Measurements of CSF biochemical tumor markers in patients with meningeal carcinomatosis]

CSF beta--glucuronidase, polyamines and carcinoembryonic antigen (CEA) were analyzed in 16 patients with meningeal carcinomatosis from solid tumors in systemic organs, 27 with benign brain lesions, 11 with primary brain tumors, 14 with metastatic brain tumors and 5 with leptomeningeal dissemination of other malignant diseases. beta--glucuronidase levels in all cases of meningeal carcinomatosis, meningeal gliomatosis and meningeal lymphoma were higher than 100 micrograms/dl/hr. On the other hand, levels in all cases of benign brain lesions were below 100 micrograms/dl/hr. Levels of beta--glucuronidase in the cases of metastatic brain tumors returned to normal levels after tumor resection. Levels of beta--glucuronidase and polyamines were not high in the cases with positive cytology in CSF after tumor resection. The polyamine level seemed to be dependent on the growth rate of the disease and was shown to below 0.05 nmol/ml in all cases after resection of the metastatic brain tumors. Cystic fluid of both benign and malignant tumor showed high levels of beta--glucuronidase and polyamines except for spermidine and spermine levels in a suprasellar cyst. Some cases of meningeal carcinomatosis with high levels of serum CEA did not always show high levels of CSF CEA. In the surgical cases with a metastatic brain tumor, the cases with leptomeningeal, especially dural attachment showed high levels of beta--glucuronidase and CEA preoperatively, but they returned to normal after surgery. In 2 cases of meningeal carcinomatosis treated by intrathecal chemotherapy with MTX and Ara-C, CSF beta--glucuronidase and CEA showed clinical condition better than the cell count in CSF decreased rapidly following chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intrathecal chemotherapy for patients with meningeal carcinomatosis

BACKGROUND: Meningeal carcinomatosis (MC) is increasing, and these patients have a poor prognosis. We analyzed the effects of intrathecal (IT) chemotherapy for these patients. METHODS: Patients received both methotrexate (MTX) (15 mg/m(2)) and prednisolone (10 mg/m(2)) 6 times in 2 weeks by Ommaya reservoir, along with cytosine arabinoside (10 mg/m(2)) for 4 doses of MTX. A cycle consisted of a 2-week period during which patients received these drugs and then 2 weeks off. Treatments were repeated 3 to 6 cycles depending on the clinical status. Cerebrospinal fluid (CSF) samples were also analyzed for cytology and a few markers. RESULTS: Of the 58 patients treated the most common tumor was lymphoma (30 patients), followed by lung and breast. Elevated soluble IL-2 receptor levels were observed in 23 of 30 patients with lymphomatous meningitis. Median survival of MC patients with malignant lymphoma, lung cancer, and breast cancer was 32.8 +/- 9.8, 13.0 +/- 4.1, and 18.4 +/- 7.4 months, respectively. Thus, the patients with lymphoma responded best, both by clearing the CSF and clinically. CONCLUSIONS: Our treatment regimen can improve the neurologic status of patients with MC. In particular, early IT chemotherapy can be effective for patients with lymphoma.     

Rare cause of subarachnoid hemorrhage: spinal meningeal carcinomatosis. Case report

Subarachnoid hemorrhage (SAH) of spinal origin is a rare entity accounting for approximately 1% of all cases of SAH. Its most frequent causes are trauma and vascular malformations. Although primary spinal tumors, especially ependymomas, are also relatively common causes, SAH secondary to a metastatic spinal tumor arising from outside the central nervous system is an extremely rare condition; only one case has been reported in the literature. The authors present a case of spinal meningeal carcinomatosis secondary to cutaneous malignant melanoma in which the patient presented with only symptoms of SAH. Although very rare, this case underscores several factors. 1) Spinal SAH due to spinal metastases should be considered in the differential diagnosis of patients with previously known malignancy. 2) Spinal SAH may manifest without paraparesis or sensory deficit. 3) Magnetic resonance imaging of the spinal cord may be important to determine the source of SAH in patients in whom four-vessel cerebral angiography demonstrates no abnormal findings.     

