Peripapillary Neuroendocrine Carcinoma Metastasis: A Novel Approach to Treatment

2021 ◽  
pp. 1-5
Author(s):  
Colin S. Ip ◽  
Yuval Raizen ◽  
David Goldfarb ◽  
Eric Kegley ◽  
Jose Munoz ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Neuroendocrine Carcinoma ◽  
Significant Risk ◽  
Subretinal Fluid ◽  
Local Therapy ◽  
Large Cell ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Intravitreal Chemotherapy ◽  
Peripapillary Retina

Peripapillary and circumpapillary retinal intraocular metastases are rare and present a treatment challenge for ophthalmologists because of the high risk of iatrogenic injury to the optic nerve. There are no clear guidelines on the management of these lesions, and many clinicians will initially observe for improvement of the metastases with systemic chemotherapy before considering local therapy with external beam radiation. Radiation to the optic disc carries a significant risk of injuring the optic nerve, leading to worsening of vision. Alternative treatment approaches are needed. We present a patient with large-cell neuroendocrine carcinoma with metastasis to the peripapillary retina who was treated with intravitreal topotecan and with intravitreal aflibercept. Serial fundus photos, ultrasound, and optical coherence tomography demonstrated a reduction in size of the lesion and a decrease in subretinal fluid with intravitreal topotecan and aflibercept. In addition, visual acuity was stabilized during treatment. Intravitreal chemotherapy for intraocular metastases in vision-sensitive areas such as the peripapillary retina may be a viable alternative for patients who seek to preserve their vision and maintain their quality of life.

scholarly journals External Beam Radiation and Brachytherapy for Prostate Cancer: Is It a Possible Trigger of Large Cell Neuroendocrine Carcinoma of the Urinary Bladder?

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Ali Zakaria ◽  
Bayan Al Share ◽  
Sri Kollepara ◽  
Cynthia Vakhariya
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Neuroendocrine Tumors ◽  
Neuroendocrine Carcinoma ◽  
Large Cell ◽  
External Beam Radiation Therapy ◽  
Large Cell Neuroendocrine Carcinoma ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation

Neuroendocrine tumors commonly involve the respiratory and gastrointestinal systems. Primary genitourinary neuroendocrine tumors are rare, accounting for less than 1% of all bladder carcinomas. Four histopathologic subtypes have been described. Among those, large cell neuroendocrine carcinoma (LCNEC) is the least common, is more aggressive, and generally presents in an advanced stage with poor prognosis compared to transitional cell bladder carcinoma. There is no standardized treatment regimen because of the rarity of the disease. Herein, we present a case of 72-year-old male patient with previously treated prostate cancer, who received external beam radiation therapy and high dose brachytherapy, presenting with intermittent hematuria. Cystoscopy and transurethral resection of bladder tumor (TURBT) were performed. The histopathology and immunohistochemistry were consistent with large cell neuroendocrine carcinoma (LCNEC). Further studies are required to proof the higher risk of neuroendocrine carcinoma of the bladder in patients treated with external beam radiation therapy and brachytherapy for prostate cancer.

scholarly journals Small Cell Neuroendocrine Carcinoma of Tonsil – A Rare Occurrence

2020 ◽  
Vol 5 (6) ◽  
pp. 1-2
Author(s):  
Peoli Mukutawat ◽  
Bibhavendra Kumar Singh ◽  
Kunwar Prativyom
Keyword(s):  
Neuroendocrine Carcinoma ◽  
Histopathological Examination ◽  
Tissue Sample ◽  
Small Cell ◽  
External Beam Radiation ◽  
Cervical Region ◽  
Small Cell Neuroendocrine Carcinoma ◽  
Beam Radiation ◽  
Proliferative Growth ◽  
The Right

Small cell neuroendocrine carcinomas of tonsil are extremely rare cancers and only a few cases have been reported till date. They carry a poor prognosis. Paraneoplastic syndromes like SIADH, Cushing’s syndrome and Eaton-Lambert myasthenic syndrome can be found associated with these carcinomas. The tumor can metastasize to liver, lungs, bone, brain and skin. A 70-year-old male presented with a 2-month history of pain in throat which was moderate to severe in intensity and intermittent. Local examination of oropharynx revealed a 5×5 cm ulcero-proliferative growth over the right tonsil extending to right side of base of tongue, vallecula, and right retromolar trigone. Multiple matted lymph nodes were palpable in the right cervical region. Histopathological examination of tissue sample from the growth over the right tonsil revealed small cell neuroendocrine carcinoma. On immunohistochemistry, chromogranin and CD56 were positive. Patient received 2-courses of neoadjuvant chemotherapy with cisplatin and etoposide. Then the patient was planned for external beam radiation therapy with dose of 60 Gy in 30 fractions in 6 weeks. Small cell neuroendocrine carcinoma of tonsil are likely to be very aggressive with a tendency of developing early regional lymphatic and systemic metastases. More research and clinical trials shall be explored to obtain a standard treatment strategy for these patients.

scholarly journals Vaccines for prostate cancer : a new era?

