Solitary Metastatic Lesion Research Articles

Initial Frontal Sinus and Orbit Tumor Signaling Late Distant Metastasis in Kidney Cancer.

Although metastases to the paranasal sinuses are exceedingly rare, when they do occur, renal clear cell carcinoma is the most frequent primary tumor involved. The aim of this work was to present a case of metastatic clear cell renal carcinoma in the frontal sinus and orbit region, 7 years after the initial diagnosis and treatment. The patient was referred to our clinic due to drooping of the left eyelid and displacement of the left eyeball. Computed tomography revealed an expansive lesion in the left frontal sinus and orbit, causing destruction of its anterior, lateral, and roof walls. Profuse bleeding from the tumor and left orbit hindered a comprehensive assessment of tumor extension into the orbit and residual tumor size. Therefore, complete tumor removal was not possible; instead, reduction was achieved. Subsequent histopathologic and immunohistochemical analysis confirmed the lesion as a metastasis of renal cell carcinoma in the sinonasal tract. Unfortunately, 10 weeks later, the patient passed away. Treatment of metastatic clear cell renal carcinoma depends on the localization of the disease as well as the overall condition of the patient. If there is a solitary metastatic lesion, as in the case of the sinonasal region, surgical treatment is recommended. Metastasis of clear cell renal carcinoma to the sinonasal region is a rare occurrence; however, it is essential to consider it in cases of rapidly growing tumor masses, typically presenting with symptoms such as epistaxis and nasal obstruction.

Palliative surgery versus non-surgery of the solitary metastatic lesion in De novo metastatic breast cancer: A SEER based study.

This study aimed to evaluate whether palliative surgery for metastatic lesion could provide a survival benefit in metastatic breast cancer (MBC) patients with solitary metastasis. De novo MBC patients with solitary distant lesions were enrolled utilizing the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was conducted to form matched pairs of the surgery group and the non-surgery group. The breast cancer-specific survival (BCSS) and overall survival (OS) outcomes between the 2 groups were compared in the following 3 sample models: the entire cohort of MBC (7665 cases); subgroups of patients with different isolated metastatic organs; and subgroups of patients with different molecular subtypes for each isolated metastatic organ. Compared with the Non-surgery group, the surgery group showed better BCSS and OS before PSM (HR = 0.88, 95% CI = 0.79-0.99, P = .04 and HR = 0.85, 95% CI = 0.76-0.95, P = .006, respectively). After PSM, palliative surgery still provided an OS benefit in patients with brain metastasis and lung metastasis (HR = 0.59, 95% CI = 0.37-0.95, P = .01 and HR = 0.64, 95% CI = 0.45-0.90, P = .02, respectively). Likewise, a better BCSS benefit was also found in the subset of patients with brain metastasis (HR = 0.61, 95% CI = 0.38-1.00, P = .01). Further stratification analysis indicated that patients with the luminal A subtype with brain metastasis have a better BCSS (HR = 0.36, 95% CI = 0.16-0.79, P = .04) and OS (HR = 0.37, 95% CI = 0.18-0.75, P = .03) after undergoing palliative surgery than nonsurgical treatment. Our study originality showed that palliative surgery for metastatic lesion could improve survival prognosis in patients with special single-organ metastasis and specific molecular subtypes. More clinical studies are needed to determine whether palliative surgery should be performed in MBC patients.

Therapeutic options for different metastatic sites arising from renal cell carcinoma: A review.

Renal cell carcinoma (RCC) stands among the top 10 malignant neoplasms with the highest fatality rates. It exhibits pronounced heterogeneity and robust metastatic behavior. Patients with RCC may present with solitary or multiple metastatic lesions at various anatomical sites, and their prognoses are contingent upon the site of metastasis. When deliberating the optimal therapeutic approach for a patient, thorough evaluation of significant risk factors such as the feasibility of complete resection, the presence of oligometastases, and the patient's functional and physical condition is imperative. Recognizing the nuanced differences in RCC metastasis to distinct organs proves advantageous in contemplating potential treatment modalities aimed at optimizing survival outcomes. Moreover, discerning the metastatic site holds promise for enhancing risk stratification in individuals with metastatic RCC. This review summarizes the recent data pertaining to the current status of different RCC metastatic sites and elucidates their role in informing clinical management strategies across diverse metastatic locales of RCC.

