A Case of Calcified Metastatic Colorectal Adenocarcinoma Mimicking a Benign Lesion: Pitfalls in Diagnosis

The radiological finding of a calcified intracranial lesion commonly represents a slow growing benign mass. Brain metastases originating from colorectal cancers are rare, occurring in approximately 2-3% of patients. Therefore the presence of a calcified brain lesion in a patient with a positive oncological history requires a high index of suspicion for brain metastases. Presented herein is a case of a frontoparietal calcified lesion initially overlooked as a benign tumour. Subsequent imaging following a neurological episode revealed a significant increase in size of the lesion with surrounding tissue oedema, prompting further investigation for suspicion of a calcified metastatic colorectal adenocarcinoma.

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Cavernous lymphangioma in the adulat parotid

The Journal of Laryngology & Otology ◽

10.1017/s0022215100138010 ◽

1997 ◽

Vol 111 (6) ◽

pp. 590-591 ◽

Cited By ~ 2

Author(s):

M. Morgan ◽

M. Bennett ◽

J.A. Wilson

Keyword(s):

Parotid Gland ◽

Salivary Glands ◽

Adult Male ◽

Late Stage ◽

Surrounding Tissue ◽

Congenital Lesion ◽

Slow Growing

AbstractCavernous lymphangioma is a benign congenital lesion that usually appears in childhood. It rarely presents in the adult but may be diagnosed at this late stage due to the slow growing nature of the tumour. It is rarely found i n the salivary glands and when it does occur, the gland is usually incorporated by lymphangioma of surrounding tissue.We present and discuss the case of a cavernous lymphangioma in the parotid gland of an adult male.

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Adeloye-Odeku Disease in Irrua, South-South Nigeria

Romanian Neurosurgery ◽

10.33962/roneuro-2019-068 ◽

2019 ◽

pp. 431-437

Author(s):

E. Morgan ◽

C. O. Okwumezie ◽

G. C. Akasike ◽

E A. Morgan

Keyword(s):

Dermoid Cyst ◽

Outpatient Clinic ◽

Benign Lesion ◽

Adult Life ◽

Anterior Fontanelle ◽

Group Counselling ◽

Health Institution ◽

The World ◽

Rare Lesion ◽

Slow Growing

First described in a publication by two Nigerian Neurosurgeons, Adeloye A and Odeku EL, in 1971, Adeloye-Odeku disease is a solitary congenital subgaleal inclusion dermoid cyst of the anterior fontanelle. This rare lesion, which makes up about 0.1-0.5% of all cranial tumours and 0.2% of all inclusion cysts, was initially thought to be found only in Africans. However, further reports have shown it to have a universal occurrence, as it has been reported in Caucasians, Chinese, Indians, and other part of the world. This lesion is also known as Congenital inclusion dermoid cyst (CIDS), is a benign slow-growing lesion, and if untreated, may persist to adult life. This article gives a highlight of the disease and its management and goes further to report 3 cases of this rare benign lesion seen in Irrua, South-South Nigeria, a rural, low-resource tertiary health institution. Incidentally and interestingly, all three cases presented within three consecutive months (January-March, 2019) at the neurosurgery outpatient clinic. Being uncomplicated cases, private and group counselling was done. The parents of the patients were much more reassured and relieved from their anxieties seeing others with similar problem. They were all worked up for surgery at different dates, had excision of the cysts with no complication and are currently being followed at the outpatient clinic.

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P14.85 Brain metastasis from Hodgkin’s Lymphoma: case report and literature review

Neuro-Oncology ◽

10.1093/neuonc/noz126.320 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii87-iii88

Author(s):

F Bruno ◽

E Pronello ◽

S Bortolani ◽

R Palmiero ◽

A Melcarne ◽

...

