Adenopatia cervical: uma apresentação rara de câncer da próstata / Cervical lymphadenopathy ­ a rare presentation of prostate cancer

A metastização ganglionar cervical por neoplasia da próstata é rara, sendo ainda menos frequente como manifestação inicial da doença. O presente estudo é um relato de um caso clínico de uma pessoa do sexo masculino, com 72 anos, que apresentava massa cervical esquerda, indolor, com 2 meses de evolução e dores ósseas lombar e torácica. A citologia aspirativa por agulha fina com estudo imuno-histoquímico revelou positividade para o antígeno prostático específico, concluindo se tratar de metástase ganglionar de carcinoma da próstata. Analiticamente, constatou-se que o valor do antígeno prostático específico foi maior que 1.000ng/mL, além da elevação da fosfatase alcalina. A cintilografia óssea de corpo inteiro revelou envolvimento ósseo secundário. Após o diagnóstico, o paciente iniciou hormonoterapia e recusou radioterapia com intuito paliativo. Oito meses após o diagnóstico, constatou-se a recorrência da doença, com elevação do valor do antígeno prostático específico novamente. Dessa forma, relata-se um caso de neoplasia da próstata com metastização óssea e ganglionar cervical esquerda em um indivíduo assintomático do ponto de vista urológico. Salienta-se que, no diagnóstico diferencial de adenopatias cervicais, deve-se considerar a neoplasia da próstata em pessoas do sexo masculino. (AU)

Cervical lymph nodes involvement is rare in prostate cancer and uncommon as an initial manifestation. This study is a clinical case report of a 72-year-old man who presented with a left cervical painless mass of 2-month progression, and bone pain on the lumbar and thoracic regions. Fine-needle aspiration cytology with immunohistochemistry staining was performed and revealed positivity for prostate-specific antigen consistent with prostate adenocarcinoma metastasis. Blood tests revealed a prostate-specific antigen of more than 1,000ng/mL, as well as high alkaline phosphatase. Whole-body bone scan showed secondary bone involvement. Following diagnosis, the patient started hormonal therapy and refused palliative radiotherapy. Eight months after diagnosis, recurrence was observed, with prostate-specific antigen elevation again. Thus, a clinical case of prostate cancer with bone and cervical lymph node metastasis in a patient with no urologic symptoms is reported. It should be noted that prostate cancer shall always be considered in the differential diagnosis of cervical lymphadenopathies in male patients. (AU)

Embolization of renal tumor bone metastasis: case report / Embolização de metástase óssea de tumor renal: relato de caso

Abstract Primary or secondary bone tumors can manifest in different ways, from simple bone pain to possible pathological fractures. Hypervascularized tumors are of greatest concern, with increased incidence of complications. Preoperative embolization of the bone tumor is an effective measure for reducing blood loss during open surgery to excise the tumor. With appropriate experience, the risks of the procedure are minimal and final outcomes are highly satisfactory. The purpose of this paper is to describe the case of a 43-year-old male patient with a metastatic renal cell tumor in the left proximal femur (seen on lower limb computed tomography) who underwent selective preoperative embolization. The procedure resulted in a remarkable absence of bleeding and successful response to subsequent onco-orthopedic surgery.

Resumo Os tumores ósseos, primários ou secundários, podem se manifestar de várias formas, desde dor óssea até fraturas patológicas. A preocupação maior repousa sobre tumores hipervascularizados, com maior incidência de complicações. A embolização pré-operatória do tumor ósseo é uma medida eficaz para reduzir a perda sanguínea durante a exérese tumoral em cirurgia aberta. Com uma experiência apropriada, os riscos do procedimento são mínimos, com resultados finais bastante satisfatórios. O presente artigo tem por finalidade descrever o caso de um paciente do sexo masculino, de 43 anos, com tumor metastático de células renais em fêmur proximal esquerdo (visualizado por angiotomografia de membro inferior), submetido à embolização arterial seletiva pré-operatória. O procedimento resultou em ausência de sangramento e ótima resposta à cirurgia onco-ortopédica realizada.

