Supervivencia de pacientes con cáncer de pulmón con metástasis cerebral en Matanzas / Survival of patients with lung cancer and brain metastasis in Matanzas

RESUMEN Introducción: las metástasis cerebrales cuando aparecen en el curso de un cáncer de pulmón reportan una precaria supervivencia al paciente, los tratamientos incluyen la cirugía o radiocirurgía. La radioterapia holocraneal constituye el estándar cuando los tratamientos locales no son posibles. Se han reportado respuestas del cerebro a la quimioterapia a un nivel comparable al de la enfermedad extra craneal, por lo que la terapia sistémica es una opción razonable para los pacientes sin síntomas neurológicos, o con síntomas relativamente controlados. Objetivo: evaluar la supervivencia de los pacientes según esquemas de tratamientos recibidos. Materiales y métodos: se realizó un estudio descriptivo y retrospectivo en pacientes con diagnóstico cito-histológico de cáncer de pulmón y metástasis cerebral, atendidos en la consulta externa del Centro Oncológico Provincial de Matanzas, en el período comprendido desde enero del 2013 a diciembre del 2016. Para obtener los datos de los tratamientos realizados, determinar fecha de fallecimiento o de última noticia del paciente se utilizaron las historias clínicas de los enfermos y las bases de datos del Servicio de Radioterapia del Centro. Resultados: el 86,5% de los pacientes recibieron tratamiento con quimioterapia de primera línea, el 76% radioterapia al cerebro y el 61,5% con nimotuzumab. Conclusiones: la aplicación de la quimioterapia, la radioterapia holocraneal y la inmunoterapia tuvieron un valor significativo, proporcionando un aumento de la supervivencia de los pacientes estudiados.

ABSTRACT Introduction: brain metastasis report a precarious survival when they appear during the course of a lung cancer. The treatments include surgery or radiosurgery. Whole brain radiotherapy is the standard treatment when the local ones are not possible. There are reports of brain answer to chemotherapy at the level of extra brain diseases; therefore, systemic therapy is a reasonable option for the patients without neurological symptoms, or with relatively controlled symptoms. Objective: to assess the patients´ survival according to the schemes of the received treatments. Materials and methods: a retrospective descriptive study was carried out in patients with cytohistological diagnosis of lung cancer and brain metastasis, who attended the external consultation of the Provincial Oncological Center of Matanzas in the period from January 2013 to December 2016. The clinical records and databases of the Radiotherapy Service of the Center were used to obtain the data of the treatments carried out, the patients' date of dead or of the last information about them. Results: 86.5 % of the patients received treatment with front-line chemotherapy, 76 % brain radiotherapy, and 61.5 % with Nimotuzumab. Conclusions: the application of chemotherapy, whole brain radiotherapy and immunotherapy achieved great improvement, increasing the survival of the studied patients.

Metástasis intraorbitárias de cáncer de mama / Breast cancer orbital metastasis

Objetivo: Describir un caso raro de una paciente previamente diagnosticada con cáncer de mama que evolucionó después de algunos años con metástasis intraorbitaria. Métodos: Relato del caso y revisión de literatura. Resultados: La correlación del diagnóstico previo de neoplasia de mama y la presencia de múltiples lesiones en la órbita y regiones adjacentes ha permitido concluir que la paciente presentaba enfermedad metastásica. Las metástasis se presentan como manifestaciones cada vez más frecuentes en enfermos oncológicos. La órbita y estruturas próximas constituyen topografías poco usuales de diseminaciónde células neoplásicas y manifestaciones iniciales pueden mimetizar otras condiciones, retrasando el diagnóstico. Como se trataban de pequeñas lesiones, se ha optado por radioterapia como tratamiento único. Después del término la paciente evolucionó con regresión de sintomatología. Conclusiones: Aunque infrecuentes, manifestaciones oculares pueden ocurrir en enfermos oncológicos y la investigación de enfermedad metastático de la órbita es esencial para el seguimiento adecuado.

