Solitary Metastatic Lesion Research Articles

Two independent incidences of skin metastases in the umbilicus and abdominal wall in ovarian serous adenocarcinoma

Rationale:Advanced ovarian cancer is usually associated with intra-abdominal metastases and while it commonly spreads directly to the omentum, intestine, liver, or other organs, it can also metastasize through the lymphatic channels and the hematogenous pathway. With an increasing number of invasive operations being performed with chemoradiotherapy, the incidence of extra-abdominal metastases has risen. Nevertheless, ovarian cancer with skin metastases is quite rare.Patient concerns:We report a case of ovarian cancer with two independent incidences of skin metastases in the umbilicus and abdominal wall.Diagnoses:The patient was a 67-year-old woman who was diagnosed with ovarian cancer stage IIIC and underwent cytoreductive surgery. A solitary brown cauliflower-like metastatic lesion, approximately 6 × 5 × 4 cm was identified in the umbilicus area two years after primary surgery. During tumorectomy, intraoperative exploration revealed that while the tumor was located close to the peritoneum, there was no penetration.Interventions:The patient recovered well and received multiple rounds of chemotherapy. Ten months later, the patient presented with skin lesions located on the abdominal wall that grew rapidly and spread from the lower abdomen wall to the bilateral waist and femoral skin. These lesions were multiple, ulcerated, rough heliotrope plaques that produced a foul-smelling faint yellow liquid. Biopsy analysis revealed skin metastasis of poorly differentiated serous adenocarcinoma.Outcomes:The patient was treated with chemotherapy but died 3 months after the skin metastasis occurred for the second time.Lessons:Ovarian cancer with skin metastasis is a rare condition with poor prognosis. Pathological diagnosis of early skin lesions is essential for ovarian cancer patients and that systemic and local disease should be treated with surgery or palliative therapy in order to provide patients with the best chances of survival. Tumorectomy is appropriate when lesions are isolated and when the patient's performance status is good. However, systemic therapy including chemotherapy and radiotherapy should be considered when skin lesions are associated with severe intro-abdominal disease.

Long-Term Survival in Oligometastatic Head and Neck Cancer

Aggressive therapies for patients with a limited burden of metastatic disease are increasingly being administered with definitive intent in the context of clinical trials. However, outcomes in oligometastatic head and neck squamous cell carcinoma (HNSCC) patients have not been well characterized. We reviewed outcomes from 1147 patients who received intensity modulated radiotherapy (IMRT) as part of definitive management for stage I-IVB HNSCC from 2001-2013 at our institution. The primary sites included oropharynx (OPC, n = 735), oral cavity (OCC, n = 182), larynx (LRX, n = 180) and hypopharynx (HPX, n = 50). Among patients who developed distant metastatic recurrence (DM), the burden of disease was assessed by enumeration of the number of clinically or radiographically apparent tumors. Survival estimates following DM were generated using the Kaplan-Meier method and compared using log-rank testing. Cox proportional hazards models were used for univariate (UVA) and multivariate analyses (MVA). A total of 148 (13%) patients developed DM at a median time of 10.7 months (range 0.3-81.2) after IMRT. The cohort included 88 OPC, 21 OCC, 25 LRX and 14 HPX patients. The median follow-up time following DM was 48 months (range 4-131). At the time of metastasis, the median age was 61 (range 28-88), and the median Karnofsky performance status (KPS) was 80 (range 50-100). 5-year survival following DM was significantly longer in patients with a solitary metastatic lesion compared to multiple lesions (Table 1, P = 0.001). No statistically significant differences in survival were seen by pairwise comparisons of patients with 2 vs 3 vs 4 vs 5+ lesions. Of the 19 patients with solitary metastasis, 14 underwent definitive local therapy to the metastatic site with either surgery or radiotherapy. Patients who received definitive local therapy for a solitary metastasis survived longer than those who did not (5-year survival 55.7% vs 0%, P = 0.001), though the patients who did not receive local therapy were of poorer KPS. On UVA and MVA, longer survival after DM was associated with KPS>70, receipt of palliative cetuximab, non-OCC primary, longer time to metastasis and solitary metastatic tumor (MVA hazard ratio 0.31, 95% CI 0.16-0.59, P = 0.001). An oligometastatic phenotype characterizes HNSCC patients with solitary metastasis, demonstrated by a significant proportion of patients surviving 5+ years following the diagnosis of metastatic disease. These findings have important implications regarding clinical trial design for HNSCC in the recurrent and oligometastatic setting.Abstract 296; Table 1Five-year survival following distant metastasis (DM) according to number of metastatic lesions at time of DM# of metastatic lesionsN5-year survival following DM (±Std. error)11939.1% (±12.6%)2317.9% (±5.3%)3205.7% (±5.5%)4110%5+670% Open table in a new tab

