Long-Term Survival after Linac-Based Stereotactic Radiosurgery and Radiotherapy with A Micro-Multileaf Collimator for Brain Metastasis

Purpose: To evaluate the prognostic factors associated with long-term survival after linear accelerator (linac)-based stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) with a micro-multileaf collimator for brain metastasis (BM). Methods: This single-center retrospective study included 226 consecutive patients with BM who were treated with linac-based SRS or fSRT with a micro-multileaf collimator between January 2011 and December 2018. Long-term survival (LTS) was defined as survival for more than 2 years after SRS/fSRT. The tumors originated from the lung (n =189, 83.6%), breast (n = 11, 4.9%), colon (n = 9, 4.0%), stomach (n = 4, 1.8%), kidney (n = 3, 1.3%), esophagus (n = 3, 1.3%), and other regions (n = 7, 3.1%). Results: The median pretreatment Karnofsky performance scale (KPS) score was 90 (range: 40–100). The median follow-up time was 13 (range: 0–120) months. Out of the 226 patients, 72 (31.8%) were categorized in the LTS group. The median survival time was 43 months and 13 months in the LTS group and in the entire cohort, respectively. The 3-year, 4-year, and 5-year survival rate in the LTS group was 59.1%, 49.6%, and 40.7%, respectively. Multivariate regression logistic analysis showed that female sex, a pre-treatment KPS score ≥80, and the absence of extracranial metastasis were associated with long-term survival. Conclusions: Female sex, a favorable pre-treatment KPS score, and the absence of extracranial metastasis were associated with long-term survival in the current cohort of patients with BM.

Bone Metastases of Glioblastoma: A Case Report and Review of the Literature

BackgroundGlioblastoma (GBM) is the most common primary intracranial tumor and originates from the small pool of adult neural stem and progenitor cells (NSPCs). According to the World Health Organization (WHO) classification of brain tumors, gliomas are classified into grades I–IV, and GBM is defined as the highest grade (IV). GBM can be disseminated by cerebrospinal fluid (CSF), but extracranial metastasis is rare. Additionally, the pathway and mechanism involved remain unclear.Case PresentationWe report a rare case of left temporal lobe GBM with multiple bone metastases and soft tissue metastasis. This 49-year-old right-handed man who was diagnosed with GBM underwent surgery on May 9, 2017, followed by radiochemotherapy in June 2017. On August 13, 2019, local relapse was found. Then, the patient received a second surgery but not radiochemotherapy. In November 2019, the patient was reported to be suffering from low back pain for nearly 1 month. On December 6, 2019, magnetic resonance imaging (MRI) of the thoracolumbar vertebrae and abdominal computed tomography (CT) confirmed metastases on the ninth posterior rib on the right, the third anterior rib on the left, and the T7 and T10 vertebrae and their appendages. CT-guided rib space-occupying puncture biopsy was performed, and GBM was identified by pathology.ConclusionWe should pay attention to extracranial metastasis of GBM. Timely detection and early treatment improve overall quality of patients’ life. The extracranial metastasis in this patient may have occurred through the spinal nerve root or intercostal nerve. Further clinical observations are required to clarify the pathway and mechanism involved.

TRLS-04. A Nomogram for Predicting Survival in Patients with Brain Metastases

Background Brain metastases are the most common intracranial tumors in adults, with a very poor prognosis, and poses distinct clinical challenges. This study aimed to develop a more accurate prognostic nomogram for predicting overall survival (OS) of patients with Brain Metastases. Methods We conducted a retrospective analysis of 1062 patients with brain metastases at the Sun Yat-sen University Cancer Center (SYSUCC, Guangzhou, China) between January 2010 and January 2018, Among them, 331 patients underwent surgery to remove brain metastases. Kaplan–Meier analysis was performed to screen for potential clinical variables that could be used to establish the nomogram for predicting overall survival. Results We found that age,gender, whether to remove intracranial lesions, radiotherapy, ECOG were independent prognostic factors for predicting the overall survival with brain metastases,and surgical resection for brain metastatic lesions could significantly improve OS,but only in certain groups of patients with brain metastases can benefit from intracranial lesion resection, such as no extracranial metastasis. And patients with brain metastases whose primary tumor is lung adenocarcinoma or breast cancer are more likely to benefit from surgery in terms of overall survival time.A nomogram for predicting 1- and 2-year overall survival rates was constructed, which exhibited good accuracy in predicting overall survival. Conclusion Through statistical analysis, we have found the factors related to the surgical benefit of patients with brain metastases, and established a prognostic nonogram,This nomogram may be used to guide individual treatments and in selecting an appropriate patient population for clinical trials.

Risk Factors, Prognosis and A New Nomogram for Predicting Cancer-Specific Survival Among Lung Cancer Patients with Brain Metastasis: A Retrospective Study Based on SEER

Purpose: A comprehensive population-based study on risk and prognostic factors of lung cancer with brain metastasis is lacking. Methods: 95191 patients diagnosed with lung cancer between 2010 and 2017 were collected from the Surveillance, Epidemiology and End Results (SEER) database. Patients were stratified by different variables. Multivariable logistic and Cox regression were applied to analyze the risk and prognostic factors of brain metastasis among lung cancer patients, respectively. The Fine and Gray’s competing risk regression model was performed to obtain prognostic factors associated with cancer-specific mortality.Results: Among the 95191 patients diagnosed with lung cancer, 10765 patients have brain metastasis, with a metastatic incidence of 11.31%. The primary site of tumor, residence type, age, histological type, race and extracranial metastasis were all independent risk factors of brain metastasis. Compared with other histological types, small cell lung cancer displayed a highest incidence of brain metastasis (16.62%). The median overall survival (OS) among lung cancer patients with brain metastasis was only 6.05 months. The primary site of tumor, median household income, age, histological type, race, gender and extracranial metastasis were all associated with the prognosis of brain metastasis. Patients with squamous cell carcinoma had the worst prognosis, the median OS was only 3.68 months. And our established new nomogram showed a good discriminative ability on predicting the probability of cancer-specific survival among patients with brain metastasis, the C-index was 0.61.Conclusion: Our study provided a deeper insight into the risk factors and prognosis of brain metastasis among lung cancer patients.

