Leptomeningeal Carcinomatosis after Major Remission to Taxane-based Front-line Therapy in Patients with Advanced Breast Cancer

Aim: To determine the incidence of leptomeningeal carcinomatosis (LMC), as the first manifestation of systemic progression, in breast cancer patients after obtaining a major response (complete response, CR or >80% partial response, PR) to first-line taxane-based chemotherapy treated between 1996 and 2000 in our Medical Oncology Unit. Patients and methods: Patients with histologically proven breast cancer having either metastatic disease, or high-risk locoregional disease that were entered into treatment protocols with first-line taxane (paclitaxel or docetaxel) plus anthracyclines or mitoxantrone combinations and developed LMC as the first evidence of progression after major response (CR or >80% PR) were analyzed in the present study (n=155). Results: Seven patients with a median age of 54 (range: 40–70) years developed LMC as their first evidence of progression after taxane-based regimens with a median interval of 6 months (range: 2–18) from start of treatment to diagnosis of LMC. Five patients received intrathecal (i.t.) methotrexate treatment and whole brain radiotherapy (RT), while one patient received i.t. methotrexate and RT to lumbar spine. Two patients responded to treatment for LMC, while two achieved stable disease and three progressed. Two patients had elevated cerebrospinal fluid tumor markers (more than serum marker levels) that proved useful in monitoring response to treatment. Median survival after LMC was 3.6 months (range: 1–31+) and correlated positively to the interval from the initiation of taxane-based therapy to LMC (r=0.84, P=0.019). Seven out of 86 responders (8.1%; 95% confidence interval, 2.4–13.9) developed LMC as the first sign of progression after a major response to first-line chemotherapy. Conclusions: LMC after a major response to front-line taxane-based regimens represents a grave disease manifestation and its incidence appears increased when compared in retrospect to non-taxane-treated patients. Prospective evaluation of the incidence of LMC after taxane versus non-taxane-based treatment from large randomized multi-institutional trials is warranted and identification of potential prognostic factors might help identify patients requiring appropriate prophylactic therapy.     

Total Vertebral Body Breast Cancer Metastases: One Case Report and Literature Review

Breast cancer is one of the most commonly seen malignant tumors in the female population, and it ranks the first in the incidence of malignancies among women. The skeleton is a common metastatic site for advanced breast cancer and is where spinal metastasis is most frequently seen. The incidence rate of spinal metastasis in descending order is as follows: thoracic vertebrae, lumbar vertebrae, sacrococcy-geal vertebrae and cervical vertebrae. Although osseous metastasis of breast cancer is very common, cases with metastasis to all vertebral bodies is currently very rare. The diagnostic method of osseous metastasis of breast cancer typically includes radiograph, CT and MRI. Ordinary radiograph has a high specificity but a low sensitivity, so total vertebral body metastases can only be detected when the extent of osteoclasia exceeds 50%. Some diagnostic shortcomings remain, although the sensitivity of CT and MRI has been greatly improved compared to the radiograph. At present, the most advanced synchronous PET-CT visualization can presumably raise the sensitivity and specificity in the diagnosis of breast cancer, based on the features of 18F-FDG imaging, and combined with morphologic change and precise localization. The following case report is in regard to a patient with total vertebral body metastasis from breast cancer detected by PET-CT.     

Carcinomatous Meningitis as the Presenting Manifestation of Gallbladder Carcinoma: Case Report and Review of the Literature

The primary tumors that typically cause carcinomatous meningitis include lung cancer, breast cancer, leukemia, lymphoma and melanoma. A variety of neurological signs and symptoms can be seen depending on the extent and location of the meningeal metastasis. Once the diagnosis of carcinomatous meningitis is confirmed, the search for the primary tumor can be a challenge and at times may require extensive radiographic or even surgical evaluation to obtain specimen for pathological confirmation. Here we report a patient who presented with bilateral cranial nerve VIII and cerebellar symptoms, and was diagnosed with carcinomatous meningitis. Only after an exploratory laporatomy did it become clear that the initial symptoms were related to a metastatic gallbladder carcinoma.     

Isolated Contralateral Axillary Lymph Node Involvement in Breast Cancer Represents a Locally Advanced Disease Not Distant Metastases

Background

Breast cancer metastases to an ipsilateral supraclavicular lymph node is assigned a N3 status in the TNM system and thus classified as stage III disease in the American Joint Commission on Cancer staging manual. Breast cancer metastatic to contralateral axillary lymph node (CAM) without metastases to any other distant organ is currently assigned M1 status (stage IV) instead of N3 (stage III).

