Radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma: dosimetric comparison and risk assessment of solid secondary cancer

PURPOSE: To determine the optimal radiotherapy technique for gastric mucosa-associated lymphoid tissue lymphoma (MALToma), we compared the dosimetric parameters and the risk of solid secondary cancer from scattered doses among anterior-posterior/posterior-anterior parallel-opposed fields (AP/PA), anterior, posterior, right, and left lateral fields (4_field), 3-dimensional conformal radiotherapy (3D-CRT) using noncoplanar beams, and intensity-modulated radiotherapy composed of 7 coplanar beams (IMRT_co) and 7 coplanar and noncoplanar beams (IMRT_non). MATERIALS AND METHODS: We retrospectively generated 5 planning techniques for 5 patients with gastric MALToma. Homogeneity index (HI), conformity index (CI), and mean doses of the kidney and liver were calculated from the dose-volume histograms. Applied the Biological Effects of Ionizing Radiation VII report to scattered doses, the lifetime attributable risk (LAR) was calculated to estimate the risk of solid secondary cancer. RESULTS: The best value of CI was obtained with IMRT, although the HI varied among patients. The mean kidney dose was the highest with AP/PA, followed by 4_field, 3D-CRT, IMRT_co, and IMRT_non. On the other hand, the mean liver dose was the highest with 4_field and the lowest with AP/PA. Compared with 4_field, the LAR for 3D-CRT decreased except the lungs, and the LAR for IMRT_co and IMRT_non increased except the lungs. However, the absolute differences were much lower than <1%. CONCLUSION: Tailored RT techniques seem to be beneficial because it could achieve adjacent organ sparing with very small and clinically irrelevant increase of secondary solid cancer risk compared to the conventional techniques.

Management of long-term breast cancer survivors in Korea

Breast cancer is the second most common cancer of Korean women population. Due to the marked development of early detection as well as treatment techniques, the number of long-term survivors from breast cancer has been rapidly increasing. As the cancer survivors from other cancers do, breast cancer survivors also have various kinds of health problems. Diverse treatment modalities including anti-cancer hormonal therapy for breast cancer are related with wide range of long-term and late effects such as lymphedema, vasomotor symptoms, skin and musculoskeletal problems, and cardiac toxicity. Many breast cancer survivors also exposed to the increased risk of secondary cancer as well as comorbidities such as diabetes, dyslipidemia, and osteoporosis. In addition, many breast cancer survivors tend to suffer from the fear of recurrence, depression, and anxiety, even after the completion of cancer treatment. To meet the complex needs of breast cancer survivors, comprehensive medical as well as psychosocial supports seem essential. However, those needs have been frequently neglected, because oncologists usually focus on cancer treatment and do not have enough time to manage the various health problems. Integrated care on the basis of intimate and interactive communication between oncologists and primary care physicians could be a desirable way of satisfying the unmet needs of breast cancer survivors and thus, improving their quality of life.

Management of long-term colorectal cancer survivors in Korea

Colorectal cancer (CRC) is the third most common cancer in Korea. Its average growth rate has been 3.7% annually from 1999 to 2013. The 5-year relative survival rate is 75.6%. The number of CRC survivors is expected to increase steadily because of its high incidence and survival rate. Because CRC survivors are at risk for recurrence, metachronous cancer, and other cancers, they should be checked regularly. Recommended surveillance includes history-taking and physical examination, colonoscopy, carcinoembryonic antigen testing, and computed tomography. Routine complete blood counts, liver function test, and positron emission tomography are not recommended. CRC survival, which is associated with Lynch syndrome and familial adenomatous polyposis, is also related to a higher risk of other cancers such as gastrointestinal and gynecologic cancers. Additional surveillance should be taken. CRC survivors could complain of general health problems such as cancer-related fatigue and psychosocial/cognitive dysfunction, in addition to treatment-related problems including bowel/urologic/sexual dysfunction, peripheral neuropathy, and ostomy care. They are also at greater risk of cardiovascular diseases. The primary care physician should counsel CRC survivors about their health problems and make an effort to address these concerns. Primary care physicians should try to communicate with CRC survivors and all specialists for clinical follow-up care.

Stomach Cancer Secondary to Hematologic Diseases

PURPOSE: Patients with hematologic diseases such as chronic myeloid leukemia (CML) or chronic lymphoid leukemia (CLL) are known to have an increased chance of acquiring a secondary neoplasm. Stomach cancer is one of the most common malignant diseases in Korea, and we investigated whether the incidence of secondary stomach cancer in patients with a hematologic disease increases, in order to determine if a more intensive screening program for detecting secondary gastric cancer was required. We also investigated the safety of performing a gastrectomy in hematologic disease patients. MATERIALS AND METHODS: From 1992 to 2006, the medical records of 8376 patients diagnosed with one of the six common hematologic diseases were reviewed. RESULTS: Nine secondary stomach cancers were found among the 8376 patients during the 15-year observation period. No surgical-related complications occurred, and there was no recurrence of stomach cancer if detected early. CONCLUSION: It seems that a more intensive screening program for detecting secondary gastric cancer in hematologic disease patients is not required, and surgery is not risky in these patients.

Glioblastoma after Radiotherapy for Pituitary Adenoma / 대한방사선종양학회지

A 39-year-old woman developed a glioblastoma about 7 years and 10 months after local radiotherapy (4500 cGy) for pituitary adenoma. Clinical and histopathological details are presented, and previously reported cases of radiation-induced glioma are reviewed.