scholarly journals Brain Metastases from Endometrial Carcinoma

ISRN Oncology ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
Ettie Piura ◽  
Benjamin Piura
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Endometrial Carcinoma ◽  
Primary Source ◽  
Whole Brain Radiotherapy ◽  
Endometrial Biopsy ◽  
The Body ◽  
Unknown Primary ◽  
Brain Radiotherapy ◽  
Disseminated Disease

This paper will focus on knowledge related to brain metastases from endometrial carcinoma. To date, 115 cases were documented in the literature with an incidence of 0.6% among endometrial carcinoma patients. The endometrial carcinoma was usually an advanced-stage and high-grade tumor. In most patients (~90%), brain metastasis was detected after diagnosis of endometrial carcinoma with a median interval from diagnosis of endometrial carcinoma to diagnosis of brain metastases of 17 months. Brain metastasis from endometrial carcinoma was either an isolated disease limited to the brain only (~50%) or part of a disseminated disease involving also other parts of the body (~50%). Most often, brain metastasis from endometrial carcinoma affected the cerebrum (~75%) and was solitary (~60%). The median survival after diagnosis of brain metastases from endometrial carcinoma was 5 months; however, a significantly better survival was achieved with multimodal therapy including surgical resection or stereotactic radiosurgery followed by whole brain radiotherapy (WBRT) and/or chemotherapy compared to WBRT alone. It is suggested that brain imaging studies should be considered in the routine follow up of patients with endometrial carcinoma and that the search for a primary source in females with brain metastases of unknown primary should include endometrial biopsy.

Prognostic factors and survival after whole-brain radiotherapy for initial brain metastases arising from non-small cell lung cancer

2021 ◽  
pp. 1-6
Author(s):  
Yukinori Okada ◽  
Mariko Kobayashi ◽  
Mio Shinozaki ◽  
Tatsuyuki Abe ◽  
Naoki Nakamura
Keyword(s):  
Prognostic Factors ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Gene Mutation ◽  
Stage Iv ◽  
Whole Brain Radiotherapy ◽  
Hazard Ratio ◽  
Small Cell Lung ◽  
Mutation Status ◽  
Brain Radiotherapy

Abstract Aim: To identify prognostic factors and investigate patient survival after whole-brain radiotherapy (WBRT) for initial brain metastases arising from non-small cell lung cancer (NSCLC). Methods: Patients diagnosed with NSCLC between 1 January 2010 and 30 September 2019, and who received WBRT upon first developing a brain metastasis, were investigated. Overall survival was determined as related to age, sex, duration between initial examination and brain metastasis detection, stage at the first examination, presence of metastases outside the brain, blood analysis findings, brain metastasis symptoms, radiotherapy dose and completion, imaging findings, therapeutic course of chemotherapy and/or radiation therapy, histological type, and gene mutation status. Results: Thirty-one consecutive patients (20 men and 11 women) with a mean age of 63·8 years and median survival of 129 days were included. Multivariate analysis with stepwise testing was performed to investigate differences in survival according to gene mutation status, lactate dehydrogenase (LDH) level, irradiation dose, WBRT completion and Stage status. Of these, a statistically significant difference in survival was observed in patients with gene mutation status (hazard ratio: 0·31, 95% CI: 0·11–0·86, p = 0·025), LDH levels <230 vs. ≥230 IU/L (hazard ratio: 4·08, 95% CI: 1·45–11·5, p < 0·01) received 30 Gy, 30 Gy/10 fractions to 35 Gy/14 fractions, and 37·5 Gy/15 fractions (hazard ratio: 0·26, 95% CI: 0·09–0·71, p < 0·01), and stage IV versus non-stage IV (hazard ratio: 0·13, 95 CI:0·02–0·64, p < 0·01) Findings: Gene mutation, LDH, radiation dose and Stage are prognostic factors for patients with initial brain metastases who are treated with WBRT.

