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Surendran HP, Sah SK, Louis DM, Kalavagunta S, Poornachary NM, Joy SC, Dutta D. Efficacy of memantine in preventing neurocognitive dysfunction induced by radiation therapy in patients with brain metastases: A systematic review of clinical trials. Semin Oncol 2023; 50:113-122. [PMID: 37775420 DOI: 10.1053/j.seminoncol.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE About 50%-90% of patients with brain metastases who receive radiation therapy experience cognitive impairment. This systematic review aims to gather credible sources of comprehensive information on the efficacy of memantine in preventing cognitive dysfunction. METHODS A comprehensive review conducted in compliance with the PRISMA statement and systematic search was performed across five databases included PubMedⓇ, EmbaseⓇ, ScopusⓇ, Cochrane LibraryⓇ, and ClinicalTrial.gov.in from inception until November 2021. RESULTS A total of four eligible studies were selected in this review that included 1,444 patients with brain metastases who received radiation therapy (Intervention group [n = 729] and control group [n = 715]). Overall, three of the four studies reported some improvement in neurocognitive function in at least one or more parameters such as recall and recognition (P = .39, P = .10 and P = .05), verbal fluency (P = .03 and P < .0001), complex attention (P = .59) executive function (P = .92) and normal appearing white matter (P = .01) following memantine therapy compared to control group. Further, two of the four studies reported an improvement in the patients' quality of life following memantine therapy compared to the control group, and there was no significant difference in the toxicity profile of the interventional compared to the control group as reported from two studies. CONCLUSION This review embraces the comprehensive evidence that the use of memantine therapy in patients with brain metastases to prevent radiation-induced neurocognitive dysfunction has a modest and statistically significant beneficial impact in improving quality of life and preserving some neurocognitive function without any complications. Pending the completion of additional ongoing studies, one can argue that memantine is a reasonable treatment to consider in patients with brain metastases while they receive whole brain radiation therapy.
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Affiliation(s)
| | - Sujit Kumar Sah
- Department of Pharmacy Practice, School of Health Sciences and Technology, Dr. Vishwanath Karad MIT World Peace University, Pune, Maharashtra, India
| | - Dhanya Mary Louis
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sruthi Kalavagunta
- Department of Radiation Oncology, Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | | | - Selin Chiriyankandath Joy
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Debnarayan Dutta
- Department of Radiation Oncology, Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
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Jayraj AS, Kumar S, Bhatla N, Malik PS, Mathur S, Rangarajan K, Vanamail P, Thulkar S, Kumar L. Central nervous system metastasis from epithelial ovarian cancer- predictors of outcome. Curr Probl Cancer 2023; 47:100918. [PMID: 36502584 DOI: 10.1016/j.currproblcancer.2022.100918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022]
Abstract
Management of central nervous system (CNS) metastases from epithelial ovarian cancer (EOC) is an unmet need. We analyzed data on 41 such patients to evaluate predictors of outcome. Between January, 2010 and December 2020, among 1028 patients with EOC treated at our institute 41 (3.98%) developed CNS metastasis. Median age of patients was 48 years, ranging from 22 to 75 years. Primary outcome measure was progression free survival (PFS). Overall survival (OS), and analysis of prognostic factors were secondary outcome measures. An intention to treat analysis was done. We also performed review the literature (n=2253) as regards to clinicopathological and radiological features, treatment received, survival outcomes and prognostic factors. Median time from diagnosis of EOC to CNS metastasis was 27 months (range: 0 to 101 months). 33(80.5%) patients had FIGO stage III-IV at baseline and serous carcinoma (75.6%) was common pathology subtype. Thirteen (31.7%) patients had isolated CNS metastasis and 28 (68.3%) had intra-abdominal disease in addition. Nineteen (46.3%) patients achieved complete response post treatment with surgery, radiation and chemotherapy. Median PFS and OS from the time of CNS metastasis is 12 (range:1 to 51) months and 33 (range: 1 to 71) months, respectively. Absence of extracranial disease and lower serum CA-125 at diagnosis of CNS metastasis were predictive of superior PFS and OS on multivariate analysis. CNS metastasis is a late event in EOC, post multiple lines of treatment. Patients with disease limited to brain and treated with surgical resection and chemoradiation have best outcome.