Complex Differential Diagnosis between Primary Breast Cancer and Breast Metastasis from EGFR-Mutated Lung Adenocarcinoma: Case Report and Literature Review

We present a case of a woman with epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma who received gefitinib for 2 years and obtained a partial response. The patient then developed liver metastasis and a breast lesion, displaying high estrogen receptor (ER) expression and harboring the same EGFR mutation. From the radiological studies, it was not possible to make a differential diagnosis between primary breast cancer and breast metastasis from lung cancer. After the removal of the breast nodule, thanks to the clinical history, radiology, and above all, molecular and immunohistochemical investigations, a diagnosis of breast metastasis from lung adenocarcinoma was made. This case emphasizes the importance of a comprehensive clinical, pathological, and molecular analysis in the differential diagnosis between primary breast cancer and metastases from extramammary tumor to guide adequate treatment decision making.     

肝门部胆管癌伴乳腺和骨骼肌同时转移1例报告及文献综述

肝门部胆管癌曾被普遍认为生长缓慢。骨骼肌是恶性肿瘤转移最不常见的部位之一。我们报道1例肝门部胆管癌伴乳腺和骨骼肌同时转移,并做相关文献综述。一48岁女性病人,因黄疸并体重减轻入院,诊断为肝门部胆管癌Bismuth-Corlette Ⅳ,行 ERCP塑料内支架置入术加体外三维适型放疗,效果良好,2个月后肝门部肿瘤明显缩小,黄疸消退,正常生活。因经济原因拒绝手术。10个月后,发现左大腿痛性肿块和左乳无痛性包块,全身检查未发现其他部位转移灶,原发灶肿瘤无明显变化,诊断为肝门部胆管癌伴左乳腺及左股网头肌的股直肌转移,并经术后病理证实。但术后4个月起,患者再次出现黄疸,频发胆管炎,不能耐受放疗,最终死于肝功能衰竭。肝门部胆管癌并远处转移文献报道很少,病人多是局部病变广泛并全身多发转移,转移部位多是颈淋巴结、骨骼及门脉系统,但原发灶肿瘤稳定时伴乳腺和骨骼肌同时转移尚未见报道。     

Isolated Peritoneal Metastasis of Prostate Cancer Presenting with Massive Ascites: A Case Report

The peritoneal carcinomatosis of prostate cancer without bone or other visceral organ involvement is extremely rare. We report a case of an isolated peritoneal metastasis of prostate cancer in a patient without other metastatic sites and a history of prostate surgery. A 63-year-old male with locally advanced prostate cancer without known distant metastasis on androgen deprivation therapy presented with abdominal distension that had persisted for a month. Abdominopelvic computed tomography (CT) showed gastric wall thickening and a moderate amount of ascites. The gastroscopy showed hyperemic mucosal patches on the antrum body. A cytological examination of the ascites fluid was negative for malignant cells. Diagnostic laparoscopy showed multiple nodules in the peritoneum. A biopsy was performed. Histological findings were compatible with metastatic carcinoma of the prostate, which was immunohistochemically positive for pan-cytokeratin, the androgen receptor, and prostate-specific antigen (PSA). The patient was then treated with abiraterone acetate. After 1 month of treatment, both ascites and the PSA value decreased. We describe an extremely rare case of isolated peritoneal carcinomatosis from prostate cancer without any organ metastasis or history of surgery. Clinicians should be aware of these very rare metastases of prostate cancer. Hormonal therapy may be helpful for such cases.     

内分泌治疗晚期乳腺癌76例分析

本文报告了应用内分泌疗法治疗无手术指征晚期乳腺癌４０例，术后复发或转移３６例。治疗总有效率４３．４％，中位有效期１２．５月，效果满意。本组报告提示晚期乳腺癌的内分泌治疗效果与患者受体水平、月经状况、转移或复发部位、是否合理应用化疗等有关。     

A Modified Weekly Docetaxel Schedule as First-Line Chemotherapy in Elderly Metastatic Breast Cancer: A Safety Study

Abstract

Standard dose docetaxel is burdened by severe toxicity. Weekly schedules have been shown to be active as standard scheme with reduced side effects. In 20-30% of elderly patients (pts) the classic 6-week schedule induces grade 3/4 fatigue and other cumulative toxicities. We carried out this safety study in order to evaluate whether a modified weekly docetaxel schedule would improve the toxicity profile. Twenty-one untreated elderly (≥70 years) pts suffering from metastatic breast cancer were enrolled in the study. Pts were treated with a weekly dose of 35 mg/m² docetaxel for 6 weeks, followed by a 2-week rest. Further cycles were performed with this modified schedule: docetaxel days 1, 8 and 15 every 29 days. All pts received at least the first cycle (6 weeks). A total of 261 doses were delivered. No toxic deaths occurred. The toxicity was mild: we recorded 1 episode of grade 3neutropenia and severe asthenia in only 2 pts (10%). We recorded an overall response rate of 33% (1 CR, 6 PR). Our data showed a reduced incidence of severe asthenia (2/21), obtained with a light modification of a weekly docetaxel schedule.     

