The management of brain metastases

Patchell, Roy A.

doi:10.1016/s0305-7372(03)00105-1

Cited by 557 publications

(348 citation statements)

References 27 publications

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“…However, the precise indications for its use and appropriate timing, and the optimum combination of WBRT and radiosurgery have yet to be elucidated (2)(3)(4)30,31). Because studies on treatment for brain metastases are based on a diagnosis by brain MRI, accurate diagnosis of small brain metastases by MRI is mandatory.…”

Section: Discussionmentioning

confidence: 99%

“…For patients with no metastatic lesions, treatment of the primary cancer lesion (e.g., surgical resection) is planned primarily. For patients with single metastasis to the brain, surgical resection plus postoperative whole-brain radiation therapy (WBRT) is preferred, provided that the location is favorable for resection and no widespread or rapidly progressive cancer is present (1,2). Recently, stereotactic radiosurgery has expanded the therapeutic options available to patients with brain metastases.…”

mentioning

confidence: 99%

“…Recently, stereotactic radiosurgery has expanded the therapeutic options available to patients with brain metastases. Radiosurgery offers a substitute for surgical treatment in patients with metastatic lesions less than about 3 cm in diameter (2). Radiosurgery plus WBRT is an alternative treatment strategy for patients with single metastasis, and is a recommended treatment for patients with single unresectable brain metastasis (2,3).…”

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confidence: 99%

“…Patients with multiple brain metastases (typically more than three lesions) are generally treated with WBRT alone. Chemotherapy is not usually the primary therapy for most patients with brain metastases; however, it may be useful for some patients with certain highly chemosensitive tumors (2). For patients with oligometastases (two to three lesions), it has been a matter of controversy whether WBRT alone, radiosurgery alone, or WBRT plus radiosurgery is the best treatment (3-5).…”

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confidence: 99%

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Contrast‐enhanced FLAIR imaging in combination with pre‐ and postcontrast magnetization transfer T1‐weighted imaging: Usefulness in the evaluation of brain metastases

Terae

Yoshida

Kudo

et al. 2007

Magnetic Resonance Imaging

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Purpose:To assess whether the use of postcontrast fluidattenuated inversion recovery (FLAIR) imaging in combination with pre-and postcontrast magnetization transfer (MT) T1-weighted imaging (T1WI) can increase diagnostic confidence in the evaluation of brain metastases. Materials and Methods:Brain MR images from 41 patients with suspected brain metastases were reviewed. Two radiologists viewed pre-and postcontrast MT-T1W images for the presence of metastatic tumors and rated the possible enhanced lesions using a five-point confidence scale (session 1). The postcontrast FLAIR images were then viewed together with pre-and postcontrast MT-T1W images, and the presence of metastasis was rated again (session 2).Results: A total of 240 possible enhanced lesions were detected in session 1. Judging by follow-up MR examinations, 196 were considered to be nonmetastatic findings and 44 were determined to be metastasis. In session 2 the confidence rating for nonmetastasis increased significantly in the subset of nonmetastatic findings (P Ͻ 0.001), and the confidence rating for metastasis increased significantly in the subset of metastases (P Ͻ 0.05). Conclusion:The addition of postcontrast FLAIR imaging to pre-and postcontrast MT-T1WI improves diagnostic confidence in evaluation of brain metastases.

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Section: Discussionmentioning

confidence: 99%

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Contrast‐enhanced FLAIR imaging in combination with pre‐ and postcontrast magnetization transfer T1‐weighted imaging: Usefulness in the evaluation of brain metastases

Terae

Yoshida

Kudo

et al. 2007

Magnetic Resonance Imaging

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“…So that the dose of 50 mg m À2 will be taken forward for further study. British Journal of Cancer (2005) (Patchel, 2003). Except for very few cases where surgery may be indicated, the mainstream accepted therapeutic modality is whole brain radiotherapy (WBRT).…”

