Evidence map›Paper›PMID 32789774›Full record

ArticleClinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico2021

Investigation of patent foramen ovale as a mechanism for brain metastasis in patients without prior lung involvement.

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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In one paragraph

Article in Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.4field-weighted citation impact, top 34% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 4 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
  4. Cardiac metastasis causes paradoxical malignant embolism.Cancer reports (Hoboken, N.J.) · 2022
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 3 institutions in 1 country.

R Levin-EpsteinDepartment of Radiation Oncology, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA, 90095, USA. RLevinepstein@mednet.ucla.edu.ORCID http://orcid.org/0000-0002-2912-626X
P KumarDepartment of Medicine/Interventional Cardiology, University of California, Los Angeles, Los Angeles, CA, USA.
J RusheenDavid Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.
R G FlemingDepartment of Medicine/Interventional Cardiology, University of California, Los Angeles, Los Angeles, CA, USA.
Z McWattersSidney Kimmel Medical College at the Thomas Jefferson University, Philadelphia, PA, USA.
W KimDepartment of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA.
T B KaprealianDepartment of Radiation Oncology, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA, 90095, USA.
B WestDepartment of Cardiology, University of California, San Diego, San Diego, CA, USA.
J M TobisDepartment of Medicine/Interventional Cardiology, University of California, Los Angeles, Los Angeles, CA, USA.
University of California, Los Angeles · USThomas Jefferson University · USUniversity of California San Diego · US

Funding

http://dx.doi.org/10.13039/100000002 5T32HL007895-19
6 · The paper itself

Abstract

purposeThe 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.

methodsWe 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.

resultsAmong 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.

conclusionIn 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.

Indexed as

AdenocarcinomaAdultAgedAged, 80 and overBrain NeoplasmsBreast NeoplasmsCerebrovascular CirculationDuodenal NeoplasmsEsophageal NeoplasmsFemaleForamen Ovale, PatentGastrointestinal NeoplasmsHumansMaleMiddle AgedPilot ProjectsSaline SolutionBrain metastasesBrain metastasisMetastatic cancerOrganotropismPatent foramen ovalePFO

Identifiers

PMID32789774
OpenAlexW3049137496

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.