Objective: Description a rare case of a patient with previous diagnosis of breast cancer that evolved years after with orbital metastasis. Method: Case report and literature review. Results: The relation between the previous diagnosis of breast cancer and the presence of multiple orbital and adjacent lesions allowed concluding that the patient presented metastatic disease. Metastasis presented as a common manifestation in oncological patients. Orbit and neighboring structures constitute unusualsite of neoplastic cells dissemination and initial manifestations could mimic other conditions, which can slow diagnosis. As they were small lesions that are close to noble structures, it was opted by performing exclusive radiotherapy. After the end of treatment, the patient referred improvement of her symptoms. Conclusions: Although unusual, ocular manifestations could occur in oncological patients and orbit metastatic disease investigation is essential to the proper follow.

Emerging radiotherapy technology in a developing country: A single Brazilian institution assessment of stereotactic body radiotherapy application / Tecnologias emergentes em radioterapia em um país em desenvolvimento: perfil do uso de radiocirurgia extracraniana em uma instituição filantrópica privada

Summary Objective: To provide a quantitative profile of the indications and use of stereotactic body radiotherapy (SBRT) in a developing country oncology-based institution. In addition, to describe the patients' and treatment characteristics, and to provide a temporal analysis. Method: SBRT patients treated from 2007 to 2015 were retrospectively evaluated by two independently investigators. Data were stratified and compared in two periods: first experience (FE) (May 2007 to April 2011), and following experience (FollowE) (May 2011 to April 2015). The following parameters were compared between the groups: total number of treated patients and lesions, treatment site, additional image fusion used, formal protocol adoption, and SBRT planning technique. Results: One hundred and seventy-six (176) patients with 191 lesions were treated: 34 (18%) lesions in the FE and 157 (82%) lesions in FollowE. The majority of lesions were metastases (60.3%), and lung (60.2%) was the most common treatment site, followed by spine (31%), and others (8.8%). An average of 1.4 (±0.6) additional imaging exams for delineation was performed. Conformal 3D radiotherapy planning technique was used in 64.4%, and intensity modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT) in the remaining 35.6% (p=0.0001). Higher rates of curative treatments were observed in FE, as well as more lung lesions, patients ≥ 70 years, 3D conformal, number of additional images and ECOG 0, and all presented p<0.05. The global rate of protocol statement was 79%, lung treatment being the most stated. Conclusion: SBRT application is rapidly increasing in our setting. Treatment sites and planning techniques are becoming more diversified and complex.

Resumo Objetivo: realizar uma análise quantitativa das indicações e do uso de SBRT (stereotactic body radiotherapy) em uma instituição filantrópica. Além disso, descrever temporalmente as características dos pacientes e tratamentos. Método: retrospectivamente, foram coletados, por dois investigadores independentes, os dados de todos os pacientes tratados com SBRT na instituição no período de maio de 2007 a fevereiro de 2015. Dados foram estratificados e comparados em dois períodos: inicial (P1) (maio de 2007 a abril de 2011) e período seguinte (P2) (maio de 2011 a abril de 2015). Os seguintes parâmetros foram comparados entre os grupos: número total de pacientes e lesões tratadas, local de tratamento, uso de imagens adicionais, adoção formal de protocolo e técnica de planejamento. Resultados: foram avaliados 176 pacientes e 191 lesões, sendo 34 (18%) no P1 e 157 (82%) no P2, tratados com SBRT. A maioria das lesões eram metastáticas (60,3%), sendo pulmão o sítio mais prevalente, contabilizando 115/191 (60,2%) lesões, seguida de lesões ósseas (30,8%). Uma média de 1,4 (±0,6) exame de imagem adicional foi usada para o delineamento. Uso formal de protocolo/recomendações foi descrito em 79% das lesões. A técnica 3D-conformada (3DCRT - three-dimensional conformal radiotherapy) foi a mais utilizada para planejamento [123/191 (64,4%) lesões] quando comparada à intensidade modulada e ao arco dinâmico (p=0.0001). O P1 esteve associado a maior número de lesões primárias tratadas (OR 2,09; p=0,0005), lesões pulmonares (OR 3,85; p=0,0198), pacientes ≥ 70 anos (OR 2,77; p=0,0005), uso de planejamento 3D (OR 16; p=0,0001), menor uso de imagens adicionais [0 ou 1 (versus > 1)] (OR 7,5; p=0,0001) e ECOG 0 (vs. > 0) (OR 0,21; p=0,0431). Conclusão: o uso de SBRT aumentou ao longo do tempo na instituição. No P2, notou-se uma evolução técnica, com indicações mais diferenciadas, maior uso de imagens auxiliares para definição do alvo e técnicas de planejamento mais sofisticadas.

