scholarly journals Difficulties associated with differential diagnosis between brain metastases and foci of necrosis resulted from stereotactic radiotherapy (case report and literature review)

2019 ◽  
Vol 9 (3) ◽  
pp. 61-71
Author(s):  
А. V. Nazarenko ◽  
Т. N. Borisova ◽  
S. V. Medvedev ◽  
S. I. Tkachev ◽  
Е. А. Kobyakova ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Radiation Necrosis ◽  
Diagnostic Methods ◽  
Whole Brain Irradiation ◽  
Brain Irradiation ◽  
Iatrogenic Complications ◽  
Local Methods ◽  
Metastasis Growth ◽  
The Brain ◽  
Careful Assessment

Modern advances in oncology can achieve significantly better results in terms of life expectancy in patients with metastatic brain disease. The combination of surgery, systemic therapy, whole brain irradiation and local methods of radiation therapy lead to good indicators for controlling the manifestations of the disease in the brain. Of course, intensification of treatment increases the risk of iatrogenic complications. The use of aggressive stereotactic radiotherapy regimens leads not only to high local control of irradiated metastases, but also to the risk of so-called radiation necrosis. The use of the most up-to-date diagnostic methods does not always allow one to unequivocally differentiate radiation necrosis from continued metastasis growth. The above example shows the need for a careful assessment of such situations and a multidisciplinary approach to interpreting the results of stereotactic radiotherapy.

Experimental delayed radiation necrosis of the brain

1979 ◽  
Vol 51 (5) ◽  
pp. 587-596 ◽  
Author(s):  
Albert N. Martins ◽  
Ralph E. Severance ◽  
James M. Henry ◽  
Thomas F. Doyle
Keyword(s):  
Rhesus Monkeys ◽  
Radiation Necrosis ◽  
Clinical Signs ◽  
Control Group ◽  
Content Type ◽  
Brain Irradiation ◽  
Primate Brain ◽  
High Doses ◽  
The Brain ◽  
Male Rhesus

✓ The authors have designed an experiment to detect a hitherto unrecognized interaction between high doses of the glucocorticoid, dexamethasone, and brain irradiation. Eighteen juvenile male rhesus monkeys received 1800 rads to the whole brain in 8.5 minutes. For 1½ days before and 10½ days after the irradiation, nine animals received approximately 2.9 mg/kg/day of dexamethasone intramuscularly in addition to irradiation, while the remaining nine animals served as the control group and received saline. All animals eventually developed a progressive neurological syndrome, and died of delayed radiation necrosis of the brain. The two groups were compared with regard to latency to onset of clinical signs, survival time, and number, distribution, and location of lesions of radionecrosis. Large doses of dexamethasone did not alter the susceptibility of the primate brain to delayed radiation necrosis. Detailed morphological study of the radionecrotic lesions supports the hypothesis that most, if not all, of the lesions develop as the consequence of injury to blood vessels.

Hypothalamic dysfunction following whole-brain irradiation

1986 ◽  
Vol 65 (4) ◽  
pp. 490-494 ◽  
Author(s):  
Jeffrey I. Mechanick ◽  
Fred H. Hochberg ◽  
Alan LaRocque
Keyword(s):  
Computerized Tomography ◽  
Radiation Necrosis ◽  
Cortical Atrophy ◽  
Whole Brain Irradiation ◽  
Whole Brain ◽  
Content Type ◽  
Hypothalamic Dysfunction ◽  
Brain Irradiation ◽  
X Irradiation ◽  
Fine Print

✓ The authors describe 15 cases with evidence of hypothalamic dysfunction 2 to 9 years following megavoltage whole-brain x-irradiation for primary glial neoplasm. The patients received 4000 to 5000 rads in 180- to 200-rad fractions. Dysfunction occurred in the absence of computerized tomography-delineated radiation necrosis or hypothalamic invasion by tumor, and antedated the onset of dementia. Fourteen patients displayed symptoms reflecting disturbances of personality, libido, thirst, appetite, or sleep. Hyperprolactinemia (with prolactin levels up to 70 ng/ml) was present in all of the nine patients so tested. Of seven patients tested with thyrotropin-releasing hormone, one demonstrated an abnormal pituitary gland response consistent with a hypothalamic disorder. Seven patients developed cognitive abnormalities. Computerized tomography scans performed a median of 4 years after tumor diagnosis revealed no hypothalamic tumor or diminished density of the hypothalamus. Cortical atrophy was present in 50% of cases and third ventricular dilatation in 58%. Hypothalamic dysfunction, heralded by endocrine, behavioral, and cognitive impairment, represents a common, subtle form of radiation damage.

