRT + chemotherapy, and 3±0.79 months in patients with supportive care, respectively (P<0.01). The HRQOL scores of all the patients were 70±1.16 (before therapy) and 76.83±1.04 (after therapy) (P<0.01). The HRQOL scores of the patients with WBRT were 72.23±0.88 (before therapy) and 78.49±0.87 (after therapy) (P<0.01). There was no central nervous system toxicity; only two (4.3%) patients were found to have BM hemorrhage. Radiation necrosis happened in one patient (2.2%). CONCLUSION Effective treatment options for patients with BMs are important. WBRT was evaluated to ensure survival outcomes and QOL were enhanced after therapy for patients with BMs.
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Affiliation(s)
- Ying Gao
- Department of Radiotherapy Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Fei Gao
- Department of Neurology, First Affiliated Hospital of Xi'an Medical University, Xi'an, People's Republic of China
| | - Jin-Lu Ma
- Department of Radiotherapy Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Dong-Li Zhao
- Department of Radiotherapy Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
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Management of Cerebral Brain Metastasis. CURRENT SURGERY REPORTS 2014. [DOI: 10.1007/s40137-014-0074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sperduto PW, Shanley R, Luo X, Andrews D, Werner-Wasik M, Valicenti R, Bahary JP, Souhami L, Won M, Mehta M. Secondary analysis of RTOG 9508, a phase 3 randomized trial of whole-brain radiation therapy versus WBRT plus stereotactic radiosurgery in patients with 1-3 brain metastases; poststratified by the graded prognostic assessment (GPA). Int J Radiat Oncol Biol Phys 2014; 90:526-31. [PMID: 25304947 PMCID: PMC4700538 DOI: 10.1016/j.ijrobp.2014.07.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/27/2014] [Accepted: 07/03/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE Radiation Therapy Oncology Group (RTOG) 9508 showed a survival advantage for patients with 1 but not 2 or 3 brain metastasis (BM) treated with whole-brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) versus WBRT alone. An improved prognostic index, the graded prognostic assessment (GPA) has been developed. Our hypothesis was that if the data from RTOG 9508 were poststratified by the GPA, the conclusions may vary. METHODS AND MATERIALS In this analysis, 252 of the 331 patients were evaluable by GPA. Of those, 211 had lung cancer. Breast cancer patients were excluded because the components of the breast GPA are not in the RTOG database. Multiple Cox regression was used to compare survival between treatment groups, adjusting for GPA. Treatment comparisons within subgroups were performed with the log-rank test. A free online tool (brainmetgpa.com) simplified GPA use. RESULTS The fundamental conclusions of the primary analysis were confirmed in that there was no survival benefit overall for patients with 1 to 3 metastases; however, there was a benefit for the subset of patients with GPA 3.5 to 4.0 (median survival time [MST] for WBRT + SRS vs WBRT alone was 21.0 versus 10.3 months, P=.05) regardless of the number of metastases. Among patients with GPA 3.5 to 4.0 treated with WBRT and SRS, the MST for patients with 1 versus 2 to 3 metastases was 21 and 14.1 months, respectively. CONCLUSIONS This secondary analysis of predominantly lung cancer patients, consistent with the original analysis, shows no survival advantage for the group overall when treated with WBRT and SRS; however, in patients with high GPA (3.5-4), there is a survival advantage regardless of whether they have 1, 2, or 3 BM. This benefit did not extend to patients with lower GPA. Prospective validation of this survival benefit for patients with multiple BM and high GPA when treated with WBRT and SRS is warranted.
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Affiliation(s)
- Paul W Sperduto
- Metro-Minnesota CCOP and Minneapolis Radiation Oncology, Minneapolis, Minnesota.
