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Advances in Research, Diagnosis and Treatment of Brain Metastases

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Metastasis".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 4581

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Special Issue Editors

Dr. Giuseppe Minniti

E-Mail Website1 Website2
Guest Editor

Radiation Oncology Unit, UPMC Hillman Cancer Center, San Pietro Hospital FBF, 00189 Rome, Italy
Interests: brain tumors; stereotactic radiosurgery; radiation therapy; gliomas; brain metastases; benign brain tumors
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Federico Pessina

E-Mail Website
Guest Editor

1. Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy
2. IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
Interests: neuro-oncology; malignant gliomas; neurosurgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Brain metastases are a common and devastating complication of cancer, and their development remains a substantial contributor to the overall mortality of cancer. Systemic therapy and local treatments, including surgical resection, whole-brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS), represent the most common therapeutic options.

In the last few years, medical therapies have evolved with the use of targeted therapies and immunotherapy. Novel agents have increasingly been used in patients with brain metastases, leading to survival benefits in different cancers such as lung, renal cell, breast, and colorectal cancer, and melanoma.

In the case of radiotherapy, the clinical management of patients with brain metastases has changed substantially in the last few years, with a shift away from WBRT to SRS, which has become the recommended treatment for patients with up to ten lesions.

Recent prognostic models of survival have been expensively revised to incorporate molecular markers unique to different primary cancers. Research concerning molecular characteristics and mechanisms of disease continues with the development of novel systemic therapies, advances in radiation techniques, and minimally invasive surgery. Basic and preclinical research is likely to develop in future clinical applications, improving the odds of survival and the quality of life of patients with brain metastases.

We are pleased to invite you to contribute to This Special Issue aiming to gather contributions from researchers working on translational, basic, and clinical research in the field of cancer and brain metastases. We hope that this important topic attracts considerable interest from a wide range of researchers and clinicians.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following: basic research, the diagnosis and clinical management of brain metastases from different types of cancer, including lung, renal cell, breast, and colorectal cancer, and melanoma.

Dr. Giuseppe Minniti
Prof. Dr. Federico Pessina
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

brain metastases
gene signature
targeted therapy
radiotherapy
immunotherapy
surgery
preclinical model
radiomics
radiosurgery

Published Papers (4 papers)

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Research

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13 pages, 1234 KiB

Open AccessArticle

Overall Survival after Radiotherapy for Brain Metastases According to ECOG Status—A Prospective Study of 294 NSCLC Patients

by Astrid Telhaug Karlsson, Marianne Jensen Hjermstad, Nina Aass, Eva Skovlund, Stein Kaasa and Olav Erich Yri

Cancers 2024, 16(8), 1486; https://doi.org/10.3390/cancers16081486 - 12 Apr 2024

Viewed by 420

Abstract

Up to 40% of non-smallcell lung cancer (NSCLC) patients develop brain metastases (BMs). The potential benefits of radiotherapy (RT) in patients with poor performance status (PS) are questionable, with considerable risk for futile treatment. We analyzed overall survival after initial radiotherapy in NSCLC patients with BMs, focusing on the relationship between PS and survival after RT. This study reports a prospective observational study including consecutive 294 NSCLC patients with first-time BMs. Overall survival (OS) was calculated from the start of RT to death or last follow-up (1 June 2023). Overall, in the 294 included patients (median age 69 years), the median OS was 4.6 months; 2.5 months after WBRT (n = 141), and 7.5 months after SRT (n = 153). After WBRT, mOS was equally poor for patients with ECOG 2 (1.9 months) and ECOG 3–4 (1.2 months). After SRT, mOS for patients with ECOG 2 was 4.1 months; for ECOG 3 patients, mOS was 4 1.6 months. For NSCLC patients with ECOG 2 diagnosed with BMs who are not candidates for surgery or SRT, WBRT should be questioned due to short survival. Full article

(This article belongs to the Special Issue Advances in Research, Diagnosis and Treatment of Brain Metastases)

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13 pages, 1529 KiB

Open AccessArticle

Cytoreduction of Residual Tumor Burden Is Decisive for Prolonged Survival in Patients with Recurrent Brain Metastases—Retrospective Analysis of 219 Patients

by Jonas Lin, Yannik Kaiser, Benedikt Wiestler, Denise Bernhardt, Stephanie E. Combs, Claire Delbridge, Bernhard Meyer, Jens Gempt and Amir Kaywan Aftahy

Cancers 2023, 15(20), 5067; https://doi.org/10.3390/cancers15205067 - 20 Oct 2023

