Small cell bladder cancer: should we consider prophylactic cranial irradiation?

ABSTRACT Purpose: To describe the clinical characteristics, treatment patterns, and outcomes in patients with small cell bladder cancer at our institution, including those who received prophylactic cranial irradiation (PCI) for the prevention of intracranial recurrence. Materials and Methods: Patients with small cell bladder cancer treated at a single institution between January 1990 and August 2015 were identified and analyzed retrospectively for demographics, tumor stage, treatment, and overall survival. Results: Of 44 patients diagnosed with small cell bladder cancer, 11 (25%) had metastatic disease at the time of presentation. Treatment included systemic chemotherapy (70%), radical surgery (59%), and local radiation (39%). Six patients (14%) received PCI. Median overall survival was 10 months (IQR 4 - 41). Patients with extensive disease had worse overall survival than those with organ confined disease (8 months vs. 36 months, respectively, p = 0.04). Among those who received PCI, 33% achieved 5 - year survival. Conclusion: Outcomes for patients with small cell bladder cancer remain poor. Further research is indicated to determine if PCI increases overall survival in small call bladder cancer patients, especially those with extensive disease who respond to chemotherapy.

Mortalidad por Carcinoma de Pulmón en el Hospital Provincial Dr Antonio Luaces Iraola de Enero de 1994 a Diciembre del 2006 / Mortality caused by Lung Carcinoma, Provincial Hospital Dr Antonio Luaces Iraola January 1994 to December 2006

Se realizó un estudio, longitudinal, retrospectivo, descriptivo de 6999 autopsias de fallecidos mayores de 15 años, en el Hospital Provincial D. Antonio Luaces Iraola de Ciego de Ávila, en el período de enero de 1994 a diciembre del 2006, donde se diagnosticaron 254 fallecidos con algún tipo de carcinoma pulmonar (3,62 por ciento). La edad promedio fue de 68 años, el mayor grupo de fallecidos tenía más de 65 años (65,64 por ciento). Las principales especialidades de egreso fueron, Medicina Interna (46,46 por ciento), Extra hospitalarias (20,47 por ciento) y Medicinas Intensivas (19,29 por ciento). Egresan en las primeras 72 horas el 66,93 por ciento de los fallecidos. Las principales causas directas de muerte unidas a las causas intermedias de muerte, fueron la Bronconeumonía (74,01 por ciento), la Diseminación extensa del tumor (56,69 por ciento) y la Insuficiencia Respiratoria Aguda (38,98 por ciento). Los tipos histológicos de tumores diagnosticados fueron el carcinoma de células escamosas (67,7) el adenocarcinoma (25,5 por ciento) y el carcinoma indiferenciado de células pequeñas (5,51 por ciento). Las coincidencias diagnósticas en las causas directas de muerte fueron totales en el 55,9 por ciento de los casos y en las causas básicas en el 37,8 por ciento.

A longitudinal, retrospective, descriptive study of 6999 autopsies to deceased people with more than 15 years old was realised, in the Provincial Hospital Dr Antonio Luaces Iraola of Ciego de Ávila, in the period from January 1994 to December of 2006, where 254 dead people with some type of pulmonary carcinoma were diagnosed (3.62 percent). The average age was 68; the greater group of deceased patients had more than 65 years of age (65.64 percent). The majority of patients were discharged to Internal Medicine (46, 46 percent), Community services (20, 47 percent), and Intensive care (19, 29 percent). The 66.93 percent of the patients, who died, left in the first 72 hours. The main direct causes of death along with other intermediate causes were the Bronchopneumonia (74.01 percent), the extensive Dissemination of tumor (56.69 percent) and the Acute Respiratory Insufficiency (38.98 percent).

Survival in small cell lung cancer in India: prognostic utility of clinical features, laboratory parameters and response to treatment.

