Addressing challenges in low-income and middle-income countries through novel radiotherapy research opportunities.

Although radiotherapy continues to evolve as a mainstay of the oncological armamentarium, research and innovation in radiotherapy in low-income and middle-income countries (LMICs) faces challenges. This third Series paper examines the current state of LMIC radiotherapy research and provides new data from a 2022 survey undertaken by the International Atomic Energy Agency and new data on funding. In the context of LMIC-related challenges and impediments, we explore several developments and advances-such as deep phenotyping, real-time targeting, and artificial intelligence-to flag specific opportunities with applicability and relevance for resource-constrained settings. Given the pressing nature of cancer in LMICs, we also highlight some best practices and address the broader need to develop the research workforce of the future. This Series paper thereby serves as a resource for radiation professionals.

Rectal adenocarcinoma in the eye: An unexpected destination.

Colorectal cancer ranks third in cancer incidence in the United States, commonly metastasizing to the liver and lungs. Despite its high prevalence, colorectal cancer with intraocular metastasis is exceedingly rare, with only a few cases reported in the literature. This study presents a 58-year-old male, previously treated for rectal adenocarcinoma with liver and lung metastases, who developed choroidal metastasis causing visual impairment. Despite radiotherapy, moderate improvement was observed, and subsequent disease progression led to systemic chemotherapy. Intraocular metastasis, primarily affecting the choroid, is infrequent, often originating from breast and lung cancers. The presented case, originating from primary KRAS wild-type rectal cancer, adds to the limited gastrointestinal-tract-related occurrences. This report underscores the importance of recognizing intraocular metastasis in colorectal cancer, contributing valuable insights for improved understanding and potential guidance for future clinical decisions. Choroidal metastasis carries a poor prognosis, emphasizing the need for tailored management strategies.

Primary cerebral angiosarcoma: a case report.

Introduction and importance: Central nervous system sarcomas are rare tumors of mesenchymal origin. Angiosarcomas are an even rarer subtype with poor prognosis and no consensus regarding therapeutic approach. Case presentation: This article presents the case of a 50-year-old Palestinian female patient with a history of treated breast cancer who presented to the emergency room with a tonic-clonic seizure. Brain computed tomography showed a cerebral space-occupying lesion managed with craniotomy and gross tumor resection. Histopathology revealed an epithelioid cerebral angiosarcoma. The patient was treated with concurrent chemoradiotherapy with temozolomide resulting in the resolution of the tumor as well as symptoms and complaints. Clinical discussion: Primary cerebral epithelioid angiosarcoma is a highly malignant tumor of an unknown etiology. The patient history of breast created an additional challenge, as recurrence with metastasis had to be excluded. Signs of blood product degradation are an important radiological feature. According to existing literature, gross tumor resection followed by concurrent chemoradiotherapy offers the best approach and outcome. Conclusion: Cerebral angiosarcoma is a rare disease with a challenging therapeutic approach due to the scarcity of available literature. It should be included in the differential diagnosis of space-occupying lesions, especially in those with a history of exposure to radiotherapy. Immunohistochemistry is key for diagnosis. Surgical resection followed by concurrent chemoradiotherapy is associated with a longer disease-free survival when compared to either option alone.

A late presentation of inguinoscrotal cutaneous squamous cell carcinoma (cSCC) masquerading as hidradenitis suppurativa-a case report.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects apocrine gland-bearing skin in intertriginous areas; it is characterized by persistent or recurrent abscesses that culminate in a purulent discharge, sinuses and scarring. Although it is a common condition, it is rarely associated with cutaneous squamous cell carcinoma (cSCC). Whereas the female-to-male ratio of HS is 3:1, SCC in HS has a female-to-male ratio of 1:5. In this study, we present a 50-year-old male patient with a late presentation of inguinoscrotal cSCC with extensive ulceration and erythema that was hidden by neglected HS and the presence of underlying human papillomavirus in the affected area. The histomorphologic and immunohistochemical findings support the diagnosis of cSCC. Timely detection is the key to improve prognosis, regular clinical examination and biopsy of any suspicious lesions in high-risk patients is highly recommended.

Toxicity of Treatment for Anal Carcinoma: 2D versus 3D Planning.

