scholarly journals SMART Syndrome (Stroke-like migraine attacks after radiation therapy): When to suspect it?

2021 ◽  
Vol 12 ◽  
pp. 561
Author(s):  
Petros Angelidis ◽  
Christian Saleh ◽  
Phillip Jaszczuk ◽  
Muhannad Seyam ◽  
Katarina Alexandra Ebner ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Radiation Treatment ◽  
Brain Biopsy ◽  
Epileptic Seizures ◽  
Cranial Irradiation ◽  
Resonance Imaging ◽  
Brain Radiotherapy ◽  
Metastatic Lung ◽  
Brain Radiation ◽  
Prompt Diagnosis

Background: Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a benign complication of brain radiation therapy, which presents circa a decade after radiation treatment. Symptoms are stroke-like deficits, epileptic seizures, and migraine. Cranial magnetic resonance imaging is characteristic for alterations in the form of unilateral cortical hyperintensities and gyriform enhancement, most prominent in the parieto-occipital regions. Prompt diagnosis is essential to avoid unnecessary investigations (e.g., brain biopsy and angiography). Case Description: We describe a 51-year-old female patient treated initially with cranial irradiation for a left-sided occipital metastatic lung adenocarcinoma. Five years later, she presented with migraine headache, aphasia, and a right sided hemiparesis. Conclusion: The triad of migraine, seizure, and hemiparesis within the context of a prior brain radiotherapy should promptly raise the suspicion of SMART syndrome. Prompt diagnosis is essential to avoid unnecessary invasive investigations.

Access to radiation oncology centers with brain tumor treatment expertise for patients with resectable brain tumors.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18509-e18509
Author(s):  
Mehee Choi ◽  
Brian P. Martin ◽  
Lisa Misell ◽  
Joseph M. Zabramski ◽  
David G. Brachman
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Access To Care ◽  
Radiation Treatment ◽  
Fold Increase ◽  
Tumor Treatment ◽  
Brain Radiotherapy ◽  
The Us ◽  
Brain Radiation

e18509 Background: Many patients with brain tumors face challenges with access to care. For rural patients, prolonged travel times may limit access to appropriate radiotherapy. Radiation centers (RCs) offering specialized brain radiotherapy, e.g., stereotactic radiosurgery (SRS), are geographically limited. Utilization of brain brachytherapy at the time of resection offers an option for such patients, but technical challenges have limited the adoption. To address the limitations of traditional brachytherapy, a device with Cs-131 seeds embedded in a bioresorbable collagen tile (GammaTile, GT Medical Technologies, Tempe, AZ USA) was developed. GammaTile (GT) is FDA-cleared for permanent implantation at the time of resection for all recurrent intracranial tumors and for newly diagnosed malignant intracranial neoplasms. To investigate if wider availability of this treatment could possibly lower the geographic barrier to access to care, we mapped the US population against existing RCs with brain tumor expertise and neurosurgery centers (NSCs) performing craniotomies. Methods: We analyzed 2018 CMS claims data using CPT codes for single- and multi-fraction SRS to identify RCs with brain tumor treatment expertise and mapped these against the population. Using similar methodology, using CPT codes for craniotomies, we identified NSCs, as any facility performing craniotomies is potentially eligible to implant GT. Results: 135 RCs used CPT codes for SRS. 193-, 119-, 82-, and 52-million Americans lived >30-, >60-, >90-, and >120-minutes from one of these centers, respectively. 530 NSCs preform craniotomies, including ≥1 in every state, a 4-fold increase over the number of RCs offering SRS. Conclusions: For many patients, substantial travel distances limit their access to RCs with brain tumor treatment expertise. In contrast, the 530 craniotomy-performing NSCs have far greater geographic dispersion. The option of undergoing brain radiation with GT implantation at the time of brain tumor craniotomy brings treatment closer to millions, ensures compliance, and reduces additional travel for follow-up radiation treatment.[Table: see text]

