A new paradigm in treatment of brain metastases

McDonald, Mark W.; McMullen, Kevin P.

doi:10.1016/j.currproblcancer.2015.03.001

Cited by 6 publications

(6 citation statements)

References 151 publications

(147 reference statements)

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“…The relationship between HM or PHM and age is unclear. However, studies have found that older age is a poor prognostic factor for survival in patients with metastatic disease in the brain [ 23 – 26 ]. The survival of younger patients with metastatic disease in the brain have a longer life expectancy, and the probability of progression of brain metastases may potentially increase, thereby increasing the probability of HM and PHM.…”

Section: Discussionmentioning

confidence: 99%

Distribution of metastatic disease in the brain in relation to the hippocampus: a retrospective single-center analysis of 6064 metastases in 632 patients

Rao

Zhou

et al. 2015

Oncotarget

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This study aimed to investigate the patterns of brain metastasis and to explore the risk factors affecting hippocampus metastasis (HM). We retrospectively analyzed the clinical information of patients with metastatic disease in the brain. The associations between clinicopathologic variables with HM and peri-hippocampal metastasis (PHM) were evaluated in univariate and multivariate regression analyses. A total of 632 patients with 6064 metastatic lesions were recruited into the present study. Of these, 4.1% (26/632) of patients developed HM, and 5.5% (35/632) of patients developed PHM. Only 0.5% (31/6064) of metastatic lesions were located in the hippocampus and 0.6% (37/6064) were in the PHM. Age ≤60 years was an independent risk factor for HM (odds ratio [OR]: 2.602, 95% confidence interval [CI]: 1.115–6.076, P = 0.027) and PHM (OR: 2.555, 95%CI: 1.229–5.310, P = 0.012) in univariate and multivariate analyses. The hippocampus is a rare site of brain metastasis. Younger patients (age ≤60 years) had increased risk of developing HM and PHM. The current study provides the opportunity to investigate the clinical feasibility of hippocampal sparing whole brain radiation therapy, especially in older patients.

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Section: Discussionmentioning

confidence: 99%

Distribution of metastatic disease in the brain in relation to the hippocampus: a retrospective single-center analysis of 6064 metastases in 632 patients

Rao

Zhou

et al. 2015

Oncotarget

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“…Currently, there is no definite agreement about the influence of age on metastatic tumors with regard to different distances in the hippocampus, predicting that age may be closely related to the prognosis of patients with intracranial metastasis. Relevant studies show that age is an adverse factor for the prognosis of patients with intracranial metastasis [26, 27]. The younger patients have the higher probability of progressive disease, due to their longer life expectancy, thus the potential possibility of hippocampal metastatic lesion or recurrence is higher.…”

Section: Discussionmentioning

confidence: 99%

Distribution of metastasis in the brain in relation to the hippocampus: a retrospective single-center analysis of 565 metastases in 116 patients

Sun

Wang

et al. 2019

Cancer Imaging

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ObjectiveTo examine the distribution of brain metastases (BM) in relation to the hippocampus, so as to determine the risk of metastasis in the hippocampus, and thus provide experimental evidence for the hippocampal avoidance (HA) in patients with BM during radiotherapy.Methods(1) For the retrospective analysis of 116 patients diagnosed with malignancies, confirmed as BM, from December 2014 to December 2016 at the First Affiliated Hospital of Bengbu Medical College. We obtained the T1-weighted, postcontrast axial, sagittal, and coronal Magnetic Resonance imaging (MRI) images f the patients, in supine position, using the head restraints and head thermoplastic masks to adjust the positioning, with computed tomography (CT) positioning scan ranging from the head to the mandible (layer thickness: 3 mm). CT and MRI images were fused on a Philips Pinnacle v9.8 treatment planning system;(2) Every metastasis of the 565 metastases was contoured;(3) hippocampus were contoured, and hippocampus with 5 mm expansion envelopes were analyzed;(4) Using the SPSS 16.0 software, we analyzed the relation between the distribution and age, sex, Karnofsky performance status (KPS), primary site, aggregate volume of intracranial metastases and the whole brain. The data were analyzed using a binary logistic regression analysis method, with two-sided P < 0.05 for statistical significance.ResultsIn this study, we recruited 116 patients with 565 metastases. Among them, 1.7% (n = 2) had metastases in the hippocampus, and 11.2% (n = 13) had metastases within 5 mm of the hippocampus, of which more than half were patients with non-small cell lung cancer (n = 7). Using a binary logistic regression to analyze the relation between the metastases located within 5 mm of the hippocampus and age (P = 0.395), sex (P = 0.139), KPS (P = 0.724), primary site (P = 0.894), aggregate volume of intracranial metastases (p = 0.093) and the whole brain (p = 0.998), and none of them showed statistically significant difference between them and the metastases location (P>0.05).ConclusionThis study showed a low risk for the perihippocampal metastases (PHM) and no significant correlation between PHM and age, sex, KPS, primary site, aggregate volume of intracranial metastases and the whole brain. Accordingly, it is may be acceptable to avoid the perihippocampal region during whole brain radiotherapy.

