Results of recent therapy for non-small-cell lung cancer with brain metastasis as the initial relapse

The results of radiosurgery for treatment of patients with non-small-cell lung cancer with brain metastasis as the initial relapse were evaluated. Twenty-three patients were included in the study. The dominant pathologic type was adenocarcinoma (56.5%). In the mean interval of 13.7 months (range, 3-52 months) between the lung operation and treatment of brain metastasis, a solitary lesion developed in 9 patients and multiple lesions developed in 14 patients. The modalities used for brain metastasis were gamma-knife radiation therapy (GKS) in nine patients, GKS plus operation in six, GKS plus whole brain radiation therapy (WBR) in two, operation plus WBR in two, operation only in one, WBR only in two, and no treatment in one. The 1- and 3-year survival rates after treatment of brain were 47.3% and 7.4%, respectively. The prognostic impact of stage and number of brain metastases was not clear. Primary tumor size and adjuvant chemotherapy after the lung operation significantly affected survival after the management of brain metastasis. The low invasive radiosurgery is beneficial in terms of improving the quality of life of patients.     

Radiation therapy in the treatment of difficult giant cell tumors

Thirteen patients with giant cell tumors of bone have been treated by radiation therapy because surgery was not feasible or unacceptably disfiguring. Seven patients were treated for primary giant cell tumors of the bone, four for recurrent disease, and three for metastasis (one presented with both distant metastasis and local recurrence after primary surgery). The follow-up time ranged from 18 months to 13 years, with a mean of 6.5 years. All patients except one are alive. Local control was achieved in 11 patients (85%). One patient whose tumor was located in the sacrum had no gross response and at 5 months was subjected to a partial sacrectomy. A second patient had local regrowth 1 year after treatment; salvage surgery was successful. There have been no long-term complications of radiation therapy. This study confirms that for patients with giant cell tumor of bone, radiation therapy offers an effective alternative to complex or difficult surgery and constitutes a good treatment method to medically inoperable patients.     

Cerebral involvement of metastatic thymic carcinoma

Summary The authors report the clinical presentations, radiological findings, and treatment outcome of thymic carcinoma patients with cerebral metastasis. The authors retrospectively reviewed the medical records of 49 patients with thymic carcinoma and 6 of them (12.2%) developed brain metastasis. There were 4 men and 2 women with a mean age of 48 years (ranging from 33 to 56 years). The pathological types of thymic carcinoma which developed brain metastasis were thymic carcinoma type C of the WHO classification in three patients, type B3 in one and carcinoid tumor in two patients. Surgical resection was performed as an initial treatment for brain lesions in three patients. Five patients received whole brain radiation therapy (WBRT) and radiosurgery was performed in one of them. The survival time was from 2 months in a patient with no treatment for brain lesions to 9 months in a patient who is still alive after surgical resection combined with WBRT and radiosurgery. There is high probability of metastasis particularly in thymic carcinoma type C or carcinoid tumor. Frequent surveillance and aggressive therapeutic approach are necessary to improve survival in these patients with cerebral involvement.     

Prophylactic brain irradiation and radiotherapy of brain metastases of small cell lung cancer

The report presents the results of cranial irradiation of 44 small cell lung cancer patients with clinically-identified intracranial metastases and 40 patients for metastatic spread prevention. Whole brain irradiation was carried out with single doses of 2-4 Gy (total dose--30-40 Gy) in both groups 5 times weekly. Patients irradiated for metastasis prevention revealed a 3.3-fold decrease in intracranial metastasis frequency and a good post-treatment tolerance. In the other group, radiation failed to reach tumor lesions in 20%; treatment produced a poor effect in 30%. There was a correlation between survival time, initial expansion of process and tumor response to primary treatment. No relationship was observed between survival time and procedure and duration of cranial irradiation. Prophylactic irradiation may be beneficial in responders to therapy. However, randomized research into the effectiveness of preventive irradiation and possible radiation injury to cranial and brain tissues is required, particularly, in patients responding to primary treatment by complete regression of localized tumor.     

Analysis of recurrence of squamous cell carcinoma of the uterine cervix after definitive radiation therapy alone: patterns of recurrence, latent periods, and prognosis

A retrospective analysis was performed with emphasis on the patterns of recurrence, latent period, and prognosis in patients with cervical squamous cell carcinoma of the uterus treated with definitive radiation therapy alone. Late recurrence, which was observed more than 5 years after the initial radiation therapy, was finally focused on and discussed.