INNV-32. ACCESS TO SPECIALTY RADIATION CARE FOR PATIENTS WITH RESECTABLE BRAIN TUMORS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi112-vi112
Author(s):  
Mehee Choi ◽  
Brian Martin ◽  
Joseph Zabramski ◽  
Lisa Misell ◽  
David Brachman
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Access To Care ◽  
Radiation Treatment ◽  
Fold Increase ◽  
Tumor Treatment ◽  
Brain Radiotherapy ◽  
The Us ◽  
Brain Radiation ◽  
Limit Access

Abstract INTRODUCTION Many patients with brain tumors face challenges with access to care. For rural patients, prolonged travel times may limit access to appropriate radiotherapy. Radiation centers (RCs) offering specialized brain radiotherapy, e.g., stereotactic radiosurgery (SRS), are geographically limited. Brain brachytherapy at the time of resection offers an option for such patients, but technical challenges have limited the adoption. To address the limitations of traditional brachytherapy, a device with Cs-131 seeds embedded in a bioresorbable collagen tile (GammaTile (GT), GT Medical Technologies, Tempe, AZ) was developed. The device is FDA-cleared for permanent implantation at the time of resection for all recurrent intracranial tumors and newly diagnosed malignant intracranial neoplasms. To investigate if wider availability of this treatment could possibly lower the geographic barrier to access to care, we mapped the US population against existing RCs with brain tumor expertise and neurosurgery centers (NSCs) performing craniotomies. METHODS We analyzed 2018 CMS claims data using CPT codes for single- and multi-fraction SRS to identify RCs with brain tumor treatment expertise and mapped these against the population. Using similar methodology, using CPT codes for craniotomies, we identified NSCs, as any facility performing craniotomies is potentially eligible to implant the device. RESULTS 135 RCs used CPT codes for SRS. 193-, 119-, 82-, and 52-million Americans lived >30-, >60-, >90-, and >120-minutes from one of these centers, respectively. 530 NSCs preform craniotomies, including ≥ 1 in every state, a 4-fold increase over the number of RCs offering SRS. CONCLUSIONS For many patients, substantial travel distances limit access to RCs with brain tumor treatment expertise. In contrast, the 530 craniotomy-performing NSCs have far greater geographic dispersion. The option of undergoing brain radiation with GT implantation at the time of brain tumor craniotomy brings treatment closer to millions, ensures compliance, and reduces additional travel for follow-up radiation treatment.

Leukoencephalopathy after whole-brain radiation therapy plus radiosurgery versus radiosurgery alone for metastatic lung cancer

Cancer ◽  
2012 ◽  
Vol 119 (1) ◽  
pp. 226-232 ◽  
Author(s):  
Edward A. Monaco ◽  
Amir H. Faraji ◽  
Oren Berkowitz ◽  
Phillip V. Parry ◽  
Uri Hadelsberg ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Whole Brain Radiation Therapy ◽  
Metastatic Lung Cancer ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Metastatic Lung ◽  
Brain Radiation

Formation of intracerebral cavernous malformations after brain radiation treatment for central nervous system neoplasia in children

1998 ◽  
Vol 88 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Jeffrey J. Larson ◽  
William S. Ball ◽  
Kevin E. Bove ◽  
Kerry R. Crone ◽  
John M. Tew
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Radiation Therapy ◽  
Radiation Treatment ◽  
Cavernous Malformation ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Content Type ◽  
Brain Radiation ◽  
Fine Print

