Upper extremity pleomorphic dermal sarcoma in a patient with chronic myelomonocytic leukemia.

BACKGROUND: Pleomorphic dermal sarcoma is a potentially high-grade cutaneous spindle cell tumor that closely resembles atypical fibroxanthoma in the superficial, dermal aspects but with adverse pathological features. Chronic inflammation, as several autoimmune disorders are co-associated with chronic myelomonocytic leukemia. CASE DESCRIPTION: We report here an 84-year-old male patient with swelling lump on the upper third of the left arm. Previously he suffered from a type I chronic myelomonocytic leukemia. Based on the initial ultrasound-guided biopsy of the lesion, the histopathological examination revealed an atypical fibroxanthoma. A wide local excision was performed and the diagnosis was revised to pleomorphic dermal sarcoma by the pathologist, based on the currently accepted criteria. Adjuvant radiotherapy was performed. CONCLUSION: Differentiating between atypical fibroxanthoma and pleomorphic dermal sarcoma is pivotal. A partial sampling of the skin lesion poses a significant pitfall, as important diagnostic features cannot be assessed. Immunosuppression seems to be involved in the pathogenesis of chronic myelomonocytic leukemia and pleomorphic dermal sarcomas, because of the advanced patient age. HIPPOKRATIA 2019, 23(4): 181-185.

Reirradiation for recurrent head and neck carcinoma.

PURPOSE: To present the outcome and toxicity profile of reirradiation (re-RT) in patients with recurrent head and neck cancer (HNC). METHODS: From 1995 to 2009, 35 patients underwent re-RT at our institution. Twenty-seven (77%) patients were initially diagnosed with stage III/IV disease. The median total doses of irradiation -first and second courses- were 66.0 Gy (range 54.0-70.0) and 55.8 Gy (range 32.5-66.6), respectively. The median time from the first course of irradiation to re-RT was 25.2 months (range 8-136). Six (17%) patients underwent salvage surgery before reirradiation. Concurrent chemotherapy was administered to 18 (51%) patients. RESULTS: With a median follow-up of 12.9 months (range 2.5-109.6), the 1- and 2-year locoregional control (LRC) rates were 41 and 9%, respectively. The 1- and 2-year disease free survival (DFS) rates were 30 and 7%, respectively. The 1- and 2-year overall survival (OS) rates were 42.9 and 7.9%, respectively. Grade 3 acute toxicity was reported in 7 (20%) patients while grade 3-4 late radiation-induced complications were seen in 8 (23%) patients. In univariate analysis, an improvement in OS was observed in patients with initial N0/N1 stage vs. those with N2/N3 stage (p=0.004). Prior neoadjuvant chemotherapy was associated with significantly inferior OS (p=0.028), while neoadjuvant chemotherapy in recurrence was predictive of improved LRC (p=0.041). CONCLUSION: re-RT in HN cancer is associated with poor prognosis, especially in patients with inoperable disease. Complications due to treatment are not infrequent. Nonetheless, our outcomes remain encouraging and applicable to a carefully selected patient population.

External beam radiotherapy of bladder carcinoma: considerations in determining the irradiation field margins.

PURPOSE: Motions of the bladder and rectum during pelvic irradiation are considered as major causes of geometrical uncertainties. As a result, the volume status of these organs is changed and the definition of the treatment margins is imperative. The aim of this study was, firstly, to determine these margins, comparing series of CT scans, performed at simulation time, with empty (EB) and full bladder (FB) and, secondly, to evaluate the dose volume histograms (DVHs) of tumor and rectum using standard treatment margins. METHODS: Fifteen patients with muscle-invading urinary bladder carcinoma underwent two scan series with EB and FB bladder during radiotherapy (RT) simulation. Gross tumor volume (GTV), clinical target volume (CTV), planning treatment volume (PTV) and organs at risk (OAR) were contoured. Displacements of the bladder wall were determined at all directions. Cumulative DVHs were generated for the volumes of interest. Using the same beam arrangements for both the EB and FB CT series, DVHs were also produced. RESULTS: The mean bladder volume was 119.3±55.9 cm3 and 264.3±145.7 cm3 for EB and FB CT series, respectively (p<0.001). The maximum bladder wall displacement was observed at cranial direction (2.2±0.6 cm for the EB vs. 3.4±1.0 cm for the FB series; p<0.001) and at caudal direction (2.3±0.6 cm for the EB vs. 3.6±1.0 cm for the FB series; p<0.001). Standard anisotropic margins of 2 cm in craniocaudal and posterior-anterior directions and 1.2 cm in lateral direction gave coverage to 75% of all bladder movements caused by FB. Analysis of DVHs and tumor control probability (TCP) calculations gave same results (74%), while normal tissue complication probability (NTCP) of the rectum showed no significant changes. CONCLUSION: CT scans series with empty and full bladder, performed at simulation time, could offer a potential advantage to evaluate the target expansion necessary to cover the bladder wall for each patient, giving more information about safe margining.

