Distribution of brain metastases: implications for non-uniform dose prescriptions

Bender, Edward T.

doi:10.1259/bjr/30173406

Cited by 38 publications

(36 citation statements)

References 9 publications

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“…Preferential involvement by lung cancer BMs of the posterior fossa, the anatomic watershed areas, and the gray-white matter junction was visually reconstructed, confirming findings from past reports. 10,12,13,15,16,18,19 Furthermore, the heterogeneity of BMs in the brain was statistically verified, confirming past reports with more objectivity. 10 -16.18,19 With a more detailed frequency map of BMs, prophylactic irradiation for patients with malignant tumor could be optimized to enhance preventive effects and reduce side effects.…”

Section: Discussionsupporting

confidence: 86%

“…10 -16.18,19 With a more detailed frequency map of BMs, prophylactic irradiation for patients with malignant tumor could be optimized to enhance preventive effects and reduce side effects. 18 Intensitymodulated radiotherapy with hippocampal avoidance, which was performed in the Radiation Therapy Oncology Group trial 0933, could be an effective radiotherapy for lung cancer patients, as BM occurrence within the hippocampus seems to be infrequent, as revealed by the current study. 29 In the present study, we hypothesized that BMs may distribute differently within the brain according to their molecular biological characteristics.…”

Section: Discussionmentioning

confidence: 52%

“…Today, with the advent of image registration and 3D structure deformation algorithms, it is now possible to deform and register individual brain images onto an averaged standard brain image, enabling detection of even the slightest difference in spatial distribution. 17 Using this technique for cross-patient lesion location analysis, Bender and Tomé 18 and Quattrocchi et al 19 analyzed the spatial distribution of BMs more objectively than before, finding that BMs preferentially involve the parieto-occipital lobes and cerebellum in lung cancer patients and the cerebellum in breast cancer patients.…”

mentioning

confidence: 99%

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Different spatial distributions of brain metastases from lung cancer by histological subtype and mutation status of epidermal growth factor receptor

et al. 2015

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 52%

mentioning

confidence: 99%

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Different spatial distributions of brain metastases from lung cancer by histological subtype and mutation status of epidermal growth factor receptor

et al. 2015

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“…In vitro , hippocampal astrocytes have been shown to express higher levels of MHC Class II protein, Il-6 and ICAM-1 compared to cortical astrocytes, as well as displaying increased nitric oxide (NO) production (Morga et al, 1998), all of which one would hypothesize to modulate astrocyte response to metastatic growth. Indeed, studies of metastatic distribution in human patients, suggest that the hippocampus is a rare locale for tumor growth, as compared to the cerebellum or frontal lobe (Delattre et al, 1988; Ghia et al, 2007; Bender and Tome, 2011). Potentially, the more robust responses of astrocytes in the hippocampus, both on a cellular and immunological basis, could hamper metastatic growth.…”

Section: Pre-clinical Models; Mechanistic Insights Into the Role Of Amentioning

confidence: 99%

The role of astrocytes in CNS tumors: pre-clinical models and novel imaging approaches

O’Brien¹,

Howarth²,

Sibson³

2013

Front. Cell. Neurosci.

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Brain metastasis is a significant clinical problem, yet the mechanisms governing tumor cell extravasation across the blood-brain barrier (BBB) and CNS colonization are unclear. Astrocytes are increasingly implicated in the pathogenesis of brain metastasis but in vitro work suggests both tumoricidal and tumor-promoting roles for astrocyte-derived molecules. Also, the involvement of astrogliosis in primary brain tumor progression is under much investigation. However, translation of in vitro findings into in vivo and clinical settings has not been realized. Increasingly sophisticated resources, such as transgenic models and imaging technologies aimed at astrocyte-specific markers, will enable better characterization of astrocyte function in CNS tumors. Techniques such as bioluminescence and in vivo fluorescent cell labeling have potential for understanding the real-time responses of astrocytes to tumor burden. Transgenic models targeting signaling pathways involved in the astrocytic response also hold great promise, allowing translation of in vitro mechanistic findings into pre-clinical models. The challenging nature of in vivo CNS work has slowed progress in this area. Nonetheless, there has been a surge of interest in generating pre-clinical models, yielding insights into cell extravasation across the BBB, as well as immune cell recruitment to the parenchyma. While the function of astrocytes in the tumor microenvironment is still unknown, the relationship between astrogliosis and tumor growth is evident. Here, we review the role of astrogliosis in both primary and secondary brain tumors and outline the potential for the use of novel imaging modalities in research and clinical settings. These imaging approaches have the potential to enhance our understanding of the local host response to tumor progression in the brain, as well as providing new, more sensitive diagnostic imaging methods.

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“…More recently, a novel radiobiological modeling suggested the potential of using nonuniform dose prescriptions in order to address the nonuniform distribution of microscopic brain metastases for different tumor histologies. For example, colorectal cancers have a higher predisposition to metastasize to the posterior fossa [47].…”

Section: Advances In Radiotherapy Deliverymentioning

confidence: 99%

Conventional radiation therapy for brain metastases

2012

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Conventional radiotherapy in the form of whole brain radiation treatment has been a longstanding treatment for brain metastases, and it continues to provide effective palliation as monotherapy and in combination with local and systemic treatments. Advances in systemic therapy have improved survival with metastatic disease, and in those patients with better prognostic factors, more aggressive local therapeutic approaches for brain metastases appear to benefit their survival and intracranial tumor control. Increased treatment intensity and longer survival following treatment of brain metastases have raised concerns about persistent treatmentrelated neurocognitive toxicities and the resulting impact on quality of life. Technological advances in conventional radiotherapy planning and delivery have led to novel approaches that may increase intracranial tumor control while minimizing the treatment-related toxicities of therapy. These innovative approaches include intensitymodulated radiotherapy, new image-guidance techniques, and volumetric modulated arc therapy, which allow for the delivery of whole brain radiotherapy with integrated boost treatment to the visible disease while sparing the hippocampal regions or delivery of hypofractionated radiotherapy to larger metastatic targets that may not be amenable to radiosurgery boost or salvage treatment.

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Distribution of brain metastases: implications for non-uniform dose prescriptions

Cited by 38 publications

References 9 publications

Different spatial distributions of brain metastases from lung cancer by histological subtype and mutation status of epidermal growth factor receptor

Different spatial distributions of brain metastases from lung cancer by histological subtype and mutation status of epidermal growth factor receptor

The role of astrocytes in CNS tumors: pre-clinical models and novel imaging approaches

Conventional radiation therapy for brain metastases

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