• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.193-199
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• 2012

Objective : The objective of study is to evaluate the incidence of leptomeningeal carcinomatosis (LMC) in breast cancer patients with parenchymal brain metastases (PBM) and clinical risk factors for the development of LMC. Methods : We retrospectively analyzed 27 patients who had undergone surgical resection (SR) and 156 patients with whole brain radiation therapy (WBRT) as an initial treatment for their PBM from breast cancer in our institution and compared the difference of incidence of LMC according to clinical factors. The diagnosis of LMC was made by cerebrospinal fluid cytology and/or magnetic resonance imaging. Results : A total of 27 patients (14%) in the study population developed LMC at a median of 6.0 months (range, 1.0-50). Ten of 27 patients (37%) developed LMC after SR, whereas 17 of 156 (11%) patients who received WBRT were diagnosed with LMC after the index procedure. The incidence of LMC was significantly higher in the SR group compared with the WBRT group and the hazard ratio was 2.95 (95% confidence interval; 1.33-6.54, p<0.01). Three additional factors were identified in the multivariable analysis : the younger age group (<40 years old), the progressing systemic disease showed significantly increased incidence of LMC, whereas the adjuvant chemotherapy reduce the incidence. Conclusion : There is an increased risk of LMC after SR for PBM from breast cancer compared with WBRT. The young age (<40) and systemic burden of cancer in terms of progressing systemic disease without adjuvant chemotherapy could be additional risk factors for the development of LMC.

• CELLMED
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• v.12 no.5
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• pp.4.1-4.3
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• 2022

Objective: A Case Study of a Patient with Cancer Fatigue Syndrome and Cancer Metastases who Received Ortho-Cellular Nutrition Therapy (OCNT) Methods: The patient is a Korean woman aged 61 years. 13 years ago, she was diagnosed with stage 1 breast cancer and underwent surgery, chemotherapy, and radiation therapy. owever, 13 years later, the disease spread to the lungs and brain. Results: Following nutritional therapy, cancer fatigue syndrome improved. Conclusion: Nutritional therapy can be beneficial for cancer fatigue syndrome, a condition that remains undiagnosed and untreated.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.5
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• pp.1901-1906
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• 2015

Background: Brain metastases occur in about 20-40% of patients with non-small-cell lung carcinoma (NSCLC), and are usually associated with a poor outcome. Whole brain radiotherapy (WBRT) is widely used but increasingly, more aggressive local treatments such as surgery or stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) are being employed. In our study we aimed to describe the various factors affecting outcomes in NSCLC patients receiving local therapy for brain metastases. Materials and Methods: The case records of 125 patients with NSCLC and brain metastases consecutively treated with radiotherapy at two tertiary centres from January 2006 to June 2012 were analysed for patient, tumour and treatment-related prognostic factors. Patients receiving SRS/SRT were treated using Cyberknife. Variables were examined in univariate and multivariate testing. Results: Overall median survival was 3.4 months (95%CI: 1.7-5.1). Median survival for patients with multiple metastases receiving WBRT was 1.5 months, 1-3 metastases receiving WBRT was 3.6 months and 1-3 metastases receiving surgery or SRS/SRT was 8.9 months. ECOG score (${\leq}2$ vs >2, p=0.001), presence of seizure (yes versus no, p=0.031), treatment modality according to number of brain metastases (1-3 metastases+surgery or $SRS/SRT{\pm}WBRT$ vs 1-3 metastases+WBRT only vs multiple metastases+WBRT only, p=0.007) and the use of post-therapy systemic treatment (yes versus no, p=0.001) emerged as significant on univariate analysis. All four factors remained statistically significant on multivariate analysis. Conclusions: ECOG ${\leq}2$, presence of seizures, oligometastatic disease treated with aggressive local therapy (surgery or SRS/SRT) and the use of post-therapy systemic treatment are favourable prognostic factors in NSCLC patients with brain metastases.

