Small cell carcinoma of the bladder: a search of the current literature.

PURPOSE: Small cell carcinoma of the urinary bladder (SCC-BL) is an extremely rare malignancy, accounting for < 1% of all bladder tumors. Its prognosis is very poor because of its highly aggressive behavior and high metastatic potential. This study aimed to update the management and outcome of SCC-BL by searching the relevant international literature. METHODS: Relevant studies were identified by searching MEDLINE and the Cochrane Central Register of Controlled Trials using a combination of terms such as small cell carcinoma, bladder cancer, therapeutic approach, radical cystectomy, radiation therapy and chemotherapy. Additional papers were identified from reviewing references of relevant articles. RESULTS: Previously published series have shown that SCC-BL has a significant male predominance, occurs mainly during the 7th and 8th decade of life and macroscopic hematuria is the most common presenting symptom. According to the most important studies, cystectomy alone seems not to be efficient enough for the management of the disease. On the other hand, radiation therapy when combined with chemotherapy is highly effective with increased survival rates. CONCLUSION: Poor prognosis and rarity render disease management complicated. A definitive treatment is not yet established but combined therapy with systemic platinum-based chemotherapy and adjuvant local radiotherapy seems to be the most effective therapeutic approach for limited-stage SCC-BL. Further research is required in order to clarify whether prophylactic cranial irradiation (PCI) should be performed on a regular basis.

Ultrasound-assisted endocavitary HDR-Ir192 brachytherapy for unresectable locally advanced uterine cervix carcinoma: retrospective analysis focusing the efficacy and tolerability

PURPOSE: To evaluate the impact of uterine cavity's ultrasound to final selected length of intracavitary tandem. The efficacy and tolerability of external beam radiation plus HDR-Ir(192) brachytherapy in our cohort of patients were also estimated. MATERIALS AND METHODS: 48 women with locally advanced unresectable uterine cervix carcinoma were treated by HDR-Ir(192) endocavitary brachytherapy between January 2007 and January 2009. The median age was 63 (range 38-74). The distribution according to Federation of Gynaecology and Obstetrics (FIGO) staging system was as follows: Stage IIB, 54.16 %; IIIA, 10.4 %; IIIB, 27.0 %; and IVA, 8.3 %. HDR intracavitary brachytherapy was given weekly, beginning at the last week of whole pelvis irradiation, with a dose of 7 Gy to point A for three to four fractions. The median overall treatment time was 50 days (range 42-73 days). The median follow-up time was 2.7 years (range 3 months to 4.9 years). Multivariate analysis was performed using the Cox regression proportional hazards model. RESULTS: The complete remission rate after radiotherapy was 93.75 % (45/48). The 5-year actuarial major complication rates (Grade 3 or above) were 6.3 % overall (2.1 % proctitis, 2.1 % cystitis and 2.1 % enteritis). Estimation of the length of uterine cavity by ultrasound helped decisively in the proper placement of the intrauterine tandem inserted. CONCLUSIONS: Prior knowledge of the length of uterine cavity can facilitate the decisions regarding the proper insertion length of the tandem. Results of cervical cancer treatment with external beam radiation and HDR intracavitary brachytherapy in our hospital are encouraging (AU)

Ameloblastoma, a rare benign odontogenic tumour: an interesting tumour review targeting the role of radiation therapy.

Ameloblastoma is known as a benign, slow-growing, rare, odontogenic neoplasm. The solid/multicystic, the unicystic with a fibrous connective-tissue capsule and the peripheral ameloblastoma represent the three well distinguished clinical types of ameloblastoma. Surgical resection with an attempt to achieve adequate free margins constitutes a well documented and accepted treatment modality. Controversies exist, however, with regard to the extent of operative intervention. Patients with inadequate or positive surgical margins or unresectable lesions can be treated with radiation or combined radiation and chemotherapy. The authors present a review of this sparse disease focusing on the special role and efficacy of radiation therapy in its management.

Ameloblastoma, a rare benign odontogenic tumour: an interesting tumour review targeting the role of radiation therapy

Ameloblastoma is known as a benign, slow-growing, rare, odontogenic neoplasm. The solid/multicystic, the unicystic with a fibrous connective-tissue capsule and the peripheral ameloblastoma represent the three well distinguished clinical types of ameloblastoma. Surgical resection with an attempt to achieve adequate free margins constitutes a well documented and accepted treatment modality. Controversies exist, however, with regard to the extent of operative intervention. Patients with inadequate or positive surgical margins or unresectable lesions can be treated with radiation or combined radiation and chemotherapy. The authors present a review of this sparse disease focusing on the special role and efficacy of radiation therapy in its management (AU)

Targeted therapy with bevacizumab (Avastin) for metastatic colorectal cancer.

