scholarly journals MET-3 A Case of Intrapituitary Adenoma Metastasis from Advanced gastric cancer

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi25-vi25
Author(s):  
Shohei Fujita ◽  
Yu Kawanishi ◽  
Hitoshi Fukuda ◽  
Naoki Fukui ◽  
Tetsuya Ueba
Keyword(s):  
Gastric Cancer ◽  
Radiation Therapy ◽  
Pituitary Adenoma ◽  
Nasal Cavity ◽  
Advanced Gastric Cancer ◽  
Gastric Wall ◽  
Plasma Osmolality ◽  
Rapid Progression ◽  
Cerebral Mri ◽  
High Level

Abstract Metastasis from extracranial tumor into a pituitary adenoma is a rare case. We report a case of metastasis from gastric cancer to a giant pituitary tumor. A 65-year-old man had been drinking more water and had an increased frequency of urine in 10 years. From that time, the patient was gradually aware of the pain in his left eye. In 20XX the patient had a sudden severe headache and pain of his eyes and visited an ophthalmologist. The patient was referred to our institution with general malaise and nausea, vomiting. A cerebral MRI disclosed Extensive neoplastic lesions from the base of the skull to the nasal cavity. The left eye had esotropia and abduction disorder. Laboratory test demonstrated hyponatremia (Na 126mEq/L) and decreased in plasma osmolality (273mOsm/kg), D-dimer, fibrinogen and CA19-9 were high level. One week after admission, the patient’s symptom was getting worse. The patient underwent FDG PET/CT, which showed FDG avid in the gastric wall and clivus tumor. The lesion was suspected gastric cancer and performed Esophagogastroduodenoscopy. The biopsy-based pathology was showed cubic and round cells with high NC ratio and signet-ring cells containing mucin. And clivus tumor was biopsied at an otolaryngologist because part of the tumor was exposed from the nasal cavity. The biopsy-based pathology was showed a small amount of adenocarcinoma cells which is surrounded by pituitary adenoma. The patient was diagnosed as intrapituitary adenoma metastasis from advanced gastric cancer and has been started radiation therapy. But the level of consciousness dropped sharply, so radiation therapy had become difficult to continue. The patient transferred to palliative care ward and died 3 months after his first visit. In this case, diagnosis and treatment were difficult due to the that the image was a finding a malignant tumor and the rapid progression of symptoms.

Manifestation of Graves’ disease, resulting from radiosurgical treatment of acromegaly, in a patient with panhypopituitarism

2019 ◽  
Vol 65 (2) ◽  
pp. 101-106
Author(s):  
Ludmila I. Astafyeva ◽  
Pavel L. Kalinin ◽  
Tatyana A. Kienia ◽  
Valentin V. Fadeyev
Keyword(s):  
Radiation Therapy ◽  
Pituitary Adenoma ◽  
Thyroid Stimulating Hormone ◽  
Hormone Deficiency ◽  
Graves Disease ◽  
Free T4 ◽  
Disease Manifestation ◽  
Secondary Hypothyroidism ◽  
Residual Tissue ◽  
High Level

Cases of thyrotoxicosis associated with a previous case of secondary hypothyroidism are extremely rare. This article presents a rare clinical case of Graves disease manifestation in a patient with secondary hypothyroidism after radiosurgical treatment of acromegaly. A 38-year old woman presented with acromegaly and endo-supra-laterosellar pituitary adenoma. After non-radical removal of the pituitary adenoma, radiosurgical treatment of the of the residual tissue of the pituitary tumor in the cavernous sinus area was performed. After 14 months of radiation therapy, the acromegaly was in remission; after 24 months of radiation therapy, panhypopituitarism developed (secondary hypothyroidism, adrenal insufficiency, hypogonadism, and growth hormone deficiency). Furthermore, 1.5 years after the panhypopituitarism was diagnosed, the manifestation of Graves disease was also noted, requiring thyrostatic and radioactive iodine treatments. Diagnostic criteria for secondary hypothyroidism are low levels of the thyroid hormones free T4 and free T3, with a reduced, normal or slightly elevated level of thyroid stimulating hormone (TSH). The criterion for the development of thyrotoxicosis in the context of the secondary hypothyroidism was the persistent increase in the level of free T4 despite adequate drug therapy with levothyroxine. In the case report, the patients diagnosis of Graves disease was confirmed by the presence of a high level of antibodies to the TSH receptor.