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Minareci Y, Ak N, Tosun OA, Sozen H, Saip PM, Topuz S, Salihoglu MY. Central nervous system metastasis in gynecologic cancers: Seeking the prognostic factors. J Cancer Res Ther 2023; 19:S523-S529. [PMID: 38384014 DOI: 10.4103/jcrt.jcrt_499_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/27/2022] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Central nervous system (CNS) metastasis originating from gynecological cancer is a very rare and late manifestation of the disease. Therefore, there is still limited data on prognostic factors for survival. The objective of the present study is to identify prognostic factors for survival in patients with CNS metastasis originating from gynecological cancer. STUDY DESIGN The present retrospective study analyzed the patients with gynecological cancers who were treated due to CNS metastases between January 1999 and December 2019 at Istanbul University Hospital. RESULTS Forty-seven patients with CNS metastasis of gynecological origin were included in the study. The median age at the time of CNS metastasis was 59 (range 34-93). The median time from initial cancer diagnosis to CNS metastasis was 24.9 (range: 0-108.2) months. Most patients had epithelial ovarian cancer (EOC) (76.6%), followed by endometrial cancer (EC) (14.8%), cervical cancer (CC) (4.3%), and vulvar cancer (VC) (4.3%). By multivariate analysis, the presence of extracranial metastasis (HR: 5.10; 95% CI: 1.71-15.18), Eastern Cooperative Oncology Group (ECOG) performance status ≥3 (HR: 2.92; 95% CI: 1.36-6.26), palliative care only for the treatment of CNS metastasis (HR: 1.47; 95% CI: 0.58-4.11), and treatment-free interval (TFI) <6 months (HR: 2.74; 95% CI: 1.23-6.08) were independent factors that associated with worse survival. CONCLUSION Patients with CNS metastasis who have favorable prognostic factors are considered to be appropriate candidates for aggressive and long-term treatment strategies. Extracranial metastasis, ECOG performance status, treatment history of CNS metastasis, and TFI were determined as independent prognostic factors that improved survival. TFI might be taken into account as a prognostic factor for patients with CNS metastasis in gynecological cancer.
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Affiliation(s)
- Yagmur Minareci
- Department of Gynecologic Oncology, Eskisehir City Hospital, Eskisehir, Turkey
| | - Naziye Ak
- Department of Medical Oncology Istanbul University, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Ozgur Aydın Tosun
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Hamdullah Sozen
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pinar Mualla Saip
- Department of Medical Oncology Istanbul University, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Samet Topuz
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Yavuz Salihoglu
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Matsunaga S, Shuto T, Serizawa T, Aoyagi K, Hasegawa T, Kawagishi J, Yomo S, Kenai H, Nakazaki K, Moriki A, Iwai Y, Yamamoto T. Gamma Knife radiosurgery for metastatic brain tumors from ovarian cancer: histopathological analysis of survival and local control. A Japanese multi-institutional cooperative and retrospective cohort study. J Neurosurg 2022; 137:1006-1014. [PMID: 35148503 DOI: 10.3171/2021.12.jns212239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Brain metastasis is rare in ovarian cancer patients. The results of Gamma Knife radiosurgery (GKRS) for the treatment of patients with brain metastases from ovarian cancer were retrospectively analyzed to derive the efficacy and prognostic factors for survival and local tumor control. Further histopathological analysis was also performed. METHODS The authors retrospectively reviewed the medical records of 118 patients with 566 tumors who had undergone GKRS at the 10 GKRS institutions in Japan. RESULTS After the initial GKRS, the median overall survival time was 18.1 months. Multivariate analysis showed that uncontrolled primary cancer (p = 0.003) and multiple intracranial metastases (p = 0.034) were significant unfavorable factors. Ten patients died of uncontrolled brain metastases at a median of 17.1 months. The 6-, 12-, and 24-month neurological death rates were 3.2%, 4.6%, and 11.9%, respectively. The 6-, 12-, and 24-month neurological deterioration rates were 7.2%, 13.5%, and 31.4%, respectively. The 6-, 12-, and 24-month distant brain control failure rates were 20.6%, 40.2%, and 42.3%, respectively. Median tumor volume was 1.6 cm3 and marginal dose was 20 Gy. The 6-, 12-, and 24-month local tumor control rates were 97.6%, 95.2%, and 88.0%, respectively. Peritumoral edema (p = 0.043), more than 7-cm3 volume (p = 0.021), and prescription dose less than 18 Gy (p = 0.014) were factors that were significantly correlated in local tumor control failure. Eight patients had symptomatic radiation injury. The 6-, 12-, and 24-month GKRS-related complication rates were 3.3%, 7.8%, and 12.2%, respectively. Primary ovarian cancer was histopathologically diagnosed for 313 tumors in 69 patients. Serous adenocarcinoma was found in 37 patients and other types in 32 patients. Median survival times were 32.3 months for the serous type and 17.4 months for other types after initial GKRS. Patients with serous-type tumors survived significantly longer than patients with other types (p = 0.039). The 6-, 12-, and 24-month local tumor control rates were 100%, 98.8%, and 98.8%, respectively. Serous-type tumors were a significantly good prognosis factor for local tumor control after GKRS (p = 0.005). CONCLUSIONS This study established a relationship between the efficacy of GKRS treatment for brain metastases and the histological type of primary ovarian cancer. GKRS for ovarian cancer brain metastasis can provide satisfactory survival and local control, especially in cases of serous adenocarcinoma.
