Predicting survival after brain metastases in patients with bladder cancer.

AIMS AND OBJECTIVES: Because of its rarity, limited data concerning brain metastasis (BM) from bladder cancer (BCa) are available, so this phenomenon remains unclear. We aimed to contribute to understanding this unique patient population's clinical behavior and outcomes. METHODS/MATERIALS: This retrospective cohort study included 27 BCa patients with BM treated at our Cancer Institute between April 2009 and December 2022. The time from initial diagnosis to BM and overall survival from BM diagnosis were calculated (Kaplan-Meier method). Cox regression was used to test key clinicopathologic associations. RESULTS: A total of 27 patients were included in the study (male/female = 23/4). The median patient age at BM diagnosis was 62.0 (47-79) years. The median interval from initial diagnosis to BM was 11.0 ± 2.59 (95 % CI, 5.91-16.08) months. Twenty (74.0 %) patients were diagnosed with BM by postsymptomatic imaging. The most common symptoms were headache-dizziness (n = 9, 33.3 %), seizure (n = 3, 11.1 %), hemiparesis (n = 2, 7.4 %), and vision defects (n = 2, 7.4 %). The most common sites of extracranial metastasis were the lung (n = 10, 52.6 %), bone (n = 7, 36.8 %), and lymph nodes (n = 6, 31.5 %). More than half of the patients (55.5 %) had multiple BMs. Eight (29.6 %) patients underwent surgery for BM. All of the patients received radiotherapy (RT) for BM (whole-brain radiotherapy (WBRT)/stereotactic radiotherapy (SRT) = 24/3), and eight patients received RT for the second time. Six patients were treated with systemic chemotherapy (CT) after BM. The median survival from BM was 3.0 ± 1.2 (95 % Cl, 0.4-5.5) months in the entire cohort. A low number of BMs (HR 0.270, 95 % CI 0.083-0.885; p = 0.031), surgery for BM (HR 0.174, 95 % CI 0.043-0.712; p = 0.015), CT after BM (HR 0.207, 95 % CI 0.057-0.755; p = 0.017), and better ECOG performance score (HR 0.248, 95 % CI 0.074-0.836; p = 0.025) were associated with better OS. CONCLUSIONS: Factors associated with improved survival in BCa patients with BM include a few brain lesions, intracranial resection, CT after BM, and better ECOG performance scores. Larger-scale prospective studies are needed to define the optimal management strategy further.

Valor pronóstico de los parámetros metabólicos volumétricos del tumor primario y ganglios linfáticos en el PET/TC pretratamiento en el carcinoma nasofaríngeo / Prognostic value of primary tumor and lymph node volumetric metabolic parameters at pre-treatment F-18 FDG PET/CT in nasopharyngeal carcinoma

Objetivo El objetivo de este estudio fue evaluar el significado pronóstico de los parámetros metabólicos volumétricos de la PET/TC pretratamiento junto con las características clínicas en pacientes con carcinoma nasofaríngeo no metastásico. Material y métodos Setenta y nueve pacientes con carcinoma nasofaríngeo se sometieron a una PET/TC con [18F]FDG para evaluación previa al tratamiento y se incluyeron en este estudio. Se analizaron las características del paciente (edad, histopatología del tumor, estadio T/N, tamaño del tumor primario y ganglio cervical más grande) y parámetros PET: valores de captación estandarizados máximo, medio y pico (SUVmáx, SUVmean, SUVpico), volumen tumoral metabólico (MTV) y glucólisis de lesión total (TLG) para el tumor primario y el ganglio linfático cervical más grande. El análisis de supervivencia para la supervivencia libre de progresión (PFS) y la supervivencia global (OS) se realizó con el método de Kaplan-Meier utilizando los hallazgos de PET y las características clínicas. Resultados La mediana de duración del seguimiento fue de 29,7 meses (rango 3-125 meses). El MTV del tumor primario y el MTV de los ganglios linfáticos cervicales fueron factores pronósticos independientes para la PFS (p = 0,025 y p = 0,004, respectivamente). Los pacientes con MTV del tumor primario > 19,4 y los pacientes con MTV de los ganglios linfáticos > 3,4 tuvieron una PFS más corta. Para OS, la edad y el tamaño del ganglio linfático fueron factores pronósticos independientes (p = 0,031 y p = 0,029). Los pacientes mayores de 54 años y los pacientes con ganglios linfáticos > 1 cm se asociaron con una OS disminuida. Conclusión El MTV del tumor primario y el MTV de los ganglios linfáticos en la PET/TC previa al tratamiento son factores pronósticos significativos para la PFS a largo plazo en el carcinoma nasofaríngeo no metastásico (AU)

