Surgical Treatment Of Metastases Research Articles

Factors Associated with Revision Surgery in Long Bones Metastases

Background. Bones as an organ are one of the most common targets for tumor metastasis. Currently, the number of patients undergoing surgical treatment for metastatic bone lesions is steadily increasing. In most patients, after surgical treatment, the manifestation of clinical symptoms decreases, primarily pain syndrome, which improves their quality of life. However, it should be noted that the number of patients with bone metastases who underwent revision surgery is also increasing. This article retrospectively analyzes the factors leading to revision after surgical treatment of metastases in long bones.
 The aim of this study was to identify factors leading to revision after surgical treatment of patients with metastases in long bones.
 Methods. A retrospective medical records analysis of 247 patients who underwent surgical treatment for metastases in long bones on the basis of the P.A. Herzen Moscow Research Institute of Oncology in 20062020 was performed. Of these, 33 patients underwent revision surgery. The median age was 62 years. The localization of the primary tumor was as follows: breast cancer 10 cases, kidney cancer 13, lung cancer 3, prostate cancer 2, rectal cancer 3, liver cancer and Ewings sarcoma with bone metastases 1 case each.
 Results. The following factors led to revision surgery: mistakes in preoperative diagnosis (3 patients); postoperative infectious complication (6 patients); dislocation of the endoprosthesis (4 patients); continued growth of solitary metastasis after osteosynthesis (5 cases); aseptic instability after intramedullary osteosynthesis (14 patients); traumatic fracture of the endoprosthesis stem (1 patient).
 Conclusions. Revision after surgical treatment of metastases in long bones, in addition to postoperative complications, lead to mistakes in diagnosis and incorrect choice of surgical treatment method. To reduce the risk of revision surgical interventions, a multidisciplinary approach is needed with the development of surgical treatment tactics in consultation and the use of specialized scales of oncological prognosis.

The role of combined treatment of metastatic colorectal cancer inpatients with liver metastases.

e16026 Background: Combined treatment for patients with metastatic colorectal cancer (mCRC) offers better long-term outcomes and chemotherapy can increase the rate of hepatic resectability for patients with initially inoperable disease. Methods: The analysis included 132 patients diagnosed with mCRC having metastases in the liver treated from 2015 to 2020. Of these, 62 (47%) were men and 70 (53%) women. The average age of the patients was 63 years. At the beginning of the treatment, the overall condition of all patients met ECOG 0-1 points. Primary metastatic CRC had 93 (71%) patients. A total of 39 (29%) patients were diagnosed with advanced disease. Localization of the primary tumor in 25 patients (18.9%) was in the right part of the large intestine and 107 (81.1%) in the left part of the colon. At the time of the sample, metastases were detected only in the liver in 73 patients (55.3%). In the remaining 59 (44.7%) other organs were affected besides the liver. Various types of surgical treatment of metastases in the liver received 42 (31.8%) patients. The decision on the choice of chemotherapy was made by the attending physician on the basis of the recommendations of NCCN and RUSSCO, taking into account the molecular genetic characteristics of the tumor. The decision to apply and choose the method of surgical treatment was taken in conjunction with the surgeon. Results: From the general population of patients receiving complex therapy, 2 groups were identified, between which a comparison was made. The first group (group A) was 42 (31.8%) patients who received some surgical treatment of the liver. The second group (group B) included 90 (68.2%) patients, who for some reason or another, did not receive any surgical treatment. The groups are fairly homogeneous in their characteristics. The median overall survival (OS) in group A was 40.1 months, and in group B, 22.3 months. A similar trend continued in subgroup analysis. The calculation of the PFS was complicated by the fact that surgical operations were given at different stages of complex treatment. Three-year survival in group A was approximately 50%, and in group B, 28%. "Five-year" survival (In those patients who were observed from the start of the study for all 5 years) in group A was 15 %, and in group B, 5,5%. Conclusions: The inclusion of modern surgical techniques in the complex therapy of metastatic colorectal cancer, if possible, at any stage, can significantly increase the life expectancy of patients.