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Affiliation(s)
- Shigeo Matsunaga
- 1Department of Neurosurgery and
- 2Stereotactic Radiotherapy Center, Yokohama Rosai Hospital, Yokohama, Kanagawa
| | - Takashi Shuto
- 1Department of Neurosurgery and
- 2Stereotactic Radiotherapy Center, Yokohama Rosai Hospital, Yokohama, Kanagawa
| | - Toru Serizawa
- 3Tokyo Gamma Unit Center, Tsukiji Neurological Clinic, Tokyo
| | - Kyoko Aoyagi
- 4Department of Neurosurgery, Gamma Knife House, Chiba Cerebral and Cardiovascular Center, Ichihara, Chiba
| | - Toshinori Hasegawa
- 5Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, Komaki, Aichi
| | - Jun Kawagishi
- 6Department of Neurosurgery, Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Miyagi
| | - Shoji Yomo
- 7Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Nagano
| | - Hiroyuki Kenai
- 8Department of Neurosurgery, Nagatomi Neurosurgical Hospital, Oita
| | - Kiyoshi Nakazaki
- 9Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima
| | | | - Yoshiyasu Iwai
- 11Department of Neurosurgery, Osaka City General Hospital, Osaka; and
| | - Tetsuya Yamamoto
- 12Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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Surendran HP, Narmadha MP, Kalavagunta S, Sasidharan A, Dutta D. Preservation of cognitive function after brain irradiation. J Oncol Pharm Pract 2022:10781552221077037. [PMID: 35112915 DOI: 10.1177/10781552221077037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Approximately 50-90% of brain metastatic patients who receive radiation therapy (RT) exhibit cognitive decline which may affects the quality of life of cancer survivors. Hence preservation of cognitive functions in brain metastatic patients becomes important. This review aims to evaluates the pathology or mechanism of cognitive function impairment after brain irradiation and strategies available to preserve cognitive function after radiation therapy. DATA SOURCES Published articles evaluating the pathology behind radiation induced cognitive impairment and strategies to resolve or preserve cognitive impairment were searched for in scientific databases (eg: PubMed, Scopus, Cochrane database, Google scholar) using keywords including memantine, brain metastases, radiation therapy, pathophysiology, pathogenesis, mechanism and prevention. DATA SUMMARY Several hypotheses have been offered to explain the mechanism of radiation induced cognitive decline. Among them, vascular hypotheses play a significant role. Some pharmacological agents have been also tested in patients receiving radiotherapy, memantine was found beneficial based with the reference to existing data. CONCLUSION Future studies are required to evaluate the impact of memantine in different types of radiation therapy procedures and its effects on quality of life of brain metastatic survivors.
