Deux séries brazzavilloises de metastases osseuses

Notre objectif a ete de comparer 2 series de malades hospitalises en rhumatologie pour metastases osseuses (MO); afin d'en evaluer les aspects epidemiologiques et diagnostiques. Nous avons enregistre deux series 1 et 2 qui concernaient respectivement 48 MO rassemblees entre juillet 1989 et septembre 1996 puis 50 cas de janvier 2001 a novembre 2004. Le diagnostic etait base sur l'analyse semeiologique clinique et radiologique; en l'absence d'etude anatomo-pathologique. Les variables etudiees ont ete : age; le genre; les frequences absolues et relatives; les incidences et la nature des cancers primitifs. La serie 1 a comporte 31 hommes et 17 femmes d'age moyen 60+/- 16 ans ; la serie 2; 33 MO ont ete respectivement de 3;5 pour cent et 6;8 cas par an pour la serie1 puis de 6;5 pour cent et 12;5 pour la serie 2. Les frequences relatives des metastases d'origine determinee (MOD) etaient de 54;1 pour cent dans la serie 1 et 68 pour cent dans la serie 2. Celles des metastases d'origine indeterminee (MOI) etaient respectivement de 45;8 pour cent et 32 pour cent. La prostate a ete l'organe siege le plus frequent du cancer primitif dans les deux series. Les deux series ont ete comparables pour l'age et le genre. Les origines des metastases osseuses ont surtout ete prostatiques et hepatiques comme particularite africaine

Tumor secundário na regiäo selar: relato de um caso / Secondary tumor to the selar region: a case report

Aparentemente carcinomas metastásticos para a regiäo justa-selar e hipófise säo mais frequentemente primários da mama e de pulmäo. Metástases para a regiäo justa selar näo säo frequentes e por vezes causam dificuldades diagnósticas em relaçäo a adenomas hipofisários. A tomografia computadorizada e a politomografia facilitam o diagnóstico, mas dificuldades podem acontecer, como na apresentaçäo deste caso

Cirugía de las metástasis pulmonares: nuestra experiencia / Surgery of the lung metastases: our experience

Se presentan 40 pacientes operados por metástasis pulmonares. Correspondieron a 31 carcinomas y 9 sarcomas, siendo los origenes más frecuentes el carcinoma de colon, de mama y osteosarcoma con 6 casos cada uno. La edad promedio fue de 53 años para los carcinomas y de 26 años para los sarcomas. Treinta y seis casos (80%) fueron asintomáticos, 32 diagnosticados por control radiológico periódico y 4 por TAC periódica. La TAC de toráx se constituyó en el estudio más útil para la evaluación de las lesiones torácicas. En los 40 pacientes se realizaron 45 resecciones, 1 caso se operó 3 veces y 3 casos, 2 veces. La resección de metástasis pulmonares con criterio oncológico es viable en un grupo seleccionado de pacientes, siendo las resecciones pulmonares menores (segmento y cuña) los procedimientos de preferencia. Las metástasis múltiples y/o bilaterales no son una contraindicación quirúrgica. El índice de sobrevida actuarial a 5 años fue mayor para los sarcomas (67%) que para los carcinomas (30%); el índice global fue de 41%. Ocho de los 9 sarcomas recibieron quimioterapía adyuvante. La sobrevida a 5 años en los pacientes con un intervalo libre tumoral de más de 36 meses fue del 59%contra 28%de aquellos con un intervalo libre menor de 36 meses. La mortalidad operatoria fue del 2,2

Cirugía de las metástasis pulmonares: nuestra experiencia / Surgery of the lung metastases: our experience

