Endobronchial metastatic disease.

Between 1969 and 1979, 90 patients of the Thoracic Surgical Unit at Harefield Hospital were found to have pulmonary metastatic disease. In 25 instances (28%) the diagnosis was established by bronchial biopsy. Twenty-four patients had endobronchial metastatic carcinoma and in one metastatic sarcoma was diagnosed. All but one had a past history of malignancy, the interval between treatment of the primary and appearance of the endobronchial metastasis ranging from a few months to 17 years. Primary sites in these patients included large intestine, breast, cervix, uterus, and bladder. There were four instances of metastatic malignant melanoma. The pulmonary secondaries were resectable in 10 patients and in one a second resection was done for a further metastasis three years after the first. Three patients are still alive two, four, and 10 years later.     

Malignant metastatic perirenal schwannoma

Only seven cases of malignant renal or perirenal schwannomas have previously been reported in the literature. Herein we report the case of a 74-year-old female with a previous history of malignant subcutaneous schwannoma and breast ductal adenocarcinoma who presented with a renal mass that was preoperatively diagnosed as a metastatic schwannoma. This is the first case of malignant perirenal schwannoma of metastatic origin.     

Treatment of extraneural metastatic medulloblastoma with a combination of cyclophosphamide, adriamycin, and vincristine

Seven patients with extraneural metastases from medulloblastoma were treated with a combination of cytoxan, adriamycin, and vincristine (CAV). None of the patients had evidence of active neural axis disease. All patients with bone metastases responded with a reduction in bone pain and improvement on the radionuclide bone scan. One patient presenting with lymph node metastases showed initial reduction in the size of the palpable nodes. In this group, the median time to the development of extraneural metastasis was 18 months from the time of original diagnosis of central nervous system medulloblastoma. The median duration of response to CAV, after extraneural metastasis, was 17 months (4-65 months). Four of seven patients died of disease-related causes, one patient presumed well was lost to follow-up, and two of seven are still without evidence of active disease at 37 and 65 months. The combination of CAV is well tolerated and provides reasonably good palliation for extraneural medulloblastoma.     

Clinicopathological characteristics,prognosis, and chemosensitivity in patients with metastatic upper tract urothelial carcinoma

PurposeTo investigate the clinical characteristics, chemosensitivity, and outcome of metastatic upper tract urothelial carcinoma (UTUC).Patients and MethodsRecords of patients with metastatic UTUC since January 2005 were retrieved from a database that included clinical and survival data. Statistical analyses including survival and multivariate analyses of factors were respectively performed by the Kaplan-Meier method and Cox proportional hazard model.ResultsA total of 250 consecutive UTUC cases were evaluated. There were 56 patients (22.4%) with initially diagnosed stage IV disease. The most common metastatic sites were lung (39.6%), distant lymph nodes (39.2%), bone (19.6%), liver (18.0%), and adrenal gland (7.2%), respectively, and the local recurrence rate was 10.4%. Two hundred thirteen patients received first-line chemotherapy. The overall response rate was only 28.7% and the median progression-free survival time was only 5.0 months. The overall survival time of the cohort was 18.0 months. Multivariate analyses showed that initially diagnosed stage IV disease, number of metastatic organs ≥3, no response to chemotherapy and cycles of chemotherapy ≤2 were adverse prognosticators for overall survival.ConclusionUTUC presented to be more prone to metastasize than locally recur and thought to have low chemosensitivity. Stage IV disease at initial diagnosis, number of metastatic organs, response and cycles of chemotherapy were independent prognosticators for metastatic UTUC.     

Calcified metastatic brain tumor

The case of a 57-year-old woman with a calcified metastatic brain tumor, histologically confirmed to be a squamous cell carcinoma, is reported. This patient is unusual because this metastatic squamous cell carcinoma contained an extraordinary huge conglomerated calcification, that was well-defined radiographically. This case is documented with a discussion of the pathogenesis of the calcification.     

Intracranial metastatic tumors in Ibadan,Nigeria

Fifty-two cases of intracranial metastatic tumors encountered in Nigerian Africans at the University College Hospital, Ibadan, Nigeria, between 1973 and 1979 are reported. Females predominated over males in a ratio of 2: 1. Choriocarcinoma of the uterus accounted for a third of the metastatic lesions.     

Melanoma metastatic to stomach, small bowel, or colon.

Approximately 60% of patients who die from melanoma have gastrointestinal (GI) metastases at autopsy, yet antemortem diagnosis is uncommon. A retrospective review was completed on 32 patients who underwent an operation at Memorial Sloan-Kettering Cancer Center between 1977 and 1987 for complications of melanoma metastatic to the stomach, small bowel, or colon. Operations were most often performed on an emergent basis, and indications included bleeding or anemia in 12, obstruction in 10, abdominal pain in 8, intestinal perforation in 1, and acute GI bleeding with obstruction in 1. GI involvement was the first sign of metastatic disease in 10 patients. Median survival after operation was 6.2 months (range: 1 to 42 months). Five patients were alive 2 years after operation, although only one remains free of disease 39 months after complete resection of a single site. Operative mortality was 3%, and 94% of patients were discharged from the hospital. Due to the low operative mortality, surgical palliation should be considered for those in whom the quality of life may be improved.     