Malignant Tumors of the Penis - Dia-gnostics and Therapy.

Penile cancer belongs to group of relatively rare malignancies. It represents, on average, 0.5-1% of all tumours in males globally and occurs predominantly in older individuals (> 65 years). The geographical distribution of malignant cancer of the penis is reported. A higher incidence is observed in less developed parts of the world, particularly in South America, Southeast Asia, and some areas of Africa (> 2.0/100,000). In Slovakia, there has been a recent increase in incidence (1.1/100,000 in 2011). Mortality has stabilized at 0.3/100,000 in recent years. Significant risk factors for malignant cancers include social and cultural habits and hygienic and religious practices. Important risk factors are inadequate hygiene of the foreskin sac, phimosis, human papillomavirus infection, sexual promiscuity, smoking, genital infections, and a low socio-economic and educational status. The present paper provides an overview of pathology, symptomatology, diagnostic approaches, and classification of the extent of the disease. Treatment of the primary tumour depends on the extent of the disease and includes topical treatment, photodynamic treatment, cryoablation, laser photocoagulation, conservative surgical treatment, especially circumcision, and even radical treatment - penile amputation with perineal urethrostomy. An important part of the management of this malignancy is surgical treatment of metastases in inguinal lymph nodes. The article devotes more attention to non-surgical treatment modalities, in particular radiotherapy (external and brachytherapy) and systemic therapy (chemotherapy and biologic therapy), offering an overview of the indications and regimens in the adjuvant, neoadjuvant and palliative approaches, with and without concomitant chemoradiotherapy, and describes possible adverse effects of the treatments. Conclusion: Patients with penile cancer should be concentrated in centres that have abundant experience in the diagnosis and treatment of this disease. Key words penile cancer - surgical treatment - radiotherapy - chemotherapy - biologic therapy The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 12. 11. 2018 Accepted: 12. 12. 2018.

Abstract P1-19-08: Prognostic factors of human epidermal growth factor 2 (HER2) positive breast cancer patients with brain metastasis in the context of all available new therapies

Abstract Background: Patients with advanced human epidermal growth factor 2 (HER2)-positive breast cancer are at the highest risk developing breast cancer brain metastases (BCBM), which are associated with significant morbidity and mortality. The advent of HER2-directed therapy resulted in greatly improved survival outcomes and have been widely used. In this context of a better controlled systemic disease, brain metastases are emerging as a new challenge for the oncologist. The aim of this study was to determine the clinicopathologic factors associated with the prognosis of patients with HER2 positive BCBM, in the scenario of new therapies. Methods: A retrospective review of clinical data from patients who have developed HER2 positive BCBM from March 2005 to January 2018 at AC Camargo Cancer Center. Patients characteristics were collected, and overall survival (OS) , time to first HER2 positive BCBM and OS after HER2 positive BCBM were estimated by the Kaplan-Meier method. Associations between OS after BCBM and clinical variables were assessed by Cox proportional hazards regression models. Results Among 80 patients with HER2-positiveBCBM median age was 51 years (range, 24–81 years). Of the patients, 55 patients (69%) had ER-positive/HER2-positive breast cancer, and 25 (31%) had ERnegative/ HER2-positive breast cancer. The median brain metastasis-free survival period from primary breast cancer was 33.5 months .The median survival after developing brain metastasis was 28 .5 months. Patients with more than 3 brain metastases had significantly shorter overall survival(p=0,01). ). Nineteen patients (24%) underwent surgical treatment of metastasis in the brain and there was no associated with survival duration(p= 0,33). Patients treated with radiotherapy 71 (88%) had significantly better survival (p= 0,013), if the patient received stereotactic radiosurgery (53.5%) compared to total brain radiotherapy received ( 46,5%) was not associated with duration of survival (p= 0,24). . Treatment with other HER2-targeting agents after BCMB had significantly increased survival (p=0,022), including trastuzumab 53 (67%), pertuzumab 21 (26%), trastuzumab emtansine (TDM1 )= 35 (43%) and lapatinib 37 ( 46%). . In multivariate analysis, the presence of more than 3 brain metastases (p=0,005) was the sole independent prognostic factors. Conclusions: Our study indicates that HER2-positive patients with more than three brain metastases had a poor prognosis and that regardless of the use of new therapies. The role of new therapies in the management of patients with brain metastases is often not clearly defined. The best treatment strategy is not yet known and the study of prognostic factors may help to choose a better treatment sequence. Citation Format: Medeiros de Melo JC, da Costa AA, de Castro DG, Gomes AA, Guimaraes AP, Sanches SM, Diniz AC, Ribeiro AR. Prognostic factors of human epidermal growth factor 2 (HER2) positive breast cancer patients with brain metastasis in the context of all available new therapies [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-19-08.