Atypical case of glioblastoma localization: infratentorial localization (Clinical Case and the Review of the Literature)

Glioblastoma is the most common high-grade primary brain tumor, occurring primarily in adults. This infiltrating tumor locates deep in the white matter, subcortical structures and thalamus. The typical localization of glioblastoma is supratentorial, accounting for more than 99% of cases. Primary infratentorial growth of glioblastomas involving the cerebellum is a very rare condition, occurring in less than 1 % of cases reported in the literature. The differential diagnosis consists mainly of solitary metastatic lesions and medulloblastoma. The clinical manifestations of cerebellar lesions are similar, but the methods of surgical and chemoradiotherapy treatment, prognosis and outcome in cases with various histologic types of the tumors are different.Thus radiology, carried out using multiparametric MRI mapping, is an decision making procedure. In thus publication we present an atypical case of infratentorial glioblastoma in a 45-yearold patient.

Case report: role of multidisciplinary approach in a case of spine osteosarcoma with oligometastatic heart disease

Introduction. Primary spinal osteosarcoma and rare metastatic heart lesion are considered significant factors for poor prognosis. The available work indicates that combined treatment, including the radical surgery of heart solitary metastatic lesion, probably provides the best outcome.Case report. Man, 27-year-old, with Th8 spinal osteosarcoma and solitary left atrial metastasis. From October 2019 to February 2020 5 cycles of chemotherapy (high doses of platinum and doxorubicin) were carried out with positive effect. Next steps were surgery: March 2020 – spondylectomy of the Th8 vertebra with combined stabilization; September 2020 – subtotal resection with plasty of the right atrium, tricuspid valve and prosthesis of the right coronary artery. Between the first and second surgery, 4 more same chemotherapy cycles were carried out. Currently, 24 months after completion of treatment, there are no signs of the disease.Conclusion. The article presents a unique case of treatment of primary osteosarcoma and metastatic lesion of rare location. Multidisciplinary approach and combination treatment in specialized centers increase the probability of favorable outcome in such cases.

FDG PET/CT reveals bone marrow oligometastasis in laryngeal squamous carcinoma: a case report with favorable outcome

Laryngeal carcinoma is the most common head and neck cancer. The vast majority of laryngeal carcinomas are of squamous-cell histologic type. Metastasis of laryngeal cancer typically occurs within the cervical lymph nodes and seldom in other regions. Although a small percentage of patients experience distant metastases, bone marrow metastasis from laryngeal cancer is among the least common metastatic sites. Previous literature has suggested that bone marrow carcinomatosis is aggressive and has a poor outcome, particularly in patients with supraglottic tumors. Ante-mortem diagnosis of this metastatic pattern has been limited. To our knowledge, this case report highlights the first documented occurrence wherein the utilization of 18-fluorine fludeoxyglucose positron emission tomography/CT imaging played a pivotal role in the early detection of bone marrow metastasis in a patient diagnosed with transglottic laryngeal cancer. A solitary metastatic distant bone marrow lesion was identified early during follow-up. As a consequence, the patient exhibited a remarkable and unforeseen favorable clinical outcome.

A rare clinical presentation of lung cancer: two cases of solitary digital metastasis on Tc-99m MDP bone scan

BackgroundAcrometastases are accounted for a very small proportion of bone metastases. Lung cancer is the most common acrometastasis origin, and it often has a poor prognosis. The aim of the present cases is to describe the probability of an acrometastasis in the differential diagnosis of finger lesions and to emphasize the importance of taking local views of extremity of complaint for proper interpretation in such patients.Case presentationHere we reported two patients with metastases to the fingers with occult primary lung carcinoma and a history of prior lung malignancy, respectively. First case was a 58-year-old man with history of pain and swelling in the fourth finger of his left hand. He underwent an amputation from the metacarpophalangeal level and the pathological diagnosis was metastatic NSCLC. The second case was a 65-year-old ex-smoker man with a history of prior lung cancer (adenocarcinoma) suffered from a swollen, erythematous, painful tip of the right third finger. Phalangectomy was performed and the histological examination of the amputated part revealed the presence of a metastatic differentiated carcinoma of pulmonary origin.ConclusionsWhen assessing the masses located at fingers, possibility of a solitary metastatic lung lesion should be considered.