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Affiliation(s)
| | - M P Narmadha
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sruthi Kalavagunta
- Department of Radiation Oncology, 29286Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Ajay Sasidharan
- Department of Radiation Oncology, 29286Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Debnarayan Dutta
- Department of Radiation Oncology, 29286Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Cagino K, Kahn R, Pannullo S, Ashamalla H, Chan S, Balogun O, Thomas C, Christos PJ, Holcomb K, Frey MK, Chapman-Davis E. Treatment patterns and outcomes among women with brain metastases from gynecologic malignancies. Gynecol Oncol Rep 2020; 34:100664. [PMID: 33204795 PMCID: PMC7649617 DOI: 10.1016/j.gore.2020.100664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 11/19/2022] Open
Abstract
Longer time between initial cancer diagnosis and brain metastasis is associated with improved survival. Brain metastasis treated with surgery and radiation is associated with improved survival. Newer targeted therapies may be beneficial in the treatment of brain metastasis.
Background Brain metastasis secondary to gynecologic malignancy is rare and has no definitive management guidelines. In this descriptive study, we aimed to identify prognostic factors and treatments that may be associated with longer overall survival. Methods Patients with brain metastases from gynecologic malignancies were identified between 2004 and 2019 at two institutions. Descriptive statistics were performed using N (%) and median (interquartile range). Univariate cox proportional hazards regression was performed to evaluate the effect of different factors on overall survival. Results 32 patients presented with brain metastasis from gynecologic primaries (ovarian/fallopian tube/primary peritoneal n = 14, uterine n = 11, cervical n = 7). Median age of initial cancer diagnosis was 61 (34–79). At initial cancer diagnosis 83% of patients were Stage III/IV and underwent surgery (66%), chemotherapy (100%), and/or pelvic radiation (33%). Median time from initial cancer diagnosis to brain metastasis was 18 months. Treatment of brain metastasis with surgery and radiation compared to stereotactic radiosurgery or whole brain radiation therapy alone revealed a trend toward longer overall survival (p = 0.07). Time from initial cancer diagnosis to brain metastasis was associated with longer overall survival with each one-month increase from initial cancer diagnosis associated with a 7% reduction in risk of death (HR 0.93, 95% CI = 0.89–0.97, p = 0.01). Initial cancer treatment, stage, histology, and number of brain lesions did not affect overall survival. Conclusions Patients with brain metastasis secondary to gynecologic malignancies with the longest overall survival had the greatest lag time between initial cancer diagnosis and brain metastasis. Brain metastasis treated with surgery and radiation was associated with longer overall survival.
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Affiliation(s)
- Kristen Cagino
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Ryan Kahn
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Susan Pannullo
- Department of Neurological Surgery, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Hani Ashamalla
- Department of Radiation Oncology, New York Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Susie Chan
- Department of Radiation Oncology, New York Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Onyinye Balogun
- Department of Radiation Oncology, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Charlene Thomas
- Department of Population Health Sciences, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Paul J Christos
- Department of Population Health Sciences, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Kevin Holcomb
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Melissa K Frey
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Eloise Chapman-Davis
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
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Brain Metastases from Ovarian Cancer: Current Evidence in Diagnosis, Treatment, and Prognosis. Cancers (Basel) 2020; 12:cancers12082156. [PMID: 32759682 PMCID: PMC7464214 DOI: 10.3390/cancers12082156] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022] Open
Abstract
With this review, we provide the state of the art concerning brain metastases (BMs) from ovarian cancer (OC), a rare condition. Clinical, pathological, and molecular features, treatment options, and future perspectives are comprehensively discussed. Overall, a diagnosis of high-grade serous OC and an advanced disease stage are common features among patients who develop brain metastases. BRCA1 and BRCA2 gene mutations, as well as the expression of androgen receptors in the primary tumor, are emerging risk and prognostic factors which could allow one to identify categories of patients at greater risk of BMs, who could benefit from a tailored follow-up. Based on present data, a multidisciplinary approach combining surgery, radiotherapy, and chemotherapy seem to be the best approach for patients with good performance status, although the median overall survival (<1 year) remains largely disappointing. Hopefully, novel therapeutic avenues are being explored, like PARP inhibitors and immunotherapy, based on our improved knowledge regarding tumor biology, but further investigation is warranted.