Bone scan positivity in non-metastatic, castrate-resistant prostate cancer: external validation study

ABSTRACT Introduction: Tables predicting the probability of a positive bone scan in men with non-metastatic, castrate-resistant prostate cancer have recently been reported. We performed an external validation study of these bone scan positivity tables. Materials and Methods: We performed a retrospective cohort study of patients seen at a tertiary care medical center (1996-2012) to select patients with non-metastatic, castrate-resistant prostate cancer. Abstracted data included demographic, anthropometric, and disease-specific data such as patient race, BMI, PSA kinetics, and primary treatment. Primary outcome was metastasis on bone scan. Multivariable logistic regression was performed using generalized estimating equations to adjust for repeated measures. Risk table performance was assessed using ROC curves. Results: We identified 6.509 patients with prostate cancer who had received hormonal therapy with a post-hormonal therapy PSA ≥2ng/mL, 363 of whom had non-metastatic, castrate-resistant prostate cancer. Of these, 187 patients (356 bone scans) had calculable PSA kinetics and ≥1 bone scan. Median follow-up after castrate-resistant prostate cancer diagnosis was 32 months (IQR: 19-48). There were 227 (64%) negative and 129 (36%) positive bone scans. On multivariable analysis, higher PSA at castrate-resistant prostate cancer (4.67 vs. 4.4ng/mL, OR=0.57, P=0.02), shorter time from castrate-resistant prostate cancer to scan (7.9 vs. 14.6 months, OR=0.97, P=0.006) and higher PSA at scan (OR=2.91, P <0.0001) were significantly predictive of bone scan positivity. The AUC of the previously published risk tables for predicting scan positivity was 0.72. Conclusion: Previously published risk tables predicted bone scan positivity in men with non-metastatic, castrate-resistant prostate cancer with reasonable accuracy.

Metástasis bilateral de húmero, en paciente con cáncer renal, tratado con inmunoterapia y cirugía: reporte de un caso / Bilateral Humeral metastases, in a patient with renal cancer, treated with immunotherapy and surgery: case report

El carcinoma de células renales es el 7mo cáncer en frecuencia a nivel mundial con más de 300.000 casos nuevos al año y es la 3era malignidad genitourinaria más frecuente. El sitio más común de metástasis es el pulmón mientras que el esqueleto ocupa el segundo lugar con una frecuencia que varía entre un 20% a un 35%. Se ha reportado una sobrevida de 12 meses en promedio luego de la aparición de metástasis óseas. Reporte del caso de un paciente con diagnóstico de cáncer renal de células claras y metástasis óseas (en columna, pelvis y ambos húmeros), que evoluciona con fractura de ambos brazos. El paciente es aceptado en un ensayo clínico de tratamiento con inmunoterapia y además se somete a una reducción y osteosíntesis bilateral de húmero con clavo endomedular, logrando la consolidación de ambas fracturas y, por ende, la regresión de la enfermedad.

Renal cell carcinoma is ranked 7th in frequent cancer worldwide with more than 3000.000 new cases per year, as well as it's ranked 3rd in frequent genitourinary malignancy. The most common area of metastases is lung followed by skeleton in second place. The frequency of skeleton metastases varies from 20% to 35%. A survival average time of 12 months is generally observed after the appearance of bone metastases. This case report is about a patient diagnosed with clear cell renal cancer and bone metastases (in the spine, pelvis and both humerus) that evolves with fracture of both arms. The patient undergoes a clinical trial with immunotherapy and also a reduction and osteosynthesis of both arms with intramedullary nail, achieving consolidation of both fractures and regression of the disease.

