Synchronous Multiple Metastases Research Articles

СОВРЕМЕННОЕ ЛЕЧЕНИЕ НЕМЕЛКОКЛЕТОЧНОГО РАКА ЛЁГКОГО С ВНУТРИМОЗГОВЫМИ МЕТАСТАЗАМИ И МЕТАСТАТИЧЕСКИМ ПОРАЖЕНИЕМ ПЕЧЕНИ, ЛИМФАТИЧЕСКИХ УЗЛОВ СРЕДОСТЕНИЯ, КОСТЕЙ СКЕЛЕТА. КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Introduction: The article covers issues related to modern methods of treatment of non-small cell lung cancer (NSCLC) with multiple synchronous metastases in brain, liver, mediastinal lymph nodes, skeletal bones and describes a clinical case of modern effective treatment and long-term follow-up of a patient with advanced NSCLC and extra- and intracranial metastatic spread.
 Purpose: Evaluation of modern methods of special antitumor treatment and their application in clinical practice for the treatment of metastatic NSCLC.
 Material and methods: Modern methods of proton and photon radiation therapy, targeted therapy are considered.
 Results: The use of modern methods of special antitumor therapy has increased the overall and relapse-free survival rate of patients with multiple metastases of NSCLC in brain, liver, mediastinal lymph nodes, skeletal bones reducing the need for additional interventions. This is confirmed by a long-term follow-up after modern effective antitumor treatment of a patient with advanced NSCLC and synchronous progression in the form of extra- and intracranial metastatic spread. The patient has been alive for more than 2 years from the moment of progression with an estimated life expectancy of 4–5 months.
 Conclusion: Modern methods of special antitumor therapy can increase the survival rate of patients with multiple synchronous NSCLC metastases in brain, liver, mediastinal lymph nodes, skeletal bones without significant deterioration in their quality of life.

Prognosis of the combination therapy results in patients with synchronous metastases of colorectal cancer

Objectives - to optimize the indications for radiofrequency thermal ablation in patients with synchronous multiple metastases of colorectal cancer to the liver on the basis of prognostic treatment results. Material and methods. The study group included 78 patients with colorectal cancer with synchronous multiple bilobar liver metastases, who have underwent combined treatment in the period of 2007- 2015, such as cytoreductive surgery removing the primary intestinal tumor in combination with RFA of metastases in the liver, followed by chemotherapy. Results. A computer program for preoperative risk assessment of disease progression was developed and introduced in clinical practice. It is based on the results of the analysis of the factors, predicting the risk of relapse during the first year after cytoreductive surgery with RFA of synchronous multiple CRC liver metastases. Conclusion. The index of metastatic liver damage (the product of the sum of the diameters of metastatic liver lesions by their number), the mutational status of the KRAS gene, CEA values are significant factors in predicting the progression of the disease, which can optimize indications for radiofrequency thermal ablation in the treatment of patients with stage IV CRC with synchronous metastases to the liver.

Long-term survival after adrenal metastasectomy from colorectal cancer: a report of two cases

BackgroundSolitary adrenal metastasis from colorectal cancer is rare. Adrenal metastasis is usually detected with synchronous multiple metastases in other organs and is, therefore, considered to be unsuitable for surgical resection. The long-term outcomes of patients with solitary adrenal metastasectomy from colorectal cancer have been reported; however, the survival advantage has not been established. We herein report two cases of curative adrenal resection in patients with solitary adrenal metastasis from colorectal cancer who achieved long-term survival of > 9 years without recurrence after surgical resection.Case presentationThe first case involved a 71-year-old man who underwent abdominoperineal rectal resection for rectal cancer. Preoperative CT revealed a mass in the right adrenal, which was growing after surgery. After chemotherapy the adrenal mass decreased in size, and adrenalectomy was performed at 8 months after the first surgery. A pathological examination confirmed metastasis from rectal cancer. The patient received adjuvant chemotherapy and is currently alive without recurrence at 9 years after the adrenalectomy. The second case involved a 53-year-old man who underwent sigmoidectomy for sigmoid colon cancer. Four years later, lobectomy was performed for isolated lung metastasis. Twenty months later, PET-CT revealed solitary metastasis in the left adrenal gland and adrenalectomy was performed. A histopathological examination revealed metastatic adenocarcinoma of sigmoid cancer. Postoperative chemotherapy was administered after adrenalectomy and the patient is currently alive and apparently disease-free at more than 9 years after undergoing adrenal metastasectomy.ConclusionCurative resection for solitary adrenal metastasis from colorectal cancer may be beneficial for survival.

Long-term outcome of adrenalectomy for metastasis resulting from colorectal cancer with other metastatic sites: A report of 3 cases.

Metastasis to the adrenal glands is a relatively frequent observation at autopsy of patients that have succumbed to cancer. Long-term disease-free survival has been reported in patients following the resection of solitary adrenal metastasis resulting from colorectal cancer. In addition, following primary resection for colorectal cancer, solitary metastasis to the adrenal glands is rare, even in outpatients at routine follow-ups. Therefore, adrenal metastasis is usually detected in combination with multiple synchronous metastases at other sites in the terminal stages of cancer. Between 1998 and 2002, 3 patients with adrenal metastasis and other synchronous metastatic sites underwent surgery for adrenal metastasis at the Department of Gastroenterological Surgery at Osaka University. The other synchronous metastatic sites observed in the 3 patients consisted of lung and para-aortic lymph nodes. In total, 2 out of the 3 patients experienced long-term disease-free survival for >5 years following surgery and 1 patient underwent curative resection for recurrence of metastases in the liver and right adrenal gland 79 months subsequent to the initial resection for adrenal metastasis. All 3 patients survived for >90 months. In conclusion, aggressive surgical resection for adrenal metastasis and other metastatic sites resulting from colorectal cancer may result in a survival benefit in selected patients.