| | - Ryan Shanley
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - David Andrews
- Thomas Jefferson University, Department of NeuroOncology, Philadelphia, Pennsylvania
| | - Maria Werner-Wasik
- Thomas Jefferson University, Department of Radiation Oncology, Philadelphia, Pennsylvania
| | - Richard Valicenti
- UC Davis Medical Center, Department of Radiation Oncology, Sacramento, California
| | | | | | - Minhee Won
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Minesh Mehta
- University of Maryland Medical System, Baltimore, Maryland
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Kraszkiewicz M, Wydmanski J. Brain metastases from stomach cancer - The role of different treatment modalities and efficacy of palliative radiotherapy. Rep Pract Oncol Radiother 2014; 20:32-7. [PMID: 25535582 DOI: 10.1016/j.rpor.2014.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/17/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022] Open
Abstract
AIM To evaluate different treatment modalities, sequences, and prognostic factors in patients with brain metastases from stomach cancer. BACKGROUND Brain metastases from gastric cancer are rare and late manifestation of the disease, occurring in less than 1% of gastric cancer patients. The prognosis is poor and median overall survival is 1.3-2.4 months. The standard treatment scheme has not yet been described. Most studies present small sample sizes. The choice of treatment scheme is individually based on performance status, number, location and size of metastases, the status of primary tumor and the presence of other metastases. MATERIALS AND METHODS Sixteen patients diagnosed with brain metastases from gastric cancer in Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch. Patients, mostly men (69%) aged 51-75 years, (median 68.5 years). Thirteen (81.25%) had treatment of primary tumor before diagnosis of brain metastases. Primary metastatic gastric cancer was diagnosed in 6 patients (37.5%), in 3 cases (18.75%) brain was the site of those metastases. Treatment schemes were individually based. RESULTS We identified prognostic factors influencing OS: performance status, number of brain metastases, type of treatment. Median OS was 2.8 months. Median time to brain metastases was 12.3 months and it was shorter in patients with pretreatment metastases to other organs. Patients treated with combined treatment had median survival of 12.3 months. CONCLUSIONS Aggressive treatment schemes are needed to improve the outcome. Prognostic factors such as performance status, number of metastases, dissemination to other organs are helpful in considering the best treatment options.
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Affiliation(s)
- Malgorzata Kraszkiewicz
- Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, ul. Wybrzeże AK 15, 44-101 Gliwice, Poland
| | - Jerzy Wydmanski
- Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, ul. Wybrzeże AK 15, 44-101 Gliwice, Poland
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Oskan F, Ganswindt U, Schwarz SB, Manapov F, Belka C, Niyazi M. Hippocampus sparing in whole-brain radiotherapy. A review. Strahlenther Onkol 2014; 190:337-41. [PMID: 24452816 DOI: 10.1007/s00066-013-0518-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 11/11/2013] [Indexed: 01/21/2023]
Abstract
Radiation treatment techniques for whole-brain radiation therapy (WBRT) have not changed significantly since development of the procedure. However, the recent development of novel techniques such as intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT) and helical tomotherapy, as well as an increasing body of evidence concerning neural stem cells (NSCs) have altered the conventional WBRT treatment paradigm. In this regard, hippocampus-sparing WBRT is a novel technique that aims to spare critical hippocampus regions without compromising tumour control. Published data on this new technique are limited to planning and feasibility studies; data on patient outcome are still lacking. However, several prospective trials to analyse the feasibility of this technique and to document clinical outcome in terms of reduced neurotoxicity are ongoing.
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Affiliation(s)
- F Oskan
- Department of Radiation Oncology & CCC Neuro-Oncology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany
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Phase 1 trial of dichloroacetate (DCA) in adults with recurrent malignant brain tumors. Invest New Drugs 2013; 32:452-64. [PMID: 24297161 DOI: 10.1007/s10637-013-0047-4] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/31/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recurrent malignant brain tumors (RMBTs) carry a poor prognosis. Dichloroacetate (DCA) activates mitochondrial oxidative metabolism and has shown activity against several human cancers. DESIGN We conducted an open-label study of oral DCA in 15 adults with recurrent WHO grade III - IV gliomas or metastases from a primary cancer outside the central nervous system. The primary objective was detection of a dose limiting toxicity for RMBTs at 4 weeks of treatment, defined as any grade 4 or 5 toxicity, or grade 3 toxicity directly attributable to DCA, based on the National Cancer Institute's Common Toxicity Criteria for Adverse Events, version 4.0. Secondary objectives involved safety, tolerability and hypothesis-generating data on disease status. Dosing was based on haplotype variation in glutathione transferase zeta 1/maleylacetoacetate isomerase (GSTZ1/MAAI), which participates in DCA and tyrosine catabolism. RESULTS Eight patients completed at least 1 four week cycle. During this time, no dose-limiting toxicities occurred. No patient withdrew because of lack of tolerance to DCA, although 2 subjects experienced grade 0-1 distal parasthesias that led to elective withdrawal and/or dose-adjustment. All subjects completing at least 1 four week cycle remained clinically stable during this time and remained on DCA for an average of 75.5 days (range 26-312). CONCLUSIONS Chronic, oral DCA is feasible and well-tolerated in patients with recurrent malignant gliomas and other tumors metastatic to the brain using the dose range established for metabolic diseases. The importance of genetic-based dosing is confirmed and should be incorporated into future trials of chronic DCA administration.
