Efficacy and Feasibility of Adding Induction Chemotherapy to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Phase II Clinical Trial

PURPOSE: Currently, neoadjuvant chemoradiation (CRT) followed by total mesorectal resection is considered the standard of care for treating locally advanced rectal cancer. This study aimed to investigate the efficacy and feasibility of adding induction chemotherapy to neoadjuvant CRT in locally advanced rectal cancer. METHODS: This phase-II clinical trial included 54 patients with newly diagnosed, locally advanced (clinical T3–4 and/or N1–2, M0) rectal cancer. All patients were treated with 3 cycles of preoperative chemotherapy using the XELOX (capecitabine + oxaliplatin) regimen before and after a concurrent standard long course of CRT (45–50.4 Gy) followed by standard radical surgery. Pathologic complete response (PCR) rate and toxicity were the primary and secondary end-points, respectively. RESULTS: The study participants included 37 males and 17 females, with a median age of 59 years (range, 20–80 years). Twenty-nine patients (54%) had clinical stage-II disease, and 25 patients (46%) had clinical stage-III disease. Larger tumor size (P = 0.006) and distal rectal location (P = 0.009) showed lower PCR compared to smaller tumor size and upper rectal location. Pathologic examinations showed significant tumor regression (6.1 ± 2.7 cm vs. 1.9 ± 1.8 cm, P < 0.001) with 10 PCRs (18.5%) compared to before the intervention. The surgical margin was free of cancer in 52 patients (96.3%). Treatment-related toxicities were easily tolerated, and all patients completed their planned treatment without interruption. Grade III and IV toxicities were infrequent. CONCLUSION: The addition of induction chemotherapy to neoadjuvant CRT is an effective and well-tolerated treatment approach in patients with rectal cancer.

Efficacy and Safety of Low-Dose-Rate Endorectal Brachytherapy as a Boost to Neoadjuvant Chemoradiation in the Treatment of Locally Advanced Distal Rectal Cancer: A Phase-II Clinical Trial

PURPOSE: Despite advances in rectal cancer treatment over the last decade, local control and risk of late side effects due to external beam radiation therapy (EBRT) remain as concerns. The present study aimed to investigate the efficacy and the safety of low-dose-rate endorectal brachytherapy (LDRBT) as a boost to neoadjuvant chemoradiation for use in treating locally advanced distal rectal adenocarcinomas. METHODS: This phase-II clinical trial included 34 patients (as the study arm) with newly diagnosed, locally advanced (clinical T3-T4 and/or N1/N2, M0) lower rectal cancer. For comparative analysis, 102 matched patients (as the historical control arm) with rectal cancer were also selected. All the patients were treated with LDRBT (15 Gy in 3 fractions) and concurrent chemoradiation (45-50.4 Gy). Concurrent chemotherapy consisted of oxaliplatin 130 mg/m2 intravenously on day 1 plus oral capecitabine 825 mg/m2 twice daily during LDRBT and EBRT. RESULTS: The study results revealed a significant differences between the study arm and the control arm in terms in the pathologic tumor size (2.1 cm vs. 3.6 cm, P = 0.001), the pathologic tumor stage (35% T3-4 vs. 65% T3-4, P = 0.003), and the pathologic complete response (29.4% vs. 11.7%, P < 0.028). Moreover, a significantly higher dose of EBRT (P = 0.041) was found in the control arm, and a longer time to surgery was observed in the study arm (P < 0.001). The higher rate of treatment-related toxicities, such as mild proctitis and anemia, in the study arm was tolerable and easily manageable. CONCLUSION: A boost of LDRBT can optimize the pathologic complete response, with acceptable toxicities, in patients with distal rectal cancer.

Lymph node metastasis in gastrointestinal stromal tumor [GIST]: to report a case

The Gastrointestinal Stromal Tumor [GIST] is a rare mesenchymal tumor of gastrointestinal [GI] tract. This tumor has tendency to liver metastasis and peritoneal recurrence, however; the primarily lymph node involvement or metastasis is rare. Here we reported a 17-years-old girl with multifocal gastric GIST and multiple lymph node involvement at presentation and recurrence in celiac lymph nodes. We also review some case reports on lymph node metastasis in GIST

Very late relapse in breast cancer survivors: a report of 6 cases

Breast cancer is the most common cancer and the leading cause of cancer death among the women worldwide. The risk of local and distant recurrence is the highest during the first two years following the initial treatment. Very late relapse [after 12 years] is uncommon in breast cancer survivors. Herein, we report the characteristics and outcomes of 6 such cases of breast cancer. The mean age of the patients was 40.1 years [range 30-57] and the mean disease free survival was 19.6 years. Late relapse is not so common in breast cancer but can occur in any stage. Therefore, we suggest life-time follow up for every patient with breast cancer

Effect of oral zinc sulphate in prevention of radiation induced oropharyngeal mucositis during and after radiotherapy in patients with head and neck cancers

Mucositis is a disturbing side effect of radiotherapy treatment for head and neck cancer. To date, no effective modality for its prophylaxis and treatment has been found. We performed this study to evaluate the efficacy of oral zinc sulphate in delaying the onset of oral and pharyngeal mucositis and decreasing their severity. A total of 58 patients who were treated for head and neck squamous cell carcinoma with radiotherapy or chemoradiotherapy were randomly assigned to receive oral zinc sulphate [220 mg] or an oral placebo 3 times a day during their radiotherapy course. Total radiation dose was 6000 cGy to 7000 cGy by conventional radiotherapy. Seventy nine percent of the patients also received concurrent chemotherapy. Oral and pharyngeal mucositis were scored according to an RTOG protocol. Time to onset of mucositis did not vary between the two groups. However, oral mucositis scores were less severe in the zinc group in weeks 4 to 6. The difference was statistically significant and the P values for weeks 4, 5 and 6 were 0.02, 0.007, and 0.012, respectively. Treatment interruptions in both groups were the same [four cases each] and all were due to dysphagia [pharyngeal mucositis]. Our results suggest that zinc is effective in reducing the severity of oral mucositis but not pharyngeal mucositis. Treatment interruptions were more frequently caused by pharyngeal mucositis which presented as dysphagia, rather than oral pain that was a manifestation of oral mucositis

Cervical lymph node metastases from meningioma: report of two cases and treatment outcome

Meningioma is usually a benign central nervous system [CNS] tumor. Metastasis is rare; however if it does occur the most metastatic sites are the liver and lungs. Here, two cases of CNS meningioma with metastasis to cervical lymph nodes are reported. The first case, a 48 year-old man developed cervical lymph node metastasis nine years after primary tumor diagnosis. The second case, a 23 year-old woman with parietal lobe meningioma, developed lymph node metastasis in the neck nine months after the diagnosis of meningioma