Metabolic and histopathological changes in the brain and plasma of rats exposed to fractionated whole-brain irradiation

2019 ◽  
Vol 1708 ◽  
pp. 146-159 ◽  
Author(s):  
Soňa Bálentová ◽  
Petra Hnilicová ◽  
Dagmar Kalenská ◽  
Eva Baranovičová ◽  
Peter Muríň ◽  
...  
Keyword(s):  
Histopathological Changes ◽  
Whole Brain Irradiation ◽  
Whole Brain ◽  
Brain Irradiation ◽  
The Brain

scholarly journals Dosimetric study of whole-brain irradiation with high-energy photon beams for dose reduction to the scalp

2020 ◽  
Vol 93 (1114) ◽  
pp. 20200159
Author(s):  
Masafumi Sawada ◽  
Etsuo Kunieda ◽  
Takeshi Akiba ◽  
Shigeto Kabuki ◽  
Ryuta Nagao ◽  
...  
Keyword(s):  
High Energy ◽  
High Energy Photon ◽  
Photon Beams ◽  
Whole Brain Irradiation ◽  
Energy Photon ◽  
Whole Brain ◽  
Brain Irradiation ◽  
Brain Surface ◽  
The Mean ◽  
The Brain

Objective: To evaluate the efficiency of high-energy photons for mitigating alopecia due to whole-brain irradiation (WBRT). Methods: Planning CT data from 10 patients who received WBRT were collected. We prepared 4 WBRT plans that used 6 or 15 MV photon beams, with or without use of a field-in-field (FiF) technique, and compared outcomes using a treatment planning system. The primary outcome was dose parameters to the scalp, including the mean dose, maximum dose, and dose received to 50% scalp (D50%). Secondary outcomes were minimum dose to the brain surface. Results: Using FiF, the mean doses were 24.4–26.0 and 22.4–24.1 Gy, and the maximum doses were 30.5–32.1 and 28.5–30.8 Gy for 6 and 15 MV photon beams, respectively. Without FiF, the mean doses were 24.6–26.9 and 22.6–24.5 Gy, and the maximum doses were 30.8–34.6 and 28.6–32.4 Gy for 6 and 15 MV photon beams. The 15 MV plan resulted in a lower scalp dose for each dose parameter (p < 0.001). Using FiF, the minimum doses to the brain surface for the 6 and 15 MV plans were 28.9 ± 0.440 and 29.0 ± 0.557 Gy, respectively (p = 0.70). Without FiF, the minimum doses to the brain surface for the 6 and 15 MV plans were 28.9 ± 0.456 and 29.0 ± 0.529, respectively (p = 0.66). Conclusion: Compared with the 6 MV plan, the 15 MV plan achieved a lower scalp dose without impairing the brain surface dose. Advances in knowledge: High-energy photon WBRT may mitigate alopecia of patients who receiving WBRT.

Linear accelerator-based stereotaxic radiosurgery for brain metastases:the influence of number of lesions on survival.

