scholarly journals Histopatholgy and Clinical Implication of Treatment-Related Changes After Gamma Knife Radiosurgery in Patients With Brain Metastases

2021 ◽  
Author(s):  
Jeong-Hwa Kim ◽  
Jung-Won Choi ◽  
Doo-Sik Kong ◽  
Ho-Jun Seol ◽  
Do-Hyun Nam ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Tumor Cells ◽  
Surgical Resection ◽  
Clinical Implication ◽  
Late Onset ◽  
Gamma Knife Radiosurgery ◽  
Progression Free Survival ◽  
Time Interval ◽  
Viable Tumor ◽  
Histologic Heterogeneity

Abstract A late-onset treatment-related changes (TRCs), which represent radiographic radiation necrosis (RN), frequently occur after stereotactic radiosurgery (SRS) for brain metastases and often need surgical treatment. This study aimed to validate the true pathology and investigate clinical implication of surgically resected TRCs on advanced magnetic resonance imaging (MRI).Retrospective analyses of 86 patients who underwent surgical resection after radiosurgery of brain metastases were performed. Fifty-four patients displayed TRCs on preoperative MRI, comprising pure RN in 19 patients (TRC-RN group) and mixed viable tumor cells in 35 patients (TRC-PD group). Thirty-two patients revealed the consistent diagnosis of progressive disease in both MRI and histopathology (PD-PD group). The TRC-PD group showed larger prescription isodose volume (9.4 cm3) than the TRC-RN (4.06 cm3, p=0.014) group and a shorter time interval from SRS to preoperative MRI diagnosis (median 4.07 months) than the PD-PD group (median 8.77 months, p=0.004). Progression-free survival was significantly different among the three groups (p<0.001), but not between TRC-RN and TRC-PD (post hoc test, p=1.00), while no difference was observed in overall survival (p=0.067).Brain metastases featured as TRCs after SRS frequently contained viable tumor cells. However, this histologic heterogeneity had a minor impact on benign prognosis of TRCs after surgical resection.

scholarly journals Histopathology and Clinical Implication of Treatment-related Image Changes After Surgical Resection of Brain Metastases Previously Treated with Gamma Knife Radiosurgery

2021 ◽  
Author(s):  
Jeong-Hwa Kim ◽  
Jung-Il Lee ◽  
Jung-Won Choi ◽  
Doo-Sik Kong ◽  
Ho-Jun Seol ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Tumor Cells ◽  
Surgical Resection ◽  
Gamma Knife ◽  
Clinical Implication ◽  
Gamma Knife Radiosurgery ◽  
Metastatic Lesions ◽  
Viable Tumor ◽  
Histologic Heterogeneity ◽  
Previously Treated

Abstract INTRODUCTION The true pathology and clinical implication of treatment-related image changes (TRICs) after stereotactic radiosurgery (SRS) for brain metastases (BM) have not been established. This study compared the surgical pathology and outcomes of intracranial metastatic lesions featured as TRICs or progressive disease (PD) in advanced magnetic resonance imaging (MRI).METHODS A total of 86 patients who underwent surgical resection of brain metastases previously treated with gamma knife radiosurgery (GKS) from 2009 to 2019 were retrospectively reviewed and classified by MRI findings and histopathology.RESULTS Among 54 patients with TRICs in preoperative MRI, the histopathology of pure radiation necrosis (RN) was confirmed in 19 patients (TRIC-RN) and mixed or predominant viable tumor cells in 35 patients (TRIC-PD). Thirty-two patients diagnosed with PD exhibited the metastatic histology well correlated with imaging (PD-PD). The TRIC-PD group showed larger prescription isodose volume (9.4 cm3) than the TRIC-RN (4.06 cm3, p=0.014) group and shorter time interval from GKS to preoperative MRI diagnosis related to neurological deficits (median 4.07 months) than the PD-PD group (median 8.77 months, p=0.004). Significant differences in progression-free survival were confirmed among the three groups (p<0.001) but not between TRIC-RN and TRIC-PD (post hoc test, p=1.00), whereas no significant difference was observed in overall survival (p=0.067). CONCLUSIONS The brain metastatic lesions diagnosed as TRICs after GKS frequently contained viable tumor cells, while they exhibited the benign prognosis as RN after surgical resection. These findings suggest that TRICs on advanced MRI can serve as a prognostic factor, regardless of the histologic heterogeneity.

