scholarly journals Lung Adenocarcinoma during Pregnancy: 11-Year Follow-Up

2020 ◽  
Vol 13 (2) ◽  
pp. 892-895
Author(s):  
Angel Acosta Rojas ◽  
Ana Collazo-Lorduy ◽  
Jordi Remon ◽  
Ovidio Hernando Requejo ◽  
Beatriz Jiménez-Munarriz ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Young Women ◽  
Whole Brain Radiotherapy ◽  
High Rate ◽  
Molecular Testing ◽  
Molecular Alterations ◽  
Brain Radiotherapy ◽  
Alk Positive ◽  
Brain Radiation

The incidence of lung cancer during pregnancy is rising due to the high rate of smokers in young women and the late mean age of pregnancy; in addition, considering that the patients are young women with a higher incidence of molecular alterations, molecular testing in lung adenocarcinoma should always be performed, even in pregnancy. Here, we report the case of a lung adenocarcinoma diagnosed during pregnancy with a long survival who benefitted from brain radiotherapy, conventional chemotherapy, and ALK TKI-targeted treatment. It reveals the safety of whole brain radiotherapy during pregnancy and consideration of other brain radiation techniques even in palliative cases, which should be personalized and managed by a multidisciplinary team. However, upfront management of brain metastasis in ALK-positive patients remains unresolved.

Access to radiation oncology centers with brain tumor treatment expertise for patients with resectable brain tumors.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18509-e18509
Author(s):  
Mehee Choi ◽  
Brian P. Martin ◽  
Lisa Misell ◽  
Joseph M. Zabramski ◽  
David G. Brachman
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Access To Care ◽  
Radiation Treatment ◽  
Fold Increase ◽  
Tumor Treatment ◽  
Brain Radiotherapy ◽  
The Us ◽  
Brain Radiation

e18509 Background: Many patients with brain tumors face challenges with access to care. For rural patients, prolonged travel times may limit access to appropriate radiotherapy. Radiation centers (RCs) offering specialized brain radiotherapy, e.g., stereotactic radiosurgery (SRS), are geographically limited. Utilization of brain brachytherapy at the time of resection offers an option for such patients, but technical challenges have limited the adoption. To address the limitations of traditional brachytherapy, a device with Cs-131 seeds embedded in a bioresorbable collagen tile (GammaTile, GT Medical Technologies, Tempe, AZ USA) was developed. GammaTile (GT) is FDA-cleared for permanent implantation at the time of resection for all recurrent intracranial tumors and for newly diagnosed malignant intracranial neoplasms. To investigate if wider availability of this treatment could possibly lower the geographic barrier to access to care, we mapped the US population against existing RCs with brain tumor expertise and neurosurgery centers (NSCs) performing craniotomies. Methods: We analyzed 2018 CMS claims data using CPT codes for single- and multi-fraction SRS to identify RCs with brain tumor treatment expertise and mapped these against the population. Using similar methodology, using CPT codes for craniotomies, we identified NSCs, as any facility performing craniotomies is potentially eligible to implant GT. Results: 135 RCs used CPT codes for SRS. 193-, 119-, 82-, and 52-million Americans lived >30-, >60-, >90-, and >120-minutes from one of these centers, respectively. 530 NSCs preform craniotomies, including ≥1 in every state, a 4-fold increase over the number of RCs offering SRS. Conclusions: For many patients, substantial travel distances limit their access to RCs with brain tumor treatment expertise. In contrast, the 530 craniotomy-performing NSCs have far greater geographic dispersion. The option of undergoing brain radiation with GT implantation at the time of brain tumor craniotomy brings treatment closer to millions, ensures compliance, and reduces additional travel for follow-up radiation treatment.[Table: see text]

Primary Lung Cribriform Adenocarcinoma With Squamoid Morules Harboring Somatic CTNNB1 Mutation in a Never-Smoked Healthy Adolescent

2020 ◽  
Vol 23 (6) ◽  
pp. 472-475
Author(s):  
Hao Wu ◽  
Qiqi Ye ◽  
Dana Razzano ◽  
Oya Tugal ◽  
Jeremy Rosenblum ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Congenital Malformation ◽  
Pediatric Patients ◽  
Molecular Testing ◽  
Adolescent Female ◽  
Healthy Adolescent ◽  
Molecular Alterations ◽  
Tissue Of Origin ◽  
Lung Adenocarcinomas ◽  
Ctnnb1 Mutation

Primary lung adenocarcinomas are rare in pediatric patients, and even rarer in patients without precedent malignancy or congenital malformation. Here we present the first reported case of primary lung cribriform adenocarcinoma with squamoid morules in a previously healthy adolescent female. Molecular testing identified CTNNB1 mutation in the tumor and excluded other common mutations in lung adenocarcinoma. Our case suggests molecular alterations to the same signaling pathway can lead to similar histomorphology regardless of the tissue of origin.

