Monthly Archives: May 2013

brain metastases from Parotid…

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Multiple brain metastases from adenoid cystic carcinoma of the parotid gland. Case report and review of the literature.

Source

Neurosurgery Clinic, Saitama Cancer Center, Ina, Japan.

Abstract

BACKGROUND:

Adenoid cystic carcinoma is a slow-growing malignant tumor occurring in the head and neck. Intracranial involvement usually results from direct skull invasion from adjacent primary sites. To our knowledge, this is the first reported case of multiple brain parenchymal metastases manifesting with hemorrhage.

CASE DESCRIPTION:

A 60-year-old male experienced sudden onset of hemiparesis caused by an intracerebral hematoma in a brain metastasis from adenoid cystic carcinoma. The primary parotid tumor was treated 15 months before the appearance of the brain metastases. The hemorrhagic metastasis was resected, and cranial irradiation was performed. The brain metastasis had increased cellular atypism compared with the primary tumor. The patient remained well and free of neurologic dysfunctions until 5 months after the radiotherapy was completed; he died of systemically advanced disease 8 months after the craniotomy.

CONCLUSION:

Hematogeneous brain metastases of adenoid cystic carcinoma are quite rare and cannot be distinguished from those of other cancers radiologically. We assume that the intratumoral hemorrhage is related to the tendency of the tumor to spread around the vessels. Although radiation therapy is not curative, it is beneficial in controlling tumor regrowth.

 

The same case I just came across.  This article has been really handy!!

President Obama announces support for closing the self-referral loophole for radiation therapy services

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President Obama’s budget for 2014, released today, includes a proposal to exclude radiation therapy services from the in-office ancillary services exception of the self-referral law. The budget estimates that excluding radiation therapy, as well as advanced imaging and physical therapy services, from the exception will save Medicare more than $6 billion over 10 years. Closing this loophole has been our top legislative priority for many years. ASTRO sent numerous letters encouraging the President to take this position, and our staff recently met with senior White House officials to urge them to close the loophole for radiation therapy services. The budget states:

Exclude Certain Services from the In-Office Ancillary Services Exception: The in-office ancillary services exception was intended to allow physicians to self refer quick turnaround services. While there are many appropriate uses for this exception, certain services, such as advanced imaging and outpatient therapy, are rarely performed on the same day as the related physician office visit. Additionally, evidence suggests that this exception may have resulted in overutilization and rapid growth of certain services. Effective calendar year 2015, this proposal would seek to encourage more appropriate use of select services by excluding radiation therapy, therapy services and advanced imaging from the in-office ancillary services exception to the prohibition against physician self-referrals (Stark law), except in cases where a practice meets certain accountability standards, as defined by the Secretary. [$6.1 billion in savings over 10 years]

While the budget is a proposal and will not likely be enacted into law given the partisan differences on key budget issues, inclusion in the President’s proposal is a huge boost to our advocacy efforts. It will serve as the starting point for budget negotiations and potentially Medicare reform. ASTRO will continue working with Congress to achieve our ultimate goal of permanently closing the self-referral loophole. We will provide more analysis as further details emerge.  Click