Se presentan 40 pacientes operados por metástasis pulmonares. Correspondieron a 31 carcinomas y 9 sarcomas, siendo los origenes más frecuentes el carcinoma de colon, de mama y osteosarcoma con 6 casos cada uno. La edad promedio fue de 53 años para los carcinomas y de 26 años para los sarcomas. Treinta y seis casos (80%) fueron asintomáticos, 32 diagnosticados por control radiológico periódico y 4 por TAC periódica. La TAC de toráx se constituyó en el estudio más útil para la evaluación de las lesiones torácicas. En los 40 pacientes se realizaron 45 resecciones, 1 caso se operó 3 veces y 3 casos, 2 veces. La resección de metástasis pulmonares con criterio oncológico es viable en un grupo seleccionado de pacientes, siendo las resecciones pulmonares menores (segmento y cuña) los procedimientos de preferencia. Las metástasis múltiples y/o bilaterales no son una contraindicación quirúrgica. El índice de sobrevida actuarial a 5 años fue mayor para los sarcomas (67%) que para los carcinomas (30%); el índice global fue de 41%. Ocho de los 9 sarcomas recibieron quimioterapía adyuvante. La sobrevida a 5 años en los pacientes con un intervalo libre tumoral de más de 36 meses fue del 59%contra 28%de aquellos con un intervalo libre menor de 36 meses. La mortalidad operatoria fue del 2,2

Tratamiento quirúrgico de las metástasis pulmonares / Surgical treatment of pulmonary metastases

En un período de 4 años se trataron 25 pacientes con metástasis pulmonares. En 11 se intentó tratamiento quirúrgico curativo y 10 fueron declarados inoperables. En los 15 operados se realizaron 27 resecciones locales, 1 segmentectomía y 3 lobectomías. Las vías de abordaje empleadas fueron 8 toracotomías laterales, 2 bilaterales y 5 esternotomías. La sobrevida actuarial a 30 meses fue del 52% y del 17% en los casos no operados. La resección de las metástasis pulmonares se recomienda cuando la enfermedad está limitada a los pulmones y el paciente está en condiciones de tolerar la resección completa de todo el tejido neoplásico. Son factores condicionantes de la evolución, la histología del tumor primitivo, el tiempo de duplicación tumoral, el tiempo de latencia entre el tratamiento del tumor primitivo y aparición de la metástasis, el número y tamaño de las mismas, la localización uni o bilateral y la propagación a los ganglios mediastinales. Se recomienda como táctica emplear vías de abordaje amplias de preferencia esternotomía, tubo endotraqueal de doble luz para permitir un mejor exámen pulmonar, resección completa de las metástasis con margen oncológico y no efectuar operaciones solo para reducir masa tumoral. (AU)

Tratamiento quirúrgico de las metástasis pulmonares / Surgical treatment of pulmonary metastases

En un período de 4 años se trataron 25 pacientes con metástasis pulmonares. En 11 se intentó tratamiento quirúrgico curativo y 10 fueron declarados inoperables. En los 15 operados se realizaron 27 resecciones locales, 1 segmentectomía y 3 lobectomías. Las vías de abordaje empleadas fueron 8 toracotomías laterales, 2 bilaterales y 5 esternotomías. La sobrevida actuarial a 30 meses fue del 52% y del 17% en los casos no operados. La resección de las metástasis pulmonares se recomienda cuando la enfermedad está limitada a los pulmones y el paciente está en condiciones de tolerar la resección completa de todo el tejido neoplásico. Son factores condicionantes de la evolución, la histología del tumor primitivo, el tiempo de duplicación tumoral, el tiempo de latencia entre el tratamiento del tumor primitivo y aparición de la metástasis, el número y tamaño de las mismas, la localización uni o bilateral y la propagación a los ganglios mediastinales. Se recomienda como táctica emplear vías de abordaje amplias de preferencia esternotomía, tubo endotraqueal de doble luz para permitir un mejor exámen pulmonar, resección completa de las metástasis con margen oncológico y no efectuar operaciones solo para reducir masa tumoral.

I-125 interstitial implantation for prostate cancer. What have we learned 10 years later?

