Altered pattern of metastasis following treatment of Ewing's sarcoma with radiotherapy and adjuvant chemotherapy

Marsa, Gerald W.; Johnson, Ralph E.

doi:10.1002/1097-0142(197105)27:5<1051::aid-cncr2820270508>3.0.co;2-7

Cited by 65 publications

(15 citation statements)

References 11 publications

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“…Some authors have argued in favor of CNS prophylaxis in pediatric patients with solid cancers, especially Ewing sarcoma. 11 Their argument is predominantly based on the premise that systemic chemotherapy prevents systemic metastases but is prevented by the bloodbrain barrier from reaching the CNS and protecting it against brain metastasis. Trigg et al 23 reviewed data from National Cancer Institute protocols through July 1980 and compared the incidence of CNS involvement in Ewing sarcoma between 92 patients receiving CNS prophylaxis (WBRT of 2000 rads) and a single dose of intrathecal methotrexate (12 mg/m 2 ) and 62 patients not receiving any CNS prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center

Suki¹,

Abdulla²,

Ding³

et al. 2014

PED

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Object Metastasis to the brain is frequent in adult cancer patients but rare among children. Advances in primary tumor treatment and the associated prolonged survival are said to have increased the frequency of brain metastasis in children. The authors present a series of cases of brain metastases in children diagnosed with a solid primary cancer, evaluate brain metastasis trends, and describe tumor type, patterns of occurrence, and prognosis. Methods Patients with brain metastases whose primary cancer was diagnosed during childhood were identified in the 1990–2012 Tumor Registry at The University of Texas M.D. Anderson Cancer Center. A review of their hospital records provided demographic data, history, and clinical data, including primary cancer sites, number and location of brain metastases, sites of extracranial metastases, treatments, and outcomes. Results Fifty-four pediatric patients (1.4%) had a brain metastasis from a solid primary tumor. Sarcomas were the most common (54%), followed by melanoma (15%). The patients' median ages at diagnosis of the primary cancer and the brain metastasis were 11.37 years and 15.03 years, respectively. The primary cancer was localized at diagnosis in 48% of patients and disseminated regionally in only 14%. The primary tumor and brain metastasis presented synchronously in 15% of patients, and other extracranial metastases were present when the primary cancer was diagnosed. The remaining patients were diagnosed with brain metastasis after initiation of primary cancer treatment, with a median presentation interval of 17 months after primary cancer diagnosis (range 2–77 months). At the time of diagnosis, the brain metastasis was the first site of systemic metastasis in only 4 (8%) of the 51 patients for whom data were available. Up to 70% of patients had lung metastases when brain metastases were found. Symptoms led to the brain metastasis diagnosis in 65% of cases. Brain metastases were single in 60% of cases and multiple in 35%; 6% had only leptomeningeal disease. The median Kaplan-Meier estimates of survival after diagnoses of primary cancer and brain metastasis were 29 months (95% CI 24–34 months) and 9 months (95% CI 6–11 months), respectively. Untreated patients survived for a median of 0.9 months after brain metastasis diagnosis (95% CI 0.3–1.5 months). Those receiving treatment survived for a median of 8 months after initiation of therapy (95% CI 6–11 months). Conclusions The results of this study challenge the current notion of an increased incidence of brain metastases among children with a solid primary cancer. The earlier diagnosis of the primary cancer, prior to its dissemination to distant sites (especially the brain), and initiation of presumably more effective treatments may support such an observation. However, although the actual number of cases may not be increasing, the prognosis after the diagnosis of a brain metastasis remains poor regardless of the management strategy.

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Section: Discussionmentioning

confidence: 99%

Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center

Suki¹,

Abdulla²,

Ding³

et al. 2014

PED

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“…Intraparenchymal metastases are much rarer 7,8,10,[12][13][14][15][16][17][18][19][20] and reported mainly in supratentorial region. In our first case there was one metastatic deposit in the cerebellum and two in the left cerebral hemisphere.…”

Section: Discussionmentioning

confidence: 99%

“…Since then many reports on the direct extension of the tumor to the skull and meninges have been published 1,[3][4][5] . This type of involvement is thought to occur in up to 56% of cases 1,7,8 . However intracerebral lesions are rare -the reported incidence is up to 4.3% 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Brain Metastases from Ewing's Sarcoma

Bekiesińska‐Figatowska¹,

Jurkiewicz

Raciborska³

2009

Neuroradiol J

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Ewing's sarcoma accounts for approximately 30% of primary malignant bone tumors, mainly in children and young adults. At the time of diagnosis many patients already have metastatic spread of the disease, most often to the lungs and skeletal system. Intracerebral metastases are rare - the reported incidence is up to 4.3%. We describe two cases of metastatic deposits within the brain tissue. Signal intensity of the lesions was similar to that of meningioma on all sequences. Strong homogenous enhancement after gadolinium administration was also similar to meningioma.

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“…This complication is still rare in nonhematologic malignancies. It has been reported with most nonhematologic tumors including the following: ovarian malignancies [12], breast cancer [4][5][6][7][8][9], Ewing's sarcoma [13], pleural mesothelioma [14], lung cancer [4][5][6][7][8][9], malignant melanoma [4,7], head and neck cancer [4], stomach cancer [5,8], pancreatic cancer [8], prostatic cancer [8,15], cardioesophageal junction and esophageal cancers [8], maxillary sinus cancer [8], squamous cell carcinoma of the skin [5], adenocarcinoma of unknown primary [4][5][6], carcinoid tumors [16,17], transitional cell carcinoma of the ureter [9], and squamous cell carcinoma of the vagina [9].…”

Section: Discussionmentioning

confidence: 99%

Carcinomatous meningitis from transitional cell carcinoma of the bladder: Case report

et al. 1989

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In the past decade, there has been an increasing awareness of central nervous system metastases as a frequent complication of some malignancies, particularly in lung, breast and hematologic cancers. However, the central nervous system remains an uncommon location for metastases from certain primary tumors including those from the genitourinary system. We report on a patient with transitional cell carcinoma of the bladder who was treated with combination chemotherapy, and during the course of his disease developed carcinomatous meningitis. We anticipate this unusual complication of bladder transitional cell carcinoma will be seen more frequently, especially in the light of available data from effective chemotherapeutic regimens. We report this patient to alert physicians to this complication and to consider using prophylactic measures in responding patients as is the case in other malignancies.

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Altered pattern of metastasis following treatment of Ewing's sarcoma with radiotherapy and adjuvant chemotherapy

Cited by 65 publications

References 11 publications

Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center

Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center

Brain Metastases from Ewing's Sarcoma

Carcinomatous meningitis from transitional cell carcinoma of the bladder: Case report

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