We report a breast cancer patient with leptomeningeal carcinomatosis (LM) who showed an excellent objective and subjective response to letrozole, with a progression-free survival of 16 months. We think that despite the poor prognosis and short survival of patients with LM, early diagnosis and treatment with appropriate hormonal manipulation may improve the outcome and achieve prolonged palliation in selected hormone-positive breast cancer patients with LM. Possible clues predicting the response were also evaluated in the context of literature data.

AIM: To retrospectively evaluate the overall survival (OS) of patients with brain metastases (BMs) who had been treated with whole brain radiotherapy (WBRT) and Gamma Knife (GK) according to prognostic factors and prognostic index scores. MATERIAL and METHODS: The study included 91 patients with BMs who had been treated with WBRT and/or GK between 2014 and 2017. The patients with BMs were retrospectively evaluated regarding age, sex, Karnofsky Performance Status (KPS), recursive partitioning analysis (RPA) class, basic score for BM (BS-BM), Graded Prognostic Assessment (DS-GPA) index, primary tumour type, extracranial metastases, primary tumour control, number of BMs, and brain metastasectomy. A univariate analysis of the OS was performed using the Kaplan-Meier method, supplemented by the log-rank test. We also applied a multivariate survival analysis using the Cox regression model. RESULTS: The median OS for all patients with BMs was 6 months. Meanwhile, the median OSs for those with WBRT, GK, and WBRT-GK treatment were 6, 4, and 15 months, respectively (p=0.00). In the multivariate analysis, the female sex (p=0.030), brain metastasectomy (p=0.047), treatment with WBRT-GK (p=0.001), and the controlled primary tumour (p=0.007) significantly correlated with the OS. Furthermore, the BS-BM (p=0.022) was closely related with the OS compared to the RPA and DS-GPA in the multivariate analysis. CONCLUSION: The BS-BM was found to better predict the survival of patients with BMs according to the prognostic index scores in the multivariate analysis. Thus, our data suggest that the BS-BM is the most appropriate prognostic index.

A 65-year-old female patient presented with complaints of abdominal pain, nausea, vomiting, constipation, and inability to perform defecation. The patient complained of abdominal pain and constipation for several days, and these symptoms were exacerbated, nausea and vomiting were added to these complaints on the day of admission. Physical examination revealed that abdominal guarding and tenderness, mainly located in the epigastric region. The patient had a history of previous total knee replacement surgery and ischemic stroke but had no history of trauma or abdominal surgery.

Akciğer kanserinde gelişen sistemik tedavi seçenekleri nedeniyle yaşam süresi uzamakta ve bu nedenle beyin metastazı insidansı da giderek artış göstermektedir. Stereotaktik radyocerrahinin tek ve oligo (iki-dört adet) beyin metastazı tedavisinde kullanılmaya başlanması bu konuda hızlı bir tedavi alternatifi olmasını sağlamıştır. Takip ettiğimiz akciğer kanserine bağlı beyin metastazlı olgularda retrospektif olarak stereotaktik radyocerrahi tedavisi etkinliğini, stereotaktik radyocerrahi tedavisine yanıtın difüzyon manyetik rezonans görüntüleme (MRG) ile değerlendirmenin konvansiyonel MRG'ye ek yararını ve klinik parametreler arası ilişkileri değerlendirmeyi amaçladık. YÖNTEM ve GEREÇLER: Kliniğimizde akciğer kanseri tanısı ile takip edilen, Batı Kooperatif Onkoloji Grubu (ECOG) performans statüleri 0-1 ve 1-4 arası beyin metastazı olan, Ocak 2016-Aralık 2017 tarihleri arasında stereotaktik radyocerrahi gören 79 olgunun verileri retrospektif olarak incelendi. BULGULAR: Hastaların medyan tanı yaşı 59 yıl (43-78) bulundu. Difüzyon MRG'nin tedavi yanıtını değerlendirmede ek yararı saptanmadı. Küçük hücreli ve küçük hücreli dışı akciğer kanseri alt gruplarında istatistiksel anlamlı mortalite farkı görülmemiştir. Beyin dışı diğer organlara metastaz varlığı tüm sağ kalım süresini azaltmış ve istatistiksel olarak anlamlı bulunmuştur (p=0,042). TARTIŞMA ve SONUÇ: Akciğer kanserine bağlı gelişen beyin metastazlı olgular genetik ve histopatolojik olarak heterojen bir hasta grubundan oluşmaktadır. Çalışmamızda, sadece stereotaktik radyocerrahi uygulanan olgularda, çok değişkenli analiz sonucu beyin metastazı dışı metastaz varlığının tüm sağ kalım süresini olumsuz etkilediğini göstermiştir.

In systemic sclerosis (SS) patients who are receiving treatment, findings of extra-parenchymal chest involvement (such as thymic abnormality, mediastinal lymph node enlargement) have been previously examined. However, these findings may be affected by medical treatment. Our aim was to evaluate the extra-parenchymal chest high-resolution computed tomography (HRCT) findings of patients with SS at the time of initial diagnosis. Methods: We retrospectively analyzed medical database of patients with SS. Chest HRCT images within 1 month after initial diagnosis of these patients were re-evaluated for the presence of distal esophageal dilatation, thymic hyperplasia, mediastinal lymph node enlargement, pleural or pericardial abnormalities (effusion or thickening). Intergroup comparisons were performed using independent t-test or a Mann-Whitney U test. To detect the relationship between continuous variables, Spearman's correlation coefficients and univariate correlations were used. Results: A total of 51 patients (45 women and 6 men, mean age + STD; 49.2 years+13.9) with SS were included in the study. Esophageal dilatation (88.2%) was the most common finding. Six patients (11.8%) had thymic enlargement. Mediastinal lymph node enlargement (11.8%) and pleural abnormalities (11.8%) were significantly more common in patients with SS diagnosed at late age (p<0.05). Conclusion: The extra-parenchymal findings are common in patients with SS at the time of initial diagnosis. Esophageal dilatation is usually present at the time of diagnosis in most patients with SS regardless of age.