Radiotherapy for Brain Metastases Near the End of Life: Characterizing Patients and Tumor Features.

PURPOSE: Patients with brain metastases are often referred for brain radiotherapy (BrRT) when exclusive palliative management would be more appropriate. To assess the indication of BrRT during end-of-life (EOL) care and evaluate the characteristics of the patients who underwent the treatment. METHODS: This retrospective study comprised patients from four independent oncology centers who had undergone BrRT for metastases. The variables included were Karnofsky performance status (KPS), primary tumor site, metastatic status, neurologic symptomatic status, the number and size of metastases, posterior fossa or meningeal involvement, type of BrRT, having undergone brain metastasectomy, and the availability of systemic therapies after BrRT. Patients were allocated into three subgroups with ≤30, 31-60, and 61-90 days of survival, and a control group of patients who survived >90 days. RESULTS: A total of 546 patients were included in the study. A KPS of <70 (P = .021), the number of brain metastases (P = .001), the lack of brain metastasectomy (P = .006), and the lack of systemic therapies after BrRT (P = .047) were significantly associated with the EOL subgroups. Multivariate analysis showed that a KPS of <70 (P < .001), the lack of brain metastasectomy (P = .015), and the lack of systemic therapies after BrRT (P = .027) were significantly associated with worse survival. In all, 241 (44.1%) patients died within 90 days-120 (22.0%) within 30 days, 75 (13.7%) within 31-60 days, and 46 (8.4%) within 61-90 days of BrRT. Patients with colorectal cancer were significantly more likely to die within 90 days of BrRT than >90 days. CONCLUSION: Considering patients' performance status and whether they are candidates for brain metastasectomy or systemic therapies after BrRT is critical to improving BrRT benefits in scenarios of EOL.

Trochlear Nerve Schwannoma: Case Report and Literature Review

Schwannomas arise from the Schwann cells of the peripheral and cranial nerves. They represent 8% of the primary cerebral neoplasms. Although schwannomas usually develop in sensory nerves, most often on the vestibular and trigeminal nerves, in very rare cases they can develop in motor nerves. We reported an unusual case of a 29-year-old woman with headache, nausea, vomiting, and blurred vision ongoing for 3 years. Magnetic resonance of the brain showed a solid-cystic expanded injury, heterogeneous, with limits partially defined and epicenter on the pineal gland. The lesion presented hyposignal in T1 and isosignal in T2. An intense enhancement of the solid part was observed after contrast injection. Foci of calcification and absence of diffusion restriction were also observed. The patient underwent microneurosurgery with supracerebellar infratentorial approach in a seated position. Subtotal resection was performed with maintenance of calcified tumor tissue adhered to the right Rosenthal basal vein. In the postoperative phase, the patient remained with diplopia when looking down; however, she reported improvement of headache and nausea.

Os schwannomas surgem das células de Schwann, dos nervos periféricos e cranianos e representam 8% das neoplasias cerebrais primárias. Apesar de os schwannomas se desenvolverem comumente em nervos sensoriais, mais frequentemente no nervo vestibular e trigêmeo, em casos muito raros ele pode se desenvolver em nervos motores. Relatamos um caso raro, de uma paciente do sexo feminino, 29 anos, com quadro de cefaleia, náuseas, vômitos e turvação visual há três anos. Ressonância magnética de encéfalo demonstrou lesão expansiva sólido-cística, heterogênea, com limites parcialmente definidos e epicentro na glândula pineal. Apresentou hipossinal em T1 e isossinal em T2. Houve intenso realce da parte sólida após injeção de contraste. Foram observados focos de calcificação e ausência de restrição à difusão. A paciente foi submetida a tratamento microneurocirúrgico com acesso infratentorial supracerebelar em posição sentada. Houve ressecção subtotal com manutenção de tecido tumoral calcificado aderido a veia basal de Rosenthal direita. No pós-operatório, a paciente permaneceu com diplopia na mirada ocular para baixo, entretanto apresentou melhora de cefaleia e náuseas.

Utilização da ultrassonografia para o seguimento de lesões mamárias benignas avaliadas por citopatologia / The use of ultrasonography for follow-up of benign breast lesions evaluated by citopathology

Objetivo: Verificar a acurácia da ultrassonografia no seguimento das lesões mamárias diagnosticadas previamente como doenças benignas pela citopatologia. Métodos: Foram selecionados casos de pacientes submetidas à punção aspirativa com agulha fina de lesões mamárias e que a citopatologia descreveu achados benignos. Um grupo foi seguido com ultrassonografia e outro submetido à biópsia excisional ou incisional das lesões. A acurácia foi calculada a partir da sensibilidade, especificidade, valor preditivo positivo e negativo; e análise através da curva ROC. Resultados: Foram analisados 507 resultados citopatológicos, no período de agosto de 2002 a dezembro de 2010. Desses, 23,23% foram excluídos do estudo por terem sido classificados como material inadequado. A acurácia da punção aspirativa com agulha fina foi de 91,76%; quando comparada com os resultados anatomopatológicos. Já a acurácia da ultrassonografia foi de 99,38%. Quando comparados simultaneamente a biópsia e a ultrassonografia, utilizando a curva ROC, a acurácia do teste índice foi de 88 e 84%, respectivamente. Conclusão: O seguimento ultrassonográfico das lesões mamárias pode ser uma alternativa no seguimento de lesões mamárias diagnosticadas previamente como benignas à citopatologia.

Objective: The objective is to verify the accuracy of ultrasonography in the follow-up of breast lesions previously diagnosed as benign diseases by cytopathology. Methods: A retrospective and observational study aimed to compare the accuracy of fine needle aspiration in relation to the pathological exam and to the ultrasonography, in follow-up of breast lesions through the calculation of the sensitivity, specificity, positive predictive value, negative predictive value, and using the ROC curve. Results: 507 fine needle aspirations were analyzed in the period of August 2002 to December 2010. A total of 23.23% were excluded from the study because they were considered as inappropriate material. When compared to the pathological exam, the accuracy of fine needle aspiration was 91.76%. When related to the ultrasonography, the accuracy was 99.38%. When compared to both pathological exam and ultrasonography, using the ROC curve, the accuracy of the index test was 88 and 84%, respectively. Conclusion: The radiological follow-up of the breast lesions can be an alternative in the follow-up of lesions previously diagnosed as benign to fine needle aspiration.