scholarly journals Brain Metastases From Differentiated Thyroid Carcinoma: Prevalence, Current Therapies, and Outcomes

2018 ◽  
Vol 3 (2) ◽  
pp. 359-371 ◽  
Author(s):  
Cristiane J Gomes-Lima ◽  
Di Wu ◽  
Sarika N Rao ◽  
Sree Punukollu ◽  
Rama Hritani ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Brain Metastases ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Differentiated Thyroid Carcinoma ◽  
Unusual Site ◽  
Current Therapies ◽  
The Brain

Abstract Background and Objective The brain is an unusual site for distant metastases of differentiated thyroid carcinoma (DTC). The aim of this study was to document the prevalence of brain metastases from DTC at our institutions and to analyze the current therapies and the outcomes of these patients. Methods We performed a retrospective chart review of patients with DTC and secondary neoplasia of the brain. Results From 2002 to 2016, 9514 cases of thyroid cancer were evaluated across our institutions and 24 patients met our inclusion criteria, corresponding to a prevalence of 0.3% of patients with DTC. Fourteen (58.3%) were female and 10 (41.7%) were male. Fifteen patients had papillary thyroid cancer (PTC) (62.5%). Brain metastases were diagnosed 0 to 37 years (mean ± SD, 10.6 ± 10.4 years) after the initial diagnosis of thyroid cancer. Patients undergoing surgery had a median survival time longer than those that did not undergo surgery (27.3 months vs 6.8 months; P = 0.15). Patients who underwent stereotactic radiosurgery (SRS) had a median survival time longer than those that did not receive SRS (52.5 months vs 6.7 months; P = 0.11). Twelve patients (50%) were treated with tyrosine kinase inhibitors (TKIs), and they had a better survival than those who have not used a TKI (median survival time, 27.2 months vs 4.7 months; P < 0.05). Conclusion The prevalence of brain metastases of DTC in our institutions was 0.3% over 15 years. The median survival time after diagnosis of brain metastases was 19 months. In our study population, the use of TKI improved the survival rates.

Thirty years' experience with Gamma Knife surgery for metastases to the brain

2009 ◽  
Vol 111 (3) ◽  
pp. 449-457 ◽  
Author(s):  
Bengt Karlsson ◽  
Patrick Hanssens ◽  
Robert Wolff ◽  
Michael Söderman ◽  
Christer Lindquist ◽  
...  
Keyword(s):  
Survival Time ◽  
Gamma Knife ◽  
Median Survival ◽  
Primary Tumor ◽  
Median Survival Time ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Primary Disease ◽  
Multiple Metastases ◽  
The Brain

Object The aim of this study was to analyze factors influencing survival time and patterns of distant recurrences after Gamma Knife surgery (GKS) for metastases to the brain. Methods Information was available for 1855 of 1921 patients who underwent GKS for single or multiple cerebral metastases at 4 different institutions during different time periods between 1975 and 2007. The total number of Gamma Knife treatments administered was 2448, an average of 1.32 treatments per patient. The median survival time was analyzed, related to patient and treatment parameters, and compared with published data following conventional fractionated whole-brain irradiation. Results Twenty-five patients survived for longer than 10 years after GKS, and 23 are still alive. Age and primary tumor control were strongly related to survival time. Patients with single metastases had a longer survival than those with multiple metastases, but there was no difference in survival between patients with single and multiple metastases who had controlled primary disease. There were no significant differences in median survival time between patients with 2, 3–4, 5–8, or > 8 metastases. The 5-year survival rate was 6% for the whole patient population, and 9% for patients with controlled primary disease. New hematogenous spread was a more significant problem than micrometastases in patients with longer survival. Conclusions Patient age and primary tumor control are more important factors in predicting median survival time than number of metastases to the brain. Long-term survivors are more common than previously assumed.

scholarly journals SRS in Combination With Ipilimumab: A Promising New Dimension for Treating Melanoma Brain Metastases

2020 ◽  
Vol 19 ◽  
pp. 153303382096560
Author(s):  
Samireh Badrigilan ◽  
Jalal Choupani
Keyword(s):  
Cancer Research ◽  
Adverse Effects ◽  
Brain Metastases ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Future Research ◽  
Treatment Groups ◽  
Melanoma Brain Metastases

Dear Editor, I am writing to you in order to highlight some miscalculations in an article published in the journal of Technology in Cancer Research & Treatment, entitled; “SRS in Combination with Ipilimumab: A Promising New Dimension for Treating Melanoma Brain Metastases” by Khan, et al.1 These miscalculations changed the derived conclusion about median survival time, and adverse effects in the selected treatment groups. So, amending these miscalculations may help readers in future research decisions.

