back to 2010, vol. 16, b. 3

Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2010, vol. 16, book 3
Subject Collection: Medicine
Page: 32 - 37
DOI: 10.5272/jimab.1632010_32-37
Online date: Nov 24, 2010

J of IMAB 2010; 16(3):32-37
Nikolay A. Peev, Svetoslav  K. Kalevski, Dimiter G. Haritonov.
Department of Neurosurgery, Medical University of Varna, Bulgaria

Although brain metastases  are  one  of  the  most frequently  diagnosed  sequelae  of  systemic malignancy, their optimal management still is not well defined. In that respect the different diagnostic and therapeutic approaches of BMs patients is an issue for serious discussions. Among the   most commonly used diagnostic tools are  computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, single photon emission computed tomography (SPECT) and positron emission tomography (PET) scans etc. Nowadays the aforementioned diagnostic modalities are usually combined in order to obtain complete diagnostic information important for establishing the optimal treatment.
With the present report we try to elaborate on the value of the modern diagnostic tools in differentiating between tumor progressions versus radiation necrosis in irradiated patients with resected brain metastases. 
Although the present advancement of the modern imaging modalities differentiating between tumor progression versus radiation necrosis is often difficult. Application of the metabolic imaging modalities like SPECT, PET and proton magnetic resonance spectroscopy (1H-MRS) contributes for the diagnose but still pathological specimens remain a gold standard for distinguishing tumor from necrosis, because none of the imaging modalities is possible to reliably differentiate necrosis from progression in 100% of the cases.

Key words: brain metastases, gamma knife, surgical resection, stereo tactic radio surgery, metabolic imaging modalities.

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Please cite this article as: Peev NA, Kalevski SK, Haritonov DG. DIAGNOSTIC PITFALLS OF BRAIN METASTASES AFTER  BRAIN IRRADIATION. J of IMAB. 2010; 16(3):32-37. DOI: 10.5272/jimab.1632010_32-37