顺铂、米托蒽醌及环磷酰胺联合治疗乳腺癌胸膜转移的临床疗效

自1990年10月至1995年3月，作者采用顺铂胸膜腔内化疗，米托蒽醌及环磷酰胺静脉化疗共治疗乳腺癌胸膜转移17例，总有效率为94．1％（16／17），中位生存期17．3个月。胃肠道反应的发生率为76．5％，白细胞减少（Ⅱ、Ⅲ级）占88．2％、所有毒性均可耐受。     

A Review of the Efficacy of Anastrozole in Postmenopausal Women with Advanced Breast Cancer with Visceral Metastases

Tumors that have spread to the liver or lungs (visceral metastases) are associated with a worse prognosis than tumors in soft tissue and bone only. Here we review available efficacy data to address whether or not anastrozole, a non-steroidal aromatase inhibitor (AI), is effective in postmenopausal patients with advanced breast cancer (ABC) and visceral metastases. We include data from Phase III clinical trials, comparing clinical benefit (CB) with anastrozole versus tamoxifen as a first-line treatment, and versus megestrol acetate (MA) or fulvestrant as a second-line therapy. Patients in these trials had adequate organ function and the volume of disease had to be minimal or moderate for them to be eligible for inclusion. First-line treatment of patients with or without visceral metastases in the overall population resulted in CB rates of 49.5 and 62.3%, respectively, for anastrozole and 46.9 and 55.9%, respectively, for tamoxifen. In patients with confirmed hormone receptor (HR)-positive tumors, the CB rate was 51.9 and 65.7%, respectively, for anastrozole and 41.6 and 58.7%, respectively, for tamoxifen. In patients with or without visceral metastases, second-line treatment with anastrozole resulted in a CB rate of 31.4 and 51.8%, respectively, compared with 31.9 and 47.1%, respectively, for those treated with MA. Patients in the overall population with and without visceral metastases treated with anastrozole obtained a CB rate of 37.4 and 43.8%, respectively, while those treated with fulvestrant obtained a CB rate of 38.2 and 47.6%, respectively. In patients with confirmed HR-positive tumors, CB was seen in 37.6 and 41.5%, respectively, of patients treated with anastrozole and in 37.3 and 47.0%, respectively, of patients treated with fulvestrant. The results reveal anastrozole to be an effective and valuable first- and second-line therapy in postmenopausal women with ABC and visceral metastases, showing similar CB to other endocrine therapies.     

Safety and Activity of the Combination of Pegylated Liposomal Doxorubicin and Weekly Docetaxel in Advanced Breast Cancer

BACKGROUND: The present study was designed with the aim of evaluating the tolerability and activity of pegylated liposomial doxorubicin (PLD) in combination with weekly docetaxel as first line treatment of advanced breast cancer. PATIENTS AND METHODS: Fifty-seven patients entered the study. PLD was administered at escalating doses starting from 30 mg/m2, on day 1; docetaxel was administered at the fixed dose of 35 mg/m2 on days 2 and 9. A cycle of therapy consisted of 21 days. RESULTS: The MTD was achieved at the dose of 40 mg/m2 of PLD, being febrile neutropenia and palmar-plantar-erythrodisesthesia (PPE) the dose-limiting toxicities (DLTs), so that the fixed dose of PLD for the Phase II study was 35 mg/m2. Forty-two consecutive patients received treatment at the established dose for a total of 194 cycles: among these, three patients were withdrawn for severe allergic reaction at the first administration of PLD. Hematological toxicity was moderate, the most common grade 1-3 non-hematological toxicities were stomatitis and PPE, occurring in 20 (47.5%) and 16 (38%) patients, respectively. No cardiac toxicity was recorded. According to the intent to treat analysis a major objective response was observed in 59.5% of patients (95% CI, 43.3-74.4%), with a median time to progression of 9 months and an estimated overall survival at 18 months of 62%. CONCLUSION: The combination of PLD and weekly docetaxel is an effective first-line therapy for patients with advanced breast cancer. PPE and mucositis are the most relevant side effects of such a combination.     

Stomach One-Point Cancer: One Case Report and Literature Review

Introduction Gastric cancer is one of the common cancers and one of the most frequent causes of cancer deaths worldwide.Early detection and accurate preoperative staging of gastric cancer is essential for planning optimal therapy such as endoscopic mucosal resection or gastric resection and offers the best prognosis.