Abstract P5-14-20: Mechanisms of radiation-induced brain edema alone and in combination with T-DM1 in Her2+ brain metastases

Abstract PURPOSE: To evaluate the efficacy of Gamma Knife radiosurgery (GKS) in patients with large brain metastases by comparing single-session radiosurgery (S-GKS) and multisession radiosurgery (M-GKS), the authors retrospectively analyzed the clinical outcomes of the patients who underwent GKS for brain metastases from non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Between January 2010 and December 2016, 66 patients with 74 lesions >=10 cm3 from large brain metastases from only NSCLC were included. Fifty-five patients with 60 lesions were treated with S-GKS; 11 patients with 14 lesions were treated with M-GKS. Median doses were 16 Gy (range, 11–18 Gy) for the S-GKS group and 8 Gy (range, 7–10 Gy) in three fractions for the M-GKS group. RESULTS: With a mean follow-up period of 13.1 months (range, 1.3–76.4 months), the median survival duration was 21.1 months for all patients. Median tumor volume was 14.3 cm3 (range, 10.0–58.3). The local control rate was 77.0% and the progression-free survival rate was 73.6% at the last follow-up. There were no significant between-group differences in terms of local control rate (p = 0.10). Compared with S-GKS, M-GKS did not differ significantly in radiation-induced complications (38.1% versus 45.4%, p = 0.83). While eight patients who underwent S-GKS experienced major complications of grade >=3, no toxicity was observed in patients treated with M-GKS. CONCLUSIONS: M-GKS may be an effective alternative for large brain metastases from NSCLC. Specifically, severe radiation-induced toxicity (≥ grade 3) did not occur in M-GKS for large-volume metastases. Although the long-term effects and results from larger samples remain unclear, M-GKS may be a suitable palliative treatment to preserve neurological function.

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Analyzing the association between dose-volume parameters and radiation-induced brain edema in patients with brain tumor receiving stereotactic radiosurgery

International Journal of Modern Physics B ◽

10.1142/s0217979220401347 ◽

2020 ◽

Vol 34 (22n24) ◽

pp. 2040134

Author(s):

Yang-Wei Hsieh ◽

Chin-Shiuh Shieh ◽

Tai-Lin Huang ◽

Shyh-An Yeh ◽

Yi-Kuan Tseng ◽

...

Keyword(s):

Brain Tumor ◽

Stereotactic Radiosurgery ◽

Brain Edema ◽

Magnetic Resonance Images ◽

Planning System ◽

Volume Index ◽

Treatment Planning System ◽

Dose Volume ◽

Study Results ◽

Radiation Induced

In this paper, three-dimensional images were used to analyze the association between dose-volume parameters and radiation-induced brain edema in patients with a brain tumor after receiving stereotactic radiosurgery (SRS). The computed tomography (CT), magnetic resonance images (MRI) and treatment parameters were transferred through the treatment planning system (Multiplan, version 5.1.3). The correlation between the dose of radiation therapy and brain edema was evaluated by image processing methods, such as image normalization, registration, filtering, segmentation, and feature extraction. The association was evaluated by volume index and intersection index. The study results suggest that the volume receiving radiation dose above 30% of the prescribed dose is highly associated with the brain edema in brain tumor patients after SRS. The small number of patients limits the study. Further investigation with larger populations and long-term epidemiological studies are required.

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Effect of prophylactic hyperbaric oxygen treatment for radiation-induced brain injury after stereotactic radiosurgery of brain metastases

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2006.08.009 ◽

2007 ◽

Vol 67 (1) ◽

pp. 248-255 ◽

Cited By ~ 45

Author(s):

Takayuki Ohguri ◽

Hajime Imada ◽

Kiyotaka Kohshi ◽

Shingo Kakeda ◽

Norihiro Ohnari ◽

...