Radical therapy for muscle-infiltrating bladder cancer (cystectomy or radiotherapy): does age affect the final therapeutic benefit for the patient?

PURPOSE: To evaluate the therapeutic outcome of radical cystectomy and radical radiotherapy in patients with T2N0M0 clinical stage bladder cancer in relation to their age. PATIENTS AND METHODS: Between 1995-2006, 119 patients with clinical stage T2N0M0 bladder cancer were treated with radical radiotherapy (group A) and were divided in 2 subgroups: >70 years old (A1) and 70 years old/B1 subgroup and

Adjuvant chemo-radiotherapy in patients with gastric cancer.

BACKGROUND: The role of adjuvant therapy in gastric cancer has been controversial. AIM: In this study, we report our experience with adjuvant chemotherapy and radiotherapy in patients with non-metastatic gastric cancer. SETTINGS AND DESIGN: Fifty patients were reviewed and assigned to three therapeutic groups. MATERIALS AND METHODS: Twenty patients received radiotherapy with concomitant administration of 5-fluorouracil and leucovorin on the first and last three days of radiotherapy; 20 patients received a five-day cycle 5-fluorouracil and leucovorin followed four to five weeks later by radiotherapy concomitant with the administration of fluorouracil on the first and the last three days of radiotherapy. Four weeks after radiotherapy two more five-day cycles of chemotherapy were administered; 10 patients received three cycles of cisplatin/docetaxel followed by radiotherapy and three additional cycles of chemotherapy after the completion of radiotherapy. STATISTICAL ANALYSIS: Patients were evaluated for treatment-related toxicity, local recurrences, distant metastases and deaths. We also aimed to make any possible comparisons between different chemo-radiation protocols. RESULTS: Within a median follow-up of 21.5 months seven patients developed local recurrence and 17 patients developed distant metastases. The overall death proportion was 42% (95% CI 28.2-56.8%). Despite the limited number of patients, no statistically significant differences in local recurrences, distant metastases and deaths were observed between the three protocols. Acute and long-term treatment-related toxicity was low and no treatment-related deaths were observed. CONCLUSION: Despite variations of chemotherapy, our study demonstrated that combined chemo-radiotherapy for patients with resected gastric cancer can be administered safely, with acceptable toxicity.

Radiation and concomitant weekly administration of paclitaxel in patients with glioblastoma multiforme. A phase II study.

The present study was conducted to evaluate the activity and toxicity profile of radiation (RT) and concomitant chemotherapy in patients with glioblastoma multiforme (GBM). Thirty-nine patients were treated postoperatively with RT and concomitant administration of paclitaxel. Cranial irradiation was initiated 2-3 weeks postoperatively and was administered in 2.0 fractions, one fraction per day, for 5 consecutive days per week, to a total of 60 Gy. Paclitaxel was delivered at a dose of 100 mg/m2 over 3-h once weekly for 6 weeks. Thirty-three patients received all 6 cycles of paclitaxel according to the protocol. Totally, 217 cycles were delivered all of them at full dose. The median relative dose intensity of paclitaxel was 1 (range 0.88-1.1). Three (7.5%) patients achieved complete and 9 (23%) partial response, while 12 (30.5%) patients demonstrated stabilization of the disease. Side effects from combined chemoradiotherapy were mainly mild. Grade III toxicity included infection (7.5%) and alopecia (5%). Median time to progression was 6 (range 0.9-27) months and median survival 10.7 (range 0.9-39.5+) months. The present study has clearly shown that 100 mg/m2 of paclitaxel in 1-h infusion weekly can be safely given concomitantly with RT in patients with GBM with manageable toxicity. However, the efficacy of this combined modality treatment does not appear to be superior to that of RT alone.

The use of an expert system of composite risk factors in breast cancer screening.

Mass Screening seems to be the only promising way to discover breast cancer patients at an early and more curable stage and a positive method improving the cost-effectiveness and compliance of mass screening is the use of prognostic factors, to identify the high-risk group, who alone then would be screened. In a 200 women sample, who had undergone screening for breast cancer with clinical examination and bilateral mammography, we calculated the Composite Risk Factors of six Characteristics (C6RF), which are family history for breast cancer, pregnancy history, menstrual history, history of cystic breast disease, history of regular breast clinical or self-examination and presence or not of breast lump, using an expert system in IBM-compatible personal computer. In these cases the average C6RF was 0.18 (SD +/- 0.19) in low-risk group and 2.61 (SD +/- 4.76) in high-risk group and all cases with C6RF values higher than 0.56 were put in the high-risk group. Under these conditions, the sensitivity of the C6RF method, in discovering breast cancer, was 90% and the specificity 81.5% and the C6RF method was proved to be clinically valuable in identifying the high-risk group and controlling breast cancer.