Bevacizumab vs laser interstitial thermal therapy in cerebral radiation necrosis from brain metastases: a systematic review and meta-analysis

Palmisciano, Paolo; Haider, Ali S; Nwagwu, Chibueze D.; Wahood, Waseem; Aoun, Salah G.; Abdullah, Kalil G.; Ahmadieh, Tarek Y. El

doi:10.1007/s11060-021-03802-x

Cited by 29 publications

(24 citation statements)

References 46 publications

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“…Our findings likely stem from the fact that adjuvant radiotherapy was mostly delivered to remnant tumors deemed unamenable to surgical resection and adjacent to critical neurovascular structures, such as the brainstem, optic apparatus, and the pituitary gland. In addition, our cases of brain/spinal cord radiation necrosis and radiation-induced neuropathies were comparable with those reported for spinal, sinonasal, and laryngeal chondrosarcomas, presumably due to the high radiation doses required to treat these radioresistant lesions [ 49 , 51 , 52 , 65 ]. This dose however underscore the importance of attempting to optimize parameters of resection with adjuvant radiation in mind when subtotal removal is undertaken because disease residual close to brainstem and optic apparatus will alter the efficacy and safety of dose-escalated radiation.…”

Section: Discussionsupporting

confidence: 85%

Primary Skull Base Chondrosarcomas: A Systematic Review

Palmisciano

Haider

Sabahi

et al. 2021

Cancers

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Background: Primary skull base chondrosarcomas (SBCs) can severely affect patients’ quality of life. Surgical-resection and radiotherapy are feasible but may cause debilitating complications. We systematically reviewed the literature on primary SBCs. Methods: PubMed, EMBASE, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA guidelines to include studies of patients with primary SBCs. Clinical characteristics, management strategies, and treatment outcomes were analyzed. Results: We included 33 studies comprising 1307 patients. Primary SBCs mostly involved the middle-fossa (72.7%), infiltrating the cavernous-sinus in 42.4% of patients. Cranial-neuropathies were reported in 810 patients (62%). Surgical-resection (93.3%) was preferred over biopsy (6.6%). The most frequent open surgical approaches were frontotemporal-orbitozygomatic (17.6%) and pterional (11.9%), and 111 patients (21.3%) underwent endoscopic-endonasal resection. Post-surgical cerebrospinal-fluid leaks occurred in 36 patients (6.5%). Radiotherapy was delivered in 1018 patients (77.9%): photon-based (41.4%), proton-based (64.2%), and carbon-based (13.1%). Severe post-radiotherapy complications, mostly hypopituitarism (15.4%) and hearing loss (7.1%) were experienced by 251 patients (30.7%). Post-treatment symptom-improvement (46.7%) and reduced/stable tumor volumes (85.4%) showed no differences based on radiotherapy-protocols (p = 0.165; p = 0.062). Median follow-up was 67-months (range, 0.1–376). SBCs recurrences were reported in 211 cases (16.1%). The 5-year and 10-year progression-free survival rates were 84.3% and 67.4%, and overall survival rates were 94% and 84%. Conclusion: Surgical-resection and radiotherapy are effective treatments in primary SBCs, with acceptable complication rates and favorable local tumor control.

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Section: Discussionsupporting

confidence: 85%

Primary Skull Base Chondrosarcomas: A Systematic Review

Palmisciano

Haider

Sabahi

et al. 2021

Cancers

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“…However, we emphasize that the rarity of extra-neural IEs metastases preclude a definite explanation, as the different management strategies adopted for the two anatomical IEs’ variants may have also played a role. Indeed, similarly to the current data on brain metastases and gliomas ( 78 , 79 ), surgical resection may be preferred for supratentorial tumors due to the favorable surgical access and tumor exposure, while less invasive and non-operative strategies, including tumor biopsy and chemo/radiotherapy for infratentorial IEs, with the goal of reducing the risks of surgical-related complications. As surgery may be related to extra-neural metastases mechanisms, the actual impact of IEs’ grading based on anatomical location remains unclear.…”

Section: Discussionmentioning

confidence: 84%

Extra-Neural Metastases From Primary Intracranial Ependymomas: A Systematic Review

Palmisciano

Ferini²,

Barone

et al. 2022

Front. Oncol.

