Therapeutic challenge: severe dyspnea in a patient with metastatic breast cancer and lymphangitis carcinomatosis syndrome

Introduction. Dyspnea, regardless of etiology (pulmonary, neuromuscular or caused by other factors),remains a significant challenge. There is still a lack of effective methods of the treatment of severe dyspneaassociated with intensifying anxiety which is the most common indication for intensification of causativeand symptomatic treatment or palliative sedation.Case report. A 48 year-old woman diagnosed with relapsed breast cancer with bone, pleural, hepaticand pulmonary metastases with lymphangitis carcinomatosis syndrome confirmed by lung biopsy. In 2011the patient underwent breast conserving surgery followed by teletherapy, brachytherapy and tamoxifenhormone therapy for 5 years. Comorbidities included chronic obstructive pulmonary disease, diabetesmellitus type 2, depression and nicotine addiction.The patient was urgently admitted to the Department of Oncology and Radiotherapy from ClinicalEmergency Department due to rapidly aggravating dyspnea and respiratory failure. Chest X-ray showedmassive bilateral pleural effusion and threatening cardiac tamponade. Treatment involved thoracentesisand pericardiocentesis with concurrent symptomatic management. After temporary stabilization of thepatient and due to rapid progression of the disease salvage, paclitaxel chemotherapy was started. Despitethe features of potential chemosensitivity (chemotherapy–naïve, rapid progression, visceral metastases)the applied treatment was ineffective. After careful evaluation of clinical situation and possible treatmentstrategies, and after obtaining patient’s consent, sedation with midazolam and morphine was applied.Conclusions. This case demonstrated ineffective salvage chemotherapy used in the patient with severe dyspnea inducedby a rapid progression of metastatic breast cancer and difficulties in obtaining effective symptomatic treatment. Palliat Med Pract 2019; 13, 3: 156–16

Przyzwojak kłębka szyjnego. Opis przypadku dwóch chorych poddanych radioterapii z modulacją intensywności dawki (IMRT)

Paraganglioma of the head and neck is a very rare tumor originating from paraganglionic cells of the chemoreceptor system. The disease has a rich symptomatology. The article presents two patients treated with intensity modulated radiation therapy (IMRT). In one patient paraganglioma was localized bilaterally, which is a particularly rare occurrence. We also presented current literature on paraganglioma treatment, addressing the effectiveness of radiotherapy compared to surgery. Onkol. Prak. Klin. 2011; 7, 5: 274–277Przyzwojak (paraganglioma) to bardzo rzadki nowotwór wywodzący się z komórek przyzwojowych układu chemoreceptorowego. Choroba posiada bogatą symptomatologię. W artykule przedstawiono dwa przypadki chorych na przyzwojaka szyi poddanych radioterapii techniką modulacji intensywności dawki (IMRT). U jednego z chorych guz był zlokalizowany obustronnie, co jest szczególnie rzadkim zjawiskiem. Omawiane przypadki przedstawiono na tle doniesień dotyczących skuteczności radioterapii przyzwojaka w porównaniu z leczeniem chirurgicznym. Onkol. Prak. Klin. 2011; 7, 5: 274–27

Radiation-induced myelopathy after hypofractionated radiotherapy in women with spinal metastases from breast cancer — a case report

Hypofractionated radiotherapy, with a single dose of 8 Gy or 20 Gy given in 4–5 fractions, remains a standard treatment of bone metastasis, including spine lesions. Hypofractionated radiotherapy is also used during re-irradiation. These schedules are associated with an increased risk of severe complications, and their differentiation from local tumour progression can be difficult. We describe a 55-year-old female with breast cancer, who underwent palliative radiotherapy with a dose of 20 Gy in four fractions to the Th6–Th10 spine levels. After four months the patient was referred for re-irradiation due to progression of neurological symptoms. MRI examination suggested local tumour progression. Due to rapid deterioration she did not receive re-irradiation, and died due to systemic fungal infection. Autopsy revealed extensive radiation myelopathy in previously irradiated thoracic spine, without the presence of cancer at the site

