Predictors of Prognosis of Surgically Resected Brain Metastasis from Lung Cancer with a Focus on Brain Recurrence

Purpose: There are many considerations to decide surgical treatment in lung cancer-brain metastasis. Herein, we analyzed survival and predictors of brain recurrence after surgery for lung cancer-brain metastasis. Methods: A total of 224 metastatic brain tumors from patients with lung cancer were analyzed. Results: There were 138 (61.6%) male and 86 (38.4%) female patients; 197 patients with non-small cell lung cancer (NSCLC) and 27 with small cell lung cancer (SCLC). The rate of postoperative complications was 4.9%. The 1-year and 2-year overall survival (OS) was 57% and 43%, respectively. The 6-month and 1-year progression-free survival (PFS) of local recurrence was 42% and 20%, respectively. In NSCLC and SCLC groups, the difference of PFS of local recurrence according to adjuvant irradiation was not significant (1-year: 20% vs. 22%, p=0.8) and (1-year: 14% vs. 25%, p=0.16), respectively. Whole-brain irradiation did not show a significant difference of distant recurrence (6-month: 54% vs. 60%, p=0.13). In predictor analysis, female sex was a favorable prognostic factor for OS, while SCLC histology and postoperative neurological deficits were poor prognostic factors in univariate analysis. Conclusions: SCLC histology and postoperative complications are negative predictors for OS. Adjuvant irradiation did not show effectiveness to reduce local and distant recurrence.

Transoral Robotic Surgery for Pharyngeal and Laryngeal Cancers—A Prospective Medium-Term Study

Transoral robotic surgery (TORS) has been used for treating pharyngeal and laryngeal cancers for many years. However, the application of neoadjuvant chemotherapy (NACT) before TORS, the sparing rate of adjuvant irradiation after TORS, and the long-term oncologic/functional outcomes of TORS are seldom reported. From September 2014 to May 2018, 30 patients with clinical T1 to T3 cancers of oropharynx (7), larynx (3), and hypopharynx (20) were prospectively recruited for TORS in a tertiary referral medical center. Twelve (40%) patients had clinical early stage (I or II) disease, and 18 (60%) patients had late-stage (III or IV) disease. All 30 patients were suggested to receive TORS with neck dissection. Cisplatin-based NACT was given to 11 patients before the surgery, and it led to a 100% reduction in tumor size. Only 40% of patients needed adjuvant irradiation with a mean dosage of 5933 cGY after TORS. After a mean follow up of 38.9± 14.7 months, the Kaplan–Meier method estimated 5-year disease-specific survival, and organ preservation was 86.3% and 96.2%, respectively. Twenty-five patients were alive without tracheostomy and tube feeding. We found that NACT is a potential method for facilitating tumor resection and TORS effectively de-escalated adjuvant irradiation with a satisfactory 5-year survival and functional outcomes.

5-aminolevulinic Acid and Surgical Margin Analysis in Calvarial Metastasis with Pericranium or Dural Extension: Technical Note

Metastasis to the calvarium with direct pericranium or dural infiltration may be treated with radical surgical removal in selected cases. We describe microsurgical resection of calvarial metastases with fluorescence-guided technique using 5-aminolevulinic acid (5-ALA) in two female patients with breast cancer. Fluorescence findings were positive in both cases. Margins in the scalp and dural layer were 5-ALA negative at the end of surgical removal. Intraoperative pathology was performed in all cases to confirm if oncological limits were free of disease. One case was 5-ALA positive in the outer layer of the dura-mater and another in the pericranium. At the end of the removal in both cases, the surgical margins were 5-ALA fluorescence-free. Intraoperative pathology confirmed oncological limits of the resection. 5-aminolevulinic acid fluorescence-guided surgery for calvarial metastases with pericranium and/or dural extension seems to be a safe and reliable method to aid the surgical margins for complete removal, possibly delaying or avoiding adjuvant irradiation for progression control.

METASTASIS OF RENAL CANCER TO BREAST: DESCRIPTION OF CLINICAL CASE

The main method of treatment of local stages of clear cell renal cancer is surgical. The question of conducting adjuvant irradiation and chemotherapy after radical operations is open. Patients with solitary distant metastases and a favorable prognosis may become candidates for surgical treatment. Surgical removal of isolated solitary metastases allows to achieve 35–60 % of 5-year overall survival. The patient, observed in N.N. Blokhin National Medical Research Center of Oncology with metastasis of renal cancer in the pancreas, and then in the breast is an extremely rare clinical case presented in this article.

Treatment Planning Optimization in Radiotherapy Using the Bolus

The present paper presents the results of the research regarding the bolus structure (Bio-Rad Win-IR instrument), the elasticity modulus, the bioadhesiveness properties (TA-XT2 Plus analyzer) and the clinical applications of the bolus in the adjuvant irradiation after radical mastectomy (Treatment Plan System Eclipse). The dose-volume histogram has made a comparative evaluation for with and without bolus treatment plans and confirmed the importance of bolus utilisation in selected patients. Conclusions: the thickness of the applied bolus is dependent on the skin dose required, on the treatment technique and must be equal to the depth of the build-up region for the removal of the skin-sparing effect of a high energy radiation.