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Önder T, Karaçin C, Kekilli E, Göksel F, Sertesen E, Onur ID, Ateş Ö, Yıldız F, Arslan ÜY. Predicting survival after brain metastases in patients with bladder cancer. J Clin Neurosci 2024; 125:146-151. [PMID: 38815300 DOI: 10.1016/j.jocn.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
AIMS AND OBJECTIVES Because of its rarity, limited data concerning brain metastasis (BM) from bladder cancer (BCa) are available, so this phenomenon remains unclear. We aimed to contribute to understanding this unique patient population's clinical behavior and outcomes. METHODS/MATERIALS This retrospective cohort study included 27 BCa patients with BM treated at our Cancer Institute between April 2009 and December 2022. The time from initial diagnosis to BM and overall survival from BM diagnosis were calculated (Kaplan-Meier method). Cox regression was used to test key clinicopathologic associations. RESULTS A total of 27 patients were included in the study (male/female = 23/4). The median patient age at BM diagnosis was 62.0 (47-79) years. The median interval from initial diagnosis to BM was 11.0 ± 2.59 (95 % CI, 5.91-16.08) months. Twenty (74.0 %) patients were diagnosed with BM by postsymptomatic imaging. The most common symptoms were headache-dizziness (n = 9, 33.3 %), seizure (n = 3, 11.1 %), hemiparesis (n = 2, 7.4 %), and vision defects (n = 2, 7.4 %). The most common sites of extracranial metastasis were the lung (n = 10, 52.6 %), bone (n = 7, 36.8 %), and lymph nodes (n = 6, 31.5 %). More than half of the patients (55.5 %) had multiple BMs. Eight (29.6 %) patients underwent surgery for BM. All of the patients received radiotherapy (RT) for BM (whole-brain radiotherapy (WBRT)/stereotactic radiotherapy (SRT) = 24/3), and eight patients received RT for the second time. Six patients were treated with systemic chemotherapy (CT) after BM. The median survival from BM was 3.0 ± 1.2 (95 % Cl, 0.4-5.5) months in the entire cohort. A low number of BMs (HR 0.270, 95 % CI 0.083-0.885; p = 0.031), surgery for BM (HR 0.174, 95 % CI 0.043-0.712; p = 0.015), CT after BM (HR 0.207, 95 % CI 0.057-0.755; p = 0.017), and better ECOG performance score (HR 0.248, 95 % CI 0.074-0.836; p = 0.025) were associated with better OS. CONCLUSIONS Factors associated with improved survival in BCa patients with BM include a few brain lesions, intracranial resection, CT after BM, and better ECOG performance scores. Larger-scale prospective studies are needed to define the optimal management strategy further.
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Affiliation(s)
- T Önder
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey.
| | - C Karaçin
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - E Kekilli
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - F Göksel
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - E Sertesen
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - I Deliktaş Onur
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - Ö Ateş
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - F Yıldız
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - Ü Y Arslan
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
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Verheijen EJ, Taal W, Tewari RDN, Giessen MC, Roshani H. Isolated cerebellar metastasis from urothelial carcinoma: A case report of a rare phenomenon. BRAIN & SPINE 2023; 3:102716. [PMID: 38105804 PMCID: PMC10724209 DOI: 10.1016/j.bas.2023.102716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/18/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
Introduction Although urothelial carcinoma (UC) generally is non-invasive, contrastingly in 25% of patients UC metastasizes. Isolated central nervous system (CNS) metastasis from UC without other distant metastases are considered rare. In this report we describe a patient with an isolated and solitary cerebellar metastasis from UC. Research question In this case report we explore the value of histological analysis of CNS metastases, imaging, treatment options and survival. Material and methods A rare case is presented of a patient diagnosed with an isolated CNS metastasis originating from UC. Through a systematic review of literature route of dissemination, current imaging and treatment options, and survival are discussed. Results A 77-year-old male was diagnosed with a pT2N0M0 high-grade UC and treated with transurethral resection and chemoradiation therapy. Several months later, the patient presented with neurological symptoms, and radiological imaging revealed a solitary cerebellar mass. A body CT scan showed no other metastasis. After surgical resection, histology confirmed urothelial origin of the mass, matching his primary UC and the patient received post-operative stereotactic radiotherapy at the surgical site. Recurrence of the cerebellar mass occurred after 6 months for which the patient received re-resection. The patient died 5.5 months after re-resection. Discussion and conclusion Isolated brain metastases without other distant metastases from UC are rare, so histologic confirmation of the brain metastasis is essential, particularly when the time interval between diagnosis of the UC and brain metastasis increases. Early brain CT is not recommended. PET CT may have additional value in detection of other distant metastases from UC. Despite advancements in treatments, prognosis for CNS metastasis from UC remains poor.
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Affiliation(s)
| | - Walter Taal
- Neurology, Haga Teaching Hospital, The Hague, the Netherlands
- Department of Neurology/Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | - Hossain Roshani
- Departments of Urology, Haga Teaching Hospital, The Hague, the Netherlands
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Zhu LK, Li ZJ, Wang ZB, Chen JT, Zhang HJ, Zhao XW, Liu HY. A rare case of bladder cancer that metastasized to brain, heart, and lung lymph nodes benefited from immunotherapy. World J Surg Oncol 2022; 20:402. [PMID: 36529739 PMCID: PMC9762084 DOI: 10.1186/s12957-022-02876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Bladder cancer is a common malignant tumor of the genitourinary system, with the primary cause of death being metastasis. The most common metastatic sites are the lymph nodes, liver, lung, bone, peritoneum, pleura, kidney, adrenal gland, and the intestine. Brain and heart metastases are rare. In this report, we describe a patient who had pulmonary lymph node metastases more than a year after being diagnosed with bladder cancer, followed by brain and cardiac metastases more than two years later. Following the failure of standard first-line chemotherapy, the patient accepted 6 cycles of tislelizumab immunotherapy. The re-examination revealed that the bilateral frontal brain metastases had vanished, the right temporal lobe metastases had been greatly decreased, the neurological symptoms had been alleviated, and the cardiac metastases had disappeared. This is a rare clinical case with encouraging effects of tislelizumab and can serve as a model for the treatment of similar patients.
