Management of cerebral metastases:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1996
|
| Schriftenreihe: | Neurosurgery clinics of North America
7,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV S., S. 337 - 569 Ill., graph. Darst. |
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| 245 | 1 | 0 | |a Management of cerebral metastases |c Griffith R. Harsh |
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Datensatz im Suchindex
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| adam_text | MANAGEMENT OF CEREBRAL METASTASES
CONTENTS
Preface xiii
Griffith R. Harsh IV, MD
Demographics of Brain Metastasis 337
John D. Johnson and Byron Young
Brain metastases are the most common intracranial tumor, significantly out¬
numbering primary brain tumors. The apparent increase in the ratio of brain
metastases to primary tumors may be the result of a number of factors, ind tid¬
ing the possibility of a CNS pharmacologic sanctuary, an aging population,
and improved imaging studies. Among adults, the most common origins of
brain metastasis include primary tumors of the lung, breast, skin (melanoma),
and gastrointestinal tract. Among patients under 21 years of age, brain metas¬
tases most often arise from the sarcomas and germ cell tumors.
Pathology of Cerebral Metastases 345
Jun A. Takahashi, Josefina F. Llena, and Asao Hirano
Important pathologic features of cerebral metastases include the route of
spread of tumor cells to the brain, differences among metastases based on
location in dura mater, leptomeninges, and brain parenchyma, differences
based on primary tumor site, both known and unknown, the means of
spread of metastases within the brain, and the brain s reactions to metastases.
Immunohistochemistry and electron microscopy are increasingly used in
the pathologic evaluation of cerebral metastasis.
Biology of Brain Metastasis 369
John W. Walsh
The appearance of a brain metastasis is generally regarded as an ominous
event in the progression of many solid tumors because it usually means
NEUROSURGERY CLINICS OF NORTH AMERICA
that the patient will have reduced quality and length of survival. It is
important to study the biology of brain metastasis because present treat¬
ments are principally palliative and new approaches to diagnosis and treat¬
ment are clearly needed.
Clinical Presentation of Intracranial Metastases 377
Asha Das and Fred H. Hochberg
Intracranial metastases are the single most costly neurologic ailment. This
article provides the clinician with detailed statements of the patterns of
their appearance and tumors of origin. Most common causative cancers are
of lung, breast, or melanoma origin. Aggressive therapies carry with them
the risk of nervous system dissemination of rare tumors, remote complica¬
tions of these cancers and the morbidity of therapy.
Imaging of Cerebral Metastases 393
Pamela W. Schaefer, Ronald F. Budzik, Jr, and R. Gilberto Gonzalez
MR imaging with intravenous gadolinium has greatly enhanced our ability
to detect and delineate intracranial metastases as well as to differentiate them
from other disease processes. Techniques such as magnetization transfer and
triple dose gadolinium imaging have further improved lesion detection.
Consideration of these radiologic techniques, including the issues and con¬
troversies of screening and cost effectiveness, suggests a reasonable ap¬
proach to imaging patients with possible intracranial metastases. Newer
modalities such as echo planar imaging, spectroscopy, PET, and SPECT,
may in the future, prove to be very useful in the evaluation of patients
with intracranial metastases. Proper imaging is also critical to appropriate
diagnosis and management of meningeal metastases, calvarial metastases,
and paraneoplastic disease.
Diagnosis of Suspected Intracranial Metastases: Role of Direct
Tissue Examination 425
Bob S. Carter and Griffith R. Harsh IV
Accurate histologic diagnosis is often critical to the appropriate choice of
treatment of patients suspected of harboring brain metastases. In most cases,
frame based stereotactic biopsy can provide an accurate histologic diagnosis
with minimal risk of morbidity. In addition, newer modalities allow for
efficient coupling of stereotactic biopsy with treatment in a single session.
These include frameless stereotactic systems that facilitate the combination
of open biopsy and resection as well as biopsy procedures that are combined
with focal interstitial or external beam irradiation. These techniques provide
increasingly convenient and effective means of achieving both diagnosis
and treatment of cerebral metastases.