Clinical and Pathological Characteristics of Brain Metastasis Resected After Failed Radiosurgery

Neurosurgery ◽  
2010 ◽  
Vol 66 (1) ◽  
pp. 208-217 ◽  
Author(s):  
Jay Jagannathan ◽  
T. David Bourne ◽  
David Schlesinger ◽  
Chun-Po Yen ◽  
Mark E. Shaffrey ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Cell Carcinoma ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Proliferation Index ◽  
Time Interval ◽  
Cell Lung Carcinoma ◽  
Viable Tumor ◽  
The Mean

Abstract OBJECTIVE This study evaluates the tumor histopathology and clinical characteristics of patients who underwent resection of their brain metastasis after failed gamma knife radiosurgery. METHODS This study was a retrospective review from a prospective database. A total of 1200 brain metastases in 912 patients were treated by gamma knife radiosurgery during a 7-year period. Fifteen patients (1.6% of patients, 1.2% of all brain metastases) underwent resective surgery for either presumed tumor progression (6 patients) or worsening neurological symptoms associated with increased mass effect (9 patients). Radiographic imaging, radiosurgical and surgical treatment parameters, histopathological findings, and long-term outcomes were reviewed for all patients. RESULTS The mean age at the time of radiosurgery was 57 years (age range, 32–65 years). Initial pathological diagnoses included metastatic non–small cell lung carcinoma in 8 patients (53%), melanoma in 4 patients (27%), renal cell carcinoma in 2 patients (13%), and squamous cell carcinoma of the tongue in 1 patient (7%). The mean time interval between radiosurgery and surgical extirpation was 8.5 months (range, 3 weeks to 34 months). The mean treatment volume for the resected lesion at the time of radiosurgery was 4.4 cm3 (range, 0.6–8.4 cm3). The mean dose to the tumor margin was 21Gy (range, 18–24 Gy). In addition to the 15 tumors that were eventually resected, a total of 32 other metastases were treated synchronously, with a 78% control rate. The mean volume immediately before surgery for the 15 resected lesions was 7.5 cm3 (range, 3.8–10.2 cm3). Histological findings after radiosurgery varied from case to case and included viable tumor, necrotic tumor, vascular hyalinization, hemosiderin-laden macrophages, reactive gliosis in surrounding brain tissue, and an elevated MIB-1 proliferation index in cases with viable tumor. The mean survival for patients in whom viable tumor was identified (9.4 months) was significantly lower than that of patients in whom only necrosis was seen (15.1 months; Fisher's exact test, P &lt; 0.05). CONCLUSION Radiation necrosis and tumor radioresistance are the most common causes precipitating a need for surgical resection after radiosurgery in patients with brain metastasis.

scholarly journals Resecting the Dominant Lesion: Patient Outcomes after Surgery and Radiosurgery vs Stand-Alone Radiosurgery in the Setting of Multiple Brain Metastases

2021 ◽  
Author(s):  
Maria Punchak ◽  
Stephen P Miranda ◽  
Alexis Gutierrez ◽  
Steven Brem ◽  
Donald O'Rourke ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Surgical Resection ◽  
Gamma Knife Radiosurgery ◽  
Median Number ◽  
University Of Pennsylvania ◽  
Multiple Brain Metastases ◽  
The Us ◽  
Median Diameter ◽  
Similar Survival ◽  
The University

Abstract BACKGROUND: Brain metastases are the most common central nervous system (CNS) tumors, occurring in 300,000 people per year in the US. The benefit of surgical resection, over radiosurgery, for dominant lesions remains unclear. METHODS: The University of Pennsylvania Health System database was retrospectively reviewed for patients presenting with multiple brain metastases from 1/1/16 to 8/31/18 with one dominant lesion > 2 cm in diameter, who underwent initial treatment with either resection of the dominant lesion or Gamma Knife radiosurgery (GKS). Inclusion criteria were age > 18, >1 brain metastasis, and presence of a dominant lesion (>2 cm). We analyzed factors associated with mortality. RESULTS: 129 patients were identified (surgery=84, GKS=45). The median number of intracranial metastases was 3 (IQR: 2-5). The median diameter of the largest lesion was 31 mm (IQR: 25-38) in the surgery group vs 21 mm (IQR: 20-24) in the GKS group (p<0.001). Mortality did not differ between surgery and GKS patients (69.1% vs 77.8%, p = 0.292). In a multivariate survival analysis, there was no difference in mortality between the surgery and GKS cohorts (aHR: 1.35, 95% CI: 0.74-2.45 p=0.32). Pre-operative KPS (aHR: 0.97, 95% CI: 0.95-0.99, p=0.004), CNS radiotherapy (aHR: 0.33, 95% CI: 0.19-0.56 p<0.001), chemotherapy (aHR: 0.27, 95% CI: 0.15-0.47, p<0.001), and immunotherapy (aHR: 0.41, 95% CI: 0.25-0.68, p=0.001) were associated with decreased mortality. CONCLUSION: In our institution, patients with multiple brain metastases and one symptomatic dominant lesion demonstrated similar survival after GKS when compared with up-front surgical resection of the dominant lesion.

