Concurrent chemoradiation in locally advanced primary middle ear lymphoepithelial carcinoma: an effective treatment modality case report

Abstract Background Definitive treatment of primary middle ear lymphoepithelial carcinoma (LEC) is not well established owing to the rarity of this disease entity. We report a case of locally advanced primary middle ear LEC treated with concurrent chemoradiation, with good oncologic outcomes. Case presentation A 46 year-old female of Cantonese (Southern Chinese) descent presented with a four-month history of left sided hearing loss and non-pulsatile tinnitus, associated with progressive ipsilateral facial weakness. She had a left facial palsy (House-Brackmann 2) which then deteriorated to complete palsy over 2 weeks. Otoscopic examination of the left ear revealed a red-hued mass replacing the tympanic membrane. There was no cervical lymphadenopathy. Fibreoptic nasoendoscopy was unremarkable. Pure tone audiometry revealed profound mixed left hearing loss with type B impedance. Computed tomography of the temporal bone showed an ill-defined left middle ear mass with erosion of the malleus, tegmen tympani and facial canal. Magnetic Resonance Imaging showed an avidly enhancing lesion involving the dura of the left middle cranial fossa, tympanic and labyrinthine portions of the facial nerve. This mass extended into the apex of the left internal acoustic canal and basal turn of the cochlea. Histopathology confirmed EBV-positive primary middle ear LEC. Concurrent chemoradiation comprising 70Gy of intensity-modulated radiation therapy and 3 cycles of concurrent Cisplatin based chemotherapy over a 6 week period was administered. The patient achieved near-complete disease resolution on 3 month post-treatment imaging. Serum EBV DNA titres declined to undetectable levels and the patient is disease-free at 18 months post-diagnosis. Discussion and conclusion Concurrent chemoradiation with curative intent may be a viable treatment option for locally advanced middle ear LEC not amenable to surgical resection due to expected surgical morbidity. It confers good oncologic outcomes that mimic the response in other head and neck EBV-related lymphoepithelial carcinomas.

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Randomized controlled trial to test the efficacy of trans-tympanic injections of a sodium thiosulfate gel to prevent cisplatin-induced ototoxicity.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e17560 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e17560-e17560

Author(s):

Francois Meyer ◽

Viannique Rolland ◽

Isabelle Bairati ◽

Matthieu Guitton ◽

André Fortin ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hearing Loss ◽

Adverse Effects ◽

Middle Ear ◽

Controlled Trial ◽

Statistical Significance ◽

Locally Advanced ◽

Sodium Thiosulfate ◽

Hearing Threshold ◽

Randomized Controlled

e17560 Background: The hearing loss due to cisplatin cochlear damage is frequent and severe. Antioxidants, such as sodium thiosulfate (STS), can neutralize the effects of cisplatin, but, when administered systemically, they decrease its efficacy. In animal experiments, STS deposited in the middle ear reached the cochlea and reduced cisplatin ototoxicity. We conducted a randomized controlled trial to test the efficacy of trans-tympanic injections of a STS gel to prevent cisplatin-induced ototoxicity. Methods: Eligible participants were patients with symmetrical hearing treated for a locally advanced head and neck cancer with chemoradiation including 3 cisplatin cycles (100 mg/m2). For each participant, one randomly selected ear received the injections while the other ear did not. On the eve of each cisplatin treatment, a trans-tympanic injection deposited 0.1 ml of an immediately prepared STS-hyaluronate gel (0.5 M) on the round window. The main outcome was assessed blindly using the shift of hearing threshold in decibels (dB) from before chemoradiation to one month thereafter for pure-tone air conduction at 0.5-14 kHz frequencies. Adverse effects were noted according to CTCAE. Assuming a lower hearing loss of 7.0 dB for the treated ears, 0.90 power and 0.05 two-sided statistical significance, 25 patients were needed. The main outcome was assessed in a mixed linear model with hearing threshold shift as dependent variable and intervention, frequency and radiation dose to the cochlea as independent variables. Results: From January to December 2015, 13 patients were randomized. The trial was stopped in June 2016 for poor accrual. The average loss of hearing over all frequencies was 1.5 dB less for the treated ears than for the control ears. The difference was not statistically (p = 0.56) nor clinically significant, but was consistently in favor of the treated ears for all frequencies between 3 and 10 kHz. The intervention adverse effects were mild. Conclusions: Our trial suggests that STS deposited in the middle ear reached the cochlea but was not clinically effective. More work is needed to improve the efficacy of trans-tympanic administration of cisplatin antidotes. Clinical trial information: NTC02281006.