Automated geometric features evaluation method for normal foot skeleton model

Normal foot model is a geometric model of a healthy human foot. As the comparison of the processed feet requires a reference ideal healthy foot parameterization it was necessary to create such a model by defining skeleton geometric features and generating the feature set on a dataset population. Manual positioning of such number of landmarks is both a complex and time consuming task for a skilled radiologist, not to mention the total cost of such a procedure. Thus it was recommended to formulate an automated computer algorithm to perform this procedure with accuracy at a comparable level as the manual process. The following paper describes our approach based on automatic landmark positioning in a volumetric foot dataset. The proposed automated procedure is based on four main steps: manual landmark positioning on a reference dataset, registration of the reference dataset with the examined study, transformation of landmark positions from the reference dataset space into the examined dataset space, and calculation of the geometric features on the basis of landmarks positions. The results of our algorithm are presented and discussed in the context of pros and cons of the automated method itself as well as in the context of the generated normal foot model

Radiation-induced myelopathy after hypofractionated radiotherapy in women with spinal metastases from breast cancer — a case report

Hipofrakcjonowana radioterapia, najczęściej z podaniem dawki 8 Gy jednorazowo lub 20 Gy w 4–5 frakcjach, pozostaje standardową formą leczenia przerzutów zlokalizowanych w układzie kostnym, w tym w kręgosłupie. Schematy te są również stosowane w przypadkach powtórnego napromieniania. Zastosowanie wyższych dawek frakcyjnych obarczone jest podwyższonym ryzykiem poważnych powikłań popromiennych, których różnicowanie z miejscowym postępem nowotworu może być trudne. W pracy przedstawiono 55-letnią chorą z rozsiewem kostnym raka piersi z narastającymi objawami neurologicznymi, skierowaną po upływie 14 miesięcy od podania dawki 20 Gy w 4 frakcjach na obszar kręgosłupa Th6–10 na powtórne napromienianie tej okolicy. W przeprowadzonym wówczas badaniu rezonansu magnetycznego (MRI) stwierdzono obszary wzmocnienia, sugerujące postęp miejscowy nowotworu. Z powodu pogarszającego się stanu ogólnego chorej zrezygnowano z ponownej radioterapii. Chora zmarła w wyniku układowej grzybicy. W badaniu pośmiertnym, oprócz rozsiewu choroby podstawowej, stwierdzono rozległą martwicę popromienną rdzenia kręgowego w napromienionym odcinku kręgosłupa, bez obecności nowotworu w tym obszarze.Hypofractionated radiotherapy, with a single dose of 8 Gy or 20 Gy given in 4–5 fractions, remains a standard treatment of bone metastasis, including spine lesions. Hypofractionated radiotherapy is also used during re-irradiation. These schedules are associated with an increased risk of severe complications and their differentiation from local tumour progression can be difficult. We describe a 55-year-old female with breast cancer who underwent palliative radiotherapy with a dose of 20 Gy in four fractions to the Th6–Th10 spine levels. After four months the patient was referred for re-irradiation due to progression of neurological symptoms. MRI examination suggested local tumour progression. Due to rapid deterioration she did not receive re-irradiation, and died due to systemic fungal infection. Autopsy revealed extensive radiation myelopathy in previously irradiated thoracic spine, without the presence of cancer at the site

Multimodal imaging of brain reorganization in hearing late learners of sign language

The neural plasticity underlying language learning is a process rather than a single event. However, the dynamics of training - induced brain reorganization have rarely been examined, especially using a multimodal magnetic resonance imaging approach, which allows us to study the relationship between functional and structural changes. We focus on sign language acquisition in hearing adults who underwent an 8‐month long course and five neuroimaging sessions. We assessed what neural changes occurred as participants learned a new language in a different modality - as reflected by task‐based activity, connectivity changes, and co‐occurring structural alterations. Major changes in the activity pattern appeared after just 3 months of learning, as indicated by increases in activation within the modality‐independent perisylvian language network, together with increased activation in modality‐dependent parieto‐occipital, visuospatial and motion‐sensitive regions. Despite further learning, no alterations in activation were detected during the following months. However, enhanced coupling between left‐lateralized occipital and inferior frontal regions was observed as the proficiency increased. Furthermore, an increase in gray matter volume was detected in the left inferior frontal gyrus which peaked at the end of learning. Overall, these results showed complexity and temporal distinctiveness of various aspects of brain reorganization associated with learning of new language in different sensory modality

An evaluation of the value of first thyroglobulin determination in the diagnostics of metastases immediately following differentiated thyroid carcinoma surgery

