13012 Background: Recent research has focused on patients with limited numbers of brain metastases and the effectiveness of intensified local treatment such as surgical resection or radiosurgery in such cohorts. Little information is available on patients which are not suitable for these approaches because the number of brain metastases is very high (defined as 10 or more for the purpose of this study). Methods: The authors performed a retrospective review of their database and identified all patients that have received whole-brain radiotherapy (WBRT) for 10 or more brain metastases from solid primary tumors. Results: The cohort consisted of 24 adult patients with a median of 14 brain metastases. The median age was 56 years and all patients had active extracranial disease (5 patients had no evidence of extracranial metastases). The presentation of brain metastases was simultaneous to first cancer diagnosis in 8 (33%) and metachronous in 16 (67%). Non-small cell lung cancer (25%), small cell lung cancer (25%) and breast cancer (21%) were the most common primary tumors. Half of the patients had KPS <70 and thus belonged to RPA class III, while the other half belonged to RPA class II. To patients failed to complete WBRT, 16 received 30 Gy in 10 fractions, and 6 higher total doses up to 50 Gy. Median survival was 2 months, maximum 14 months, and 12.5% were alive at 6 months. At least partial remission was evident on serial imaging in 8 patients (33%) and 25% had clinical symptom improvement beyond that obtained by steroids before WBRT. No prognostic parameters associated with survival were identified. No factors predictive for response were identified either. Conclusions: Patients with a large number of brain metastases have a worse outcome after WBRT (with regard to all endpoints) than previously reported for other patient cohorts. To our knowledge, this is the first report that focuses specifically on such patients. For the majority of patients with 10 or more brain metastases, short course WBRT, e.g., 20 Gy in 5 fractions, might be preferable over prolonged regimens as survival typically is very short. No significant financial relationships to disclose.
Purpose: Magnetic resonance imaging (MRI) is the gold standard in visualizing brain tumors and their effects on adjacent structures.However, no reliable information concerning different tumor components and borders between perifocal edema and infiltration areas can be received.The aim of the study was to establish and evaluate a multimodal imaging concept, in order to differentiate different biological tumor components and to determine tumor borders.Materials and Methods: 12 patients with cerebral gliomas (four low and eight high grade) received a "morphological" MRI, a 3D MR spectroscopy and a T2* MR perfusion examination prior to surgery.Data was evaluated by defining different tumor components, which were entitled based upon their multimodal characteristics and histological data.Results: In high grade gliomas different components can be differentiated, which were described as: "true edema", "cellular proliferation", "vascular proliferation", "cellular infiltration", "tumor" and "necrosis".In low grade gliomas, four different tumor components were found: "true edema", "cellular infiltration", "cellular proliferation" and "tumor".Conclusion: With the applied multimodal imaging and a novel evaluation concept, it was possible to detect different tumor components, which could be helpful in detecting the optimal sites for tumor biopsy.Especially in morphological "edema appearing" sites, this knowledge could be important for the adaption of tumor resection borders and the planning of radiation therapy.Further studies with more patients and histological correlation are needed.