Keyword(s):

Case Report ◽

Complete Remission ◽

Brain Metastasis ◽

Brain Metastases ◽

Hodgkin’S Lymphoma ◽

Brain Lesion ◽

Whole Brain Radiotherapy ◽

Hodgkin's Lymphoma ◽

High Dose ◽

Thoracic Pain

Abstract BACKGROUND Central nervous system (CNS) metastases from Hodgkin’s Lymphoma (HL) are very rare, occurring in 0.02–0.5% of cases. They are usually associated to systemic relapse of the disease. Treatment options for HL brain metastases include surgery, radiotherapy, and systemic chemotherapy. CASE REPORT A 54 year-old woman presented with thoracic pain and dyspnea. Chest CT showed a thoracic bulky mass larger than 10 cm. Biopsy confirmed HL stage IIA, nodular sclerosing variant. No typical B symptoms, such as fever, night sweats or weight loss, were observed. The patient underwent chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD scheme), followed by 30Gy mediastinic radiotherapy (RT), which led to complete remission in September 2017. After 3 months, she presented with headache and rapidly progressing gait disorder. MRI showed a contrast-enhanced lesion in the right occipital lobe, with central necrosis and massive edema. Total-body CT scan and FDG-PET ruled out either the presence of new solid tumors or systemic relapses of HL. Gross total resection of the brain lesion was carried out, and HL histology was confirmed. CSF analysis from lumbar puncture was normal. Afterwards, the patient underwent 2 cycles of high dose cytarabine, but she rapidly progressed, and received salvage RT (30 Gy). Nevertheless, further systemic progression occurred: the patient developed headache, diplopia and dysphagia and, unfortunately, she died 6 months after the diagnosis of brain metastasis. DISCUSSION Thus far, only 45 cases of CNS HL have been reported from 2000 to 2018. Whole brain radiotherapy, with or without chemotherapy, was the most common treatment. In our patient, we chose surgical resection for the solitary brain metastasis followed by chemotherapy, delaying RT at recurrence. In the literature, median overall survival of patients diagnosed with brain metastases from HL is 18 months (1–273): 17 patients (38%) showed a progression (local / systemic: 12/17 - 71%), while 28 (62%) showed complete remission after a median follow-up of 20 months (6–273). CONCLUSION Intracranial localisation of Hodgkin’s Lymphoma is a rare entity but still has to be taken into account. Advanced brain imaging could be of help in case of uncertain radiological presentation. A multidisciplinary approach is needed as there is no consensus on the best treatment to choose: surgery, radiotherapy and chemotherapy should be considered on individual basis.

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OTHR-12. DRIVING RECOMMENDATIONS IN PATIENTS WITH NEWLY DIAGNOSED BREAST CANCER BRAIN METASTASES

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz014.089 ◽

2019 ◽

Vol 1 (Supplement_1) ◽

pp. i20-i20

Author(s):

Leigh Swartz ◽

Heidi Egloff ◽

Aki Morikawa ◽

Catherine Van Poznak

Keyword(s):

Breast Cancer ◽

Brain Metastases ◽

Seizure Activity ◽

Descriptive Analysis ◽

Brain Lesion ◽

Primary Objective ◽

Develop Breast Cancer ◽

Newly Diagnosed ◽

Eligibility Criteria ◽

Breast Cancer Brain Metastases

Abstract BACKGROUND: Approximately 5% of all patients with breast cancer develop breast cancer brain metastases (BCBM). Medical and legal guidance on health conditions associated with driving may vary by state. The paucity of data to guide clinicians’ recommendations on driving in the setting of BCBM prompted this review of clinical practice. The primary objective is to determine the frequency of provider-documented driving recommendations with secondary objectives to define associated clinical factors. METHODS: University of Michigan’s (UM) DataDirect tool retrospectively searched records dated 11/30/2012 to 11/30/2018 using ICD 9 and 10 codes for breast cancer (C50.912, C50.911, C50.919, 174.9, 175.9) and for brain metastases (C79.31, D49.6, D43.2, 198.3, 239.6). Eligibility criteria were: age ≥ 18, BCBM, UM pathology confirmation of breast cancer, CNS imaging at time of diagnosis performed or reviewed at UM, and UM consultation with medical oncology, radiation oncology, neuro-oncology, neurosurgery, or neurology within 4 weeks of BCBM diagnosis. Chart abstraction included clinical and demographic factors for descriptive analysis. RESULTS: Only 87 of the 188 identified subjects (46%) met eligibility criteria. The most common exclusions were non-breast cancer brain lesion (n=40), neither UM imaging nor pathology (n=23) and no intra-parenchymal brain metastases (n=22). Of the 87 eligible subjects, 21 (24%) had documented recommendations against driving. Five of the 7 subjects with documented seizure history within 4 weeks of diagnosis also had documented recommendations against driving. There were 32 of 87 subjects on anti-epileptics of which 13 had documented driving recommendations. CONCLUSIONS: The minority of patients (24%) with newly diagnosed BCBM had a documented recommendation against driving. Seizure activity was strongly associated with documentation of driving recommendations. Other than seizure activity, general parameters regarding the safety of driving with newly diagnosed BCBM are not well defined. Prospective study is indicated to provide data supported recommendations regarding driving with BCBM.

