Safe distal margin resection in patients with low rectal cancer undergoing neoadjuvant chemoradiation

Background: Colorectal carcinoma is the third most common cause of death in Iran. This study was performed in order to determine the appropriate distal clearance margin [DCM] for resection of rectal cancer in patients who undergo neoadjuvant chemoradiotherapy for sphincter preserving procedure. Materials and Methods: This was a cross-sectional study conducted in Shahid Faghihi Hospital of Shiraz University of Medical Sciences from 2006 to 2011. We included all patients with low rectal cancer who underwent neoadjuvant chemoradiotherapy. The medical charts of patientsand disease characteristics were recorded. The local recurrence, recurrence-free survival and mortality rates were compared between those with DCM >/=2cm and DCM <2cm. Results: Overall, 82 patients with a mean age of 56.7 +/- 16.4 years were included. The DCM was found to be >/=2cm in 45 [54.9%] patients and <2cm in 37 [45.1%]. The two study groups were comparable in terms of age [p=0.573], sex [p=0.505], histopathological tumor grade [p=0.165], and distance of tumor to anal verge [p=0.125]. Patients with DCM >/=2cm had a lower local recurrence rate [35.6% vs. 97.3%; p<0.001], a higher recurrence-free survival rate [88.9% vs. 67.6%; p=0.032] and a lower mortality rate [11.1% vs. 32.4%; p=0.027]. Conclusion: Although some studies have showed that DCM<2cm leads to similar results compared to DCM>/= 2cm, our findings revealed that obtaining a distal clearance margin of 2cm for resection of rectal cancer in patients who have undergone neo-adjuvant chemoradiotherapy is associated with a lower local recurrence rate, higher recurrence-free survival rate and lower mortality rate

Drug-induced vasculitis in a breast cancer patient receiving chemotherapy

Introduction: Drug-induced vasculitis following chemotherapy has been rarely reported. We report such a case of drug-induced vasculitis following chemotherapy in a breast cancer patient

Report of the Case: A 52 year old woman with stage III breast cancer developed pathologically proven vasculitis presenting as bilateral severe erythema, edema and ulceration on both feet 10 days following the 4th cycle of adjuvant chemotherapy. Chemotherapy consisted of docetaxel, doxorubicin, and cyclophosphamide in each cycle that was preceded by premedication including dexamethasone, granisetron, and H1 and H2 blockers. Furthermore, filgrastim [5 micro g/kg] was administered following each cycle of chemotherapy during days 5-9. By discontinuing chemotherapy and starting high-dose intravenous methylprednisolone, vasculitis was resolved. The patient did not experience vasculitis following the re-challenge of chemotherapy excluding docetaxel and filgrastim

Conclusion: This case suggests that docetaxel and filgrastim might be added to the list of agents causing drug-induced vasculitis

Fine needle aspiration diagnosed skin metastasis in a young man with rectal cancer

Introduction: Although colon cancer is one of the most common human cancers, skin metastasis in this disease is rare and necessitates pathological confirmation

Report of the Case: Herein we present a 33 year old man with rectal cancer with ascites. Six cycles of Oxaliplatin based chemotherapy were given. The ascites improved. After three weeks, skin lesions appeared in the upper trunk, both chest wall and back, with extension to the anterior neck Fine Needle Aspiration from the lesions showed malignancy and second line chemotherapy was started. Although the skin lesions showed partial response, unfortunately, the patient died after the fourth chemotherapy injection

Conclusion: Skin metastasis in colorectal cancer, although rare, is a devastating sign, and a careful dermatologic examination should be included in these patients' follow up visits

phase II study of docetaxel, cisplatin and 5- fluorouracil [TPF] in patients with locally advanced head and neck carcinomas

The combination of cisplatin and 5-fluorouracil [PF] is currently considered a standard and effective regimen for the treatment of advanced head and neck carcinomas. The aim of this study was to evaluate the efficacy and safety of docetaxel, cisplatin and 5-fluorouracil [TPF] in patients with unresectable head and neck carcinomas. Forty-six patients with previously untreated non-metastatic stage IV head and neck carcinomas were enrolled. All patients received three cycle of induction chemotherapy with docetaxel [75mg/m[2]], cisplatin [40 mg/m[2]] [days 1-2/, and 5-FU [500 mg/m[2], days 1-3], repeated every 21 days. Following induction chemotherapy, all patients underwent concurrent chemoradiotherapy using weekly cisplatin [30 mg/m[2]] and a median total dose of 70 Gy was delivered. Clinical response rate and toxicity were the primary and secondary end-points of the study. There were 31 men and 15 women. All patients had non-metastatic stage IV [T2-3N2-3 or T4N0-3] of disease. Overall and complete response rates were 74% and 24% respectively. Advanced T4 classification was associated with poorer response rate [p value= 0.042]. The major [grade 3-4] treatment-related toxicities were myelosuppression [78%], anorexia [13%], diarrhea [7%], emesis [11%] and stomatitis/pharyngitis [24%]. In comparison with the data of historical published trials of the PF regimen, the TPF regimen was more effective. However, the TPF regimen appears to be associated with a higher incidence of major toxicities. Therefore, our limited findings support the TPF regimen as an alternative chemotherapeutic regimen for advanced head and neck carcinomas

