A Multiparametric MR-Based RadioFusionOmics Model with Robust Capabilities of Differentiating Glioblastoma Multiforme from Solitary Brain Metastasis

This study aimed to evaluate the diagnostic potential of a novel RFO model in differentiating GBM and SBM with multiparametric MR sequences collected from 244 (131 GBM and 113 SBM) patients. Three basic volume of interests (VOIs) were delineated on the conventional axial MR images (T1WI, T2WI, T2_FLAIR, and CE_T1WI), including volumetric non-enhanced tumor (nET), enhanced tumor (ET), and peritumoral edema (pTE). Using the RFO model, radiomics features extracted from different multiparametric MRI sequence(s) and VOI(s) were fused and the best sequence and VOI, or possible combinations, were determined. A multi-disciplinary team (MDT)-like fusion was performed to integrate predictions from the high-performing models for the final discrimination of GBM vs. SBM. Image features extracted from the volumetric ET (VOIET) had dominant predictive performances over features from other VOI combinations. Fusion of VOIET features from the T1WI and T2_FLAIR sequences via the RFO model achieved a discrimination accuracy of AUC = 0.925, accuracy = 0.855, sensitivity = 0.856, and specificity = 0.853, on the independent testing cohort 1, and AUC = 0.859, accuracy = 0.836, sensitivity = 0.708, and specificity = 0.919 on the independent testing cohort 2, which significantly outperformed three experienced radiologists (p = 0.03, 0.01, 0.02, and 0.01, and p = 0.02, 0.01, 0.45, and 0.02, respectively) and the MDT-decision result of three experienced experts (p = 0.03, 0.02, 0.03, and 0.02, and p = 0.03, 0.02, 0.44, and 0.03, respectively).

SURG-01. Management of solitary brain metastasis less than 4 cm in diameter. Surgical resection versus stereotactic radiotherapy: a meta-analysis

Introduction To treat a solitary metastasis in the brain, surgical resection and/or radiotherapy are the standard treatments of care. However, the clinical scenarios in which to use these techniques alone or in combination are controversial. While a course of stereotactic radiotherapy is often administered to a patient who presents with multiple metastases, surgical resection is often directed against a larger solitary brain metastasis before irradiating the resection bed. The management of a smaller solitary tumor (diameter less than 4 cm) is less clear. Accordingly, our meta-analysis assembled studies that focused on patients with a solitary tumor less than 4 cm in diameter. Methods Following PRISMA guidelines (PROSPERO ID: CRD42021242434), we searched PubMed, Web of Knowledge, and Cochrane Library databases for randomized controlled trials (RCT) and observational studies comparing surgery to radiotherapy for solitary metastatic brain tumors less than 4 cm in diameter. From 498 total records, we included 9 studies for meta-analysis. Analysis was performed on R. Results 2 RCTs and 7 observational studies were identified. 431 patients underwent surgical intervention, and 349 patients exclusively underwent radiotherapy. The surgical treatment cohort did not exhibit a difference in 1-year (OR [95% CI] = 0.866 [0.609–1.289]), 2-year (1.7 [0.843–3.428]), or overall survival (1.18 [0.598–2.327]). However, the surgical treatment group demonstrated greater local tumor recurrence after 1-year (3.975 [1.979–7.987]) and overall local recurrence (3.045 [1.276 - 7.268]). There was no difference between the overall rates of distant recurrence (0.565 [0.218 - 1.466]). Conclusions Our analysis opens more discussion about the management of solitary brain metastasis. Patient selection is paramount in achieving better local control. Stereotactic radiotherapy should be considered for treatment of solitary brain metastasis less than 4 cm in diameter in selected patients. Future randomized control trials for small solitary masses are recommended.

Near complete resolution of COVID-19 pneumonia lesions in a patient of carcinoma lung treated with volumetric modulated arc therapy

A 49-year-old male presented with non-small cell lung cancer in right upper lobe lung with solitary brain metastasis. He developed COVID-19 infection and received domiciliary treatment for 3 weeks. Three weeks after testing negative for RT-PCR test, he received stereotactic radiosurgery (SRS) to brain metastasis. He then presented in emergency with pain in the epigastrium and was detected with amoebic liver abscess. Subsequently, he developed recurrent hemoptysis for which he was planned for palliative radiation to right lung mass. Planning CT scan showed COVID-19 pneumonia lesions involving bilateral lungs in addition to right upper lobe tumour. Palliative radiation 8 Gy/1 fraction was delivered to lung tumour with VMAT technique. He showed near total resolution of COVID-19 lesions with low-dose scatter radiation and relief of haemoptysis.

Is Function-Based Resection Using Intraoperative Awake Brain Mapping Feasible and Safe for Solitary Brain Metastases Within Eloquent Areas?

ObjectiveTo assess feasibility and safety of function-based resection under awake conditions for solitary brain metastasis patients.MethodsRetrospective, observational, single-institution case-control study (2014-2019). Inclusion criteria: adult patients, solitary brain metastasis, supratentorial location within eloquent areas, function-based awake resection. Case matching (1:1) criteria between metastasis group and control group (high-grade gliomas): sex, tumor location, tumor volume, preoperative Karnofsky Performance Status score, age, educational level.ResultsTwenty patients were included. Intraoperatively, all patients were cooperative, no obstacles precluded procedure from being performed. A positive functional mapping was achieved at both cortical and subcortical levels, allowing for a function-based resection in all patients. The case-matched analysis showed that intraoperative and postoperative events were similar, except for a shorter duration of the surgery (p<0.001) and of the awake phase (p<0.001) in the metastasis group. A total resection was performed in 18 cases (90%, including 10 supramarginal resections), and a partial resection was performed in two cases (10%). At three months postoperative months, none of the patients had worsening of their neurological condition or uncontrolled seizures, three patients had an improvement in their seizure control, and seven patients had a Karnofsky Performance Status score increase ≥10 points.ConclusionsFunction-based resection under awake conditions preserving the brain connectivity is feasible and safe in the specific population of solitary brain metastasis patients and allows for high resection rates within eloquent brain areas while preserving the overall and neurological condition of the patients. Awake craniotomy should be considered to optimize outcomes in brain metastases in eloquent areas.

A solitary brain metastasis as the only site of recurrence of HR positive, HER2 negative breast cancer: a case report and review of the literature

Background Breast cancer is one of the most common causes of brain metastases. However, the presence of isolated central nervous system (CNS) metastatic disease early in the course of disease relapse is a rare event in cases of hormone receptor positive, human epidermal growth factor receptor 2 (HER2) negative breast cancer. Case presentation We summarize the clinical course of a pre-menopausal, 39-year old Caucasian female with history of operable, hormone receptor positive, HER2 negative breast cancer who was initially treated with curative-intend therapy but who unfortunately developed solitary metastatic lesion in the left thalamus. A biopsy of the lesion confirmed the presence of hormone receptor positive, HER2 negative metastatic breast cancer. Patient’s CNS metastases continued to progress without any evidence of metastatic disease outside of the central nervous system and she eventually passed away about 5 years after the date of her initial diagnosis and 18 months following the diagnosis with brain metastasis. Conclusion Based on our case, although rare, patients with treated, operable, hormone receptor positive, HER2 negative breast cancer can present with solitary brain metastasis as the only sign of disease recurrence.