Object. Radiation is a common treatment modality for pediatric brain tumors. The authors present a retrospective review of six children who developed cerebral cavernous malformations after they underwent radiation treatment for central nervous system (CNS) neoplasia and propose two possible models to explain the formation of cavernous malformations. Methods. Three boys, aged 13, 9, and 17 years, suffered intracerebral hemorrhages from cerebral cavernous malformations 87, 94, and 120 months, respectively, after they received whole-brain radiation therapy (WBRT) for acute lymphocytic leukemia. A 10-year-old girl and a 19-year-old man developed temporal lobe cavernous malformations 46 and 48 months, respectively, after they received radiation therapy for posterior fossa astrocytomas. A 12-year-old girl developed a temporal lobe cavernous malformation 45 months after WBRT was administered for a medulloblastoma. In all of these cases the cavernous malformation appeared in the irradiated field, was not known to be present prior to radiation therapy, and developed after a latency period following treatment. The incidence of cavernous malformations in these patients suggests that children who undergo radiation therapy of the brain may have an increased risk of hemorrhage. Conclusions. Two possible models may explain the formation of cavernous malformations following brain radiation in these patients. First, the cavernous malformations may form de novo in response to the radiation. Second, the cavernous malformations may have been present, but radiographically occult, at the time of radiation therapy and may have hemorrhaged in response to the radiation. The authors conclude that cavernous malformations may develop after brain radiation and propose a possible mechanism for this formation.

Lead-In Phase to Randomized Trial of Motexafin Gadolinium and Whole-Brain Radiation for Patients With Brain Metastases: Centralized Assessment of Magnetic Resonance Imaging, Neurocognitive, and Neurologic End Points

2002 ◽  
Vol 20 (16) ◽  
pp. 3445-3453 ◽  
Author(s):  
Minesh P. Mehta ◽  
William R. Shapiro ◽  
Michael J. Glantz ◽  
Roy A. Patchell ◽  
Michael A. Weitzner ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Radiation Therapy ◽  
Brain Metastases ◽  
Response Rate ◽  
Resonance Imaging ◽  
End Points ◽  
Motexafin Gadolinium ◽  
Whole Brain Radiation ◽  
Neurocognitive Tests ◽  
Brain Radiation

PURPOSE: Motexafin gadolinium is a redox mediator that selectively targets tumor cells, is detectable by magnetic resonance imaging (MRI), and enhances the effect of radiation therapy. This lead-in phase to a randomized trial served to evaluate radiologic, neurocognitive, and neurologic progression end points and to evaluate the safety and radiologic response of motexafin gadolinium administered concurrently with 30 Gy in 10-fraction whole-brain radiation therapy for the treatment of brain metastases. PATIENTS AND METHODS: Motexafin gadolinium (5.0 mg/kg/d for 10 days) was administered before each radiation treatment in this prospective international trial. Patients were evaluated by MRI, neurologic examinations, and neurocognitive tests. Prospective criteria and centralized review procedures were established for radiologic, neurocognitive, and neurologic progression end points. RESULTS: Twenty-five patients with brain metastases from lung (52%) and breast (24%) cancer, recursive partitioning analysis class 2 (96%), and an average of 11 brain metastases were enrolled. Neurocognitive function was highly impaired at presentation. Motexafin gadolinium was well tolerated. Freedom from neurologic progression was 77% at 1 year. Median survival was 5.0 months. In 29% of patients, the cause of death was brain metastasis progression. The radiologic response rate was 68%. Motexafin gadolinium’s tumor selectivity was established with MRI. CONCLUSION: (1) Centralized neurologic progression scoring that incorporated neurocognitive tests was implemented successfully. (2) Motexafin gadolinium was well tolerated. (3) Local control, measured by radiologic response rate, neurologic progression, and death caused by progression of brain metastasis, seemed to be improved compared with historical results. A randomized phase III trial using these methods for evaluation of efficacy has just been completed.

Primitive neuroectodermal tumor after radiation therapy for craniopharyngioma

2011 ◽  
Vol 30 (1) ◽  
pp. E3 ◽  
Author(s):  
Michael Chan ◽  
Sebastian R. Herrera ◽  
Sergey Neckrysh ◽  
Adam Wallace ◽  
Tibor Valyi-Nagy ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
African American Male ◽  
Primitive Neuroectodermal Tumor ◽  
Radiation Treatment ◽  
Histopathological Examination ◽  
Neuroectodermal Tumor ◽  
Left Hemiparesis ◽  
Whole Brain Radiation ◽  
Radiation Induced ◽  
Brain Radiation

