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1.
Metastatic esophageal tumors from distant primary lesions: report of three esophagectomies and study of 1835 autopsy cases 总被引:1,自引:0,他引:1
Mizobuchi S; Tachimori Y; Kato H; Watanabe H; Nakanishi Y; Ochiai A 《Japanese journal of clinical oncology》1997,27(6):410-414
Three cases of esophagectomy for secondary esophageal carcinoma
metastasized from the ovary, breast and lung are reported. Long-term
survival, 14 and 4 years, after esophagectomy was achieved in two patients.
The intervals between surgery for primary cancer and dysphagia onset in
these two patients were 16 and 7 years, respectively. An aggressive
surgical approach appears to be the therapeutic procedure of choice for
metastatic esophageal carcinoma when the primary tumor growth rate is
suspected to be slow. Autopsy data on 1835 cases revealed 112 (6.1%) had
metastasis to the esophagus. The lung was the most common primary
tumor-bearing organ and the diffusely infiltrative type was the most common
esophageal tumor observed macroscopically which corresponded to the
findings in our three patients. When an esophageal stricture with normal
mucosa is encountered, a metastatic tumor must be taken into consideration.
相似文献
2.
Primary endocrine therapy in locally advanced breast cancers--the Nottingham experience 总被引:1,自引:0,他引:1
Mathew J Agrawal A Asgeirsson KS Buhari SA Jackson LR Cheung KL Robertson JF 《Breast cancer research and treatment》2009,113(2):403-407
Introduction There are trials comparing different neoadjuvant chemotherapy regimens for locally advanced primary breast cancer (LAPC).
Few studies have evaluated alternative therapeutic approaches towards LAPC. A previous trial from our institute in LAPC patients
unselected for oestrogen receptor (ER) status, comparing primary endocrine therapy versus multimodal treatment, showed no
difference in breast cancer related deaths or overall survival. We report our experience of primary endocrine therapy in ER+
LAPC. Methods Between 1988 and 2007, 195 ER+, non-inflammatory LAPC patients were treated with primary endocrine agents in our institute,
due to patient choice, being unfit for chemotherapy, or recruitment into the above mentioned trial. All patients had disease
assessable by UICC criteria. Results Median age was 69 years. The median follow-up was 61 months. 154 patients (79%) received endocrine treatment alone. 185 patients
(95%) derived clinical benefit (complete response/ partial response/ stable disease) for ≥6 months from primary endocrine
therapy. Overall 5-year survival was 76% and 5-year breast cancer specific survival was 86%. Conclusion In selected group of ER+ LAPC patients, primary endocrine treatment achieves excellent survival outcome and is a viable alternative
to other modalities of treatment. 相似文献
3.
Whole-brain radiotherapy and tumor bed radiosurgery following resection of solitary brain metastases
David Roberge Kevin Petrecca Munir El Refae Luis Souhami 《Journal of neuro-oncology》2009,95(1):95-99
A standard approach to solitary brain metastases is resection followed by whole-brain radiation therapy (WBRT). Despite WBRT,
the tumor bed remains a common site of failure. We reviewed outcomes following adjuvant WBRT with tumor bed radiosurgery (SRS).
We retrospectively identified patients having undergone neurosurgical resection of a single brain metastasis followed by adjuvant
WBRT and tumor bed SRS. SRS dose selection was independent of target volume (10 Gy peripheral dose). Outcomes were calculated
actuarially. Patients were censured for local control at the time of last imaging. From 2005 to 2008, 27 patients were treated
with WBRT and tumor bed SRS. Median age was 58.7 years, median KPS 80%. The primary malignancy was non-small cell lung cancer
in 70%. Median follow-up was 9.7 months. Following the combination of surgery, WBRT and SRS the median overall survival was
17.6 months. Actuarial 2-year local control was 94%. The SRS boost was well tolerated with one patient (4%) requiring reoperation
for symptomatic radiation necrosis 16 months post treatment. Radiosurgery can be safely added to WBRT as an adjuvant treatment
following resection of a single brain metastasis. In our retrospective series, this combination treatment produced a high
rate of local control. 相似文献
4.