Long-term survival in oligometastatic head and neck cancer patients.

6029 Background: Aggressive therapies for patients with oligometastatic disease are increasingly being administered with definitive intent in the context of clinical trials. However, outcomes in oligometastatic head and neck squamous cell carcinoma (HNSCC) patients have not been well characterized. Methods: We reviewed outcomes from 1147 patients who received intensity modulated radiotherapy (IMRT) as part of definitive management for stage I-IVB HNSCC from 2001-2013 at our institution. The primary sites included oropharynx (n=735), oral cavity (OCC, n=182), larynx (n=180) and hypopharynx (n=50). Among patients who developed distant metastasis (DM), the the number of clinically or radiographically apparent tumors was assessed. Survival estimates following DM were generated using the Kaplan-Meier method and compared using log-rank testing. Cox proportional hazards models were used for univariate (UVA) and multivariate analyses (MVA). Results: A total of 148 (13%) patients developed DM at a median time of 10.7 months (range 0.3-81.2) after IMRT. The median follow-up time following DM was 48 months. 5-year survival following DM was significantly longer in patients with a solitary metastatic lesion compared to multiple lesions (table 1, p=0.001). Of the 19 patients with solitary metastasis, the 14 who received definitive local therapy with either surgery or radiation survived longer than those who did not (5-year survival 55.7% vs 0%, p=0.001), though patients who did not receive local therapy were of poorer performance status. On UVA and MVA, longer survival after DM was associated with presence of a solitary metastatic tumor (MVA hazard ratio 0.31, 95% CI 0.16-0.59, p=0.001). Conclusions: An oligometastatic phenotype characterizes HNSCC patients with solitary metastasis, especially when amenable to definitive local therapy. These findings have important implications regarding clinical trial design for HNSCC in the recurrent and oligometastatic setting. [Table: see text]

Surgical Management of Non-small Cell Lung Cancer with Solitary Hematogenous Metastases

The treatment of patients with solitary hematogenous metastases from non-small cell lung cancer (NSCLC) remains controversial, although numerous retrospective studies have reported favorable results for patients offered combined surgical therapy. Our aim was to determine the role of surgical resection in the management of NSCLC with solitary extrapulmonary metastases and to investigate for possible prognostic factors. Between January 2004 and December 2012, 12 patients with NSCLC, from two Institutions, underwent metastasectomy for their solitary metastatic lesion. Sites of metastases included brain (n=3), adrenal gland (n=6), thoracic wall (n=2) and diaphragm (n=1). All patients had undergone pulmonary resections for their primary NSCLC. Median survival for the entire cohort was 24.1 months, whereas 1- and 5-year survival rates were 73% and 39%, respectively. Patients with stage III intrathoracic disease had significantly worse survival than those with lower tumor stage. A tendency for adenocarcinomatous histology to positively affect survival was recognized, although it was proven not to be statistically significant. Despite the retrospective nature of our study and the small cohort size, it is emerging that combined surgical resection might offer patients with NSCLC with solitary hematogenous metastases a survival benefit. Limited intrathoracic disease and adenocarcinomatous histology might be associated with better outcomes.

SUCCESSFUL TREATMENT OF A SOLITARY SKULL METASTASIS IN A CHILD WITH WILMS' TUMOR.

This report presents the successful treatment of a child with a solitary metastatic lesion to the calvarium following treatment for Stage III anaplastic Wilms' Tumor.

