Brain Metastases

2018 ◽  
Author(s):  
Adam M. Robin ◽  
Steven N. Kalkanis
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Surgical Resection ◽  
Systemic Therapy ◽  
Immune Therapy ◽  
Treatment Strategies ◽  
Targeted Agents ◽  
Significant Percentage ◽  
Solitary Brain Metastases

A significant percentage of patients with systemic cancer will develop brain metastasis at some point in the course of their disease. Brain metastases should be suspected if patients with known cancer histories present with new neurologic symptoms. Treatment for brain metastasis typically involves radiation. Patients with large, symptomatic and/or solitary brain metastases may benefit from surgical resection in addition to radiation. The role of systemic therapy for brain metastases remains somewhat limited, but newer treatment strategies such as immune therapy and molecular targeted agents may play a role in the future.

scholarly journals SURG-10. The evolving role of neurosurgery for central nervous system metastases in the era of personalized medicine

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii25-iii25
Author(s):  
Philipp Karschnia ◽  
Emilie Le Rhun ◽  
Stefan J Grau ◽  
Matthias Preusser ◽  
Riccardo Soffietti ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Personalized Medicine ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Surgical Resection ◽  
Current Status ◽  
Unknown Primary ◽  
Mixed Response

Abstract Background Novel therapies translating into improved survival of patients with advanced cancer have emerged. The number of metastases in the central nervous system is therefore seen to increase. Neurosurgery assumes an expanding role within multi-disciplinary care structures for such patients. Methods We performed a comprehensive literature review on the current status of neurosurgery for brain metastases patients. Based on the extracted data, we developed a review from experts in the field on the role of brain metastasis surgery in the era of personalized medicine. Results Traditionally, three metastases were considered the cutoff to offer surgical resection. With respect to the clinical status, the resection of a symptomatic mass may nowadays be considered even in presence of multiple tumors in a multimodal setting: surgical resection of brain metastasis provides immediate relief from mass effect-related symptoms and histology in case of unknown primary tumor; surgery may help stabilizing the disease, thus enabling further therapy; and in situations where immunotherapy is considered and non-surgical management would require long-term steroid administration, surgery may also provide expeditious relief of edema and reduction of needs for steroids. In patients with multiple brain metastasis and mixed response to non-surgical therapy, tumor resampling may allow tissue analysis for expression of molecular tumor targets. In patients with leptomeningeal dissemination and consecutive hydrocephalus, ventriculo-peritoneal shunting improves quality of life but also allows for time to administer more therapy thus prolonging survival. Addressing the limited efficacy of many oncological drugs for brain metastases, clinical trial protocols in which surgical specimens are analyzed for pre-surgically administered agents may offer pharmacodynamic insights. Conclusion Comprehensive neurosurgical care will have to be an integral element of multi-disciplinary oncological centres providing care to patients with brain metastases to improve on therapy and tumour biology research.

Hemorrhagic and Cystic Brain Metastases Are Associated With an Increased Risk of Leptomeningeal Dissemination After Surgical Resection and Adjuvant Stereotactic Radiosurgery

Neurosurgery ◽  
2018 ◽  
Vol 85 (5) ◽  
pp. 632-641 ◽  
Author(s):  
Robert H Press ◽  
Chao Zhang ◽  
Mudit Chowdhary ◽  
Roshan S Prabhu ◽  
Matthew J Ferris ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Cumulative Incidence ◽  
Postoperative Radiotherapy ◽  
Multivariable Analysis ◽  
Treatment Strategies ◽  
Competing Risk ◽  
Leptomeningeal Dissemination ◽  
Increased Risk

Abstract BACKGROUND Brain metastases (BM) treated with surgical resection and focal postoperative radiotherapy have been associated with an increased risk of subsequent leptomeningeal dissemination (LMD). BMs with hemorrhagic and/or cystic features contain less solid components and may therefore be at higher risk for tumor spillage during resection. OBJECTIVE To investigate the association between hemorrhagic and cystic BMs treated with surgical resection and stereotactic radiosurgery and the risk of LMD. METHODS One hundred thirty-four consecutive patients with a single resected BM treated with adjuvant stereotactic radiosurgery from 2008 to 2016 were identified. Intracranial outcomes including LMD were calculated using the cumulative incidence model with death as a competing risk. Univariable analysis and multivariable analysis were assessed using the Fine & Gray model. Overall survival was analyzed using the Kaplan-Meier method. RESULTS Median imaging follow-up was 14.2 mo (range 2.5-132 mo). Hemorrhagic and cystic features were present in 46 (34%) and 32 (24%) patients, respectively. The overall 12- and 24-mo cumulative incidence of LMD with death as a competing risk was 11.0 and 22.4%, respectively. On multivariable analysis, hemorrhagic features (hazard ratio [HR] 2.34, P = .015), cystic features (HR 2.34, P = .013), breast histology (HR 3.23, P = .016), and number of brain metastases >1 (HR 2.09, P = .032) were independently associated with increased risk of LMD. CONCLUSION Hemorrhagic and cystic features were independently associated with increased risk for postoperative LMD. Patients with BMs containing these intralesion features may benefit from alternative treatment strategies to mitigate this risk.

scholarly journals Systemic therapy in patients with NSCLC with brain metastasis: the emerging role of immunotherapy

