A case report of long-term survival after radiotherapy for a solitary brain metastasis from breast cancer

This is the report of a patient with a solitary brain metastasis from breast cancer who survived more than 8 years after the first brain metastasis. The brain metastasis was treated with partial removal followed by 30 Gy/15 fructions of whole brain irradiation plus 20 Gy/10 fructions of local boost irradiation for 5weeks. Brain metastases from breast cancer are usually a sign of rapid systemic tumor progression and long-term survivors are extremely rare. However, this case demonstrated the possibility of long-term survival in rare cases of brain metastases from breast cancer. This suggests a need for aggressive therapy in patients with a solitary brain metastasis.     

A case of liver metastasis of breast cancer responding to letrozole

The patient was a 68-year-old woman who had a right mastectomy performed in another hospital in 1987. Her right breast tumor was histologically diagnosed IDC and ER(-), with an uncertain PgR and HER2. Tamoxifen was administered as adjuvant therapy for five years after surgery. Because she had abdominal pain in January, 2007, she consulted her family doctor. At that doctor's hospital, metastatic tumors of the liver were found, and she was therefore referred to our hospital. A liver biopsy of the tumor was conducted in our hospital, and hormone therapy was also conducted because her cancer status was ER(+), PgR(+), HER2(0), and was not life-threatening. Hormone therapy had a good effect on the tumor. ER, PgR and HER2 expression might make the difference between a primary tumor and a metastatic one, as in this case. Therefore, we should perform biopsies on metastatic tumors to determine the best treatment method. There is a possibility that hormone therapy will become an effective therapeutic procedure for breast cancer patients who are hormone receptor positive, are not in a life threatening situation, and have had a long, disease-free survival. We reported one case in which the aromatase third generation inhibitor letrozole was effective for treating liver metastases of breast cancer.     

A case of rectal cancer with solitary adrenal metastasis

This is the case of a 67-year-old woman with a sudden on-set of lower abdominal pain and pre-shock. A physical examination showed signs of pan-peritonitis. Emergency was operation performed 5 hours after the onset. She had undergone Hartmann's operation for rectal cancer. Six month after the operation, abdominal CT scan revealed the mass of puriform acites, about 20 mm in diameter, in the right suprarenal region. Right adrenalectomy was performed with a diagnosis of solitary adrenal metastasis from rectal cancer. Histologically, the metastatic adenocarcinoma was moderately differentiated to the adrenal medulla. The capsule was kept intact, and no swelled lymph nodes were found around the adrenal gland. There have been no signs of recurrence for 4 years after the operation.     

A case of hepatic arterial infusion chemotherapy with docetaxel for liver metastasis from breast cancer

We experienced a case of hepatic arterial infusion chemotherapy using docetaxel for liver metastasis, which showed no response to CEF therapy, from breast cancer. A 63-year-old woman had undergone modified radical mastectomy for right breast cancer (T2aN1bM0: Stage II) in October, 1995. Six-cycle CMF therapy and toremifene citrate (40 mg/day) were administered as adjuvant therapy, but multiple recurrent tumors in liver, lung, and local site were detected in February 1997. Six-cycle CEF therapy was given for recurrent disease and there was a complete response for lung and local recurrence, but no change in liver metastasis. Chemoendocrine therapies using 5'-DFUR or CMitF in addition to TAM and fadrozole hydrochloride hydrate had developed progressive disease for liver metastasis. A catheter and port kit were operatively inserted and implanted in March 1998. Hepatic arterial infusion of docetaxel (30-40 mg/body/month, one hour administration) was repeated 4 times, once in our clinic. Leukopenia, general fatigue and fever, which were mild and did not require any treatment, appeared as side effects. This treatment reduced multiple liver metastatic sites on abdominal CT finding and was thought to be a partial response. However, the patient had multiple brain metastasis and died on August 2, 1998. While docetaxel, even by systemic administration, has a 36-77% response rate for liver metastasis, arterial infusion might have a good response and mild side effect with a lower dose than by intravenous administration.     

