Lymphoangionodulary anastomosis in cancer with metastases in lymph nodes

The paper presents the research results of lymphoangionodulary anastomosis perfusion properties in breast cancer. We have carried out the detailed study of 100 axillary lymph nodes affected with metastatic breast cancer and removed them using the method of sonolipodestruction ex vivo. The results obtained in the course of the study provide a basis for a new look at the problems of lymphodynamics in metastatic damage of a lymph system.     

The Medical Treatment of Metastatic Renal Cell Cancer

Patients who present with or subsequently develop metastases from renal cell carcinoma still have a poor prognosis. However, in recent years the use of immunotherapy as either a single agent or in double or triple combinations has shown some welcome reproducible responses in this disease. Too much reliance, however, on phase II studies has tended to obscure the critical role of prognostic factors in the survival of patients with metastatic renal cell cancer. A critical analysis is offered with the current state of therapy and the exciting new fields of therapeutic research are discussed.     

Metastatic tumors in the hand from adenocarcinoma of the colon

Osseous metastases to the hand are rare. The primary site is usually in the lung, breast, or kidney. Two cases of metastatic tumor in the hand from adenocarcinoma of the colon are reported herein. These patients presented two and four years after initial resections of colonic carcinomas. General aspects of diagnosis, etiology, and management are discussed.     

ER、PR、Her-2及Ki-67在乳腺癌原发灶及同期腋窝淋巴结转移灶中表达一致性的研究进展

雌激素受体、孕激素受体、人表皮生长因子受体2及细胞核相关抗原是乳腺癌诊疗中常用的生物学标志物。临床上多是基于上述生物学标志物在乳腺癌组织中的表达情况来区分乳腺癌不同的分子亚型以及制订个体化的治疗方案。近来,国内外很多临床研究表明,上述生物学标志物在乳腺癌原发灶与腋窝淋巴结转移灶中的表达存在一定的差异,该文就乳腺癌原发灶与同期腋窝淋巴结转移灶中常见生物学标志物表达的差异予以综述。     

Outcomes of pulmonary metastases in hepatoblastoma — is the prognosis always poor?

Background

Hepatoblastoma is a rare tumour accounting for approximately 1% of all paediatric malignancies. Hepatoblastoma complicated by pulmonary metastatic disease continues to cause management difficulties due to a lack of robust evidence and treatment guidelines.

Method

This series is the experience of a tertiary paediatric referral centre. Patients were prospectively enlisted, and their charts were retrospectively reviewed.

Results

Thirty-seven patients were treated for hepatoblastoma from 1995 to 2012 inclusive. The overall survival was 34/37(91.9%). Eight patients had lung metastases at diagnosis (LMD) and twenty-nine did not (NLMD). Two-year EFS was 62.5% in the LMD group and 89.3% in the NLMD group (p = 0.078). Overall survival in the LMD and NLMD groups was 100% and 89.7%, respectively (p = 0.389). Two patients in the LMD group required multiple thoracic resections to achieve cure. Within the NLMD group, two patients developed lung metastases whilst on treatment, and both of these patients died.

Conclusion

In this series, children presenting with lung metastases had a higher risk of relapse but excellent overall survival. However, children who developed pulmonary disease during treatment had a poor prognosis. We advocate aggressive surgical treatment of pulmonary hepatoblastoma to achieve cure.     

Thermometry during coblation and radiofrequency ablation of vertebral metastases: a cadaver study

Purpose

To evaluate safety of coblation of simulated lytic metastases in human cadaveric vertebral bodies by measuring heat distribution during thermal tissue ablation and comparing it to radiofrequency ablation (RFA).

Materials and methods

Three devices were compared: a 10 mm single-needle RFA electrode, a 20 mm array RFA electrode and the coblation device. To simulate bone metastases, a spinal tumor model was used stuffing a created lytic cavity with muscle tissue. Measuring of heat distribution was performed during thermal therapy within the vertebral body, in the epidural space and at the ipsilateral neural foramen. Eight vertebral bodies were used for each device.

Results

Temperatures at heat-sensitive neural structures during coblation were significantly lower than using RFA. Maximum temperatures measured at the end of the procedure at the neural foramen: 46.4 °C (±2.51; RFA 10 mm), 52.2 °C (±5.62; RFA 20 mm) and 42.5 °C (±2.88; coblation). Maximum temperatures in the epidural space: 46.8 °C (±4.7; RFA 10 mm), 49.5 °C (±6.48; RFA 20 mm) and 42.1 °C (±2.5; coblation). Maximum temperatures measured within the vertebral body: 50.6 °C (±10.48; RFA 10 mm), 61.9 °C (±15.39; RFA 20 mm) and 54.4 °C (±15.77; coblation).

Conclusion

In addition to RFA, the application of coblation is a safe method to ablate vertebral lesions with regards to heat distribution at heat-sensitive neural spots. The measured temperatures did not harbor danger of thermal damage to the spinal cord or the spinal nerves.     

Gamma Knife radiosurgery in the management of brainstem metastases

Background

Metastases to the brainstem portend a poor prognosis and present a challenge in clinical management. Surgical resection is rarely a viable option.

Methods

Post-treatment MRI scans of patients with brainstem metastases treated with radiosurgery were used to determine local control and disease progression. Median survival was calculated using Kaplan–Meier analysis. Univariate and multivariate analyses were performed using log-rank test and Cox proportional hazards model, respectively.

Results

Thirty-two consecutive patients with brainstem metastasis underwent Gamma Knife radiosurgery. Median age was 50 years. Median tumor volume was 0.71 cm³ and median tumor margin dose was 13 Gy. Seventeen of 32 patients received WBRT prior to stereotactic radiosurgery. Median survival was 5.2 months. There was a statistically significant difference in survival based on RTOG recursive partition analysis (RPA) class. Median survival of patients categorized as RPA class I was 19.2 months, RPA class II was 8.4 months, and RPA class III was 1.9 months. The overall local tumor control rate was 87.5%. There were no acute complications following stereotactic radiosurgery and no evidence of radiation necrosis noted on post-treatment MRI scans.

Conclusion

Stereotactic radiosurgery is an effective treatment for brainstem metastases and should be considered especially for patients with good performance status.