Brain metastasis in hypernephroma

Of 926 patients with hypernephroma, 36 (3.9%) had metastasis to the brain. The median age at presentation was 61 years (range, 34 to 82). Nineteen patients had a single lesion metastatic to the brain, and 16 of these lesions were supratentorial. In 28% of the patients, computed tomography showed hyperdense lesions before contrast material was injected. All patients, except 2 with incomplete records, had evidence of widespread disease involving bone, liver, or lung. The median time interval between the initial diagnosis and the discovery of brain metastasis was 65.5 weeks (range, 0 to 462), with only 2 patients initially presenting with brain metastasis. Twenty-five of the patients who received only radiation therapy had a median survival of 13 weeks (range, 4 to 146), while 7 selected patients who underwent surgical resection and postoperative radiation had a median survival of 66 weeks (range, 18 to 260). In 5 of the 7 patients, scans demonstrated recurrent tumor from 6 to 23 weeks postoperatively. One patient had a pronounced reduction in the size of the tumor after radiation therapy only. This study shows that brain metastasis is usually a late complication of hypernephroma and is associated with a poor prognosis.Abstract published in Proceedings of American Society of Clinical Oncology 3:158, 1984.     

Brain metastasis from melanoma

Eighty-one patients with brain metastasis from melanoma were identified at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1978 and 1980. Of 78 evaluable patients, 51 (65%) had multiple brain metastases. Of 64 patients with non-contrast CT scans, 29% had hemorrhagic metastases. Leptomeningeal metastases were found in 15 patients. Patients were grouped into three categories: Group 1, multiple brain metastases treated with radiation therapy (RT) (n = 49); Group 2, single brain metastasis treated with RT (n = 17); Group 3, single brain metastasis treated with surgery with or without RT (n = 9). Median survivals for Groups 1, 2 and 3 were 11, 9 and 41 weeks, respectively. Eighty-six percent, 65% and 33% of patients in Groups 1, 2 and 3, respectively, were steroid-dependent until death. Seizures occurred in 38 patients (48%). In 17 (21%), seizures were the first manifestation of metastasis. Of 51 patients not receiving prophylactic anticonvulsants, 37% had seizures. Of 12 patients treated prophylactically, 17% developed seizures. Surgical extirpation should be considered in highly selected patients with brain metastasis from melanoma. Prophylactic anticonvulsants are recommended if there is no contraindication.     

Gross tumor volume and clinical target volume in radiotherapy: bone metastasis]

Bone is one of the three most favored sites of solid tumor metastasis. Skeletal metastasis may be identified by four clinical imaging methods: plain film radiography, computed tomography scanning, radioisotope scanning, and magnetic resonance imaging. The dose per fraction, total dose, and anatomic distribution of the radiation (dosimetry) are important factors in determining the efficacy and normal tissue tolerance to radiotherapy. Controversies about fractionation of palliative radiotherapy for bone metastasis are steel ongoing. The most commonly used schedules are a single treatment of 8 Gy, 30 Gy in 10 fractions and 20 Gy in 5 fractions. Treatment volumes and safety margins depend on the location and the extent of the bone metastasis, and are also determined by the symptoms felt by the patient.     

Brain metastasis from esophageal carcinoma

Metastatic esophageal carcinoma to the brain is a rare occurrence that may account for abnormal neurological findings.     

Brain metastasis from breast cancer

Thirty-seven patients with breast cancer who developed brain metastasis were analyzed. At the diagnosis of brain metastasis, all patients had widespread metastasis, and 36 patients were receiving chemotherapy. Thirty patients were treated by radiotherapy to the brain at doses of 4,000 rads. There were 6 CRs (20%) and 5 PRs (17%). The median survival time for all patients was 53 months (8-177+) from diagnosis of the primary tumor, 24 months (7-126+) from the first recurrence, and 6 months (1-47+) from diagnosis of brain metastasis. Patients who achieved CR or PR survived longer than non-responders (11+ months vs. 6 months: p less than 0.01). Several backgrounds factors were analyzed, and the results indicated that patients with better performance status survived significantly longer than those with poorer performance status (11 months vs. 4 months: p less than 0.001).     

Brain metastasis in breast cancer

Brain metastasis is an important issue in modern neurooncology. Our results of combined treatment of brain metastases are presented and available approaches to brain irradiation and chemotherapy are discussed. There is strong evidence to suggest that maximum combinations of approaches might improve treatment efficacy and extend median overall survival to as long as 6 months (p < or = 0.05).     

Brain metastasis from prostatic cancer

Four cases of prostatic carcinoma with metastasis to brain are described. Two of those cases are diagnosed antemortem. Our experience from postmortem case studies and review of the literature point to the fact that metastasis to brain from a prostatic cancer remains a rare occurrence.     

Role of radiotherapy in the combined treatment of uterine choriocarcinoma with brain metastasis]

A retrospective analysis of data on 27 patients with uterine choriocarcinoma metastatic to the brain and other distant sites treated at the Center's Clinic (1980-1996) has been undertaken. Advantages offered by combined treatment (irradiation of the brain + combination chemotherapy) of 15 patients are discussed and practical advice is given.     

