Background
In recent years, many studies have proven that percutaneous thermal ablation is an effective second-line treatment method with low complication rates in early-stage non-small cell lung ...carcinoma and lung metastases. Radiofrequency ablation and microwave ablation are commonly used for this purpose.
Purpose
To evaluate the factors affecting the success of the percutaneous thermal ablation treatment with technical success, complication rates, and long-term follow-up results in metastatic lung lesions.
Material and Methods
Computed tomography (CT)-guided percutaneous ablation was performed for 70 metastatic lung lesions in 35 patients (22 men, 13 women; mean age = 61.34 years; age range = 41–75 years). Radiofrequency ablation was performed in 53/70 (75.7%) lesions and microwave ablation in 17/70 (24.3%) lesions.
Results
The technical success rate was 98.6%. Median overall survival, progression-free survival, and local recurrence-free survival of the patients were 33.9 months (range=25.6–42.1 months), 12 months (range=4.9–19.2 months), and 24.2 months (range=8.2–40.1 months), respectively. One- and two-year overall survival rates were 84% and 74%, respectively. Median progression-free survival times were 20.3 months and 11.4 months, respectively, according to the number of metastatic lung lesions being single and multiple, and the difference was statistically significant (P = 0.046). According to the number of lesions ≤3 and >3, the difference was also found statistically significant (P = 0.024) (14.3 months and 5.7 months, respectively).
Conclusion
In conclusion, CT-guided percutaneous thermal ablation is a safe and effective treatment method in metastatic lung lesions. The number of lesions is the most important factor in predicting treatment success.
Background: The relapses of colorectal cancer (CRC) frequently occur in 2 years period after the time of diagnosis. However, a considerable proportion of patients relapse in the late period.
Aim: The ...aim of the present study is to define the factors predicting the early and late relapses of patients with early stage CRC.
Materials and Methods: A total of 250 patients with CRC, who relapsed after completion of primary therapy between 2005 and 2014, were enrolled in the study. According to the time of relapse, patients were divided into two groups as follows: Early relapse (Group 1: Within first 24 months) and late relapse (Group 2: Later than 24 months). Clinicopathological features and survival rates of the two groups were compared.
Results: Of 250 patients, 151 (60.4%) (Group 1) were relapsed within the first 24 months after completion of the primary therapy and 105 (39.6%) were relapsed later than 24 months. The patients with T1-T2 and Grade I tumors were relapsed in late period (P < 0.05). The rates of administered systemic chemotherapy and targeted therapies after relapse were similar in both groups. The median overall survival rates in patients relapsed within the first 24 months and after 24 months were 18 months and 21 months, respectively (P = 0.05).
Conclusions: In patients with CRC, the time duration of relapse after completion of the operation and adjuvant chemotherapy was a prognostic factor. Grade I and superficial tumors (T1-T2) are the predictors of late relapses (after >24 months). The patients relapsed within the first 24 months after primary therapy had poor prognosis compared to those who relapsed in late period.
•Lorlatinib is highly extracranial (EC) and intracranial (IC) effective for ALK+ or ROS1+ in advanced NSCLC.•Response rates (RR) of EC 60% and IC 62% for ALK + and EC and IC RR of 62% and 67% for ...ROS1+, respectively.•Mean duration of therapy (DoT) for ALK + was 23.9 ± 1.6 months and median overall survival (mOS) 89.1 ± 19.6 months.•ROS1 + cohort had a median DoT of 18.1 ± 2.5 months and mOS of 90.3 ± 24.4 months.
Lorlatinib is a third-generation tyrosine-kinases inhibitor (TKI) targeting ALK/ROS1 fusions. The FDA has approved lorlatinib for TKI-pretreated ALK(+) NSCLC, while its approval for ROS1(+) is still pending. Here we present the largest real-world data of NSCLC patients harboring ALK/ROS1 rearrangements treated with lorlatinib.
123 patients were enrolled retrospectively (data cut-off 1/1/2019). Lorlatinib was administered through an early access program for patients with no other available therapy. Outcome and response were defined by each investigator upon RECIST 1.1 criteria.
106 ALK(+) and 17 ROS1(+) patients recruited from 8 different countries. The ALK(+) cohort included 50 % males, 73 % never-smokers and 68 % with brain metastases. Extracranial (EC) and intracranial (IC) response rates (RR) were 60 % and 62 %, with disease control rates (DCR) of 91 % and 88 % respectively. Mean duration of therapy (DoT) was 23.9 ± 1.6 months and median overall survival (mOS) was 89.1 ± 19.6 months. ROS1 cohort enrolled 53 % males, 65 % never-smokers and 65 % had brain metastases. EC and IC RR were 62 % and 67 % with DCR of 92 % and 78 % respectively. Median DoT was 18.1 ± 2.5 months and mOS of 90.3 ± 24.4 months. OS and DoT in both cohorts were not significantly correlated with line of therapy nor other parameters.
