Cerebral metastases from ovarian carcinoma

Apart from choriocarcinoma, involvement of the central nervous system (CNS) by gynecologic malignancy is rare. A 10-year retrospective review at the University of Washington Medical Center (Seattle, WA) and Swedish Hospital and Medical Center Tumor Registry (Seattle, WA) identified 14 patients with cerebral metastases from ovarian carcinoma. Median age at diagnosis of cerebral metastases was 52.5 years. Median interval from the diagnosis of ovarian carcinoma to the diagnosis of CNS metastases was 14.5 months. Seven patients had received cisplatin therapy before CNS relapse. Seven patients underwent second-look procedures before developing CNS metastases; in three, results were negative. Eight patients had evidence of extraperitoneal spread to other sites at the time of CNS relapse. Clinical manifestations included motor weakness, seizures, headache, confusion, and speech disturbance. All lesions were contrast enhancing on computed tomography (CT) scans and were located in the cerebral hemispheres. Nine patients had single lesions, five of whom underwent surgical resection of the lesion with histologic confirmation of metastases from the primary site. Median survival was 2 months in patients receiving radiation therapy alone and 17 months in patients who received surgery and radiation. Median survival of the entire series was 3 months. The presence of multiple cerebral metastases or evidence of extraperitoneal spread elsewhere in the body was adversely associated with survival. The prognosis of patients with cerebral metastases from ovarian carcinoma appears poor. However, early diagnosis by routine CT scanning followed by surgical resection and radiation may improve overall survival in a select group of patients.     

Prostate cancer presenting as a solitary cerebellar metastasis. A case report and review of the literature

We describe a case of a 70-year-old patient with sudden onset of gait ataxia, headache, dizziness and dysarthria. Magnetic resonance imaging revealed a solitary lesion in the left cerebellar hemisphere with strong and irregular enhancement of the contrast medium, surrounded by extensive edema. Rectal examination revealed an abnormally enlarged and stiff left prostate lobe, and ultrasound-guided transrectal biopsies showed prostate adenocarcinoma of mild differentiation. Neurosurgical intervention and histopathologic examination revealed metastatic prostate adenocarcinoma. The patient underwent orchiectomy and was given antiandrogens. He is still alive and closely followed. According to the literature, prostate cancer presenting as a solitary cerebellar metastasis is an extremely rare clinical problem.     

Irinotecan+cisplatin and irradiation are effective for brain metastases of gastric cancer--two case reports

We treated two patients in whom irinotecan (CPT-11)+cisplatin (CDDP) and irradiation showed efficacy against brain metastases of gastric cancer. CPT-11 and CDDP were administered on days 1 and 15 of a 28-day cycle at 60 mg/m(2) and 30 mg/m(2), respectively. The first patient was a 63-year-old man,who complained of headache and weakness. In March 2003, he was diagnosed as having Stage IV gastric cancer with peritoneal dissemination (T3, Nx, P1) and underwent total gastrectomy with D1 dissection. Chemotherapy with S-1 was continued after surgery. Two years and two months later, a metastatic tumor was found in the upper lobe of the right lung. The protocol was changed to S-1+CDDP, but progression of his disease occurred. The weekly paclitaxel (PTX) therapy was tried instead. Seven months later, he developed headache and weakness, and multiple brain metastases were diagnosed by CT scanning. We performed total brain irradiation (30 Gy) and started CPT-11+CDDP therapy, which was continued on a fortnightly basis at 60 mg/m(2) and 30 mg/m(2), respectively. The brain metastases regressed (PR), and this therapy led to a marked improvement in his quality of life. The second patient was a 78-year-old man, who complained of weakness of the lower extremities and dizziness. In November 2003, he was diagnosed as having stage IB gastric cancer (T2 (ss), N0, P0), and underwent total gastrectomy and splenectomy with D2 dissection. One year and four months later, local recurrence at the anastomosis was detected, as well as a metastatic tumor in the right lung. S-1, S-1+CDDP, and weekly PTX therapy were all tried. One year later, the patient was admitted with weakness and dizziness,and brain metastases were detected by CT scanning. We then performed Cyber Knife treatment and administered CPT-11+CDDP. As a result, his brain metastases partially regressed (PR).     

