Manual Handbook of Radiosurgery in CNS Disease

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Symptomatic RT was observed in 16 patients. Asymptomatic RT typical imaging changes without clinical signs was observed in nine patients. One patient developed an asymptomatic intratumoral hemorrhage after SRS. The presence of multiple brain metastases from breast carcinoma portends rapid clinical deterioration. Most patients with these metastases undergo palliative WBRT. However, unsatisfactory overall survival results and relatively high brain failure rates have been reported by various investigators.

YONG CHA, MD PhD Stereotactic Radiosurgery for CNS Disorders: From Malignant to Benign

It can be used in conjunction with, or as an alternative to, other treatment methods and can be performed on an outpatient basis. Due to a limited number of reported treatment results after SRS for brain metastases of patients with breast carcinoma, the therapeutic impact on this patient subpopulation remains unclear. Our objective was to assess the specific therapeutic impact of a local treatment concept SRS on patients with brain metastases from breast carcinoma.

Only 9 of patients did not respond to local treatment. Radiosurgical retreatment was performed for all patients with local or new distant metastases to the brain and a stable systemic tumor status. The overall MST was 10 months. For example, an overall survival of 4—5 months was reported after conventional WBRT. Longer survival durations have been reported following surgery and WBRT. One could argue that the true impact of SRS is overshadowed by the effects of systemic chemotherapy which has been reported to yield favorable responses in selected patients with breast carcinoma applied to most patients in the current study.

However, the interaction of systemic chemotherapy and radiosurgery was not further analyzed in the current study. The current analysis refers to a selected subpopulation with small and primarily multiple brain metastases from breast carcinoma. Radiosurgical treatment planning and execution were comparable for all patients.

SRS was planned and exclusively performed for all patients by a single neurosurgery specialist. The remarkable finding was that the presence of multiple metastases had no prognostic impact for this selected patient population. This finding does not support the results of several recent surgical, radiosurgical, and radiotherapeutic trials.

It is noteworthy that the WBRT, which is regarded as the standard treatment for patients with multiple brain metastases, did not have a prognostic impact on 46 patients who received additional WBRT. There was no difference in local tumor control or survival time. Most notably, patients undergoing multiple radiosurgical procedures for local or distant retreatment did not have a higher risk of developing radiogenic complications compared with patients undergoing a single session.

In summary, outpatient stereotactic radiosurgery is a feasible treatment method for controlling small brain metastases from breast carcinoma. Outcome is particularly favorable in patients with a controlled primary tumor and no extracranial disease RPA Class I. The number of brain metastases has no prognostic relevance. Volume , Issue 8. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account.

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Original Article Free Access. Alexander Muacevic M. Corresponding Author E-mail address: amuacevi helios. Friedrich W. Kreth M. Berndt Wowra M. Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Characteristic No.

Gy: grays; SD: standard deviation.

Adult CNS Radiation Oncology. Principles and Practice

Statistical Methods The reference point of the study was the date of the radiosurgical procedure. Role of radiotherapy in the treatment of motor dysfunction due to metastatic spinal cord compression: comparison of three different fractionation schedules. Gamma Knife radiosurgery for brain metastases from primary breast cancer. Radiotherapeutic and surgical management for newly diagnosed brain metastasis es : An American Society for Radiation Oncology evidence-based guideline. Practical Radiation Oncology.

The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. Whole-brain radiotherapy versus stereotactic radiosurgery for patients in recursive partitioning analysis classes 1 and 2 with 1 to 3 brain metastases. Whole brain irradiation for metastases from lung carcinoma. A clinical investigation. Acta Radiol Oncol. Radiation therapy for brain metastases from lung carcinoma. Prospective randomized trial according to the level of lactate dehydrogenase.

Strahlenther Onkol.

Radiotherapy and radiosurgery for benign skull base meningiomas

The combined use of radiation therapy and lonidamine in the treatment of brain metastases. Randomized trial of radiotherapy versus radiotherapy plus metronidazole for the treatment metastatic cancer to brain. A Southwest Oncology Group study. A randomized phase III protocol for the evaluation of misonidazole combined with radiation in the treatment of patients with brain metastases RTOG Survival and neurologic outcomes in a randomized trial of motexafin gadolinium and whole-brain radiation therapy in brain metastases.

Results of a randomized comparison of radiotherapy and bromodeoxyuridine with radiotherapy alone for brain metastases: report of RTOG trial Phase III study of efaproxiral as an adjunct to whole-brain radiation therapy for brain metastases. Gamma Knife surgery for metastatic brain tumors from primary breast cancer: treatment indication based on number of tumors and breast cancer phenotype. J Neurosurg. A phase II trial of vinorelbine and intensive temozolomide for patients with recurrent or progressive brain metastases.

Vinorelbine combined with a protracted course of temozolomide for recurrent brain metastases: a phase I trial. Trastuzumab treatment improves brain metastasis outcomes through control and durable prolongation of systemic extracranial disease in HER2-overexpressing breast cancer patients. Br J Cancer. Treatment of HER2-positive metastatic breast cancer with lapatinib and capecitabine in the lapatinib expanded access programme, including efficacy in brain metastases--the UK experience.

Phase I study of lapatinib in combination with whole-brain radiation therapy in patients with brain metastases from HER2-positive breast cancer. Sites of distant recurrence and clinical outcomes in patients with metastatic triple-negative breast cancer: high incidence of central nervous system metastases. Phase 2 trial of temozolomide using protracted low-dose and whole-brain radiotherapy for nonsmall cell lung cancer and breast cancer patients with brain metastases.

A phase 2 trial of whole-brain radiotherapy combined with intravenous chemotherapy in patients with brain metastases from breast cancer.

Learning Objectives

Multimodality treatment of brain metastases: an institutional survival analysis of patients. World J Surg Oncol. Treatment and prognosis of brain metastases from breast cancer. Resection plus whole-brain irradiation versus resection plus whole-brain irradiation plus boost for the treatment of single brain metastasis. The effect of early detection of occult brain metastases in HER2-positive breast cancer patients on survival and cause of death.

Surgery followed by radiotherapy for the treatment of metastatic epidural spinal cord compression from breast cancer. Spine Phila Pa Assessing suspected spinal cord compression: a multidisciplinary outcomes analysis of episodes. Support Care Cancer. Husband DJ. Malignant spinal cord compression: prospective study of delays in referral and treatment.

Magnetic resonance imaging in suspected metastatic spinal cord compression. Clin Radiol. Hoskin PJ. Radiotherapy in symptom management. Central nervous system emergencies. In Wittes RE, ed. Manual of oncologic therapeutics. UK guidance document: treatment of metastatic breast cancer. A specialist breast care nurse role for women with metastatic breast cancer: enhancing supportive care. Oncol Nurs Forum. Cheville A. Rehabilitation of patients with advanced cancer.

Receptor conversion in distant breast cancer metastases. Breast Cancer Res. Tissue confirmation of disease recurrence in breast cancer patients: pooled analysis of multi-centre, multi-disciplinary prospective studies. Cancer Treat Rev. The management of brain edema in brain tumors. Curr Opin Oncol. The role of steroids in the management of brain metastases: a systematic review and evidence-based clinical practice guideline.

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