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Al Farii H, McChesney G, Patel SS, Rhines LD, Lewis VO, Bird JE. The risk of neurological deterioration while using neoadjuvant denosumab on patients with giant cell tumor of the spine presenting with epidural disease: a meta-analysis of the literature. Spine J 2024; 24:1056-1064. [PMID: 38301904 DOI: 10.1016/j.spinee.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND CONTEXT Giant cell tumor (GCT) of bone is most commonly a benign but locally aggressive primary bone tumor. Spinal GCTs account for 2.7% to 6.5% of all GCTs in bone. En bloc resection, which is the preferred treatment for GCT of the spine, may not always be feasible due to the location, extent of the tumor, and/or the patient's comorbidities. Neoadjuvant denosumab has recently been shown to be effective in downstaging GCT, decreasing the size and extent of GCTs. However, the risk of neurologic deterioration is of major concern for patients with epidural spinal cord compression due to spinal GCT. We experienced this concern when a patient presented to our institution with a midthoracic spinal GCT with progressive epidural disease. The patient was not a good surgical candidate due to severe cardiac disease and uncontrolled diabetes. In considering nonoperative management for this patient, we asked ourselves the following question: What is the risk that this patient will develop neurologic deterioration if we do not urgently operate and opt to treat him with denosumab instead? PURPOSE The purpose of this study was to assess the literature to (1) determine the risk of neurological deterioration in patients receiving neoadjuvant denosumab for the treatment of spinal GCT and (2) to evaluate the secondary outcomes including radiographic features, surgical/technical complexity, and histological features after treatment. STUDY DESIGN/SETTING Meta-analysis of the literature. PATIENT SAMPLE Surgical cases of spinal GCT that (1) presented with type III Campanacci lesions, (2) had epidural disease classified as Bilsky type 1B or above and (3) received neoadjuvant denosumab therapy. OUTCOME MEASURES The primary outcome measure of interest was neurologic status during denosumab treatment. Secondary outcome measures of interest included radiographic features, surgical/technical complexity, histological features, tumor recurrence, and metastasis. METHODS Using predetermined inclusion and exclusion criteria, PubMed and Embase electronic databases were searched in August 2022 for articles reporting spinal GCTs treated with neoadjuvant denosumab and surgery. Keywords used were "Spine" AND "Giant Cell Tumor" AND "Denosumab." RESULTS A total of 428 articles were identified and screened. A total of 22 patients from 12 studies were included for review. 17 patients were female (17/22, 77%), mean age was 32 years (18-62 years) and average follow-up was 21 months. Most GCTs occurred in the thoracic and thoracolumbar spine (11 patients, 50%), followed by 36% in the lumbar spine and 14% in the cervical spine. Almost half of the patients had neurological deficits at presentation (10/22 patients, 45%), and more than 60% had Bilsky 2 or 3 epidural spinal cord compression. None of the patients deteriorated neurologically, irrespective of their neurological status at presentation (p-value=.02, CI -2.58 to -0.18). There were no local recurrences reported. One patient was found to have lung nodules postoperatively. More than 90% of cases had decreased overall tumor size and increased bone formation. Surgical dissection was facilitated in more than 85% of those who had documented surgical procedures. Four patients (18%) underwent initial spinal stabilization followed by neoadjuvant denosumab and then surgical excision of the GCT. Regarding the histologic analyses, denosumab eradicated the giant cells in 95% of cases. However, residual Receptor Activator of Nuclear Factor Kappa B Ligand (RANKL)-positive stromal cells were noted, in 27% (6 cases). CONCLUSIONS Neoadjuvant denosumab was a safe and effective means of treating spinal GCTs prior to surgery. Neurologic status remained stable or improved in all cases included in our review, irrespective of the presenting neurologic status. The most appropriate dosage and duration of denosumab therapy is yet to be determined. We recommend future well-designed studies to further evaluate the use of neoadjuvant denosumab for patients with spinal GCT.
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Affiliation(s)
- Humaid Al Farii
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, University of Texas, 1400 Pressler St, Houston, TX 77030
| | - Grant McChesney
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, University of Texas, 1400 Pressler St, Houston, TX 77030
| | - Shalin S Patel
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, University of Texas, 1400 Pressler St, Houston, TX 77030
| | - Laurence D Rhines
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, University of Texas, 1400 Pressler St, Houston, TX 77030
| | - Valerae O Lewis
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, University of Texas, 1400 Pressler St, Houston, TX 77030
| | - Justin E Bird
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, University of Texas, 1400 Pressler St, Houston, TX 77030.
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Cheng Y, Wang H, Yuan W, Wang H, Zhu Y, Chen H, Jiang W. Combined radiomics of primary tumour and bone metastasis improve the prediction of EGFR mutation status and response to EGFR-TKI therapy for NSCLC. Phys Med 2023; 116:103177. [PMID: 38000098 DOI: 10.1016/j.ejmp.2023.103177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 10/08/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE To develop radiomics models of primary tumour and spinal metastases to predict epidermal growth factor receptor (EGFR) mutations and therapeutic response to EGFR-tyrosine kinase inhibitor (TKI) in patients with metastatic non-small-cell lung cancer (NSCLC). METHODS We enrolled 203 patients with spinal metastases between December 2017 and September 2021, classified as patients with the EGFR mutation or EGFR wild-type. All patients underwent thoracic CT and spinal MRI scans before any treatment. Radiomics analysis was performed to extract features from primary tumour and metastases images and identify predictive features with the least absolute shrinkage and selection operator. Radiomics signatures (RS) were constructed based on primary tumour (RS-Pri), metastases (RS-Met), and in combination (RS-Com) to predict EGFR mutation status and response to EGFR-TKI. Receiver operating characteristic (ROC) curve analysis with 10-fold cross-validation was applied to assess the performance of the models. RESULTS To predict the EGFR mutation status, the RS based on the combination of primary tumour and metastases improved the prediction AUCs compared to those based on the primary tumour or metastasis alone in the training (RS-Com-EGFR: 0.927) and validation (RS-Com-EGFR: 0.812) cohorts. To predict response to EGFR-TKI, the developed RS based on combined primary tumour and metastasis generated the highest AUCs in the training (RS-Com-TKI: 0.880) and validation (RS-Com-TKI: 0.798) cohort. CONCLUSIONS Primary NSCLC and spinal metastases can provide complementary information to predict the EGFR mutation status and response to EGFR-TKI. The developed models that integrate primary lesions and metastases may be potential imaging markers to guide individual treatment decisions.
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Affiliation(s)
- Yuan Cheng
- Department of Biomedical Engineering, School of Intelligent Medicine, China Medical University, Liaoning 110122, PR China
| | - Huan Wang
- Radiation Oncology Department of Thoracic Cancer, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Liaoning 110042, PR China
| | - Wendi Yuan
- Department of Biomedical Engineering, School of Intelligent Medicine, China Medical University, Liaoning 110122, PR China
| | - Haotian Wang
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Liaoning 110042, PR China
| | - Yuheng Zhu
- Department of Biomedical Engineering, School of Intelligent Medicine, China Medical University, Liaoning 110122, PR China
| | - Huanhuan Chen
- Department of Oncology, Shengjing Hospital of China Medical University, 110004 Shenyang, PR China.
| | - Wenyan Jiang
- Department of Scientific Research and Academic, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Liaoning 110042, PR China.
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Liu S, Wang Z, Wei Q, Duan X, Liu Y, Wu M, Ding J. Biomaterials-enhanced bioactive agents to efficiently block spinal metastases of cancers. J Control Release 2023; 363:721-732. [PMID: 37741462 DOI: 10.1016/j.jconrel.2023.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 09/25/2023]
Abstract
The spine is the most common site of bone metastases, as 20%-40% of cancer patients suffer from spinal metastases. Treatments for spinal metastases are scarce and palliative, primarily aiming at relieving bone pain and preserving neurological function. The bioactive agents-mediated therapies are the most effective modalities for treating spinal metastases because they achieve systematic and specific tumor regression. However, the clinical applications of some bioactive agents are limited due to the lack of targeting capabilities, severe side effects, and vulnerability of drug resistance. Fortunately, advanced biomaterials have been developed as excipients to enhance these treatments, including chemotherapy, phototherapy, magnetic hyperthermia therapy, and combination therapy, by improving tumor targeting and enabling sustaining and stimuli-responsive release of various therapeutic agents. Herein, the review summarizes the development of biomaterials-mediated bioactive agents for enhanced treatments of spinal metastases and predicts future research trends.
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Affiliation(s)
- Shixian Liu
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun 130041, PR China; Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China
| | - Zhonghan Wang
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun 130041, PR China
| | - Qi Wei
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China; Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun 130033, PR China
| | - Xuefeng Duan
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun 130041, PR China; Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China
| | - Yang Liu
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China
| | - Minfei Wu
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun 130041, PR China.
| | - Jianxun Ding
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China; Key Laboratory of Advanced Drug Delivery Systems of Zhejiang Province, 388 Yuhangtang Road, Hangzhou 310058, PR China.
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Sereno M, Franco SR, de la Reina L, Campo-Cañaveral de la Cruz JL, Muñoz de Legaría M, Casado Saénz E. Conversion in a Resectable Tumor after Denosumab Neoadjuvant in a Large Dorsal Giant Cells Tumor: A Case Report and a Literature Review. Curr Oncol 2023; 30:9335-9345. [PMID: 37887575 PMCID: PMC10605573 DOI: 10.3390/curroncol30100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Giant cell tumors of bone are a rare entity, usually occurring in young patients and characteristically arising in the long bones. The spinal location is rare and usually presents with pain and/or neurological symptoms. The treatment of choice is surgery. Treatment with Denosumab, a bisphosphonate inhibitor of RANK-L, which is highly expressed in these tumors, has shown extensive activity in unresectable patients or those undergoing incomplete surgery. Preoperative treatment with this drug is gaining increasing interest, as its high potency in tumor reduction in this subtype of neoplasm has allowed resectability in selected patients. We present the case of a young patient with a large spinal tumor who, after neoadjuvant Denosumab, underwent complete en bloc surgery with clean margins and a great pathological response.
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Affiliation(s)
- María Sereno
- Medical Oncology Department, Infanta Sofía University Hospital, Europe Avenue 32, San Sebastián de los Reyes, 28702 Madrid, Spain; (S.R.F.); (E.C.S.)