Prolonged Response to Cytoreductive Surgery and Sunitinib in an Elderly Patient with Synchronous Multiple Metastases from Renal Cell Carcinoma

One third of patients with renal cell cancer have metastatic disease at diagnosis. Until now the outcome of these patients has been poor due to the variable natural history of the disease and the lack of effective therapy. Multitargeted therapy of advanced renal cell cancer appears to be a better option than immunotherapy. We report the case of an elderly patient with skin, lung, bone and brain metastases and widespread intraabdominal disease treated with cytoreductive surgery and sunitinib, resulting in a prolonged response.

The role of initial immunotherapy as selection for nephrectomy in patients with metastatic renal cell carcinoma and the primary tumor in situ.

A prospective pilot study in patients with metastatic renal cell cancer and the primary in situ to assess the feasibility of immunotherapy prior to nephrectomy and to evaluate the rationale for a future randomized trial to define the role of response to upfront immunotherapy as selection for cytoreductive surgery. Sixteen patients with synchronous multiple metastases were treated with the primary tumor in place and were evaluated with regard to age, sex, sites of extrarenal disease, morbidity, response, nephrectomy rate, time to progression and overall survival. Immunotherapy consisted of 2 courses low-dose IL-2 4MIU/m(2), subcutaneous GM-CSF 2.5 microg/kg and interferon-alpha (IFN-alpha) 5MU flat on day 1-13 and 22-34. Patients with either partial remission (PR) or stable disease (SD) underwent nephrectomy followed by a third and fourth course. No response was seen in the primary tumors. With regard to extrarenal sites SD was noted in nine cases, PR in two and progressive disease (PD) in five. Eleven patients underwent nephrectomy. No surgical complete response (CR) could be achieved. All patients with PD died after a median overall survival of 3 months versus 11.5 months (range 4-22) in those who underwent nephrectomy. Four patients are still alive at 10, 12, 18 and 19 months. Median duration of response was 6 months (range 2-10). One patient with SD following nephrectomy developed CR after two additional cycles, which is currently maintained for >10 months. Absence of progression at metastatic sites following immunotherapy may be used as a selection for nephrectomy in this selected group. Non-responding patients can be spared from surgery. A randomized study is needed to assess the timing of nephrectomy in combination with immunotherapy with regard to morbidity, overall survival and quality of life.

AN 7-YEAR SURVIVING PATIENT WITH STAGE IV MUCINOUS CARCINOMA OF THE COLON WITH RESECTION OF METASTATIC FOCI 4 TIMES

We report a patient with stage IV mucinous carcinoma of the colon who is surviving for 7 years after the initial operation with resection of metastatic foci 4 times. The patient was a 47-year-old man. In October, 1990, he underwent a laparotomy for a cancer of the transverse colon adhered to the jejunum, when peritoneal dissemination was noted in the greater omentum and resections of the transverse colon, jejunum and omentum with colostomy were performed. Pathological report was mucinous carcinoma, H0, P1 and stage IV. Another peritoneal dissemination involved the descending colon and ileum appeared and was resected in November 1993. A recurrence of the abdominal wall incision appeared and was resected in February, 1996. Peritoneal dissemination involved the ileum and left ureter appeared which was resected in May, 1997 and metastasis to the left external iliac lymph node was resected in March, 1998. In spite of 4 times of operations for metastasis, the patient is doing well as of 7 years after the initial operation. It is thought that we were able to resect lesions because no synchronous multiple metastasis had occurred. The positive additional resection for metastasis is useful for long term survival if the lesion is solitary.

大腸癌同時性多発性肝転移症例に対する肝切除術の意義

大腸癌同時性多発性肝転移症例に対する肝切除術の意義

Site-Specific Differences in pp60 c-src Activity in Human Colorectal Metastases

The c- src proto-oncogene has been implicated in the progression of primary human colorectal carcinoma to hepatic metastasis. To determine if increased pp60 c- src tyrosine kinase activity is a colon-specific phenomenon present in colorectal metastases to all sites, the pp60 c- src -specific kinase activity of noncolon tumor metastases to the liver was compared to that of colorectal liver metastases. Activity of extrahepatic colon carcinoma metastases was compared to that of colorectal liver metastases as well as that of normal colonic mucosa. The specific activity of pp60 c- src in multiple synchronous metastases from colon carcinoma was also examined. Tyrosine kinase activity was determined by immune complex kinase assay; protein levels were determined by immunoblotting. Specific activity was calculated for each group by dividing the total activity by protein level. Colon carcinoma metastases to the liver had significantly ( P < 0.04) increased pp60 c- src activity with an average 2.2-fold increase over normal mucosa. In contrast, noncolon tumor metastases to the liver showed minimal pp60 c- src kinase activity. Extrahepatic colorectal metastases demonstrated significantly increased ( P < 0.005) pp60 c- src activity with an average 12.7-fold increase over normal mucosa. When compared to colon liver metastases, extrahepatic colorectal tumor metastases show a significant difference in activity ( P < 0.05) with an average 5.7-fold increase. Examination of multiple synchronous colon carcinoma metastases confirmed these results. In summary, we conclude that (1) the activation of pp60 c- src between primary tumors and metastases is specific to colon metastases, and (2) although pp60 c- src activity is significantly increased in colorectal metastases, site-specific differences in the magnitude of activity are evident.