No abstract

The most common sites of metastatic differentiated thyroid cancer are the neck lymph nodes, while distant metastases typically involve the lungs, the bones, and less frequently the brain. Uncommon metastatic sites include the liver, adrenal gland, kidney, pancreas, and skin. The epidemiological aspects of thyroid metastases in rare sites are largely unknown and their identification could have a significant impact on patients management. A mini-series of unusual metastatic sites of thyroid carcinoma is proposed as a contribution to current knowledge on anatomopathological characteristics and clinical outcome. Of the six cases that were assessed, the metastases were the following: skin metastases (2), skin and pancreas metastases (1), renal metastasis (1), adrenal metastasis (1), and liver metastasis (1). In our experience, metastases in rare sites do not always represent a negative prognostic factor for disease outcome. In fact they can occur as single distant lesion and if surgically resectable, their treatment can also lead to local disease remission.

Aims To determine the efficacy of MGMT depletion plus BCNU (carmustine) therapy and the impact of methylation status in adults with glioblastoma (GBM) and gliosarcoma. Methods Methylation analysis was performed on GBM patients with adequate tissue samples. Patients with newly-diagnosed GBM or gliosarcoma were eligible for this Phase III open-label clinical trial. At registration patients were randomized to Arm 1: O6-BG + BCNU (reduced dose) plus radiation therapy (RT) or Arm 2: BCNU plus radiation therapy. Results One hundred eighty-three patients with newly diagnosed GBM or gliosarcoma were enrolled from 42 United States institutions; 90 eligible patients received O6-BG + BCNU plus radiation therapy (RT), and 89 received BCNU plus RT. The trial was halted at first interim analysis per stopping guidelines due to futility (less than 40% improvement on O6BG + BCNU arm). Following adjustment for stratification factors, there was no significant difference in overall (OS) or progression-free survival (PFS) between the two groups (one sided p=0.94 and p=0.88 respectively). Median OS was 11 months (95% c.i. 8 – 13 months) for patients on the O6BG+BCNU arm and 10 months (95% c.i. 8 – 12) for the BCNU arm. PFS was 4 months for patients in each arm. Adverse events were reported in both arms, with significantly more grade 4 and 5 events in the experimental arm. Conclusions The addition of O6-BG to the standard regimen of radiation and BCNU for treatment of newly-diagnosed glioblastoma and gliosarcoma did not offer added benefit and in fact caused additional toxicity.

Short-course RT in elderly NMSC patients produces >90% local control of disease.