- European University of Madrid, Medicine Departtment, Calle Tajo 1, Villaviciosa de Odón, 28745 Madrid, Spain;
- FIIB HUIS HHEN, 28703 Madrid, Spain
- Precision Nutrition and Cancer Program, Clinical Oncology Group, IMDEA Food Institute, CEI UAM, CSIC, 28049 Madrid, Spain
| | - Silvia Roa Franco
- Medical Oncology Department, Infanta Sofía University Hospital, Europe Avenue 32, San Sebastián de los Reyes, 28702 Madrid, Spain; (S.R.F.); (E.C.S.)
- FIIB HUIS HHEN, 28703 Madrid, Spain
- Precision Nutrition and Cancer Program, Clinical Oncology Group, IMDEA Food Institute, CEI UAM, CSIC, 28049 Madrid, Spain
| | - Laura de la Reina
- Neurosurgeon, Neurosurgery Department, Puerta de Hierro University Hospital, C. Joaquín Rodrigo, 1, Majadahonda, 28222 Madrid, Spain; (L.d.l.R.); (M.M.d.L.)
| | - José Luis Campo-Cañaveral de la Cruz
- European University of Madrid, Medicine Departtment, Calle Tajo 1, Villaviciosa de Odón, 28745 Madrid, Spain;
- Thoracic Surgery Department, Puerta de Hierro University Hospital, C. Joaquín Rodrigo, 1, Majadahonda, 28222 Madrid, Spain
| | - Marta Muñoz de Legaría
- Neurosurgeon, Neurosurgery Department, Puerta de Hierro University Hospital, C. Joaquín Rodrigo, 1, Majadahonda, 28222 Madrid, Spain; (L.d.l.R.); (M.M.d.L.)
- Pathology Department, Infanta Sofía University Hospital, Europe Avenue 32, San Sebastián de los Reyes, 28702 Madrid, Spain
| | - Enrique Casado Saénz
- Medical Oncology Department, Infanta Sofía University Hospital, Europe Avenue 32, San Sebastián de los Reyes, 28702 Madrid, Spain; (S.R.F.); (E.C.S.)
- European University of Madrid, Medicine Departtment, Calle Tajo 1, Villaviciosa de Odón, 28745 Madrid, Spain;
- FIIB HUIS HHEN, 28703 Madrid, Spain
- Precision Nutrition and Cancer Program, Clinical Oncology Group, IMDEA Food Institute, CEI UAM, CSIC, 28049 Madrid, Spain
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Qian J, Su L, He J, Ruan R, Wang J, Wang Z, Xiao P, Liu C, Cao Y, Li W, Zhang J, Song J, Yang H. Dual-Modal Imaging and Synergistic Spinal Tumor Therapy Enabled by Hierarchical-Structured Nanofibers with Cascade Release and Postoperative Anti-adhesion. ACS Nano 2022; 16:16880-16897. [PMID: 36136320 DOI: 10.1021/acsnano.2c06848] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Most treatments for spinal cancer are accompanied by serious side effects including subsequent tumor recurrence, spinal cord compression, and tissue adhesion, thus a highly effective treatment is crucial for preserving spinal and neurological functionalities. Herein, trilayered electrospun doxorubicin@bovine serum albumin/poly(ε-caprolactone)/manganese dioxide (DOX@BSA/PCL/MnO2) nanofibers with excellent antiadhesion ability, dual glutathione/hydrogen peroxide (GSH/H2O2) responsiveness, and cascade release of Mn2+/DOX was fabricated for realizing an efficient spinal tumor therapy. In detail, Fenton-like reactions between MnO2 in the fibers outermost layer and intra-/extracellular glutathione within tumors promoted the first-order release of Mn2+. Then, sustained release of DOX from the fibers' core layer occurred along with the infiltration of degradation fluid. Such release behavior avoided toxic side effects of drugs, regulated inflammatory tumor microenvironment, amplified tumor elimination efficiency through synergistic chemo-/chemodynamic therapies, and inhibited recurrence of spinal tumors. More interestingly, magnetic resonance and photoacoustic dual-modal imaging enabled visualizations of tumor therapy and material degradation in vivo, achieving rapid pathological analysis and diagnosis. On the whole, such versatile hierarchical-structured nanofibers provided a reference for rapid and potent theranostic of spinal cancer in future clinical translations.
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Affiliation(s)
- Jiaqi Qian
- College of Chemical Engineering, Fuzhou University, 2 Xueyuan Road, Fuzhou 350108, P. R. China
- Qingyuan Innovation Laboratory, 1 Xueyuan Road, Quanzhou 362801, P. R. China
| | - Lichao Su
- College of Chemical Engineering, Fuzhou University, 2 Xueyuan Road, Fuzhou 350108, P. R. China
- Qingyuan Innovation Laboratory, 1 Xueyuan Road, Quanzhou 362801, P. R. China
| | - Jingjing He
- College of Chemical Engineering, Fuzhou University, 2 Xueyuan Road, Fuzhou 350108, P. R. China
- Qingyuan Innovation Laboratory, 1 Xueyuan Road, Quanzhou 362801, P. R. China
| | - Renjie Ruan
- College of Chemical Engineering, Fuzhou University, 2 Xueyuan Road, Fuzhou 350108, P. R. China
- Qingyuan Innovation Laboratory, 1 Xueyuan Road, Quanzhou 362801, P. R. China
| | - Jun Wang
- MOE Key Laboratory for Analytical Science of Food Safety and Biology, College of Chemistry, Fuzhou University, Fuzhou 350108, P. R. China
| | - Ziyi Wang
- College of Chemical Engineering, Fuzhou University, 2 Xueyuan Road, Fuzhou 350108, P. R. China
- Qingyuan Innovation Laboratory, 1 Xueyuan Road, Quanzhou 362801, P. R. China
| | - Peijie Xiao
- College of Chemical Engineering, Fuzhou University, 2 Xueyuan Road, Fuzhou 350108, P. R. China
- Qingyuan Innovation Laboratory, 1 Xueyuan Road, Quanzhou 362801, P. R. China
| | - Changhua Liu
- College of Chemical Engineering, Fuzhou University, 2 Xueyuan Road, Fuzhou 350108, P. R. China
- Qingyuan Innovation Laboratory, 1 Xueyuan Road, Quanzhou 362801, P. R. China
| | - Yang Cao
- College of Chemical Engineering, Fuzhou University, 2 Xueyuan Road, Fuzhou 350108, P. R. China
- Qingyuan Innovation Laboratory, 1 Xueyuan Road, Quanzhou 362801, P. R. China
| | - Weidong Li
- College of Chemical Engineering, Fuzhou University, 2 Xueyuan Road, Fuzhou 350108, P. R. China
- Qingyuan Innovation Laboratory, 1 Xueyuan Road, Quanzhou 362801, P. R. China
| | - Jin Zhang
- College of Chemical Engineering, Fuzhou University, 2 Xueyuan Road, Fuzhou 350108, P. R. China
- Qingyuan Innovation Laboratory, 1 Xueyuan Road, Quanzhou 362801, P. R. China
| | - Jibin Song
- MOE Key Laboratory for Analytical Science of Food Safety and Biology, College of Chemistry, Fuzhou University, Fuzhou 350108, P. R. China
| | - Huanghao Yang
- Qingyuan Innovation Laboratory, 1 Xueyuan Road, Quanzhou 362801, P. R. China
- MOE Key Laboratory for Analytical Science of Food Safety and Biology, College of Chemistry, Fuzhou University, Fuzhou 350108, P. R. China
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Liang H, Zhou L, Hu Z, Ge Y, Zhang T, Chen Q, Wang B, Lu S, Ding W, Dong J, Xue F, Jiang L. Siglec15 Checkpoint Blockade for Simultaneous Immunochemotherapy and Osteolysis Inhibition in Lung Adenocarcinoma Spinal Metastasis via a Hollow Nanoplatform. Small 2022; 18:e2107787. [PMID: 35751455 DOI: 10.1002/smll.202107787] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/13/2022] [Indexed: 06/15/2023]
Abstract
Low responsiveness to anti-programmed death-1/programmed death-ligand 1 (anti-PD-1/PD-L1) for solid tumors indicates the presence of other immunosuppressive pathways. Siglec15, a newly discovered immune checkpoint, has been reported to repress immune responses in the tumor microenvironment (TME) and regulate osteoclast differentiation. However, the role of Siglec15 in the treatment for bone metastasis remains unclear. Herein, Siglec15 shows significantly higher expression in lung adenocarcinoma spinal metastasis (LUAD-SM) than in para-cancerous spinal tissues and primary LUAD. Subsequently, a TME-responsive hollow MnO2 nanoplatform (H-M) loaded with Siglec15 siRNA and cisplatin (H-M@siS15/Cis) is developed, and the surface is modified with an aspartic acid octapeptide (Asp8 ), thus allowing H-M to target spinal metastasis. High drug-loading capacity, good biocompatibility, effective tumor accumulation, and efficient Siglec15 silencing are demonstrated. Furthermore, the nanoparticles could reverse immunosuppression caused by tumor cells and tumor-associated macrophages (TAMs) and inhibit osteoclast differentiation via Siglec15 downregulation in vitro. In a LUAD-SM mouse model, H-M@siS15/Cis-Asp8 exhibits superior therapeutic efficacy via synergetic immunochemotherapy and osteolysis inhibition. Taken together, this single nanoplatform reveals the therapeutic potential of the new immune checkpoint Siglec15 in LUAD-SM and provides a strategy to treat this disease.
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Affiliation(s)
- Haifeng Liang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Lei Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zhichao Hu
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yuxiang Ge
- Department of Orthopedics Surgery, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Taiwei Zhang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Qing Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ben Wang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Shunyi Lu
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Wang Ding
- Department of Orthopedics Surgery, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Jian Dong
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Department of Orthopaedic Surgery, Zhongshan Hospital Wusong Branch, Fudan University, Shanghai, 200940, China
| | - Fengfeng Xue
- Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Libo Jiang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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Anusitviwat C, Ruangchainikom M, Korwutthikulrangsri E, Sutipornpalangkul W. Total neurological recovery after surgical decompression and treatment with denosumab of large unresectable spinal giant cell tumour expanding to mediastinum. BMJ Case Rep 2022; 15:15/5/e248837. [PMID: 35550320 PMCID: PMC9109021 DOI: 10.1136/bcr-2022-248837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
There is a controversy over the medical treatment of unresectable spinal giant cell tumour (GCT) regarding dosing and duration. We studied a spinal GCT case that had expanded to the thoracic spinal canal and mediastinum and was successfully treated by surgical decompression and denosumab. A woman in her 30s presented with weakness in both the lower extremities. MRI revealed a large tumour in the posterior mediastinum expanding from the thoracic vertebrae (T3–6), which compressed the spinal cord. The patient underwent urgent spinal decompression with instrumentation and her tissue was sent for a pathology study. Histologically and immunohistochemistry confirmed the diagnosis of GCT. Since it was an unresectable tumour, this patient was treated with denosumab. Her neurological problem resolved after 6 months of treatment. After 4 years of follow-up, the patient displayed no further progression and no side effects from long-term denosumab usage.
