scholarly journals Sinonasal teratocarcinosarcoma: is minimally invasive resection followed by adjuvant histology directed chemo-radiation a better alternative to radical excision? Case report

2017 ◽  
Vol 3 (2) ◽  
pp. 452 ◽  
Author(s):  
N. Dhaneshwar Singh ◽  
Kanwar Sen ◽  
Arun Sharma ◽  
Meenakshi Bharadwaj
Keyword(s):  
Local Recurrence ◽  
Vision Loss ◽  
Early Stage ◽  
External Beam Radiation ◽  
Recurrence Time ◽  
Radical Excision ◽  
Craniofacial Resection ◽  
Beam Radiation ◽  
Recurrent Epistaxis ◽  
Sinonasal Teratocarcinosarcoma

<p class="abstract">Sinonasal teratocarcinosarcoma (SNTCS) is a rare higly malignant tumour occuring almost exclusively in the sinonasal tract. This aggressive tumour arising from the primitive embryonic or immature pluripotential cells of olfactory epithelium has high propencity for loco-regional recurrence and mortality. SNTCS generally presents with relatively benign symptoms like nasal obstruction and recurrent epistaxis in its early stage. In advance stage with orbital and intracranial spread other symptoms raising suspicion of malignancy, such as dysphagia, odynophagia, epiphora, vision loss, exophthalmos, anosmia, headache and altered sensorium appears. In view of its aggressive behaviour, radical excision with or without chemoradiation is advocated as the optimum treatment. Local recurrence of SNTCS after excision has been reported as high as 45% with a mean recurrence time of 21.3 months. Even though distant metastasis is rare, local recurrence frequently leads to treatment failure and subsequent death. <span lang="EN-IN">Here we share our experience of SNTCS in a 23 year old male managed with endoscopic craniofacial resection followed by histocytology directed chemotherapy with external beam radiation. He remains disease free in last 3 years of follow up.</span></p><p> </p>

Spinal laser interstitial thermal therapy: single-center experience and outcomes in the first 120 cases

2020 ◽  
pp. 1-10
Author(s):  
Dhiego C. A. Bastos ◽  
Rafael A. Vega ◽  
Jeffrey I. Traylor ◽  
Amol J. Ghia ◽  
Jing Li ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Local Control ◽  
Thoracic Spine ◽  
Adjuvant Radiotherapy ◽  
Neurological Complications ◽  
Thermal Therapy ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Laser Interstitial Thermal Therapy ◽  
Hazard Ratios

OBJECTIVEThe objective of this study was to present the results of a consecutive series of 120 cases treated with spinal laser interstitial thermal therapy (sLITT) to manage epidural spinal cord compression (ESCC) from metastatic tumors.METHODSThe electronic records of patients treated from 2013 to 2019 were analyzed retrospectively. Data collected included demographic, pathology, clinical, operative, and imaging findings; degree of epidural compression before and after sLITT; length of hospital stay; complications; and duration before subsequent oncological treatment. Independent-sample t-tests were used to compare means between pre- and post-sLITT treatments. Survival was estimated by the Kaplan-Meier method. Multivariate logistic regression was used to analyze predictive factors for local recurrence and neurological complications.RESULTSThere were 110 patients who underwent 120 sLITT procedures. Spinal levels treated included 5 cervical, 8 lumbar, and 107 thoracic. The pre-sLITT Frankel grades were E (91.7%), D (6.7%), and C (1.7%). The preoperative ESCC grade was 1c or higher in 92% of cases. Metastases were most common from renal cell carcinoma (39%), followed by non–small cell lung carcinoma (10.8%) and other tumors (35%). The most common location of ESCC was in the vertebral body (88.3%), followed by paraspinal/foraminal (7.5%) and posterior elements (4.2%). Adjuvant radiotherapy (spinal stereotactic radiosurgery or conventional external beam radiation therapy) was performed in 87 cases (72.5%), whereas 33 procedures (27.5%) were performed as salvage after radiotherapy options were exhausted. sLITT was performed without need for spinal stabilization in 87 cases (72.5%). Post-sLITT Frankel grades were E (85%), D (10%), C (4.2%), and B (0.8%); treatment was associated with a median decrease of 2 ESCC grades. The local control rate at 1 year was 81.7%. Local control failure occurred in 25 cases (20.8%). The median progression-free survival was not reached, and overall survival was 14 months. Tumor location in the paraspinal region and salvage treatment were independent predictors of local recurrence, with hazard ratios of 6.3 and 3.3, respectively (p = 0.01). Complications were observed in 22 cases (18.3%). sLITT procedures performed in the lumbar and cervical spine had hazard ratios for neurological complications of 15.4 and 17.1 (p < 0.01), respectively, relative to the thoracic spine.CONCLUSIONSsLITT is safe and provides effective local control for high-grade ESCC from vertebral metastases in the thoracic spine, particularly when combined with adjuvant radiotherapy. The authors propose considering sLITT as an alternative to open surgery in selected patients with spinal metastases.