Pancreatic cancer in Southern Iran

Pancreatic cancer is still a health problem worldwide. The present study aimed to report the clinical characteristics, prognostic factors and treatment outcomes of 55 cases of pancreatic cancer and the literature review and analysis. Between 1998 and 2008, 55 consecutive patients proven pathologically with adenocarcinoma of the pancreas and treated at our institution were enrolled. To find out the recent major series, a literature review was performed. We selected 35 major series including 257950 patients with pancreatic cancer for discussing the present study. Twenty-four patients [44%] had resectable disease, 19 [34%] had locally advanced disease, and 12 [22%] had metastatic disease. There were 22 women and 33 men ranging in age from 16 to 76 years, with a median age of 57 years at diagnosis. After a median follow-up of 15 months [range=2-104 months] for surviving patients, 14 patients were alive and without disease, 3 patients were alive with disease and 38 patients had died due to disease. The 5-year overall survival was 27%. In this study and by analyzing the large data collection of recent major reported series, we found that pancreatic cancer tended to present at advanced stage, with a high frequency of locoregional and distant failure and a poor outcome. More effective local and systemic treatment for improving overall survival is needed

Combined neoadjuvant chemotherapy and celecoxib in locally advanced breast cancer

Locally advanced breast cancer is a presentation form of cancer with poor prognosis. The optimal method of treatment for these cases remains unclear. In this trial, the role of low dose celecoxib combined with neoadjuvant chemotherapy in locally advanced breast cancer was evaluated. Fifty women with pathologically proven locally advanced breast cancer were enrolled. All patients received preoperative chemotherapy with CAF [Cyclophosphamide 600 mg/m[2], doxorubicin 60 mg/m[2], 5-FU 600 mg/m[2]] regimen. They were randomly assigned into two groups. The first group received oral celecoxib [100mg twice daily] concurrently with chemotherapy and the second group was offered placebo. Chemotherapy was administered every three weeks and celecoxib continued until one week before the surgery. The patients received an average of 3 months treatment. The size of breast mass was measured before each cycle of chemotherapy by a caliper. The pathologic response rate was the primary endpoint of the study. In this trial, 50 patients were eligible, of whom 44 were evaluable. There were 25 patients in the celecoxib group and 25 patients in the placebo arm. Two patients in each group developed metastasis during the treatment course and two patients in group one could not tolerate celecoxib and quit it, so they were excluded from the trial. There was no statistically significant difference in terms of partial or complete response [90.5% vs. 87.0%] between celecoxib and placebo groups. Histological type, grade and hormonal receptor were similar in the two groups. No significant association was observed between menstrual status, size of mass at presentation and response to celecoxib. This study suggests that the use of celecoxib with a dose of 100 mg twice daily combined with neoadjuvant chemotherapy does not improve response rate in locally advanced breast cancer

optimal time of adjuvant radiation therapy in locoregional breast cancer

The optimal time and sequence of adjuvant radiation therapy and chemotherapy after breast surgery is controversial. Radiation therapy is the most effective method for preventing locoregional recurrence following primary surgery for invasive breast cancer. Delay in radiation therapy after surgery can lead to increased local recurrence and delay in chemotherapy after surgery is associated with an increasing rate of failure in the systemic control of breast cancer. This study was undertaken to determine the optimal sequencing of adjuvant chemotherapy and radiotherapy for patients with locoregional breast cancer after modified radical mastectomy. Additionally, this study aimed at determining the possible effect of time of radiotherapy on local and distant cancer control and the overall survival in these patients. Over a 2.5 year period, 100 patients received chemotherapy and radiation therapy for a locoloregional breast cancer after modified radical mastectomy. The population was randomly divided into two equal groups based on the timing of radiation treatment. Fifty patients [Group I] began their radiation after completion of chemotherapy and about 21 weeks after surgery. Group II began their radiation therapy about 3 weeks after surgery in combination with chemotherapy. There was no statistically significant difference between the two groups with respect to nodal status, stage of breast cancer, age, sex and type of surgery performed. Comparison of local and distant failure and overall survival rate between the delayed radiation group [Group I], and early radiation group [Group II] was not significant. In patients who require both chemotherapy and radiation therapy for a localoregional breast cancer, a delay in the initiation of radiotherapy for completion of adjuvant chemotherapy appears safe and may be preferable in patients with high risk of dissemination

Glioblastoma multiforme 35 years after radiation therapy for tinea capitis

Although carcinogenesis is a well-known late side effect of ionizing radiation, development of malignant glioma in patients who have received low dose superficial radiation many years ago for the treatment of tinea capitis has been rarely reported. This is a case report of a patient with glioblastoma multiforme in the parietal lobe after treatment with superficial radiation for tinea capitis 35 years before referral. The patient was a 62- year- old lady who presented with left-sided weakness. Physical examination revealed decreased motor power in the left upper and lower extremities. CT-scan showed a ring-enhancing lesion in the right parietal lobe with peripheral edema. She underwent surgery and histological examination of the lesion was in favor of glioblastoma multiforme. She received post-operative radiotherapy [5400 CGY in 27 fractions] but after six months the tumor recurred. In patients with a history of previous radiation to the head and neck region, and who present with neurological disturbances, a complete evaluation to rule out the presence of a tumor is suggested