Surgical Treatment Options for Metastatic Spinal Tumors

Introduction Metastatic spinal tumors are surgically challenging lesions. Around 10 to 20% of all cancer patients develop symptoms of bone metastases that are most common in spine and pelvis. The metastatic tumors can involve any part of the spinal column, invade the spinal canal, and spread to the neighboring tissue and to the mediastinal or retroperitoneal space. The indication for surgery is usually rapidly progressive spinal cord compression as an initial manifestation of a malignant disease. Methods Most of the patients with spinal metastatic disease present with the local pain and/or neurological deterioration. The patients are assessed regarding the severity of the pain and neurological deficit, and there are several systems that are helping us classify the patients (Karnofsky performance score, Tomita and Tokuhashi predicting survival scores, etc.). The main goals of surgical treatment of metastases are preservation and improvement of neurological functions, pain control, and stabilization of the spine. The surgery usually involves a multidisciplinary approach. The type of operative and postoperative treatment depends on the histological nature of the tumor, extension of the tumor, and integrity of the bony elements of the spine. The prognosis and extension of the primary disease and other comorbidities is also to be considered. Variety of surgical options include: microsurgical decompression of the neural structures, posterior, anterior, or lateral fusion, corpectomy, vertebroplasty, or kyphoplasty, and combination of those options. Results In the last years in our department, a single-step posterolateral approach was increasingly utilized, consisting of maximal tumor resection, combined with stabilization. Favorable clinical results and good palliation were achieved in most patients. The additional oncological therapy is usually necessary. Conclusion The prognosis for most patients with metastatic spinal tumors is still very unpredictable. Individual treatment strategy is mandatory for each patient and usually consists of multidisciplinary approach. The surgery has moved from multiple-steps to one-step surgery in the last years and with this a favorable clinical results could be achieved.

Alloplasty of Thoracic and Lumbar Vertebrae in Patients with Malignant Cancer Metastases - Results, Hazards and Deviations

Background: The increasing number of patients with malignant cancers and their prolonged survival resulting from progress in oncology contribute to development of complications in form of metastases to bones. They are usually located in the thoracic and the lumbar spine, causing tormenting pain, limiting performance, and decreasing quality of life. Correct qualifying of patients for various treatments, based on multi-specialist and comprehensive approach is of importance. Methods: In this study results of surgical treatment for metastases using vertebral body prosthetic devices in the thoracic and lumbar spine were evaluated. 72 patients were operated in total. Indications for use of prostheses and selected surgical techniques were evaluated. Results: The achieved results included improvement in performance assessed in accordance with the Karnofsky scale, reduction in pain intensity according to the VAS scale, and improvement in the neurological status in accordance with the Frankel scale. Complications were scarce. One patient suffered from permanent limb paralysis after the surgery. Conclusions: Surgical treatment of metastases to the spine differs from standard procedures for traumatic or degenerative lesions. Different implants must be used, bone grafts are used rarely, and stabilisations are multi-segmental. The bone fusion does not guarantee a good treatment result.