Between 1976 and 1994, 256 patients with squamous cell carcinoma of the uterine cervix without hematogenous metastasis were treated with definitive radiation therapy alone. The patients were staged as follows according to the FIGO classification: 26 in Stage I, 56 in Stage II, 124 in Stage III, 28 in Stage IVa, and 22 in Stage IVb. All the patients were treated with external beam irradiation and low-dose-rate intracavitary brachytherapy.

A total of 74 patients had recurrence. The recurrence appeared in 67 cases (90.5%) within 5 years. Metastasis to para-aortic and/or supraclavicular nodes developed later than other types of recurrence. Among patients with lymphogenous metastasis, there were more 5-year survivors after recurrence than with other types of recurrence. Patients with early recurrence, within 2 years of the initial therapy, had a worse prognosis than those with recurrence more than 2 years after treatment. Seven patients (2.7%) in all developed late recurrence more than 5 years after the treatment. The first site of recurrence was an abdominal para-aortic or supraclavicular node in all patients, excluding one patient who developed intrapelvic lymph node metastasis. Six patients had pelvic node metastasis detected with lymphangiography at the initial treatment. Median survival after late recurrence was 16.0 months. Two of 7 patients survived more than 3 years after secondary radiation therapy, and the remainder died of recurrent disease.

Patients with para-aortic and/or supraclavicular node metastasis that developed late after the initial treatment are more likely to survive due to secondary radiation therapy. Careful follow-up is emphasized for long-term survivors.     

Malignant Germ Cell Tumors Metastatic to the Brain: A Model for a Curable Neoplasm? The Freiburg Experience and a Review of the Literature

The aim of this study on malignant germ cell tumors metastasizing to the brain is (a) to report our institutional experience, (b) to present three patients surviving for more than seven years, and (c) to review the literature with regard to long-term survival.From 1985 to 2000, 916 consecutive patients were treated with whole brain radiation therapy for brain metastases at our hospital. Eleven patients had cerebral lesions from histologically proven malignant germ cell tumors. Brain metastases were diagnosed at presentation (n = 2), following complete remission (n = 3), or along with extracerebral tumor progression (n = 6). Seven patients had a single brain metastasis. Three patients underwent resection. Eight patients reached the planned total dose of 50Gy. Eight patients had chemotherapy.Median survival was 6.6 months. The long-term survivors all had an isolated cerebral relapse after complete remission, presented with a single brain metastasis, and were treated with resection and whole brain radiation therapy to a total dose of 50Gy. The first patient died from a late relapse 89 months after the diagnosis of brain metastasis, the second patient is well and alive at 95 months. The third patient is currently being treated for a second malignancy originating from the lung. He is alive at 194 months, the longest survival for brain metastases from malignant germ cell tumors ever reported.Altogether, our study demonstrates that advanced extracerebral disease at initial diagnosis and isolated cerebral relapse after complete remission do not preclude long-term survival. Resection and whole brain radiation therapy might result in durable cerebral control with minimal morbidity.     

Small cell lung cancer with a brain metastasis controlled for 5 years: a case report

We report a case of small cell lung cancer whose initial presentation was a solitary brain metastasis. On chest radiography the primary tumor was unclear and only detected by bronchofiberscopy. A small single pulmonary metastasis was noted in the right lower lobe. Subtotal resection and external irradiation were applied to the brain tumor and external irradiation was applied to the lung. Concurrently one course of systemic chemotherapy was administered. The tumors in the brain and lung had disappeared by the end of the treatment. The patient has been alive and well for 5 years without recurrence.     

ESTHESIONEUROBLASTOMA: A report of seven cases

The biologic behavior of esthesioneuroblastoma in seven patients, treated from 1978 to 1989, is reviewed. The patients were initially treated with surgical resection (2 cases), radiation alone (1 case) or a combination of radiation and surgery (4 cases). The radiation dose ranged from 30 to 62 Gy. Operations were performed via a transmaxillary approach (2 cases), lateral rhinotomy approach (3 cases) and craniofacial approach (1 case). Four of the seven patients experienced local recurrence, occurring after disease-free intervals as long as 6 years. The other three patients died of distant metastasis within one year after initial treatment. The effectiveness of radiation therapy varied, and in some patients a dose of 60 Gy was not enough to control microscopic disease. One patient developed bone marrow metastases which was fatal due to the ensuing pancytopenia. One patient developed a brain metastasis. Hyams' histopathologic staging of the tumor appeared to be related to prognosis.     