Kobayashi T Yoshida M Kawabe A Isogaki J Wada H Kazui T Nozue M Nishimura T 《Gan to kagaku ryoho. Cancer & chemotherapy》1999,26(14):2233-2236
A 63-year-old man was admitted to our institution with a hard tumor on the left side of the neck. He was diagnosed as having advanced esophageal cancer (Stage IV) with a massive supraclavicular lymph node metastasis, and the lesion was thought to be unresectable. He was treated with chemotherapy (CDDP-VDS-5-FU) and radiation therapy, and all the tumors completely disappeared on endoscopic and CT examination. A stricture with scarring was detected in the esophagus at 6 months after treatment. No neoplastic tissue was detected in the lesion, and his dysphagia was relieved by dilation of the stricture. Recurrence on the left side of the neck was detected by CT at 2.5 years after chemoradiation therapy. However, the tumor has not grown over the 2-year interval since then, so it seems to be dormant. He has now survived with a good QOL for 5 years since the first hospital admission. We conclude that advanced esophageal cancer can be treated with chemoradiation therapy if the patient is in sufficiently good overall condition. 相似文献
5.
6.
Toshihisa Ogawa Ei-ichi Tsuji Kazuo Shirakawa Noriaki Hayashibara Rie Kurabayashi Kotoe Terada Yasuko Kikuchi Hajime Kanauchi Takashi Sakatani 《Breast cancer (Tokyo, Japan)》2011,18(1):68-72
Extranodal non-Hodgkin’s lymphoma (NHL) is a rare breast disease. Here we report three cases of primary NHL of the breast.
The first patient was a 29-year-old woman with a firm mass in her right breast with ipsilateral axillary lymphadenopathy.
An excisional biopsy revealed NHLs. Clinical stage was IIAE. The tumor and enlarged lymph nodes had successfully been treated
following the combination therapy. The second patient was a 70-year-old women with an elastic hard mass in her left breast.
An excisional biopsy revealed NHLs and clinical stage was 1AE. The tumor disappeared following the combination therapy. The
third patient was a 67-year-old women with a hard mass in her left breast. Core needle biopsy revealed NHLs and clinical stage
was 1AE. The tumor disappeared following chemotherapy. All patients are alive with no evidence of recurrence 4–8 years after
the initial treatment. Although a standard treatment has yet to be established, an initial treatment with combination therapy
without surgical intervention including axillary dissection appears to be appropriate for this rare disease. 相似文献
7.
Oouchi A Sakata K Masuoka H Tamakawa M Nagakura H Someya M Nakata K Asaishi K Okazaki M Okazaki Y Ohmura T Hareyama M Hori M Shimokawara I Okazaki A Watanabe Y Yamada T Yuyama T Satoh T Hirata K 《Breast cancer (Tokyo, Japan)》2009,16(1):49-57
Background Treatment outcome was evaluated in patients who underwent breast-conserving therapy and tangential irradiation. After verifying
background factors including systemic therapy, the clinical efficacy of postoperative irradiation was investigated.
Method There were 708 study subjects, all of whom had early breast cancer treated between 1992 and 2002. The median follow-up period
was 83 months. After breast-conserving surgery, in patients with negative surgical margins, only tangential irradiation at
48 Gy/24 fr was performed. In contrast, in those with positive surgical margins, 10 Gy of radiation boost to the tumor bed
with electrons was administered after tangential irradiation with 50 Gy/25 fr. Treatment outcome was analyzed using the Kaplan–Meier
method and Cox’s proportional hazards regression model.
Results The disease-free survival and no-recurrence rates within the ipsilateral breast after 5 years were 93.4 and 97.2%, respectively.
Risk factors for recurrence within the ipsilateral breast included younger age of patient, the number of positive lymph nodes,
and no endocrine therapy. However, the surgical margin was not a risk factor. Risk factors for relapse outwith the ipsilateral
breast included younger age, the number of positive lymph nodes, and recurrence within the ipsilateral breast.
Conclusions From our analysis of 708 Japanese women who received breast-conserving therapy, which can be regarded as a standard method
in Japan, the treatment outcome was compatible with previous reports from other countries.
