Sarah H. Taylor

Metastatic patterns in adenocarcinoma

Unique metastatic patterns cited in the literature often arise from anecdotal clinical observations and autopsy reports. The authors analyzed clinical data from a large number of patients with histologically confirmed, distant‐stage adenocarcinoma to evaluate metastatic patterns.

Incidence of hypercalcemia in patients with malignancy referred to a comprehensive cancer center

Background. Hypercalcemia is a serious and not infrequent complication of malignant diseases; precise information about the incidence of hypercalcemia is not readily available. The study was designed to determine the incidence of hypercalcemia in patients with cancer.

Sarcoma metastatic to the brain: results of surgical treatment.

We report on 21 patients surgically treated for intraparenchymal brain metastasis from sarcoma, including six osteosarcomas, four leiomyosarcomas, three malignant fibrous histiocytomas, two alveolar soft-part sarcomas, two Ewings bone sarcomas, one extraskeletal osteosarcoma, one extraskeletal Ewings sarcoma, and two unclassified sarcomas. Median survival after craniotomy was 11.8 months. Patients with a preoperative Karnofsky performance score of > 70 survived for 15.7 versus 6.6 months for those with a Karnofsky performance score < or = 70. Patients. undergoing complete resection survived 14.0 versus 6.2 months for patients undergoing incomplete resection. Patients with evidence of lung metastases at the time of surgery survived 11.8 months, which was similar to the 10.5-month survival for patients with disease limited to the brain. The two patients with alveolar soft-part sarcoma are alive at 16 and 25 months after surgery. We conclude that surgery is effective in treating selected patients with sarcoma metastatic to the brain and that patients with metastasis from alveolar soft-part sarcoma may have a relatively good prognosis if they are surgically treated. The complete removal of all brain metastases and a Karnofsky performance score > 70 are associated with a favorable prognosis, whereas the presence of concurrent lung metastases is not a contraindication to surgery.

Number of metastatic sites is a strong predictor of survival in patients with nonsmall cell lung cancer with or without brain metastases

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.

Risk of intracranial hemorrhage and cerebrovascular accidents in non-small cell lung cancer brain metastasis patients

Background: Brain metastases confer significant morbidity and a poorer survival in non-small cell lung cancer (NSCLC). Vascular endothelial growth factor-targeted antiangiogenic therapies (AAT) have demonstrated benefit for patients with metastatic NSCLC and are expected to directly inhibit the pathophysiology and morbidity of brain metastases, yet patients with brain metastases have been excluded from most clinical trials of AAT for fear of intracranial hemorrhage (ICH). The underlying risk of ICH from NSCLC brain metastases is low, but needs to be quantitated to plan clinical trials of AAT for NSCLC brain metastases. Methods: Data from MD Anderson Cancer Center Tumor Registry and electronic medical records from January 1998 to March 2006 was interrogated. Two thousand one hundred forty-three patients with metastatic NSCLC registering from January 1998 to September 2005 were followed till March 2006. Seven hundred seventy-six patients with and 1367 patients without brain metastases were followed till death, date of ICH, or last date of study, whichever occurred first. Results: The incidence of ICH seemed to be higher in those with brain metastasis compared with those without brain metastases, in whom they occurred as result of cerebrovascular accidents. However, the rates of symptomatic ICH were not significantly different. All ICH patients with brain metastasis had received radiation therapy for them and had been free of anticoagulation. Most of the brain metastasis-associated ICH’s were asymptomatic, detected during increased radiologic surveillance. The rates of symptomatic ICH, or other cerebrovascular accidents in general were similar and not significantly different between the two groups. Conclusions: In metastatic NSCLC patients, the incidence of spontaneous ICH appeared to be higher in those with brain metastases compared with those without, but was very low in both groups without a statistically significant difference. These data suggest a minimal risk of clinically significant ICH for NSCLC brain metastasis patients and proposes having more well designed prospective trail to see the role of AAT in this patient population.

Local recurrence and survival among black women with early-stage breast cancer treated with breast-conservation therapy or mastectomy.

