scholarly journals Prostate cancer metastatic to the planum sphenoidale presenting as sequential bilateral vision loss

2018 ◽  
Vol 5 (4) ◽  
pp. 5
Author(s):  
Binoy Yohannan ◽  
Mark Feldman
Keyword(s):  
Prostate Cancer ◽  
Vision Loss ◽  
Early Recognition ◽  
Locally Advanced ◽  
Surgical Excision ◽  
Neurological Impairment ◽  
High Dose ◽  
Tissue Mass ◽  
Metastatic Involvement ◽  
Planum Sphenoidale

Metastasis to the anterior cranial fossa from solid tumors is very unusual. We describe a 72-year-old male with history of locally advanced prostate cancer who presented with sequential bilateral vision loss, initially misdiagnosed and mistreated as giant cell arteritis. Neuroimaging eventually revealed an extra-axial soft tissue mass in the planum sphenoidale exerting a pressure effect on the cisternal segments of the optic nerves. He underwent surgical excision of the mass to try to improve his vision. Biopsy results confirmed high grade metastatic adenocarcinoma of the prostate. He was started on high dose glucocorticoids and radiation therapy and his visual symptoms improved. Patients with metastatic prostate cancer can develop cranial nerve deficits secondary to metastatic involvement of the skull base. Early recognition and appropriate therapy is essential to prevent permanent neurological impairment.

scholarly journals Simulation of an HDR “Boost” with Stereotactic Proton versus Photon Therapy in Prostate Cancer: A Dosimetric Feasibility Study

2020 ◽  
Author(s):  
Jill S. Remick ◽  
Pouya Sabouri ◽  
Mingyao Zhu ◽  
Søren M. Bentzen ◽  
Kai Sun ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Dose Escalation ◽  
Locally Advanced ◽  
High Dose Rate ◽  
Rank Test ◽  
High Dose ◽  
Prostate Brachytherapy ◽  
High Risk Prostate Cancer ◽  
Prostate Size ◽  
Ct Simulation

Abstract Purpose/Objectives To compare the dose escalation potential of stereotactic body proton therapy (SBPT) versus stereotactic body photon therapy (SBXT) using high-dose rate prostate brachytherapy (HDR-B) dose-prescription metrics. Patients and Methods Twenty-five patients previously treated with radiation for prostate cancer were identified and stratified by prostate size (≤ 50cc; n = 13, > 50cc; n = 12). Initial CT simulation scans were re-planned using SBXT and SBPT modalities using a prescription dose of 19Gy in 2 fractions. Target coverage goals were designed to mimic the dose distributions of HDR-B and maximized to the upper limit constraint for the rectum and urethra. Dosimetric parameters between SBPT and SBXT were compared using the signed-rank test and again after stratification for prostate size (≤ 50cm3 and >50cm3) using the Wilcoxon rank test. Results Prostate volume receiving 100% of the dose (V100) was significantly greater for SBXT (99%) versus SBPT (96%) (P ≤ 0.01), whereas the median V125 (82% vs. 73%, P < 0.01) and V200 (12% vs. 2%, P < 0.01) was significantly greater for SBPT compared to SBXT. Median V150 was 49% for both cohorts (P = 0.92). V125 and V200 were significantly correlated with prostate size. For prostates > 50cm3, V200 was significantly greater with SBPT compared to SBXT (14.5% vs. 1%, P = 0.005), but not for prostates 50cm3 (9% vs 4%, P = 0.11). Median dose to 2cm3 of the bladder neck was significantly lower with SBPT versus SBXT (9.6 Gy vs. 14 Gy, P < 0.01). Conclusion SBPT and SBXT can be used to simulate an HDR-B boost for locally advanced prostate cancer. SBPT demonstrated greater dose escalation potential than SBXT. These results are relevant for future trial design, particularly in patients with high risk prostate cancer who are not amenable to brachytherapy.

scholarly journals Squamous Cell Carcinoma: An Update on Diagnosis and Treatment

2020 ◽  
pp. e2020066
Author(s):  
Andrea Combalia ◽  
Cristina Carrera
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Checkpoint Inhibitors ◽  
Early Recognition ◽  
Imaging Techniques ◽  
Locally Advanced ◽  
Growth Factor Receptor ◽  
Surgical Excision ◽  
Diagnosis And Treatment

Squamous cell carcinoma (SCC) accounts for most nonmelanoma skin cancer–related metastatic disease and deaths. Histopathology and correct surgical excision remain the gold standard for the diagnosis and treatment of SCC; however, new diagnostic imaging techniques such as dermoscopy and reflectance confocal microscopy have increased the diagnostic accuracy in terms of early recognition, better differential diagnosis, more precise selection of areas to biopsy, and noninvasive monitoring of treatments. The therapeutic intervention in patients with severe actinic damage and multiple in situ/low-risk SCC, and the development of innovative treatments such as epidermal growth factor receptor inhibitors and immune checkpoint inhibitors for locally advanced and metastatic SCC, are improving considerably the approach to the disease. This review summarizes the up-to-date knowledge in the field of detection, treatment, and monitoring of cutaneous SCC.

