CANCER NEUROLOGY IN CLINICAL PRACTICE

CANCER NEUROLOGY

IN CLINICAL PRACTICE

Edited by

DAVID SCHIFF, MD Department of Neurology-University of Virginia Medical Center, Charlottesville, VA

and

PATRICK Y. WEN, MD Center for Neuro-Oncology Dana-Farber Cancer Institute; and Department of Neurology­Brigham and Women's Hospital, Boston, MA

Foreword by

JEROME B. POSNER, MD Memorial Sloan-Kettering Cancer Center, New York, NY

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© 2003 Springer Science+Business Media New York Originally published by Humana Press Inc. in 2003

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Cover Illustration: The top left (brain) MRI is a post-contrast TI scan demonstrating multiple cerebral metastases in a patient with renal cell carcinoma. The bottom right spine MRI reveals multiple enhancing leptomeningeal nodules reflecting metastatic spread of melanoma. Both of these photos are courtesy of Dr. Schiff from personal archives. Upper right photo is Fig. lA in Chapter 29, "Neuro-Oncologic Complications of Sarcomas" by Lara Kunscher. Lower left photo is Fig. 10 in Chapter 11, "Neuromuscular Disease and Its Complications" by Magdy Selim, David A. Chad, and Lawrence D.Recht.

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10987654321

Library of Congress Cataloging-in-Publication Data

Cancer neurology in clinical practice 1 edited by David Schiff and Patrick Y. Wen. p. ;cm.

Includes bibliographical references and index. ISBN 978-1-4757-4703-4 ISBN 978-1-59259-317-0 (eBook) DOI 10.1007/978-1-59259-317-0 1. Neurologic manifestations of general diseases 2. Cancer--Complications 3.

Cancer--Treatment--Complications 4. Metastasis I. Schiff, David, 1959- II. Wen, Patrick Y.

[DNLM: 1. Neoplasms--complications. 2. Neoplasms--therapy. 3. Neurologic Manifestations. 4. Therapeutics--adverse effects. QZ 200 C2153627 2002] RC347 .C364 2002 616.99'4--dc21

2002017287

FOREWORD

I last wrote a Foreword for a book on neuro­oncology in 1995. At that time, I suggested that neuro-oncology was an important and emerging sub­specialty involving neurologists, neurosurgeons, radiation oncologists, neuroradiologists, and medical oncologists. In the ensuing seven years, interest in neuro-oncology has increased. A new American organization, the Society for Neuro­Oncology, has joined the European Association for Neuro-Oncology as a multidisciplinary organiza­tion devoted to the study of neuro-oncology in all of its aspects. In addition, a number of books have appeared encompassing neuro-oncologic material and a second journal, N euro-Oncology, has joined the Journal ofNeuro-Oncology as a specialty jour­nal related to the subject.

With so much written liter<;lture, one might ask why this book? There are several answers: First, many books emphasize primary brain tumors rather than the more common neurologic complications of systemic cancer.. Cancer Neurology in Clinical Practice gives a comprehensive analysis of how can­cer affects the nervous system. A book such as this one allows the reader interested, but not working, in neuro-oncology an opportunity to peruse the entire field of cancer neurology in one reference. Second, the field is evolving. Although neuro-oncologists are discouraged by . our slow progress, there have been substantial advances in our understanding of the biology that underlies the clinical subspecialty of neuro-oncology and, in addition, there have been some areas in whlch treatment has changed, e.g., radiosurgery for single or multiple metastatic lesions and chemotherapy for some metastases. Thirdly, the editors of this book, David Schiff and Patrick Wen, have pulled together a group of experts who are

currently active in the clinical management of the problems they are writing about.

It is with pride, I note, that 24 of the 50 authors received their neuro-oncological training at Memo­rial Sloan-Kettering, and that several others were trained by those who received their training here. Nonetheless, this is not a provincial book. It encom­passes the experience of senior physicians actively engaged in neuro-oncology at centers throughout the world. I also note that most of the authors are clinical neurologists. It is important and appropriate that neurologists play a leadership role in neuro­oncology. Neurologists are in a better position than their colleagues in radiation oncology and medical oncology to understand nervous system function and how tumors affecting it differ from tumors affecting other organs qf the body. They are also better able than the neurosurgeons to manage the chronic neu­rologic disability seen in these patients. Because of this unique perspective, clinical neurologists can serve as coordinators in the diagnosis and manage­ment of all neuro-oncological problems.

The broad scope of this book will appeal to phy­sicians who are not specialists, but who want an up­to-date reference on all aspects of neuro-oncology. And it will appeal to practicing neuro-oncologists who want to get the viewpoint of an expert on a particular problem. I hope it will also serve as an inducement for young physicians and scientists to become interested in this most importantdiscipline. As I have indicated before, one role of highly spe­cialized institutions such as Memorial Sloan­Kettering Cancer Center is to train physicians who can then disseminate their knowledge to less spe­cialized institutions. This book indicates that we are fulfilling that role.

