‘Metastasize’ means to spread, grow or change form. In pathology (the science of disease), ‘metastasize’ describes the spread of cancer cells from the primary site of the disease to other parts of the body. From primary sites such as the lungs, breasts, kidneys, bladder or skin, tumor cells can spread via the circulatory system (or, in the case of leukemia and lymphoma, can originate within it) to the brain.
Metastatic brain tumors (also referred to as brain metastases, secondary brain tumors or metastasis to the brain) are the most common type of brain tumor in adults. The majority of them are discovered after the primary cancer has already been diagnosed, when a cancer patient first experiences neurological symptoms and undergoes a CT or MRI scan. In rarer cases, a person with neurological symptoms (or requiring imaging for other medical reasons) and no history of cancer may undergo a brain scan that leads to the discovery of brain metastases. Over 80% of metastatic brain tumors arise as multiple lesions in the brain (with fewer than 20% manifesting as a single tumor), and over 80% of all lesions appear in the cerebrum (the uppermost, largest, most recently evolved part of the brain that receives the majority of blood flow).
The signs and symptoms of metastatic brain tumors are the same as any expanding intracranial (within the skull) lesion. They result from the pressure the metastases put on the surrounding tissue, from edema (fluid-based swelling) or from hemorrhage (bleeding). Symptoms vary based on the location of the tumor within the brain and include headaches, seizures, cognitive difficulties (loss of memory or changes in personality or behavior), weakness in an area of the body, decreased coordination or issues with vision, numbness, tingling or other sensation.
As cancer therapies have improved, an increasing number of cancer patients are living longer. Unfortunately, increased patient life expectancy gives cancer cells greater opportunity to spread from their primary sites, causing the incidence of metastatic brain tumors to rise as well. Thus, techniques for treating intracranial tumors, such as Gamma Knife radiosurgery, are vital components of the fight against cancer. Utilized by doctors at the
Boston Gamma Knife Center at Tufts Medical Center to limit the growth of small or delicately situated metastases, Gamma Knife radiosurgery isn’t traditional surgery—no incisions are made. Instead, this state-of-the-art technology focuses 192 beamlets of gamma radiation on the tumor, delivering a high dosage at the site of convergence while saving the vital surrounding tissue from radiation’s harmful effects.
Programs + Services
Our Neuro-Oncology Program, located in downtown Boston, offers the most advanced methods for diagnosing and treating your specific benign and malignant tumors of the brain.
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Our Team of brain tumor specialists diagnose and treat all types of brain tumors. Learn more about the most advanced techniques used at Tufts Medical Center.
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Research + Clinical Trials
This is an international multi-centre, open-label, randomized phase III trial comparing stereotactic radiosurgery (SRS) to whole brain radiotherapy (WBRT) in patients with 5 to 15 brain metastases.
Primary Objectives
• To compare the overall survival in patients with five to fifteen brain metastases who receive SRS compared to patients who receive WBRT.
• To compare the neurocognitive progression-free survival in patients with five to fifteen brain metastases who receive SRS compared to patients who receive WBRT.
Secondary Objectives
Patient/treatment Related Secondary Outcomes
• To compare time to central nervous system (CNS) failure (local, distant, and leptomeningeal) in patients who receive SRS compared to patients who receive WBRT.
• To evaluate if there is any difference in CNS failure patterns (local, distant, or leptomeningeal) in patients who receive SRS compared to patients who receive WBRT.
• To evaluate number of salvage procedures following SRS in comparison to WBRT.
• To evaluate the individual cognitive test results following SRS in comparison to WBRT.
• To tabulate and descriptively compare the post-treatment adverse events associated with the interventions.
• To evaluate the time delay to (re-)initiation of systemic therapy in patients receiving SRS in comparison to WBRT.
• To prospectively validate a predictive nomogram for distant brain failure [Ayala-Peacock 2014].
Economic Endpoints
• To compare the estimated cost of brain-related therapies in patients who receive SRS compared to patients who receive WBRT:
- Comparison based on payer rates (Medicare for US / provincial heath authorities in Canadian jurisdictions with activity-based funding).
Quality of Life Endpoints
• To evaluate patient’s quality of life, as assessed by the EORTC QLQ-C30 + BN20, EQ-5D, ECOG performance status, for those who receive SRS compared to those who receive WBRT.
Translational Endpoints
• Collect plasma to evaluate whether detectable somatic mutations in liquid biopsy can enhance prediction of the overall survival and development of new brain metastases.
• Analysis of serum samples for inflammatory biomarker C-reactive protein and brain-derived-neurotrophic factor (BDNF) to elucidate molecular/genomic mechanisms of neurocognitive decline and associated radiographic changes.
Imaging/Dosimetric Endpoints
• Collect whole-brain dosimetry in SRS patients to be prospectively correlated with cognitive toxicity, intracranial control and radiation necrosis (hippocampal dosimetry will be retrospectively assessed).
• Collect imaging parameters and workflow details relating to the radiosurgery planning MRIs (including timing of MR prior to radiosurgery, magnet field strength, contrast type/dose/timing, use of image post-processing, and formal reviewed by radiology) to be prospectively correlated with tumour control outcomes (local control, intracranial control).
• Evaluate serial changes in imaging features found in routine MRI images (T2w changes, morphometry) that may predict tumour control and/or neurocognitive outcomes
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