1. Al-Shamy G., Sawaya R. Management of brain metastases: the indispensable role of surgery. J Neurooncol 2009 May;92(3):275-282 [PubMed]
2. Bartumeus F., Clavel P. Surgical treatment of brain metastases. Rev Neurol. 2000 Dec 16-31;31(12): 1247-1249 (Article in Spanish) [PubMed]
3. Chan Y, Yeung DKW, Leung S, Cao G, Proton magnetic resonance spectroscopy of late delayed radiation-induced injury of the brain. J Magn Reson Imaging 1999 Aug;10(2):130–137 [PubMed]
4. Coia LR, Aaronson N, Linggood R, Loeffer J, Priestman TJ, A report of the consensus workshop panel on the treatment of  brain metastases. Int J Radiat Oncol Biol Phys 1992 23(1):223-227 [PubMed]
5. Endo K, Yui N, Suzuki K, Torizuka K. Clinical usefulness of  thallium-201 chloride in the diagnosis of tumor (1)-evaluation in brain tumor-.Kaku Igaku 1994 Jan;31(1): 53-56 (Jpn) [PubMed]
6. Jagannathan J, Yen CP, Ray DK, Schlesinger D, Oskouian RJ, Pouratian N, Shaffrey ME, Larner J, Sheehan JP (2009)Gamma Knife radiosurgery to the surgical cavity following resection of brain metastases. J Neurosurg 111:431–438 [PubMed]
7. Kano H, Kondziolka D, Zorro O, Lobato-Polo J, Flickinger JC, Lunsford LD(2009) The results of resection after stereotactic radiosurgery for brain metastases. J Neurosurg. [CrossRef]
8. Kimura T, Sako K, Tohyama Y, Aizawa S, Yoshida H, Aburano T, Tanaka K, Tanaka T (2003)Diagnosis and treatment of progressive space-occupying radiation necrosis following stereotactic radiosurgery for brain metastasis: value of proton magnetic resonance spectroscopy. Acta Neurochir (Wien) 145(7):557-64 [PubMed]
9. Lohr F, Pirzkall A, Hof H, Fleckenstein K,Debus J (2001) Adjuvant treatment of brain metastases. Semin Surg Oncol. 20(1): 50-56 [CrossRef]
10. Mehta MP, Shapiro WR, Glantz MJ, Patchell RA, Weitzner MA, Meyers  CA,  et  al (2002)  Lead-in  phase  to  randomized  trial of motexafn  gadolinium  and whole-brain  radiation  for  patients with brain metastases: centralized assessment of magnetic resonance imaging, neurocognitive, and neurologic endpoints. J Clin Oncol 20:3445-3453 [CrossRef] [Medline]
11. Massot-Punyet R, Almajano J, Camacho JM, Cerebral metastases. Rev Neurol 2000 Dec 16-31;31(12):1242-1247 (Article in Spanish) [PubMed]
12. Mandell L, Hilaris B, Sullivan M, Sundaresan N, Nori D, Kim JH, Martini N, Fuks Z, The treatment of single brain metastasis from non-oat cell lung carcinoma. Surgery and radiation versus radiation therapy alone. Cancer 1986 Aug 1; 58(3):641-649 [PubMed]
13. Muacevic A, Wowra B, Siefert A, Tonn JC, Steiger HJ, Kreth FW. Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicentre phase III trial. J Neurooncol 2008 May;87(3):299-307 [PubMed]
14. Muacevic A, Kreth FW, Horstmann GA, Schmid-Elsaesser R, Wowra B, Steiger HJ,  et  al. Surgery  and  radio­therapy  compared  with  gamma  knife  radiosurgery  in  the  treatment  of solitary cerebral metastases of small diameter. J Neurosurg 1999 Jul;91(1):35–43 [PubMed]
15. Ogawa T, Inugami A, Hatazawa J, Kanno I, Murakami M, Yasui N, et al. Clinical positron emission tomography for brain tumors: comparison of  fludeoxyglucose F18 and L-methyl-11C-methionine. AJNR Am J Neuroradiol 1996 Feb;17(2):345–353 [PubMed]
16. Patchell RA, Regine WF, The  rationale  for  adjuvant whole brain radiation therapy with radiosurgery in the treatment of single brain metastases. Technol Cancer Res Treat 2003 Apr;2(2):111–115 [PubMed]
17. Rao G, Klimo P Jr, Thompson CJ, Samlowski W, Wang M, Watson G, et al. Stereotactic radiosurgery as therapy for melanoma, renal carcinoma, and sarcoma brain metastases: impactof added surgical resection and whole brain radiotherapy. Int JRadiat Oncol Biol Phys 2006 66 (4 Suppl):S20-S25 [CrossRef]
18. Schoggl A, Kitz K, Reddy M, Wolfsberger S, Schneider B,Dieckmann K, Ungersbock K, Defining the role of stereotactic radiosurgery versus microsurgery in the treatment of single brain metastases. Acta Neurochir (Wien) 2000 142(6):621–626 [PubMed]
19. Seo Y, Fukuoka S, Nakagawara J, TakanashiM, Nakamura J, Early effect of gamma knife radiosurgery on brain metastases: assessment by 201TlCl SPECT and 99m Tc-DTPA-Human Serum Albumin SPECT. Neurol Med Chir (Tokyo) 1997 Jan;37(1):25–31 [PubMed]
20. Truong MT, St Clair EG, Donahue BR, Rush SC, Miller DC, Formenti SC, et al. Results of surgical resection for progression of brain metastases previously  treated by gamma knife radiosurgery. Neurosurgery 2006 Jul;59(1):86–97 [PubMed]
21. Tsuyuguchi N, Sunada I, Iwai Y, Yamanaka K, Tanaka K, Takami T, et al. Methionine positron emission tomography of recurrent metastatic brain tumor and radiation necrosis after stereotactic radiosurgery: is a differential diagnosis possible? J Neurosurg 2003 May;98(5):1056–1064 [PubMed]
22. Tashima T, Morioka T, Nishino S, Fukui M, Sasaki M. Delayed cerebral radiation necrosis with a high uptake of 11 C-methionine on positron emission tomography and 201Tl-chloride on single-photon emission computed tomography. Neuroradiology 1998 Jul;40(7):435–438 [PubMed]
23. Vecht CJ, Haaxma-Reiche H, Noordijk EM, Padberg GW, Voormolen JH, et al. Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 1993 Jun;33(6):583–590 [PubMed]
24. Vecil GG, Suki D, Maldaun MV, Lang FF, Sawaya R, Resection of brain metastases previously  treated with  stereotactic radiosurgery. J Neurosurg 2005 Feb;102(2):209–215  [PubMed]
25. WHO. Fact sheet N°297 February 2006 Cancer fact sheet.pdf
26. WHO.World health statistics 2007.
27. Williams BJ, Suki D, Fox BD, Pelloski CE, Maldaun MV, Sawaya RE, et al. Stereotactic radiosurgery for metastatic brain tumors: a comprehensive review of complications. J Neurosurg 2009 Sep;111(3):439–448 [PubMed]

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