SURG-01. CYSTIC BRAIN METASTASES MANAGED WITH RESERVOIR PLACEMENT AND STEREOTACTIC RADIOSURGERY

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi194-vi195
Author(s):  
David Park ◽  
Prashin Unadkat ◽  
Anuj Goenka ◽  
Michael Schulder
Keyword(s):  
Brain Tumors ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Treatment Method ◽  
Tumor Location ◽  
Volume Reduction ◽  
Successful Outcome ◽  
Metastatic Brain Tumors ◽  
Cystic Component ◽  
Cyst Aspiration

Abstract BACKGROUND Stereotactic radiosurgery (SRS) has become a mainstay of treatment for patients with metastatic brain tumors. However, metastatic tumors with a large cystic component often exceed the size limit for safe and effective SRS. In such cases, surgical resection may not be the preferred first method of treatment, due to tumor location, patient co-morbidities, and patient preference. In such cases volume reduction by cyst aspiration followed by SRS may be a preferred option. OBJECTIVE To present the treatment of patients with cystic metastases using reservoir placement followed by SRS. METHODS Seven patients were treated with this method. We performed reservoir insertion for the aspiration of cystic component in each patient and followed that with outpatient SRS. RESULTS Mean overall volume reduction from this treatment method was 80% (range 46.5-94.9). Mean volume reduction from the cyst aspiration alone was 60.7% (range 3.5-90.9), and after SRS a further 71.6% (range 34.6-94.4), accounting for some cyst reaccumulation between the time of surgery and SRS. The interval between those two procedures were 24 days on average (range 11-58 days). Repeat reservoir aspiration was done a total of 10 times in 5 patients. CONCLUSION Cyst aspiration with reservoir placement followed by SRS is a good option for patients with large cystic brain metastases. The reservoir allows for repeat aspiration if needed. Catheter placement at the center of the cyst, and SRS within 2-3 weeks of surgery, can maximize the likelihood of a successful outcome.

scholarly journals RADI-01. Cystic brain metastases managed with reservoir placement and stereotactic radiosurgery

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii18-iii18
Author(s):  
David Park ◽  
Michael Schulder
Keyword(s):  
Brain Tumors ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Treatment Method ◽  
Tumor Location ◽  
Volume Reduction ◽  
Successful Outcome ◽  
Metastatic Brain Tumors ◽  
Cystic Component ◽  
Cyst Aspiration

Abstract Background Stereotactic radiosurgery (SRS) has become a mainstay of treatment for patients with metastatic brain tumors. However, metastatic tumors with a large cystic component often exceed the size limit for safe and effective SRS. In such cases, surgical resection may not be the preferred first method of treatment, due to tumor location, patient co-morbidities, and patient preference. In such cases volume reduction by cyst aspiration followed by SRS may be a preferred option. Methods Seven patients were treated with this method. We performed reservoir insertion for the aspiration of cystic component in each patient and followed that with outpatient SRS. Results Mean overall volume reduction from this treatment method was 80% (range 46.5–94.9). Mean volume reduction from the cyst aspiration alone was 60.7% (range 3.5–90.9), and after SRS a further 71.6% (range 34.6–94.4), accounting for some cyst reaccumulation between the time of surgery and SRS. The interval between those two procedures were 24 days on average (range 11–58 days). Repeat reservoir aspiration was done a total of 10 times in 5 patients. Conclusion Cyst aspiration with reservoir placement followed by SRS is a good option for patients with large cystic brain metastases. The reservoir allows for repeat aspiration if needed. Catheter placement at the center of the cyst, and SRS within 2–3 weeks of surgery, can maximize the likelihood of a successful outcome.