Acrometástasis óseas, serie de casos y revisión de la literatura / Bone acrometástasis, case series and literature review

Resumen: Las acrometástasis se definen como metástasis óseas localizadas distales al codo y la rodilla. Su prevalencia es muy baja, aproximadamente el 0,1% de todas las metástasis óseas y se presentan en pacientes con enfermedad avanzada y son indicador de mal pronóstico. Hasta en el 10% de los casos se presentan como el primer signo de neoplasia oculta. Su forma de presentación clínica y radiológica es inespecífica, lo que genera retraso en su diagnóstico y tratamiento. La resonancia magnética es la imagen de elección para el diagnóstico. El tratamiento en la mayoría de los casos es paliativo. Presentamos cuatro pacientes con acrometástasis y una revisión de la literatura.

Abtract: Acrometastasis are defined as localized bone metastases distal to the elbow and knee. Its prevalence is very low, approximately 0.1% of all bone metastases and they present in patients with advanced disease and are considered indicators of poor prognosis. In up to 10% of cases are the first sign of undiagnosed neoplasia. Its clinical and radiological presentation is non-specific which generates delays in its diagnosis and treatment. Magnetic resonance is the image of choice for diagnosis. The treatment in most cases is palliative. We present four patients with acrometastasis and a review of the literature.

Expression of PD1 and BTLA on the CD8+ T Cell and γδT Cell Subsets in Peripheral Blood of Non-Small Cell Lung Cancer Patients / 中国医学科学杂志(英文版)

Objective To investigate the expression and regulation of programmed cell death protein 1 (PD1), B lymphocyte and T lymphocyte attenuator (BTLA) in peripheral blood of patients with non-small cell lung cancer (NSCLC); to examine the correlation of the mRNA levels between PD and BTLA in NSCLC. Methods Flow cytometry was used to detect the expression of PD1 and BTLA on the surfaces of CD8+ T cells and γδ+ T cells in the peripheral blood samples collected from 32 in-patients with stage IV NSCLC and 30 healthy individuals. We compared the expression of PD1 and BTLA on the surfaces of γδ+ T cells in the NSCLC patients with bone metastasis before and after the treatment of zoledronic acid. The correlations of PD1 and BTLA, as well as their ligands were analyzed using Pearson correlation analysis with the cBioPortal data platform. Results The frequency of PD1 on the surfaces of CD8+ T cells was significantly higher than that of the γδT cells in both healthy controls (t=2.324, P=0.024) and NSCLC patients（t=2.498, P=0.015). The frequency of PD1 on CD8+ T cells, rather than on γδ+ T cells, was significantly upregulated in advanced NSCLC patients compared with that in healthy controls (t=4.829, P<0.001). The PD1+ BTLA+γδT cells of the healthy controls were significantly lower than that of the NSCLC patients (t=2.422, P=0.0185). No differences in percentage of PD1+γδ+ and BTLA+γδ+ T cells were observed in 7 NSCLC patients with bone metastasis before and after zoledronic acid treatment. PD1 was positively correlated with BTLA in both lung adenocarcinoma (r=0.54; P<0.05) and lung squamous cell carcinoma (r=0.78; P<0.05). Conclusions The upregulation of co-inhibitory molecules occurs on the surfaces of both CD8+ T cells and γδT cells in advanced NSCLC, suggesting that these molecules were involved in regulating the inactivation of CD8+ T cells and γδ+ T cells, immune escape and tumor invasion.

