Meningeal carcinomatosis in breast cancer

Article Abstract:

The hallmark of cancer is the ability of the tumor cells to spread, or metastasize, to regions in the body far from the primary tumor. As might be expected, the metastatic spread of cancer is associated with a poor prognosis. One of the sites that seems to be preferred by spreading breast cancer cells is the brain. Breast cancer cells can also colonize the meninges (lining of the brain and spinal cord) and, although meningeal carcinomatosis is relatively uncommon, it is extremely serious and requires rapid diagnosis and intervention. Although estimates of the frequency of meningeal carcinomatosis vary, most studies suggest that it occurs in between 1 and 2 percent of all cases of breast cancer. Without treatment, the life expectancy in cases of meningeal carcinomatosis is between four and six weeks. The authors report the features of 58 cases of breast cancer patients with meningeal carcinomatosis. For the 44 patients who received intensive treatment by intraventricular chemotherapy, the median survival was 12 weeks. Two patients remain alive at 28 and 39 months since the start of treatment. Curiously, for the 14 patients who did not receive intraventricular chemotherapy, the median survival was also 12 weeks. Since intraventricular chemotherapy causes severe neurological side effects in as many as half of all cases, these data would suggest that its use is not justified. The primary factors influencing survival in the patients with meningeal carcinomatosis were unrelated to treatment. Not surprisingly, patients who also had metastatic disease in the lungs did poorly. Patients more than 55 years of age also had diminished survival, as did patients whose cranial nerves were involved in the metastasis to the brain. Patients with low glucose in their cerebrospinal fluid (CSF) had a poor prognosis, but this may simply be due to the fact that these patients might have large, active tumors which simply consumed the available glucose. More curious is an inverse correlation with elevated protein levels in the cerebrospinal fluid. Patients with mildly elevated CSF proteins had the poorest outcome, patients with moderately elevated CSF protein did somewhat better, and the patients with the most abnormally high levels of CSF proteins had the longest survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Breast cancer, Cancer metastasis, Nervous system cancer

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Flexibility and efficacy of automatic continuous fluorodeoxyuridine infusion in metastases from a renal cell carcinoma

Article Abstract:

For renal cell carcinoma, a form of kidney cancer, metastatic disease is associated with high mortality. However, a preliminary report suggested that continuous infusion chemotherapy with fluorodeoxyuridine (FUDR) may be beneficial. This method has now been used to obtain significant remissions in a patient with metastatic renal cell carcinoma. The patient was a 47-year-old man, first diagnosed after developing left arm weakness. The cause was found to be a brain tumor metastatic from cancer in the right kidney. The kidney tumor was resected, and the patient was treated with cortisone and barbiturates; three months later new metastases were found in a lung and lymph nodes. The patient was given continuous infusion of FUDR. In this method, the infusion pump was implanted into the patient, and ran for two weeks followed by a two-week 'rest' period. Although the pump runs continuously, the rate of infusion varies during each 24-hour period to follow the patient's daily physiological cycles. During the rest period, the pump infused only saline (with heparin to prevent clotting). In this chemotherapeutic protocol, the patient was able to continue his normal routine; a hospital stay was not required for the periods of infusion, only for the implantation and maintenance of the pump. After three months of alternating two-week cycles, the patient experienced a complete remission at all tumor sites, which lasted for 22 months. After the development of a second metastatic tumor in the brain, radiation therapy and cisplatin was used to obtain a second complete remission. This remission has continued for over 31 months, about four times longer than the reported survival for any patient with metastatic renal cell carcinoma. Over the period of treatment, the total hospital stay for this patient has been two days. In this patient, the continuous automatic infusion of chemotherapeutic drugs has been very effective with few side effects. Continuous infusion methods of chemotherapeutic treatment warrant further research and greater interest from the medical community. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Chemotherapy, Kidney cancer, Infusion therapy, Drug infusion pumps

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