Brain metastases from small cell lung cancer and non-small cell lung cancer: comparison of spatial distribution and identification of metastatic risk regions

Multi-institutional atlas of brain metastases informs spatial modeling for precision imaging and personalized therapy

Brain metastases are a frequent and debilitating manifestation of advanced cancer. Here, we collect and analyze neuroimaging of 3,065 cancer patients with 13,067 brain metastases, representing an extensive collection for research. We find that metastases predominantly localize to high perfusion areas near the grey-white matter junction, but also identify notable differences depending on the primary cancer histology as well as brain regions which do not conform to this relationship. Lung and breast cancers, in contrast to melanoma, frequently metastasize to the cerebellum, hinting at biological pathways of spread. Additionally, the deep brain structures are relatively spared from metastasis, regardless of primary cancer type. Leveraging this data, we propose a probabilistic brain metastasis risk model to enhance the therapeutic ratio of whole-brain radiotherapy by targeting high risk areas while preserving cortical and subcortical brain regions of functional significance and low metastasis risk, potentially reducing the cognitive side effects of therapy.

Spatial-demographic analysis model for brain metastases distribution

PURPOSE

The distribution analysis of the morphologic characteristics and spatial relations among brain metastases (BMs) to guide screening and early diagnosis.

MATERIAL AND METHODS

This retrospective study analysed 4314 BMs across 30 brain regions from MRIs of 304 patients. This paper proposed a unified analysis model based on persistent homology (PH) and graph modelling to provide a comprehensive portrait of BMs distribution. Spatial relationships are quantified through dynamic multiple-scale graphs constructed with Rips filtration. The multi-scale centrality importance and clustering coefficients are extracted to decode BMs spatial relations. Morphologic BMs characteristics are further analysed by varying radius and volume values that are considered as clinically influential factors. Finally, two-tailed proportional hypothesis testing is used for BM statistical distribution analysis.

RESULTS

For spatial analysis, results have shown a statistical increase in the proportions of high-level centrality BMs at the left cerebellum (p<0.01). BMs rapidly form graphs with high clustering rather than those with high centrality. For demographic analysis, the cerebellum and frontal are the top high-frequency areas of BMs with 0-4 and 5-10 radii. Statistical increases in the proportions of BMs at cerebellum (p<0.01).

CONCLUSION

Results indicate that distributions of both BMs spatial relations and demographics are statistically non-random. This research offers novel insights into the BMs distribution analysis, providing physicians with the BMs demographic to guide screening and early diagnosis.

Clinical characteristics and outcomes of surgical resection for brain metastases from lung adenocarcinoma

Objective

The purpose of this study was to explore the clinical characteristics, survival time and prognostic factors of patients undergoing craniotomy for brain metastases (BM) from lung adenocarcinoma (LUAD).

Methods

A total of 208 patients with BM from LUAD who underwent craniotomy at the Zhengzhou University People's Hospital, Henan province, China from March 2005 to October 2022 were included in this retrospective study. All patients were confirmed as BM of LUAD by histopathology. The clinical data included patient gender, age, occupation, family history of tumor, smoking history, alcohol drinking history, neurological symptoms, history of lung cancer treatment, tumor location, tumor number, tumor size, gene status, expression of S-100, CEA, Ki67, and PD-L1 by immunohistochemistry, KPS after craniotomy, whether tumor therapy was continued after craniotomy, and survival time. Univariate and multivariate Cox regression was used to analyze the prognostic factors of patients undergoing craniotomy for LUAD BM.

Results

A total of 208 patients met the inclusion and exclusion criteria, including 110 males (52.9%) and 98 females (47.1%), with an average age of 61.4 years. 203 patients (97.6%) had neurological symptoms. 84 patients (40.4%) had smoking history, 89 patients (42.8%) had alcohol drinking history, and 31 patients (14.9%) had the family history of tumor. Only 5 patients (2.4%) had received lung cancer treatment before craniotomy. The intracranial location of BM was mostly in the frontal lobe (54, 26.0%) and the metastatic sites were mostly single (117, 56.3%); the metastatic tumor size was mostly between 2-5 cm (141, 67.8%). Genetically, 43.3% patients (90 cases) had EGFR mutations, and immunohistochemical analysis showed that most patients were PD-L1 positive (160, 76.9%) and Ki67 > 30% (137, 65.9%). Most patients (145, 69.7%) had KPS score under 80 after craniotomy. Only 72 patients (34.7%) received continued tumor therapy after craniotomy. 190 patients (91.3%) were successfully followed up. The median survival time was 11.5 months, and the 3-year survival rate was 15.7%. Multivariate analysis revealed that smoking history, Ki67 percentage, KPS after craniotomy, and molecular targeted therapy after craniotomy were independent factors affecting the survival time of patients.

Conclusions

Although survival remains poor, patients who had no-smoking history, Ki67 percentage ≤30%, KPS≥80 after craniotomy, and molecular targeted therapy after craniotomy can improve the prognosis and prolong the survival time.