Chemoradiotherapy for highly advanced gastric cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 121-121
Author(s):  
Mai Tsutsui ◽  
Tsunehiro Takahashi ◽  
Yoshiro Saikawa ◽  
Hirofumi Kawakubo ◽  
Norihito Wada ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Radiation Therapy ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Multidisciplinary Treatment ◽  
Multimodality Treatment ◽  
Complete Response ◽  
Technological Advancement ◽  
Regional Lymph Nodes ◽  
Grade 3

121 Background: Although the prognosis of early gastric cancer is favorable, the treatment for advanced cases still have difficulty in achieving satisfactory results. Thus, more effective multimodality treatment should be established. Chemoradiotherapy has become a standard treatment for gastric cancer especially as an adjuvant therapy while radiotherapy has been expected as one of the modalities against highly advanced gastric cancer. Methods: Patients with advanced gastric cancer who were treated with chemotherapy of S-1 and cisplatin plus radiation were analyzed retrospectively. Concurrent radiation therapy (5 days/week) at 2 Gy/day was started with chemotherapy and repeated daily on days 1–5, 8–12, 15–19 and 22–26. Irradiation was planned using a computed tomography (CT) simulator for two rectangular portals with a pair of 45-degree wedge filters and was targeted at the primary tumor and surrounding lesions, including lymph nodes. Results: A total 109 patients were treated with chemoradiotherapy between 2002 and 2013 at our institute. The median age was 64 years. Histological type included 45 differentiated and undifferentiated 64 subtypes. The TNM stage before the treatment was diagnosed as IIIA: 11; IIIB: 10; IIIC: 14; IV: 74. Of the 98 evaluable patients, 69 patients had partial responses while no patients had a complete response, resulting in an overall response rate of 70%. Progressive disease (PD) occurred in 2 patients (4%). The most frequent adverse events more than grade 3 were hematologic toxicities, including leukocytopenia (47%), neutropenia (25%), and thrombocytopenia (24%). Non-hematologic toxicities such as general fatigue, renal-related events, and gastrointestinal toxicities were manageable with no treatment-related death. The median survival time was 537 days. Conclusions: While there were disadvantages of radiotherapy including the difficulty of confirming the area of irradiation due to peristaltic movement, risk of perforation and ulceration, recent technological advancement of radiation therapy has enabled pinpoint accuracy in treatment of primary gastric lesions and regional lymph nodes. There has been much anticipation that chemoradiotherapy will be a part of multidisciplinary treatment for advanced cancer.

scholarly journals Concurrent apatinib and local radiation therapy for advanced gastric cancer

Medicine ◽  
2017 ◽  
Vol 96 (9) ◽  
pp. e6241 ◽  
Author(s):  
Ming Zhang ◽  
Weiye Deng ◽  
Xiaoci Cao ◽  
Xiaoming Shi ◽  
Huanfen Zhao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Radiation Therapy ◽  
Advanced Gastric Cancer ◽  
Local Radiation

scholarly journals Prognostic Significance of Preoperative Serum Uric Acid to Lymphocyte Ratio in Advanced Gastric Cancer A Propensity Score-Matched Analysis

2021 ◽  
Author(s):  
Li Heng Liu ◽  
Shan Shan Hu ◽  
Cheng Lei Liao ◽  
ziwei wang
Keyword(s):  
Gastric Cancer ◽  
Uric Acid ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Prognostic Significance ◽  
D2 Lymphadenectomy ◽  
Entire Cohort ◽  
Lymphocyte Ratio ◽  
Incidence And Mortality ◽  
High Level