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EXTH-31. COMBINATION OF TUMOR TREATING FIELDS (TTFIELDS) AND PACLITAXEL PRODUCES ADDITIVE REDUCTIONS IN PROLIFERATION AND CLONOGENICITY IN PATIENT-DERIVED METASTATIC NON-SMALL CELL LUNG CANCER (NSCLC) CELLS

Neuro-Oncology ◽

10.1093/neuonc/noz175.363 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi88-vi88

Author(s):

Sharon Michelhaugh ◽

Sandeep Mittal

Keyword(s):

Brain Metastases ◽

Clonogenic Assay ◽

Brain Lesion ◽

Left Lung ◽

Standard Of Care ◽

Cell Number ◽

Tumor Treating Fields ◽

Institutional Review ◽

Previously Treated

Abstract Clinical trials are underway to test the efficacy of TTFields in patients with progressive NSCLC or NSCLC brain metastases following standard-of-care or radiosurgery, respectively. Our study utilized patient-derived cells isolated from NSCLC brain metastases from a patient previously treated with standard-of-care chemo-radiation prior to progression to brain metastasis. These patient-derived cells underwent TTFields application in vitro with and without paclitaxel to determine if the response to the combination of TTFields with paclitaxel would be different from either treatment alone. Use of patient tissues was approved by the Institutional Review Board. Written informed consent was obtained from the patient, who was 60 years-old and female. She received concurrent carboplatin/paclitaxel and radiotherapy to the upper lobe of her left lung prior to discovery and resection of a solitary brain lesion. Cells isolated from the metastatic brain tumor were cultured for 3 passages prior to plating on coverslips (4×104 each) in DMEM/F12 media with 10% fetal bovine serum. TTFields were applied at ~1.6 V/cm at 150 kHz. Paclitaxel was added to the media to a final concentration of 5 nM. After 14 days, cell lysates were assayed for lactase dehydrogenase (LDH) to represent cell number (n=5) or were harvested and replated in triplicate for the clonogenic assay (n=3). Groups were compared with one-way ANOVA. Mean ± SD of LDH for the control, TTFields-alone, paclitaxel-alone, and the combination were 1.83 ± 0.09, 1.34 ± 0.15, 0.81 ± 0.04, and 0.46 ± 0.21, respectively (ANOVA p< 0.0001). Clonogenic assay counts for the same groups were 26641 ± 4625, 17399 ± 5998, 8697 ± 1617, and 1598 ± 598 (ANOVA p= 0.0003). The additive effects of TTFields and paclitaxel suggest that they target different cell populations within a heterogeneous tumor, and that patients previously treated with standard-of-care may benefit from TTFields therapy.

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Survival of patients with melanoma metastatic brain metastases in the era of novel systemic therapies in Cardiff, Wales

Neuro-Oncology ◽

10.1093/neuonc/noz167.055 ◽

2019 ◽

Vol 21 (Supplement_4) ◽

pp. iv13-iv13

Author(s):

Joseph Pasquale ◽

Joanita Ocen ◽

James Powell ◽

Satish Kumar

Keyword(s):