Presented in part at the 19th meeting of the Japanese Society for Therapeutic Radiation Oncology (JASTRO), 23–25 November
2006, Sendai, Japan. 相似文献
8.
《Annals of oncology》2012,23(12):3081-3091
BackgroundRadiotherapy for breast cancer may expose the esophagus to ionizing radiation, but no study has evaluated esophageal cancer risk after breast cancer associated with radiation dose or systemic therapy use.DesignNested case–control study of esophageal cancer among 289 748 ≥5-year survivors of female breast cancer from five population-based cancer registries (252 cases, 488 individually matched controls), with individualized radiation dosimetry and information abstracted from medical records.ResultsThe largest contributors to esophageal radiation exposure were supraclavicular and internal mammary chain treatments. Esophageal cancer risk increased with increasing radiation dose to the esophageal tumor location (Ptrend < 0.001), with doses of ≥35 Gy associated with an odds ratio (OR) of 8.3 [95% confidence interval (CI) 2.7–28]. Patients with hormonal therapy ≤5 years preceding esophageal cancer diagnosis had lower risk (OR = 0.4, 95% CI 0.2–0.8). Based on few cases, alkylating agent chemotherapy did not appear to affect risk. Our data were consistent with a multiplicative effect of radiation and other esophageal cancer risk factors (e.g. smoking).ConclusionsEsophageal cancer is a radiation dose-related complication of radiotherapy for breast cancer, but absolute risk is low. At higher esophageal doses, the risk warrants consideration in radiotherapy risk assessment and long-term follow-up. 相似文献
9.
Hanna WC Sudarshan M Roberge D David M Waschke KA Mayrand S Alcindor T Ferri LE 《Current oncology (Toronto, Ont.)》2012,19(2):e60-e66
Background
The palliation of dysphagia in metastatic esophageal cancer remains a challenge, and the optimal approach for this difficult clinical scenario is not clear. We therefore sought to define and determine the efficacy of various treatment options used at our institution for this condition.Methods
We reviewed a prospective database for all patients managed in an esophageal cancer referral centre over a 5-year period. All patients receiving palliation of malignant dysphagia were reviewed for demographics, palliative treatment modalities, complications, and dysphagia scores (0 = none to 4 = complete). The Wilcoxon signed rank test was used to determine significance (p < 0.05).Results
During 2004–2009, 63 patients with inoperable esophageal cancer were treated for palliation of dysphagia. The primary treatment was radiotherapy in 79% (brachytherapy in 18 of 50; external-beam in 10 of 50; both types in 22 of 50), and stenting in 21%. Mean wait time from diagnosis to treatment was 22 days in the stent group and 54 days in the radiotherapy group (p = 0.003). Mean duration of treatment was 1 day in the stent group and 40 days in the radiotherapy group (p = 0.001). In patients treated initially by stenting, dysphagia improved within 2 weeks of treatment in 85% of patients (dysphagia score of 0 or 1). However, 20% of patients presented with recurrence of dysphagia at 10 weeks of treatment. In the radiotherapy group, the onset of palliation was slower, with only 50% of patients palliated at 2 weeks (dysphagia score of 0 or 1). However, long-term palliation was more satisfactory, with 90% of patients remaining palliated after 10 weeks of treatment.Conclusions
In inoperable esophageal cancer at our centre, radiation treatment provided durable long-term relief, but came at a high price of a long wait time for initiation of treatment and a long lag time between initiation of treatment and relief of symptoms. On the other hand, endoluminal stenting provided more rapid and effective early relief from symptoms, but was affected by recurrence of dysphagia in the long-term. It is now time for a prospective randomized trial to assess the safety and efficacy of combined-modality treatment with both endoluminal stenting and radiation therapy compared with either treatment alone. 相似文献10.
