Brain metastases are significant causes of morbidity or mortality for patients with metastatic cancer.With the application of novel systematic therapy and improvement of overall survival,the prevalence of brain metast...Brain metastases are significant causes of morbidity or mortality for patients with metastatic cancer.With the application of novel systematic therapy and improvement of overall survival,the prevalence of brain metastases is increasing.The paradigm of treatment for brain metastases evolved rapidly during the last 30 years due to the development of technology and emergence of novel therapy.Brain metastases used to be regarded as the terminal stage of cancer and left life expectancy to only 1 month.The application of whole brain radiotherapy for patients with brain metastases increased the life expectancy to 4–6 months in the 1980s.Following studies established surgical resection followed by the application of whole brain radiotherapy the standard treatment for patients with single metastasis and good systematic performance.With the development of stereotactic radiosurgery,stereotactic radiosurgery plus whole brain radiotherapy provides an alternative modality with superior neurocognitive protection at the cost of overall survival.In addition,stereotactic radiosurgery combined with whole brain radiotherapy may offer a promising modality for patients with numerous multiple brain metastases who are not eligible for surgical resection.With the advancing understanding of molecular pathway and biological behavior of oncogenesis and tumor metastasis,novel targeted therapy including tyrosine-kinase inhibitors and immunotherapy are applied to brain metastases.Clinical trials had revealed the efficacy of targeted therapy.Furthermore,the combination of targeted therapy and radiotherapy or chemotherapy is the highlight of current investigation.Advancement in this area may further change the treatment paradigm and offer better modality for patients who are not suitable for surgical resection or radiosurgery.展开更多
Background: A rare case of cerebral abscess concurrent with pulmonary arteriovenous fistula (PAVF), hyperhemoglobinemia, and hypoxemia was reported. Case presentation: A 37-year-old man was admitted with a headache, n...Background: A rare case of cerebral abscess concurrent with pulmonary arteriovenous fistula (PAVF), hyperhemoglobinemia, and hypoxemia was reported. Case presentation: A 37-year-old man was admitted with a headache, nausea, vomiting, fever, and numbness of the left cheek and upper limb for 10 days. Cerebral magnetic resonance imaging (MRI) shows the lesion in his right frontal lobe. Blood gas analysis indicated lower blood oxygen saturation level, and blood routine test showed hemoglobin elevation. Craniotomy for the lesion and decompressive craniotomy were performed. Brain abscess was confirmed by pathology examination. The chest computed tomography angiography (CTA) revealed a pulmonary arteriovenous fistula (PAVF) in his right lower lung. After 1 month, embolization of PAVF was performed. Anoxic symptom improved after surgery. Cranioplasty was performed after 7 months. Conclusion: The author reported a rare case of cerebral abscess associated with pulmonary arteriovenous fistula. Brain abscess, hyperhemoglobinemia, and hypoxemia might be secondary to PAVF. Treatment of patients includes not only craniotomy for abscess removal but also embolization of PAVF which can prevent recurrence of brain abscess.展开更多
文摘Brain metastases are significant causes of morbidity or mortality for patients with metastatic cancer.With the application of novel systematic therapy and improvement of overall survival,the prevalence of brain metastases is increasing.The paradigm of treatment for brain metastases evolved rapidly during the last 30 years due to the development of technology and emergence of novel therapy.Brain metastases used to be regarded as the terminal stage of cancer and left life expectancy to only 1 month.The application of whole brain radiotherapy for patients with brain metastases increased the life expectancy to 4–6 months in the 1980s.Following studies established surgical resection followed by the application of whole brain radiotherapy the standard treatment for patients with single metastasis and good systematic performance.With the development of stereotactic radiosurgery,stereotactic radiosurgery plus whole brain radiotherapy provides an alternative modality with superior neurocognitive protection at the cost of overall survival.In addition,stereotactic radiosurgery combined with whole brain radiotherapy may offer a promising modality for patients with numerous multiple brain metastases who are not eligible for surgical resection.With the advancing understanding of molecular pathway and biological behavior of oncogenesis and tumor metastasis,novel targeted therapy including tyrosine-kinase inhibitors and immunotherapy are applied to brain metastases.Clinical trials had revealed the efficacy of targeted therapy.Furthermore,the combination of targeted therapy and radiotherapy or chemotherapy is the highlight of current investigation.Advancement in this area may further change the treatment paradigm and offer better modality for patients who are not suitable for surgical resection or radiosurgery.
文摘Background: A rare case of cerebral abscess concurrent with pulmonary arteriovenous fistula (PAVF), hyperhemoglobinemia, and hypoxemia was reported. Case presentation: A 37-year-old man was admitted with a headache, nausea, vomiting, fever, and numbness of the left cheek and upper limb for 10 days. Cerebral magnetic resonance imaging (MRI) shows the lesion in his right frontal lobe. Blood gas analysis indicated lower blood oxygen saturation level, and blood routine test showed hemoglobin elevation. Craniotomy for the lesion and decompressive craniotomy were performed. Brain abscess was confirmed by pathology examination. The chest computed tomography angiography (CTA) revealed a pulmonary arteriovenous fistula (PAVF) in his right lower lung. After 1 month, embolization of PAVF was performed. Anoxic symptom improved after surgery. Cranioplasty was performed after 7 months. Conclusion: The author reported a rare case of cerebral abscess associated with pulmonary arteriovenous fistula. Brain abscess, hyperhemoglobinemia, and hypoxemia might be secondary to PAVF. Treatment of patients includes not only craniotomy for abscess removal but also embolization of PAVF which can prevent recurrence of brain abscess.
