Limits...
Stabilization of metastatic myxopapillary ependymoma with sorafenib.

Fegerl G, Marosi C - Rare Tumors (2012)

Bottom Line: As neither resection, debulking, nor radiation therapy were considered to be indicated, systemic therapy with temozolomide was started.Imatinib delayed the progression, but had to be stopped after six months because of critical increased pleural effusion.Using the multikinase inhibitor sorafenib, the disease was stabilized and an acceptable quality of life could be obtained for one year.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna;

ABSTRACT
We report on a 59-year old woman with three huge intrathoracal masses that were accidentally diagnosed when she consulted a physician for upper abdominal discomfort. A biopsy revealed that they were metastases of a coccygeal myxopapillary ependymoma, resected 20 years before. As neither resection, debulking, nor radiation therapy were considered to be indicated, systemic therapy with temozolomide was started. At the first evaluation after four months, the metastases had progressed. Imatinib delayed the progression, but had to be stopped after six months because of critical increased pleural effusion. Using the multikinase inhibitor sorafenib, the disease was stabilized and an acceptable quality of life could be obtained for one year.

No MeSH data available.


Related in: MedlinePlus

Coronal computed tomography scan overview of the patient's thorax with metastasized myxopapillary ependymoma. Findings and clinical symptoms: A) three pleural masses and multiple pulmonary nodules, a small encapsulated pleural effusion on the left side; B) progression of intrapulmonary nodules and of the pleural effusion on the left side; C) progression (dyspnea on exertion, thoracal pain, weight loss); D) progression of pleural effusion (dyspnea at rest); E) decrease of pleural effusion, but increase of tumor masses (hoarseness); F) stable disease (dry skin, paraesthesias, hoarseness, aphthes and films in the mouth, pain); G) stable disease (sleep disturbances, pain, hypertension); H) stable disease (weakness); I) stable disease (weakness and mixed axonal polyneuropathy in 3/11). Antineoplastic therapy: start temozolomide (B), start imatinib (C), reinduction imatinib (E), sorafenib (F), dose reduction because of suspect metastases in the spinal cord, reinduction of the full dose (G), sorafenib ongoing (H, I).
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3475949&req=5

Figure 1: Coronal computed tomography scan overview of the patient's thorax with metastasized myxopapillary ependymoma. Findings and clinical symptoms: A) three pleural masses and multiple pulmonary nodules, a small encapsulated pleural effusion on the left side; B) progression of intrapulmonary nodules and of the pleural effusion on the left side; C) progression (dyspnea on exertion, thoracal pain, weight loss); D) progression of pleural effusion (dyspnea at rest); E) decrease of pleural effusion, but increase of tumor masses (hoarseness); F) stable disease (dry skin, paraesthesias, hoarseness, aphthes and films in the mouth, pain); G) stable disease (sleep disturbances, pain, hypertension); H) stable disease (weakness); I) stable disease (weakness and mixed axonal polyneuropathy in 3/11). Antineoplastic therapy: start temozolomide (B), start imatinib (C), reinduction imatinib (E), sorafenib (F), dose reduction because of suspect metastases in the spinal cord, reinduction of the full dose (G), sorafenib ongoing (H, I).

Mentions: Fourteen years later, in 2009, the patient again underwent a computed tomography (CT) scan because of upper abdominal discomfort. Unexpectedly, three pleural polylobulated, heterogeneous enhancing masses were described in the lungs: in the recessus costo-mediastinalis of the right side (12×7×11 cm), in the left recessus paravertebralis (6×6×10 cm) and aorto-pulmonal (5×8×8 cm), as well as a smaller nodule of 16 mm in diameter in the left lung, and a small, encapsulated pleural effusion of the left side (Figure 1A). The patient underwent transthoracal needle biopsy of the right pleural mass which confirmed that the intrathoracal masses were indeed metastases of the ependymoma diagnosed 20 years previously. Subsequent 18F-FDG-PET/CT imaging (F-18 fluorodeoxyglucose positron emission tomography computed tomography scan) showed the same three tumor masses and revealed no further FDG-enhancing regions. At this time, the patient was clinically symptom free.


