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1.
Artigo em Russo | MEDLINE | ID: mdl-34965693

RESUMO

The vertebral hemangioma (VH) and vertebrogenic pain syndromes of other etiologies are currently not a problem in terms of the choice of treatment method. However, the combination of these conditions makes the situation much more challenging. The question of the safety of physical treatment methods in these patients remains open, since there is no scientific evidence in this area. OBJECTIVE: To study the long-term results of electrotherapy, magnet therapy, lazer therapy, therapeutic exercises (TE), and therapeutic massage (in different combinations) in patients with degenerative-dystrophic processes of the spine and nonaggressive VH. MATERIAL AND METHODS: The study included 104 patients (75 females, 29 males) with degenerative-dystrophic processes of the spine and non-aggressive VH. The time between the treatment course and follow-up examination was 12 months. RESULTS: VHs remained unchanged in 86.5% of patients. An increase in size was noted in 13.5%. In no case did the VH become aggressive. After the TE course, the rate of VH size increase was 10.8%. The combination of TE with massage and electrotherapy (including a combination of all methods) resulted in an increase in VH size in 17.9, 20.0, 23.8% of cases, respectively. When magnet therapy was used, an increase in VH size was recorded significantly less frequently (p=0.021). No differences in the rate of VH size increase depending on sex, age (40-70 years), localization, and size were observed. In case of multiple VHs, the rate of growth was 23.1. CONCLUSION: A limitation of the study was the relatively small number of patients, which could, in some cases, affect the correctness of statistical data. Nevertheless, there is a general trend of the effect of physical treatments on the course of non-aggressive VH in patients with vertebrogenic pain syndromes. Such patients may be recommended low-frequency low-intensity electro- and magnet therapy, therapeutic back massage, and TE.


Assuntos
Hemangioma , Neoplasias da Coluna Vertebral , Adulto , Idoso , Dor nas Costas , Feminino , Hemangioma/complicações , Hemangioma/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/terapia , Coluna Vertebral
2.
Pediatrics ; 148(5)2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34716219

RESUMO

Lymphomatous involvement of the larynx is a rare entity. We present a case of atypical laryngotracheitis as the initial manifestation of non-Hodgkin's lymphoma in a pediatric patient. The diagnosis was aided through the use of microbial cell-free DNA (mcfDNA) testing, which detected the presence of Epstein-Barr virus in the patient's plasma. This enabled the consideration of an Epstein-Barr virus-related lymphoproliferative process, leading to additional workup and the final diagnosis of lymphoma. To our knowledge, this is the first case of mcfDNA testing leading not simply to an infectious organism, but further to a new oncologic diagnosis. Plasma mcfDNA testing has the potential to inform clinical practice beyond classic infectious disease manifestations. In this article, we review both the possible future applications and the areas of further investigation that remain.


Assuntos
Infecções por Vírus Epstein-Barr/diagnóstico , Herpesvirus Humano 4/genética , Sequenciamento de Nucleotídeos em Larga Escala , Neoplasias Laríngeas/diagnóstico , Linfoma não Hodgkin/diagnóstico , Ácidos Nucleicos Livres/sangue , Criança , Citomegalovirus/genética , Herpesvirus Humano 4/isolamento & purificação , Humanos , Neoplasias Infratentoriais/terapia , Neoplasias Laríngeas/complicações , Neoplasias Laríngeas/virologia , Laringite/diagnóstico , Laringite/etiologia , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/virologia , Masculino , Meduloblastoma/terapia , Neoplasias da Coluna Vertebral/terapia , Tomografia Computadorizada por Raios X , Traqueíte/diagnóstico , Traqueíte/etiologia
3.
Sci Rep ; 11(1): 17871, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34504208

RESUMO

Spinal metastases often occur in the advanced stages of breast, lung or prostate cancer, resulting in a significant impact on the patient's quality of life. Current treatment modalities for spinal metastases include both systemic and localized treatments that aim to decrease pain, improve mobility and structural stability, and control tumour growth. With the development of non-toxic photosensitizer drugs, photodynamic therapy (PDT) has shown promise as a minimally invasive non-thermal alternative in oncology, including for spinal metastases. To apply PDT to spinal metastases, predictive algorithms that optimize tumour treatment and minimize the risk of spinal cord damage are needed to assess the feasibility of the treatment and encourage a broad acceptance of PDT in clinical trials. This work presents a framework for PDT modelling and planning, and simulates the feasibility of using a BPD-MA mediated PDT to treat bone metastases at two different wavelengths (690 nm and 565 nm). An open-source software for PDT planning, PDT-SPACE, is used to evaluate different configurations of light diffusers (cut-end and cylindrical) fibres with optimized power allocation in order to minimize the damage to spinal cord or maximize tumour destruction. The work is simulated on three CT images of metastatically involved vertebrae acquired from three patients with spinal metastases secondary to colorectal or lung cancer. Simulation results show that PDT at a 565 nm wavelength has the ability to treat 90% of the metastatic lesion with less than 17% damage to the spinal cord. However, the energy required, and hence treatment time, to achieve this outcome with the 565 nm is infeasible. The energy required and treatment time for the longer wavelength of 690 nm is feasible ([Formula: see text] min), but treatment aimed at 90% of the metastatic lesion would severely damage the proximal spinal cord. PDT-SPACE provides a simulation platform that can be used to optimize PDT delivery in the metastatic spine. While this work serves as a prospective methodology to analyze the feasibility of PDT for tumour ablation in the spine, preclinical studies in an animal model are ongoing to elucidate the spinal cord damage extent as a function of PDT dose, and the resulting short and long term functional impairments. These will be required before there can be any consideration of clinical trials.


