A 39-year-old female, in her 31st week of pregnancy, presented with a 5 cm breast nodule with inflammatory signs. From ultrasound, it was suspected to be invasive cancer; subsequent biopsy confirmed a diagnosis of invasive adeno-carcinoma. From 14 October 2015 to 18 February 2016, she received neo-adjuvant chemotherapy with four cycles of 90 mg/sqm epirubicin and 600 mg/sqm cyclophosphamide by i.v. infusion, with each cycle occurring every four weeks, followed by weekly 80 mg/sqm paclitaxel by i.v. infusion. This treatment was interrupted on 18 February 2016 because of disease progression. On 3 March 2016, she underwent a radical left mastectomy; post-operative histology showed infiltrating ductal carcinoma without lympho-vascular invasion. pT2 No Mo was the post-operative TNM classification, G3, ER+ (30%) Pr+ (10%), Ki67 90%, and HER2 negative. From 28 April 2016 to 04 July 2016, she received adjuvant chemotherapy with three cycles of CMF (600/40/600 mg/sqm on days 1, 8, and 28, by i.v. infusion) and, from 31 May 2016 to 08 July 2016, she received conventional radiotherapy on the chest wall and lymph-nodes at II–III–IV levels. From 29 July 2016 to 1 February 2017, 25 mg of exemestane daily plus an LHRH agonist every 28 days were administered. On 2 February 2017, exemestane was replaced by tamoxifen because a hormonal assessment showed the recovery of ovarian functionality. On 22 May 2017, diffusion whole body magnetic resonance imaging (MRI) was carried out at the European Institute of Oncology, in Milan, and it signaled an 8 mm nodule of the middle lung lobe, which was suspected for relapse. A 13 mm nodule in the same site of the suspected relapse was confirmed on 30 May 2017 by WB CT. The subsequent biopsy showed that the nodule had malignant characteristics. On 13 June 2017, the metastatic lung nodule was removed by atypical lung resection. The immunophenotype from post-operative histology confirmed that the primary breast cancer was the probable origin; ER, PR, and Ki67 were 30%, negative, and 50%, respectively. From 18 July 2017 to 24 August 2017, the patient received four cycles of liposomal doxorubicin. From 18 September 2017 to date, this patient received four consecutive cycles of IT twice, and the last cycle was followed by one month of rest and then four successive cycles of oral ChT with vinorelbine and capecitabine. In contrast to previous reports on the metronomic use of vinorelbine and capecitabine [,,] in breast cancer patients with detectable metastatic disease, one week of ChT interruption was planned because our patient did not show clinical-radiological evidence of metastatic disease. Vinorelbine at 30 mg was given every other day, and 500 mg of capecitabine was given three times a day continuously, on days 1–14 every 21 days. On 8 October 2018 and 16 October 2019, bone scanning (BS) and WB CT, respectively, were negative for relapse and circulating CEA-TPA-CA.15.3 levels were in the normal range on 14 October 2019.\nA study [] evaluated 103 breast cancer patients who underwent surgery for suspected pulmonary metastases. In this study, the median survival time (ST) was 29 months and the three-year survival was 43% in 14 patients with a disease-free interval (DFI) of less than 24 months. All patients had received complete resections of their lung metastases. Another study [] reported that, in 37 recruited breast cancer patients with completely resected pulmonary metastases (27 with a single pulmonary nodule (SPN) and 10 with two or more pulmonary nodules), the actuarial five-year survival was 59%. However, in five of them with a DFI of one year or less, the mean survival was only 15 ± 3.6 months, and all patients were dead at 26 months. Before, after, or both before and after thoracotomy, all 37 patients received ChT, tamoxifen, or both. Similarly, in another series [] of 40 patients (most of them with one or two pulmonary metastases) who had undergone complete pulmonary resection, the five-year survival rate was 35.6%, while the median DFI following complete pulmonary resection was 1.6 years. Most breast oncologists, even in SPN cases, prefer systemic medical treatment to surgery. In fact, pulmonary metastasis is considered a systemic disease, and poor survival rates have been reported for those with a DFI of <3 years or with discordance in the hormone receptor status between the primary cancer and the SPN [,].
