Brain metastases

Current Treatment Options in Oncology (Impact Factor: 2.42). 12/2001; 2(6):537-547. DOI: 10.1007/s11864-001-0075-8

ABSTRACT Metastatic tumors to the brain are an increasing cause of morbidity and mortality in patients with systemic cancers. Many
new therapies used to treat systemic cancers do not penetrate the central nervous system (CNS) and do not protect patients
from the development of brain metastases. Surgery, radiosurgery, and radiation therapy are all used to treat brain metastases.
It is in our opinion a mistake to use only one or two of these modalities to the exclusion of other(s). The role of systemic
chemotherapy is still limited, due to both the issues of drug delivery caused by the blood brain barrier and to the relative
resistance of many of these tumors to chemotherapy. Traditionally, brain metastases have been grouped together regardless
of the origin of the tumor and have been treated with a single algorithm. As we encounter more patients for whom treatment
of the brain metastases is an important determinant of survival, we must tailor our treatment strategies to individual tumor
types. Also, we must recognize differences in each tumor’s sensitivity to chemotherapy and radiotherapy and differences in
their biology.

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    ABSTRACT: To review the existing literature on brain metastasis (BM) from ovarian cancer and to assess the frequency, anatomical, clinical and paraclinical information and factors associated with prognosis. Ovarian cancer is a rare cause of brain metastasis with a recently reported increasing prevalence. Progressive neurologic disability and poor prognosis is common. A comprehensive review on this subject has not been published previously. This systematic literature search used the Pubmed and Yale library. A total of 66 publications were found, 57 of which were used representing 591 patients with BM from ovarian cancer. The median age of the patients was 54.3 years (range 20-81). A majority of patients (57.3 %) had multiple brain lesions. The location of the lesion was cerebellar (30 %), frontal (20 %), parietal (18 %) and occipital (11 %). Extracranial metastasis was present in 49.8 % of cases involving liver (20.7 %), lung (20.4 %), lymph nodes (12.6 %), bones (6.6 %) and pelvic organs (4.3 %). The most common symptoms were weakness (16 %), seizures (11 %), altered mentality (11 %) visual disturbances (9 %) and dizziness (8 %). The interval from diagnosis of breast cancer to BM ranged from 0 to 133 months (median 24 months) and median survival was 8.2 months. Local radiation, surgical resection, stereotactic radiosurgery and medical therapy were used. Factors that significantly increased the survival were younger age at the time of ovarian cancer diagnosis and brain metastasis diagnosis, lower grade of the primary tumor, higher KPS score and multimodality treatment for the brain metastases. Ovarian cancer is a rare cause of brain metastasis. Development of brain metastasis among older patients and lower KPS score correlate with less favorable prognosis. The more prolonged survival after using multimodality treatment for brain metastasis is important due to potential impact on management of brain metastasis in future.
    Journal of Neuro-Oncology 05/2014; · 3.12 Impact Factor
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    ABSTRACT: Abstract Introduction. As median survival in patients with brain metastases is short, but with wide confidence intervals, it is crucial to select the appropriate therapy. Various specialists diagnose brain metastases and refer selected patients to neurosurgical departments. There is, however, no robust and objective instrument for clinical decision making in individual patients with brain metastases. In consecutive patients treated with open surgery, we aimed to explore if clinical outcomes differed between the specialties of the referring physicians. Methods. We retrospectively included all adult (≥ 18years) patients undergoing open surgery for brain metastases from 2004 through 2009 (n = 141). We divided the specialties of referring physicians in three groups; oncologists, pulmonologists and others. Results. 59 patients (42%) were referred from oncologists, 24 (17%) referred from pulmonologists and 58 (41%) referred from other specialties. There was no significant association between the graded prognostic assessment score and clinical specialty (P = 0.366), reflecting similar referral practice. Twenty-four patients (17%) died within 3 months from surgery. There was no association between clinical specialty and 3 months mortality (P = 0.461). The perioperative mortality was 7% (n = 10), and we registered 19% (n = 27) complications. Risk of perioperative mortality (P = 0.448) or surgical complications (P = 0.330) were also not associated with the specialty of the referring clinician. Conclusion. Patient selection and clinical outcomes did not differ between the specialties of referring physicians. We believe patient selection and outcomes were fairly similar between groups as a result of the multidisciplinary work-up between referring physicians and neurosurgeons. However, with 17% 3-month mortality there is still room for improvement in patient selection.
    British Journal of Neurosurgery 02/2012; 26(5):679-83. · 0.86 Impact Factor
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    ABSTRACT: Brain metastasis (B-Met) from melanoma remains mostly incurable and the main cause of death from the disease. Early stage clinical trials and case studies show some promise for targeted therapies in the treatment of melanoma B-Met. However, the progression-free survival for currently available therapies, although significantly improved, is still very short. The development of new potent agents to eradicate melanoma B-Met relies on the elucidation of the molecular mechanisms that allow melanoma cells to reach and colonize the brain. The discovery of such mechanisms depends heavily on pre-clinical models that enable the testing of candidate factors and therapeutic agents in vivo. In this review we summarize the effects of available targeted therapies on melanoma B-Met in the clinic. We provide an overview of existing pre-clinical models to study the disease and discuss specific molecules and mechanisms reported to modulate different aspects of melanoma B-Met and finally, by integrating both clinical and basic data, we summarize both opportunities and challenges currently presented to researchers in the field.
    Frontiers in Oncology 01/2013; 3:127.