Lack of immunological privilege in chick brain as a transplantation site

1985 ◽  
Vol 63 (2) ◽  
pp. 223-227 ◽  
Author(s):  
L. G. Clements ◽  
P. A. Stewart
Keyword(s):  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Gallus Domesticus ◽  
Chick Brain ◽  
Histological Features ◽  
Orthotopic Xenografts ◽  
The Brain ◽  
Transplantation Site ◽  
Privileged Site

To determine if the chick brain is an immunologically privileged site, skin autografts, allografts, and xenografts were transplanted into the brain of chicks (Gallus domesticus) and the rate of rejection of the grafts was compared with that of skin autografts, allografts, and xenografts transplanted to orthotopic sites. Rejection of the orthotopic grafts was evaluated by microscopic examination to determine the presence of the histological features of rejection. Grafts in the brain were examined microscopically for the histological features of rejection. Autografts were found to survive in the brain and on the skin for at least 4 weeks. However, when allografts and xenografts were transplanted into the brain, they were rejected just as quickly as when they were transplanted to the skin. The median survival time was 7 1/2 days for allografts to the brain and 8 1/2 days for orthotopic allografts. The median survival time was approximately 6 1/2 days for orthotopic xenografts and 7 days for xenografts to the brain. In the chick, then, the brain is not an immunologically privileged site.

Brain Metastases Treated with Radiosurgery Alone: An Alternative to Whole Brain Radiotherapy?

Neurosurgery ◽  
2003 ◽  
Vol 52 (6) ◽  
pp. 1318-1326 ◽  
Author(s):  
Toshinori Hasegawa ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
Anand Germanwala ◽  
L. Dade Lunsford
Keyword(s):  
Brain Metastases ◽  
Survival Time ◽  
Scale Score ◽  
Median Survival ◽  
Primary Tumor ◽  
Median Survival Time ◽  
Tumor Control ◽  
Karnofsky Performance Scale ◽  
Karnofsky Performance Scale Score ◽  
Performance Scale

Abstract OBJECTIVE Whole brain radiotherapy (WBRT) provides benefit for patients with brain metastases but may result in neurological toxicity for patients with extended survival times. Stereotactic radiosurgery in combination with WBRT has become an important approach, but the value of WBRT has been questioned. As an alternative to WBRT, we managed patients with stereotactic radiosurgery alone, evaluated patients' outcomes, and assessed prognostic factors for survival and tumor control. METHODS One hundred seventy-two patients with brain metastases were managed with radiosurgery alone. One hundred twenty-one patients were evaluable with follow-up imaging after radiosurgery. The median patient age was 60.5 years (age range, 16–86 yr). The mean marginal tumor dose and volume were 18.5 Gy (range, 11–22 Gy) and 4.4 ml (range, 0.1–24.9 ml). Eighty percent of patients had solitary tumors. RESULTS The overall median survival time was 8 months. The median survival time in patients with no evidence of primary tumor disease or stable disease was 13 and 11 months. The local tumor control rate was 87%. At 2 years, the rate of local control, remote brain control, and total intracranial control were 75, 41, and 27%, respectively. In multivariate analysis, advanced primary tumor status (P = 0.0003), older age (P = 0.008), lower Karnofsky Performance Scale score (P = 0.01), and malignant melanoma (P = 0.005) were significant for poorer survival. The median survival time was 28 months for patients younger than 60 years of age, with Karnofsky Performance Scale score of at least 90, and whose primary tumor status showed either no evidence of disease or stable disease. Tumor volume (P = 0.02) alone was significant for local tumor control, whereas no factor affected remote or intracranial tumor control. Eleven patients developed complications, six of which were persistent. Nineteen (16.5%) of 116 patients in whom the cause of death was obtained died as a result of causes related to brain metastasis. CONCLUSION Brain metastases were controlled well with radiosurgery alone as initial therapy. We advocate that WBRT should not be part of the initial treatment protocol for selected patients with one or two tumors with good control of their primary cancer, better Karnofsky Performance Scale score, and younger age, all of which are predictors of longer survival.