Trading treatment toxicity for survival in locally advanced non-small cell lung cancer.

1997 ◽  
Vol 15 (1) ◽  
pp. 330-340 ◽  
Author(s):  
M D Brundage ◽  
J R Davidson ◽  
W J Mackillop
Keyword(s):  
Prostate Cancer ◽  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Small Cell ◽  
Survival Advantage ◽  
High Dose ◽  
Small Cell Lung ◽  
Trade Off

PURPOSE To determine how patients weigh potential survival benefits against the potential toxicity of different treatment strategies for locally advanced non-small cell lung cancer (NSCLC). Specifically, we were interested in what improvement in survival probability patients would want to have before accepting more toxic therapy. PATIENTS AND METHODS Fifty-six outpatients who had experienced lung cancer (n = 22) or prostate cancer (n = 34), and 20 clinic nurses and radiation therapy technologists participated. A treatment trade-off interview was conducted with each participant that compared low-dose versus high-dose radiotherapy and high-dose radiotherapy versus combination chemo-radiotherapy. Preferences for treatments were assessed by systematically increasing the hypothetical survival advantage of the more toxic treatment until the person reached his or her threshold for choosing the more toxic treatment. RESULTS A wide range of thresholds was observed for both groups. The distributions of survival advantage thresholds for lung cancer and prostate cancer patients were not significantly different but were generally lower thresholds than those declared by staff. If the 3-year survival advantage was 10%, 60% of patients and 15% of staff would consider combination therapy over high-dose radiotherapy. Within patients, apparent willingness to consider more toxic treatments was not significantly related to age, sex, education, or preferred role in decision making. The treatment trade-off method had good test-retest reliability. CONCLUSION There is great interindividual variability in willingness to accept aggressive treatments for locally advanced NSCLC. When choosing NSCLC treatment, each patient should be provided with comprehensive information about the options so that he or she may express his or her preferences should he or she wish to participate in the decision.

Are men with favorable intermediate-risk prostate cancer candidates for active surveillance?

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 82-82
Author(s):  
Ann Caroline Raldow ◽  
Danjie Zhang ◽  
Ming-Hui Chen ◽  
Michelle H. Braccioforte ◽  
Brian Joseph Moran ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Active Surveillance ◽  
Locally Advanced ◽  
Low Risk ◽  
P Value ◽  
High Dose ◽  
Intermediate Risk ◽  
Increased Risk ◽  
Risk Prostate Cancer

82 Background: Active surveillance (AS) is considered appropriate for patients with low-risk prostate cancer (PC) and a life expectancy of at least 10 years. However, with grade migration following the 2005 International Society of Urologic Pathology consensus conference, AS may also be an initial option for men with favorable intermediate-risk PC. We estimated and compared the risk of PC-specific mortality (PCSM) following high dose radiation therapy and androgen deprivation therapy as appropriate amongst men with low, favorable intermediate, unfavorable intermediate, and high-risk PC. Methods: The study consisted of 6,595 consecutively treated men (median age: 68 years) with localized or locally advanced PC at the Chicago PC Center between 1997 and 2013. Fine and Gray competing risks regression analyses (table) were used to assess the risk of PCSM in men with favorable intermediate, unfavorable intermediate or high-risk compared to low-risk PC, adjusting for age at and year of treatment. Results: After median follow-up of 7.76 years, 820 men died: 72 of PC. While men with favorable intermediate-risk did not have significantly increased risk of PCSM as compared to low-risk PC (adjusted hazard ratio (HR) 1.28, 0.63-2.62 95% confidence interval (CI), p-value 0.49), men with high (adjusted HR 9.91, 5.48-17.94 95% CI, p-value <0.0001) or unfavorable intermediate-risk PC (adjusted HR 3.17, 1.60-6.30, p-value 0.001) did. Eight-year point estimates of PCSM were low: 0.68% [0.32-1.31% 95% CI] and 0.44% [0.25-0.75% 95% CI] for men with favorable intermediate and low-risk PC, respectively. Conclusions: Men with low and favorable intermediate-risk PC have similar and low estimates of PCSM during the first decade following standard management. These results provide evidence to support AS as an initial approach for men with favorable intermediate-risk PC. [Table: see text]

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