Multidisciplinary Approach to Brain Metastasis from Melanoma: The Emerging Role of Systemic Therapies

2013 ◽  
pp. 393-398 ◽  
Author(s):  
Georgina V. Long ◽  
Kim A. Margolin
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Phase Ii ◽  
Phase Ii Study ◽  
Performance Status ◽  
Local Therapy ◽  
Whole Brain Radiotherapy ◽  
Brain Radiotherapy ◽  
First Line Therapy ◽  
Melanoma Brain Metastases

Melanoma brain metastases are common, difficult to treat, and carry a poor prognosis. Until recently, systemic therapy was ineffective. Local therapy (including surgery, stereotactic radiotherapy, and whole brain radiotherapy) was considered the only option for a chance of disease control in the brain, and was highly dependent on the patient's performance status and age, number and size of brain metastases, and the presence of extracranial metastases. Since 2010, three drugs have demonstrated activity in progressing or “active” brain metastases including the anti-CTLA4 antibody ipilimumab (phase II study of 72 patients), and the BRAF inhibitors dabrafenib (phase II study of 172 patients, both previously treated and untreated brain metastases) and vemurafenib (a pilot study of 24 patients with heavily pretreated brain metastases). The challenge and unanswered question for clinicians is how to sequence all the available therapies, both local and systemic, to optimize the patient's quality of life and survival. This is an area of intense clinical research. The treatment of patients with melanoma brain metastases should be discussed by a multidisciplinary team of melanoma experts including a neurosurgeon, medical oncologist, and radiation oncologist. Important clinical features that help determine appropriate first line therapy include single compared with solitary brain metastasis, resectablity, BRAF mutation status of melanoma, rate of progression/performance status, and the presence of extracranial disease.

Low protracted dose of temozolomide (TMZ) and concurrent radiotherapy for brain metastasis of solid tumors

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 12525-12525
Author(s):  
R. Addeo ◽  
V. Faiola ◽  
G. Cennamo ◽  
R. Guarrasi ◽  
L. Montella ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Overall Response Rate ◽  
Response Rate ◽  
Whole Brain Radiotherapy ◽  
Primary Brain Tumours ◽  
Brain Radiotherapy ◽  
Dna Alkyltransferase ◽  
Grade 3

12525 Background. Whole brain radiotherapy (WBRT) remains the mainstay of therapy for brain metastasis of solid tumours not amenable to surgical resection. Chemotherapy with temozolomide (TMZ) has emerged as an alterative approach for recurrent brain metastases. It has been already used alone or in combination with radiotherapy in the treatment of primary brain tumours. Protracted administration of TMZ, even at relatively low daily doses, leads to significant and prolonged depletion of enzyme O6-alkylguaninae-DNA alkyltransferase (AGAT) activity, with may enhance the antitumor activity of the agent. Methods. Patients with histologically or cytologically confirmed breast cancer and NSCLC and inoperable brain metastasis were eligible for the study .We have treated 29 consecutive patients (16 F and 13 M, mean age: 55, range 46–76) affected by brain metastases ( 16 non-small-cell lung cancer and 13 breast cancer) with WBRT at 3 Gy/day administered over a two-week period (on wks 1–2), total dose 30 Gy, and an induction with TMZ 50 mg/m2/day during this period, following TMZ 50mg/m2 fractionated in 21 days every 28 days, for up to 12 cycles. Pts who received at least one cycle of TMZ were assessable for response. Results. Twenty-four patients were subjected to the induction therapy and 124 cycles were performed. TMZ was generally well tolerated, and the main toxicities seen were hematologic. The toxicities were generally between grade 1 or 2 in severity although two patients had grade 3 events. Two CR, in patients with breast cancer and NSCLC. Nine partial responses were recorded in 5/11 patients with breast cancer, 4/13 patients with NSCLC, while a stable disease was achieved in other 5 patients. Eight patients showed progressive BM growth during the treatment. The overall response rate was 45.5% (C.I. 38.7–56.9%), while the disease control rate was 77% (C.I. 61.7–82.4%). At the present, the overall survival at 12 months was 64%. Conclusions. We developed a new regimen based on a different strategy: the utilization of a more intensive TMZ dosing schedule that would permit the concomitant use of a second cytotoxic agent on the primary cancer. Final data analysis will be presented. The schedule was safe and well tolerated and has suggested an encouraging activity in brain metastases. No significant financial relationships to disclose.