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Gil-Gil MJ, Martinez-Garcia M, Sierra A, Conesa G, Del Barco S, González-Jimenez S, Villà S. Breast cancer brain metastases: a review of the literature and a current multidisciplinary management guideline. Clin Transl Oncol 2013; 16:436-46. [PMID: 24277572 PMCID: PMC3983876 DOI: 10.1007/s12094-013-1110-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 09/10/2013] [Indexed: 01/19/2023]
Abstract
Breast cancer represents the second most frequent etiology of brain metastasis (BM). It is estimated that 10–30 % of patients with breast cancer are diagnosed with BM. Breast cancer BM are increasing due to the aging population, detection of subclinical disease, and better control of systemic disease. BM is a major cause of morbidity and mortality affecting neurocognition, speech, coordination, behavior, and quality of life. The therapy of BM remains controversial regarding use and timing of surgical resection, application of whole-brain radiotherapy, stereotactic radiosurgery and systemic drugs in patients with particular tumor subtypes. Despite numerous trials, the range of interpretation of these has resulted in differing treatment perspectives. This paper is a review of the state of the art and a multidisciplinary guideline on strategies to improve the therapeutic index in this situation.
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Affiliation(s)
- M J Gil-Gil
- Breast Cancer Unit and Neurooncology Unit, Institut Català d'Oncologia (ICO), IDIBELL, Gran Via 199-203, L'Hospitalet, 08908, Barcelona, Spain,
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30
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Anzalone N, Essig M, Lee SK, Dörfler A, Ganslandt O, Combs SE, Picozzi P. Optimizing contrast-enhanced magnetic resonance imaging characterization of brain metastases: relevance to stereotactic radiosurgery. Neurosurgery 2013; 72:691-701. [PMID: 23381488 DOI: 10.1227/neu.0b013e3182889ddf] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Intracranial metastases are the most common form of intra-axial brain tumor. Management approaches to brain metastases include surgical resection, whole-brain radiotherapy, and stereotactic radiosurgery (SRS). The management approach that is selected is based typically on algorithms that incorporate the number, size, and location of lesions. SRS is the treatment of choice when metastases detected on imaging are few (maximum, 3-5) and/or of small size (≤30 mm) and offers the advantages of noninvasiveness and the ability to treat inaccessible lesions compared with surgical resection. Contrast-enhanced magnetic resonance imaging (MRI) is the standard imaging technique for determining the number, size, and location of metastatic lesions. In SRS, the capability of MRI to delineate lesion borders precisely in 3 dimensions helps reduce recurrence rates and minimize radiation necrosis in surrounding tissue. Optimization of the MRI protocol, including selection of the appropriate gadolinium-based contrast agent (GBCA), is paramount for accurate lesion imaging. GBCAs differ in their safety, tolerability, and efficacy because of their diverse physicochemical properties. Gadobutrol and gadobenate dimeglumine are high-relaxivity GBCAs that demonstrate superior efficacy for imaging metastatic lesions compared with other GBCAs, whereas gadobutrol additionally provides macrocyclic stability. This article reviews recent comparative trials of GBCAs and discusses their relevance for optimizing MRI protocols in the management of brain metastases, with particular relevance to SRS.
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Affiliation(s)
- Nicoletta Anzalone
- Department of Neuroradiology, Scientific Institute H. S. Raffaele, Milan, Italy.