Surgical resection of a cerebral metastasis from cervical cancer: case report and review of the literature

AIMS AND BACKGROUND: Central nervous system metastasis from cervical carcinoma is uncommon. CASE REPORT: We report the case of a 51-year-old woman who developed a solitary cerebral metastasis 29 months after radical hysterectomy with pelvic lymphadenectomy for a stage IB, grade III cervical cancer. The patient suddenly complained of headache, confusion and dizziness; she was submitted to emergency surgical resection of a 2 x 3 cm metastasis in the right frontal lobe. The postoperative course was uneventful and she completely recovered from her neurological deficit. Following surgery the patient underwent careful restaging. Massive bilateral involvement of the pelvic wall was diagnosed, and the patient received three courses of cisplatin-based chemotherapy. She developed liver and lung metastases and died 10 months later of progressive disseminated disease, without, however, any sign of recurrent or persistent cerebral involvement. CONCLUSION: Neurosurgical resection should be considered in cervical cancer patients with solitary brain metastasis in the absence of systemic disease.     

髓母细胞瘤的CT和MRI影像学分析及临床意义

目的：通过对髓母细胞瘤的CT及MRI表现分析,加强对本病的认识,提高术前诊断的准确性并合理选择治疗方案。方法：对31例经手术、病理证实的髓母细胞瘤进行回顾性分析,所有病例均行CT和／或MRI检查。结果：髓母细胞瘤好发于儿童,常见于小脑蚓部;成人髓母细胞瘤少见,多见于小脑半球。CT平扫呈等或稍高密度影,增强扫描多强化明显。MRI扫描T1加权像呈低或等信号,T2加权像呈略高或混杂信号,增强扫描强化明显。结论：髓母细胞瘤有特定的发生部位、年龄及影像学特征性;仔细分析CT和MRI表现,可做出准确的术前诊断并指导制定治疗方案,改善预后。     

Two cases of leptomeningeal metastases from lung adenocarcinoma which progressed during gefitinib therapy but responded to erlotinib

We present two patients with leptomeningeal metastases (LM) from lung adenocarcinoma that progressed or newly developed, respectively, during gefitinib therapy which had exhibited substantial antitumor effects on widespread lesions. In both cases, a switch to erlotinib therapy brought about long-lasting dramatic symptomatic improvement and markedly prolonged survival. The first patient is a 46-year-old female who presented with progressive headache and vomiting. Multiple pulmonary, hepatic and bone metastases immediately shrank in response to gefitinib. However, 1?month after completion of concurrent whole brain radiation, dizziness and urinary retention newly emerged, worsening the symptoms observed at presentation. Magnetic resonance imaging (MRI) demonstrated enlargement of ventricles and new gadolinium (Gd)-enhanced disseminated nodules on the surface of the cerebral cortex, suggesting the existence of uncontrollable LM. Sequential erlotinib therapy resulted in symptomatic improvement with a finding of regression of Gd-enhancement on MRI. The beneficial effect lasted for 10?months, though a follow-up brain MRI showed further enlarged ventricles. She finally died due to LM after surviving for 11?months under erlotinib treatment. The other patient is a 55-year-old female in whom headache and vomiting occurred while gefitinib therapy had maintained shrinkage of all pre-existing tumors in the thorax and bones. Brain MRI strongly suggested occurrence of LM with a finding of Gd-enhanced sulci. A switch to erlotinib therapy relieved the symptoms with disappearance of Gd-enhancement. However, the symptoms recurred with a finding of further enlargement of ventricles on brain MRI after 11?months. Finally, she died due to LM after surviving for 12?months under erlotinib treatment.     

Palliative radiation therapy for brain metastases from endometrial carcinoma: report of two cases

Although endometrial carcinoma is a common invasive neoplasm of the female genital tract, brain metastases are extremely rare and few reports exist of their treatment with radiation therapy. We report two patients with manifest clinical signs of brain metastases from endometrial carcinoma on computed tomography (CT) or magnetic resonance imaging (MRI). These two patients had multiple brain metastases, with widespread dissemination late in the course of the disease and received palliative whole-brain radiation therapy to a total dose of 50 Gy in 25 fractions (case 1) and 30 Gy in 10 fractions (case 2). After radiation therapy, improvement of neurological function (NF) was observed in both patients. The duration of improvement of NF was 9 weeks in case 1 and 12 weeks in case 2. The patients died 5 months and 3 months after the diagnosis of brain metastases, respectively. In these two cases, palliative radiation therapy was effective in improving the quality of the remaining lifetime and appears to be the best treatment for brain metastases from endometrial carcinoma as well as those frequently seen from other primaries.     

