Cerebellar Mets

[Ray D. Ayshun]

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I'm about to SBRT a patient with metastatic esophageal cancer with several cerebellar mets but nothing in the brainstem or supratentorium. I was just wondering if there's a molecular reason for some cancers to prefer over or under the tentorium.

 

[TheWallnerus]

I'm about to SBRT a patient with metastatic esophageal cancer with several cerebellar mets but nothing in the brainstem or supratentorium. I was just wondering if there's a molecular reason for some cancers to prefer over or under the tentorium.

What part of the esophagus and have there been any virchow or supraclav mets

 

[Ray D. Ayshun]

What part of the esophagus and have there been any virchow or supraclav mets

Distal, adeno. HER2+. No SCV mets. Bilateral adrenal though.

Edit: By mentioning HER2+ to you, it led me to this

Subtypes of breast cancer show different spatial distributions of brain metastases - PubMed

The aim of our study was to test the hypothesis that the spatial distribution of breast cancer brain metastases (BM) differ according to their biological subtypes. MR images of 100 patients with BM from primary breast cancer were retrospectively reviewed. Patients were divided according to the...

pubmed.ncbi.nlm.nih.gov

 

[StIGMA]

Seed and soil. The cerebellar ‘soil’ (microenvironment) is a bit different than the rest of the brain. I dont know if anyone has explored a better molecular explanation but ive seen this many times clinically.

 

[A_DeMichele]

something to do with Her2neu and cerebellum, perhaps. like breast ca

 

[randomname2018]

There is some neurotropism by pathology. It isn't strong, but there are some known predilctions.

 

[evilbooyaa]

I think it depends on where the first cancer cells cross the BBB.... if it's in the cerebellum then more likely to get cerebellar mets, vice-versa. Unless uncontrolled extracranial tumor continues to seed other regions. Generlaly the folks I see with one vs the other (cerebellum vs not) have controlled extracranial disease, and it's microsopic disease in the brain that declares itself going forwrad. In some situations I've seen and done posterior fossa 30/10 rather than WBRT if tentorium is unaffected, when SRS is no longer an option.