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Jiang H, Liang G, Dai M, Dong Y, Wu Y, Zhang L, Xi Q, Qi L. Preparation of doxorubicin-loaded collagen-PAPBA nanoparticles and their anticancer efficacy in ovarian cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:880. [PMID: 32793724 DOI: 10.21037/atm-20-5028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The aims of this study were to prepare the collagen-poly (3-acrylamidophenylboronic acid) nanoparticles (collagen-PAPBA NPs) encapsulating doxorubicin (DOX) and research their anticancer efficacy in ovarian cancer. Methods Collagen-PAPBA NPs were prepared, and their morphology and stability morphology were observed by transmission electron microscopy (TEM) and dynamic light scattering system (DLS). Preparation of doxorubicin-loaded Collagen-PAPBA NPs (DOX-loaded NPs) were then prepared, and the drug-loading content, encapsulation efficiency, and in vitro drug-release profiles were calculated. The morphology of DOX-loaded NPs was also observed by DLS, in vitro cytotoxicity to A2780 cells was analyzed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay, in vitro antitumor activity on A2780 cells was observed by immunofluorescence, and in vivo antitumor activity was assessed using an experimental BALB/c mice tumor model. Results DOX-encapsulating collagen-PAPBA NPs were successfully prepared with mediation by biomolecule. The average hydrodynamic diameter of collagen-PAPBA NPs as measured by DLS was about 79 nm, with a homogeneous distribution of size. TEM revealed that nanoparticles were well-dispersed, spherical, and a roughly uniform 75 nm in size. Collagen-PAPBA NPs were quite stable in a wide range of pH and temperature conditions and associated with the concentration of glucose. DLS revealed that the average hydrodynamic diameter of DOX-loaded NPs was about 81.3 nm, with homogeneous distribution of size. TEM revealed that drug-loaded nanoparticles were spherical, well-dispersed, and gad a roughly uniform size of 79 nm. The proportion of DOX loaded into the nanoparticles was 10%, while the encapsulating efficiency was 97%. The result of the releasing test showed that the drug-loaded nanoparticles, as carriers for DOX, had a good sustained-release effect. The cell toxicity experiment showed that the blank NPs had no cytotoxicity to A2780 cells, and that the drug-loaded NPS had good a sustained-release function. They may thus have potential toxic-reducing side effects. Conclusions Under the same doses, the drug-loaded NP had a superior inhibitory effect to free DOX on the growth of human ovarian cancer.
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Affiliation(s)
- Haiyan Jiang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong, China.,Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Guiwen Liang
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Min Dai
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong, China
| | - Yansong Dong
- School of Medicine, Nantong University, Nantong, China
| | - Yao Wu
- School of Medicine, Nantong University, Nantong, China
| | - Luzhong Zhang
- School of Medicine, Nantong University, Nantong, China
| | - Qinghua Xi
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong, China
| | - Lei Qi
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong, China.,Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
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Umana GE, Alberio N, Amico P, Maria Lavecchia A, Fagone S, Fricia M, Nicoletti G, Cicero S, Scalia G. Giant cystic brain metastasis from ovarian papillary serous adenocarcinoma: Case report and review of the literature. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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10
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A Rare Cause of Headache in Common Cancer: Ovarian Carcinoma with Brain Metastasis. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-018-0255-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Keskin S, Küçücük S, Ak N, Atalar B, Sarı M, Sozen H, Ibis K, Topuz S, Saip P. Survival Impact of Optimal Surgical Cytoreduction in Recurrent Epithelial Ovarian Cancer with Brain Metastasis. Oncol Res Treat 2019; 42:101-106. [PMID: 30661076 DOI: 10.1159/000494334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 10/05/2018] [Indexed: 11/19/2022]
Abstract
AIM The aim of this study was to determine the clinicopathological characteristics, treatment details and outcome of patients with brain metastasis from epithelial ovarian carcinoma (EOC). METHODS This study included 21 patients diagnosed with brain metastasis from EOC between 1999 and 2009. RESULTS Median age was 61 years (range 38-77). The median time elapsed from EOC diagnosis to brain metastasis detection was 32 months. Single brain metastases were found in 10 (48%) cases, and there was extra-cranial disease in 11 (52%) cases. During the mean 86 months of follow-up, 18 of the patients (86%) died of the disease and 3 (14%) were alive with disease. The median survival time after the initial diagnosis of brain metastasis was 9 months. The median overall survival (OS) from initial diagnosis of EOC was 50 months. In univariate analysis, prolonged time from initial diagnosis to central nervous system metastasis (more than 32 months) (p = 0.001), treatment with radiotherapy (p < 0.001), optimal cytoreductive operation (p = 0.02) were all positively correlated with OS. CONCLUSION The prognosis of patients with brain metastasis from EOC is still poor. The significant predictors of survival in our series were whole brain radiotherapy, prolonged elapsed time from initial diagnosis to brain metastasis and optimal cytoreductive surgery.
