scholarly journals Paraneoplastic dermatomyositis revealing undifferentiated nasopharyngeal carcinoma at early stage: a case report

2022 ◽  
Vol 16 (1) ◽  
Author(s):  
Souleymane Panandtigri ◽  
Nioka Pierre Xavier Siaˡ ◽  
Meryeme Charkaouiˡ ◽  
Nadia Benchakrounˡ ◽  
Zineb Bouchbikaˡ ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Early Stage ◽  
Performance Status ◽  
Locally Advanced ◽  
Nasopharyngeal Cancer ◽  
Skin Lesions ◽  
University Hospital ◽  
Muscle Enzymes ◽  
Progressive Muscle Weakness ◽  
The Face

Abstract Context Dermatomyositis is a rare autoimmune disease characterized by noninfectious inflammatory damage of skin and predominant muscles in the belts. It is believed to be associated with about 1 in 1000 cases of nasopharyngeal carcinoma. This association has been described for locally advanced stages II and III nasopharyngeal carcinoma. It has rarely been described in the early stages (stage I). Case presentation A 65-year-old Moroccan patient residing in Casablanca, with no particular history was referred to the Mohamed VI Center for the treatment of cancers of the University Hospital Center IBN ROCHD in Casablanca, for treatment of nasopharyngeal cancer. He was admitted in poor general condition, performance status 3, with erythema on the face, neck, and extremities. The diagnosis of paraneoplastic dermatomyositis was made owing to progressive muscle weakness and elevation of muscle enzymes associated with the typical rash of the face and hands. He received corticosteroid therapy and then radiotherapy to the nasopharynx with good clinical outcome, disappearance of skin lesions, and recovery of muscle strength. Conclusions We report this case of dermatomyositis in early-stage nasopharyngeal carcinoma, which is a rarely described entity. Rapid treatment of dermatomyositis improved the patient’s quality of life and enabled him to support specific cancer treatments. This can be used as an element of early diagnosis and monitoring after treatment.

scholarly journals Undifferentiated carcinoma of the nasopharynx associated with an early paraneoplastic dermatomyositis T1N0M0: About a one case

2021 ◽  
Vol 1 (2) ◽  
pp. 60-64
Author(s):  
S Panandtigri ◽  
M Charkaoui ◽  
NPX Sia ◽  
N Benchakroun ◽  
C Tarek ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Autoimmune Disease ◽  
Corticosteroid Therapy ◽  
Muscle Biopsy ◽  
Early Stage ◽  
Locally Advanced ◽  
Undifferentiated Carcinoma ◽  
Advanced Stage ◽  
Muscle Enzymes ◽  
Inflammatory Damage

ABSTRACT: Dermatomyositis (DM) is a rare autoimmune disease characterized by non-infectious inflammatory damage to the skin and the predominant muscles in the belts. It is believed to be associated with about one case per 1,000 nasopharyngeal carcinoma (NPC). This association has been described for the locally advanced stage, stage II and stage III of the NPC. Little described in the early stages (stage I), its symptomatology is often indicative of cancer whose diagnosis is based on five criteria: muscle weakness of the proximal limbs, elevation of serum muscle enzymes, histological muscle abnormalities in muscle biopsy, electromyographic abnormality and clinical inflammatory dermatological manifestation. Treatment is based on corticosteroid therapy and etiological treatment of cancer. The prognosis of NPC in patients with paraneoplastic DM is comparable to non-infected patients. We report this case of DM revealing an early stage NPC and we take stock of the state of knowledge about paraneoplastic DM associated with rarely described NPC. Indeed, in Morocco the last description of a case dates back to 2016.