Assuntos
Metástase Neoplásica/patologia , Fotoquimioterapia , Fármacos Fotossensibilizantes/uso terapêutico , Neoplasias da Coluna Vertebral/terapia , Humanos , Fotoquimioterapia/métodos , Estudos Prospectivos , Qualidade de Vida , Neoplasias da Coluna Vertebral/secundário , Coluna Vertebral/patologia , Verteporfina/uso terapêutico
4.
Ugeskr Laeger ; 183(33)2021 08 16.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34477101

RESUMO

Metastatic spinal cord compression is an oncologic emergency, and the most frequent initial symptom is radicular backpain. Urgent diagnostics with acute MRI and early treatment is essential to prevent permanent neurologic damage. Treatment is mainly palliative. For patients who have a good prognosis, the treatment of choice is decompressive surgery followed by radiotherapy, but only few patients are candidates to surgery due to significant comorbidities and poor performance status. Optimal therapy is required to maintain high quality of life at an acceptable risk, as argued in this review.


Assuntos
Compressão da Medula Espinal , Neoplasias da Coluna Vertebral , Descompressão Cirúrgica , Humanos , Cuidados Paliativos , Qualidade de Vida , Compressão da Medula Espinal/cirurgia , Compressão da Medula Espinal/terapia , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/terapia
5.
Eur Spine J ; 30(10): 2839-2851, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34415449

RESUMO

PURPOSE: Spinal bone tumors include a heterogeneous broad of primary or metastatic lesions that may present as incidental findings or manifest with painful symptoms and pathological fractures. Optimal management of spine bone lesions is often difficult and treatment algorithms are usually solidly based on surgery. We aimed to evaluate the contribution of trans-arterial embolization in this field, with particular attention to the procedure efficacy, technical difficulties and complications. METHODS: We present a literature review on the role of trans-arterial embolization in the management of spinal bone tumors, both primary and metastatic, evaluating its contribution as preoperative treatment, palliative procedure and standalone curative strategy. RESULTS: Trans-arterial embolization provides an important contribution to reducing surgery hemorrhagic risks, offering a better visualization of the operating field, and possibly increasing tumor susceptibility to chemotherapy or radiation therapy. Nonetheless, it plays an important part in pain palliation, with the unquestionable advantage of being easily repeatable in case of necessity. Its curative role as a standalone therapy is still subject of debate, and at the present time, satisfactory results have been recorded only in the treatment of aneurysmal bone cysts. CONCLUSION: Percutaneous trans-arterial embolization has established as a highly useful minimally invasive procedure in the management of spinal bone lesions, particularly as adjuvant preoperative therapy and palliative treatment.


Assuntos
Cistos Ósseos Aneurismáticos , Embolização Terapêutica , Fraturas Espontâneas , Neoplasias da Coluna Vertebral , Cistos Ósseos Aneurismáticos/terapia , Humanos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/terapia , Coluna Vertebral
6.
Neuroradiology ; 63(11): 1935-1945, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34427707

RESUMO

PURPOSE: The purpose of this study is to evaluate the role of spinal angiography and arterial embolization in avoiding spinal cord ischemia in patients undergoing CT-guided alcohol injection of aggressive vertebral hemangiomas. METHODS: In this retrospective study, patients with vertebral hemangioma who underwent CT-guided direct alcohol injection between January 2007 and October 2018 were identified. Of 28 such patients, 26 had neurological deficits, and 2 had only back pain or radiculopathy. Direct alcohol injection without prior arterial embolization was done in 17 patients. Direct alcohol injection with prior arterial embolization was done in 11 patients. Clinical outcome was assessed immediately after the intervention and at follow-up. RESULTS: Three patients, who underwent alcohol injection without trans-arterial embolization, had worsening of neurological deficits in the post procedure period due to spinal cord ischemia. No complications related to spinal cord ischemia were noted in the embolization group. There was no significant difference in the outcomes between the two groups if the three patients with complications are excluded (p = 0.34). CONCLUSION: While CT-guided direct alcohol injection is effective in the management of symptomatic and aggressive vertebral hemangiomas, spinal angiography and trans-arterial embolization of the blood supply to the vertebral body hemangioma, prior to the direct transpedicular alcohol embolization of the lesion, improves the safety of the procedure.