Jerome B. Posner, MD

v

PREFACE

Neuro-oncology has evolved substantially as a clinical and research discipline over the past few decades. Initially the province of isolated devo­tees, it has become a well-recognized subspecialty of neurology, oncology, and neurosurgery. The Society for Neuro-Oncology, founded just five years ago, now has almost 1000 members. Most tertiary care hospitals have staff physicians who consider themselves neuro-oncologists. These phy­sicians typically are involved in the evaluation and management of neurologic complications of sys­temic cancer and its treatment, as well as of pri­mary brain tumors. Neurologic complications occur in a substantial proportion of cancer patients, often present complex diagnostic and management problems, and commonly have a major impact on quality of life.

Simultaneously, improvements in and the wide­spread availability of such diagnostic studies as magnetic resonance scanning, as well as market forces, have resulted in most patients with neuro­logic complications of cancer receiving treatment outside of the tertiary care setting. Many medical and radiation oncologists have little formal train­ing in the evaluation of neurologic symptoms. Conversely, most neurologists see relatively few cancer patients and do not have time to keep abreast of technological and pharmacological advances in cancer management. These circumstances contrib­ute to the risk that some patients may not have access to a desirable level of expertise.

The principal aim of this work is to provide cli­nicians from various backgrounds and levels of training with a reference to help focus the differen­tial diagnosis, diagnostic strategy, and treatment plan for the cancer patient with neurologic symp­toms and findings. The volume begins with an overview of the field of neuro-oncology. Several chapters on interpretation and management of com­mon neuro-oncologic symptoms follow. Subse­quent sections contain chapters on the direct and indirect neurologic complications of cancer as well as complications of therapy. After a chapter reviewing the role of neuroimaging in the diagno­sis of neuro-oncologic disease, the final section focuses on the spectrum and management ofneu­rologic disease in patients with cancer of specific organs. Although there is necessarily some overlap between these chapters and the earlier, more gen­eral chapters, this structure allows the reader the flexibility of approaching a clinical problem either from the symptoms or in the context of the patient's known diagnosis of malignancy.

Our great hope is that in broadening and deepen­ing the familiarity of clinicians with the range and management of neuro-oncologic diagnoses we may improve the quality of care for cancer patients. The increased confidence and competence of the treat­ing physicians in securing a diagnosis, selecting a treatment plan, and communicating prognosis should translate into increased peace of mind and quality of life for patients and their loved ones.

David Schiff, MD

vii

ACKNOWLEDGMENTS

Patrick Wen, Jerry Posner, Lisa DeAngelis, Kathy Foley, and Brian 0' Neill have served as role models of consummate clinical and academic neuro-oncologists and have provided support, encouragement, and enthusiasm. I am also indebted to the individual chapter authors for their skilled efforts in providing fresh topical reviews. Agnes Zachoszcz provided requisite organizational and secretarial assistance with unflagging good cheer and competence. The editors at Humana Press have been patient and helpful at every turn. Most of all, I would like to thank my patients, my family, and Tanya Nezzer, MD, for all they have taught me and for allowing me to do what I love.

David Schiff, MD

I would also like to thank all the authors for their willingness to contribute to this book, despite their busy schedules, the editors for their support and encouragement, and Suzanne Markloff for administrative and secretarial assistance. I am especially grateful for all the work that David Schiff did to make this book possible and for his friendship over the years. I would like to dedicate this book to my parents Hsiang-Lai Wen, MD and Grace Wen and to my family, May, Katherine, and Jessica.

Patrick Wen, MD

ix

CONTENTS

Part I.

Part II.

Part III.

Part IV.

Foreword ..................................................................................................................... v

Preface ...................................................................................................................... vii

Acknowledgments ........................................................................................................ ix

Contributors ............................................................................................................... xv

Overview

1 The Prevalence and Impact of Neurologic Disease in Cancer ............................ 3 Charles J. Vecht, MD, PhD

Neurologic Symptoms

2 The Epidemiology and Management of Seizures in Patients with Cancer ......... 9 Michael J. Glantz, MD and Keith R. Edwards, MD

3 Corticosteroids in Neuro-Oncology ................................................................... 17 Nina A. Paleo logos, MD and Nicholas A. Vick, MD

4 Headache Associated with Intracranial Neoplasms .......................................... 23 Siraj M. Husain, MD, FRCPC and Peter A. Forsyth, MD

5 Confusion and Delirium ..................................................................................... 41 Augusto Caraceni, MD, Marco Bosisio, PhD,

and Jane M. Ingham, MB, BS, FRACP

6 Cancer Pain ........................................................................................................ 57 Julie E. Hammack, MD

