Conclusion: Surgery should be considered whenever possible. This means that the patient has to be in good clinical condition (Karnofsky performance score > 70), the extracerebral metastases should be stable, the number of cerebral lesions should not exceed more than 3 seedings, and the age of the patient should be below 70 years. Since brain metastases are usually well circumscribed, complete extirpation seems to be possible. Postoperative MRI should be demanded in order to confirm complete extirpation. Additional radiotherapy is indicated in case of subtotal resection of a single lesion and in multiple lesions. In single brain metastasis a prospective randomized trial is necessary to prove whether conventional radiotherapy is essential after surgery in the primary treatment of the tumors or can be delayed until cerebral lesions recur. Radiosurgery is an alternative to surgery in the treatment of metastasis. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Brain metastases are treated with surgery, radiotherapy, radiosurgery, and chemotherapy. In this review, recently published studies concerning different treatment strategies are presented with respect to solitary lesions, multiple metastases, and recurrent tumor growth. Selection criteria for the appropriate therapy are: control of the primary tumor, extent of extracerebral metastases, time interval between diagnosis of the primary tumor and the development of cerebral lesions, number of cerebral metastases, Karnofsky performance scale score, and age. Treatment approaches were evaluated with respect to median survival time and quality of life. A singular brain metastasis can be treated with surgery or with radiosurgery. Especially when the primary tumor is under control, there are few extracerebral lesions which are stable, the Karnofsky performance scale score is above 70, the lesion is larger than 3 cm in diameter and surgically accessible surgery is the treatment of choice. Postoperative adjuvant radiotherapy may delay relapse. Median survival time ranges between 10 to 18 months. Radiosurgery can be applied in lesions smaller than 3 cm in diameter and is the treatment of choice in lesions which are surgically not accessible. Multiple metastases are treated either by conventional radiotherapy, radiosurgery or surgery. Commonly, no more than 3 lesions are approached by either surgery or radiosurgery. Median survival time ranges between 6 to 9 months for both treatment concepts, but without therapy only is 4–6 weeks. According to the clinical and neurological condition of the patient, recurrent brain metastases can be treated by operation, reirradiation, or radiosurgery. The efficacy of chemotherapy depends on the chemosensitivity of the primary tumor and the ability to penetrate the blood-brain barrier. Long-term survivors with cancer disease encourage to perform active treatment strategies. / Hirnmetastasen werden durch Operation, Ganzhirnbestrahlung, Radiochirurgie und Chemotherapie behandelt. In dieser Übersichtsarbeit werden kürzlich publizierte Studien bezüglich der Therapiekonzepte für solitäre Läsionen, multiple Metastasen und Tumorrezidive vorgestellt. Auswahlkriterien für eine angemessene Behandlung sind: Kontrolle des Primärtumors, Ausmaß der extrakraniellen Metastasen, Zeitintervall zwischen Diagnose des Primärtumors und dem Auftreten der Hirntumoren, Anzahl der zerebralen Metastasen, Karnofsky-Performance-Scale-Score und Lebensalter. Behandlungskonzepte wurden nach der medianen Überlebenszeit und Lebensqualität ausgewertet. Singuläre Hirnmetastasen können operativ oder radiochirurgisch behandelt werden. Insbesondere wenn der Primärtumor unter Kontrolle ist, wenige extrazerebrale Läsionen bestehen und diese stabil sind, der Karnofsky-Performance-Scale-Score über 70 ist, die Tumoren größer als 3 cm im Durchmesser und chirurgisch erreichbar sind, ist die Operation die Methode der Wahl. Postoperative adjuvante Strahlentherapie kann erneute Progression verzögern. Die mediane Überlebenszeit liegt zwischen 10 und 18 Monaten. Für Läsionen, die kleiner als 3 cm sind und chirurgisch nicht erreicht werden können, ist die Radiochirurgie die Therapie der Wahl. Multiple Metastasen können durch konventionelle Ganzhirnbestrahlung, Radiochirurgie oder Operation behandelt werden. Im allgemeinen werden nicht mehr als 3 Herde operativ oder radiochirurgisch angegangen. Die mediane Überlebenszeit liegt bei beiden Therapieformen zwischen 6 und 9 Monaten, ohne Behandlung hingegen bei nur 4–6 Wochen. Entsprechend dem klinischen und neurologischen Zustand der Patienten können Rezidive von Hirnmetastasen durch chirurgische Entfernung, erneute Bestrahlung oder durch Radiochirurgie therapiert werden. Die Wirkung der Chemotherapie hängt von der Chemosensitivität des Primärtumors und der Durchlässigkeit der Blut-Hirn-Schranke für das Chemotherapeutikum ab. Langzeitüberleber motivieren zu aktiven Behandlungsstrategien. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Stem cell therapy may present an effective treatment for metastatic brain cancer and glioblastoma. Here we posit the critical role of a leaky blood-brain barrier (BBB) as a key element for the development of brain metastases, specifically melanoma. By reviewing the immunological and inflammatory responses associated with BBB damage secondary to tumoral activity, we identify the involvement of this pathological process in the growth and formation of metastatic brain cancers. Likewise, we evaluate the hypothesis of regenerating impaired endothelial cells of the BBB and alleviating the damaged neurovascular unit to attenuate brain metastasis, using the endothelial progenitor cell (EPC) phenotype of bone marrow-derived mesenchymal stem cells. Specifically, there is a need to evaluate the efficacy for stem cell therapy to repair disruptions in the BBB and reduce inflammation in the brain, thereby causing attenuation of metastatic brain cancers. To establish the viability of stem cell therapy for the prevention and treatment of metastatic brain tumors, it is crucial to demonstrate BBB repair through augmentation of vasculogenesis and angiogenesis. BBB disruption is strongly linked to metastatic melanoma, worsens neuroinflammation during metastasis, and negatively influences the prognosis of metastatic brain cancer. Using stem cell therapy to interrupt inflammation secondary to this leaky BBB represents a paradigm-shifting approach for brain cancer treatment. In this review article, we critically assess the advantages and disadvantages of using stem cell therapy for brain metastases and glioblastoma. / National Institutes of Health / Revisión por pares