RSR13 Plus Cranial Radiation Therapy in Patients With Brain Metastases: Comparison With the Radiation Therapy Oncology Group Recursive Partitioning Analysis Brain Metastases Database

2003 ◽  
Vol 21 (12) ◽  
pp. 2364-2371 ◽  
Author(s):  
Edward Shaw ◽  
Charles Scott ◽  
John Suh ◽  
Sidney Kadish ◽  
Baldassarre Stea ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Recursive Partitioning ◽  
Radiation Therapy Oncology Group ◽  
Class Ii ◽  
Recursive Partitioning Analysis ◽  
Oncology Group

Purpose: This phase II, open-label, multicenter study assessed the efficacy and safety of the potential radiation enhancer RSR13 plus cranial radiation therapy (RT) in patients with brain metastases. The primary end point was patient survival in comparison with the Radiation Therapy Oncology Group Recursive Partitioning Analysis Brain Metastases Database (RTOG RPA BMD). Patients and Methods: Eligibility criteria were age ≥ 18 years, Karnofsky performance score ≥ 70, and brain metastases with solid tumor histology. Patients received cranial RT, 30 Gy in 10 fractions of 3 Gy each, preceded by RSR13, 50 to 100 mg/kg intravenously over 30 minutes. Univariate and multivariate comparisons of survival and cause of death were made between class II study patients and RTOG BMD patients. Results: Fifty-seven RPA class II patients were enrolled. With a minimum follow-up of 24 months, the median survival time and 1- and 2-year survival rates were 6.4 months, 23%, and 11% for the RSR13-treated patients compared with 4.1 months, 15%, and 3% for the RTOG BMD patients (P = .0174). In an exact-matched case analysis (n = 38), median survival time for RSR13 patients was 7.3 months versus 3.4 months for the RTOG BMD patients (P = .006). There was a 54% reduction in the risk of death for RSR13 patients (P = .0267). RSR13-related adverse events of greater than or equal to grade 3 toxicity that occurred in more than one patient included hypoxia, headache, anemia, fatigue, hypertension, and intracranial hypertension. Conclusion: RSR13 plus cranial RT resulted in a significant improvement in survival, as well as a reduction in death due to brain metastases, compared with class II patients in the RTOG BMD.

scholarly journals A case-matched study of stereotactic radiosurgery for patients with multiple brain metastases: comparing treatment results for 1–4 vs ≥ 5 tumors

2013 ◽  
Vol 118 (6) ◽  
pp. 1258-1268 ◽  
Author(s):  
Masaaki Yamamoto ◽  
Takuya Kawabe ◽  
Yasunori Sato ◽  
Yoshinori Higuchi ◽  
Tadashi Nariai ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Brain Metastases ◽  
Survival Time ◽  
Stereotactic Radiosurgery ◽  
Median Survival ◽  
Median Survival Time ◽  
Free Survival ◽  
Group A ◽  
Group B ◽  
Matched Study

