Late Metastasis of Renal Cell Carcinoma in Distal Femur Treated with Knee Joint Preservation: A Case Report.

Introduction: Late metastasis and recurrences after 10 years of curative treatment is a known biological behavior of renal cell carcinoma (RCC) and a long follow-up is required for the detection of metastasis. Late solitary bony metastasis is very rare. No case of a late solitary metastasis of distal femur, treated with wide local excision and reconstruction, is available in the literature. We present a case of solitary metastatic lesion of distal femur 12 years after radical nephrectomy for renal cell carcinoma in a 64-year-old male. Case Report: The patient presented to us with swelling in the right distal thigh for three years with a history of radical nephrectomy for RCC 12-years back. The lesion was not responding to local radiotherapy, and chemotherapy in the form of oral pazopanib, taken before orthopedic consultation. After core biopsy, the tumor was managed by intercalary wide local excision and reconstruction using a cement block and a lateral locking plate. Post-operatively, the histopathology report confirmed the diagnosis to be a clear cell tumor, consistent with metastatic RCC. The patient is independently mobile and tumor-free 2 years after the surgery. Conclusion: Wide resection and reconstruction of the skeletal defect remains the mainstay of the management of metastatic solitary lesion. We have presented a unique case of distal fem-oral solitary metastatic deposit from a primary RCC 12 years post radical nephrectomy treated by intercalary resection and reconstruction with bone cement-plate hybrid construct.

Impact of nationwide lockdown on cancer care during COVID-19 pandemic: A retrospective analysis from western India.

BACKGROUND AND AIMS: COVID-19 has impacted healthcare system worldwide including cancer case. Aim of this study was to describe the experience of lockdown on cancer care concerning patient's visit and reception of treatment in western India. METHODS: This is a retrospective observational study conducted in patients with cancer attending a tertiary care center pre-lockdown and during lockdown (from January to May 2020). Data related to demographic parameters, type of tumor, type of treatment received and functional status of patients were retrieved from hospital medical records of patients. RESULTS: Of the 5258 patients included, 4363 visited hospital pre-lockdown (median age, 50 years) and 895 visited during the lockdown period (median age, 47 years). A total of 1168 and 106 patients visiting hospital before and during lockdown, respectively, had comorbidities. Breast cancer (25.6% and 29.7%), head and neck cancer (21.3% and 16.9%) were the most common type of solid tumors; leukemia (58.0% and 73.0%), lymphoma (18.8% and 13.5%) and multiple myeloma (18.6% and 12.2%) were the most common type of hematological malignancies observed in patients visiting pre-lockdown and during lockdown, respectively. Chemotherapy was most commonly received treatment (pre-lockdown, 71.8%; during lockdown, 45.9%). Other therapies reported includes supportive/palliative, targeted, hormonal, and immunotherapy. The majority of patients who visited the hospital pre-lockdown (68.4%) and during lockdown (62.8%) had 0 or 1 Eastern Cooperative Oncology Group (ECOG) score. CONCLUSION: Overall observations highlight a substantial impact of an imposed nationwide lockdown during COVID-19 pandemic on cancer care of patients in terms of reduced patient visits and number of treatments received.

Atypical central neurocytoma with leptomeningeal dissemination: a case report.

BACKGROUND: Central neurocytomas represent 0.25-0.5% of all intracranial tumors in adults. Leptomeningeal spread is uncommon, and the exact incidence of meningeal spread is unknown due to sparse literature. We present the clinical course and management outcome of a case of atypical central neurocytoma with leptomeningeal spread. CASE PRESENTATION: A young gentleman, who initially presented with memory loss, was found to have a right intra-axial periventricular mass on imaging. He underwent subtotal resection, and operative histopathology suggested a periventricular atypical neurocytoma. In view of subtotal resection, adjuvant focal radiation therapy was recommended, but he developed headache and blurring of vision 10 days postoperatively. Contrast enhanced craniospinal magnetic resonance imaging (MRI) showed residual primary tumor as well as diffuse leptomeningeal spread. Cerebrospinal fluid cytology also showed malignant cells. After tumor board discussion, craniospinal axis irradiation was advised and delivered. He remained disease-free for 10 months after radiation therapy, but then developed local and spinal recurrence, and offered salvage chemotherapy. His general condition deteriorated following chemotherapy with disease progression, and he was subsequently advised best supportive care. CONCLUSION: Leptomeningeal dissemination in atypical neurocytomas portends an aggressive course and adverse prognosis; management decisions may need tailoring as per individual presentation.

Clinical outcomes of adaptive radiotherapy in head and neck cancers.

OBJECTIVE: The present study evaluated the efficacy and toxicity of adaptive radiotherapy (RT) among patients with head and neck cancer. METHODS: 36 patients eligible for radical RT underwent RT planning scans and were planned for 54-Gy dose to both high-risk and low-risk target volumes in Phase I. All patients underwent a second (adaptive) scan during the fifth week of RT. Phase II plans for 16 Gy to high-risk planning target volume were developed on these mid-treatment scans. The primary end point was local response. Disease-free survival (DFS), overall survival (OS) and treatment-related morbidity were secondary end points. RESULTS: Median reductions in gross primary and nodal disease volumes on mid-treatment scans were 34% and 43.2%, respectively. 16 patients experienced grade 3 acute mucositis. No patient had grade 3 or above haematologic toxicity. Four patients developed local recurrences, all within the RT field. Median DFS and OS were 17.5 and 23.5 months, respectively. CONCLUSION: Adaptation to changes in the anatomic and tumour volume or shape may help tilt the balance towards more efficient dose delivery as well as better normal tissue sparing. ADVANCES IN KNOWLEDGE: This study supports the need for adaptive replanning for minimizing normal tissue toxicity without compromising local control and adds to the existing body of literature.