Investigation of patent foramen ovale as a mechanism for brain metastasis in patients without prior lung involvement
| Autor: | R, Levin-Epstein, P, Kumar, J, Rusheen, R G, Fleming, Z, McWatters, W, Kim, T B, Kaprealian, B, West, J M, Tobis |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Aged 80 and over Male Pulmonary Circulation Esophageal Neoplasms Brain Neoplasms Ultrasonography Doppler Transcranial Valsalva Maneuver Foramen Ovale Patent Breast Neoplasms Pilot Projects Adenocarcinoma Middle Aged Duodenal Neoplasms Regional Blood Flow Thyroid Cancer Papillary Cerebrovascular Circulation Prevalence Humans Female Prospective Studies Saline Solution Thyroid Neoplasms Aged Gastrointestinal Neoplasms |
| Zdroj: | Clinicaltranslational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico. 23(4) |
| ISSN: | 1699-3055 |
| Popis: | The mechanisms of brain metastasis are incompletely understood. Circulating tumor cells travel to the right heart and through the pulmonary circulation, where they may become lung metastases, and can circulate further to the left heart and brain. In patients who develop brain metastases without lung involvement, we hypothesized that cancer cells may travel directly from the right atrium to left atrium via a patent foramen ovale (PFO), akin to paradoxical embolism. If the prevalence of PFO is greater in these individuals compared to the general population (20-30%), PFO may play a role in brain metastasis, and prophylactic closure may provide benefit. Accordingly, we investigated the prevalence of PFO in patients with brain metastases without prior lung involvement.We prospectively identified patients with brain metastases from a non-lung primary cancer with no preceding or concurrent lung involvement. Nine eligible participants underwent a transcranial Doppler study with intravenous agitated saline to assess for PFO.Among nine participants, primary cancers were breast (n = 6), upper gastrointestinal (n = 2), and thyroid (n = 1). A positive bubble study was identified in 2/9 (22.2%) participants: one female with breast cancer and one male with duodenal adenocarcinoma. No participants developed lung metastases on subsequent chest imaging.In this prospective pilot study, we found a similar prevalence of PFO in patients who developed brain metastases without preceding lung involvement compared to estimates for the general population. Through a larger study is needed, the development of brain metastases in these individuals may primarily reflect tumor-specific biological factors diecting metastasis organotropism. |
| Databáze: | OpenAIRE |
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