Brain Mets Flashcards
most common primary site of brain mets
P1766
Lung 50%
2nd: breast: 15-20 %
Metastatic brain tumors
outnumber primary brain tumors by a factor of
10 is to 1 in favor of brain mets
most common symptom of brain mets
Headache - 49%
Mental prob - 32%
Most common sign of brain mets
Hemiparesis - 59%
Cognitive deficits - 58%
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
MRI
Factors impacting prognosis:
Factors impacting prognosis:
- Performance status
- Extracranial disease status
- RPA score
What are the categories of RPA I? How many months is the median survival for RPA i?
RPA
I:
Karnofsky performance score[KPS] ≥70
controlled primary
age
Reasonable regimen of corticosteroids in brain mets
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
standard of care in patients with brain metastasis?
What is the standard dose and fraction for a vast majority?
WBRT
30 Gy in 10 fractions
can provide immediate relief of the tumor mass effect
For Solitary lesion
Surgical resection
reserved for lesions causinglife-threatening complications or for those patients with good performance status (i.e., KPS ≥70)
provides a substitute or alternative to conventional surgery provide similar local control rates (in the order of 80% to 90% onlywhen combined with WBRT)
radiosurgery boost
In RTOG-95-08
08WBRT plus SRS vs WBRT
alone arms
The end points and conclusions are?
Primary EP: OS- EQUAL
Secondary EP: local control and
performance measures is higher in the SRS boost
arm
Trial showed: SRS is
associated with:
ülower edema
ü Lower corticosteroid use
Trials evaluating Postoperative or Postradiosurgery Whole-Brain
Radiotherapy
Patchell et al.
The conclusion is?
Confirmed the importance of post- operative WBRT inpreventing brain failure and death from neurologic
causes.
Trials evaluating Postoperative orPostradiosurgery Whole-Brain
Radiotherapy
Japanese Radiation Oncology Study Group JROSG- 99-1
Conclusion?
- very little evidence that adjuvant WBRT after surgery is likely to improveoverall survival.
• demonstrated the importance of WBRT in decreasing brain failure
Trials evaluating Postoperative orPostradiosurgery Whole-Brain
Radiotherapy
EORTC-22952-26001
Conclusion?
*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.
Repeat Whole-Brain RadiotherapyWong et al.
The1st and 2nd doses are?
Percent improvement aftee retreatment with RT?
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
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
Temozolomide
What is the latest update of De Angelis in neurognition of patients post WBRT?
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.
What is the American Academy of Neurology stand on anticonvulsant use?
What is considered best as antiseizure med for brain mets?
Prophylactic anticonvulsants not beinitiated in newly diagnosed brain
tumor patients who have not
experienced a seizure
levetiracetam
Most patients with MSCC have ______ survival
Limited
up to 1/3 will survive beyond 1 year.
MSCC develops in what ways or pathophysiology?
Give the 3 processes
(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
The most significant damagecaused by MSCC: appears to be
Vascular in nature
Most common primary site of MSCC?
Breast 29%
Lung 17%
Prostate 14%
Most common level of theMSCC involvement
Thoracic spine (59% to 78%)•
Lumbar (16% to 33%)
• Cervical spine (4% to 15%)
the standard modality for spine imaging.
MRI
The single strongest predictor for ambulatory status after therapy onmultivariate analysis:
Time to development of motor
deficits before radiation (P
has been the standard of care in the treatment of patients with
MSCC
RT
30 Gy in 10 fractions
• is the most common
histology of pediatric MSCC
Neuroblastoma
MOA for MSCC in pediatric patients
“direct neural foraminalinvasion”
• characteristic “dumb
bell” tumor
Most common presentation of MSCC?
Back pain in 90%
Most common presentation in Intramedullary Spinal Cord Metastasis
Weakness 91%
Most common primary cancer with Leptomeningeal carcinomatosis?
Breast (27% to 50%)
Often HER2-neu over expression
2nd Lungs Adenocarcinoma
Rising incidence of brainmetastasis is most likely:
P 1766
1. combination of increasing survival from recent advances insystemic therapy 2. greater availability and use of magnetic resonance imaging (MRI)