Assuntos
Embolização Terapêutica , Hemangioma , Neoplasias da Coluna Vertebral , Angiografia , Descompressão Cirúrgica , Hemangioma/cirurgia , Hemangioma/terapia , Humanos , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/terapia , Tomografia Computadorizada por Raios X
7.
Biomaterials ; 275: 120917, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34182327

RESUMO

Metastatic tumors present great challenges in diagnosis and treatment. Herein, a proof-of-concept theranostic nanoplatform composed of an Au nanoparticle core and a double-shell of metal-organic framework (MOF) and mesoporous silica (MS) is developed for combating spinal metastasis of lung cancer in an orthotopic model. Two drugs, Alpelisib (BYL719) as an inhibitor and cisplatin as a chemotherapeutic drug, are separately loaded into the double-shell with high loading content. A targeting peptide called dYNH and indocyanine green (ICG) are conjugated onto the outmost MS layer for specifically targeting metastatic tumor cells and enhancing photothermal effect. The resultant Au@MOF@MS-ICG -dYNH-PAA (AMMD) shows enhanced cellular uptake on tumor cells and accumulation at metastatic spinal tumors, as evidenced by fluorescent and photoacoustic imaging. Benefiting from this ultra-high affinity to tumor cells and the photothermal effect of ICG, the dual-drug-loaded AMMD (BCAMMD) modified with ICG exhibits superior therapeutic efficacy on spinal tumors. More importantly, bone destruction, which frequently occurs in bone-related tumors, is effectively suppressed by BYL719 in BCAMMD. Hence, by rationally integrating multiple functions, including excellent targeting ability, dual-drug loading, photothermal therapy, and photoacoustic imaging, the developed all-in-one theranostic nanoplatform provides a useful paradigm of employing nanomedicine to treat metastatic spinal tumors efficiently.


Assuntos
Nanopartículas Metálicas , Nanopartículas , Neoplasias da Coluna Vertebral , Linhagem Celular Tumoral , Ouro , Humanos , Verde de Indocianina , Peptídeos , Fototerapia , Medicina de Precisão , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/terapia , Nanomedicina Teranóstica
8.
Spine J ; 21(9): 1430-1439, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33992794

RESUMO

BACKGROUND CONTEXT: Studies regarding treatment of spinal metastases are critical to evidence-based decision-making. However, variation exists in how a key outcome, ambulatory function, is assessed. PURPOSE: To characterize the sources and tools investigators have used to evaluate ambulatory function as an outcome following treatment of spinal metastases. We also sought to understand the ways ambulatory function has been conceptualized in prior studies. STUDY DESIGN: Systematic review of the literature. PATIENT SAMPLE: We identified 44 published studies for inclusion. Samples within these investigations ranged from 20 to 2,096 subjects. OUTCOME MEASURES: We describe the methods investigators have used to evaluate ambulatory function following treatment for spinal metastases. METHODS: We conducted a systematic review through PubMed, Scopus and Web of Science following PRISMA guidelines. We included studies that consisted of adult patients receiving operative or non-operative treatment for spinal metastases. We also required that study investigators specified post-treatment ambulatory function as an outcome. We recorded year of publication, study design, types of spinal metastases included in the study, treatments employed, and sample size. We also described the source (medical record, study-specific observer and/or provider, patient and/or participant), tool (standardized measure, quantitative, qualitative) and concept (eg, ambulatory vs. non-ambulatory; independent ambulation vs. ambulatory with assistance vs. non-ambulatory) used to assess ambulatory function. RESULTS: We found the plurality of studies relied on medical record documentation as their source. Amongst prospective studies, only a minority used a quantitative measure (eg, prespecified degree of walking ability) to assess ambulatory function. Most studies conceptualized ambulatory function as a dichotomized outcome, typically ambulatory versus non-ambulatory or a similar equivalent. CONCLUSIONS: Wide variation exists in how ambulatory function is defined in studies involving patients with spinal metastases. We suggest several improvements that will allow a more robust assessment of the quality and quantity of ambulatory function among patients treated for spinal metastases.


