Brain Edema in Neurooncology: Radiological Assessment and Management

Wick, Wolfgang; Küker, Wilhelm

doi:10.1159/000077976

Cited by 55 publications

(51 citation statements)

References 36 publications

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“…Symptomatic patients generally require steroids, but in our patient group corticosteroids were also used to prevent edema in WBRT or SRS. Dexamethasone effectively minimizes neurological symptoms and radiotherapy-related side effects, but the associated side effects such as metabolic changes, Pneumocystis carinii pneumonia and thromboembolism itself increase over time [36]. As in previous analyses the question of survival misbenefit was not considered, and therefore future analysis regarding the use of corticosteroids as preventive agents is required.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors and Impact of Treatment in Melanoma Brain Metastases: Better Prognosis for Women?

Hofmann¹,

Coll²,

Küchler

et al. 2007

Dermatology

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Background: Brain metastases are a common consequence in patients with stage IV melanoma associated with a grim prognosis. Objective: The objective of this study was the examination of prognostic factors and the evaluation of different treatment options. Methods: A consecutive series of 133 patients with melanoma brain metastases with regard to prognostic factors and the impact on survival were analyzed. Results: 82 patients had involvement of only the cerebrum at the initial diagnosis, whereas in 7 patients only the cerebellum and the brainstem were involved. Seizures (n = 29) were the single most often reported symptom. The overall median survival time was 24 weeks (1–196) from diagnosis of brain metastases. Women had a significantly longer survival with 36 weeks (3–196) compared to 17 weeks (1–159) for men. Multivariate analysis has established as significant prognostic factors: female gender, number of brain metastases, surgery, chemotherapy, radiotherapy and corticosteroid application. Conclusion: With regard to the prognostic factors, an improved survival can be achieved in this patient group using more elective treatment options, also with emphasis on corticosteroids.

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Section: Discussionmentioning

confidence: 99%

Prognostic Factors and Impact of Treatment in Melanoma Brain Metastases: Better Prognosis for Women?

Hofmann¹,

Coll²,

Küchler

et al. 2007

Dermatology

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show abstract

“…It is induced by various conditions such as cerebral ischemia, 1 physical damage, 2 central nervous system infections, 3 and brain tumors. 4 Brain edema sometimes leads to high intracranial pressure and deterioration of the patient's condition.…”

mentioning

confidence: 99%

Vascular Endothelial Growth Factor Antagonist Reduces Brain Edema Formation and Venous Infarction

Kimura

Nakase

Tamaki

et al. 2005

Stroke

100

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Background and Purpose-Cerebral venous ischemia often induces severe brain edema. Vascular endothelial growth factor (VEGF), which induces angiogenesis, is also known as vascular permeability (VP) factor. The present study was undertaken to investigate whether the inhibition of VEGF could reduce brain edema formation and cerebral venous infarction (CVI) in a rat 2-vein occlusion (2-VO) model. Methods-We used 2-VO model in which 2 adjacent cortical veins were photochemically occluded. Male Wistar rats (nϭ25) were divided into 2 groups: one group was treated with a VEGF antagonist (antagonist group, nϭ10) and the second group was treated with phosphate-buffered solution (PBS) (PBS group, nϭ15). VEGF antagonist or PBS was injected intraperitoneally immediately after 2-VO. The developing ischemic infarct was evaluated by magnetic resonance imaging (MRI) and histology 24 hours after occlusion. Results-VEGF expression was observed in the cytoplasm of neurons exclusively in the area of vasogenic edema that was shown as a high-intensity area in the apparent diffusion coefficient of water map. Ischemic volumes calculated from each MR images, which are related to infarction and/or vasogenic edema, respectively, were significantly smaller in the antagonist group as compared with the PBS group (PϽ0.05) Conclusions-Our study is the first to provide evidence that the inhibition of VEGF attenuates VP and reduces CVI in the acute stage. Although VEGF is a significant angiogenesis factor, we concluded that the inhibition of VEGF might be a new therapy for both brain edema formation and CVI.

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“…Regarding lung cancer, little is known about the frequency and size distribution of peritumoral brain edema and its clinical relevance regarding OS [7,8]. In our brain metastasectomy group, patients with thicker peritumoral edema had longer survival, partly explained by earlier neurological symptoms requiring urgent neurosurgical intervention.…”

Section: Discussionmentioning

confidence: 90%

Significance of Primary Tumor Location and Histology for Brain Metastasis Development and Peritumoral Brain Edema in Lung Cancer

et al. 2016

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Background: Brain metastasis of lung cancer adversely affects overall survival (OS) and quality of life, while peritumoral brain edema is responsible for life-threatening complications. Methods: We retrospectively analyzed the clinicopathological and cerebral radiological data of 575 consecutive lung cancer patients with brain metastases. Results: In adenocarcinoma and squamous cell carcinoma, peritumoral brain edema was more pronounced than in small-cell lung cancer (p < 0.001 and p < 0.001, respectively). There was a positive correlation between the size of metastasis and the thickness of peritumoral brain edema (p < 0.001). It was thicker in supratentorial tumors (p = 0.019), in younger patients (≤50 years) (p = 0.042), and in females (p = 0.016). The time to development of brain metastasis was shorter in central than in peripheral lung cancer (5.3 vs. 9.0 months, p = 0.035). Early brain metastasis was characteristic for adenocarcinomas. A total of 135 patients had brain only metastases (N0 disease) characterized by peripheral lung cancer predominance (p < 0.001) and a longer time to development of brain metastasis (9.2 vs. 4.4 months, p < 0.001). OS was longer in the brain only subgroup than in patients with N1-3 diseases (p < 0.001). Conclusions: The clinicopathological characteristics of lung cancer are related to the development and radiographic features of brain metastases. Our results might be helpful in selecting patients who might benefit from prophylactic cranial irradiation.

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Brain Edema in Neurooncology: Radiological Assessment and Management

Cited by 55 publications

References 36 publications

Prognostic Factors and Impact of Treatment in Melanoma Brain Metastases: Better Prognosis for Women?

Prognostic Factors and Impact of Treatment in Melanoma Brain Metastases: Better Prognosis for Women?

Vascular Endothelial Growth Factor Antagonist Reduces Brain Edema Formation and Venous Infarction

Significance of Primary Tumor Location and Histology for Brain Metastasis Development and Peritumoral Brain Edema in Lung Cancer

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