Adjuvant Gamma Knife radiosurgery following surgical resection of brain metastases: a 9-year retrospective cohort study

2009 ◽  
Vol 98 (1) ◽  
pp. 77-82 ◽  
Author(s):  
Steven W. Hwang ◽  
Mohab M. Abozed ◽  
Andrew Hale ◽  
Rebecca L. Eisenberg ◽  
Tomas Dvorak ◽  
...  
Keyword(s):  
Cohort Study ◽  
Brain Metastases ◽  
Surgical Resection ◽  
Gamma Knife ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Gamma Knife Radiosurgery

Upfront EGFR TKI with or without brain radiotherapy (RT) in EGFR-driven non-small cell lung cancer (NSCLC) with brain metastases.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20614-e20614
Author(s):  
Nicolas Villanueva ◽  
Klarissa Son ◽  
Jona Ashok Hattangadi ◽  
Daniel Robert Simpson ◽  
Parag R. Sanghvi ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Late Onset ◽  
Treatment Options ◽  
Progression Free Survival ◽  
Brain Radiotherapy ◽  
Predominantly Female ◽  
Line Setting ◽  
Egfr Mutated ◽  
Egfr Tki ◽  
Egfr Tkis

e20614 Background: The central nervous system (CNS) remains a common site of metastatic disease for NSCLC, especially in EGFR-driven disease. Surgery and RT are upfront treatment options but have potential early and late onset complications. Osimertinib (Osi) is now approved for use in the front-line setting for EGFR-mutated NSCLC and is highly CNS penetrant. A prior retrospective study showed that the use of early generation EGFR TKIs had an inferior overall survival (OS) compared to upfront RT in newly diagnosed brain metastases, but the applicability of this data in the Osi-era is unknown. Methods: This was a single institution retrospective analysis of patients with EGFR mutated NSCLC and brain metastases who were referred to Radiation Oncology from 1/1/2012 to 12/31/2018. We separated EGFR TKIs between Osi and non-Osi. The primary objectives were to evaluate OS, intracranial progression free survival (icPFS), and intracranial response (icORR) among upfront or delayed RT, and type of EGFR TKI. Results: 67 patients with a median age of 64 years old (33-89) were divided into one of four groups: non-Osi TKI with (N = 38) or without RT (N = 12), and Osi with (N = 14) or without RT (N = 3). Fourteen patients who did not get upfront Osi, received Osi with (N = 7) or without RT (N = 7) after intracranial progressive disease (icPD). Patients were predominantly female, never-smokers, and with an ECOG PS 0-1. Brain metastases were mostly asymptomatic and < 10 mm. The OS for the entire population was 26.7 months (95% CI, 23.9-29.5); there was no difference between groups, and use or type of RT versus TKI. The icPFS was 14.3 months (95% CI, 9.1-19.5), icORR was 64.2%, and icDCR was 82.7%, without any difference between groups. Among those patients who did not receive upfront Osi, use in the post-progression setting resulted in a significantly longer OS (54.8 vs. 23.0 months, p = 0.001). Conclusions: We found no statistical difference in OS, icPFS, or icORR in patients treated with upfront RT or EGFR TKI. Results should be confirmed with a prospective study.

The Mechanical Spread of Viable Tumor during Surgery

1986 ◽  
Vol 94 (3) ◽  
pp. 278-281 ◽  
Author(s):  
Raja A. Atiyah ◽  
Yosef P. Krespi ◽  
Denise Hidvegi ◽  
George A. Sisson
Keyword(s):  
Stem Cell ◽  
Head And Neck ◽  
Tumor Cells ◽  
Surgical Resection ◽  
Tumor Stem Cell ◽  
Physical Trauma ◽  
The Past ◽  
Viable Tumor ◽  
Surgical Field ◽  
Tumor Stem Cell Assay

The “mechanical” spread of tumor is that which occurs through physical trauma, such as during surgical resection. There has been a waxing and waning of interest in this concept over the past 70 years. We have collected the blood that comes off the surgical field during major head and neck resections and separated and plated all nucleated cells in the tumor stem cell assay of Hamburger and Salmon. In one of six such preparations, we demonstrated the presence of viable, colony-forming tumor cells. Two were contaminated and three did not grow. We demonstrated, therefore, that the blood that bathes the raw open surgical field contains tumor cells that are viable and potentially capable of producing new foci of tumor.

scholarly journals SURG-13. Multiplicity does not affect outcomes in patients with surgically treated brain metastases