Radiofrequency ablation of liver metastasis from breast cancer

As the hepatic metastasis from breast cancer has a tendency to have an extrahepatic lesion, systemic therapy therefore becomes acclimatization. However, local therapy is regarded as one of the choices if there is no extrahepatic lesion. We present three cases of liver metastasis from the breast treated by radiofrequency ablation (RFA). Case 1: A 65-year-old woman was treated by left mastectomy in 1997. Radiation exposure was performed for lung metastasis, and a weekly paclitaxel therapy was administered in 2001. We performed RFA percutaneously for liver metastasis of 2.8 cm in 2002. The aggravation spread to the lung lesion and she died after RFA within one year. The liver metastasis finally enlarged to 4 cm in size. Case 2: A 36-year-old woman was treated by left mastectomy (Stage IIIa), and was followed by chemotherapy in 2000. We performed RFA for metastasis of 2 cm of liver (S7) percutaneously in 2001, and didn't recognize a recurrence to date for 3 years and 8 months. Case 3: A 43-year-old woman was treated by left mastectomy (Stage IIIa), and followed by chemotherapy in 2003. We performed RFA for a liver metastasis of 3.5 x 4 cm under laparotomy in 2004. She has been disease free for 15 months.     

A case of pancreatic metastasis from breast cancer during multimodality therapy

We report a case of pancreatic metastasis from breast cancer during multimodality therapy. A 53-year-old woman received right breast-conserving surgery for invasive ductal carcinoma and then chemo-radiotherapy for liver, brain, bone, neck and axillary lymphnodes, mediastinum, pleural, and spinal cord metastasis. Although she then survived in a tumor-free condition, a blood examination performed 4 years after the surgery showed an elevated serum amylase level. Abdominal CT and US revealed swelling of the pancreas head and body with main pancreatic duct dilatation of the pancreatic tail. ERCP showed diffuse stenosis of the extrahepatic bile duct and the main pancreatic duct of the pancreatic head and body. Immunohistochemical staining of the biopsy specimen from the pancreatic head confirmed pancreatic metastasis from breast cancer. Despite the intensive chemotherapy including trastuzumab, she died 2 years after the onset of pancreatic metastasis. Metastatic breast cancer to the pancreas is very rare. However, considering the recent advances of multimodality therapy for breast cancer, this clinical state may become more common.     

A case of breast metastasis of gastric cancer

We report a rare case of breast metastasis of gastric cancer in a 61-year-old female. She was diagnosed as primary gastric cancer with peritoneal dissemination and received systemic chemotherapy after distal gastrectomy for a primary lesion. A tumor developed in her right breast 4 years after the surgery, and was confirmed to be the metastasis from gastric cancer by aspiration cytology. In Japan, there are 25 reports of breast metastasis from gastric cancer. Two possible pathways from gastric lesion were lymphatic and one vascular, but the mechanism of breast metastasis has remained controversial.     

A long-term survival case of metachronous liver metastasis from gastric cancer

A 62-year-old man was admitted for gastric cancer. He was performed a distal gastrectomy with Billroth I reconstruction in August 1999. Then he had remnant gastric cancer and metachronous liver cancer in November 2002. He was performed a total gastrectomy and partial hepatic resection. The histological findings of remnant stomach and liver cancer showed a same pattern of the primary gastric cancer. Another metachronous liver cancer appeared in March 2006. He was treated with chemotherapy using S-1 (day 1-21) and CDDP 20 mg/m2 (day 1, 8 and 15) q5w. The size of liver metastasis was kept the same for 16 months.     

A case of brain metastasis from breast cancer responding to chemoendocrine therapy

Brain metastasis is one of the most critical metastatic lesion on the treatment of breast cancer. We reported a case with brain metastasis from breast cancer responding to chemoendocrine therapy. The patient was 71 years old female complaining gait disturbance. Solitary brain metastasis and multiple bone metastases of breast cancer were diagnosed by CT scan and bone scintigram. Standard radical mastectomy was done. Estrogen receptor was proved to be positive in both of the tumor and metastatic lymph node. Tamoxifen and UFT were administered as chemoendocrine therapy. Complete response of brain metastasis was recognized in CT scan and gait disturbance was complete recovered two months after the treatment. She is now living well.     

乳腺癌肝转移的治疗(附48例病例报告)

目的比较乳腺癌肝转移肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)和全身化疗的疗效.方法对48例经检查证实的乳腺癌肝转移患者28例行TACE治疗,20例行单纯全身化疗进行分析.结果 TACE组有效率为35.7%,显著高于全身化疗组(P<0.05),1、2、3年生存率TACE组分别为62.24%、31.12%、10.37%,单纯化疗组分别为31.58%、10.69%、0%,结果发现两者的生存期存在明显差异(P<0.05).结论 TACE治疗和全身治疗疗效有明显差异,TACE治疗在乳腺癌肝转移治疗中更值得提倡.     