《Cancer radiothérapie》2015,19(3):192-197
Metastatic non-small cell lung cancer is associated with a poor prognosis, and palliative chemotherapy is the mainstay of treatment. However, long-time survival has been observed in oligometastatic patients treated with locally ablative therapies to all sites of metastatic disease. An 80-year-old man was diagnosed with an adenocarcinoma of the lung. The right upper lobe lesion was classified cT2aN0M0 and was treated with stereotactic body radiation therapy at the dose of 60 Gy in eight fractions. A few months after, he successively presented with two brain metastases and one left adrenal metastasis, with a complete response on the primary tumor. The three secondary lesions were treated with stereotactic body radiation therapy alone. Thirty months after the diagnosis and 12 months after metastases’ apparition, primary and brain lesion kept controlled (complete response). Oligometastatic non-small cell lung cancer management is not clear. Locally ablative therapies such as stereotactic body radiation therapy, surgery and radiofrequency are efficient and should be considered. A phase III study should evaluate radical treatment strategies in such patients. 相似文献
11.
Bone metastasis is a common event in advanced cancers such as prostate, breast, lung, and renal cancers. Radiation therapy
has been widely used for bone metastasis. However, it remains a challenging therapy because no radiation therapeutic guidelines,
including radiation dose, radiation field, and fractionation, for patients with bone metastasis have been established. Many
randomized controlled trials for bone metastasis have been carried out. They showed no significant difference in pain relief
with a short course of radiation therapy such as 8 Gy/1 Fr and 20 Gy/5 Fr or with a long course of radiation therapy such
as 30 Gy/10 Fr, 37.5 Gy/15 Fr, and 40 Gy/20 Fr. Toxicity rates with short and long courses were also the same. Recurrence
rate at 2 years, however, was significantly higher in patients irradiated with a short course than in patients irradiated
with a long course. Those trials also showed that response rate is affected by patient’s age, performance state, tumor type,
pathological state, number of metastatic tumors, and span from diagnosis of cancer to development of metastatic tumor. Breast
cancer has a better prognosis than most other cancers. Recently, there have been significant advances in cancer therapy techniques
and improvement in clinical results. Bone metastasis can cause extreme pain and motor deficits. Quality of life for patients
with bone metastasis is drastically worsened. Patients with bad prognosis should be treated with radiation therapy when analgesia
is the main aim of treatment. Survival of patients with oligometastasis or predominantly bone metastasis is expected to be
better than that of patients with visceral metastasis. For patients with vertebral or weight-bearing long bone metastasis,
long-course therapy is recommended. Many patients who are expected to have a good prognosis should be treated with a long
course of radiation. 相似文献
12.
13.
Baek JM Jin Q Ensor J Boulbes DR Esteva FJ 《Breast cancer research and treatment》2011,130(3):1029-1036
CD44 is an adhesion molecule involved in tumor cell invasion and metastasis. The function of CD44 in breast cancer is not
understood completely, or is its role as a predictive or prognostic factor. In this study, we tested for the hypothesis that
the concentration of soluble CD44 (sCD44) in serum is correlated with clinicopathological factors, especially HER2, and survival
in patients with breast cancer. We retrospectively identified 110 patients with breast cancer who had been treated at The
University of Texas MD Anderson Cancer Center (MDACC) from September 2001 to May 2004. Sera were collected before definitive
surgery in patients with stage I or II breast cancer, before initiation of neoadjuvant chemotherapy (if indicated) for patients
with stage I–III breast cancer, and before initiation of systemic therapy in patients with stage IV breast cancer. sCD44 levels
were determined using an enzyme-linked immunosorbent assay. The median age at diagnosis was 51 years (range, 28.6–87.1 years).
sCD44 concentration was correlated with tumor stage (P = 0.0308). sCD44 serum concentration did not predict pathological response in patients treated with neoadjuvant chemotherapy.
Among patients with distant metastases, sCD44 levels were significantly higher in patients with liver involvement than in
patients with metastases at other sites. The overall survival rate did not differ between patients with high sCD44 concentration
and patients with low sCD44 concentration. However, sCD44 concentration was a significant predictor of overall survival for
patients with HER2-positive breast cancer, while no difference in overall survival rates was observed in patients with HER2-negative
breast cancer. To the best of our knowledge, this is the first study to show an association between circulating sCD44 levels
and survival in HER2-positive breast cancer patients. Our results suggest a role for sCD44 as a prognostic marker. Furthermore,
sCD44 level may offer a new clinical therapeutic target in HER2-positive breast cancer. 相似文献
14.
