Presentation, patterns of care, and survival in patients with brain metastases

Nieder, Carsten; Spanne, Oddvar; Mehta, Minesh P.; Grosu, Anca L.; Geinitz, Hans

doi:10.1002/cncr.25707

Cited by 181 publications

(132 citation statements)

References 23 publications

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“…1 Primary malignancies most commonly associated with brain metastases are lung, breast, and gastrointestinal cancers and melanoma, constituting up to 80% of brain metastases. [1][2][3] Management of brain metastases often consists of tumor-directed treatment with radiotherapy (RT). Traditionally, RT had been administered with conventionally fractionated whole-brain RT (WBRT), although over the past several decades, stereotactic radiosurgery (SRS), targeted at individual cranial lesions, has become accepted.…”

mentioning

confidence: 99%

Radiosurgery for Brain Metastases: Changing Practice Patterns and Disparities in the United States

Kann¹,

Park²,

Johnson³

et al. 2017

J Natl Compr Canc Netw

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Background: Management of brain metastases typically includes radiotherapy (RT) with conventional fractionation and/or stereotactic radiosurgery (SRS). However, optimal indications and practice patterns for SRS remain unclear. We sought to evaluate national practice patterns for patients with metastatic disease receiving brain RT. Methods: We queried the National Cancer Data Base (NCDB) for patients diagnosed with metastatic non-small cell lung cancer, breast cancer, colorectal cancer, or melanoma from 2004 to 2014 who received upfront brain RT. Patients were divided into SRS and non-SRS cohorts. Patient and facility-level SRS predictors were analyzed with chi-square tests and logistic regression, and uptake trends were approximated with linear regression. Survival by diagnosis year was analyzed with the Kaplan-Meier method. Results: Of 75,953 patients, 12,250 (16.1%) received SRS and 63,703 (83.9%) received non-SRS. From 2004 to 2014, the proportion of patients receiving SRS annually increased (from 9.8% to 25.6%; P<.001), and the proportion of facilities using SRS annually increased (from 31.2% to 50.4%; P<.001). On multivariable analysis, nonwhite race, nonprivate insurance, and residence in lowerincome or less-educated regions predicted lower SRS use (P<.05 for each). During the study period, SRS use increased disproportionally among patients with private insurance or who resided in higher-income or higher-educated regions. From 2004 to 2013, 1-year actuarial survival improved from 24.1% to 49.6% for patients selected for SRS and from 21.0% to 26.3% for non-SRS patients (P<.001). Conclusions: This NCDB analysis demonstrates steadily increasing-although modest overall-brain SRS use for patients with metastatic disease in the United States and identifies several progressively widening sociodemographic disparities in the adoption of SRS. Further research is needed to determine the reasons for these worsening disparities and their clinical implications on intracranial control, neurocognitive toxicities, quality of life, and survival for patients with brain metastases.

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mentioning

confidence: 99%

Radiosurgery for Brain Metastases: Changing Practice Patterns and Disparities in the United States

Kann¹,

Park²,

Johnson³

et al. 2017

J Natl Compr Canc Netw

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“…Es la complicación más frecuente en los pacientes oncológicos 24 ; así mismo, es la neoplasia más frecuente del SNC 25 .…”

Section: Metástasis En Sncunclassified

Diagnóstico diferencial de lesiones cerebrales con realce en anillo en tomografía computarizada y resonancia magnética