Surgical treatment of patients with lung cancer and bone metastases: a prospective, observational study

BackgroundAs life expectancy improves in patients with lung cancer and bone metastases, effective surgical treatment to relieve pain and improve quality of life and neurological function is increasingly needed. Indications for surgery in patients with bone metastases are controversial. We aimed to assess a protocol for the surgery of patients with lung cancer and bone metastases. MethodsWe developed a surgical protocol for both spinal and appendicular metastases. According to the aim of surgery, eligible patients were placed into four classes (class 1: solitary metastatic bone lesion; class 2: spinal cord compression or pathological fracture; class 3: impending fracture; and class 4: severe pain after medical treatment or radiation). We assessed mobility and neurological functions 1 day before and 1 week, 1 month, 3 months, and 6 months after surgery with the visual analog scale for pain (VAS; scale 1–10), Karnofsky performance status scale (KPS), mobility scale with a score of 0 representing no limitation, a score of 1 representing limitation without the need for orthopaedic aids, a score of 2 representing limitation necessitating orthopaedic aids, and a score of 3 representing bedridden operative technique. Kaplan-Meier analysis was used to calculate survival. This study was approved by the ethics committee of the Sixth People's Hospital, Shanghai Jiao Tong University. Written informed consent was provided by the patient or their legal guardian. FindingsBetween Jan 1, 2005 and Jan 1, 2014, 134 patients underwent surgery (49 spine lesions and 86 appendicular skeleton lesions; one patient was operated in both lumbar and pelvis). VAS decreased after surgery (mean score 6·58 [SD 1·12] before vs 5·33 [1·38] at 1 week, 4·39 [1·35] at 1 month, 3·71 [1·29] at 3 months, and 3·99 [1·02] at 6 months, all p<0·0001 vs baseline). KPS and mobility scale scores were decreased 1 week after surgery (KPS 69·2 [SD 8·8] vs 65·4 [9·1], p=0·0012; mobility scale score (0/1/2/3) 32/47/34/21 vs 19/43/48/23, p<0·0001), and returned to preoperative levels at 1 month for appendicular surgery (KPS 67·2 [10·1] and mobility 21/34/19/11) or 3 months for spinal surgery (KPS 70·8 [11·7] and mobility 21/13/11/4). Mobility scale scores increased at 3 months and 6 months after surgery (48/46/26/12 at 3 months, p<0·0001; 54/39/21/6 at 6 months, p<0·0001). Frankel classification in patients with spinal metastases also improved at 3 months and 6 months after surgery (D/C/B/A from 17/5/3/4 to 12/4/3/2 and 19/0/0/1; p=0·0234 and p=0·0114), as did Musculo-Skeletal Tumor Society rating scale (MSTS) scores in patients with appendicular metastases (from 14·8 [6·1] 1 week after surgery to 20·3 [5·8] at 1 month, 24·1 [4·3] at 3 months, and 22·6 [5·5] at 6 months; all p<0·05 vs 1 week postoperative). The amounts of blood loss in spinal surgery were larger than appendicular surgery (mean 1620 mL [SD 1078] vs 571 mL [775]; p<0·0001). Median overall survival time after surgery was 13·5 months [SD 0·8]. Survival time in the group aimed at radical cure (Class 1: 27·0 months [3·5]) was significantly longer than the other three group (Class 2: 12·6 months [1·0]; Class 3: 13·1 months [1·0]; Class 4: 9·6 months [0·7]; p<0·0001). InterpretationAppropriate surgery provides pain relief, improvement of quality-of-life, and increased neurological function with an acceptably low rate of complications. Our protocol enabled physicians to identify patients with lung cancer and bone metastases who might be candidates for radical surgery. FundingNational Natural Science Foundation of China Grant (81201628).

The role of cerebral blood flow gradient in peritumoral edema for differentiation of glioblastomas from solitary metastatic lesions.