Assuntos
Neoplasias da Coluna Vertebral , Adulto , Humanos , Estudos Prospectivos , Neoplasias da Coluna Vertebral/terapia
9.
World Neurosurg ; 151: e630-e651, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33940276

RESUMO

OBJECTIVE: Financial toxicity associated with cancer treatment has a deleterious impact on patient outcomes but has not been well characterized among patients with metastatic cancers. We characterize the extent of financial toxicity among this population and identify factors associated with financial toxicity. METHODS: We prospectively surveyed adult patients with brain and spine metastases who received radiosurgery at a large academic medical center between January 2018 and December 2019. Financial toxicity was measured with the Personal Financial Wellness (PFW) scale. RESULTS: In total, 93 patients were included, with a median survival of 17.7 months. Most patients had private insurance (47%) or Medicare with supplementary insurance (42%), whereas 11% of patients were uninsured or insured by Medicaid/Medicare/Veterans Affairs. Of patients, 60% were primary income earners, of whom 52% had dependents. The median PFW score was 7.0 (interquartile range, 5.1-9.1), with financial toxicity reported in 23 patients (25%). After adjusting for age and education level, private insurance (odds ratio [OR], 0.28; P = 0.080) was associated with a lower likelihood of financial toxicity. Having ≥1 emergency department visit (OR, 3.87; P = 0.024) and a cancer-related change in employment status (OR, 3.63; P = 0.036) were associated with greater likelihood of reporting financial toxicity. CONCLUSIONS: Most patients with cancer with brain and spine metastases with a poor prognosis treated at a tertiary center are primary income earners and experience financial toxicity. Further studies are warranted to assess the longitudinal impact of financial toxicity in patients with metastatic cancer, particularly those with ≥1 emergency department visit and a cancer-related change in employment status.


Assuntos
Neoplasias Encefálicas/economia , Neoplasias Encefálicas/secundário , Estresse Financeiro/etiologia , Neoplasias da Coluna Vertebral/economia , Neoplasias da Coluna Vertebral/secundário , Adulto , Idoso , Neoplasias Encefálicas/terapia , Estudos de Coortes , Feminino , Humanos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/terapia , Inquéritos e Questionários , Estados Unidos
10.
J Pediatr Orthop ; 41(4): 227-235, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33655901

RESUMO

BACKGROUND: Primary benign osseous tumors and tumor-like lesions at the sacrum are rare in the pediatric population and exact surgical strategy is still unclear. In this study, we evaluate the outcome for pediatric patients with benign tumors and tumor-like lesions at the sacrum who were receiving surgical treatment according to our proposed surgical strategy and classification. METHODS: We analyzed 49 pediatric patients with sacral benign tumors or tumor-like lesions aged 18 years and below from 2005 to 2018. There were 23 men and 26 women with a mean age of 14.0±3.8 years. Nineteen patients had giant cell tumors (GCTs), 9 aneurysmal bone cysts, 5 osteoblastomas, 5 neurogenic tumors, 3 hemangiomas, 3 teratomas, 2 Langerhans cell histiocytosis, 1 chondroblastoma, 1 fibrous dysplasia, and 1 GCT of tendon sheath. We proposed our surgical plan and surgical classification for pediatric patients with sacral benign tumors or tumor-like lesions. RESULTS: The mean follow-up duration was 6.2 years (range, 1.0 to 18.9 y). GCTs (39%, 19/49) and primary aneurysmal bone cysts (18%, 9/49) are the top 2 common histologic types. Preoperative selective arterial embolization (SAE) was performed in 12 cases and 24 patients received intraoperative aortic balloon occlusion (ABO) as the preoperative surgical plan. Furthermore, according to tumor location at the sacrum, we classified surgical excision of sacral benign tumors and tumor-like lesions into 3 types. Fourteen cases were classified as type I, 27 as type II, 3 as type III, and 5 patients with neurogenic tumors cannot be classified into this surgical classification. Ten patients had wound complications. Two had femoral artery thrombosis because of ABO application. One had mechanical failure. Rate of local recurrence was 16%. Seven patients with GCTs and 1 with neurogenic tumor had local recurrence. No patient died of disease at the last follow-up. For the assessment of neurological function, the rate of neurological dysfunction was 12% (6/49). Four cases had urinary incontinence, 3 fecal incontinence, and 3 had bowel obstruction. Next, univariate analysis for influence of preoperative SAE and intraoperative ABO on complications demonstrated that both of them exerted no significant influence on the occurrence of oncological and nononcological complications. CONCLUSIONS: The proposed surgical strategy can provide an excellent therapeutic effect for pediatric benign tumors and tumor-like lesions at the sacrum. Preoperative SAE and intraoperative ABO can safeguard pediatric patients with high vascularity of benign tumor at the sacrum during the operation. LEVEL OF EVIDENCE: Level IV.