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Linear accelerator-based radiosurgery and hypofractionated stereotactic radiotherapy for brain metastasis secondary to gynecologic malignancies: A single institution series examining outcomes of a rare entity. Gynecol Oncol Rep 2018; 25:19-23. [PMID: 29977986 PMCID: PMC6030026 DOI: 10.1016/j.gore.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/08/2018] [Accepted: 05/10/2018] [Indexed: 11/20/2022] Open
Abstract
Objective The use of SRS and fSRT to determine overall survival, tumor control, and local-disease free progression in patient diagnosed with gynecologic brain metastasis. Methods In this retrospective review, 11 patients aged 50 to 85 (median age of 71) were treated with linear accelerator-based SRS and hypofractionated SRT for brain metastasis secondary to gynecologic malignancies. In total, 16 tumors were treated from 2007 to 2017. Patients were treated to a median dose of 24 Gy (range 15 to 30 Gy) in 3 Fx (range 1 to 5). Median follow-up from SRS or SRT was 4 months (range 3–38 months). Results The actuarial 1-year overall survival rate was 26% with a median overall survival of 8 months. In addition, 1-year actuarial local control rate was 83.3% and the 1-year distant brain control rate was 31%. One patient experienced toxicity that presented as seizures after 7 months (due to minimal edema) that required anticonvulsants. There was no other acute or late treatment-related toxicity. Conclusion: Linear-accelerator based SRS or fSRT is safe and effective for control of local tumor growth in brain metastases secondary to gynecologic malignancies. The course of disease remains aggressive as seen by poor overall survival and distant failure rate. Brain Metastases as a result of gynecologic malignancies are rare, making up <3% of CNS metastasis. Improved systemic treatment and radiographic sensitivity has led to increased incidence of gynecologic brain metastasis. Stereotactic technique, including radiosurgery and radiotherapy, remain a safe, effective treatment option.
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Ben Kridis W, Sghaier S, Toumi N, Khanfir A, Daoud J, Frikha M. An exceptional evolution of primary peritoneal serous carcinoma. Acta Clin Belg 2017; 72:439-442. [PMID: 28271744 DOI: 10.1080/17843286.2017.1300216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Primary peritoneal serous carcinoma (PPSC) is a rare malignancy of the peritoneum. Clinically and histopathologically, PPSC is similar to serous ovarian papillary carcinoma. Brain metastases (BM) from PPSC are exceedingly rare. We report here a new case of BM two years after complete remission from a PPSC, to make aware physicians about this entity. This case is exceptional; firstly given the rarity of this entity and secondly due to the good response after radiotherapy then systemic chemotherapy with Carboplatin and Paclitaxel.
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Affiliation(s)
- Wala Ben Kridis
- Department of Oncology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Syrine Sghaier
- Department of Oncology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Nabil Toumi
- Department of Oncology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Afef Khanfir
- Department of Oncology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Jamel Daoud
- Department of Radiotherapy, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Mounir Frikha
- Department of Oncology, Habib Bourguiba Hospital, Sfax, Tunisia
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14
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Kasper E, Ippen F, Wong E, Uhlmann E, Floyd S, Mahadevan A. Stereotactic radiosurgery for brain metastasis from gynecological malignancies. Oncol Lett 2017; 13:1525-1528. [PMID: 28454285 PMCID: PMC5403471 DOI: 10.3892/ol.2017.5621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 04/15/2016] [Indexed: 12/04/2022] Open
Abstract
Brain metastases are relatively uncommon in gynecological malignancies, and there is limited available data on their management. The present study reports the outcomes of patients with brain metastasis from gynecological malignancies who were treated with stereotactic radiosurgery (SRS). Patients with brain metastasis from a gynecological primary site were treated with SRS using the Cyberknife™ frameless SRS system. Primary lesions were treated with a single fraction of 16–22 Gy. A total of 3 resection cavities were treated with 8 Gy 3 times, meaning a total of 24 Gy, and 1 recurrent lesion was re-irradiated with 5 Gy 5 times, meaning a total of 25 Gy. All patients were followed up with regular magnetic resonance imaging and clinical examinations 1 month after treatment and every 2 months thereafter. A total of 20 lesions in 8 patients were included in this study; 1 patient presented with metastatic endometrial cancer and the remaining 7 presented with metastatic ovarian cancer. The median age was 61 years (range, 48–78 years). All patients had received systemic therapy prior to developing brain metastasis. A total of 3 patients underwent surgical resection and 1 patient was administered re-irradiation for recurrence. There were 3 local failures in 2 patients. The actuarial 1-, 2- and 3-year local control rates were 91, 91 and 76%, respectively. The median overall survival time was 29 months. No SRS-associated toxicities or neurological mortalities were observed. In conclusion, brain metastasis from gynecological malignancies is uncommon, however, SRS is a safe and effective treatment modality for local control as a primary or adjuvant treatment in patients with this disease.
