Curative radiotherapy of 70 Gy was given and control of the primary lesion was good Nasopharynx biopsy specimen showing sheets of hyperchromatic and pleomorphic tumor cells. Some inflammatory cell chiefly neutrophil infiltration is also evident. In August 3. Chemotherapy was suggested, but the patient refused. Subsequently, just over a year later, he returned with stable lung Fig. In , the lung lesions recurred, but the patient again refused treatment.
From January , PEFL cisplatin, epirubicin, 5-fluorouracil, leucovorin was given for four courses, with partial response of the lung metastases. In December , multiple bone metastases developed. The patient was now in a serious condition, with dyspnea at rest due to multiple lung metastases, pain from the bone metastases, and liver metastases.
Starting in October , single-agent ifosfamide 2. In the first course, the patient received only 2 days of treatment before high fever developed with grade 4 leucopenia and infection, and subsequent cycles were reduced to 1. In January , whole-body bone scan and abdominal sonography showed resolution of all the bone and liver lesions and a chest X-ray showed only residual fibrotic changes in the lungs Fig.
In January , a CT scan showed multiple nodules over both lungs and the liver. The patient had poorly controlled non-insulin dependent diabetes mellitus, complicated by azotemia, and was not willing to receive any more therapy. He died in July , just over 10 years after the initial diagnosis and 82 months after diagnosis of metastatic disease. Chest radiograph taken in , showing multiple metastatic lesions with several central cavitation foci over the bilateral lung fields, mostly in both lower lobes. Chest radiograph disclosing multiple cavitary lesions over both lung fields in As compared with the previous films taken in , no obvious change is evident without treatment.
Our patient survived 82 months from the time metastatic disease was first diagnosed and almost 10 years from the first presentation. This may have reflected the biologic behavior of his disease, having attained a 3. Reports of long-term survival of patients with nasopharyngeal carcinoma after development of metastatic disease have been limited. In the largest serial report of 17 long-term survivors who survived more than two years after initial diagnosis of metastatic disease, analysis concluded that patients with only intrathoracic metastases, showing complete response to chemotherapy, and one patient with a completely resectable thyroid metastasis, were able to survive prolonged periods of more than 5 years 8.
Comparable survival data have also been reported for three other patients with a similar scenario of lung-only metastases 5. Shorter survival periods were attained by patients with bone-only, or bone and intrathoracic metastases 8. The longest survivor was a year-old man in whom multiple foci of pulmonary metastases were reduced to a single focus after chemotherapy cisplatin-based. Radiotherapy was then given to the residual pulmonary disease and the patient remained clinically disease-free months later 8 , 9.
Other reports have included a patient who received an anti-lymphoma regimen consisting of cyclophosphamide, vincristine, procarbazine and prednisolone 20 , and survived at least 12 years; the histology of the tumor was reviewed and confirmed to be anaplastic carcinoma Nasopharyngeal carcinoma is a very chemosensitive tumor.
Excellent response has been attained with cisplatin-based chemotherapy in patients with recurrent or previously untreated advanced nasopharyngeal carcinoma. The typical profile of a long-term survivor with metastatic disease would be: initial diagnosis before the age of 40 years 7 , 8 , long disease-free survival after initial radiotherapy prior to relapse, metastatic disease limited to the lung with or without mediastinal lymph node involvement , without local recurrence, and complete response to aggressive multimodal therapy 8 , the chemotherapy regimen being platinum based 8 , 11 , 18 and ifosfamide perhaps playing a potentially significant role.
Another unusual feature noted in our patient was the fact that metastatic disease remained stable and unchanged without any treatment for one year.
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Our patient underwent bronchoscopic biopsy at that time and the pathology was carcinoma, poorly differentiated type. Even after four previous chemotherapy combinations, the patient still attained near-complete remission with ifosfamide lasting 11 months. To date, there has been little information on single agent ifosfamide in NPC, although preliminary data have been reported Nasopharyngeal carcinoma patients with mainly thoracic metastases may still enjoy prolonged disease-free control if the tumor is chemosensitive.
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Google Scholar. Ming Jacqueline Liu. Ming Fang Wu. Anna Fen Yau Li. Chue Mei Tie. This population-based study indicates that the prognosis of patients with metastatic EC differs according to the site of DM, and also that multimodality treatment may improve OS in metastatic EC. Similarly to previous retrospective reports and autopsy studies of patients with metastatic EC, 12 — 15 the most common sites of DM in this study were the liver, followed by distant lymph nodes, lung, bone, and brain.