Clinical features of pharyngeal cancer: a retrospective study of 258 consecutive patients

2001 ◽  
Vol 115 (2) ◽  
pp. 112-118 ◽  
Author(s):  
A. Escribano Uzcudun ◽  
P. Bravo Fernández ◽  
J. J. Sánchez ◽  
A. García Grande ◽  
I. Rabanal Retolaza ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Head And Neck ◽  
Clinical Features ◽  
Medical Records ◽  
Performance Status ◽  
Nasopharyngeal Cancer ◽  
University Hospital ◽  
Premalignant Lesions ◽  
Pharyngeal Cancer ◽  
Presenting Symptoms

Pharyngeal cancer still presents an unsatisfactory mortality (30-40 per cent in most series, with a slightly better prognosis for nasopharyngeal cancer relative to both oropharyngeal and hypophyarngeal cancers) despite advances in treatment. Therefore, it is critical to know the clinical features of pharyngeal cancer. The purpose of this study was to investigate the most relevant clinical features of pharyngeal cancer (oropharyngeal, hypopharyngeal, and nasopharyngeal) in order to improve knowledge of this malignancy with the aim of ameliorating diagnosis and treatment.The retrospective study was based on a review of medical records from 258 consecutive patients with pharyngeal cancer (oropharyngeal, hypopharyngeal and nasopharyngeal) diagnosed at La Paz University Hospital, Madrid, Spain, between January 1 1991 and and December 31 1995. Medical records were provided by the Departments of Otorhinolaryngology, Head and Neck Surgery, Radiation Oncology, and Medical Oncology.All medical records were analysed for the following clinical variables: 1) incidence, 2) sociodemographics, 3) sites (oropharynx, hypopharynx, nasopharynx) and subsites, 4) clinical and histological staging, 5) pathlogy, 6) presenting symptoms, 7) time to diagnosis, 8) patients’ general performance status at diagnosis, 9) personal cancer history and synchronous head and neck tumours, 10) premalignant lesions, and 11) paediatric cases.Our most outstanding finding was the excessively long time that elapsed between first clinical manifestation appearance and conclusive diagnosis of pharyngeal cancer (4.7 months for pharynx, 4.5 for oropharynx, 4.4 for hypopharynx and 6.5 for nasopharynx cancers). It was found that nasopharyngeal cancer was quite different from both oropharyngeal and hypopharyngeal cancers with respect to its potential aetiology, risk factors and clinical presentation. In addition it has a better prognosis.

scholarly journals Extensive Lepromatous Lymphadenitis Preceding Lesions on the Face and Earlobes: An Unusual Presentation of Leprosy in Singapore

2018 ◽  
Vol 10 (1) ◽  
pp. 35-40
Author(s):  
Shi Yao Sam Yang ◽  
Wai Mun Sean Leong ◽  
Cruz Maria Teresa Kasunuran ◽  
Jing Xiang Huang ◽  
Sue-Ann Ju Ee Ho ◽  
...  
Keyword(s):  
Early Stage ◽  
Developed Countries ◽  
Skin Lesions ◽  
The Body ◽  
The Other ◽  
Cutaneous Lesions ◽  
Poor Countries ◽  
Geographical Regions ◽  
Resource Poor ◽  
The Face

Leprosy is also known as Hansen disease, as in some countries the diagnosis of leprosy carries a negative stigma and patients fear being shunned as outcasts. Presently, leprosy is primarily limited to specific geographical regions in resource-poor countries. As a result, there is increased difficulty for the younger generation of physicians today to correctly identify leprosy due to a lack of exposure and a low-index of suspicion, particularly in developed countries. In this case, the indurated lesions over the face demonstrated a preference for the outer lateral aspects over the maxillary areas, the nose bridge, and the pinna of the ears consistent with the organism’s preference for cooler regions of the body. This was also evident in the other skin lesions affecting the more acral regions of the limbs in the early stage of disease progression. There is a need to keep this infective condition as an alternate diagnosis to all unusual cutaneous lesions.

scholarly journals Screening Patients With Cancer Admitted to Hanoi Medical University Hospital for Palliative Care Needs

2020 ◽  
pp. 1321-1327
Author(s):  
Quang V. Le ◽  
Huy L. Trinh ◽  
Kim Ngan T. Mai ◽  
Manh D. Pham ◽  
Paul A. Glare
Keyword(s):  
Palliative Care ◽  
Screening Tool ◽  
Performance Status ◽  
Locally Advanced ◽  
Eastern Cooperative Oncology Group ◽  
University Hospital ◽  
Care Needs ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medical University