Changes in Target Coverage and Dose to the Normal Brain during Fractionated Stereotactic Radiotherapy for Metastatic Brain Tumors

Fractionated stereotactic radiotherapy (SRT) has been applied to large brain metastases to reduce the risk of radiation necrosis. For fractionated SRT, potential of interfractional tumor changes during the treatment period, such as tumor size, shape, and geometry, must be considered to improve the tumor local control. Our center performs adaptive re-planning for large brain metastases based on repeat MRI verification with a contrast agent in the middle of the treatment period. Purpose of this study is to evaluate the dosimetric impact of the changes in tumor size, shape, and geometry on the doses to the targets and normal brain in patients with brain metastases undergoing fractionated SRT. Fifteen solitary large intracranial metastatic lesions treated with fractionated SRT were investigated. Standardized planning MRI (MRI-1) and repeat verification MRI (MRI-2) were performed during the middle of the irradiation period. The GTV on the MRI-1 and MRI-2 scans was contoured by the same oncologist. The PTV was created by adding an isotropic margin of 1 mm from the GTV in all directions. Volumetric modulated arc therapy (VMAT) with beam energies of 6 MV (flattening filter-free mode) was used and plans were normalized such that PTV D95% or D98% was equal to the prescribed dose. Beam configuration and intensity on the initial VMAT plan were used to evaluate the dose to the tumor and the normal brain on MRI-2. We evaluated the impact of D98% on the GTV using the plans on the MRI-1 and MRI-2 scans. For the normal brain, the V90%, V80%, and V50% were investigated. The median GTV changed from 9.8 cc (range of 3.2-33.0 cc) to 9.7 cc (range of 2.8-36.5 cc) (p = 0.482). Three and four tumors exhibited volume shrinkage and enlargement changes of >10%. Five tumors exhibited volume shrinkage and enlargement changes of <10%. Three tumors showed no volume changes. Of the 15 large brain metastases, 12 tumors required treatment plan modification. The dosimetric parameters of the GTV, PTV, and normal brain did not significantly differ between the MRI-1 and MRI-2 scans. Regarding the tumor dose, the D98% to the GTV increased in patients with tumor shrinkage because of dose inhomogeneity and decreased in patients with tumor enlargement. The V90%, V80%, and V50% increase with decreasing tumor volumes and were linearly related to the tumor volume difference, with a coefficient of determination of 0.97, 0.98, and 0.97, respectively. Our study demonstrated the usefulness of repeat verification MRI for adaptive radiotherapy in the middle of the treatment period due to changes in tumor size, shape, and geometry in patients with brain metastases. Repeated MRI should be considered to evaluate the dose to the target and normal brain, which improves tumor local control and reduces brain necrosis, to reduce the magnitude of underdosing to the target or overdosing to the normal brain during the treatment period.

Metastasectomy for oligometastatic bone disease of the appendicular skeleton: A concise review.

As the life expectancy of patients with carcinomas improves, there is an associated increase in the risk of development of metastatic bone disease. Patients with solitary or oligometastatic bone disease of the appendicular skeleton may benefit from metastasectomy and reconstruction to improve overall survival. Specifically, patients with renal cell carcinoma and a solitary metastatic bone lesion will have long-term survival benefit from metastasectomy and reconstruction. There remains controversy in the literature about metastasectomy for solitary metastatic bone disease in other common carcinomas, such as breast and thyroid.

