Small cell bladder cancer: should we consider prophylactic cranial irradiation?

ABSTRACT Purpose: To describe the clinical characteristics, treatment patterns, and outcomes in patients with small cell bladder cancer at our institution, including those who received prophylactic cranial irradiation (PCI) for the prevention of intracranial recurrence. Materials and Methods: Patients with small cell bladder cancer treated at a single institution between January 1990 and August 2015 were identified and analyzed retrospectively for demographics, tumor stage, treatment, and overall survival. Results: Of 44 patients diagnosed with small cell bladder cancer, 11 (25%) had metastatic disease at the time of presentation. Treatment included systemic chemotherapy (70%), radical surgery (59%), and local radiation (39%). Six patients (14%) received PCI. Median overall survival was 10 months (IQR 4 - 41). Patients with extensive disease had worse overall survival than those with organ confined disease (8 months vs. 36 months, respectively, p = 0.04). Among those who received PCI, 33% achieved 5 - year survival. Conclusion: Outcomes for patients with small cell bladder cancer remain poor. Further research is indicated to determine if PCI increases overall survival in small call bladder cancer patients, especially those with extensive disease who respond to chemotherapy.

Small cell bladder cancer: should we consider prophylactic cranial irradiation?

PURPOSE: To describe the clinical characteristics, treatment patterns, and outcomes in patients with small cell bladder cancer at our institution, including those who received prophylactic cranial irradiation (PCI) for the prevention of intracranial recurrence. MATERIALS AND METHODS: Patients with small cell bladder cancer treated at a single institution between January 1990 and August 2015 were identified and analyzed retrospectively for demographics, tumor stage, treatment, and overall survival. RESULTS: Of 44 patients diagnosed with small cell bladder cancer, 11 (25%) had metastatic disease at the time of presentation. Treatment included systemic chemotherapy (70%), radical surgery (59%), and local radiation (39%). Six patients (14%) received PCI. Median overall survival was 10 months (IQR 4 - 41). Patients with extensive disease had worse overall survival than those with organ confined disease (8 months vs. 36 months, respectively, p = 0.04). Among those who received PCI, 33% achieved 5 - year survival. CONCLUSION: Outcomes for patients with small cell bladder cancer remain poor. Further research is indicated to determine if PCI increases overall survival in small call bladder cancer patients, especially those with extensive disease who respond to chemotherapy.

Palliative care in poor-performance status small cell lung cancer patients: is there a mandatory role for chemotherapy?

PURPOSE: Small cell lung cancer (SCLC) is an aggressive malignancy but with a high response rate to chemotherapy. Eastern Cooperative Oncology Group performance status (ECOG PS) has been recognized as one of the main prognostic factors in SCLC. There are few data about risk-benefit ratio of chemotherapy over exclusive best supportive care in ECOG PS 3 and 4 patients. This study was performed to assess the outcome of poor ECOG PS SCLC patients that received chemotherapy in our institution. METHODS: A retrospective review of medical records from patients with ECOG PS 3-4 SCLC, who received systemic chemotherapy, was performed between January 2001 and December 2006 at the Instituto Nacional do Câncer, Rio de Janeiro, Brazil. RESULTS: A total of 40 patients were included. Extensive disease was observed in 85% of patients and 25% had PS 4. The median overall survival was 53 days (64 days for ECOG PS 3 and 7 days for ECOG PS 4). There were 30% of early deaths. On univariate analysis, lactate dehydrogenase value, need for hospital admission, and exposure to radiotherapy had impact on survival. ECOG PS 3 patients had better survival than PS 4 patients, even when adjusted for stage. On multivariate analysis, ECOG PS, combined with stage, sustained a major influence on survival. CONCLUSIONS: Median survival for ECOG PS 4 patients treated with chemotherapy in our series was extremely short with a high rate of early deaths. ECOG PS 3 patients also showed a poor survival. These data suggest that we need a more comprehensive approach and further studies, regarding the palliative care of this high-risk population.

Primary neuroendocrine small cell undifferentiated carcinoma of the parotid gland.