• The Journal of Korean Society for Radiation Therapy
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• v.34
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• pp.43-50
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• 2022

Objective: The purpose of this study is to choose a treatment plan and equipment to maximize tangential irradiation to protect the normal brain tissues as much as possible during total scalp irradiation. Subjects and Methods: After zoning the total scalp of a phantom and selecting a target area for treatment, the study made a Helical TomoTherapy(HT) plan, a Helical TomoTherapy with a Complete Block(HTCB) plan, and a Volumetric Modulated Arc Therapy(VMAT) plan. All of these plans made sure that the volume of a treatment plan with 95% of a prescription dose(40 Gy) would not exceed 95% of the entire volume and that Dmax would not be more than 110% of the prescription dose. The therapy plans compared doses among organs at risk of damage including the brain. Doses in the brain tissues were assessed based on the volumetric criteria for normal tissues in Emami et al. Results: HT, HTCB, and VMAT had a dose of 21.68 Gy, 13.75 Gy, and 20.89 Gy, respectively, in brain tissues at D_33%, a dose of 7.06 Gy, 3.21 Gy, and 7.84 Gy, respectively, at D_67%, and a dose of 3.14 Gy, 1.75 Gy, and 3.84 Gy, respectively, at D_100%. They recorded a Dmean of 16.64 Gy, 11.78 Gy, and 16.64 Gy, respectively. These results show that the overall dose was low in the HTCB plan. When the volume of a low dose was calculated based on 5 Gy, they recorded 87%, 49%, and 96%, respectively, in V_5Gy. In addition, the maximum dose in the remaining organ(brain stem, hippocampus, and both lenses) except for the optic pathway was the lowest in HTCB Conclusion: The findings demonstrate that TomoTherapy with a complete block minimized a dose in organs at risk of damage including the brain and hippocampus on both sides and accordingly reduced the probability of side effects such as radiation-induced brain injuries and a resulting decrease in neurocognitive functions. In addition to total scalp irradiation, if additional studies on ring targets treated in various areas are conducted to establish the benefits of tangential irradiation, it is believed that TomoTherapy using Complete Block can be used to maximize tangential irradiation in treatment planning.

• The Korean Journal of Nuclear Medicine
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• v.26 no.2
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• pp.360-364
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• 1992

Treatment for the brain tumors consist of surgery, chemotherapy, and a variety of methods of irradiation. Therapy is aimed to destroy the tumor, but necrosis and edema occur concurrently. Conventional structural imaging techniques such as CT or MRI are unable to reliably distinguish persistent and recurrent tumor from necrosis or edema. T1-201 has been shown to be useful in the evaluation of the myocardial viability by comparing the early uptake and redistribution image. The aim of this study is to evaluate the clinical usefulness of the early uptake and delayed washout images of the T1-201 brain SPECT in the brain tumors. In the pathologically diagnosed various brain tumor patients, brain SPECT was done with rotating gamma camera 15 minutes and 3 hours after T1-201 injection, and the T1-201 uptake in the tumor was compared with the skull and scalp activity. In the glioblastoma multiforme, meningioma and metastatic tumor, the T1-201 uptake was higher than low grade glioma in both 15 minute and 3 hour images (p<0.02). In the low grade glioma,3 hour T1-201 uptake was significantly lower than 15 minute uptake (p<0.05) but in the glioblastoma, meningioma and metastatic tumor there was no significant difference. There was no significant difference in the T1-201 uptake among the glioblastoma, meningioma and metastatic tumors. In one matastatic tumor, T1-201 uptake was decreased after radiation therapy. T1-201 brain SPECT could distinguish the benign and malignancy, and seems to be useful in the follow-up after treatment. But one of the early or delayed SPECT seems not to be necessary for these purposes.