Radioterapia estereotáctica extracraneal un nuevo paradigma: en terapéutica oncológica: experiencia preliminar / Extra cranial stereotactic radiation therapy: a new paradigm in oncology therapeutic: preliminar experience

Presentar resultados preliminares del tratamiento con radioterapia estereotáctica extracraneal en metástasis hepáticas, tumores pulmonares y otras lesiones metastásicas. Se describe método terapéutico y se presenta un análisis prospectivo de 25 pacientes tratados en el servicio de radioterapia la Trinidad con esta modalidad de radioterapia de alta precisión, desde marzo de 2009. Se utilizó un acelerador lineal Varian® IX versión Trilogy con equipo de imágenes incorporado. Las dosis de radioterapia oscilaron entre 60 Gy en 3 fracciones a 44,5 Gy en 10 fracciones. El tiempo de seguimiento osciló de <1 mes a 16 meses. Se incluyeron un total de 25 individuos (44 lesiones); 14 pacientes con metástasis hepáticas, 5 con metástasis pulmonares (3 de ellos también recibieron tratamiento por metástasis hepáticas), 4 con tumores primarios de pulmón, 2 con metástasis vertebrales y 3 con otras lesiones secundarias. La tolerancia al tratamiento fue en general satisfactoria, sin complicaciones severas. Se observó estabilización o regresión parcial de las lesiones en 17 pacientes, persistencia o progresión local en 3 pacientes. En 13 individuos la enfermedad a distancia permaneció estable y en 10 ocurrió progresión de la misma, durante este tiempo limitado de seguimiento. Cuatro pacientes han fallecido con enfermedad. La radioterapia extracraneal estereotáctica es una modalidad terapéutica novedosa, con gran potencial en el manejo multidisciplinario de las enfermedades neoplásicas. Los resultados preliminares de este trabajo, demuestran su efectividad, seguridad y la factibilidad de su aplicación en nuestro país

Present the preliminary results obtained with stereotactic body radiation therapy in liver metastases, pulmonary tumors and other metastatic lesions. Treatment is described, presenting a prospective analysis of 25 patients treated in La Trinidad Radiation Therapy Service since March 2009. Patients were treated using a dual energy IX Varian® linear accelerator Trilogy version, with on board imaging. Doses of radiation varied from 60 Gy in 3 fractions to 44.5 Gy in 10 fractions. Follow up time varied from < 1 month to 16 months. Total of 25 patients were included in the study (44 lesions); 14 patients with liver metastases, 5 with lung metastases (3 of them also received treatment for liver metastases), 4 primary lung tumors, 2 vertebral metastases, and 3 with other metastatic lesions. Treatment was in general well tolerated with no serious complications. Partial regression or stabilization of the treated lesions occurred in 17 patients, persistence or local progression was seen in 3 patients. In 13 individuals there was no appearance of new metastatic disease and 10 showed progression of distant disease, during this limited follow up time. Four patients have died with disease. Stereotactic body radiation is a novel high precision radiation therapy technique with a great potential in the multidisciplinary management of patients with neoplastic disease. The preliminary results of this study and the review of the literature support the safety, and effectiveness of this treatment modality and the feasibility of employing in Venezuela

Braquiterapia endobronquial de alta tasa de dosis en pacientes con obstrucción de la vía aérea central: experiencia en el Instituto Nacional del Cáncer y revisión de la literatura / High dose rate endobronchial brachytherapy in patients with central airway obstruction

