Surgical treatment of brain metastasis: A review

Mut, Melike

doi:10.1016/j.clineuro.2011.10.013

Cited by 83 publications

(64 citation statements)

References 83 publications

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“…It is, however, conspicuously better than that seen in the adult population, as overall median survival following CNS metastasis in adults can range up to 12-15 months with adequate surgical intervention, whole-brain radiotherapy, and adjuvant chemotherapy, but it is more typically in the range of 4-8 months, and can be as low as 1-2 months in the absence of treatment. 7,13,16 Patients with a nephroblastoma/Wilms tumor had the longest overall survival and the longest survival after diagnosis of the CNS metastasis in our series. Overall, clinical outcome was poor but slightly better than reported in previous studies.…”

Section: Discussionmentioning

confidence: 92%

“…Adult CNS metastases are similarly most common in the cerebral hemispheres, corresponding to vascular distribution and tissue volumes, and they are often symptomatic. 6,13,16 At the time that CNS involvement is diagnosed, the presence of metastases in other organs, particularly lungs, is common in the pediatric population, and, as expected, prognosis for pediatric CNS metastases is poor despite aggressive therapy for primary malignant disease and metastatic disease. It is, however, conspicuously better than that seen in the adult population, as overall median survival following CNS metastasis in adults can range up to 12-15 months with adequate surgical intervention, whole-brain radiotherapy, and adjuvant chemotherapy, but it is more typically in the range of 4-8 months, and can be as low as 1-2 months in the absence of treatment.…”

Section: Discussionmentioning

confidence: 99%

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The pathological spectrum of solid CNS metastases in the pediatric population

Wiens

Hattab²

2014

PED

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Object Collectively, metastatic tumors are the most common malignancy encountered in the adult central nervous system (CNS), arising most often from lung, breast, skin, and gastrointestinal tract carcinomas. Limited information is available in the literature regarding solid nonhematopoietic CNS metastases in children. The authors carried out a retrospective study of pediatric metastatic neoplasms to the CNS treated in a 30-year period to characterize their frequency, common histological subtypes, and sites of origin. Methods The archival pathology files were searched (1981–2011) for metastatic tumors to the CNS in patients 21 years of age and younger. Pathology material was reviewed, tumors were classified by site of origin and histological subtype, and survival was evaluated. Results The authors identified 26 patients with solid nonhematopoietic CNS metastases out of 1135 pediatric CNS tumors diagnosed from 1981 to 2011. Patients ranged in age from 1.5 to 20.3 years and were equally divided between sexes. Most CNS metastases were supratentorial (85%) and solitary (65%). The mean interval from primary malignant diagnosis to CNS metastasis was 27 months. Sites of origin included kidney/adrenal, bone/soft tissue, gonads, head and neck, lung, and liver. Mean survival after CNS involvement was 36.6 months. Overall 1-year and 5-year survival rates were 52% and 16%, respectively. Conclusions In neuropathology practice, nonhematopoietic pediatric CNS metastases are far less common than are nonhematopoietic adult CNS metastases, accounting for approximately 2% of all pediatric CNS tumors. The most common tumors to exhibit CNS metastasis are of kidney/adrenal origin, followed by those from bone/soft tissue. As expected, prognosis is dismal, despite aggressive therapy.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

The pathological spectrum of solid CNS metastases in the pediatric population

Wiens

Hattab²

2014

PED

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“…33 Intraoperative NIR imaging may aid in resection of these challenging tumors. 19,[26][27][28][29][30][31][32][33][34][35][36][37][38][39] The long-term interest in the intraoperative NIR fluorescence visualization is driven by the development of new agents capable of improved delineation of brain tumor margins. Examples of dyes include various derivatives of NIR fluorescent dye currently undergoing preclinical or clinical evaluations, such as BLZ-100, a chlorotoxin-ICG conjugate; 36,37 CLR1502, an alkylphopholine derivative of a cyanine dye; 40,41 anti-EGFR antibody fragments conjugated to IRDye 800 CW; 42,43 and others.…”

Section: Discussionmentioning

confidence: 99%

“…Current treatment modalities include surgical resection of tumors and their adjacent tissue, which often contains infiltrative neoplastic cells. 34,35 Aggressive resection is associated with the risk of removing normal brain tissue and impairing functions of the patient. On the other hand, incomplete resection of tumor results in its immediate relapse in 90% of patients.…”

Section: Discussionmentioning

confidence: 99%

Augmented microscopy: real-time overlay of bright-field and near-infrared fluorescence images

et al. 2015

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Abstract. Intraoperative applications of near-infrared (NIR) fluorescent contrast agents can be aided by instrumentation capable of merging the view of surgical field with that of NIR fluorescence. We demonstrate augmented microscopy, an intraoperative imaging technique in which bright-field (real) and electronically processed NIR fluorescence (synthetic) images are merged within the optical path of a stereomicroscope. Under luminance of 100,000 lx, representing typical illumination of the surgical field, the augmented microscope detects 189 nM concentration of indocyanine green and produces a composite of the real and synthetic images within the eyepiece of the microscope at 20 fps. Augmentation described here can be implemented as an add-on module to visualize NIR contrast agents, laser beams, or various types of electronic data within the surgical microscopes commonly used in neurosurgical, cerebrovascular, otolaryngological, and ophthalmic procedures.

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“…sites accessible to surgical treatment. Hence the resectability of the tumor is usually limited by adjacent functionally important regions and surgical technique, although good performance status and controlled extracranial disease remain a precondition for this approach 15,16 . Surgery allows prompt removal of tumor causing perifocal edema and especially for tumors larger than 3 cm, particularly in the posterior fossa 16 and also provides information on tumor histology.…”

Section: Treatment Of Brain Metastases In Patients With Favorable Promentioning

confidence: 99%

Treatment of brain metastases

Matzenauer¹,

Vrána²,

Melichar³

2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Brain metastases are a very common neurological sequela in cancer patients. The ability of current anticancer therapies to prolong overall survival is beleaguered by this development in the case of a number of different cancers. This review provides a general overview of relevant treatment modalities, highlights major decision strategies used in selecting the optimal treatment algorithm and summarizes important steps necessary before initiating therapy. Methods. A PubMed database search was done to identify publications describing the treatment of brain metastases including surgery, radiotherapy and symptomatic care. Results and Conclusion. Patient performance status and extent of disease play the most important roles in selecting between an aggressive or more conservative approach. As several other options are available, treatment decisions should be made in cooperation with multiple medical specialties and the involvement of multidisciplinary teams. In the future, brain metastases could become less of a treatment obstacle than they are today.

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Surgical treatment of brain metastasis: A review

Cited by 83 publications

References 83 publications

The pathological spectrum of solid CNS metastases in the pediatric population

The pathological spectrum of solid CNS metastases in the pediatric population

Augmented microscopy: real-time overlay of bright-field and near-infrared fluorescence images

Treatment of brain metastases

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