ABSTRACT
Low-grade myofibroblastic sarcoma (LGMS) is a very rare, atypical myofibroblastic tumor with fibromatosis-like features with predilection mostly in head and neck region. LGMS occurs primarily in adult patients with a slight male predominance. Only few cases of LGMS affecting the larynx have been reported in literature to this date. We describe a case of low-grade myofibroblastic sarcoma of the larynx in a 40-year-old male patient. The clinicopathological characteristics, immunohistochemical ï¬ndings and treatment are discussed.
Subject(s)
Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Myofibroblasts/pathology , Myosarcoma/pathology , Myosarcoma/surgery , Adult , Diagnosis, Differential , Diagnostic Imaging , Humans , Laryngeal Neoplasms/diagnosis , Laryngoscopy , Male , Myosarcoma/diagnosis , TracheostomyABSTRACT
We report a case of a 59-year-old man with solitary extramedullary plasmacytoma in his oropharynx. Because the diagnosis is rare and there is only limited experience in the literature based on retrospective data, the optimal planning target volume and optimal dose of radiation therapy (RT) are still controversial. The frequently discussed problem is the necessity of first echelon lymph node irradiation because it is associated with a higher rate of complications such as xerostomia caused by damage to salivary glands. In order to prevent late toxicity, intensity-modulated RT with the use of simultaneous integrated boost and parotid salivary gland sparing was used in this patient's treatment. The RT was performed in 23 identical fractions, the primary tumor region was irradiated with a dose of 46 Gy and the first echelon lymph node region with the risk of subclinical disease with a dose of 41.4 Gy; the dose per fraction was 2 Gy and 1.8 Gy, respectively. The patient is alive and well > 20 months after the irradiation, without any evidence of disease. Parotid gland function remained intact, and no xerostomia occurred. This is the first report of the use of intensity-modulated RT with parotid gland sparing in the treatment of solitary extramedullary plasmacytoma in the head and neck region.
Subject(s)
Oropharyngeal Neoplasms/radiotherapy , Plasmacytoma/radiotherapy , Radiotherapy, Intensity-Modulated/methods , Dose-Response Relationship, Radiation , Humans , Male , Middle Aged , Oropharyngeal Neoplasms/pathology , Plasmacytoma/pathology , Treatment OutcomeABSTRACT
Acute toxicity has been evaluated in head and neck cancer patients treated with intensity-modulated radiotherapy using simultaneous integrated boost (SIB-IMRT). The basis of the treatment protocol is an irradiation in 30 fractions with a total dose: 66 Gy to the region of macroscopic tumor, 60 Gy to the region of high-risk subclinical disease and 54 Gy to the region of low-risk subclinical disease. Between December 2003 and September 2005, 38 patients with carcinoma of different locations in the head and neck region were irradiated. Five patients underwent concurrent chemotherapy (weekly cisplatin). Acute toxicity was evaluated according to Radiation Therapy Oncology Group toxicity scale for skin, mucous membrane, salivary glands, pharynx and esophagus and larynx. All 38 patients completed the therapy without urgency of interruption due to acute toxicity of radiotherapy. No patient experienced grade 4 toxicity. More severe toxicity was observed in patients with concurrent chemotherapy. The results confirm that the irradiation according to our SIB-IMRT protocol is a therapy with acceptable toxicity and there is a space for radiobiological enhancement of this regimen by concurrent chemotherapy, e.g. weekly cisplatin.
