Quadruple cancer in a single patient: a report of four cases.

Multiple primary neoplasia was once considered a rare curiosity but is now a well recognized phenomenon. Only a few papers have been published in the English literature with regard to occurrence of four or more primary malignancies in a single patient. We report four cases of quadruple cancer; a review of the literature about this topic is discussed.

Choroidal metastasis from carcinoma of the hypopharynx: a case report.

Choroidal metastasis from primaries other than breast or lung cancer is a rare event. There is no documented case in the literature of choroidal metastases in patients with hypopharynx carcinoma. Early treatment with radiation therapy provides effective palliation by preserving visual function and preventing the need for enucleation. Chemotherapy alone does not seem to be as effective as radiation therapy for patients with choroidal metastases. In this paper a case of choroidal metastasis arising from a primary hypopharynx carcinoma is presented.

Primary non-Hodgkin's lymphoma of the female genital tract.

Genital tract lymphoma is a rare disease; information on diagnosis, treatment and outcome are limited. We report on eight patients affected by non-Hodgkin's lymphoma of the genital tract, five from the cervix, two from the vagina and one from the vulva collected between 1987 and 1998. Age at presentation ranged from 36 to 82 (median 67) years. The commonest initial symptom was vaginal bleeding, post coital in 1 patient. Three patients complained of vescical symptoms. Ann Arbor classification was stage IAE for 6 patients. Histology, according to the IWF, was either intermediate grade (4 patients), or high grade (3 patients), not evaluable in one case. Seven patients were treated with chemotherapy (anthracycline based in four) followed by pelvic radiotherapy in five; one patient received irradiation alone. Five patients are currently alive and free of disease with follow-up ranging from 8 to 126 months. Based on our experience in this series, we support a management scheme of combination chemotherapy and radiotherapy for patients with non-Hodgkin's lymphoma of the genital tract.

[Role of adjuvant radiotherapy in the treatment of rectal carcinoma]. / Ruolo della radioterapia adiuvante nel trattamento del carcinoma rettale.

Radiotherapy (RT) either pre or postoperative is widely accepted as the standard adjuvant treatment in rectal carcinoma invading the perirectal tissues. The main effect of RT was to decrease the incidence of local recurrence by 30%-50%; there was however no evidence of any impact on survival. With preoperative RT a large range of doses was tested; a dose of 35 Gy or more with fractions of 1.8-2.0 Gy five times per week (or a biologically equivalent regimen) is required to affect the local recurrence rate; with postoperative RT a more uniform dose of 45-50 Gy in 5 five weeks was used. Wether RT is better to be given pre or postoperatively has been the object of a continuing debate. The preoperative option seems at present preferable: the main advantages of this option are the lower morbidity and the possible increase of sphincter saving surgery; the availability of the intrarectal imaging modalities made the clinical staging very reliable, eliminating the major concern of preoperative RT represented by the possible overtreatment of early intraparietal tumours. For tumours located in the range of applicability of intrarectal US or MR (extraperitoneal rectum) preoperative RT should be considered the first choice adjuvant treatment. For tumours located in the intraperitoneal part of the rectum postoperative RT, on the basis of pathological staging, is probably preferable. Two randomized trials reported an improvement of the overall survival when postoperative RT was given concomitantly with 5 Fluorouracil but at the expense of a higher morbidity and a lower compliance. The most promising approach to be explored seems therefore the concomitant combination of preoperative RT and 5 Fluorouracil. Future studies should also define the more effective modality of this combination and wether 5 Fluorouracil has to be given alone or combined with other drugs.