Onega T Cook A Kirlin B Shi X Alford-Teaster J Tuzzio L Buist DS 《Breast cancer research and treatment》2011,129(1):269-275
Travel time has been shown to influence some aspects of cancer characteristics at diagnosis and care for women with breast
cancer, but important gaps remain in our understanding of its impact. We examined the influence of travel time to the nearest
radiology facility on breast cancer characteristics, treatment, and surveillance for women with early-stage invasive breast
cancer. We included 1,012 women with invasive breast cancer (stages I and II) who had access to care within an integrated
health care delivery system in western Washington State. The travel times to the nearest radiology facility were calculated
for all the U.S. Census blocks within the study area and assigned to women based on residence at diagnosis. We collected cancer
characteristics, primary and adjuvant therapies, and surveillance mammography for at least 2.5 years post diagnosis and used
multivariable analyses to test the associations of travel time. The majority of women (68.6%) lived within 20 min of the nearest
radiology facility, had stage I disease (72.7%), received breast conserving therapy (68.7%), and had annual surveillance mammography
the first 2 years after treatment (73.7%). The travel time was not significantly associated with the stage or surveillance
mammography after adjusting for covariates. Primary therapy was significantly related to travel time, with greater travel
time (>30 min vs. ≤ 10 min) associated with a higher likelihood of mastectomy compared to breast conserving surgery (RR = 1.53;
95% CI, 1.16–2.01). The travel time was not associated with the stage at diagnosis or surveillance mammography receipt. The
travel time does seem to influence the type of primary therapy among women with breast cancer, suggesting that women may prefer
low frequency services, such as mastectomy, if geographic access to a radiology facility is limited. 相似文献
15.
Masaaki Saito Hirokazu Kiyozaki Fumihiro Chiba Osamu Takata Takayoshi Yoshida Chio Shuto Shigeki Yamada Fumio Konishi 《Gastric cancer》2011,14(3):295-299
We report a 75-year-old woman who suffered multiple metachronous osteosclerotic bone metastases 4 years after a distal gastrectomy
for early gastric cancer (EGC). The primary tumor was a poorly differentiated adenocarcinoma, which had invaded the submucosal
layer, and only one lymph node metastasis was noted. To the best of our knowledge, cases of EGC combined with metachronous
osteosclerotic multiple bone and bone marrow metastases that respond to chemoradiotherapy are very rare. In this case, the
multiple bone metastases were diagnosed 4 years after surgery. The patient’s metastatic tumor was successfully treated using
S-1, paclitaxel, and camptothecin, with subsequent irradiation. The patient survived for 24 months after the treatment, without
having any major symptoms. 相似文献
16.
17.
Purpose The risk of second malignancies among female breast cancer patients has been studied for decades. In contrast, very little
is known about second primary tumors in men. Risk factors for breast cancer in men, including genetic, hormonal and environmental
factors, provide parallels to the etiology of breast cancer in women. This review considers the literature related to the
risk of developing a second cancer in patients with male breast cancer.
Materials and methods A systematic review of the literature between 1966 and 2007 was conducted and acceptable articles used for analysis. All retrieved
articles were screened to identify any papers that had been missed. Studies were included if they discussed the risk of subsequent
malignancy in patients with male breast cancer.
Results Patients with history of male breast cancer have an increased risk of a second ipsilateral, or contralateral breast cancer
(standardized incidence ratio 30–110). The risk of subsequent contralateral breast cancer was highest in men under 50 years
of age at the time of the diagnosis of the initial cancer. The data on non-breast second primary cancers is diverse. One study
has suggested an increased incidence of cancers of the small intestine, prostate, rectum and pancreas, and of non-melanoma
skin cancer and myeloid leukaemia. Other investigators did not find an increase in the overall risk of subsequent cancer development
in men diagnosed initially with primary breast cancer. Although sarcoma, lung and esophageal cancers are well recognized complications
of radiation therapy for female breast cancer, there is no evidence for the association of these cancers following radiation
therapy in male breast cancer.
Conclusions Although the incidence of second primary cancer in patients with primary male breast cancer requires further study, male breast
cancer survivors should probably undergo periodic screening for the early detection of second breast cancers and other adverse
health effects. 相似文献
18.