1996 ◽  
Vol 14 (4) ◽  
pp. 1085-1092 ◽  
Author(s):  
J Joseph ◽  
J R Adler ◽  
R S Cox ◽  
S L Hancock
Keyword(s):  
Brain Metastases ◽  
Linear Accelerator ◽  
Radiation Necrosis ◽  
Karnofsky Performance Status ◽  
Survival Duration ◽  
Survival Times ◽  
Whole Brain Irradiation ◽  
Whole Brain ◽  
Solitary Metastasis ◽  
Brain Irradiation

PURPOSE To evaluate the influence of the number of brain metastases on survival after stereotaxic radiosurgery and factors that affect the risk of delayed radiation necrosis after treatment. MATERIALS AND METHODS Between March 1989 and December 1993, 120 consecutive patients underwent linear accelerator-based stereotaxic radiosurgery for brain metastases identified by computed tomography (CT) or magnetic resonance imaging (MRI) scans. The influence of various clinical factors on outcome was assessed using Kaplan-Meier plots of survival from the date of radiosurgery, and univariate and multivariate analyses. RESULTS The median survival time was 32 weeks. Progressive brain metastases, both local and regional, caused 25 of 104 deaths. Patients with two metastases (n = 30) or a solitary metastasis (n = 70) had equivalent actuarial survival times (P = .07; median, 37 weeks; maximum, 211+ weeks). Patients treated to three or more metastases (n = 20) had significantly shorter survival times (P < .002; median, 14 weeks; maximum, 63 weeks). Prognostic factors associated with prolonged survival included a pretreatment Karnofsky performance status > or = 70% and fewer than three metastases. Delayed radiation necrosis at the treated site developed in 20 patients and correlated with prior or concurrent delivery of whole-brain irradiation and the logarithm of the tumor volume. CONCLUSION Survival duration is equivalent for patients with one or two brain metastases and is similar to that reported for patients with a solitary metastasis managed by surgical resection and whole-brain irradiation. Survival after radiosurgery for three or more metastases was similar to that reported for whole-brain irradiation.

Chemotherapy for patients with brain metastases from melanoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19012-e19012
Author(s):  
David R. Naskhletashvili ◽  
Vera A. Gorbunova ◽  
Mark B. Bychkov ◽  
Ali H. Bekyashev ◽  
Vladislav B. Karahan ◽  
...  
Keyword(s):  
Partial Response ◽  
Brain Metastases ◽  
Metastatic Melanoma ◽  
Objective Response ◽  
Complete Response ◽  
Combined Chemotherapy ◽  
Whole Brain Irradiation ◽  
Whole Brain ◽  
Brain Irradiation ◽  
The Brain

e19012 Background: There have not been standards of chemo- and chemo-radiotherapy for treatment for patients with brain metastases. The patients (pts) with brain metastases (BM) from melanoma have poor prognoses. The main goal of this trial is to assess the efficacy of nitrosoureas (CCNU or FCNU), temozolomide (TMZ) as monotherapy, TMZ combined with whole brain irradiation (WBI), or combined chemotherapy of TMZ and cisplatin in pts with BM from melanoma. Methods: 78 pts were included in this study. 21 pts were treated with WBI (3Gy/30Gy) and concomitant TMZ therapy (75 mg/m2/day orally on days 1-14), 19 pts were treated with TMZ (150 mg/m2/day orally on days 1-5, every 4 weeks) as monotherapy, 17 pts pts were treated with nitrosoureas (CCNU or FCNU), 21 pts were treated with combined chemotherapy of TMZ (150/mg/m2/day orally on days 1-5, every 4 weeks) + cisplatin (20/mg/m2/day intravenous on days 1-5, every 4 weeks). The main aims of this study were objective response (OR) – complete response (CR) + partial response (PR) in the brain and in the extracranial sites (ES), median of survival (mOS), 1-year and 2-year survival. Results: Observations were as follows: in the TMZ + WBI treated pts, 4 OR (19,0%) in 21 pts group in the brain and 1 OR (6,7%) in 15 pts group in ES. The mOS was 6.0 months, 1-year survival was 23,8%. In the TMZ monotherapy treated pts there were 5 OR (26,3%) in 19 pts group in the brain and no OR in 13 pts group in ES. The mOS was 6 months, 1-year survival was 21,1%. In the nitrisoureas treated pts we achieved 2 OR (11,8%) in 17 pts group in the brain and 1 OR (9,1%) in 11 pts group in ES. The mOS was 5 months, 1-year survival was 17,6%. In the TMZ + cisplatin treated pts there were 7 OR (33.3%) in 21 pts group in the brain and 7 OR (35,0%) in 20 pts group in ES. The mOS was 8 months, 1-year survival was 33,3%. 2-year survival (19,0%) was achieved only in TMZ and cisplatin group. Conclusions: Previous results of our study showed promising higher efficacy of TMZ and cisplatin, especially in OR in ES (p<0.05) and in 2-year survival (p<0.05), in comparison with TMZ alone, nitrosoureas or TMZ with whole brain irradiation in patients with metastatic melanoma with BM. Control of extracranial lesions is important factor for patients with BM. Further investigation is to be expected.

