IVIM Magnetic Resonance Imaging in Guiding Target Delineation and Dose Escalation of Concurrent Radiochemotherapy in Recurrent Stage IIIB Pulmonary Adenosquamous Carcinoma: A Case Report

Abstract Background: Concurrent radiochemotherapy is regarded as a standard treatment for inoperable, locally advanced non-small cell lung cancer (NSCLC). However, the local control rate is less than 50%. Functional imaging can reveal changes in the tumour microstructure and tumour volume early during the process of radiotherapy, which is beneficial for the early evaluation of efficacy and dose escalation radiotherapy.Case presentation: Here, we describe a case of recurrent stage IIIB pulmonary adenosquamous carcinoma. Intravoxel incoherent motion (IVIM) was used to guide the delineation of the target area and dose escalation of radical concurrent chemoradiotherapy, and complete remission was achieved.Conclusion: Our case report provides a novel method for IVIM functional MRI in guiding accurate target delineation and dose escalation of radical radiotherapy.

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Neoadjuvant transarterial chemoembolization (TACE) using cisplatin with the combination of dose-dense intravenous administration of paclitaxel for the locally advanced cervical adenocarcinoma

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16518 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16518-e16518 ◽

Cited By ~ 2

Author(s):

H. Tsubamoto ◽

R. Wada ◽

R. Kanazawa ◽

S. Komori ◽

H. Maeda ◽

...

Keyword(s):

Radiation Therapy ◽

Adenosquamous Carcinoma ◽

Alternative Therapy ◽

Locally Advanced ◽

Sensory Neuropathy ◽

Figo Stage ◽

Cervical Adenocarcinoma ◽

Stage Iiib ◽

Clinical Response Rate ◽

Dose Dense

e16518 Background: Adenocarcinoma (including adenosquamous carcinoma) of the uterine cervix has a tendency to early lymph node metastasis and is resistant to radiation therapy, thus results in poor prognosis compared with squamous cell carcinoma. Neoadjuvant chemotherapy (NAC) followed by radical hysterectomy (RH) for bulky cervical adenocarcinoma seems to be an alternative therapy to primary radiation. Methods: P2 at the single institution. Eligible criteria were as follows: Histologically diagnosed cervical adeno or adenosquamous carcinoma with FIGO stage IB2-IVA, Age < or equal to 75, PS 0–2, given informed consent. The NAC regimen consisted of paclitaxel (60mg/m2, iv, D1, D8, D15) and cisplatin (70 mg/m2, trans-uterine arterial infusion followed by embolization using the gelform, D2) repeated every 3 weeks for 2–3 cycles, followed by RH. Primary endpoints were clinical and pathological responses, and secondary endpoints were toxicities, relapse free survival (RFS) and overall survival (OS). Results: Enrolled patients: 22 (1998–2006), Age: median 51 (33–75), FIGO stage: IB2 (9), IIA-IIB (8), IIIB (3), IVA (2), adeno/adenosquamous: 16/6. Toxicities during NAC (CTCAE ver.3) were as follows: G3/G4 neutropenia 18% (4/22), G3/G4 anemia 14% (3/22), G3/G4 thrombocytopenia 0%, G2/G3 sensory neuropathy 0 %, G3/G4 creatinine elevation 0%, G2 alopecia 100%. Clinical response rate (RR: CR+PR) of the patients with stage IB2-IIB was 100%. 16 of 17 received RH, and no residual malignant cells were found pathologically (pCR) in 3. RR of the patients with stage IIIb-IVa was 80%, three patients completed RH with either modified anterior or posterior exenteration, and pCR was found in one patient. The rate of radiation therapy following either NAC or surgery among enrolled patients were 18% (3/17) with stage IB2-IIB and 40% (2/5) with IIIB-IVA. 5 year RFS/OS were 69%/68% with stage IB2-IIb and 60%/60% with stage IIIb-IVa. All 15 alive patients had RH. One patient with stage IVa had urostomy, and other 14 patients have no trouble in urination function. Conclusions: TACE with cisplatin and dose dense paclitaxel in the neoadjuvant setting is feasible and effective for cervical adenocarcinoma. [Table: see text]

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