Object Although stereotactic radiosurgery (SRS) alone for patients with 4–5 or more tumors is not a standard treatment, a trend for patients with 5 or more tumors to undergo SRS alone is already apparent. The authors' aim in the present study was to reappraise whether SRS results for ≥ 5 tumors differ from those for 1–4 tumors. Methods This institutional review board–approved retrospective cohort study used the authors' database of prospectively accumulated data that included 2553 consecutive patients who underwent SRS, not in combination with concurrent whole-brain radiotherapy, for brain metastases (METs) between 1998 and 2011. These 2553 patients were divided into 2 groups: 1553 with tumor numbers of 1–4 (Group A) and 1000 with ≥ 5 tumors (Group B). Because there was considerable bias in pre-SRS clinical factors between Groups A and B, a case-matched study was conducted. Ultimately, 1096 patients (548 each in Groups A and B) were selected. The standard Kaplan-Meier method was used to determine post-SRS survival and the post-SRS neurological death–free survival times. Competing risk analysis was applied to estimate cumulative incidences of local recurrence, repeat SRS for new lesions, neurological deterioration, and SRS-induced complications. Results The post-SRS median survival time was significantly longer in the 548 Group A patients (7.9 months, 95% CI 7.0–8.9 months) than in the 548 Group B patients (7.0 months 95% [CI 6.2–7.8 months], HR 1.176 [95% CI 1.039–1.331], p = 0.01). However, incidences of neurological death were very similar: 10.6% in Group A and 8.2% in Group B (p = 0.21). There was no significant difference between the groups in neurological death–free survival intervals (HR 0.945, 95% CI 0.636–1.394, p = 0.77). Furthermore, competing risk analyses showed that there were no significant differences between the groups in cumulative incidences of local recurrence (HR 0.577, 95% CI 0.312–1.069, p = 0.08), repeat SRS (HR 1.133, 95% CI 0.910–1.409, p = 0.26), neurological deterioration (HR 1.868, 95% CI 0.608–1.240, p = 0.44), and major SRS-related complications (HR 1.105, 95% CI 0.490–2.496, p = 0.81). In the authors' cohort, age ≤ 65 years, female sex, a Karnofsky Performance Scale score ≥ 80%, cumulative tumor volume ≤ 10 cm3, controlled primary cancer, no extracerebral METs, and neurologically asymptomatic status were significant factors favoring longer survival equally in both groups. Conclusions This retrospective study suggests that increased tumor number is an unfavorable factor for longer survival. However, the post-SRS median survival time difference, 0.9 months, between the two groups is not clinically meaningful. Furthermore, patients with 5 or more METs have noninferior results compared to patients with 1–4 tumors, in terms of neurological death, local recurrence, repeat SRS, maintenance of good neurological state, and SRS-related complications. A randomized controlled trial should be conducted to test this hypothesis.

Results of surgical treatment of patients with multiple brain metastases

2016 ◽  
Vol 21 (3) ◽  
pp. 116-121
Author(s):  
Liudmila R. Kurilina ◽  
A. F Rekhalov ◽  
S. S Pavlov ◽  
V. A Kolesnikov ◽  
P. V Smirnov
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Whole Brain Radiation Therapy ◽  
Whole Brain ◽  
Multiple Brain Metastases ◽  
Whole Brain Radiation ◽  
Brain Radiation

Objective: to evaluate the results of surgical treatment ofpatients with multiple brain metastases and to determine prognostic factors. Material and methods. 57 patients with multiple brain metastases were operated, 146 metastatic foci were removed. All metastases were removed in 42 persons; only large clinically significant metastases were removed in 15 patients. Whole brain radiation therapy was applied in 37patients, alone or in combination with chemotherapy, 20 patients after surgery received only corticosteroid and symptomatic therapy. Results. Median survival time of the whole group was 7.3 months; for patients, who received adjuvant whole brain radiation therapy - 11.6 months. Two-year survival was 8.8 %. The number of patients with Karnofsky performance score ≥ 70 increased from 12 persons (21,1%) at admission to the hospital to 38 (66.7 %) at 9-1th day after surgery. Median survival time for patients with complete resection was 9,2 months, with partial resection - 3,7 months. Prognostic factors were Karnofsky performance score and RPA class, estimated before operation, but after the corticosteroid therapy: median survival time for patients with RPA-class I was 19.5 monthsversus 5.6 months for patients with RPA- class II and III. Conclusions. Surgery rapidly improves the condition of patients with multiple brain metastases and saves the time for postoperative adjuvant treatment. Median survival time for patients who received adjuvant whole brain radiation therapy reaches 11.6 months. Favorable prognostic factors for prolonged survival are total resection of all lesions, RPA-class I and adjuvant whole brain radiation therapy.

scholarly journals CTNI-30. THERAPEUTIC EFFECTS OF RADIOTHERAPY WITH CONCOMITANT AND ADJUVANT TEMOZOLOMIDE VERSUS RADIOTHERAPY WITH CONCOMITANT TEMOZOLOMIDE ALONE IN CHILDREN WITH DIPG: A SINGLE-CENTER EXPERIENCE WITH 82 CASES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii49-ii49
Author(s):  
Mingyao Lai ◽  
Juan Li ◽  
Qingjun Hu ◽  
Jiangfen Zhou ◽  
Shaoqun Li ◽  
...  
Keyword(s):  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Disease Recurrence ◽  
Diffuse Intrinsic Pontine Glioma ◽  
Hematological Toxicity ◽  
Therapeutic Effects ◽  
Single Center Experience ◽  
Adjuvant Temozolomide ◽  
Temozolomide Chemotherapy