• Journal of Korean Neurosurgical Society
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• v.58 no.3
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• pp.262-270
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• 2015

Objective : Long-term oral anticoagulation or antiplatelet therapy has been used with increasing frequency in the elderly. These patients are at increased risk of morbidity and mortality from expansion of intracranial hemorrhage. We conducted a single-center retrospective case control study to evaluate risk factors associated with outcomes and to identify the differences in outcome in traumatic brain injury between preinjury anticoagulation use and without anticoagulation. Methods : A retrospective study of patients who underwent craniotomy or craniectomy for acute traumatic cerebral hemorrhage, between January 2005 and December 2014 was performed. Results : A consecutive series of 50 patients were evaluated. The factors significantly differed between the two groups were initial Prothrombin Time-International Normalized Ratio, initial platelet count, initial Glasgow Coma Scale score, and postoperative intracranial bleeding. Mean Glasgow Outcome Scale (GOS) score were similar between the two groups. In the patient with low-energy trauma only, no significant differences in GOS score, postoperative bleeding and many other factors were observed. The contributing factors to postoperative bleeding was preinjury anticoagulation and its adjusted odds ratio was 12 [adjusted odds ratio (OR), 12.242; p=0.0070]. The contributing factors to low GOS scores, which mean unfavorable neurological outcomes, were age (adjusted OR, 1.073; p=0.039) and Rotterdam scale score for CT scans (adjusted OR, 3.123; p=0.0020). Conclusion : Preinjury anticoagulation therapy contributed significantly to the occurrence of postoperative bleeding. However, preinjury anticoagulation therapy in the patients with low-energy trauma did not contribute to the poor clinical outcomes or total hospital stay. Careful attention should be given to older patients and severity of hemorrhage on initial brain CT.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.13
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• pp.5401-5406
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• 2015

Background: Brain metastases are the most common intra-cranial neoplasms. The incidence is on a rise due to advanced imaging techniques. Aims: The objective of the study was to analyse the clinical and demographic profile of patients with brain metastases from primary solid tumors. Materials and Methods: This is a retrospective single institutional study covering 130 consecutive patients with brain metastases from January 2007 to August 2014. Results: Some 64.6% of the patients were females. The majority were in the sixth decade of life. The site of the primary tumor was the lungs in 50.8% of the cases. The overall median time from the diagnosis of the primary malignancy to detection of brain metastases was 21.4 months. Survival was found to be significantly improved in patients with solitary brain lesions when compared to patients with multiple brain metastases, and in patients undergoing surgical excision with or without cranial irradiation when compared to whole brain irradiation alone. The majority of the cases belonged to the recursive partitioning analysis class II group. Whole brain radiation therapy was delivered to 79% of the patients. Conclusions: Most of the patients with brain metastases in the study belonged to recursive partitioning analysis classes II or III, and hence had poor prognosis. Most of the patients in the Indian context either do not satisfy the indications for surgical excision or are incapable of bearing the high cost associated with stereotactic radiosurgery. Treatment should be tailored on an individual basis to all these patients.

• Korean Journal of Head & Neck Oncology
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• v.20 no.1
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• pp.7-12
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• 2004

Background and Objectives: Brain metastasis from well-differentiated thyroid carcinoma is uncommon, and the treatment remains controversial. In this study, we analyzed cases of brain metastasis from well differentiated thyroid carcinoma to determine optimal treatment. Material and Methods: From March 1986 to May 2003, we experienced 13 cases of brain metastases from well-differentiated thyroid carcinomas. There were 6 men and 7 women with a mean age of 62.3 years. The time interval detecting the brain metastasis, treatment methods, outcomes, and the prognostic factors were analyzed. Results: In 11 patients, brain metastasis was found at a mean of 96 months after thyroid surgery (range, 1-204months). In 1 patient, brain metastasis was found simultaneously with the thyroid cancer. In the remaining one, brain metastasis was presented as the first sign. Treatment included gamma knife therapy in 2, external radiation therapy (ExRT) in 2, resection and ExRT in 2, gamma knife therapy and ExRT in 2 and intracranial holmium injection in 1. Three patients received no treatment. The mean survival was 20.5months (1-119 months). Only 2 patients with early detection remained alive after treatment (23months and 119months). The age, sex, primary tumor size, combined organs of distant metastasis and treatment methods did not affect the prognosis. There were noticeable symptomatic improvements in patients who received any kind of treatment for brain metastasis. Conclusion: Early detection and treatment of brain metastasis appears to bring symptomatic relief and improve survival. Therefore, early screening for brain metastasis is recommended for patients with symptoms. However, further study is needed to determine the optimal method of treatment.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7401-7407
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• 2013

