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Brain metastases guidelines

Nicola Mumoli, Stefano Barco, Marco Cei, Matteo Giorgi-Pierfranceschi, Mauro Campanini, Andrea Fontanella, Walter Ageno, Francesco Dentali
The decision concerning the introduction of primary and secondary prophylaxis of venous thromboembolism (VTE) in patients with solid brain neoplasms and brain metastases is often challenging due to the concomitant increased risk of intracranial hemorrhage and to limited evidence from available literature. A standardized questionnaire composed of nine multiple-choice questions regarding primary VTE prevention in non-surgical patients during high-risk conditions and VTE secondary prevention in patients with a solid brain neoplasm or cerebral metastases was sent via electronic mail to all the members (n = 2420) of the Italian Federation of the Internal Medicine Hospital Executives' Associations (FADOI) in June 2015...
November 23, 2016: Internal and Emergency Medicine
Phan Tuong Huynh, Sergy V Lemeshko, Mary C Mahoney, Mary S Newell, Lisa Bailey, Lora D Barke, Carl D'Orsi, Jennifer A Harvey, Mary K Hayes, Peter M Jokich, Su-Ju Lee, Constance D Lehman, Martha B Mainiero, David A Mankoff, Samir B Patel, Handel E Reynolds, M Linda Sutherland, Bruce G Haffty
Stage I breast carcinoma is classified when an invasive breast carcinoma is ≤2 cm in diameter (T1), with no regional (axillary) lymph node metastases (N0) and no distant metastases (M0). The most common sites for metastases from breast cancer are the skeleton, lung, liver, and brain. In general, women and health care professionals prefer intensive screening and surveillance after a diagnosis of breast cancer. Screening protocols include conventional imaging such as chest radiography, bone scan, ultrasound of the liver, and MRI of brain...
November 2016: Journal of the American College of Radiology: JACR
Jennifer A Crozier, Lauren F Cornell, Bhupendra Rawal, Edith A Perez
BACKGROUND: No clear guidelines exist for management of breast cancer brain metastases (BCBM). OBJECTIVE: We assessed the relationship between patient and tumor characteristics, treatment, and overall survival (OS). METHODS: We conducted a retrospective review of 196 patients who received brain radiation for BCBM between 2009-2013 at Mayo Clinic. Primary tumor characteristics were collected, including simplified molecular subtype. Other characteristics included patient's ECOG, number of brain lesions at BCBM diagnosis, and treatment received, including neurosurgery, whole-brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS)...
October 14, 2016: Breast Disease
Soon Keat Cheah, Thomas Matthews, Bin Sing Teh
BACKGROUND: Whole brain radiotherapy (WBRT) and stereotactic radiosurgery were frequently used to palliate patients with brain metastases. It remains controversial which modality or combination of therapy is superior especially in the setting of limited number of brain metastases. The availability of newer medical therapy that improves survival highlighted the importance of reducing long term radiation toxicity associated with WBRT. In this study, we aim to demonstrate the hippocampal sparing technique with whole brain and integrated simultaneous boost Materials and Methods: Planning data from 10 patients with 1-5 brain metastases treated with SRS were identified...
2016: Asian Pacific Journal of Cancer Prevention: APJCP
Damodar Pokhrel, Sumit Sood, Christopher McClinton, Xinglei Shen, Christopher Lominska, Habeeb Saleh, Rajeev Badkul, Hongyu Jiang, Melissa Mitchell, Fen Wang
PURPOSE: To retrospectively evaluate the accuracy, plan quality and efficiency of intensity-modulated arc therapy (IMAT) for hippocampal sparing whole-brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) in patients with multiple brain metastases (m-BM). MATERIALS AND METHODS: A total of 5 patients with m-BM were retrospectively replanned for HS-WBRT with SIB using IMAT treatment planning. The hippocampus was contoured on diagnostic T1-weighted magnetic resonance imaging (MRI) which had been fused with the planning CT image set...
September 27, 2016: Medical Dosimetry: Official Journal of the American Association of Medical Dosimetrists
Christian Doehn, Viktor Grünwald, Thomas Steiner, Markus Follmann, Heidrun Rexer, Susanne Krege
BACKGROUND: In 2014, 15 500 persons in Germany were given the diagnosis of renal cell carcinoma. This disease is the third most common cancer of the urogenital system. The mean age at diagnosis is 68 years in men and 71 in men. METHODS: Pertinent publications up to 2014 were retrieved by a systematic literature search and reviewed in a moderated, formalized consensus process. Key questions were generated and answered by the adaptation of existing international guidelines, on the basis of an independent literature review, and by expert consensus...