Cited by 1 | Viewed by 752

Abstract

Background: Despite advances in treatment for brain metastases (BMs), the prognosis for recurrent BMs remains poor and requires further research to advance clinical management and improve patient outcomes. In particular, data addressing the impact of tumor volume and surgical resection with regard to survival remain scarce. Methods: Adult patients with recurrent BMs between December 2007 and December 2022 were analyzed. A distinction was made between operated and non-operated patients, and the residual tumor burden (RTB) was determined by using (postoperative) MRI. Survival analysis was performed and RTB cutoff values were calculated using maximally selected log-rank statistics. In addition, further analyses on systemic tumor progression and (postoperative) tumor therapy were conducted. Results: In total, 219 patients were included in the analysis. Median age was 60 years (IQR 52–69). Median preoperative tumor burden was 2.4 cm³ (IQR 0.8–8.3), and postoperative tumor burden was 0.5 cm³ (IQR 0.0–2.9). A total of 95 patients (43.4%) underwent surgery, and complete cytoreduction was achieved in 55 (25.1%) patients. Median overall survival was 6 months (IQR 2–10). Cutoff RTB in all patients was 0.12 cm³, showing a significant difference (p = 0.00029) in overall survival (OS). Multivariate analysis showed preoperative KPSS (HR 0.983, 95% CI, 0.967–0.997, p = 0.015), postoperative tumor burden (HR 1.03, 95% CI 1.008–1.053, p = 0.007), and complete vs. incomplete resection (HR 0.629, 95% CI 0.420–0.941, p = 0.024) as significant. Longer survival was significantly associated with surgery for recurrent BMs (p = 0.00097), and additional analysis demonstrated the significant effect of complete resection on survival (p = 0.0027). In the subgroup of patients with systemic progression, a cutoff RTB of 0.97 cm³ (p = 0.00068) was found; patients who had received surgery also showed prolonged OS (p = 0.036). Single systemic therapy (p = 0.048) and the combination of radiotherapy and systemic therapy had a significant influence on survival (p = 0.036). Conclusions: RTB is a strong prognostic factor for survival in patients with recurrent BMs. Operated patients with recurrent BMs showed longer survival independent of systemic progression. Maximal cytoreduction should be targeted to achieve better long-term outcomes. Full article

(This article belongs to the Special Issue Advances in Research, Diagnosis and Treatment of Brain Metastases)

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27 pages, 4620 KiB

Open AccessArticle

Impact of Novel Treatments in Patients with Melanoma Brain Metastasis: Real-World Data

by Sophie H. A. E. Derks, Joost L. M. Jongen, Edgar L. van der Meer, Li Shen Ho, Cleo Slagter, Arjen Joosse, Maja J. A. de Jonge, Joost W. Schouten, Esther Oomen-de Hoop, Martin J. van den Bent and Astrid A. M. van der Veldt

Cancers 2023, 15(5), 1461; https://doi.org/10.3390/cancers15051461 - 25 Feb 2023

Cited by 2 | Viewed by 1533

Abstract

Background: Melanoma brain metastasis (MBM) is associated with poor outcome, but targeted therapies (TTs) and immune checkpoint inhibitors (ICIs) have revolutionized treatment over the past decade. We assessed the impact of these treatments in a real-world setting. Methods: A single-center cohort study was performed at a large, tertiary referral center for melanoma (Erasmus MC, Rotterdam, the Netherlands). Overall survival (OS) was assessed before and after 2015, after which TTs and ICIs were increasingly prescribed. Results: There were 430 patients with MBM included; 152 pre-2015 and 278 post-2015. Median OS improved from 4.4 to 6.9 months (HR 0.67, p < 0.001) after 2015. TTs and ICIs prior to MBM diagnosis were associated with poorer median OS as compared to no prior systemic treatment (TTs: 2.0 vs. 10.9 and ICIs: 4.2 vs. 7.9 months, p < 0.001). ICIs directly after MBM diagnosis were associated with improved median OS as compared to no direct ICIs (21.5 vs. 4.2 months, p < 0.001). Stereotactic radiotherapy (SRT; HR 0.49, p = 0.013) and ICIs (HR 0.32, p < 0.001) were independently associated with improved OS. Conclusion: After 2015, OS significantly improved for patients with MBM, especially with SRT and ICIs. Demonstrating a large survival benefit, ICIs should be considered first after MBM diagnosis, if clinically feasible. Full article

(This article belongs to the Special Issue Advances in Research, Diagnosis and Treatment of Brain Metastases)

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Review

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15 pages, 1847 KiB

Open AccessReview

Radiosurgery for Brain Metastases: Challenges in Imaging Interpretation after Treatment

by Andrea Romano, Giulia Moltoni, Antonella Blandino, Serena Palizzi, Allegra Romano, Giulia de Rosa, Lara De Blasi Palma, Cristiana Monopoli, Alessia Guarnera, Giuseppe Minniti and Alessandro Bozzao

Cancers 2023, 15(20), 5092; https://doi.org/10.3390/cancers15205092 - 21 Oct 2023

Viewed by 1379

Abstract

Stereotactic radiosurgery (SRS) has transformed the management of brain metastases by achieving local tumor control, reducing toxicity, and minimizing the need for whole-brain radiation therapy (WBRT). This review specifically investigates radiation-induced changes in patients treated for metastasis, highlighting the crucial role of magnetic resonance imaging (MRI) in the evaluation of treatment response, both at very early and late stages. The primary objective of the review is to evaluate the most effective imaging techniques for assessing radiation-induced changes and distinguishing them from tumor growth. The limitations of conventional imaging methods, which rely on size measurements, dimensional criteria, and contrast enhancement patterns, are critically evaluated. In addition, it has been investigated the potential of advanced imaging modalities to offer a more precise and comprehensive evaluation of treatment response. Finally, an overview of the relevant literature concerning the interpretation of brain changes in patients undergoing immunotherapies is provided. Full article

(This article belongs to the Special Issue Advances in Research, Diagnosis and Treatment of Brain Metastases)

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