During the last decade, the development of new drugs known as targeted therapies was the result of a better understanding of the processes involved in the transformation of normal cells into cancer. The term targeted therapy refers to drugs that selectively target specific molecular pathways involved in tumorigenesis or tumour progression. Angiogenesis is important for tumour growth and metastasis, and is an important target for new biological agents. Bevacizumab is a humanised recombinant antibody that prevents vascular endothelial growth factor (VEGF) receptor binding, and inhibits angiogenesis and tumour growth. On February 26, 2004, the Food and Drug Administration approved bevacizumab as first-line treatment for patients with metastatic colorectal cancer (CRC). The integration of targeted therapies in the treatment of colon cancer has resulted in significant improvements in efficacy outcomes. The efficacy of bevacizumab in the treatment of metastatic CRC is presented in this review article.

Targeted therapy with bevacizumab (Avastin) for metastatic colorectal cancer

During the last decade, the development of new drugs known as targeted therapies was the result of a better understanding of the processes involved in the transformation of normal cells into cancer. The term targeted therapy refers to drugs that selectively target specific molecular pathways involved in tumorigenesis or tumour progression. Angiogenesis is important for tumour growth and metastasis, and is an important target for new biological agents. Bevacizumab is a humanised recombinant antibody that prevents vascular endothelial growth factor (VEGF) receptor binding, and inhibits angiogenesis and tumour growth. On February 26, 2004, the Food and Drug Administration approved bevacizumab as first-line treatment for patients with metastatic colorectal cancer (CRC). The integration of targeted therapies in the treatment of colon cancer has resulted in significant improvements in efficacy outcomes. The efficacy of bevacizumab in the treatment of metastatic CRC is presented in this review article (AU)

Therapeutic interventions targeting organ preservation in muscle-invasive bladder cancer: a review

Nowadays in modern oncology there is a tendency towards therapies that target organ preservation. Organ preservation protocols have become standard in the treatment of laryngeal carcinoma, oesophageal cancer, breast carcinoma and soft tissue sarcomas. The three-combined therapy consisting of a transurethral resection of the bladder tumour followed by concomitant chemoradiotherapy has been shown to be an attractive alternative for bladder preservation in selected patients with muscle-invasive bladder cancer. In order to evaluate the organ preservation approaches in muscle-invasive bladder cancer we have conducted a comprehensive literature review. Data reported from the studies have shown that bladder preservation therapy with a trimodality approach is safe and effective. Moreover, such an approach provides patients with the opportunity to maintain an intact and functional bladder with a survival rate similar to that of radical cystectomy (AU)

Oral pseudomembranous candidiasis, herpes simplex virus-1 infection, and oral mucositis in head and neck cancer patients receiving radiotherapy and granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthwash.

Oral pseudomembranous candidiasis (OPC) was evaluated in 61 patients receiving head and neck radiotherapy (RT). Herpes simplex virus-1 (HSV-1) reactivation was also investigated in 14 patients. According to the agreed protocol, granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthwash was administered in 46 patients with radiation-induced ulcers. Candidiasis was diagnosed in 31 patients. Candida albicans was the most frequent isolate. Multiple Candida species were isolated from the lesions of four patients. Concurrent candidiasis and radiation-induced ulcers were observed in 17 patients. Viral culture and the polymerase chain reaction disclosed the presence of HSV-1 in five patients. Twenty of the 46 patients, with initial mucositis grade II and grade III, completed RT with mucositis grade I, indicating a beneficial effect of GMCSF mouthwash, although further controlled studies are necessary to verify that. In conclusion, OPC was an important infection in patients undergoing radiotherapy. The role of HSV-1 in oral mucositis during head and neck radiotherapy needs additional study.

A pilot study of the effect of granulocyte-macrophage colony-stimulating factor on oral mucositis in head and neck cancer patients during X-radiation therapy: a preliminary report.

PURPOSE: To evaluate the effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) in reduction of radiotherapy-induced oral mucositis. METHODS AND MATERIALS: Seventeen patients who were going to be irradiated with a total dose of 50-70 Gy for head and neck malignancies were included in the study. After the second week of radiotherapy, with the experience of oral pain, GM-CSF 400 microg was administered locally, once a day, until completion of radiotherapy. Patients were evaluated weekly for mucosal reaction and functional impairment. RESULTS: Three patients with gross and functional mucositis grade I after the second week, completed the planned radiotherapy showing mucositis grade I. Eleven patients who experienced, after 2 weeks of radiotherapy, mucositis grade II and III, presented after the third week with gross mucositis grade I and II and functional impairment grade I. One of these 11 patients was then lost to follow-up and the remaining 10 completed their planned radiotherapy having an almost asymptomatic mucositis grade I. The 15th patient with gross mucositis grade III after the 2 weeks of radiotherapy, had a 2-day interruption because of painful mucositis and then continued and completed radiotherapy with gross and functional mucositis grade I. The 16th patient with mucositis grade III after the second week, did not show any improvement, and completed her planned radiotherapy with mucositis grade III which finally healed after the administration of acyclovir. The last, 17th patient discontinued radiotherapy at the third week because of mucositis grade IV and severe ulceration in apposition to an extensive gold prosthesis. CONCLUSION: The local administration of GM-CSF significantly reduced and almost healed radiation-induced oral mucositis in 14 of 17 patients during the radiotherapy, which was completed within the preplanned time and without any significant patient weight loss or functional impairment.