Incidence, location, and diagnostic evaluation of metastatic bone disease

Metastatic carcinoma is the most common malignancy of bone. The clinical presentation of patients with skeletal metastasis is variable. When asked to evaluate a patient with a pathologic lesion or unexplained bone pain, the orthopedic surgeon should follow a logical sequence of steps in evaluating the patient with suspected metastasis to optimize care and avoid complications. In the majority of cases, a systematic approach to the patient with skeletal metastasis leads to the correct diagnosis.     

Hepatectomy for metastatic noncolorectal gastrointestinal, breast and testicular tumours

BACKGROUND: The indications for hepatectomy for colorectal or neuroendocrine metastases are becoming clear with increasing experience reported. For other primary diseases, however, the overall number of cases is relatively small, and it is more difficult to derive clear guidelines. This paper reviews the reported experience of hepatectomy for metastases from non-colorectal gastrointestinal primary cancers, breast cancer and testicular teratoma. The aim is to determine for each whether and under what circumstances hepatectomy is indicated. METHODS: A Medline search was used to identify papers reporting hepatectomy for metastases from non-colorectal gastrointestinal carcinomas, breast carcinomas and testicular teratomas. The data collected included the primary disease, the number of cases reported, the survival post-hepatectomy and any prognostic factors associated with outcome. RESULTS: Of the gastrointestinal malignancies, hepatectomy for gastric metastases yields a 5-year survival, roughly half that reported for colorectal disease, and further elucidation of prognostic factors would be desirable. Results were poor for other gastrointestinal malignancies. Good results were reported for breast and testicular teratoma. CONCLUSION: Of the non-colorectal gastrointestinal primaries, at present only hepatectomy for gastric metastases can be cautiously recommended. For nongastrointestinal primaries, hepatic metastases probably represent widespread dissemination even if occult, and therefore, hepatectomy may only be of use when effective adjuvant treatments are available.     

Surgical procedures for primary, metastatic or adjacent parotid tumours

OBJECTIVE: The retrospective analysis of the surgical procedures in primary parotid and metastatic or adjacent parotid tumors. PATIENTS AND METHODS: Retrospective review of the records of 145 patients operated on for primary, metastatic or adjacent parotid tumors revealed 85 patients with benign tumors, 24 with primary malignant tumors, 19 with squamous skin carcinomas, 12 with skin melanomas, 3 with basocellular carcinomas and 2 with sarcomas of the parotid region. The analysis included the type of parotidectomy, the need for facial nerve sacrifice (FNS), type of neck dissection and soft part reconstruction. RESULTS: Superficial parotidectomy was performed in 81% of the benign parotid tumors and 100% of skin melanomas. Total parotidectomy was frequent in malignant parotid tumors (62%), epidermoid skin tumors (64%) and in basocellular/sarcomas of the parotid region (80%). Skin graft or flaps was infrequent in primary malignant tumors (12.5%), and frequent in epidermoid skin tumors (74%), melanomas (58%) and basocellular/sarcomas (100%). FNS was necessary in primary malignant (25%), adjacent epidermoid (37%), melanomas (17%) and basocellular/sarcomas (80%). Details on neck dissections are provided. CONCLUSIONS: Superficial parotidectomy was an adequate procedure for most benign parotid tumors and for melanoma patients. In primary malignant and adjacent or metastatic skin tumors, total parotidectomy, neck dissection and soft part reconstruction were frequent procedures. FNS and soft part reconstruction should be anticipated more frequently in squamous/basocellular skin tumors or sarcomas adjacent to the parotid gland.     

Evaluation, prognosis, and medical treatment considerations of metastatic bone tumors.

Metastatic cancer can cause severe pain and disability. Metastases can occur in any bone, but usually are located in the axial or proximal appendicular skeleton. The most frequently encountered primary tumors that spread to bone are those of the prostate, breast, kidney, lung, and thyroid. When the origin of the primary cancer is known, skeletal metastases are more often from breast or prostate. When the primary site is unknown, the lung and kidney should be suspected as sites of origin. The nonoperative management of skeletal metastases from multiple myeloma and from carcinomas of the prostate, breast, kidney, lung, and thyroid are discussed.     