EPEN-12. MULTIPLE RECURRENCES OF ANAPLASTIC EPENDYMOMA WITH EXTRA AXIAL AND EXTRA NEURAL METASTASIS IN A PEDIATRIC PATIENT

Background Ependymomas are the third most common CNS tumor in the pediatric population, accounting for 10% of all CNS tumors. Co-occurring extraneural and extracranial metastasis of ependymomas are extremely rare, with only 1 reported adult case in current literature. Case Description We describe the case of a patient with multiple reoccurrences of anaplastic ependymoma. Initial imaging showed a 5 x 8 x 8 cm complex cystic mass with nodular enhancing components within the left occipital lobe. The 4th ventricle was intact and imaging was negative for metastasis. Pathology following resection demonstrated perivascular pseudorosettes, areas of calcification, and increased mitotic activity. Biopsy revealed GFAP, EMA, neurofilament, INI-1, and was negative for CAM5.2, confirming anaplastic ependymoma. Methylation studies for PFA or PFB subgroup differentiation were not available. The patient had recurrences at 4-, 5-, and 6-years after his initial diagnosis. Seven years from his initial diagnosis, the patient underwent resection of four nodular lesions from the occipital lobe and surrounding soft tissue. Pathology of these lesions and the lymph nodes/soft tissue confirmed anaplastic ependymoma. A PET scan showed increase uptake in the supraclavicular lymph nodes and had multiple bilateral pulmonary nodules. Scans at 3 months post-surgery were negative for leptomeningeal metastases but showed further lymph node involvement with progression of pulmonary disease. Conclusion Co-occurring extraneural and extracranial metastasis of ependymoma is a rare occurrence across all populations. To our knowledge, this would be the first published pediatric case of anaplastic ependymoma with lymph node, soft tissue, and pulmonary involvement. Treatment of ependymoma itypically local and the utility of chemotherapy remains unclear. Treatment options for extraneural mets is very limited, illustrating the need for new therapies and further studies directed at understanding the biology of these tumors and the factors that could influence their ability to metastasize to extraneural and extracranial sites.

Rhabdoid Meningioma Metastases Cervical Lymph Nodes: A Rare Clinical Case Report and Treatment Outcome

Meningioma is the most common central nervous system tumor that usually behaves benignly and has a good prognosis after treatment with tumor gross resection and with or without adjuvant therapy. Malignancy in meningioma is very rare and extracranial metastasis to cervical lymph nodes is even rarer. We report a case of a 40-year-old woman diagnosed with metastatic rhabdoid meningioma. She had recurrent primary disease and metastasis to bilateral cervical lymph nodes. She previously had intracranial tumor twice resected. We also review relevant, previously published cases in the literature. I hope you find these suggestions helpful.

Approachment to the Brain Metastasis without Extracranial Metastasis of the HER2 Positive Metastatic Breast Cancer

Introduction: Breast cancer is one of the most common malignancy that metastases to brain with the risk of 10-16%. Brain metastasis has been reported to be more common among younger women with tumors larger diameter and higher grade, hormone negative and HER2 positive ones. We reviewed inhere treatment of patients with brain metastasis without extracranial metastasis of HER-2 positive breast cancer. Patients and Method: Totally 470 HER2 positive breast cancer patients were evacuated and treatment and clinicopathological factors of 20 patients with brain progression without extracranial metastasis were revised retrospectively. Overall survival (OS) and progression free survival (PFS)and related factors were analysed with univariate analysis. Results: Median survival could not to be reached but, 3 years survival rate was 77% and median PFS was 16.1 months. Brain metastasis were treated with surgery followed with radiotherapy among 9 patients (45%) and only with radiotherapy other 11 (55%) patients. While nearly half of the patients received trastuzumab based therapy after local treatment, lapatinib-capecitabine were given to 7 (35%) and TDM-1 to 4 (20%) patients. There is no significant relation with anti-HER2 therapy in respect to OS or PFS. Conclusion: Although anti-HER2 therapy has known to be improve prognosis of HER-2 positive breast cancer with brain metastasis, there is no consensus which therapy is better. Treatment option can be based adverse effect, patient performance or cost-effectiveness until in the future prospectively designed study related the anti-HER2 therapy after local brain therapy will be come up.

Multiple extracranial metastases from glioblastoma multiforme: a case report and literature review

Extracranial metastasis from glioblastoma multiforme (GBM) is rare, especially multi-site metastases without intracranial recurrence. However, the metastatic mechanism of GBM remains unknown and there is currently no consensus regarding the best therapeutic regimen. We report the case of a 46-year-old man with primary GBM who developed scalp metastases and subsequent multiple pulmonary metastases. He was treated with the Stupp regimen after surgery for the intracranial tumor. However, a series of soft masses in the scalp were subsequently identified, and new nodules were found in his left eyebrow arch during chemoradiotherapy. Despite salvage chemotherapy and targeted therapy, the patient eventually died of respiratory failure with multiple pulmonary metastases. This case highlights the need for rigorous follow-up, including brain magnetic resonance imaging, in patients with GBM. The occurrence of extra-central nervous system symptoms indicates the possibility of metastasis, and the relevant examinations should be conducted promptly. Positive therapies may help to relieve symptoms and prolong survival in patients with metastatic GBM.