International Cancer Conference Journal最新文献

Locally advanced gastric cancer (LAGC) with pancreatic head invasion (T4b) carries a poor prognosis despite radical surgery. Herein, we report the effectiveness of neoadjuvant chemotherapy (NAC) in improving the resectability of advanced gastric cancer with pancreatic invasion. A total of 2191 cases of gastric cancer were retrospectively analyzed from 13 institutions within the Hiroshima Surgical Study Group of Clinical Oncology (Hisco) database from 2018 to 2020. Among them, 5 of the 24 patients with Stage cT4b gastric cancer underwent NAC for three-to-eight cycles. Following chemotherapy, three patients underwent total gastrectomy, two patients underwent distal gastrectomy, and no patient underwent pancreaticoduodenectomy (PD). All five patients achieved a chemotherapeutic response of Grade 1b or higher, and only one case showed residual pancreatic invasion on pathology. This study suggests that NAC for Stage T4b LAGC with pancreatic head invasion may have the potential to obviate the need for PD.

Lacrimal sac tumors are rare, with approximately 800 cases reported worldwide; primary adenocarcinoma of the lacrimal sac is particularly rare. Although there is no established treatment strategy, surgical removal is generally performed. However, complete removal often requires extensive resection, including orbital exenteration and lateral rhinoplasty, which is highly invasive and creates significant cosmetic issues. Here, we report our experience with a 72-year-old woman with primary adenocarcinoma of the lacrimal sac with ethmoid bone invasion. She refused surgery and was treated with radiation therapy alone, totaling 70 Gy in 35 fractions. This is the first report of a patient with primary adenocarcinoma of the lacrimal sac who survived for 5 years without recurrence after radiation therapy alone. She experienced late radiation-related complications: the affected eye developed grade-3 retinopathy according to the common terminology criteria for adverse events, version 5.0, and secondary neovascular glaucoma. Cataract and vitreous surgery with retinal photocoagulation were performed. Her cosmetic appearance was maintained after all treatments were completed. Radiation therapy may be an effective treatment for primary adenocarcinoma of the lacrimal sac for patients who either refuse surgery or in whom surgery is not feasible.

A 64 year-old man underwent a radical cystectomy for muscle-invasive bladder cancer. Five years later, lung and mediastinal lymph node metastases were detected. After 15 courses of gemcitabine and cisplatin for metastatic urothelial carcinoma, the patient was switched to avelumab maintenance therapy. During this period, the patient developed a therapy-related myelodysplastic syndrome, leading to difficulty in continuing treatment. Therapy-related myelodysplastic syndrome is a dose-dependent complication that can develop several years after chemotherapy or radiotherapy. Therefore, excessive cisplatin administration should be avoided.

Enfortumab Vedotin (EV), an antibody-drug conjugate targeting Nectin-4, combined with pembrolizumab (Pem), has become a first-line therapy for locally advanced or metastatic urothelial carcinoma (la/mUC). However, the concurrent use of EV + Pem with radiotherapy (RT) remains underexplored. We report the case of a 74-year-old man with a history of robot-assisted radical cystectomy for muscle-invasive bladder cancer. Nine months post-cystectomy, the patient presented with a symptomatic calcified recurrence in the left obturator internus muscle, causing left leg numbness. The patient underwent concurrent EV + Pem therapy and RT (50 Gy in 25 fractions). Treatment was well-tolerated, with only grade 2 alopecia, grade 2 dysgeusia, and grade 1 pruritus observed. Notably, the leg numbness resolved completely by the end of RT, and imaging revealed substantial tumor shrinkage with residual calcification after two cycles of EV + Pem. This case demonstrates that concurrent administration of RT with EV + Pem can achieve significant tumor reduction and symptomatic relief without severe toxicities in la/mUC. This approach may provide a promising therapeutic strategy for managing symptomatic, radiotherapy-accessible lesions in la/mUC, warranting further investigation.