Direct Complications of Cancer

7 Brain Metastases ................................................................................................ 73 Raja B. Khan, MD and Lisa M. DeAngelis, MD

8 Skull and Dural Metastases ............................................................................... 87 Ben P. W. Jansen, MD and Peter A. E. Sillevis Smitt, MD, PhD

9 Spinal Metastases ............................................................................................... 93 David Schiff, MD

10 Leptomeningeal Metastases ............................................................................. 107 Warren P. Mason, MD, FRCPC

11 Neuromuscular Disease and Its Complications ............................................... 121

Magdy Selim, MD, PhD, David A. Chad, MD, and Lawrence D. Recht, MD

Indirect Complications of Cancer

12 Cerebrovascular Complications of Cancer ...................................................... 137 Megan C. Leary, MD and leffrey L. Saver, MD

xi

xii Contents

Part V.

13 Paraneoplastic Syndromes of the Nervous System ......................................... 159 Myrna R. Rosenfeld, MD, PhD and Josep Dalmau, MD, PhD

Compl ications of Cancer Therapy

14 Neurologic Sequelae of Radiotherapy on the Nervous System ....................... 173 Anthony Behin, MD and Jean-Yves Delattre, MD

15 Cancer and Cancer Treatment-Related Neuromuscular Disease..................... 193 Casilda Balmaceda, MD and Elina Korkin, BS

16 Central Nervous System Complications of Cancer Therapy ........................... 215 Patrick Y. Wen, MD

17 Neurologic Complications of Hematopoietic Stem Cell Transplantation ....... 233

Hendrikus G. J. Krouwer, MD, PhD and Eelco F. M. Wijdicks, MD, PhD

18 Central Nervous System Infections in Cancer Patients .................................... 253 Neil E. Anderson, MB, CHB, FRACP and Mark G. Thomas, MD, FRACP, FRCPA

Part VI. Diagnostic Studies

19 Imaging Neurologic Manifestations of Oncologic Disease ............................ 273 Carolyn C. Meltzer, MD and Melanie B. Fukui, MD

Part VII. Neuro-Oncologic Complications of Specific Malignancies

20 Neuro-Oncologic Complications of Lung Cancer ............................................ 295 Suriya A. Jeyapalan, MD, MA and John W. Henson, MD

21 Neuro-Oncologic Complications of Breast Cancer ......................................... 309 Willem Boogerd, MD, PhD

22 Neurologic Complications of Genitourinary Malignancies ............................ 327 David Schiff, MD, Donald L. Trump, MD, and Patrick Y. Wen, MD

23 Melanoma ......................................................................................................... 339 Denise M. Damek, MD

24 Leukemia .......................................................................................................... 355 Hanny Haaxma-Reiche, MD, PhD

25 Neurologic Complications of Hodgkin's Disease and the Non-Hodgkin's Lymphomas ...................................................................................................... 371

Brian Patrick O'Neill, MD

26 Neurologic Disorders in Benign and Malignant Plasma Cell Dyscrasias ....... 385 John J. Kelly, MD

27 Female Reproductive Tract Cancers ................................................................ 397 Lauren E. Abrey, MD

Contents xiii

28 Neurologic Complications of Gastrointestinal Malignancies .......................... 405 Deborah T. Blumenthal, MD and Richard H. Wheeler, MD

29 Neuro-Oncologic Complications of Sarcomas ................................................ 417 Lara J. Kunschner, MD

30 Neurologic Complications of Head and Neck Cancer ..................................... 425 David Schiff, MD, Dong M. Shin, MD, Paul L. Moots, MD,

and Ronald G. Wiley, MD

31 Neurologic Complications in Children with Systemic Cancer ....................... 435 Nuno Lobo Antunes, MD

Index ..................................................................................................................... 451

CONTRIBUTORS

LAUREN E. ABREY, MD • Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY

NEIL E. ANDERSON, MB, CHB, FRACP • Neurologist, Auckland Hospital, University of Auckland, Auckland, New Zealand

NUNo LOBO ANTuNEs, MD • Departments of Neurology and Pediatrics, Memorial Sloan­Kettering Cancer Center, New York, NY

CASILDA BALMACEDA, MD • Department of Neurology, Columbia Presbyterian Medical Center, Columbia University, New York, NY

ANTHONY BEHIN, MD· Federation de Neurologie Mazarin, Groupe Hospitalier Pitie-Salpetriere, Paris, France

DEBORAH T. BLUMENTHAL, MD· Department of Neurology, University of Utah Medical Center, Salt Lake City, UT

WILLEM BOOGERD, MD, PhD • Department of Neuro­Oncology, The Netherlands Cancer Institute/ Antoni van Leeuwenhoekhuis and Slotervaart Hospital, Amsterdam, The Netherlands

