scholarly journals SURG-04. SALVAGE RESECTION OF RECURRENT PREVIOUSLY-IRRADIATED BRAIN METASTASES: CLINICAL AND RADIOGRAPHIC OUTCOMES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii203-ii204
Author(s):  
Jessica Wilcox ◽  
William Newman ◽  
Anne Reiner ◽  
Samantha Brown ◽  
Robert Young ◽  
...  
Keyword(s):  
Treatment Effect ◽  
Tumor Recurrence ◽  
Radiation Necrosis ◽  
Recurrence Risk ◽  
Extent Of Resection ◽  
Cancer Center ◽  
Radiographic Outcomes ◽  
Viable Tumor ◽  
Local Progression ◽  
Salvage Resection

Abstract BACKGROUND The management of brain metastasis (BrM) recurrence after stereotactic body radiotherapy (SBRT) poses a clinical challenge. The efficacy of salvage resection is undefined, and the role of adjuvant resection cavity reirradiation is unclear given the compounded risk of radiation injury. METHODS Retrospective analysis of previously-irradiated BrM that underwent resection between March 2003 and February 2020 at Memorial Sloan Kettering Cancer Center was performed. Only cases with histopathologic evidence of viable malignancy were included, and specimens were classified by the gross proportion of viable tumor versus treatment effect. Clinical and radiographic parameters were collected. Post-operative recurrence and radiation necrosis were based on RANO-BM criteria and distinguished by histopathologic, radiographic and clinical characteristics. Equivocal cases were adjudicated by a blinded neuroradiologist. RESULTS One-hundred fifty-five resected recurrent BrM following SBRT in 135 patients were evaluated. Seventeen received additional prior whole-brain radiation. Metastases derived from non-small-cell lung (36.8%), melanoma (27.1%), breast (21.3%), renal (3.9%), colorectal (1.9%) and other (9.0%) primary malignancies. Forty-eight (31.0%) had only microscopic malignant disease with extensive necrosis, 44 (28.4%) had mixed or unspecified tumor with treatment effect, and 63 (40.6%) were reported as purely viable tumor by histopathologic report. Thirty-nine (25.2%) post-operative cavities underwent adjuvant reirradiation within 60 days. At 6 and 12 months, local tumor recurrence occurred in 31.6% (95% CI: 24.4%-39.1%) and 40.4% (95% CI: 32.5%-48.2%), respectively, with a proportion of these lesions displaying mixed tumor plus treatment effect. Median overall survival was 13.4 months (95% CI: 10.5-17.7) from salvage resection. CONCLUSIONS Salvage of previously-irradiated BrM remains challenging. This represents the largest known series correlating salvage resection and histopathologically-confirmed viable recurrent BrM with long-term outcomes. Tumor recurrence risk remains high at one year. Further exploration will stratify local progression and radiation necrosis rates by features including extent of resection, degree of viable tumor and adjuvant reirradiation use.

scholarly journals SURG-03. The effect of surgery on radiation necrosis in irradiated brain metastases: extent of resection and long-term clinical and radiographic outcomes

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii23-iii24
Author(s):  
William Newman ◽  
Jacob Goldberg ◽  
Sergio Guadix ◽  
Samantha Brown ◽  
Anne Reiner ◽  
...  
Keyword(s):  
Radiation Necrosis ◽  
Extent Of Resection ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Subtotal Resection ◽  
Continuous Variables ◽  
Whole Brain Irradiation ◽  
Full Cohort ◽  
Steroid Dependency

Abstract Objective Radiation therapy is a cornerstone of brain metastasis (BrM) management but carries the risk of radiation necrosis (RN), which can require resection for palliation or diagnosis. We sought to determine the relationship between extent of resection (EOR) of pathologically-confirmed RN and postoperative radiographic and symptomatic outcomes. Methods A single-center retrospective review was performed at an NCI-designated Comprehensive Cancer Center to identify all surgically-resected, previously-irradiated necrotic BrM without admixed recurrent malignancy from 2003–2018. Clinical, pathologic and radiographic parameters were collected. Volumetric analysis determined EOR and longitudinally evaluated perilesional T2-FLAIR signal preoperatively, postoperatively, and at 3-, 6-, 12-, and 24-months postoperatively when available. Rates of time to 50% T2-FLAIR reduction was calculated using cumulative incidence in the competing risks setting with last follow-up and death as competing events. The Spearman method was used to calculate correlation coefficients, and continuous variables for T2-FLAIR signal change, including EOR, were compared across groups. Results Forty-six patients were included. Most underwent prior stereotactic radiosurgery with or without whole-brain irradiation (n=42, 91%). Twenty-seven operations resulted in gross-total resection (59%; GTR). For the full cohort, T2-FLAIR edema decreased by a mean of 78% by 6 months postoperatively that was durable to last follow-up (p<0.05). EOR correlated with edema reduction at last follow-up, with significantly greater T2-FLAIR reduction with GTR versus subtotal resection (p<0.05). There was a trend towards decreased steroid use, from 8mg daily dexamethasone-equivalent (range 2–36) preoperatively to 3mg 12-months postoperatively (range 1–8; p=0.063). Conclusions RN resection conferred both durable T2-FLAIR reduction, which correlated with EOR, and reduced steroid dependency.

