Secondary brain tumors

Metastasis is the spread of cancer. Cancer that begins in other parts of the body may spread to the brain and cause secondary brain tumors, also called brain metastases. Brain metastases occur in about 15-40% of all cancer patients [60]. In up to 15% of all cases, the primary tumor of brain metastases remains unknown despite thorough investigation by standard screening techniques. The failure to detect the primary tumor is usually due to its small size and lack of symptoms, and constitutes the main problem to select an organ-specific therapy. 

---

Of major concern is a report of an increased incidence of secondary brain tumors after radiotherapy in children with decreased TPMT activity phenotypes and/or high concentrations of thioguanine nucleotides in blood... 

Relling M V, Rubnitz J E, Rivera G K, et al. (1999). High incidence of secondary brain tumors related to radiation and antimetabolite therapy. Lancet. 354 34-39. 

Brain injury from trauma, stroke, space-occupying brain tumors, brain infection such as HIV and syphilis, and inflammatory conditions such as lupus and multiple sclerosis can all induce these so-called secondary manias (Table 3.15). For this... 

IR concentrated oral solution and tablets/suppositories - Respiratory insufficiency or depression severe CNS depression attack of bronchial asthma heart failure secondary to chronic lung disease cardiac arrhythmias increased intracranial or CSF pressure head injuries brain tumor acute alcoholism delirium tremens convulsive disorders after biliary tract surgery suspected surgical abdomen surgical anastomosis concomitantly with MAOIs or within 14 days of such treatment paralytic ileus. 

Carmustine and lomustine can produce remissions that last from 3 to 6 months in 40 to 50% of patients with primary brain tumors. Both drugs also are used as secondary treatment of Hodgkin s disease and in experimental combination chemotherapy for various types of lung cancer. Other tumors in which remission rates of 10 to 30% have been obtained are non-Hodgkin s lymphomas, multiple myeloma, melanoma, renal cell carcinoma, and colorectal cancer. 

Marcus CL, Trescher WH, Halbowere AC, Luiz J (2000) Secondary narcolepsy in children with brain tumor. Sleep 25 435-439... 

It has also been demonstrated that PEGylated liposomal doxorubicin, Caelyx, can cross the BBB with a consequent accumulation in primary and secondary brain lesions [389], In 10 patients with metastatic brain tumors treated with radiolabeled Caelyx concurrent with radiotherapy, the accumulation of the liposomal doxorubicin was 7-13 times higher in the metastatic lesions compared to the normal brain. 

Because of its ability to cross the blood-brain barrier, carmustine is used against brain tumors and other tumors (e.g.. leukemias) that have metastasized to the brain. It also is used as secondary therapy in combination with other agents for Hodgkin s di.sease and other lymphoma.s. Multiple myeloma responds to a combination of carmustine and prednisone. Delayed myelosuppression is the most frequent and serious toxicity. ITiis condition u.sually develops 4 to 6 weeks after treatment. Thrombtxtytopcnia is the most pronounced effect, followed by leukopenia. Nausea and vomiting frequently occur about 2 hours after treatment. 

Lomustine is used against both primary and metastatic brain tumors and as secondary therapy in relapsed Hodgkin s di.sease. The mast common adverse reactions are nausea and vomiting, thrombocytopenia, and leukopenia. As in the case of carmustine, the myelosuppression cau.sed by lomastine is delayed. ... 

Trade names Becenun BiCNU (Bristol-Myers Squibb) Carmubris Gliadel Wafer (Guilford) Nitrumon Indications Brain tumors, Hodgkin s disease, multiple myeloma Category Alkylating agent Nitrosourea Half-life initial 1.4 minutes secondary 20 minutes Clinically important, potentially hazardous interactions with aldesleukin, cimetidine, dorazepate... 

A recent innovation imder study in the area of radiation therapy is boron—neutron capture therapy for brain tumor. This form of therapy uses an inactive tracer containing boron, an element with a high absorption rate of neutron radiation. When the radiopharmaceutical has accumulated in the tumor, the patient is exposed to neutron radiation, which is absorbed by boron. The energy of secondary low-range a-radiation, which is formed in the boron—neutron reactions, is then absorbed by the tumor cells that are to be destroyed. 

---