The authors report a case of primitive neuroectodermal tumor induced by radiation therapy of craniopharyngioma. This African-American male patient originally presented with craniopharyngioma, for which he underwent resection and whole-brain radiation therapy. Eight years later, at the age of 20 years, he returned with a left facial droop and left hemiparesis. A right basal ganglia mass was identified and resected. Histopathological examination identified the lesion as primitive neuroectodermal tumor. Although radiation therapy has shown to be beneficial in decreasing the recurrence rate in subtotally resected craniopharyngioma, the risks of radiation treatment should be clearly communicated to the patients, their families, and neurosurgeons before starting such treatment. This report expands the spectrum of reported radiation-induced neoplasms in the CNS.

scholarly journals Stroke-like migraine attacks after radiation therapy syndrome: Case report and review of the literature

2017 ◽  
Vol 30 (6) ◽  
pp. 568-573 ◽  
Author(s):  
Achint K Singh ◽  
Bundhit Tantiwongkosi ◽  
Anna-Marieta Moise ◽  
Wilson B Altmeyer
Keyword(s):  
Radiation Therapy ◽  
Vision Loss ◽  
Rare Complication ◽  
Review Of The Literature ◽  
Resonance Imaging ◽  
Brain Irradiation ◽  
Contrast Enhanced ◽  
Delayed Complication ◽  
Brain Radiation ◽  
The Brain

A 26-year-old female presented with vision loss accompanied by migraine-like headaches. A contrast-enhanced magnetic resonance imaging of the brain was performed which revealed findings suggestive of stroke-like migraine attacks after radiation therapy (SMART) syndrome. SMART syndrome is a delayed complication of brain radiation characterized by neurologic symptoms including migraine-like headaches, seizures, and hemispheric impairment. The purpose of this article is to make the readers aware of this rare complication of brain irradiation. Appropriate diagnosis of SMART syndrome is essential to avoid invasive tests.

Gamma knife treatment for multiple metastatic brain tumors compared with whole-brain radiation therapy

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 32-36 ◽  
Author(s):  
Toru Serizawa ◽  
Toshihiko Iuchi ◽  
Junichi Ono ◽  
Naokatsu Saeki ◽  
Katsunobu Osato ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Cerebral Metastases ◽  
Whole Brain Radiation Therapy ◽  
Whole Brain ◽  
Content Type ◽  
Whole Brain Radiation ◽  
Brain Radiation ◽  
Fine Print

Object. The purpose of this retrospective study was to compare the effectiveness of gamma knife radiosurgery (GKS) for multiple cerebral metastases with that of whole-brain radiation therapy (WBRT). Methods. Ninety-six consecutive patients with cerebral metastases from nonsmall cell lung cancer were treated between 1990 and 1999. The entry criteria were the presence of between one and 10 multiple brain lesions at initial diagnosis, no surgically inaccessible tumors with more than a 30-mm diameter, no carcinomatous meningitis, and more than 2 months of life expectancy. The patients were divided into two groups: the GKS group (62 patients) and the WBRT group (34 patients). In the GKS group, large lesions (> 30 mm) were removed surgically and all other small lesions (≤ 30 mm) were treated by GKS. New distant lesions were treated by repeated GKS without prophylactic WBRT. In the WBRT group, the patients were treated by the traditional combined therapy of WBRT and surgery. In both groups, chemotherapy was administered according to the primary physician's protocol. The two groups did not differ in terms of age, sex, initial Karnofsky Performance Scale (KPS) score, type, lesion number, and size of lesion, systemic control, and chemotherapy. Neurological survival and qualitative survival of the GKS group were longer than those of the WBRT group. In multivariate analysis, significant poor prognostic factors were systemically uncontrolled patients, WBRT group, and poor initial KPS score. Conclusions. Gamma knife radiosurgery without prophylactic WBRT could be a primary choice of treatment for patients with as many as 10 cerebral metastases from nonsmall cell cancer.

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