September 5, 2016: Deutsches Ärzteblatt International
Alissa S Marr, Chi Zhang, Apar Kishor Ganti
Small cell lung cancer (SCLC) often presents with either regional or systemic metastases, but approximately 4% of patients present with a solitary pulmonary nodule. Surgical resection can be an option for these patients and is endorsed by the National Comprehensive Cancer Network (NCCN) guidelines. There are no prospective randomized clinical trials evaluating the role of adjuvant systemic therapy in these resected SCLC patients. A recent National Cancer Database analysis found that the receipt of adjuvant chemotherapy alone [hazard ratio (HR), 0...
August 2016: Journal of Thoracic Disease
Christopher J D Wallis, Michelle R Downes, Georg Bjarnason, Raj Satkunasivam
The identification of small renal masses is increasing. Active surveillance is a guideline-approved management strategy for select patients with small renal masses. Metastases during the observation of small renal masses are uncommon, and no cases of brain metastasis have been reported. We report the case of a 73-year-old man who presented with tonic-clonic seizures as the result of a brain metastasis from a small renal mass (3.5 cm in maximal dimension). Treatment with whole brain radiotherapy was undertaken successfully...
2016: BMJ Case Reports
Saeed Dabestani, Lorenzo Marconi, Axel Bex
PURPOSE OF REVIEW: Although novel targeted therapies for metastatic renal cell carcinoma (RCC) are emerging, metastasectomy still remains the only potentially curable intervention and plays an important role both in disease control, cancer-specific survival (CSS) and overall survival (OS). A systematic review was conducted in 2014 by the European Association of Urology RCC guidelines panel to summarize evidence on the subject at hand. The purpose of this review is to update the current evidence base...
November 2016: Current Opinion in Urology
Jennifer S Chang, Angelica Perez-Andujar, Igor J Barani, Lijun Ma, David A Larson
PURPOSE/OBJECTIVES: Whole-brain radiation for brain metastases can result in cognitive side effects. Hippocampal-sparing techniques have been developed to decrease morbidity, but they carry the risk of underdosing lesions near the hippocampus due to the unavoidable dose gradient from the hippocampal surface to the prescription isodose surface. This study examines the impact of variable levels of hippocampal sparing on the underdosing of potential brain metastases. MATERIALS/METHODS: Helical intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans were developed for hippocampal-sparing whole-brain treatment...
August 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
David Pfister, Friederike Haidl, Pia Paffenholz, Axel Heidenreich
PURPOSE OF REVIEW: In testis cancer, prognosis is excellent even in metastatic disease. Treatment and timing of patients with multiple metastatic deposits can be challenging. This review was performed to underline the current guideline recommendations. RECENT FINDINGS: Depending on the primary histology, the indication of further surgical resections differ. In seminoma, resídual tumor resections are performed according to the results of a flouoro-deoxy-D-glucose-PET...
November 2016: Current Opinion in Urology
Gerald B Fogarty, Angela Hong, Vinai Gondi, Bryan Burmeister, Kari Jacobsen, Serigne Lo, Elizabeth Paton, Brindha Shivalingam, John F Thompson
Every year 170,000 patients are diagnosed with brain metastases (BMs) in the United States. Traditionally, adjuvant whole brain radiotherapy (AWBRT) has been offered following local therapy with neurosurgery (NSx) and/or stereotactic radiosurgery (SRS) to BMs. The aim is to increase intracranial control, thereby decreasing symptoms from intracranial progression and a neurological death. There is a rapidly evolving change in the radiation treatment of BMs happening around the world. AWBRT is now being passed over in favour of repeat scanning at regular intervals and more local therapies as more BMs appear radiologically, BMs that may never become symptomatic...
2016: BMC Cancer
Ahmed M Ragab Shalaby, Hoshi Kazuei, Honma Koichi, Saeed Naguib, Lubna A Al-Menawei
BACKGROUND: The most common sites of origin for neuroendocrine carcinoma are gastrointestinal tract and its accessory glands, and lungs. MATERIALS AND METHODS: One-hundred fifty cases diagnosed with metastatic brain lesions were retrieved from hospital records within 5 years. For these cases, the primary neoplasm, histopathological classification, metastasis, treatment, and fate all were studied. RESULTS: Intracranial deposits were detected in 10%...