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Heart rate variability is associated with survival in patients with brain metastasis: a preliminary report. BIOMED RESEARCH INTERNATIONAL 2013; 2013:503421. [PMID: 24102056 PMCID: PMC3786541 DOI: 10.1155/2013/503421] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 08/12/2013] [Indexed: 11/17/2022]
Abstract
Impaired heart rate variability (HRV) has been demonstrated as a negative survival prognosticator in various diseases. We conducted this prospective study to evaluate how HRV affects brain metastasis (BM) patients. Fifty-one BM patients who had not undergone previous brain operation or radiotherapy (RT) were recruited from January 2010 to July 2012, and 40 patients were included in the final analysis. A 5-minute electrocardiogram was obtained before whole brain radiotherapy. Time domain indices of HRV were compared with other clinical factors on overall survival (OS). In the univariate analysis, Karnofsky performance status (KPS) <70 (P = 0.002) and standard deviation of the normal-to-normal interval (SDNN) <10 ms (P = 0.004) significantly predict poor survival. The multivariate analysis revealed that KPS <70 and SDNN <10 ms were independent negative prognosticators for survival in BM patients with hazard ratios of 2.657 and 2.204, respectively. In conclusion, HRV is associated with survival and may be a novel prognostic factor for BM patients.
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Rava P, Leonard K, Sioshansi S, Curran B, Wazer DE, Cosgrove GR, Norén G, Hepel JT. Survival among patients with 10 or more brain metastases treated with stereotactic radiosurgery. J Neurosurg 2013; 119:457-62. [DOI: 10.3171/2013.4.jns121751] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The goal of this study was to evaluate outcomes in patients with ≥ 10 CNS metastases treated with Gamma Knife stereotactic radiosurgery (GK-SRS).
Methods
Patients with ≥ 10 brain metastases treated using GK-SRS during the period between 2004 and 2010 were identified. Overall survival and local and regional control as well as necrosis rates were determined. The influence of age, sex, histological type, extracranial metastases, whole-brain radiation therapy, and number of brain metastases was analyzed using the Kaplan-Meier method. Univariate (log-rank) analyses were performed, with a p value of < 0.05 considered significant.
Results
Fifty-three patients with ≥ 10 brain metastases were treated between 2004 and 2010. All had a Karnofsky Performance Status score of ≥ 70. Seventy-two percent had either non–small cell lung cancer (38%) or breast cancer (34%); melanoma, small cell lung cancer, renal cell carcinoma, and testicular, colon, and ovarian cancer contributed the remaining 28%. On average, 10.9 lesions were treated in a single session. Sixty-four percent of patients received prior whole-brain radiation therapy. The median survival was 6.5 months. One-year overall survival was 42% versus 14% when comparing breast cancer and other histological types, respectively (p = 0.074). Age, extracranial metastases, number of brain metastases, and previous CNS radiation therapy were not significant prognostic factors. Although the median time to local failure was not reached, the median time to regional failure was 3 months. Female sex was associated with longer time to regional failure (p = 0.004), as was breast cancer histological type (p = 0.089). No patient experienced symptomatic necrosis.
Conclusions
Patients with ≥ 10 brain metastases who received prior CNS radiation can safely undergo repeat treatment with GK-SRS. With median survival exceeding 6 months, aggressive local treatment remains an option; however, rapid CNS failure is to be expected. Although numbers are limited, patients with breast cancer represent one group of individuals who would benefit most, with prolonged survival and extended time to CNS recurrence.