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Affiliation(s)
- Lian-kai Zhu
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Zhong-jian Li
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Zhi-bo Wang
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Jin-tao Chen
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Hua-jun Zhang
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Xu-wei Zhao
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Hong-yao Liu
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
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Song KW, Budhu J, Isroff C, Siegmund S, Gonzalez Castro LN. Clinical Problem Solving: A 56-Year-Old Woman With Right Facial Weakness, Numbness, and Diplopia. Neurohospitalist 2022; 12:512-515. [DOI: 10.1177/19418744221074456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We discuss a case of a middle-aged woman with a history of urothelial carcinoma, who presented with subacute progression of double vision, right facial numbness, and back pain. Her MRI brain and spine demonstrated multifocal enhancing lesions at the skull base and throughout the spine. Since her initial serum and cerebrospinal fluid (CSF) studies were unrevealing, she underwent a biopsy of her skull base lesion, which was initially concerning for infection. However, her symptoms worsened despite appropriate antibiotic therapy, necessitating a spinal root biopsy that was consistent with leptomeningeal urothelial carcinoma. Her case illustrates the challenge of accurately diagnosing isolated leptomeningeal metastatic disease, which can be difficult to diagnose from CSF analysis and often requires multiple lumbar punctures to improve sensitivity. While genitourinary cancers rarely metastasize to the CNS, clinicians should retain high suspicion for neoplastic etiologies of leptomeningeal disease in patients with a history of cancer and new neurologic deficits.
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Affiliation(s)
- Kun-Wei Song
- Neurology Department, Brigham and Women’s Hospital, Boston, MA, USA
- Neurology Department, Massachusetts General Hospital, Boston, MA, USA
- Neuro-Oncology Department, Dana-Farber Cancer Center, Boston MA, USA
| | - Joshua Budhu
- Neurology Department, Brigham and Women’s Hospital, Boston, MA, USA
- Neurology Department, Massachusetts General Hospital, Boston, MA, USA
- Neuro-Oncology Department, Dana-Farber Cancer Center, Boston MA, USA
| | - Catherine Isroff
- Neurology Department, Brigham and Women’s Hospital, Boston, MA, USA
- Neurology Department, Massachusetts General Hospital, Boston, MA, USA
| | | | - L. Nicolas Gonzalez Castro
- Neurology Department, Brigham and Women’s Hospital, Boston, MA, USA
- Neuro-Oncology Department, Dana-Farber Cancer Center, Boston MA, USA
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Silveira LA, Adams D, DeWitt J, Skidd P, Tranmer B. Urothelial cell carcinoma presenting with rapid visual deterioration, a case of rare brain metastases with unique clinical presentation. Br J Neurosurg 2021; 37:1-4. [PMID: 33629613 DOI: 10.1080/02688697.2021.1887451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Urothelial cell carcinoma (UCC), the most common cancer of the urinary system, rarely metastasizes to the brain. 1-3 More rare still is the subset of patients with urothelial carcinoma brain metastases whose UCC primary is first diagnosed at the same time as their CNS metastatic disease, with oncologic workup prompted by CNS clinical manifestations.4 Paraneoplastic optic neuropathy (PON) is likewise a rare clinical entity, which has not yet been described in association with UCC brain metastases. CASE DESCRIPTION Herein, we present the sentinel case of UCC believed to be of endometrial origin in an 81 year old woman initially presenting with symptoms of fatigue, nausea, vertigo, and rapidly deteriorating vision over the course of 1 month. Visual deterioration prompted neuro imaging remarkable for multiple supratentorial and infratentorial metastases as well as likely neoplastic inflammatory involvement of the bilateral optic nerves. The patient underwent a right temporal open brain biopsy, with pathology findings consistent with UCC. Subsequent PET scanning demonstrated a heavy burden of disease including an FDG-avid uterine mass with local and distal extension of disease including bilateral hydroureteronephrosis with obstruction of the distal ureters. The patient and her family elected to pursue home hospice without further workup or intervention. CONCLUSIONS While this is the first such case presented, it is possible that UCC of the uterine wall represents a particularly aggressive form of the disease more prone to presenting with CNS metastases and PON.
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Affiliation(s)
| | - Dylan Adams
- Neurosurgery, UVM Medical Center, Burlington, VT, USA
| | - John DeWitt
- Neuropathology, UVM Medical Center, Burlington, VT, USA
| | - Philip Skidd
- Neuro-ophthalmology, Neurology, UVM Medical Center, Burlington, VT, USA
| | - Bruce Tranmer
- Neurosurgery, UVM Medical Center, Burlington, VT, USA
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Brenneman RJ, Gay HA, Christodouleas JP, Sargos P, Arora V, Fischer-Valuck B, Huang J, Knoche E, Pachynski R, Picus J, Reimers M, Roth B, Michalski JM, Baumann BC. Review: Brain Metastases in Bladder Cancer. Bladder Cancer 2020. [DOI: 10.3233/blc-200304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Nearly 50% of bladder cancer patients either present with metastatic disease or relapse distantly following initial local therapy. Prior to platinum-based chemotherapy, the incidence of bladder cancer central nervous system metastases was approximately 1%; however, their incidence has increased to 3–16% following definitive treatment as platinum-based regimens have changed the natural history of the disease. Bladder cancer brain metastases are generally managed similarly to those from more common malignancies such as non-small cell lung cancer, with surgery +/–adjuvant radiotherapy, or radiotherapy alone using stereotactic radiosurgery or whole brain radiotherapy. Limited data suggest that patients with inoperable urothelial carcinoma brain metastases who are not candidates for stereotactic radiosurgery may benefit from shorter whole brain radiation therapy courses compared to other histologies, but data is hypothesis-generating. Given improvements in the efficacy of systemic therapy and supportive care strategies for metastatic urothelial carcinoma translating in improved survival, the incidence of intracranial failures may increase. Immune checkpoint blockade therapy may benefit cisplatin-ineligible metastatic urothelial carcinoma patients as first-line therapy; however, the effectiveness of immune checkpoint blockade to treat central nervous system disease has not been established. In this review, we discuss the incidence and management of bladder cancer brain metastases and considerations regarding variations in management relative to more commonly encountered non-urothelial histologies.