The most common adverse events of any grade were peripheral edema (48 %), hyperlipidemia (47 %), weight gain (25 %) and fatigue (30 %). CNS adverse events such as cognitive effect of grade 1–2 were reported in 18 % of patients.
Lorlatinib shows outstanding EC/IC efficacy in ALK/ROS1(+) NSCLC. The observed mOS of 89 ± 19 months in ALK(+) NSCLC supports previous reports, while mOS from of 90 ± 24 months is unprecedented for ROS1(+) NSCLC.
In this article, we present a case of diffuse follicular variant papillary thyroid carcinoma with pituitary metastasis, which is a rare cause of pituitary metastasis. The follicular variant of ...papillary thyroid carcinoma is an uncommon variant of papillary carcinoma. A 74-year-old male was presented with weakness, fatigue, and a decreased appetite. The patient was diagnosed with secondary adrenal and thyroid insufficiencies. Imaging revealed a pituitary mass with suprasellar extension, right cavernous sinus invasion, and optic chiasm compression. Thyroid ultrasonography revealed a nodule with a maximum size of 7.2cm in the right lobe. Cytological examination via fine-needle aspiration suggested papillary thyroid cancer. Total thyroidectomy with central and right lateral neck dissection confirmed the diagnosis of diffuse follicular variant of papillary thyroid carcinoma. Owing to visual field defects, the patient underwent transsphenoidal surgery. Histological and immunohistochemical evaluations confirmed pituitary metastasis from the papillary thyroid cancer. Radioactive iodine treatment and gamma knife radiotherapy of the pituitary gland were performed. The initiation of sorafenib treatment was deemed appropriate during the follow-up. A significant decrease in the thyroglobulin levels was observed after sorafenib treatment. Pituitary metastasis should be considered in patients diagnosed with hypopituitarism and pituitary lesions at initial evaluation. The presence of visual field defects may be an indication for neurosurgical intervention and guide both diagnosis and treatment. The management of papillary thyroid cancer and the role of treatment modalities in prognosis depend on the biological behavior of the tumor. Early diagnosis and multidisciplinary management are crucial for the treatment of these patients.
Hormone positive breast cancer is a tumor with high mortality. Combining antihormonal therapy with cyclin dependent kinase 4/6 inhibitors (CDK4/6i) has resulted in longer survival. The effect of ...inflammatory parameters such as c-reactive protein and c-reactive protein/lymphocyte ratio (CLR) on efficacy and survival in CDK4/6i treatment is unknown. In our study, we aimed to investigate the role of CLR and some parameters in predicting progression-free survival (PFS) with CDK4/6i.ObjectiveHormone positive breast cancer is a tumor with high mortality. Combining antihormonal therapy with cyclin dependent kinase 4/6 inhibitors (CDK4/6i) has resulted in longer survival. The effect of inflammatory parameters such as c-reactive protein and c-reactive protein/lymphocyte ratio (CLR) on efficacy and survival in CDK4/6i treatment is unknown. In our study, we aimed to investigate the role of CLR and some parameters in predicting progression-free survival (PFS) with CDK4/6i.This retrospective cohort study included 78 patients with denovo and recurrent metastatic breast cancer treated with CDK4/6i. Cut off values for the prediction of mortality by various numerical parameter scores were performed by ROC Curve analysis. The effect of clinical variables, inflammatory and histopathological parameters on survival was analyzed by Kaplan-Meier method.MethodsThis retrospective cohort study included 78 patients with denovo and recurrent metastatic breast cancer treated with CDK4/6i. Cut off values for the prediction of mortality by various numerical parameter scores were performed by ROC Curve analysis. The effect of clinical variables, inflammatory and histopathological parameters on survival was analyzed by Kaplan-Meier method.Neutrophil/lymphocyte ratio (NLR) and CLR were statistically significant in predicting mortality (p < 0.05). Ki67 and CLR were correlated with PFS. Age and CLR were correlated with OS (p < 0.05). CLR was statistically significant for both PFS (p = 0.022) and OS (p = 0.006).ResultsNeutrophil/lymphocyte ratio (NLR) and CLR were statistically significant in predicting mortality (p < 0.05). Ki67 and CLR were correlated with PFS. Age and CLR were correlated with OS (p < 0.05). CLR was statistically significant for both PFS (p = 0.022) and OS (p = 0.006).In patients with metastatic hormone-positive breast cancer using CDK4/6i, low CLR and low Ki67 were correlated with longer PFS duration.ConclusionIn patients with metastatic hormone-positive breast cancer using CDK4/6i, low CLR and low Ki67 were correlated with longer PFS duration.