Outcomes of patients with bone metastases from differentiated thyroid cancer

ABSTRACT Objective Bone metastases (BM) from differentiated thyroid cancer (DTC) are associated with poor survival rates. Due to the low frequency of this entity, we performed a multicentric retrospective study that aimed to evaluate the presentation, outcome and causes of death in this population. Subjects and methods We reviewed file records from 10 databases. BM were diagnosed by: i) biopsy and/or ii) radioiodine (RAI) bone uptake + elevated thyroglobulin (Tg) levels and/or c) bone uptake of 18-FDG in the PET-CT scan + elevated Tg levels. Results Fifty-two patients with DTC were included (44% male, mean age 54 years); 58% had papillary histology. BM were synchronous with DTC diagnosis in 46% of the participating cases. BM were symptomatic in 65% of the cases. Multiple BM were present in 65% of patients, while simultaneous metastatic disease in additional sites was found in 69%. Ninety-eight percent of patients received treatment for the BM, which included RAI therapy in 42 patients; 30 of them received cumulative RAI doses that were larger than 600 mCi 131I. The mean follow-up after a BM diagnosis was 34 months. The 2- and 5-year survival rates after diagnosis of the first BM were 64% and 38%, respectively. The status on the last evaluation was DTC-related death in 52% of the patients; 26% of them died from direct complications of BM or their treatments. Conclusion BM are usually radioiodine-refractory and are associated with a short overall survival, although most of the patients died of causes not directly related to the BM.

Renal mucinous tubular and spindle cell carcinoma combined with multiple bone metastasis: a case report and literature review / 北京大学学报(医学版)

Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare sub-type of renal cell carcinoma (RCC). It has been considered to be a kind of "indolent" tumor with low-grade fashion, weak invasive capacity and relatively favorable prognosis. However, in the current case, a 3.7 cm×2.8 cm spherical mass with contrast enhancement was found in the left kidney incidentally by computed tomography (CT) in a 60-year-old male patient. A lesion in the right humerus (2.1 cm×1.6 cm×3.1 cm) was found at the same time without any symptoms or sign of pathological fracture by magnetic resonance (MR) imaging. Further positron emission tomography (PET)/CT scan which was ordered immediately after admission suggested multiple bone destruction including skull, pelvis, sternum, right humerus and femur, left scapula, multiple vertebrae and libs. Pathological examination after radical nephrectomy and palliative resection with internal fixation of the lesion in the right humerus indicated that both renal (3.0 cm×3.0 cm×2.5 cm) and bone lesions were MTSCC with the features of high-grade ovoid epithelioid cells, cord-like spindle cells and mucinous matrix under light microscope. The diagnosis of renal MTSCC concurrent with multiple bone metastasis was made. This case report suggested the necessity of general evaluation, especially bone scan for possible distant metastasis, as MTSCC might present unexpected advanced behaviors without any orthopedic symptoms. The behavior of bone metastasis might be associated with male and elderly age. MTSCC has similar enhancement features to papillary RCC on CT scan. As results, attentions are needed to differentiate MTSCC from papillary RCC as they both tend to show lesser enhancement degrees than cortex. Rather than exhibiting a dedifferentiating appearance, the pathological characteristics of bone metastasis lesion were close to those of primary renal lesion. The reason of distant metastasis to the bone remained unclear, negative expression of cytokeratin (CK) 7 might be attributed to. Though immunotherapy, chemotherapy and target therapy could all be methods for systematic therapies, procedures to remove renal lesions and prevent skeletal related events are still highly recommended.

Clinical and pathological analysis of renal cell carcinoma bone metastasis / 北京大学学报(医学版)

OBJECTIVE@#To analyze the clinical and pathological characteristics of renal cell carcinoma bone metastasis (RCC-BM) patients.@*METHODS@#Data of RCC-BM patients from July 2003 to November 2017 were retrospectively reviewed. The patients' baseline characteristics (age, gender), tumor characteristics [specific sites of bone metastasis, time to bone metastasis (TTBM), imaging features of bone disease, coexistence of other metastasis], as well as pathological features (histological classification of primary and bone metastasis, immunohistochemical stain results) were collected. Descriptive analysis and difference analysis were used.@*RESULTS@#A total of 113 RCC-BM patients were enrolled with the gender ratio (male:female) of 4:1, mean age of 59.39 years, and all present of osteolysis bone lesions. The common sites of bone metastasis were vertebra (46.0%) and pelvis (38.9%). Other distant metastasis sites coexisted in 28.3%, while 48.18% RCC-BM patients presented with synchronous metastasis (TTBM=0). The median TTBM for metachronous metastasis was 48 months. The majority in this cohort were determined to have primary tumor of clear cell carcinoma. After immunohistochemical examination to 104 RCC-BM patients and sub-group analysis, tendencies of higher positive rates of vascular endothelial growth factor (VEGF) was also found in synchronous group (P=0.097) while tendencies of higher positive rates of carbonic anhydrase (CA)-IX was found in the same group (P=0.100). The patients with clear cell RCC-BM had a significantly higher positive expression of epithelial growth factor receptor (EGFR, P<0.05) than those with non-clear cell RCC-BM group.@*CONCLUSION@#More male and younger patients with metastatic lesions in axial skeleton were found in this cohort. Tendencies in the expression of CA-IX and VEGF in different TTBM sub-group and EGFR in different histology-derived subgroup indicate that they might be associated with risk and prognostic factors and support further target therapies of RCC-BM.