Keyword(s):

Brain Injury ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Treatment ◽

Oxygen Treatment ◽

Radiation Induced

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Multivoxel proton MRS for differentiation of radiation-induced necrosis and tumor recurrence after gamma knife radiosurgery for brain metastases

Brain Tumor Pathology ◽

10.1007/s10014-006-0194-9 ◽

2006 ◽

Vol 23 (1) ◽

pp. 19-27 ◽

Cited By ~ 48

Author(s):

Mikhail F. Chernov ◽

Motohiro Hayashi ◽

Masahiro Izawa ◽

Masao Usukura ◽

Shimetoshi Yoshida ◽

...

Keyword(s):

Brain Metastases ◽

Gamma Knife ◽

Tumor Recurrence ◽

Gamma Knife Radiosurgery ◽

Proton Mrs ◽

Radiation Induced

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Correlation of large brain edema with favorable prognosis in patients with single brain metastases.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.2053 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 2053-2053

Author(s):

Matthias Preusser ◽

Anna Sophie Berghoff ◽

Carina Dinhof ◽

Markus Hutterer ◽

Adelheid Woehrer ◽

...

Keyword(s):

Brain Metastases ◽

Brain Edema ◽

Significant Positive Correlation ◽

Cox Regression ◽

Univariate Analysis ◽

Magnetic Resonance Images ◽

Contralateral Hemisphere ◽

Primary Tumors ◽

Positive Correlation ◽

Favorable Prognosis

2053 Background: The sub-cohort of brain metastases (BM) patients (pts) with single BM has relatively favorable survival times, but novel prognostic factors are needed to individualize patient management. Methods: We retrospectively evaluated pre-operative magnetic resonance images in patients, who underwent neurosurgical resection of a single BM. The localization and largest diameter of the BM was recorded. The extent of brain edema (BE) was graded on contrast-enhanced T1, T2 and fluid-attenuated inversion recovery (FLAIR) images as follows: BE <1cm, BE >1 cm without affection of the contralateral hemisphere, BE >1cm with affection of the contralateral hemisphere. Further, immunohistochemically assessed expression of hypoxia-induced factor 1 alpha (HIF1a) was analyzed in each BM tissue specimen. Results: 159 pts were studied (81 male, 78 female; age range 24 to 80 years, median 58). The primary tumors were lung carcinoma in 74, breast cancer in 26, kidney cancer in 13, colorectal cancer in 11, melanoma in 9 and other tumor types in 26 cases. At univariate analysis, we found a significant positive correlation of overall survival time (OS) with young age, Karnofsky index >80, non-melanoma histology, and, surprisingly, large BE (p<0.05, log-rank test). At multivariate analysis, pts age, histological diagnosis and extent of BE remained independent prognostic parameters (Cox regression model, p<0.05). We found a significant positive correlation of extent of BE with expression of HIF1a (Mann-Whitney-U test, p=0.003). Conclusions: Large BE positively and independently correlates with favorable prognosis in pts operated for single BM. Peritumoral BE correlates with HIF1a expression, indicating a possible role of tumor hypoxia in its formation. [Table: see text]

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Radiographic features of metastatic brain tumors from non-small cell lung cancer with ALK rearrangement.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e20533 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e20533-e20533

Author(s):

Li Chu ◽

Ruimin Li ◽

Xi Yang ◽

Fan Xia ◽

Zhengfei Zhu

Keyword(s):