Prostatic meningeal carcinomatosis with low serum level of prostate-specific antigen

Less than 1% of patients with metastatic prostate cancer present with abnormally low serum levels of prostate-specific antigen (PSA). Furthermore, cases of prostatic metastases to the meninges with a low serum level of PSA are extremely rare. The present report describes a patient with prostatic meningeal carcinomatosis and low serum PSA levels.     

Sudden bilateral profound hearing loss resulting from meningeal carcinomatosis.

SBPHL is a rare manifestation of hearing loss. Patients with SBPHL should have a thorough evaluation for meningeal carcinomatosis as the cause, including a complete neurologic evaluation, CT scan, and, probably, MRI. If MC is highly suspected, an LP is necessary. Because the diagnosis of MC can be confirmed only by the presence of malignant cells in the CSF, multiple LPs may be necessary to find them. Although MC should be strongly considered in the differential diagnosis of SBPHL, MC should also be considered with other patterns of eighth cranial nerve involvement, especially in patients with a history of malignancy. These patterns include unilateral hearing loss associated with tinnitus, unilateral hearing loss rapidly progressing to severe bilateral involvement, audiologic and caloric studies that show eighth cranial nerve impairment, and facial nerve palsy associated with hearing loss. The prognosis for MC is poor, although intraventricular chemotherapy and whole brain radiotherapy can provide significant palliation.     

Computed tomography in metastatic brain tumors and meningeal carcinomatosis (author's transl)

The computed tomogrpahy has been proved to be highly reliable in diagnosis of CNS diseases. The findings in 26 cases of metastatic brain tumors, and 2 cases of meningeal carcinomatosis performed with Hitachi CT-H scanner are analized. Metastatic tumors are seen on plain CT as mainly isodense nodules (60%). But, on enhanced CT, they increase in their density (97%). Larger nodules of metastatic tumors (over 2 cm in diameter) are tend to contain less dense central area, so called central cavitation. The direction of the expansion and/or extension of the perifocal low density is characteristic to the location of the tumor. In cases of meningeal carcinomatosis, diffuse periventricular higher density can be recognized enhanced CT.     

Adoptive immunotherapy of human meningeal gliomatosis and carcinomatosis with LAK cells and recombinant interleukin-2

Previous in vitro studies have demonstrated that peripheral blood lymphocytes activated with recombinant interleukin-2 (rIL-2) generated cells that were lytic for fresh autologous tumor cells but not for normal lymphocytes or lymphoblasts. Adoptive transfer of autologous lymphokine-activated killer (LAK) cells induced in vitro with rIL-2 was used in two patients: one with meningeal gliomatosis and the other with meningeal carcinomatosis. The adoptive transfer of LAK cells was very effective in reducing the clinical symptoms and signs, and in eliminating the malignant cells from the cerebrospinal fluid. Thus, this therapy is an attractive approach for the treatment of malignant tumors that have poor immunogenicity and are insensitive to several anti-cancer agents, and for patients with severe immunosuppressive conditions induced by repeated radiation therapy or chemotherapy.     

Surgical treatment of peritoneal carcinomatosis: current treatment modalities

Background

Selected patients with peritoneal surface malignancies (PSM) have been treated effectively by the combination of cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Purpose

The purpose of this study is to summarize the treatment outcomes and general considerations regarding definitions and staging systems of current CRS and HIPEC modalities in malignant peritoneal mesothelioma and in secondary peritoneal malignancies such as peritoneal metastasis from appendiceal, colorectal, gastric, and epithelial ovarian cancers.

Conclusion

Disease progression within the peritoneal cavity has in the past been regarded as a terminal event. Accumulating evidence underlines the therapeutic potential and the acceptable morbidity and mortality rates of CRS and HIPEC in selected patients.     