Surgical vertebral body cementoplasty as spinal cancer metastasis management

Spinal metastases of cancer are frequent and their treatment strategy remains a problem. The aim of the present paper is to present the technique of cementoplasty and its originality. Spine corporeal cementoplasty techniques were performed in 9 patients with spine metastasis treated at Neurosurgery Department between 2002 and 2005. This series is composed of four women and five men. The average age of patients was 54 years. All patients were admitted for treatment of metastasis of breast carcinoma, metastasis of breast adenocarcinoma (three cases), colon cancer (two cases), pulmonary adenocarcinoma (one case) and melanoma (three cases). Metastasis was located on the cervical spine (3 cases), thoracic spine (4 cases) and lumbar spine (2 cases).No case of cement leaking was observed. In eight patients neurological deficit and pain were decreased. In one patient we noted a persistence of neurological deficit but pain decreased. A post-operative radiological analysis showed good spine stability. Before their death this treatment had improved their quality of life.The technique of surgical cementoplasty described in this paper may be used for a surgical treatment of metastasis and spinal stabilisation. It is an alternative to a palliative treatment of metastasis when it is not possible to perform vertebroplasty.

食道癌術後大腸転移の1例

食道癌術後大腸転移の1例

P-0244 - Surgical Treatment of Metastases and Its Impact on Prognosis in Patients with Metastatic Colorectal Carcinoma

Background: Approximately one quarter of patients with colorectal carcinoma have distant metastases at initial diagnosis and almost 50% will develop them during the disease course. Only radical surgical resection of metastases improves the clinical outcome and offers the chance of long-term survival. Initially unresectable metastases can become resectable after downsizing with systemic therapy. Methods: Our analysis included 21 patients older than 18 years of age (10 men, 11 women) with metastatic colorectal carcinoma (mCRC) who underwent resection/ ablation of metastases. 14 patients had resection at initial diagnosis of metastatic disease and 7 patients achieved operability of metastases after the systemic treatment. The aim of our analysis was to evaluate following parameters: age structure, localization of primary tumor and metastases, disease free survival (DFS), progression free survival (PFS) and overall survival (OS). We also assessed frequency of KRAS and BRAF mutations in the primary tumor and importance of BRAF as negative prognostic factor. Patients have been treated at the St. Elizabeth Cancer Institute in Bratislava since 2006 and the results were evaluated in January 2013. Results: The median age of patients was 59 years. Primary tumor was most frequently localized in colon sigmoideum. Typical localization of metastatic spread was liver observed in 14 patients. 1 patient had metastases in lungs, 2 patients had combination of hepatic and extrahepatic metastases and 4 patients had metastases in other regions. 12 patients were already diagnosed with stage IV colon cancer, 9 patients underwent adjuvant therapy in the past and developed metastases later with median DFS of 11 months. In median follow-up of 47 months (range 14-61 months) 17 patients experienced disease progression and 13 patients died. Median PFS after surgical resection of metastases was 17 months (95% CI 13.88-20.12) and median OS was 48 months (95% CI 38.78-57.23). 7 patients who had only solitary metastasis (in liver) reached better median PFS (18 months; 95% CI 15.43-20.57) and median OS (51 months; 95% CI 25.76-76.24) compared to patients with 2 and more metastases who had median PFS of 14 months (95 % CI 10.55-17.45) and median OS of 45 months (95% CI 19.61-70.39). KRAS mutation was detected in 47.6% of patients and BRAF mutation in 9.5% of patients. Patients with BRAF mutation had worse median PFS (10 months) and median OS (22 months) compared to patients with BRAF wild-type who had median PFS of 17 months and median OS of 51 months. Conclusion: These data suggest that resection/ablation of metastases significantly improves the prognosis of patients with mCRC. All patients with mCRC should by evaluated by multidisciplinary team and surgical treatment has to be always considered in appropriate selected patients. Our results also indirectly support the notion that mutated BRAF has a strong negative prognostic significance.

