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Brain Mets Flashcards

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1
Q

most common primary site of brain mets

A

P1766

Lung 50%

2nd: breast: 15-20 %

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2
Q

Metastatic brain tumors

outnumber primary brain tumors by a factor of

A

10 is to 1 in favor of brain mets

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3
Q

most common symptom of brain mets

A

Headache - 49%

Mental prob - 32%

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4
Q

Most common sign of brain mets

A

Hemiparesis - 59%

Cognitive deficits - 58%

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5
Q

Has become the standard of care forimaging of the central nervous
system (CNS) in cancer patients

It will frequently pick up smaller
lesions not seen on CT scans

A

MRI

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6
Q

Factors impacting prognosis:

A

Factors impacting prognosis:

  1.   Performance status
  2.   Extracranial disease status
  3.   RPA score
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7
Q

What are the categories of RPA I? How many months is the median survival for RPA i?

A

RPA

I:
Karnofsky performance score[KPS] ≥70
controlled primary
age

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8
Q

Reasonable regimen of corticosteroids in brain mets

A

Reasonable Regimen
•  10 mg intravenous (IV) or oral bolus •  followed by a 4 to 6 mg every 6 to 8 hours of dexamethasone equivalent
dose

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9
Q

standard of care in patients with brain metastasis?

What is the standard dose and fraction for a vast majority?

A

WBRT

30 Gy in 10 fractions

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10
Q

can provide immediate relief of the tumor mass effect

For Solitary lesion

A

Surgical resection

reserved for lesions causinglife-threatening 
complications  
—  or for those patients with 
good performance status 
(i.e., KPS ≥70)
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11
Q 
provides a substitute or 
alternative to conventional 
surgery  
—  provide similar local control 
rates  
— 
(in the order of 80% to 90% onlywhen combined with WBRT)
A

radiosurgery boost

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12
Q

In RTOG-95-08
08WBRT plus SRS vs WBRT
alone arms

The end points and conclusions are?

A

Primary EP: OS- EQUAL
Secondary EP: local control and
performance measures is higher in the SRS boost
arm

Trial showed: SRS is
associated with:
ülower edema
ü  Lower corticosteroid use

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13
Q

Trials evaluating Postoperative or Postradiosurgery Whole-Brain
Radiotherapy
Patchell et al.

The conclusion is?

A

Confirmed the importance of post- operative WBRT inpreventing brain failure and death from neurologic
causes.

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14
Q

Trials evaluating Postoperative orPostradiosurgery Whole-Brain
Radiotherapy

Japanese Radiation Oncology Study Group JROSG- 99-1

Conclusion?

A
  • very little evidence that adjuvant WBRT after surgery is likely to improveoverall survival.
    •  demonstrated the importance of WBRT in decreasing brain failure
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15
Q

Trials evaluating Postoperative orPostradiosurgery Whole-Brain
Radiotherapy

EORTC-22952-26001

Conclusion?

A

*did not improve duration of functional independence or
overall survival
•  associated with decreased 2-year local and distant brain
relapse rate of roughly 30%, resulting in a 16% decrease inneurologic death.

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16
Q

Repeat Whole-Brain RadiotherapyWong et al.

The1st and 2nd doses are?
Percent improvement aftee retreatment with RT?

A 
Median dose for the 1st 
course:  30 Gy 
—  Median dose for the 2nd 
course: 20 Gy 
—  70% experienced 
neurologic improvement 
o  7% - complete neurologic 
resolution while  
o  43% - partial improvement
17
Q 
is an oral alkylating agent with 
excellent CNS penetration.  
—  considered in a patient with 
bulky brain metastases burden 
who is unlikely to become a SRS candidate
A

Temozolomide

18
Q

What is the latest update of De Angelis in neurognition of patients post WBRT?

A

estimated the risk of radiation-induced dementia to be 1.9% to 5.2% for all patients presenting with brain metastasis.

Therefore:
this risk of dementia is not high enough to warrant withholding quality-of-life–prolonging WBRT.

19
Q

What is the American Academy of Neurology stand on anticonvulsant use?

What is considered best as antiseizure med for brain mets?

A

Prophylactic anticonvulsants not beinitiated in newly diagnosed brain
tumor patients who have not
experienced a seizure

levetiracetam

20
Q

Most patients with MSCC have ______ survival

A

Limited

up to 1/3 will survive beyond 1 year.

21
Q

MSCC develops in what ways or pathophysiology?

Give the 3 processes

A 
(a) continued growth 
and expansion of 
vertebral bone metastasis 
into the epidural space 
(c) destruction of vertebral 
cortical bone, causing vertebral 
body collapse with 
displacement of bony 
fragments into the epidural 
space 
(b) neural foraminaextension by a 
paraspinal mass
22
Q

The most significant damagecaused by MSCC: appears to be

A

Vascular in nature

23
Q

Most common primary site of MSCC?

A

Breast 29%
Lung 17%
Prostate 14%

24
Q

Most common level of theMSCC involvement

A

Thoracic spine (59% to 78%)• 
Lumbar (16% to 33%)
•  Cervical spine (4% to 15%)

25
Q

the standard modality for spine imaging.

A

MRI

26
Q

The single strongest predictor for ambulatory status after therapy onmultivariate analysis:

A

Time to development of motor

deficits before radiation (P

27
Q

has been the standard of care in the treatment of patients with
MSCC

A

RT

30 Gy in 10 fractions

28
Q

•  is the most common

histology of pediatric MSCC

A

Neuroblastoma

29
Q

MOA for MSCC in pediatric patients

A

“direct neural foraminalinvasion”
• characteristic “dumb
bell” tumor

30
Q

Most common presentation of MSCC?

A

Back pain in 90%

31
Q

Most common presentation in Intramedullary Spinal Cord Metastasis

A

Weakness 91%

32
Q

Most common primary cancer with Leptomeningeal carcinomatosis?

A

Breast (27% to 50%)
Often HER2-neu over expression

2nd Lungs Adenocarcinoma

33
Q

Rising incidence of brainmetastasis is most likely:

A

P 1766

1. combination of increasing 
survival from recent advances insystemic therapy 
2. greater availability and use of 
magnetic resonance imaging 
(MRI)

Brain Mets (1 decks)

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