Peritoneal carcinomatosis. Surgical treatment, including hyperthermal intraperitoneal chemotherapy]

Colorectal cancer is a common malignant disease with increasing incidence and a significant cause of death in cancer patients. More than 10% of patients with colorectal cancer show peritoneal carcinomatosis at initial diagnosis. Moreover, peritoneal metastasis is a common sign of recurrence. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are a new treatment strategy for highly selected patients with peritoneal carcinomatosis. Numerous studies show prolonged survival after CRS and HIPEC with acceptable morbidity and mortality rates. Accurate preoperative diagnostics and patient selection play a pivotal role in postoperative patient outcome. This promising treatment strategy is discussed regarding surgical technique, intraperitoneal chemotherapy, and patient outcome.     

Surgical treatment of peritoneal carcinomatosis

Surgical treatment of peritoneal carcinomatosis with curative intent involves the resection of all macroscopic malignant tissue and the treatment of microscopic residual tissue with local chemotherapy. Intraperitoneal chemotherapy is efficient only when associated with hyperthermia. This article details the technical aspect of intraperitoneal chemohyperthermia. These techniques involve specific and important features. At these conditions, peritoneal carcinomatosis can be cured in two-thirds of cases.     

Surgical treatment of peritoneal carcinomatosis

Surgical treatment of peritoneal carcinomatosis with curative intent involves the resection of all macroscopic malignant tissue and the treatment of microscopic residual tissue with local chemotherapy. Surgical procedures for peritoneal carcinomatosis involve specific features and should be performed at the condition that all supramillimetric deposit could be removed with an acceptable postoperative quality of life. This article details the technical aspect of peritonectomy.     

Sudden bilateral sensorineural hearing loss as the presenting symptom of meningeal carcinomatosis of gastric cancer: Report of a case

Meningeal carcinomatosis is the diffuse infiltration of the meninges by metastatic carcinoma. A 62-year-old man presented with a sudden onset of profound hearing loss affecting both ears. Brain magnetic resonance imaging showed increased signal intensity on T1-weighted images of both vestibulocochlear nerves. Upper gastrointestinal endoscopy revealed a large type 3 gastric cancer, and the pathological diagnosis was poorly differentiated adenocarcinoma. Although combination chemotherapy with oral S-1 and weekly paclitaxel and radiation therapy were performed, the patient’s condition gradually worsened, and he eventually died 12 weeks after the onset of deafness. Isolated bilateral hearing loss is therefore considered to be a rare first manifestation of meningeal carcinomatosis.     

Peritoneal carcinomatosis of colorectal origin: incidence and current treatment strategies

OBJECTIVE: To review the literature with regard to the incidence and prognostic significance of peritoneal seeding during surgery for primary colorectal cancer (CRC), the incidence of intraperitoneal recurrence of CRC, and the current treatment strategies of established PC of colorectal origin, with special focus on cytoreductive surgery and intraperitoneal chemotherapy (IPEC). SUMMARY BACKGROUND DATA: Although hematogenous dissemination forms the greatest threat to patients with CRC, peritoneal carcinomatosis (PC), presumably arising from intraperitoneal seeding of cancer cells, is a relatively frequent event in patients with recurrent CRC. METHODS: The PubMed and Medline literature databases were searched for pertinent publications regarding the incidence and prognostic significance of exfoliated tumor cells in the peritoneal cavity during curative surgery for primary CRC, the incidence of intraperitoneal recurrence of CRC, and the therapeutic results of systemic chemotherapy or cytoreductive surgery followed by IPEC. RESULTS: The incidence of peritoneal seeding during potentially curative surgery for primary CRC, as reported in 12 patient series, varied widely, from 3% to 28%, which may be explained by differences in methods to detect tumor cells. PC is encountered in approximately 7% of patients at primary surgery, in approximately 4% to 19% of patients during follow-up after curative surgery, in up to 44% of patients with recurrent CRC who require relaparotomy, and in 40% to 80% of patients who succumb to CRC. The reported median survival after systemic 5-fluorouracil-based chemotherapy for PC varies from 5.2 to 12.6 months. Median survival after aggressive cytoreductive surgery followed by (hyperthermic) IPEC in selected patients, as reported in 16 patient series, tends to be better and varies from 12 to 32 months at the cost of morbidity and mortality rates of 14% to 55% and 0% to 19%, respectively. One randomized controlled trial has been published confirming the superiority of aggressive surgical cytoreduction and intraperitoneal chemotherapy over strictly palliative treatment. CONCLUSIONS: Peritoneal seeding of cancer cells possibly leading to PC is a rather common phenomenon in patients with CRC. Cytoreductive surgery and adjuvant (hyperthermic) IPEC have been shown to be efficacious in selected patients and should therefore be considered in patients with resectable PC of colorectal origin.     