ObjectiveDifferentiation of glioblastomas from solitary brain metastases using conventional MRI remains an important unsolved problem. In this study, we introduced the conception of the cerebral blood flow (CBF) gradient in peritumoral edema—the difference in CBF values from the proximity of the enhancing tumor to the normal-appearing white matter, and investigated the contribution of perfusion metrics on the discrimination of glioblastoma from a metastatic lesion.Materials and MethodsFifty-two consecutive patients with glioblastoma or a solitary metastatic lesion underwent three-dimensional arterial spin labeling (3D-ASL) before surgical resection. The CBF values were measured in the peritumoral edema (near: G1; Intermediate: G2; Far: G3). The CBF gradient was calculated as the subtractions CBFG1 –CBFG3, CBFG1 – CBFG2 and CBFG2 – CBFG3. A receiver operating characteristic (ROC) curve analysis was used to seek for the best cutoff value permitting discrimination between these two tumors.ResultsThe absolute/related CBF values and the CBF gradient in the peritumoral regions of glioblastomas were significantly higher than those in metastases(P < 0.038). ROC curve analysis reveals, a cutoff value of 1.92 ml/100g for the CBF gradient of CBFG1 –CBFG3 generated the best combination of sensitivity (92.86%) and specificity (100.00%) for distinguishing between a glioblastoma and metastasis.ConclusionThe CBF gradient in peritumoral edema appears to be a more promising ASL perfusion metrics in differentiating high grade glioma from a solitary metastasis.

Total enbloc spondylectomy for metastatic high grade spinal tumors: Early results.

Background:High grade metastatic spinal tumors are most common and are invasive. These patients can succumb to disease progression if not treated timely. Although considered as invasive and morbid, total enbloc spondylectomy (TES) in selected cases has better survival rates. The authors describe the results of TES for high grade metastatic spinal tumors.Materials and Methods:Five patients (four females and one male) underwent TES for solitary metastatic vertebral lesion between November 2012 and January 2014. These patients presented to us with spinal instability, unrelenting severe spinal pain and/or with severe progressive radiculopathy. Average age was 46.2 years (range 39–62 years). After complete investigations, computed tomography scan, magnetic resonance imaging scan and positron emission tomography (PET) scan, it was confirmed that these patients had high grade solitary vertebral metastatic tumor.Results:Average duration of followup was 18 months (range 16–20 months). The average preoperative visual analog scale score of 9.4 (range 9–10) improved to 2 (range 1–4) at last followup. Average blood loss was 1440 mL (range 1000–2000 mL). Average duration of surgery was 198 min (range 180–240 min). Significant pain relief was noticed in each patient in the immediate postoperative period and during followups. These patients attained complete functional activities of daily living with in a month. The imaging showed implants in situ, no recurrence of tumor, and no activity on PET scan at the final followup.Conclusion:The present series shows favorable short term results of TES for solitary, metastatic, high grade vertebral body tumors by a team approach.

99m Tc–MDP Bone Scan in Lung Cancer: Predilection Sites for Metastasis

Introduction: Bone scan with 99m Tc-MDP is a commonly used procedure for evaluation of bone metastases because of its high sensitivity, availability, and relatively low cost. The predilection sites for bone metastasis in patients particularly with lung cancers were investigated in this study.Methods: The study was done at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS) between January 2013 and June 2014. A total of 123 patients with lung cancers who had whole body scintigraphy with 99mTc-MDP were studied. The bone scans were interpreted by experienced Nuclear Medicine physicians and the predilection sites with pattern of skeletal metastasis were analyzed.Results: Among the 123 (m/f: 104/19) cases studied, 99 (80.5%) patients had bone metastasis. Solitary metastatic lesion was detected in 18.2% cases, multiple lesions in 59.6% cases and extensive metastases were noted in 18.2% cases. Features of hypertrophic pulmonary osteoarthopathy were present in 4% cases. The predilection sites for metastases from lung cancer appear to be in the ribs (75% cases) followed by spines (54% cases) and pelvis (23% cases). In total 595 metastatic lesions were detected, among them 469(78.8%) were distributed in axial skeleton and 126 (21.2%) were in appendicular skeleton. Metastatic involvement was higher in axial skeleton comparing to the appendicular skeleton and the difference was statistically significant (Z=13.99, P&lt;0.001). Similarly metastatic lesions detected on right side of body were 235 in number and on left side of the body were 189 in number. This difference of distribution between right and left side was also found to be statistically significant (Z=2.218, p&lt;0.002).Conclusion: Bone metastasis is very common in patients with lung cancer. The predilection site for metastasis was the axial skeleton, which had statistically higher involvement than appendicular skeleton. Distributions of metastatic bone lesions were higher in ribs followed by vertebrae and pelvis. Significant difference was observed in the distribution of metastasis between the right and left side of body.Bangladesh J. Nuclear Med. 17(2): 120-124, July 2014