非小细胞肺癌局限性脑转移的治疗现状及研究进展

癌症经查证仅存在脑部转移称为局限性脑转移。肺癌的脑转移分子调控机制尚待进一步研究,以手术、放疗、化疗为基础的非小细胞肺癌局限性脑转移综合治疗的效果较好,但联合治疗的适应证需严格掌握。全脑放疗后肿瘤区局部增加照射剂量有利于提高肿瘤局控率,延长整体生存;脑预防照射未见生存期的明显延长。靶向药物联合全脑放疗对于一般状态较差的患者耐受性较好,且生存期得到了一定的延长。     

Brain metastasis as the first manifestation of small cell lung cancer in a female adolescent

Small cell lung cancer is commonly regarded as an old age related disease. Although the brain is a common site of metastasis for this type of lung cancer, the first manifestation is rarely shown from the metastasis site. In this paper, we report a rare case of 19-year-old female patient with small cell lung cancer whose initial presentation was a solitary brain metastasis. The patient was admitted to our hospital for the recurrence of brain tumor, and the histological diagnosis after operation showed small cell lung cancer. Three months later, she suffered from dry cough and was diagnosed as small cell lung cancer by trans-bronchial biopsy. Due to the identical cell types and immunohistochemical phenotypes, the brain tumor was retrospectively diagnosed as metastasis of small lung cancer by two neurological pathologists. She is the youngest female with brain metastasis as the first manifestation of small cell lung cancer reported so far internationally as to our knowledge. Second-hand smoking was possibly one of the risk factors.     

Long-term survival after successful surgical treatment of a solitary brain metastasis

Background We investigated the factors associated with survival duration in 9 patients with brain metastases who survived for more than 6 years, and focused on the factors associated with long survival. Methods Of 9 primary lesions, 5 were lung cancer, 1 was colon cancer, 1 was uterine cancer, 1 was choriocarcinoma, and 1 was renal cancer. All patients underwent total removal of a solitary brain metastasis. Of the 9 patients, 6 received chemotherapy and adjuvant radiation therapy, 1 patient received only radiation therapy, and 2 patients had no adjuvant therapy. Results The factors we isolated in the 9 long-term survivors were that they were relatively young, their systemic diseases were well controlled, there was a relatively long interval between diagnosis of the primary tumor and the brain metastasis, the metastatic lesion was located in the nondominant hemisphere, and the patients were generally in good condition or had only a mild neurologic deficit. Conclusion In some patients with controlled or absent extracranial tumor activity in whom a single brain metastatic tumor is identified after a prolonged period, surgery and local radiotherapy may provide hope for a long survival period.     

Multiagent chemotherapy and deferred radiotherapy in infants with malignant brain tumors: a report from the Children's Cancer Group.

PURPOSE: To evaluate response rate, event-free survival (EFS), and toxicity of two chemotherapeutic regimens for treatment of children younger than 36 months with malignant brain tumors and to estimate control intervals without irradiation in children with no residual tumor after initial surgery and induction chemotherapy and with delayed irradiation in patients with residual tumor or metastatic disease at diagnosis. PATIENTS AND METHODS: Patients were randomly assigned to one of two regimens of induction chemotherapy (vincristine, cisplatin, cyclophosphamide, and etoposide v vincristine, carboplatin, ifosfamide, and etoposide). Maintenance chemotherapy began after induction in children without progressive disease. Children with no residual tumors after induction therapy and no metastatic disease at diagnosis were not to receive radiation therapy unless their tumors progressed. RESULTS: Two hundred ninety-nine infants were enrolled. Forty-two percent of patients responded to induction chemotherapy. At 5 years from study entry, the EFS rate was 27% +/- 3%, and the survival rate was 43% +/- 3%. There was no significant difference between the two arms in terms of response rate or EFS. For medulloblastoma, supratentorial primitive neuroectodermal tumor, ependymoma, and rhabdoid tumors, 5-year EFS rates were 32% +/- 5%, 17% +/- 6%, and 32% +/- 6%, and 14% +/- 7%, respectively. Fifty-eight percent of patients who were alive 5 years after study entry had not received radiation therapy. CONCLUSION: Intensified induction chemotherapy resulted in a high response rate of malignant brain tumors in infants. Survival was comparable to that of previous studies, and most patients who survived did not receive radiation therapy.     