Paraneoplastic cerebellar degeneration

Summary Six patients developed a pancerebellar syndrome with symptoms preceding the diagnosis of neoplasia in five (median - 4 months) and following in one (2 years). In all patients, the initial cranial computed tomographic (CT) scans were normal. Five patients had repeat CTs and of these three were abnormal; cerebellar atrophy appearing 7 to 25 months following the initial CT. Median follow-up was 31 months (range 12–84 months) without evidence of CNS metastatic disease. In five of six patients the neurologic impairment did not progress. One patient's neurologic signs improved markedly with mantle radiation therapy of her Hodgkin's disease. An initially negative CT does not preclude the diagnosis of remote effect cerebellar atrophy. Paraneoplastic cerebellar degeneration is a self-limited nonprogressive process in the majority of patients.Presented in part at the 35th Annual Meeting of the American Academy of Neurology, San Diego, CA, April 28–30, 1983.     

The influence of surgery and radiation therapy on patients with brain metastases

The place for operation and for radiation therapy in the management of brain metastases is reviewed from the experience of 1895 patients treated in two studies of the Radiation Therapy Oncology Group. Operative removal may be of benefit to patients with solitary peripheral lesions in non-critical brain locations. Operation is also appropriate when the diagnosis is in doubt. Radiation therapy with appropriate steroid management is of benefit to patients with multiple metastases or where operative intervention is not reasonable. Short course low-dose treatment has been as beneficial as more aggressive prolonged radiation therapy.     

放射治疗脑转移瘤患者的流行病学及其与临床特征的相关性（附205例）

目的:探讨放射治疗脑转移瘤患者的流行病学及其与临床特征的关联,为其诊治提供依据。方法:收集2007年1月至2017年12月间行放射治疗的205例脑转移瘤（brain metastases,BM）患者的临床资料,并对其进行统计学分析。结果:205例脑转移瘤患者男女比为1.47∶1,中位年龄60岁,肺癌占82.0%;男性吸烟及饮酒率明显高于女性(P＜0.05);性别在年龄、城乡分布、转移灶数量及原发肿瘤上无统计学差异。接受IMRT的患者比例整体呈上升趋势。BM首发有症状者68.3%,其中头晕头痛恶心占47.8%、肢体障碍占32.2%。BM病灶位于额叶及顶叶最多。病灶位于额叶及枕叶与意识下降及反应迟钝相关（P=0.015、P=0.034）;位于小脑与头晕头痛恶心相关（P=0.04）。BM与原发肿瘤间隔的中位时间为7.0（0～166）个月,与性别、是否有颅外转移、病种及病理类型相关（P＜0.05）。结论:BM多继发于肺癌,男性多于女性,男性吸烟及饮酒者明显高于女性。首发有症状者较多,以头晕头疼恶心、肢体障碍为主。占位以额叶及顶叶常见,病灶位于额叶及枕叶者容易出现意识下降及反应迟钝,位于小脑容易有头晕头痛恶心症状。男性、无颅外转移及肺癌患者更易发生脑转移。     

Brain metastases from prostate adenocarcinoma

Brain metastases of prostate adenocarcinoma are rare. We report a case of brain metastases from prostate adenocarcinoma 15 months after the diagnosis of the primary tumour. The patient had headache and one solitary metastasis upon magnetic resonance imaging (MRI). The biopsy performed showed metastatic prostate adenocarcinoma. He was treated with surgery and cranial irradiation.     

Bildgebung in der Diagnostik des CUP-Syndroms

Diagnostic imaging in patients with CUP (cancer of unknown primary) is aimed at identification of well treatable subgroups, staging (local versus disseminated disease), and early detection of complications in addition to the search for a primary tumor. The basic diagnostic imaging modality is contrast-enhanced whole-body computer tomography (neck to pelvis). Additional PET/CT is recommended as the next step in cases with negative or solitary findings and the possibility for a radical therapy. Mammography, breast sonography and in negative cases breast MRI are recommended for female patients with axillary CUP. In cervical CUP with negative CT or MRI of the neck and thorax, there is strong evidence for PET/CT. Special imaging of the somatostatin receptors is indicated in neuroendocrine metastases with unknown primary.     

