Factors predicting 'time to distant metastasis' in radically treated head and neck cancer.

Context: Various studies have shown the important risk factors for distant metastasis in head and neck cancer (HNC) which are present in most of the patients in developing countries. Identification of factors on the basis of time to distant metastasis (TDM) can help in future trials targeting smaller subgroups. Aims and Objectives: To identify the factors that predict TDM in radically treated HNC patients. Settings and Design: Retrospective audit. Materials and Methods: Retrospective audit of the prospectively maintained electronic database of a single HNC radiotherapy clinic from 1990 to 2010 was done to identify radically treated patients of HNC who developed distant metastasis. Univariate and multivariate analysis were done to identify baseline (demographic, clinical, pathological, and treatment) factors which could predict TDM, early time to metastasis (ETM; <12 months), intermediate time to metastasis (ITM; 12-24 months), and late time to metastasis (LTM; >2 years) using Kaplan Meier and Cox regression analysis, respectively. Results: One hundred patients with distant metastasis were identified with a median TDM of 7.4 months; 66 had ETM, 17 had ITM, and 17 had LTM. On multivariate analysis, the nodal stage 2-3 (N2/3) was the only baseline factor independently predicting TDM, ETM, and ITM, whereas none of the baseline factors predicted LTM. Conclusions: Higher nodal burden (N2/3) is associated with both ETM and ITM, and calls for aggressive screening, systemic therapy options, and surveillance. It is difficult to predict patients who are at a risk of developing LTM with baseline factors alone and evaluation of biological data is needed.

Deux séries brazzavilloises de metastases osseuses

Notre objectif a ete de comparer 2 series de malades hospitalises en rhumatologie pour metastases osseuses (MO); afin d'en evaluer les aspects epidemiologiques et diagnostiques. Nous avons enregistre deux series 1 et 2 qui concernaient respectivement 48 MO rassemblees entre juillet 1989 et septembre 1996 puis 50 cas de janvier 2001 a novembre 2004. Le diagnostic etait base sur l'analyse semeiologique clinique et radiologique; en l'absence d'etude anatomo-pathologique. Les variables etudiees ont ete : age; le genre; les frequences absolues et relatives; les incidences et la nature des cancers primitifs. La serie 1 a comporte 31 hommes et 17 femmes d'age moyen 60+/- 16 ans ; la serie 2; 33 MO ont ete respectivement de 3;5 pour cent et 6;8 cas par an pour la serie1 puis de 6;5 pour cent et 12;5 pour la serie 2. Les frequences relatives des metastases d'origine determinee (MOD) etaient de 54;1 pour cent dans la serie 1 et 68 pour cent dans la serie 2. Celles des metastases d'origine indeterminee (MOI) etaient respectivement de 45;8 pour cent et 32 pour cent. La prostate a ete l'organe siege le plus frequent du cancer primitif dans les deux series. Les deux series ont ete comparables pour l'age et le genre. Les origines des metastases osseuses ont surtout ete prostatiques et hepatiques comme particularite africaine

Choroidal metastases: clinical and echographic patterns

The purpose of this study is to report the clinical and echographic data from a retrospective series of patients diagnosed of having choroidal metastases. This study included twenty two patients [26 eyes] with choroidal metastases. They were fifteen females and seven males. Their ages ranged from 35-65 years. All the patients were subjected to careful history taking, thorough ophthalmic examination and ultrasonography. At the time of ocular diagnosis of choroidal metastases, 14 patients [63.6%] reported a history of malignancy, while 8 patients [36.4%] had no knowledge about their malignancy. After systemic work up, in the fifteen female patients the primary malignancy site was breast cancer in 12 patients [80%], lung cancer in one patient [6.7%] and unknown in two patients [13.3%], while in the 7 male patients the primary malignancy site was lung cancer in four patients. [57.1%], colon cancer in one patient [14.3%] and unknown in two patients [28.6%]. On ophthalmoscopy visible tumors appeared as yellow or creamy yellow subretinal mass lesions. Exudative retinal detachment was noted in 84.6% of the eyes. On ultrasonography, in 5 eyes [19.2%] the tumors were dome-shaped, and in 21 eyes [80.8%] the tumors were flat and diffuse. In 25 eyes [96.2%] these metastatic tumors had medium to high intemal reflectivity with irregular internal structure, and in only one eye [3.8%] the tumor had medium to low internal reflectivity with irregular internal structure. Bullous non rhegmatogenous retinal detachment and/or choroidal metastases can be the first manifestation of cancer. Ultrasonography, using A- and B-mode criteria, offers an opportunity for high accuracy in the diagnosis of choroidal metastases. The best set of echographic parameters for differentiation of choroidal metastases is moderate to high internal reflectivity, irregular internal structure and a flat shape with irregular surface contour. Routine ophthahlic examination should be included as a part of evaluation of patients with cancers. Prompt detection can provide the patients access to therapeutic modalities reducing their ocular morbidity as well as, overall morbidity and mortality