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Gemcitabine twice weekly as a radiosensitiser for the treatment of brain metastases in patients with carcinoma: a phase I study

et al. 2005

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Conventional treatment for brain metastases (BM) is whole-brain radiotherapy (WBRT). Efficacy is poor. It might be increased by a potent radiosensitiser such as gemcitabine which is believed to cross the disrupted blood -brain barrier. Primary objective of this study was to determine the maximum tolerated dose (MTD) of twice weekly gemcitabine given concurrently with WBRT. Patients with BM from carcinoma were included. The dose of WBRT was 30 Gys (10 daily fractions). Gemcitabine was given 2 -4 h prior to WBRT on days 1 and 8 for the first cohort of patients and then on days 1, 4, 8 and 11. Starting dose was 25 mg m À2 , escalated by 12.5 mg m À2 increments. At least three patients were included per level. Dose limiting toxicity (DLT) was defined as grade 4 haematological or grade X3 nonhaematological toxicity. A total of 25 patients were included; 74% had a PS 1 (ECOG). In all, 23 had non-small-cell lung cancer, six colorectal, four breast, two renal cell and one oesophageal carcinoma. A total of 92% had concurrent extracranial disease. Six had single BM, 13 had two or three BM and six multiple. Up to 50 mg m À2 (level 4) no DLT was observed. At 62.5 mg m À2 , one out of six patients developed DLT (thrombocytopenia-bleeding). The next dose level (75 mg m À2 ) was abandoned after grade 4 bone marrow toxicity (fatal neutropenic sepsis) was seen in one out of two patients. So that the dose of 50 mg m À2 will be taken forward for further study. British Journal of Cancer (2005) (Patchel, 2003). Except for very few cases where surgery may be indicated, the mainstream accepted therapeutic modality is whole brain radiotherapy (WBRT). Gamma-knife radiosurgery and conformal radiotherapy are recent developments that may confer a prognosis improvement to selected patients mostly in cases of single BM and controlled extracranial disease. The prognosis of the vast majority of patients who develop BM is poor. The median survival for treated patients with WBRT is approximately 4 months and the 1-year survival only 12% (Lagerwaard et al, 1999). Chemotherapy is not usually given and if the patient is actually receiving chemotherapy, it is often discontinued. This attitude has been fostered by the theoretical difficulty of drugs to pass the blood -brain barrier and achieve therapeutic significance in brain micrometastases. This however is probably not the case with macroscopic metastases. Brain metastases in patients with many chemosensitive tumours (e.g. testicular cancer, lymphoma, choriocarcinoma) are well known to respond to chemotherapy. A recent study by Postmus et al (2000) in patients with small-cell carcinoma and BM showed a 22% response rate to chemotherapy alone. However, the combination of chemotherapy and radiotherapy produced a 57% response rate and the control in the brain disease in these patients was longer than in patients who received only chemotherapy. A phase III study of early vs late WBRT with concurrent cisplatin and vinorelbine in patients with non-smallcell lung cancer (NSCLC) and BM was reported by Robi...

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Stereotactic Radiosurgery Plus Whole-Brain Radiation Therapy vs Stereotactic Radiosurgery Alone for Treatment of Brain Metastases

Aoyama¹,

Shirato²,

Tago³

et al. 2006

JAMA

2,007

1,328

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The management of brain metastases

Cited by 557 publications

References 27 publications

Contrast‐enhanced FLAIR imaging in combination with pre‐ and postcontrast magnetization transfer T1‐weighted imaging: Usefulness in the evaluation of brain metastases

Contrast‐enhanced FLAIR imaging in combination with pre‐ and postcontrast magnetization transfer T1‐weighted imaging: Usefulness in the evaluation of brain metastases

Gemcitabine twice weekly as a radiosensitiser for the treatment of brain metastases in patients with carcinoma: a phase I study

Stereotactic Radiosurgery Plus Whole-Brain Radiation Therapy vs Stereotactic Radiosurgery Alone for Treatment of Brain Metastases

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