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By Alessandro Franciscon doctor
Nils D Arvold, Eudocia Q Lee, Minesh P Mehta, Kim Margolin, Brian M Alexander, Nancy U Lin, Carey K Anders, Riccardo Soffietti, D Ross Camidge, Michael A Vogelbaum, Ian F Dunn, Patrick Y Wen
The clinical management/understanding of brain metastases (BM) has changed substantially in the last 5 years, with key advances and clinical trials highlighted in this review. Several of these changes stem from improvements in systemic therapy, which have led to better systemic control and longer overall patient survival, associated with increased time at risk for developing BM. Development of systemic therapies capable of preventing BM and controlling both intracranial and extracranial disease once BM are diagnosed is paramount...
August 2016: Neuro-oncology
David W Andrews, Charles B Scott, Paul W Sperduto, Adam E Flanders, Laurie E Gaspar, Michael C Schell, Maria Werner-Wasik, William Demas, Janice Ryu, Jean-Paul Bahary, Luis Souhami, Marvin Rotman, Minesh P Mehta, Walter J Curran
BACKGROUND: Brain metastases occur in up to 40% of all patients with systemic cancer. We aimed to assess whether stereotactic radiosurgery provided any therapeutic benefit in a randomised multi-institutional trial directed by the Radiation Therapy Oncology Group (RTOG). METHODS: Patients with one to three newly diagnosed brain metastases were randomly allocated either whole brain radiation therapy (WBRT) or WBRT followed by stereotactic radiosurgery boost. Patients were stratified by number of metastases and status of extracranial disease...
May 22, 2004: Lancet
Alexander N Slade, Sinisa Stanic
INTRODUCTION: Two recent clinical trials, phase III RTOG 0614 and phase II RTOG 0933, showed some effectiveness of Memantine and IMRT planning for hippocampus sparing, among patients receiving whole brain radiotherapy (WBRT) for brain metastases; however, their use in routine clinical practice is unknown. METHODS: A survey was sent to 1933 radiation oncologists in the US. Data collected included utilization of Memantine and hippocampus sparing, reasons for adoption and non-adoption, and demographic variables...
March 2016: Contemporary Clinical Trials
Vinai Gondi, Stephanie L Pugh, Wolfgang A Tome, Chip Caine, Ben Corn, Andrew Kanner, Howard Rowley, Vijayananda Kundapur, Albert DeNittis, Jeffrey N Greenspoon, Andre A Konski, Glenn S Bauman, Sunjay Shah, Wenyin Shi, Merideth Wendland, Lisa Kachnic, Minesh P Mehta
PURPOSE: Hippocampal neural stem-cell injury during whole-brain radiotherapy (WBRT) may play a role in memory decline. Intensity-modulated radiotherapy can be used to avoid conformally the hippocampal neural stem-cell compartment during WBRT (HA-WBRT). RTOG 0933 was a single-arm phase II study of HA-WBRT for brain metastases with prespecified comparison with a historical control of patients treated with WBRT without hippocampal avoidance. PATIENTS AND METHODS: Eligible adult patients with brain metastases received HA-WBRT to 30 Gy in 10 fractions...
December 1, 2014: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Thankamma Ajithkumar, Christine Parkinson, Kate Fife, Pippa Corrie, Sarah Jefferies
Melanoma is a leading cause of lost productivity due to premature cancer mortality. Melanoma frequently spreads to the brain and is associated with rapid deterioration in quality and quantity of life. Until now, treatment options have been restricted to surgery and radiotherapy, although neither modality has been well studied in clinical trials. However, the new immune checkpoint inhibitors and molecularly targeted agents that have been introduced for treatment of metastatic melanoma are active against brain metastases and offer new opportunities to improve disease outcomes...
October 2015: Lancet Oncology
Scott G Soltys, John P Kirkpatrick, Nadia N Laack, Brian D Kavanagh, John C Breneman, Helen A Shih
No abstract text is available yet for this article.
August 1, 2015: International Journal of Radiation Oncology, Biology, Physics
Xuling Lin, Lisa M DeAngelis
Brain metastases (BMs) occur in 10% to 20% of adult patients with cancer, and with increased surveillance and improved systemic control, the incidence is likely to grow. Despite multimodal treatment, prognosis remains poor. Current evidence supports use of whole-brain radiation therapy when patients present with multiple BMs. However, its associated cognitive impairment is a major deterrent in patients likely to live longer than 6 months. In patients with oligometastases (one to three metastases) and even some with multiple lesions less than 3 to 4 cm, especially if the primary tumor is considered radiotherapy resistant, stereotactic radiosurgery is recommended; if the BMs are greater than 4 cm, surgical resection with or without postoperative whole-brain radiation therapy should be considered...
October 20, 2015: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
David B Shultz, Leslie A Modlin, Priya Jayachandran, Rie Von Eyben, Iris C Gibbs, Clara Y H Choi, Steven D Chang, Griffith R Harsh, Gordon Li, John R Adler, Steven L Hancock, Scott G Soltys
PURPOSE: To report the outcomes of repeat stereotactic radiosurgery (SRS), deferring whole-brain radiation therapy (WBRT), for distant intracranial recurrences and identify factors associated with prolonged overall survival (OS). PATIENTS AND METHODS: We retrospectively identified 652 metastases in 95 patients treated with 2 or more courses of SRS for brain metastases, deferring WBRT. Cox regression analyzed factors predictive for OS. RESULTS: Patients had a median of 2 metastases (range, 1-14) treated per course, with a median of 2 courses (range, 2-14) of SRS per patient...
August 1, 2015: International Journal of Radiation Oncology, Biology, Physics
Christina H Son, Rachel Jimenez, Andrzej Niemierko, Jay S Loeffler, Kevin S Oh, Helen A Shih
PURPOSE: Patients with brain metastases are often treated with whole brain radiation therapy (WBRT) for purposes of palliation. The treatment of those who experience subsequent intracranial disease progression can include a second course of WBRT, although there is controversy surrounding its safety and efficacy. This study examines the outcomes in patients at Massachusetts General Hospital who underwent reirradiation. PATIENTS AND METHODS: We examined the medical records of 17 patients at Massachusetts General Hospital with brain metastases who were initially treated with WBRT between 2002 and 2008 and were subsequently retreated with a second course of WBRT...
February 1, 2012: International Journal of Radiation Oncology, Biology, Physics
Martin Kocher, Riccardo Soffietti, Ufuk Abacioglu, Salvador Villà, Francois Fauchon, Brigitta G Baumert, Laura Fariselli, Tzahala Tzuk-Shina, Rolf-Dieter Kortmann, Christian Carrie, Mohamed Ben Hassel, Mauri Kouri, Egils Valeinis, Dirk van den Berge, Sandra Collette, Laurence Collette, Rolf-Peter Mueller
PURPOSE: This European Organisation for Research and Treatment of Cancer phase III trial assesses whether adjuvant whole-brain radiotherapy (WBRT) increases the duration of functional independence after surgery or radiosurgery of brain metastases. PATIENTS AND METHODS: Patients with one to three brain metastases of solid tumors (small-cell lung cancer excluded) with stable systemic disease or asymptomatic primary tumors and WHO performance status (PS) of 0 to 2 were treated with complete surgery or radiosurgery and randomly assigned to adjuvant WBRT (30 Gy in 10 fractions) or observation (OBS)...
January 10, 2011: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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