Introduction: The main indication of modern high dose rate end bronchial brachyherapy (HDR EBBT) is the palliation of symptoms related to the growth of the endobronchial lung cancer. Methods: EBBT was performed to 27 patients who suffered symptomatic tumoral endobronchial or tracheal pathology, due to primary bronchial disease or secondary metastasis cancer, evaluating the rate of clinical benefit. The tumors were located at tracheal, carinal or proximal bronchial level. Fibrobronchoscopy was performed to all the patients to measure the degree of airway obstruction and to install brachytherapy endobronchial catheters. Between 1 to 4 fractions of 7 to 7.5 Gy were administered. Dyspnea, cough and hemoptysis were subjectively registered before and after treatment, according to an international validated scale. Results: After treatment, all symptoms considerably decreased, disappearing all of the severe categories. Hemoptysis and dyspnea resolved in a 100 percent and 40 percent of patients, respectively; and cough disappeared or was reduced to a minimum grade in 90 percent of cases.

Introducción: La indicación principal de la braquiterapia endobronquial moderna (BTEB) de alta tasa de dosis (HDR), es la paliación de síntomas por crecimiento endobronquial de cánceres pulmonares. Métodos: Se realizó BTEB HDR a 27 pacientes sintomáticos de patología tumoral endobronquial o traqueal, debido a patologías primarias bronquiales o secundarias metastásicas. Los tumores se ubicaban en tráquea, carina o a nivel bronquialproximal. Para observar mejorías en la sintomatología clínica, a todos se les realizó una fibrobroncoscopía (FBC) para medir el grado de obstrucción bronquial e instalar catéteres endobronquiales de braquiterapia. Se administraron entre 1 y 4 fracciones de 7 a 7,5 Gy. Se registró subjetivamente la disnea, tos y hemoptisis antes y después del tratamiento, de acuerdo a una escala internacionalmente validada. Resultados: Tras el tratamiento todos los síntomas disminuyeron considerablemente, desapareciendo toda sintomatología severa. La hemoptisis y disnea desaparecieron en el 100 por ciento y 40 por ciento de los pacientes respectivamente, y la tos desapareció o disminuyó a grado leve en el 90 por ciento de los pacientes.

Análise evolutiva da dor e função neurológica de pacientes submetidos à descompressão medular por lesão vertebral metastática / Pain and neurological function analysis of patients submitted to decompression and stabilization due to metastatic vertebral lesion

Objetivo: Avaliar a evolução da dor e função neurológica em pacientes com lesão metastática em coluna vertebral operados por abordagem posterior. Material e método: Foram avaliados 32 pacientes (17 do gênero feminino e 15 do masculino), idade média de 56,46 anos, com diagnóstico de metástase em coluna vertebral. Os critérios para indicação cirúrgica foram a presença de alteração neurológica progressiva (6 pacientes - 18,75%) dor incapacitante (23 pacientes - 71,87%) ou, ainda, pacientes que sofriam destas condições combinadas (3 pacientes - 9,37%). Foi aplicado o questionário VAS para avaliação de dor e escala de Frankel modificada para avaliação de função neurológica no período pré-operatório, um e seis meses após a cirurgia. Resultado: Foi observada uma variação estatística significante na análise comparativa entre os valores de escala de dor (VAS), com valores finais médios de 5,29 pontos e iniciais de 8,48 pontos. Na avaliação da função neurológica observamos diferenças na análise do nível neurológico através de escala Frankel nos diversos momentos de observação, entretanto não foi possível comprovar estatisticamente quais as principais variações quando comparadas individualmente nesta evolução. Na avaliação inicial, um mês após o procedimento, dos 29 pacientes avaliados, 17 (58,62%) mantiveram o mesmo nível neurológico pré-operatório 7 pacientes (24,13%) apresentaram melhora em ao menos um nível na escala Frankel e em 5 pacientes (17,24%) foi observada piora de ao menos um nível na escala Frankel.