Assuntos
Oclusão com Balão , Cistos Ósseos Aneurismáticos/cirurgia , Tumor de Células Gigantes do Osso/cirurgia , Recidiva Local de Neoplasia , Osteoblastoma/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adolescente , Aorta , Cistos Ósseos Aneurismáticos/patologia , Criança , Pré-Escolar , Condroblastoma/patologia , Condroblastoma/cirurgia , Incontinência Fecal/etiologia , Feminino , Displasia Fibrosa Óssea/cirurgia , Seguimentos , Tumor de Células Gigantes do Osso/patologia , Hemangioma/cirurgia , Histiocitose de Células de Langerhans/cirurgia , Humanos , Obstrução Intestinal/etiologia , Masculino , Recidiva Local de Neoplasia/patologia , Doenças do Sistema Nervoso/etiologia , Complicações Pós-Operatórias/etiologia , Sacro , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/terapia , Teratoma/cirurgia , Resultado do Tratamento , Incontinência Urinária/etiologia
11.
Acta Med Okayama ; 75(1): 95-101, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33649620

RESUMO

A 21-year-old man consulted our hospital for treatment of a spinal giant cell tumor (GCT) of Enneking stage III. Lower lumbar-spine tumors and severe spinal canal stenosis are associated with high risk for surgical mor-bidity. Stability was temporarily secured with a percutaneous pedicle screw fixation in combination with deno-sumab, which shrank the tumor. Total en bloc spondylectomy was then performed 6 months after initiation of denosumab, and the patient was followed for 3 years. There was no local recurrence, and bony fusion was obtained. Minimally invasive surgery and denosumab allowed safer and easier treatment of a collapsing lower lumbar extra-compartmental GCT.


Assuntos
Denosumab/administração & dosagem , Tumores de Células Gigantes/terapia , Vértebras Lombares/cirurgia , Neoplasias da Coluna Vertebral/terapia , Parafusos Ósseos , Tumores de Células Gigantes/diagnóstico por imagem , Tumores de Células Gigantes/patologia , Humanos , Masculino , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
12.
J Neurooncol ; 151(3): 429-442, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33611709

RESUMO

INTRODUCTION: Laser Interstitial Thermotherapy (LITT; also known as Stereotactic Laser Ablation or SLA), is a minimally invasive treatment modality that has recently gained prominence in the treatment of malignant primary and metastatic brain tumors and radiation necrosis and studies for treatment of spinal metastasis has recently been reported. METHODS: Here we provide a brief literature review of the various contemporary uses for LITT and their reported outcomes. RESULTS: Historically, the primary indication for LITT has been for the treatment of recurrent glioblastoma (GBM). However, indications have continued to expand and now include gliomas of different grades, brain metastasis (BM), radiation necrosis (RN), other types of brain tumors as well as spine metastasis. LITT is emerging as a safe, reliable, minimally invasive clinical approach, particularly for deep seated, focal malignant brain tumors and radiation necrosis. The role of LITT for treatment of other types of tumors of the brain and for spine tumors appears to be evolving at a small number of centers. While the technology appears to be safe and increasingly utilized, there have been few prospective clinical trials and most published studies combine different pathologies in the same report. CONCLUSION: Well-designed prospective trials will be required to firmly establish the role of LITT in the treatment of lesions of the brain and spine.


Assuntos
Neoplasias Encefálicas/terapia , Hipertermia Induzida/métodos , Terapia a Laser/métodos , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Coluna Vertebral/terapia , Ensaios Clínicos como Assunto , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos
13.
World Neurosurg ; 149: e316-e328, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33601078

RESUMO

OBJECTIVE: Spinal chondrosarcomas are rare primary malignant neoplasms composed of cartilage-producing cells. They are slow-growing but locally aggressive lesions that have high rates of recurrence and progression after treatment. We provide the largest comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in patients with spinal chondrosarcoma using a large, prospectively collected national database. METHODS: Patients with diagnosis codes specific for chondrosarcoma of the spine, sacrum, and coccyx were queried from the National Cancer Database (NCDB) during 2004-2016. Outcomes were investigated using Cox univariate and multivariate regression analyses, and survival curves were generated for comparative visualization. RESULTS: A total of 1843 individuals were identified with a diagnosis of chondrosarcoma, 82.1% of which were at the sacrum or coccyx and 17.9% at the spine. The mean overall survival of patients in our cohort was 7.91 years. Increased age, larger tumor, dedifferentiated histology, and presence of metastases were associated with worsened overall survival. Regarding management, 77.7% of patients received surgical intervention and both partial and radical resection were associated with significantly improved overall survival (P < 0.001). Neither radiotherapy nor chemotherapy administration improved overall survival; however, among patients who received radiation, those who received higher-dose radiation had significantly improved overall survival compared with those who received lower-dose radiation. CONCLUSIONS: Surgical resection significantly improves overall survival in patients with spinal chondrosarcoma. In those patients receiving radiation, those who receive high doses have improved overall survival compared with those who receive lower doses. Further studies into optimal radiation modality and doses are required.