PO64 METRONOMIC CHEMOTHERAPY (CHT) COMBINATION OF VINORELBINE (VRL) AND CAPECITABINE (CAPE) IN HER2- ADVANCED BREAST CANCER (ABC) PATIENTS (PTS) DOES NOT IMPAIR GLOBAL QOL. FIRST RESULTS OF THE VICTOR-2 STUDY

age distribution at the time of MBC diagnosis: 41-57 years (n=3) and 76/79 years (n=2). Two patients had solitary metastatic lesions (bone, n=2; lung, n=1), one patient had extensive bone metastases, and one patient had multiple bony and pulmonary metastases. In only one of the five cases did the patient receive chemotherapy in the supposed palliative situation. Discussion: There are patients who, despite the diagnosis of distant metastases, may be considered cured of their disease; however, these cases are rare. The long-term survivors in our study cohort comprised a relatively heterogeneous group with regard to age at MBC diagnosis, therapy and metastatic sites. The factors contributing to the quite rare and felicitous case of long-term survival or even cure, can hardly be evaluated systematically and remain a black box. It appears, however, that aggressive chemotherapy-containing regimens, are not the key to solving the mystery of this black box.

Case of tuberculosis acromioclavicular joint presenting as lytic lesion in lateral end clavicle: rare case report

Background: Rise in the incidence of tuberculosis (TB) seen in recent years. Skeletal TB accounts for less than 10% of all cases of TB. Most of these cases are in the spine and hip. The acromio-clavicular (AC) joint is a very uncommon site of skeletal TB. Case report: A 30 year old female developed pain in her right shoulder after sustaining trivial trauma. She was treated conservatively for six weeks, but patient complaints of increase in the intensity of pain with restricted movements. Radiographs repeated after six weeks showed a lytic lesion in the lateral end of clavicle with differential diagnosis of a solitary bone cyst or metastatic lesion. FNAC of the swelling done and MRI right shoulder advised. Histo-pathological report revealed evidence consistent with TB. The patient started on a multidrug anti-tubercular therapy (ATT) regimen with diagnosis of tuberculosis lateral end clavicle. MRI report after two weeks showed synovial hypertrophy and capsular distension with mild joint effusion in right AC joint. The diagnosis changed to tuberculosis of AC joint with continuation of the same treatment. Conclusion: The rarity of the occurrence of TB at unusual sites, and the ability of tuberculosis to mimic other diseases, combined with a lack of awareness by the treating orthopaedist often leads to diagnostic delays. A high index of suspicion should be maintained in cases of swellings around the shoulder, even if they lack systemic features of tuberculosis.rn

Clinical and Endoscopic Features of Metastatic Tumors in the Stomach.

Background/AimsMetastasis to the stomach is rare. The aim of this study was to describe and analyze the clinical outcomes of cancers that metastasized to the stomach.MethodsWe reviewed the clinicopathological aspects of patients with gastric metastases from solid organ tumors. Thirty-seven cases were identified, and we evaluated the histology, initial presentation, imaging findings, lesion locations, treatment courses, and overall patient survival.ResultsEndoscopic findings indicated that solitary lesions presented more frequently than multiple lesions and submucosal tumor-like tumors were the most common appearance. Malignant melanoma was the tumor that most frequently metastasized to the stomach. Twelve patients received treatments after the diagnosis of gastric metastasis. The median survival period from the diagnosis of gastric metastasis was 3.0 months (interquartile range, 1.0 to 11.0 months). Patients with solitary lesions and patients who received any treatments survived longer after the diagnosis of metastatic cancer than patients with multiple lesions and patients who did not any receive any treatments.ConclusionsProper treatment with careful consideration of the primary tumor characteristics can increase the survival period in patients with tumors that metastasize to the stomach, especially in cases with solitary metastatic lesions in endoscopic findings.