Metástasis hipofisaria / Hypophyseal metastasis

Los tumores metastásicos de la glándula hipofisaria son poco comunes. En su mayoría son lesiones silentes descubiertas accidentalmente en las autopsia. La aparición de metástasis sintomáticas es, en cambio, excepcional. Se describen aquí los hallazgos clínicos y radiológicos de una paciente femenina de 69 años, con un carcinoma indiferenciado del pulmón, diagnosticado hace 2 años y medio, que comenzó con cefalea y trastornos visuales sin hipopituitarismo ni diabetes insípida. Se le realizó resonancia magnética nuclear y se le diagnosticó una lesión hipofisaria, que fue operada por vía tranesfenoidal, y se informó por anatomía patológica una metástasis del carcinoma del pulmón. La paciente se encuentra en estos momentos recibiendo quimioterapia, radioterapia y anticuerpo monoclonal con evolución favorable(AU)

Metastatic tumors of hypophyseal gland are infrequent. Most are silent lesions discovered accidentally in necropsy. Appearance of symptomatic metastasis is however, exceptional. We describe here clinical and radiological findings in a female patient aged 69, presenting with a non-differential carcinoma of lung, diagnosed two years a half ago, starting with headache and visual disorders without hypopituitarism and insipidus diabetes. We made a nuclear magnetic resonance and diagnosis was a hypophyseal lesion operated on by trans-esphenoidal route, and Pathological Anatomy Service reports a metastasis of lung carcinoma. Patient receives chemotherapy, radiotherapy, and monoclonal antibody with a favorable evolution(AU)

Radioterapia como tratamiento de las metástasis tumorales: reporte de dos casos / Radiotherapy as treatment of tumor metastasis: report of two cases

Se presentan dos casos de pacientes con neuroblastoma y sarcoma de Ewing respectivamente, los cuales presentan lesiones metastásicas. El primer caso presenta una lesión a nivel de cuerpo vertebral, el cual a su vez le produjo un síndrome de compresión medular. El paciente presenta alteración en la movilidad y sensibilidad de miembros inferiores, y alteración en el control de sus esfínteres. En el segundo caso se encontró una lesión metastásica a nivel de tejidos blandos en la zona parietal derecha. En ambos cuadros se valora el tratamiento por medio de la radioterapia para el control y reversión de los síntomas

Q12 cáncer diferenciado de tiroides (CDT): estimulación de la TSH endógena con múltiples dosis de TRH y su tratamiento con 131I: experiencia de 3 años / Differentiated thyroid carcinoma: endogenous TSH stimulation by multiple dosage of TRH and treatment with 131I

La búsqueda un método alternativo a la rh-TSH para estimular el aumento de la TSH sérica previo al tratamiento con 131I en pacientes con CDT operados con reducción del tiempo del hipotiroidismo pre ablativo fue el propósito del trabajo que iniciamos en el año 2001 en el Paraguay utilizando múltiples dosis de TRH para estimular la TSH endógena de los pacientes para luego lograr la ablación del remanente tiroideo con 131I. Se conoce que la inyección de una dosis única de 200µU de TRH por vía EV logra el aumento de la TSH endógena en los pacientes con carcinoma diferenciado de tiroides logrando elevar la TSH entre 30 - 35 mUI/L al final de la primera hora , sin embargo, no se cuentan con datos estadísticos de los efectos de múltiples inyecciones de TRH aplicadas por vía EV o por vía IM en los pacientes operados de tiroides por CDT previamente a la ablación con 131I. Material y Método: Desde el 2001al 2007 doscientos pacientes operados por CDT fueron estudiados por este método en el Centro de Diagnostico y Tratamiento Nuclear (CEDIN), 120 correspondieron a cáncer papilar y 80 a cáncer folicular. Ciento ochenta no presentaron metástasis a distancia y 20 presentaron metástasis en cuello, tórax, pelvis y columna dorsal. Tiroidectomía total se realizó en 120 y lobectomía total e itsmectomía más hemilobectomía del lado contra lateral en 80. Todos fueron tratados con dosis ablativas (100 mCi (3.700 mBq) de 131I excepto aquellos con metástasis que recibieron 150 mCi (5.500 mBq) previa estimulación con TRH por vía EV en dos dosis diarias por dos días con previa suspensión de L-tiroxina por 25 días antes del tratamiento reemplazándola por triyodotironina 25 mcg/día por 15 días tras lo cual también fue suspendida 10 días antes de la estimulación con TRH y el tratamiento con 131I. Dos pacientes con metástasis recibieron otra dosis extra de 150 mCi (5.550 MBq) 6 meses después...