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Affiliation(s)
- Paul Rava
- 1Department of Radiation Oncology, Tufts Medical Center, Boston
| | - Kara Leonard
- 1Department of Radiation Oncology, Tufts Medical Center, Boston
| | - Shirin Sioshansi
- 2Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts; and
| | | | - David E. Wazer
- 1Department of Radiation Oncology, Tufts Medical Center, Boston
- 3Departments of Radiation Oncology and
| | | | - Georg Norén
- 4Neurosurgery, Rhode Island Hospital, Providence, Rhode Island
| | - Jaroslaw T. Hepel
- 1Department of Radiation Oncology, Tufts Medical Center, Boston
- 3Departments of Radiation Oncology and
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S100B protein as a possible participant in the brain metastasis of NSCLC. Med Oncol 2013; 29:2626-32. [PMID: 22286962 DOI: 10.1007/s12032-012-0169-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 01/14/2012] [Indexed: 01/02/2023]
Abstract
Brain metastasis is a frequent occurrence in lung cancer, especially non-small cell lung cancer (NSCLC), the prognosis for NSCLC with brain metastasis is very poor. Our previous study found high S100B expression in the brain-specific metastatic NSCLC line PC14/B, suggested S100B is closely correlated with brain metastasis in NSCLC. However, the details have not yet been revealed. The aim of this study was to investigate the correlation between S100B and brain metastasis in NSCLC and to study the effects of S100B on non-brain metastatic NSCLC line PC14. We investigated serum S100B levels in 30 newly diagnosed NSCLC patients (15 with brain metastasis and 15 without brain metastasis) using enzyme-linked immunosorbent assay. Results showed that serum S100B levels were significant higher in NSCLC patients with brain metastasis compared to those without brain metastasis (P<0.01). We constructed the full-length S100B expression vector and transfected into PC14 cells. MTT and flow cytometric analysis showed that S100B transfection promoted cell proliferation and inhibited cell apoptosis (P<0.05). Transwell migration and invasion assays indicated that S100B transfection promoted cell invasion and cell migration compared to control cells transfected with empty vector alone (P<0.01). These results suggested that S100B could be involved in the development of brain metastasis in NSCLC.
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Ray S, Dacosta-Byfield S, Ganguli A, Bonthapally V, Teitelbaum A. Comparative analysis of survival, treatment, cost and resource use among patients newly diagnosed with brain metastasis by initial primary cancer. J Neurooncol 2013; 114:117-25. [PMID: 23700325 DOI: 10.1007/s11060-013-1160-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 05/13/2013] [Indexed: 01/13/2023]
Abstract
Brain metastases are a frequent complication of many systemic cancers and portend a poor prognosis. This retrospective analysis of health claims data compared survival, treatment and health care utilization and costs in patients with brain metastasis by primary tumor site. Adult commercial and Medicare Advantage enrollees newly diagnosed with brain metastasis in 01 Jan 2004 through 30 Apr 2010 were identified. Inclusion required at least 2 claims that identified the same primary cancer site prior to diagnosis of brain metastasis and no evidence of primary brain tumors. Health care utilization rates and costs were calculated at the patient level for each month of follow-up. Differences among primary cancer site cohorts were assessed by ANOVA (continuous variables), Chi square test (proportions) and the Poisson distribution (utilization rates). The primary cancer cohorts comprised 1,031 lung cancer, 93 melanoma and 395 female breast cancer patients. During the 6 months prior to brain metastasis diagnosis, 59 % of lung cancer patients had no evidence of lymph node involvement or other metastatic disease compared to 55 and 42 % of melanoma and breast cancer patients (P < 0.001). Survival after brain metastasis diagnosis was less than 3 months for 52, 43 and 39 % for lung cancer, breast cancer and melanoma, respectively (P < 0.001). Melanoma patients had the highest rate of inpatient stays and outpatient visits (P ≤ 0.003). Total monthly all-cause costs were: melanoma, $23,426; breast cancer $19,708; lung cancer, $17,007 (P = 0.003). Health care utilization and costs after brain metastasis diagnosis were substantial and differed by primary tumor site.
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Affiliation(s)
- Saurabh Ray
- Abbott Laboratories, Abbott Park, IL 60064, USA
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Levitt MR, Levitt R, Silbergeld DL. Controversies in the management of brain metastases. Surg Neurol Int 2013; 4:S231-5. [PMID: 23717794 PMCID: PMC3656559 DOI: 10.4103/2152-7806.111300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 03/11/2013] [Indexed: 01/20/2023] Open
Abstract
The multidisciplinary management of brain metastases has generated substantial controversy as treatment has diversified in recent years. Debate about the type, role, and timing of different diagnostic and therapeutic strategies has promoted rigorous scientific research into efficacy. However, much still remains unanswered in the treatment of this difficult disease process. This manuscript seeks to highlight some of the controversies identified in previous sections of this supplement, including prognosis, pathology, radiation and surgical treatment, neuroimaging, and the biochemical underpinnings of brain metastases. By recognizing what is yet unanswered, we hope to identify areas in which further research may yield promising results.