scholarly journals Outcome of early stage Merkel carcinoma treated by exclusive radiation: a study of 53 patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Manon Dubois ◽  
Henry Abi Rached ◽  
Alexandre Escande ◽  
Frédéric Dezoteux ◽  
Franck Darloy ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Early Stage ◽  
Cox Model ◽  
Combined Treatment ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
Merkel Cell ◽  
Beam Radiation ◽  
Metastatic Relapse

Abstract Purpose Early stage Merkel cell carcinoma (MCC) is a rare and aggressive primary skin cancer. The standard of care for MCC is broad excision and adjuvant external beam radiation therapy (EBRT). However, for some patients, anesthesia is contraindicated, while others run the risk of serious aesthetic sequelae. In such cases, exclusive radiotherapy is an interesting alternative to surgery. Though limited data is available, this study evaluates exclusive radiotherapy for MCC, using data from the largest retrospective study to date. Methods All patients who were followed in our center between 1989 and 2019 for histologically proven early stage MCC were included in the study. They were treated either by surgery with a 2-cm clear margin followed by adjuvant radiotherapy (RT) or by exclusive RT. Survival rates with adjuvant and exclusive EBRT were analyzed using Cox model and Fine and Gray model depending on the type of survival. p value < 0.05 was considered significant. Results Eighty-four patients treated for MCC were included. Fifty-three of them (63.1%) were treated by exclusive RT, and 31 (36.9%) had surgical excision followed by adjuvant RT. Local relapse rate was 13.7% (95% CI 8.0–43.7) in the RT monotherapy group (group A) and 25.8% (95% CI 10.3–56.2) in the surgery + RT group (group B) (p = 0.42). No statistical difference was found for nodal relapse (p = 0.81), metastatic relapse (p = 0.10), disease free survival (p = 0.83) or overall survival (p = 0.98). Conclusion Our study suggests that exclusive radiotherapy for early Merkel cell carcinoma leads to a similar oncological outcome as combined treatment, with fewer aesthetic sequelae. The approach is interesting for elderly patients with comorbidities or patients for whom surgery would cause significant functional or aesthetic sequelae.

Regional Therapies for Extremity Sarcoma

2018 ◽  
Author(s):  
Chiara Colombo ◽  
Sandro Pasquali
Keyword(s):  
Local Recurrence ◽  
Local Treatment ◽  
Tumor Resection ◽  
Treatment Strategies ◽  
Soft Tissue Sarcomas ◽  
Isolated Limb Perfusion ◽  
External Beam Radiation ◽  
Resection Margins ◽  
Beam Radiation ◽  
Limb Perfusion

Several regional therapies are used for the local treatment of patients with soft tissue sarcomas (STS), especially for tumors at high risk for local recurrence. Surgery with negative tumor resection margins is the main treatment for primary STS. External-beam radiation therapy is considered for deeply seated, large, and high-grade disease to lower the risk of local recurrence. A combination of preoperative chemo-radiation is associated with improved local control. TNF-α-based isolated limb perfusion is another regional chemotherapy strategy available at specialized surgical oncology units for unresectable STS. Other strategies suitable for management of advanced STS include cryoablation and radiofrequency. This review discusses these and other current regional treatment strategies.  This review contains 10 figures, 6 tables and 64 references Key words: cryoablation, extremity, hyperthermia, isolated limb perfusion, limb infusion, radiotherapy, regional therapy, sarcoma

Hemi salvage HIFU in patients with radio recurrent prostate cancer: Early experience and results.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 99-99
Author(s):  
Gilles Pasticier ◽  
Eduard Baco ◽  
Olivier Rouviere ◽  
Sebastien Crouzet ◽  
Jean-Yves Chapelon ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Local Recurrence ◽  
Treatment Options ◽  
Cancer Control ◽  
Artificial Urinary Sphincter ◽  
Androgen Deprivation ◽  
High Intensity Focused Ultrasound ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Salvage Hifu