External validation and newly development of a nomogram to predict overall survival of abiraterone-treated, castration-resistant patients with metastatic prostate cancer / 亚洲男科学杂志(英文版)

Abiraterone acetate is approved for the treatment of castration-resistant prostate cancer (CRPC); however, its effects vary. An accurate prediction model to identify patient groups that will benefit from abiraterone treatment is therefore urgently required. The Chi model exhibits a good profile for risk classification, although its utility for the chemotherapy-naive group is unclear. This study aimed to externally validate the Chi model and develop a new nomogram to predict overall survival (OS). We retrospectively analyzed a cohort of 110 patients. Patients were distributed among good-, intermediate-, and poor-risk groups, according to the Chi model. The good-, intermediate-, and poor-risk groups had a sample size of 59 (53.6%), 34 (30.9%), and 17 (15.5%) in our dataset, and a median OS of 48.4, 29.1, and 10.5 months, respectively. The C-index of external validation of Chi model was 0.726. Univariate and multivariate analyses identified low hemoglobin concentrations (<110 g l-1), liver metastasis, and a short time interval from androgen deprivation therapy to abiraterone initiation (<36 months) as predictors of OS. Accordingly, a new nomogram was developed with a C-index equal to 0.757 (95% CI, 0.678-0.836). In conclusion, the Chi model predicted the prognosis of abiraterone-treated, chemotherapy-naive patients with mCRPC, and we developed a new nomogram to predict the overall survival of this group of patients with less parameters.

Bone-targeted therapies to reduce skeletal morbidity in prostate cancer / 亚洲男科学杂志(英文版)

Bone metastases are the main driver of morbidity and mortality in advanced prostate cancer. Targeting the bone microenvironment, a key player in the pathogenesis of bone metastasis, has become one of the mainstays of therapy in men with advanced prostate cancer. This review will evaluate the data supporting the use of bone-targeted therapy, including (1) bisphosphonates such as zoledronic acid, which directly target osteoclasts, (2) denosumab, a receptor activator of nuclear factor-kappa B (RANK) ligand inhibitor, which targets a key component of bone stromal interaction, and (3) radium-223, an alpha-emitting calcium mimetic, which hones to the metabolically active areas of osteoblastic metastasis and induces double-strand breaks in the DNA. Denosumab has shown enhanced delay in skeletal-related events compared to zoledronic acid in patients with metastatic castration-resistant prostate cancer (mCRPC). Data are mixed with regard to pain control as a primary measure of efficacy. New data call into question dosing frequency, with quarterly dosing strategy potentially achieving similar effect compared to monthly dosing for zoledronic acid. In the case of radium-223, there are data for both pain palliation and improved overall survival in mCRPC. Further studies are needed to optimize timing and combination strategies for bone-targeted therapies. Ongoing studies will explore the impact of combining bone-targeted therapy with investigational therapeutic agents such as immunotherapy, for advanced prostate cancer. Future studies should strive to develop biomarkers of response, in order to improve efficacy and cost-effectiveness of these agents.