The search of an alternative method to the rh-TSH to stimulate endogenous rising of TSH previous to thyroid ablation with 131I in patients with CDT operated. The purpose of the work began in 2001 in Paraguay using multiple dose of TRH IV (200µU of TRH Threlea® Argentina) to stimulate the own TSH of patients previous to 131I ablation. It is known that the injection of an unique dose of 200µU of TRH IV achieves the increasing of the endogenous TSH in patients with differentiated thyroid carcinoma up to 30 - 35 mUI/L at the end of the first hour, however, there is not statistical data of the effects of multiple injections of TRH applied IV or IM in operated patients of DTC previous to the ablation with 131I. Since 2001-2007, two hundred patients operated for DTC were studied by this method, 120 were papillary cancer and 80 follicular cancer. One hundred eighty did not have distance metastasis and 20 presented metastasis in thorax, pelvis and dorsal spine. Total thyroidectomy was carried out in 120 and total lobectomy with itsmectomy plus hemilobectomy of the other lobe in 80. All were treated with ablative dose of 100 mCi (3.700 mBq) of 131I, except those with metastasis which receive 150 mCi (5.500 mBq) with the previous stimulation with TRH IV with two daily dose for three days with previous suspension of L-tiroxine for 25 days and replaced by triyodotiroxine 25 mcg/d for 15 days with suspension 10 days before the stimulation with TRH and treatment with 131I. Two patients with metastasis received another extra dose of 150 mCi (5.550 MBq) 6 months later. One presented uptake in thyroid bed one year after the ablation received a new ablative dose of 100 mCi (3.700 mBq) of 131I. All the patients were interned and isolated by 48 hours. Twenty feminine patients had later pregnancies in 1-3 years after their ablative dose with healthy products. TSH was measured during the stimulation with TRH in all patients...

Metástasis inusual a distancia de carcinoma epidermoide de laringe: acrometástasis hacia las partes blandas de la muñeca / Unusual distant metastasis from epidermoid carcinoma of the larynx: acrometastasis to the soft parts of the wrist

Se presenta un caso de metástasis hacia partes blandas de la muñeca (acrometástasis) de un carcinoma epidermoide de la laringe. Se trata de un paciente de 65 años de edad, a quien se realizó una laringectomía total con disección radical de cuello derecho y funcional del otro lado. La operación se practicó hace 12 meses a causa de una lesión glótica supraglótica. A los 30 días de la intervención el paciente fue irradiado con cobaltoterapia en ambos cuellos. En la actualidad presenta aumento de volumen de las partes blandas de la región anterior de la muñeca izquierda, por lo que se le realizó una biopsia aspirativa con aguja fina. La biopsia arrojó un informe positivo de metástasis de carcinoma(AU)

A case of metastasis to soft parts of the wrist (acrometastasis) from an epidermoid carcinoma of the larynx was presented. The case of a 65-year-old male patient, who underwent total laryngectomy with radical dissection of the right neck and functional dissection of the other side was presented. The operation was performed 12 months ago due to a supraglotic and glotic lesion. 30 days after surgery, the patient was irradiated with cobalt therapy in both necks. At present, he presents increase of the volume of the soft parts of the anterior region of the left wrist, so a fine needle aspiration biopsy was performed. The biopsy yielded a positive report of metastasis from epidermoid carcinoma and of multiple metastases in both lung fields(AU)