2018 ◽  
Vol 5 (8) ◽  
pp. 32
Author(s):  
Jiaxin Niu ◽  
Junle Zhou ◽  
Sara Lindebak ◽  
Fade Mahmoud
Keyword(s):  
Brain Metastasis ◽  
Systemic Therapy

scholarly journals CMET-23. IMPACT OF SYSTEMIC THERAPY IN MELANOMA BRAIN METASTASIS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi56-vi56
Author(s):  
Soumya Sagar ◽  
Adam Lauko ◽  
Addison Barnett ◽  
Wei (Auston) Wei ◽  
Samuel Chao ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Systemic Therapy ◽  
Checkpoint Inhibitors ◽  
Care Center ◽  
Performance Status ◽  
Tertiary Care ◽  
P Value ◽  
Surgical Removal

Abstract BACKGROUND Melanoma is the third most common malignancy that results in brain metastasis and is associated with a median overall survival (OS) of approximately 9 months. In recent years, management of melanoma brain metastases (MBM) by surgery and radiation [stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT)] has been bolstered by targeted therapy and immune checkpoint inhibitors (ICI). METHODS 351 patients, treated for MBM at our tertiary care center from 2000–2018, were grouped into: received chemotherapy, ICI, or targeted therapy. 34% of patients treated with ICI had received other systemic therapies as well as part of their management. OS was calculated from the date of diagnosis of the brain metastases. The Kaplan Meier analysis was utilized to determine median OS and difference in OS was determined by utilizing the Cox proportional hazard model. RESULTS The median survival after the diagnosis of brain metastasis was 10.4, 11.96, and 7.06 months in patients who received ICI, chemotherapy and targeted therapy respectively. A multivariate model was developed including the type of systemic therapy, presence of extracranial metastases, age, KPS and number of intracranial lesions. 114 patients underwent SRS alone, 56 underwent SRS and WBRT, 43 underwent SRS and surgical removal, 28 had surgical removal, SRS and WBRT, and 78 had no intracranial therapy. Compared to patients who received chemotherapy, patients who received immunotherapy had a hazard ratio, HR = 0.628 (confidence interval = 0.396 – 0.994, p-value = 0.047). Presence of EC metastases (HR= 1.25, p-value < .001), lower KPS (HR = .97, p-value < .0001) and multiple brain lesions (HR = 1.117, p-value < .0001) were associated with significantly worse OS. CONCLUSIONS Addition of ICI significantly improves the OS in MBM compared to chemotherapy. Lower performance status, multiple brain metastases, and EC metastases are associated with poor OS.

Outcomes among women with brain metastases from gynecologic (gyn) malignancies.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18034-e18034
Author(s):  
Kristen Cagino ◽  
Ryan Kahn ◽  
Susie Chan ◽  
Charlene Thomas ◽  
Paul J. Christos ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Surgical Resection ◽  
Cancer Diagnosis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Continuous Variables ◽  
Presenting Symptoms ◽  
Risk Of Death ◽  
Whole Brain Radiation

e18034 Background: Brain metastasis secondary to gyn malignancy is rare and associated with poor prognosis, with limited available data and no definitive management guidelines. We aimed to identify factors and treatments associated with improved overall survival (OS). Methods: Patients were identified retrospectively with brain metastases from gyn malignancies between 2004-2019. Descriptive statistics were used to describe the cohort of patients using N (%) and median [IQR] for categorical and continuous variables, respectively. Univariate cox proportional hazards regression was performed to evaluate the effect of different prognostic factors on OS. Results: 32 patients presented with brain metastasis from gyn primaries (ovarian/primary peritoneal n = 14, cervical n = 7, uterine n = 11). Median age of initial cancer diagnosis was 62 (54-59). At initial diagnosis 83% of patients were Stage III/IV and underwent surgical management (56%), chemotherapy (100%), or pelvic radiation (31%). The median time from cancer diagnosis to brain metastasis was 18mos. 66% presented with multiple; 34% with isolated brain metastases. The most common presenting symptoms were extremity weakness/numbness (78%), seizures (34%), and headaches (28%). Surgical resection was most often combined with stereotactic radiosurgery (SRS) and/or whole brain radiation therapy (WBRT) (Table 1). Median survival from date of brain metastases was longer in patients treated by SRS alone compared to WBRT alone (95 vs 11 mos). Treatment with SRS + Surgery compared to SRS or WBRT alone revealed a trend toward improved OS (p = .06; p = .07). Increased time from initial cancer diagnosis to brain metastasis was associated with improved OS, with one-month increase in time associated with a 7% reduction in risk of death (p = 0.01). Initial cancer treatment, Stage, histology, and number of brain lesions did not affect OS. Conclusions: Patients with brain metastasis secondary to gyn malignancies with the longest OS had the greatest lag time between initial cancer diagnosis and brain metastasis diagnosis. Treatment with multimodal therapy with radiation and surgical resection was associated with the longest OS. [Table: see text]

scholarly journals Involved field radiation therapy after surgical resection of solitary brain metastases—mature results

2013 ◽  
Vol 15 (5) ◽  
pp. 589-594 ◽  
Author(s):  
Eileen P. Connolly ◽  
Maya Mathew ◽  
Moses Tam ◽  
Josephine Vera King ◽  
Saroj D. Kunnakkat ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Surgical Resection ◽  
Field Radiation ◽  
Involved Field ◽  
Solitary Brain Metastases

Brain metastases from colorectal cancer: the role of surgical resection in selected patients

2012 ◽  
Vol 14 (7) ◽  
pp. e378-e385 ◽  
Author(s):  
B.-H. Kye ◽  
H. J. Kim ◽  
W. K. Kang ◽  
H.-M. Cho ◽  
Y.-K. Hong ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Brain Metastases ◽  
Surgical Resection
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