Background: Development of brain metastases in advanced melanoma patients is a frequent event that limits patients’ quality of life and survival. Despite recent insights into melanoma genetics, systematic analyses of genetic alterations in melanoma brain metastasis formation are lacking. Moreover, whether brain metastases harbor distinct genetic alterations beyond those observed at different anatomic sites of the same patient remains unknown. Experimental Design and Results: In our study, 54 intracranial and 18 corresponding extracranial melanoma metastases were analyzed for mutations using targeted next generation sequencing of 29 recurrently mutated driver genes in melanoma. In 11 of 16 paired samples, we detected nucleotide modifications in brain metastases that were absent in matched metastases at extracranial sites. Moreover, we identified novel genetic variants in ARID1A, ARID2, SMARCA4 and BAP1, genes that have not been linked to brain metastases before; albeit most frequent mutations were found in ARID1A, ARID2 and BRAF. Conclusion: Our data provide new insights into the genetic landscape of intracranial melanoma metastases supporting a branched evolution model of metastasis formation.

No description available.

No description available.

Distant brain metastases from oral squamous cell carcinomas (OSCC) are extremely rare. Here we describe a case of a 53-year-old man with a primary OSCC who referred to the neurosurgical department because of epileptic seizures. MR imaging revealed an enhancing lesion in the right parietal lobe. A craniotomy with tumor removing was performed. Histopathological examination verified an invasive, minimally differentiated metastasis of the primary OSCC. The patient refused whole brain radiation therapy and died from pulmonary metastatic disease 10 months after the neurosurgical intervention without any cerebral recurrence. To the authors’ knowledge, only two similar cases have been previously reported.

Les déterminants psychologiques de la qualité de vie des patients atteints de métastases cérébrales traités par des techniques de neurochirurgie sont peu connus, et en particulier la contribution du fonctionnement cognitif et émotionnel. Des auteurs encouragent la prise en compte de la temporalité pour mieux saisir le concept de qualité de vie. Zimbardo et ses collaborateurs ont développé une théorie du temps psychologique qui permet de relier la qualité de vie et la dépression, nommée la « perspective temporelle ». La thèse vise à confirmer le rôle prédicteur du fonctionnement cognitif dans la qualité de vie de patients traités chirurgicalement pour tumeur(s) cérébrale(s) métastatique(s) et à mieux comprendre les relations entre la perspective temporelle, la dépression et la qualité de vie. Une première étude a comparé le profil sociocognitif en inter-sujets (patients versus témoins) et en intra-sujets (avant traitement neurochirurgical versus après), et a exploré des déterminants de la qualité de vie (i.e., fonctionnement cognitif, symptomatologie dépressive et perspective temporelle). Les résultats principaux sont que les patients présentent un dysfonctionnement cognitif global qui impacte négativement leur autonomie fonctionnelle et qu’une symptomatologie dépressive, même légère, est un important prédicteur de leur qualité de vie globale. Les patients sont plus orientés vers le « présent fataliste » que des témoins, et les dimensions « passé » de leur perspective temporelle sont liées à leur qualité de vie, notamment à travers leur influence sur l’état émotionnel. Une deuxième étude a examiné les relations entre la dimension « passé négatif » de la perspective temporelle en particulier, la dépression et la qualité de vie chez un groupe de patients. Les résultats suggèrent que la symptomatologie dépressive des patients est un médiateur des effets de la dimension « passé négatif » sur leur qualité de vie. Une troisième recherche a exploré, via une étude de cas, les dynamiques du profil de perspective temporelle, de la symptomatologie dépressive, de « l’incertitude vers le futur » et de la qualité de vie au cours du suivi médical. Le principal résultat de cette étude est que les dynamiques des deux dimensions « présent » évoluent conjointement à celle de l’incertitude vers le futur. La thèse encourage la mise en œuvre d’études interventionnelles destinées à évaluer l’efficacité d’interventions psychologiques centrées sur la perspective temporelle chez des patients atteints de métastases cérébrales. / Little is known about the psychological determinants of quality of life in brain metastases patients treated with neurosurgical techniques, in particular the contribution of cognitive and emotional functioning. Authors encourage the consideration of temporality in order to better understand the concept of quality of life. Zimbardo and his collaborators developed a psychological time theory that links quality of life and depression, called the "time perspective". The thesis aims to confirm the predictive role of cognitive functioning in the quality of life of patients treated surgically for metastatic cerebral tumors and to better understand the relationships between time perspective, depression and quality of life. A first study compared the sociocognitive profile in inter-subjects (patients versus controls) and in intra-subjects (before neurosurgical treatment versus after), and explored determinants of quality of life (ie, cognitive functioning, depressive symptomatology and time perspective). The main results are that patients have a global cognitive dysfunction that negatively impairs their functional autonomy and that a depressive symptomatology, even minimal, is an important predictor of their overall quality of life. Patients are more oriented towards the "present-fatalistic " than the controls, and the "past" dimensions of their time perspective are related to their quality of life, notably through their influence on the emotional state. A second study examined the relationship between the "past-negative" dimension of the time perspective in particular, depression and quality of life in a group of patients. The results suggest that the depressive symptomatology of patients mediate the effects of the "past negative" dimension on their quality of life. A third study explored, through a case study, the dynamics of the time perspective profile, depressive symptomatology, "uncertainty towards the future" and quality of life during medical follow-up. The main result of this study is that the dynamics of the two "present" dimensions evolve jointly with the future uncertainty. The thesis encourages the implementation of interventional studies to evaluate the effectiveness of psychological interventions centered on the time perspective in brain metastases patients.

