Long-term survival after brain metastasis from endometrial cancer

A case is reported of prolonged survival after radical hysterectomy for poorly differentiated adenocarcinoma of the endometrium and resection of metastatic carcinoma of the brain followed by radiation therapy. The 43-year-old patient has survived for seven years after hysterectomy and six years 10 months after excision of the brain metastasis. Our results show that the surgical excision of a single metastatic lesion of the brain with postoperative irradiation offers hope of prolonged survival in patients with a solitary brain metastasis and no evident systemic disease.     

乳头状肾细胞癌的临床治疗分析——附23例报告

目的总结分析乳头状肾细胞癌的临床特点,提高其治疗水平。方法回顾性分析1980～2000年收治的23例乳头状肾细胞癌患者的临床资料。男14例,女9例。中位年龄48岁（24～71岁）。左侧11例,右侧12例。在19例初治的患者中,临床表现血尿8例（42．1％）,腰痛7例（36．8％）,无症状者4例（21．1％）;肾脏肿瘤中位最大径5．5cm（2．5～10．0cm）。另4例为外院术后出现复发和转移。结果乳头状肾细胞癌占同期收治肾癌的2．4％（23／975）。失随访4例。术后总5年生存率69．6％。其中初治19例,5年生存率为84．2％。14例早期局限性癌（T1a～T2N0M0）患者5年生存率100％,但2例分别于术后7年6个月和10年出现转移,其中1例双肺转移患者行肺转移瘤切除和生物化疗后已生存9年且健在,1例失访。3例局部淋巴结转移和2例远处转移的患者中,1例术后2年6个月出现肺转移瘤和切口转移手术联合生物化疗后生存3年,1例同期肺转移瘤患者行肺转移瘤切除和放疗后生存6年,而余3例中,2例失访,1例生存6个月。而外院初治出现复发的4例中,2例患者再次行复发肿瘤切除,分别生存1年和2年6个月,另2例转移患者中,1例生存9个月,1例失访。结论乳头状肾细胞癌在国内少见。早期局限性乳头状肾细胞癌术后预后良好。对于复发或转移的乳头状肾细胞癌患者,手术切除转移瘤或复发瘤可提高生存期。     

Pancreatic resection for metastatic tumors to the pancreas

We report 3 cases of resectable pancreatic metastasis. CASE 1: A 76-year-old woman was followed after nephrectomy for renal cell carcinoma for 13 years. CT examination demonstrated a high vascular lesion in the pancreatic body and tail. We conducted distal pancreatectomy and diagnosed with metastatic tumor from renal cell carcinoma. She died of liver metastasis 8 years after pancreatic resection. CASE 2: A 64-year-old man, who had undergone right lower lobectomy for lung cancer a year ago, was found to have a mass in the pancreatic tail. We performed distal pancreatectomy and diagnosed with metastatic tumor from lung cancer. He died of lung metastasis 12 months after pancreatic resection. CASE 3: A 62- year-old woman, who had undergone left nephrectomy for renal cell carcinoma 3 years ago, was found to have a mass in the pancreatic body. With a diagnosis of metastatic pancreatic tumor from renal cell carcinoma, distal pancreatectomy was done. She died of liver and lung metastases 15 months after pancreatic resection. Long-term survival can be achieved in patients undergoing a pancreatic standard resection including lymphadenectomy for isolated metastasis from nonpancreatic sites.     

A long survival case of sigmoid colon cancer patient with initially unresectable hepatic metastases

The prognosis of a colorectal cancer patient with unresectable hepatic metastases is extremely poor. To improve the prognosis, when the hepatic metastases were initially unresectable, we performed second-look hepatectomy (s-l hepatectomy) after neoadjuvant hepatic arterial 5-FU infusion plus UFT (HAI-PMC). Here, we report the case of a sigmoid colon cancer patient with initially unresectable hepatic metastases showing a prolonged survival (6.5 years) by second-look operation after HAI-PMC. A 57-year-old woman was diagnosed with sigmoid colon cancer with unresectable liver metastases. Sigmoidectomy and hepatic arterial catheterization were performed in the initial operation, and HAI-PMC was performed 6 months after. Metastatic foci of the liver had shrunk (90.9%), but solitary metastatic lung cancer was detected during HAI. As no other metastatic lesion was observed, partial resection of the liver and lung was performed as a second-look operation, 6 months after the initial operation. The woman continued venous infusion chemotherapy as an outpatient, and she survived for 6.5 years after the initial operation. This result suggests that strategic multidisciplinary treatment utilizing s-l hepatectomy after neoadjuvant chemotherapy can lead to better prognosis for colorectal cancer patients with hepatic metastases.     