Background The aim of this study was to evaluate the prognostic significance of volumetric metabolic parameters of pre-treatment PET/CT along with clinical characteristics in patients with non-metastatic nasopharyngeal carcinoma. Material and methods Seventy-nine patients with nasopharyngeal carcinoma underwent F18-FDG PET/CT for pretreatment evaluation and included in this study. The patient features (patient age, tumor histopathology, T and N stage, size of primary tumor and the largest cervical lymph node) and PET parameters were analyzed: maximum, mean and peak standardized uptake values (SUVmax, SUVmean, SUVpeak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for primary tumor and largest cervical lymph node. After treatment, patients were evaluated for disease progression and mortality. Survival analysis for progression-free survival (PFS) and over-all survival (OS) was performed with Kaplan–Meier method using PET findings and clinical characteristics. Results The median follow-up duration was 29.7 months (range 3–125 months). Among clinical characteristics, no parameters had significance association for PFS. Primary tumor-MTV and cervical lymphnode-MTV were independent prognostic factors for PFS (p = 0.025 and p = 0.004, respectively). Patients with primary tumor-MTV > 19.4 and patients with lymph node-MTV > 3.4 had shorter PFS. For OS, age and the size of the lymph node were independent prognostic factor (p = 0.031 and p = 0.029). Patients with age over 54 years and patients with lymph node size > 1 cm were associated with decreased OS. Conclusion Primary tumor-MTV and lymph node-MTV on pre-treatment PET/CT are significant prognostic factors for long-term PFS in non-metastatic nasopharyngeal carcinoma (AU)

The treatment of intertrochanteric fractures comparison of PFN and hemiarthroplasty 3-year mortality study.

Intertrochanteric fractures in elderly patients can increase mortality due to complications and negative functional results. The aim of this study is to retrospectively compare the follow-up and mortality rates among patients given a proximal femoral nail (PFN), the current routine treatment for these types of fractures, with those given hemiarthroplasty.The study retrospectively investigated 202 patients over the age of 60 who completed at least 3 years of follow-up after hemiarthroplasty or PFN for intertrochanteric fractures between 2007 and 2012. While 132 patients underwent cemented hemiarthroplasty, 70 had PFN.The monitoring duration for those with PFN surgery was 31.25±1.3 months while the duration of follow-up for those with hemiarthroplasty surgery was 20.0±1.2 months. At the end of 3 years of monitoring of the 202 patients, 99 were deceased. There was a statistically significant difference found in terms of patient life expectancy between those with PFN and those with hemiarthroplasty; Cox regression analysis identified that the mortality rate of those with hemiarthroplasty was 5.1 times greater.As a result, patients undergoing hemiarthroplasty should be carefully chosen and if possible, PFN should be preferred.

Turkish community-based palliative care model: a unique design.

An organized palliative care system was lacking in Turkey before 2010. One of the pillars of Turkish Cancer Control Programme is palliative care. The Pallia-Turk project in this respect has been implemented by the Ministry since 2010. The project is unique since it is population based and organized at the primary level. This means, the whole population (>70 million) will have the quickest and easiest way for access to palliative care. This manuscript briefly summarizes the situation before the project and updates what has been done in last 2 years with the project.

Frequency of distribution according to histological types of lung cancer in the tracheobronchial tree.

The incidence of the location within the bronchi related to the cell types was investigated with the flexible fiberoptic bronchoscope in 355 cases of lung carcinoma. In 5 patients carcinoma was situated only in the trachea. In the other 350 cases the cell types other than adenocarcinoma were found to show different locations following their cell type. Epidermoid carcinoma was found more frequently in the two upper lobes (p less than 0.001), while small cell carcinomas showed predilection for the main bronchus on the right side, and the upper lobe in the left (p less than 0.001). No difference could be found between the upper, lower lobes and main bronchi for adenocarcinoma. It was also observed that large cell carcinomas were situated more often in the right upper lobe. The most important finding in this investigation was that, apart from adenocarcinoma, the other types were located mainly in the upper lobes, and much less frequently in the lower lobes. The predilection of localization of epidermoid and small cell carcinomas in the upper lobes suggests a possible relationship to tobacco smoke inhalation as these regions have been shown to be more affected by the smoke.

A preliminary report on a study of serum alpha-1-antitrypsin and immunoglobulin levels in lepromatous leprosy.

IgG, IgA, and IgM immunoglobulins and alpha-1-antitrypsin globulin in sera from 30 patients with lepromatous leprosy were determined and compared with 30 age- and sex-matched healthy controls. Mean levels of IgG, IgM, IgA, and alpha-1-antitrypsin were significantly elevated in the sera of lepromatous leprosy patients in comparison with levels found in normal subjects. Statistical analysis of the relationships between levels of alpha-1-antitrypsin and immunoglobulins in the sera of lepromatous leprosy patients and controls revealed no correlation. It is therefore concluded that factors responsible for concentrations of immunoglobulins and alpha-1-antitrypsin are independent of each other in patients with lepromatous leprosy.