The role of radiation therapy in the treatment of small cell undifferentiated bronchogenic cancer.

The current enthusiasm for polychemotherapy in small cell undifferentiated bronchogenic carcinoma obscures the necessity for primary control by radiation therapy. One hundred and sixty-three patients with this diagnosis were treated in the periods 1965-67 (56) and 1974-76 (107). In the earlier period patients received radiation alone or radiation plus single-agent chemotherapy. In the latter period, all patients were treated with multiple-agent chemotherapy in addition to radiation therapy. Median survival time was extended approx. 4 weeks for the latter group of patients at the cost of much morbidity and occasional lethality. In the patients that were autopsied from both series, only 5/30 were free of disease within the treatment portals and all had received more than 4000 rad tumor dose regardless of adjuvant therapy. A total of 14 autopsies were performed on patients treated by chemo-immunotherapy alone during the 1974-76 period. All of these revealed disease in the primary site and mediastinum although some had no evidence of distant metastasis. Tumor volume is sufficiently large within the primary site and regional lymphatics that presently available chemoimmunotherapy without high dose irradiation is unlikely to sterilize loco-regional disease. Elective radiation to the whole brain was administered to 25 patients and only 3 developed cerebral metastases. Of the remaining 82 patients who were treated concurrently, 25 developed cerebral metastasis and then received radiation therapy to the whole brain, 10 of these patients subsequently died.     

Effective radiation therapy of two cases of primary Ewing's sarcoma of the rib

Two cases of primary Ewing's sarcoma of the rib are reported, in which radiation therapy was quite effective. Case 1 was an 18-year-old female who had had an operation and radiation therapy for Ewing's sarcoma of the left 7th rib. She was referred to our hospital after a recurrent tumor was found. Radiation therapy (tumor dose 46.2 Gy) and chemotherapy were given. The tumor disappeared and there has been no relapse for 1 year and 3 months after the treatment. Case 2 was a 2-year-old-infant. Radiation therapy (tumor dose 74 Gy) was given for primary Ewing's sarcoma of the left 6th rib. The tumor became small and was successfully removed at operation. There has been no relapse or distant metastasis for 8 months following the operation. We emphasize the importance of multidisciplinary treatment in case 1 and the usefulness of preoperative radiotherapy in case 2.     

Radiation therapy in the management of patients with mesothelioma

The results of radiation therapy in the management of 27 patients with malignant mesothelioma were reviewed. Eight patients were treated with a curative intent combining attempted surgical excision of tumor (thoracic in 6 and peritoneal in 2), aggressive radiation therapy, and combination chemotherapy using an adriamycin-containing regimen. One patient achieved a 2-year disease-free interval followed by recurrence of tumor above the thoracic irradiation field. This patient was retreated with localized irradiation and is disease-free after 5 years of initial diagnosis. One patient has persistent abdominal disease at 18 months; the other 6 patients suffered local recurrence within 8-13 months of initiation of treatment. Radiation therapy was used in 19 other patients who received 29 courses for palliation of dyspnea, superior vena cava syndrome, dysphagia, or neurological symptoms of brain metastasis. A palliation index was used to determine the effectiveness of irradiation and revealed that relief of symptoms was complete or substantial in 5 treatment courses, moderately effective in 6 courses and inadequate in 18 treatment courses. Adequate palliation strongly correlated with a dose at or above 4,000 rad in 4 weeks. The management of patients with mesothelioma requires new and innovative approaches to increase the effectiveness of radiation therapy and minimize the significant potential combined toxicity of pulmonary irradiation and adriamycin.     