A retrospective survival analysis of whole brain radiotherapy (WBRT) for brain metastases at Mount Vernon Cancer Centre (MVCC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 2068-2068
Author(s):  
P. J. Mulholland ◽  
M. Assoku ◽  
P. Sasieni
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factor ◽  
Brain Metastases ◽  
Whole Brain Radiotherapy ◽  
Skin Tumor ◽  
Unknown Primary ◽  
Tumor Type ◽  
Rank Analysis ◽  
Brain Radiotherapy ◽  
Tumor Types

2068 Background: The primary purpose of this retrospective study was to determine the survival of patients with brain metastases following WBRT with regards to the influence of tumor type, age < 65 versus ≥ 65 (RPA RTOG prognostic factor) and recency of treatment date. Methods: From treatment records we identified 1,926 patients with brain metastases from solid tumors who were treated with WBRT at MVCC between February 1992 and March 2008. Dates of death were sourced from records at MVCC, the Cancer Registry and GP practices. Results: We obtained dates of death for patients with lung (n=804), breast (n=457), colorectal (n=129), skin (n=119), kidney (n=82), and unknown primary (n=124) cancers. 42 patients were excluded from analysis as their tumor types were unspecified. A heterogeneous group of 169 patients with a variety of other primary tumor types were also excluded from our primary analyses. 22% of the patients died within the first month following WBRT and only 2.4% remained alive at 2 years. Log-rank analysis of age < 65 versus ≥ 65 demonstrated improved survival for the former for the colorectal, lung, and skin tumor types (p = 0.0048, 0.0001, and 0.0456 respectively). This relationship did not reach significance for the breast, unknown primary, and renal cancer groups (p = 0.14, 0.13, and 0.06 respectively). With the exception of colorectal cancer, the analysis of the effect of treatment date on survival did not reveal recent improvements in survival for patients with brain metastases. An improvement in survival was experienced by the colorectal subgroup treated after March 2006 (HR= 0.51 95% CI 0.27- 0.96). Conclusions: Our data validate age as an important prognostic factor for many tumor types with notable exceptions for as yet undetermined reasons. Metastasis to the brain is a late stage feature of colorectal malignancy. The survival of the majority of patients undergoing WBRT for brain metastases is poor and with the possible exception of colorectal cancer, has not improved over the last decade. [Table: see text] [Table: see text]

scholarly journals Effect of xenon on pain severity and adaptational status of neuro-oncological and oncogynecological patients

2019 ◽  
Vol 19 (1S) ◽  
pp. 228-230 ◽  
Author(s):  
N N Popova ◽  
M S Zinkovich ◽  
A I Shikhlyarova ◽  
G V Zhukova ◽  
L Ya Rozenko ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Visual Analogue Scale ◽  
Brain Metastases ◽  
Radical Hysterectomy ◽  
Analgesic Effect ◽  
Analogue Scale ◽  
Whole Brain Radiotherapy ◽  
The Body ◽  
Brain Radiotherapy ◽  
Hematological Indicators

The severity of pain and changes in the adaptational status were studied in patients with brain metastases or cervical cancer receiving xenon therapy after whole brain radiotherapy or after radical hysterectomy. Hematological indicators of the nature and tensiton of general nonspecific adaptional reactions of the body (ARs) by Garkavi-Kvakina-Ukolova, the QLQ-C15 questionnaire and a 10-point graphic visual analogue scale for the assessment of the intensity of pain were used. Xenon caused concurrent reduce in the intensity of pain and improvement of characteristics of ARs in all studied patients. The results suggested an association between the analgesic effect of xenon and the normalization of neuroimmune processes and reduced damaging effects of special antitumor treatment on the body under the influence of xenon.