From 1975 to 1984, 120 patients were treated at Eastern Virginia Medical School with iodine-125 (I-125) interstitial implantation and pelvic lymphadenectomy as the definitive therapy for stage A2-C prostatic carcinoma. As might be expected, a higher incidence of local recurrence was seen with tumors at a more advanced stage but also with tumors of moderate and poor differentiation. Local tumor control in these groups did not compare favorably with patients externally irradiated during this period, of which 246 patients were available for study. Only 57% of recurrences with I-125 were clinically evident by 5 years follow-up with failures detected at up to 10 years, as opposed to the development of 91% of local recurrences by 5 years with external beam irradiation (P = 0.001), suggesting a later incidence of local recurrence with I-125 therapy. Major complications attributable to local tumor recurrence were also more frequent in implanted patients (20% vs. 8%; P = 0.006). The incidence of distant metastasis increased significantly in patients who experienced local recurrences, i.e., 83% versus 18%, with the expected adverse affect on survival. Disease-free survival by grade and stage showed a particular disadvantage for patients with moderately well and poorly differentiated tumors and stage C disease treated by I-125 therapy. In conclusion, then, it appears that I-125 interstitial implantation is well suited to only a select group of prostate cancer patients with well-differentiated, early stage disease and in most cases does not provide results comparable with external beam irradiation.

Primary tumors of the trachea. Results of radiation therapy.

From 1959 to 1986, 24 patients with primary malignant tumors of the trachea received radiotherapy as all or part of treatment. Common presentations included respiratory symptoms in 20 patients and hemoptysis in 15. Thirteen patients had squamous carcinomas with undifferentiated and adenoid cystic cancers in five and four patients, respectively. Overall actuarial survival was 45% at 1 year, 25% at 5 years, and 13% at 10 years. Survival was significantly correlated to histologic type (adenoid cystic versus squamous, P less than 0.03), but not to tumor extent or to patient age or sex. Local control was attained in 10 of 24 patients overall and was more frequent for patients with tumors localized to the trachea and for patients who were treated with combined surgery and radiotherapy. For the 18 patients treated with radiotherapy alone, complete response (CR) was seen to be significantly (P less than 0.001) related to dose: six of seven (86%) patients receiving greater than or equal to 6000 cGy attained CR versus one of 11 (9%) receiving less than 6000 cGy. Three patients developed complications related to radiotherapy. Radiotherapy can provide durable local control of localized tracheal tumors and should be considered for medically inoperable patients with localized tumors and for patients with high risk of recurrence after resection.

Tumors of the liver, other than primary hepatocellular carcinoma.

Hepatic angiosarcoma is the second most common primary malignant neoplasm of the liver. Although comprising only 2 per cent of all hepatic primary tumors, it represents a major clinical problem because of its strong association with industrial vinyl chloride exposure and its incurability. Strict ceilings on the amount of exposure for vinyl chloride workers has reduced the incidence of this devastating tumor. In addition, recent chemotherapeutic trials have provided both improved performance status and prolonged survival in several patients.

Distant metastases in epithelial ovarian carcinoma.

A review of 255 patients with epithelial ovarian carcinoma revealed that metastases consistent with Stage IV disease developed in 97 patients (38.0%) at some time during the natural history of their disease. Malignant pleural effusions developed in 63 patients (24.7%), and their median survival (from the time of diagnosis of the effusion) was 6 months. Parenchymal liver metastases developed in 24 patients (9.4%; median survival, 5 months); parenchymal lung metastases in 18 patients (7.1%; median survival, 8 months); distant lymph node metastases in 18 patients (7.1%; median survival, 9 months); subcutaneous nodules in nine patients (3.5%; median survival, 12 months); a malignant pericardial effusion in six patients (2.4%; median survival, 2.3 months); central nervous system metastases in five patients (2%; median survival, 1.3 months); and bone metastases in four patients (1.6%; median survival, 4 months). Patients with Stage IV disease at the time of diagnosis had a median survival of 9.1 months, while patients with a delayed occurrence of distant metastases had a median survival of only 4 months from the time of diagnosis of the distant metastases. Significant risk factors for distant metastases were malignant ascites, peritoneal carcinomatosis, large metastatic disease within the abdomen, and retroperitoneal lymph node involvement at the time of the initial surgery. The significance of positive retroperitoneal nodes and bulky upper abdominal disease has important therapeutic implications.

Prognostic factors of early gastric cancer--results of long-term follow-up and analysis of recurrent cases.