Interrelationship between Skeletal and Visceral Metastases in Invasive Ductal Carcinoma of Breast- Observational Study at INMAS, Mitford, Dhaka

Background: Invasive Ductal Carcinoma (IDC) is the most common of all diagnosed breast cancers, and it frequently presents with metastatic spread to the bone as well as other viscera. Bone scintigraphy is the primary tool for detecting bone metastases, while different imaging modalities can be useful in detecting visceral metastases. The purpose of this study was to determine the relationship between skeletal and visceral metastases in female patients with IDC referred to INMAS, Mitford, for bone scintigraphy. Patients and Methods: This observational study was conducted at the Institute of Nuclear Medicine and Allied Sciences (INMAS), Mitford, Dhaka, from July 2020 to July 2021. Bone scintigraphy was done with a Siemens dual-head gamma camera after an intravenous injection of 20 mCi of 99mTc-MDP. Both anterior and posterior views were obtained, with additional SPECT images when needed. Images were interpreted and analysed by Nuclear Medicine (NM) physicians of this institute. Data about visceral metastases were collected from patients’ record files. Results: The patients were divided into two groups based on the presence of visceral metastases. Group-A had 95 patients with no known metastases to the viscera, and in Group-B, there were 50 patients who had documented visceral metastases. The majority of the patients in the first group (53.7%) showed no bone metastasis, while a small portion (5.3%) revealed a solitary skeletal metastatic lesion and the rest (41.1%) presented with multiple skeletal metastases. Sixty-six percent of patients in Group B had solitary visceral metastases, with the remaining 34% having metastases to multiple viscera. All the patients in this group were affected at various levels by secondary skeletal deposits. Conclusion: The findings of the study revealed that the presentation of visceral metastases was related to the extent and severity of bone metastases in patients with carcinoma of the breast. Bangladesh J. Nuclear Med. 25(2): 117-120, 2022

Solitary Metastasis in the Tibia as a Feature of Primary Squamous Vaginal Carcinoma

Aim: Primary vaginal cancer is rare, comprising about 3% of all gynaecological malignancies. Solitary bone metastases to appendicular skeleton are extremely rare and there are only few published reports. We report the case of isolated metastasis in the tibia as a feature of primary squamous vaginal carcinoma. We present this case because of its rarity and for documentation and discussion purposes. Case report: We present a case of a 44-year old woman diagnosed with squamos vaginal cancer in June 2015. Computed tomography of the thorax, abdomen and pelvis revealed no distant metastases. She was treated with interstitial intracavitary brachytherapy and concomitant chemoradiotherapy. In March 2016 she was admitted to our hospital because of the swelling and the pain in the lower right leg. There was no history of trauma and plain radiographs were normal. Two months later, after further progression of pain, plain radiographs showed intramedullary permeative bone lesion with cortical disruption of tibial dyaphisis and local soft tissue swelling. MRI and core needle biopsy confirmed vaginal cancer metastasis containing tumor cells identical to the primary tumor. The patient was treated with radiotherapy and chemotherapy. Despite the treatment there was further progression of the disease with multiple bone metastases and eventually lung and brain metastases. Conclusion: This case report is another reminder that although extremely rare, solitary metastatic bone lesions of vaginal cancer are possible. Since symptoms mimic various benign conditions, it is important to consider bone metastasis as possible diagnosis in patients with progressive bone pain not responding to analgesic treatment.

Development of a prognostic model in patients with metastatic bone lesions to choose surgical treatment: retrospective study

Choosing surgical management for patients with metastatic bone lesions is one of the essential problems of modern oncology. Surgical interventions are aimed at palliative treatment in most patients with metastatic skeletal lesions. However, curative resections with reconstruction and plasty steps may be considered in selected cases of a solitary metastatic lesion. The life expectancy prognosis based on the histological structure of the tumor is a significant and decisive factor in choosing the appropriate surgery.&#x0D; Aim. To develop a prognostic model for choosing surgical treatment for metastatic bone lesions.&#x0D; Materials and methods. Treatment analysis of 715 patients with a history of surgery for metastatic bone lesions of various localizations is presented. A total of 780 surgical interventions were performed. Surgeries for the complications of bone metastases were mainly performed on the spine (48.5% of all surgeries), followed by long bones with 247 (35%) surgeries, pelvic bones with 81 (11%) interventions, and the chest wall with 40 (5.5%) surgeries.&#x0D; Results. The most unfavorable prognostic factors in patients with metastatic bone lesions are the histological type of the primary tumor of the rapid growth group (risk ratio [RR]=5.11), visceral metastases (RR=3.1), Charlson Comorbidity Index over 10 (RR=3.07) and presence of critical laboratory abnormalities (RR=2.91), as they have the highest rates of impact on survival (over 2.9).&#x0D; Conclusion. The developed 14-point mathematical score of life expectancy prognosis, which includes five oncological and four clinical factors, defines with an accuracy of 91% the risk groups of good (estimated life expectancy over one year), moderate (6 to 12 months), and poor (less than six months) prognosis in patients with metastatic bone lesions.