Background: Black women with breast cancer have significantly worse survival rates and receive diagnoses at relatively younger ages, compared with white patients with breast cancer, in the United States. Young age at diagnosis has been associated with increased risk for local recurrence (LR) after breast-conservation therapy (BCT). The goal of this study was to evaluate the impact of age and BCT on LR and survival rates among black patients with breast cancer.Methods: The records for 363 black women treated for breast cancer (excluding stage IV disease) at a comprehensive cancer center were reviewed.Results: Fifty-eight percent of patients (n = 211) had tumors ≤5 cm in diameter. Forty-two of these patients (19.9%) received BCT; the LR rate for this group was 9.8%. A total of 168 patients (79.6%) underwent mastectomy; the LR rate for this group was 8.9%. Data on the primary operation were unavailable for one patient. Five-year disease-free survival rates were similar for patients treated with BCT and those treated with mastectomy (88% and 73%, respectively). LR was associated with significant decreases in 5-year overall survival rates for both the BCT group (67% vs. 95%, P < .01) and the mastectomy group (43% vs. 76%, P < .01). LR and 5-year diseasespecific survival rates were similar for patients <50 years of age and patients ≥50 years of age, regardless of treatment.Conclusions: LR and survival rates are not compromised by the use of BCT among black American patients. LR is associated with an increased risk of breast cancer death, regardless of treatment type. Younger age at diagnosis was not associated with an increased rate of LR after BCT in this series.

Increased Malignancy Risk in the Cutaneous T-Cell Lymphoma Patient Population

BACKGROUND Cutaneous T-cell lymphoma (CTCL) has been associated with increased risk for second malignancies. However, the degree of risk and types of second cancers detected have been inconsistent in previous studies. PATIENTS AND METHODS To further characterize the risk for malignancy associated with CTCL, patients treated for CTCL at M. D. Anderson Cancer Center in Houston, Texas, between November 1979 and November 1999 were assessed for the occurrence of additional cancers by analysis of institutional tumor registry data. RESULTS Of 672 patients with CTCL, 112 had > or = 1 additional cancer, 37 occurring after the diagnosis of CTCL. This represents a significant elevation in cancer prevalence and incidence, with a 1.79-fold risk (95% CI, 1.22-2.39) for developing cancer after CTCL. An excess of Hodgkin and non-Hodgkin lymphoma, acute myeloid leukemia, and vulvar cancers was seen. CONCLUSION These data provide evidence for an increased overall incidence of second malignancy in CTCL, particularly with respect to other lymphoproliferative malignancies. Appropriate monitoring for the early detection of second cancers might be warranted in patients with CTCL.

Epidemiology of Inflammatory Breast Cancer

Inflammatory breast cancer (IBC) is the most aggressive and fatal form of invasive breast cancer. The disease affects approximately 2.5% of breast cancer patients in the United States typically with younger age of onset and higher incidence in African-Americans. Incidence rates vary due to the clinical nature, rather than pathological, of the diagnosis. Changes to the SEER coding rules will also likely have an impact on IBC reporting rates. Epidemiological observations have also suggested geographic differences in the incidence of IBC but without resulting in the identification of risk factors. Few risk factors have been established but associations have been noted with African American race and younger age of onset, as well as high BMI. Decreased survival rates in patients with ER-negative tumors have also been noted. An ongoing registry is being conducted at The University of Texas MD Anderson Cancer Center to address this issue. It is a prospective registry, and although relatively small, some observations of note can be made. The patients enrolled on the registry have a mean age at diagnosis of 55 years and over half of the patients present with ER-negative tumors. Also 18% of the patients reported a first-degree relative with breast cancer. The majority was overweight or obese and were former or still currently smokers. The registry includes sites in both the United States and internationally and information collected in the registry will be used in order to further elucidate the etiology and risk factors for IBC.

Inadequacies of the current American Joint Committee on cancer staging system for prostate cancer

Two major objectives of the American Joint Committee on Cancer (AJCC) staging system are to ensure appropriate treatments for patients and to determine prognosis. AJCC stage for distant prostate cancer includes patients with regional lymph node involvement. In the current study, the authors assessed whether patients with lymph node involvement and patients with distant metastasis, as determined using the Surveillance, Epidemiology, and End Results (SEER) staging system, had similar treatment and survival duration and, thus, were grouped together appropriately in the AJCC system.

Potential impact of tumor registry rule changes for recording inflammatory breast cancer

New tumor registry rules for abstracting multiple primaries and histologies include 1 specifically for inflammatory breast cancer (IBC), which states that the International Classification for Oncology (ICD‐O) histology code 8530 (3) for IBC should be used only when it is on the pathology report. IBC is typically clinically diagnosed. The purpose of this project is to determine the potential impact of this new rule on identifying IBC cases by searching on the ICD‐O histology code.