Stereotactic body radiation therapy (SBRT) is the standard treatment for patients who are medically inoperable or who refuse surgery with stage I non-small cell lung cancer (NSCLC). While acute lymphopenia following SBRT is documented, the long-term effects on the immune system and infectious disease remain unclear. In this report, we present two cases of chronic progressive pulmonary aspergillosis (CPPA) occurring within the irradiated field following SBRT for inoperable stage I NSCLC. Case 1 was a man in his 70 s with a history of smoking and a previous pulmonary resection and SBRT for metachronous primary lung cancer. He received SBRT for T1aN0M0 NSCLC in the right lower lobe as his third primary lung cancer. After 20 months, the patient developed a cough and sputum, and a computed tomography (CT) scan revealed a cavity shadow in the irradiated field, which led to the diagnosis of CPPA. Intravenous voriconazole was immediately started, and after 3 week's administration, the symptoms improved, and the cavity disappeared. After 34 months, the patient died with no recurrence of CPPA and lung cancer. Case 2 was a man in his 80 s with a history of smoking and previous pulmonary resection for lung cancer. He received SBRT for T1cN0M0 NSCLC in the right lower lobe as his second primary lung cancer. After 19 months, the patient developed a fever, and a CT scan revealed a cavity shadow in the irradiated field, which led to the diagnosis of CPPA. Oral itraconazole was administered, followed by diarrhea and anorexia. After 22 days, the patient died. During the follow-up period, there was no recurrence of lung cancer. Risk factors for CPPA include a history of smoking and lung resection, common among candidates for pulmonary SBRT. When a cavity shadow develops following SBRT, differentiating consolidation as radiation pneumonitis, local recurrence, or infection can be challenging. When a cavity is identified on a follow-up CT scan after SBRT, it is crucial to include CPPA in the differential diagnosis.

A 70-year-old female patient was referred to our department for further abnormal chest shadow assessment in the right upper lung field. Computed tomography (CT) imaging detected multiple ground-glass nodules, resulting in primary lung cancer suspicion with no evidence of nodal involvement or distant metastasis. Three-dimensional CT revealed the presence of tracheal bronchus, directly branching off the right B1 bronchus from the trachea. Anomalous venous return was not observed. The patient was preoperatively diagnosed with cStage IA1 lung adenocarcinoma (cT1miN0M0) and underwent thoracoscopic S1 segmentectomy of the right upper lobe. Apical segmental bronchus was directly resected from the trachea, as expected based on preoperative CT examination. Pathologic diagnosis was pStage IA1 lung adenocarcinoma (pT1miN0M0). Multiple synchronous primary lung cancers were observed. The postoperative course was uneventful, and the patient demonstrated no recurrence at the 3-year postoperative follow-up. Tracheal bronchus is a rare abnormality observed in only 1% of patients undergoing thoracic surgery. Thoracic surgeons should be aware that preoperative planning based on three-dimensional CT is crucial in patients with tracheal bronchus because of potential issues associated with anomalous venous return. Good planning will contribute to safe segmentectomy in such cases.

Chylous ascites is a rare complication of abdominal surgery. Although most patients show improvement with conservative treatment. Long-term leakage of chylous ascites can cause malnutrition, dehydration, and immunosuppression; therefore, an early cure is desirable, but no standard treatment for chylous ascites has been established, and determining the timing of surgical intervention is difficult. A 74-year-old woman underwent surgery for carcinosarcoma of the fallopian tube, including dissection of the pelvic and para-aortic lymph nodes. She was noted to have a large amount of chylous ascites postoperatively. Furthermore, a low-fat diet, weekly ascites punctures and lymphangiography were performed. However, the leakage was not resolved. After ten weeks of intensive treatment with fasting, total parenteral nutrition (TPN), octreotide, etilefrine, and fibrogammin, beginning 18 weeks postoperatively, the chylous ascites changed to serous and disappeared. Long-term conservative treatment may improve chylous ascites, and continued conservative treatment without surgical intervention is an option. The patient was resistant to a low-fat diet, although fasting and TPN were effective. In addition, a change in the color of the ascites from milky white to serous as a precursor to improvement of the erosive ascites may help to consider the timing of surgical intervention.