Case Series: Cystic Brain Metastases Managed With Reservoir Placement and Stereotactic Radiosurgery

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
David J Park ◽  
Prashin Unadkat ◽  
Anuj Goenka ◽  
Michael Schulder
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Case Series ◽  
Treatment Method ◽  
Volume Reduction ◽  
Successful Outcome ◽  
Tumor Control ◽  
Cystic Component ◽  
Alternative Treatment Option

Abstract BACKGROUND Stereotactic radiosurgery (SRS) has become one of the mainstays of treatment for patients with metastatic brain tumors. However, metastatic tumors with a large cystic component often exceed the size limit for safe and effective SRS. In such cases, surgical resection may not be the preferred first method of treatment, due to tumor location, patient co-morbidities, and patient preference. In these patients, volume reduction by cyst aspiration (CA) followed by SRS may be a viable alternative treatment option. OBJECTIVE To present the treatment of patients with cystic metastases using reservoir placement followed by SRS. METHODS Nine patients were treated with this method. We performed reservoir insertion for the aspiration of cystic component in each patient and followed that with outpatient SRS. RESULTS Mean overall volume reduction from this treatment method was 78.5%. Mean volume reduction from the CA alone was 59.8%, and after SRS, a further 66.6%, accounting for some cyst reaccumulation between the time of surgery and SRS. Repeat reservoir aspiration was done a total of 10 times in 5 patients. Our study showed local tumor control in 7 of 9 patients (77.8%), while 2 patients required later surgical resection of their tumors. CONCLUSION CA with reservoir placement followed by SRS is a good option for patients with large cystic brain metastases. The reservoir allows for repeat aspiration if needed. Catheter placement at the center of the cyst, and SRS within 2 to 3 wk of surgery, can maximize the likelihood of a successful outcome.

Stereotactic radiosurgery in the treatment of adults with metastatic brain tumors

2020 ◽  
Vol 64 (3) ◽  
Author(s):  
Boryana M. Eastman ◽  
Vyshak A. Venur ◽  
Simon S. Lo ◽  
Jerome J. Graber
Keyword(s):  
Brain Tumors ◽  
Stereotactic Radiosurgery ◽  
Metastatic Brain Tumors

The Cost Effectiveness of Stereotactic Radiosurgery versus Surgical Resection in the Treatment of Solitary Metastatic Brain Tumors

Neurosurgery ◽  
1995 ◽  
Vol 37 (3) ◽  
pp. 445-455 ◽  
Author(s):  
Michael J. Rutigliano ◽  
L. Dade Lunsford ◽  
Douglas Kondziolka ◽  
Michael J. Strauss ◽  
Vikram Khanna ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Brain Tumors ◽  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Metastatic Brain Tumors ◽  
The Cost

scholarly journals 55. A RANDOMIZED, MULTICENTER PHASE III TRIAL OF SURGERY PLUS STEREOTACTIC RADIOSURGERY (SRS) COMPARED WITH SURGERY PLUS PERMANENTLY IMPLANTED COLLAGEN TILE BRACHYTHERAPY (CTBT) FOR RESECTABLE METASTATIC BRAIN TUMORS-PROTOCOL IN PROGRESS

2020 ◽  
Vol 2 (Supplement_2) ◽  
pp. ii11-ii11
Author(s):  
Jeffrey Weinberg ◽  
Mary Frances McAleer ◽  
Hussein Tawbi ◽  
Frederick Lang
Keyword(s):  
Brain Tumors ◽  
Stereotactic Radiosurgery ◽  
Word Association ◽  
Verbal Learning ◽  
Phase Iii ◽  
Secondary Outcome ◽  
Karnofsky Performance Scale ◽  
Metastatic Brain Tumors ◽  
Recurrence Rates ◽  
The Impact