Neuroendocrine small cell carcinoma is a malignant neoplasm that most frequently arises in the lung. Salivary gland involvement is rare, and the parotid is the main gland affected. We describe the fine-needle aspiration (FNA) cytology findings, the immunophenotypical study and the differential diagnosis of a small cell carcinoma that presented in the parotid of a 91-year-old man. The tumour was treated only with radiotherapy and presented a complete response, with no evidence of the disease after three years of follow-up. This is the first case reported in the literature with good outcome after exclusive irradiation.

Clinical outcome in patients with intramedullary spinal cord metastases from lung cancer.

Intramedullary spinal cord metastases (ISCM) are uncommon and present with rapidly progressing neurological deficits. The objective of this study was to determine the rate, duration of neurological response and survival after radiation therapy. We have retrospectively reviewed the clinical outcome of six cases with a diagnosis of ISCM from primary lung cancer, non-small cell (NSCLC) (n=3) and small cell (SCLC) (n=3). Total radiation dose ranged from 27 Gy/5 fr to 40 Gy/20 fr. Ambulation was preserved in 3 patients and partially recovered in one. Five out of the six patients (83%) showed improvement in neurological signs/symptoms with a mean duration of 17.2 days (max: 40 days; min: 6 days). Median survival time was 5 months (confidence interval (CI) 95%: 0-12) for NSCLC and 5 months (CI 95%: 4-6) for SCLC. Although radiation response rate is high, the interval free of neurological progression is very short. A therapeutic approach should be considered for each individual.

Irradiated volume and the risk of fatal hemoptysis in patients submitted to high dose-rate endobronchial brachytherapy.

To determine risk factors associated with fatal hemoptysis (FH) in endobronchial high dose-rate brachytherapy (EHDRB) 84 patients treated with EHDRB from January 1991 to June 2002 were studied. Clinical and technical parameters (including treatment volumes) were analyzed. Eight (9.5%) patients died of FH, all but one with recurrent or persistent local disease. Median interval until death due to FH was 4 months versus 6 months for the whole group. The only factor with significant correlation with FH was the 100% isodose volume (V100) (p=0.04). Larger irradiated volumes were related to FH. Analysis of volume parameters is suggested, together with the dose and number of fractions prescribed for each patient.

Choroidal mass as the presenting sign of small cell lung carcinoma.

CASE REPORT: To report the case of a 58-year-old man with blurred vision and metamorphopsia who had an amelanotic choroidal mass in the right eye as the presenting sign of a small cell lung carcinoma. Systemic screening failed to reveal a tumor elsewhere, and the lesion was initially treated as a primary ocular tumor. Discovery of the primary site was made 10 months after the ocular diagnosis, and the patient was then treated with systemic chemotherapy and local radiation therapy. COMMENTS: The ophthalmologist has a crucial role not only in the management of ocular metastases but also in the diagnosis of the primary nonocular malignancies that present as a choroidal mass. The possibility of ocular metastases in patients with choroidal masses should always be considered whether or not there is a diagnosis of cancer elsewhere.

Pontine metastases as a cause of dysphagia in lung carcinoma.

Dysphagia is an unusual symptom in the clinical course of lung carcinoma. When it appears, it is necessary to differentiate between regional dissemination, drug toxicity, opportunistic infection and, most rarely, metastatic dissemination to the brain stem. Magnetic resonance imaging (MRI) is the best diagnostic option to exclude this last possibility. We present a male patient with progressive dysphagia 15 months after the diagnosis of an oat-cell lung carcinoma. Cerebral MRI revealed a pontine lesion, probably of metastatic origin.

[Combined radiochemotherapy in localised small-cell lung cancer. Concurrent treatment protocols?]. / Radioquimioterapia de la enfermedad limitada del carcinoma pulmonar de célula pequeña. Tratamiento concomitante en protocolos asistenciales?