Up-regulated expression of CD147 gene in malignant bone tumor and the possible induction mechanism during osteoclast formation

It is increasingly evident that the microenvironment of bone can influence cancer phenotype in many ways that favor growth in bone. CD147, a transmembrane protein of the immunoglobulin (Ig) superfamily, was identified independently in different species and has many designations across different species. However, expression levels of CD147 mRNA in bone cancer have not been described. In this study, we have used real-time fluorescence quantification (RT-PCR) to demonstrate CD147 expression in malignant bone cancer and benign bone tumor tissues. The results suggested that the expression of CD147 gene was significantly up-regulated in malignant bone cancer. Moreover, we found that over-expressed RANKL progressively enhanced osteoclast formation up to 48 h, which suggested that RANKL could promote the formation of osteoclast, indicating that both CD147 and RANKL play important roles in the formation of osteoclasts. Furthermore, the expressions of four osteoclast specific expression genes, including TRACP, MMP-2, MMP-9 and c-Src, were analyzed using RT-PCR. The results indicated that four osteoclast-specific expression genes were detectable in all osteoclast with different treatments. However, the highest expression level of these four osteoclast-specific expression genes appears in the CD147+ RANKL group and the lowest expression level of these four osteoclast-specific expression genes appears with si-RANKL treatment. Characterization of the role of CD147 in the development of tumors should lead to a better understanding of the changes occurring at the molecular level during the development and progression of primary human bone cancer.

Intrathoracic stomach mimicking bone metastasis from thyroid cancer in whole-body iodine-131 scan diagnosed by SPECT/CT

SUMMARY The whole-body iodine-131 scintigraphy is an imaging technique in monitoring patients with a history of thyroid cancer. Although the rate of false positives is negligible, it is not nonexistent. We report the case of an intervened and treated patient for thyroid cancer with good clinical and biochemical response. Scintigraphic findings were consistent with unsuspected bone metastasis. Fused SPECT/CT data allowed accurate diagnosis of giant diaphragmatic hernia associated with intrathoracic stomach, a very rare pathology that can lead to false positive results.

Carcinoma vesicular de células en anillo de sello: diseminación poco frecuente: reporte de un caso con tomografía computada por emisión de positrones con fluor 18-deoxiglucosa / Bone metastases of a gallbladder carcinoma detected by positron emission tomography/computed tomography: case report

Signet ring gallbladder carcinoma is a rare aggressive variant of mucinous adenocarcinoma with poor prognosis. Positron emission tomography/computed tomography (PET/CT) with Fluor18 deoxyglucose (F18-FDG) is a useful tool in the staging of gallbladder cancer. We report a 68 years old man with a surgically resected acute cholecystitis, whose biopsy was positive for signet ring cell gallbladder carcinoma. During surgery, locoregional lymph nodes, liver or peritoneal involvement were not detected. A PET/CT was performed for staging, finding multiple hypermetabolic lytic bone lesions. Percutaneous biopsy of a pelvis bone lesion, confirmed a metastasis of the tumor. In this case, the staging with PET/CT allowed the diagnosis of unsuspected bone metastases and was a useful tool for deciding the best site of biopsy for histologic confirmation.

Manejo con instrumentación 360 o de enfermedad ósea metastásica que condiciona inestabilidad en columna cervical. Reporte de un caso clínico / 360 degrees instrumentation for cervical instability due to metastatic bone disease. Case report

Resumen: Introducción: La columna vertebral es el sitio más frecuente de localización para las metástasis óseas; siendo los tumores de mama, próstata y pulmón los que mayor afectación presentan. La columna torácica es afectada en un 70% de los casos, seguida de la región lumbar y cervical. Material y métodos: se presenta el caso de un paciente con diagnóstico de adenocarcinoma mamario derecho, con enfermedad ósea metastásica en región cervical a nivel de C2, C3, inestabilidad del segmento cervical por fractura por compresión del cuerpo C3 de mayor al 80%, sin invasión a canal medular, inicia con parestesias de extremidades torácicas. Se realiza instrumentación 360º en dos tiempos. Posterior al procedimiento la paciente evolucionó sin dolor cervical y tolerando la vía oral. Discusión: la enfermedad ósea metastásica genera lesiones importantes en la columna vertebral condicionando inestabilidad; la instrumentación mejora el estado funcional y el pronóstico.

