Defining the Impact of Adjuvant Treatment on the Prognosis of Patients with Inoperable Glioblastoma Undergoing Biopsy-only: Does the Survival Benefit Outweigh the Treatment Effort?

Purpose: Patients with inoperable glioblastoma (GBM) usually experience worse prognosis compared to those in whom gross total resection (GTR) is achievable. Considering the treatment duration and its side effects identification of patients with survival benefit from treatment is essential to guarantee the best achievable quality of life. The aim of this study was to evaluate the survival benefit from radio-chemotherapy and to identify clinical, molecular, and imaging parameters associated with better outcome in patients with biopsied GBMs. Methods: Consecutive patients with inoperable GBM, who underwent tumor biopsy at our department from 2005 to 2019 were retrospectively analyzed. All patients had histologically confirmed GBM and were followed up until death. The overall survival (OS) was calculated from date of diagnosis to date of death. Clinical, radiological and molecular predictors of OS were evaluated. Results: A total of 95 patients with biopsied primary GBM were enrolled in the study. The mean age was 64.3±13.2 years, 56.8 % (54/95) were male and 43.2 % (41/95) female. Mean OS in the entire cohort was 9 months. After stratification for adjuvant treatment a higher median OS was found in the group with adjuvant treatment (7 months, range 2-88) compared to the group without treatment (1 month, range 1-5) Log-rank test, p<0.0001.Conclusion: Patients with inoperable GBM undergoing biopsy indeed experience a very limited OS. Adjuvant treatment is associated with significantly longer OS compared to patients not receiving treatment and should be considered, especially in younger patients with good clinical condition at presentation.

Three weekly versus weekly concurrent cisplatin: safety propensity score analysis on 166 head and neck cancer patients

Background Radio-chemotherapy with CDDP is the standard for H&N squamous cell cancer. CDDP 100 mg/m2/q3 is the standard; alternative schedules are used to reduce toxicity, mostly 40 mg/m2/q1. Methods Patients were treated from 1/2010 to 1/2017 in two Radiation Oncology Centres. Propensity score analysis (PS) was retrospectively used to compare these two schedules. Results Patients analyzed were 166. Most (114/166) had 1w-CDDP while 52 had 3w-CDDP. In the 3w-CDDP group, patients were younger, with better performance status, smaller disease extent and a more common nodal involvement than in the 1w-CDDP. Acute toxicity was similar in the groups. Treatment compliance was lower in the w-CCDP. Overall survival before PS was better for female, for oropharyngeal disease and for 3w-CDDP group. After PS, survival was not related to the CDDP schedule. Conclusions 3w-CDDP remains the standard for fit patients, weekly schedule could be safely used in selected patients.

MANAGEMENT OF ORBITAL RHABDOMYOSARCOMA: ABOUT 2 CASES AND LITERATURE REVIEW

Rhabdomyosarcoma is the most common primary malignancy in children. It constitutes a therapeutic emergency. The ocular region, particularly the orbital soft tissues, is an important anatomic location for RMS, which is the most common primary orbital malignancy of childhood. Radio-chemotherapy with conservative surgery allows a recurrence-free survival of 87% at 5 years. The aim of this study was to improve the understanding of the clinical features by reviewing the literature and analysing the medical records of patients who were diagnosed with orbital Rhabdomyosarcoma in our hospital. We report 2 cases of patients treated for an orbital Rhabdomyosarcoma at the radiotherapy department of the Hassan II University Hospital of FES.

MALIGNANT PROLIFERATING TRICHILEMMAL TUMOR ONE CASE AND LITERATURE REVIEW

Proliferating trichilemmal tumors (PTTs) are uncommon lesions. PTT is thought to originate from the trichilemmal cyst (TC) and have the potential for malignant transformation, at which point it is termed a malignant proliferating trichilemmal tumor (MPTT). we report an observation of a 55-year-old lady patient presenting with a malignant proliferative trichilemmal tumor, emphasizing the aggressive, rapidly extensible and metastatic character. MPTTare aggressive tumors with a bad prognosis, the treatment of which is based on surgery with margins of 1 cm, lymph node dissection in the event of lymph node involvement and radio-chemotherapy.

PATH-32. EXTENT, PATTERN, AND PROGNOSTIC VALUE OF MGMT PROMOTOR METHYLATION: DOES IT DIFFER BETWEEN GLIOBLASTOMA AND IDH-WILDTYPE/TERT-MUTATED ASTROCYTOMA?

INTRODUCTION The cIMPACT-NOW update 6 introduced glioblastoma diagnosis based on the combination of IDH-wildtype (IDHwt) status and TERT promotor mutation (pTERTmut). In glioblastoma as defined by histopathology according to the WHO 2016 classification, MGMT promotor status is associated with outcome. Whether this is also true in glioblastoma defined by molecular markers is yet unclear. METHODS We searched the institutional database for patients with: 1.) glioblastoma defined by histopathology; and 2.) IDHwt astrocytoma with pTERTmut. MGMT promotor methylation was analysed using methylation-specific PCR and Sanger sequencing of CpG sites within the MGMT promotor region. RESULTS We identified 224 patients with glioblastoma diagnosed based on histopathology, and 71 patients with IDHwt astrocytoma with pTERTmut (32 astrocytomas WHO grade II and 39 astrocytomas WHO grade III). There was no difference in the number of MGMT methylated tumors between the two groups as determined per PCR, and also neither the number nor the pattern of methylated CpG sites differed as determined per Sanger sequencing. Progression-free (PFS) and overall survival (OS) was similar between the two groups. Surgery was associated with improved overall survival in IDHwt astrocytoma with pTERTmut. In patients treated with radiochemotherapy or radiotherapy, higher numbers of methylated CpG sites were associated with favourable outcome in both groups. CONCLUSION Extent and pattern of methylated CpG sites are similar in glioblastoma and IDHwt astrocytoma with pTERTmut. In both groups, higher numbers of methylated CpG sites are associated with favourable outcome when radio/chemotherapy is administered. Surgery may form the basis for favourable outcome.