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Affiliation(s)
- Michael R Levitt
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle WA, USA
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36
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Stelzer KJ. Epidemiology and prognosis of brain metastases. Surg Neurol Int 2013; 4:S192-202. [PMID: 23717790 PMCID: PMC3656565 DOI: 10.4103/2152-7806.111296] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 02/01/2013] [Indexed: 01/23/2023] Open
Abstract
A substantial, but uncertain, number of patients with cancer develop brain metastases. Risk of brain metastasis is recognized to vary with type of primary cancer. Within specific types of primary cancer, prognostic factors for development of brain metastases are being recognized. Recent data suggest that molecular biomarkers that relate to cellular function can predict risk of developing brain metastases. Such information could optimize surveillance standards and/or be used to select patients for preventive interventions. Though average survival for patients with brain metastases is typically less than 6 months, it is well-recognized that subgroups of patients have significant probability of longer survival. Multiple prognostic models have been proposed, validated, and compared without clearly demonstrating superiority of one model over another. However, some factors show consistency as predictive variables across models, and performance status is almost universally significant. Application of predictive models to specific treatments has been difficult. Tumor-specific prognostic models are evolving, and combinations of biological and clinical factors may be used to optimize models for particular primary tumor types.
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Affiliation(s)
- Keith J Stelzer
- Department of Radiation Oncology, Celilo Cancer Center, Mid-Columbia Medical Center, The Dalles, Oregon, USA
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Martínez-Aranda A, Hernández V, Picón C, Modolell I, Sierra A. Development of a preclinical therapeutic model of human brain metastasis with chemoradiotherapy. Int J Mol Sci 2013; 14:8306-27. [PMID: 23591844 PMCID: PMC3645744 DOI: 10.3390/ijms14048306] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 03/16/2013] [Accepted: 03/26/2013] [Indexed: 01/22/2023] Open
Abstract
Currently, survival of breast cancer patients with brain metastasis ranges from 2 to 16 months. In experimental brain metastasis studies, only 10% of lesions with the highest permeability exhibited cytotoxic responses to paclitaxel or doxorubicin. Therefore, radiation is the most frequently used treatment, and sensitizing agents, which synergize with radiation, can improve the efficacy of the therapy. In this study we used 435-Br1 cells containing the fluorescent protein (eGFP) gene and the photinus luciferase (PLuc) gene to develop a new brain metastatic cell model in mice through five in vivo/in vitro rounds. BR-eGFP-CMV/Luc-V5 brain metastatic cells induce parenchymal brain metastasis within 60.8 ± 13.8 days of intracarotid injection in all mice. We used this model to standardize a preclinical chemoradiotherapy protocol comprising three 5.5 Gy fractions delivered on consecutive days (overall dose of 16.5 Gy) which improved survival with regard to controls (60.29 ± 8.65 vs. 47.20 ± 11.14). Moreover, the combination of radiotherapy with temozolomide, 60 mg/Kg/day orally for five consecutive days doubled survival time of the mice 121.56 ± 52.53 days (Kaplan-Meier Curve, p < 0.001). This new preclinical chemoradiotherapy protocol proved useful for the study of radiation response/resistance in brain metastasis, either alone or in combination with new sensitizing agents.
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Affiliation(s)
- Antonio Martínez-Aranda
- Biological Clues of the Invasive and Metastatic Phenotype Group, Bellvitge Biomedical Research Institute (IDIBELL), L’ Hospitalet de Llobregat, Barcelona 08907, Spain; E-Mails: (A.M.-A.); (V.H.)
- Autonoma University of Barcelona (UAB), Faculty of Biosciences, Campus Bellaterra, Building C, Cerdanyola del Vallés, Barcelona 08193, Spain
| | - Vanessa Hernández
- Biological Clues of the Invasive and Metastatic Phenotype Group, Bellvitge Biomedical Research Institute (IDIBELL), L’ Hospitalet de Llobregat, Barcelona 08907, Spain; E-Mails: (A.M.-A.); (V.H.)
| | - Cristina Picón
- Medical Physics Service, Oncology Catalan Institut, Duran I Reynals Hospital, L’Hospitalet de Llobregat, Barcelona 08907, Spain; E-Mails: (C.P.); (I.M.)
