Arco terapia volumétrica modulada para el abordaje de metástasis cerebralesaspectos radio-oncológicos y manejo terapéutico de la epilepsia en el paciente neuro-oncológico

Abstract

Introduction: Currently, brain metastases (BMs) represent the most frequent intracranial tumor, occurring in about 20-40% of cancer patients. Improved diagnostic imaging techniques as well as more effective treatment regimens, have contributed to the increased incidence of BMs, making the therapeutic approach to BMs an emerging challenge. Whole-brain radiation therapy and stereotactic radiosurgery are two treatment modalities commonly utilized to treat BMs. The radiosurgery technique consists of the administration of a concentrated dose of radiation to the lesion, with a high dose gradient in the surrounding area in order to minimize side effects on healthy brain tissue as well as a lower neurocognitive impact. Aim: This thesis memorandum as a compendium of publications aims to analyze the response to radiosurgical treatment in a population of patients with BMs, and the therapeutic management of brain tumor-related epilepsy. Material and methods: This is a cross-sectional observational design study with retrospective review of medical records of patients with brain metastases treated with VMAT-RS. Clinical and demographic data, with special attention to primary tumor, brain tumor-related epilepsy (BTRE), psychiatric comorbidity, type of epileptic seizures, antiseizure medication (ASM) used, number and brain location of BMs, Karnofsky Performance Status (KPS), the updated DS-GPA prognostic index and the survival estimated according to the Kaplan-Meier model from the date of radiosurgery were analyzed. Results: The publications that make up the thematic unit presented in this Doctoral Thesis defended in the form of a compendium of publications are the following: 1º. Sánchez-Villalobos JM, Serna-Berna A, Salinas-Ramos J, Escolar-Pérez PP, Martínez-Alonso E, Achel DG, Alcaraz M. Volumetric modulated arc radiosurgery for brain metastases from breast cancer: A single-center study. Colomb Méd (Cali), 2021; 52(3):e2004567. 2º. Sánchez-Villalobos JM, Aledo-Serrano Á, Serna-Berna A, Salinas-Ramos J, Martínez-Alonso E, Pérez-Vicente JA, Alcaraz-Baños M. Antiseizure medication for brain metastasis-related epilepsy: Findings of optimal choice from a retrospective cohort. Epilepsy Res. 2021;178:106812. 3º. Sánchez-Villalobos JM, Aledo-Serrano Á, Villegas-Martínez I, Shaikh MF, Alcaraz M. Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios. Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios. Front Pharmacol. 2022; 13:991244. 4º. Sánchez-Villalobos, JM, Serna-Berna, A, Salinas-Ramos, J, Escolar-Pérez, PP, Andreu-Gálvez, M, Martínez-Alonso, E, Pérez-Vicente, JA, Alcaraz M. Volumetric Modulated Arc Therapy for Radiosurgery of Brain Metastases: A Single-Center Study. Appl. Sci. 2023; 13(18):10097. Conclusion: The VMAT-RS is a technique with an overall survival comparable to other radiosurgery techniques. The baseline situation at the time of treatment, the updated DS-GPA and the molecular subtypes of breast cancer, are factors that significantly influence patient survival. Regarding to the pharmacological treatment in BTRE patients, levetiracetam is the most widely used ASM in patients with BMRE treated with VMAT-RS. Nevertheless, common psychiatric comorbidities in this population might change the decision-making of ASM choice. Finally, antiepileptic treatment should be personalized to the patient's characteristics, especially in some special situations such as patients with psychiatric comorbidity, elderly patients and women with reproductive desires or pregnancy.