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Affiliation(s)
- Randall J. Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hiram A. Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - John P. Christodouleas
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Paul Sargos
- Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Vivek Arora
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Jiayi Huang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric Knoche
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Russell Pachynski
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joel Picus
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa Reimers
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Bruce Roth
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Chandra AA, Kwon YS, Braver JK, Stanford BJ, Dave DS. Isolated Metastasis to the Brain From Upper Tract Urothelial Carcinoma. Urology 2020; 145:e8-e11. [PMID: 32791291 DOI: 10.1016/j.urology.2020.07.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/28/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
Isolated brain metastasis from cancers of urothelial origin are rare, especially after a long recurrence-free interval with few reports in the literature. We herein present the case of a 62 year old male with history of recurrent bladder cancers treated in 2004 and 2005 and a left distal ureteral high grade pT3aN1M0 urothelial cancer treated with distal ureterectomy and reimplant followed by adjuvant chemotherapy in 2014 who presented after a 5 year recurrence-free interval with tonic-clonic seizure. Further workup revealed an isolated 12.0 mm x 18.0 mm x 8.0 mm mass overlying the left parietal lobe with no other metastatic sites. The patient was treated with resection of the mass and adjuvant radiation therapy with pathology confirming metastatic carcinoma of urothelial origin. Though prognosis for patients with such a presentation remains poor, we provide a review of the current literature with respect to incidence, presentation and therapeutic considerations for such patients.
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Affiliation(s)
| | - Young Suk Kwon
- Division of Urology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ
| | - Joel K Braver
- Department of Radiation Oncology, Robert Wood Johnson University Hospital - Somerset, Somerville, NJ
| | - Brian J Stanford
- Department of Pathology & Laboratory Medicine, Robert Wood Johnson University Hospital - Somerset, Somerville, NJ
| | - Dhiren S Dave
- Division of Urology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ.
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Weiner AB, Pham MN, Isaacson DS, Ko OS, Breen KJ, Nadler RB. Predictors of use and overall survival for patients undergoing metastasectomy for bladder cancer in a national cohort. Int J Urol 2020; 27:736-741. [PMID: 32588523 DOI: 10.1111/iju.14288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the use of surgical resection of metastatic disease in a large national sample and its association with overall survival. METHODS The National Cancer Database was queried for patients with metastatic bladder cancer (2004-2016). Overall survival was assessed using Kaplan-Meier and multivariable Cox analyses. The associations between covariates and use of metastasectomy were assessed with multivariable logistic regression. RESULTS Of the 16 382 patients with metastatic bladder cancer included, 6.8% underwent metastasectomy. Its use increased over time (4.7% in 2004 to 6.6% in 2016; per year odds ratio 1.02, 95% confidence interval 1.00-1.04, P = 0.019). Median survival was 7.0 months for patients who received metastasectomy and 5.1 months for those who did not (hazard ratio 0.85, 95% confidence interval 0.79-0.91, P < 0.001). In subgroup analyses, metastasectomy predicted longer survival in patients with lung (hazard ratio 0.73, 95% confidence interval 0.61-0.88, P = 0.001) or brain metastases (hazard ratio 0.58, 95% confidence interval 0.35-0.96, P = 0.035) and in patients with variant histology (hazard ratio 0.80, 95% confidence interval 0.69-0.93, P = 0.003). CONCLUSIONS In a national sample, the use of metastasectomy for bladder cancer is low. Furthermore, metastasectomy is associated with longer survival overall and in multiple subgroups. However, these results should be validated in future studies.
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Affiliation(s)
- Adam B Weiner
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Minh N Pham
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dylan S Isaacson
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Oliver S Ko
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kieran J Breen
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert B Nadler
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Yao Z, Zheng Z, Ke W, Wang R, Mu X, Sun F, Wang X, Garg S, Shi W, He Y, Liu Z. Prognostic nomogram for bladder cancer with brain metastases: a National Cancer Database analysis. J Transl Med 2019; 17:411. [PMID: 31815624 PMCID: PMC6902467 DOI: 10.1186/s12967-019-2109-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/26/2019] [Indexed: 12/29/2022] Open
Abstract
Background This study aimed to establish and validate a nomogram for predicting brain metastasis in patients with bladder cancer (BCa) and assess various treatment modalities using a primary cohort comprising 234 patients with clinicopathologically-confirmed BCa from 2004 to 2015 in the National Cancer Database. Methods Machine learning method and Cox model were used for nomogram construction. For BCa patients with brain metastasis, surgery of the primary site, chemotherapy, radiation therapy, palliative care, brain confinement of metastatic sites, and the Charlson/Deyo Score were predictive features identified for building the nomogram. Results For the original 169 patients considered in the model, the areas under the receiver operating characteristic curve (AUC) were 0.823 (95% CI 0.758–0.889, P < 0.001) and 0.854 (95% CI 0.785–0.924, P < 0.001) for 0.5- and 1-year overall survival respectively. In the validation cohort, the nomogram displayed similar AUCs of 0.838 (95% CI 0.738–0.937, P < 0.001) and 0.809 (95% CI 0.680–0.939, P < 0.001), respectively. The high and low risk groups had median survivals of 1.91 and 5.09 months for the training cohort and 1.68 and 8.05 months for the validation set, respectively (both P < 0.0001). Conclusions Our prognostic nomogram provides a useful tool for overall survival prediction as well as assessing the risk and optimal treatment for BCa patients with brain metastasis.
