Neuroprotection in radiotherapy of brain metastases: A pattern-of-care analysis in Germany, Austria and Switzerland by the German Society for radiation Oncology - working group Neuro-Radio-Oncology (DEGRO AG-NRO).

Background and purpose: Many patients with solid tumors develop brain metastases (BM). With more patients surviving long-term, preservation of neurocognitive function gains importance. In recent years, several methods to delay cognitive deterioration have been tested in clinical trials. However, knowledge on the extent to which these neuroprotective strategies have been implemented in clinical practice is missing. Materials and methods: We performed an online survey regarding treatment patterns of BM in German-speaking countries, focused on the use of neuroprotective approaches. The survey was distributed among radiation oncologists (ROs) registered within the database of the German Society for Radiation Oncology (DEGRO). Results: Physicians of 78 centers participated in the survey. Whole brain radiotherapy (WBRT) is still preferred by 70 % of ROs over stereotactic radiotherapy (SRT) in patients with 6-10 BM. For 4-5 BM WBRT is preferred by 23 % of ROs. The fraction of ROs using hippocampal sparing (HS) in WBRT has increased to 89 %, although the technique is used on a regular basis only by a minority (26 %). The drug memantine is not widely prescribed (14% of ROs). A trend was observed for university hospitals to implement neuroprotective approaches more frequently. Conclusion: There is considerable heterogeneity regarding the treatment of BM in German-speaking countries and a general standard of care is lacking. Neuroprotective strategies are not yet standard approaches in daily clinical routine, although usage is increasing. Further clinical trials, as well as improvement of technical opportunities and reimbursement, might further shift the treatment landscape towards neuroprotective radiation treatments in the future.

Long-term survival in patients with brain metastases-clinical characterization of a rare scenario.

PURPOSE: This study aimed to assess clinical, treatment, and prognostic features in patients with brain metastases (BM) from solid tumors achieving long-term survival (LTS). Further, the accuracy of diagnosis-specific Graded Prognostic Assessment scores (ds-GPA) to predict LTS was evaluated. METHODS: Patients admitted for radiotherapy of BM between 2010 and 2020 at a large tertiary cancer center with survival of at least 3 years from diagnosis of BM were included. Patient, tumor, treatment characteristics and ds-GPA were compiled retrospectively. RESULTS: From a total of 1248 patients with BM, 61 (4.9%) survived ≥ 3 years. In 40 patients, detailed patient charts were available. Among LTS patients, median survival time from diagnosis of BM was 51.5 months. Most frequent primary tumors were lung cancer (45%), melanoma (20%), and breast cancer (17.5%). At the time of diagnosis of BM, 11/40 patients (27.5%) had oligometastatic disease. Estimated mean survival time based on ds-GPA was 19.7 months (in 8 cases estimated survival < 12 months). Resection followed by focal or whole-brain radiotherapy (WBRT) was often applied (60%), followed by primary stereotactic radiotherapy (SRT) (20%) or WBRT (20%). 80% of patients received systemic treatment, appearing particularly active in specifically altered non-small lung cancer (NSCLC), melanoma, and HER2-positive breast cancer. Karnofsky performance score (KPS) and the presence of oligometastatic disease at BM diagnosis were persisting prognostic factors in LTS patients. CONCLUSION: In this monocentric setting reflecting daily pattern of care, LTS with BM is heterogeneous and difficult to predict. Effective local treatment and modern systemic therapies often appear crucial for LTS. The impact of concomitant diseases and frailty is not clear.

Hepatitis-associated antigen in sporadic cases of acute viral hepatitis.

Serum specimens collected during the period from September 1970 to April 1971 from hospitalized patients and apparently healthy staff members at risk were tested for the presence of hepatitis-associated antigen (HAA) by the parallel use of three techniques: the complement fixation test, crossover-electrophoresis and immuno-electronmicroscopy.Out of a total of 204 persons investigated 63 (30.9%) were found to harbour the antigen. The HAA-positive sera originated almost exclusively from sporadic cases of acute viral hepatitis (clinically diagnosed as "infectious hepatitis" or "serum hepatitis"). The great majority of the hepatitis cases studied had a history of drug addiction.

Vaccination of school children with live mumps virus vaccine.

Live, attenuated mumps virus vaccine (Mumpsvax) was administered to 146 school children 6 to 9 years of age. One child developed clinical mumps nine days after vaccination; epidemiological and serological data strongly suggest that this child had become infected before vaccination. Apart from this single instance there were no apparent clinical reactions that could be ascribed to the administration of the vaccine. Sixty-three of the 146 children with no clinical history of mumps had an initial serum neutralizing antibody titre of less than 1:2. Specific antibodies to mumps virus were detected in 93.5% of the sera of the susceptible children 28 days after vaccination, and the geometric mean antibody titre of these sera was low (1:6). Of the 80 initially seropositive children 21 (26.2%) showed a significant antibody response to the vaccine and this was influenced by the pre-existing antibody level. These data have further demonstrated the safety and efficacy of the live mumps vaccine in children.

WHO collaborative study on the sero-epidemiology of rubella.

Under the auspices of WHO an investigation was made by 9 laboratories in different parts of the world on the distribution of rubella antibodies in girls and women of child-bearing age. In the first part of the study the objective was to determine the reliability and reproducibility of the tests employed. It was found that there were no significant differences in the variability of the titres obtained in different laboratories when the results were compared with those obtained by repeatedly testing the same sera in one laboratory.In the second part of the study sera were obtained from girls in schools and women attending clinics and health centres. They were not taken from random samples of the populations. In most of the studies the pattern of development of antibody was similar. About half the persons had antibody at 6-8 years of age and 80%-87% at 17-22 years of age, the percentage remaining relatively constant thereafter. The island populations of Trinidad and Jamaica and a rural area of Japan were, however, found to have significantly fewer women with antibodies than urban areas in Europe or the Americas.

WHO collaborative study on the sero-epidemiology of rubella

Under the auspices of WHO an investigation was made by 9 laboratories in different parts of the world on the distribution of rubella antibodies in girls and women of child-bearing age. In the first part of the study the objective was to determine the reliability and reproducibility of the tests employed. It was found that there was no significant differences in the variability of the titres obtained by repeatedly testing the same sera in one laboratory. In the second part of the study sera were obtained from girls in schools and women attending clinics and health centres. They were not taken from random samples of the populations. In most of the studies the pattern of development of antibody was similar. About half the persons had antibody at 6-8 years of age and 80 percent-87 percent at 17-22 years of age, the percentage remaining relatively constant thereafter. The island populations of Trinidad and Jamaica and a rural area of Japan were, however, found to have significantly fewer women with antibodies than urban areas in Europe or the Americas.(AU)