Pulmonary Blastoma with Brain Metastasis Treated with Surgical Resection and Whole Brain Irradiation

2009 ◽

Vol 27 (15_suppl) ◽

pp. 2067-2067

Author(s):

M. A. Alrefae ◽

D. Roberge ◽

L. Souhami

Keyword(s):

Brain Metastasis ◽

Brain Metastases ◽

Surgical Resection ◽

Local Failure ◽

Unknown Primary ◽

Whole Brain Irradiation ◽

Whole Brain ◽

Brain Irradiation ◽

Short Course ◽

Single Brain Metastasis

2067 Background: Surgical resection followed by whole-brain irradiation is a standard treatment approach for patients with a single brain metastasis from solid tumours. As short-course hypofractionated irradiation has proven equivalent to more protracted schedules for the palliative treatment of brain metastasis, it has been commonly applied in the adjuvant setting. Methods: By reviewing our pathology database, we identified patients having undergone complete neurosurgical resection of a single brain metastasis followed by short-course (4–6 fractions) whole-brain irradiation. Irradiation was delivered using standard lateral-opposed megavoltage radiation portals. Local failure and new brain metastases were identified by chart and imaging study reviews. All outcomes were calculated actuarially. Results: Between March 2000 and August 2005, 50 patients received short-course whole-brain irradiation (20 Gy in 5 fractions in 41 of 50 cases) following complete surgical resection of a single brain metastasis. The most common primary malignancies were lung (66%), breast (14%), and cancer of unknown primary origin (10%). Median age was 60 years. Imaging studies were available for all patients and a preoperative MRI was reviewed in 94% of cases. Median follow-up for living patients was 30.0 months. The median overall survival was 10.92 months (29% at 2 years). Following radiation, failure at the surgical site was seen in 51% and 79% of patients at 1 and 2 years. New metastases elsewhere in the brain developed in 26% and 53% of these patients at 1 and 2 years. Conclusions: When calculated actuarially, local failure and new brain metastases were common following surgery and short-course whole-brain radiation therapy. In part, this may represent inefficacy of the short hypofractionated radiation scheme. Further investigation into the local and systemic treatment of these patients is warranted. No significant financial relationships to disclose.

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1432 POSTER Hypofractionated stereotactic radiotherapy alone without whole-brain irradiation for patients with solitary and oligo brain metastasis with diameter more than 3.5 cm: a feasible and efficacy alternative

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(05)81723-9 ◽

2005 ◽

Vol 3 (2) ◽

pp. 414-415

Keyword(s):

Brain Metastasis ◽

Stereotactic Radiotherapy ◽

Whole Brain Irradiation ◽

Whole Brain ◽

Hypofractionated Stereotactic Radiotherapy ◽

Brain Irradiation ◽

Radiotherapy Alone

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An Updated Review on Memantine Efficacy in Reducing Cognitive Dysfunction of Whole-brain Irradiation for Adult Patients with Brain metastasis

International Journal of Cancer Management ◽

10.5812/ijcm.111966 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Anya jafari ◽

Zahra Siavashpour ◽

Mohammad Houshyari

Keyword(s):