The prognosis of early gastric cancer (EGC) is generally excellent, however, EGC is not an exception to recurrence. In order to know what type of EGC is liable to recur, long-term results were studied in 304 cases of resection. The cumulative 10-year survival rate was poorer in patients with positive lymph nodes than in those with negative nodes (52.8 +/- 15.8 per cent vs 94.1 +/- 2.4 per cent; p less than 0.05). It was also less favorable when the EGC was greater than 5 cm in diameter (61.5 +/- 13.2 per cent vs 92.9 +/- 2.4 per cent; p less than 0.05). Among 50 cases which died postoperatively, six deaths were due to recurrence. A predominant mode of recurrence was hematogenous metastasis (4/6). The characteristics of EGC which recurred later included large cancer (greater than or equal to 5 cm) (6/6), macroscopically combined-type cancer (5/6), cancer of depth invasion to the submucosa (4/6) and histologically differentiated cancer (6/6). Lymph node dissection was not carried out in two of these patients at their primary operation. Adjuvant therapy should be added in the EGC bearing risk factors depicted above. Primary cancer in other organs, either metachronous or synchronous, was found in 13 cases (4.3 per cent). Colonic cancer, in particular, was seen in three, and it was 4.8 times as frequent as the expected number of the general population, calculated using the person-year method.

Squamous cell carcinoma of the pyriform sinus treated with radical radiation therapy.

This is an analysis of 54 patients with squamous cell carcinoma of the pyriform sinus treated with radical irradiation at the University of Florida between October 1964 and March 1984. There is a 2-year minimum follow-up on all patients and 85% have at least 5 years of follow-up. Patients were excluded from analysis of disease control at the primary site, neck, and/or above the clavicles if they died less than 2 years from treatment with the site(s) continuously disease-free. All patients were included in the analysis of complications and survival. The rates of local control following initial treatment with irradiation and the ultimate local control rates, including surgical salvage of irradiation failures, were as follows: T1, 8/9 and 8/9; T2, 15/20 (75%) and 18/20 (90%); T3, 2/5 and 3/5; and T4, 0/4 and 0/4. The 5-year determinate survival rates as a function of modified AJCC stage were I, 1/1; II, 3/3; III, 5/8; IVA, 7/12; and IVB, 2/8.

[Prognosis of 5-year survivors of esophageal cancer treated with radiation and chemotherapy].

Seventeen 5-year survivors, treated with a combination of radiation and chemotherapy, were followed up from 5 to 10 years. Out of them, 10 cases died within 10 years after the completion of radiotherapy. Late local recurrence and remote metastasis of esophageal cancer were observed in 3 cases, and other malignancies of the stomach, lung and esophagus were found in 3 other cases. Furthermore, the cause of death was late radiation injuries (radiation myelopathy and pulmonary fibrosis) in 2 cases and intercurrent disease in 2 others. Dysphagia due to cicatricial structure of the esophagus occurred in 5 cases.

[The Munich follow-up program in advanced non-seminoma testicular tumors. Benefits and costs]. / Münchner Nachsorge-Schema bei fortgeschrittenen nicht-seminomatösen Hodentumoren. Nutzen und Kosten.

Results in 185 of 197 patients with non-seminomatous testicular tumours treated since 1979 were retrospectively analysed. Most of them had been given chemotherapy according to the PVB schedule. In 138 patients (75%) a first complete remission was achieved, and 131 (71%) are currently disease-free. All patients in complete remission were entered in a follow-up programme consisting of physical examination, laboratory tests including tumour markers, chest X-ray and abdominal CT. A total of 326 patient-years of follow-up has so far been carried out at a cost of DM 650,000. A first relapse was detected in 18 patients (13%); 13 of them reached a second remission after further treatment. The 20 first and second relapses were detected by clinical symptoms (n = 6), chest X-ray (n = 6), abdominal CT (n = 5), or a rise in tumour markers (n = 3). Only one of six patients in whom clinical symptoms were the initial evidence of a first relapse, obtained a second complete remission. The five others in this group died of progressive disease. In contrast, all the twelve patients whose first relapses were detected by follow-up investigations in the absence of clinical symptoms, obtained second complete remission. 15 of the 18 first relapses were detected within the first two years. All three patients with late relapses were brought into second complete remissions. On this evidence, follow-up for at least five years appears justified.