White matter changes in breast cancer brain metastases patients who undergo radiosurgery alone compared to whole brain radiation therapy plus radiosurgery.
Identifieur interne : 000615 ( PubMed/Corpus ); précédent : 000614; suivant : 000616White matter changes in breast cancer brain metastases patients who undergo radiosurgery alone compared to whole brain radiation therapy plus radiosurgery.
Auteurs : Timothy B. Stokes ; Ajay Niranjan ; Hideyuki Kano ; Phillip A. Choi ; Douglas Kondziolka ; L. Dade Lunsford ; Edward A. MonacoSource :
- Journal of neuro-oncology [ 1573-7373 ] ; 2015.
English descriptors
- KwdEn :
- Brain Neoplasms (mortality), Brain Neoplasms (secondary), Brain Neoplasms (therapy), Breast Neoplasms (mortality), Breast Neoplasms (pathology), Breast Neoplasms (therapy), Cranial Irradiation (adverse effects), Female, Humans, Kaplan-Meier Estimate, Middle Aged, Radiation Injuries (mortality), Radiation Injuries (pathology), Radiosurgery (adverse effects), White Matter (pathology), White Matter (radiation effects).
- MESH :
- adverse effects : Cranial Irradiation, Radiosurgery.
- mortality : Brain Neoplasms, Breast Neoplasms, Radiation Injuries.
- pathology : Breast Neoplasms, Radiation Injuries, White Matter.
- radiation effects : White Matter.
- secondary : Brain Neoplasms.
- therapy : Brain Neoplasms, Breast Neoplasms.
- Female, Humans, Kaplan-Meier Estimate, Middle Aged.
Abstract
Delayed toxicity after whole brain radiation therapy (WBRT) is of increasing concern in patients who survive more than one year with brain metastases from breast cancer. Radiation-related white matter toxicity is detected by magnetic resonance imaging (MRI) and has been correlated with neurocognitive dysfunction. This study assessed the risk of developing white matter changes (WMC) in breast cancer patients who underwent either WBRT plus stereotactic radiosurgery (SRS) or SRS alone. We retrospectively compared 35 patients with breast cancer brain metastases who received WBRT and SRS to 30 patients who only received SRS. All patients had evaluable imaging at a median of one year after their initial management. The development of white matter T2 prolongation as detected by T2 or FLAIR imaging was graded: grade 1 = little or no white matter T2 hyperintensity; grade 2 = limited periventricular hyperintensity; and grade 3 = diffuse white matter hyperintensity. After WBRT plus SRS, patients demonstrated a significantly higher incidence of WMC (p < 0.0001). After one year, 71.5 % of patients whose treatment included WBRT demonstrated WMC (42.9 % grade 2; 28.6 % grade 3). Only one patient receiving only SRS developed WMC. In long-term survivors of breast cancer, the risk of WMC was significantly reduced when SRS alone was used for management. Further prospective studies are necessary to determine how these findings correlate with neurocognitive toxicity. WBRT usage as initial management of limited brain disease should be replaced by SRS alone to reduce the risk of delayed white matter toxicity.