放射治疗与分子靶向药物在脑转移瘤治疗中的联合应用效果分析

目的 分析放射治疗与分子靶向药物在脑转移瘤治疗中的联合应用效果,为提高脑转移瘤的临床疗效提供科学依据.方法 选取60例脑转移瘤患者,所有患者均有病理明确的原发病灶且经头颅CT或头颅MRI检查确诊为脑转移瘤,按照数字表法随机分为观察组与对照组,每组30例.对照组采用全脑放射治疗方案,观察组采用立体定向放疗(IMRT)联合分子靶向药物治疗方案.结果 观察组治疗有效率为83.3%;对照组治疗有效率为26.7%,两组治疗有效率比较差异有统计学意义(P<0.05).结论 立体定向放疗IMRT联合分子靶向药物在脑转移瘤治疗中具有较好的应用效果,能够提高临床疗效以及生活质量,改善患者的预后,具有重要的现实意义.     

Multiple Cysts in the Cerebral White Matter: A Rare Complication of Whole Brain Radiation Therapy

We describe a patient with multiple cysts in the cerebral white matter, several years after whole brain radiation therapy (WBRT) for a solitary cerebellar metastasis of a lung carcinoma. MR images of the brain show diffuse white matter changes, 1 year after radiation, and cyst formation in the white matter, starting 3.5 years later. We conclude that cysts in the cerebral white matter can be a late stage of white matter damage after whole brain radiation therapy in long-term survivors with brain metastases.     

Radiologische „Überdiagnostik“ in der Onkologie

Evidence-based data are lacking that address the question of quantitative or qualitative“overprovision” of radiological diagnostics in oncology. The most important organ regions for diagnostic work-up in oncology are the brain, lungs, liver, and skeleton. In the region of the brain, MRI is the only procedure to be recommended. Pulmonary diagnostics are a domain of CT; in individual cases, a panoramic X-ray image in two planes suffices. In the diagnostic work-up of liver conditions, provided that optimal technologies are applied, specific contrast-enhanced MRI represents the gold standard. In the skeletal system, scintigraphy is still the investigation technique of choice; threat to the stability of the spine is examined with CT, and the most sensitive method to detect metastases is MRI. The most important organ tumors in oncological diagnostics are bronchial carcinoma, breast cancer, colorectal carcinoma, and prostate cancer. For bronchial carcinoma the general statement for the lungs applies regarding verification, staging, and aftercare, provided that in doubtful cases PET-CT is performed preoperatively. The pillars in the diagnosis of breast cancer are clinical examination, ultrasound, and mammography, supplemented by MR mammography. Aftercare of breast cancer can be limited to a minimum. In screening and prevention of colorectal tumors, virtual colonography will gain importance in the future; for reasons of radiation protection this is predominantly MRI in Germany. CT is the method of choice for staging; aftercare with MRI and PET is indicated before treating locoregional metastases. For cases of prostate cancer, the PSA level and transrectal sonography including biopsy determine the therapy regimen. The combination of MRI/MRS and PET-CT with choline may be used for tumor aftercare.     

Fractionated stereotactic body radiation therapy in the treatment of primary, recurrent, and metastatic lung tumors: the role of positron emission tomography/computed tomography-based treatment planning

PURPOSE: The aim of this study was to assess the outcomes of patients treated with stereotactic body radiation therapy (SBRT) in patients with primary, recurrent, or metastatic lung lesions, with a focus on positron emission tomography (PET)/computed tomography (CT)-based management. PATIENTS AND METHODS: Fifty-one patients with primary stage I non-small-cell lung cancer (NSCLC; n = 26), recurrent lung cancer after definitive treatment (n = 12), or solitary lung metastases (n = 13) were treated with SBRT between 2005 and 2007. Patients were treated with the CyberKnife Robotic Radiosurgery System with Synchrony respiratory tracking. A dose of 60 Gy was delivered in 3 fractions. All patients had CT or PET/CT performed at approximately 3-month intervals after treatment. RESULTS: The median follow-up was 12 months. Local control at median follow-up was 85% in patients with stage I NSCLC, 92% in patients with recurrent lung cancer, and 62% in the patients with solitary lung metastasis. Analysis of the 28 patients with pre- and post-treatment PET/CT scans demonstrated that those with stable disease (n = 4) had a mean standardized uptake value (SUV) decrease of 28%, partial responders (n = 11) had a decrease of 48%, and patients with a complete response (n = 11) had a decrease of 94%. Patients with progressive disease (n = 2) had an SUV decrease of only 0.4%. Only 2 patients (7%) who had reduced fluorodeoxyglucose avidity later progressed locally. No correlations were found between pretreatment SUV and tumor response, disease progression, or survival. Overall 1-year survival rates were 81%, 67%, and 85% among the patients with primary NSCLC, recurrent lung cancer, and solitary lung metastases, respectively. CONCLUSION: Stereotactic body radiation therapy with CyberKnife is an effective treatment for patients with medically inoperable recurrent or metastatic lung cancer. Positron emission tomography/CT is valuable in staging, planning, and evaluating treatment response and might predict long-term outcome.     