A systematic review of endoprosthetic replacement versus cement spacer in reconstruction of proximal humerus following proximal humerus metastasis

Abstract Background The choice between cement spacer and endprosthesis in the treatment of metastatic lesions to the proximal humerus is increasingly controversial. However, it may be easier to categorize the patients, and their socioeconomic and perioperative parameters into two groups. Aim This work aims to review the available literature on the topic of endoprosthetic replacement versus cement spacer in the reconstruction of the proximal humerus following metastatic lesions to the proximal humerus regarding the surgical technique, its indications, its advantages, and limitations. Patients and methods We followed the preferred reporting items for systematic review and Meta-analysis (PRISMA) statement guidelines during this systematic review and performed all steps according to the Cochrane Handbook of Systematic Reviews of Intervention. Results Four studies were included in this systematic review, and a total of 100 patients were included (22 of which had cement spacer and 78 had endprosthesis). Several parameters were compared in the reviewed studies including the MSTS score of the patients; the primary tumor; postoperative complications; the patients’ age; follow-up periods; and the presenting symptoms of the patients. Conclusion This systematic review suggests that the cement spacer technique is not inferior to endoprosthetic replacement of the proximal humerus in cases of metastases. Therefore, we suggest that determining whether to use an end prosthesis or a cement spacer depends on categorizing the patients into two groups. Endoprosthetic replacement will be an appropriate choice for patients with preserved deltoid and axillary nerve function following resection, solitary and nonaggressive metastatic lesion, and long-life expectancy with minimal co-morbidities. We believe that cement spacer is a more appropriate choice in patients with nonfunctioning deltoid or axillary nerve following resection; multiple and aggressive metastatic lesions; short life expectancy with many co-morbidities, and poor socioeconomic status.

Metastasis-directed Therapy Without Androgen Deprivation Therapy in Solitary Oligorecurrent Prostate Cancer.

As controversy remains regarding the role of metastasis-directed therapy in patients with oligometastatic prostate cancer, we sought to characterize outcomes of metastasis-directed therapy without concomitant androgen deprivation therapy in the specific subset of patients with a solitary metastatic lesion on C-11 choline positron emission tomography imaging whose primary tumor has already been treated. We identified 124 consecutive prostate cancer patients from 2008 to 2018 with a solitary oligorecurrent metastatic lesion on positron emission tomography imaging who were treated with metastasis-directed therapy without androgen deprivation therapy from the Mayo Clinic C-11 choline registry. Metastasis-directed therapy consisted of either stereotactic body radiation therapy or surgical excision. Of these 124 patients, 67 were treated with surgery (median follow-up 54 months) and 57 patients were treated with stereotactic body radiation therapy (median follow-up 53 months). Of patients treated with surgery, 80.5% had &gt;50% decline in prostate specific antigen at first follow-up, and the 3-year radiographic progression-free survival was 29%. Median time to initiation of systemic therapy in this cohort was 18.5 months (interquartile range 8.4-44.7 months). Meanwhile, for patients treated with stereotactic body radiation therapy, 40.3% had &gt;50% decline in prostate specific antigen at first follow-up, and the 3-year radiographic progression-free survival was 17%. Similarly, median time to initiation of systemic therapy was 17.8 months (interquartile range 7.1-42.3 months). This study represents the first reported series of metastasis-directed therapy without androgen deprivation therapy in patients with solitary oligorecurrent metastatic prostate cancer. These results suggest that metastasis-directed therapy without androgen deprivation therapy can delay initiation of systemic therapy and highlight the need for further prospective study for select patients with solitary metastatic recurrences of prostate cancer.

