The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline

QUESTION: What evidence is available regarding the use of whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), surgical resection or chemotherapy for the treatment of recurrent/progressive brain metastases? TARGET POPULATION: This recommendation applies to adults with recurrent/progressive brain metastases who have previously been treated with WBRT, surgical resection and/or radiosurgery. Recurrent/progressive brain metastases are defined as metastases that recur/progress anywhere in the brain (original and/or non-original sites) after initial therapy. RECOMMENDATION: Level 3 Since there is insufficient evidence to make definitive treatment recommendations in patients with recurrent/progressive brain metastases, treatment should be individualized based on a patient\u27s functional status, extent of disease, volume/number of metastases, recurrence or progression at original versus non-original site, previous treatment and type of primary cancer, and enrollment in clinical trials is encouraged. In this context, the following can be recommended depending on a patient\u27s specific condition: no further treatment (supportive care), re-irradiation (either WBRT and/or SRS), surgical excision or, to a lesser extent, chemotherapy. Question If WBRT is used in the setting of recurrent/progressive brain metastases, what impact does tumor histopathology have on treatment outcomes? No studies were identified that met the eligibility criteria for this question

Vinblastine (VLB), bleomycin (BLEO), cis‐diamminedichloroplatinum (DDP) in disseminated extragonadal germ cell tumors. A southwest oncology group study

Nineteen patients considered to have metastatic primary extragonadal germ cell cancer were entered on a Phase II chemotherapy study using as induction therapy a combination of vinblastine (VLB) 12 mg/m2 day 1, bleomycin (BLEO) 15 U/m2 I.V. or I.M. twice weekly, and cis‐diamminedichloroplatinum (DDP) 15 mg/m2 days 1–5, with vinblastine and DDP repeated at 28‐day intervals for four months. All complete or partial responders were then placed on a maintenance regimen of vinblastine 12 mg/m2 alternating monthly with actinomycin‐D 1.5 mg/m2 day 29, and chlorambucil, 10 mg/m2 P.O. days 32–37. There were three complete remissions (CR's), six partial remissions (PR's), and two stable disease. The response rate (CR's + PR's) was 56%; however, the mean duration of response was only two months (range, 1–8 months). Drug toxicity was significant and there was one toxic death. Unlike patients with disseminated testicular cancer, patients with primary metastatic extragonadal germ cell carcinoma appear to do less well on this particular drug regimen. Further investigation using different drug regimens seems necessary

Successful therapy of peritoneal mesothelioma with intraperitoneal chemotherapy alone. A case report

Malignant peritoneal mesothelioma is a disease that remains relatively refractory to conventional intravenous chemotherapy with currently available agents. Single-agent and combination chemotherapy offer a response rate of 20%. Direct intraperitoneal administration of some chemotherapeutic agents results in a significant pharmacologic advantage with much greater area under the concentration versus time curve (AUC). We report a case of a patient with peritoneal mesothelioma treated with combination intraperitoneal cisplatin and Ara-C who achieved a pathologic complete remission. This patient is still alive and has been in complete remission for 53 months. This combination of intraperitoneal chemotherapy deserves further evaluation in malignant mesothelioma

Visual recovery from radiation-induced optic neuropathy. The role of hyperbaric oxygen therapy

Optic neuropathy resulting in permanent visual loss is an infrequent delayed complication of radiation therapy. Hyperbaric oxygen therapy (HBO) has been used to treat such a complication, but its efficacy is controversial. We report a patient who presented with radiation-induced optic neuropathy 17 months after irradiation for a left maxillary antrum melanoma. HBO fully reversed visual loss in the more recently involved eye, and slightly improved vision in the earlier affected eye