Weekly paclitaxel therapy leading to complete disappearance of multiple liver metastases and subsequent surgical resection for advanced gastric cancer

A 59-year-old man visited our hospital. After examination he was diagnosed with advanced gastric cancer with multiple liver metastases. At first, chemotherapy of S-1/CDDP was administered. After two weeks, he had severe diarrhea and anorexia, so the therapy was discontinued. Weekly paclitaxel was selected as the next therapy. Depending on the leukocytopenia, doses and intervals were controlled. After 4 courses, CT and MRI revealed that the liver metastases had disappeared, while the primary lesion remained. Seven months after beginning treatment, distal gastrectomy was performed. After the operation, 6 courses of paclitaxel therapy were given at the same doses and the same intervals as before the operation. Two years have passed since the operation, and no recurrence was seen on CT and MRI. Because of the relatively low frequency of adverse events in the digestive system, continued treatment with paclitaxel is possible. These findings show that paclitaxel is an effective drug for advanced gastric cancer with liver metastasis.     

9例脑原发淋巴瘤的MRI影像特征

背景与目的:脑原发淋巴瘤少见,术前常被误诊为恶性胶质瘤或转移瘤.由于脑原发淋巴瘤对化学治疗及放射治疗敏感,因此术前明确诊断具有重要意义.本研究回顾性分析9例经病理证实的免疫状态正常人脑原发淋巴瘤的MRI表现,以提高对本病的诊断及鉴别诊断能力.方法:分析9例脑原发淋巴瘤MRI表现特征(包括病灶的数目、位置、信号强度、瘤周水肿、占位效应程度及瘤体强化特点).结果:9例病变均为单发,病灶位于幕上者8例,同时累及幕上幕下者1例.平扫T1WI上呈低信号8例,等信号1例;平扫T2WI上等信号6例,低信号1例,稍高信号2例.2例病灶中见坏死改变.瘤周水肿轻度5例,中度3例,重度1例.增强后肿瘤呈团块状强化4例,分叶状强化3例,环状强化2例.结论:免疫状态正常人脑原发淋巴瘤具有较典型的MRI征象,结合患者影像学及临床资料,术前可作出明确诊断.     

Cerebellar metastases from prostatic carcinoma

A 67‐year‐old man presented with worsening headaches and gait disturbance, and with minimal clinical signs. A brain MRI showed multiple solid cerebellar metastases. The pathological diagnosis of metastatic carcinoma of the prostate was further suggested by an elevation in prostate specific antigen, and was pathologically confirmed following the neurosurgical removal of the tumours. The rarity of this presentation, as documented in the clinical literature, is reviewed.     

单椎体116例良恶性骨肿瘤临床及影像学分析

目的:分析单椎体骨肿瘤的临床特征及影像学表现,以提高对单椎体骨肿瘤的认知及疾病诊断水平。 方法:回顾2011年1月至2017年9月本院收治的资料完整的116例单椎体骨肿瘤。总结分析患者的性别、年龄、病理类型及影像学表现。两名放射科诊断医师分别对DR、CT、MRI诊断骨肿瘤的价值进行评价。结果:原发肿瘤93例,转移瘤23例。男62例,女54例,年龄8～75岁,平均（48.6±8.3）岁。良性骨肿瘤23例,占19.83%;中间型骨肿瘤21例,占18.10%;恶性骨肿瘤72例,占62.07%。良性骨肿瘤平均发病年龄32（11～60）岁,常见病种有骨软骨瘤、纤维结构不良;中间型骨肿瘤平均发病年龄36（20～64）岁,常见病种有骨巨细胞瘤、侵袭性血管瘤;恶性骨肿瘤平均发病年龄59（37～76）岁,常见病种有转移瘤、孤立性浆细胞瘤。CT和MRI骨肿瘤的诊断符合率均高于DR(P＜0.05),CT和MRI的诊断符合率差异没有统计学意义(P＞0.05)。结论:单椎体骨肿瘤恶性多见,以转移瘤、孤立性浆细胞瘤为主。CT和MRI单椎体骨肿瘤诊断价值优于DR。