Management of cerebral metastasis: Evidence-based approach for surgery, stereotactic radiosurgery and radiotherapy

Jenkinson, Michael D.; Haylock, Brian; Shenoy, Aditya; Husband, David; Javadpour, Mohsen

doi:10.1016/j.ejca.2010.11.033

Cited by 89 publications

(64 citation statements)

References 40 publications

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“…Stereotactic radiosurgery does not cause the long-term neurological deficits associated with whole-brain irradiation. 2,4,5,10,12 However, because SRS is a local therapy, it is important to avoid "missing" or inadequately treating metastases that could be detected and targeted during planned SRS.…”

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confidence: 99%

Time-delayed contrast-enhanced MRI improves detection of brain metastases and apparent treatment volumes

Kushnirsky

Nguyen

Katz

et al. 2016

JNS

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B rain metastases (BMs) are the most common intracranial tumors in adults, occurring in 20%-40% of cancer patients. 26 Their incidence has been increasing due to both prolonged systemic control and improved detection, making BMs a growing cause of mortality and morbidity.14,31 Magnetic resonance imaging is currently the standard of care for the diagnosis of BMs because its sensitivity is superior to CT,22,32 and refinements in MRI techniques allow the modality to detect metastases that are not seen with routine image-acquisition protocols. The abbreviatioNs BM = brain metastasis; GRE = gradient echo; SRS = stereotactic radiosurgery. obJective Contrast-enhanced MRI is the preeminent diagnostic test for brain metastasis (BM). Detection of BMs for stereotactic radiosurgery (SRS) planning may improve with a time delay following administration of a high-relaxivity agent for 1.5-T and 3-T imaging systems. Metastasis detection with time-delayed MRI was evaluated in this study. methods Fifty-three volumetric MRI studies from 38 patients undergoing SRS for BMs were evaluated. All studies used 0.1-mmol/kg gadobenate dimeglumine (MultiHance; Bracco Diagnostics) immediately after injection, followed by 2 more axial T1-weighted sequences after 5-minute intervals (final image acquisition commenced 15 minutes after contrast injection). Two studies were motion limited and excluded. Two hundred eighty-seven BMs were identified. The studies were randomized and examined separately by 3 radiologists, who were blinded to the temporal sequence. Each radiologist recorded the number of BMs detected per scan. A Wilcoxon signed-rank test compared BM numbers between scans. One radiologist determined the scan on which BMs were best defined. All confirmed, visible tumors were contoured using iPlan RT treatment planning software on each of the 3 MRI data sets. A linear mixed model was used to analyze volume changes. results The interclass correlations for Scans 1, 2, and 3 were 0.7392, 0.7951, and 0.7290, respectively, demonstrating excellent interrater reliability. At least 1 new lesion was detected in the second scan as compared with the first in 35.3% of subjects (95% CI 22.4%-49.9%). The increase in BM numbers between Scans 1 and 2 ranged from 1 to 10. At least 1 new lesion was detected in the third scan as compared with the second in 21.6% of subjects (95% CI 11.3%-35.3%). The increase in BM numbers between Scans 2 and 3 ranged from 1 to 9. Between Scans 1 and 3, additional tumors were seen on 43.1% of scans (increase ranged from 1 to 14). The median increase in tumor number for all comparisons was 1. There was a significant increase in number of BMs detected from Scan 1 to Scan 2 (p < 0.0367) and from Scan 1 to Scan 3 (p < 0.0264). In 34 of the 51 subjects (66.7%), the radiologist selected the third scan as the one providing the clearest tumor definition. There was an average 25.4% increase in BM volume between Scans 1 and 2 (p < 0.0001) and a 9% increase in BM volume between Scans 2 and 3 (p = 0.0001). coNclusioNs In patients who are ...

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confidence: 99%

Time-delayed contrast-enhanced MRI improves detection of brain metastases and apparent treatment volumes

Kushnirsky

Nguyen

Katz

et al. 2016

JNS

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“…Metastasis treatment The Journal of Medical Investigation Vol. 64 February 2017 options depend on whether there is a single or multiple lesion ; generally, for patients with a single lesion, surgery is considered effective, but a recent study concluded that whole brain radiation therapy combined with stereotactic radiosurgery could be better (23)(24)(25).…”

Section: Discussionmentioning

confidence: 99%

Differences In High-Intensity Signal Volume Between Arterial Spin Labeling And Contrast-Enhanced T1-Weighted Imaging May Be Useful For Differentiating Glioblastoma From Brain Metastasis

et al. 2017

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: Purpose : To determine whether differences in tumor volume between arterial spin labeling (ASL) and contrast-enhanced T1-weighted MR images (CE+T1WI) can help differentiate glioblastoma (GBM) from brain metastasis. Materials and methods : Patients with a diagnosis of GBM (n=25) or brain metastasis (n=13) were examined by both conventional and ASL MR imaging. Volumes of interest with high signal intensity on ASL and CE+T1WI were defined using three dimensional analysis software. Tumor volume difference (ASL-CE) and tumor volume ratio (ASL/CE) were obtained. Absolute maximal tumor blood flow (TBF) and TBF ratio (normalized to white matter) were also measured. The Mann -Whitney U test and receiver operating characteristic curve analysis were performed to compare measurements between the tumor groups. Results : Both tumor volume difference and tumor volume ratio were significantly higher in GBM than in metastasis. Both TBF and TBF ratio were higher for GBM than for metastasis, but the differences were not significant. Conclusion : The difference in tumor volume as measured by ASL high signal intensity and CE+T1WI might be useful for differentiating GBM from metastasis, whereas ASL-derived TBF is insufficient.

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“…The most common sites of distant metastasis of mucinous adenocarcinomas are ovary, peritoneum, liver or lung [1,2]. In many patients with unknown primary cancer, the brain metastasis could be the initial presentation [3][4][5][6]. According to Narita and Shibui, the primary sources of adenocarcinoma metastasis to the brain are lung (52.3%), breast (8.9%), renal (5.4%), rectum (5.2%), gastric (5.2%), and colon (4.1%) [7].…”

Section: Discussionmentioning

confidence: 99%

Solitary Metastasis to the Facial/Vestibulocochlear Nerve Complex Case Report and Review of the Literature

Eggers¹

2014

Surgery Curr Res

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Management of cerebral metastasis: Evidence-based approach for surgery, stereotactic radiosurgery and radiotherapy

Cited by 89 publications

References 40 publications

Time-delayed contrast-enhanced MRI improves detection of brain metastases and apparent treatment volumes

Time-delayed contrast-enhanced MRI improves detection of brain metastases and apparent treatment volumes

Differences In High-Intensity Signal Volume Between Arterial Spin Labeling And Contrast-Enhanced T1-Weighted Imaging May Be Useful For Differentiating Glioblastoma From Brain Metastasis

Solitary Metastasis to the Facial/Vestibulocochlear Nerve Complex Case Report and Review of the Literature

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