Metastatic brain tumors: from development to cutting-edge treatment

Metastatic brain tumors, also called brain metastasis (BM), represent a challenging complication of advanced tumors. Tumors that commonly metastasize to the brain include lung cancer and breast cancer. In recent years, the prognosis for BM patients has improved, and significant advancements have been made in both clinical and preclinical research. This review focuses on BM originating from lung cancer and breast cancer. We briefly overview the history and epidemiology of BM, as well as the current diagnostic and treatment paradigms. Additionally, we summarize multiomics evidence on the mechanisms of tumor occurrence and development in the era of artificial intelligence and discuss the role of the tumor microenvironment. Preclinically, we introduce the establishment of BM models, detailed molecular mechanisms, and cutting-edge treatment methods. BM is primarily treated with a comprehensive approach, including local treatments such as surgery and radiotherapy. For lung cancer, targeted therapy and immunotherapy have shown efficacy, while in breast cancer, monoclonal antibodies, tyrosine kinase inhibitors, and antibody-drug conjugates are effective in BM. Multiomics approaches assist in clinical diagnosis and treatment, revealing the complex mechanisms of BM. Moreover, preclinical agents often need to cross the blood-brain barrier to achieve high intracranial concentrations, including small-molecule inhibitors, nanoparticles, and peptide drugs. Addressing BM is imperative.

Current preclinical models of brain metastasis

Brain metastases (BMs) represent the most prevalent intracranial malignancy within the adult. They are identified in up to 20% of patients with solid tumors and this percentage varies between tumor types and age. Due to the selective permeability of the blood-brain barrier, most anticancer drugs can't reach significant concentrations in the brain, representing a major obstacle to the patients' survival. Furthermore, intra- and inter-patient heterogeneity and the unique brain microenvironment add a layer of complexity to the clinical management of BMs. In the perspective of finding new therapeutic approaches and better understanding the molecular mechanisms involved in brain metastasis, the use of appropriate preclinical models is essential. Here, we review current in vivo, in vitro and ex vivo models for the study of brain metastasis while outlining their advantages and limitations.

Synchronous double primary small cell lung cancer and invasive ductal breast carcinoma: a case report

BACKGROUND

Although lung and breast cancers are common malignancies, the occurrence of primary synchronous neoplasms involving these organs has been rarely reported in literature.

CASE PRESENTATION

A 75-year-old female patient presented at a local hospital with a ten-day history of dizziness and slurred speech. A CT contrast-enhanced scan revealed a 4.2 cm mass in the lower lobe of the right lung and a 3.8 cm space-occupying lesion in the right breast. Subsequent breast ultrasound identified a hypoechoic lesion measuring5.41 × 4.75 × 3.06 cm in the right breast, and an ultrasound-guided biopsy confirmed the presence of infiltrating ductal carcinoma of the right breast. The immunohistochemistry analysis of the breast mass revealed positive staining for ER, PR, HER-2, AR and Ki67 in the tumor cells, while negative staining was observed for P63, Calponin, CK5/6 and CK14. MR imaging of the head detected abnormal signals in the right frontal lobe (3.6 cm×2.9 cm in size), left cerebellar hemisphere, and punctate enhancement in the left temporal lobe, indicating potential metastasis. Pathological examination of a lung biopsy specimen confirmed the presence of small cell lung cancer (SCLC). Furthermore, immunohistochemistry analysis of the lung lesions demonstrated positive staining for TTF-1, CK-Pan, Syn, CgA, CD56, P53 (90%) and Ki67 (70%), and negative staining for NapsinA and P40 in the tumor cells. The patient's diagnosis of SCLC with stage cT2bN0M1c IVB and brain metastases (BM), as well as invasive ductal breast carcinoma (IDC), was confirmed based on the aforementioned results. Whereupon we proposed a treatment plan consisting of whole-brain radiation (40 Gy/20fractions), focal radiotherapy (60 Gy/20fractions), and adjuvant concurrent chemotherapy with oral etoposide (50 mg on days 1 to 20).

CONCLUSIONS

To the best of our knowledge, the present case is the first of its kind to describe the synchronous double cancer, consisting of primary SCLC and IDC.

Modern Stereotactic Radiotherapy for Brain Metastases from Lung Cancer: Current Trends and Future Perspectives Based on Integrated Translational Approaches

Brain metastases (BMs) represent the most frequent metastatic event in the course of lung cancer patients, occurring in approximately 50% of patients with non-small-cell lung cancer (NSCLC) and in up to 70% in patients with small-cell lung cancer (SCLC). Thus far, many advances have been made in the diagnostic and therapeutic procedures, allowing improvements in the prognosis of these patients. The modern approach relies on the integration of several factors, such as accurate histological and molecular profiling, comprehensive assessment of clinical parameters and precise definition of the extent of intracranial and extracranial disease involvement. The combination of these factors is pivotal to guide the multidisciplinary discussion and to offer the most appropriate treatment to these patients based on a personalized approach. Focal radiotherapy (RT), in all its modalities (radiosurgery (SRS), fractionated stereotactic radiotherapy (SRT), adjuvant stereotactic radiotherapy (aSRT)), is the cornerstone of BM management, either alone or in combination with surgery and systemic therapies. We review the modern therapeutic strategies available to treat lung cancer patients with brain involvement. This includes an accurate review of the different technical solutions which can be exploited to provide a "state-of-art" focal RT and also a detailed description of the systemic agents available as effective alternatives to SRS/SRT when a targetable molecular driver is present. In addition to the validated treatment options, we also discuss the future perspective for focal RT, based on emerging clinical reports (e.g., SRS for patients with many BMs from NSCLC or SRS for BMs from SCLC), together with a presentation of innovative and promising findings in translational research and the combination of novel targeted agents with SRS/SRT.