Gastric Adenocarcinoma Presenting as a Solitary Metastatic Bone Lesion in the Scapula

Gastric Adenocarcinoma Presenting as a Solitary Metastatic Bone Lesion in the Scapula

Gradient of apparent diffusion coefficient values in peritumoral edema helps in differentiation of glioblastoma from solitary metastatic lesions.

Glioblastoma and solitary metastatic lesions can be difficult to differentiate with conventional MRI. The use of diffusion-weighted MRI to better characterize peritumoral edema has been explored for this purpose, but the results have been conflicting. The purpose of this study was to test the hypothesis that the gradient of apparent diffusion coefficient (ADC) values in peritumoral edema--that is, the difference in ADC values from the region closest to the enhancing tumor and the one closest to the normal-appearing white matter--may be a marker for differentiating glioblastoma from a metastatic lesion. Forty patients, 20 with glioblastoma and 20 with a solitary metastatic lesion, underwent diffusion-weighted brain MRI before surgical resection. The ADC values were retrospectively collected in the peritumoral edema in three positions: near, an intermediate distance from, and far from the core enhancing tumor (G1, G2, and G3). The ADC gradient in the peritumoral edema was calculated as the subtractions ADCG3 - ADCG1, ADCG3 - ADCG2, and ADCG2 - ADCG1. The ADC values in the enhancing tumor, peritumoral edema, ipsilateral normal-appearing white matter, contralateral healthy white matter, and CSF were also collected. A gradient of ADC values was found in the peritumoral edema of glioblastoma. The ADC values increased from the region close to the enhancing tumor (1.36 ± 0.24 × 10(-3) mm(2)/s) to the area near the normal-appearing white matter (1.57 ± 0.34 × 10(-3) mm(2)/s). In metastatic lesions, however, those values were nearly homogeneous (p = 0.04). The ADC gradient in peritumoral edema appears to be a promising tool for differentiating glioblastoma from a metastatic lesion.

Spontaneous pneumothorax after intensive chemotherapy in endometrial cancer: A rare complication

ObjectiveEndometrial cancer with hematogenous metastases can be treated with chemotherapy. We present a case of spontaneous pneumothorax that occurred when a solitary pulmonary endometrial metastatic lesion was treated with paclitaxel plus carboplatin. Case reportA 38-year-old female had stage II endometrial endometrioid adenocarcinoma. Solitary bilateral pulmonary metastases developed after primary treatment. Complete remission accompanied by a right spontaneous pneumothorax occurred during chemotherapy with paclitaxel plus carboplatin. ConclusionRapid shrinkage of a pulmonary space-occupying tumor sometimes causes rare but life-threatening spontaneous pneumothoraces. We report the first case of a spontaneous pneumothorax after using paclitaxel plus carboplatin in the treatment of endometrial cancer.

Synchronous Distal Pancreatic Metastatic Lesion Arising from Colonic Adenocarcinoma: Case Report and Literature Review

Solitary metastatic pancreatic lesions comprise 0.5% to 3% of all pancreas neoplasms, most commonly arising from primary tumors of the kidney, lung, or colon. Synchronous metastatic pancreatic lesions are exceptionally rare. Only 25 cases of isolated colorectal pancreatic metastasis amenable to resection have been reported, 11 of those in the distal pancreas. To our knowledge we report the first case of a primary colonic malignancy with a synchronous distal pancreatic metastatic lesion treated with resection.