PURPOSE To evaluate a screening tool for identifying which patients admitted to the oncology ward of a Vietnamese hospital should be referred to specialist palliative care (PC). METHODS We performed a cross-sectional survey of consecutive patients hospitalized in the Department of Oncology and Palliative Care at Hanoi Medical University Hospital between June 2019 and September 2019. We translated a validated 11-item screening tool into Vietnamese and used a total score of ≥ 5 as a positive screen. RESULTS One hundred participants were recruited. Forty-four patients (44%) screened positive. Of these, 37 (84%) had locally advanced or metastatic disease, 31 (70%) had uncontrolled symptoms, and 43 (98%) requested a PC consultation. A score ≥ 5 was significantly more common in patients with stage IV disease versus earlier stage, performance status of Eastern Cooperative Oncology Group (ECOG) 2 versus ECOG 0, and when life-limiting complications of cancer were present. Screening identified four patients overlooked by oncologists as needing referral, and 34% of patients requesting a referral had scores < 5. CONCLUSION This screening tool provided oncologists with easy-to-use criteria for referring patients for PC. At the same time, it relieved the work load for under-resourced PC physicians by screening out requests with low-level need. This tool should be part of routine assessment on admission in all oncology units in Vietnam.

scholarly journals Local and Lymph Node Relapse of Nasopharyngeal Carcinoma: A Single-Center Experience

2020 ◽  
pp. 014556132090895
Author(s):  
Nabil Toumi ◽  
Sana Ennouri ◽  
Ilhem Charfeddine ◽  
Jamel Daoud ◽  
Afef Khanfir
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Lymph Nodes ◽  
Concurrent Chemoradiotherapy ◽  
Performance Status ◽  
Locally Advanced ◽  
World Health ◽  
Late Relapse ◽  
Good Performance Status ◽  
Relapsed Disease ◽  
Neck Lymph Nodes

Objectives: The study aimed to investigate the epidemiological and clinical characteristics as well as the therapeutic results in patients with locoregional (LR) relapse after treatment of nasopharyngeal carcinoma (NPC). Methods: We retrospectively reviewed the medical records of patients with local and/or regional recurrent NPC over 13 years (2003-2015). Results: Twenty-five patients were treated for local or/and local–regional recurrence of NPC. The rate of LR relapse was 7.2%. The mean age of the patients was 46 ± 13.9 years. The median time to relapse was 25 months. The recurrence was nasopharyngeal in 17 patients, nasopharyngeal and neck lymph nodes in 7 patients, and neck lymph nodes in 1 patient. Fifteen relapsed patients had a locally advanced disease (rT3-rT4). Patients who had initially T1 or T2 tumor had a locally advanced relapsed disease (rT3rT4) in 27.3% and patients whose disease was initially classified as T3 or T4 had a locally advanced relapsed disease (rT3T4) in 85.7% ( P = .005, Fisher test). Twelve patients had chemotherapy after relapse. Chemotherapy was followed by concurrent chemoradiotherapy in 3 patients and by radiotherapy (RT) in 4 patients. Nine patients had concurrent chemoradiotherapy and 1 patient had exclusive RT. The overall survival (OS) at 1 year, 3 years, and 5 years was, respectively, 58%, 18%, and 10%. The OS was significantly higher in patients with good performance status at the time of relapse (World Health Organization = 1; P = .01) and in patients with late relapse (after 2 years; P = .03). Conclusions: Locoregional relapse rate in our study was 7.2%. Locoregional reirradiation was the mainstay treatment modality in relapsed NPC. Relapsed NPC had a poor prognosis with a 5-year survival rate of 18%. The OS was significantly higher in patients with good performance status and in patients with late relapse (after 2 years).