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BackgroundPrimary intracranial ependymomas (IE) are rare brain tumors rarely metastasizing outside the central nervous system. We systematically reviewed the literature on extra-neural metastases from primary IEs.MethodsPubMed, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA guidelines to include studies of extra-neural metastases from primary IEs. Clinical features, management strategies, and survival were analyzed.ResultsWe collected 48 patients from 43 studies. Median age was 13 years (range, 2-65). Primary IEs were frequently located in the parietal (22.9%) and frontal (16.7%) lobes, and mostly treated with resection (95.8%) and/or radiotherapy (62.5%). Most IEs were of grade-III (79.1%), and few of grade-I (6.3%) or grade-II (14.6%). 45 patients experienced intracranial recurrences, mostly treated with resection (86.7%), radiotherapy (60%), and/or chemotherapy (24.4%). Median time-interval from primary IEs was 28 months (range, 0-140). Most extra-neural metastases were diagnosed at imaging (37.5%) or autopsy (35.4%). Extra-neural metastases were multifocal in 38 patients (79.1%), mostly involving cervical or hilar lymph-nodes (66.7%), lung/pleura (47.9%), and/or scalp (29.1%). Surgical resection (31.3%), chemotherapy (31.3%) and locoregional radiotherapy (18.8%) were the most common treatments for extra-neural metastases, but 28 (58.3%) patients were not treated. At last follow-up, 37 patients died with median overall-survivals from primary IEs of 36 months (range, 1-239), and from extra-neural metastases of 3 months (range, 0.1-36). Overall-survival was significantly longer in patients with grade-I and II IEs (P=0.040).ConclusionExtra-neural metastases from primary IEs are rare, but mostly occur at later disease stages. Multidisciplinary management strategies should be intended mostly for palliation.

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“…Our deep learning algorithm detected with high discriminative capacity specific microscopic parameters of glioblastomas, PCNSLs and BMs and hidden radiological differences between brain tumors. The rationale behind the use of T1Gd images stems from their superior distinction of tumors borders and clear representation of central necroses, which are pathological hallmarks of most glioblastomas and BMs ( 34 , 35 ).…”

Section: Discussionmentioning

confidence: 99%

A Deep Learning Model for Preoperative Differentiation of Glioblastoma, Brain Metastasis and Primary Central Nervous System Lymphoma: A Pilot Study

et al. 2022

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BackgroundNeuroimaging differentiation of glioblastoma, primary central nervous system lymphoma (PCNSL) and solitary brain metastasis (BM) remains challenging in specific cases showing similar appearances or atypical features. Overall, advanced MRI protocols have high diagnostic reliability, but their limited worldwide availability, coupled with the overlapping of specific neuroimaging features among tumor subgroups, represent significant drawbacks and entail disparities in the planning and management of these oncological patients.ObjectiveTo evaluate the classification performance metrics of a deep learning algorithm trained on T1-weighted gadolinium-enhanced (T1Gd) MRI scans of glioblastomas, atypical PCNSLs and BMs.Materials and MethodsWe enrolled 121 patients (glioblastoma: n=47; PCNSL: n=37; BM: n=37) who had undergone preoperative T1Gd-MRI and histopathological confirmation. Each lesion was segmented, and all ROIs were exported in a DICOM dataset. The patient cohort was then split in a training and hold-out test sets following a 70/30 ratio. A Resnet101 model, a deep neural network (DNN), was trained on the training set and validated on the hold-out test set to differentiate glioblastomas, PCNSLs and BMs on T1Gd-MRI scans.ResultsThe DNN achieved optimal classification performance in distinguishing PCNSLs (AUC: 0.98; 95%CI: 0.95 - 1.00) and glioblastomas (AUC: 0.90; 95%CI: 0.81 - 0.97) and moderate ability in differentiating BMs (AUC: 0.81; 95%CI: 0.70 - 0.95). This performance may allow clinicians to correctly identify patients eligible for lesion biopsy or surgical resection.ConclusionWe trained and internally validated a deep learning model able to reliably differentiate ambiguous cases of PCNSLs, glioblastoma and BMs by means of T1Gd-MRI. The proposed predictive model may provide a low-cost, easily-accessible and high-speed decision-making support for eligibility to diagnostic brain biopsy or maximal tumor resection in atypical cases.

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Bevacizumab vs laser interstitial thermal therapy in cerebral radiation necrosis from brain metastases: a systematic review and meta-analysis

Cited by 29 publications

References 46 publications

Primary Skull Base Chondrosarcomas: A Systematic Review

Primary Skull Base Chondrosarcomas: A Systematic Review

Extra-Neural Metastases From Primary Intracranial Ependymomas: A Systematic Review

A Deep Learning Model for Preoperative Differentiation of Glioblastoma, Brain Metastasis and Primary Central Nervous System Lymphoma: A Pilot Study

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