The local hyperthermochemotherapy for pleural carcinomatosis]

Local hyperthermochemotherapy was performed in 17 cases to control malignant effusion and intrathoracic disseminated lesions. Of these 15 patients, 11 cases primary lung cancer, 4 cases metastatic lung cancer had pleural carcinomatosis and 2 cases were malignant diffuse mesotheliomas. The procedure was radiofrequency hyperthermia (13.56 MHz) maintaining the peripleural temperature at 42-43 degrees C for 45-60 minutes, combined simultaneously with the intrathoracic administration of cisplatin (1-2 mg/m2, bolus) through a thoracic double lumen trocar tube. The treatment was repeated from 2 to 4 times at 7-day intervals. In 14 cases (87.5%) complete or partial response according to the criteria of the Japan Lung Cancer Society were obtained. There were 2 cases of no change and one case that was impossible to evaluate. In one lung cancer case, the disappearance of pleural disseminated lesions was confirmed by flexible thoracoscopy after the procedure. In 12 cases, there were abdominal complaints due to side effects of the hyperthermochemotherapy, such as vomiting and nausea, but these symptoms were milder than those caused by intravenous injection of anti-cancer agents, for example cisplatin, in conventional chemotherapy treatment. The median survival time and 2 years survival of the patients with the present procedure were 15 months and 41.7% respectively. Although distant metastases appeared in most cases, none had local recurrence and particularly noteworthy pleural effusion was well controlled. The above experience suggested that the local hyperthermochemotherapy is useful to control pleural effusion and can improve the quality of life of patients with pleural carcinomatosis.     

The diagnosis and treatment of bronchial carcinoids]

The results of diagnosis and treatment of bronchial carcinoids in 37 patients are discussed. Establishment of the diagnosis is difficult because the clinico-radiological pictures of these tumours are similar to those of unspecific diseases of the lungs as well as tuberculosis. Twenty-six patients received antituberculotic treatment for a long period of time (2 to 5.5 years). Bronchoscopy with biopsy revealed the true cause of the disease in all of the 37 patients, in 9 of them coexistence of bronchial carcinoid and tuberculosis of the lung was found. Eight operations for pulmonectomy, 4 for bilobectomy, and 25 for lobectomy were performed. The volume of the surgical intervention was determined by the location of the bronchial carcinoids and extent of the secondary changes in the pulmonary tissue. Retrospective analysis showed that in timely diagnosis of bronchial carcinoids treatment of some of the patients could be limited to reconstructive-plastic operations with preservation of the whole lung or part of it.     

The diagnosis and treatment of postvagotomy disorders]

From experience with various types of vagotomy in 3,102 patients and study of the late-term results, it was established that recurrent ulcer developed in 4.7%, dysphagia in 2.9%, incompetence of the esophagogastric junction in 9.7%, reflux esophagitis in 3.8%, dyskinesia of the duodenum in 2.6%, duodenostasis in 5.3%, the dumping syndrome in 5.4%, diarrhea in 6.1%, and hiatal hernia in 0.3% of cases. The surgical correction of disorders after vagotomy is marked by specific techniques which must be borne in mind to improve treatment.