Abstract: Introduction: The spine is the most common site for bone metastases; being the breast, prostate and lung cancer which have most affected. The thoracic spine is involved in 70% of cases, followed by the lumbar and cervical region. Material and methods: This is a 59 years old female diagnosed with breast adenocarcinoma and metastatic bone disease in cervical spine C2, C3 level and instability of that segment because of a compression fracture of C3 greater than 80% without invasion of the spinal canal, she begins with paresthesias of upper limbs. A 360º instrumentation was performed in two stages. After the surgical procedure the patient were without neck pain and a good neurological status. Discussion: Metastatic bone disease causes significant damage to the spine sometimes create instability proper instrumentation is needed to improve the functional status and prognosis of these lesions.

Experiencia de tratamiento paliativo en metástasis óseas / Bone metastases and palliative radiotherapy

Abstract Background: About 40-50% of cancer patients have indication of palliative radiotherapy during the course of their disease. Bone metastases are the most common cause of cancer-related pain. Evidence shows that there is no statistically significant difference between long and short treatments modalities in pain relief. The aim of this study is to review the experience in treatment of patients requiring palliative radiotherapy for bone metastases treated in Clinica IRAM during 2012. methods: Descriptive retrospective analysis of medical records of patients treated during 2012 at Clínica IRAM with palliative radiotherapy for painful bone metastases. results: 197 patients were included. The median time between onset of symptoms and initiation of treatment was 4 months (1-42 months). The scheme of 8 Gy in one fraction was the most prescribed.Sixty-two percent of patients had a very good/good response to treatment, and 10% had a poor response. Themedian survival was 10.5 months. One, 12 and 24 months survival was 91.8%, 46.3%, 28.7% respective ly.Ten patients were re-irradiated, 7 of them had received 8 Gy in a single fraction as first treatment dose. conclusion: The palliative treatment of cancer patients is an important indication of radiotherapy. The most common indication for treatment was 8 Gy/1 fraction; however, there was a 40% multi fractionated treatments. Since pain relief is similar between different treatment modalities, to offer a shorter treatment appears to bea more reasonable option.

Resumen Introducción: Aproximadamente 40-50% de los pacientes con cáncer tiene indicación de radioterapia paliativa durante el curso de su enfermedad. Las metástasis óseas son la causa más frecuente de dolor relacionado al cáncer. Existe evidencia que demuestra que no existe diferencia estadísticamente significativa entre esquemas de tratamientos prolongados y cortos en alivio del dolor. Objetivo: Revisión de la experiencia en el tratamiento de pacientes con indicación de radioterapia paliativa por metástasis ósea tratados en Clínica IRAM en el año 2012. Método: Análisis retrospectivo descriptivo de fichas clínicas de pacientes tratados el año 2012 en Clínica IRAM con indicación de radioterapia paliativa por metástasis óseas. Resultados: Se incluyeron 197 pacientes. La mediana de tiempo entre inicio de síntomas e inicio de tratamiento fue de 4meses (1-42 meses). El esquema de 8 Gy en 1 fracción fue el más prescrito; 62% de los pacientes tuvo una respuesta muy buena/buena al tratamiento, y 10% tuvo una respuesta pobre. La mediana de sobrevida fue10,5 meses. La sobrevida al mes, 12 y 24 meses fue 91,8%, 46,3%, 28,7% respectivamente. Diez pacientes fueron reirradiados, 7 de ellos tuvieron primer esquema de mono dosis 8 Gy/1 fracción. Conclusión: El manejo paliativo de pacientes con cáncer representa una importante indicación de radioterapia. La indicación más frecuente de tratamiento fue 8 Gy/1 fracción, sin embargo, hubo un 40% de tratamientos multifraccionados. Dado que el alivio del dolor es similar entre distintas modalidades terapéuticas, realizar un tratamiento más corto parece ser una alternativa más razonable.

