ABSTRACT
BACKGROUND: With breast-conserving therapy (BCT) as the standard of care for patients with noninvasive and early stage invasive breast cancer, a small incidence of post-BCT angiosarcoma has emerged. The majority of therapeutic interventions have been unsuccessful. To the authors' knowledge, there is no consensus in the medical literature to date regarding the treatment of this malignancy. The current study was conducted to report the long-term outcomes of a novel approach using hyperfractionated and accelerated radiotherapy (HART) for angiosarcoma developing after BCT. METHODS: The authors retrospectively reviewed the outcomes of 14 patients treated with HART with or without surgery at the University of Florida between November 1997 and March 2006 for angiosarcoma that developed after BCT. RESULTS: At the time of last follow-up, 9 patients had remained continuously without evidence of disease for a median of 61 months after HART (range, 36-127 months). Five patients had further manifestations of angiosarcoma after HART at a median of 1 month (range, 1-28 months): 3 with progressive pulmonary and/or mediastinal disease that was likely present before HART and 2 with local or regional disease extension. Progression-free survival rates for the 14 patients at 2 years and 5 years were 71% and 64%, respectively. The overall and cause-specific survival rates were both 86% at 2 years and 5 years. CONCLUSIONS: To the best of the authors' knowledge, HART with or without subsequent surgery, as documented in the current series, is the first approach to provide a high rate of local control, disease-free survival, and overall survival after the development of post-BCT angiosarcoma. The authors believe the success noted with this approach is related to both the hyperfractionation and acceleration of the RT.
Subject(s)
Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Dose Fractionation, Radiation , Hemangiosarcoma/cerebrospinal fluid , Hemangiosarcoma/radiotherapy , Adult , Aged , Disease-Free Survival , Female , Hemangiosarcoma/mortality , Hemangiosarcoma/surgery , Humans , Mastectomy, Segmental , Middle Aged , Neoplasms, Second Primary/radiotherapy , Retrospective Studies , Treatment OutcomeABSTRACT
A patient with cerebellar hemangioblastoma and secondary erythrocytosis is presented. Erythropoietin, indirectly determined by measuring 59Fe incorporation in polycythemic mouse bioassay, was not detected in serum and urine, but was found in cerebrospinal fluid. The significance of erythropoietin determination in cerebrospinal fluid in patients with cerebellar hemangioblastoma is stressed.
Subject(s)
Cerebellar Neoplasms/cerebrospinal fluid , Erythropoietin/cerebrospinal fluid , Hemangiosarcoma/cerebrospinal fluid , Animals , Biological Assay , Cerebellar Neoplasms/complications , Female , Hemangiosarcoma/complications , Humans , Male , Mice , Mice, Inbred CBA , Middle Aged , Polycythemia/complicationsABSTRACT
Twenty-six patients with extra- and intramedullary tumors of the spinal cord had a considerably increased content of serotonin, 5-hydroxyindoleacetic acid, and melatonin in the cerebrospinal fluid (highest in patients with total blockade of the subarachnoid space) as well as of serotonin in blood platelets. The results of tests for serotonin metabolism can be used as a diagnostic test in the early stages of the tumor growth and are an additional factor in determining the indications for contrast examination of patients with a suspected spinal tumor.
Subject(s)
Cholesteatoma/cerebrospinal fluid , Hemangiosarcoma/cerebrospinal fluid , Meningeal Neoplasms/cerebrospinal fluid , Meningioma/cerebrospinal fluid , Neurilemmoma/cerebrospinal fluid , Serotonin/cerebrospinal fluid , Spinal Cord Diseases/cerebrospinal fluid , Spinal Cord Neoplasms/cerebrospinal fluid , Adult , Aged , Female , Humans , Hydroxyindoleacetic Acid/cerebrospinal fluid , Male , Melatonin/cerebrospinal fluid , Middle AgedABSTRACT
The role of changes in CSF inflow in patients without intracranial pathology has been studied. The CSF outflow resistance has been calculated, by dividing the CSF pressure rise by the speed of intrathecal saline infusion. The average CSF pressure rise produced during infusion test (infusion 2 ml/min) amounted to 11.15 mmHg. The calculated CSF outflow resistance equaled to 5.58 +/- 1.1 mm Hg/ml/min. On-line computer assisted analysis during infusion test helps to shorten the procedure and makes it more precise.
Subject(s)
Cerebrospinal Fluid/physiology , Intracranial Pressure , Adult , Brain Neoplasms/cerebrospinal fluid , Female , Hemangiosarcoma/cerebrospinal fluid , Humans , Intervertebral Disc Displacement/cerebrospinal fluid , Male , Middle AgedABSTRACT
In 12 patients with different posterior fossa tumours the concentrations of homovanillic acid (HVA) and of 5-hydroxyindoleacetic acid (5-HIAA) were measured in cerebrospinal fluid from the lateral ventricles. All patients had obstructive hydrocephalus. Patients with a clear increase of 5-HIAA/HVA ratio in the ventricular CSF have died subsequently. This feature may have a diagnostic value, and indicates the prevalence of serotoninergic neurones in patients with obstructive hydrocephalus with fatal course after surgery.