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Affiliation(s)
| | - Monchai Ruangchainikom
- Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Han X, Zhou L, Zhuang H, Wei P, Li F, Jiang L, Yi T. Hybrid Mesoporous MnO 2-Upconversion Nanoparticles for Image-Guided Lung Cancer Spinal Metastasis Therapy. ACS Appl Mater Interfaces 2022; 14:18031-18042. [PMID: 35426297 DOI: 10.1021/acsami.1c22322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Upconversion nanoparticles (UCNPs) and MnO2 composite materials have broad prospects in biological applications due to their near-infrared (NIR) imaging capability and tumor microenvironment-responsive features. Nevertheless, the synthesis of such composite nanoplatforms still faces many hurdles such as redundant processing and uneven coatings. Here, we explored a simple, rapid, and universal method for precisely controlled coating of mesoporous MnO2 (mMnO2) using poly(ethylene imine) as a reducing agent and potassium permanganate as a manganese source. Using this strategy, a mMnO2 shell was successfully coated on UCNPs. We further modified the mMnO2-coated UCNPs (UCNP@mMnO2) with a photosensitizer (Ce6), cisplatin drug (DSP), and tumor targeting pentapeptide (TFA) to obtain a nanoplatform UCNP/Ce6@mMnO2/DSP-TFA for treating spinal metastasis of nonsmall cell lung cancer (NSCLC-SM). The utilization of both upconversion and downconversion luminescence of UCNPs with different NIR wavelengths can avoid the simultaneous initiation of NIR-II in vivo imaging and tumor photodynamic therapy, thus reducing damage to normal tissues. This platform achieved a high synergistic effect of photodynamic therapy and chemotherapy. This leads to beneficial antitumor effects on the therapy of NSCLC-SM.
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Affiliation(s)
- Xuemin Han
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, P. R. China
| | - Lei Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China
| | - Hongjun Zhuang
- Departments of Rehabilitation, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China
- State Key Laboratory of Molecular Engineering of Polymers, Department of Chemistry, Fudan University, Shanghai 200438, P. R. China
| | - Peng Wei
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, P. R. China
| | - Fuyou Li
- State Key Laboratory of Molecular Engineering of Polymers, Department of Chemistry, Fudan University, Shanghai 200438, P. R. China
| | - Libo Jiang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China
| | - Tao Yi
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, P. R. China
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Maethungkul R, Atthakomol P, Phinyo P, Phanphaisarn A, Murakami H, Sangsin A. Adjunctive Topical Tranexamic Acid for Blood Salvage Does Not Reduce Postoperative Blood Loss Compared with Placebo in Patients Who Undergo Palliative Decompressive Spinal Metastasis Surgery: A Randomized Controlled Trial. Spine (Phila Pa 1976) 2022; 47:187-194. [PMID: 34802026 DOI: 10.1097/brs.0000000000004280] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVE To evaluate the efficacy of adjunctive topical tranexamic acid (tTXA) in reducing postoperative blood loss and packed red cell (PRC) transfusion in patients who underwent palliative decompressive spinal metastasis surgery for malignant epidural spinal cord compression. SUMMARY OF BACKGROUND DATA Palliative decompressive spinal metastasis surgery is associated with massive postoperative blood loss and increased transfusion rate. tTXA reduces blood loss in traumatic or degenerative spinal surgery; however, the role of topical TXA in decompressive spinal metastasis surgery remains controversial. METHOD A total of 65 patients who underwent palliative decompressive thoracolumbar spinal metastasis surgery were included in this study. In 33 patients, 1 g of tTXA (20 mL) was soaked in an absorbable gelatin sponge and placed lateral to the decompressive site. The remaining 32 patients in the control group received the same procedures with normal saline at the same volume, instead of TXA. All of the patients received standard 1 g intravenous TXA, just before initiating the operation. The primary outcome was postoperative blood loss, and the secondary outcomes were postoperative PRC transfusion and complications. RESULTS No differences were found in postoperative blood loss between tTXA and placebo group (P50 778 mL [IQR 347, 1,122 mL] versus P50 490 mL [IQR 295, 920 mL]; P = 0.238). The number of patients requiring postoperative PRC transfusion were quite similar in tTXA and placebo groups (PRC transfusion in 15 patients [45.45%] versus 16 patients [50%]; P = 0.585). No complications related to TXA and absorbable gelatin sponge were observed. CONCLUSION We do not recommend tTXA as an adjunctive treatment for patients undergoing decompressive spinal metastasis surgery since it does not provide additional benefit to prophylactic intravenous TXA in postoperative blood loss and transfusion rate.Level of Evidence: 2.
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Affiliation(s)
- Ronnakrit Maethungkul
- Department of Orthopaedics Surgery, Faculty of Medicine Chiang Mai University, Maharaj Nakorn Chiangmai Hospital, Chiangmai, Thailand
| | - Pichitchai Atthakomol
- Department of Orthopaedics Surgery, Faculty of Medicine Chiang Mai University, Maharaj Nakorn Chiangmai Hospital, Chiangmai, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine and Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Areerak Phanphaisarn
- Department of Orthopaedics Surgery, Faculty of Medicine Chiang Mai University, Maharaj Nakorn Chiangmai Hospital, Chiangmai, Thailand
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Apiruk Sangsin
- Department of Orthopaedics Surgery, Faculty of Medicine Chiang Mai University, Maharaj Nakorn Chiangmai Hospital, Chiangmai, Thailand
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Klejnow EV, Hoban K, Nixon I, Elswood TR. Metastatic chordoma with pancreatic disease and response to imatinib. BMJ Case Rep 2022; 15:e240062. [PMID: 35046072 PMCID: PMC8772418 DOI: 10.1136/bcr-2020-240062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/03/2022] Open
Abstract
A 45-year-old woman presented with a left-sided neck swelling following treatment a year prior for cervical spine chordoma. She had initially been managed surgically with a cervical vertebrectomy and a course of proton beam therapy. Although there had been a degree of residual tissue, her disease remained stable radiologically and clinically. Repeat MRI demonstrated an increasing left paravertebral mass and a head of pancreas metastasis, which shared pathological characteristics with chordoma. Given the advanced metastatic nature of her disease, imatinib was offered with a palliative intent. While waiting for treatment she developed a spinal cord compression, managed with radiotherapy. She commenced imatinib and her disease remained stable for 9 months before progressing clinically and radiologically. This case demonstrates an unusual pattern of metastatic chordoma and provides further rationale for imatinib in such patients.
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Affiliation(s)
- Eleanor V Klejnow
- Department of Paediatric Haematology and Oncology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Katie Hoban
- Department of Orthopaedics, Queen Elizabeth University Hospital Campus, Glasgow, UK
| | - Ioanna Nixon
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
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11
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Ito K, Ogawa H. Stereotactic Body Radiation Therapy for Patients With Sacral Chordoma Who Previously Received Carbon Ion Therapy. Int J Radiat Oncol Biol Phys 2021; 110:1263-1264. [PMID: 34273319 DOI: 10.1016/j.ijrobp.2018.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Kei Ito
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiroaki Ogawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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12
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Kurucu N, Akyüz C, Varan A, Akçören Z, Aydin B, Yalçin B, Kutluk T. Primary Paraspinal and Spinal Epidural Non-Hodgkin Lymphoma in Childhood. J Pediatr Hematol Oncol 2021; 43:e395-e400. [PMID: 32520843 DOI: 10.1097/mph.0000000000001858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 05/10/2020] [Indexed: 11/26/2022]
Abstract
Primary paraspinal/spinal epidural lymphoma (PPSEL) is rare in childhood. Here, we retrospectively evaluated patients with PPSEL treated in our department. We also reviewed the cases reported in the literature. Fifteen of 1354 non-Hodgkin lymphoma cases diagnosed over a 38-year period were PPSEPL. There were 11 male individuals and 4 female individuals with a median age of 13 years. Most common symptoms were pain and limb weakness. Physical examination revealed spinal cord compression in 80% of patients. The most common tumor location was the lumbar region. Histopathologic subtypes were lymphoblastic lymphoma in 6 and Burkitt lymphom in 5 patients. Subtotal or near-total excision of the tumor with laminectomy was performed in 6 patients. Thirteen and 9 patients received chemotherapy and radiotherapy, respectively. Neurologic recovery was observed in 70% of patients. Seven patients were alive without disease at a median of 88 months. Overall and event-free survival rates were 61.7% and 50.1%, respectively. We reviewed clinical features, treatment, and outcome of 69 PPSEL cases reported in the literature. Neurologic recovery and long-term survival was achieved in 66.7% of them. Heterogeneity in diagnostic methods and treatment have made it difficult to establish the prognostic indicators for neurologic outcome and survival. Multicenter prospective studies with more cases are necessary to determine the prognostic factors.
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Affiliation(s)
- Nilgün Kurucu
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine
| | - Canan Akyüz
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine
| | - Ali Varan
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine
| | - Zuhal Akçören
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burça Aydin
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine
| | - Bilgehan Yalçin
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine
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13
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Uluc K, Siler DA, Lopez R, Varallyay C, Netto JP, Firkins J, Lacy C, Huddleston A, Ambady P, Neuwelt EA. Long-Term Outcomes of Intra-Arterial Chemotherapy for Progressive or Unresectable Pilocytic Astrocytomas: Case Studies. Neurosurgery 2021; 88:E336-E342. [PMID: 33548921 PMCID: PMC7956020 DOI: 10.1093/neuros/nyaa588] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/18/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Progressive and/or unresectable pilocytic astrocytomas (PAs) carry a poor prognosis compared to typical PA. Early radiotherapy (RT) may have severe long-term neurocognitive side effects in this patient population. Intra-arterial (IA) chemotherapy is a viable alternative or addition to intravenous (IV) chemotherapy, which may be beneficial in avoidance of early RT. OBJECTIVE To evaluate the safety and efficacy of IA chemotherapy in this subset of patients. METHODS This is a retrospective review of medical records of PA patients who are treated with IA chemotherapy at Oregon Health & Science University from 1997 until 2019. Response to treatment was categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Progression free survival (PFS) and overall survival (OS) are also reported. RESULTS Twelve patients were identified. All patients experienced progression prior to initiation of IA chemotherapy. The most common grade 3 or 4 toxicities related to chemotherapy were thrombocytopenia (66%), neutropenia (66%), leukopenia (50%), anemia (33%), and lymphopenia (16%). Responses achieved were CR in 1, PR in 3, SD in 7, and PD in 1. Median PFS and median OS were 16.5 and 83.5 mo, respectively. A total of 112 procedures (IA injections) were performed and 250 arteries were catheterized. There were 3 minor and no major complications attributable to procedures. CONCLUSION This study demonstrates that IA chemotherapy can be safely used in patients with unresectable or progressive PA.