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Affiliation(s)
- Ekkehard Kasper
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Franziska Ippen
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Eric Wong
- Department of Neuro-oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Eric Uhlmann
- Department of Neuro-oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Scott Floyd
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Anand Mahadevan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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15
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Keller A, Ismail R, Potrebko PS, Pepe J, Wu M, Saigal K, Biagioli M, Shridhar R, Holloway R, Field M, Rao NG. Role of Gamma Knife® Radiosurgery for the Treatment of Brain Metastases from Gynecological Cancers. Cureus 2016; 8:e947. [PMID: 28168125 PMCID: PMC5289899 DOI: 10.7759/cureus.947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: Gamma Knife® (GK) (Elekta Instruments, Stockholm, Sweden) radiosurgery is well established for treatment of brain metastases. There are limited data on patients treated with GK from gynecological cancers. The authors sought to determine the effectiveness of the GK in patients with brain metastases from gynecological cancers. Methods: An IRB-approved database was queried for patients with gynecologic cancers treated with GK between June 1996 and May 2016. Imaging studies were reviewed post-SRS (stereotactic radiosurgery) to evaluate local control (LC) and distant brain control (DC). Overall survival (OS), local control, and distant brain control were calculated using the Kaplan-Meier (KM) method and log-rank test. Results: Thirty-three patients underwent SRS for 73 separate cranial lesions. The median age was 58.5 years, and 17 (52%) also had extracranial metastases. Ten (30%) patients had previously received whole brain radiotherapy (WBRT), and 11 (33%) underwent concurrent WBRT. The median tumor volume was 0.96 cm3. Median radiographic follow-up was 11 months. At the time of treatment, 39% of patients were categorized as recursive partitioning analysis (RPA) Class I, 55% as RPA Class II, and 6% as RPA Class III. The local failure rate was 8%. Five patients (15%) developed new brain lesions outside the radiation field with a median progression-free survival (PFS) of seven (range: 3-9) months. Median OS was 15 months from GK treatment. One-year OS was 72.9% from GK treatment. Primary cancer histology was a significant predictor of OS, favoring ovarian and endometrial cancer (p = 0.03). Conclusions: Gamma Knife stereotactic radiosurgery for gynecologic brain metastases leads to excellent control rates of treated lesions. Primary histology may have a significant impact on OS following GK, with improved survival seen with ovarian and cervical cancer following Gamma Knife radiosurgery (p = 0.03).
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Affiliation(s)
| | - Rahim Ismail
- College of Medicine, University of Central Florida
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16
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Matsunaga S, Shuto T, Sato M. Gamma Knife Surgery for Metastatic Brain Tumors from Gynecologic Cancer. World Neurosurg 2016; 89:455-63. [DOI: 10.1016/j.wneu.2016.01.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/14/2016] [Accepted: 01/14/2016] [Indexed: 11/30/2022]
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17
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Wang YJ, Han TT, Xue JX, Chang DS, Li HQ, Li P, Wang JD, Wang YJ, Xia TY. Stereotactic gamma-ray body radiation therapy for asynchronous bilateral renal cell carcinoma. Radiol Med 2014; 119:878-83. [DOI: 10.1007/s11547-014-0402-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/05/2014] [Indexed: 10/25/2022]
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