Brain Metastasis ◽

Brain Tumors ◽

Brain Metastases ◽

Brain Edema ◽

Metastatic Brain Tumors ◽

Small Cell Lung ◽

Alk Rearrangement ◽

Peritumoral Brain Edema ◽

Nsclc Patients ◽

The Military

e20533 Background: Approximately 5% of Non-Small Cell Lung Cancer (NSCLCs) have ALK rearrangement, in which brain metastases are common. The radiographic features of metastatic brain tumors have not been previously studied. Finding the features of brain metastasis could help establishing the treatment pattern for the ALK-rearranged NSCLC patients. Methods: All NSCLC patients with ALK rearrangement (132 patients) were detected from March 2008 through December 2016. The metastatic brain tumors (34 patients) detected from July 2014 through December 2016 were divided into metachronous brain metastasis (MBM) and synchronous brain metastasis (SBM) groups according to the diagnosis time. All patients were followed up using brain magnetic resonance imaging (MRI). The number of brain tumors, size of the largest brain tumors, and size of peritumoral brain edema were compared between the two groups. Results: Thirty-four patients were observed.The number of brain tumors in ALK-rearranged NSCLC patients is 4.6 with 41.07mm Peritumoral Brain Edema Size (PBES). Only one patient has the military brain metastases. All patients were divided into two groups: metachronous (15 patients) and synchronous (19 patients). The two groups had rare active and former smoker. The SBM group had more female patients. The SBM group had larger number of brain tumors (6.1 VS 2.8), but there was no significant difference ( P= 0.0672). The MBM group had smaller brain tumors (14.2mm vs 20.9mm, P= 0.0798) with smaller PBES (25.7mm vs 53.2mm, P= 0.0018) and Peritumoral Brain Edema Index (PBEI) (0.9 vs 1.9, P= 0.0201) than the SBM group. Conclusions: Only one patient in SBM group has the military brain metastases. The SBM group has larger brain tumors with larger peritumoral brain edema and PBEI. The MBM patients have smaller ones. Our studies show that ALK-rearranged NSCLC patients have a small number brain tumors and relatively large PBES.

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Re-Irradiation of Brain Metastases and Metastatic Spinal Cord Compression: Clinical Practice Suggestions

Tumori Journal ◽

10.1177/030089160509100408 ◽

2005 ◽

Vol 91 (4) ◽

pp. 325-330 ◽

Cited By ~ 19

Author(s):

Ernesto Maranzano ◽

Fabio Trippa ◽

Diamante Pacchiarini ◽

Luigia Chirico ◽

Maria Luisa Basagni ◽

...

Keyword(s):

Spinal Cord ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Stereotactic Radiotherapy ◽

Whole Brain Radiotherapy ◽

Cord Compression ◽

Whole Brain ◽

Brain Radiotherapy ◽

Radiation Induced ◽

The Brain

The recent improvements of therapeutic approaches in oncology have allowed a certain number of patients with advanced disease to survive much longer than in the past. So, the number of cases with brain metastases and metastatic spinal cord compression has increased, as has the possibility of developing a recurrence in areas of the central nervous system already treated with radiotherapy. Clinicians are reluctant to perform re-irradiation of the brain, because of the risk of severe side effects. The tolerance dose for the brain to a single course of radiotherapy is 50–60 Gy in 2 Gy daily fractions. New metastases appear in 22–73% of the cases after whole brain radiotherapy, but the percentage of re-irradiated patients is 3–10%. An accurate selection must be made before giving an indication to re-irradiation. Patients with Karnofsky performance status >70, age <65 years, controlled primary and no extracranial metastases are those with the best prognosis. The absence of extracranial disease was the most significant factor in conditioning survival, and maximum tumor diameter was the only variable associated with an increased risk of unacceptable acute and/or chronic neurotoxicity. Re-treatment of brain metastases can be done with whole brain radiotherapy, stereotactic radiosurgery or fractionated stereotactic radiotherapy. Most patients had no relevant radiation-induced toxicity after a second course of whole brain radiotherapy or stereotactic radiosurgery. There are few data on fractionated stereotactic radiotherapy in the re-irradiation of brain metastases. In general, the incidence of an “in-field” recurrence of spinal metastasis varies from 2.5–11% of cases and can occur 2–40 months after the first radiotherapy cycle. Radiation-induced myelopathy can occur months or years (6 months-7 years) after radiotherapy, and the pathogenesis remains obscure. Higher radiotherapy doses, larger doses per fraction, and previous exposure to radiation could be associated with a higher probability of developing radiation-induced myelopathy. Experimental data indicate that also the total dose of the first and second radiotherapy, interval to re-treatment, length of the irradiated spinal cord, and age of the treated animals influence the risk of radiation-induced myelopathy. An α/β ratio of 1.9–3 Gy could be generally the reference value for fractionated radiotherapy. However, when fraction sizes are up to 5 Gy, the linear-quadratic equation become a less valid model. The early diagnosis of relapse is crucial in conditioning response to re-treatment.

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