Marked response to nivolumab combined with external radiation therapy for metastatic renal cell carcinoma: report of two cases.

Although nivolumab has been regarded as a standard agent for patients with previously treated advanced renal cell carcinoma (RCC), a significant proportion of these patients fail to achieve a response to nivolumab. In recent years, several studies have reported the favorable therapeutic impact of combined therapy with immune checkpoint inhibitors and radiotherapy on a wide variety of advanced malignant tumors, such as melanoma and lung cancer; however, the significance of this combined treatment for advanced RCC patients has not been well characterized. Here, we report two patients with metastatic RCC showing a marked response to nivolumab and external radiation therapy, including one with an abscopal response, after progression on prior treatment with multiple targeted agents. Based on the clinical courses of these two patients suggesting additive or synergistic efficacies on combining radiation with nivolumab, it might be worthwhile to consider the addition of radiotherapy for metastatic RCC patients treated with nivolumab.

Cases presenting to orthopedists with manifestations of lung cancer on skeletal radiographs.

The value of cervical spine or shoulder radiography has been established for the detection of Pancoast tumors. However, for the detection of lung cancers other than Pancoast tumors, the value of these skeletal radiographies has not been assessed. The aim of our study was to determine how many patients first presented to orthopedists with manifestations of lung cancer on skeletal radiographs and to present several cases for illustration. From the registry of the pathology department of our hospital, we identified 345 lung cancer patients diagnosed histologically over 10 years. From these patients, we selected 310 who had no previous history of malignancies at histological diagnosis of lung cancer. The study population consisted of individuals from the selected patients who had presented once or more to orthopedists at our hospital for any reason, at up to 2 years prior to histological diagnosis of lung cancer. For the study population, all radiological examinations performed by the orthopedists were reviewed by radiologists. The study population included 46 patients constituting 14.8 % (46/310) of the selected patients. Of these 46 patients, 37 (80.4 %) received 97 skeletal radiographies. Reviewing these skeletal radiographies disclosed lung tumors on 13 in 11 (11/46, 23.9 %) of the patients. We found that more than 10 % of lung cancer patients with no previous history of malignancies had presented to orthopedists on one or more occasions, at up to 2 years before histological diagnosis, and that approximately 25 % of these patients had manifestations of lung cancer on skeletal radiographs.

Delay by patients and doctors in treatment of Pancoast tumor.

PURPOSE: Long delays in diagnosis and treatment of Pancoast tumor have been reported but the reasons for these delays have yet to be fully considered. The aim of this study was to assess recent delays in diagnosis and treatment of Pancoast tumor and to determine the reasons for the delays. PATIENTS AND METHODS: We identified Pancoast tumors in patients with lung cancer referred to the radiation department of a city hospital between September 1999 and August 2004. From interviews conducted by a radiation oncologist and review of the medical records, delay due to a patient was calculated as the interval between the onset of symptoms and presentation to a physician, and delay due to a doctor as the interval between the presentation and the definitive treatment. The overall treatment delay was calculated as the sum of those delays. Radiological workups were also reviewed for errors, and the effect of any errors on the delays was estimated. RESULTS: The study population included 42 men and six women with a median age of 65.5 years at presentation. Treatment delay ranged widely from 38 to 400 days (mean 164.0): delay due to patients ranged from 0 to 371 days (mean 55.8), accounting for 34% of the mean treatment delay; delay due to doctors ranged from 14 to 349 days (mean 108.2), and accounted for the remaining (66%) mean treatment delay. In 166 radiological studies reviewed, 98 radiological errors (59%) were identified in 28 patients (58%). These patients waited an additional mean of 88.4 days for correct radiological interpretation, accounting for 48% of the mean doctors' delay. Thus, the mean doctors' delay with radiological errors was significantly longer than that without radiological errors (p < 0.05). CONCLUSIONS: Treatment delay for Pancoast tumor was relatively long, and approximately two-thirds of the delay was due to doctors, mainly because of errors in radiology.