Phase II neoadjuvant docetaxel/cisplatin followed by concurrent cisplatin/radiotherapy for locally advanced nasopharyngeal cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6059-6059
Author(s):  
M. S. Kandil ◽  
H. S. Alnasser ◽  
S. A. Bandey ◽  
A. S. Almutairy ◽  
F. A. Ammar ◽  
...  
Keyword(s):  
Phase Ii ◽  
Performance Status ◽  
Locally Advanced ◽  
Nasopharyngeal Cancer ◽  
Disease Free Survival ◽  
Stage Iii ◽  
Impaired Hearing ◽  
Partial Responder ◽  
Female Ratio ◽  
Grade One

6059 Background: Neoadjuvant cisplatin/docetaxel are active agents for locally advanced nasopharyngeal cancer (LANPXCA). The efficacy and tolerability of neoadjuvant cisplatin/docetaxel followed by concurrent cisplatin with radiotherapy are explored in a phase II trial. Methods: From Jan 2003 to Jan 2005; 23 patients with LANPXCA stage III, IVA, IVB, (AJCC 2002), were treated with 3 cycles of neoadjuvant docetaxel 60mg/m2, 1 hour IV infusion D1 and cisplatin 60 mg/m2, 2 hours IV infusion D1 with prophylactic GSCF as 5μg/kg sc D3–7,(recycle D22). This was followed by 2 cycles of cisplatin 100 mg/m2, 2 hours IV infusion D1 , (recycle D22), concurrently with radiotherapy aiming at 70Gy / 35 fractions / 7 weeks. The median follow up was 27.9 months (18.3–47.3). Results: The median age was 38 years (16–68) and male to female ratio was 7.66:1. Neck mass 95.7%, neck pain 73.9%, nasal obstruction 65.2%, , headache 56.5%, impaired hearing 52.2%, and epistaxis 52.2% were the commonest symptoms. All patients had G3 squamous cell carcinoma. The majority of patients were stage IV 52.2% while 47.8 % were stage III. Grade one ECOG performance status was the commonest 52.2% while 47.8% were G2. The treatment was tolerable with commonest G3 acute toxicities were dysphagia 43.4% , and oral mucositis 8.7%. The commonest G3 late toxicities were dry mouth 17.4% and impaired hearing 13%. Complete remission was achieved in 22/23 patients 95.7% while 1/23 patients 4.3% was partial responder. Failure sites include; Distant; liver and/or bone 8.7%, local; skull base 4.3% or local and distant 4.3%.The Kaplan Meyer 47 month disease free survival was 82.61% while the 47 month overall survival was 91.3%. Conclusion: Neoadjuvant docetaxel / cisplatin followed by concurrent Cisplatin with radiotherapy is an effective and tolerable outpatient treatment for LANPXCA. No significant financial relationships to disclose.

Induction gemcitabine cisplatin followed by chemoradiation in locally advanced nasopharyngeal cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6027-6027 ◽  
Author(s):  
Sadaf Usman ◽  
Sara Rasheed ◽  
Ali Raza ◽  
Raza Hussain ◽  
Arif Jamshed
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Randomized Clinical Trials ◽  
Locally Advanced ◽  
Nasopharyngeal Cancer ◽  
Stage Iv ◽  
Attractive Alternative ◽  
Current Standard ◽  
Alternative Approach ◽  
Recent Addition ◽  
Gemcitabine And Cisplatin