Surgical treatment for metastasis to the parotid gland and cervical lymph nodes from malignant tumor in the periorbital area

眼部悪性腫瘍はまれな疾患で，その耳下腺や頸部リンパ節転移に対する診断や治療は見解が分かれる。悪性リンパ腫と悪性黒色腫を除いた眼部悪性腫瘍例で，耳下腺・頸部リンパ節転移を認めた5例を検討した。原発部位は，眼窩3例，眼瞼2例。耳下腺のみの転移1例，耳下腺＋頸部転移3例，頸部のみの転移1例である。原発部には，1例で重粒子線治療，4例は手術を行った。転移部には，耳下腺全摘＋頸部郭清2例，耳下腺浅葉切除＋頸部郭清1例，頸部郭清のみ2例である。5例中4例で術後放射線治療を行った。結果は，1例が原病死した以外全例生存している。眼部悪性腫瘍の耳下腺・頸部リンパ節転移症例の治療についてはさらなる検討が必要である。

Management of the Adrenal Gland During Partial Nephrectomy

Nephron sparing surgery is an increasingly used alternative to Robson's radical nephroadrenalectomy. The indications for adrenalectomy in patients undergoing partial nephrectomy are not clearly defined and some surgeons perform it routinely for large and/or upper pole renal tumors. We analyzed initial management and oncological outcomes of adrenal glands after open partial nephrectomy. Institutional review board approval was obtained for this study. During partial nephrectomy the ipsilateral adrenal gland was resected if a suspicious adrenal nodule was noted on radiographic imaging, or if intraoperative findings indicated direct extension or metastasis. Concomitant adrenalectomy was performed in 48 of 2,065 partial nephrectomies (2.3%). Pathological analysis revealed direct invasion of the adrenal gland by renal cell carcinoma (1), renal cell carcinoma metastasis (2), other adrenal neoplasms (3) or benign tissue (42, 87%). During a median followup of 5.5 years only 15 patients underwent subsequent adrenalectomy (0.74%). Metachronous adrenalectomy was ipsilateral (10), contralateral (2) or bilateral (3), revealing metastatic renal cell carcinoma in 11 patients. Overall survival at 5 years in patients undergoing partial nephrectomy with or without adrenalectomy was 82% and 85%, respectively (p = 0.56). Adrenalectomy should not be routinely performed during partial nephrectomy, even for upper pole tumors. We propose concomitant adrenalectomy only if a suspicious adrenal lesion is identified radiographically or invasion of the adrenal gland is suspected intraoperatively. Using these criteria adrenalectomy was avoided in more than 97% of patients undergoing partial nephrectomy. Even using such strict criteria only 13% of these suspicious adrenal nodules contained cancer. The rarity of metachronous adrenal metastasis and the lack of an observable benefit to concomitant adrenalectomy support adrenal preservation during partial nephrectomy except as previously outlined.

CLC012 POSTER Surgical treatment of metastases of malignant melanomas in the lung

CLC012 POSTER Surgical treatment of metastases of malignant melanomas in the lung

Management of metastatic disease of the appendicular skeleton

<h2>Summary</h2> Treatment advances have resulted in improved prognosis for patients with cancer metastatic to bone. The management of appendicular skeletal metastases requires a multi-disciplinary approach. The overall disease prognosis is important in determining the appropriate surgical treatment of metastases, with simple measures for those with the poorest prognosis and resection with reconstruction for those expected to survive more than 1 year. This article reviews management options available for patients with skeletal metastases affecting the appendicular skeleton and broaches the controversies of prophylactic fixation of impending fractures.