巴氏腺腺样囊性癌临床病理分析

目的 探讨巴氏腺腺样囊性癌的临床病理特征和治疗方法.方法 回顾性分析6例巴氏腺腺样囊性癌患者的临床及病理资料.6例患者的中位年龄为40.5岁(30～54岁).主要治疗方式为手术切除,其中单纯外阴肿物剥除术1例,外阴根治性切除术加双侧腹股沟淋巴结清扫或活检术4例,外阴局部扩大切除术加双侧腹股沟淋巴结活检术1例.有2例患者术后补充放疗.6例患者均随访至2009年4月1日,中位随访时间124.5个月(8～241个月).结果 6例巴氏腺腺样囊性癌均经病理确诊,肿瘤细胞呈筛状排列及侵犯神经是其典型的病理特点.术后病理显示,切缘阳性2例,阴性1例,邻近肿瘤1例,不详2例.腹股沟淋巴结阴性5例,不详1例.有4例患者复发,其中3例局部复发,后出现肺转移;1例仅出现肺转移.在复发患者中,死亡1例,生存时间为135个月;另3例患者分别带瘤生存120、30和36个月,总生存时间分别为241、128和103个月.2例无复发患者无瘤生存8个月和121个月.结论 巴氏腺腺样囊性癌生长缓慢,患者长期预后较好,但容易局部复发和肺转移.首选治疗方法为手术切除,对于术后切缘阳性、局部浸润较深或侵犯神经者以及复发无法手术者可行辅助放疗或姑息性放疗.     

Surgical resection of pulmonary metastases from colorectal cancer. 10-year follow-up

Pulmonary resection of metastatic lesions from colorectal cancer was performed in 62 patients, and their cumulative 5-year and 10-year survival rates were 42% and 22%, respectively. The overall median survival was 24 months. The survival curve decrease even after 5 years after pulmonary resection; four of 13 patients who survived more than 5 years subsequently died of metastatic disease and only two patients survived more than 10 years. The number and size of the pulmonary metastases were significantly correlated with postthoracotomy survival. Solitary metastases less than 3.0 cm in diameter were good indicators of favorable postthoracotomy survival. There were no significant differences in survival based on Dukes' classification or location of the primary lesion. Sex, age, disease-free interval between the primary tumor and appearance of metastasis, and extent of pulmonary resection had no influence on survival. It is impossible to say from our experience that surgical resection of pulmonary metastases increased the cure rate. Presumably a good 5-year survival rate after thoracotomy would be a reflection of a length bias caused by the biologic behavior of the metastatic pulmonary lesions.     

Adrenalectomy for solitary adrenal metastasis from colorectal carcinoma

A 60-year-old man underwent anterior resection for advanced rectal carcinoma. Seven years and 2 months later, right lower pneumonectomy was performed for a metastatic lung tumor. Two years and 2 months thereafter, left adrenalectomy was performed for solitary adrenal metastasis. The patient remained disease-free for 10 months postoperatively, until multiple lung metastases appeared. The patient is alive and well, under mild chemotherapy with oral doxifluridine, 3 years and 5 months after left adrenalectomy. We conclude that patients with solitary adrenal metastasis may benefit from surgical resection and that resection could be considered as a therapy for solitary adrenal metastasis from colorectal carcinoma.     

Chemotherapy followed by lung resection in inoperable non-small cell lung carcinomas due to locally far-advanced disease

From 1977, 29 patients with inoperable non-small cell lung carcinoma due to locally far-advanced disease underwent lung resection after receiving two to eight courses of chemotherapy. After the surgery was performed, three additional courses of chemotherapy were given. The overall median survival from onset of the chemotherapy was 30.5 months; postoperatively, it was 24.5 months (five patients survived greater than 5 years). Postoperative mortality was 10.3%. The overall survival results compare favorably with those obtained with radiation therapy.     

Surgery for T4 Lung Cancer: The Prognoses of T4 Lung Cancer

The prognoses of T4 lung cancer patients treated surgicallywere investigated in 76 patients. Extended resection was performedin 21 patients, palliative resection in 21 and exploratory thoracotomyin 34. Although the five-year survival of the extended resectiongroup did not differ significantly from that obtained in theexploratory thoracotomy group, the mean survival time of theextended resection group was 3.1 months longer than that ofthe exploratory thoracotomy group. Two patients who had undergoneresection for left atrial involvement, survived for two yearsor more, and a T4N0 patient with squamous cell carcinoma, inwhom resection for aortic involvement was carried out, diedfrom an unrelated disease after 15 months. Two patients withpleural dissemination, who underwent panpleuropneumonectomy,survived for two years. Surgical intervention did not improvethe prognosis of patients with N2-squamous cell carcinoma, thosewith malignant effusion or those with multiple organ involvement.     