Abstract Purpose: Gastric cancer ranks sixth and second in incidence and mortality among all cancer. The purpose of our research was to evaluate the prognostic value of uric acid to lymphocyte ratio (ULR) for advanced gastric cancer (AGC) patients after gastrectomy with D2 lymphadenectomy.Methods: In this research, we included 287 AGC patients underwent gastrectomy with D2 lymphadenectomy. These patients were followed up for 5 years, and their clinicopathological data were collected. All patients were divided into two groups based on the preoperative ULR level. Then we established the propensity score matching (PSM) cohort to confirm our results. Finally, The clinical characteristics and survival indexes of the two groups in the PSM cohort and the entire cohort were compared. Results：We found that age and gender were significantly correlated with the ULR level. Multivariate analysis for the entire cohort and PSM cohort showed that high levels of ULR, poor differentiation, postoperative pathology of T4 stage, and regional lymph node metastasis were independent prediction factors for poor outcomes of overall survival (OS) and Disease-free survival (DFS) in patients with AGC after gastrectomy with D2 lymphadenectomy. Survival analysis showed that the OS and DFS in the high level ULR group were significantly shorter than in the low level ULR group (log-rank P < 0.001). Conclusion: High level ULR is a poor predictive factor for patients with AGC underwent gastrectomy with D2 lymphadenectomy, and high levels of ULR predict shorter OS and DFS.

scholarly journals Demonstration of the Capabilities of Transabdominal Ultrasonography in Assessment of Structures and Functional Disorders of Locally Advanced Gastric Cancer of Diverse Localization

2018 ◽  
Vol 1 (4) ◽  
pp. 10-21
Author(s):  
Rizvan Yagubovich Abdullaiev ◽  
Irina Victorovna Kryzhanovskaya ◽  
Youri Alekseevich Vinnik ◽  
Philip Narteh Gorleku
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Color Doppler ◽  
Gastric Wall ◽  
Locally Advanced ◽  
Transabdominal Ultrasonography ◽  
X Ray ◽  
Locally Advanced Gastric Cancer ◽  
Virtual Gastroscopy

Introduction: Ultrasound study of locally advanced gastric cancer that has spread to adjoining tissue and lymph nodes. This tumor can be associated with T2 to T4 stages of cancer. A “Locally advanced gastric cancer” is a tumor, which may be categorized as ‘resectable’ cancer when compared with M1 advanced cancer. Objective: The aim of this study was to evaluate the Capabilities of transabdominal ultrasonography in assessment of structures and functional disorders of the locally advanced gastric cancer of diverse localization Materials and Methods: A total of61 patients with locally advanced gastric cancer were analyzed of which 36 (59,0%) were males (mean age 62.7 years) and 25 (41,0%) were females (mean age 59.3 years). All patients were managed surgically and underwent preoperative X-ray, virtual gastroscopy techniques, multidetector computed tomography and transabdominal ultrasonography (USG). Histopathology results found, in 58 (95,1%) cases adenocarcinoma, in 3 (4,9%) – ring-cell carcinoma (cricoidal) gastric cancer was established. Stage T2 was diagnosed in 16 (26.2%) cases, T3 - in 41 (67.2%) cases, T4 - in 4 (6.6%) cases. The stomach tumor in 29 (47.5%) cases was localized mainly in the antrum, 27 (44.3%) – in the body, 5 (8.2%) in the cardia and fundus (Table 1). In 24 (39,3%) cases, pyloric stenos was diagnosed - of which in 6 (9,8%) it was compensated, in 18 (29,5%) - sub compensated. All patients underwent preoperative X-ray, virtual gastroscopy techniques, multidetector computed tomography and transabdominal ultrasonography (USG). Normal ultrasound features were observed in 35 patients without gastric pathology. Ultrasonography was carried out with the convex and micro convex transducers in the frequency range of 2-5 MHz and 4-7 MHz respectively in B and color Doppler modes. Results: The polypoid type of gastric cancer was detected in 3 (4,9±2,8%) cases, the ulcerative type – in 18 (29,5±5,8%), the infiltrative ulcerative type – in 27 (44,3±6,4%) and the diffuse infiltrative type – in 13 (21,3%±5,2%) cases respectively. In 24 (39,3%) cases, pyloric stenos was diagnosed - of which in 6 (9,8%) it was compensated, in 18 (29,5%) – sub compensated. The layers of the gastric wall were not differentiated in all patients with sub compensated pyloric stenos. The gastric wall thickness of the affected area was 10,2±2,9mm in the case compensated pyloric stenosis, the length was 27,1±6,2mm, the diameter of the pylorus was 8,3±0,8mm. Among patients with sub compensated pyloric stenos, the thickness of the gastric wall was 19,8±4,1mm, the length was 43,6±4,5mm, the pyloric diameter was 4,3±1,1mm. Among the 61 patients studied, pathological vascularization was detected in 42 (68.8%) cases. It was observed that, all 4 (6.5%) patients with gastric cancer were stage T4 and 38 (62.3%) were stage T3. Vascularization was weak in 13 cases, in 24 cases - moderate, and in 5 cases - enhanced. Metastases to the regional lymph nodes were diagnosed in 52 cases. Ultrasonographically, they were detected only in 37 (71.2%) cases. Conclusions: In the diagnosis of locally advanced gastric cancer, ultrasonography demonstrates good capabilities for determining the extent and depth of the affected area. Color doppler mode allows the study of vascularisation of a locally thickened area, as well as nearby enlarged lymph nodes, which is very important to ascertain the degree of malignancy of the hyperplastic process. ltrasonography can independently determine the degree of pyloric stenosis in patients with distal gastric cancer.

