• Journal of Korean Neurosurgical Society
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• v.30 no.9
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• pp.1108-1114
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• 2001

Objective : Prognostic factors of metastatic brain tumors have been widely reported and their operative indications also have been extended gradually even to the poor grade patients. Authors intended to analyze the causative factors for the clinical outcome of metastatic brain tumors, especially with relevant to the poor prognosis by one year follow-up evaluation. Patients and Methods : The authors retrospectively studied the clinical characteristics of 46 cases(35 patients) with metastatic brain tumors among 466 cases(437 patients) which were operated on due to the brain tumor, during the period between January 1994 to June 1999. Statistical analysis was performed by using SPSS 8.0$^{(R)}$. A p-value of less than 0.05 was considered clinically significant. Result : Among the variable clinical factors in patients with metastatic brain tumors, Karnofsky Performance Scale (KPS) score of less than 70(16 patients), uncontrolled primary tumor(8 patients), and surgical resection without further adjuvant therapy(9 patients) showed statistically significant poor prognosis ; p value of 0.002, 0.032, and 0.001, respectively. Other tested variables, such as old age(greater than 65 years ; 10 patients), gender(male ; 20 patients), type of primary cancer(primary undefined ; 6 patients, lung cancer ; 15 patients), location(infratentorial ; 9 patients, sellar ; 5 patients), number of lesion(multiple ; 12 patients), and number of operation(multiple craniotomy ; 7 patients) were not related to the poor prognosis. Conclusions : The most common primary site of distant metastasis was lung. The poorer prognosis was highly correlated with various factors including low KPS score(<70), no postoperative adjuvant therapy, and uncontrolled primary tumors.

• The Journal of Korean Medicine
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• v.30 no.5
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• pp.157-162
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• 2009

Objectives: The purpose of this study is reporting the possibility of the treatment of metastatic brain tumors with allergen removed Rhus verniciflua Stokes (aRVS) after gamma knife radiosurgery. Methods: A patient with lung cancer felt a headache about one year after conventional therapies, and metastatic brain tumors were diagnosed. He received gamma knife radiosurgery twice but refused to get more conventional therapies afterwards. So he has been treating with aRVS since then. Results: During 143 weeks of administration of aRVS, the size of brain masses has decreased continuously without extracranial metastasis and the patient has maintained a good performance status. Conclusions: This report suggests that aRVS may play a therapeutic role in the treatment of metastatic brain tumors. Further studies will be needed to determine the effect of aRVS on metastatic brain tumors.

• Journal of Korean Neurosurgical Society
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• v.61 no.5
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• pp.633-639
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• 2018

Objective : We investigated the outcomes of repeat stereotactic radiosurgery (SRS) for metastatic brain tumors that locally recurred despite previous SRS, focusing on the tumor control. Methods : A total of 114 patients with 176 locally recurring metastatic brain tumors underwent repeat SRS after previous SRS. The mean age was 59.4 years (range, 33 to 85), and there were 68 male and 46 female patients. The primary cancer types were non-small cell lung cancer (n=67), small cell lung cancer (n=12), gastrointestinal tract cancer (n=15), breast cancer (n=10), and others (n=10). The number of patients with a single recurring metastasis was 95 (79.8%), and another 19 had multiple recurrences. At the time of the repeat SRS, the mean volume of the locally recurring tumors was 5.94 mL (range, 0.42 to 29.94). We prescribed a mean margin dose of 17.04 Gy (range, 12 to 24) to the isodose line at the tumor border primarily using a 50% isodose line. Results : After the repeat SRS, we obtained clinical and magnetic resonance imaging follow-up data for 84 patients (73.7%) with a total of 108 tumors. The tumor control rate was 53.5% (58 of the 108), and the median and mean progression-free survival (PFS) periods were 246 and 383 days, respectively. The prognostic factors that were significantly related to better tumor control were prescription radiation dose of 16 Gy (p=0.000) and tumor volume less than both 4 mL (p=0.001) and 10 mL at the repeat SRS (p=0.008). The overall survival (OS) periods for all 114 patients after repeat SRS varied from 1 to 56 months, and median and mean OS periods were 229 and 404 days after the repeat SRS, respectively. The main cause of death was systemic problems including pulmonary dysfunction (n=58, 51%), and the identified direct or suspected brain-related death rate was around 20%. Conclusion : The tumor control following repeat SRS for locally recurring metastatic brain tumors after a previous SRS is relatively lower than that for primary SRS. However, both low tumor volume and high prescription radiation dose were significantly related to the tumor control following repeat SRS for these tumors after previous SRS, which is a general understanding of primary SRS for metastatic brain tumors.