Targeted Therapy ◽

Brain Metastases ◽

Small Sample Size ◽

Brain Lesion ◽

Small Sample ◽

Simultaneous Treatment ◽

Local Progression ◽

Significant Difference ◽

Retrospective Nature ◽

The Uk

Abstract The incidence of malignant melanoma (MM) is increasing in the UK; it’s projected to rise by 7% by 2035. MM has high predisposition to developing brain metastases (BM) with 50–60% of patients being affected. Stereotactic radiosurgery (SRS) and surgery, key interventions in managing patients with BM, have been shown to improve survival outcomes of patients. Patients’ prognosis and survival has also significantly improved with the advent of novel therapies in the last few years. It was noted that the Cardiff Neuro-Oncology multidisciplinary team were receiving increasing amount of referrals for consideration of surgery or SRS in patients with MM. 106 MDT referrals were retrospectively reviewed. 31 patients had surgery, 20 patients had SRS and the remaining 54 patients had WBRT. There was no significant difference in the patient distribution. The majority of patients had 1 brain lesion in both groups (in similar proportions). The 12 month survival for the surgical cohort was 65% for immunotherapy group, 55%- targeted therapy and 30%- no therapy. For the SRS group the 12 month survival for immunotherapy was 45%, targeted therapy- 40% and 20%- no therapy. The median OS for surgery versus SRS was 8 and 7 months respectively. The results suggest that simultaneous treatment with surgery or SRS in conjunction with SACT does improve survival. Interpretation of results will have to be taken with caution due to the retrospective nature and the small sample size. Going forward, we will delve deeper and review local progression rates and SACT timing/sequencing in our practice.

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EGF105084, a phase II study of lapatinib for brain metastases in patients (pts) with HER2+ breast cancer following trastuzumab (H) based systemic therapy and cranial radiotherapy (RT)

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.1012 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 1012-1012 ◽

Cited By ~ 32

Author(s):

N. U. Lin ◽

V. Dieras ◽

D. Paul ◽

D. Lossignol ◽

C. Christodoulou ◽

...

Keyword(s):

Breast Cancer ◽

Brain Metastases ◽

Phase Ii ◽

Systemic Therapy ◽

Preliminary Data ◽

Brain Lesion ◽

Stage Iv ◽

Cranial Radiotherapy ◽

Cns Disease ◽

Her2 Breast Cancer

1012 Background: CNS disease is a major problem among pts treated with H for stage IV HER2+ breast cancer with a reported incidence of 28–43%. This study was designed to characterize further the activity reported with lapatinib in an initial phase II trial in women with HER2+ disease metastatic to brain (Lin et al ASCO ‘06). Methods: Eligible pts had HER2+ breast cancer, prior H therapy and cranial RT, ECOG PS 0–2, and radiographic evidence of progressive brain metastases with at least one measurable (LD = 10mm) brain lesion. Pts received lapatinib 750 mg PO BID. Brain MRIs were obtained at 3.0 mm slices without gaps in the axial dimension. The primary endpoint was CNS response as defined by a = 50% volumetric (vol) reduction of CNS lesions in the absence of: new lesions, need for increased dose of steroids, progressive neurological signs/symptoms (NSS), or progressive extra-CNS disease. CNS disease progression was defined as either a = 40% vol increase from nadir, increase in steroid requirements, or progression of NSS. Results: The study exceeded its accrual goal of 220 pts in < 1 year; 238 pts were enrolled from Jan-Nov 06. Preliminary data from the initial 104 pts have undergone independent radiology review. 8 pts (7.7%) met vol criteria for partial response with a median absolute vol reduction of CNS disease of 3.6 cm3 (range 0.4 to 29.7 cm3). Exploratory analysis revealed that 17 of the initial 104 pts (16.3%) experienced a = 20% vol reduction of CNS disease with a median absolute vol reduction of 3.3cm3. The median time to vol progression in these 17 pts was 16 wks (range 12 -24 wks). Analysis of efficacy and tolerability based upon protocol defined criteria from all 238 pts will be presented. Conclusions: Preliminary data from this large multicenter trial provides evidence that lapatinib has activity based on vol reductions in pts with progressive HER2+ CNS disease following prior H-based systemic therapy and cranial RT. Definitive conclusions will be based on the entire database. Additional studies are warranted incorporating lapatinib in combination with other therapies and/or in a less refractory setting to optimize its use in HER2+ CNS disease. [Table: see text]

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Whole brain radiation therapy (WBRT) with or without oral topotecan (TPT) in patients (pts) with non-small cell lung cancer (NSCLC) with brain metastases: Final analysis of an open-label phase III study.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.2031 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 2031-2031 ◽

Cited By ~ 1

Author(s):

Rodryg Ramlau ◽

Jacek Jassem ◽

Zsolt Papai-Szekely ◽

Pierre Chabot ◽

Philippe Legenne ◽

...

