Intracranial tumours

2020 ◽  
pp. 6048-6054
Author(s):  
Jeremy Rees
Keyword(s):  
Histological Grade ◽  
Whole Brain Radiotherapy ◽  
Accurate Information ◽  
Cancer Treatments ◽  
Intracranial Tumours ◽  
Li Fraumeni Syndrome ◽  
Von Hippel Lindau ◽  
Brain Radiotherapy ◽  
Integrated Diagnosis ◽  
Anti Cancer

Intracranial tumours represent about 2% of all cancers. There are no known risk factors apart from prior irradiation to the skull and brain and a few rare neurogenetic syndromes (e.g. neurofibromatosis, von Hippel–Lindau syndrome, Li–Fraumeni syndrome). They may be intrinsic or extrinsic, which determines potential resectability. Neuroepithelial tumours (predominantly gliomas) account for 50–60% of all primary tumours. Molecular analysis has now been added to the histological grade and subtype to provide an integrated diagnosis which provides more accurate information for treatment and prognosis. As systemic anti-cancer treatments evolve and produce long-term control of visceral and bone disease, brain metastases are becoming increasingly common and are best treated with feither stereotactic radiosurgery or neurosurgery to avoid the cognitive decline associated with whole brain radiotherapy.

scholarly journals Fertility preservation techniques: laboratory and clinical progress and current issues

Reproduction ◽  
2008 ◽  
Vol 136 (6) ◽  
pp. 667-669 ◽  
Author(s):  
R A Anderson
Keyword(s):  
Fertility Preservation ◽  
Survival Rates ◽  
Current Status ◽  
Accurate Information ◽  
Cancer Treatments ◽  
Supporting Cells ◽  
Human Fertility ◽  
Anti Cancer ◽  
Younger Men ◽  
Pubertal Boys

Human fertility is dependent on maturation of germ cells through meiosis and their association with supporting cells, which in the female are also the source of sex steroids. These processes are sensitive to both chemotherapy and radiotherapy thus can be damaged by anti-cancer treatments. The uterus is also sensitive to radiotherapy. Our understanding of and the ability to manipulate fertility has increased together with survival rates from many cancers, particularly those affecting children, younger men, and women. The growth of interest in fertility preservation for cancer patients is a natural union of these two fields. Sperm banking has been available for many years, and is a recognized and evidence-based option for men that should be available to all. Options for women and pre-pubertal boys and girls are, however, more experimental, other than for women of committing oocytes to fertilization and cryopreservation as embryos. This Focus Issue of Reproduction aims to address the current status of some of the clinical and laboratory aspects of this burgeoning subspecialty to highlight not only areas of progress but also areas of uncertainty where future developments are required to allow the provision of accurate information, and safe and effective treatments.

Intracranial tumours

2010 ◽  
pp. 4967-4972
Author(s):  
Jeremy Rees
Keyword(s):  
Risk Factors ◽  
Intracranial Tumours ◽  
Li Fraumeni Syndrome ◽  
Von Hippel Lindau ◽  
Li Fraumeni ◽  
Von Hippel Lindau Syndrome ◽  
Neuroepithelial Tumours

Intracranial tumours represent about 2% of all cancers. There are no known risk factors apart from prior irradiation to the skull and brain and a few rare neurogenetic syndromes, e.g. neurofibromatosis, von Hippel–Lindau syndrome, Li–Fraumeni syndrome. They may be intrinsic or extrinsic, which determines potential resectability. Neuroepithelial tumours (predominantly gliomas) account for 50 to 60% of all primary tumours. Recent discovery of ...

Circadian rhythms, sleep, and anti-cancer treatments

2018 ◽  
Author(s):  
Pasquale F. Innominato ◽  
David Spiegel
Keyword(s):  
Quality Of Life ◽  
Circadian Rhythms ◽  
Biological Functions ◽  
Cancer Treatments ◽  
Anti Cancer ◽  
Timing System ◽  
Physical Wellbeing ◽  
Circadian Timing System ◽  
Chemotherapy Agents

The circadian timing system temporally regulates biological functions relevant for psycho-physical wellbeing, spanning all the systems related to health. Hence, disruption of circadian rhythms, along with sleep cycles, is associated with the development of several diseases, including cancer. Moreover, altered circadian and sleep functions negatively impact on cancer patients’ quality of life and survival, above and beyond known determinants of outcome. This alteration can occur as a consequence of cancer, but also of anti-cancer treatments. Indeed, circadian rhythms govern also the ability of detoxifying chemotherapy agents across the 24 hours. Hence, adapting chemotherapy delivery to the molecular oscillations in relevant drug pathways can decrease toxicity to healthy cells, while increasing the number of cancer cells killing. This chronomodulated chemotherapy approach, together with the maintenance of proper circadian function throughtout the whole disease challenge, would finally result in safer and more active anticancer treatments, and in patients experiencing better quality and quantity of life.