Wstęp: Celem pracy była ocena wartości różnicowej pierwszego oznaczenia stężenia tyreoglobuliny (Tg) po tyreoidektomii (Tx), a przed ablacją kikutów tarczycy u chorych ze zróżnicowanym rakiem tarczycy (DTC, differentiated thyroid carcinoma) jako wskaźnika obecności przerzutów i/lub ognisk nowotworowych (M). Materiał i metoda: Retrospektywnej analizie poddano dane 517 chorych po Tx z powodu DTC skierowanych w celu ablacji kikutów tarczycy, obserwowanych następnie dłużej niż 1,5 roku. Z analizy wykluczono pacjentów o niepewnym przebiegu choroby i z interferencją w badaniu Tg (a-TgAb[+], odzysk Tg < 80%). Ostatecznie analizowano wyniki 247 chorych z DTC (14-79 lat; 223 kobiet, 24 mężczyzn). Porównano wyniki badań TSH, wychwytu 131I nad szyją (Tup24), objętości resztek tarczycy (V) i Tg u chorych z rozpoznanymi w chwili badania M (Grupa M1; n = 35) z tymi samymi parametrami u pacjentów bez obserwowanego powyżej 1,5 roku nawrotu choroby (Grupa M0; n = 212). Obliczono pole pod krzywą ROC stężeń Tg w badanej grupie. Wyznaczono wartość referencyjną stężenia Tg dla podejrzenia M za pomocą krzywej wydajności badania Tg. Wyniki: Grupy M0 i M1 nie różniły się pod względem stężenia TSH (mediana 49,7 jm./l vs. 44,3; p = 0,16), objętości kikutów tarczycy (1,4 vs. 1,1 ml; p = 0,79), różnice dotyczyły natomiast Tup24 (7,6 vs. 3,2%; p = 0,01) oraz Tg (4,5 vs. 96,7 ng/ml; p = 0,000000). Pole pod krzywą ROC dla Tg dla badanej grupy wynosiło 0,78 &plusmn; 0,05 (śr. &plusmn; s.e.m.). Wartość referencyjną Tg dla podejrzenia M wyznaczono na 38,1 ng/ml, czułość oznaczenia Tg wynosiła 0,57 (95%CI 0,39-0,74), a swoistość 0,96 (95%CI 0,92-0,98). Wnioski: Pierwsze stężenie Tg oznaczone po Tx przybiera u chorych z przerzutami raka tarczycy wartości większe niż u chorych bez tych przerzutów, co wskazuje, iż wymieniony parametr może być stosowany jako wczesny wskaźnik obecności przerzutów raka tarczycy (również w obecności kikutów tarczycy).Introduction: Evaluation of the differential value of the first thyroglobulin (Tg) concentration, measured after thyroidectomy (Tx) but before thyroid remnant ablation, in patients with differentiated thyroid carcinoma (DTC) as a marker of either metastases or residual cancer (M). Material and methods: Data from 517 patients with DTC after Tx, with follow-up > 1.5 year were analysed retrospectively. Patients in whom either the course of the disease was unclear or interference in the Tg test was possible (a-TgAb [+], Tg recovery < 80%) were excluded from the study. Finally, the data from 247 patients were evaluated (age: 14-79 years; 223 women, 24 men). The results of TSH, thyroid radioiodine uptake (Tup24), thyroid remnant volume (V) and Tg in patients with diagnosed M (group M1; n = 35) were compared with the same parameters in patients with remission > 1.5 year (group M0; n = 212). The area under the ROC curve was calculated. The clinical decision limit of Tg level to be suggestive of metastases was determined by means of efficiency curve. Results: Groups M0 and M1 did not differ from each other with respect to TSH concentration (median 49.7 mIU/l vs 44.3; p = 0.16) or thyroid remnant volume (1.4 vs 1.1 ml; p = 0.79). However, they did differ with respect to Tup24 (7.6 vs 3.2%; p = 0.01) and Tg (4.5 vs 96.7 ng/ml; p = 0.000000). Area under ROC for Tg was 0.78 &plusmn; 0.05 (mean &plusmn; s.e.m.). The decision limit of Tg for suspected M was determined at 38.1 ng/ml, Tg sensitivity was 0.57 (95%CI 0.39-0.74) and specificity 0.96 (95%CI 0.92-0.98). Conclusions: First thyroglobulin concentration, determined after thyroidectomy but before other treatment, is higher in patients with metastatic DTC than in patients without such metastases. This indicates that Tg level may be used as an early marker of either residual or metastatic DTC (even if thyroid remnants are present)