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.

scholarly journals The Biology of Brain Metastasis

2013 ◽  
Vol 59 (1) ◽  
pp. 180-189 ◽  
Author(s):  
Robert R Langley ◽  
Isaiah J Fidler
Keyword(s):  
Central Nervous System ◽  
Endothelial Cells ◽  
Nervous System ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Disease Progression ◽  
Microvascular Endothelial Cells ◽  
Number Of Patients ◽  
The Central Nervous System ◽  
Microvascular Endothelial

BACKGROUND It is estimated that at least 200 000 cases of brain metastases occur each year in the US, which is 10 times the number of patients diagnosed with primary brain tumors. Brain metastasis is associated with poor prognosis, neurological deterioration, diminished quality of life, and extremely short survival. Favorable interactions between tumor cells and cerebral microvascular endothelial cells encourage tumor growth in the central nervous system, while tumor cell interactions with astrocytes protect brain metastases from the cytotoxic effects of chemotherapy. CONTENT We review the pathogenesis of brain metastasis and emphasize the contributions of microvascular endothelial cells and astrocytes to disease progression and therapeutic resistance. Animal models used to study brain metastasis are also discussed. SUMMARY Brain metastasis has many unmet clinical needs. There are few clinically relevant tumor models and no targeted therapies specific for brain metastases, and the mean survival for untreated patients is 5 weeks. Improved clinical outcomes are dependent on an enhanced understanding of the metastasis-initiating population of cells and the identification of microenvironmental factors that encourage disease progression in the central nervous system.

Role of the 5-HT7 Receptor in the Central Nervous System: from Current Status to Future Perspectives

2011 ◽  
Vol 43 (3) ◽  
pp. 228-253 ◽  
Author(s):  
Anne Matthys ◽  
Guy Haegeman ◽  
Kathleen Van Craenenbroeck ◽  
Peter Vanhoenacker
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Current Status ◽  
Future Perspectives ◽  
The Central Nervous System

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.

The Role of Tumor Size in the Radiosurgical Management of Patients with Ambiguous Brain Metastases

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 272-281 ◽  
Author(s):  
Eric L. Chang ◽  
Samuel J. Hassenbusch ◽  
Almon S. Shiu ◽  
Frederick F. Lang ◽  
Pamela K. Allen ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Local Control ◽  
Medical Records ◽  
Tumor Volume ◽  
Unknown Primary ◽  
Inclusion Criteria ◽  
Peripheral Dose

Abstract OBJECTIVE To identify a size cutoff below which it is safe to observe obscure brain lesions suspected of being metastases so that treatment of nonmetastases can be avoided. METHODS Medical records from patients who underwent linear accelerator-based radiosurgery from August 1991 to October 2001 were reviewed. Inclusion criteria were defined as brain metastasis tumor volume less than 5 cm3 (diameter, ∼2.1 cm) treated with a dose of 20 Gy or more. One hundred thirty-five patients had 153 evaluable brain metastases with follow-up imaging that met inclusion criteria. Median age was 54 years (range, 18–79 yr). Lesion primaries were non-small-cell lung (n = 39), melanoma (n = 44), renal (n = 37), breast (n = 18), colon (n = 3), sarcoma (n = 5), other (n = 5), and unknown primary (n = 2). Median tumor volume was 0.67 cm3 (range, 0.06–4.58 cm3). The minimum peripheral dose was 20 Gy (n = 132) or 21 to 24 Gy (n = 21). At the time of analysis, the median follow-up for all patients was 10 months (range, 0.2–99 mo). RESULTS The 1- and 2-year actuarial local control rates for all of the lesions were 69 and 46%, respectively. For lesions of 1 cm (0.5 cm3) or less, the corresponding local control rates were 86 and 78%, respectively, which was significantly higher than the corresponding rates of 56 and 24%, respectively, for lesions larger than 1 cm (0.5 cm3) (P = 0.0016). CONCLUSION A convincing brain metastasis measuring less than 1 cm should be pursued aggressively. If the suspected brain metastasis is ambiguous, observation is proposed up to a diameter of 1 cm. This is the first study in the literature to identify a 1-cm cutoff for radiosurgical control of small brain metastases, and validation by additional studies is required.

Short-course irradiation as adjuvant treatment of surgically resected single brain metastases

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.

scholarly journals The role of surgery in primary central nervous system lymphomas

2018 ◽  
Vol 76 (3) ◽  
pp. 139-144 ◽  
Author(s):  
Juan Francisco Villalonga ◽  
Lucas Alessandro ◽  
Mauricio Franco Farez ◽  
Rubén Mormandi ◽  
Andrés Cervio ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Retrospective Study ◽  
Survival Time ◽  
Surgical Resection ◽  
Median Survival Time ◽  
Traditional Treatment ◽  
Resection Group ◽  
Improvement In Survival

ABSTRACT Background Primary central nervous system lymphomas (PCNSL) are infrequent. The traditional treatment of choice is chemotherapy. Complete resections have generally not been recommended, because of the risk of permanent central nervous system deficits with no proven improvement in survival. The aim of the current study was to compare survival among patients with PCNSL who underwent biopsy versus surgical resection. Methods A retrospective study was conducted on 50 patients with a confirmed diagnosis of PCNSL treated at our center from January 1994 to July 2015. Results Patients in the resection group exhibited significantly longer median survival time, relative to the biopsy group, surviving a median 31 months versus 14.5 months; p = 0.016. Conclusions In our series, patients who had surgical resection of their tumor survived a median 16.5 months longer than patients who underwent biopsy alone.

Sign in / Sign up

Export Citation Format

Share Document