Stabilization of metastatic myxopapillary ependymoma with sorafenib.

Fegerl G, Marosi C - Rare Tumors (2012)

Coronal computed tomography scan overview of the patient's thorax with metastasized myxopapillary ependymoma. Findings and clinical symptoms: A) three pleural masses and multiple pulmonary nodules, a small encapsulated pleural effusion on the left side; B) progression of intrapulmonary nodules and of the pleural effusion on the left side; C) progression (dyspnea on exertion, thoracal pain, weight loss); D) progression of pleural effusion (dyspnea at rest); E) decrease of pleural effusion, but increase of tumor masses (hoarseness); F) stable disease (dry skin, paraesthesias, hoarseness, aphthes and films in the mouth, pain); G) stable disease (sleep disturbances, pain, hypertension); H) stable disease (weakness); I) stable disease (weakness and mixed axonal polyneuropathy in 3/11). Antineoplastic therapy: start temozolomide (B), start imatinib (C), reinduction imatinib (E), sorafenib (F), dose reduction because of suspect metastases in the spinal cord, reinduction of the full dose (G), sorafenib ongoing (H, I).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3475949&req=5

Figure 1: Coronal computed tomography scan overview of the patient's thorax with metastasized myxopapillary ependymoma. Findings and clinical symptoms: A) three pleural masses and multiple pulmonary nodules, a small encapsulated pleural effusion on the left side; B) progression of intrapulmonary nodules and of the pleural effusion on the left side; C) progression (dyspnea on exertion, thoracal pain, weight loss); D) progression of pleural effusion (dyspnea at rest); E) decrease of pleural effusion, but increase of tumor masses (hoarseness); F) stable disease (dry skin, paraesthesias, hoarseness, aphthes and films in the mouth, pain); G) stable disease (sleep disturbances, pain, hypertension); H) stable disease (weakness); I) stable disease (weakness and mixed axonal polyneuropathy in 3/11). Antineoplastic therapy: start temozolomide (B), start imatinib (C), reinduction imatinib (E), sorafenib (F), dose reduction because of suspect metastases in the spinal cord, reinduction of the full dose (G), sorafenib ongoing (H, I).
Mentions: Fourteen years later, in 2009, the patient again underwent a computed tomography (CT) scan because of upper abdominal discomfort. Unexpectedly, three pleural polylobulated, heterogeneous enhancing masses were described in the lungs: in the recessus costo-mediastinalis of the right side (12×7×11 cm), in the left recessus paravertebralis (6×6×10 cm) and aorto-pulmonal (5×8×8 cm), as well as a smaller nodule of 16 mm in diameter in the left lung, and a small, encapsulated pleural effusion of the left side (Figure 1A). The patient underwent transthoracal needle biopsy of the right pleural mass which confirmed that the intrathoracal masses were indeed metastases of the ependymoma diagnosed 20 years previously. Subsequent 18F-FDG-PET/CT imaging (F-18 fluorodeoxyglucose positron emission tomography computed tomography scan) showed the same three tumor masses and revealed no further FDG-enhancing regions. At this time, the patient was clinically symptom free.

Bottom Line: As neither resection, debulking, nor radiation therapy were considered to be indicated, systemic therapy with temozolomide was started.Imatinib delayed the progression, but had to be stopped after six months because of critical increased pleural effusion.Using the multikinase inhibitor sorafenib, the disease was stabilized and an acceptable quality of life could be obtained for one year.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna;

ABSTRACT
We report on a 59-year old woman with three huge intrathoracal masses that were accidentally diagnosed when she consulted a physician for upper abdominal discomfort. A biopsy revealed that they were metastases of a coccygeal myxopapillary ependymoma, resected 20 years before. As neither resection, debulking, nor radiation therapy were considered to be indicated, systemic therapy with temozolomide was started. At the first evaluation after four months, the metastases had progressed. Imatinib delayed the progression, but had to be stopped after six months because of critical increased pleural effusion. Using the multikinase inhibitor sorafenib, the disease was stabilized and an acceptable quality of life could be obtained for one year.

No MeSH data available.


Related in: MedlinePlus