Medical Management of Cerebral Metastases 435
Tracy Batchelor and Lisa M. DeAngelis
Brain edema, seizures, and venous thromboembolism are frequently en¬
countered complications of cerebral metastases that result in increased mor¬
bidity and mortality. Effective medical management of these complications
with steroids, anticonvulsants, and anticoagulants can result in symptomatic
improvement and a better quality of life for these patients. However, these
medical therapies should be administered only when indicated as each is
associated with potentially serious toxicity.
Viii CONTENTS
Clinical Decision Making in Brain Metastases 447
Ehud Arbit and Marek Wronski
Surgery for metastatic cancer of the brain parenchyma has been shown to
increase length of survival, especially in patients with primary breast cancer,
RCC, and lung cancer. The identification of prognostic variables common
to patients with brain metastases has permitted development of therapeu¬
tic guidelines.
Surgical Management of Cerebral Metastases 459
Frederick F. Lang and Raymond Sawaya
Important issues related to surgery for patients with cerebral metastases,
including surgical anatomy and techniques, patient selection criteria, sur¬
gery for multiple and recurrent metastases, and the roles of adjunctive
whole brain radiation, and stereotactic radiosurgery. A practical algorithm
for decision making and survival statistics for the common metastatic tumors
have been developed.
Interstitial Brachytherapy for Intracranial Metastases 485
Michael W. McDermott, G. Rees Cosgrove, David A. Larson, Penny K. Sneed,
and Philip H. Gutin
In large medical centers, the availability of radiosurgery has relegated
brachytherapy to a lesser role in the treatment of newly diagnosed solitary
brain metastases. However, the treatment planning in radiosurgery is com¬
plex, and in some case the hardware is prohibitively expensive; low or high
dose rate brachytherapy requires only a stereotactic frame, commercially
available software, and encapsulated radionuclides or newer tiny linear
accelerators. Interstitial brachytherapy also remains an option for the treat¬
ment of recurrent solitary metastases when other forms of treatment have
failed. This article reviews the radiobiology of low and high dose rate
interstitial brachytherapy, the University of California San Francisco (UCSF)
results using iodine 125 implants, and early experience with the photon
radiosurgery system (PRS) at Massachusetts General Hospital for the treat¬
ment of brain metastases.
Radiosurgery: Its Role in Brain Metastasis Management 497
John C. Flickinger, L. Dade Lunsford, Salvador Somaza, and Douglas Kondziolka
Stereotactic radiosurgery is effective in controlling brain metastasis at pre¬
sentation and those that recur after radiotherapy. It is the treatment of choice
for most patients with small solitary brain metastasis by virtue of its low
morbidity, high effectiveness, and cost.
Radiotherapy for Cerebral Metastases 505
Penny K. Sneed, David A. Larson, and William M. Wnra
Whole brain radiotherapy (VVBRT) for patients with unresected brain metas¬
tases results in symptomatic response in about 50 of patients and improve¬
ment in median survival to 3 to 6 months. Most patients with brain metasta¬
ses are appropriately treated with a conventional palliative course of 30 Gy
in 10 fractions over 2 weeks, although accelerated hyperfractionation with
32 Gy to the whole brain plus a boost to at least 54.4 Gy at 1.6 Gy twice
daily yields better results for patients with solitary metastases. Patients with
a life expectancy of greater than 6 months should receive at most that or
equal to 2.0 Gy per fraction to minimize the risk of radiation induced
CONTENTS IX
leukoencephalopathy and dementia. Patients with good performance status,
absent or controlled primary tumor, and no extracranial metastases might
benefit from surgical resection or radiosurgery (with or without adjunctive
WBRT) to improve local control.