2016 ◽  
Vol 28 (3) ◽  
pp. i-iii
Author(s):  
Julius I Mulia
Keyword(s):  
Prostate Cancer ◽  
Clinical Symptoms ◽  
Specific Antigen ◽  
Local Therapy ◽  
The United States ◽  
External Beam Radiation ◽  
Western World ◽  
Beam Radiation ◽  
Hormone Refractory ◽  
Androgen Independent

Prostate adenocarcinoma is the most prevalent type of noncutaneous cancer in the Western world, with an estimated 218,890 new cases and 27,050 deaths in the United States in 2007. Currently prostate cancer is detected by measurement of prostate-specific antigen (PSA), a serine protease synthesized by the prostatic epithelium. PSA is an organ-specific and tumor-associated antigen (TAA) but it is not tumor-specific.(1) Partly because of increased cancer screening with PSA, prostatic cancer may now be diagnosed when it is still localized. Localized tumors of the prostate are generally treated with radical prostatectomy, external-beam radiation therapy (EBRT), brachytherapy, or watchful waiting. Unfortunately, up to 30%-40% of patients fail local therapy. The standard treatment of recurrent or metastatic disease is androgen-deprivation therapy (ADT), but this is only a temporary measure as in the majority of cases the cancer ultimately becomes hormone refractory, the condition being termed androgen-independent prostate cancer (AIPC) or hormone refractory prostate cancer (HRPC), which then progresses rapidly. The only available nonpalliative therapy for androgen-independent prostate cancer is docetaxel in combination with prednisone. However, ADT given prior to the onset of clinical symptoms results in rising PSA levels with castrate levels of testosterone, often with a relatively low tumor burden. This systemic treatment earlier in the disease course combined with effective palliative chemotherapy is implicated in the improvement in median survival time of patients with AIPC from an average of about 12 months to about 17-18 months.

Results of chemotherapy (CT) based protocol for treatment of retinoblastoma (RB)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 9068-9068
Author(s):  
L. Goyal ◽  
S. Banavali ◽  
R. Bhagwat ◽  
B. Arora ◽  
M. Muckaden ◽  
...  
Keyword(s):  
Early Stage ◽  
Local Therapy ◽  
Stage Iv ◽  
Stage I ◽  
External Beam Radiation ◽  
Patient Treatment ◽  
Delayed Presentation ◽  
Beam Radiation ◽  
Early Stage Disease ◽  
Stage Disease

9068 Background: One the main reasons for delayed presentation of children with RB in India is non acceptance of enucleation. CT is being increasingly utilized as primary treatment of RB to reduce the tumor volume and thus avoid enucleation and/or external beam radiation (EBRT) in early stage disease and reduce the risk of relapse in advanced stage disease. Methods: This retrospective (from 1996 to 2001) study involved 62 Patients (pts) (30 were bilateral) who received CT consisting of monthly cycles of carboplatin, etoposide, vincristine and cyclophosphomide. Pts with stage I disease, were started on CT alone, whereas most of the other pts were also started on concurrent EBRT (50Gy). Where indicated, pts also received local therapy, usually cryotherapy & EBRT. Eyes which did not show response or had stable disease, were advised enucleation. Results: Majority of pts had Reese-Ellsworth groups IV-V (74.1%). 17 pts had Stg I, 22 Stg II, 17 Stg III & 6 Stg IV disease (St Jude’s). All pts received CT (median 12 cycles). Out of 92 eyes only 79 were evaluable (13 were already enucleated).The response rate was 73.2% (51.8% CR or near CR); 12.9% had progressive disease. 47 Pts (74%) received RT. Only 23 pts received focal treatment (Cryotherapy 15, laser 3, combination 5). Vision was present in 38 eyes (48.1%) at presentation. 26 eyes (68.4%) were finally saved with useful vision. 20 pts had recurrence. 18 have died (17 died of disease, 1 treatment related sepsis). In those following up in the clinic, survival is 77% for stage I; 78.5% for stage II; 41.6% for stage III. All stage IV pts have died except 1 with nodal disease. Conclusions: CT has a role in the management of RB, however unless it is coupled with good focal therapy the results are poor as shown here. Also longer follow-ups are required because of late recurrences. This data highlights that in developing countries the social reasons complicate patient treatment & compliance. Further efforts are needed to spread awareness of this disease so that patients are diagnosed and treated in earlier stages so as to improve the outcomes. No significant financial relationships to disclose.

scholarly journals Clinical presentation, treatment and outcome of anaplastic thyroid carcinoma: results of a multicenter study in Germany