Keyword(s):

Brain Metastases ◽

Population Analysis ◽

Brain Lesion ◽

Signs And Symptoms ◽

Final Analysis ◽

Primary Objective ◽

Phase Iii ◽

Smoking History ◽

Hematologic Toxicity ◽

Open Label

2031 Background: Brain metastases from NSCLC occur in ~ 20% of pts and if untreated are associated with a 1 to 2 month overall survival (OS). Pre-clinical studies show that TPT added to radiation results in a radiotherapy enhancement ratio of 1.4 to 1.6. This trial was designed to test the effect of TPT co-administered with WBRT on OS. Methods: Pts with NSCLC and at least one measurable brain lesion were eligible. 472 pts were randomized to WBRT (3 Gy/day x 10 days) or WBRT and TPT 1.1 mg/m2/day for 10 days. Stratification factors: number of brain metastases and recursive partitioning analysis (RPA) class. Two weeks following WBRT, systemic anti-cancer therapy could be restarted at the treating physician’s discretion. Results: 468 pts were in the modified ITT population; 235 pts (WBRT + TPT) and 233 pts (WBRT+ best supportive care [BSC]). Of the 235 pts administered WBRT + TPT, 91 also received TPT after WBRT. The treatment arms were balanced for gender, age and smoking history. Median daily TPT dose was 2.25 mg. The median OS in the TPT arm was not better than in the BSC alone arm; 4.0 months (95%CI 3.4,4.8) vs.3.6 months (95%CI 3.0, 4.0), respectively; HR 0.88 (0.73, 1.07), P=0.1862. In the ITT population analysis by stratification variables, RPA class (I vs. II/III) was significantly different (HR 0.59) whereas baseline brain lesions (1 vs >1) were not (HR 0.97). Complete response and overall response rates in the WBRT+ TPT were 10% and 27%, and with BSC 5% and 26%, respectively. There were no differences in time to response or neurologic signs and symptoms. All adverse events (AEs) were more frequent in the TPT arm (87% vs. 64%) as were AEs related to study treatment (57% vs. 21%), serious AEs (41% vs. 18%) and fatal AEs (5% vs. 0%). The AEs more frequently seen in the TPT arm were typical for TPT (hematologic toxicity, febrile neutropenia and diarrhea). Conclusions: The study did not achieve its primary objective. There was no difference in OS achieved by the addition of TPT to WBRT. AEs were more common in the TPT arm. Clinical trial information: NCT00390806.

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Brain metastases in patients with urothelial carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.282 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 282-282

Author(s):

Helen Jane Boyle ◽

Emilie Lavergne ◽

Jean Pierre Droz ◽

Nathalie Bonnin ◽

Aude Flechon

Keyword(s):