Costs of prostate cancer,metastatic to the bone,in the Netherlands

OBJECTIVE: To quantify medical costs associated with bone metastases in patients with prostate cancer. Bone metastases in patients with prostate cancer are associated with considerable morbidity, negatively impact quality of life, and can add substantially to medical costs, given a median survival of 30-35 months from diagnosis of bone metastases. METHODS: A retrospective cost analysis from both a community and university hospital in The Netherlands was conducted. Twenty-eight patient records (14 from each hospital) were investigated to assess the impact of skeletal-related events (SREs), including fractures, spinal cord compression, and radiotherapy, on total direct medical costs and cost of hospitalization. Costs are given in EUROS (Euros). RESULTS: The average total cost of treatment was Euros 13,051 per patient over the 24-month follow-up period, which includes an average cost of Euros 6973 per patient to treat SREs. Treatment of SREs more than doubled total treatment costs. Patients in this analysis experienced, on average, one SRE per year, and the cost of SREs varied from Euros 1187 to Euros 40,948. CONCLUSIONS: Occurrence of SREs contributes significantly to the cost of care for patients with advanced prostate cancer. These data suggest that bisphosphonates, which can reduce pain and SREs, may reduce healthcare costs.     

Vincristine,bleomycin, methotrexate, 5-fluorouracil,and prednisone in metastatic,hormonally unresponsive prostatic adenocarcinoma

Patients with hormonally unresponsive prostatic adenocarcinoma were subjected to a five-drug chemotherapy program using bleomycin, 5-fluorouracil, methotrexate, vincristine, and prednisone. Analysis of survival curves indicated that deletion of an alkylating agent from this five-drug program reduced survival when patients with equal risk factors were compared. Bleomycin was poorly tolerated by this aged population.     

Percutaneous biopsy in large,locally advanced or metastatic renal tumors

Introduction

The role of percutaneous biopsy to characterize large, locally advanced and metastatic primary renal tumors has not been well described. The goal of this article is to describe the potential advantages of biopsy for preoperative evaluation of patients with large renal tumors and advanced disease.

Radiologic, endoscopic, and surgical considerations of melanoma metastatic to the gastrointestinal tract

Malignant melanoma is the most common malignancy to metastasize to the gastrointestinal tract. In a retrospective computer-assisted data search of over 2500 patients with melanoma registered over the past 10 years, 110 patients have been identified to have premortem gastrointestinal metastatic disease (metastatic disease identified at least 6 months before death). The small intestine (35%), colon (14.5%), and stomach (7%) are the most common sites for metastases. Polypoid or ulcerating masses and intramucosal nodules are typical radiologic presentations for gastric and colonic lesions, while over 50% of the small bowel metastases are polypoid masses that many times act as leading points for intussusception. Endoscopic studies are helpful in the preoperative diagnosis of these lesions. In a subset of 38 patients with symptomatic small bowel metastatic disease, complete resections were performed in 26% of patients, with palliative bypasses being performed in 40%, despite the fact that over 50% of the patients had documented visceral metastasis in other body sites. The operative morbidity rate was 15% with no operative deaths. Ninety percent of patients gained relief of symptoms, and overall survival from the time of confirmed small bowel disease averaged 17.3 months, with a range of 6 months to 9 years. It would seem that patients with melanoma with gastrointestinal metastatic disease can benefit from aggressive radiologic and endoscopic procedures for diagnosis and staging. Only through surgical interventions for symptomatic gastrointestinal disease can the quality of life be improved and life expectancy be extended.     

The changing pattern of management for hormone-refractory, metastatic prostate cancer

Prostate cancer responds initially to hormonal manipulation by androgen withdrawal and peripheral androgen blockade. The inevitable progression to a hormone-refractory state is accompanied by an exacerbation of local symptoms and metastatic spread, principally to the bones, which has a considerable impact on quality of life and survival. Treatment of hormone-refractory prostate cancer is palliative, and surgery and radiotherapy are used for the relief of lower urinary tract symptoms and localized painful bony metastases. Systemic treatments are not widely accepted in this setting, but clinical trials have demonstrated the potential for bone targeting agents such as strontium-89 and the bisphosphonates to palliate painful bone metastases and to delay progression in certain settings. Chemotherapy with mitozantrone in combination with steroids has previously been shown to have palliative benefits and to delay progression. The additional costs incurred by the use of chemotherapy or bone-targeting therapies may be offset by gains in overall care with fewer in-patient admissions compared with steroid monotherapy. Recent clinical trials have demonstrated that docetaxel significantly improves patient quality of life, and importantly, increases survival. Future studies investigating the timing of chemotherapy, combinations with existing treatments or other novel therapies are underway.     

Early experience with sunitinib, combined with docetaxel, in patients with metastatic breast cancer

Sunitinib malate (SUTENT^®) is an oral, multitargeted tyrosine kinase inhibitor that blocks several pathways central to angiogenesis and tumor cell proliferation and migration, including vascular endothelial growth factor receptors (VEGFRs) and platelet-derived growth factor receptors (PDGFRs). Sunitinib has demonstrated clinical activity as a single agent in patients with metastatic breast cancer and it is hypothesized that enhanced clinical benefit may be derived by combining sunitinib with chemotherapy or other targeted agents. The current report describes four patients with advanced/metastatic breast cancer who experienced clinically meaningful responses following treatment with sunitinib in combination with docetaxel.