99 Background: One third of patients treated with External beam radiation therapy (EBRT) for localized prostate cancer (PCa) experience local recurrence. Salvage treatment options include prostatectomy, cryoablation, and High Intensity Focused Ultrasound (HIFU). Whole gland treatment in these patients offers acceptable cancer control, but carries a risk of severe urinary incontinence in at least 20% of cases and reduction of Quality of Life (QoL). In patients with unilateral local relapse, focal HIFU is feasible. The aim of this prospective study was to evaluate the effect of Hemi HIFU in patients with unilateral recurrence after radiotherapy. Methods: Between 2009 and 2012, 48 patients were prospectively included in 2 centers. Inclusion criteria were positive MRI and biopsy in one lobe diagnosing unilateral cancer after EBRT (46 patients) and after brachytherapy (2 patients). Mean age was 68.8 ± 6 years, mean pre HIFU PSA was 5.2 ± 5.2 ng/mL and the repartition of Gleason score was ≤7: 28, ≥8: 18 and not determined: 2. Median follow-up was 16.3 months [range 3-43]. Treatments were performed with Ablatherm® HIFU device. Results: The mean PSA nadir value was 0.69 ± 0.83 (median: 0.4). Disease progression occured in 16 patients (35,5%). Local recurrence was found in 4 patients in the controlateral lobe, and in 4 patients in both lobes. Six patients developped metastases and 2 had rising PSA without local recurence or proven metastasis. Fifteen of these 16 patients received salvage treatments (3 re-HIFU, 11 androgen-deprivation, and 1 re-HIFU plus androgen-deprivation). Thirthy-six patients (75%) were pad-free. Seven patients (14.6 %) required 1 pad a day. Severe incontinence occured in 5 patients (10.4%). One of them received artificial urinary sphincter. Paired results indicated no significant change in QoL and IPSS scores: EORTC-QLC-30: (from 35.7 ± 8.7 to 36.8 ± 8.6, p=0.22) and IPSS: (from 7 ± 5.6 to 8.5 ± 5.1, p=0.13) Conclusions: Hemi-salvage HIFU is efficient in patients with unilateral radio-recurrent PCa with a preserved QoL offering comparable cancer control to whole gland treatment.

Salvage image-guided radiotherapy to the prostate after cryotherapy failure.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. e637-e637
Author(s):  
Austin B Hopper ◽  
John Paul Einck ◽  
Ajay Pal Sandhu
Keyword(s):  
Prostate Cancer ◽  
Local Recurrence ◽  
Primary Treatment ◽  
External Beam Radiation ◽  
High Dose ◽  
Beam Radiation ◽  
Image Guided Radiotherapy ◽  
Image Guided ◽  
Gu Toxicity ◽  
Treatment Margins

e637 Background: Cryotherapy is used in increasing frequency for the primary treatment of localized prostate cancer. While it is known that local recurrence can occur in > 20% of patients treated with primary cryotherapy there is a paucity of data on salvage treatments after failure. The use of external beam radiation therapy is an attractive option after cryotherapy failure but there is little data on efficacy and toxicity. We evaluate our data on a group of patients treated with image-guided dose-escalated radiotherapy (IGRT) at our institution. Methods: An IRB-approved database of patients treated with IGRT for prostate cancer from 2005 to 2013 was used to identify patients who underwent primary cryotherapy followed by salvage IGRT. Patients’ EMR were reviewed for age, cryotherapy-to-salvage interval, pre/post-salvage PSA and Gleason score (GS). All patients were treated with dose-escalated IGRT using standard treatment margins of 3 mm posterior and 7 mm in all other directions and daily CBCT or kv imaging to implanted fiducial markers. Narrative notes were used to identify GU/GI toxicity and scored according to CTCAE v4.03. The Phoenix definition of nadir + 2 was used to determine disease control following RT. Results: 5 patients were identified within the study period as having received salvage RT after primary cryotherapy. Mean age at the time of salvage RT was 74 (range 65-80). Median cryotherapy-salvage interval was 49 months (range 25-97) and prior to RT patients had GS of 7 (n = 3) or 8 (n = 2) and mean PSA of 8.1 ng/mL (range 4.2-14.38). Median total dose and follow-up were 76.7 Gy (range 75.6 – 81.0) and 52 months (range 6-63). One patient’s PSA did not decline post-RT and developed metastases while four patients responded post-RT with one experiencing biochemical recurrence after 30 months. No patients had acute GU/GI toxicities grade 2 or higher; one experienced late grade 2 GU toxicity (dysuria) which resolved with medication. There were no late grade 3 toxicities. Conclusions: High-dose radiotherapy as salvage treatment after cryotherapy failure is tolerated without significant GU or GI toxicities. Additionally, salvage IGRT is a viable option for long-term biochemical control in cases of local recurrence and warrants additional study.