Squamous cell carcinoma (SCC) rarely accounts for 2-5% of urinary bladder cancer. Chronic irritation of the bladder from infection or indwelling catheter is a risk factor for SCC. Only a handful of cases of suprapubic cystostomy (SPC) site SCC have been reported and have been always seen in paraplegics or urethral stricture requiring long-standing catheterization. We report a case of a 69-year-old male with an indwelling (SPC) of 25 years duration for a urethral stricture who presented with a fungating growth around the SPC site enveloping the catheter confirmed to be squamous cell carcinoma. Imaging revealed involvement of abdominal wall and urinary bladder with no metastatic spread. He underwent wide local excision (WLE) of the lesion with radical cystectomy and ileal conduit reconstruction with bilateral ilio-inguinal lymphadenectomy and pedicled anterolateral thigh flap for abdominal wall reconstruction. He received adjuvant radiotherapy and was found to be recurrence free at 3 months. Among the cases previously reported, 9 of the 12 cases were treated surgically with 4 of those combined with partial cystectomy and 4 with radical cystectomy. SPC site SCC tends to be localized around the catheter and into the abdominal tract and wide surgical excision offers the best hope for cure. Regular cystoscopy and biopsy from bladder around the catheter site can help early detection and the treatment should be personalized to each patient.

In several studies, hyperprolactinemia has been associated with increased breast cancer risk. Evidence shows that prolactin (PRL) is linked to mammary tumorigenesis, especially in postmenopausal patients, but the data remain controversial. We present a case of a 67 year-old patient with a resistant PRL-secreting PitNET who subsequently developed breast cancer. The patient was known to have persistent high PRL levels despite multimodal treatment (surgery, radiotherapy, and high doses of cabergoline). The tumor specimens obtained after transsphenoidal intervention were histologically and immunohistochemically examined for the following parameters: anterior pituitary hormones, the ki-67 labeling index, CAM 5.2 expression, ER ∝ expression, and somatostatin receptors, which revealed a densely granulated tumor with intense positivity for PRL and ER ∝ , a ki-67 labeling index of 6% and negative MGMT expression. Years later, the patient was diagnosed with breast carcinoma. Histopathological and immunohistochemical examination of the tumor specimen obtained after radical mastectomy confirmed ductal invasive breast cancer with negative immunostaining for prolactin receptors (PLRr) but positive immunostaining for estrogen (ER) and progesterone receptors (PGR) and a ki-67 labeling index of 8%. PRL is involved in mammary development and differentiation, which leads to lactation, the major driver during pregnancy, by regulating ovarian progesterone production. On the basis of the physiological actions of PRL, a role for this hormone in breast cancer has been suggested. Few cases of different types of breast carcinoma associated with hyperprolactinemia due to a pituitary tumor have been reported in the literature. The association between hyperprolactinemia and the risk of breast carcinoma is not well understood. Immunohistochemistry evaluation of PLRr can be helpful to provide information in these cases.

A 70-year-old woman with the breast cancer exhibited interstitial lung disease 20 months after the administration with anastrozole, which was performed as the post-operative adjuvant therapy. The drug-induced lymphocyte stimulation test revealed that anastrozole was responsible for the development of interstitial lung disease in this patient. The interstitial lung disease was effectively treated by prednisolone. Then, tamoxifen was used as an alternative therapy, resulting in the occurrence of agranulocytosis 24 days after the administration with tamoxifen. Both anastrozole and tamoxifen are widely used and are highly effective drugs for the treatment of breast cancer. However, the current patient shows that both drugs could cause, albeit very rare, serious side effects in some patients.