A case of liver metastasis from gastric cancer treated with stereotactic radiation therapy

We report a case of liver metastasis from gastric cancer that was effectively controlled with stereotactic radiation therapy (SRT). A 77-year-old man underwent total gastrectomy, splenectomy, cholecystectomy and D2 dissection in February 2007 for type 3 gastric cancer in the upper third area that was diagnosed well to moderately differentiated adenocarcinoma and Stage II (T3 (SE) N0 H0 P0 CY0 M0). He suffered from the liver and peritoneal metastases with ascites in December 2007, so S-1 was administered. Ascites was disappeared, but liver metastasis was enlarged. Therefore, SRT (total of 52.8 Gy per 4 fractions) was performed for the liver metastasis. A clear reduction in tumor size was noted and he was presently alive with no sign of recurrence after 2 years. Immediately after SRT, grade 3 neutropenia and grade 2 AST/ALT elevation were occurred. Grade 2 pneumothorax and pleural effusion were recognized in August 2009 as tardive adverse event. It is thought that SRT is one of effective treatments for liver metastasis from gastric cancer.     

A case with liver resection of metastasis from rectal cancer after bevacizumab treatment

The advancement of systemic chemotherapy for colorectal carcinoma has improved a clinical response rate and expanded a possibility of resection, which we thought we could not have been operable at the initial visit. It also improved a prognosis of patients. We report here a case with liver resection of metastasis from rectal cancer followed by bevacizumab treatment.     

A case of multi-drug resistant breast cancer with liver metastasis treated effectively by S-1 monotherapy

We report a case of multi-drug-resistant breast cancer with liver metastases which completely responded and improved the quality of life (QOL)by S-1 monotherapy. The patient was a 53-year-old woman, who was diagnosed as breast cancer with invasive chest wall, cervical lymph node metastases, multiple bone metastases and bilateral pleural effusion[invasive ductal carcinoma, scirrhous type, ER(-), PgR(+), HER2(1+)]. After six courses of cyclophosphamide+epirubicin(CE)and weekly paclitaxel for 3 months, cervical lymph node metastasis was judged as a partial response(PR)and the bilateral pleural effusion disappeared. After chemotherapy, aromatase inhibitor (AI) was used. However, primary lesion and multiple bone metastases no change(NC). Following pass through AI+ oral anticancer drug combination chemotherapy and oral anticancer drug monotherapy, the therapy was changed to palliative, and she was referred to our hospital in January 2007. On arrival at the hospital, respiratory distress and bilateral pleural effusion had appeared, so it was an emergency admission. After removing the pleural effusion, pleurodesis was done and the symptoms disappeared. Although AI plus bisphosphonate therapy were started at hospital discharge, disease progression and fatigue appeared. In December 2007, we started S-1 monotherapy. S-1 was given orally at 80 mg/m2 for day 1-28 followed by a 2-week rest period, within a 6-week courses. Six months after treatment was started, multiple liver metastases disappeared and peritoneal effusion decreased. During the period of S-1 treatment, there were no serious adverse events, and treatment was possible without compromising QOL. This result suggested that S-1 treatment was a reasonable option for multi-drug-resistant breast cancer.     

A case of paclitaxel and trastuzumab-resistant recurrent breast cancer with liver metastasis responding to S-1

We experienced a case of paclitaxel- and trastuzumab-resistant recurrent breast cancer with liver metastases showing significant improvement by S-1. A 76-year-old woman was diagnosed with left breast cancer(T2N1M0, Stage II B). She received total mastectomy and CEF(cyclophosphamide 500 mg/m(2), epirubicin 60 mg/m(2), 5-FU 750 mg/m(2))as adjuvant chemotherapy in March 2004. But twelve months later, she was referred to our clinic for management of lung and left supraclavicular lymphnode metastases. Then weekly paclitaxel(80 mg/m(2))and trastuzumab were started. After 2 cycles of weekly paclitaxel and trastuzumab treatment, lung and lymphnode metastases were reduced and the patient showed a clinical response(CR), so she was treated by trastuzumab only. But seven months later, she was diagnosed as a recurrence of liver metastases. She was treated by combined paclitaxel and trastuzumab again, but liver metastases and tumor marker were progressive. S-1 was administered orally 100 mg/day every day for 4 weeks, followed by a 2-week rest interval as 1 cycle, and trastuzumab was injected at 2 mg/kg/week for every weeks. After 2 courses of the treatment, the level of tumor marker and tumor size of liver metastases were reduced. Only rash(grade 1)was observed during treatment. The treatment of S-1 is thought to be effective for taxane-resistant recurrent breast cancer.     

