Locoregional proton radiotherapy of a primary cavernous sinus non-Hodgkin's lymphoma: case report.

Primary B cell lymphomas of the skull base are uncommon and lack well-defined treatment guidelines. We report a case of diffuse, large B-cell lymphoma of the cavernous sinus with sphenoid sinus and clivial extension, treated with partial resection, chemotherapy, and proton beam irradiation. To our knowledge, this is the first report of a skull-base lymphoma treated with protons. A 53-year-old female presented with a two-month history of diplopia, persistent headaches, and paresthesia over the left side of her mouth. A skull MRI revealed an enhancing mass in the right cavernous sinus and right sphenoid sinus. Transsphenoidal subtotal resection of the mass confirmed the presence of a diffuse, large B-cell lymphoma. Treatment consisted of CHOP-R chemotherapy and locoregional radiation with protons. Locoregional radiation of the lesion required moderate doses, below the radiation tolerance of adjacent normal structures. Conformal protons were utilized to minimize the volume of normal brain receiving radiation. Conformal proton beam radiotherapy to a moderate dose proved valuable in this case because it minimized the volume of normal brain receiving low to moderate doses of radiation.

Patient tolerance of rectal balloons in conformal radiation treatment of prostate cancer.

PURPOSE: To evaluate patient tolerance of intrarectal balloons used during conformal prostate irradiation. METHODS AND MATERIALS: A retrospective analysis was performed on 3,561 patients who underwent conformal radiation for prostate cancer. Therapy consisted of proton irradiation of the prostate and seminal vesicles and X-ray treatment of the pelvis when warranted. The number of treatments in which the balloon was tolerated was recorded. Results were stratified according to method of irradiation (protons alone vs. combined proton/X-ray) and method of planning (2D vs. 3D planning of X-ray fields in patients undergoing combination treatment). RESULTS: Of all the patients evaluated, 3,474 (97.6%) tolerated the balloon throughout treatment; 87 (2.4%) declined the balloon for 1 or more treatments and tolerated the balloon for 85.5% of their treatments. Chi-square analysis revealed a significant tolerance advantage in those who received protons alone compared with combination treatment (99.5% vs. 95.7%; p < 0.001). In patients undergoing combination treatment, chi-square analysis did not reveal significant tolerance differences in patients undergoing 3D vs. 2D planning for pelvic X-ray fields (95.74% vs. 95.72%; p = 0.990). CONCLUSIONS: Intrarectal balloons are well tolerated over a course of conformal prostate irradiation.

Fractionated proton beam irradiation of pituitary adenomas.

PURPOSE: Various radiation techniques and modalities have been used to treat pituitary adenomas. This report details our experience with proton treatment of these tumors. METHODS AND MATERIALS: Forty-seven patients with pituitary adenomas treated with protons, who had at least 6 months of follow-up, were included in this analysis. Forty-two patients underwent a prior surgical resection; 5 were treated with primary radiation. Approximately half the tumors were functional. The median dose was 54 cobalt-gray equivalent. RESULTS: Tumor stabilization occurred in all 41 patients available for follow-up imaging; 10 patients had no residual tumor, and 3 had greater than 50% reduction in tumor size. Seventeen patients with functional adenomas had normalized or decreased hormone levels; progression occurred in 3 patients. Six patients have died; 2 deaths were attributed to functional progression. Complications included temporal lobe necrosis in 1 patient, new significant visual deficits in 3 patients, and incident hypopituitarism in 11 patients. CONCLUSION: Fractionated conformal proton-beam irradiation achieved effective radiologic, endocrinological, and symptomatic control of pituitary adenomas. Significant morbidity was uncommon, with the exception of postradiation hypopituitarism, which we attribute in part to concomitant risk factors for hypopituitarism present in our patient population.

Interleukin 2 gene transfer prevents NKG2D suppression and enhances antitumor efficacy in combination with cisplatin for head and neck squamous cell cancer.

Cisplatin has been the most promising single chemotherapeutic agent usedagainst head and neck squamous cell cancer to date. However, dose-related toxicity has been one of the major limiting factors in cisplatin-based therapies, because high doses are required for obtaining a significant antitumor effect. To face the challenge of this limiting factor, a novel interleukin 2 (IL-2)-based combination strategy has been developed. Here we show that the strategy of combination of cisplatin with nonviral IL-2 gene therapy resulted in significant antitumor effects while avoiding dose-limiting toxicity in a head and neck squamous cell cancer murine model. Cisplatin systemic therapy alone suppressed NKG2D expression in lymphocytes. The use of local regional IL-2 gene transfer prevented NKG2D suppression. The combination strategy demonstrated a clear synergistic interaction between cisplatin and IL-2, and NKG2D-based cytotoxicity manifested by increased tumor specific lysis from CTLs and natural killer cells. Moreover, the combination of cisplatin and IL-2 gene therapy greatly enhanced apoptosis and growth inhibition in the treated tumors. This novel combination strategy holds promise for the treatment of head and neck cancer, and the mechanism of NKG2D in activating natural killer and CTL receptors provides a foundation for additional investigation, and development of immune modulation and chemotherapy regimens.