Whole-Brain Radiotherapy with 20 Gy in 5 Fractions for Brain Metastases in Patients with Cancer of Unknown Primary (CUP)

2007 ◽  
Vol 183 (11) ◽  
pp. 631-636 ◽  
Author(s):  
Dirk Rades ◽  
Guenther Bohlen ◽  
Radka Lohynska ◽  
Theo Veninga ◽  
Lukas J. A. Stalpers ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Whole Brain Radiotherapy ◽  
Cancer Of Unknown Primary ◽  
Unknown Primary ◽  
Whole Brain ◽  
Patients With Cancer ◽  
Brain Radiotherapy

Resection and brain brachytherapy with permanent iodine-125 sources for brain metastasis

2016 ◽  
Vol 126 (6) ◽  
pp. 1749-1755 ◽  
Author(s):  
David R. Raleigh ◽  
Zachary A. Seymour ◽  
Bryan Tomlin ◽  
Philip V. Theodosopoulos ◽  
Mitchel S. Berger ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Local Control ◽  
Whole Brain Radiotherapy ◽  
Cavity Volume ◽  
Term Survival ◽  
Whole Brain ◽  
Brain Radiotherapy ◽  
Iodine 125

OBJECTIVEStereotactic radiosurgery (SRS) with or without whole-brain radiotherapy can be used to achieve local control (> 90%) for small brain metastases after resection. However, many brain metastases are unsuitable for SRS because of their size or previous treatment, and whole-brain radiotherapy is associated with significant neurocognitive morbidity. The purpose of this study was to investigate the efficacy and toxicity of surgery and iodine-125 (125I) brachytherapy for brain metastases.METHODSA total of 95 consecutive patients treated for 105 brain metastases at a single institution between September 1997 and July 2013 were identified for this analysis retrospectively. Each patient underwent MRI followed by craniotomy with resection of metastasis and placement of 125I sources as permanent implants. The patients were followed with serial surveillance MRIs. The relationships among local control, overall survival, and necrosis were estimated by using the Kaplan-Meier method and compared with results of log-rank tests and multivariate regression models.RESULTSThe median age at surgery was 59 years (range 29.9–81.6 years), 53% of the lesions had been treated previously, and the median preoperative metastasis volume was 13.5 cm3 (range 0.21–76.2 cm3). Gross-total resection was achieved in 81% of the cases. The median number of 125I sources implanted per cavity was 28 (range 4–93), and the median activity was 0.73 mCi (range 0.34–1.3 mCi) per source. A total of 476 brain MRIs were analyzed (median MRIs per patient 3; range 0–22). Metastasis size was the strongest predictor of cavity volume and shrinkage (p < 0.0001). Multivariable regression modeling failed to predict the likelihood of local progression or necrosis according to metastasis volume, cavity volume, or the rate of cavity remodeling regardless of source activity or previous SRS. The median clinical follow-up time in living patients was 14.4 months (range 0.02–13.6 years), and crude local control was 90%. Median overall survival extended from 2.1 months in the shortest quartile to 62.3 months in the longest quartile (p < 0.0001). The overall risk of necrosis was 15% and increased significantly for lesions with a history of previous SRS (p < 0.05).CONCLUSIONSTherapeutic options for patients with large or recurrent brain metastases are limited. Data from this study suggest that resection with permanent 125I brachytherapy is an effective strategy for achieving local control of brain metastasis. Although metastasis volume significantly influences resection cavity size and remodeling, volumetric parameters do not seem to influence local control or necrosis. With careful patient selection, this treatment regimen is associated with minimal toxicity and can result in long-term survival for some patients.▪ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: retrospective case series; evidence: Class IV.