Aim: To compare survival outcomes after whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and WBRT plus SRS combination therapy in Korea, by performing a quantitative systematic review. Materials and Methods: We searched 10 electronic databases for reports on Korean patients treated with WBRT or SRS for brain metastases published prior to July 2010. Independent reviewers screened all articles and extracted the data. When a Kaplan-Meier survival curve was available, median survival time and standard errors were calculated. Summary estimates for the outcomes in each study were calculated using the inverse variance random-effects method. Results: Among a total of 2,761 studies, 20 studies with Korean patients (n=1,053) were identified. A combination of 12 studies (n=566) with WBRT outcomes showed a median survival time of 6.0 months (95%CI: 5.9-6.2), an overall survival rate of 5.6% (95%CI: 1-24), and a 6-month survival rate of 46.5% (95%CI: 37.2-56.1). For nine studies (n=412) on SRS, the median survival was 7.9 months (95%CI: 5.1-10.8), and the 6-month survival rate was 63.1% (95%CI: 49.8-74.8). In six studies (n=75) using WBRT plus SRS, the median survival was 10.7 months (95%CI: 4.7-16.6), and the overall and 6-month survival rates were 16.8% (95%CI: 6.2-38.2) and 85.7% (95%CI: 28.3-96.9), respectively. Conclusions: WBRT plus SRS showed better 1-year survival outcome than of WBRT alone for Korean patients with metastatic brain tumors. However, the results of this analysis have to be interpreted cautiously, because the risk factors of patients were not adjusted in the included studies.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.9
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• pp.4233-4235
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• 2016

Background: Whole brain radiotherapy (WBRT) and stereotactic radiosurgery were frequently used to palliate patients with brain metastases. It remains controversial which modality or combination of therapy is superior especially in the setting of limited number of brain metastases. The availability of newer medical therapy that improves survival highlighted the importance of reducing long term radiation toxicity associated with WBRT. In this study, we aim to demonstrate the hippocampal sparing technique with whole brain and integrated simultaneous boost Materials and Methods: Planning data from 10 patients with 1-5 brain metastases treated with SRS were identified. Based on the contouring guideline from RTOG atlas, we identified and contoured the hippocampus with 5mm isocentric expansion to form the hippocampal avoidance structure. The plan was to deliver hippocampal sparing whole brain radiotherapy (HSWBRT) of 30 Gy in 10 fractions and simultaneous boost to metastatic lesions of 30 Gy in 10 fractions each. Results: The PTV, hippocampus and hippocampal avoidance volumes ranges between 1.00 - 39.00 cc., 2.50 - 5.30 cc and 26.47 - 36.30 cc respectively. The mean hippocampus dose for the HSWBRT and HSWBRT and SIB plans was 8.06 Gy and 12.47 respectively. The max dose of optic nerve, optic chiasm and brainstem were kept below acceptable range of 37.5 Gy. Conclusions: The findings from this dosimetric study demonstrated the feasibility and safety of treating limited brain metastases with HSWBRT and SIB. It is possible to achieve the best of both worlds by combining HSWBRT and SIB to achieve maximal local intracranial control while maintaining as low a dose as possible to the hippocampus thereby preserving memory and quality of life.