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Affiliation(s)
- Kutluay Uluc
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Dominic A Siler
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Ricardo Lopez
- Ponce Health Sciences University, Ponce, Puerto Rico
| | - Csanad Varallyay
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Department of Radiology, Oregon Health & Science University, Portland, Oregon
| | - Joao Prola Netto
- Department of Radiology, Providence St Joseph, Portland, Oregon
- The Radiology Group, Providence St Vincent Medical Center, Portland, Oregon
| | - Jenny Firkins
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Cindy Lacy
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Amy Huddleston
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Prakash Ambady
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon
- Portland Veterans Affairs Medical Center, Portland, Oregon
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14
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Bukata SV, Blay JY, Rutkowski P, Skubitz K, Henshaw R, Seeger L, Dai T, Jandial D, Chawla S. Denosumab Treatment for Giant Cell Tumor of the Spine Including the Sacrum. Spine (Phila Pa 1976) 2021; 46:277-284. [PMID: 33038190 PMCID: PMC7864639 DOI: 10.1097/brs.0000000000003728] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/27/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN This was a subanalysis of an international, multicenter, open-label study. OBJECTIVE The aim of this study was to assess the efficacy and safety of denosumab in a subset of patients with giant cell tumors of bone (GCTB) of the spine including the sacrum from an international, open-label, single-arm, phase 2 study (ClinicalTrials.gov: NCT00680992). SUMMARY OF BACKGROUND DATA Standard GCTB treatment is surgical removal, either by curettage or resection, combined with intraoperative adjuvant therapy; however, some sites may not be amenable to resection (e.g., skull, spine). METHODS Adults or skeletally mature adolescents with pathologically confirmed GCTB of the spine including the sacrum, and radiologically measurable evidence of active disease, were included. Patients received denosumab (120 mg subcutaneously) once every 4 weeks during the treatment phase, with loading doses on days 8 and 15 of the first cycle. Patients had surgically unsalvageable GCTB (Cohort 1), had planned surgery expected to result in severe morbidity (Cohort 2), or were enrolled from a previous GCTB study (Cohort 3). RESULTS Overall, 132 patients were included in the safety analysis (103 in Cohort 1, 24 in Cohort 2, and five in Cohort 3); 131 patients were included in the efficacy analysis. Kaplan-Meier estimated probabilities of disease progression or recurrence were 3% (95% confidence interval [CI], 0.0-6.2) at year 1 and 7.4% (95% CI, 2.1-12.7) at years 3 and 5 in Cohort 1, and not estimable in Cohorts 2 and 3. Of 23 patients (Cohort 2) with surgery planned at baseline, 10 (43%) had on-study surgery; of these, one patient had reported disease progression or recurrence after the on-study surgery. Clinical benefit was reported in 83% of patients overall (all cohorts). CONCLUSION Results from the analysis suggest that denosumab is potentially effective treatment for patients with GCTB of the spine including the sacrum. The adverse event profile was consistent with the full study population.Level of Evidence: 2.
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Affiliation(s)
- Susan V. Bukata
- Department of Orthopedic Surgery, UCLA Health System, Los Angeles, CA
| | - Jean-Yves Blay
- Department of Medicine, Centre Léon Bérard Cancer Center & Université Claude Bernard Lyon, Lyon, France
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | | | - Robert Henshaw
- Georgetown University and MedStar Washington Cancer Institute, Washington, DC
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15
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Shen XZ, Wang W, Luo ZY. 18F-FDG PET/CT imaging for aggressive melanotic schwannoma of the L3 spinal root: A case report. Medicine (Baltimore) 2021; 100:e24803. [PMID: 33663098 PMCID: PMC7909145 DOI: 10.1097/md.0000000000024803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Melanotic schwannoma (MS) is an unusual variant of a nerve sheath neoplasm that accounts for less than 1% of all primary peripheral nerve sheath tumors. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has unique value in detecting malignant MS lesions. To date, only 4 cases of MS with hepatic metastasis have been reported. Herein, we report the fifth case, which is the first reported patient with MS of Asian ethnicity with hepatic metastasis. PATIENT CONCERNS A 29-year-old woman with a 1-day history of backache was admitted to our hospital. PET/CT showed a paravertebral heterogeneous soft tissue mass along the spinal nerve at the L2-L3 level with strong FDG uptake, and a nodule with increased FDG uptake in the lateral lobe of the left liver. DIAGNOSIS A puncture biopsy of the L3 bony destruction and surrounding soft tissue mass was performed. The final diagnosis was spinal MS with hepatic metastasis. INTERVENTIONS The patient underwent 6 courses of systemic chemotherapy. OUTCOMES The patient did not receive further treatment for half a year after the end of chemotherapy and recovered well. LESSONS Unlike conventional schwannomas, which are completely benign, MS has an unpredictable prognosis. It is thought to have low malignant potential, and the malignant type tends to metastasize. FDG PET/CT has a unique and important value in the differential diagnosis of benign and malignant lesions, in detecting occult metastases, monitoring the treatment response, and assessing the prognosis of MS.
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Affiliation(s)
- Xun-Ze Shen
- PET/CT Center, Shaoxing People's Hospital, the First Affiliated Hospital of Shaoxing University, 568 Zhongxing North Rd, Shaoxing City
| | - Wei Wang
- Wei Wang, Department of Pathology, Zhejiang Provincial People's hospital, Hangzhou City, Zhejiang Province, China
| | - Zhou-Ye Luo
- PET/CT Center, Shaoxing People's Hospital, the First Affiliated Hospital of Shaoxing University, 568 Zhongxing North Rd, Shaoxing City
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Sano M, Iseki T, Sasaki M, Tsukune Y, Yasuda H, Kanazawa K, Arakawa A, Yokoyama K, Komatsu N, Hattori N, Nishioka K. Improvement in the Symptoms and VEGF Levels after Resection of an Extrame Dullary Spinal Tumor and Additional Chemotherapy in a Patient with Multiple Myeloma Complicated with POEMS Syndrome. Intern Med 2021; 60:3625-3630. [PMID: 34776466 PMCID: PMC8666231 DOI: 10.2169/internalmedicine.6929-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of multiple myeloma and polyneuropathy, organomegaly, endocrinopathy, myeloma protein, and skin changes (POEMS) syndrome. The patient experienced exacerbated gait disturbance due to weakness and numbness in the lower limbs. Thoracic magnetic resonance imaging revealed an extramedullary tumor with spinal compression that required surgical resection. Plasmacytoma was diagnosed based on a biopsy. Radiation, betamethasone, and chemotherapy were therefore administered. Surgical removal of extramedullary tumors improved his symptoms, motor conduction velocity, and amplitude of the muscle action potential in the peroneal and tibial nerves, as shown by the nerve conduction study. Surgery also decreased the serum vascular endothelial growth factor levels. The patient required additional chemotherapy due to multiple myeloma and showed better outcomes nine months after discharge. The benefits of some treatments remain controversial due to the small number of patients. However, our findings reveal that an early diagnosis and comprehensive treatment may result in better outcomes in such patients.
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Affiliation(s)
- Mariko Sano
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Tatou Iseki
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Makoto Sasaki
- Department of Hematology, Juntendo University School of Medicine, Japan
| | - Yutaka Tsukune
- Department of Hematology, Juntendo University School of Medicine, Japan
| | - Hajime Yasuda
- Department of Hematology, Juntendo University School of Medicine, Japan
| | - Kazo Kanazawa
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Atsushi Arakawa
- Department of Human Pathology, Juntendo University School of Medicine, Japan
| | - Kazumasa Yokoyama
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Kenya Nishioka
- Department of Neurology, Juntendo University School of Medicine, Japan
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Boriani S, Cecchinato R, Cuzzocrea F, Bandiera S, Gambarotti M, Gasbarrini A. Denosumab in the treatment of giant cell tumor of the spine. Preliminary report, review of the literature and protocol proposal. Eur Spine J 2020; 29:257-271. [PMID: 31098716 DOI: 10.1007/s00586-019-05997-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 05/01/2019] [Accepted: 05/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The interest on the role of Denosumab in the treatment strategy of giant cell tumor of the spine is growing. En bloc resection is considered the Enneking appropriate treatment, but morbidity and functional loss are sometimes unacceptable. Denosumab could play a role as a stand-alone treatment, but also as preoperative treatment or as postoperative after intralesional surgery. MATERIALS AND METHODS A cohort of 10 out of 12 cases of spinal GCT consecutively treated with Denosumab are analyzed and discussed compared to the cases reported in the literature. A staging of the radiological effect of the treatment is proposed. RESULTS The stand-alone and postoperative treatments are still running (12 to 88 months). One therapy was stopped after 15 months, once a satisfactory local effect was achieved, but the treatment had to be restarted 2 months later due to the recurrence of the erosive images. The new treatment was successful. At 1-year follow-up after the gross total excision followed by postoperative Denosumab treatment, no evidence of local recurrence was found. The preoperative treatment duration ranged from 3 to 24 months. No local recurrence followed the en bloc resections. CONCLUSIONS Denosumab alone is effective in relieving pain, increasing the ossification and sometimes reducing the tumor volume. It can be considered an excellent solution in spine GCTs whose surgical treatment cannot be Enneking appropriate or is associated with unacceptable morbidity or loss of functions. It is still impossible to state when to safely stop the treatment. Denosumab also plays a role as preoperative protocol. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
| | | | - Fabrizio Cuzzocrea
- University Department of Orthopedics, IRCCS Policlinico di Pavia, Pavia, Italy
| | - Stefano Bandiera
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Gambarotti
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Lu F, Zhong Q, Tian J, Zhang K. Computed tomography-guided paravertebral doxorubicin injection for refractory pain in patients with spinal metastases: Two case reports. Medicine (Baltimore) 2020; 99:e18939. [PMID: 32000411 PMCID: PMC7004785 DOI: 10.1097/md.0000000000018939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/28/2019] [Accepted: 12/30/2019] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Diagnosing and treating refractory cancer pain have become standardized and effective procedures with guidance from the Expert Consensus on Refractory Cancer Pain released in 2017 by the Committee of Rehabilitation and Palliative Care of China. Doxorubicin has been used for perineural injection in the treatment of chronic non-cancer pain owing to its retrograde sensory ganglion resection effect. Our study reports a new fourth-ladder treatment for cancer pain: CT-guided paravertebral doxorubicin injection for patients with refractory cancer pain caused by paraspinal metastasis. PATIENT CONCERNS A 48-year-old female and a 47-year-old male patients suffered from refractory cancer pain over the past months. They had both undergone surgical tumor resection, chemotherapy, and precision radiotherapy but result in limited analgesic effect. The daily oral morphine dosage was around 60 to 100 mg and rescue analgesic methods had been used at the time. DIAGNOSES Refractory cancer pain in 2 patients with renal cancer and hepatobiliary adenocarcinoma. INTERVENTIONS The patients both received computed tomography (CT)-guided 1 mL of 0.5% doxorubicin paravertebral injection at each affected nerve root segments. OUTCOMES The Visual Analog Scale and Douleur Neuropathique four Questions were used for 6-month follow-up, and the analgesic requirement was also recorded. The patients enjoyed satisfactory analgesia for up to 6 months without adverse reaction. In addition, the oral opioid analgesic doses were significantly reduced after the neurolytic block. LESSONS The CT-guided paravertebral doxorubicin injection was an effective fourth-step analgesic interventional technology that allowed our 2 patients with refractory cancer pain to maintain satisfactory analgesia. This analgesia method taken at an appropriate stage, according to the latest analgesic concept, results in good analgesia and opioid use reduction. Also, with the imaging guidance, only a small amount of neurolytic agent is needed to achieve analgesia in a precise and safe way.