| | - Ignasi Modolell
- Medical Physics Service, Oncology Catalan Institut, Duran I Reynals Hospital, L’Hospitalet de Llobregat, Barcelona 08907, Spain; E-Mails: (C.P.); (I.M.)
| | - Angels Sierra
- Biological Clues of the Invasive and Metastatic Phenotype Group, Bellvitge Biomedical Research Institute (IDIBELL), L’ Hospitalet de Llobregat, Barcelona 08907, Spain; E-Mails: (A.M.-A.); (V.H.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +34-93-260-7429, Fax: +34-93-260-7426
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Rodrigues G, Bauman G, Palma D, Louie AV, Mocanu J, Senan S, Lagerwaard F. Systematic review of brain metastases prognostic indices. Pract Radiat Oncol 2013; 3:101-6. [DOI: 10.1016/j.prro.2012.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
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Abstract
Surgical excision in brain metastases has been well evaluated in unique metastases. Two randomized phase III trials have shown that combined with adjuvant whole brain radiotherapy, it significantly improves overall survival. However, even in the presence of multiple brain metastases, surgery may be useful in large, symptomatic or life-threatening lesions (posterior fossa tumor with mass effect). Also, even in lesions amenable to radiosurgery, surgical resection is preferred when tumors displayed cystic or necrotic aspect with important edema or when located in highly eloquent areas or cortico-subcortically. Furthermore, surgery may have a diagnostic role, in the absence of histological documentation of the primary disease, if the radiological aspect is atypical to rule out differential diagnosis (brain abscess, lymphoma, primary tumor of the central nervous system) or in case of suspicion of progression after irradiation to differentiate radionecrosis from a genuine progression of brain disease. Finally, the issue of biological documentation of brain disease may arise in situations where a specific targeted therapy can be proposed. If the surgical indications are relatively well defined, the selection of patients who will really benefit from surgery should take into account three factors, clinical and functional status of the patient, systemic disease status and characteristics of intracranial metastases. Given the improved survival of cancer patients due to the advent of effective targeted therapies on systemic disease, a renewed interest has been given to local therapy (surgery or radiosurgery) in brain metastases. Surgical resection currently represents a valuable tool in the armamentarium of brain metastases but has also become a diagnostic and decision tool that can affect therapeutic strategies in these patients.
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Spanberger T, Berghoff AS, Dinhof C, Ilhan-Mutlu A, Magerle M, Hutterer M, Pichler J, Wöhrer A, Hackl M, Widhalm G, Hainfellner JA, Dieckmann K, Marosi C, Birner P, Prayer D, Preusser M. Extent of peritumoral brain edema correlates with prognosis, tumoral growth pattern, HIF1a expression and angiogenic activity in patients with single brain metastases. Clin Exp Metastasis 2012; 30:357-68. [PMID: 23076770 DOI: 10.1007/s10585-012-9542-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 10/01/2012] [Indexed: 01/21/2023]
Abstract
To analyze the prognostic value of the extent of peritumoral brain edema in patients operated for single brain metastases (BM), we retrospectively evaluated pre-operative magnetic resonance images in a discovery cohort of 129 patients and a validation cohort of 118 patients, who underwent neurosurgical resection of a single BM in two different hospitals. We recorded clinical parameters and immunohistochemically assessed the Ki67 index, the microvascularization patterns and the expression of hypoxia-induced factor 1 alpha (HIF1a) in the BM tissue specimens retrieved at neurosurgery. Statistical analysis including uni- and multivariate survival analyses were performed. Baseline characteristics were well balanced between the discovery and validation cohorts. In univariate analysis, we found a significant association of favorable overall survival time with young patient age, high Karnofsky performance score, low graded prognostic assessment (GPA) class, absence of extracranial metastases, adjuvant treatment with whole brain radiotherapy and, surprisingly, large brain edema. In multivariate analysis, only GPA and extent of brain edema remained independent prognostic parameters. The prognostic impact of the extent of brain edema was consistent in the two patient cohorts. Furthermore, we found a significant correlation of small brain edema with brain-invasive tumor growth pattern as assessed intraoperatively by the neurosurgeon, low neo-angiogenic activity and low expression of HIF1a. Extent of brain edema independently correlates with prognosis in patients operated for single BM. In conclusion, patients with small peritumoral edema have shorter survival times and their tumors are characterized by a more brain-invasive growth, lower HIF1a expression and less angiogenic activity.