Neuroendocrine Carcinoma of Oral Cavity: A Case Report of an Unusual Presentation

Neuroendocrine carcinoma (NEC) are tumors affecting lungs in the first line. Extra-pulmonary locations are rare, and involvement of the oral cavity is uncommon. The therapeutic strategy of this clinically aggressive entity is not codified. Nevertheless, multimodal treatment combining surgery and radio-chemotherapy is associated with the best results in terms of local control and overall survival. We report a case of a 67-year-old patient, diagnosed with a NEC, the computed tomography (CT) of the facial mass objectified a jugal mass of 2x2.4 cm with two lymph nodes. The patient benefited from an excisional biopsy of the mass, and whose histological examination and immunohistochemical testing returned in favor of a small cell neuroendocrine carcinoma.

Carcinosarcoma del cuello uterino: reporte de un caso y revisión de la literatura

Cervical carcinosarcomas are extremely rare, accounting for less than 0.5% of cervical tumors. Due to its low incidence there is no specific protocol of action, which is associated with a poor prognosis. It is frequently diagnosed in postmenopausal women and in advanced stage, with large tumors with vaginal and parametrial metastases. Surgery is considered the treatment of choice, requiring in some cases adjuvant radio-chemotherapy. The prognosis will depend fundamentally on the stage at the time of diagnosis. Since there is little published evidence on this type of tumors we see the need for the publication of cases and reviews of the literature in this regard, to develop unified protocols for the management of this rare pathology. We present the case of a 51-yearold woman who consulted for postmenopausal metrorrhagia, observing a cervical mass with vaginal involvement, corresponding to a carcinosarcoma of the cervix; receiving treatment with radio-chemotherapy, with few side effects and good response. Keywords: Carcinosarcoma, uterine cervix, chemotherapy, radiotherapy, surgery.

Duration of acute esophageal toxicity in concomitant radio-chemotherapy for non-small cell lung cancer with different fractionation schedules

Objectives: In our previous prospective trial on accelerated hypofractionated concomitant radiochemotherapy (AHRT-CHT) for non-small-cell lung cancer (NSCLC) the incidence of grade ≥3 acute esophageal toxicity (AET) was similar to that reported for conventionally fractionated concomitant radiochemotherapy (CFRT-CHT), but its duration was prolonged. Thus, we aimed to compare the duration of grade ≥3 AET between AHRT-CHT and CFRT-CHT. Methods: Clinical data of 76 NSCLC patients treated with CFRT-CHT (60–66 Gy/2 Gy) during 2015–2020 were retrospectively compared with the data of 92 patients treated with AHRT-CHT (58.8 Gy/2.8 Gy) in the prospective trial. The maximum grade of AET, incidence, and duration of grade ≥3 AET were the endpoints. Univariate and multivariate analyses were applied to correlate clinical and treatment variables with these endpoints. Results: Neither the maximum grade of AET (p = 0.71), nor the incidence of grade ≥3 AET (p = 0.87) differed between the two groups. The number of CHT cycles delivered (2 vs 1, p = 0.005) and higher esophagus mean BED (p = 0.009) were significant predictors for a higher maximum grade of AET; older age was a significant predictor for higher incidence of grade ≥3 AET (p = 0.03). The median duration of grade≥3 AET in AHRT-CHT and CFRT-CHT group was 30 days (range 5-150) vs 7 days (range 3-20), respectively, p = 0.0005. In multivariate analysis, only the AHRT-CHT schedule (p=0.003) was a significant predictor for a longer duration of grade≥3 AET. Conclusions Despite similar incidence of grade≥3 AET, its duration is significantly prolonged in NSCLC patients treated with AHRT-CHT compared to CFRT-CHT. Advances in knowledge Reporting only the rate of grade≥3 AET in clinical trials may underestimate the real extent of the esophageal toxicity; its duration should also be routinely reported.

Tumor Microenvironment of Esophageal Cancer

Esophageal cancer is among the top ten most deadly cancers worldwide with adenocarcinomas of the esophagus showing increasing incidences over the last years. The prognosis is determined by tumor stage at diagnosis and in locally advanced stages by response to (radio-)chemotherapy followed by radical surgery. Less than a third of patients with esophageal adenocarcinomas completely respond to neoadjuvant therapies which urgently asks for further strategies to improve these rates. Aiming at the tumor microenvironment with novel targeted therapies can be one strategy to achieve this goal. This review connects experimental, translational, and clinical findings on each component of the esophageal cancer tumor microenvironment involving tumor angiogenesis, tumor-infiltrating immune cells, such as macrophages, T-cells, myeloid-derived suppressor cells, and cancer-associated fibroblasts. The review evaluates the current state of already approved concepts and depicts novel potentially targetable pathways related to esophageal cancer tumor microenvironment.