Analytical study of 253 cases of central nervous system tumours

This is an analytical study of 253 cases of central nervous system space occupying lesions which were received and diagnosed histologically at the histopathology department at the laboratory section in the specialized surgical hospital at Saddam's Medical City for the period between June 1990 till the end of December 1992. Out of these 253 cases, 231 cases of intracranial and intraspinal tumours were confirmed histologically and 22 cases were miscellaneous. 109 cases were reported among male patients and 122 cases among female. The highest peak incidence was reported in the fifth decade. Of these tumours Glioma constituded the highest incidence [39.4%], and the majority were of high grade malignancy and poor prognosis. This was found to be similar to other previous Iraqi studies and other similar studies reported in literatures

Distant metastasis in bilharzial bladder cancer

Three hundred-fifty-seven billharzial bladder cancer patients, were treated at the National Cancer Institute, Cairo during the period 1981-1990. They were treated with either cystectomy alone, cystectomy preceded by a short course of preoperative radiotherapy [200 cGy/5 fractions/one week] or cystectomy followed by postoperative irradiation [5000 cGy/25 fraction/5 weeks or 3750 cG/30 fractions/2 weeks]. The overall 5-year actuarial rate of distant metastasis was 23 +/- 2%, which was nearly the same in the three therapeutic groups. Both univariate and multivariate analyses revealed that the independent risk factors for distant metastasis were: pelvic nodal incolvement [p=0.005], pathological stage [p=0.04] histopathological grade [p=0.05]. Tumor cell type and local pelvic recurrence though appeared by univariate analysis as working risk factors, it was proved by multivariate analysis that they were dependent on other risk factors. Patients who had none of the independent risk factors enjoyed a low distant metastasis rate [11 +/- 3%] and a high local control rate [88 +/- 3%]. Those who had more than one risk factor experienced a high distant metastasis rate [51 +/- 6%] and a low local control rate [41 +/- 8%], regardless of the therapeutic modality adopted. The identified independent risk factors determined both the distant metastasis and the local control rates. The identification of such risk factors suggests the expected beneficial effect of adding adjuvant systemic therapy for the high risk patients in an attempt to improve the disease-free survival

Tumor secundário na regiäo selar: relato de um caso / Secondary tumor to the selar region: a case report

Aparentemente carcinomas metastásticos para a regiäo justa-selar e hipófise säo mais frequentemente primários da mama e de pulmäo. Metástases para a regiäo justa selar näo säo frequentes e por vezes causam dificuldades diagnósticas em relaçäo a adenomas hipofisários. A tomografia computadorizada e a politomografia facilitam o diagnóstico, mas dificuldades podem acontecer, como na apresentaçäo deste caso

Cirugía de las metástasis pulmonares: nuestra experiencia / Surgery of the lung metastases: our experience

Se presentan 40 pacientes operados por metástasis pulmonares. Correspondieron a 31 carcinomas y 9 sarcomas, siendo los origenes más frecuentes el carcinoma de colon, de mama y osteosarcoma con 6 casos cada uno. La edad promedio fue de 53 años para los carcinomas y de 26 años para los sarcomas. Treinta y seis casos (80%) fueron asintomáticos, 32 diagnosticados por control radiológico periódico y 4 por TAC periódica. La TAC de toráx se constituyó en el estudio más útil para la evaluación de las lesiones torácicas. En los 40 pacientes se realizaron 45 resecciones, 1 caso se operó 3 veces y 3 casos, 2 veces. La resección de metástasis pulmonares con criterio oncológico es viable en un grupo seleccionado de pacientes, siendo las resecciones pulmonares menores (segmento y cuña) los procedimientos de preferencia. Las metástasis múltiples y/o bilaterales no son una contraindicación quirúrgica. El índice de sobrevida actuarial a 5 años fue mayor para los sarcomas (67%) que para los carcinomas (30%); el índice global fue de 41%. Ocho de los 9 sarcomas recibieron quimioterapía adyuvante. La sobrevida a 5 años en los pacientes con un intervalo libre tumoral de más de 36 meses fue del 59%contra 28%de aquellos con un intervalo libre menor de 36 meses. La mortalidad operatoria fue del 2,2

Tratamiento quirúrgico de las metástasis pulmonares / Surgical treatment of pulmonary metastases

En un período de 4 años se trataron 25 pacientes con metástasis pulmonares. En 11 se intentó tratamiento quirúrgico curativo y 10 fueron declarados inoperables. En los 15 operados se realizaron 27 resecciones locales, 1 segmentectomía y 3 lobectomías. Las vías de abordaje empleadas fueron 8 toracotomías laterales, 2 bilaterales y 5 esternotomías. La sobrevida actuarial a 30 meses fue del 52% y del 17% en los casos no operados. La resección de las metástasis pulmonares se recomienda cuando la enfermedad está limitada a los pulmones y el paciente está en condiciones de tolerar la resección completa de todo el tejido neoplásico. Son factores condicionantes de la evolución, la histología del tumor primitivo, el tiempo de duplicación tumoral, el tiempo de latencia entre el tratamiento del tumor primitivo y aparición de la metástasis, el número y tamaño de las mismas, la localización uni o bilateral y la propagación a los ganglios mediastinales. Se recomienda como táctica emplear vías de abordaje amplias de preferencia esternotomía, tubo endotraqueal de doble luz para permitir un mejor exámen pulmonar, resección completa de las metástasis con margen oncológico y no efectuar operaciones solo para reducir masa tumoral.