Palliative treatment with local-field reirradiation for painful bone metastases

To evaluate prospectively the outcome in terms of palliation, prognostic factors for pain relief and side effects of the local-field reirradiation for painful bone metastases. Between April 2005 and Feb. 2006, 32 cancer patients in Assiut University Hospital, Oncology Department were reirradiated for painful bone metastases. All patients were previously treated with the same regimen 30 Gy/10 Fr/2 wk for the same bone metastases. Reirradiation doses were 10 Gy in 5 fractions in one week to vertebra lesions related to the spinal cord [from C1 to L1] [regimen A] and 20 Gy in 10 fractions in two weeks to other lesions [regimen B]. For regimen A, accumulated biological effective dose [BED] for acute and late effects = 42.5 Gy10 and 43.67 Gy3 respectively. For regimen B, accumulated BED for acute and late effects = 52.5 Gy10 and 53.67 Gy3 respectively. At initial treatment of palliative irradiation: 7 [21.88%] had complete pain relief [CR], 22 [68.65%] had partial relief [PR] and 3 [9.38%] had no response. After reirradiation: 5 patients [15.6%] had CR and 12 [37.5%] had PR. The remaining 15 patients [46.9%] did not benefit from retreatment. 7 patients in first palliative irradiation in CR had obtained either CR in [5] and PR [2]. The response rate of patients with CR at initial treatment was 100% [7/7], and that of patients with previous PR was 45.4% [10/22, p<0.01]. The median duration of pain relief was five months. The median duration of response was 8.5 months and four months with initial CR and initial PR, respectively, [p<0.01]. The factors associated with pain relief were the status of bone metastases [solitary bone metastases], PS [KPS >/= 70%], and duration after initial treatment [>4 months]. All patients tolerated retreatment very well. During treatment and follow-up, no serious side effects were seen. The presented study shows usefulness of the re-radiotherapy with the prescribed doses as a safe and effective method of palliative treatment in cases of painful bone metastases

Metástase cerebral devido a carcinoma de esôfago: relato de caso / Brain metastasis from esophageal carcinoma: report of case

Metástases cerebrais relacionadas a carcinoma primáriode esôfago são extremamente raras. A principal via de disseminaçãoé hematogênica, porém discute-se uma via dedisseminação pelo plexo venoso vertebral devido à raridadede associação com metástases pulmonares em muitos casos. Odiagnóstico da metástase cerebral é feito através da tomografiacomputadorizada. Os pacientes apresentam péssimoprognóstico, com uma sobrevida de 24 meses em 3% dos casos.A ressecção cirúrgica associada com a radioterapia no tratamentodesses pacientes tem obtido melhores resultados doque a radioterapia isolada. Os autores relatam um caso demetástases cerebrais devidas a carcinoma de esôfago.

Uso de radioisótopos en metástasis óseas dolorosas: samario 153 EDTMP / Use of radioisotopes in painful bone metastasis: samarium 153 EDTMP

Los pacientes con dolor debido a metástasis óseas deben ser tratados por un equipo multidisciplinario. Los mecanismos de producción del dolor son poco conocidos y su fisiopatología es compleja, su evolución es progresiva y su manejo difícil. Entre las alternativas terapéuticas del dolor está el uso de isótopos radioactivos, que irradian al órgano blanco mediante emisión de partículas beta. Entre estos isótopos se encuentra el Samario153-EDTMP que está diponible en nuestro país y que tiene una bio distribución favorable y características fisioquímicas y de toxicidad aceptables para ser utilizado en metástasis principalmente osteoblásticas con alivio progresivo del dolor desde las primeras 48 horas y con una duración entre 4 a 35 semanas

Cáncer de mama metastásico al nervio óptico / Methastasic mama cancer a the optic nerve