On 22 April 2010, a 65-year-old male underwent RP and vesiculectomy for prostate adeno-carcinoma. The pre-operative serum PSA was 13.66 ng/mL. pT3b No Mo was the post-operative TNM classification, G3, 4 + 4 Gleason, stage III. On 7 July 2010, the serum PSA was 0.01 ng/mL. On 10 April 2013, three months after RP, BCR was found to have occurred with two consecutive serum PSA values higher than 0.2 ng/mL (PSA level of 0.23 ng/mL). From 22 April 2013 to 10 May 2015, he received IAD therapy with 150 mg bicalutamide pills (once a day) and, on 9 February 2015, the serum PSA level was 0.02 ng/mL. From 11 May 2015 to 1 November 2015, no adjuvant therapy was given and, on 6 October 2015, the serum PSA level was 0.27 ng/mL. From 2 November 2015 to 29 October 2017, cyclic IT was administered. On 5 October 2017, the serum PSA level was 0.65 ng/mL. From 30 October 2017 to 13 May 2018, he received only 150 mg bicalutamide pills (once a day) and, on 9 May 18, the serum PSA level was 0.24 ng/mL. After that, as a result of a misunderstanding, the patient delayed the beginning of cyclic IT from 14 May 2018 to 11 June 2018. Moreover, during the first cycle of this new round of cyclic IT (from 11 June 2018 to 7 July 2018), he took one instead of four celecoxib pills a day. On 11 July 2018, the serum PSA level was 0.58 ng/mL. From 22 July 2018, he correctly underwent IT cycles and, on 11 May 19, the serum PSA was 0.99 ng/mL. He started on 50 mg bicalutamide pills (once a day), and an LHRH agonist was given subcutaneously once every three months. On 10 August 19, PSA was undetectable; therefore, he again started the IT schedule. On 10 October 19, the last PSA determination was 0.04 ng/mL.\nIn a study [], researchers examined 148 patients who prospectively enrolled in sequential Institutional Review Board approved vaccine protocols. The T stage was T1–T2 in 54% and T3–T4 in the remaining 46%; Gleason was 6–7 in 71% and 8–9 in the remaining 29%. All subjects had recurrent disease and no detectable radiological metastases. Recurrent disease manifested as BCR after surgery or as clinically localized disease at the sites for which they had undergone radiation therapy. The median PSA value at the time of protocol enrollment was 8.2 ng/mL and the median PSA double time (PSADT) was 4.7 months. Overall, 110 (74%) of the 148 patients showed metastatic progression at a median of 19 months and metastases were detected in 68% and 84% of them at 3 and 5 years, respectively. Patients with a T3 stage and Gleason score of 7 or more at the time of diagnosis were more likely to develop metastatic disease (log-rank test; p = 0.006), while the type of primary therapy and the presence of nodal disease were not predictive. In another study [], the researchers analyzed 1590 patients who developed recurrent disease, among 5277 patients who had undergone either RP (1003 patients) or EBRT (587 subjects). In the RP group, about 13% of the 1003 patients had received neo-adjuvant or adjuvant androgen deprivation therapy (ADT) and the mean time between primary treatment and recurrence was 34 months. PSA data after salvage therapy were available for 1050 patients (430 patients who had received initial EBRT and 620 patients from the RP group). In 367 patients (59.2%) in the RP group, ADT was the most common salvage treatment, followed by EBRT, which was carried out in the other 248 patients (40%). ADT was also administered to 402 subjects (93.5%) in the EBRT group. Failure after salvage therapy was defined as a PSA level of >0.2 ng/mL after treatment. Overall, 420 (68%) of the 620 patients in the RP group and 319 (74%) of the 430 patients in the EBRT group recurred after salvage therapy. Among these, 739 patients (24.8%) died. The mean survival was 81.1 months (median of 59.9 months) compared with 103.2 months (median of 101.2 months) for those who did not recur after salvage therapy. This difference in overall survival was statistically significant (p < 0.001). A report of a phase III randomized trial [] presented the long-term results of immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer. In a subgroup of 127 high-risk patients, eight-year clinical disease-free survival (DFS) was about 40%. The high-risk category was defined as having at least two of the following three risk factors: WHO performance status > 0, G3, and initial PSA > 10. Our patient, who shares these characteristics, is alive and in good health 114 months after RP.