Advances in diagnosis and treatment of metastatic cervical cancer / 부인종양

Cervical cancer is one of the most common cancers in women worldwide. The outcome of patients with metastatic cervical cancer is poor. We reviewed the relevant literature concerning the treatment and diagnosis of metastatic cervical cancer. There are two types of metastasis related to different treatments and survival rates: hematogenous metastasis and lymphatic metastasis. Patients with hematogenous metastasis have a higher risk of death than those with lymphatic metastasis. In terms of diagnosis, fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) and PET-computed tomography are effective tools for the evaluation of distant metastasis. Concurrent chemoradiotherapy and subsequent chemotherapy are well-tolerated and efficient for lymphatic metastasis. As for lung metastasis, chemotherapy and/or surgery are valuable treatments for resistant, recurrent metastatic cervical cancer and chemoradiotherapy may be the optimal choice for stage IVB cervical cancer. Chemotherapy and bone irradiation are promising for bone metastasis. A better survival is achieved with multimodal therapy. Craniotomy or stereotactic radiosurgery is an optimal choice combined with radiotherapy for solitary brain metastases. Chemotherapy and palliative brain radiation may be considered for multiple brain metastases and other organ metastases.

Advances in diagnosis and treatment of metastatic cervical cancer / 부인종양

Cervical cancer is one of the most common cancers in women worldwide. The outcome of patients with metastatic cervical cancer is poor. We reviewed the relevant literature concerning the treatment and diagnosis of metastatic cervical cancer. There are two types of metastasis related to different treatments and survival rates: hematogenous metastasis and lymphatic metastasis. Patients with hematogenous metastasis have a higher risk of death than those with lymphatic metastasis. In terms of diagnosis, fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) and PET-computed tomography are effective tools for the evaluation of distant metastasis. Concurrent chemoradiotherapy and subsequent chemotherapy are well-tolerated and efficient for lymphatic metastasis. As for lung metastasis, chemotherapy and/or surgery are valuable treatments for resistant, recurrent metastatic cervical cancer and chemoradiotherapy may be the optimal choice for stage IVB cervical cancer. Chemotherapy and bone irradiation are promising for bone metastasis. A better survival is achieved with multimodal therapy. Craniotomy or stereotactic radiosurgery is an optimal choice combined with radiotherapy for solitary brain metastases. Chemotherapy and palliative brain radiation may be considered for multiple brain metastases and other organ metastases.

The negative prognostic impact of bone metastasis with a tumor mass

OBJECTIVE: Typically, bone metastasis causes osteolytic and osteoblastic lesions resulting from the interactions of tumor cells with osteoclasts and osteoblasts. In addition to these interactions, tumor tissues may grow inside bones and cause mass lesions. In the present study, we aimed to demonstrate the negative impact of a tumor mass in a large cohort of patients with bone metastatic cancer. METHODS: Data from 335 patients with bone metastases were retrospectively reviewed. For the analysis, all patients were divided into three subgroups with respect to the type of bone metastasis: osteolytic, osteoblastic, or mixed. The patients were subsequently categorized as having bone metastasis with or without a tumor mass, and statistically significant differences in median survival and 2-year overall survival were observed between these patients (the median survival and 2-year overall survival were respectively 3 months and 16% in patients with a tumor mass and 11 months and 26% in patients without a tumor mass; p<0.001). RESULTS: According to multivariate analysis, the presence of bone metastasis with a tumor mass was found to be an independent prognostic factor (p=0.011, hazard ratio: 1.62, 95% confidence interval: 1.11–1.76). Bone metastasis with a tumor mass was more strongly associated with osteolytic lesions, other primary diseases (except for primary breast and prostate cancers), and spinal cord compression. CONCLUSION: Bone metastasis with a tumor mass is a strong and independent negative prognostic factor for survival in cancer patients. .