scholarly journals Composite risk and benefit from adjuvant dose-dense chemotherapy in hormone receptor-positive breast cancer

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Fabio Puglisi ◽  
Lorenzo Gerratana ◽  
Matteo Lambertini ◽  
Marcello Ceppi ◽  
Luca Boni ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Effect ◽  
Hormone Receptor ◽  
Recurrence Risk ◽  
Receptor Expression ◽  
Phase Iii ◽  
Composite Measure ◽  
Node Positive ◽  
Hormone Receptor Positive ◽  
Dose Dense

AbstractThe GIM2 phase III trial demonstrated the benefit of dose-dense chemotherapy in node-positive early breast cancer (eBC). To better define the dose-dense effect in the hormone receptor-positive subgroup, we evaluated its benefit through a composite measure of recurrence risk. We conducted an ancillary analysis of the GIM2 trial evaluating the absolute treatment effect through a composite measure of recurrence risk (CPRS) in patients with hormone receptor-positive HER2-negative eBC. CPRS was estimated through Cox proportional hazards models applied to the different clinicopathological features. The treatment effect was compared to the values of CPRS by using the Sub-population Treatment Effect Pattern Plot (STEPP) process. The Disease-Free Survival (DFS)-oriented STEPP analysis showed distinct patterns of relative treatment effect with respect to CPRS. Overall, 5-year DFS differed across CPRS quartiles ranging from 95.2 to 66.4%. Each CPRS quartile was characterized by a different patients’ composition, especially for age, lymph node involvement, tumor size, estrogen and progesterone receptor expression, and Ki-67. A number needed to treat of 154 and 6 was associated with the lowest and the highest CPRS quartile, respectively. Dose-dense adjuvant chemotherapy showed a consistent benefit in node-positive eBC patients with hormone receptor-positive HER2-negative disease, but its effect varied according to CPRS.

Histopathologic quantification of viable tumor versus treatment effect in surgically resected recurrent glioblastoma

2018 ◽  
Vol 141 (2) ◽  
pp. 421-429 ◽  
Author(s):  
Stephen J. Bagley ◽  
Robert D. Schwab ◽  
Ernest Nelson ◽  
Angela N. Viaene ◽  
Zev A. Binder ◽  
...  
Keyword(s):  
Treatment Effect ◽  
Recurrent Glioblastoma ◽  
Viable Tumor ◽  
Versus Treatment

scholarly journals The ratio of BRAFV600E alleles can be used to assess the biological behavior of papillary thyroid carcinoma

2020 ◽  
Author(s):  
Dingcun Luo ◽  
Yeqin Ni ◽  
Shirong Zhang ◽  
Yanping Xun ◽  
Pan Zhao ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Tumor Recurrence ◽  
Recurrence Risk ◽  
Tumor Stage ◽  
Biological Behavior ◽  
Clinicopathological Parameters ◽  
Quantitative Detection ◽  
Papillary Thyroid ◽  
Brafv600e Mutation

ABSTRACTBackgroundThe BRAFV600E mutations is an important molecular event in the occurrence and development of papillary thyroid carcinoma (PTC). A qualitative detection of the BRAFV600E mutation is still insufficient to explain the biological behavior of PTC. Though quantitative detection of the BRAFV600E mutation can reflect certain characteristics of PTC, its clinical value is still controversial. We aimed to investigate the association between the ratio of BRAFV600E alleles and clinicopathological parameters in PTC patients.MethodsGenomic DNA was extracted from specimens obtained from 329 PTC patients undergoing thyroidectomy. The ratio of BRAFV600E alleles was determined by amplification refractory mutation system (ARMS) and droplet digital polymerase chain reaction (ddPCR). Inconsistent results were further verified by next-generation sequencing (NGS). The clinicopathologic features, clinical tumor stage, and tumor recurrence risk stratification of all patients were correlated with the ratio of BRAFV600E alleles.ResultsThe sensitivity of ddPCR was superior to that of ARMS and almost the same as that of NGS. In total, 275 of 329 patients had the BRAFV600E mutation as determined by ARMS, ddPCR and NGS. The ratio of BRAFV600E alleles ranged from 0.17%-48.0%, with a median ratio of 12.58%, and significantly correlated with tumor size (p<0.001), capsule or extrathyroidal invasion (p<0.001), the number or rate of lymph node metastases (p<0.001), tumor stage (p=0.006) and tumor recurrence risk (p<0.001) but not with sex, age or multifocality. The ratio of BRAFV600E alleles was much lower in PTC patients with Hashimoto’s thyroiditis than in those without (p<0.001).ConclusionsThe ratio of BRAFV600E alleles can reliably reflect the biological behavior of PTC, making it a molecular-based stratification index of recurrence risk. The quantitative detection of BRAFV600E has the potential to guide the clinical diagnosis and treatment of PTC.