Notably, this study was based on a much larger sample size than the previous studies. Moreover, our analysis provides additional information on the prognostic impact of site-specific DM in metastatic EC. There are limited studies on the effect of the site of DM on survival in metastatic EC. In this study, patients with distant lymph node metastases had better OS than patients with liver metastases, while bone metastases were associated with poorer OS compared to liver metastases, especially in esophageal AC. We also observed similar OS rates for patients with liver, bone, or lung metastases in esophageal SCC.
Therefore, patients with stage IV EC represent a heterogeneous group that could potentially be classified by site-specific metastasis. In addition, the number of DM was also an independent prognostic factor for OS. These observations may help physicians more accurately assess the prognosis of patients with metastatic EC. In this study, patients with distant lymph node metastases had significantly longer OS median, 10 months than patients with DM to other sites.
Chao et al reported a similar median OS duration of In breast cancer, patients with bone metastases achieve significantly better survival than patients with metastasis to other sites. Bone metastases were also associated with poor survival in a population-based study of metastatic lung cancer. Overexpression of parathyroid hormone-related protein PTHrP is associated with increased risk of bone metastases in small cell lung cancer. There is no consensus on whether palliative radiotherapy or surgery is of value in metastatic EC.
Throat (Laryngeal) Cancer
Several retrospective and prospective studies have suggested that palliative radiotherapy could improve survival in metastatic EC. Radiotherapy and chemotherapy were independent favorable prognostic factors for OS, similarly to results in metastatic breast cancer, colorectal cancer, and renal cell carcinoma. In addition, these retrospective studies possess methodological defects.
Therefore, further studies are required to identify the subgroups of patients who may benefit from aggressive multimodality therapy. We should acknowledge that this study has several limitations. First, retrospective analyses may be inherently biased. Second, the SEER database lacks detailed information on comorbidities, which could lead to potential selection bias towards patients receiving a specific treatment. In addition, the SEER program only included five site-specific DM at the initial diagnosis, and we could not obtain further details concerning the other sites of DM. However, the radiotherapy and chemotherapy data had a high specificity.
In conclusion, in advanced EC, patients with bone metastases seem to have the poorest OS, while patients with distant lymph node metastases have the best OS. This study suggests that increased attention should be paid to the mechanisms and prognostic value of site-specific metastases. Furthermore, additional studies are required to identify the subset s of patients with advanced EC who may benefit from primary local treatment.
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This article has been cited by other articles in PMC. Abstract Background There are few population-based studies of the sites of distant metastasis DM and survival from esophageal cancer EC. Results We included patients in this study; the most common site of DM was the liver, followed by distant lymph nodes, lung, bone and brain.
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Conclusion Site of metastasis affects survival in metastatic EC; OS was worst for bone metastases and greatest for distant lymph node metastases. Keywords: esophageal cancer, SEER, bone metastases, liver metastases, lung metastases, brain metastases.
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Introduction Metastasis to distant organs is the leading cause of cancer-related deaths. Table 1 Characteristics of the patients with stage IV esophageal cancer. Open in a separate window. Table 2 Patterns of distant metastases for the patients with stage IV esophageal cancer. Survival outcomes and prognostic analysis Median OS was 6 and 5 months for patients with a single site of DM and multiple sites of DM, respectively. Table 3 Univariate Cox regression analysis of prognostic factors for overall survival in stage IV esophageal cancer.
Figure 1. Table 4 Multivariate Cox regression analysis of prognostic factors for overall survival in stage IV esophageal cancer. Figure 2. Discussion This population-based study indicates that the prognosis of patients with metastatic EC differs according to the site of DM, and also that multimodality treatment may improve OS in metastatic EC. Conclusion In conclusion, in advanced EC, patients with bone metastases seem to have the poorest OS, while patients with distant lymph node metastases have the best OS.
Footnotes Disclosure The authors report no conflicts of interest in this work. References 1. Tumor cell-organ microenvironment interactions in the pathogenesis of cancer metastasis. Endocr Rev. The seed and soil hypothesis revisited—the role of tumor-stroma interactions in metastasis to different organs. Int J Cancer. Cancer metastasis networks and the prediction of progression patterns. Br J Cancer. Genome-wide analysis of organ-preferential metastasis of human small cell lung cancer in mice. Mol Cancer Res. Global incidence of oesophageal cancer by histological subtype in Epidemiologic trends in esophageal and gastric cancer in the United States.
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Epidemiology, diagnosis, and management of esophageal adenocarcinoma. Esophageal cancer. N Engl J Med. Surgery combined with radiotherapy improved survival in metastatic esophageal cancer in a surveillance epidemiology and end results population-based study. Sci Rep. Autopsy findings in carcinoma of the esophagus.
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