BACKGROUND: Predictors of survival and response to treatment in patients with small cell lung cancer (SCLC) are ill-defined and unclear. In an attempt to assess the impact of common presenting symptoms and laboratory values on survival, we undertook this retrospective review of patients with SCLC. To our knowledge, there is no study on survival in SCLC patients from the Indian subcontinent. DESIGN: Retrospective Cohort study. MATERIALS AND METHODS: All newly diagnosed small cell lung cancer cases from December 2001 through December 2004, were identified and clinical data on presenting symptoms and laboratory findings from their hospital records, noted. The influence of various pretreatment factors on survival was investigated using Kaplan-Meier plots and Cox multivariate regression model. RESULTS: 76 subjects were included (84% males, 91% smokers). 57% patients had five or more symptoms at presentation. Cumulative symptom burden was strongly associated with survival (P =0.02). Survival was also significantly related with Karnofsky performance status (KPS) (P =0.04), disease extent (P =0.03) and symptomatic response to treatment (P< 0.001). Patients with higher hemoglobin (P =0.02), serum sodium (P =0.04) and serum globulin (P =0.02), survived significantly longer. By multivariate regression analysis, hemoglobin, KPS and brain metastases, were significant predictors of survival (P =0.01, P =0.02, P< 0.01 respectively). CONCLUSION: Cumulative symptom burden, KPS, disease extent and symptomatic assessment of improvement after treatment, are useful predictors of survival. This has important clinical implications, keeping in view, the infrastructure and cost involved in more objective tests like CT scan, for evaluation of disease extent and prognosis. These findings can provide a simple basis for predicting prognosis in small cell lung cancer, especially in developing countries like ours.

Clinical Overview of Extrapulmonary Small Cell Carcinoma

The objective of this study was to review the natural history of extrapulmonary small cell carcinoma (EPSCC) with specific emphasis on clinical features, response to treatment and survival. The records of all patients (n=34) with EPSCC treated at Yeungnam University Medical Center and Catholic University of Daegu Medical Center between 1998 and 2005 were retrieved and reviewed. The primary sites of tumor were the esophagus and thymus in 6 patients (17.6%) each, pancreas and stomach in 5 patients each (14.7%); other sites included were the cervix, abdominal lymph nodes, abdominal wall, bladder, colon, maxillary sinus, nasal cavity, ovary, parotid gland and liver. Twenty three patients out of 34 had limited disease. The median survival of all patients was 14 months. Independent prognostic factors included stage and primary tumor location. The prognosis for the patients with extensive disease and in the gastrointestinal group was unfavorable. EPSCC is a non homogeneous disease entity. As a result of its frequent recurrence, multimodal therapy has a better outcome even in cases of limited disease. Combination chemotherapy plays a central role for treatment of extensive disease in EPSCC. Further multicenter studies are now needed to determine more details regarding disease sub-class and optimal treatment modality.

Desmoplastic small round cell tumor: extra abdominal and abdominal presentations and the results of treatment.

BACKGROUND: Desmoplastic small round cell tumor (DSRCT) is a rare malignant neoplasm of adolescent males. Current multimodality treatment prolongs life and rarely achieves cure. AIM: To review the presenting features, histopathology and outcome of 18 patients with DSRCT treated at a single institution. SETTING AND DESIGN: This is a retrospective observational study of patients with DSRCT who presented at the Tata Memorial Hospital between January 1994 to January 2005. MATERIALS AND METHODS: Eighteen patients of DSRCT seen during this period were evaluated for their clinical presentation, response to chemotherapy and other multimodality treatment and overall survival. The cohort of 18 patients included 11 males (61%) and 7 females (39%) with a mean age of 16 years (Range 1(1/2)--30 years). Majority (83%) presented with abdomino-pelvic disease. The others, involving chest wall and extremities. There were 6 patients (33%) with metastatic disease at presentation. RESULTS: The treatment primarily included a multimodality approach using a combination of multiagent chemotherapy with adjuvant surgery and radiotherapy as applicable. A response rate of 39% (CR-1, PR-6), with chemotherapy was observed. The overall response rate after multimodality treatment was 39% (CR-5, PR-2). The overall survival was poor except in patients who had complete excision of the tumor. Conclusion:0 Abdomino-pelvic site was the commonest presentation, the disease can occur at other non-serosal surfaces also. Despite aggressive treatment the outcome was poor. However, complete surgical excision seems to provide a better survival.