小细胞肺癌脑转移治疗进展

肺癌是呼吸系统发病率、死亡率最高的恶性肿瘤,小细胞肺癌属于神经内分泌癌,侵袭性强、恶性程度高,易发生脑转移,严重影响患者生活质量及生存期。小细胞肺癌脑转移治疗方式有手术、化疗、放疗、靶向治疗和免疫治疗,治疗措施多,治疗效果差异大。随着各种诊断、治疗措施进展,小细胞肺癌脑转移治疗效果较前明显改善,对不同患者如何选择个体精准有效的临床治疗措施,延长脑转移患者生存时间,提高生活质量,是目前研究的热点之一。     

A case report of small cell carcinoma of the esophagus successfully treated by irinotecan and cisplatin

Small cell carcinoma of the esophagus is regarded as having a poor prognosis with frequent and early recurrence against various treatments. We have experienced a case of small cell carcinoma of the esophagus manifested by massive lymph node metastasis in the upper mediastinum successfully treated by CPT-11 and CDDP, and that a patient survived for 17 months after the initial treatment. A 62-year-old man underwent endoscopy due to a disturbance of the food passage. Pathological evaluation of biopsy specimen revealed small cell carcinoma of the esophagus. As he was diagnosed with bilateral lymph node metastasis in the upper mediastinum by CT scan, a systemic chemotherapy with CPT-11 and CDDP was adopted. After 2 courses of chemotherapy he could be discharged as the size of the tumor was reduced. After 3 courses of additional chemotherapy 8 months after the initial treatment, a recurrent tumor was indicated at the right side of the lymph node of the neck. A weekly radiation with concurrent administration of docetaxel was carried out as a second line treatment. He is surviving for 17 months after the initial treatment without any evidence of recurrence. Due to histo-pathological similarity, a treatment for small cell carcinoma of the esophagus resembles that of the lung. Recently, the combined treatment of CPT-11 and CDDP was reported to demonstrate a better influence on a patient's survival for small cell carcinoma of the lung. For the esophagus, CPT-11 and CDDP was also an effective treatment.     

Long-term survival after brain metastasis from endometrial cancer

A case is reported of prolonged survival after radical hysterectomy for poorly differentiated adenocarcinoma of the endometrium and resection of metastatic carcinoma of the brain followed by radiation therapy. The 43-year-old patient has survived for seven years after hysterectomy and six years 10 months after excision of the brain metastasis. Our results show that the surgical excision of a single metastatic lesion of the brain with postoperative irradiation offers hope of prolonged survival in patients with a solitary brain metastasis and no evident systemic disease.     

Surgical management of cerebral metastases from non-small cell lung cancer

AIMS AND BACKGROUND: The objective of the study was to assess the efficacy of surgical resection of solitary brain metastasis in patients with non-small-cell lung cancer. METHODS AND STUDY DESIGN: We report a retrospective analysis of 32 patients with single brain metastasis surgically excised at our hospital. All but one patient underwent postoperative whole brain radiation therapy. RESULTS: The median survival of patients was 12.5 months postoperatively (mean, 17 months), and the overall 1-year survival was 53%. Thirteen patients had recurrence of brain metastasis: 6 of 13 underwent reoperation for the recurrent lesion, and 1 of the 6 patients had a third craniotomy. Baseline characteristics, which significantly influenced survival, included age less than 60 years, tumor histology (ie, adenocarcinoma), and treatment of the primary lung cancer. The analysis did not yield any significant differences between treatment modalities. CONCLUSIONS: Our findings correspond well with those reported in the literature and suggest that surgical resection of single brain metastasis in patients with non-small cell lung cancer can improve survival over conservative management. Furthermore, surgical treatment of the primary tumor and the single brain metastasis, combined or not with radiotherapy and chemotherapy, represents an approach that merits further investigation with more patients and a prospective longitudinal design.     

An autopsy case of postirradiation cutaneous angiosarcoma of the hip

Presented is the case of a 63-year-old woman who developed a cutaneous angiosarcoma of the hip after receiving adjuvant radiation therapy for a squamous cell carcinoma of the uterine cervix after a hysterectomy. The time lapse between the radiation therapy and the occurrence of the angiosarcoma was 15 years, and its systemic metastasis was seen on autopsy. This autopsy was carried out 26 years after the patient had received the initial irradiation and no recurrence of the uterine cancer was found. Factor involved in the etiology of an angiosarcoma are discussed, and 34 previously reported cases of a postirradiation angiosarcoma are reviewed.