Background
PET–CT is important for evaluating the cancer stage preoperatively. In patients with locally advanced disease, who are candidates for curative treatment modalities following computed ...tomography (CT) and ultrasonography evaluation, PET–CT can show distant metastases and spare patients unnecessary surgical interventions. We aimed to evaluate the contribution of PET–CT scans compared to conventional imaging studies on the change of treatment plan in patients with locally advanced esophagogastric cancer from neoadjuvant to palliative setting.
Materials and methods
In this study, 91 patients with histopathologically proven diagnosis of esophageal or gastric cancer in our clinic between the years 2010–2014 were included. Prior to PET–CT evaluation, all of the patients were evaluated with thorax and abdomen computed tomography. Seventy-six of these patients were further evaluated by PET–CT due to ambiguous findings on computed tomography and 15 of them for staging purposes. The patients, who were shown to have distant metastases on conventional radiological imaging, were excluded from the study population.
Results
Ninety-one patients were included in the study. Their median age was 57 (range 30–80) years and three-quarters of the patients were male. Most of the patients were evaluated by PET–CT due to suspicion of distant metastasis (83.5 %). Primary sites of the tumors on PET–CT were: esophagus 38.5 % and stomach 61.5 %. Between CT and PET–CT tumor stage and pathological lymphadenopathy concordance rates were 75.8, and 69.2 %, respectively. On PET–CT evaluation 47.3 % of patients had distant metastasis. New metastases were detected in 34.1 % of patients by PET–CT despite entering to scanning field of tomography. Following the PET–CT evaluation due to detected metastasis, 47.3 % of patients’ treatment plan was changed from neoadjuvant to palliative therapy.
Conclusion
In the current study, 47.3 % (
n
= 43) of patients had distant metastasis that were not detected by CT evaluation. These patients were spared unnecessary surgical interventions. Evaluating the locally advanced gastric and esophageal cancer patients for PET–CT new metastasis could be indicated when the treatment plan of these patients would be changed from curative to palliative.
IntroductionColonic wall thickening (CWT) is frequently observed incidentally via abdominal computerized tomography (aCT). Although the general approach to evaluating incidental CWT is a colonoscopic ...examination, there is a lack of definitive recommendation guidelines. Thus, we aimed to determine neoplasia rates and identify the factors predictive of neoplasia via colonoscopic examinations of patients with CWT incidentally diagnosed via aCT.MethodsWe retrospectively reviewed 5,300 colonoscopy reports. A total of 122 patients who had CWT incidentally observed via aCT were included in the study. CWT was graded as mild (3-5 mm), moderate (6-12 mm), or severe (≥12 mm). A logistic regression model was used to determine the predictive factors for neoplasia.ResultsThe mean age of the patients was 60 years, and abnormal findings were noted in 52% of the colonoscopies. Neoplastic lesions were detected in 24 patients (19.6%), while colon adenocarcinoma was detected in 8 patients (6.5%). Multivariate analysis showed that moderate-severe, focal, and asymmetric CWT were independent factors for predicting neoplasia (p=0.049, p=0.033, and p=0.018, respectively).ConclusionPathological findings can be noted via colonoscopic examination in cases of incidental CWT; therefore, patients with moderate-severe, focal, or asymmetric CWT require colonoscopic examination for the purpose of detecting neoplasia.
We present a patient with uncommon metastases of lung cancer. The patient has been followed-up for early stage laryngeal carcinoma in the remission and has had dyspeptic complaints as well. A ...62-year-old male patient had epigastric complaints for three months. In the upper endoscopy, a biopsy specimen taken from the polyp in the second region of the duodenum was reported as squamous cell cancer. Immunohistochemical staining of tumor cells were positive for CK5/6, p40, and p63. A mass in the right lung was detected on thorax tomography. The result of the transthoracic needle biopsy indicated squamous cell cancer. Duodenal metastasis of lung cancer is highly unlikely. Lesions below 1 cm can be safely removed endoscopically. Duodenal metastasis of primary lung cancer can be considered in the differential diagnosis of resistant dyspepsia.
Coexistence of two or more primary cancers is a relatively rare case. Not with standing that the coexistence of multiple primary cancers is often discussed in the literature, there is a small number ...of publications concerning the coexistence of squamous cell lung carcinoma and renal cancer. In this case report, detection of both squamous cell lung carcinoma and primary renal cancer in one male patient is going to be discussed.
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