July 2016: Journal of Neurosciences in Rural Practice
Michael C Dewan, Reid C Thompson, Steven N Kalkanis, Fred G Barker, Constantinos G Hadjipanayis
OBJECTIVE Antiepileptic drugs (AEDs) are often administered prophylactically following brain tumor resection. With conflicting evidence and unestablished guidelines, however, the nature of this practice among tumor surgeons is unknown. METHODS On November 24, 2015, a REDCap (Research Electronic Database Capture) survey was sent to members of the AANS/CNS Section on Tumors to query practice patterns. RESULTS Responses were received from 144 individuals, including 18.8% of board-certified neurosurgeons surveyed (across 86 institutions, 16 countries, and 5 continents)...
June 24, 2016: Journal of Neurosurgery
William Jacot, Elvire Pons, Jean-Sébastien Frenel, Séverine Guiu, Christelle Levy, Pierre Etienne Heudel, Thomas Bachelot, Véronique D'Hondt, Amélie Darlix, Nelly Firmin, Gilles Romieu, Simon Thezenas, Florence Dalenc
Few data are currently available regarding the efficacy and safety of T-DM1 in breast cancer (BC) patients with unselected brain metastases (BM), since most clinical trials have excluded BM patients or have only included highly selected patients. HER2 + BC patients with BM treated with T-DM1 in 5 French centers were included in this retrospective study. Clinical management was performed according to the product guidelines. Efficacy was evaluated recording tumor response rates, progression-free (PFS) and overall survival, treatment compliance, and safety...
June 2016: Breast Cancer Research and Treatment
Troels Dreier Christensen, Karen-Lise Garm Spindler, Jesper Andreas Palshof, Dorte Lisbet Nielsen
BACKGROUND: Brain metastases (BM) from colorectal cancer (CRC) are a rare event. However, the implications for affected patients are severe, and the incidence has been reported to be increasing. For clinicians, knowledge about the characteristics associated with BM is important and could lead to earlier diagnosis and improved survival. METHOD: In this paper, we describe the incidence as well as characteristics associated with BM based on a systematic review of the current literature, following the PRISMA guidelines...
2016: BMC Cancer
Dario J Englot, Edward F Chang, Charles J Vecht
Seizures are common in patients with brain tumors, and epilepsy can significantly impact patient quality of life. Therefore, a thorough understanding of rates and predictors of seizures, and the likelihood of seizure freedom after resection, is critical in the treatment of brain tumors. Among all tumor types, seizures are most common with glioneuronal tumors (70-80%), particularly in patients with frontotemporal or insular lesions. Seizures are also common in individuals with glioma, with the highest rates of epilepsy (60-75%) observed in patients with low-grade gliomas located in superficial cortical or insular regions...
2016: Handbook of Clinical Neurology
Ayumi Takaoka, Tsuyoshi Nakagawa, Norihito Ogawa, Mikiko Hayashi, Sonjin Park, Hideaki Iseki, Yuan Bei
The prognosis of patients with T1a breast cancer is generally good, with a 5-year overall survival rate of 95%. However, HER2 overexpression is a risk factor for recurrence. A 46-year-old woman with left breast cancer underwent a total breast resection. The resected specimen showed invasive ductal carcinoma (T1a, NX, MX, g, ly0, v0, ER [-], PgR [-], HER2 [3+], Ki-67 20%). The patient did not receive adjuvant chemotherapy based on treatment guidelines. Nine months after the mastectomy, multiple liver metastases and severe acute hepatic insufficiency were found...
November 2015: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Jiro Akimoto, Hirokazu Fukuhara, Tomohiro Suda, Kenta Nagai, Megumi Ichikawa, Shinjiro Fukami, Michihiro Kohno, Jun Matsubayashi, Toshitaka Nagao
BACKGROUND: A neuroendocrine tumor (NET) can develop anywhere in the body, but is mainly found in the pancreas, gastrointestinal tract, and lungs. This report is a retrospective study of the clinicopathological features of NET patients with brain metastasis whose tissue diagnosis was made at our hospital. METHODS: Patients with brain metastasis evidenced by clinical records and images were accumulated among 302 patients in whom tissue diagnosis of NETs was made at our hospital between 2008 and 2013...
2016: BMC Cancer
M T Freitag, S Bickelhaupt, C Ziener, K Meier-Hein, J P Radtke, J Mosebach, T-A Kuder, H-P Schlemmer, F B Laun
BACKGROUND: Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique that was established in the clinical routine primarily for the detection of brain ischemia. In the past 15 years its clinical use has been extended to oncological radiology, as tumor and metastases can be depicted in DWI due to their hypercellular nature. PRINCIPLES: The basis of DWI is the Stejskal-Tanner experiment. The diffusion properties of tissue can be visualized after acquisition of at least two diffusion-weighted series using echo planar imaging and a specific sequence of gradient pulses...
February 2016: Der Radiologe
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