MARCO BOSISIO, PhD • Psychology Unit, National Cancer Institute, Milan, Italy

AUGUSTO CARACENI, MD· Neurology Unit, Rehabilitation and Palliative Care Unit, National Cancer Institute, Milan, Italy

DAVID A. CHAD, MD • Department of Neurology, University of Massachusetts Medical School, Worcester, MA

JOSEP DALMAU, MD, PhD • Department of Neurology, University of Arkansasfor Medical Sciences, Little Rock, AR

DENISE M. DAMEK, MD • Department of Neurology, University of Colorado Health Sciences Center, Denver, CO

LISA M. DEANGELIS, MD • Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY

JEAN-YVES DELATTRE, MD· Federation de Neurologie Mazarin, Groupe Hospitalier Pitie-Salpetriere, Paris, France

KEITH R. EDWARDS, MD· Neurological Research Center, Bennington, VT

PETER A. FORSYTH, MD • Departments of Oncology, Clinical Neurosciences, and Medicine, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada

MELANIE B. FUKUI, MD • Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA

MICHAEL J. GLAN1Z, MD • Department of Neurology, University of Massachusetts, Amherst, MA

HANNY HAAXMA-REICHE, MD, PhD • Departmentof Neurology, University Hospital Groningen, Groningen, The Netherlands

JULIE E. HAMMACK, MD • Department of Neurology, Mayo Clinic, Rochester, MN

JOHN W. HENSON, MD • Brain Tumor Center, Massachusetts General Hospital, Boston, MA

SIRAJ M. HUSAIN, MD, FRCPC • Department of Radiation Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada

JANE M. INGHAM, MB, BS, FRACp· Palliative Care Program, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC

BEN P. W. JANSEN, MD • Department of Neurology of Tweesteden Ziekenhuis, Tilburg, The Netherlands

SURIYA A. JEYAPALAN, MD, MA • Brain Tumor Center, Massachusetts General Hospital, Boston, MA

JOHN J. KELLY, MD· Department of Neurology, The George Washington University Medical Center, Washington, DC

RAJA B. KHAN, MD • Divisions of Neurology and Neuro-Oncology, St. Jude's Children's Research Hospital, Memphis, TN

ELINA KORKIN, BS • Department of Surgery, Department of Neurology, Columbia Presbyterian Medical Center, Columbia University, New York, NY

HENDRIKUS G. J. KROUWER, MD, PhD· Department of Neurology, Medical College of Wisconsin, Milwaukee, WI

LARA J. KUNSCHNER, MD • Department of Neurology, Allegheny General Hospital, Pittsburgh, PA

MEGAN C. LEARY, MD • UCLA Stroke Center, Los Angeles, CA

WARREN P. MASON, MD, FRCPC • Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Ontario, Canada

CAROLYN C. MELTZER, MD • Departments of Radiology and Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA

xv

xvi

PAUL L. MOOTS, MD • Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN

BRIAN PATRICK O'NEllL, MD • Department of Neurology, Mayo Clinic, Rochester, MN

NINA A. PALEOLOGOS, MD· Department of Neurology, Evanston Northwestern Healthcare, Evanston, IL

LAWRENCE D. RECHT, MD • Department of Neurology, University of Massachusetts Medical School, Worcester, MA

MYRNA R. ROSENFELD, MD, PhD • Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR

JEFFREY L. SAVER, MD· UClA Stroke Center, Los Angeles, CA

DAVID SCHIFF, MD • Department of Neurology, University of Virginia Medical Center, Charlottesville, VA

MAGDY SELIM, MD, PhD • Department of Neurology, University of Massachusetts Medical School, Worcester, MA

DONG M. SHIN, MD • Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA

Contributors

PETER A. E. SILLEVIS SMITT, MD, PhD· Department of Neuro-Oncology, Daniel den Hoed Cancer Center, University Hospital Rotterdam, Rotterdam, The Netherlands

MARK G. THOMAS, MD, FRACP, FRCPA· Infectious Disease Physician, Auckland Hospital, University of Auckland, Auckland, New Zealand

DONALD L. TRUMP, MD • Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA

CHARLES J. VECHT, MD, PhD· Department of Neurology, Medical Center The Hague, The Hague, Netherlands

NICHOLAS A. VICK, MD • Department of Neurology, Evanston Northwestern Healthcare, Evanston, IL

PATRICK Y. WEN, MD • Center for and Division of Neuro-Oncology, Dana Farber Cancer Institute, and Department of Neurology, Brigham and Women's Hospital, Boston, MA

RICHARD H. WHEELER, MD • Medical Oncology, Huntsman Cancer Institute, Salt Lake City, UT

EELCO F. M. WUDICKS, MD, PhD • Department of Neurology, Mayo Clinic, Rochester, MN

RONALD G. WILEY, MD • Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN