Results and prognostic factors of surgery in the management of non-small cell lung cancer with solitary brain metastasis

Article Abstract:

The failure of treatment for lung cancer is generally indicated by the appearance of metastatic disease spread to distant parts of the body. One of the most common locations for metastatic lung cancer is the brain. Once lung cancer metastasis in the brain has been found, chances are good there are, in fact, more than one tumor; the identification of multiple tumors in the brain rules out surgery as a therapeutic option, leaving only the less-than-satisfactory whole-brain irradiation and chemotherapy. The best therapeutic choice is less certain, however, when only a single metastatic tumor is found in the brain. In about one-third of the cases, only one tumor develops in the brain, and some researchers believe that surgery remains an effective therapeutic approach in such cases. Other investigators remain skeptical. To help resolve this question, the cases of 37 patients with non-small cell lung cancer and a single brain metastasis were reviewed. Surgical removal of the primary tumor and the brain metastasis resulted in a five-year survival rate of 30 percent. The median survival was 27 months, which represents a range extending from three months to more than 10 years. Analysis of patient characteristics and treatments revealed that patients who received adjuvant chemotherapy as a part of their surgical treatment survived significantly longer than patients who did not. Three patients in the present study have survived over 10 years. These results strongly indicate that oncologists should review the assumption held by many that even a single brain metastasis heralds certain death. While in the past such patients were often treated only for the relief of symptoms, it is now clear that such patients should be treated with the intent to cure, and that long-term survival can be achieved by some patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Surgery, Cancer invasiveness, Lung cancer, Non-small cell, Non-small cell lung cancer

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Prognostic significance of intramural metastasis in patients with esophageal carcinoma

Article Abstract:

Cancer of the esophagus is generally thought to have a very poor prognosis. In addition, esophageal cancers are often quite advanced by the time they are clinically detected. Some of the metastases, or spread of cancer, resulting from esophageal carcinoma are to other areas of the esophagus and to the stomach. Such spread is termed intramural metastasis. To determine if intramural metastasis has a significant impact on prognosis, the cases of 201 patients who underwent surgery for esophageal carcinoma were reviewed. Intramural metastases were observed in 24 cases (11.9 percent). Lymph node metastases were observed in 91.7 percent of the patients with intramural metastases, and in 67.7 percent of those without. Similarly, metastatic spread to distant organs was seen in 29.2 percent of the patients with intramural metastases, and in 7.3 percent of those without. Both the overall survival and the survival of patients with advanced stage esophageal cancer was greater among those patients without intramural metastases. In either case, however, the prognosis for esophageal cancer remains bleak. The results indicate that the presence of intramural metastases, which may be determined by preoperative examination or by postoperative histopathologic analysis, is one of the most important prognostic indicators for esophageal carcinoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Cancer, Esophageal cancer

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