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Affiliation(s)
- Thomas Spanberger
- Division of Neuroradiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
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Fernandez G, Pocinho R, Travancinha C, Netto E, Roldão M. Quality of life and radiotherapy in brain metastasis patients. Rep Pract Oncol Radiother 2012; 17:281-7. [PMID: 24669309 DOI: 10.1016/j.rpor.2012.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 08/02/2012] [Accepted: 08/10/2012] [Indexed: 11/15/2022] Open
Abstract
AIM The primary objective of this study was to assess whether there was an improvement in QoL for patients with brain metastases after radiotherapy treatments. BACKGROUND Assessment of quality of life (QoL) in brain metastasis patients has become increasingly recognized as an important outcome. MATERIALS AND METHODS Patients treated for brain metastasis in our department during 2010 were included in our prospective study. QoL assessments were conducted at baseline, 1 month, and 3 months after completion of whole-brain radiotherapy (WBRT). Wilcoxon test for multiple comparisons was calculated to detect significant differences in global QoL scores. RESULTS Thirty-nine patients with brain metastases completed the EORTC QLQ-C30/BN-20 questionnaire independently. Median age was 59.9 years (from 37 to 81 years). Our results report differences between the baseline and 3 months in worsening of a global health status (p = 0.034) and cognitive function (p = 0.004), as well as drowsiness (p = 0.001), appetite loss (p = 0.031) and hair loss (p = 0.005). There is a tendency for deterioration of physical function (p = 0.004), communication deficit (p = 0.012), and weakness of legs (p = 0.024), between the baseline and 1 month evaluation. There was no difference in a global cognitive status between different evaluations. Median survival time was 3 months (CI 95% 1.85; 4.15). CONCLUSIONS Our findings indicate a small deterioration for a global QoL status, and large deterioration for cognitive function after radiation treatments, as well as worsening of brain metastasis related symptom items. Further research is necessary to refine treatment selection for patients with brain metastases, since it may at least contribute to the stabilization of their QoL status.
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Affiliation(s)
- Gonçalo Fernandez
- Radiotherapy Department at Instituto Português de Oncologia de Lisboa - Francisco Gentil, Portugal
| | - Rute Pocinho
- Radiotherapy Department at Instituto Português de Oncologia de Lisboa - Francisco Gentil, Portugal
| | - Catarina Travancinha
- Radiotherapy Department at Instituto Português de Oncologia de Lisboa - Francisco Gentil, Portugal
| | - Eduardo Netto
- Radiotherapy Department at Instituto Português de Oncologia de Lisboa - Francisco Gentil, Portugal
| | - Margarida Roldão
- Radiotherapy Department at Instituto Português de Oncologia de Lisboa - Francisco Gentil, Portugal
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Preusser M, Winkler F, Collette L, Haller S, Marreaud S, Soffietti R, Klein M, Reijneveld JC, Tonn JC, Baumert BG, Mulvenna P, Schadendorf D, Duchnowska R, Berghoff AS, Lin N, Cameron DA, Belkacemi Y, Jassem J, Weber DC. Trial design on prophylaxis and treatment of brain metastases: lessons learned from the EORTC Brain Metastases Strategic Meeting 2012. Eur J Cancer 2012; 48:3439-47. [PMID: 22883982 DOI: 10.1016/j.ejca.2012.07.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 07/04/2012] [Indexed: 11/12/2022]
Abstract
Brain metastases (BM) occur in a significant proportion of cancer patients and are associated with considerable morbidity and poor prognosis. The trial design in BM patients is particularly challenging, as many disease and patient variables, statistical issues, and the selection of appropriate end-points have to be taken into account. During a meeting organised on behalf of the European Organisation for Research and Treatment of Cancer (EORTC), methodological aspects of trial design in BM were discussed. This paper summarises the issues and potential trial strategies discussed during this meeting and may provide some guidance for the design of trials in BM patients.
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Affiliation(s)
- Matthias Preusser
- Department of Medicine I & Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
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