scholarly journals AB0080 A SYSTEM-LEVEL APPROACH IDENTIFIES A CRITICAL REGULATOR OF CHONDROSARCOMA PROGRESSION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1340.3-1340
Author(s):  
H. Kim ◽  
Y. Cho ◽  
J. H. Kim
Keyword(s):  
Histological Grade ◽  
System Level ◽  
Clinical Approach ◽  
Cancer Therapies ◽  
Functional Roles ◽  
Network Analyses ◽  
Molecular Events ◽  
Anti Cancer ◽  
Tumor Growth And Metastasis ◽  
Chemotherapy Agents

Background:Chondrosarcomas are cartilaginous tumors that constitute one-third of skeletal system cancers. Chondrosarcomas are capable of transitioning to highly metastatic and treatment-refractory states, resulting in significant patient mortality. However, the molecular events accompanying this behavior remain unknown.Objectives:We aimed to uncover the molecular pathway underlying such tumor progression that confers a higher malignancy to chondrosarcoma.Methods:We conducted unsupervised gene co-expression network analyses using transcriptomes of patients with chondrosarcoma and extracted a characteristic transcription network underlying chondrosarcoma malignancy. By implementing a system-level upstream analysis of this gene network, we identified the transcriptional factor as a key regulator governing chondrosarcoma progression. We unraveled the functional roles of the identified factor in promoting tumor growth and metastasis of chondrosarcomas in the context of their unique microenvironments.Results:By conducting system-level upstream analysis, we identified a factor as a transcriptional regulator that governs the malignancy gene module. The identified factor was upregulated in chondrosarcoma biopsies associated with a high histological grade and conferred chondrosarcoma cells invasiveness and tumor-initiating capacity. In an orthotopic xenograft mouse model, the identified factor modulated local outgrowth and pulmonary metastasis of chondrosarcoma. Pharmacological inhibition of the identified factor in conjunction with the chemotherapy agents such as cisplatin or doxorubicin synergistically enhanced chondrosarcoma cell apoptosis and abolished malignant phenotypes of chondrosarcoma in mice.Conclusion:Our study provides a proof of concept evidence that inhibiting the identified factor suppresses progression of chondrosarcoma and improves the efficacy of chemotherapy in cellular and pre-clinical levels. Taken together, we believe that our findings provide novel molecular insights for the development of new anti-cancer therapies to target chondrosarcomas.References:[1]Gelderblom H, et al. The clinical approach towards chondrosarcoma. Oncologist 13, 320-329 (2008)Disclosure of Interests:None declared

scholarly journals CTNI-01. EFFECT OF STEREOTACTIC RADIOSURGERY COMPARED TO WHOLE-BRAIN RADIOTHERAPY FOR LIMITED BRAIN METASTASIS ON LONG TERM COGNITION AND QUALITY OF LIFE: A POOLED ANALYSIS OF RANDOMIZED CLINICAL TRIALS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii40-ii41
Author(s):  
Joshua Palmer ◽  
Brett Klamer ◽  
Karla Ballman ◽  
Paul Brown ◽  
Jane Cerhan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Clinical Trials ◽  
Whole Brain Radiotherapy ◽  
Pooled Analysis ◽  
Cognitive Outcomes ◽  
Phase Iii ◽  
Brain Radiotherapy ◽  
Over Time

Abstract PURPOSE We investigated the long term impact of SRS and WBRT in two large prospective phase III trials. METHODS Patients with 1–4 BMs +/- resection were randomized to SRS or WBRT. Cognitive deterioration was a drop of >1 standard deviation from baseline in >2/6 cognitive measures (CM). Quality of life (QOL) scores were scored 0–100 point scale. CM and QOL scores were modeled using baseline adjusted Linear Mixed Models (LMM) with uncorrelated random intercept for subject and random slopes for time. Differences over time between groups and the effect of >2 cognitive scores with >2 SD change from baseline were assessed. RESULTS 88 patients were included with median follow up of 24 months. We observed decreasing CM over time (SRS: 4/6; WBRT: 5/6). Mean CM was significantly higher in SRS for Total recall and Delayed Recall at 3, 6, 9, 12 months. More patients in WBRT arm declined 1 SD in >1 and >2 CM at the 3, 6, 9, and 12 months. A 1 SD decline in >3 CM at 1 year was 21% SRS vs 47% WBRT (p=0.02). SRS had fewer patients with a 2 SD decline in >1 CM at every time point. SRS had fewer patients with a 2 SD decline at >2 and >3 CM. WBRT had lower QOL at 3 months, but switched to SRS having lower QOL at 24 months for PWB, EWB, FWB, FactG, BR, and FactBR (p< 0.05). A 2 SD decline in cognition decreased mean FWB by 6.4 units (95% CI: -11, -1.75; p=0.007) and decreased QOL by 5.1 units (95% CI: -7.7, -2.5; p< 0.001). CONCLUSIONS We report the first pooled prospective study demonstrating the long term outcomes of patients with BMs after cranial radiation. WBRT was associated with worse cognitive outcomes. Impaired cognition is associated with worse QOL.

