Supervivencia tras el tratamiento de metástasis cerebral, única, tardía en una paciente afectada de cáncer de ovario / Survival after treatment for late, isolated, cerebral metastasis from ovarian cancer

La incidencia de las metástasis cerebrales en el cáncer de ovario es baja. Presentamos el caso de una paciente de 48 años con carcinoma serosopapilar de ovario bilateral. Se decide quimioterapia neoadyuvante, cirugía citorreductora de rescate y radioterapia pelviana, por ser subóptima la cirugía. A los 9 años presenta una recidiva pleural que se resuelve con 6 ciclos de carbotaxol. A los 11 años presenta una metástasis cerebral de 8 cm, que se extirpa, y se administra tratamiento complementario con radioterapia holocraneal y boost sobre el lecho quirúrgico. Actualmente, la paciente está asintomática y sin secuelas. En pacientes con metástasis cerebral única, la cirugía, seguida de radioterapia y quimioterapia sistémica, ofrece los mejores resultados

Central nervous system metastases from ovarian carcinoma are uncommon. We present the case of a 48-year-old woman with a bilateral serous papillary ovarian carcinoma. She received neoadjuvant chemotherapy and underwent suboptimal cytoreductive surgery and pelvic irradiation. Nine years later she had a pleural relapse of the disease and was treated with six cycles of carbotaxol. Eleven years after the initial diagnosis she presented an 8 cm brain metastasis and underwent resection followed by whole-brain radiotherapy with a boost on the tumor bed. The patient is currently asymptomatic and shows no sequels. In patients with an isolated brain metastasis, surgery followed by radiotherapy and systemic chemotherapy offers the best results

First-trimester screening for trisomy 21 in twin pregnancy: does the addition of biochemistry make an improvement?

OBJECTIVE: To evaluate the effectiveness of the addition of first-trimester biochemistry to fetal nuchal translucency (NT) measurement in the Combined Test when screening for trisomy 21 in twin pregnancies. METHODS: Maternal serum free beta-hCG and PAPP-A were determined at 8 to 12 weeks and fetal NT was measured at 11 to 14 weeks. The individual risks were estimated for each of the fetuses using both NT screening alone and the Combined Test. An invasive diagnostic procedure was offered when the risk was 1:250 or over in either one of the fetuses. In the first period, only the results of NT screening were clinically applied. After previous analysis, the Combined Test was introduced into clinical practice. RESULTS: In the two-and-a-half-year study period, a complete follow-up was obtained in 100 twin pregnancies. Three fetuses (two pregnancies) with trisomy 21 were detected by both methods. The false-positive rate achieved by NT screening (14.3% of pregnancies and 8.6% of fetuses) was substantially reduced when first-trimester biochemistry was added in the Combined Test (5.1% of pregnancies and 3.6% of fetuses). CONCLUSION: The Combined Test appears to maintain the detection rate achieved by NT screening for trisomy 21 in twin pregnancies, but false-positive rates and invasive diagnostic procedures are reduced.