Abstract BACKGROUND Resection (R) followed by single or multi-fraction stereotactic radiosurgery (SRS) lowers resection bed recurrence compared to R alone. Nevertheless for larger brain metastasis (>2.5 cm) 12-month recurrence rates after R+SRS can exceed 20–30%. Aiming to improve outcomes, a permanently implanted collagen tile brachytherapy (CTBT) device (GammaTile, GT Medical Technologies, Tempe AZ) utilizing Cs-131 was developed, hypothesizing that immediate adjuvant radiotherapy (RT) and/or RT dose intensification could improve outcomes. The device received FDA clearance for this indication, based on a single-arm pre-commercial study and in early commercial use due to the excellent safety and local control of R+CTBT. It is hypothesized that R+CTBT will increase the time to post-resection-recurrence, while prolonging survival and reducing the impact on functional and neurocognitive status compared to R+SRS. STUDY DESIGN Multicenter, randomized, comparison trial. Patients with resectable, previously untreated “index” brain metastases measuring >2.5–5 cm and 0–3 other tumors will be preoperatively randomized 1:1 to undergo either R+ SRS or R+CTBT to the index lesion; unresected tumors in both groups will receive SRS. Planned sample size is 160 from ~5 sites; accrual to start in Q3-2020. Primary endpoint is surgical bed-recurrence free survival. Secondary endpoints include overall survival, quality of life (Functional Assessment of Cancer Therapy-Brain, Linear Analog Self-Assessment), neurocognition (Hopkins Verbal Learning Test, Trail Making Tests, Mini-Mental Status Exam, Controlled Oral Word Association), functional decline (Karnofsky Performance Scale, Barthel-ADL), and adverse events. Follow-up will be at 1,3,6,9, and 12 months, then q 6 months through 5 years. CONCLUSIONS This will be the first randomized trial comparing R+SRS versus R+CTBT delivered by Cs-131 sources in permanently implanted resorbable collagen tile carriers. Primary and secondary outcome measures will be captured to elucidate the potential risks and benefits of these two differing approaches for patients with metastatic brain tumors.

scholarly journals 90-gene signature assay for tissue origin diagnosis of brain metastases

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Yulong Zheng ◽  
Yongfeng Ding ◽  
Qifeng Wang ◽  
Yifeng Sun ◽  
Xiaodong Teng ◽  
...  
Keyword(s):  
Gene Expression ◽  
Brain Tumors ◽  
Brain Metastases ◽  
Expression Profiles ◽  
Gene Expression Signature ◽  
Similarity Score ◽  
Primary Site ◽  
Tumor Type ◽  
Metastatic Brain Tumors ◽  
Expression Signature

Abstract Background Brain metastases (BM) are the most common intracranial tumors. 2–14% of BM patients present with unknown primary site despite intensive evaluations. This study aims to evaluate the performance of a 90-gene expression signature in determining the primary sites for BM samples. Methods The sequence-based gene expression profiles of 708 primary brain tumors (PBT) collected from The Cancer Genome Atlas (TCGA) database were analyzed by the 90-gene expression signature, with a similarity score for each of 21 common tumor types. We then used Optimal Binning algorithm to generate a threshold for separating PBT from BM. Eighteen PBT samples were analyzed to substantiate the reliability of the threshold. In addition, the performance of the 90-gene expression signature for molecular classification of metastatic brain tumors was validated in a cohort of 48 BM samples with the known origin. For each BM sample, the tumor type with the highest similarity score was considered tissue of origin. When a sample was diagnosed as PBT, but the similarity score below the threshold, the second prediction was considered as the primary site. Results A threshold of the similarity score, 70, was identified to discriminate PBT from BM (PBT: > 70, BM: ≤ 70) with an accuracy of 99% (703/708, 95% CI 98–100%). The 90-gene expression signature was further validated with 18 PBT and 44 BM samples. The results of 18 PBT samples matched reference diagnosis with a concordance rate of 100%, and all similarity scores were above the threshold. Of 44 BM samples, the 90-gene expression signature accurately predicted primary sites in 89% (39/44, 95% CI 75–96%) of the cases. Conclusions Our findings demonstrated the potential that the 90-gene expression signature could serve as a powerful tool for accurately identifying the primary sites of metastatic brain tumors.

