Five-year survivors of brain metastases: A single-institution report of 32 patients

Chao, Samuel T.; Barnett, Gene H.; Liu, Stephanie W.; Reuther, Alwyn M.; Toms, Steven; Vogelbaum, Michael A.; Videtic, Gregory M.M.; Suh, John H.

doi:10.1016/j.ijrobp.2006.05.015

Cited by 44 publications

(33 citation statements)

References 18 publications

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“…15 In their study, long-term survivors (44 of a total of 677 patients; 6.5%) had a higher initial KPS, fewer brain metastases, and less extracranial disease at the time of presentation. 15 Recently, Chao et al 23 reported that 32 of 1288 (2.5%) patients survived !5 years, with a median survival of 9.3 years, after diagnosis of their brain metastases. 23 They concluded that for patients with good prognostic factors such as young age (aged <65 years), good RPA characteristics (class 1), and a single metastasis, aggressive treatment with surgery or SRS may offer the best chance for long-term survival.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgical treatment of brain metastases in older patients

Kim

Weil

Chao

et al. 2008

Cancer

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BACKGROUND. This study was designed to evaluate the therapeutic effect of stereotactic radiosurgery (SRS) in patients aged ≥75 years who presented with brain metastasis. METHODS. The authors analyzed the data from 44 consecutive patients treated with SRS for ≥1 brain metastasis. The median age at the time of treatment for brain metastases was 79.3 years (range, 75 years–86 years), and the median Karnofsky performance status was 80 (range, 50–100). At the time of SRS, 31 patients were treated for a single metastasis, and the remaining 13 patients were treated for ≥2 lesions (n = 74 lesions). The median tumor volume was 1.2 cm3 (range, 0.007 cm3‐22.5 cm3). The median maximal and marginal doses were 36 grays (Gy) (range, 18.8 Gy‐48.2 Gy) and 20 Gy (range, 10 Gy‐24 Gy), respectively. RESULTS. Median survival was 7.3 ± 1.65 months (range, 1.6 months‐38.9 months) from the time of diagnosis of brain metastasis. Median survival of the patients with a single brain metastasis (10.1±1.92 months) was longer than that of the patients with ≥2 metastases (6.6±1.28 months) (P <.02). A single lesion was found to be an independent favorable prognostic factor (P±=±.017; odds ratio, 2.385 [95% confidence interval, 1.167‐4.874]) in univariate and multivariate analysis. Patients with nonsmall cell lung cancer fared worse than patients with other tumor types (survival of 6.5 ± 0.70 months vs 10.1 ± 2.33 months [P<.05]). CONCLUSIONS. SRS for patients aged ≥75 years with brain metastases is an effective and safe treatment modality that appears to improve survival, with outcomes that compare favorably with those reported for younger patients in an appropriately selected population. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgical treatment of brain metastases in older patients

Kim

Weil

Chao

et al. 2008

Cancer

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“…Although most (n = 4) had a single lesion, our patient with multiple lesions was treated effectively, as has been established for other metastatic tumors [2,8,14,16]. Patients with supra-or infratentorial tumors were equally distributed and fared equally well, which is not always the case with other tumors [8,10,14].…”

Section: Discussionmentioning

confidence: 61%

“…Optimal management of patients with metastatic brain tumors in general, and prostate cancer in particular, has become controversial and remains in flux [2,10,12,17,21]. For patients with oligometastases (3 or fewer), a supple management approach, which uses surgery and WBRT for surgically accessible lesions, especially with symptomatic mass effect and SRS with WBRT in other cases, tends to be the most common approach [2,8,10,17].…”

Section: Discussionmentioning

confidence: 99%

“…For patients with oligometastases (3 or fewer), a supple management approach, which uses surgery and WBRT for surgically accessible lesions, especially with symptomatic mass effect and SRS with WBRT in other cases, tends to be the most common approach [2,8,10,17]. In patients with more than 3 lesions, either WBRT (followed as needed by SRS for lesions that do not respond) or a combined SRS and WBRT approach (depending on the clinical status of the patient) is used in some centers [10,17].…”