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Affiliation(s)
- Fan Lu
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu
| | - Qing Zhong
- Department of Anesthesiology and Pain Medicine, Jianyang People's Hospital, Jianyang, Sichuan, China
| | - Jie Tian
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu
| | - Kexian Zhang
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu
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Abstract
INTRODUCTION Giant cell tumor of bone with pulmonary and bone metastases is exceedingly rare in adolescents. Furthermore, Denosumab and Sunitinib in the treatment of giant cell tumor of bone has never been reported. PATIENT CONCERNS A 16-year-old boy complained of fever, chest tightness, and shortness of breath and back pain for 5 days. DIAGNOSIS Giant cell tumor of bone with pulmonary and bone metastases. INTERVENTIONS The patient underwent 2 surgeries for giant cell tumor of bone located in the spine and received Denosumab to reduce local recurrence and control the metastases. Then Sunitinib was added into treatment strategies after the progressing of metastases. OUTCOMES Within 5 months of Denosumab and Sunitinib, lung metastases were shrinking (stable disease, response evaluation criteria in solid tumors version 1.1). Until now about 4 years into treatment the patient is still survival. Pulmonary and bone metastases are stable. CONCLUSIONS This is a case of multi-center giant cell tumor of bone, it does not only provide a reference to the treatment of similar cases of the clinic but also reflects the limitations of the application of Denosumab in the real world.
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Affiliation(s)
- Guannan Wang
- Department of Medical Oncology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Sujing Jiang
- Department of Radiation and Medical Oncology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhouqi Li
- Department of Medical Oncology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Ying Dong
- Department of Medical Oncology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
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20
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Chang VA, Simpson DR, Daniels GA, Piccioni DE. Infliximab for treatment-refractory transverse myelitis following immune therapy and radiation. J Immunother Cancer 2018; 6:153. [PMID: 30577851 PMCID: PMC6303890 DOI: 10.1186/s40425-018-0471-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Neurologic toxicities with immune therapy are rare, but can cause devastating and often permanent injury when they occur. Although there is increasing interest in the potential synergism between immune therapy and radiation, it is possible that such combinations may lead to a greater number or increased severity of immune-related adverse events. We present here a case of extensive and progressive transverse myelitis following combined therapy, which did not improve until treatment with infliximab. This case highlights the unmet need for treatment of adverse events that are refractory to consensus recommendations, and may ultimately require further study and incorporation into future published guidelines. CASE PRESENTATION We report a case of a 68-year-old with metastatic melanoma, who developed transverse myelitis in the setting of immune checkpoint blockade and spinal irradiation for vertebral metastases. Despite management according to published consensus guidelines: cessation of immune therapy, high-dose steroids, and plasmapheresis, he continued to deteriorate neurologically, and imaging revealed a progressive and ascending transverse myelitis. The patient was then treated with infliximab, and demonstrated dramatic imaging and modest clinical improvement following the first treatment cycle. CONCLUSIONS This is the first report describing the successful use of infliximab in immune therapy and radiation-related transverse myelitis that was not responding to recommended therapy. Evaluation of additional treatment options such as infliximab for high-grade immune-related neurologic toxicities is warranted, and may be needed earlier in the disease process to prevent significant morbidity. The adverse effects of immune therapy when used in combination with radiation also require further investigation.
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Affiliation(s)
- Victoria A Chang
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Daniel R Simpson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, Moores Cancer Center, La Jolla, California, USA
| | - Gregory A Daniels
- Department of Hematology & Oncology, University of California San Diego, Moores Cancer Center, La Jolla, California, USA
| | - David E Piccioni
- Division of Neuro-Oncology, Department of Neurosciences, University of California San Diego, La Jolla, California, USA.
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Yang H, Im GH, Nielsen GP, Kheterpal A, Schwab JH. Primary thoracic giant cell tumor of bone sensitive to steroids. Skeletal Radiol 2018; 47:1431-1435. [PMID: 29502130 DOI: 10.1007/s00256-018-2911-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 02/02/2023]
Abstract
Spinal giant cell tumor of bone (GCTB) is a rare benign, but locally aggressive, entity. We report the case of a 40-year-old man diagnosed with GCTB of the thoracic spine. The only symptom upon presentation was progressive back pain with pain radiating to the chest. Magnetic resonance imaging showed that the soft tissue mass extended posteriorly into the spinal canal, causing severe spinal cord compression. We initially treated this case with Decadron (Fresenius kabi, Bad Homburg vor der Hohe, Germany) for 1 week. This led to a reduction of tumor size and decompression of the spinal cord. To the best of our knowledge, there have been no prior reports of primary GCTB sensitive to steroid therapy within the existing literature.
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Affiliation(s)
- Huiliang Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
- Department of Orthopaedic Surgery, Orthopaedic Spine and Oncology Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gi Hye Im
- Department of Orthopaedic Surgery, Orthopaedic Spine and Oncology Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gunnlaugur Petur Nielsen
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Arvin Kheterpal
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Spine and Oncology Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Stacchiotti S, Morosi C, Lo Vullo S, Casale A, Palassini E, Frezza AM, Dinoi G, Messina A, Gronchi A, Cavalleri A, Venturelli E, Morelli D, Pilotti S, Collini P, Brich S, Tamborini E, Mariani L, Casali PG. Imatinib and everolimus in patients with progressing advanced chordoma: A phase 2 clinical study. Cancer 2018; 124:4056-4063. [PMID: 30216418 DOI: 10.1002/cncr.31685] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/12/2018] [Accepted: 06/19/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND We present the results of an academic phase 2 study on imatinib plus everolimus in patients who have progressive advanced chordoma. METHODS In January 2011, 43 adult chordoma patients were enrolled in the study and received imatinib 400 mg/day and everolimus 2.5 mg/day until progression or limiting toxicity. Eligible patients had progressed in the 6 months before study entry. PDGFRB, S6, and 4EBP1 expression and phosphorylation were evaluated by way of immunohistochemistry and/or western blotting. The primary endpoint was the overall response rate (ORR) according to Choi criteria. Secondary endpoints were RECIST 1.1 response, progression-free survival (PFS), overall survival (OS), correlation between S6/4EBP1 phosphorylation and response. RESULTS Thirteen of 43 patients were pretreated with imatinib. Among 40 of the 43 patients who were evaluable by Choi criteria, the best responses were 9 with partial response (ORR, 20.9%), 24 with stable disease (SD) (ORR, 55.8%), and 7 with progressive disease (ORR, 16.3%). Forty-two patients were evaluable by RECIST criteria, with 1 partial response (ORR, 2.3%), 37 stable disease (ORR, 86%), and 4 progressive disease (ORR, 9.3%). The median PFS according to Choi criteria was 11.5 months (range, 4.6-17.6 months), and 58.8% and 48.1% of patients were progression-free at 9 and 12 months, respectively. The median PFS by RECIST criteria was 14 months; the median OS was 47.1 months. When assessable, S6/4EBP1 was phosphorylated in a high and moderate/low proportion of tumor cells in responsive and nonresponsive patients, respectively. Toxicity caused a temporary and definitive treatment discontinuation in 60.5% and 30.2% of patients, respectively. CONCLUSIONS Imatinib plus everolimus showed a limited activity in progressing advanced chordoma. Interestingly, the amount of tumor cells activated for mammalian target of rapamycin effectors correlated with the response. Toxicity was not negligible.
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Affiliation(s)
- Silvia Stacchiotti
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Casale
- Radiology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Elena Palassini
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Anna Maria Frezza
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Gabriella Dinoi
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Antonella Messina
- Radiology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Adalberto Cavalleri
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Daniele Morelli
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Silvana Pilotti
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paola Collini
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Silvia Brich
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elena Tamborini
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo G Casali
- Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazione dei Tumori, Milan, Italy
- Oncolgy and Hemato-Oncology Department, University of Milan, Milan, Italy
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Abstract
RATIONALE Mucosa-associated lymphoid tissue (MALT) lymphoma is an indolent B-cell lymphoma which occurs mainly in the organs having mucosal layer and owns a fairly good prognosis. To date, 7 cases of spinal primary MALT has been reported before. However, there is no consensus on the optimal adjuvant treatment modalities for primary spinal MALT. The aim of this study was to add a new case of MALT which responded well to systemic therapy to the literature and to review the current literature. PATIENT CONCERNS A 68-year-old woman visited to our hospital due to back pain and progressive bilateral lower extremity weakness for 2 months. Magnetic resonance imaging (MRI) of the spine revealed a diffusely contrast-enhancing epidural mass extending from vertebral body T6 to T8 with compression of the spinal cord. Due to the spinal cord compression, patient underwent surgical resection. Histological examination indicated monocytoid small B-cells. Immunochemical study demonstrates that most tumor cells were positive for CD20, CD21, CD45, CD79a, CD43, bcl-2 with Ki-67 labing index was 15%, but were negative for CD3, CD5 cyclin D1, BCL6, and CD23. The positron emission tomography/computer tomography (PET/CT) revealed that right iliac wing and right liver were metastases for the standard uptake value (SUV) were 9.05 and 8.35, respectively. DIAGNOSES Based on these findings, final diagnosis of spinal MALT lymphoma was made. INTERVENTIONS After the diagnosis, the patient received 6 cycles of immuno-chemotherapy and repeated intrathecal methotrexate and intrathecal cytarabine. OUTCOMES At 1 year follow up, no recurrence or other dissemination was detected. LESSONS Chemotherapy and/or radiation have been employed in larger case series. While there is no defined treatment guideline for this rare disease entity, our reported case suggests a favorable prognosis when combining both surgical and adjuvant systemic approach.