Landscape and metastases of the lymph nodes in prostatic anterior fat pad at radical prostatectomy

Objectives: To examine the landscape and metastases of the lymph nodes in prostatic anterior fat pad (PAFP) at radical prostatectomy (RP), and to describe the clinical characteristic of the patients with lymph node metastases in PAFP. Methods: The clinical and pathological data of 287 prostate cancer patients underwent RP from December 2019 to August 2021 in Department of Urology, Sun Yat-sen University Cancer Center were collected and analyzed retrospectively. All patients were male, aging (66±7) years (range: 42 to 83 years). The preoperative prostate-specific antigen (PSA) (M(IQR)) were 16.00(29.64) μg/L (range: 0.01 to 99.90 μg/L). There were 244 patients with localized or locally advanced prostate cancer and 43 patients with metastatic prostate cancer. All PAFP were dissected at RP routinely and were sent for pathologic analysis respectively. The PAFP was dissected from the prostate apex caudally toward the bladder neck and dissection extended to the joint of the prostate and the endopelvic fascia bilaterally. All the specimen of PAFP were examined and reported by subspecialty pathologists of genitourinary tumors. Statistical analysis was performed by Student t test, Wilcoxon rank-sum test, χ2 test or Fisher exact test. Results: There were 8.0% (23/287) patients with lymph nodes in PAFP, 3.8% (11/287) patients with PAFP lymph node metastases. Pathologically upstaged occurred in 1 patient due to the PAFP lymph node as the solitary metastatic lesion. Patients with lymph node metastases in PAFP presented higher preoperative PSA (M(IQR): 48.2(73.0) μg/L vs. 15.4(26.5) μg/L, Z=3.158, P=0.002), clinical T stage and N stage (Z=2.977, P=0.003; Z=2.780, P=0.005) and preoperative Gleason score (Z=2.205, P=0.027). Conclusions: Routine dissection of PAFP at RP and separately pathological analysis may allow more lymph nodes and lymph node metastases detection. More accurate pathological N stage may be acquired and consequently may improve the survival of patients by offering more appropriate adjuvant or salvage therapy.

Differencial diagnosis of primary central nervous system lymphomas based on multiparametric MRT mapping

INTRODUCTION: Primary central nervous system lymphoma (PCNSL) represent a rare and aggressive form of extranodal NonHodgkin’s lymphoma, which is in most cases confined to the brain. Prompt diagnosis and starting treatment are vital. According to imaging, the tumor is characterized by low MR signal in T1, isointense in T2, pronounced and homogeneous uptake of contrast agent and restricted diffusion.OBJECTIVE: to study the effectiveness of MR-/CT perfusion techniques, underlying the multiparametric MRT mapping with the differential diagnosis of primary CNS lymphomas in comparison with poorly differentiated gliomas (grade 3–4 WHO 2021) and solitary metastatic brain injury.МATERIALS AND METODS: The study includes 80 patients with newly identified CNS tumors, later having check-up/neurosurgery treatment in Federal Centre of Neurosurgery (Tyumen, Russia) with histological verification within the period from 2018 to 2021. Depending on histological conclusion, 4 groups of patients were identified: 1–33 cases with PCNSL (out of which 10 cases with not typical manifestation based on the data of perfusion parameters and 23 cases of classical PCNSL), 2 — with anaplastic astrocytomas — 14 cases, 3–23 cases with glioblastomas and 4–10 cases with solitary metastatic lesion. The research was held on magnetic resonance tomography General Electric Discovery W750 3Т, multispiral x-ray computer tomography Canon Aquilion One before and after the contrast enhancement.RESULTS: During the study it was established that MR-/CT perfusion is a limited imaging method, possessing ambiguous sensitivity and specificity with PCNSL diagnosis, as they are characterized by not typical manifestation considered as exception. Nevertheless, the method has some undeniable advantages being indispensable in the algorithm of complex multiparametric diagnostic approach for this type of neoplasm.CONCLUSION: The capacity of neuroimaging PCNSL, even applying improved techniques of MR-/CT data collection, is rather limited and it doesn’t always allow to differentiate this tumor with other neoplasms accurately.