scholarly journals Brain surgery in combination with tyrosine kinase inhibitor and whole brain radiotherapy for epidermal growth factor receptor-mutant non-small-cell lung cancer with brain metastases

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Hsin-Hua Lee ◽  
Chien-Hung Chen ◽  
Hung-Yi Chuang ◽  
Yu-Wei Huang ◽  
Ming-Yii Huang
Keyword(s):  
Lung Cancer ◽  
Epidermal Growth Factor Receptor ◽  
Growth Factor Receptor ◽  
Whole Brain Radiotherapy ◽  
Small Cell ◽  
Brain Surgery ◽  
Small Cell Lung ◽  
Brain Radiotherapy ◽  
Epidermal Growth

AbstractThe role of brain surgery (BS) on the survival of patients with non-small-cell lung cancer (NSCLC) and brain metastases (BM), particularly those with epidermal growth factor receptor (EGFR) mutations under tyrosine kinase inhibitors (TKIs) is yet to be defined. We aimed to investigate whether BS could improve the survival of patients in addition to the combination of TKIs and whole brain radiotherapy (WBRT). A cohort of 1394 NSCLC patients between 2011 and 2016 was retrospectively studied. One hundred patients with BM receiving TKI + RT were enrolled. Forty patients (40%) received TKI + BS + RT, and 60 patients (60%) received TKI + RT. Survival time was calculated from the date of BM diagnoses to the date of death or last follow-up. With a median follow-up of 25.6 months (95% CI, 18.6–35.7), the median survival after BM was 18.2 months (95% CI, 10.8 to 27.4) in the TKI + BS + RT group and 11.8 months (95% CI, 5.2 to18) in the TKI + RT group. Cox proportional hazards regression model for the patients with the largest BM over 1 cm showed that TKI + BS + RT group was associated with improved survival relative to TKI + RT group (HR, 0.49; 95% CI, 0.29 to 0.83; P = 0.008). BS adds significant survival benefits in addition to TKIs and WBRT, especially for patients with EGFR-mutant NSCLC and the largest BM over 1 cm.

scholarly journals Hippocampal avoidance whole-brain radiotherapy without memantine in preserving neurocognitive function for brain metastases: a phase II blinded randomized trial

2020 ◽  
Author(s):  
Wen-Chi Yang ◽  
Ya-Fang Chen ◽  
Chi-Cheng Yang ◽  
Pei-Fang Wu ◽  
Hsing-Min Chan ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Phase Ii ◽  
Whole Brain Radiotherapy ◽  
Neurocognitive Function ◽  
Mean Difference ◽  
Whole Brain ◽  
Delayed Recall ◽  
Brain Radiotherapy ◽  
Hippocampal Avoidance

Abstract Background Hippocampal avoidance whole-brain radiotherapy (HA-WBRT) shows potential for neurocognitive preservation. This study aimed to evaluate whether HA-WBRT or conformal WBRT (C-WBRT) is better for preserving neurocognitive function. Methods This single-blinded randomized phase II trial enrolled patients with brain metastases and randomly assigned them to receive HA-WBRT or C-WBRT. Primary endpoint is decline of the Hopkins Verbal Learning Test–Revised (HVLT-R) delayed recall at 4 months after treatment. Neurocognitive function tests were analyzed with a mixed effect model. Brain progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Results From March 2015 to December 2018, seventy patients were randomized to yield a total cohort of 65 evaluable patients (33 in the HA-WBRT arm and 32 in the C-WBRT arm) with a median follow-up of 12.4 months. No differences in baseline neurocognitive function existed between the 2 arms. The mean change of HVLT-R delayed recall at 4 months was −8.8% in the HA-WBRT arm and +3.8% in the C-WBRT arm (P = 0.31). At 6 months, patients receiving HA-WBRT showed favorable perpetuation of HVLT-R total recall (mean difference = 2.60, P = 0.079) and significantly better preservation of the HVLT-R recognition-discrimination index (mean difference = 1.78, P = 0.019) and memory score (mean difference = 4.38, P = 0.020) compared with patients undergoing C-WBRT. There were no differences in Trail Making Test Part A or Part B or the Controlled Oral Word Association test between the 2 arms at any time point. There were no differences in brain PFS or OS between arms as well. Conclusion Patients receiving HA-WBRT without memantine showed better preservation in memory at 6-month follow-up, but not in verbal fluency or executive function.

