Investigation of patent foramen ovale as a mechanism for brain metastasis in patients without prior lung involvement
- 13 August 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Clinical and Translational Oncology
- Vol. 23 (4), 783-787
- https://doi.org/10.1007/s12094-020-02471-y
Abstract
Purpose 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. Methods 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. Results 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. Conclusion 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.Keywords
This publication has 33 references indexed in Scilit:
- Summary Report on the Graded Prognostic Assessment: An Accurate and Facile Diagnosis-Specific Tool to Estimate Survival for Patients With Brain MetastasesJournal of Clinical Oncology, 2012
- Brain metastases from solid tumors: disease outcome according to type of treatment and therapeutic resources of the treating centerJournal of Experimental & Clinical Cancer Research, 2011
- Identifying breast cancer patients at risk for Central Nervous System (CNS) metastases in trials of the International Breast Cancer Study Group (IBCSG)Annals of Oncology, 2006
- Power M-Mode Transcranial Doppler for Diagnosis of Patent Foramen Ovale and Assessing Transcatheter ClosureJournal of Neuroimaging, 2004
- Incidence Proportions of Brain Metastases in Patients Diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance SystemJournal of Clinical Oncology, 2004
- Dissemination and growth of cancer cells in metastatic sitesNature Reviews Cancer, 2002
- Brain metastases in breast cancer; natural history, prognostic factors and outcomeJournal of Neuro-Oncology, 1993
- Prevalence of Patent Foramen Ovale in Patients with StrokeThe New England Journal of Medicine, 1988
- Incidence and Size of Patent Foramen Ovale During the First 10 Decades of Life: An Autopsy Study of 965 Normal HeartsMayo Clinic Proceedings, 1984
- Metastatic neoplasms of the brain: Their frequency in relation to ageCancer, 1964