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Affiliation(s)
- Zhixian Yao
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Zhong Zheng
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Wu Ke
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Renjie Wang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Xingyu Mu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Feng Sun
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Xiang Wang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China
| | - Shivank Garg
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Sidney Kimmel Cancer Center, Philadelphia, PA, USA
| | - Wenyin Shi
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Sidney Kimmel Cancer Center, Philadelphia, PA, USA.
| | - Yinyan He
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China.
| | - Zhihong Liu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Shanghai, 200080, People's Republic of China.
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Ding ZS, He YH, Deng YS, Peng PX, Wang JF, Chen X, Zhao PY, Zhou XF. MicroRNA-34a inhibits bladder cancer cell migration and invasion, and upregulates PTEN expression. Oncol Lett 2019; 18:5549-5554. [PMID: 31612063 DOI: 10.3892/ol.2019.10877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/27/2019] [Indexed: 12/27/2022] Open
Abstract
MicroRNA-34a (miR-34a) serves as a tumor suppressor in a number of different types of cancer. The present study was performed to investigate the involvement of miR-34a in bladder cancer. In the present study, miR-34a was downregulated in patients with bladder cancer compared with the healthy controls in bladder biopsies and plasma. Downregulation of miR-34a distinguished between patients with bladder cancer and the healthy controls. miR-34a expression was associated with tumor metastasis; however, not with tumor size. Transfection of miR-34a mimics upregulated the expression of phosphatase and tensin homolog (PTEN) in bladder cancer cells, and decreased cell migration and invasion. miR-34a may inhibit bladder cancer cell migration and invasion by upregulating PTEN. miR-34a may additionally serve as a potential therapeutic target for bladder cancer.
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Affiliation(s)
- Zhen-Shan Ding
- Department of Urology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Yu-Hui He
- Department of Urology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, P.R. China
| | - Yi-Sen Deng
- Department of Urology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, P.R. China
| | - Pan-Xin Peng
- Department of Urology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, P.R. China
| | - Jian-Feng Wang
- Department of Urology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Xing Chen
- Department of Urology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Pei-Yu Zhao
- Department of Urology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Xiao-Feng Zhou
- Department of Urology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
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Wang Y, Xu Z, Wang X. miRNA-373 promotes urinary bladder cancer cell proliferation, migration and invasion through upregulating epidermal growth factor receptor. Exp Ther Med 2018; 17:1190-1195. [PMID: 30679992 PMCID: PMC6327664 DOI: 10.3892/etm.2018.7061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/10/2018] [Indexed: 01/07/2023] Open
Abstract
MicroRNA (miRNA)-373 has been demonstrated to be involved in several types of cancer, whereas its involvement in urinary bladder cancer and the mechanism of its function remains poorly understood. The present study aimed to investigate the functionality of miRNA-373 in urinary bladder cancer. Tumor tissues and adjacent healthy tissues were collected from patients with urinary bladder cancer (n=55), and blood samples were collected from patients with urinary bladder cancer and healthy controls (n=45). The expression of miRNA-373 in these tissues was detected by reverse transcription quantitative polymerase chain reaction. The diagnostic value of serum miRNA-373 for urinary bladder cancer was investigated by receiver operating characteristic curve analysis and survival curve analysis, respectively. miRNA-373 mimics were transfected into urinary bladder cancer cells, and the effects on cancer cell proliferation, migration and invasion, and on epidermal growth factor receptor (EGFR) expression was assessed by Cell Counting kit-8 assay, Transwell migration and invasion assays, and western blot analysis. It was identified that the miRNA-373 expression level was increased in tumor tissues compared with adjacent healthy tissues. The serum level of miRNA-373 was increased in patients with cancer compared with the healthy controls. Serum miRNA-373 may be used to accurately predict urinary bladder cancer. miRNA-373 overexpression promoted tumor cell proliferation, migration and invasion, and resulted in upregulated EGFR expression in urinary bladder cancer cells. It was concluded that miRNA-373 overexpression may promote urinary bladder cancer cell proliferation, migration and invasion by upregulating EGFR.
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Affiliation(s)
- Yibing Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Zhenqun Xu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Xia Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
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Global DNA demethylation as an epigenetic marker of human brain metastases. Biosci Rep 2018; 38:BSR20180731. [PMID: 30254100 PMCID: PMC6200709 DOI: 10.1042/bsr20180731] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/20/2018] [Accepted: 08/24/2018] [Indexed: 12/29/2022] Open
Abstract
Brain metastases are the most common intracranial tumors in adults. They usually originate from: lung, breast, renal cell and gastrointestinal cancers, as well as melanoma. Prognosis for brain metastases is still poor and classical treatment combining surgery and radiation therapy should be strongly supported with molecular approaches. However, their successful application depends on a deep understanding of not only genetic, but also epigenetic background of the disease. That will result in an earlier and more precise diagnosis, successful treatment, as well as individualized estimation of clinical outcomes and prognosis. It has already been shown that the epigenetic machinery plays a crucial role in cancer biology, development, and progression. Therefore, we decided to look for metastasis through changes in the most studied epigenetic mark, 5-methylcytosine (m5C) in DNA. We performed global analysis of the m5C contents in DNA isolated from the brain metastatic tumor tissue and peripheral blood samples of the same patients, using thin layer chromatography separation of radioactively labeled nucleotides. We found that the m5C level in DNA from brain metastases: changes in the broad range, overlaps with that of blood, and negatively correlates with the increasing tumor grade. Because the amount of m5C in tumor tissue and blood is almost identical, the genomic DNA methylation can be a useful marker for brain metastases detection and differentiation. Our research creates a scope for future studies on epigenetic mechanisms in neuro-oncology and can lead to development of new diagnostic methods in clinical practice.