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Affiliation(s)
- Rongrong Dong
- Department of Medical Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine
| | - Jiali Ji
- Department of Medical Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine
| | - Hong Liu
- Department of Medical Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine
| | - Jue Wang
- Zhejiang Chinese Medical University Affiliated Third Hospital, Hangzhou, China
| | - Xuexin He
- Department of Medical Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine
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Hong S, Ogiwara H. Dumbbell-shaped atypical teratoid rhabdoid tumor in the cervical spine mimicking schwannoma. Childs Nerv Syst 2018; 34:27-28. [PMID: 29018929 DOI: 10.1007/s00381-017-3603-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 09/12/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Sukwoo Hong
- Division of Neurosurgery, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Hideki Ogiwara
- Division of Neurosurgery, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan.
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Ohga N, Yamazaki Y, Tsuboi K, Kitagawa Y. Healing of osteonecrosis of the jaw (ONJ) after discontinuation of denosumab in a patient with bone metastases of colorectal cancer: a case report and hypothesis. Quintessence Int 2017; 46:621-6. [PMID: 25646168 DOI: 10.3290/j.qi.a33528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Osteonecrosis of the jaw (ONJ) is associated with the use of bisphosphonates (BPs), denosumab, and antiangiogenic drugs; however, the pathophysiology of medication-related ONJ (MRONJ) remains unknown. Recent advances in therapies for diseases that affect bone remodeling have led to the development of agents that inhibit the receptor activator of nuclear factor-kappa B ligand (RANKL). One such inhibitor is denosumab, a highly specific, fully human immunoglobulin G2 monoclonal antibody against RANKL. We report a case of ONJ that developed following dental extraction in a patient treated for metastatic colorectal cancer with denosumab. At the first medical examination at our hospital, her clinical presentation was indistinguishable from stage 2 MRONJ, classified according to the 2014 American Academy of Oral Medicine position paper. Discontinuation of denosumab was directed by her oncologist, and we prescribed oral antibiotics and irrigated the exposed area of bone. Seven months after denosumab cessation, the sequestrum of the anterior part of the mandible was naturally shed and the site was healed. Denosumab and BPs have significantly different mechanisms of action. The effects of denosumab on bone turnover are more rapid and reversible than those of BPs. Discontinuation of denosumab may be effective in the management of denosumab-related ONJ, depending on the primary tumor control.
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Paterakis K, Brotis A, Tasiou A, Kotoula V, Kapsalaki E, Vlychou M. Intradural extramedullary Ewing's sarcoma: A case report and review of the literature. Neurol Neurochir Pol 2016; 51:106-110. [PMID: 27939398 DOI: 10.1016/j.pjnns.2016.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 10/08/2016] [Accepted: 11/20/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Extra-skeletal Ewing's sarcomas are very rare lesions to the spine surgeon, with the intradural, extramedullary lesions being even rarer. Herein we present a patient with an intradural, extramedullary form of Ewing's sarcoma and review the relevant literature. The medical records, operative reports, radiographical studies and histological examinations of a single patient are retrospectively reviewed. CASE REPORT A 31-year old male presented with back-pain, right-leg progressive paraparesis, and inability to walk. Both motor and sensory disturbances were revealed on the right leg at the clinical examination. Lumbar MRI showed two lesions. The first one was an intradural, extramedullary lesion at the L2-L3 level, while the second was smaller, located at the bottom of the dural sac. The patient underwent gross total resection of the L2-L3 lesion after a bilateral laminectomy. Histological examination was compatible with Ewing's sarcoma, and was verified by molecular analysis. No other extra-skeletal or skeletal lesion was found. A chemotherapy scheme was tailored to the patients' histological diagnosis. The patient presented with local recurrence and bone metastasis 2 years after his initial diagnosis. A second operation was performed and the follow up of the patient showed no disease progression 18 months after revision surgery. CONCLUSION The spine surgeon should be aware of the existence of such rare entities, in order to timely fulfill the staging process and institute the proper therapy. The management of patients with extra-skeletal Ewing's sarcomas involves professionals as members of a multidisciplinary team, all of which should co-operate for the patient's optimal outcome.
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Affiliation(s)
| | - Alexandros Brotis
- Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece
| | - Anastasia Tasiou
- Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece
| | - Vasiliki Kotoula
- Department of Pathology, University Hospital "AHEPA", Thessaloniki, Greece
| | - Eftychia Kapsalaki
- Department of Radiology, University Hospital of Larissa, Larissa, Greece
| | - Marianna Vlychou
- Department of Radiology, University Hospital of Larissa, Larissa, Greece.
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Abstract
Purpose: To compare T1-weighted spin-echo and fat-suppressed long echo time inversion recovery turbo spin-echo (long TE IR-TSE) MR images in the evaluation of early response of breast cancer bone metastases to chemotherapy. Material and Methods: Eighteen breast cancer patients with known bone metastases were investigated prospectively by MR, using T1-weighted and long TE IR-TSE sequences on the sternum, spine, pelvis and proximal femora, before and after a median of 6 courses of chemotherapy. Therapeutic response evaluation with MR was based on change in tumor size assessed quantitatively by measuring all focal metastases, and change in pattern and signal intensity (SI) of the metastases, assessed visually. Combined response evaluation based on clinical findings, conventional radiography, and scintigraphy was used as reference. Results: Progressive disease (2 patients) and no change (4 patients) were assessed equally well on both MR sequences. Long TE IR-TSE demonstrated partial response with higher accuracy than T1-weighted images, 58% (7/12 patients) vs. 17% (2/12 patients). In patients without progression there was an SI increase in or around the metastases in 6 patients on T1-weighted images and in 7 patients on long TE IR-TSE images. Conclusion: The long TE IR-TSE sequence demonstrated early partial response of breast cancer bone metastases to chemotherapy more accurately than the T1-weighted sequence.
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Affiliation(s)
- I Ciray
- Department of Diagnostic Radiology, Uppsala University Hospital, Uppsala, Sweden
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Zhang Y, Ilaslan H, Krishnaney AA, Bauer TW. Morphological Transformation of Giant-Cell Tumor of Bone After Treatment with Denosumab: A Case Report. JBJS Case Connect 2016; 6:e74. [PMID: 29252651 DOI: 10.2106/jbjs.cc.16.00015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE Denosumab, an inhibitor of RANKL (receptor activator of nuclear factor κ-B ligand), was recently introduced for the treatment of giant-cell tumor of bone (GCTB). We describe the clinical, radiographic, and histological features of a GCTB of the spine in a 24-year-old woman that progressed after neoadjuvant treatment with denosumab. Disappearance of the multinuclear osteoclastic giant cells was accompanied by newly formed woven bone, which was deposited in interconnected strands with a prominent fibrovascular stroma that was histologically and radiographically similar to that of an osteoblastoma. CONCLUSION Pathologists, radiologists, and surgeons should be aware of this post-treatment transformation to avoid misdiagnosis.
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Affiliation(s)
- Yaxia Zhang
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute (Y.Z. and T.W.B.), Department of Diagnostic Radiology (H.I.), Department of Neurosurgery and Center for Spine Health (A.A.K. and T.W.B.), and Department of Orthopaedic Surgery (T.W.B.), Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Hakan Ilaslan
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute (Y.Z. and T.W.B.), Department of Diagnostic Radiology (H.I.), Department of Neurosurgery and Center for Spine Health (A.A.K. and T.W.B.), and Department of Orthopaedic Surgery (T.W.B.), Cleveland Clinic, Cleveland, Ohio
| | - Ajit A Krishnaney
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute (Y.Z. and T.W.B.), Department of Diagnostic Radiology (H.I.), Department of Neurosurgery and Center for Spine Health (A.A.K. and T.W.B.), and Department of Orthopaedic Surgery (T.W.B.), Cleveland Clinic, Cleveland, Ohio
| | - Thomas W Bauer
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute (Y.Z. and T.W.B.), Department of Diagnostic Radiology (H.I.), Department of Neurosurgery and Center for Spine Health (A.A.K. and T.W.B.), and Department of Orthopaedic Surgery (T.W.B.), Cleveland Clinic, Cleveland, Ohio
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Shinji A, Okada S, Nakamura T. [A Case of Chordoma of the Sacrum Treated with Pazopanib]. Gan To Kagaku Ryoho 2016; 43:267-269. [PMID: 27067697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A-70-year-old man with chordoma of the sacrum was treated with pazopanib (initially 400 mg/day, upto 800 mg/day). After 2 months of treatment, a significant tumor reduction was achieved and the patient was able to sit down easily. Therefore, the pazopanib therapy was continued. He had 14 months of progression-free survival.