Family building preferences among young women with invasive breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24057-e24057
Author(s):  
Angelena Crown ◽  
Nadia Abdo ◽  
Ariela Noy ◽  
Cassandra Chang ◽  
Mary Gemignani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prospective Study ◽  
Fertility Preservation ◽  
Young Women ◽  
Invasive Breast Cancer ◽  
Reproductive History ◽  
High Rate ◽  
Childbearing Age ◽  
Family Building

e24057 Background: The American Society of Clinical Oncology guidelines recommend discussing the possibility of infertility in cancer patients of childbearing age being treated with gonadotoxic therapies. This prospective study examines the reproductive history and future family building preferences of young women with breast cancer. Methods: This is an Institutional Review Board approved prospective study of women < 45 years of age with non-metastatic invasive breast cancer who completed a questionnaire on reproductive history and family building preferences between April 2013 and December 2019. Questionnaires were administered at initial diagnosis and then annually. Results: Baseline questionnaires were completed by 164 women with a median age of 39 years old (range 20-45); 110 (59%) completed the 1 year follow up survey. Clinicopathologic features and treatment are shown in the table. The majority of women (n = 90, 55%) were parous and many had previous infertility (n = 60, 37%) at time of diagnosis. Most women (n = 87, 53%) wanted additional children or were unsure. Interest in embryo and/or oocyte cryopreservation was common (n = 51, 31%) as was interest in adoption (n = 52, 32%). Of the 110 women who completed the one year follow-up, 39 (35%) saw a reproductive endocrinologist, including 22 (20%) who elected embryo (n = 14) or oocyte (n = 8) cryopreservation. Overall, 88 (80%) women declined fertility preservation. The most common reasons included worrying about delay in cancer treatment (n = 10, 9%), fear of hormonal exposure (n = 7, 6%), and feeling rushed into making a decision (n = 6, 6%). Of 92 women with available data regarding satisfaction with their decision to pursue fertility preservation or not, 84% (n = 77) reported satisfaction whereas 14% (n = 15) reported mixed feelings or regret. Conclusions: Young women with breast cancer expressed a significant interest in family building options. However, pursuit of fertility preservation was uncommon despite a high rate of prior infertility in this cohort of mostly parous women. Decisional satisfaction was common. Further study of factors contributing to patient decision-making regarding fertility preservation and alternative family building options is warranted. Clinical trial information: NCT01788839 . [Table: see text]

scholarly journals Rituximab, Methotrexate, Procarbazine, and Vincristine Followed by Consolidation Reduced-Dose Whole-Brain Radiotherapy and Cytarabine in Newly Diagnosed Primary CNS Lymphoma: Final Results and Long-Term Outcome

2013 ◽  
Vol 31 (31) ◽  
pp. 3971-3979 ◽  
Author(s):  
Patrick G. Morris ◽  
Denise D. Correa ◽  
Joachim Yahalom ◽  
Jeffrey J. Raizer ◽  
David Schiff ◽  
...  
Keyword(s):  
Primary Cns Lymphoma ◽  
Whole Brain Radiotherapy ◽  
Cns Lymphoma ◽  
Karnofsky Performance Score ◽  
Whole Brain ◽  
Long Term Outcome ◽  
Reduced Dose ◽  
Brain Radiotherapy

Purpose A multicenter phase II study was conducted to assess the efficacy of rituximab, methotrexate, procarbazine, and vincristine (R-MPV) followed by consolidation reduced-dose whole-brain radiotherapy (rdWBRT) and cytarabine in primary CNS lymphoma. Patients and Methods Patients received induction chemotherapy with R-MPV (five to seven cycles); those achieving a complete response (CR) received rdWBRT (23.4 Gy), and otherwise, standard WBRT was offered (45 Gy). Consolidation cytarabine was given after the radiotherapy. The primary end point was 2-year progression-free survival (PFS) in patients receiving rdWBRT. Exploratory end points included prospective neuropsychological evaluation, analysis of magnetic resonance imaging (MRI) white matter changes using the Fazekas scale, and evaluation of the apparent diffusion coefficient (ADC) as a prognostic factor. Results Fifty-two patients were enrolled, with median age of 60 years (range, 30 to 79 years) and median Karnofsky performance score of 70 (range, 50 to 100). Thirty-one patients (60%) achieved a CR after R-MPV and received rdWBRT. The 2-year PFS for this group was 77%; median PFS was 7.7 years. Median overall survival (OS) was not reached (median follow-up for survivors, 5.9 years); 3-year OS was 87%. The overall (N = 52) median PFS was 3.3 years, and median OS was 6.6 years. Cognitive assessment showed improvement in executive function (P < .01) and verbal memory (P < .05) after chemotherapy, and follow-up scores remained relatively stable across the various domains (n = 12). All examined MRIs (n = 28) displayed a Fazekas score of ≤ 3, and no patient developed scores of 4 to 5; differences in ADC values did not predict response (P = .15), PFS (P = .27), or OS (P = .33). Conclusion R-MPV combined with consolidation rdWBRT and cytarabine is associated with high response rates, long-term disease control, and minimal neurotoxicity.

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