• Journal of Korean Neurosurgical Society
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• v.65 no.6
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• pp.861-867
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• 2022

Objective : High-dose radiation is well known to induce and modulate the immune system. This study was performed to evaluate the correlation between clinical outcomes and changes in natural killer cell activity (NKA) after Gamma Knife Radiosurgery (GKS) in patients with brain cancer. Methods : We performed an open-label, prospective, cross-sectional study of 38 patients who were treated with GKS for brain tumors, including metastatic and benign brain tumors. All of the patients underwent GKS, and blood samples were collected before and after GKS. NKA was measured using an enzyme-linked immunosorbent assay kit, to measure interferon-gamma (IFNγ) secreted by ex vivo-stimulated NK cells from whole blood. We explored the correlations between NK cell-produced IFNγ (NKA-IFNγ) levels and clinical parameters of patients who were treated with GKS for brain tumors. Results : NKA-IFNγ levels were decreased in metastatic brain tumor patients compared to those with benign brain tumors (p<0.0001). All the patients who used steroid treatment to reduce brain swelling after GKS had an NKA-IFNγ level of zero except one patient. High NKA-IFNγ levels were not associated with a rapid decrease in brain metastasis and did not increase after GKS. Conclusion : The activity of NK cells in metastatic brain tumors decreased more than that in benign brain tumors after GKS.

• Investigative Magnetic Resonance Imaging
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• v.4 no.1
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• pp.34-41
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• 2000

Purpose: To evaluate the clinical usefulness of diffusion weighted MR imaging(DWI) in the differential diagnosis of brain tumors. Materials and methods: DWI and conventional MR images of nineteen patients with brain tumors(10 metastatic tumors, 4 high grade gliomas, 4 low grade astrocytomas, one oligodendroglioma)were obtained on 1.5T unit. DWI was obtained using single shot spin echo planar imaging with b-value near 1000. We analyzed the signal intensities of lesions including solid portion, necrotic or cystic portion and peritumoral edema of brain tumors (classified five grades comparison with the signal intensities of brain parenchyma and CSF)and calculate the SIR(signal intensity ratio)of lesions to the contralateral normal brain parenchyma. We analyzed statistically the signal intensities and SIR of tumors using independence T test. Results: In solid portions of tumors, all the metastatic tumors and high grade gliomas showed high signal intensities, but low grade astrocytomas and oligodendroglioma showed iso or slight high signal intensities to the normal brain parenchyma. The SIR of solid portion has positive correlation with malignant pot ential(metastatic tumors 1.52, high grade gliomas 1.38, low grade astrocytomas 1.16, oligodendroglioma 1.31)(p < 0.05). In peritumoral edema where seen in 14 tumors, seven of 10 metastatic tumors and two of 4 high grade gliomas showed iso signal intensities, whereas edemas in other 5 brain tumors showed hyperintense to the normal brain parenchyma. The SIRs of peritumoral edemas in metastatic tumors (1.14) was lower than high grade gliomas(1.31),but statistically insignificant. The SIR of cystic or necrotic portion of brain tumors was 0.63. In non enhancing solid portions, three of six cases showed hyperintense to the adjacent peritumoral edema. Conclusion: On DWI, the signal intensities of solid portion has positive correlation with malignant potential, and perilesional edema of brain tumors appear various signal intensities owing to "T2 shine through effect" and the extensiveness of vasogenic edema. Another merit using DWI on the evaluation of brain tumors is to improved better delineation of tumor margins from the adjacent edemas, especially at the non enhancing solid portion of the tumors.

