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Brain Metastasis of Patients with Lung Adenocarcinoma: Epidermal Growth Factor Receptor Mutations and Response to Whole-Brain Radiation Therapy

Introduction Approximately 1.2 million new cases of lung cancer occur worldwide every year ( ). Most patients with non-small cell lung cancer (NSCLC) are diagnosed at an advanced stage ( ). Brain metastases develop during the course of the disease in ≈30–50% of the NSCLC patients, especially in those with adenocarcinoma ( ). Brain metastasis results in significant morbidity and mortality in NSCLC patients, so the…

Multiple Small Brain Metastases with Limited Focal Brain Edema from Non-Small Cell Lung Cancer with Epidermal Growth Factor Receptor Mutations

Introduction Lung cancer remains the leading cause of cancer-related death worldwide. Non-small cell lung cancer (NSCLC) accounts for approximately 80% of cases of primary lung cancer ( ). Lung cancer is also the most frequent origin of metastatic brain tumors and accounts for 50% of cases. In addition, more than 25% of patients with lung cancer develop brain metastases (BM) during the clinical course of their…

Synovial Sarcoma Metastasized to the Brain

Introduction Synovial sarcoma is a distinct mesenchymal spindle cell tumor, which displays variable epithelial differentiation and has a characteristic chromosomal translocation t(X; 18) (p11; q11). It can rarely metastasize to the brain. Brain Synovial Sarcomas By searching Pubmed for synovial sarcoma and brain, we could find 38 references. Nine of them described nine cases of brain synovial sarcoma. One of these patients was the same in…

Multiple Metastases to the Brain from Primary Cancers: Whole Brain Radiotherapy

Introduction Brain metastases from primary cancers represent a significant disease burden and common source of morbidity and mortality in the cancer population. Brain metastases, for example, are estimated to occur in 20–40% of all patients with cancer during the course of their illness ( ). In diseases such as melanoma, the incidence of brain metastases has been found to be close to 60% in autopsy studies…

The Role of Chemotherapy in Metastatic Brain Tumors

Introduction Brain metastases pose a major treatment challenge and typically confer a poor prognosis for patients diagnosed with these secondary tumors. While surgical resection and various forms of radiation therapy play important roles in the multidisciplinary therapy of brain metastases, the role of chemotherapy is less clear. In this chapter we will examine the evidence for and against the use of chemotherapy for brain metastases. The…

Second Malignancies in Children Following Treatment for Neuroblastoma

Introduction Treatment for childhood cancer has become progressively more effective in the last few decades leading to a remarkable increase in both 5- and 10-year overall survival for these patients, which now approaches 80% overall ( ). However, the mortality due to recurrence or progression of the original tumor after these time periods remains a relevant problem ( ). In addition, long-term survivors of cancer diagnosed…

Targeting Angiogenesis, Enhancing Radiosensitization and Crossing the Blood–Brain Barrier for Brain Metastases

Introduction Brain metastases (BM) constitute a significant disease burden and have a major impact on patient morbidity and mortality ( ). Recent progress in the preclinical and clinical development of molecular targeted drugs has revealed that some of them have potent therapeutic efficacy for BM. Here the preclinical and clinical knowledge on the role of targeting angiogenesis in BM is discussed. In addition, the potential of…

Non-Uniform Distribution of Metastatic Intracranial Tumors in Cancer Patients

Introduction Epidemiology and Clinical Presentation of Brain Metastases Brain metastases (BMs) occur in 20–40% of adult cancer patients with an incidence of>170 000 new cases per year in the USA ( ) and become symptomatic during life in 60–75% of the patients. Thus, they represent the most common tumors of the central nervous system (CNS). Although the exact incidence is unknown because some brain metastatic patients…

Involvement of the CXCL12/CXCR4/CXCR7 Axis in Brain Metastases

Introduction Chemokines are a superfamily of small cytokines (8–12 kDa) with chemotactic properties. They bind to specific receptors and are involved in cell trafficking, activation and differentiation. More than 50 different chemokines have been identified and are classified into four families based on the position of four conserved cysteine residues. The first group, so-called CC chemokines because of two adjacent cysteines near the amino terminus, has…

Epidemiology of Central Nervous System Metastases

Introduction Brain metastases are the most common type of brain tumors ( ) and are associated with significant mortality and morbidity ( ). The incidence of brain metastases varies by reporting institution, and different studies have reported different results. For example, the reported incidence varies from 2.8 to 14.3 individuals per 100 000 population ( ). At the same time, study-specific data indicate a rate of…