DOI: 10.1007/s11060-014-1670-4
PubMed: 25445836
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pubmed:25445836Le document en format XML
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Choi</name></author><author><name sortKey="Kondziolka, Douglas" sort="Kondziolka, Douglas" uniqKey="Kondziolka D" first="Douglas" last="Kondziolka">Douglas Kondziolka</name></author><author><name sortKey="Dade Lunsford, L" sort="Dade Lunsford, L" uniqKey="Dade Lunsford L" first="L" last="Dade Lunsford">L. Dade Lunsford</name></author><author><name sortKey="Monaco, Edward A" sort="Monaco, Edward A" uniqKey="Monaco E" first="Edward A" last="Monaco">Edward A. Monaco</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2015">2015</date><idno type="RBID">pubmed:25445836</idno><idno type="pmid">25445836</idno><idno type="doi">10.1007/s11060-014-1670-4</idno><idno type="wicri:Area/PubMed/Corpus">000615</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000615</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">White matter changes in breast cancer brain metastases patients who undergo radiosurgery alone compared to whole brain radiation therapy plus radiosurgery.</title><author><name sortKey="Stokes, Timothy B" sort="Stokes, Timothy B" uniqKey="Stokes T" first="Timothy B" last="Stokes">Timothy B. Stokes</name><affiliation><nlm:affiliation>Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Niranjan, Ajay" sort="Niranjan, Ajay" uniqKey="Niranjan A" first="Ajay" last="Niranjan">Ajay Niranjan</name></author><author><name sortKey="Kano, Hideyuki" sort="Kano, Hideyuki" uniqKey="Kano H" first="Hideyuki" last="Kano">Hideyuki Kano</name></author><author><name sortKey="Choi, Phillip A" sort="Choi, Phillip A" uniqKey="Choi P" first="Phillip A" last="Choi">Phillip A. Choi</name></author><author><name sortKey="Kondziolka, Douglas" sort="Kondziolka, Douglas" uniqKey="Kondziolka D" first="Douglas" last="Kondziolka">Douglas Kondziolka</name></author><author><name sortKey="Dade Lunsford, L" sort="Dade Lunsford, L" uniqKey="Dade Lunsford L" first="L" last="Dade Lunsford">L. Dade Lunsford</name></author><author><name sortKey="Monaco, Edward A" sort="Monaco, Edward A" uniqKey="Monaco E" first="Edward A" last="Monaco">Edward A. Monaco</name></author></analytic><series><title level="j">Journal of neuro-oncology</title><idno type="eISSN">1573-7373</idno><imprint><date when="2015" type="published">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Brain Neoplasms (mortality)</term><term>Brain Neoplasms (secondary)</term><term>Brain Neoplasms (therapy)</term><term>Breast Neoplasms (mortality)</term><term>Breast Neoplasms (pathology)</term><term>Breast Neoplasms (therapy)</term><term>Cranial Irradiation (adverse effects)</term><term>Female</term><term>Humans</term><term>Kaplan-Meier Estimate</term><term>Middle Aged</term><term>Radiation Injuries (mortality)</term><term>Radiation Injuries (pathology)</term><term>Radiosurgery (adverse effects)</term><term>White Matter (pathology)</term><term>White Matter (radiation effects)</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Cranial Irradiation</term><term>Radiosurgery</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Brain Neoplasms</term><term>Breast Neoplasms</term><term>Radiation Injuries</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Breast Neoplasms</term><term>Radiation Injuries</term><term>White Matter</term></keywords><keywords scheme="MESH" qualifier="radiation effects" xml:lang="en"><term>White Matter</term></keywords><keywords scheme="MESH" qualifier="secondary" xml:lang="en"><term>Brain Neoplasms</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Brain Neoplasms</term><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Female</term><term>Humans</term><term>Kaplan-Meier Estimate</term><term>Middle Aged</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Delayed toxicity after whole brain radiation therapy (WBRT) is of increasing concern in patients who survive more than one year with brain metastases from breast cancer. Radiation-related white matter toxicity is detected by magnetic resonance imaging (MRI) and has been correlated with neurocognitive dysfunction. This study assessed the risk of developing white matter changes (WMC) in breast cancer patients who underwent either WBRT plus stereotactic radiosurgery (SRS) or SRS alone. We retrospectively compared 35 patients with breast cancer brain metastases who received WBRT and SRS to 30 patients who only received SRS. All patients had evaluable imaging at a median of one year after their initial management. The development of white matter T2 prolongation as detected by T2 or FLAIR imaging was graded: grade 1 = little or no white matter T2 hyperintensity; grade 2 = limited periventricular hyperintensity; and grade 3 = diffuse white matter hyperintensity. After WBRT plus SRS, patients demonstrated a significantly higher incidence of WMC (p < 0.0001). After one year, 71.5 % of patients whose treatment included WBRT demonstrated WMC (42.9 % grade 2; 28.6 % grade 3). Only one patient receiving only SRS developed WMC. In long-term survivors of breast cancer, the risk of WMC was significantly reduced when SRS alone was used for management. Further prospective studies are necessary to determine how these findings correlate with neurocognitive toxicity. WBRT usage as initial management of limited brain disease should be replaced by SRS alone to reduce the risk of delayed white matter toxicity.