Brain Metastases from Biliary Tract Cancer: A Monocentric Retrospective Analysis of 450 Patients

Frega, Giorgio; Garajová, Ingrid; Palloni, Andrea; Barbera, Maria Aurelia; Pastore, Marco Trossello; Faccioli, Luca; Spinardi, Luca; Lorenzo, Stefania De; Cubelli, Marta; Pantaleo, Maria Abbondanza; Biasco, Guido; Brandi, Giovanni

doi:10.1159/000479929

Cited by 15 publications

(26 citation statements)

References 23 publications

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“…The median survival after diagnosis of brain metastasis from cholangiocarcinoma ranges from 9.5 weeks to 16 weeks. [1][2][3] Therefore, the outcome in this case was particularly successful, as the patient was alive at last follow-up, 49 weeks after diagnosis.…”

Section: Dovepressmentioning

confidence: 72%

“…Distant metastasis is uncommon, and the incidence of brain metastasis was 0.15%, 0.47% and 1.4% in three large case series of cholangiocarcinoma. [1][2][3] Even more rare are neuro-ophthalmologic and ocular presentations of cholangiocarcinoma, with only eight such cases in the literature. [4][5][6] We report a woman with isolated sixth cranial nerve palsy from an invasive brain metastatic sellar/suprasellar mass as the presenting feature of cholangiocarcinoma, which to our knowledge has not been previously reported.…”

Section: Introductionmentioning

confidence: 99%

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<p>Sixth Cranial Nerve Palsy as the Presenting Sign of Metastatic Cholangiocarcinoma</p>

Fowler¹,

Lam²

2020

IMCRJ

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Background: Cholangiocarcinoma is a locally invasive, poorly treatable malignancy of the biliary tract that uncommonly metastasizes to the brain and rarely causes neuroophthalmologic complications. Case Presentation: A 34-year-old woman with an isolated sixth cranial nerve palsy underwent brain neuroimaging and was found to have a large sellar/suprasellar mass invading the cavernous sinus. Gross total resection was performed with improvement in the sixth cranial nerve nerve palsy. Next-generation sequencing and histology studies revealed an adenocarcinoma with a fibroblast growth factor receptor (FGFR)2-BICC1 gene mutation. Positron emission tomography/computed tomography scan demonstrated a large hypermetabolic partially necrotic hepatic mass with local invasion, and liver biopsy confirmed a diagnosis of cholangiocarcinoma. At three weeks after resection, the brain lesion recurred and the patient developed worsening diplopia. The patient then received stereotactic radiotherapy applied to the brain lesion and began treatment with gemcitabine and cisplatin. The patient was transitioned to FGFR-targeted therapy with pemigatinib, and the patient was alive at last follow-up, 49 weeks after diagnosis. Conclusion: To our knowledge, this is the first report of cholangiocarcinoma presenting as a neuro-ophthalmologic finding, consisting of an isolated sixth cranial nerve palsy, which was the harbinger of a brain metastatic sellar/suprasellar mass. The case highlights the importance of prompt neuroimaging in isolated cranial nerve palsies, particularly in younger patients, and consideration of rare aggressive metastasis to the sellar region, where prompt surgery and pathology are critical in identifying the primary carcinoma and to instituting expedited therapy.

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Section: Dovepressmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

<p>Sixth Cranial Nerve Palsy as the Presenting Sign of Metastatic Cholangiocarcinoma</p>

Fowler¹,

Lam²

2020

IMCRJ

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“…Hepatobiliary and pancreatic cancers are aggressive diseases with a poor prognosis [41][42][43][44]. Though pancreas, gallbladder, and liver are not part of the alimentary canal, these organs are essential to digestion and pancreatic cancer, biliary tract, and liver cancer are exposed to the gut microbiome via blood flow through the portal vein [45].…”