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Abstract
Brain metastases (BM) are the most commonly diagnosed type of central nervous system tumor in the United States. Estimates of the frequency of BM vary significantly, as there is no nationwide reporting system for metastases. BM may be the first sign of a previously undiagnosed cancer, or occur years or decades after the primary cancer was diagnosed. Incidence of BM varies significantly by primary cancer site. Lung, breast, and melanoma continue to be the leading cause of BM. These tumors are increasingly more common as new therapeutics, advanced imaging, and improved screening have led to lengthened survival after primary diagnosis for cancer patients. BM are difficult to treat, and for most individuals the diagnosis of BM generally portends a poor prognosis.
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Affiliation(s)
- Quinn T Ostrom
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Christina Huang Wright
- Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, United States
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
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14
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Patel V, Collazo Lorduy A, Stern A, Fahmy O, Pinotti R, Galsky MD, Gakis G. Survival after Metastasectomy for Metastatic Urothelial Carcinoma: A Systematic Review and Meta-Analysis. Bladder Cancer 2017; 3:121-132. [PMID: 28516157 PMCID: PMC5409038 DOI: 10.3233/blc-170108] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Cisplatin-based combination chemotherapy is standard treatment for metastatic urothelial carcinoma; however, the vast majority of patients experience disease progression. As systemic therapy alone is rarely curative for the treatment of metastatic urothelial cancer, not only are new therapies needed but also refinement of general treatment principles. Herein, we conducted a systematic review and meta-analysis to explore the role of metastasectomy in metastatic urothelial carcinoma. Methods: We conducted a systematic review of the literature regarding local treatment for metastatic urothelial carcinoma. An online electronic search of the PubMed/MEDLINE and EMBASE databases was performed to identify peer-reviewed articles. All procedures were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Information was then extracted including number of patients, gender, the site of the primary urothelial tumor, site of metastasis, chemotherapy before or after metastasectomy, overall survival (OS), and disease specific survival (DSS) after metastasectomy. A meta-analysis was performed with those studies with sufficient survival data to obtain pooled overall survival. The article quality was assessed using the Cochrane Handbook “risk of bias” tool. Results: Seventeen out of 3963 articles were eligible for review between 1990–2015, including a total of 412 patients. The mean time to recurrence after metastasectomy was 14.25 months. The overall survival from time of metastasectomy ranged from 2 to 60 months. Pooled analyses of studies reported survival data revealed an improved overall survival for patients treated with metastasectomy compared with non-surgical treatment of metastatic lesions (HR 0.63; 95% CI, 0.49–0.81). All, except for three studies, were retrospective and non-randomized, leading to a high risk of bias associated with patient selection, patient attrition, and reporting. Such high potential of selection bias may lead to higher OS than expected. Additionally, treatment and outcome details reported across studies was highly variable. Conclusions: Limited conclusions can be drawn from the available literature exploring the role of metastasectomy in the management of metastatic urothelial cancer due to lack of uniform reporting elements and multiple sources of bias particularly related to a lack of prospective randomized trials. As a subset of patients treated with metastasectomy achieve durable disease control, this approach may be considered for select patients.
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Affiliation(s)
- Vaibhav Patel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ana Collazo Lorduy
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Spanish Society of Medical Oncology, Madrid, Spain
| | - Aaron Stern
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Omar Fahmy
- Department of Urology, Universiti Putra Malaysia, Selangor, Malaysia
| | - Rachel Pinotti
- Information and Education Service, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew D Galsky
- Icahn School of Medicine at Mount Sinai, Division of Hematology and Medical Oncology, Tisch Cancer Institute, New York, NY, USA
| | - Georgios Gakis
- Urology and Nephrology Center, University of Mansoura, Mansoura, Egypt
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15
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Matsumoto K, Mochizuki K, Hirayama T, Ikeda M, Nishi M, Tabata KI, Okazaki M, Fujita T, Taoka Y, Iwamura M. Gemcitabine plus nedaplatin as salvage therapy is a favorable option for patients with progressive metastatic urothelial carcinoma after two lines of chemotherapy. Asian Pac J Cancer Prev 2016; 16:2483-7. [PMID: 25824784 DOI: 10.7314/apjcp.2015.16.6.2483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This study was conducted to evaluate the effectiveness of a combination of gemcitabine and nedaplatin therapy among patients with metastatic urothelial carcinoma previously treated with two lines of chemotherapy. Between February 2009 and August 2013, 30 patients were treated with gemcitabine and paclitaxel as a second-line chemotherapy. All had received a first-line chemotherapy consisting of methotrexate, vinblastine, doxorubicin and cisplatin. Ten patients who had measurable histologically proven advanced or metastatic urothelial carcinoma of the urinary bladder and upper urinary tract received gemcitabine 1,000 mg/m2 on days 1, 8 and 15 and nedaplatin 70 mg/m2 on day 2 as a third-line chemotherapy. Tumors were assessed by imaging every two cycles. The median number of treatment cycles was 3.5. One patient had partial response and three had stable disease. The disease-control rate was 40%, the median overall survival was 8.8 months and the median progression-free survival was 5.0 months. The median overall survival times for the first-line and second-line therapies were 29.1 and 13.9 months, respectively. Among disease-controlled patients (n=4), median overall survival was 14.2 months. Myelosuppression was the most common toxicity. There were no therapy-related deaths. Gemcitabine and nedaplatin chemotherapy is a favorable third-line chemotherapeutic option for patients with metastatic urothelial carcinoma. Given the safety and benefit profile seen in this study, further prospective trials are warranted given the implications of our results with regard to strategic chemotherapy for patients with advanced or metastatic urothelial carcinoma.