Abstract OBJECTIVE To retrospectively analyze the therapeutic effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy with concomitant temozolomide alone for pediatric diffuse intrinsic pontine glioma (DIPG), and to evaluate the value of temozolomide in the treatment of pediatric DIPG. METHODS The clinical data of children with confirmed DIPG in Guangdong Sanjiu Brain Hospital between January 1, 2010 and December 30, 2019 were collected. The inclusive criteria included (1) receiving a total radiotherapy dose of 54 Gy in 27 fractions, (2) treated with concomitant temozolomide chemotherapy, and (3) with or without adjuvant temozolomide chemotherapy. RESULTS A total of 82 pediatric patients were eligible for the study, with a median age of 7 years (range 2–16 years). The median follow-up was 8.6 months (range 2–28 months) and the median survival time was 9.4 months. The median survival time of 66 patients treated with radiotherapy with concomitant and adjuvant temozolomide was 9.8 months, longer than 7.5 months of the other 16 patients treated with radiotherapy with concomitant temozolomide alone, with statistical differences (P=0.010). Moreover, bevacizumab and nimotuzumab didn’t bring survival benefits to patients with disease recurrence or progression. Hematological toxicity (Grade IV) was not found. CONCLUSION Radiotherapy with concomitant and adjuvant temozolomide prolongs the survival time of children with DIPG.

scholarly journals Survival after surgery among patients with cholangiocarcinoma in Northeast Thailand according to anatomical and morphological classification

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chaiwat Tawarungruang ◽  
Narong Khuntikeo ◽  
Nittaya Chamadol ◽  
Vallop Laopaiboon ◽  
Jaruwan Thuanman ◽  
...  
Keyword(s):  
Survival Rate ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Cox Regression ◽  
Survival Rates ◽  
Care Program ◽  
Tumor Location ◽  
Northeast Thailand ◽  
Curative Surgery

Abstract Background Cholangiocarcinoma (CCA) has been categorized based on tumor location as intrahepatic (ICCA), perihilar (PCCA) or distal (DCCA), and based on the morphology of the tumor of the bile duct as mass forming (MF), periductal infiltrating (PI) or intraductal (ID). To date, there is limited evidence available regarding the survival of CCA among these different anatomical and morphological classifications. This study aimed to evaluate the survival rate and median survival time after curative surgery among CCA patients according to their anatomical and morphological classifications, and to determine the association between these classifications and survival. Methods This study included CCA patients who underwent curative surgery from the Cholangiocarcinoma Screening and Care Program (CASCAP), Northeast Thailand. The anatomical and morphological classifications were based on pathological findings after surgery. Survival rates of CCA and median survival time since the date of CCA surgery and 95% confidence intervals (CI) were calculated. Multiple cox regression was performed to evaluate factors associated with survival which were quantified by hazard ratios (HR) and their 95% CIs. Results Of the 746 CCA patients, 514 had died at the completion of the study which constituted 15,643.6 person-months of data recordings. The incidence rate was 3.3 per 100 patients per month (95% CI: 3.0–3.6), with median survival time of 17.8 months (95% CI: 15.4–20.2), and 5-year survival rate of 24.6% (95% CI: 20.7–28.6). The longest median survival time was 21.8 months (95% CI: 16.3–27.3) while the highest 5-year survival rate of 34.8% (95% CI: 23.8–46.0) occurred in the DCCA group. A combination of anatomical and morphological classifications, PCCA+ID, was associated with the longest median survival time of 40.5 months (95% CI: 17.9–63.0) and the highest 5-year survival rate of 42.6% (95% CI: 25.4–58.9). The ICCA+MF combination was associated with survival (adjusted HR: 1.45; 95% CI: 1.01–2.09; P = 0.013) compared to ICCA+ID patients. Conclusions Among patients receiving surgical treatment, those with PCCA+ID had the highest 5-year survival rate, which was higher than in groups classified by only anatomical characteristics. Additionally, the patients with ICCA+MF tended to have unfavorable surgical outcomes. Showed the highest survival association. Therefore, further investigations into CCA imaging should focus on patients with a combination of anatomical and morphological classifications.

Sign in / Sign up

Export Citation Format

Share Document