scholarly journals EXTH-08. REPLACEMENT OF MICROGLIA BY BRAIN-ENGRAFTED MACROPHAGES PREVENTS MEMORY DEFICITS AFTER THERAPEUTIC WHOLE-BRAIN IRRADIATION

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi83-vi84
Author(s):  
Xi Feng ◽  
Sonali Gupta ◽  
David Chen ◽  
Zoe Boosalis ◽  
Sharon Liu ◽  
...  
Keyword(s):  
Cognitive Deficits ◽  
Memory Deficits ◽  
Protective Effects ◽  
Whole Brain Irradiation ◽  
Synaptic Loss ◽  
Whole Brain ◽  
Brain Irradiation ◽  
Brain Radiotherapy ◽  
The Brain ◽  
Therapeutic Avenue

Abstract Microglia have a distinct origin compared to blood circulating myeloid cells. Under normal physiological conditions, microglia are maintained by self-renewal, independent of hematopoietic progenitors. Following genetic or pharmacologic depletion, newborn microglia derive from the local residual pool and quickly repopulate the entire brain. The depletion of brain resident microglia during therapeutic whole-brain irradiation fully prevents irradiation-induced synaptic loss and recognition memory deficits but the mechanisms driving these protective effects are unknown. Here, we demonstrate that after CSF-1R inhibitor-mediated microglia depletion and therapeutic whole-brain irradiation, circulating monocytes engraft into the brain and replace the microglia pool. These monocyte-derived brain-engrafted macrophages have reduced phagocytic activity compared to microglia from irradiated brains, but similar to locally repopulated microglia without brain irradiation. Transcriptome comparisons reveal that brain-engrafted macrophages have both monocyte and embryonic microglia signatures. These results suggest that monocyte-derived brain-engrafted macrophages represent a novel therapeutic avenue for the treatment of brain radiotherapy-induced cognitive deficits.

scholarly journals Replacement of microglia by monocyte-derived macrophages prevents long-term memory deficits after therapeutic irradiation

2019 ◽  
Author(s):  
Xi Feng ◽  
David Chen ◽  
Sonali Gupta ◽  
Sharon Liu ◽  
Nalin Gupta ◽  
...  
Keyword(s):  
Memory Deficits ◽  
Intermediate Phenotype ◽  
Long Term Memory ◽  
Protective Effects ◽  
Whole Brain Irradiation ◽  
Whole Brain ◽  
Brain Irradiation ◽  
Brain Radiotherapy ◽  
Therapeutic Irradiation ◽  
The Brain

AbstractResident microglia of the brain have a distinct origin compared to macrophages in other organs. Under physiological conditions, microglia are maintained by self-renewal from the local pool, independent of hematopoietic progenitors. Pharmacologic depletion of microglia during therapeutic whole-brain irradiation prevents synaptic loss and rescues recognition memory deficits but the mechanisms behind these protective effects are unknown. Here we demonstrate that after a combination of therapeutic whole-brain irradiation and microglia depletion, macrophages originating from circulating monocytes engraft into the brain and replace the microglia pool. Comparisons of transcriptomes reveal that brain-engrafted macrophages have an intermediate phenotype that resembles both monocytes and embryonic microglia. Importantly, the brain-engrafted macrophages have a reduced phagocytic activity for synaptic compartments compared to the activated microglia from irradiated brains, which in turn prevent the aberrant and chronic synapse loss that results in radiation-induced memory deficits. These results are the first to demonstrate that replacement of microglia by brain-engrafted macrophages represent a potential therapeutic avenue for the treatment of brain radiotherapy induced cognitive deficits.

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