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Affiliation(s)
- Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan E-mail :
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16
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Urothelial Superior Vena Cava Syndrome with Limited Response to Radiation Therapy. Case Rep Oncol Med 2015; 2015:513685. [PMID: 26634162 PMCID: PMC4655034 DOI: 10.1155/2015/513685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/19/2015] [Indexed: 11/26/2022] Open
Abstract
Radiation therapy (RT) is the standard of care for cases of superior vena cava (SVC) syndrome secondary to metastatic adenopathy. Histologies vary in radiosensitivity and response time, making alternative therapies such as chemotherapy and/or intravenous stenting preferable alternative options for certain diagnoses. Metastatic urothelial carcinoma is a particularly rare cause of SVC syndrome with only 3 cases reported in the literature. Consequently, optimal management remains challenging, particularly in cases of high tumor burden. Here we present a case of highly advanced metastatic urothelial cancer with SVC syndrome and tracheal compression. The patient started urgent RT but expired midway through her treatment course due to systemic progression of disease, requiring SVC and tracheal stenting. The authors review the literature including discussion of the few other known cases of SVC syndrome due to urothelial carcinoma and a review of this histology's response to RT. This experience suggests, that in cases of SVC syndrome with widespread advanced disease, stenting and chemotherapy with or without RT may be the most important initial treatment plan, depending on goals of care.
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17
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Recurrent ureteric transitional cell carcinoma presenting as an isolated brain metastasis: incidental detection with 18F-FDG PET/CT. Clin Nucl Med 2015; 40:273-4. [PMID: 25275417 DOI: 10.1097/rlu.0000000000000597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Brain metastasis from transitional cell carcinoma (TCC) of the ureter is extremely rare. Here we present a case of a 73-year-old woman, a follow-up case of ureteric TCC in whom isolated brain metastasis was incidentally detected at follow-up 18F-FDG PET/CT. This was corroborated with MRI. She underwent excision of the lesion, and histopathology confirmed metastatic TCC.
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18
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Vaa B, Kohli M, Price KA, Swetz KM. Solitary cystic cerebellar metastasis in a patient with invasive transitional cell carcinoma of the bladder. BMJ Case Rep 2014; 2014:bcr-2013-200137. [PMID: 24920508 DOI: 10.1136/bcr-2013-200137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Transitional cell carcinoma of the bladder (TCC) represents nearly 90% of genitourinary malignancies and typically presents with locally invasive symptoms. Metastasis to the central nervous system (CNS) is uncommon occurring in <5% of patients. When present, metastatic lesions are typically solid, isolated and located in the cerebrum. We report a case of a patient with a history of TCC who presented with lethargy and ataxia and was found to have a solitary cystic cerebellar lesion consistent with metastatic disease. Unfortunately, the prognosis for patients with TCC and CNS metastases is poor. Treatment options include debulking surgery, whole brain radiation, stereotactic radiosurgery and chemotherapy. Unfortunately, treatment may not appreciably extend survival and care is often supportive in previously reported cases. Though uncommon, TCC can metastasise to the CNS and should be considered in the differential diagnosis of patients, particularly those who were treated with aggressive surgery or combination chemotherapy previously.
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Affiliation(s)
| | - Manish Kohli
- Mayo Clinic, Rochester, Minnesota, USA Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katharine A Price
- Mayo Clinic, Rochester, Minnesota, USA Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Keith Mark Swetz
- Mayo Clinic, Rochester, Minnesota, USA Department of General Internal Medicine/Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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19
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Choi YJ, Gabikian P, Zhu F, Appelbaum DE, Wollmann R, Lukas RV. Advanced neuroimaging studies in a patient with brain metastases from transitional cell carcinoma of the bladder. J Neuroimaging 2013; 24:429-31. [PMID: 23551927 DOI: 10.1111/jon.12024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 11/28/2012] [Accepted: 01/01/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE The differential diagnosis in single or oligo-brain lesions in metastatic cancer patients remains broad. Advanced imaging studies can be employed to help refine the differential and potentially guide treatment. METHODS Case report of a 52-year-old male patient with known transitional cell carcinoma of the bladder presented with headaches, cognitive symptoms, and episodic presyncope. Brain magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and octreotide scans were performed to evaluate the underlying etiology of his symptoms. RESULTS MRI revealed two enhancing mass lesions in left temporal and left cerebellar locations. Both lesions were octreotide avid and MRS of the temporal lesion showed a single large lipid peak at 1.3 ppm, a small NAA peak, and a markedly increased choline:creatine ratio that was relatively characteristic for metastases. Pathology from surgical resection revealed transitional cell carcinoma of the bladder. CONCLUSIONS Resection of both lesions revealed metastatic transitional cell carcinoma. This is the first report of octreotide scan characteristics in a patient with transitional cell carcinoma with central nervous system (CNS) metastases. The octreotide avidity of these transitional cell CNS metastases suggests the presence of somatostatin receptors that may be considered as a potential therapeutic target.