Recurrent epidermoid cancer of the anus

Of 83 patients with recurrent epidermoid cancer of the anus, 67 had tumors in the anal canal and 16 had tumors at the anal margin. Local pelvic or perineal recurrence after abdominoperineal resection of tumors in the canal had a poor prognosis. Median survival after combination chemotherapy and megavoltage irradiation was 14 months. With irradiation alone, median survival was 7 months, although nearly half of these patients had been treated with orthovoltage techniques. Untreated patients with visceral metastases had a median survival of 8 months, but no improvement in survival was seen after treatment with chemotherapy. In contrast, patients who had metastases in inguinal lymph nodes had a 55% 5-year survival rate after inguinal dissection. Patients with tumors at the anal margin did not have visceral metastases. This is an important difference between tumors arising in the canal and those arising at the anal margin. Local excision was satisfactory treatment for 90% of the patients who had local recurrence in the perianal skin; abdominoperineal resection was rarely required. Inguinal lymph node metastases from margin cancer are uncommon, but three of five such patients survived 5 years after groin dissection. A combination of 5-fluorouracil, mitomycin C, and radiation therapy was used for patients with pelvic recurrence after abdominoperineal resection of epidermoid cancer of the anal canal. In this study, there was no evaluation of the role of megavoltage irradiation alone at the recommended doses of 5500 to 6000 rad for these patients. Some patients with visceral metastases respond to combination chemotherapy, but median survival is not improved; evaluation of new chemotherapeutic regimens is required. Patients with canal tumors metastatic to inguinal nodes should be treated by groin dissection as their prognosis is relatively good. Local recurrence of tumors at the anal margin can be satisfactorily treated by further local excision; those patients with margin tumors metastatic to inguinal nodes require groin dissection.     

Radiosurgery for solitary brain metastases using the cobalt-60 gamma unit: methods and results in 24 patients.

To define the role of stereotactic radiosurgery in the treatment of metastatic brain tumors we treated 24 consecutive patients (20 men, 4 women) with the 201-source 60Co gamma unit between May 1988 and March 1990. The primary tumors included malignant melanoma (n = 10), non-small cell lung carcinoma (n = 6), renal cell carcinoma (n = 3), colorectal carcinoma (n = 1), oropharyngeal carcinoma (n = 1), and adenocarcinoma of unknown origin (n = 3). All tumors were less than or equal to 3.0 cm in greatest diameter. Twenty patients received a planned combination of 30-40 Gy whole brain fractionated irradiation and a radiosurgical "boost" of 16-20 Gy to the tumor margins; one patient refused conventional fractionated irradiation. Three patients with recurrent, persistent, or new non-small cell lung carcinomas had radiosurgical treatment 12-20 months after receiving 30-42.5 Gy whole-brain external beam irradiation. Stereotactic computed tomographic imaging was used for target coordinate determination and imaging-integrated dose planning. All tumors were enclosed by the 50-90% isodose shell using one (n = 22), two (n = 1), or three (n = 1) irradiation isocenters. During this 23-month period (median follow-up of 7 months) no patient died from progression of a radiosurgically-treated brain metastasis. Ten patients died of systemic disease (n = 8) or remote central nervous system metastasis (n = 2) between 1 week and 10 months after radiosurgery. One patient had tumor progression and underwent craniotomy and tumor excision 5 months after radiosurgery. To date, median survival after radiosurgery has been 10 months; 1-year survival was 33.3%. Stereotactic radiosurgery eliminated the surgical and anesthetic risks associated with craniotomy and resection of solitary brain metastases. Radiosurgery also effectively controlled the growth of tumors considered "resistant" to conventional irradiation.     