Assuntos
Condrossarcoma/epidemiologia , Condrossarcoma/terapia , Neoplasias da Coluna Vertebral/epidemiologia , Neoplasias da Coluna Vertebral/terapia , Resultado do Tratamento , Adolescente , Adulto , Idoso , Antineoplásicos/uso terapêutico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Radioterapia/métodos , Estados Unidos/epidemiologia , Adulto Jovem
14.
Spine J ; 21(3): 500-517, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33589095

RESUMO

Chordoma is a notochord-derived primary tumor of the skull base and vertebral column known to affect 0.08 to 0.5 per 100,000 persons worldwide. Patients commonly present with mechanical, midline pain with or without radicular features secondary to nerve root compression. Management of these lesions has classically revolved around oncologic resection, defined by en bloc resection of the lesion with negative margins as this was found to significantly improve both local control and overall survival. With advancement in radiation modalities, namely the increased availability of focused photon therapy and proton beam radiation, high-dose (>50 Gy) neoadjuvant or adjuvant radiotherapy is also becoming a standard of care. At present chemotherapy does not appear to have a role, but ongoing investigations into the ontogeny and molecular pathophysiology of chordoma promise to identify therapeutic targets that may further alter this paradigm. In this narrative review we describe the epidemiology, histopathology, diagnosis, and treatment of chordoma.


Assuntos
Cordoma , Neoplasias da Coluna Vertebral , Cordoma/terapia , Humanos , Recidiva Local de Neoplasia , Sacro , Neoplasias da Coluna Vertebral/terapia , Resultado do Tratamento
15.
Medicine (Baltimore) ; 100(4): e24323, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530223

RESUMO

ABSTRACT: Although the incidence of malignant sacrococcygeal germ cell tumors (MSGCTs) is high in the East Asian countries, information about MSGCTs from this region is limited. This report aimed to analyze the data of children with MSGCTs in a single medical center in Taiwan.Patients aged 18 years or younger with primary MSGCTs or malignant recurrence of a sacrococcygeal teratoma who underwent surgery during the neonatal period between January 1999 and December 2016 were identified from the Linkou Chang Gung Cancer Center registry. The clinical features, laboratory data, and treatment outcomes were reviewed.Fifteen children (1 man and 15 women) with MSGCTs were identified. Sacrococcygeal tumors were present at birth in 7 patients. All patients presented with a bulging mass at the buttock region and they had normal alpha-fetoprotein levels at the time of diagnosis. They underwent primary excision of the tumor. Immature teratoma was histologically diagnosed in 5 neonates, and mature teratoma in 2. Only 1 patient with grade 3 immature teratoma received adjuvant chemotherapy. Two patients with mature teratoma developed malignant recurrence 1.6 and 2.1 years later, respectively. Eight patients were diagnosed with MSGCTs after the neonatal period. The common presenting symptoms included buttock asymmetry (37.5%), abdominal distension (25%), and constipation (12.5%). Seven patients had elevated alpha-fetoprotein levels for their age. They were administered neoadjuvant chemotherapy followed by tumor excision if a residual tumor was present. The histology of the excised tumor included mature teratoma (66.7%) and necrosis (33.3%). One patient with a normal alpha-fetoprotein level underwent primary tumor excision followed by adjuvant chemotherapy. Grade 2 immature teratoma with embryonal carcinoma was diagnosed histologically. Among the 15 patients with MSGCTs, 3 had a recurrence (at age of 2.1, 0.5, and 2.4 years, respectively) and 1 died (at age of 6.1 years) of disease progression. The 5-year overall and event-free survival rates were 90% and 80%, respectively.Children with MSGCTs had good overall prognoses in this case series. For those with sacrococcygeal mature teratoma or low-grade immature teratoma in the neonatal period, we recommend close follow-up for at least 3 years after surgery to detect malignant recurrence.


Assuntos
Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias da Coluna Vertebral/patologia , Teratoma/patologia , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Neoplasias Embrionárias de Células Germinativas/epidemiologia , Neoplasias Embrionárias de Células Germinativas/terapia , Estudos Retrospectivos , Região Sacrococcígea/patologia , Neoplasias da Coluna Vertebral/epidemiologia , Neoplasias da Coluna Vertebral/terapia , Taiwan/epidemiologia , Teratoma/epidemiologia , Teratoma/terapia , Resultado do Tratamento
16.
World Neurosurg ; 148: e527-e535, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33460817