Primary Pulmonary Mucinous (Colloid) Adenocarcinoma with Postoperative Bone Metastasis

We describe rare primary pulmonary mucinous (colloid) adenocarcinoma in an 80-year-old man. Chest computed tomography revealed a lobulated, well-defined nodule with a diameter of 3.2 cm in the right middle lobe. Transbronchial biopsy via endobronchial ultrasound with a guide sheath did not uncover malignancy. Right middle lobectomy proceeded because the tumor was located close to the pulmonary hilum. Macroscopically, the cut surface of the nodule comprised a well demarcated area of somewhat transparent granular aggregates and a yellow-white gelatinous substance. Computed tomography findings of a solitary metastatic lesion in the left fifth costal head 28 months thereafter were consistent with those of a mucin-rich tumor, which was effectively treated by radiotherapy.

The Outcome of Bifocal Surgical Resection in Non-Small Cell Lung Cancer with Synchronous Brain Metastases: Results of a Single Center Retrospective Study

The reported median survival in patients with non-small cell lung cancer (NSCLC) metastases to the brain varies from 3 to 12 months with combined treatment modalities. Bifocal surgical resection of synchronous brain metastasis and primary NSCLC has not been reported widely, and there have been only a small number of articles published in the literature. The aim of this retrospective study was to evaluate the prognostic factors among patients undergoing bifocal surgical resection. We retrospectively analyzed 28 patients who had a solitary metastatic brain lesion at the time of diagnosis, and underwent synchronous surgical resection of the brain metastasis and primary lung tumor. Survival time was measured in all the patients from the date of craniotomy until death or the most recent date of follow-up for those still surviving. Mean age was 53 years. The mean length of follow-up was 23.6 (4-69) months. The overall survival rates were 79, 42, and 8% at the 1st, 2nd, and 5th years, respectively. The median length of survival was 24 ± 3.8 months. The median survival was found to be statistically significantly lower for the stage T3 tumors when compared with both stage T1 and T2 tumors (p = 0.037). NSCLC patients with resectable solitary cranial metastasis, low locoregional stage (stages IA, IB, IIA) in which T3 status is counted out, with no mediastinal lymph node involvement or any other extrathoracic spread will mostly benefit from consecutive complete resection of both tumors and are supposed to have a better survival.

Solitary Labial Metastasis of Adrenocortical Carcinoma Resembling a Cystic Tumor in a Child

Solitary Labial Metastasis of Adrenocortical Carcinoma Resembling a Cystic Tumor in a Child

Evaluation of the prognostic significance of refinement and stratification of distant metastasis status in 1016 cases of nasopharyngeal carcinoma

To investigate the prognostic factors for nasopharyngeal carcinoma (NPC) with different metastatic status, and to improve the NPC management by multi-level refinement and stratification of M1 stage distant metastases. Clinicopathological data of 1016 NPC patients with distant metastases were retrospectively reviewed. The M1 stage distant metastases were subdivided into synchronous or metachronous metastases, metastatic sites (lung, bone, liver), number of metastatic organs (solitary, multiple) and number of metastases (solitary, multiple) subgroups to analyze the prognosis and survival of the patients. The most frequently involved metastatic sites were bone (542, 53.3%), lung (420, 41.3%) and liver (302, 29.7%). There were solitary metastatic lesions in 164 patients (16.2%), synchronous metastases in 376 cases and metachronous metastases in 640 cases. The median overall survival of the whole group of 1016 NPC patients was 30.8 months since the time of diagnosis of metastasis. For the 376 patients in the synchronous metastasis group, the median survival was 23.3 months and the 1-, 3- and 5-year overall survival rates were 74.2%, 27.6% and 18.5%, respectively. For the 640 patients in the metachronous metastases group, the median survival was 36.7 months, and the 1-, 3- and 5-year overall survival rates were 88.1%, 49.6% and 28.6%, respectively, with a significant difference between the two groups (all P < 0.001). Cox multivariate analysis indicated that the number of metastatic lesions, different metastatic sites and N stage at initial diagnosis were independent prognostic factors for patients with metachronous metastases (P < 0.05). A theory of detailed multi-level metastasis (M1) stratification aiming at different distant metastasis status for nasopharyngeal carcinoma is proposed. To take appropriate individualized treatment scheme according to the prognosis and expected survival should be helpful to improving the diagnosis and treatment of nasopharyngeal cancer.