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">25445836</PMID><DateCreated><Year>2015</Year><Month>02</Month><Day>09</Day></DateCreated><DateCompleted><Year>2015</Year><Month>10</Month><Day>27</Day></DateCompleted><DateRevised><Year>2017</Year><Month>10</Month><Day>30</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1573-7373</ISSN><JournalIssue CitedMedium="Internet"><Volume>121</Volume><Issue>3</Issue><PubDate><Year>2015</Year><Month>Feb</Month></PubDate></JournalIssue><Title>Journal of neuro-oncology</Title><ISOAbbreviation>J. Neurooncol.</ISOAbbreviation></Journal><ArticleTitle>White matter changes in breast cancer brain metastases patients who undergo radiosurgery alone compared to whole brain radiation therapy plus radiosurgery.</ArticleTitle><Pagination><MedlinePgn>583-90</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1007/s11060-014-1670-4</ELocationID><Abstract><AbstractText>Delayed toxicity after whole brain radiation therapy (WBRT) is of increasing concern in patients who survive more than one year with brain metastases from breast cancer. Radiation-related white matter toxicity is detected by magnetic resonance imaging (MRI) and has been correlated with neurocognitive dysfunction. This study assessed the risk of developing white matter changes (WMC) in breast cancer patients who underwent either WBRT plus stereotactic radiosurgery (SRS) or SRS alone. We retrospectively compared 35 patients with breast cancer brain metastases who received WBRT and SRS to 30 patients who only received SRS. All patients had evaluable imaging at a median of one year after their initial management. The development of white matter T2 prolongation as detected by T2 or FLAIR imaging was graded: grade 1 = little or no white matter T2 hyperintensity; grade 2 = limited periventricular hyperintensity; and grade 3 = diffuse white matter hyperintensity. After WBRT plus SRS, patients demonstrated a significantly higher incidence of WMC (p < 0.0001). After one year, 71.5 % of patients whose treatment included WBRT demonstrated WMC (42.9 % grade 2; 28.6 % grade 3). Only one patient receiving only SRS developed WMC. In long-term survivors of breast cancer, the risk of WMC was significantly reduced when SRS alone was used for management. Further prospective studies are necessary to determine how these findings correlate with neurocognitive toxicity. WBRT usage as initial management of limited brain disease should be replaced by SRS alone to reduce the risk of delayed white matter toxicity.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Stokes</LastName><ForeName>Timothy B</ForeName><Initials>TB</Initials><AffiliationInfo><Affiliation>Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Niranjan</LastName><ForeName>Ajay</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Kano</LastName><ForeName>Hideyuki</ForeName><Initials>H</Initials></Author><Author ValidYN="Y"><LastName>Choi</LastName><ForeName>Phillip A</ForeName><Initials>PA</Initials></Author><Author ValidYN="Y"><LastName>Kondziolka</LastName><ForeName>Douglas</ForeName><Initials>D</Initials></Author><Author ValidYN="Y"><LastName>Dade Lunsford</LastName><ForeName>L</ForeName><Initials>L</Initials></Author><Author ValidYN="Y"><LastName>Monaco</LastName><ForeName>Edward A</ForeName><Initials>EA</Initials><Suffix>3rd</Suffix></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D003160">Comparative Study</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2014</Year><Month>12</Month><Day>02</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Neurooncol</MedlineTA><NlmUniqueID>8309335</NlmUniqueID><ISSNLinking>0167-594X</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="Cites"><RefSource>Cancer. 1979 Oct;44(4):1256-72</RefSource><PMID Version="1">387205</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Cancer. 2005 Dec 15;104(12):2784-91</RefSource><PMID 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MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001943" MajorTopicYN="N">Breast Neoplasms</DescriptorName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName><QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016371" MajorTopicYN="N">Cranial Irradiation</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D053208" MajorTopicYN="N">Kaplan-Meier Estimate</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011832" MajorTopicYN="N">Radiation Injuries</DescriptorName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName><QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016634" MajorTopicYN="N">Radiosurgery</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D066127" MajorTopicYN="N">White Matter</DescriptorName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000528" MajorTopicYN="Y">radiation effects</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2014</Year><Month>03</Month><Day>26</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2014</Year><Month>11</Month><Day>23</Day></PubMedPubDate><PubMedPubDate 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