Aljure

Arias

Monroy

et al. 2016

Duazary

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RESUMENLa tomografía computarizada y la resonancia magnética nuclear son técnicas imagenológicas de diagnóstico médico que ofrecen información excelente de diferentes procesos infecciosos, traumáticos o tumorales de cualquier parte del cuerpo humano. Con ellos se permitió la identificación de innumerables patologías y patrones característicos de las mismas, siendo una de ellas, el realce en anillo en el Sistema Nervioso Central. Numerosas patologías presentan este patrón imagenológico: Glioblastoma multiforme, síndromes desmielinizantes, metástasis, abscesos cerebrales, toxoplasmosis cerebral, neurocisticercosis, linfomas, entre otros. El objetivo del presente artículo es brindar una revisión general de las patologías más frecuentes en los servicios de imagenología, permitiendo su correlación con las características clínicas y brindando una ayuda al clínico que para establecer un diagnóstico adecuado. Palabras clave: Neuroimagen; Diagnóstico Diferencial; Encefalopatías ABSTRACTComputed tomography and magnetic resonance imaging are medical diagnostic imaging techniques that provide excellent information from different infectious, traumatic or tumor processes anywhere in the body. It is identifying with them many diseases and characteristic patterns of them, one of them the ring enhancement in the central nervous system allowed. Many diseases have this imaging pattern: Glioblastoma multiforme, demyelinating syndromes, metastases, brain abscesses, cerebral toxoplasmosis, neurocysticercosis, lymphomas, and others. The objective of this article is to provide an overview of the most common diseases in imaging services, allowing its correlation with clinical features and providing aid to the clinician to establish a proper diagnosis.

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“…Whole brain radiation therapy (WBRT) is effective, but results in significant neurocognitive side effects for many patients, especially in terms of verbal memory. As survival for patients with metastatic brain disease increases,1, 2 approaches to spare neurocognition have become an intense area of study. Focal radiation with stereotactic radiosurgery (SRS) is one approach that results in less neurocognitive impairment,3 but is not an option for many patients with more diffuse metastatic disease.…”

Section: Introductionmentioning

confidence: 99%

Assessment of multi‐criteria optimization (MCO) for volumetric modulated arc therapy (VMAT) in hippocampal avoidance whole brain radiation therapy (HA‐WBRT)

Zieminski

Khandekar

Wang

2018

J Applied Clin Med Phys

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This study compared the dosimetric performance of (a) volumetric modulated arc therapy (VMAT) with standard optimization (STD) and (b) multi‐criteria optimization (MCO) to (c) intensity modulated radiation therapy (IMRT) with MCO for hippocampal avoidance whole brain radiation therapy (HA‐WBRT) in RayStation treatment planning system (TPS). Ten HA‐WBRT patients previously treated with MCO‐IMRT or MCO‐VMAT on an Elekta Infinity accelerator with Agility multileaf collimators (5‐mm leaves) were re‐planned for the other two modalities. All patients received 30 Gy in 15 fractions to the planning target volume (PTV), namely, PTV30 expanded with a 2‐mm margin from the whole brain excluding hippocampus with margin. The patients all had metastatic lesions (up to 12) of variable sizes and proximity to the hippocampus, treated with an additional 7.5 Gy from a simultaneous integrated boost (SIB) to PTV37.5. The IMRT plans used eight to eleven non‐coplanar fields, whereas the VMAT plans used two coplanar full arcs and a vertex half arc. The averaged target coverage, dose to organs‐at‐risk (OARs) and monitor unit provided by the three modalities were compared, and a Wilcoxon signed‐rank test was performed. MCO‐VMAT provided statistically significant reduction of D100 of hippocampus compared to STD‐VMAT, and Dmax of cochleas compared to MCO‐IMRT. With statistical significance, MCO‐VMAT improved V30 of PTV30 by 14.2% and 4.8%, respectively, compared to MCO‐IMRT and STD‐VMAT. It also raised D95 of PTV37.5 by 0.4 Gy compared to both MCO‐IMRT and STD‐VMAT. Improved plan quality parameters such as a decrease in overall plan Dmax and total monitor units (MU) were also observed for MCO‐VMAT. MCO‐VMAT is found to be the optimal modality for HA‐WBRT in terms of PTV coverage, OAR sparing and delivery efficiency, compared to MCO‐IMRT or STD‐VMAT.

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Presentation, patterns of care, and survival in patients with brain metastases

Cited by 181 publications

References 23 publications

Radiosurgery for Brain Metastases: Changing Practice Patterns and Disparities in the United States

Radiosurgery for Brain Metastases: Changing Practice Patterns and Disparities in the United States

Diagnóstico diferencial de lesiones cerebrales con realce en anillo en tomografía computarizada y resonancia magnética

Assessment of multi‐criteria optimization (MCO) for volumetric modulated arc therapy (VMAT) in hippocampal avoidance whole brain radiation therapy (HA‐WBRT)

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