A case of radical resection for brain metastases of pancreatic cancer after curative chemotherapy for para-aortic lymph node metastases

Utsunomiya, Takeshi; Funamizu, Naotake; Ozaki, Erina; Tamura, Kazutoshi; Sakamoto, Katsunori; Ogawa, Kazuhiko; K, Kusakabe; Suehiro, Satoshi; Yamashita, Daisuke; Kurata, Masahiro; Kitazawa, Riko; Takada, Yasutsugu

doi:10.1186/s40792-022-01461-2

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…Based on our literature review, 24 articles were found, including 61 patients ( Supplementary Table S1 , Supplementary Materials ) ( 15 – 38 ). The pooled patient characteristics are described in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

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Management and outcomes of brain metastases from pancreatic adenocarcinoma: a pooled analysis and literature review

Gouton,

Gilabert,

Launay

et al. 2024

Front. Oncol.

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BackgroundBrain metastases (BM) are rare in pancreatic ductal adenocarcinoma (PDAC) and little data exists concerning these patients and their outcomes.AimWe aimed to analyze the management, practices, and outcomes of patients presenting BM from PDAC both in our institution and in all cases reported in the literature.MethodsWe conducted a retrospective, monocentric analysis using a data mining tool (ConSoRe) to identify all patients diagnosed with PDAC and BM in our comprehensive cancer center (Paoli-Calmettes Institute), from July 1997 to June 2022 (cohort 1). Simultaneously, we reviewed and pooled the case reports and case series of patients with PDAC and BM in the literature (cohort 2). The clinical characteristics of patients in each cohort were described and survival analyses were performed using the Kaplan-Meier method.ResultsIn cohort 1, 19 patients (0.3%) with PDAC and BM were identified with a median age of 69 years (range: 39-81). Most patients had metastatic disease (74%), including 21% with BM, at diagnosis. Lung metastases were present in 58% of patients. 68% of patients had neurological symptoms and 68% were treated by focal treatment (surgery: 21%, radiotherapy: 42%, Gamma Knife radiosurgery: 5%). In cohort 2, among the 61 PDAC patients with BM described in the literature, 59% had metastatic disease, including 13% with BM at diagnosis. Lung metastases were present in 36% of patient and BM treatments included: surgery (36%), radiotherapy (36%), radiosurgery (3%), or no local treatment (25%). After the pancreatic cancer diagnosis, the median time to develop BM was 7.8 months (range: 0.0-73.9) in cohort 1 and 17.0 months (range: 0.0-64.0) in cohort 2. Median overall survival (OS) in patients of cohort 1 and cohort 2 was 2.9 months (95% CI [1.7,4.0]) and 12.5 months (95% CI [7.5,17.5]), respectively.ConclusionBM are very uncommon in PDAC and seem to occur more often in younger patients with lung metastases and more indolent disease. BM are associated with poor prognosis and neurosurgery offers the best outcomes and should be considered when feasible.

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Section: Resultsmentioning

confidence: 99%

“…( 29 ). One additional patient displayed a somatic BRCA2 mutation in both the primary pancreatic tumor and BM ( 38 ). At initial diagnosis, 25 patients (41%) had localized PDAC.…”

Section: Resultsmentioning

confidence: 99%

Management and outcomes of brain metastases from pancreatic adenocarcinoma: a pooled analysis and literature review

Gouton,

Gilabert,

Launay

et al. 2024

Front. Oncol.

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“…Molecular profiling of tumour may provide the answer to why certain patients are more likely to develop brain metastasis. Two recent case series and case report had identified possible link between germline BRCA1/2 mutations and development of brain metastasis in patients with pancreatic adenocarcinoma 6 13. While BRCA gene mutation only accounts for 4%–7% of patients with pancreatic adenocarcinoma, studies had shown that treatment with platinum-based chemotherapy and poly-ADP ribose polymerase inhibitor such as olaparib in this population may prolong overall survival and progression-free survival, respectively 14 15.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic adenocarcinoma with brain metastases

Law

Lomma

2023

BMJ Case Rep

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Brain metastases are rare for patients with pancreatic adenocarcinoma. The incidence of brain metastasis may increase as improved systemic treatment regimens improve overall survival. Given the low incidence of brain metastasis, recognition of disease and management remain a challenge. We report three cases of metastatic pancreatic adenocarcinoma with brain metastases, review the literature and discuss its management principles.

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“…Brain metastases from hepatocellular carcinoma (HCC), cholangiocarcinoma (CCC), and pancreatic carcinoma (PCC) are very rare, with incidence rates of 0.2-2.2%, 0.5-1.4%, and 0.3-0.6%, respectively [1][2][3]. The onset of brain metastases from these primary malignancies often represents a late manifestation of the primary disease.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Radiosurgery for Patients with Brain Metastases from Hepatopancreaticobiliary Cancers

Wei,

Srinivasan,

Patel

et al. 2024

Cancers

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Background: The role of stereotactic radiosurgery (SRS) for patients with brain metastases from hepatopancreaticobiliary (HPB) cancers has yet to be established. The authors present a single-institution experience of patients with HPB cancers who underwent SRS when their cancer spread to the brain. Methods: We surveyed our Gamma Knife SRS data base of 18,000 patients for the years 1987–2022. In total, 19 metastatic HPB cancer patients (13 male) with 76 brain metastases were identified. The median age at SRS was 61 years (range: 48–83). The primary cancer sites were hepatocellular carcinoma (HCC, 11 patients), cholangiocarcinoma (CCC, 2 patients), and pancreatic carcinoma (PCC, 6 patients). The median Karnofsky Performance Score (KPS) was 80 (range: 50–90). Two patients underwent pre-SRS whole-brain fractionated radiation therapy (WBRT) and eight patients underwent pre-SRS surgical resection. All SRS was delivered in single session. The median margin dose was 18 Gy (range: 15–20). The median cumulative tumor volume was 8.1 cc (range: 1.0–44.2). Results: The median patient overall survival (OS) after SRS was 7 months (range 1–79 months). Four patients had documented local tumor progression after SRS at a median time of 8.5 months (range: 2–15) between SRS and progression. Out of 76 treated tumors, 72 tumors exhibited local control. The local tumor control rate per patient was 78.9%. The local tumor control per tumor was 94.7%. Four patients developed new brain metastases at a median of 6.5 months (range: 2–17) after SRS. No patient experienced adverse radiation effects (AREs). At the last follow-up, 18 patients had died, all from systemic disease progression. Conclusions: Metastatic spread to the brain from HPB cancers occurs late in the course of the primary disease. In this study, all deceased patients ultimately died from primary disease progression. SRS is a non-invasive strategy that maximally preserves quality of life, and our results reported favorable outcomes compared to the existing literature. SRS should be considered as one of the primary management strategies for patients with brain metastatic spread from HPB cancer.

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A case of radical resection for brain metastases of pancreatic cancer after curative chemotherapy for para-aortic lymph node metastases

Cited by 5 publications

References 16 publications

Management and outcomes of brain metastases from pancreatic adenocarcinoma: a pooled analysis and literature review

Management and outcomes of brain metastases from pancreatic adenocarcinoma: a pooled analysis and literature review

Pancreatic adenocarcinoma with brain metastases

Stereotactic Radiosurgery for Patients with Brain Metastases from Hepatopancreaticobiliary Cancers

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