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Affiliation(s)
- Yoon J Choi
- Departments of Neurology, University of Chicago, Chicago, IL
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20
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Menendez JY, Bauer DF, Shannon CN, Fiveash J, Markert JM. Stereotactic radiosurgical treatment of brain metastasis of primary tumors that rarely metastasize to the central nervous system. J Neurooncol 2012; 109:513-9. [PMID: 22870850 DOI: 10.1007/s11060-012-0916-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 06/14/2012] [Indexed: 12/12/2022]
Abstract
We evaluated the local control of gamma knife stereotactic radiosurgery (GKSRS) in the treatment of cerebral metastases from primary tumors that rarely metastasize to the central nervous system (CNS). There is little published data on this subject with very few series on specific primary tumors. We present our experience treating these lesions with GKSRS combined with a review of the salient literature. A retrospective study of 36 patients who collectively underwent 44 GKSRS procedures for CNS metastatic disease was undertaken. Our series includes four patients with sarcoma, two with prostate cancer, three with thyroid cancer, five with endometrial cancer, seven with ovarian cancer, two with cervical cancer, six with esophageal cancer, two with bladder cancer, one with liver cancer, one with pancreatic cancer, and three with testicular cancer. With 44 gamma knife sessions treating 74 tumors, 63 tumors showed no radiographic evidence of progression, and 13 tumors demonstrated radiographic progression between one and 12 months after gamma knife treatment. In six patients in the population, further treatment with GKSRS was necessary due to enlargement of untreated lesions or new metastatic disease. GKSRS for uncommon CNS metastases is appears to be efficacious in controlling the treated tumor. The majority of tumors treated in our study did not progress post gamma knife.
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Affiliation(s)
- Joshua Y Menendez
- Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, FOT 1060, 1530 3rd Avenue South, Birmingham, AL 35294, USA.
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21
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Kyritsis AP, Markoula S, Levin VA. A systematic approach to the management of patients with brain metastases of known or unknown primary site. Cancer Chemother Pharmacol 2011; 69:1-13. [DOI: 10.1007/s00280-011-1775-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 10/20/2011] [Indexed: 12/13/2022]
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22
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Moon KS, Jung S, Lee KH, Hwang EC, Kim IY. Intracranial metastasis from primary transitional cell carcinoma of female urethra: case report & review of the literature. BMC Cancer 2011; 11:23. [PMID: 21244713 PMCID: PMC3033851 DOI: 10.1186/1471-2407-11-23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 01/19/2011] [Indexed: 11/16/2022] Open
Abstract
Background Transitional cell carcinoma (TCC) of the female urethra is a rare urological malignancy, and intracranial metastasis of this cancer has not yet been reported in the literature. This review is intended to present a case of multiple intracranial metastasis in a female patient with a remote history of primary urethral TCC. Case Presentation A 49-year-old woman, presented with a prolapsed mass in urethral orifice that was diagnosed as primary urethral TCC with distant lung and multiple bone metastases. The patient subsequently underwent chemotherapy under various regimens. A year later, the patient developed headache and vomiting which as was found to be due to multiple intracranial metastasis. The patient underwent surgical resection of the largest lesion located on the cerebellum, and consecutively gamma knife radiosurgery was performed for other small-sized lesions. Pathological examination of the resected mass revealed a metastatic carcinoma from a known urethral TCC. Serial work-up of systemic metastasis revealed concomitant aggravation of lung, spleen, and liver metastasis. The patient died of lung complication 2 months after the diagnosis of brain metastasis. Conclusion To the best of our knowledge, this is the first reported case of cerebral metastasis from primary urethral TCC, with pathological confirmation. As shown in intracranial metastasis of other urinary tract carcinoma, this case occurred in the setting of uncontrolled systemic disease and led to dismal prognosis in spite of aggressive interventional modalities.
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Affiliation(s)
- Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea
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23
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Bex A, Sonke GS, Pos FJ, Brandsma D, Kerst JM, Horenblas S. Symptomatic brain metastases from small-cell carcinoma of the urinary bladder: The Netherlands Cancer Institute experience and literature review. Ann Oncol 2010; 21:2240-2245. [PMID: 20427346 DOI: 10.1093/annonc/mdq225] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The incidence of symptomatic brain metastases in small-cell carcinoma of the urinary bladder (SCBC) is unknown. This precludes advice about prophylactic cranial irradiation (PCI). PATIENTS AND METHODS The medical records of all patients with SCBC seen at The Netherlands Cancer Institute from 1993 to 2009 (n = 51) were reviewed. Limited disease (LD) was defined as any pT, cN₀₋₁, and cM₁. Patients with LD were offered bladder-preserving treatment involving combined chemoradiotherapy. Patients with extensive disease (ED) were treated with palliative chemotherapy. PCI was not applied in any patient. RESULTS Among 39 patients with LD, median disease-specific survival was 35 months. Four developed symptomatic brain metastases after a median follow-up of 15 months (range 3-24) and were treated with whole-brain radiotherapy. No patient with ED developed symptomatic brain metastases during a median follow-up of 6 months. The reported incidence of brain metastases in SCBC in the literature ranges between 0% and 40%. On the basis of all reported series, the pooled estimate of the cumulative incidence of brain metastases is 10.5% (95% confidence interval 7.5% to 14.1%). CONCLUSIONS The incidence of symptomatic brain metastases from SCBC is significantly lower than that from small-cell lung cancer. Therefore, we do not routinely advise PCI in patients with SCBC.