Clinical case of the neoadjuvant treatment with nivolumab in a patient with microsatellite unstable (MSI-H) locally advanced gastric cancer

2020 ◽  
Vol 13 (9) ◽  
pp. e236144
Author(s):  
Viacheslav Chubenko ◽  
Gamzat Inusilaev ◽  
Evgeny Imyanitov ◽  
Vladimir Moiseyenko
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Tumour Size ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Immune Checkpoint Blockade ◽  
Patients With Cancer ◽  
Locally Advanced Gastric Cancer ◽  
Programmed Death 1 ◽  
High Level

Locally advanced gastric cancer (GC) is often managed by neoadjuvant chemotherapy and surgery; however, pathological complete responses to preoperative systemic treatment are rare. Some GCs are characterised by high-level microsatellite instability (MSI-H) and therefore are potentially sensitive to anti-PD1 (the programmed death 1) therapy. Neoadjuvant immune checkpoint blockade demonstrated promising results in a number of trials involving various categories of patients with cancer; therefore, we considered feasible to offer preoperative nivolumab to a patient with T3N1M0 MSI-H GC. The patient experienced a reduction of the tumour size and the analysis of surgical material revealed complete elimination of tumour cells. MSI-H status deserves to be considered in future trials on patients with GC.

Clinical benefit of palliative radiation therapy in advanced gastric cancer

2008 ◽  
Vol 47 (3) ◽  
pp. 421-427 ◽  
Author(s):  
Michelle M. Kim ◽  
Michelle M. Kim ◽  
Vishal Rana ◽  
Nora A. Janjan ◽  
Michelle M. Kim ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Radiation Therapy ◽  
Advanced Gastric Cancer ◽  
Clinical Benefit ◽  
Palliative Radiation ◽  
Palliative Radiation Therapy

scholarly journals ANALYSIS OF HEMATOLOGIC, HEPATIC AND PANCREATIC TOXICITY DURING NEOADJUVANT CHEMORADIOTHERAPY IN PATIENTS WITH LOCALLY ADVANCED GASTRIC CANCER

2018 ◽  
Vol 17 (3) ◽  
pp. 20-27 ◽  
Author(s):  
V. Yu. Skoropad ◽  
D. D. Kudryavtsev ◽  
E. N. Anikina ◽  
M. V. Poluaktova ◽  
L. N. Titova
Keyword(s):  
Gastric Cancer ◽  
Radiation Therapy ◽  
Advanced Gastric Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Subtotal Resection ◽  
Combined Modality Treatment ◽  
Symptomatic Therapy ◽  
Locally Advanced Gastric Cancer ◽  
Pancreatic Toxicity

