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Intracranial Metastases from Prostate Carcinoma: Classification, Management, and Prognostication.

前列腺癌颅内转移: 分类、处理和预后。

  • 影响因子:1.52
  • DOI:10.1016/j.wneu.2019.10.125
  • 作者列表:"Ganau M","Gallinaro P","Cebula H","Scibilia A","Todeschi J","Gubian A","Nannavecchia B","Signorelli F","Pop R","Coca HA","Proust F","Chibbaro S
  • 发表时间:2020-02-01
Abstract

BACKGROUND:Prostate carcinomas rarely metastasize to the central nervous system but, when they do, dural localizations are as common as and far more aggressive than intraparenchymal ones. Those metastases can be further classified according to their extension toward the subdural or extradural space and can frequently simulate other pathologic conditions including chronic subdural hematomas, abscess, and primary bone tumors. Beside the challenges of the preoperative differential diagnostic and complexity of surgical planning and operative excision, subdural metastases seem to carry a much poorer prognosis. METHODS:A series of consecutive patients admitted during a 12-year period through our oncall pathway for subdural/extradural collections or intraparenchymal lesions found, on histologic analysis, to represent intracranial prostate cancer metastases was retrospectively reviewed. RESULTS:A total of 19 patients were included, but only 3 were diagnosed with small cell prostate carcinoma, while the majority had a primary prostate adenocarcinoma. Metastases could be classified as pure subdural space lesions, dural-based lesions, extradural/bony lesions, and pure intraparenchymal lesions. All patients with subdural metastases and 3 out of 5 patients with dural-based lesions required an emergency intervention due to rapidly deteriorating neurologic status. The mean follow-up in our series was 37 months; only subdural localizations had a remarkably unfavorable outcome. CONCLUSIONS:Supported by our experience and the review of the literature, we suggest that a low threshold for contrast-enhanced computed tomography/magnetic resonance imaging is advisable in case of suspicious subdural collection, even in an emergency setting, for patients with previous medical history of prostate cancer.

摘要

背景: 前列腺癌很少转移到中枢神经系统,但当它们转移时,硬脑膜定位与实质内的一样常见,并且比实质内的侵袭性更强。这些转移可根据其向硬膜下或硬膜外间隙的扩展进一步分类,并可频繁模拟其他病理情况,包括慢性硬膜下血肿、脓肿和原发性骨肿瘤。除了术前鉴别诊断的挑战和手术计划和手术切除的复杂性之外,硬膜下转移瘤的预后似乎要差得多。 方法: 在 12 年期间通过我们的oncall通路收治的一系列连续患者,在组织学分析中发现硬膜下/硬膜外集合或实质内病变,为了代表颅内前列腺癌转移进行回顾性分析。 结果: 共纳入 19 例患者,但只有 3 例诊断为小细胞癌,而大多数为原发性前列腺腺癌。转移瘤可分为单纯硬膜下间隙病变、以硬脑膜为基础的病变、硬膜外/骨性病变和纯实质内病变。所有硬膜下转移的患者和 5 例以硬膜为基础的病变患者中 3 例因神经功能状态迅速恶化而需要紧急干预。我们系列的平均随访时间为 37 个月; 只有硬膜下定位的结果非常不利。 结论: 根据我们的经验和文献回顾,我们建议在可疑硬膜下集合的情况下,对比度增强计算机断层扫描/磁共振成像的低阈值是可取的。即使在紧急情况下,对于既往有前列腺癌病史的患者。

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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

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影响因子:2.83
发表时间:2020-01-01
DOI:10.1007/s00520-019-04843-9
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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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