Traitement chirurgical des métastases digestives de mélanome

Aim. – Metastases of melanoma are frequent. On the gastro-intestinal tract, commonest localizations are small bowel, stomach and colon. Surgical treatment of digestive metastases from melanoma is not well known and its value is still debated. Patients and methods. – Medical records of 10 patients (six female and four male) operated for metastatic melanoma to gastro-intestinal tract were reviewed to determine results of surgery. Results. – Gastro-intestinal metastases were symptomatic in eight patients (abdominal pain in three, bowel obstruction in three, abdominal mass and obstructive jaundice in one each). Two patients had anemia. Diagnosis has been suggested by imaging in seven patients and endoscopy in three. All patients were operated on by laparotomy for resection of metastases located on small bowel in four patients, gallbladder in two, stomach in two and colon in two. Complete resection suppressed symptoms in nine cases. In one patient, resection was incomplete but provided satisfying symptomatic relief. One patient died at day 3; in other patients, median survival was 18 months (range: 3–120). Conclusion. – In a patient with previous history of melanoma, digestive symptoms indicate morphological explorations due to suspicion of metastases to gastro-intestinal tract. Surgical treatment of these metastases is usually palliative but, in some cases, allows long-term survival.

Palliative surgery for bone metastases

Advances in the treatment of patients who have bone metastases are an issue of high importance to the orthopaedic surgeon. Early diagnosis requires knowledge of the pathogenesis of bone metastases. A primary route of metastatic cells is via Batson's vertebral vein plexus. An understanding of the pathophysiology enables the surgeon to plan effective treatment. As many patients continue to survive for prolonged periods following the detection of bone metastases, it is important to plan treatment that relieves pain and is functional. In long bones non-operative treatment with radiotherapy, patient education to avoid excessive torsional loads and systemic chemotherapy or hormonal therapy as well as diphosphonates are utilized for small lesions with less than 25 percent of the cortical diameter. The indications for surgical treatment include lesions with elevated fracture risk according to Mirels score. Special emphasis is led on the surgical treatment of spinal metastasis. Early and effective treatment improves the remaining quality of life in patients with metastatic bone disease. However a firm knowledge of the pathogenesis and pathophysiology helps the clinician in making an early diagnosis. Nevertheless the orthopaedic surgeon must recognize the need to approach management of these patients from a multidisciplinary perspective in cooperation with the oncologist, radiotherapist, rehabilitation medicine specialist, radiologist, and pathologist. The cooperation among all members of the team will assure the best possible care for the patient who has metastatic bone disease.

Surgical treatment of metastases in renal cell carcinoma

The aim of the present study was to investigate the efficacy of surgical excision of metastases in patients with renal cell carcinoma (RCC). Eighteen patients with metastatic RCC underwent resection of metastases between 1988 and 1994 (pulmonary: n = 6; skeletal: n = 6; cerebral: n = 3; local relapse: n = 3). Two patients suffered from synchronous appearance of metastases, whereas in 16 cases a metachronous occurrence was observed. In 12 out of a total of 18 patients metastases were completely resected. These patients survived longer than patients in whom metastases were incompletely resected (30 vs. 12 months). Six out of these 12 patients with a complete resection of metastases are presently free of disease for a mean duration of 24 months (10-34 months). The resection of lung metastases seems to be associated with longer survival times. In conclusion, surgical resection of metastases--solitary or single organ site--especially in the lung appears to be justified in patients with RCC. The surgical excision of skeletal metastases at least improves quality of life.

Editorial surgical treatment of metastases—Viewed from an increasing molecular biological understanding

Editorial surgical treatment of metastases—Viewed from an increasing molecular biological understanding

Surgical Treatment of Metastatic Renal Cell Carcinoma

The survivals of 174 patients who underwent nephrectomy for renal cell carcinoma were analyzed to evaluate the influence of the surgical treatment of metastases on their prognosis. For 34 of the 174 patients, surgical resections of the metastases were performed concurrently with nephrectomy. For 38 patients, 44 surgical resections of metastases were performed in the follow-up period after nephrectomy. Apparently curative resections of metastases, at the time of nephrectomy or after nephrectomy, were significantly correlated with good survivals after surgery, irrespective of the number of metastatic foci. Aggressive surgical treatment was beneficial in patients with a longer tumor-free period after nephrectomy or with stable disease for about six months after surgical treatment, although this might simply be a reflection of a longer natural disease course in this specific group of patients.