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Affiliation(s)
- Akihiro Shinji
- Dept. of Medical Oncology, Japanese Red Cross Society Suwa Hospital
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Affiliation(s)
- Eisuke Kobayashi
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
| | - Nokitaka Setsu
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
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Abstract
Objective:Hemangiopericytoma is an aggressive vascular tumour that rarely affects the central nervous system and is even more rarely spinal in presentation. The clinical features of a patient with a recurrent extraspinal hemangiopericytoma presenting with an epidural spinal cord compression by local invasion are described, including a review of the literature on metastatic hemangiopericytoma to the spine.Methods:A case of a 53-year-old male, with a recurrent extraspinal hemangiopericytoma which metastasized to the thoracic spine five years after detection of the primary tumour is presented. A chart review was conducted where all pertinent history, physical, laboratory, and radiological data were collected. A Pub-Med search using the keyword “hemangiopericytoma” identified all reported cases documenting clinical features, treatment, recurrence and outcome with respect to metastatic hemangiopericytoma to the spine.Results:Nine patients have been reported to have metastatic hemangiopericytoma to the spine. The median patient age was 47 years and there was a slight male preference. An unusual feature of the hemangiopericytoma is the prolonged period, up to 16 years, between the diagnosis of the primary hemangiopericytoma and the metastases to the spine. All patients were treated with a combination of radiation and surgery.Conclusion:Hemangiopericytomas show a slow clinical evolution with a strong propensity to relapse long after previous treatment and thus, once identified, prolonged follow-up for recurrence is indicated. A close follow-up of these patients is required because of frequent recurrences and delayed metastases even if the primary lesion was well-controlled. Although overall uncommon, hemangiopericytoma should be kept in mind in the differential diagnosis of vascular epidural spinal cord tumours.
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Affiliation(s)
- Steven David Brass
- Department of Neurology, Harvard University, Brigham and Women's Hospital, Boston, MA, USA
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Ellsworth S. Methylprednisolone for the prophylaxis of pain flare: commentary on Yousef and El-mashad. J Pain Symptom Manage 2014; 48:759. [PMID: 25193607 DOI: 10.1016/j.jpainsymman.2014.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Susannah Ellsworth
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Yousef AAAM, El-Mashad NM. Pre-emptive value of methylprednisolone intravenous infusion in patients with vertebral metastases. A double-blind randomized study. J Pain Symptom Manage 2014; 48:762-9. [PMID: 24704801 DOI: 10.1016/j.jpainsymman.2013.12.232] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/29/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
Abstract
CONTEXT The vertebral column is the most common site of bone metastases irrespective of the primary tumor. Vertebral metastases are a major cause of motor deficit of the lower extremities. The use of radiotherapy is the treatment of choice in these patients. A temporary worsening of pain shortly during the course of palliative radiotherapy is clinically a common problem. Steroid infusion has well-documented neuroprotective effects. OBJECTIVES Our study objective is to evaluate the effect of pre-emptive infusion of methylprednisolone on pain flare and motor function in patients with vertebral metastases. METHODS One hundred twenty patients with vertebral metastases received short-course external beam radiotherapy as high-voltage irradiation with a 6 MeV, via linear accelerator. In addition to the short-course radiotherapy, 60 patients received pre-emptive methylprednisolone infusion (5 mg/kg) the day just before initiation of radiotherapy (Group 1 [G1]). The other 60 patients received short-course radiotherapy without pretreatment methylprednisolone infusion, and only normal saline was infused (Group 2 [G2]). The Brief Pain Inventory, incidence of pain flare during radiotherapy, and motor functions were evaluated using the Tomita scale at the time of initial assessment, at the end of external beam radiotherapy, and after two weeks. RESULTS Four patients (6.6%) in G1 experienced pain flare compared with 12 patients (20%) in G2 during the two-week short-course radiotherapy. The mean values of pain scores were significantly reduced in both groups at the end of radiotherapy; the mean value of worst, average, and current pain scores in G1 remained statistically significant in comparison to pretreatment and G2 mean values two weeks later. Significant increase was noticed in patients with normal motor and ambulatory status in G1 at two and four weeks of initial assessment. CONCLUSION Pre-emptive methylprednisolone infusion is an effective prophylactic agent in the prevention of radiation-induced pain flare and improves functional motor status after short-term radiotherapy in patients with vertebral metastases.
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Qiao J, Zhu F, Zhu Z, Liu Z, Qian B, Qiu Y. Conservative treatment for osteoid osteoma of the odontoid process of the axis: a case report. World J Surg Oncol 2014; 12:305. [PMID: 25287277 PMCID: PMC4197231 DOI: 10.1186/1477-7819-12-305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 09/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoid osteoma is a primary benign bone lesion, which constitutes about 10% of all primary benign bone tumors and 3% of all primary bone tumors. The spine is involved in 10% of the cases, and the lumbar spine is the most commonly affected whereas the tumor is rarely seen in the cervical spine. With regard to the osteoid osteoma being located at the odontoid process of the axis, limited cases have been reported in the literature. CASE PRESENTATION An osteoid osteoma of the odontoid process of the axis was diagnosed by computed tomography in an 18-year-old male patient with a 3-month history of pain. The patient's parents refused surgery for fear of surgical risks and high expense. Considering the benign nature of osteoid osteoma, we prescribed celecoxib 200 mg per day to the patient. With the treatment, the patient's pain was alleviated gradually and the range of motion of the cervical spine also recovered to normal. At the two-year phone follow-up, the patient was free of symptoms. CONCLUSIONS For this kind of benign tumor, conservative treatment plus close follow-up is applicable whereas surgery bears significant risks and a heavy economic burden.
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Affiliation(s)
- Jun Qiao
- Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008 China
| | - Feng Zhu
- Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008 China
| | - Zezhang Zhu
- Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008 China
| | - Zhen Liu
- Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008 China
| | - Bangping Qian
- Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008 China
| | - Yong Qiu
- Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008 China
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Bourlon MT, Kessler ER. What next? Choosing second-line therapy in progressive renal cell carcinoma. Oncology (Williston Park) 2014; 28:794-796. [PMID: 25225803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Monteagudo M, Palazón-García E, Lozano-Setién E, García-García J. [The 'black turbinate sign' in a case of rhinocerebral mucormycosis]. Rev Neurol 2014; 58:234-235. [PMID: 24570362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- María Monteagudo
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
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Affiliation(s)
- Christine Pocha
- University of Minnesota, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.
| | - James Roat
- University of Minnesota, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Kimberly Viskocil
- University of Minnesota, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
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Matamalas A, Gargallo A, Porcel JA, García de Frutos A, Pellisé F. Cervical spine epithelioid hemangioendothelioma: case report. Eur Rev Med Pharmacol Sci 2014; 18:72-75. [PMID: 24825046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Epithelioid Hemangioendothelioma (EHE) is a rare aggressive vascular tumor and can occur in almost all locations. Spine location is rare. There are just a few cases published in the literature and the longer series included only five cases. CASE REPORT We report a case of a 58-year-old woman who presented with anemia and cervical pain without neurological deficit. Radiological diagnosis revealed a C2-C3 mass with vertebral artery involvement and liver metastases. Partial resection and arthrodesis followed by radiotherapy and chemotherapy were performed. Local control of the diseases was achieved but distance metastasis appears two years after surgery. CONCLUSIONS EHE of the spine is extremely rare in clinic as a primary aggressive vascular tumor. Metastatic disease is the most important factor to predict prognosis. It is not clear in the literature which is the best surgical approach in this patients and it mainly depends of the location and systemic illness. En bloc resection or expanded resection supported with adjunct radiation therapy may present with acceptable results of local control of the tumor. Systemic disease control must be achieved with chemotherapy.
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Affiliation(s)
- A Matamalas
- Department of Orthopaedic Surgery of Vall Hebron Hospital, Barcelona, Spain.
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Yoneyama S, Yumura Y, Koizumi M, Hanai T, Ishida H, Hattori Y, Teranishi J, Miyoshi Y, Kondo K, Noguchi K. [Case of renal cell carcinoma with intertrabecular vertebral metastases detected f-18 fluorodeoxyglucose positron emission tomography and MRI]. Hinyokika Kiyo 2014; 60:29-32. [PMID: 24594770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report a case of renal cell carcinoma with intertrabecular vertebral metastases detected by F-18 fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) and magnetic resonance imaging (MRI). The patient was a 40-year-old female, referred to our hospital for fever of > 38°C, and loss of body weight. Examination showed anemia and elevated C-reactive protein (CRP). Abdominal enchanced CT showed a mass 3 cm in diameter, located on left kidney. She was diagnosed with left renal cell carcinoma (cT1aN0M0). Laparoscopic radical nephrectomy with a transabdominal approach was performed. Histological findings showed clear cell renal cell carcinoma G2>G3. Although after operation, she presented with fever of >38°C, anemia, and elevated CRP and alkaline phosphatase. Systemic bone scan could not detect any bone metastases, but FDG-PET/CT and lumber MRI revealed cancer invasion to the bone of the whole body. Histological findings at bone biopsy showed clear cell carcinoma infiltrating the marrow space. We diagnosed the case as bone metastases of intertrabecular vertebral type. She was treated with temsirolimus,but died about five months after her first visit. Intertrabecular vertebral metastases that infiltrate the marrow space without trabecular bone alteration are not visible on radiographs or bone scans. FDG-PET/CT and MRI are more useful for diagnosis of intertrabecular vertebral metastases such as in this case.
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Affiliation(s)
- Shuko Yoneyama
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Yasushi Yumura
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Mitsuyuki Koizumi
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Takahiro Hanai
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Hiroaki Ishida
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Yusuke Hattori
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Jyunichi Teranishi
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Yasuhide Miyoshi
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Keiichi Kondo
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
| | - Kazumi Noguchi
- The Department of Urology and Renal Transplantation, Yokohama City University Medical Center
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Choi WT, Stetsenko GY, Zhang J, Olerud JE, Argenyi ZB, George E. Cutaneous angiosarcoma clinically presenting as progressive solid facial edema in a 43-year-old male. Dermatol Online J 2013; 19:20409. [PMID: 24314784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 11/15/2013] [Indexed: 06/02/2023] Open
Abstract
Cutaneous angiosarcoma of the head and neck is a rare, highly malignant neoplasm; prognosis is heavily influenced by tumor size, resectability, and stage at initial diagnosis. Most patients present with one to several erythematous to violaceous patches, plaques, or nodules. However, the clinical presentation is highly variable and leads to delayed diagnosis. We report cutaneous angiosarcoma in a 43-year-old man who presented with an 11-month history of progressive solid (non-pitting) edema involving his entire face, scalp, eyelids, and neck without characteristic clinical features of cutaneous angiosarcoma. A skin biopsy had shown non-specific findings consistent with solid facial edema or rosacea. Various etiologies were considered but there was no significant improvement after directed medical therapy. Repeat skin biopsies revealed angiosarcoma involving the dermis and sub-cutis. Computed tomography (CT) of the chest showed multiple lung nodules bilaterally and a lytic lesion in the T6 vertebra consistent with metastases. He was treated with single agent chemotherapy (paclitaxel), and had a partial response that restored his ability to open both eyes spontaneously; However, his edema has recently progressed 7 months after diagnosis. This is a rare example of cutaneous angiosarcoma presenting as progressive solid facial edema, which underscores the diverse range of clinical manifestations associated with this neoplasm.