Brain Metastasis ◽

Verbal Learning ◽

Whole Brain Radiotherapy ◽

Protective Effects ◽

Whole Brain Irradiation ◽

Whole Brain ◽

Brain Irradiation ◽

Brain Radiotherapy ◽

Delayed Recognition

Context: Increased survival of patients with cancer raises the need to pay attention to long-term side effects. Patients with brain metastasis experienced cognition failure after whole-brain radiotherapy. This review aimed at concluding the efficacy of Memantine in preserving cognitive function by reducing the brain toxicity of whole-brain radiotherapy for metastatic brain cancers. Evidence Acquisition: Published studies evaluating memantine protective effects during brain metastasis radiotherapy were searched for in scientific databases (e.g., Embase, PubMed, Cochrane database, Google Scholar, Scopus) using keywords including whole-brain radiotherapy and Memantine. Results: A total of 4 prospective clinical trials were included in the review. Effects of Memantine on cognition tests were evaluated in these trials. A significantly better Hopkins Verbal Learning Test-Revised (HVLT-R) delayed recognition at months 6 was achieved in RTOG 0614 and NRG CC001. Longer time to cognitive decline was found in the memantine arm of the RTOG trial and was statistically significant. Memantine effects were not statistically significant before 2 months. Conclusions: It seems reasonable to consider Memantine during radiation to prevent long-term cognitive failure in patients with brain metastasis due to the current results. Memantine improves cognition function during whole-brain radiotherapy (WBRT) without adding irreparable complications.

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Sector Irradiation vs. Whole Brain Irradiation After Resection of Singular Brain Metastasis—A Prospective Randomized Monocentric Trial

Frontiers in Oncology ◽

10.3389/fonc.2020.591884 ◽

2020 ◽

Vol 10 ◽

Author(s):

Johannes Kerschbaumer ◽

Daniel Pinggera ◽

Bernhard Holzner ◽

Margarete Delazer ◽

Thomas Bodner ◽

...

Keyword(s):

Overall Survival ◽

Brain Metastasis ◽

Statistical Significance ◽

Local Tumor Control ◽

Comparable Efficacy ◽

Tumor Control ◽

Whole Brain Irradiation ◽

Clinical Trial Registration ◽

Whole Brain ◽

Brain Irradiation

To minimize recurrence following resection of a cerebral metastasis, whole-brain irradiation therapy (WBRT) has been established as the adjuvant standard of care. With prolonged overall survival in cancer patients, deleterious effects of WBRT gain relevance. Sector irradiation (SR) aims to spare uninvolved brain tissue by applying the irradiation to the resection cavity and the tumor bed. 40 were randomized to receive either WBRT (n = 18) or SR (n = 22) following resection of a singular brain metastasis. Local tumor control was satisfactory in both groups. Recurrence was observed earlier in the SR (median 3 months, 1–6) than in the WBRT cohort (median 8 months, 7–9) (HR, 0.63; 95% CI, 0.03–10.62). Seventeen patients experienced a distant intracranial recurrence. Most relapses (n = 15) occurred in the SR cohort, whereas only two patients in the WBRT group had new distant tumor manifestation (HR, 6.59; 95% CI, 1.71–11.49; p = 0.002). Median overall survival (OS) was 15.5 months (range: 1–61) with longer OS in the SR group (16 months, 1–61) than in the WBRT group (13 months, 3–52), without statistical significance (HR, 0.55; 95% CI, 0.69–3.64). Concerning neurocognition, patients in the SR group improved in the follow-up assessments, while this was not observed in the WBRT group. There were positive signals in terms of QOL within the SR group, but no significant differences in the global QLQ and QLQ-C30 summary scores were found. Our results indicate comparable efficacy of SR in terms of local control, with better maintenance of neurocognitive function. Unsurprisingly, more distant intracranial relapses occurred.Clinical Trial Registration:ClinicalTrials.gov, identifier NCT01667640.

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Brain metastasis from cervical carcinoma

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.00808.x ◽

2007 ◽

Vol 17 (1) ◽

pp. 141-146 ◽

Cited By ~ 24

Author(s):

J. C. Chura ◽

K. Shukla ◽

P. A. Argenta

Keyword(s):