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Acute toxicity profile of three-dimensional conformal concurrent chemoradiation in carcinoma cervix: an institutional experience

Journal of Radiotherapy in Practice ◽

10.1017/s1460396919000906 ◽

2020 ◽

Vol 19 (4) ◽

pp. 355-358

Author(s):

Rajanigandha Tudu ◽

Anup Kumar ◽

Rashmi Singh ◽

Payal Raina

Keyword(s):

Cervical Cancer ◽

Locally Advanced ◽

Three Dimensional ◽

Concurrent Chemoradiation ◽

Definitive Treatment ◽

Cancer Cervix ◽

Carcinoma Cervix ◽

Treatment Interruptions ◽

Locally Advanced Cancer ◽

3D Crt

AbstractBackground:Concurrent chemoradiation is the definitive treatment for advanced cervical cancer. Pelvic radiation is known to damage the adjacent normal tissues thereby causing acute toxicities. The modern conformal radiation techniques like three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy are known to reduce the toxicities and improve clinical outcomes.Aim:To retrospectively evaluate the frequency and severity of acute toxicities encountered during concurrent chemoradiation of locally advanced cancer cervix treated with 3D-CRT.Methods:The medical case records of 174 cervical cancer patients treated between November 2015 and November 2018 were studied. One hundred and thirteen histologically proven locally advanced cancer cervix patients (Stage IIB–IIIB) treated with concurrent 3D conformal chemoradiation between were included in the study. Patients received 46 Gy in 23 fractions with concurrent weekly cisplatin (40 mg/m2) on days 1, 8, 15 and 22 of radiation. The study endpoints were treatment-related toxicities which were graded according to CTCAE version 5.0.Results:One hundred and thirteen patients were analysed for the study. Gastrointestinal toxicity was the predominant toxicity observed followed by haematological toxicity. 31·7% patients reported grade 1–2 diarrhoea and 39·7% reported grade 1–2 leucopenia. None of the patients reported grade 3 or higher toxicities. Treatment interruptions were noted due to these toxicities.Conclusion:Concurrent chemoradiation is the definitive treatment for locally advanced carcinoma cervix with acceptable toxicities. Proper management measures should be undertaken for these toxicities to avoid treatment interruptions and ensure better treatment compliance.

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Triweekly Carboplatin Alone Instead of Cisplatin in the Definitive Treatment of Locally Advanced Laryngeal Carcinoma With Concurrent Chemoradiation: One Institution’s Experience and a Comparison to RTOG 9111 Results

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2014.05.1633 ◽

2014 ◽

Vol 90 (1) ◽

pp. S537

Author(s):

S. Iganej

Keyword(s):

Laryngeal Carcinoma ◽

Locally Advanced ◽

Concurrent Chemoradiation ◽

Definitive Treatment ◽

Advanced Laryngeal Carcinoma

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Total laparoscopic radical hysterectomy for locally advanced cervical carcinoma (stages IIB, IIA and bulky stages IB) after concurrent chemoradiation therapy: Surgical morbidity and oncological results

Gynecologic Oncology ◽

10.1016/j.ygyno.2009.05.043 ◽

2009 ◽

Vol 114 (3) ◽

pp. 404-409 ◽

Cited By ~ 42

Author(s):

P.E. Colombo ◽

M.M. Bertrand ◽

M. Gutowski ◽

A. Mourregot ◽

M. Fabbro ◽

...

Keyword(s):

Cervical Carcinoma ◽

Radical Hysterectomy ◽

Locally Advanced ◽

Chemoradiation Therapy ◽

Concurrent Chemoradiation ◽

Surgical Morbidity ◽

Laparoscopic Radical Hysterectomy ◽

Advanced Cervical Carcinoma ◽

Oncological Results ◽

Concurrent Chemoradiation Therapy

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Neoadjuvant chemotherapy in pregnant patients with cervical cancer: a Latin-American multicenter study

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001764 ◽

2021 ◽

Vol 31 (3) ◽

pp. 468-474

Author(s):

Aldo Lopez ◽

Juliana Rodriguez ◽

Erick Estrada ◽

Alejandro Aragona ◽

Carlos Chavez ◽

...

Keyword(s):

Cervical Cancer ◽

Neoadjuvant Chemotherapy ◽

Latin American ◽

Radical Hysterectomy ◽

Early Stage ◽

Locally Advanced ◽

Complete Response ◽

Oncologic Outcomes ◽

Definitive Treatment ◽

Obstetric Outcomes

ObjectiveTo describe oncologic and obstetric outcomes in patients diagnosed with cervical cancer during pregnancy who had a successful delivery after neoadjuvant chemotherapy.MethodsA multicenter retrospective review was conducted in 12 institutions from six Latin American countries, between January 2007 and December 2018. Data collected included clinical characteristics, neoadjuvant chemotherapy agents, treatment, obstetric and oncologic outcomes.ResultsThirty-three patients were included. Median age was 34 years (range 31–36). Twenty (60.6%) women were diagnosed at early stage (IB), and 13 (39.4%) with locally advanced stage (IIA–IIIB) according to FIGO 2009 classification. Carboplatin and paclitaxel was the most frequent combination used (60.6%). Partial and complete response rates were 27.3% and 9.1%, respectively. Median gestational age at delivery was 35 weeks (range 34–36). All patients had live births delivered by cesarean section. Obstetric pathology: pre-term labor, placenta percreta or intra-uterine growth restriction, was documented in seven patients (21.2%). Two (6.1%) neonates had low birth weight. Definitive treatment was primary chemo-radiation in 19 (57.6%) patients, radical hysterectomy in 11 (33.3%), abandoned radical hysterectomy with para-aortic lymphadenectomy and ovarian transposition in 1 patient (3.0%), and no further treatment in 2 (6.1%) patients. After a median follow-up of 16.3 months (range 2.0–36.9), 8 (26.7%) patients had recurrent disease. Of these, four (13.3%) died due to disease.ConclusionNeoadjuvant chemotherapy may be offered to patients wishing to preserve an ongoing pregnancy in order to achieve fetal maturity. Long-term consequences of chemotherapy in the child are yet to be determined.

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