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Gleim N, Rühle A, Heider S, Nägler F, Giordano F, Combs S, Becker J, Niyazi M, Grosu A, Nicolay N, Seidel C. Neuroprotection in radiotherapy of brain metastases: A pattern-of-care analysis in Germany, Austria and Switzerland by the German Society for radiation Oncology - working group Neuro-Radio-Oncology (DEGRO AG-NRO). Clin Transl Radiat Oncol 2024; 47:100783. [PMID: 38706724 PMCID: PMC11063589 DOI: 10.1016/j.ctro.2024.100783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/14/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024] Open
Abstract
Background and purpose Many patients with solid tumors develop brain metastases (BM). With more patients surviving long-term, preservation of neurocognitive function gains importance. In recent years, several methods to delay cognitive deterioration have been tested in clinical trials. However, knowledge on the extent to which these neuroprotective strategies have been implemented in clinical practice is missing. Materials and methods We performed an online survey regarding treatment patterns of BM in German-speaking countries, focused on the use of neuroprotective approaches. The survey was distributed among radiation oncologists (ROs) registered within the database of the German Society for Radiation Oncology (DEGRO). Results Physicians of 78 centers participated in the survey. Whole brain radiotherapy (WBRT) is still preferred by 70 % of ROs over stereotactic radiotherapy (SRT) in patients with 6-10 BM. For 4-5 BM WBRT is preferred by 23 % of ROs. The fraction of ROs using hippocampal sparing (HS) in WBRT has increased to 89 %, although the technique is used on a regular basis only by a minority (26 %). The drug memantine is not widely prescribed (14% of ROs). A trend was observed for university hospitals to implement neuroprotective approaches more frequently. Conclusion There is considerable heterogeneity regarding the treatment of BM in German-speaking countries and a general standard of care is lacking. Neuroprotective strategies are not yet standard approaches in daily clinical routine, although usage is increasing. Further clinical trials, as well as improvement of technical opportunities and reimbursement, might further shift the treatment landscape towards neuroprotective radiation treatments in the future.
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Affiliation(s)
- N. Gleim
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, Stephanstraße 9a, Leipzig, Germany
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, Leipzig, Germany
| | - A. Rühle
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, Stephanstraße 9a, Leipzig, Germany
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, Leipzig, Germany
| | - S. Heider
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, Stephanstraße 9a, Leipzig, Germany
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, Leipzig, Germany
| | - F. Nägler
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, Stephanstraße 9a, Leipzig, Germany
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, Leipzig, Germany
| | - F.A. Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
- DKFZ Hector Cancer Institute, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany
- Mannheim Institute for Intelligent Systems in Medicine (MIiSM), Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | - S.E. Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Straße 22, Munich, Germany
| | - J. Becker
- Department of Radiotherapy and Special Oncology, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, Hannover, Germany
| | - M. Niyazi
- Department of Radiation Oncology, University Hospital Tübingen, Hoppe-Seyler-Straße 3, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Herrenbergerstraße 23, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, A Partnership between DKFZ and University Hospital Tübingen, Auf der Morgenstelle 15, Tübingen, Germany
| | - A.L. Grosu
- Department of Radiation Oncology, University of Freiburg - Medical Center, Robert-Koch-Straße 3, Freiburg, Germany
| | - N.H. Nicolay
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, Stephanstraße 9a, Leipzig, Germany
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, Leipzig, Germany
| | - C. Seidel
- Department of Radiotherapy and Radiation Oncology, University Hospital Leipzig, Stephanstraße 9a, Leipzig, Germany
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, Leipzig, Germany
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Zhu Y, Zhou M, Li C, Kong W, Hu Y. Gastric cancer with brain metastasis: from molecular characteristics and treatment. Front Oncol 2024; 14:1310325. [PMID: 38577333 PMCID: PMC10991736 DOI: 10.3389/fonc.2024.1310325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/12/2024] [Indexed: 04/06/2024] Open
Abstract
Gastric cancer is one of the cancers with increasing incidence and ranks fourth globally among the most frequent causes of cancer-related mortality. Early gastric cancer is often asymptomatic or presents with atypical symptoms, and the majority of patients present with advanced disease upon diagnosis. Brain metastases are present in approximately 1% of gastric cancer patients at the time of diagnosis, which significantly contributed to the overall mortality of the disease worldwide. Conventional therapies for patients with brain metastases remain limited and the median overall survival of patients is only 8 months in advanced cases. Recent studies have improved our understanding of the molecular mechanisms underlying gastric cancer brain metastases, and immunotherapy has become an important treatment option in combination with radiotherapy, chemotherapy, targeted therapy and surgery. This review aims to provide insight into the cellular processes involved in gastric cancer brain metastases, discuss diagnostic approaches, evaluate the integration of immune checkpoint inhibitors into treatment and prognosis, and explore the predictive value of biomarkers in immunotherapy.
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Affiliation(s)
- Yingze Zhu
- Department of Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Miao Zhou
- Department of Oncology, Tang Shan Central Hospital, Tangshan, China
| | - Congling Li
- School of Clinical Medicine, Affiliated Hospital, North China University of Science and Technology, Tangshan, China
| | - Wenyue Kong
- School of Clinical Medicine, Affiliated Hospital, North China University of Science and Technology, Tangshan, China
| | - Yuning Hu
- School of Clinical Medicine, Affiliated Hospital, North China University of Science and Technology, Tangshan, China
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Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative Review. Cancers (Basel) 2022; 14:cancers14112736. [PMID: 35681716 PMCID: PMC9179311 DOI: 10.3390/cancers14112736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Decline in cognitive function is a major problem for patients undergoing whole-brain radiotherapy (WBRT). Scientific interest has increased due to the high dropout rate of patients in the first months after WBRT and the early onset of cognitive decline. Therefore, the study of antiglutamatergic pharmacological prophylaxis and hippocampal-sparing WBRT techniques has been deepened based on the knowledge of the mechanisms of hyperglutamatergic neurotoxicity and the role of some hippocampal areas in cognitive decline. In order to provide a summary of the evidence in this field, and to foster future research in this setting, this literature review presents current evidence on the prevention of radiation-induced cognitive decline and particularly on the role of memantine. Abstract Preserving cognitive functions is a priority for most patients with brain metastases. Knowing the mechanisms of hyperglutamatergic neurotoxicity and the role of some hippocampal areas in cognitive decline (CD) led to testing both the antiglutamatergic pharmacological prophylaxis and hippocampal-sparing whole-brain radiotherapy (WBRT) techniques. These studies showed a relative reduction in CD four to six months after WBRT. However, the failure to achieve statistical significance in one study that tested memantine alone (RTOG 0614) led to widespread skepticism about this drug in the WBRT setting. Moreover, interest grew in the reasons for the strong patient dropout rates in the first few months after WBRT and for early CD onset. In fact, the latter can only partially be explained by subclinical tumor progression. An emerging interpretation of the (not only) cognitive impairment during and immediately after WBRT is the dysfunction of the limbic and hypothalamic system with its immune and hormonal consequences. This new understanding of WBRT-induced toxicity may represent the basis for further innovative trials. These studies should aim to: (i) evaluate in greater detail the cognitive effects and, more generally, the quality of life impairment during and immediately after WBRT; (ii) study the mechanisms producing these early effects; (iii) test in clinical studies, the modern and advanced WBRT techniques based on both hippocampal-sparing and hypothalamic-pituitary-sparing, currently evaluated only in planning studies; (iv) test new timings of antiglutamatergic drugs administration aimed at preventing not only late toxicity but also acute effects.
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