Cervical Cancer ◽

Brain Metastasis ◽

Median Survival ◽

Figo Stage ◽

Additional Treatment ◽

Whole Brain Irradiation ◽

Whole Brain ◽

Brain Irradiation ◽

Neurologic Sequelae ◽

Median Interval

The aim of this study was to describe the features of patients with brain metastasis from cervical cancer. Twelve patients with brain metastasis from cervical cancer were identified. Information regarding symptoms, treatment, and survival was analyzed. The incidence of brain metastasis in our population was 0.77%. Median patient age at initial diagnosis of cervical cancer was 43.5 years (range 29–57 years) compared with 44.5 years (range 31–58 years) at identification of brain metastasis. Six patients had FIGO stage IB disease; three had stage IIB disease; and one each had stage IIIA, IIIB, and IVB disease. The median interval from diagnosis of cervical cancer to identification of brain metastasis was 17.5 months (range 1.1–96.1 months). All but one patient presented with neurologic symptoms. Eight patients received whole-brain irradiation and steroids, three received steroids alone, and one underwent surgery, followed by irradiation. All the patients who received whole-brain irradiation experienced improvement in their symptoms. Median survival from diagnosis of brain metastasis to death was 2.3 months (range 0.3–7.9 months). Five patients who received chemotherapy after brain irradiation had a median survival of 4.4 months compared to 0.9 months for those who received no additional treatment after brain irradiation (P= .016). Most patients with brain metastasis from cervical cancer presented with neurologic sequelae. Brain irradiation improved these symptoms. Survival after diagnosis of brain metastasis was poor; however, patients who received chemotherapy after brain irradiation appeared to have improved survival.

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Phase II trial of hippocampal-sparing whole brain irradiation with simultaneous integrated boost for metastatic cancer

Neuro-Oncology ◽

10.1093/neuonc/noaa092 ◽

2020 ◽

Vol 22 (12) ◽

pp. 1831-1839 ◽

Cited By ~ 4

Author(s):

Kenneth D Westover ◽

J Travis Mendel ◽

Tu Dan ◽

Kiran Kumar ◽

Ang Gao ◽

...

Keyword(s):

Radiation Therapy ◽

Brain Metastasis ◽

Phase Ii ◽

Phase Ii Trial ◽

Simultaneous Integrated Boost ◽

Whole Brain Irradiation ◽

Whole Brain ◽

Brain Irradiation ◽

Integrated Boost ◽

Hippocampal Sparing

Abstract Background Advanced radiotherapeutic treatment techniques limit the cognitive morbidity associated with whole-brain radiotherapy (WBRT) for brain metastasis through avoidance of hippocampal structures. However, achieving durable intracranial control remains challenging. Methods We conducted a single-institution single-arm phase II trial of hippocampal-sparing whole brain irradiation with simultaneous integrated boost (HSIB-WBRT) to metastatic deposits in adult patients with brain metastasis. Radiation therapy consisted of intensity-modulated radiation therapy delivering 20 Gy in 10 fractions over 2–2.5 weeks to the whole brain with a simultaneous integrated boost of 40 Gy in 10 fractions to metastatic lesions. Hippocampal regions were limited to 16 Gy. Cognitive performance and cancer outcomes were evaluated. Results A total of 50 patients, median age 60 years (interquartile range, 54–65), were enrolled. Median progression-free survival was 2.9 months (95% CI: 1.5–4.0) and overall survival was 9 months. As expected, poor survival and end-of-life considerations resulted in a high exclusion rate from cognitive testing. Nevertheless, mean decline in Hopkins Verbal Learning Test–Revised delayed recall (HVLT-R DR) at 3 months after HSIB-WBRT was only 10.6% (95% CI: −36.5‒15.3%). Cumulative incidence of local and intracranial failure with death as a competing risk was 8.8% (95% CI: 2.7‒19.6%) and 21.3% (95% CI: 10.7‒34.2%) at 1 year, respectively. Three grade 3 toxicities consisting of nausea, vomiting, and necrosis or headache were observed in 3 patients. Scores on the Multidimensional Fatigue Inventory 20 remained stable for evaluable patients at 3 months. Conclusions HVLT-R DR after HSIB-WBRT was significantly improved compared with historical outcomes in patients treated with traditional WBRT, while achieving intracranial control similar to patients treated with WBRT plus stereotactic radiosurgery (SRS). This technique can be considered in select patients with multiple brain metastases who cannot otherwise receive SRS.

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