6027 Background: The current standard of treatment in locally advanced nasopharyngeal cancer is concurrent chemoradiation, however recent addition of induction chemotherapy in the already established regimen has presented an attractive alternative approach. We report on survival with induction Gemcitabine and Cisplatin (GC) followed by chemoradiation (CRT) in the treatment of advanced nasopharyngeal carcinoma. Methods: Between 2005 and 2015, 300 patients (M 70%: F 30%) with histologically confirmed nasopharyngeal carcinoma. Histological subtypes WHO I 4% (13) and WHO III 96% (287). AJCC (7th edition) stage was Stage III 28% (85) and Stage IV 72% (215) patients. IC included a 2 drug combination; intravenous gemcitabine 1000 mg/m2 on day 1 and 8 and cisplatin 75 mg/m2 on day 1 only. Radiotherapy was given as a phase treatment to a total dose of 70 Gy in 35 fractions. Concurrent three weekly cisplatin (75 mg/m2) was administered to all patients. Results: Median follow up time was 30 months. The 5-year overall survival (OS), loco regional control (LRC) and relapse free survival (RFS) rates were 70% (95% CI 6.43 – 7.52), 69% (95% CI 6.52 – 7.64) and 52% (95% CI 5.25 – 6.34) respectively. One hundred and seven patients failed treatment; local or loco-regional 39% (42), regional 16% (17) and distant 45% (48). Conclusions: We conclude that induction gemcitabine and cisplatin followed by chemo-radiation is an effective regimen in management of nasopharyngeal carcinoma, meriting further investigation in randomized clinical trials.

scholarly journals How the COVID-19 Pandemic Impacted on Integrated Care Pathways for Lung Cancer: The Parallel Experience of a COVID-Spared and a COVID-Dedicated Center

2021 ◽  
Vol 11 ◽  
Author(s):  
Giulia Pasello ◽  
Jessica Menis ◽  
Sara Pilotto ◽  
Stefano Frega ◽  
Lorenzo Belluomini ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Integrated Care ◽  
Cancer Patients ◽  
Early Stage ◽  
Locally Advanced ◽  
University Hospital ◽  
Care Pathways ◽  
Systemic Treatments ◽  
Integrated Care Pathways ◽  
The Impact

IntroductionThe COVID-19 pandemic has proved to be a historic challenge for healthcare systems, particularly with regard to cancer patients. So far, very limited data have been presented on the impact on integrated care pathways (ICPs).MethodsWe reviewed the ICPs of lung cancer patients who accessed the Veneto Institute of Oncology (IOV)/University Hospital of Padua (Center 1) and the University Hospital of Verona (Center 2) before and after the COVID-19 pandemic, through sixteen indicators chosen by the members of a multidisciplinary team (MDT).ResultsTwo window periods (March and April 2019 and 2020) were chosen for comparison. Endoscopic diagnostic procedures and major resections for early stage NSCLC patients increased at Center 1, where a priority pathway with dedicated personnel was established for cancer patients. A slight decrease was observed at Center 2 which became part of the COVID unit. Personnel shortage and different processing methods of tumor samples determined a slightly longer time for diagnostic pathway completion at both Centers. Personnel protection strategies led to a MDT reshape on a web basis and to a significant selection of cases to be discussed in both Centers. The optimization of patient access to healthcare units reduced first outpatient oncological visits, patient enrollment in clinical trials, and end-of-life cancer systemic treatments; finally, a higher proportion of hypofractionation was delivered as a radiotherapy approach for early stage and locally advanced NSCLC.ConclusionsBased on the experience of the two Centers, we identified the key steps in ICP that were impacted by the COVID-19 pandemic so as to proactively put in place a robust service provision of thoracic oncology.

scholarly journals Role of Pretreatment Hemoglobin-to-Platelet Ratio in Predicting Survival Outcome of Locally Advanced Nasopharyngeal Carcinoma Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Cosphiadi Irawan ◽  
Andhika Rachman ◽  
Puji Rahman ◽  
Arif Mansjoer
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Cancer Patients ◽  
Cox Regression ◽  
Locally Advanced ◽  
Nasopharyngeal Cancer ◽  
Bivariate Analysis ◽  
Kaplan Meier ◽  
Cell Components ◽  
Negative Predictor

