Biliary cancer brain metastases: a multi-institution case series with case reports

Falkson, Samuel R.; Zhang, Karen; Bhambhvani, Hriday P.; Wild, Jennifer L.; Griffin, A. Clark; Kelley, Robin K.; Gephart, Melanie Hayden

doi:10.21037/jgo-21-818

Cited by 4 publications

(7 citation statements)

References 28 publications

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“…Compared to lung, renal, and breast cancers, HPB brain metastases are rare [1,2]. The improved systemic management of these cancers has resulted in improved survival and recognition of the potential for late brain metastases.…”

Section: Discussionmentioning

confidence: 99%

“…Brain metastases from hepatocellular carcinoma (HCC), cholangiocarcinoma (CCC), and pancreatic carcinoma (PCC) are very rare, with incidence rates of 0.2-2.2%, 0.5-1.4%, and 0.3-0.6%, respectively [1][2][3]. The onset of brain metastases from these primary malignancies often represents a late manifestation of the primary disease.…”

Section: Introductionmentioning

confidence: 99%

“…The onset of brain metastases from these primary malignancies often represents a late manifestation of the primary disease. The prognosis of patients with brain metastases from these malignancies is poor, with survivals after diagnosis of brain spread ranging between 1 and 8.4 months, 2.5 and 3.7 months, and 3.9 and 7.4 months for HCC, CCC, and PCC, respectively [1,2,4]. In recent years, the development of advanced systemic treatment therapies, and consequently longer potential survivals, has led to the increased recognition of brain metastases from these malignancies [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…The prognosis of patients with brain metastases from these malignancies is poor, with survivals after diagnosis of brain spread ranging between 1 and 8.4 months, 2.5 and 3.7 months, and 3.9 and 7.4 months for HCC, CCC, and PCC, respectively [1,2,4]. In recent years, the development of advanced systemic treatment therapies, and consequently longer potential survivals, has led to the increased recognition of brain metastases from these malignancies [1,2]. There is currently no established guideline for the management of patients with brain metastases of hepatopancreaticobiliary (HPB) origin [5].…”

Section: Introductionmentioning

confidence: 99%

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Stereotactic Radiosurgery for Patients with Brain Metastases from Hepatopancreaticobiliary Cancers

Wei,

Srinivasan,

Patel

et al. 2024

Cancers

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Background: The role of stereotactic radiosurgery (SRS) for patients with brain metastases from hepatopancreaticobiliary (HPB) cancers has yet to be established. The authors present a single-institution experience of patients with HPB cancers who underwent SRS when their cancer spread to the brain. Methods: We surveyed our Gamma Knife SRS data base of 18,000 patients for the years 1987–2022. In total, 19 metastatic HPB cancer patients (13 male) with 76 brain metastases were identified. The median age at SRS was 61 years (range: 48–83). The primary cancer sites were hepatocellular carcinoma (HCC, 11 patients), cholangiocarcinoma (CCC, 2 patients), and pancreatic carcinoma (PCC, 6 patients). The median Karnofsky Performance Score (KPS) was 80 (range: 50–90). Two patients underwent pre-SRS whole-brain fractionated radiation therapy (WBRT) and eight patients underwent pre-SRS surgical resection. All SRS was delivered in single session. The median margin dose was 18 Gy (range: 15–20). The median cumulative tumor volume was 8.1 cc (range: 1.0–44.2). Results: The median patient overall survival (OS) after SRS was 7 months (range 1–79 months). Four patients had documented local tumor progression after SRS at a median time of 8.5 months (range: 2–15) between SRS and progression. Out of 76 treated tumors, 72 tumors exhibited local control. The local tumor control rate per patient was 78.9%. The local tumor control per tumor was 94.7%. Four patients developed new brain metastases at a median of 6.5 months (range: 2–17) after SRS. No patient experienced adverse radiation effects (AREs). At the last follow-up, 18 patients had died, all from systemic disease progression. Conclusions: Metastatic spread to the brain from HPB cancers occurs late in the course of the primary disease. In this study, all deceased patients ultimately died from primary disease progression. SRS is a non-invasive strategy that maximally preserves quality of life, and our results reported favorable outcomes compared to the existing literature. SRS should be considered as one of the primary management strategies for patients with brain metastatic spread from HPB cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Stereotactic Radiosurgery for Patients with Brain Metastases from Hepatopancreaticobiliary Cancers

Wei,

Srinivasan,

Patel

et al. 2024

Cancers

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“…Retrospective analyses by Falkson et al and Frega et al reported median OS times of approximately 7 and 3 months, respectively, highlighting the complexity of treatment decisions. [3,7] Supportive care remains the predominant treatment modality for brain metastasis, constituting 47% of the cohorts. [8] For patients tolerating therapies, local treatments such as neurosurgical resection, stereotactic radiosurgery (SRS), and whole-brain radiation therapy (WBRT) are considered as treatment options.…”

Section: Discussionmentioning

confidence: 99%

Unveiling the unprecedented – Very late brain metastasis in cholangiocarcinoma: A case report and comprehensive analysis

Cha,

Lee,

Jang

et al. 2024

Medicine

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Rationale: Cholangiocarcinoma (CCA) frequently invades nearby lymph nodes, the liver, and lungs. The liver and lungs are also common anatomic sites for the first recurrence of CCA. However, metastasis to the brain is exceptionally rare. Patient concerns: A 79-year-old male patient who was diagnosed with distal CCA and underwent pylorus-preserving pancreaticoduodenectomy along with adjuvant chemotherapy 13-years ago visited the neurosurgery outpatient department. He complained of dysarthria and right leg weakness that had started 7 days previously. Diagnoses: Brain computed tomography (CT) showed a 32 mm × 28 mm mass in the left frontal lobe with peripheral ring enhancement and vasogenic edema. A tumor mass removal operation was performed, and pathological examination revealed metastatic adenocarcinoma. Immunohistochemistry analysis revealed negativity for thyroid transcription factor-1 and napsin A, and positivity for cytokeratin (CK)7, CK20, and CK19. Simultaneously, Chest CT, abdomen–pelvis CT and 18-Fluoro-deoxyglucose positron emission tomography showed only two small nodules in the left upper lung, with no evidence of locoregional recurrence in the abdominal cavity. Considering these CT, positron emission tomography-CT, and pathologic findings, very late recurrence of biliary tract cancer with brain and lung metastases was suggested. Interventions and outcomes: A therapeutic plan involving systemic chemotherapy with gemcitabine and cisplatin was proposed, but the patient refused further chemotherapy. Lessons: This case highlights the unpredictable nature of metastatic patterns in CCA, where brain metastasis occurs very late, preceding locoregional recurrence in the liver. This challenges conventional expectations and underscores the need for vigilant surveillance and consideration of atypical metastatic sites in long-term survivors of CCA.

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Antineoplastics/folinic acid/hydroxychloroquine

2023

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Biliary cancer brain metastases: a multi-institution case series with case reports

Cited by 4 publications

References 28 publications

Stereotactic Radiosurgery for Patients with Brain Metastases from Hepatopancreaticobiliary Cancers

Stereotactic Radiosurgery for Patients with Brain Metastases from Hepatopancreaticobiliary Cancers

Unveiling the unprecedented – Very late brain metastasis in cholangiocarcinoma: A case report and comprehensive analysis

Antineoplastics/folinic acid/hydroxychloroquine

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