Therapeutic management of brain metastasis

Kaal, Evert C. A.; Niël, C.; Vecht, Charles J.

doi:10.1016/s1474-4422(05)70072-7

Cited by 149 publications

(95 citation statements)

References 75 publications

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“…23,25 Whereas defining the surgical target volume is important for glial tumors, for patients with intracranial metastases, the need is to accurately define the precise number, size, and location of lesions to select the most appropriate treatment option. 26,27 A possible advantage of gadobenate dimeglumine in this setting is the detection of additional lesions or the improved depiction of small or poorly enhancing lesions that might otherwise go undetected with a standard dose of gadodiamide or another conventional gadolinium agent. In this study, 2 of 27 patients with brain metastases who had 2 or 3 lesions detected after gadodiamide, each had an additional lesion detected after gadobenate dimeglumine.…”

Section: Discussionmentioning

confidence: 99%

Contrast-Enhanced MR Imaging of Brain Lesions: A Large-Scale Intraindividual Crossover Comparison of Gadobenate Dimeglumine versus Gadodiamide

Rowley¹,

Scialfa²,

Gao³

et al. 2008

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Contrast-Enhanced MR Imaging of Brain Lesions: A Large-Scale Intraindividual Crossover Comparison of Gadobenate Dimeglumine versus Gadodiamide

Rowley¹,

Scialfa²,

Gao³

et al. 2008

AJNR Am J Neuroradiol

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“…In brain metastases, treatment options such as whole resection, whole-brain radiation therapy, external fractionated radiotherapy, radiosurgery, and brachytherapy (4,5) are frequently used; additionally, recent experimental developments are heading toward new immunotherapies being able to cross the BBB (6).…”

mentioning

confidence: 99%

¹⁸F-FET PET Uptake Characteristics in Patients with Newly Diagnosed and Untreated Brain Metastasis

Galldiks

Suchorska

Kowalew³

et al. 2016

J Nucl Med

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In patients with brain metastasis, PET using labeled amino acids has gained clinical importance, mainly regarding the differentiation of viable tumor tissue from treatment-related effects. However, there is still limited knowledge concerning the uptake characteristics in patients with newly diagnosed and untreated brain metastases. Hence, we evaluated the uptake characteristics in these patients using dynamic . In 39 of 45 brain metastases eligible for dynamic analysis, a wide range of TTP min was observed (median, 22.5 min; range, 4.5-47.5 min). All 18 F-FETnegative metastases had a diameter of # 1.0 cm, whereas metastases with a . 1.0 cm diameter all showed pathologic 18 F-FET uptake, which did not correlate with lesion size. The highest variability of uptake intensity was observed within the group of melanoma metastases. Conclusion: Untreated metastases predominantly show increased 18 F-FET uptake, and only a third of metastases , 1.0 cm were 18 F-FET-negative, most likely because of scanner resolution and partial-volume effects. In metastases . 1.0 cm, 18 F-FET uptake intensity was highly variable and independent of tumor size (even intraindividually). 18 F-FET PET might provide additional information beyond the tumor extent by reflecting molecular features of a metastasis and might be a useful tool for future clinical applications, for example, response assessment. Br ain metastases are secondary intracerebral neoplasms and occur in up to 17% of all cancer patients. Because of the improved treatment options for extracranial primary tumors with consecutive prolonged survival, the incidence of brain metastases is expected to increase. The most common originating primary tumors are lung cancer, breast cancer, and malignant melanoma (in sum up to 80% of all metastases) (1).Systemic treatment usually consists of chemotherapy, immunotherapies, and targeted therapy, which, however, are mostly unable to cross the blood-brain barrier (BBB) (2,3). In brain metastases, treatment options such as whole resection, whole-brain radiation therapy, external fractionated radiotherapy, radiosurgery, and brachytherapy (4,5) are frequently used; additionally, recent experimental developments are heading toward new immunotherapies being able to cross the BBB (6).Currently, contrast-enhanced standard MRI represents the diagnostic gold standard in the clinical management of patients with brain metastases (7). However, the diagnostic performance of this technique is limited regarding the differentiation between primary and secondary intracerebral malignancies, tumor delineation, differentiation of recurrent brain metastasis from posttherapeutic effects, and providing prognostic information in newly diagnosed brain tumors (8,9). Thus, there is an increasing demand for additional imaging options.Regarding the diagnostic evaluation of intracerebral neoplasms, molecular imaging using PET has gained great importance. Particularly, radiolabeled amino acids such as O-(2-18 F-fluoroethyl)-L-tyrosine ( 18 F-FET) were reported to be particula...

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“…15,16 However, recent guidelines and current opinions concerning the treatment of BM are based on studies in which BM were detected through CT. [17][18][19] It is debatable whether recommendations emanating from these studies are applicable to all patients with BM diagnosed through MRI.…”

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confidence: 99%

Detection of brain metastases from small cell lung cancer

Seute

Leffers

Velde

et al. 2008

Cancer

153

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BACKGROUNDThe aims of this study were to show 1) the effect of changing from computed tomography (CT) to magnetic resonance imaging (MRI) on the prevalence of detected brain metastases (BM) in patients with newly diagnosed small cell lung cancer (SCLC); 2) the difference in survival between patients with single and multiple BM; and 3) the effect of the change in patient labeling on eligibility for prophylactic brain irradiation.METHODSFrom 1980 to 2004, 481 consecutive patients with SCLC were enrolled. Brain imaging was routinely performed after diagnosis of SCLC. At the start of 1991, MRI replaced CT in almost all patients. All patients were regularly examined by a neurologist.RESULTSThe prevalence of detected BM was 10% in the CT era and 24% in the MRI era. In the CT era, all detected BM were symptomatic, whereas in the MRI era, 11% were asymptomatic. In both periods, patients labeled as single BM survived longer than those labeled as multiple BM. For patients labeled as single BM or multiple BM, survival was longer in the MRI era than in the CT era. The proportion of patients who were eligible for prophylactic cranial irradiation was lower in the MRI era.CONCLUSIONSThe estimated prevalence of BM increases when MRI is used instead of CT. Patients with a detected single BM survive longer than patients with multiple BM. The apparently increased survival in the MRI era can be attributed to the “Will Rogers phenomenon”. The use of MRI makes fewer patients eligible for prophylactic cranial irradiation. Cancer 2008. ©2008 American Cancer Society.

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Therapeutic management of brain metastasis

Cited by 149 publications

References 75 publications

Contrast-Enhanced MR Imaging of Brain Lesions: A Large-Scale Intraindividual Crossover Comparison of Gadobenate Dimeglumine versus Gadodiamide

Contrast-Enhanced MR Imaging of Brain Lesions: A Large-Scale Intraindividual Crossover Comparison of Gadobenate Dimeglumine versus Gadodiamide

¹⁸F-FET PET Uptake Characteristics in Patients with Newly Diagnosed and Untreated Brain Metastasis

Detection of brain metastases from small cell lung cancer

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Therapeutic management of brain metastasis

Cited by 149 publications

References 75 publications

Contrast-Enhanced MR Imaging of Brain Lesions: A Large-Scale Intraindividual Crossover Comparison of Gadobenate Dimeglumine versus Gadodiamide

Contrast-Enhanced MR Imaging of Brain Lesions: A Large-Scale Intraindividual Crossover Comparison of Gadobenate Dimeglumine versus Gadodiamide

18F-FET PET Uptake Characteristics in Patients with Newly Diagnosed and Untreated Brain Metastasis

Detection of brain metastases from small cell lung cancer

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¹⁸F-FET PET Uptake Characteristics in Patients with Newly Diagnosed and Untreated Brain Metastasis