• The Korean Journal of Cytopathology
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• v.9 no.1
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• pp.21-28
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• 1998

Cytologic evaluation of cerebrospinal fluid(CSF) is an effective tool in diagnosing many disorders involving the central nervous system(CNS). CSF examination has been found to be of particular value in the diagnosis of metastatic carcinoma, lymphomatous or leukemic involvement of CNS and certain primary CNS tumors. As a survey of metastatic tumors to CSF and an evaluation of the preparation techniques increasing cellular yield in our laboratory, 713 CSF specimens examined between July 1995 and April 1997(1 year 10 months), were reviewed. There were 75 positive and 5 suspicious cases, the latter have had no evidence of tumors clinically. Primary tumors of 75 positive cases were classified as follows; 4(5.3%) as primary brain tumors, 40(53.3%) as secondary carcinomas, 13(17.3%) as leukemias, and 18 (24.0%) as lymphomas. The most common primary site of metastatic carcinomas was the lung in 17 cases(42.5%) followed by the stomach in 13(32.5%), breast in 8 (20.0%), and unknown primary in 2(5.0%). Four primary brain tumors were 3 cerebellar medulloblastomas and a supratentorial primitive neuroectodermal tumor (PNET). All 40 metastatic carcinomas were adenocarcinoma presented as single cells or cell clusters. Although signet ring cells were frequent in the cases of gastric primary cancers, no significant cytologic differences according to the primary site were observed. The cytologic features of leukemia and lymphoma were characterized by hypercellular smears presenting as individual atypical cells with increased N/C ratio, presence of nucleoli, and nuclear protrusions. In medulloblastomas and PNET, the principal cytologic findings were small undifferentiated cells arranged singly or in loose clusters with occasional rosettoid features. This study suggests that the CSF cytology is useful in the diagnosis of malignancy, especially metastatic extracranial tumors and the diagnostic accuracy can be improved by increasing cellular yield using cytocentrifuge.

• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.360-364
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• 2009

Objective : Several treatment options have proven effective for metastatic brain tumors, including surgery and stereotactic radiosurgery. Tumors with cystic components, however, are difficult to treat using a single method. We retrospectively assessed the outcome and efficacy of gamma knife radiosurgery (GKRS) for cystic brain metastases after stereotactic aspiration of cystic components to decrease the tumor volume. Methods : The study population consisted of 24 patients (13 males, 11 females; mean age, 58.3 years) with cystic metastatic brain tumors treated from January 2002 to August 2008. Non-small cell lung cancer was the most common primary origin. After Leksell stereotactic frame was positioned on each patient, magnetic resonance images (MRI)-guided stereotactic cyst aspiration and GKRS were performed (mean prescription dose : 20.2 Gy). After treatment, patients were evaluated by MRI every 3 or 4 months. Results : After treatment, 13 patients (54.2%) demonstrated tumor control, 5 patients (20.8%) showed local tumor progression, and 6 patients (25.0%) showed remote progression. Mean follow-up duration was 13.1 months. During this period, 10 patients (41.7%) died, but only 1 patient (4.2%) died from brain metastases. The overall median survival after these procedures was 17.8 months. Conclusion : These results support the usefulness of GKRS after stereotactic cyst aspiration in patients with large cystic brain metastases. This method is especially effective for the patients whose general condition is very poor for general anesthesia and those with metastatic brain tumors located in eloquent areas.

• The Korean Journal of Nuclear Medicine
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• v.26 no.2
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• pp.360-364
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• 1992

Treatment for the brain tumors consist of surgery, chemotherapy, and a variety of methods of irradiation. Therapy is aimed to destroy the tumor, but necrosis and edema occur concurrently. Conventional structural imaging techniques such as CT or MRI are unable to reliably distinguish persistent and recurrent tumor from necrosis or edema. T1-201 has been shown to be useful in the evaluation of the myocardial viability by comparing the early uptake and redistribution image. The aim of this study is to evaluate the clinical usefulness of the early uptake and delayed washout images of the T1-201 brain SPECT in the brain tumors. In the pathologically diagnosed various brain tumor patients, brain SPECT was done with rotating gamma camera 15 minutes and 3 hours after T1-201 injection, and the T1-201 uptake in the tumor was compared with the skull and scalp activity. In the glioblastoma multiforme, meningioma and metastatic tumor, the T1-201 uptake was higher than low grade glioma in both 15 minute and 3 hour images (p<0.02). In the low grade glioma,3 hour T1-201 uptake was significantly lower than 15 minute uptake (p<0.05) but in the glioblastoma, meningioma and metastatic tumor there was no significant difference. There was no significant difference in the T1-201 uptake among the glioblastoma, meningioma and metastatic tumors. In one matastatic tumor, T1-201 uptake was decreased after radiation therapy. T1-201 brain SPECT could distinguish the benign and malignancy, and seems to be useful in the follow-up after treatment. But one of the early or delayed SPECT seems not to be necessary for these purposes.