图像引导放疗技术提高椎骨转移瘤放疗精度的临床观察

目的 用图像引导放疗(IGRT)技术对椎骨转移瘤行三维适形或调强放疗以提高放疗精度.方法 用医科达SynergyTM的锥形束CT(CBCT)对15例椎骨转移患者进行扫描,通过IGRT技术对15例患者进行三维适形或调强放疗.采用x轴3 mm、y轴3mm、z轴4 mm外放临床靶体积至计划靶体积.缩野照射时脊髓安全边界外放3mm.结果 4例颈椎骨转移患者首次CBCT扫描采集的图像与计划参考图像比较在左右、头脚、前后方向上平均误差分别为1.8、0、3.6 mm;调整治疗床后3个方向上的平均误差分别为0.1、0.4、0.3 mm;11例胸、腰椎骨转移患者首次CBCT扫描采集的图像与计划参考图像比较在3个方向上的平均误差分别为1.9、0.1、-2.1mm;调整治疗床后3个方向的平均误差分别为0.9、0.5、-0.3mm.结论 IGRT技术是治疗椎骨转移瘤的重要组成部分,可使椎骨转移瘤的放疗精度控制在2 mm以内,为提高瘤床照射剂量、保护脊髓、提高患者生存质量提供可能.     

Brain metastasis from prostatic carcinoma.

Between 1959 and 1971 there were 91 patients with clinically diagnosed prostatic carcinoma who were autopsied at Roswell Park Memorial Institute. In four of these 91 (4.4%) intracerebral metastasis were found at autopsy, but only in one of these four was the diagnosis arrived at pre-mortem. This report describes the diagnosis and management of intracerebral metastasis from prostate carcinoma. It appears, on the basis of our initial experience, that the clinical diagnosis of this entity deserves more frequent consideration.     

Brain metastasis responding to gefitinib alone

A woman with stage IIIb non-small cell lung cancer (NSCLC) developed disease progression with brain metastases during chemotherapy. Due to unusual circumstances, the patient received gefitinib alone, without the use of corticosteroid treatment or radiotherapy. There was a dramatic clinical improvement within 1 week. Follow-up magnetic resonance imaging of the brain 1 month later showed decreases in both the size and number of brain metastases. The patient remains well 9 months after initiation of gefitinib. It is proposed that gefitinib may have a role in treatment of brain metastases from NSCLC.     

Image-guided radiotherapy]

Recent advances in radiation oncology are based on improvement in dose distribution thanks to IMRT and improvement in target definition through new diagnostic imaging such as spectroscopic or functional MRI or PET. However, anatomic variations may occur during treatment decreasing the benefit of such optimization. Image-guided radiotherapy reduces geometric uncertainties occurring during treatment and therefore should reduce dose delivered to healthy tissues and enable dose escalation to enhance tumour control. However, IGRT experience is still limited, while a wide panel of IGRT modalities is available. A strong quality control is required for safety and proper evaluation of the clinical benefit of IGRT combined or not with IMRT.     

肾上腺转移癌的立体定向放射治疗

目的探讨立体定向放射治疗肾上腺转移癌的临床可行性与近期疗效。方法采用OUR-QGD型立体定向体部伽玛射线放射治疗系统,治疗肾上腺转移癌43例,根据肿瘤的位置、临床靶体积、患者的身体状况与治疗目的,制定放疗计划及调整剂量分布。肿瘤体积7~1362 cm3,等剂量曲线50%~80%,周边照射总剂量3100~3600 cGy,分割处方剂量400~600 cGy,重复治疗6~9次,隔日治疗。结果治疗前腰背部疼痛28例,治疗结束后1~6个月,症状完全消失16例(57.1%),部分缓解10例(35.7%),2例无效(7.1%),疼痛缓解有效率为92.9%;43例肾上腺转移癌,共53个治疗病灶,治疗后3个月复查CT、MR或PET,肿瘤消失17例(32.1%),缩小27例(50.9%),无变化7例(13.2%),增大2例(3.8%),总有效率96.2%。结论立体定向放射治疗肾上腺转移癌临床效果确切,不良反应较轻。     

骨转移肿瘤放射治疗的疗效观察

为了观察骨转移肿瘤不同分割方式对放射止痛的治疗效果,90例患者中44例采用常规分割照射,2 Gy/次,每周5次,DT36～50 Gy;46例采用大分割照射,(3～5)Gy/次,每周3～5次,DT20～30 Gy.结果全组病例止痛有效率(CR PR)为91.11%;常规分割组CR PR为90.90%,大分割组CR PR为91.30%,两组比较差异无统计学意义,P=0.95.常规分割组单发转移灶CR PR为91.67%,多发转移灶CR PR为90.00%,放疗止痛疗效相近,P=0.85;大分割组单发转移灶CR PR为93.75%,多发转移灶CR PR为90.00%,放疗止痛疗效相近,P=0.67.初步研究结果提示,骨转移肿瘤进行局部止痛放疗是一种非常有效的治疗手段,两种分割方式之间无明显疗效差异.     

Clinical research of radiotherapy in brain metastasis

One hundred and four patients with brain metastasis were received the conventional radiotherapy from 1980 to 1985 at 3 hospitals. Results were as follows. 1. Primary sites were lung (41 cases), breast (34) and others (29). 2. Tumor was 3.15 cm in mean size (0.6-8.2 cm) and 2.6 in number of average (1-15) 3. Radiation dose was 46.5 Gy in average (30-66 Gy) and almost of all cases were irradiated with whole brain field. 4. Over all response rate on CT findings was 65.4% (CR rate: 23.1%) and 63.4% for lung and 73.5% for breast cancer. 5. Survival rate were 25.5% in 1 year, 8.8% in 2 year, 5.4% in 3 year and 3.6% in 5 year. 6. The longer interval was between onset of brain metastasis and primary treatment, the longer survival after brain irradiation. 7. No significant differences of survival rate were seen in size and in number of brain metastasis and with on without improvement of neurological symptoms. 8. The better response was on CT, the better prognosis after radiotherapy. 9. Identification of treatment for brain metastasis according to patient's characteristics and tumor factors were important.