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Stereotactic Radiosurgery as Part of Multimodal Treatment in a Bulky Leptomeningeal Recurrence of Breast Cancer.

Bertke MH, Burton EC, Shaughnessy JN - Cureus (2016)

Bottom Line: Breast cancer metastatic to the brain and/or leptomeningeal spread of disease is a frequently encountered clinical situation, especially given the extended course of disease in these patients. Systemic therapies can often effectively prolong extracranial disease control, making effective strategies to control central nervous system-based disease even more critical.In order to treat the patient's bulky disease and leptomeningeal spread while avoiding the potential toxicities of repeat whole brain radiation, the patient was treated with frameless stereotactic radiosurgery and intrathecal chemotherapy.The patient had an excellent response to treatment and durable intracranial control.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, University of Louisville.

ABSTRACT
Breast cancer metastatic to the brain and/or leptomeningeal spread of disease is a frequently encountered clinical situation, especially given the extended course of disease in these patients. Systemic therapies can often effectively prolong extracranial disease control, making effective strategies to control central nervous system-based disease even more critical. We present a case of bulky leptomeningeal relapse of breast cancer in the setting of prior whole brain radiation therapy. In order to treat the patient's bulky disease and leptomeningeal spread while avoiding the potential toxicities of repeat whole brain radiation, the patient was treated with frameless stereotactic radiosurgery and intrathecal chemotherapy. This is the first report of this treatment approach for leptomeningeal relapse of breast cancer. The patient had an excellent response to treatment and durable intracranial control.

No MeSH data available.


Related in: MedlinePlus

Brain MRI FindingsAxial T1 post-contrast MRI shows areas of concern and response to treatment at two representative slices at the time of diagnosis of leptomeningeal relapse (A and B), one month post-radiosurgery (C and D), and five months post-radiosurgery (E and F). Dual arrows (A, C, E) highlight an area of bulky cerebellar disease and leptomeningeal involvement. Single arrows (B, D, F) highlight an area of bulky subventricular disease.
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FIG1: Brain MRI FindingsAxial T1 post-contrast MRI shows areas of concern and response to treatment at two representative slices at the time of diagnosis of leptomeningeal relapse (A and B), one month post-radiosurgery (C and D), and five months post-radiosurgery (E and F). Dual arrows (A, C, E) highlight an area of bulky cerebellar disease and leptomeningeal involvement. Single arrows (B, D, F) highlight an area of bulky subventricular disease.

Mentions: Repeat imaging of the brain performed 31 months after completion of her WBRT showed multiple new enhancing parenchymal and subventricular lesions and MRI findings consistent with leptomeningeal disease (Figures 1A-1B). Seven discrete bulky lesions were seen, with the largest lesion measuring 1.5 cm in the right cerebellum and the remainder measuring less than 1 cm. There was evidence of leptomeningeal involvement of the cerebellar fissures throughout the posterior fossa, and MRI of the complete neuraxis showed possible leptomeningeal caking in the patient’s lumbar nerve roots. At this time, the patient’s neurologic complaints consisted of mild ataxia and right occipital headaches, but she was free from any other focal deficits on neurologic examination. The patient’s case was discussed at a multidisciplinary neurooncology tumor board, with input from neuroradiology, neurooncology, radiation oncology, and neurosurgery. In light of her prior whole brain radiation therapy, the bulk of recurrent intracranial disease, and the presence of leptomeningeal carcinomatosis, a combined treatment approach using SRS followed by intrathecal chemotherapy was designed.


Stereotactic Radiosurgery as Part of Multimodal Treatment in a Bulky Leptomeningeal Recurrence of Breast Cancer.

Bertke MH, Burton EC, Shaughnessy JN - Cureus (2016)

Brain MRI FindingsAxial T1 post-contrast MRI shows areas of concern and response to treatment at two representative slices at the time of diagnosis of leptomeningeal relapse (A and B), one month post-radiosurgery (C and D), and five months post-radiosurgery (E and F). Dual arrows (A, C, E) highlight an area of bulky cerebellar disease and leptomeningeal involvement. Single arrows (B, D, F) highlight an area of bulky subventricular disease.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4829399&req=5

FIG1: Brain MRI FindingsAxial T1 post-contrast MRI shows areas of concern and response to treatment at two representative slices at the time of diagnosis of leptomeningeal relapse (A and B), one month post-radiosurgery (C and D), and five months post-radiosurgery (E and F). Dual arrows (A, C, E) highlight an area of bulky cerebellar disease and leptomeningeal involvement. Single arrows (B, D, F) highlight an area of bulky subventricular disease.
Mentions: Repeat imaging of the brain performed 31 months after completion of her WBRT showed multiple new enhancing parenchymal and subventricular lesions and MRI findings consistent with leptomeningeal disease (Figures 1A-1B). Seven discrete bulky lesions were seen, with the largest lesion measuring 1.5 cm in the right cerebellum and the remainder measuring less than 1 cm. There was evidence of leptomeningeal involvement of the cerebellar fissures throughout the posterior fossa, and MRI of the complete neuraxis showed possible leptomeningeal caking in the patient’s lumbar nerve roots. At this time, the patient’s neurologic complaints consisted of mild ataxia and right occipital headaches, but she was free from any other focal deficits on neurologic examination. The patient’s case was discussed at a multidisciplinary neurooncology tumor board, with input from neuroradiology, neurooncology, radiation oncology, and neurosurgery. In light of her prior whole brain radiation therapy, the bulk of recurrent intracranial disease, and the presence of leptomeningeal carcinomatosis, a combined treatment approach using SRS followed by intrathecal chemotherapy was designed.

Bottom Line: Breast cancer metastatic to the brain and/or leptomeningeal spread of disease is a frequently encountered clinical situation, especially given the extended course of disease in these patients. Systemic therapies can often effectively prolong extracranial disease control, making effective strategies to control central nervous system-based disease even more critical.In order to treat the patient's bulky disease and leptomeningeal spread while avoiding the potential toxicities of repeat whole brain radiation, the patient was treated with frameless stereotactic radiosurgery and intrathecal chemotherapy.The patient had an excellent response to treatment and durable intracranial control.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, University of Louisville.

ABSTRACT
Breast cancer metastatic to the brain and/or leptomeningeal spread of disease is a frequently encountered clinical situation, especially given the extended course of disease in these patients. Systemic therapies can often effectively prolong extracranial disease control, making effective strategies to control central nervous system-based disease even more critical. We present a case of bulky leptomeningeal relapse of breast cancer in the setting of prior whole brain radiation therapy. In order to treat the patient's bulky disease and leptomeningeal spread while avoiding the potential toxicities of repeat whole brain radiation, the patient was treated with frameless stereotactic radiosurgery and intrathecal chemotherapy. This is the first report of this treatment approach for leptomeningeal relapse of breast cancer. The patient had an excellent response to treatment and durable intracranial control.

No MeSH data available.


Related in: MedlinePlus