RESUMO

BACKGROUND: Spinal hemangiomas are common primary tumors of the vertebrae. Although these tumors are most frequently benign and asymptomatic, they can rarely exhibit aggressive growth and invasion into neighboring structures. Treatment for these aggressive variants is controversial, often involving surgery, chemotherapy, and/or radiotherapy. This study sought to investigate current trends affecting overall survival (OS) using the National Cancer Database (NCDB) and to formulate treatment recommendations. METHODS: The National Cancer Database was queried for spinal hemangiomas between 2004 and 2016. A Cox proportional hazards model was used to perform multivariate regression analysis of survival. Survival curves for comparative visualization of demographic and treatment factors were generated using a semiparametric Cox approach. RESULTS: A cohort of 102 patients with histologically confirmed spinal hemangiomas was identified in the database. Mean OS was 1.94 years. Administered treatments included partial surgical resection (n = 17), radical resection (n = 14), chemotherapy (n = 34), and radiotherapy (n = 56). Multivariate analysis revealed associations between decreased OS and advanced age (>65 years) and presence of metastasis. Cox survival analysis further revealed improved OS in patients who received surgical treatment and higher radiation dose. CONCLUSIONS: This retrospective analysis finding that treatment with surgical resection and/or radiotherapy is associated with increased OS constitutes the largest cohort of patients with aggressive vertebral hemangiomas to date. Given that the mean OS of the study cohort was 1.94 years, our findings suggest that the optimal treatment regimen to maximize survival should consist of early surgical resection with adjuvant high-dose radiotherapy.


Assuntos
Hemangioma/terapia , Neoplasias da Coluna Vertebral/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Estudos de Coortes , Terapia Combinada , Bases de Dados Factuais , Feminino , Hemangioma/tratamento farmacológico , Hemangioma/cirurgia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Modelos de Riscos Proporcionais , Doses de Radiação , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/tratamento farmacológico , Neoplasias da Coluna Vertebral/cirurgia , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos , Adulto Jovem
17.
Radiat Oncol ; 16(1): 21, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482844

RESUMO

BACKGROUND: Most previous studies focused on the minimum interval between surgery and radiotherapy in spinal metastases, leaving the maximum interval under-investigated. However, in real world, limited radiotherapist and equipment cannot meet the needs of a large patient population to obtain timely radiotherapy after the index spine surgery in developing countries. This study aimed to estimate the clinical risks of delayed radiotherapy after surgery in patients with spinal metastases in developing country. METHODS: Data from 89 patients who underwent surgery and postoperative radiotherapy at a single site in a developing country were retrospectively reviewed. Patients were divided into the progression before radiotherapy (PBR) and no progression before radiotherapy (NPBR) groups. Kaplan-Meier analysis and log-rank tests were used to compare the local control (LC) and overall survival (OS) between groups. RESULTS: Within 1 month after surgery, only 20.2% of patients underwent radiotherapy. Risk of local progression before radiotherapy at 1, 3, and 6 months was 1.2%, 24.1%, and 45.1%, respectively. The LC rate at 1 year was lower in the PBR group than in the NPBR group (53.3% vs. 76.3%, P = 0.040). The OS rate at 1 year was 61.9% and 79.6% in the PBR and NPBR groups, respectively (P = 0.001). The Karnofsky performance status significantly improved only in the NPBR group (52.5 ± 17.6 vs. 66.8 ± 26.3, P < 0.001). The sphincter dysfunction significantly improved in the NPBR group (0.3 ± 0.5 vs. 0.1 ± 0.3, P = 0.007) but it tended to be deteriorated in the PBR group (0.1 ± 0.4 vs. 0.3 ± 0.5, P = 0.500). CONCLUSIONS: In real world, about 80% of patients had delayed radiotherapy 1 month after spine surgery for metastases in our developing country. Patients had a higher risk for radiographic local progression before radiotherapy and poorer LC, OS, and quality of life as time to radiotherapy increased.


Assuntos
Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/terapia , Adulto , Idoso , Terapia Combinada , Progressão da Doença , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/mortalidade , Fatores de Tempo
18.
Neurosurg Rev ; 44(1): 289-300, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32078084

RESUMO

"Benign" metastatic leiomyomas (BML) are indolently growing metastatic tumors which mostly associate with uterine leiomyomas in women in reproductive ages. The reason to define these lesions as "benign" despite metastasis is their pathological features with low mitotic counts, lack of or minimal nuclear atypia, pseudocyst formation, and coagulative necrosis unlike leiomyosarcomas. Despite lack of pathological malignant features, they may cause significant morbidity and even mortality. Here, we describe a BML case with metastases to vertebrae and skull bones. Vertebral and skull metastases of BMLs were very rarely reported. In treatment of these tumors, hysterectomy and GnRH modifier treatments are widely employed. GnRH agonists act by desensitization and downregulation of the GnRH receptors, while GnRH antagonists act via the canonical competitive blockage. These treatments reduce FSH and LH levels, thereby reducing the systemic levels of sex steroids which stimulate leiomyoma growth. However, leiomyomas inherently harbor aromatase activity and synthesize their own estrogen; hence, treatment with systemic estrogen antagonists may provide better tumor control. Another important factor in BML pathogenesis is progesterone, and both progesterone receptor antagonists and high-dose progesterone receptor agonists may reduce BML growth. Following surgical treatment of the calvarial mass and radiotherapy of the vertebral metastatic foci, our BML case was successfully managed with hysterectomy and anastrozole treatment. Higher awareness of BML cases and their molecular endocrinological features in the neurosurgical community may pave to develop better strategies for treatment of these tumors causing high morbidity.