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Affiliation(s)
| | | | - F J Pos
- Department of Radiation Oncology
| | - D Brandsma
- Department of Neuro-Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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24
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Hypofractionated whole-brain radiotherapy for multiple brain metastases from transitional cell carcinoma of the bladder. Int J Radiat Oncol Biol Phys 2010; 78:404-8. [PMID: 20171794 DOI: 10.1016/j.ijrobp.2009.07.1717] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 07/22/2009] [Accepted: 07/23/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE Brain metastases in bladder cancer patients are extremely rare. Most patients with multiple lesions receive longer-course whole-brain radiotherapy (WBRT) with 10 × 3 Gy/2 weeks or 20 × 2 Gy/4 weeks. Because its radiosensitivity is relatively low, metastases from bladder cancer may be treated better with hypofractionated radiotherapy. This study compared short-course hypofractionated WBRT (5 × 4 Gy/1 week) to longer-course WBRT. METHODS AND MATERIALS Data for 33 patients receiving WBRT alone for multiple brain metastases from transitional cell bladder carcinoma were retrospectively analyzed. Short-course WBRT with 5 × 4 Gy (n = 12 patients) was compared to longer-course WBRT with 10 × 3 Gy/20 × 2 Gy (n = 21 patients) for overall survival (OS) and local (intracerebral) control (LC). Five additional potential prognostic factors were investigated: age, gender, Karnofsky performance score (KPS), number of brain metastases, and extracranial metastases. The Bonferroni correction for multiple tests was used to adjust the p values derived from the multivariate analysis. p values of <0.025 were considered significant. RESULTS At 6 months, OS was 42% after 5 × 4 Gy and 24% after 10 × 3/20 × 2 Gy (p = 0.31). On univariate analysis, improved OS was associated with less than four brain metastases (p = 0.021) and almost associated with a lack of extracranial metastases (p = 0.057). On multivariate analysis, both factors were not significant. At 6 months, LC was 83% after 5 × 4 Gy and 27% after 10 × 3/20 × 2 Gy (p = 0.035). Improved LC was almost associated with a KPS of ≥70 (p = 0.051). On multivariate analysis, WBRT regimen was almost significant (p = 0.036). KPS showed a trend (p = 0.07). CONCLUSIONS Short-course WBRT with 5 × 4 Gy should be seriously considered for most patients with multiple brain metastases from bladder cancer, as it resulted in improved LC.
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25
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Stereotactic radiosurgery as a therapeutic strategy for intracranial metastatic prostate carcinoma. J Neurooncol 2009; 96:369-74. [PMID: 19609490 DOI: 10.1007/s11060-009-9966-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
Abstract
Intracranial metastatic prostate carcinoma is rare. We sought to determine the clinical outcomes after Gamma Knife stereotactic radiosurgery (GKSRS) for patients with intracranial prostate carcinoma metastases. We studied data from 10 patients who underwent radiosurgery for 15 intracranial metastases (9 dural-based and 6 parenchymal). Six patients had radiosurgery for solitary tumors and four had multiple tumors. The primary pathology was adenocarcinoma (eight patients) and small cell carcinoma (two patients). All patients received multimodality management for their primary tumor (including resection, radiation therapy, androgen deprivation therapy) and eight patients had evidence of systemic disease at time of radiosurgery. The mean tumor volume was 7.7 cm(3) (range 1.1-17.2 cm(3)) and a median margin dose of 16 Gy was administered. Two patients had progressive intracranial disease in spite of fractionated partial brain radiation therapy (PBRT) prior to SRS. A local tumor control rate of 85% was achieved (including patients receiving boost, upfront and salvage SRS). New remote brain metastases developed in three patients (33%) and one patient had repeat SRS for tumor recurrence. The median survival after radiosurgery was 13 months and the 1-year survival rate was 60%. SRS was a well tolerated and effective therapy either alone or as a boost to fractionated radiation therapy in the management of patients with intracranial prostate carcinoma metastases.
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26
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Zennami K, Yamada Y, Nakamura K, Aoki S, Taki T, Honda N. Solitary brain metastasis from pT1, G3 bladder cancer. Int J Urol 2008; 15:96-8. [DOI: 10.1111/j.1442-2042.2007.01935.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Kolla SB, Hemal AK. An unusual case of transitional cell carcinoma of renal pelvis presenting with brain metastases. Int Urol Nephrol 2007; 39:747-50. [PMID: 17203346 DOI: 10.1007/s11255-006-9155-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2006] [Accepted: 11/13/2006] [Indexed: 11/30/2022]
Abstract
We report a rare case, who had presented with a constellation of neurological symptoms (due to multiple brain metastases), but without any urological symptoms, to the department of neurosurgery. The patient was managed with gamma knife stereotactic radiosurgery for the metastatic lesions. During an evaluation for primary, he was found to be having transitional cell carcinoma (TCC) of right renal pelvis, for which palliative radical nephroureterectomy was performed, following which he received four cycles of paclitaxel and carboplatin chemotherapy. The patient is alive with stable disease at 22-months follow-up.
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Affiliation(s)
- Surendra B Kolla
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029, India
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28
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Ammerman JM, Baggenstos M, Jones RV, Sweet J, Goldstein K, Caputy AJ. Multiple metachronous brain metastases from primary ureteral carcinoma. Urology 2006; 68:673.e9-12. [PMID: 16979725 DOI: 10.1016/j.urology.2006.03.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2005] [Revised: 02/26/2006] [Accepted: 03/27/2006] [Indexed: 10/24/2022]
Abstract
Transitional cell carcinoma (TCC) of the ureter is an uncommon urologic malignancy, with approximately 150 cases diagnosed annually. Metastatic brain disease from ureteral TCC is exceedingly rare. To our knowledge, our case report represents only the second report of brain metastasis from ureteral TCC and the only reported patient to undergo resection of their TCC brain metastasis.
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Affiliation(s)
- Joshua M Ammerman
- Department of Neurological Surgery, George Washington University School of Medicine, Washington, DC 20037, USA.
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29
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Davies BJ, Bastacky S, Chung SY. Large cerebellar lesion as original manifestation of transitional cell carcinoma of the bladder. Urology 2003; 62:749. [PMID: 14550465 DOI: 10.1016/s0090-4295(03)00662-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with transitional cell carcinoma of the bladder classically present with irritative voiding symptoms or painless hematuria. Common sites of vascular metastases include the liver (38%), lung (36%), bone (27%), adrenal glands (21%), and intestine (13%). Vascular metastasis to the brain, without a prior history of chemotherapy, is extremely rare. To our knowledge, this is the first report of a patient with bladder transitional cell carcinoma whose original presentation was from a symptomatic, metastatic, cerebellar lesion.
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Affiliation(s)
- Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA
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