Se presenta el caso de una paciente femenina de 50 años de edad con diagnóstico de carcinoma de mama derecha de 7 años de evolución, con clínica de dolor óseo generalizado y disminución de la agudeza visual bilateral. Los estudios de extensión revelaron un estadio IV con enfermedad metastásica en hueso, hígado y bilateral al nervio óptico. Recibió tratamiento multidisciplinario con radioterapia paliativa a ambas órbitas, encéfalo, zonas dolorosas óseas y en huesos de sostén, se añadió hormonoterapia con Acetato de megestrol, tamoxifén y dexametasona. Se obtuvo una respuesta parcial satisfactoria con incremento de la agudeza visual y disminución del dolor óseo. El tratamiento paliativo de los pacientes con enfermedad avanzada, permite obtener respuestas subjetivas importantes, al mejorar la sintomatología logramos que el paciente se integre a su entorno familiar y social elevando su calidad de vida, cumplimos así con uno de los preceptos de la medicina "aliviar el dolor", comprender el sufrimiento y aumentar la esperanza en la vida

Metástasis coroídea de carcinoma papilar de tiroides: subtipo tall cell / Choroidal metastasis of papillary thyroid carcinoma: tall cell subtypes

Se presenta un caso de metástasis coroidea de un cáncer papilar de tiroides. La metástasis es el mecanismo más frecuente de la aparición de patología ocular maligna. Sin embargo el tumor primario más frecuente es el de la mama y del pulmón seguido por riñón, testículo, próstata e intestino. El cáncer de tiroides es raro y menos frecuente aún es que envíe metástasis a la coroides. El paciente presentaba además metástasis a huesos largos, tórax y cerebro. La lesión coroidea fue tratada con radioterapia con mal resultado

Half body irradiation as a pain relief tool for osseous metastases in breast cancer

This study included 18 patients 16 female and 2 male with wide spread bone metastases from breast cancer. All patients had either failed to respond to chemotherapy, hormonal therapy or developed recurrence of their symptoms. The half of the body showing most agonizing symptoms was irradiated first. The dose of the upper half was limited to 6 Gy. in order to subside the risk of radiation pneumonitis and lung complications. The lower half recieved 8 Gy after a 4-6 weeks in terval to allow bone marrow recovery. A line passing accross the bottom of the L4 vertebra is the line to separate upper and lower hemibody irradiation. The upper half hemibody irradiation extended from inferior margin of the orbit to L4. The lower half body irradiation extended 1 cm from lower border of L4 to just below knees. Premedication was given to all patients before irradiation to subside nausea and vomiting.Pain relief occured within 24-48 hours in 66.6% of all responders and in 27.8% within 2-14 days of treatment.Duration of pain relief range from less than one month to more than six months

Cutaneous malignant melanoma with metastatic intracerebral space occupying lesion

A detailed case report of a patient with cutaneous malignant melanoma having a metastatic intracerebral space occupying lesion causing hemiplegia has been presented. A brief and relevant review of the subject has been summarized. It is our conclusion that [a] in the presence of slight pigmentation at the edge of any nodular or ulcerated lesion a diagnosis of malignant melanoma should be considered especially in sites where a predisposing mole may or can not have been noticed; [b] it is necessary to carry out thorough clinical, laboratory and radiological investigations to detect the presence of lymphatic or visceral [lung/liver/cerebral] metastasis, and [c] intracerebral metastatic lesions of malignant melanoma are uncommon and such lesions presenting as space occupying lesion in the brain are extremely rare

Half body irradiation in metastatic cancer: Technique, results and morbidity

The study included 73 patients with disseminated skeletal metastases from different primary cancers. They received 101 half body irradiation [HBI] treatments, 34 upper HBI and 67 lower HBI. Patients were r and omized into two groups; either receiving single fraction HBI [65 treatments] giving 850 cGy midplane dose, or fractionated HBI [36 treatments] giving the same dose divided over two fractions separated by 24 hours. The overall response to UHBI was 100% with 82% complete responses, while in LHBI they were 94% and 75% respectively. The mean duration of response was 25.8 weeks and 23.8 weeks in upper and lower HBI respectively and the mean survival times were 34.9 and 33.3, respectively. Pretreatment performance status was the most important parameter significantly affecting the response to therapy. Treatment toxicities were tolerable, reversible and could be managed effectively by simple medical measures. Acute toxicities were mainly gastrointestinal and hematological. Late morbidity includes alopecia, change of taste and interstitial pneumonitis with UHBI and amenorrhea with LHBI