РЕКОНСТРУКТИВНЫЕ И СТАБИЛИЗИРУЮЩИЕ ВМЕШАТЕЛЬСТВА В КОМПЛЕКСНОЙ ТЕРАПИИ ПАЦИЕНТОВ С СОЛИТАРНЫМИ МЕТАСТАЗАМИ ПОЗВОНОЧНИКА

Abstract. Introduction: The problem of diagnosis and treatment of patients with oncological pathology of the spine is relevant due to treatment complexity and the increasing number of patients’ morbidity. Secondary neoplastic processes are common in spine because of its anatomy, physiological features, complex biomechanics and enhanced vascularization. The main clinical manifestations of metastatic lesions of the spine are pain and neurological deficit. The development of spinal cord compression and pain syndrome leads to a sharp deterioration in the quality of life in patients with metastatic lesions of the spine. Despite the progress made in modern surgery of patients with oncological diseases with metastasis to the spine, mortality rates after surgery reaches 6.3% and complications appear in 23% of cases. Aim: Improving the results of treatment of patients with solitary spinal metastases and spinal cord compression. Methods and materials: Between 2010 and 2018, patients with spinal neoformations (N=240) received surgical treatment at Traumatology Unit of North-Western State Medical University named after I.I. Mechnikov. All patients were put into the categories according to their sex, age, histologic type and location of tumors. We assessed patients’ pain severity (BAIII), neurologic status (Frankel scale) and life span (by Kaplan-Meier method). Results: The study presents the analysis of the results of complex therapy of 183 patients with solitary metastases of the spine, who underwent the surgical stage of treatment. For these patients the epidemiological structure and the main clinical and radiological characteristics of solitary metastatic lesions of the spine were determined, a comparative assessment of the effectiveness of various options for surgical interventions in the complex treatment was carried out. To do so, all patients of the primary cohort were divided into 2 groups depending on the volume of surgery. The first group included 54 patients who underwent a radical resection of the affected vertebra in a single block with prosthetics of the anterior support column and posterior instrumental fixation. The second group included 129 patients after palliative decompressive and stabilizing operations from the posterior approach. Conclusion: There were no statistically significant differences between the two studied methods of surgical treatment in terms of the dynamics of the level of pain syndrome, regression of neurological deficit and life expectancy. When choosing the tactics of surgical treatment of patients with solitary spinal metastases, the main method is decompressive and stabilizing interventions, which helps to reduce the risk of surgical complications, improve the quality of life of the patient and continue the complex treatment of the underlying disease.

MP48-08 RESPONSE RATES AND SURVIVAL OUTCOMES OF METASTASIS DIRECTED THERAPIES IN SOLITARY OLIGO-RECURRENT PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022MP48-08 RESPONSE RATES AND SURVIVAL OUTCOMES OF METASTASIS DIRECTED THERAPIES IN SOLITARY OLIGO-RECURRENT PROSTATE CANCER Mohamed Ahmed, Jack Andrews, Vidit Sharma, Cameron Britton, Vidhu Joshi, Bradley Stish, Ryan Phillips, R. Jeffrey Karnes, and Eugene Kwon Mohamed AhmedMohamed Ahmed More articles by this author , Jack AndrewsJack Andrews More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Cameron BrittonCameron Britton More articles by this author , Vidhu JoshiVidhu Joshi More articles by this author , Bradley StishBradley Stish More articles by this author , Ryan PhillipsRyan Phillips More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author , and Eugene KwonEugene Kwon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002619.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Much controversy exists regarding the role of metastasis-direct-therapy (MDT) in patients with oligometastatic prostate cancer. We sought to assess whether there is a role for MDT without ADT in oligometastatic prostate cancer by evaluating a select subset of patients who present early with a solitary metastatic lesion on PET imaging and whose primary tumor has already been treated. METHODS: We identified 124 prostate cancer patients from 2008 to 2018 with solitary oligo-recurrent metastatic lesions on PET imaging who were treated with MDT without ADT from the Mayo Clinic C-11 Choline registry. Patients were treated with either stereotactic body radiation therapy (SBRT) or surgical excision and these cohorts were analyzed separately. RESULTS: Of these 124 patients, 67 were treated with surgery (median follow-up of 54 months) and 57 patients were treated with SBRT (median follow-up of 53 months). Of patients treated with surgery, 86% had >50% decline in PSA at first follow up (Figure 1a) and a median time to radiographic progression of 15 months (Figure 2a). Of patients treated with SBRT, 51% had >50% decline in PSA at first follow up (Figure 1b) and a median time to radiographic progression of 12 months (Figure 2b). CONCLUSIONS: This study represents the first reported series of metastasis directed therapy in patients with solitary metastatic prostate cancer. These results suggest that metastasis directed therapy alone can delay progression of disease, delay initiation of systemic therapy and may have role in the treatment of oligometastatic prostate cancer. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e823 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Ahmed More articles by this author Jack Andrews More articles by this author Vidit Sharma More articles by this author Cameron Britton More articles by this author Vidhu Joshi More articles by this author Bradley Stish More articles by this author Ryan Phillips More articles by this author R. Jeffrey Karnes More articles by this author Eugene Kwon More articles by this author Expand All Advertisement PDF DownloadLoading ...