BACKGROUND: Anal cancer is a relatively uncommon disease, accounting for only 4% of cancers of the lower gastrointestinal tract. OBJECTIVES: To summarize a single-center experience in the treatment of anal carcinoma using various radiation techniques. METHODS: We conducted a retrospective chart review of consecutive patients who were treated for anal cancer between the years 2002 and 2011. The data extracted included demographics, type of radiation technique, treatment-associated acute toxicity, and patterns of failure and survival. For statistical analysis purposes, the patients were divided into two groups according to radiotherapy technique: 2D (group A) and 3D (group B). RESULTS: A total of 42 patients--25 (59.5%) females and 17 males (40.5%)--underwent definitive chemo-radiation treatment (CRT) for anal cancer. Group A comprised 26 patients and group B 14 patients. Toxicity did not differ significantly between the groups; only in grade 1-2 skin toxicity which was more common in group B. There were significant differences in the unplanned interruptions in treatment, in both the number of patients who needed a treatment break and the number of days needed (more in group A). There were no differences in treatment response and patterns of failure between these two techniques, or in overall survival between the two groups. CONCLUSIONS: Our study results are consistent with reported large randomized trials, indicating that current treatments for anal carcinomas are associated with high grade acute toxicity that may result in significant treatment interruptions. The 2D technique was associated with significantly more treatment interruptions but did not differ from 3D with regard to treatment efficacy.

Toxicity of induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil for advanced head and neck cancer.

BACKGROUND: The role of induction chemotherapy in advanced squamous cell carcinoma of the head and neck (SCCHN) is under constant debate. Surgery, radiotherapy, chemotherapy, and targeted therapies are part of the treatment strategy in these patients, but their sequence remains to be defined. OBJECTIVES: To evaluate the feasibility of induction chemotherapy with docetaxel-cisplatin-5-flurouracil (TPF) followed by external beam radiotherapy (EBRT) with concomitant chemotherapy or cetuximab (ERT) in the treatment of patients with advanced SCCHN. METHODS: We reviewed the data of all patients with advanced SCCHN, stage III and IV, treated in 2007-2010. Tolerability was assessed and scored according to the proportion of patients completing the planned study protocol. Toxicity was scored using the U.S. National Cancer Institute Common Toxicity Criteria (version 4) for classification of adverse events. RESULTS: The study included 53 patients. TPF was initiated at a reduced dose in 13 patients (25%). Twenty-two patients (41.5%) received primary prophylaxis with granulocyte colony-stimulating factor (GCSF) and 42 (77%) completed treatment according to schedule. During the induction phase one patient (2%) died and 24 (45%) had one or more grade 3-4 complications. The number of patients who developed neutropenia was lower in the group that received primary GCSF prophylaxis. Secondary dose reductions were required in 21% of the patients. CONCLUSIONS: Induction TPF was associated with grade 3-4 toxicity. Prophylaxis with GCSF should be part of the treatment regimen.

Brain metastasis of nasopharyngeal carcinoma: a case report and literature review.

Central nervous system metastases from nasopharyngeal carcinoma (NPC) are uncommon. The patient presented was diagnosed with aggressive advanced NPC resistant to treatment and complicated by a solitary brain metastasis. A PubMed database search was conducted to review the existing literature regarding brain metastases of NPC, using the search terms "nasopharyngeal neoplasia," "nasopharyngeal carcinoma," "nasopharynx," "radiotherapy," "central nervous system," and "brain" in section of "Title/Abstract." The articles were first evaluated by title and then by abstract, and thereafter appropriate manuscripts were evaluated by full text. References of the published papers were also reviewed.

Successful desensitization protocol for hypersensitivity reaction caused by sunitinib in a patient with a gastrointestinal stromal tumor.

Sunitinib is an orally bioavailable small molecule that inhibits multiple receptor tyrosine kinases. Generalized hypersensitivity reactions (HSR) to sunitinib have not been described. A patient with a gastrointestinal stromal tumor (GIST) who developed a type I HSR to sunitinib and who was successfully treated by drug desensitization is reported. A 51-year-old man with metastatic GIST developed a type I HSR during sunitinib treatment. Four days after treatment initiation, the patient presented to the Emergency Department with acute generalized urticaria and facial and throat swelling. Sunitinib was restarted 1 week later, using a desensitization protocol in which 10 escalating reduced doses, beginning with 0.05 mg, were given following pre-medication with prednisone and promethazine. This protocol was well tolerated and allowed us to continue the treatment, obtaining partial remission of the liver metastasis that was followed by complete resection. Sunitinib was temporarily discontinued before the operation and renewed after surgery by repeating the same desensitization procedure. At the time of this report, sunitinib has been continued for 1 year without evidence of recurrent disease. Oral desensitization appears to be an option for patients with hypersensitivity type I to sunitinib and may permit its safe administration to patients who experience HSR to this life-prolonging medication.