Hemangiopericytoma: long-term outcome revisited

2011 ◽  
Vol 114 (3) ◽  
pp. 747-755 ◽  
Author(s):  
Marco Schiariti ◽  
Pablo Goetz ◽  
Hussien El-Maghraby ◽  
Jignesh Tailor ◽  
Neil Kitchen
Keyword(s):  
Overall Survival ◽  
Local Recurrence ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Long Term Outcome ◽  
Free Interval ◽  
Initial Surgery ◽  
The Mean

Object Hemangiopericytomas are rare tumors that behave aggressively with a high rate of local recurrence and distant metastases. With the aim of determining the outcome and response to various treatment modalities, a series of 39 patients who underwent microsurgical resection for primary meningeal hemangiopericytoma over a 24-year period is presented. Methods Patients with hemangiopericytoma were identified from histopathology records and their medical records were analyzed retrospectively by 2 independent reviewers to collect data on surgical treatment, adjuvant therapy, postoperative course, local or distant recurrence, and follow-up. Results Of the 39 patients, 19 were male and 20 were female. Mean patient age was 44.1 years. Thirty-four tumors were intracranial and 5 were spinal. The mean follow-up period was 123 months. Twenty-eight patients developed local recurrence. The recurrence rate at 1, 5, and 15 years was 3.5%, 46%, and 92%, respectively. Extraneural metastasis occurred in 8 patients (26%) at an average of 123 months after initial surgery. Recurrences and metastases were treated by surgical excision, external beam radiation therapy (EBRT), chemotherapy, and/or stereotactic radiosurgery. Adjuvant EBRT following initial surgery was found to extend the disease-free interval from 154 months to 254 months, although it did not prevent the development of metastasis. In those patients with EBRT and complete resection, the mean recurrence-free interval was found to be 126.3 months longer (p = 0.04) and overall survival 126 months longer than without EBRT. Furthermore, adjusting for resection, patients undergoing EBRT had 0.33 times increased risk of recurrence compared with those who did not (p = 0.03). A majority of patients remained able to live independently despite revision surgery for recurrence. Conclusions The mean follow-up of this patient series represents the longest follow-up duration published to date and demonstrates extended survival in a significant number of patients with hemangiopericytoma. Gross-total resection followed by adjuvant EBRT provides patients with the highest probability of an increased recurrence-free interval and overall survival. Prolonged survival justifies long-term follow-up and aggressive treatment of initial, recurrent, and metastatic disease.

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.

Definitive Chemoradiotherapy in Elderly Cervical Cancer Patients: A Multiinstitutional Analysis

2017 ◽  
Vol 27 (7) ◽  
pp. 1446-1454 ◽  
Author(s):  
Ozan Cem Guler ◽  
Sezin Yuce Sari ◽  
Sumerya Duru Birgi ◽  
Melis Gultekin ◽  
Ferah Yildiz ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Prognostic Factors ◽  
Local Recurrence ◽  
Cancer Patients ◽  
Local Control ◽  
External Beam Radiation ◽  
Significant Prognostic Factor ◽  
Definitive Chemoradiotherapy ◽  
Beam Radiation ◽  
Significant Difference

ObjectiveThe aim of the study was to investigate the prognostic factors for survival and treatment-related toxicities in older (≥65 years) cervical cancer patients treated with definitive chemoradiotherapy. In addition, we sought to compare the outcomes between the older elderly (≥75 years) and their younger old counterparts (age, 65–74 years).Materials and MethodsWe retrospectively reviewed medical records from 269 biopsy-proven nonmetastatic cervical cancer patients treated with external radiotherapy and intracavitary brachytherapy at the departments of radiation oncology in 2 different universities. The prognostic factors for survival, local control, and distant metastasis (DM) were analyzed.ResultsThe median follow-up time was 38.8 months (range, 1.5–175.5 months) for the entire cohort and 70.0 months (range, 6.1–175.7 months) for survivors. The 2- and 5-year overall survival (OS), disease-free survival (DFS), and cause-specific survival rates were 66% and 42%, 63% and 39%, and 72% and 55%, respectively. Patients 75 years or older showed significantly worse OS compared with patients aged 65 to 74 years but showed no significant difference in DFS. The 2- and 5-year local control rates were 86% and 71%, respectively. The incidences of DMs at 2 and 5 years were 22% and 30%, respectively. In multivariate analysis, vaginal infiltration and lymph node metastasis were predictive of OS, DFS, local recurrence, and DM. Concomitant chemotherapy was predictive of OS, DFS, and local recurrence, and larger tumor (>4 cm) was a significant prognostic factor for local recurrence. None of the patients had toxicity that necessitated the discontinuation of radiotherapy. All patients were evaluable for acute toxicity, and no grade higher than 3 adverse events occurred during external beam radiation therapy or brachytherapy.ConclusionsAlthough age limited the delivery of aggressive treatment, concurrent chemoradiotherapy in elderly patients associated with improved outcomes similar as in younger counterparts without increasing serious acute and late toxicities.

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