• The Korean Journal of Nuclear Medicine
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• v.26 no.1
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• pp.14-25
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• 1992

Thallium-201 $(^{201}T1)$ SPECT studies were performed on a normal volunteer and 12 patients with intracerebral lesions: 3 patients with gliomas, 3 patients with meningiomas, 1 patient each with metastatic tumor, brain abscess, and cerebral infarction, and 3 postirradiation patients. (2 with metastatic tumors, 1 with lymphoma). A $^{201}T1$ index, based on the ratio of $^{201}T1$ uptake in the brain lesion versus the homologous contralateral brain, was calculated and compared with tumor histology and CT/MRI findings. The SPECT $^{201}T1$ scan showed minimal uptake of tracer in a normal brain. There was substantial uptake of $^{201}T1$ in high-grade gliomas (index>1.5) with little uptake in low-grade lesions. A previously irradiated patient with recurrent astrocytoma, in whom MRI study was unable to distinguish tumor recurrence from necrosis, showed the lesions with high $^{201}T1$ indices in both hemispheric regions (2.50/1.93), suggesting tumor recurrence. Two meningiomas and a metastatic tumor showed varying degrees of $^{201}T1$ uptake (index $1.71\sim8.15$), revealing that $^{201}T1$ uptake is not exclusive to high-grade gliomas. In 2 postirradiation patients with metastatic tumors, no abnormal $^{201}T1$ uptake was found in the cerebral lesions, shortly after the initiation of radiation therapy or despite the persistence of enhancing lesions-though improved-on MR images, suggesting that $^{201}T1$ uptake may reflect the metabolic and possibly clonogenic activities of tumors and the brain $^{201}T1$ SPECT imaging might be valuable for the evaluation of tumor responsiveness to the therapy and for early detection of tumor recurrence. A patient with brain abscess on antibiotic treatment, showig increased uptake of $^{201}T1$ in the resolving lesions (index 2.87/1.52) is discussed. In a patient with cerebral infarction, there was no abnormal uptake of $^{201}T1$ in infarcted tissue. When using a threshold index of 1.5, correlation rate between $^{201}T1$ uptake and contrast enhancement of the cerebral lesions on CT/MRI was 73% (8/11). In conclusion, the brain $^{201}T1$ SPECT imaging may be useful for assessment of tumor response to the therapy and to predict low-or high-grade lesions.

• Journal of Korean Biological Nursing Science
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• v.7 no.1
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• pp.47-56
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• 2005

nm23-H1 gene expression has been inversely correlated with tumor metastatic potential in certain tumors including melanomas, breast carcinomas, and hepatocellular carcinomas. However, its role with respect to the invasive behavior of central nervous system tumors has scarcely been addressed Because cell motility and invasion plays an essential role in metastatic dissemination, we have studied whether motile human glioma cell(U87MG) transfected with nm23-H1 complementary DNA have any alterations in their ability to migrate and invade. There was no significant changes in the shape and size of the cells following nm23-H1 transfection. The role of nm23-H1 in glioma migration and invasion have been evaluated by in vitro simple scratch technique and brain slice invasion model Basal migration ability of nm23-H1 transfectants cell(U87MG-pEGFP-nm23) were lesser than U87MG. Accordingly, U87MG-pEGFP-nm23 didn't migrate away apparently from the tumors implanted site comparing U87MG in brain slice invasion model. These results suggest that nm23-H1 may play an important role in suppressing the human glioma migration and invasion.