2016 ◽  
Vol 175 (6) ◽  
pp. 521-529 ◽  
Author(s):  
Julia Wendler ◽  
Matthias Kroiss ◽  
Katja Gast ◽  
Michael C Kreissl ◽  
Stephanie Allelein ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thyroid Carcinoma ◽  
Tertiary Care ◽  
Significant Risk ◽  
Anaplastic Thyroid Carcinoma ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Treatment Pathways ◽  
Factors Associated ◽  
Disease Specific

Context Anaplastic thyroid carcinoma (ATC) is an orphan disease and confers a dismal prognosis. Standard treatment is not established. Objective The aim of this study is to describe clinical characteristics, current treatment regimens and outcome of ATC and to identify clinical prognostic markers and treatment factors associated with improved prognosis. Design Retrospective cohort study at five German tertiary care centers. Patients and methods Totally 100 ATC patients diagnosed between 2000 and 2015 were included in the analysis. Disease-specific overall survival (OS) was compared with the Kaplan–Meier method and log-rank test; Cox proportional hazard model was used to identify risk factors. Results The 6-month, 1-year and 5-year disease-specific OS rates were 37, 28 and 5%, respectively. Stage-dependent OS at 6 months was 78, 54 and 18% for stage IVA, B and C, respectively. 29% patients survived >1 year. Multivariate analysis of OS identified age ≥70 years, incomplete local resection status and the presence of distant metastasis as significant risk factors associated with shorter survival. Radical surgery (hazard ratio [HR] 2.20, 95% confidence interval (CI) 1.19–4.09, P = 0.012), external beam radiation therapy (EBRT) ≥40 Gy (HR = 0.34, 0.15–0.76, P = 0.008) and any kind of chemotherapy (CTX) (HR = 11.64, 2.42–60.39, P = 0.003) were associated with longer survival in multivariate analyses adjusted for age and tumor stage. A multimodal treatment regimen was significantly associated with a survival benefit (HR = 1.04, 1.01–1.08, P < 0.0001) only in IVC patients. Conclusion Disease-specific OS is still poor in ATC. Treatment factors associated with improved OS provide a rationale to devise treatment pathways for routine care. Collaborative research structures should be aimed to advance treatment of ATC.

Unusual cause of Fournier’s gangrene: colorectal-genitourinary tract fistulae status post brachytherapy

2020 ◽  
Vol 13 (10) ◽  
pp. e235903
Author(s):  
Nabil Saleem ◽  
William J Devan ◽  
Daniel R Pitts ◽  
Graham T VerLee
Keyword(s):  
Significant Risk ◽  
External Beam Radiation Therapy ◽  
Fournier’S Gangrene ◽  
Genitourinary Tract ◽  
External Beam Radiation ◽  
High Dose ◽  
Soft Tissue Infections ◽  
Fournier's Gangrene ◽  
Beam Radiation ◽  
Urinary Tract Symptoms

There are few reports of radiation associated colorectal–genitourinary tract (CRGU) fistulae causing Fournier’s gangrene (FG). We describe a case of FG in a patient with possibly two CRGU fistulae in the context of previous high-dose brachytherapy and external beam radiation therapy for prostate cancer. Unfortunately, CRGU fistulae are not well classified as significant risk factors for the development of FG. Our case demonstrates the rationale for maintaining a broad differential in patients presenting with recurrent urinary tract symptoms or necrotising soft tissue infections to include undiagnosed fistulae.

scholarly journals Applications and limitations of machine learning in radiation oncology

2019 ◽  
Vol 92 (1100) ◽  
pp. 20190001 ◽  
Author(s):  
Daniel Jarrett ◽  
Eleanor Stride ◽  
Katherine Vallis ◽  
Mark J. Gooding
Keyword(s):  
Machine Learning ◽  
Radiation Oncology ◽  
Learning Algorithms ◽  
Significant Risk ◽  
Ground Truth ◽  
Multimodal Fusion ◽  
External Beam Radiation ◽  
Learning Approaches ◽  
Beam Radiation

Machine learning approaches to problem-solving are growing rapidly within healthcare, and radiation oncology is no exception. With the burgeoning interest in machine learning comes the significant risk of misaligned expectations as to what it can and cannot accomplish. This paper evaluates the role of machine learning and the problems it solves within the context of current clinical challenges in radiation oncology. The role of learning algorithms within the workflow for external beam radiation therapy are surveyed, considering simulation imaging, multimodal fusion, image segmentation, treatment planning, quality assurance, and treatment delivery and adaptation. For each aspect, the clinical challenges faced, the learning algorithms proposed, and the successes and limitations of various approaches are analyzed. It is observed that machine learning has largely thrived on reproducibly mimicking conventional human-driven solutions with more efficiency and consistency. On the other hand, since algorithms are generally trained using expert opinion as ground truth, machine learning is of limited utility where problems or ground truths are not well-defined, or if suitable measures of correctness are not available. As a result, machines may excel at replicating, automating and standardizing human behaviour on manual chores, meanwhile the conceptual clinical challenges relating to definition, evaluation, and judgement remain in the realm of human intelligence and insight.

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