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“…HFIGMI–VMAT has the radiobiological advantage of fractionation, whereas GK-SRS is administered in one to three fractions [25, 26]. Radiosurgical doses ranging from 15 to 24 Gy according to tumor diameters have been widely administered as a single treatment [9, 27]; however, tumor size correlates strongly with local tumor control. Vogelbaum et al reported the following results for GK-SRS treatment using the RTOG 90–05 dosing scheme: 1-year local control rate 85% for 20 mm or smaller (24 Gy), 49% for 21–30 mm (18 Gy), and 45% for 31–40 mm (15 Gy) tumors.…”

Section: Discussionmentioning

confidence: 99%

“…The risk of developing new brain metastases increases in parallel with the number of brain metastases present at diagnosis [38, 39]. WBRT has traditionally been the standard treatment for multiple brain metastases; however, the resultant acute toxicities may delay initiation of systemic therapy, and this therapy is associated with an increased risk of late neurocognitive decline [9, 40]. SRS may carry a lower risk of neurocognitive decline; however, whether SRS is indicated in patients with more than four brain metastases is controversial [9].…”

Section: Discussionmentioning

confidence: 99%

“…SRS is a well-established means of treating brain metastases. However, the indications for SRS are generally limited by the number of lesions and tumor volumes [9, 10]. Volumetric-modulated arc therapy (VMAT) improves dose conformity and decreases dose to the surrounding healthy tissue, allowing escalation of the dose to the target volume [11, 12].…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of hypofractionated image-guided multifocal irradiation using volumetric-modulated arc therapy for brain metastases

Furutani

Ikushima

Sasaki

et al. 2018

Journal of Radiation Research

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Volumetric-modulated arc therapy (VMAT) can be used to design hypofractionated radiotherapy treatment plans for multiple brain metastases. The purpose of this study was to evaluate treatment outcomes of hypofractionated image-guided multifocal irradiation using VMAT (HFIGMI–VMAT) for brain metastases. From July 2012 to December 2016, 67 consecutive patients with 601 brain metastases were treated with HFIGMI–VMAT at our institution. The prescribed dose was 50 Gy to a 95% volume of the planning target volume in 10 fractions. Fifty-five of the 67 patients had non-small-cell lung cancer, and the remaining 12 had other types of cancer. The median number of brain metastases was five, and the median maximum diameter was 1.2 cm. The median duration of follow-up was 12.0 months (range, 1.9–44.8 months), and the median survival time 18.7 months. Four patients with six lesions had local recurrences. The local control rate in the 64 assessed patients was 98.4% and 95.3% at 6 and 12 months, respectively (three died before assessment). The local control rate for the 572 assessed lesions was 99.8% and 99.3% at 6 and 12 months, respectively. Thirty-nine patients developed distant brain metastases, the distant brain control rate being 59.7% and 40.5% at 6 and 12 months, respectively. Acute toxicities were generally mild (Grade 1–2). Three patients (4.5%) developed radiation necrosis requiring corticosteroid therapy. The HFIGMI–VMAT technique with flat dose delivery was well tolerated and achieved excellent local control. This technique is a promising treatment option for patients with multiple and large brain metastases.

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A new paradigm in treatment of brain metastases

Cited by 6 publications

References 151 publications

Distribution of metastatic disease in the brain in relation to the hippocampus: a retrospective single-center analysis of 6064 metastases in 632 patients

Distribution of metastatic disease in the brain in relation to the hippocampus: a retrospective single-center analysis of 6064 metastases in 632 patients

Distribution of metastasis in the brain in relation to the hippocampus: a retrospective single-center analysis of 565 metastases in 116 patients

Clinical outcomes of hypofractionated image-guided multifocal irradiation using volumetric-modulated arc therapy for brain metastases

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