Background. The three-year survival rate of locally advanced nasopharyngeal carcinoma (NPC) patients in Indonesia is lower than in other Asian countries. Calculation of hemoglobin-to-platelet ratio (HPR) may become a more practical predictor than the ratios using leukocyte cell components. Yet, no study has been conducted to investigate the potential of HPR in predicting survival outcomes in locally advanced nasopharyngeal cancer patients. Objective. To determine the role of pretreatment hemoglobin-to-platelet ratio in predicting the three-year overall survival (OS) of locally advanced NPC. Method. A retrospective cohort study followed up on 289 locally advanced NPC patients who had undergone therapy at the Dr. Cipto Mangunkusumo National General Hospital between January 2012 and October 2016. HPR cut-off was determined using ROC. Subjects were classified into two groups according to the HPR value. Kaplan-Meier curve was utilized to illustrate patients’ three-year survival, and Cox regression test analyzed confounding variables to yield an adjusted hazard ratio (HR). Results. The optimal cut-off for HPR was 0.362 (AUC 0.6228, 95% CI: 0.56-0.69, sensitivity 61.27%, specificity 60.34%). Of the subjects, 48.44% had HPR ≤ 0.362 , and they had a higher three-year mortality rate than those with HPR > 0.362 (50% vs. 31.54%). In bivariate analysis, HPR ≤ 0.362 and age ≥ 60 significantly showed a worse three-year OS ( p value = 0.003 and 0.075, respectively). In multivariate analysis, we concluded that a pretreatment HPR ≤ 0.362 was an independent negative predictor of three-year OS in locally advanced NPC patients (adjusted HR 1.82; 95% CI: 1.25–2.65). Conclusion. Pretreatment HPR ≤ 0.362 was a negative predictor of three-year OS in locally advanced nasopharyngeal cancer patients.

Plasma EBV DNA and cell-free GAPDH DNA as prognostic factors of locally advanced nasopharyngeal carcinoma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6053-6053
Author(s):  
J. Chen ◽  
L. Ting ◽  
J. Ko ◽  
P. Lou ◽  
C. Wang ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Nucleic Acids ◽  
Plasma Cell ◽  
Cox Regression ◽  
Locally Advanced ◽  
University Hospital ◽  
Rank Test ◽  
Poor Survival ◽  
Free Survival ◽  
Ebv Dna

6053 Background: Plasma cell-free nucleic acids have been investigated to be potential prognostic and predictive markers of treatment response, residual disease, and survival of cancer patients. However, these nucleic acids will be confounded by normal cell death, which might be caused by cancer-related inflammation, infection, or chemotherapy. Nasopharyngeal carcinoma is endemic in Taiwan, highly related to EBV infection. Plasma EBV DNA level has been suggested to be predictive of disease status and outcomes. We try to find out whether plasma EBV and cell-free glyceraldehydes-3-phosphate dehydrogenase DNA before definite treatment of locally advanced NPC predict tumor outcomes better. Methods: 144 stage IV (AJCC version 6) NPC patients received induction chemotherapy followed by concurrent chemoradiotherapy in National Taiwan University Hospital from 1998 to 1999. Pre-treatment blood samples were colleted for real-time quantitative polymerase chain reactions of EBV and GAPDH DNA. The results will be analyzed by SPSS version 13 to see if correlated with tumor extent, locoregional/distant failure, and overall survival. Results: Our patients were mainly composed of T4(97%) and N2(56%) patients. 23 % were in N3 stage. Plasma EBV and cell-free GAPDH DNA levels were not correlated with T stage. Plasma EBV DNA level was significantly correlated with N3 status(Mann-Whitney test p=0.021). After Cox regression model, only age (p=0.024) was a significant predictor of recurrence-free survival; N3 status(p=0.007) and positive plasma EBV DNA (p=0.002) predicted shorter metastasis-free survival. N3 status (p=0.031) and positive plasma EBV DNA (p=0.002) were significantly related to poor survival by log-rank test; whereas T4 lesions (p=0.524) and plasma cell-free GAPDH DNA level (p=0.182) were not. After multivariate Cox regression, positive plasma EBV DNA (hazard ratio 4.936 p=0.006) was the only significant predictor of poor survival. Conclusions: To use circulating DNA as prognostic marker, a specific one, such as EBV DNA, might be better than a non-specific one, like GAPDH DNA. This is important in the development of tumor markers for other solid tumors. No significant financial relationships to disclose.

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