Carcinoma of lung with a solitary cerebral metastasis. Surgical management and review of the literature

During the years 1975 to 1980, 10 male patients and 1 female, with ages ranging between 40 to 61 years, underwent combined resection of primary lung cancer and solitary brain metastasis. In 8 patients the lung cancer was diagnosed and treated first. In those patients, craniotomy for removal of a solitary brain metastasis was carried out 8 to 60 months (mean, 27 months) after excision of the lung tumor. In 3 patients, brain metastasis was diagnosed and treated first and lung excision followed, 2 to 4 weeks after craniotomy. The most common histologic type of the tumor was adenocarcinoma (63.6%). There were no operative deaths. Three patients survived less than 6 months after surgery and were considered as a failure of surgical treatment. Seven patients lived longer than 1 year and three of them are still alive with a follow-up period between 2 to 3 1/2 years after both operations. One of the patients underwent recently successfully second brain intervention for removal of recurrent histologically identical solitary brain metastasis and is well. Our results and those reported in literature encourage the combined surgical removal of primary lung cancer and a solitary brain metastasis.     

直肠癌术后转移性肺癌的外科疗效

目的　研究直肠癌肺转移的病人的外科疗效。方法　我院胸外科 1 978年 1月到 2 0 0 0年 1 0月为 32例直肠癌肺转移患者施行了肺切除术。直肠癌术后无瘤间期为 0～ 1 0 8月 (平均为 44 .6月 )。孤立病灶者 2 6例 ,占 81 .3 % ,累及两个肺叶者 4例 ,占 1 2 .5 %。结果　楔形切除 1 2例 ,一叶切除 1 4例 ,两叶切除 2例 ,全肺切除 3例 ,姑息性切除 1例。全组无手术期死亡 ,平均随访 8年 ,随访为 1 0 0 %。 1年、3年、5年、1 0年的生存率分别为 78.6 %、46 .3 %、2 8.7%、1 8.1 %。资料显示多发性转移病人的生存期明显小于孤立性病灶者 (P <0 .0 5) ,肺手术前癌胚抗原正常组生存期明显大于增高组病人 (P <0 .0 1 )。结论　对于直肠癌肺转移的病人在尽可能多保留肺组织的情况下实行肺切除术是安全、有效的     

Solitary metastases from renal cell carcinoma: a review.

Nineteen patients with solitary metastatic lesions from renal cell carcinoma, 5 synchronous and 14 metachronous, were seen at the Tata Memorial Hospital over a 7 year period between 1981 and 1987. The mean metastatic interval for the metachronous lesions was 31.2 months. The commonest sites of metastases were bone, lung, and liver. The solitary nature of the metastasis was confirmed by appropriate investigations. All patients underwent nephrectomy for the primary kidney lesion. The metastatic lesions were treated with intent of cure. Only 1 patient with synchronous metastasis survived for 2 years and none survived 5 years while in the metachronous metastasis group, the estimated overall survival was 50% at 2 years and 25% at 5 years. The patients with a long metastasis-free interval were found to have a better survival. The patients with liver metastasis did poorly as compared to those with metastases at other sites. The stage of the disease also had a bearing on the survival.     

133例非小细胞肺癌脑转移的综合治疗分析

目的：通过回顾性分析探讨影响非小细胞肺癌脑转移治疗效果的预后因素。方法：对133例非小细胞肺癌脑转移患者进行以全脑射治疗为主结合其他方法的治疗。脑转移症状缓解定义为脑部放射治疗结束后1个月，50％以上的症状和体征消失。将脑转移时原发灶控制与否，脑外转移灶，单发或多发脑转移，化疗周期等因素进行多因素分析。结果：所有患者经放射治疗后脑转移灶症状缓解率达88％，缓解期为1．5－55．0个月，中位缓解期为6个月；全脑放射治疗后CT或MRI显示脑转移灶局部控制率为83％；全组中位生存期为6个月，1、2年生存率分别为24．5％和7．8％，经多因素分析显示生存率与多发脑转移，原发灶未控呈负相关，而与化疗3周期以上呈正相关，结论：影响非小细胞肺癌脑转移的主要因素是脑转移时原发灶控制与否，多发或单发脑转移，化疗周期数，对于单发脑转移，脑转移时原发灶控制以及身体条件能够耐受3周期以上化疗的患者，应采取积极的治疗。     

Involvement of the central nervous system by ovarian carcinoma

Ovarian carcinoma rarely metastasizes to the central nervous system (CNS). Of 110 patients with epithelial ovarian carcinoma treated at the Northern Israel Oncology Center between the years 1979 and 1985, only five (4.5%) had CNS involvement. The median age of the patients with 54.5 years. All of them had treatment with cisplatin and Adriamycin (doxorubicin). The median duration from diagnosis to the development of brain involvement was 17 months. The median survival time was 28 months from diagnosis of carcinoma and 2 months from diagnosis of CNS disease. The increased incidence of this kind of metastasis in patients achieving local control of their advanced disease suggests that a change in the pattern of metastatic spread or the prolonged survival permits occult CNS metastases to become apparent. A routine computerized axial tomography (CAT) scan of the brain should therefore be performed on patients with ovarian carcinoma with prolonged survival.     