Brain Metastases

Introduction Metastases to the brain are among the most clinically significant, because even a single one is likely to cause serious disability. Because most may be at least partially protected from otherwise effective systemic therapies by the blood–brain barrier, they present special management problems. But whether their pathogenesis differs from that of metastases at other sites is not known. Origin of Primary Tumors Since the first…

Adult T-Cell Leukemia/Lymphoma

Summary of Key Points Definition Adult T-cell leukemia/lymphoma (ATLL) is a distinct mature peripheral T-cell malignancy associated with human T-cell leukemia/lymphotropic virus type I (HTLV-I). Virology and Pathogenesis HTLV-I is reverse-transcribed into DNA and randomly integrated into the host cell. The HTLV-I genome encodes two unique regulatory proteins—Tax and Rex—responsible for viral expression and cellular transformation. Tax trans -activates viral and cellular genes that could be…

Cutaneous T-Cell Lymphoma and Cutaneous B-Cell Lymphoma

Summary of Key Points Incidence Cutaneous lymphomas represent 3.9% of non-Hodgkin lymphomas. The annual incidence of cutaneous T-cell lymphoma (CTCL) in the United States is approximately 9.6 cases per 1 million population with a median age of 60 years at initial presentation. CTCL accounts for up to 71% and cutaneous B-cell lymphoma (CBCL) accounts for up to 29% of all cutaneous lymphomas. Biological Characteristics CTCLs may…

Non-Hodgkin Lymphomas

Summary of Key Points Incidence Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy; more than 70,000 cases were estimated to be diagnosed in the United States in 2018. Diffuse large B-cell (DLBCL) and follicular lymphoma (FL) are the most common subtypes, each comprising approximately one third of cases in the Western Hemisphere. In the Western Hemisphere, approximately 85% of lymphomas are of B-cell origin, and…

Hodgkin Lymphoma

Summary of Key Points Incidence There were an estimated 8260 new cases of Hodgkin lymphoma (HL) in the United States in 2017 with 1070 deaths. The US age-adjusted incidence rate is 2.6 per 100,000 per year. There is a higher incidence among males than females. The highest incidence is in North America and Western Europe. There is a bimodal age distribution (peaks at 15–35 years and…

Multiple Myeloma and Related Disorders

Summary of Key Points Multiple Myeloma Multiple myeloma accounts for approximately 10% of hematologic malignancies. Approximately 30,000 new cases are estimated to occur each year in the United States. In almost all patients, multiple myeloma is thought to evolve from an asymptomatic premalignant stage termed monoclonal gammopathy of undetermined significance (MGUS). The most common presenting symptoms are fatigue and bone pain. Osteolytic bone lesions are the…

Hairy Cell Leukemia

Summary of Key Points Classic hairy cell leukemia and hairy cell leukemia variant are rare clonal B-cell lymphoproliferative disorders. The BRAF V600E mutation is present in nearly all cases of classic hairy cell leukemia but absent in other B-cell lymphoproliferative disorders and represents a disease-defining genetic event in classic hairy cell leukemia. In general, physical findings are confined to splenomegaly. Purine analogues remain the initial therapeutic…

Chronic Lymphocytic Leukemia

Summary of Key Points Chronic lymphocytic leukemia (CLL) is the most prevalent type of adult leukemia and is defined by a distinctive immunophenotype of CD19+, CD5+, CD23+, and surface immunoglobulin (sIg)–positive cells. The environmental or genetic cause of CLL in most patients is not known, although 8% to 10% of patients have a first-degree relative with this diagnosis. CLL lacks a single driving mutation that defines…

Chronic Myeloid Leukemia

Summary of Key Points Incidence The incidence of chronic myeloid leukemia (CML) is 1.5 in 10 5 , about 5000 cases per year in the United States; CML represents 15% of all leukemias. The prevalence of CML was 30,000 cases in 2000 and increased to 80,000 to 100,000 cases in 2016. Median age is 55 to 65 years at diagnosis. Clinical Findings Common findings include fatigue,…

Myeloproliferative Neoplasms

Summary of Key Points Incidence Each of the three classic BCR-ABL1 − myeloproliferative neoplasms (MPNs)—that is, polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF)—are estimated to occur at the rate of 0.5 to 2.5 per 100,000 people per year. Differential Diagnosis All three classic BCR-ABL1 − MPNs may be considered as diagnoses of exclusion because a specific diagnostic marker is currently lacking. The presence…