A 3D quantitative imaging biomarker in pre-treatment MRI predicts overall survival after stereotactic radiation therapy of patients with a singular brain metastasis.

A 3D quantitative imaging biomarker in pre-treatment MRI predicts overall survival after stereotactic radiation therapy of patients with a singular brain metastasis. Acta Radiol. 2019 Mar 06;:284185119831692 Authors: Della Seta M, Collettini F, Chapiro J, Angelidis A, Engeling F, Hamm B, Kaul D Abstract BACKGROUND: Brain metastases (BM) are the most frequent intracranial malignant tumor. Various prognostic factors facilitate the prediction of survival; however, few have become tools for clinical use. PURPOSE: To investigate the role of three-dimensional (3D) quantitative tissue enhancement in pre-treatment cranial magnetic resonance imaging (MRI) as a radiomic biomarker for survival (OS) in patients with singular BM treated with stereotactic radiation therapy (SRT). MATERIAL AND METHODS: In this retrospective study, 48 patients (27 non-small cell lung cancer and 21 melanoma) with singular BM treated with SRT, were analyzed. Contrast-enhanced MRI scans of the neurocranium were used for quantitative image analyses. Segmentation-based 3D quantification was performed to measure the enhancing tumor volume. A cut-off value of 68.61% of enhancing volume was used to stratify the cohort into two groups (≤68.61% and > 68.61%). Univariable and multivariable cox regressions were used to analyze the prognostic factors of OS and intracranial progression-free survival (iPFS). RESULTS: The level of enhancing tumor volume achieved stati...
Source: Acta Radiologica - Category: Radiology Authors: Tags: Acta Radiol Source Type: research

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A long time ago, metastatic brain tumors were often not treated and patients were only given palliative care. In the past decade, researchers selected those with single or 1-3 metastases for more aggressive treatments like surgical resection, and/or stereotactic radiosurgery (SRS), since the addition of whole brain radiotherapy (WBRT) did not increase overall survival for the vast majority of patients. Different studies demonstrated significantly less cognitive deterioration in 0-52% patients after SRS versus 85-94% after WBRT at 6 months. WBRT is the treatment of choice for leptomeningeal metastases. WBRT can lower the ri...
Source: Current Cancer Therapy Reviews - Category: Cancer & Oncology Source Type: research
Nature Reviews Neurology, Published online: 01 September 2020; doi:10.1038/s41582-020-0391-xThis Review outlines the advances of molecular treatment of brain metastases from non-small-cell lung cancer, breast cancer and melanoma. Substantial improvements in survival have been achieved in patients with molecular subgroups whose alterations can be targeted with specific molecular compounds.
Source: Nature Reviews Neurology - Category: Neurology Authors: Source Type: research
Abstract Brain metastasis (BM) is associated with a poor prognosis, with the typical overall survival rate ranging from weeks to months in the absence of treatment. Although the concept of immune privilege in the central nervous system has eroded over time, the advent of immunotherapy has opened a new set of potential therapeutic options for patients with BM. Recently, immunotherapy has been demonstrated to confer survival advantages to patients with multiple malignancies commonly associated with BMs. Data from a number of clinical trials have demonstrated that immune checkpoint inhibitors are effective for patien...
Source: International Journal of Oncology - Category: Cancer & Oncology Authors: Tags: Int J Oncol Source Type: research
Randomized controlled trials have failed to report any survival advantage for WBRT combined with SRS in the management of brain metastases, despite the enhanced local and distant control in comparison to each treatment alone. Literature review have revealed important role of primary histology of the tumor when dealing with brain metastases. NSCLC responds better to combined approach even when there was only single brain metastasis present while breast cancer has registered better survival with SRS alone probably due to better response of primary tumor to advancement in surgical and chemotherapeutic agents. Furthermore, mut...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
Authors: Majd N, Dasgupta P, de Groot J Abstract Immunotherapy has changed the landscape of treatment of many solid and hematological malignancies and is at the forefront of cancer breakthroughs. Several circumstances unique to the central nervous system (CNS) such as limited space for an inflammatory response, difficulties with repeated sampling, corticosteroid use for management of cerebral edema, and immunosuppressive mechanisms within the tumor and brain parenchyma have posed challenges in clinical development of immunotherapy for intracranial tumors. Nonetheless, the success of immunotherapy in brain metastase...
Source: Advances in Experimental Medicine and Biology - Category: Research Tags: Adv Exp Med Biol Source Type: research
emiek M.E. Walenkamp The introduction of immune checkpoint inhibitors (ICI), as a novel treatment modality, has transformed the field of oncology with unprecedented successes. However, the efficacy of ICI for patients with glioblastoma or brain metastases (BMs) from any tumor type is under debate. Therefore, we systematically reviewed current literature on the use of ICI in patients with glioblastoma and BMs. Prospective and retrospective studies evaluating the efficacy and survival outcomes of ICI in patients with glioblastoma or BMs, and published between 2006 and November 2019, were considered. A total of 88 studies...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Review Source Type: research
Authors: Han RH, Dunn GP, Chheda MG, Kim AH Abstract Metastases from melanoma, lung and breast cancer are among the most common causes of intracranial malignancy. Standard of care for brain metastases include a combination of surgical resection, stereotactic radiosurgery, and whole-brain radiation. However, evidence continues to accumulate regarding the efficacy of molecularly-targeted systemic treatments and immunotherapy. For non-small cell lung cancer (NSCLC), numerous clinical trials have demonstrated intracranial activity for inhibitors of EGFR and ALK. Patients with melanoma brain metastases may benefit from ...
Source: Oncotarget - Category: Cancer & Oncology Tags: Oncotarget Source Type: research
AbstractPurpose of ReviewThe goal of our review is to describe the rationale for immunotherapy in the treatment of breast cancer brain metastases (BCBM), the current landscape of clinical trials for this disease process, and possible future directions based on anticipated results.Recent FindingsImmune checkpoint inhibition has shown efficacy in the treatment of several solid tumor brain metastases (i.e., melanoma and non-small cell lung cancer), but data specific to BCBM is relatively sparse. Preclinical studies in BCBM have illustrated a lower immune content in the brain microenvironment measured by tumor-infiltrating lym...
Source: Current Breast Cancer Reports - Category: Cancer & Oncology Source Type: research
ConclusionsThere was limited intracranial clinical activity for abemaciclib monotherapy in NSCLC and MEL pts in this study; OIRR and short median PFS suggest that no further studies for abemaciclib monotherapy are warranted in this pt population.Clinical trial identificationNCT02308020.Editorial acknowledgementMedical writing assistance was provided by Kristi Gruver, employee of Eli Lilly and Company.Legal entity responsible for the studyEli Lilly and Company.FundingEli Lilly and Company.DisclosureE. Le Rhun: Advisory / Consultancy, Research grant / Funding (institution), Oscar Lambert Center, Lille, FR: Mundipharma; Resea...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
F, Kamp MA Abstract 5-ALA fluorescence-guided surgery (FGS) is a major advance in neuro-oncological surgery. So far, Protoporphyrin IX (PpIX)-fluorescence has been observed in about half of cerebral metastases resected with routinely equipped microscopes during 5-ALA FGS. The aim of the present pilot study was to quantify PpIX-induced fluorescence of cerebral metastases with a spectrometer. We hypothesize that non-fluorescing metastases under the operating microscope may have spectrometrically measurable levels of fluorescence. A second aim was to analyze correlations between quantified 5-ALA fluorescence and hist...
Source: Clinical Breast Cancer - Category: Cancer & Oncology Authors: Tags: Clin Exp Metastasis Source Type: research
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