Treatment of Brain Metastases From Gastrointestinal Primaries: Comparing Whole Brain Radiotherapy and Stereotactic Radiosurgery in Terms of Survival

Dinçer, Selvi Tabak

doi:10.14744/nci.2021.65725

Cited by 3 publications

(4 citation statements)

References 39 publications

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“…Prognosis is often dismal with overall survival after BMs of a mere 5 months. [2] Tuberculosis is considered to be a commonly transmittable diseases worldwide including in Taiwan. Though the incidence of new cases decreases annually in Taiwan, there were still over 7000 tuberculosis cases in 2021.…”

Section: Discussionmentioning

confidence: 99%

“…Detection of BMs in esophageal carcinoma is (1.4%–1.8%), in gastric carcinomas (0.16%–0.69%), in hepatic carcinomas (1.3%–2.9%), in pancreatic carcinoma (0.1%–0.3%), and in carcinoma of the gallbladder (<0.5%) which have all been previously established. [2] Brain metastases cause a wide range of symptoms based on the location, size, and rate of growth of the tumors, with the most common symptoms including headaches, mental changes, or focal neurologic deficits including changes in vision.…”

Section: Introductionmentioning

confidence: 99%

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Visual change as the presenting symptom of a suspected metastatic brain lesion in esophageal cancer: A case report

Hsieh,

2023

Medicine

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Introduction: Esophageal cancer is the seventh most common malignancy worldwide and the sixth leading cause of cancer mortality with an overall survival rate of <20%. Esophageal cancer frequently metastasizes to distant lymph nodes, lungs, liver, and bones. Cerebral metastases originating from esophageal cancer are rare and often carry a poor prognosis as do most all metastatic lesions in esophageal cancer. Case presentation: In this report, we describe a 55-year-old patient with past history of esophageal carcinoma who presented with blurred vision after taking ethambutol for tuberculosis. Ethambutol-induced optic neuropathy was the lead diagnosis. Initial vision testing was normal so additional testing with visual field examination was warranted. The visual field examination revealed homonymous hemianopsia. Subsequent magnetic resonance imaging of his brain, demonstrated a focal lesion, consistent with but not diagnostic of a brain metastasis likely from his primary esophageal malignancy. Conclusion: We conclude that a careful review of the medical history and comprehensive assessment are essential in establishing an obscure clinical diagnosis especially in the event that an uncommon metastatic lesion is encountered.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Visual change as the presenting symptom of a suspected metastatic brain lesion in esophageal cancer: A case report

Hsieh,

2023

Medicine

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“…However, there are a few types of BM that are relatively radioresistant. These include BM from melanoma, renal cell carcinoma, sarcoma, and gastrointestinal cancers [ 13 , 14 ]. Primary malignant brain tumors [ 15 ] are often initially responsive to radiation, but the high-grade tumors which represent the majority of primary brain tumors eventually recur despite high initial doses of RT.…”

Section: Radioresistancementioning

confidence: 99%

Biological Insights and Radiation–Immuno–Oncology Developments in Primary and Secondary Brain Tumors

Gregucci,

Beal,

Knisely

et al. 2024

Cancers

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Malignant central nervous system (CNS) cancers include a group of heterogeneous dis-eases characterized by a relative resistance to treatments and distinguished as either primary tumors arising in the CNS or secondary tumors that spread from other organs into the brain. Despite therapeutic efforts, they often cause significant mortality and morbidity across all ages. Radiotherapy (RT) remains the main treatment for brain cancers, improving associated symptoms, improving tumor control, and inducing a cure in some. However, the ultimate goal of cancer treatment, to improve a patient’s survival, remains elusive for many CNS cancers, especially primary tumors. Over the years, there have thus been many preclinical studies and clinical trials designed to identify and overcome mechanisms of resistance to improve outcomes after RT and other therapies. For example, immunotherapy delivered concurrent with RT, especially hypo-fractionated stereotactic RT, is synergistic and has revolutionized the clinical management and outcome of some brain tumors, in particular brain metastases (secondary brain tumors). However, its impact on gliomas, the most common primary malignant CNS tumors, remains limited. In this review, we provide an overview of radioresistance mechanisms, the emerging strategies to overcome radioresistance, the role of the tumor microenviroment (TME), and the selection of the most significant results of radiation–immuno–oncological investigations. We also identify novel therapeutic opportunities in primary and secondary brain tumors with the purpose of elucidating current knowledge and stimulating further research to improve tumor control and patients’ survival.

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“…Several comparative studies showed that stereotactic radiotherapy (SRT) showed advantages in tumour control or quality of life for patients with BM compared with WBRT [ 3 – 5 ]. In SRT for patients with BM can be delivered as either a single fraction (usually 18 to 24 Gy) of highly conformal and high-dose treatment or as a fractionated SRT, ranging from 24 to 30 Gy in 3 fractions or 25 to 35 Gy in 5 fractions [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Dose-effect relationship of linear accelerator based stereotactic radiotherapy for brain metastases

Wu,

Wang,

Guo

et al. 2023

Radiat Oncol

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Objective The purpose of this study is to reveal the dose-effect relationship of linear accelerator (LINAC)-based stereotactic radiotherapy (SRT) in patients with brain metastases (BM). Materials and methods The PubMed, Cochrane, and Web of Science databases were used to identify studies that reported local tumour control after LINAC-based SRT in patients with BMs. Studies of other approaches that could affect local tumour control, such as whole brain radiotherapy, targeted therapy, and immunotherapy, were excluded from the dose-effect relationship analysis. Data extracted included patient and treatment characteristics and tumour local control. Probit model in XLSTAT 2016 was used for regression analysis, and P < 0.05 was set as the statistically significant level. Results After literature screening, 19 eligible studies involving 1523 patients were included in the probit model regression analysis. There was no significant dose-effect relationship between nominal BED10 and peripheral BED10 versus 12-month local control probability. There were significant dose effect relationships between the centre BED10 and the average BED10 versus the 12-month local control probability, with P values of 0.015 and 0.011, respectively. According to the model, the central BED10 and the average BED10 corresponding to probabilities of 90% 12-month local control were 109.2 GyBED10 (95% confidence interval (CI): 88.7–245.9 GyBED10) and 87.8 GyBED10 (95% CI: 74.3–161.5 GyBED10), respectively. A 12-month local control rate of 86.9% (95% CI: 81.7–89.7%) and 85.5% (95% CI: 81.2–89.2%) can be expected at a centre BED10 of 80 Gy and an average BED10 of 60 Gy, respectively. Conclusion For patients with BM treated with LINAC-based SRT, more attention should be given to the central and average doses of PTV. A clear definition of the dose prescription should be established to ensure the effectiveness and comparability of treatment.

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Treatment of Brain Metastases From Gastrointestinal Primaries: Comparing Whole Brain Radiotherapy and Stereotactic Radiosurgery in Terms of Survival

Cited by 3 publications

References 39 publications

Visual change as the presenting symptom of a suspected metastatic brain lesion in esophageal cancer: A case report

Visual change as the presenting symptom of a suspected metastatic brain lesion in esophageal cancer: A case report

Biological Insights and Radiation–Immuno–Oncology Developments in Primary and Secondary Brain Tumors

Dose-effect relationship of linear accelerator based stereotactic radiotherapy for brain metastases

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