Radiotherapy in symptom management

Radiotherapy has a major role in symptom control and over 40% of all radiation treatments are given with palliative intent. In the palliative setting, radiotherapy will usually be delivered using high-energy external beam treatment from a linear accelerator. Bone metastases may be treated with intravenous systemic radioisotopes and dysphagia with endoluminal brachytherapy. A general principle of palliative radiotherapy is that it should be delivered in as few treatment visits as possible and be associated with minimal acute toxicity. The main indications for palliative radiotherapy are in the management of symptoms due to local tumour growth and infiltration. These include pain from bone metastases, visceral pain from soft tissue metastases, and neuropathic pain from spinal, pelvic, and axillary tumour. Local pressure symptoms are particularly onerous and potentially dangerous when they affect the nervous system; thus, spinal canal compression remains one of the few true emergency situations in which radiotherapy is indicated. Similarly, brain, meningeal, or skull base metastases require urgent assessment and can be helped with local radiotherapy. Obstruction of a hollow tube or drainage channels can lead to significant symptoms and again local radiotherapy can be valuable in addressing this scenario. Such indications would include dysphagia, bronchial obstruction, leg or arm oedema, vena cava obstruction, or hydrocephalus. Finally, haemorrhage can be distressing if rarely life-threatening. Local radiotherapy to bleeding tumours in the lung, bronchus, bowel, genitourinary tract, and skin is very effective at control of bleeding.

Cerebellar metastasis of a Liposarcoma: Case report and literature review

Background: Liposarcoma (LPS) is a rare type of tumor; they come from the adipose tissue. It is the most common type of soft-tissue sarcoma. Every type of LPS has morphological features, immunophenotypic, and molecular pathogenesis characteristics of their own. In this case, we are going to report a cerebellar metastatic disease from a well-differentiated liposarcoma (WDL) with pleomorphic component, not found in our literature research. Case Description: A 72-year-old woman with progressive pain and inflammation in the left knee with functional limitation when climbing stairs. MRI shows a tumor in the vastus medialis of the left thigh. Pathology result was pleomorphic and WDL, Stage III and negative for MDM2 and CDK4. Extension study was carried out, finding nodular lesion in the right cerebellar hemisphere with mass effect and partial obliteration of the fourth ventricle, suspicious of distant disease. Conclusion: Cerebellar metastasis of LPS is uncommon; there are only a few cases reports with the literature reviews describing orbital or skull base metastases, but not in the cerebellum. Our case allows us to remember that neurological symptoms, no matter how subtle, in patients diagnosed with LPS, a secondary affectation of the central nervous system must be ruled out, even though it is a rare location. The findings of distant disease in LPSs, allow planning oncological treatment options and targeted radiotherapeutic.

Skull Base Metastasis of Breast Cancer With Oculomotor and Trochlear Nerve Palsy

Skull base metastatic tumors are rare. Breast cancer in particular can cause bone metastases after a long period of time. A 70-year-old woman presented with multiple cranial nerve palsy. Magnetic resonance imaging revealed a lesion that extended from the orbit to the base of the skull, and the patient was referred to our department. Ophthalmological evaluation showed left visual acuity impairment, left oculomotor nerve palsy, and left trochlear nerve palsy. Endoscopic biopsy performed 5 years after the completion of breast cancer treatment revealed skull base metastases. In unilateral multiple cranial nerve palsy, the possibility of skull base metastases should be considered.

Rare Paravertebral and Skull Base Metastases in Prostate Cancer

Prostate cancer is the most commonly diagnosed visceral cancer in the United States. A majority of cases exhibit an insidious course and nonaggressive tumor behavior. Prostate cancer can manifest as lesions which remain localized, regionally invading or metastasize to lymph nodes, bones, and lungs. Here, we report a unique case of metastatic prostate cancer to the right upper mediastinum, presenting as a paravertebral mass within 2 years of initial tissue diagnosis. Paravertebral spread has not been described for prostate cancer, and herein, we discuss the clinical presentation, diagnostic workup, and possible therapeutic options available in light of the literature.