Brain Metastases ◽

Urothelial Carcinoma ◽

Metastatic Disease ◽

Cox Model ◽

Brain Mri ◽

Brain Lesion ◽

Local Treatment ◽

Local Therapy ◽

Initial Diagnosis ◽

Initial Presentation

282 Background: Muscle invasive urothelial cancers are infrequent. Patients (pts) with metastatic disease have poor prognosis. Brain metastases (BM) are rare. The aim of this retrospective study is to analyse the characteristics, the treatment and the evolution of patients with BM treated in a single centre. Methods: Thirty pts with BM were identified among the 1591 pts with urothelial carcinoma seen at the Centre Léon Bérard, between 1994 and 2011. The study population was described, overall survival (OS) from diagnosis of BM was estimated by Kaplan-Meier method and prognostic factors were explored using a Cox model. Results: Twenty seven pts in our series were male. Median age at initial diagnosis was 60 years (range: 33.9-78.9 years). Twenty two pts had primary bladder tumours and 8 upper urinary tract tumours. Twenty four pts underwent surgery for their primary lesion, 2 received chemoradiotherapy and 4 did not receive any radical local treatment. Six pts had metastatic disease at initial presentation: 3 were operated on. Median delay between initial diagnosis and BM was 16.6 months (range: 0-56.4 months), 3 patients had BM at initial presentation. Median time between first metastases and BM was 10 months (range=0-52 months). Eleven patients developed BM as one of the first sites of metastases. BM were symptomatic in 28 pts: specific neurological symptoms (n=25), headaches (n=6), epilepsy (n=2). For the 2 other pts, they were discovered on a systematic brain MRI. Eighteen pts had cerebral metastases only, 5 pts had cerebellar metastases only, 6 had both; the last patient had cerebral, cerebellar and meningeal involvement. Half of the pts had only 1 brain lesion. Five pts were operated on: 4 received postoperative radiotherapy; 19 patients were given radiotherapy alone and 6 did not get any local therapy. In this series, median OS from diagnosis of BM was 3.4 months (IC95% [2.2-10.3]). Only the administration of chemotherapy after the diagnosis of BM was significantly associated with OS; probably because only fit enough patients were offered treatment. Conclusions: Prognosis of patients with urothelial carcinoma and BM is poor; however some patients have long survivals. Treatment is not codified as there is little data in the literature.

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Outcomes from 735 patients with breast cancer brain metastases (BM) according to biological subtype, number of BMs, and systemic treatment after local therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.2078 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 2078-2078 ◽

Cited By ~ 3

Author(s):

Anna Niwinska ◽

Katarzyna Pogoda ◽

Halina Rudnicka ◽

Agnieszka Irena Jagiello-Gruszfeld ◽

Sebastian Rybski ◽

...

Keyword(s):

Breast Cancer ◽

Brain Metastasis ◽

Brain Metastases ◽

Systemic Treatment ◽

Brain Lesion ◽

Local Treatment ◽

Local Therapy ◽

Luminal Breast Cancer ◽

Solitary Brain Metastasis ◽

Biological Subtype

2078 Background: To assess survival when BM is detected according to the biological subtype of breast cancer, number of BMs and systemic treatment after local therapy. Methods: Subjects were 735 consecutive breast cancer patients with BM treated during 2003-2015. Whole brain radiotherapy was undertaken in 97%, neurosurgery -19% and systemic therapy was performed in 74% cases. The biological subtypes: triple-negative (TNBC), HER2+ER/PR-, HER2+/ER/PR+ and ER/PR+HER2- (Luminal) were determined in 714 subjects. Survival after BM detection was assessed in the entire group, in patients with a single BM (1 brain lesion regardless of metastases in other organs) and those with a solitary brain metastasis (1 brain lesion but no metastases in other organs). Factors influencing survival upon detecting BM were assessed by Cox multivariate analysis. Results: The median survivals for all patients with TNBC, HER2+ER/PR-, HER2+/ER/PR+ and Luminal breast cancer BM were respectively 4, 8, 10 and 9 months (p < 0.001). In those both treated and untreated systemically within the TNBC, HER2+ER/PR-, HER2+/ER/PR+ and Luminal subtypes survivals were correspondingly 6, 10, 14, 11 and 2, 3, 2, 2 months (p < 0.001). Median survivals of 171 patients with a single BM treated and untreated systemically were respectively 15 and 5 months (p < 0.001). Median survivals of 70 patients with solitary BM treated and untreated systemically were respectively 28 and 6 months (p < 0.001). In patients with solitary brain metastasis, median survival within the TNBC, HER2+ER/PR-, HER2+/ER/PR+ and Luminal subtypes, with systemic treatment was respectively 16, 28, 28, 28 months and without systemic treatment 6, 7, 7 and 7 months (p < 0.001). Conclusions: Patients with TNBC and BM had the worst prognosis. Systemic treatment performed after local therapy is an important factor prolonging survival of patients with breast cancer BM, even in those with solitary brain metastasis. Based on the present evidence and our recent publication, systemic treatment should be performed in all patients with BM after local treatment, even those with brain metastases as an isolated recurrence.

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