Unique histopathologic features of brain metastases from hepatocellular carcinoma.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 169-169
Author(s):  
Yu Yun Shao ◽  
Min-Shu Hsieh ◽  
Chung-Yi Huang ◽  
Li-Chun Lu ◽  
Chih-Hung Hsu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Brain Metastasis ◽  
Brain Tumors ◽  
Brain Metastases ◽  
Lung Metastasis ◽  
Positive Staining ◽  
Metastatic Brain Tumors ◽  
Tumor Tissues ◽  
Metastatic Lung ◽  
Histopathologic Features

169 Background: In the era of anti-angiogenic therapy as treatment for advanced hepatocellular carcinoma (HCC), the incidence and importance of brain metastases are increasing. We aimed to study their histopathologic features. Methods: We searched for all patients who were diagnosed to have HCC with brain metastasis from 1999 to 2010 at National Taiwan University Hospital, Taipei, Taiwan. Patients who had HCC with lung metastasis were also included for comparison. Patients with available tissues of both primary and metastatic tumors were enrolled in this study. Tumor slides from paired primary and metastatic HCCs were stained by H and E, and immunohistochemically stained for CK7, p53, Ki67, vimentin, Hes1, and c-Met. The expressions of CK7, p53, and vimentin were graded according to percentages of positive staining, but those of Hes1 and c-Met were recorded as an H score, which was defined as intensity (0, 1, 2, or 3) × percentages of positive staining. Results: A total of 14 patients had available tumor tissues of both primary and metastatic brain tumors. Another 21 patients had tumor tissues of both primary and metastatic lung tumors. The metastatic brain tumors, comparing to the metastatic lung tumors, had significantly more bizarre dilated vessels (86% vs. 14%, p < 0.001), hyaline globules (50% vs. 5%, p = 0.003), higher Hes1 H scores (mean, 245 vs. 131, p = 0.001), and lower c-Met H scores (mean, 15.4 vs. 38.1, p = 0.046). Tumor necrosis also tended to be more common among metastatic brain tumors (93% vs. 62%, p = 0.056). On the contrary, the above differences were not identified between the primary tumors which later developed brain metastasis and those which later developed lung metastasis. When disease progressed from primary liver to brain metastasis, mitosis counts (p = 0.034) and bizarre dilated vessels (p = 0.020) significantly increased, and necrosis (p = 0.059) tended to be more common. Conclusions: Metastatic brain tumors from HCC had unique histopathologic features compared to primary liver tumors or lung metastases. The increased Hes1 expression and decreased c-Met expression in HCC brain metastasis should be further explored. (This study was supported by the grant of NSC101-2314-B-002 -141, 100CAP1020-2 & NTUH.101-N1965.)

scholarly journals The Role of Stereotactic Cyst Aspiration for Glial and Metastatic Brain Tumors

2000 ◽  
Vol 27 (3) ◽  
pp. 229-235 ◽  
Author(s):  
Ajay Niranjan ◽  
Timothy Witham ◽  
Douglas Kondziolka ◽  
L. Dade Lunsford
Keyword(s):  
Brain Tumors ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Symptomatic Improvement ◽  
Resonance Imaging ◽  
Metastatic Brain Tumors ◽  
Metastatic Tumors ◽  
Stereotactic Aspiration ◽  
Cyst Aspiration

Objective:To evaluate the role of stereotactic cyst aspiration in the context of multimodality management of cystic glial and metastatic tumors, we retrospectively reviewed our experience with 38 patients during a 10-year interval.Methods:All 38 patients had one or more computed tomography or magnetic resonance imaging guided stereotactic cyst aspirations. Twenty-seven patients had glial neoplasms and 11 had metastatic brain tumors. Twenty-two patients underwent cyst aspiration as the initial treatment modality while 15 patients had cyst aspiration following previous treatments.Results:In the immediate postoperative period, 19 of the 27 (70%) patients with gliomas and nine of the 11 (82%) patients with metastatic tumors experienced symptomatic improvement. No procedure-related morbidity was encountered. Twelve patients (31.5%) eventually required a catheter-reservoir system. Thirty-seven percent of patients with cystic glial neoplasms and 18% of patients with metastatic tumors had delayed cytoreductive surgery by craniotomy subsequent to stereotactic cyst aspiration. Reduction in tumor volume following aspiration facilitated Gamma knife radiosurgery in seven patients.Conclusion:Single stereotactic aspiration is a low risk procedure that provides immediate relief of symptoms in patients with cystic brain tumors. It appears to be valuable together with the use of other therapeutic strategies.

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