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Hong RX, Lin QJ, Luo J, Dai Z, Wang WN. [Clinical features and prognosis in 104 colorectal cancer patients with bone metastases]. Zhonghua Zhong Liu Za Zhi 2013; 35:787-791. [PMID: 24378104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate the clinical features and prognosis of bone metastases in colorectal cancer patients. METHODS The clinical data of 104 cases of colorectal cancer with bone metastasis were collected and retrospectively analyzed. RESULTS Among all the 104 patients included, 45 (43.3%) patients had multiple bone metastases, and 59 (56.7%) patients had single bone metastasis. Pelvis (46.1%) was the most common site, followed by thoracic vertebrae (41.3%), lumbar vertebrae (40.4%), sacral vertebrae (29.8%) and ribs (29.8%). One hundred and two patients (98.1%) were complicated with other organ metastases. The median time from colorectal cancer diagnosis to bone metastasis was 16 months, and the median time from bone metastasis to first skeletal-related events (SREs) was 1 month. The most common skeletal-related events (SREs) were the need for radiotherapy (44.2%), severe bone pain (15.4%) and pathologic fracture (9.6%). The median survival time of patients with bone metastases was 10.0 months, and 8.5 months for patients with SREs. ECOG score, systemic chemotherapy and bisphosphonate therapy were prognostic factors by univariate analysis (all P < 0.05). ECOG score and systemic chemotherapy were independent prognostic factors by Cox multivariate analysis. CONCLUSIONS Bone metastasis in colorectal cancer patients has a poor prognosis and the use of chemotherapy and bisphosphonates may have a benefit for their survival.
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Affiliation(s)
- Ruo-xi Hong
- Department of Medical Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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43
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Shimada A, Sugimoto KJ, Wakabayashi M, Imai H, Sekiguchi Y, Nakamura N, Sawada T, Ota Y, Komatsu N, Noguchi M. Primary sacral non-germinal center type diffuse large B-cell lymphoma with MYC translocation: a case report and a review of the literature. Int J Clin Exp Pathol 2013; 6:1919-1928. [PMID: 24040459 PMCID: PMC3759501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 07/30/2013] [Indexed: 06/02/2023]
Abstract
An 85-year-old man presented with pain and numbness in the left buttock, and physical examination revealed an approximately 7 cm mass extending from the first to the third sacral vertebrae; biopsy of the mass led to the diagnosis of CD10-negative, BCL6-weakly positive, MUM1-positive, non-germinal center (non-GC) type diffuse large B-cell lymphoma (DLBCL). Furthermore, serological testing showed negative results for Epstein-Barr virus (EBV) infection, and fluorescence in situ hybridization (FISH) revealed a MYC translocation. Radiographs showed no remarkable osteolytic bone destruction, and the patient was staged with Stage IAE. After 8 cycles of rituximab therapy and 6 cycles of CHOP therapy, complete remission has been maintained until now, approximately 1 year after the treatment. Primary sacral lymphoma is very rare, with only 6 reported cases, including the present one. A review of the reported cases revealed that the disease predominantly affects elderly men, is usually non-GC-type DLBCL and stage IAE, measures approximately 2-7 cm in diameter in general, and does not show early recurrence after chemotherapy or chemoradiotherapy. There is no report in the literature yet of primary sacral DLBCL with MYC translocation, and this is the first case report. On the other hand, 35 cases of CD10-negative DLBCL with MYC translocation, including the present one, have been reported, and a review of the reported cases showed that the disease predominantly affects Asians, middle-aged or elderly men, shows positivity for either BCL6 or MUM1 and negativity for EBV, and has a high international prognostic index and poor prognosis.
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MESH Headings
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biopsy
- Genetic Predisposition to Disease
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Lymphoma, Large B-Cell, Diffuse/chemistry
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Magnetic Resonance Imaging
- Male
- Phenotype
- Positron-Emission Tomography
- Proto-Oncogene Proteins c-myc/genetics
- Remission Induction
- Sacrum/pathology
- Spinal Neoplasms/chemistry
- Spinal Neoplasms/drug therapy
- Spinal Neoplasms/genetics
- Spinal Neoplasms/pathology
- Tomography, X-Ray Computed
- Translocation, Genetic
- Treatment Outcome
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Affiliation(s)
- Asami Shimada
- Department of Hematology, Juntendo University Urayasu HospitalUrayasu, Japan
| | - Kei-Ji Sugimoto
- Department of Hematology, Juntendo University Urayasu HospitalUrayasu, Japan
| | - Mutsumi Wakabayashi
- Department of Hematology, Juntendo University Urayasu HospitalUrayasu, Japan
| | - Hidenori Imai
- Department of Hematology, Juntendo University Urayasu HospitalUrayasu, Japan
| | - Yasunobu Sekiguchi
- Department of Hematology, Juntendo University Urayasu HospitalUrayasu, Japan
| | - Noriko Nakamura
- Department of Clinical Laboratory, Juntendo University Urayasu HospitalUrayasu, Japan
| | - Tomohiro Sawada
- Department of Clinical Laboratory, Juntendo University Urayasu HospitalUrayasu, Japan
| | - Yasunori Ota
- Department of Pathology, Research Hospital, the Institute of Medical Science, the University of TokyoTokyo, Japan
| | - Norio Komatsu
- Department of Hematology, juntendo university school of medicineTokyo, Japan
| | - Masaaki Noguchi
- Department of Hematology, Juntendo University Urayasu HospitalUrayasu, Japan
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Affiliation(s)
- J Michael Bostwick
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Casamiquela KM, Cohen PR. Chemotherapy-associated tongue hyperpigmentation and blue lunula. J Drugs Dermatol 2013; 12:223-226. [PMID: 23377398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Combination chemotherapy is associated with cutaneous and mucosal side effects. Antineoplastic agents have been associated with mucosal and nail pigmentation. We describe a 16-year-old Saudi Arabian girl with combination chemotherapy-associated black tongue hyperpigmentation and blue lunula. The diagnosis of drug-associated pigmentary changes is based on correlating the onset of the clinical observations with the temporal initiation of the patient's chemotherapy agents. Spontaneous fading of antineoplastic therapy-induced tongue or nail dyschromia may subsequently occur following discontinuation of the causative drug.
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Affiliation(s)
- Kathleen M Casamiquela
- Department of Dermatology, The University of Texas Medical School at Houston, Houston, TX, USA
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Desai B, Gross ME, Jadvar H. Multimodality imaging in biochemical recurrence of prostate cancer: utility of (18)F-NaF PET/CT in early detection of metastasis. Rev Esp Med Nucl Imagen Mol 2012; 31:231-2. [PMID: 22980132 DOI: 10.1016/j.remn.2012.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 11/18/2022]
Affiliation(s)
- B Desai
- Department of Radiology, PET Imaging Science Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
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Wise-Milestone L, Akens MK, Lo VCK, Yee AJ, Wilson BC, Whyne CM. Local treatment of mixed osteolytic/osteoblastic spinal metastases: is photodynamic therapy effective? Breast Cancer Res Treat 2011; 133:899-908. [PMID: 22058005 DOI: 10.1007/s10549-011-1854-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 10/25/2011] [Indexed: 11/24/2022]
Abstract
The widespread use of systemic and local therapies aimed at spinal metastatic lesions secondary to breast cancer has increased the incidence of mixed osteolytic/osteoblastic patterns of bony disease. The complex structure of these lesions requires novel therapeutic approaches to both reduce tumor burden and restore structural stability. In photodynamic therapy (PDT), a minimally invasive approach can be used to employ light to activate a photosensitizing agent that preferentially accumulates in tumor tissue, leading to cell toxicity and death. Previous work in an osteolytic rat model (MT-1) demonstrated that PDT effectively ablates tumor and improves vertebral structural properties. The aim of this study was to assess the efficacy of PDT in a rat model of mixed osteolytic/osteoblastic spinal metastases. Mixed spinal metastases were generated through intracardiac injection of Ace-1 canine prostate cancer cells into female athymic rats (day 0). A single PDT treatment was applied to lumbar vertebra L2 of tumor-bearing and healthy control rats (day 14). PDT-treated and untreated control rats were euthanized and excised spines imaged with μCT to assess bone quality (day 21). Spines were mechanically tested or histologically processed to assess mechanical integrity, tumor burden, and remodelling properties. Untreated tumor-bearing vertebrae showed large areas of osteolysis and areas of immature, new bone formation. The overall bone quality resulting from these lesions consisted of decreased structural properties but without a significant reduction in mechanical integrity. PDT was shown to significantly decrease tumor burden and osteoclastic activity, thereby improving vertebral bone structural properties. While non-tumor-bearing vertebrae exhibited significantly more new bone formation following PDT, the already heightened level of new bone formation in the mixed tumor-bearing vertebrae was not further increased. As such, the effect of PDT on mixed metastases may be more influenced by suppression of osteoclastic resorption as opposed to the triggering of new bone formation.
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Affiliation(s)
- L Wise-Milestone
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, UB-19, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
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Amrani Raissouni T, Moya Espinosa P, Ramos Moreno E, Martínez Del Valle Torres MD, Sanz Viedma S, Ortega Lozano SJ. [Bisphosphonate-induced osteonecrosis of the jaw in a patient with metastatic breast cancer]. Rev Esp Med Nucl 2011; 30:322-323. [PMID: 21440957 DOI: 10.1016/j.remn.2010.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 12/10/2010] [Accepted: 12/10/2010] [Indexed: 05/30/2023]
Affiliation(s)
- T Amrani Raissouni
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de la Victoria, Málaga, España
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Slovacek L, Priester P, Petera J, Slanska I, Kopecky J. Tamoxifen/norfloxacin interaction leading to QT interval prolongation in a female patient with extracranial meningioma. BRATISL MED J 2011; 112:353-354. [PMID: 21692412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The authors report on a case of tamoxifen/norfloxacin interaction leading to QT interval prolongation in an 83-year-old female patient with extracranial meningioma treated with radiation and hormonal therapy (with Tamoxifen). This case report highlights the potential risk of tamoxifen causing depression of electrical impulse in sinoatrial node, leading to symptomatic sinus bradycardia with prolonged QT interval. At the same time it indicates the need to be on the look out for drug interactions (in our case between tamoxifen and norfloxacin), as well as to be aware of other drugs possibly inducing QT interval prolongation (Fig. 2, Ref. 7).
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Affiliation(s)
- L Slovacek
- Clinical Oncology and Radiation Therapy Department, Charles University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic.
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