ABSTRACT
BACKGROUND: Metastastic carcinoma to extraocular muscles is extremely rare, but even more so is the case of a bilateral one. CASE REPORT: A 50-year-old woman with a history of mastectomy for a T4N1M0 right breast carcinoma was referred to us with diplopia due to bilateral extraocular muscle metastases, 5 years post mastectomy. Multiple metastases to the whole body were also present. A combination of high-dose irradiation, hormonotherapy and chemotherapy were performed. RESULTS: Despite the multidisciplinary treatment approach, the diplopia persisted. A literature review revealed only 4 cases of bilateral metastases to extraocular muscles. The present case is the second attributed to lobular carcinoma and the only one treated with a high dose of radiotherapy combined with systemic therapy. CONCLUSION: In a cancer patient, any orbital change must be examined for the possibility of an extraocular metastasis. Conclusions affecting the optimal treatment policy of extraocular muscle metastases are difficult to determine, due to the small number of reported cases.
Subject(s)
Carcinoma, Lobular/diagnosis , Carcinoma, Lobular/secondary , Eye Neoplasms/diagnosis , Eye Neoplasms/secondary , Muscle Neoplasms/diagnosis , Muscle Neoplasms/secondary , Oculomotor Muscles/pathology , Female , Humans , Middle AgedABSTRACT
BACKGROUND: The aim of this study was to evaluate the effectiveness and possible toxicity of the combination of temozolomide (TMZ) with whole-brain irradiation (WBI) in the treatment of brain metastases from solid tumors. PATIENTS AND METHODS: 33 patients with brain metastases were included in the study and treated with TMZ 60 mg/m2/day (days 1-16) concomitantly with WBI (36 Gy/12 fractions given in 16 days). One month after the end of radiotherapy, 6 cycles of TMZ were administered as adjuvant treatment (200 mg/m2/day for 5 consecutive days every 28 days). RESULTS: Responses were assessed using computed tomography at the end of the 3rd and 6th cycle of chemotherapy. The objective response rate was 54.5% and 57.6% after the 3rd and the 6th cycle, respectively. The median overall survival was 12 months. In patients with metastases from lung cancer the objective response rate was 11/14 (78.6%) after both the 3rd and the 6th cycle of treatment. The most common side effects were anemia (24.2%), thrombocytopenia (18.2%), as well as nausea and vomiting (18.2%). The high incidence of hepatotoxicity (45.5%) might be related to concomitantly administered antiepileptic drugs and not to TMZ. CONCLUSION: WBI combined with TMZ as concomitant and adjuvant treatment is effective in treating brain metastases, with acceptable mild side effects.
Subject(s)
Antineoplastic Agents, Alkylating/therapeutic use , Brain Neoplasms/secondary , Cranial Irradiation , Dacarbazine/analogs & derivatives , Aged , Aged, 80 and over , Antineoplastic Agents, Alkylating/adverse effects , Brain Neoplasms/drug therapy , Brain Neoplasms/mortality , Brain Neoplasms/radiotherapy , Breast Neoplasms/drug therapy , Breast Neoplasms/mortality , Breast Neoplasms/radiotherapy , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/radiotherapy , Carcinoma, Non-Small-Cell Lung/secondary , Carcinoma, Small Cell/drug therapy , Carcinoma, Small Cell/mortality , Carcinoma, Small Cell/radiotherapy , Carcinoma, Small Cell/secondary , Chemotherapy, Adjuvant , Clinical Trials, Phase II as Topic , Combined Modality Therapy , Dacarbazine/adverse effects , Dacarbazine/therapeutic use , Female , Humans , Lung Neoplasms/drug therapy , Lung Neoplasms/mortality , Lung Neoplasms/radiotherapy , Male , Melanoma/drug therapy , Melanoma/mortality , Melanoma/radiotherapy , Melanoma/secondary , Middle Aged , Mouth Neoplasms/drug therapy , Mouth Neoplasms/mortality , Mouth Neoplasms/radiotherapy , Neoplasms, Unknown Primary/drug therapy , Neoplasms, Unknown Primary/mortality , Neoplasms, Unknown Primary/radiotherapy , Palliative Care , Rectal Neoplasms/drug therapy , Rectal Neoplasms/mortality , Rectal Neoplasms/radiotherapy , Research Design , Temozolomide , Treatment OutcomeABSTRACT
BACKGROUND: Classic biphasic pulmonary blastoma (CBPB) is a rare and aggressive primary malignancy, brain metastases of this type of tumor are even rarer. CASE REPORT: A 51-year-old male patient with a solitary cerebral metastasis, diagnosed ten months after left pneumonectomy for a CBPB, was treated by surgery and accelerated hypofractionated radiotherapy. RESULTS: The patient died 15 months after partial removal of the brain metastasis. Literature review revealed only 4 cases of solitary brain metastases from this type of malignancy. The present case is the second one reported with a combined treatment of surgery and radiotherapy resulting in the longest survival. CONCLUSION: The best treatment for CBPB is difficult to determine because of the small number of cases, however, the combination of surgery with radiotherapy seems to be effective. The effectiveness of chemotherapy has not been ascertained.
Subject(s)
Brain Neoplasms/diagnosis , Brain Neoplasms/secondary , Lung Neoplasms/diagnosis , Pulmonary Blastoma/diagnosis , Pulmonary Blastoma/secondary , Humans , Male , Middle Aged , Rare Diseases/diagnosisABSTRACT
BACKGROUND: Acrometastases are very rare and have been identified in only a few cases on the foot. At the onset, they might be misdiagnosed as arthritis. CASE REPORT: A 59-year-old woman with isolated metastasis to the talus, originating from breast carcinoma was treated by radiotherapy, letrazole, and intravenous bisphosphonates. RESULTS: The review of the literature revealed that this is the first case of an isolated metastasis to the bone of talus from a breast carcinoma, while there are a few cases originating from other organs. The differential diagnosis of acrometastases may be difficult. CONCLUSION: Pain in the foot or hand of a patient with a known history of malignancy should be considered as potential metastasis.