Purpose.We analyzed the frequency and severity of hematologic, hepatic and pancreatic toxicity during and after completion of neoadjuvant chemoradiotherapy in patients with gastric cancer.Material and methods. Phase II clinical trial was conducted to  evaluate the efficacy of the combined modality treatment including neoadjuvant chemoradiotherapy followed by D2  gastrectomy for patients with locally advanced gastric cancer. The  main inclusion criteria were: histologically verified gastric cancer,  cT3-4N0, cT2-4N1-3; M0. Before starting neoadjuvant therapy, all  patients underwent thoracic and abdominal CT and laparoscopy to  exclude peritoneal carcinomatosis. A total dose of radiation therapy  was 45 Gy (1 + 1.5 Gy/fraction/day with a 4–5 hour interval)  concurrently with the modified CAPOX chemotherapy regimen.  Gastrectomy or subtotal resection of the stomach was planned 4-6  weeks after the completion of chemoradiotherapy. The toxicity  assessment of neoadjuvant chemoradiotherapy was performed using the NCI CTC scale, version 3.0. The assessment of hematological, hepatic and pancreatic toxicities was done.Results.Among the toxicity during and after completion of  neoadjuvant chemoradiotherapy, thrombocytopenia, neutropenia and leukopenia (grade 1–2) were the most common, requiring no  additional symptomatic therapy. Radiation therapy was completed in  45 (98 %) patients. Chemotherapy was completed in 42 (91 %)  patients. The median time between the completion of  chemoradiotherapy and surgery was 44 days. Surgery following  chemoradiotherapy was performed in 100 % of patients, including R0 resection in 93 % of patients.Conclusion.Preoperative chemoradiotherapy was well tolerated by  patients, could be completed in most cases and did not prevent  subsequent surgical treatment.

A phase ll study of trastuzumab in combination with triweekly S-1 plus CDDP in HER2-positive advanced gastric cancer (HERBIS-1).

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 70-70 ◽  
Author(s):  
Naotoshi Sugimoto ◽  
Junji Tanaka ◽  
Masahiro Tsuda ◽  
Wataru Okamoto ◽  
Hiroyuki Okuda ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Response Rate ◽  
Rapid Progression ◽  
Her2 Positive ◽  
Eligibility Criteria ◽  
Threshold Response ◽  
Esophagogastric Junction Adenocarcinoma ◽  
Ecog Ps ◽  
Measurable Lesion

70 Background: S-1, an oral fluoropyrimidine, plus cisplatin (SP) regimen is one of the standard chemotherapy as first-line for advanced gastric cancer (AGC). Although ToGA study demonstrated that trastuzumab (T-mab) in combination with capecitabine plus cisplatin or fluorouracil plus cisplatin improved the overall survival of patients (pts) with HER2-positive AGC, there was no study evaluating the efficacy and the safety of T-mab in combination with SP regimen. Methods: Eligibility criteria included gastric or esophagogastric junction adenocarcinoma; HER2-positive confirmed by IHC and/or FISH (IHC 3+ or IHC 2+ and FISH positive); unresectable or recurrent; measurable lesion; no history of chemotherapy or radiotherapy; age≤75; ECOG PS of 0-1; and adequate organ function. Pts received S-1 at 40–60 mg depending on body surface area, po bid, day 1-14, and cisplatin 60 mg/m2, iv, day 1, plus T-mab 8 mg/ kg, iv, day 1 (6 mg/ kg, iv, d1 from 2nd course), repeated every 3 weeks until disease progression. Primary endpoint was response rate assessed by the RECIST (ver 1.1). The planned sample size was 50 based on the threshold response rate of 35%, the expected rate of 50%, power of 80%, and 1-sided α of 0.1. Results: A total of 56 pts were enrolled from July 2011 to May 2012. Two pts were ineligible with inadequate renal function and no measurable lesion. Characteristics of 54 eligible pts were as follows: median age of 66 (range 34-75), M/F: 42/12, PS0/1: 42/12, unresectable/recuurent: 51/3, and IHC 2+/3+: 9/45. As one patient did not receive the protocol treatment due to the rapid progression of tumor, the efficacy and the safety analyses were conducted in the full analysis set of 53 pts. The confirmed response rate assessed by the independent review committee was 68%, and the disease control rate was 94%. The response rate without interval confirmation was 75%. The grade 3/4 adverse events (>5% of pts) were as follows: neutropenia 30%, leucopenia 8%, anorexia 21%, diarrhea 8%, hypoalbuminemia 8%, vomiting 6%, and increased creatinine 6%. Conclusions: T-mab in combination with triweekly SP regimen showed promising antitumor activity and manageable toxicities in pts with HER2-positiveAGC. Clinical trial information: UMIN000005739.

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