Section: Discussionmentioning

confidence: 99%

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Stereotactic radiosurgical treatment of parenchymal brain metastases from prostate adenocarcinoma

Kim¹,

Chao²,

Toms³

et al. 2008

Surgical Neurology

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“…Patients are typically treated according to age, functional performance, neurological status, type of cancer, number and localization of BM, radiosensitivity and chemosensitivity of the tumors, and systemic control of the primary cancer [5][6][7][8] . Local control of BM can restore neurological functional status and increase survival of patients that may die due to extracranial progression of the disease [9][10][11][12] . Some trials suggest that neurosurgical resection is a good option, presenting low recurrence rates especially when followed by radiotherapy [6][7][8]11,12 .…”

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confidence: 99%

Intraoperative ultrasonography for presumed brain metastases: a case series study

Picarelli¹,

Oliveira

Bor-Seng-Shu

et al. 2012

Arq. Neuro-Psiquiatr.

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Brain metastases (BM) represent more than 50% of intracranial tumors in the adult population and have shown an increasing incidence over recent decades 1,2 . Around 170,000 patients per year are diagnosed with BM in the United States of America. In addition, 10% to 40% of oncologic patients develop BM in the course of the disease [1][2][3][4][5][6][7][8] . The factors associated with this increasing incidence include advances in neuroimaging techniques, easier access to health care systems, and increased survival of cancer patients. The best strategy for treating BM remains controversial, but the management includes radiotherapy, stereotactic radiosurgery and surgical resection. Patients are typically treated according to age, functional performance, neurological status, type of cancer, number and localization of BM, radiosensitivity and chemosensitivity of the tumors, and systemic control of the primary cancer [5][6][7][8] . Local control of BM can restore neurological functional status and increase survival of patients that may die due to extracranial progression of the disease [9][10][11][12] . Some trials suggest that neurosurgical resection is a good option, presenting low recurrence rates especially when followed by radiotherapy [6][7][8]11,12 . BM resection can rapidly decrease the mass effect and surrounding edema, improve symptoms and quality of life, control epileptic seizures and provide tissue for histological analysis and diagnosis of suspected lesions [6][7][8] . In addition, resection of multiple BM can also bring positive outcomes if systemic cancer is controlled [13][14][15] . The objective ABSTRACTBrain metastases (BM) are one of the most common intracranial tumors and surgical treatment can improve both the functional outcomes and patient survival, particularly when systemic disease is controlled. Image-guided BM resection using intraoperative exams, such as intraoperative ultrasound (IOUS), can lead to better surgical results. Methods: To evaluate the use of IOUS for BM resection, 20 consecutives patients were operated using IOUS to locate tumors, identify their anatomical relationships and surgical cavity after resection. Technical difficulties, complications, recurrence and survival rates were noted. Results: IOUS proved effective for locating, determining borders and defining the anatomical relationships of BM, as well as to identify incomplete tumor resection. No complications related to IOUS were seen. Conclusion: IOUS is a practical supporting method for the resection of BM, but further studies comparing this method with other intraoperative exams are needed to evaluate its actual contribution and reliability.Key words: intraoperative ultrasound, brain metastases, neurosurgery. RESUMOAs metástases cerebrais (MC) são os tumores intracranianos mais frequentes e seu tratamento cirúrgico pode melhorar a sobrevida e a funcionalidade do paciente, especialmente quando a doença sistêmica está controlada. A ressecção das MC guiada por imagens de exames intraoperatórios, como ultrassom intraoper...

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Five-year survivors of brain metastases: A single-institution report of 32 patients

Cited by 44 publications

References 18 publications

Stereotactic radiosurgical treatment of brain metastases in older patients

Stereotactic radiosurgical treatment of brain metastases in older patients

Stereotactic radiosurgical treatment of parenchymal brain metastases from prostate adenocarcinoma

Intraoperative ultrasonography for presumed brain metastases: a case series study

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