Radiation necrosis or glioma recurrence: is computer-assisted stereotactic biopsy useful?

1995 ◽  
Vol 82 (3) ◽  
pp. 436-444 ◽  
Author(s):  
Peter A. Forsyth ◽  
Patrick J. Kelly ◽  
Terrence L. Cascino ◽  
Bernd W. Scheithauer ◽  
Edward G. Shaw ◽  
...  
Keyword(s):  
Disease Progression ◽  
Tumor Recurrence ◽  
Stereotactic Biopsy ◽  
Radiation Necrosis ◽  
Low Grade ◽  
Tumor Type ◽  
Content Type ◽  
Radiation Induced ◽  
Chondroblastic Osteosarcoma ◽  
Fine Print

✓ Fifty-one patients with supratentorial glioma treated with external beam radiotherapy (median dose 59.5 Gy) who then demonstrated clinical or radiographic evidence of disease progression underwent stereotactic biopsy to differentiate tumor recurrence from radiation necrosis. The original tumor histological type was diffuse or fibrillary astrocytoma in 21 patients (41%), oligodendroglioma in 13 (26%), and oligoastrocytoma in 17 (33%); 40 tumors (78%) were low-grade (Kernohan Grade 1 or 2). The median time to suspected disease progression was 28 months. Stereotactic biopsy showed tumor recurrence in 30 patients (59%), radiation necrosis in three (6%), and a mixture of both in 17 (33%); one patient (2%) had a parenchymal radiation-induced chondroblastic osteosarcoma. The tumor type at stereotactic biopsy was similar to the original tumor type and was astrocytoma in 24 patients (47%), oligodendroglioma in eight (16%), oligoastrocytoma in 16 (31%), unclassifiable in two (4%), and chondroblastic osteosarcoma in one patient (2%). At biopsy, however, only 19 tumors (37%) were low grade (Kernohan Grade 1 or 2). Subsequent surgery confirmed the stereotactic biopsy histological findings in eight patients. Follow-up examination showed 14 patients alive with a median survival of 1 year for the entire group. Median survival times after biopsy were 0.83 year for patients with tumor recurrence and 1.86 years for patients with both tumor recurrence and radionecrosis; these findings were significantly different (p = 0.008, log-rank test). No patient with radiation necrosis alone died. Other factors associated with reduced survival were a high proportion of residual tumor (p = 0.024), a low proportion of radionecrosis (p < 0.001), and a Kernohan Grade of × or 4 (p = 0.005). In conclusion, in patients with previously irradiated supratentorial gliomas in whom radionecrosis or tumor recurrence was clinically or radiographically suspected, results of stereotactic biopsy could be used to differentiate tumor recurrence, radiation necrosis, a mixture of both lesions, or radiation-induced neoplasm. In addition, biopsy results could predict survival rates.

scholarly journals P14.08 Bevacizumab treatment for the lesion emerging after the radiotherapy for malignant glioma

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii68-iii68
Author(s):  
K Miwa ◽  
T Ito ◽  
K Yokoyama ◽  
J Shinoda
Keyword(s):  
Malignant Glioma ◽  
Tumor Recurrence ◽  
Clinical Course ◽  
Radiation Necrosis ◽  
Neurological Dysfunction ◽  
Vascular Endothelial ◽  
Recurrent Malignant Glioma ◽  
Positron Emission ◽  
Bevacizumab Treatment ◽  
Endothelial Growth Factor

Abstract BACKGROUND Because blocking vascular endothelial growth factor from reaching leaky capillaries is a logical strategy for the treatment, we reasoned that bevacizumab might be an effective treatment on recurrent malignant glioma and radiation necrosis (RN). In this study, the authors examined to differentiate RN from recurrent malignant glioma, and evaluated the results of bevacizumab treatment in each diagnosis. MATERIAL AND METHODS Four patients of malignant glioma (2 glioblastomas and 2 anaplastic astrocytomas), which demonstrated symptomatic lesion after radiotherapy, were involved in this study. All four patients were treated with bevacizumab on a 10 mg/kg biweekly (one cycle), for a total dose of 30 mg/kg (3 cycles) or furthermore. RN was differentiated from local recurrence in all four patients on the basis of 11C-methionine positron emission tomography and/or clinical course. Clinical evaluation and MRI studies were obtained after bevacizumab treatment in all cases repeatedly as possible. RESULTS Two patients were diagnosed as RN, and another two patients as tumor recurrence. Of the two patients with RN, neurological dysfunction was distinctly alleviated after bevacizumab treatment. Other two patients with tumor recurrence demonstrated no remarkable improvement in neurological dysfunction after bevacizumab treatment. Of all the two patients with RN, post-treatment MRI performed after the bevacizumab therapy showed a significant reduction of the massive lesion. CONCLUSION We concluded that bevacizumab could control the symptomatic massive lesion occurring after radiotherapy, and it might be more effective with the patients of RN, than with those of recurrent tumor.

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