Adrenalectomy for solitary adrenal metastasis from colorectal cancer

A 77-year-old man had sigmoidectomy for sigmoid colon cancer. Two years later, a right hepatectomy for a liver metastasis was performed. Two years thereafter, abdominal computed tomography scanning and FDG-PET showed the right adrenal mass. Right adrenalectomy was performed with a diagnosis of solitary adrenal metastasis from sigmoid colon cancer. On pathology, adrenal metastasis was confirmed. The patient underwent adjuvant chemotherapy (IRIS). There have been no signs of recurrence for 6 months after the operation. We conclude that patients with solitary adrenal metastasis from colorectal cancer may benefit from surgical resection.     

A case of liver metastasis from colon cancer masquerading as focal sparing in a fatty liver

Focal sparing in diffusely fatty liver is a well recognized entity. However, it occasionally creates some problems in the diagnosis of hepatic mass lesions. We recently experienced a case of liver metastasis from colon cancer which appeared as a wedge-shaped hyperdense area on non-enhanced CT (computed tomography). Other imaging techniques also demonstrated a wedge-shaped area which was difficult to distinguish from mere focal sparing in the fatty liver. CT arteriography and dynamic magnetic resonance images were useful for diagnosing this metastatic tumor. CT during arterial portography showed a wedge-shaped ischemic area in the anterior segment caused by intrahepatic portal vein blockade. The histological findings eventually revealed that the tumor, an adenocarcinoma, was surrounded by fibrotic tissue that mimicked focal sparing. We present the radiological features of this case and discuss how to arrive at a correct diagnosis.      

Brain metastasis from breast cancer

Thirty-seven patients with breast cancer who developed brain metastasis were analyzed. At the diagnosis of brain metastasis, all patients had widespread metastasis, and 36 patients were receiving chemotherapy. Thirty patients were treated by radiotherapy to the brain at doses of 4,000 rads. There were 6 CRs (20%) and 5 PRs (17%). The median survival time for all patients was 53 months (8-177+) from diagnosis of the primary tumor, 24 months (7-126+) from the first recurrence, and 6 months (1-47+) from diagnosis of brain metastasis. Patients who achieved CR or PR survived longer than non-responders (11+ months vs. 6 months: p less than 0.01). Several backgrounds factors were analyzed, and the results indicated that patients with better performance status survived significantly longer than those with poorer performance status (11 months vs. 4 months: p less than 0.001).     

乳腺癌肝转移机制研究进展

肝脏是乳腺癌常见的转移部位。乳腺癌肝转移的过程包括多个步骤,涉及乳腺癌细胞和肝脏微环境中的多种因素。在本文中,我们综述了与乳腺癌肝转移相关的分子（包括连接蛋白类、蛋白激酶类、miRNAs）、信号转导通路（包括CXCL12－CXCR4轴、Wnt／β－catenin信号通路、AF1q／TCF7／CD44调节轴、层黏连蛋白受体／Akt／ERK信号通路、瘦素／ERK／IL－8信号通路）以及肝脏微环境中的影响因素（包括缺氧诱导因子、肿瘤相关成纤维细胞、脂肪基质干细胞、金属蛋白酶、选择性配体、炎性细胞免疫浸润）。     

Successful management of solitary malar metastasis from lung cancer

A right malar mass developed in a 68-year-old man who had undergone right upper and middle bilobectomy for lung cancer 2 years previously. The mass was diagnosed to be a malar metastasis from lung cancer and was surgically resected because no other metastases were found. The patient is well without signs of recurrence 5 years after resection of the malar mass. This is the first report of a malar metastasis from lung cancer and of successful resection for malar metastasis.