Section: Hepatobiliary and Pancreatic Cancersmentioning

confidence: 99%

The role of the microbiome in drug resistance in gastrointestinal cancers

Garajová

Balsano

Wang

et al. 2020

Expert Review of Anticancer Therapy

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Introduction:The microbiota is recognized for its impact on both human health and disease. The human microbiota is made up of trillions of cells, including bacteria, viruses, and fungi. The largest population of microbes reside in the gut, prompting research for better understanding of the impact of gastrointestinal microbiota in different diseases. Evidence from numerous studies has pointed out the role of commensal microbes as key determinants of cancer pathogenesis. Moreover, gut microbiota may play an important role in chemoresistance; consequently, this knowledge might be important for novel strategies to improve anticancer treatment efficacy. Areas covered: We describe the role of microbiota in different gastrointestinal cancer types (esophageal, gastric, colorectal, hepatocellular and pancreatic-biliary tract cancers). Moreover, we analyzed the impact of the microbiota on resistance to anticancer therapies, and, lastly, we focused on possibilities of microbiota modulation to enhance anticancer therapy efficacy. Expert opinion: Increasing evidence shows that gut microbiota might influence resistance to anticancer treatment, including conventional chemotherapy, immunotherapy, radiotherapy, and surgery. Therefore, a better knowledge of gut microbiota and its interactions with anticancer drugs will enable us to develop novel anticancer treatment strategies and subsequently improve the cancer patients' outcome.

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“…Limited studies have evaluated brain metastases from biliary tract cancers. Beyond the few case reports of patients with BMs from BTC, two case series of eight [9] patients from Thailand and six [10] patients from Italy have been reported in the literature. In our series of nine patients, the median age at BM diagnosis was 63.7 years, which is similar to that reported in the two case series of 60 years and 68 years, respectively.…”

Section: Case Seriesmentioning

confidence: 99%

“…The incidence of brain metastases (BMs) from BTC is largely unknown. Only a few case reports and two case series have characterized BMs from BTC [9][10][11][12][13][14]. The most recent case series reports the incidence of BMs from BTC to be 1.4% [10].…”

Section: Introductionmentioning

confidence: 99%

Brain Metastases from Biliary Tract Cancers: A Case Series and Review of the Literature in the Genomic Era

et al. 2019

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Background. Biliary tract cancers (BTCs) are highly fatal malignancies that make up less than 1% of all cancers. BTC is often diagnosed at an unresectable stage; surgical resection remains the only definitive treatment. Brain metastases (BMs) from BTC are extremely rare, and few studies on patients with BMs from BTC exist. The aim of this study was to identify clinical characteristics associated with poor prognosis for patients with BMs from BTC. Materials and Methods. We performed a retrospective review of electronic medical records for patients with BMs from BTC managed at Mount Sinai Hospital from 2000 to 2017. Data on patient characteristics, magnetic resonance imaging findings, treatment regimens, and clinical outcomes were analyzed. Results. We identified 1,910 patients with BTC. Nine patients developed BMs, with an incidence of 0.47%. Of these nine patients, six had intrahepatic cholangiocarcinoma, two had extrahepatic cholangiocarcinoma, and one had gallbladder cancer. Six (66.7%) patients had one BM, one (11.1%) patient had two BMs, and two (22.2%) patients had three or more BMs. Four (44.4%) patients underwent BM resection, and seven (77.8%) received BM radiation. Median overall survival from time of BM diagnosis was 3.8 months (95% confidence interval 0.1-16.9). Conclusion. Development of BMs from BTC is rare; however, prognosis is less than 4 months. BM diagnosis can occur within 2 years of primary diagnosis. As targeted therapeutics emerge, future studies ought to focus on identifying genomic BM markers associated with BTC subtypes.

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Brain Metastases from Biliary Tract Cancer: A Monocentric Retrospective Analysis of 450 Patients

Cited by 15 publications

References 23 publications

<p>Sixth Cranial Nerve Palsy as the Presenting Sign of Metastatic Cholangiocarcinoma</p>

<p>Sixth Cranial Nerve Palsy as the Presenting Sign of Metastatic Cholangiocarcinoma</p>

The role of the microbiome in drug resistance in gastrointestinal cancers

Brain Metastases from Biliary Tract Cancers: A Case Series and Review of the Literature in the Genomic Era

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