Hideo Shigematsu Yoshiaki Nakamura Kimihiro Tanaka Satoko Shiotani Chinami Koga Hidetoshi Kawaguchi Sumiko Nishimura Kenichi Taguchi Kenichi Nishiyama Shinji Ohno 《International journal of clinical oncology / Japan Society of Clinical Oncology》2010,15(6):615-620
We report a case of HER-2-positive advanced inflammatory breast cancer with invasive micropapillary component showing a complete
response to trastuzumab and paclitaxel treatment. A 37-year-old woman was referred to our hospital for right breast swelling
with broad skin redness and right axillary tumor. Ipsilateral infraclavicular and contralateral axillary lymph nodes swelling
were also recognized. The histopathological findings of core-needle biopsy specimens from primary breast tumor and ipsilateral
axillary lymph node were invasive ductal carcinoma with a micropapillary component. Immunohistochemical examination gave a
negative result for estrogen receptor (ER)/progesterone receptor (PgR), and overexpression of HER-2 (Hercep Test 3+). Advanced
inflammatory breast cancer with an invasive micropapillary component was diagnosed (T4d N3 M1 (LYM), stage IV). The patient
was treated with combination chemotherapy using weekly paclitaxel and trastuzumab. After administration of three courses,
the breast swelling, skin redness, and lymph node swelling disappeared completely. She maintained complete remission of disease
for 12 months and was judged to have a clinically complete response by the RECIST criteria. Invasive micropapillary carcinoma
is known to be an aggressive histological type associated with a high incidence of lymph node metastasis and poor prognosis.
This is the first reported case of advanced inflammatory breast cancer with an invasive micropapillary component showing a
clinically complete response to trastuzumab-containing treatment. This report suggests trastuzumab-containing chemotherapy
is a promising therapy for HER-2-positive advanced invasive micropapillary carcinoma. 相似文献
19.
Olivia Pagani Karen N. Price Richard D. Gelber Monica Castiglione-Gertsch Stig B. Holmberg Jurij Lindtner Beat Thürlimann John Collins Martin F. Fey Alan S. Coates Aron Goldhirsch 《Breast cancer research and treatment》2009,117(2):319-324
The current therapeutic strategy in breast cancer is to identify a target, such as estrogen receptor (ER) status, for tailoring
treatments. We investigated the patterns of recurrence with respect to ER status for patients treated in two randomized trials
with 25 years’ median follow-up. In the ER-negative subpopulations most breast cancer events occurred within the first 5–7 years
after randomization, while in the ER-positive subpopulations breast cancer events were spread through 10 years. In the ER-positive
subpopulation, 1 year endocrine treatment alone significantly prolonged disease-free survival (DFS) with no additional benefit
observed by adding 1 year of chemotherapy. In the small ER-negative subpopulation chemo-endocrine therapy had a significantly
better DFS than endocrine alone or no treatment. Despite small numbers of patients, “old-fashioned” treatments, and competing
causes of treatment failure, the value of ER status as a target for response to adjuvant treatment is evident through prolonged
follow-up. 相似文献
20.
Yoshii T Ohkawa S Watanabe T Ogata T Kitamura T 《Gan to kagaku ryoho. Cancer & chemotherapy》2011,38(11):1845-1848
A 63-year-old man with dysphagia visited our hospital in February 2007. Esophagogastroduodenoscopy and computed tomography revealed that he suffered from advanced esophageal cancer with intramural metastasis at clinical stage III (T3N1). The patient underwent induction chemotherapy because he had great difficulty deciding which treatment would be more beneficial for him use dash surgery or chemoradiation. The reason for his in decision was that esophageal cancer with intramural metastasis is known to have a poor prognosis after surgery, and although chemoradiation is the more attractive therapy that avoids invasive surgery, it is very difficult to predict a response. Currently, he has survived for more than 3 years with no recurrence, after chemoradiation that followed a good response to induction chemotherapy. This result suggested that induction chemotherapy followed by chemoradiation can be one of the useful strategies for patients who have esophageal cancer with a negative prognosis factor for surgery, such as intramural metastasis. 相似文献