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii26-iii26
Author(s):  
Kaiyun Yang ◽  
Enrique Gutierrez ◽  
Alexander Landry ◽  
Aristotelis Kalyvas ◽  
Jessica Weiss ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Surgical Resection ◽  
Progression Free Survival ◽  
Primary Treatment ◽  
Local Failure ◽  
Large Tumor ◽  
Entire Cohort ◽  
Primary Treatment Modality ◽  
Significant Difference

Abstract Background Having multiple brain lesions has been considered a negative prognostic factor in patients with brain metastases. The role of surgery in the management of these patients remains a matter of debate. Methods We retrospectively reviewed our patients who underwent surgical resection of brain metastases from January 2018 to December 2019, and examined outcomes including overall survival (OS), progression free survival (PFS) and rates of local failure. Results We identified 130 patients who underwent surgical resection as the primary treatment modality of brain metastases. At the time of surgery, 117 patients harbored 1–3 lesions, 13 had more than 3 lesions. Overall survival at two years for our entire cohort was 46%. The difference in OS between patients with &gt; 3 metastases (21%) and 1–3 metastases (49%) was not statistically significant (HR=1.34, 95% CI: 0.67–2.68, p=0.41). Similarly, 27% of patients had PFS at two years, with 25% in the multiple metastases group and 28% in the comparison group (HR=1.19, 95% CI: 0.63–2.23, p=0.59). Additionally, 32% of patients overall experienced local failure at two years and there was no significant difference between patients with &gt;3 metastases (15%) and those with fewer (33%) (HR=0.68, 95% CI: 0.21–2.19, p=0.52). A multivariate regression model examining multiple preoperative features revealed large tumor volume to be the only independent predictor of limited OS (p = 0.017) and PFS (p = 0.023), and local failure (p = 0.031). Conclusions In carefully selected patients, surgical resection is a reasonable management option for patients with multiple brain metastases.

Results of Surgical Resection for Progression of Brain Metastases Previously Treatedby Gamma Knife Radiosurgery

Neurosurgery ◽  
2006 ◽  
Vol 59 (1) ◽  
pp. 86-97 ◽  
Author(s):  
Minh Tam Truong ◽  
Eric G. St. Clair ◽  
Bernadine R. Donahue ◽  
Stephen C. Rush ◽  
Douglas C. Miller ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Surgical Resection ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery

Long-Term Outcome after Aggressive Surgical Resection of Clival Chordomas and Gamma Knife Radiosurgery for Recurrences

Skull Base ◽  
2007 ◽  
Vol 17 (S 1) ◽  
Author(s):  
Kiyoshi Saito ◽  
Tetsuya Nagatani ◽  
Yuri Aimi ◽  
Masahiro Ichikawa ◽  
Jun Yoshida
Keyword(s):  
Surgical Resection ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Term Outcome ◽  
Long Term Outcome

Gamma knife radiosurgery for intracranial metastatic melanoma: a 6-year experience

2002 ◽  
Vol 97 ◽  
pp. 494-498 ◽  
Author(s):  
Jorge Gonzalez-martinez ◽  
Laura Hernandez ◽  
Lucia Zamorano ◽  
Andrew Sloan ◽  
Kenneth Levin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Brain Metastases ◽  
Metastatic Melanoma ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Karnofsky Performance Scale ◽  
Content Type ◽  
Significant Difference ◽  
The Mean ◽  
Fine Print

Object. The purpose of this study was to evaluate retrospectively the effectiveness of stereotactic radiosurgery for intracranial metastatic melanoma and to identify prognostic factors related to tumor control and survival that might be helpful in determining appropriate therapy. Methods. Twenty-four patients with intracranial metastases (115 lesions) metastatic from melanoma underwent radiosurgery. In 14 patients (58.3%) whole-brain radiotherapy (WBRT) was performed, and in 12 (50%) chemotherapy was conducted before radiosurgery. The median tumor volume was 4 cm3 (range 1–15 cm3). The mean dose was 16.4 Gy (range 13–20 Gy) prescribed to the 50% isodose at the tumor margin. All cases were categorized according to the Recursive Partitioning Analysis classification for brain metastases. Univariate and multivariate analyses of survival were performed to determine significant prognostic factors affecting survival. The mean survival was 5.5 months after radiosurgery. The analyses revealed no difference in terms of survival between patients who underwent WBRT or chemotherapy and those who did not. A significant difference (p < 0.05) in mean survival was observed between patients receiving immunotherapy or those with a Karnofsky Performance Scale (KPS) score of greater than 90. Conclusions. The treatment with systemic immunotherapy and a KPS score greater than 90 were factors associated with a better prognosis. Radiosurgery for melanoma-related brain metastases appears to be an effective treatment associated with few complications.

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