scholarly journals Use of a Head-Tilting Baseplate During Tomotherapy to Shorten the Irradiation Time and Protect the Hippocampus and Lens in Hippocampal Sparing-Whole Brain Radiotherapy

2021 ◽  
Vol 20 ◽  
pp. 153303382098682
Author(s):  
Kosei Miura ◽  
Hiromasa Kurosaki ◽  
Nobuko Utsumi ◽  
Hideyuki Sakurai
Keyword(s):  
At Risk ◽  
Planning Target Volume ◽  
Irradiation Time ◽  
Organs At Risk ◽  
Absorbed Dose ◽  
Whole Brain Radiotherapy ◽  
Target Volume ◽  
Whole Brain ◽  
Brain Radiotherapy ◽  
Hippocampal Sparing

Purpose: The aim of this study is to comparatively examine the possibility of reducing the exposure dose to organs at risk, such as the hippocampus and lens, and improving the dose distribution of the planned target volume with and without the use of a head-tilting base plate in hippocampal-sparing whole-brain radiotherapy using tomotherapy. Methods: Five paired images of planned head computed tomography without and with tilt were analyzed. The hippocampus and planning target volume were contoured according to the RTOG 0933 contouring atlas protocol. The hippocampal zone to be avoided was delineated using a 5-mm margin. The prescribed radiation dose was 30 Gy in 10 fractions. The absorbed dose to planning target volume dose, absorbed dose to the organ at risk, and irradiation time were evaluated. The paired t-test was used to analyze the differences between hippocampal-sparing whole-brain radiotherapy with head tilts and without head tilts. Results: Hippocampal-sparing whole-brain radiotherapy with tilt was not superior in planning target volume doses using the homogeneity index than that without tilt; however, it showed better values, and for Dmean and D2%, the values were closer to 30 Gy. Regarding the hippocampus, dose reduction with tilt was significantly greater at Dmax, Dmean, and Dmin, whereas regarding the lens, it was significantly greater at Dmax and Dmin. The irradiation time was also predominantly shorter. Conclusion: In our study, a tilted hippocampal-sparing whole-brain radiotherapy reduced the irradiation time by >10%. Therefore, our study indicated that hippocampal-sparing whole-brain radiotherapy with tomotherapy should be performed with a tilt. The head-tilting technique might be useful during hippocampal-sparing whole-brain radiotherapy. This method could decrease the radiation exposure time, while sparing healthy organs, including the hippocampus and lens.

Prognostic factors and survival after whole-brain radiotherapy for initial brain metastases arising from non-small cell lung cancer

2021 ◽  
pp. 1-6
Author(s):  
Yukinori Okada ◽  
Mariko Kobayashi ◽  
Mio Shinozaki ◽  
Tatsuyuki Abe ◽  
Naoki Nakamura
Keyword(s):  
Prognostic Factors ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Gene Mutation ◽  
Stage Iv ◽  
Whole Brain Radiotherapy ◽  
Hazard Ratio ◽  
Small Cell Lung ◽  
Mutation Status ◽  
Brain Radiotherapy

Abstract Aim: To identify prognostic factors and investigate patient survival after whole-brain radiotherapy (WBRT) for initial brain metastases arising from non-small cell lung cancer (NSCLC). Methods: Patients diagnosed with NSCLC between 1 January 2010 and 30 September 2019, and who received WBRT upon first developing a brain metastasis, were investigated. Overall survival was determined as related to age, sex, duration between initial examination and brain metastasis detection, stage at the first examination, presence of metastases outside the brain, blood analysis findings, brain metastasis symptoms, radiotherapy dose and completion, imaging findings, therapeutic course of chemotherapy and/or radiation therapy, histological type, and gene mutation status. Results: Thirty-one consecutive patients (20 men and 11 women) with a mean age of 63·8 years and median survival of 129 days were included. Multivariate analysis with stepwise testing was performed to investigate differences in survival according to gene mutation status, lactate dehydrogenase (LDH) level, irradiation dose, WBRT completion and Stage status. Of these, a statistically significant difference in survival was observed in patients with gene mutation status (hazard ratio: 0·31, 95% CI: 0·11–0·86, p = 0·025), LDH levels <230 vs. ≥230 IU/L (hazard ratio: 4·08, 95% CI: 1·45–11·5, p < 0·01) received 30 Gy, 30 Gy/10 fractions to 35 Gy/14 fractions, and 37·5 Gy/15 fractions (hazard ratio: 0·26, 95% CI: 0·09–0·71, p < 0·01), and stage IV versus non-stage IV (hazard ratio: 0·13, 95 CI:0·02–0·64, p < 0·01) Findings: Gene mutation, LDH, radiation dose and Stage are prognostic factors for patients with initial brain metastases who are treated with WBRT.

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