Recurrent Brain Metastases 517
Eben Alexander III and Jay S. Loeffler
Metastases of the brain are the most frequent metastatic neurologic complica¬
tion of systemic cancer and are second only to metabolic encephalopathies
as a cause of central nervous system dysfunction in cancer patients. Despite
recent significant advances in the diagnosis and treatment of metastases to
the brain, many patients will suffer from recurrence. Future advances in
the use of chemotherapy, radiosurgery, and newer cancer therapy tech¬
niques may lead to further increases in the efficacy of treatment for recurrent
brain metastases.
Chemotherapy of Cerebral Metastases from Solid Tumors 527
Glenn J. Lesser
With proper staging, patients with parenchymal brain metastases from solid
tumors are usually found to have widespread extracranial disease. Systemic
chemotherapy offers the potential advantage of simultaneous therapy of
both intracranial and extracranial tumor. Limited data is available on the
efficacy of drug therapy alone in this patient population, for selected patients
with chemosensitive malignancies and brain metastases, systemic chemo¬
therapy administration represents a useful treatment modality when given
at presentation or following recurrence after surgery or radiation therapy.
Immunotoxin Therapy 537
Walter A. Hall
Immunotoxins are extremely potent agents that recognize specific antigens
located on metastatic tumor cells and cause cytotoxicity after cell entry by
inhibiting protein synthesis. These agents have considerable in vitro efficacy
against numerous metastatic tumor cell lines. In vivo studies have shown
complete tumor regression in athymic animals bearing flank tumors or
with leptomeningeal neoplasia. Phase I clinical trials have demonstrated
therapeutic efficacy in patients with carcinomatous meningitis or with intra
parenchymal brain metastases. These agents may be particularly appropriate
for patients with widespread intracranial metastatic disease or with radiore
sistant tumor histology.
Cost and Outcome Analysis 547
Paul L. Penar
The analysis of cost issues has become increasingly important in all fields
of medicine. Understanding these economic analyses can make providers
more cognizant of the ultimate health, economic, and social outcomes of
their treatment decisions. The methodology of cost studies and the surgical
costs of treatment of intracranial metastatic tumors warrant review. Costs
of surgical and radiosurgical treatment are in the range of that for the care
of other serious illnesses, but comparison of the available options is still
sensitive to assumptions, and open to varied interpretations.
X CONTENTS
Recommendations for Treatment of Brain Metastases 559
Allan F. Thornton and Griffith R. Harsh IV
As treatment options for cerebral metastases have increased, so has contro¬
versy regarding relative indications for their use. The therapeutic options,
criteria for choice, and recommendations for treatment require careful con¬
sideration of available data.
Index 565
Subscription Information Inside back cover
CONTENTS XI
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| physical | XIV S., S. 337 - 569 Ill., graph. Darst. |
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| series | Neurosurgery clinics of North America |
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| spelling | Management of cerebral metastases Griffith R. Harsh Philadelphia [u.a.] Saunders 1996 XIV S., S. 337 - 569 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Neurosurgery clinics of North America 7,3 Head and Neck Neoplasms Neoplasm Metastasis Hirnmetastase (DE-588)4262900-7 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Hirnmetastase (DE-588)4262900-7 s DE-604 Harsh, Griffith R. Sonstige oth Neurosurgery clinics of North America 7,3 (DE-604)BV002758938 7,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007295102&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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| subject_GND | (DE-588)4262900-7 (DE-588)4143413-4 |
| title | Management of cerebral metastases |
| title_auth | Management of cerebral metastases |
| title_exact_search | Management of cerebral metastases |
| title_full | Management of cerebral metastases Griffith R. Harsh |
| title_fullStr | Management of cerebral metastases Griffith R. Harsh |
| title_full_unstemmed | Management of cerebral metastases Griffith R. Harsh |
| title_short | Management of cerebral metastases |
| title_sort | management of cerebral metastases |
| topic | Head and Neck Neoplasms Neoplasm Metastasis Hirnmetastase (DE-588)4262900-7 gnd |
| topic_facet | Head and Neck Neoplasms Neoplasm Metastasis Hirnmetastase Aufsatzsammlung |
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