La radiothérapie est souvent utilisée pour contrôler la progression d'un cancer. Cependant, la mauvaise spécificité de ciblage de la plupart des techniques de radiothérapie peut entraîner une réponse clinique ambiguë. Une stratégie alternative - et complémentaire - est d'utiliser des matériaux possédant un numéro atomique élevé et qui peuvent ainsi agir en synergie avec les rayonnements ionisants pour améliorer le ratio thérapeutique de la radiothérapie. Dans ce contexte, une nanoparticule (NP) théranostique à base de gadolinium (Gd) est particulièrement adaptée pour fournir simultanément une plus grande précision en Imagerie par Résonance Magnétique (IRM) et une meilleure efficacité en radiothérapie clinique. Au cours de cette thèse, nous avons étudié d'un point de vue préclinique la pharmacocinétique et le métabolisme de ces NP chez des rongeurs et des primates non humains afin d'élucider leurs voies d'élimination et de calculer la dose sans effet nocif observé (NOAEL). De plus, nous avons démontré la capacité d'imagerie et de thérapie de ces particules sur un modèle de souris porteuses de mélanome cérébral, ceci afin d'appuyer le potentiel des NP pour la radiothérapie guidée par IRM en clinique. Ces travaux de thèse - ainsi que des résultats précédents - ont contribué au début d'un essai clinique actuellement en cours / Combinations of chemotherapy and radiotherapy are often used to control cancer progression. However, the poor targeting specificity of most chemotherapies and radiotherapies can cause toxicity and ambiguous clinical response. In particular, dose escalation in radiotherapy inevitably increases radiation exposure for some surroundings normal tissues and organs, putting them at risk for debilitating damage. An alternative – and complementary – strategy is the use of materials with high atomic numbers (Z) that strongly interact with low energy photons to produce photoelectrons and Auger electrons In this context, a new efficient type of gadolinium (Gd)-based theranostic agent (AGuIX®) has recently been developed by the team of Prof. Tillement for MRI-guided radiotherapy. AGuIX® is a 3-nm size nanoparticles of 9 kDa, consist of a polysiloxane network surrounded by Gd chelates. In this thesis, we investigated the elimination kinetics of AGuIX nanoparticle’s (NPs) from sub-cellular to whole organ scale using original and complementary techniques. This combination of techniques allows the exact mechanism of AGuIX NPs elimination to be elucidated. We reported the preclinical pharmacokinetics and toxicology studies of intravenous AGuIX NPs administration in healthy and atherosclerosis non-human primates (NHP), the goal of which is to demonstrate the safety of AGuIX NPs, in particular, for pre-clinical evaluation. Subsequently, we performed experimental and theoretical studies to investigate the radiosensitization of AGuIX NPs, in particular with B16F10 mouse melanoma as a model for brain metastases. After, we implemented experimental and theoretical studies to precisely understand the mechanism of this radiosensitization, we suggest additional mechanism, potentially caused by chemical and biological effects induced by the combination of Gd and radiation (i.e. high yield of radicals formation and combination, and bystander effect)

Distant brain metastases from oral squamous cell carcinomas (OSCC) are extremely rare. Here we describe a case of a 53-year-old man with a primary OSCC who referred to the neurosurgical department because of epileptic seizures. MR imaging revealed an enhancing lesion in the right parietal lobe. A craniotomy with tumor removing was performed. Histopathological examination verified an invasive, minimally differentiated metastasis of the primary OSCC. The patient refused whole brain radiation therapy and died from pulmonary metastatic disease 10 months after the neurosurgical intervention without any cerebral recurrence. To the authors’ knowledge, only two similar cases have been previously reported.