Brain Metastasis

Neurosurgery ◽  
1979 ◽  
Vol 5 (5) ◽  
pp. 617-631 ◽  
Author(s):  
Perry Black
Keyword(s):  
Brain Metastasis ◽  
Primary Tumor ◽  
Combined Therapy ◽  
Whole Brain Radiotherapy ◽  
Surgical Excision ◽  
Metastatic Lesion ◽  
The Body ◽  
Cerebral Metastasis ◽  
Therapeutic Modality ◽  
Brain Radiotherapy

Abstract An overview of brain metastasis with respect to the pathological, diagnostic, and therapeutic aspects is presented. Management is almost always palliative, with cure being a rare exception. Evaluation of various therapeutic modalities—radiation, chemotherapy, or surgery—has been confounded by a lack of controlled, randomized studies whereby the relative benefit of the respective modalities can be assessed objectively. Despite these limitations, some progress is being made in the identification of those patients for whom therapy is likely to be of benefit. Apart from the use of steroids to control cerebral edema, radiotherapy is currently the most commonly employed therapeutic modality for cerebral metastasis. It is the treatment of choice for multiple intracranial metastases and it affords temporary improvement in neurological symptoms in about 60% of patients. For solitary metastases, combined therapy—surgical excision followed by whole brain radiotherapy—has been shown to result in a better quality and longer duration of survival than either modality alone. Except for patients who are terminally ill, aggressive treatment seems warranted, inasmuch as therapeutic results have been improving steadily over the years. Neither chemotherapy nor immunotherapy has been shown to be of benefit in the management of cerebral metastasis. An exception is choriocarcinoma, which responds well to a combination of radiation therapy and chemotherapy. Although the prognosis for meningeal carcinomatosis is poor, improved survival may be achieved by a combination of chemotherapy and radiotherapy. These are recommended guidelines for surgical intervention, usually followed by radiotherapy: (a) In general, surgical excision is recommended only for patients with relatively superficial, solitary lesions. It is reasonable, however, to consider the excision of a metastatic lesion that is immediately life-threatening or incapacitating, even though one or more other metastatic brain lesions may be present. This may be extended to the removal of multiple metastatic brain tumors if they are surgically accessible. (b) The second consideration is whether the primary tumor can or has been treated or if the primary tumor will permit reasonably long survival. (c) There should not be metastases elsewhere in the body, although their presence should not categorically exclude the patient as a surgical candidate. (d) The patient's general condition should be satisfactory. (e) Operation is recommended if the diagnosis of the intracranial lesion is uncertain. (f) A shunt should be considered for treatment of hydrocephalus secondary to obstruction of the cerebrospinal fluid pathway by tumor or edema.

MODERN STRATEGIES FOR TREATMENT OF PATIENTS WITH BRAIN METASTASES

2017 ◽  
Vol 63 (4) ◽  
pp. 523-535
Author(s):  
Sergey Banov ◽  
Andrey Golanov ◽  
Sergey Ilyalov ◽  
Yelena Vetlova ◽  
Natalya Antipina ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Whole Brain Radiotherapy ◽  
Standard Of Care ◽  
Current Treatment ◽  
Management Options ◽  
Brain Radiotherapy ◽  
Tumor Pathology ◽  
Treatment Paradigm ◽  
Overall Health Status

Brain metastases are the most common intracranial malignancy accounting for significant morbidity and mortality in cancer patients. The current treatment paradigm for brain metastasis depends on patient’s overall health status, the primary tumor pathology and the number and location of brain lesions. Treatment of brain metastases should be individualized for each patient: in case of single brain metastasis surgery or radiosurgery should be considered as first options of treatment; in case of multiple lesions whole-brain radiotherapy is the standard of care in association with systemic therapy or surgery/radiosurgery. Herein, we review the modern management options for these tumors including surgical resection, radiotherapy. In the last decades TKIs or monoclonal antibodies have showed an increase in overall response rate and overall survival in Phase II-III trials. The aim of this paper is to make an overview of the current approaches in management of patients with brain metastases.

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