ABSTRACT
Nasopharyngeal sarcomatoid carcinoma (SaCa) is extremely rare, and concurrent chemoradiation is the standard treatment for squamous cell-based nasopharyngeal cancer (NPC). This case report gives the first explanation of a nasopharyngeal SaCa patient treated with volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB), which is an excellent treatment modality that leads to complete response for locally advanced NPC. A 70-year-old male presented with nasal obstruction, epistaxis, and right neck node enlargements. Examination revealed an extensive tumor of nasopharyngeal tumor extending into the nasal cavity and right parapharyngeal space with bilateral lymphadenopathy on positron emission tomography (PET)–computed tomography images of focal hypermetabolic bone lesion in C4 body (stage T3N2M1). An excisional biopsy of nasopharyngeal wall mass showed a SaCa. He received concurrent chemoradiation which was VMAT and systemic chemotherapy (cisplatin 60 mg). A dose of 70 Gy was delivered to the planning target volume (PTV70) (gross tumor volume plus margin 3–5 mm) and PTV59.4(a wider margin around high-risk clinical target volume, including the clivus and neck nodes) all given in 33 fractions. Radiological examination such as magnetic resonance imaging (MRI) and PET images at the completion of external beam therapy revealed questionable residual disease. Follow-up MRI scans 4 weeks after radiotherapy revealed a complete tumor response. VMAT with SIB can be an effective treatment option for SaCa of the advanced nasopharynx.
ABSTRACT
Kaposi's sarcoma (KS) is an uncommon neoplastic vascular disease. The standard treatment for localized classic KS lesions is surgical excision or radiation. Superficial skin lesions are generally treated with electrons or low-energy photon fields using boluses. Radiotherapy (RT) can be used for poor surgical candidates or when surgery is expected to result in a poor cosmetic or functional outcome. This study is the first to describe a case of KS of the toe and web treated with electron RT, which precisely targeted the irregular skin lesion with a markedly higher presided effective treatment. An electron field is often limited in its effectiveness to deliver a homogeneous dose in cases with irregular contours. Here, we report our successful experience using low-energy electron beam radiation to treat KS of the toe and web. The patient was a 78-year-old woman who was diagnosed with KS located on the first and second toe and web, based on radiology, pathology, and immunohistochemical examinations. KS was located on the left foot and measured more than 2.5 cm. No regional nodal or distant organ metastasis was observed. She was medically inoperable. RT was performed using a 6-MeV electron with a 0.5-cm bolus and a dose of 50 Gy delivered in 25 fractions. Follow-up computed tomography 2 months after RT revealed a complete tumor response. Toxicity was limited to mild skin desquamation during treatment. The patient remains alive and has shown no evidence of disease for 2 years. This study suggests that electron RT is a safe and effective treatment option for skin lesions located on the toe and web