BACKGROUND: The staging system for non–small cell lung cancer (NSCLC) does not consider tumor burden or number of metastatic sites, although oligometastases are more favorable. METHODS: Using log‐rank testing, the authors analyzed overall survival (OS) in 1284 patients newly presenting with metastatic NSCLC by number of metastatic organ sites and the presence of brain metastases. RESULTS: OS for patients without brain metastases was found to be correlated with the number of metastatic sites (P = .0009). Brain metastases conferred an inferior OS (median of 7 months vs 9 months; 95% confidence interval, 7‐8 months vs 8‐10 months [P = .00,002]). To evaluate the influence of tumor burden on OS, the authors considered subsets of patients in whom the brain (n = 135) or lung (n = 137) was the solitary metastatic organ site. In patients with brain metastases, OS was found to be correlated inversely with the volume of all metastases or the largest lesion (hazards ratio, 1.04 or 1.03, respectively; P = .01). For patients with lung metastases, OS was better for those with a maximum tumor size below the median of 40 mm (P = .0004). CONCLUSIONS: Staging of NSCLC and clinical trial patient stratification should include quantitation of tumor burden. The prognostic impact of brain metastases is small and partly dependent on tumor volume, which indicates the need for aggressive therapy for patients with NSCLC brain metastasis and their inclusion in clinical trials. Cancer 2009. © 2009 American Cancer Society.

Background We carried out this study to define the incidence of radiographic retropharyngeal lymph node (RPLN) involvement in oropharyngeal cancer (OPC) and its impact on clinical outcomes, which have not been well established to date. Methods Our departmental database was queried for patients irradiated for OPC from 2001–2007. Analyzable patients were those with imaging data available for review to determine radiographic RPLN status. Demographic, clinical, and outcomes data were retrieved and analyzed. Results The cohort consisted of 981 patients. Median follow up was 69 months. The base of tongue (47%) and tonsil (46%) were the most common primary sites. The majority of patients had T1-2 primaries (64%) and 94% stage 3-4B disease. IMRT was used in 77%, and systemic therapy was delivered to 58%. The incidence of radiographic RPLN involvement was 10% and highest for pharyngeal wall (23%) and lowest for base of tongue tumors (6%). RPLN adenopathy correlated with a number of patient and tumor factors. RPLN involvement was associated with poorer 5-year outcomes on univariate analysis (p <.001 for all): local control (79% vs. 92%), nodal control (80% vs. 93%), recurrence-free (51% vs. 81%), distant metastases-free (66% vs. 89%), and overall survival (52% vs. 82%), and maintained significance for local control (p=.023), recurrence-free (p=.001), distant metastases-free (p=.003), and overall survival (p=.001) on multivariate analysis. Conclusions In this cohort of nearly 1000 patients investigating radiographic RPLN adenopathy in OPC, RPLN involvement was observed in 10% of patients and portends a negative influence on disease recurrence, distant relapse, and survival.

BACKGROUND AND PURPOSE: ECD is a rare non-Langerhans-cell histiocytosis, which can involve the CNS; therefore, CNS imaging findings have been described in only a small number of patients. To gain additional insight into the CNS manifestations of ECD, we reviewed the findings on imaging of the brain, head and neck, and spine in patients with ECD who presented to our institution. Here, we illustrate manifestations that have not, to our knowledge, been previously described.

SUMMARY:We report the imaging features of 4 cases of patients with papillary tumor of the pineal region, a tumor newly recognized in the 2007 World Health Organization "Classification of Tumors of the Nervous System." In each case, the tumor was intrinsically hyperintense on T1-weighted images with a characteristic location in the posterior commissure or pineal region. The pathologic hallmarks of the tumor are discussed, including a possible explanation for the MR imaging characteristics in our cases. P rimary papillary tumors of the central nervous system and particularly the pineal region are rare. Papillary tumor of the pineal region (PTPR) is a recently described neoplasm that has been formally recognized in the 2007 World Health Organization (WHO) "Classification of Tumors of the Nervous System."1 Histologic features and immunohistochemical staining distinguish this type of papillary tumor from other papillary-like tumors that occur in the region. [2][3][4][5][6][7] It is postulated that the masses arise from the specialized ependymocytes of the subcommissural organ located in the lining of the posterior commissure. 4 There are documented cases in the neuropathology and neurosurgery literature but limited descriptions of MR imaging features.7-9 Here, we present 4 patients who underwent MR imaging and surgical resection of tumors in the posterior commissure and pineal region where the pathologic diagnosis was a PTPR. Case Reports Case 1A 27-year-old woman presented with headache and hydrocephalus. MR imaging at 1.5T revealed a mass centered between the posterior commissure and pineal region, which compressed the tectum and aqueduct (Fig 1). The mass was hyperintense on noncontrast T1-weighted images and enhanced heterogeneously after administration of gadolinium.The patient underwent ventriculostomy and surgical resection of the mass. Gross and histologic examinations of the mass did not display evidence of hemorrhage, calcification, melanin, keratin debris, or fat. Focal calcification was present in the adjacent pineal gland, which was displaced to the left. The pineal gland was normal on histologic examination. Case 2A 51-year-old woman presented with a headache and impairment of upward gaze. Imaging demonstrated a mass centered on the posterior commissure with mass effect on the pineal gland, aqueduct, and posterior third ventricle (Fig 2A). As in case 1, there was intrinsic hyperintensity on T1-weighted images throughout the mass on 1.5T unenhanced sequences. Small cystic areas were present in the mass, and the solid portions of the mass enhanced heterogeneously. Resection of the mass was accomplished by an infratentorial-supracerebellar approach, and immunohistochemical profiling confirmed the mass to be a PTPR. Case 3A 50-year-old woman presented with a 3-year history of gait imbalance, fatigue, and short-term memory loss. She reported a recent episode of confusion associated with weakness of the right lower extremity and was taken to the emergency department, where a 1.5T MR imaging examination demons...

No abstract