Assuntos
Leiomioma/diagnóstico por imagem , Progesterona/antagonistas & inibidores , Neoplasias Cranianas/terapia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias Uterinas/diagnóstico por imagem , Adulto , Feminino , Antagonistas de Hormônios/farmacologia , Antagonistas de Hormônios/uso terapêutico , Humanos , Leiomioma/sangue , Leiomioma/terapia , Progesterona/sangue , Neoplasias Cranianas/sangue , Neoplasias Cranianas/diagnóstico por imagem , Neoplasias Cranianas/secundário , Neoplasias da Coluna Vertebral/sangue , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/terapia , Neoplasias Uterinas/sangue , Neoplasias Uterinas/terapia
19.
World Neurosurg ; 145: e298-e304, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33068800

RESUMO

BACKGROUND: Osteoid osteomas (OOs) are benign bone forming tumors that, usually, occur in the extremities, with about 10% of them arising in the spine more commonly in the posterior elements. The aim of this study is to evaluate the long-term results of patients suffering from spinal OO treated with surgery and radiofrequency ablation. METHODS: This was a retrospective comparison analysis of data prospectively collected from 2 cohorts of consecutive patients diagnosed with OO of the spine treated at the same Institute from November 2002 to February 2019. The first cohort included patients submitted to an intralesional extracapsular excision of the lesion (surgery group); the second cohort included patients submitted to radiofrequency ablation (RFA group). RESULTS: The surgery group showed a local recurrence rate of 1.7% versus a recurrence rate of 12.5% in the RFA group with a statistically significant difference in the disease-free survival at longest follow-up (P = 0.012). No statistically significant differences were observed in local recurrence rate stratified for level and site of lesion. No complications were observed in both groups at the time of first procedure. CONCLUSIONS: Surgery and RFA are both safe and effective interventional procedures for the management of spinal OO, although RFA is associated with a greater recurrence rate. Treatment should be tailored according to the relationship of lesions with neural structures and to advantages and disadvantages of each technique.


Assuntos
Recidiva Local de Neoplasia/epidemiologia , Procedimentos Ortopédicos/métodos , Osteoma Osteoide/terapia , Ablação por Radiofrequência/métodos , Neoplasias da Coluna Vertebral/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Virchows Arch ; 479(2): 393-400, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33103211

RESUMO

Epithelioid sarcoma (EpS) is a rare malignant neoplasm that accounts for < 1% of adult soft tissue sarcomas. Primary EpS of the bone is extremely rare and only a few cases have been reported to date. We report a case of primary distal-type EpS of the lumbar vertebra. A 30-year-old man without any history of malignant tumors had complained of lumbago for 3 months before visiting the hospital. Magnetic resonance imaging (MRI) of the lumbar spine showed a high signal intensity on the fat-suppressed T2-weighted image (WI) and a low signal on the T1WI at the L1 vertebral body. The tumor protruded toward the anterior components. Systemic radiological examination revealed no other lesion. A biopsy revealed a primary malignant tumor with epithelioid features. After chemotherapy, total en bloc spondylectomy was performed. Macroscopically, the tumor replaced the entire L1 with necrosis. Histologically, the tumor showed nodules of epithelioid cells that were strongly positive for epithelial markers, but a lack of INI1 expression. Central necrosis in the tumor nodule was also observed. This tumor showed loss of heterozygosity at the SMARCB1 locus but without the SMARCB1 mutation. The result of Foundation One ®CDx showed no actionable mutations. Seven months after surgery, a subcutaneous metastasis to the left cheek and bilateral lung metastasis with pleural dissemination were observed on radiological examination. A final diagnosis of distal-type EpS was made based on these findings. The patient died of the disease 8 months after surgery.


Assuntos
Vértebras Lombares/patologia , Sarcoma/secundário , Neoplasias da Coluna Vertebral/patologia , Adulto , Biomarcadores Tumorais/genética , Progressão da Doença , Evolução Fatal , Predisposição Genética para Doença , Humanos , Perda de Heterozigosidade , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Fenótipo , Proteína SMARCB1/genética , Sarcoma/diagnóstico por imagem , Sarcoma/genética , Sarcoma/terapia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/genética , Neoplasias da Coluna Vertebral/terapia , Resultado do Tratamento
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