Multiparametric MR Imaging Features of Primary CNS Lymphomas.

ObjectivePrimary central nervous system lymphomas (PCNS) are relatively rare tumors, accounting for about 4% of all brain tumors. On neuroimaging, they are characterized by a low MR signal in T1, isointense in T2, bright uniform contrast enhancement, and diffusion restriction. The aim of this study is to note the lack of effectiveness of the MR/CT perfusion technique in complex multiparametric imaging in the differential diagnosis of primary lymphomas of the central nervous system in comparison with highly malignant gliomas and brain metastases.Materials and MethodsThis prospective study included 80 patients with CNS tumors examined/operated at the Federal Center for Neurosurgery (Tyumen, Russia) from 2018 to 2021. The patients were divided into 4 groups: group 1 consisted of 33 cases with primary CNS lymphomas (10 cases with atypical manifestations according to perfusion parameters and 23 cases of classic CNS lymphomas), group 2 with anaplastic astrocytomas—14 cases, group 3—23 cases with glioblastomas and group 4—10 cases with solitary metastatic lesions. The study was carried out on a General Electric Discovery W750 3T magnetic resonance tomograph, a Canon Aquilion One multispiral X-ray computed tomograph (Gadovist 7.5 ml, Yomeron 400 mg−50 ml). Additionally, immunohistochemical analysis was carried out with the following markers: CD3, CD20, CD34, Ki-67, VEGF.ResultsIt has been established that MR/CT perfusion is not a highly sensitive method for visualizing primary CNS lymphomas, as previously thought, but at the same time, the method has a number of undeniable advantages that make it indispensable in the algorithm of a complex multiparametric diagnostic approach for this type of tumor. Nevertheless, PLCNS is characterized by an atypical manifestation, which is an exception to the rule.ConclusionsThe possibilities of neuroimaging of primary lymphomas, even with the use of improved techniques for collecting MR/CT data, are limited and do not always allow reliable differentiation from other neoplasms.

Primary undifferentiated pleomorphic sarcoma of the jejunal mesentery with a complicated course: A case report

A primary Undifferentiated Pleomorphic Sarcoma (UPS) of the mesentery is a rare form of malignancy, most commonly usually affecting the soft tissues of the extremities. Due to their location in the abdominal cavity distant from the intestinal loops they remain asymptomatic for a long time. In this study, an incidental finding on imaging is presented in a 66-year-old woman. CT imaging revealed a large mass in her abdomen, with difficulty pinpointing its exact origin. Exploratory laparotomy was performed to remove the mass in its entirety. Examination of the mass showed findings consistent with an undifferentiated pleomorphic sarcoma. She recovered well after her surgery. However, on follow-up imaging, a solitary metastatic lesion in her lung was detected. The prognosis of UPS is historically dismal with invasive treatment options currently being the preferred methods for management.