PURPOSE: We retrospectively reviewed our Institution's database to investigate the outcome and impact of combined radiochemotherapy (RT/CT; concomitant or in sequence) in localised small-cell lung cancer (L-SCLC). MATERIAL AND METHODS: Between January 1995 to November 1999, 79 patients with L-SCLC received combined RT/CT at our Institution. RT was delivered concurrently or sequentially following the CT. Patients with treatment response received additional prophylactic cranial irradiation (PCI). RESULTS: Of the patients treated, 54% had received concurrent CT/RT compared to 46% receiving RT following the CT. PCI was administered to 80% of the patients. Complete response was observed in 66% of patients. With a median follow up of 30 months, median overall survival was 15.9 months; 14.3 months for patients who received RT following CT and 21.6 months for those receiving concurrent CT/RT. The type of schedule of combined radiochemotherapy was an independent prognostic factor for survival free of local recurrence, as was additional PCI for distant metastasis-free survival. CONCLUSIONS: Our results are similar to those reported previously in the literature. The main point of interest is that our patients were non-selected. We strongly support the use of concurrent CT/RT so as to achieve results comparable to the best in the literature.

Prophylactic cranial irradiation in small cell lung cancer.

Prophylatic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC) is a treatment under evaluation for about 30 years. Since the first randomized trials, it was clear that its use significantly decreased the brain metastasis rate. However, its effect on overall survival was not demonstrated. Retrospective reviews suggested that PCI could induce late neurologic damage. In recent years, two large randomized trials did not confirm this deleterious effect and even suggested a beneficial effect on survival. A recent meta-analysis including almost 1,000 randomized patients confirmed an improvement in overall survival. We discuss here the different aspects of this preventive treatment in a potentially curable disease.

Análisis del tratamiento y sobrevida del cáncer de pulmón a células pequeñas. Hospital de Clínicas 1990-1996 / Analysis of treatment and survival for small cell lung cancer. Hospital de Clinicas 1990-1996

Objetivo: Evaluar en forma retrospectiva el tratamiento y la sobrevida de los pacientes con cáncer de pulmón a células pequeñas. Material y método: Fueron incluidos todos los pacientes registrados en el Departamento de Oncología del Hospital de Clínicas portadores de cáncer de pulmón a células pequeñas en el período 1990-1996. La estadificación fue clínica y paraclínica, usando el sistema de 2 etapas, dearrollado por el Grupo de Estudio del Cáncer de Pulmón de la Administración de Veteranos(1). Los pacientes con derrame pleural masivo y ganglios supraclaviculares contralaterales han sido incluidos en la etapa limitada. La evaluación inicial incluyó exámen físico, Rx de tórax, tomografía computada de tórax y abdomen superior, hemograma y enzimograma hepático. Se incluyeron en el grupo de tratamiento oncoespecífico aquellos pacientes que recibieron tratamiento de radioterapia sobre el tumor primario a dosis igual o mayor de 4000 cGy y una o más series de quimioterapia. Para el análisis de sobrevida se utilizó el test Logrank. Resultados: Fueron evaluados 50 pacientes y estadificados como estadío localizado 17 pacientes y como estadío extendido 33 pacientes. La edad promedio fue de 61 años. La sobrevida global fue de 8 meses. La sobrevida mediana para los pacientes con tratamiento oncoespecífico fue de 9 meses; sin tratamiento oncoespecífico de 2,5 meses. Conclusiones: Los 2/3 de los tumores en células pequeñas se presentan con enfermedad diseminada en el momento del diagnóstico. El tratamiento oncoespecífico aumenta la sobrevida casi 4 veces comparada con los pacientes que no reciben tratamiento oncoespecífico. La sobrevida continúa siendo reducida llegando al 0 por ciento a los 3 años y medio(AU)

Quimio-radioterapia em carcinoma tipo "oat cell" do esôfago / Chemoradiotherapy in oat cell carcinoma of esophagus

É relatado um caso de um paciente com carcinoma indiferenciado de pequenas células originário no esôfago que foi tratado com quimio-radioterapia. Durante a quimioterapia de induçäo com Ciclofosfamida, Epirrubicina e Etoposide houve desaparecimento completo da neoplasia. A radioterapia foi utilizada para consolidaçäo da resposta. Dois anos e meio após diagnóstico o paciente foi a óbito após desenvolvimento de múltiplas metástases.