Brain metastases following interleukin-2 plus interferon-alpha-2a therapy: a follow-up study in 94 stage IV melanoma patients

This study analyses the frequency and therapy of brain metastases in 94 stage IV melanoma patients after treatment with high-dose interleukin-2 (IL-2) and interferon-alpha (IFN-alpha) within three subsequent trials between 1990 and 1995. Central nervous system (CNS) metastases occurred in 28 patients (30%) during the potential follow-up period of 6 years. Time to occurrence of brain metastases varied between 1 and 53 months, with a median of 10 months. Of 28 patients, 19 had < 5 metastases, which were treated with stereotactic radiosurgery (SR) in 9 patients. In 2 patients, SR was followed by resection. 9 patients had multiple metastases, of which 4 received whole brain irradiation (WBI). Median survival after the detection of CNS metastases was 6 months (95% Confidence Interval (CI) 1-11 months). SR plus resection was associated with a prolonged survival of 34 and 35 months in 2 patients, 1 patient survived for 41 months after WBI, demonstrating the efficacy of these therapeutic strategies.     

Study of surgical resection of sternal metastasis from carcinoma of the breast

Three patients with a sternal metastasis from a carcinoma of the breast were treated with a partial resection of their sternum . Two patients died 13 and 14 months after their sternectomy. The remaining patients, however, has survived without a subsequent metastasis for 7 years. The sternal metastasis in the 7-year survival case was confined to the sternum for 7 months before the metastatic resection. Thus, a sternectomy, followed by chemo-endocrine therapy for several months may be indicated for patients with a solitary sternal metastasis, if there is no evidence of a systemic spread.     

Protracted survival after resection of metastatic uveal melanoma

BACKGROUND: The objective of this study was to evaluate the usefulness of resection of metastatic uveal melanoma and to analyze the characteristics of patients who may benefit from surgical intervention. PATIENTS AND METHODS Twelve patients underwent surgical removal of metastasis between 1976 and 1998. Data regarding primary uveal melanoma, systemic metastasis, surgical procedures, and outcomes were reviewed retrospectively. RESULTS: There were seven patients with liver metastases, two with lung metastases, one with brain metastasis, and two patients with metastases in the liver and other organs. Median time to systemic metastasis was 8 years. Seven of 12 patients were asymptomatic when they were found to have metastasis. Ten patients underwent complete resection of metastasis. No significant surgical complications were experienced. Median recurrence free and overall survival periods after complete resection were 19 months (range, 6-78 months) and greater than 27 months (range, 11-86 months), respectively. Recurrence free and overall 5-year survival rates of those patients were 15.6% and 53.3%, respectively. Three of these patients had no further systemic recurrence. All patients whose time to systemic metastasis was within 5 years developed further systemic recurrence within 2 years after surgery. In contrast, in 8 patients whose time to systemic metastases was greater than 5 years, 4 patients either were recurrence free or developed second metastasis more than 4 years after surgery. CONCLUSIONS: Complete surgical removal of metastatic uveal melanoma provided unexpectedly long survival without significant morbidity for the selected patients. These results are encouraging and justify a trial in which patients eligible for resection are randomized between standard treatment and surgery.     

Long-term survival after successful surgical treatment of a solitary brain metastasis

Background We investigated the factors associated with survival duration in 9 patients with brain metastases who survived for more than 6 years, and focused on the factors associated with long survival. Methods Of 9 primary lesions, 5 were lung cancer, 1 was colon cancer, 1 was uterine cancer, 1 was choriocarcinoma, and 1 was renal cancer. All patients underwent total removal of a solitary brain metastasis. Of the 9 patients, 6 received chemotherapy and adjuvant radiation therapy, 1 patient received only radiation therapy, and 2 patients had no adjuvant therapy. Results The factors we isolated in the 9 long-term survivors were that they were relatively young, their systemic diseases were well controlled, there was a relatively long interval between diagnosis of the primary tumor and the brain metastasis, the metastatic lesion was located in the nondominant hemisphere, and the patients were generally in good condition or had only a mild neurologic deficit. Conclusion In some patients with controlled or absent extracranial tumor activity in whom a single brain metastatic tumor is identified after a prolonged period, surgery and local radiotherapy may provide hope for a long survival period.