Cancer diagnosis & prognosis最新文献

Background/aim: This study compared dosimetric differences in target coverage and organs-at-risk (OARs) sparing among coplanar (co-VMAT), non-coplanar (nonco-VMAT), and mixed-arc (mxd-VMAT) volumetric modulated arc therapy (VMAT) for stereotactic radiation treatment of head and face skin cancers (HFSC).

Patients and methods: Five patients with HFSC, presenting with tumors located in critical areas near OARs were selected to represent distinct clinical scenarios. At least three competing VMAT plans per case (up to five for extensive tumors) were generated. The planning target volume (PTV) was obtained by applying a 1 mm isotropic expansion to the clinical target volume (CTV), except for portions extending beyond the body contour. Dosimetric parameters, including PTV indices [Dmax, D2%, D98%, V95%, conformity index (CI), and homogeneity index (HI)], dose to surrounding healthy tissues, beam-on time (BOT), and monitor units (MU) were evaluated and compared under identical optimization conditions.

Results: Nonco-VMAT improved CI, HI, and OAR sparing for the first (left temporal-zygomatic) and third (nasal pyramid) patients. For the second patient (right frontal and zygomatic targets), mxd-VMAT was optimal for the frontal target, while nonco-VMAT was superior for the zygomatic target. Co-VMAT provided the highest plan quality for the fourth (occipital) patient, though mxd-VMAT slightly reduced OAR doses. For the fifth patient (scalp and vertex), co-VMAT achieved the best balance between target coverage and OAR sparing.

Conclusion: This study highlights the potential benefits of non-coplanar arcs in HFSC treatment. VMAT arc arrangement should be tailored to tumor location, as the inclusion of non-coplanar arcs can enhance plan quality for both target coverage and OAR protection in specific cases. However, non-coplanar techniques may prolong treatment duration due to couch rotations and increased MU, potentially reducing patient tolerability.

Background/aim: Neurofibromatosis type 1 (NF1) is a tumor predisposition syndrome and a bone disease. Dystrophic facial skull often is topographically related to diffuse neurofibromas (DNFs). The report traces the diagnosis and treatment of an oral DNF that was registered in adolescence and describes associated bone findings. The aim of the investigation was to illustrate and specify the interplay of tumor-associated and dysmorphic changes of the facial skull in NF1.

Case report: This 14-year-old patient with NF1 had developed a solid tumor arising from the mandibular anterior lingual alveolar process. Histological examination of the tumor identified a DNF. Imaging showed a funnel-shaped vertical defect of the alveolar process between incisors, asymmetry of bony chin and vertical position of mental foramina. The chin showed irregular, bi-cortical connected bone canals suspected to indicate enlarged neurovascular channels. Thirteen years later, the patient developed a local tumor recurrence (DNF). Meanwhile, the anterior bone defect had become larger. However, the bony chin appeared considerably sclerosed. In contrast, mandibular shape and surface were unchanged.

Conclusion: DNF can affect the position of teeth, invade the bone, and cause enlarged bone channels. Surface erosion and trophic effects of the mandible may arise adjacent to the neurogenic lesion. DNF of the oral cavity can recur. It is becoming apparent that the tumor-associated skeletal and dental changes in the mandible correlate with the time of development of the peripheral nerve sheath tumor. The findings could be useful as indications for an expanded tumor search in the affected area.

Background/aim: Peritoneal carcinomatosis is the end stage for patients with gastrointestinal cancer, with survival ranging between 2 and 9 months. Pancreatic acinar cell carcinoma (PACC) is rare and can result in peritoneal metastases. The efficacy of chemotherapy for patients with PACC is unknown, and a systemic treatment strategy has not been established. The aim of the present perspective is to discuss a potential curative strategy combining surgery, heated intraperitoneal chemotherapy (HIPEC), and the histoculture drug response assay (HDRA) to identify effective adjuvant chemotherapy for PACC with peritoneal metastases, based on a published case report.

Case report: A 31-year-old man with a 20 cm epigastric mass, diagnosed as PACC, had curative-intent resection of a tumor on the distal stomach and pancreas tail. The patient recurred after four courses of adjuvant oral S-1 treatment. Laparotomy demonstrated peritoneal metastases with a peritoneal cancer index of 18. Ascites or other cancer cells in the peritoneal wash were not found. Peritonectomy, combined with HIPEC with gemcitabine and docetaxel, was performed intraoperatively. Postoperative 3-dimensional histoculture of fragments of the resected tumor with drug response testing with the histoculture drug response assay (HDRA) showed gemcitabine had the highest tumor inhibitory rate (70%) among six drugs tested. Based on the HDRA results, the patient was treated with adjuvant systemic gemcitabine chemotherapy. The patient did not have a recurrence within 18 months after surgery.

Conclusion: The present innovative treatment of PACC with peritoneal metastases used laparotomy to determine the extent of peritoneal metastases, peritonectomy to attempt to completely remove the tumor, HIPEC for intraoperative hyperthermic-chemotherapy, and the HDRA to determine the most effective drug for adjuvant chemotherapy. These procedures can be individualized for each patient's cancer, and the HDRA is most critical for individualization.

Background/aim: The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index is an innovative immunonutritional biomarker calculated from CRP, serum albumin, and lymphocyte count levels. This study aimed to determine the significance of the preoperative CALLY index as a prognostic biomarker in patients with stage II-III colorectal cancer who underwent colorectal surgery.

Patients and methods: This retrospective study included 223 patients who underwent colorectal surgery for stage II-III colorectal cancer. The CALLY index was calculated as follows: (albumin × lymphocyte)/(CRP × 104). The patients were divided into CALLY-high group (n=112) and CALLY-low group (n=111) according to the preoperative CALLY index. The associations between the preoperative CALLY index and recurrence-free survival (RFS) and overall survival (OS) were evaluated.

Results: The cutoff value of the CALLY index was 3.41. The Kaplan-Meier survival curves for both RFS and OS in patients with stage II-III colorectal cancer demonstrated worse outcomes in the CALLY-low group than in the CALLY-high group (p=0.062 and p=0.008, respectively). A subgroup analysis of both stage II and stage III showed that patients in the CALLY-low group who did not receive postoperative adjuvant chemotherapy had the worst RFS and OS.

Conclusion: The preoperative CALLY index may serve as a prognostic biomarker in patients with colorectal cancer. Additionally, a low CALLY index may indicate a poorer prognosis, particularly in patients who did not receive postoperative adjuvant chemotherapy.

Background/aim: A malignant Triton tumor (MTT) is a rare and aggressive soft tissue sarcoma associated with poor prognosis and with no established treatment protocol.

Case report: A 38-year-old man presented with severe right thigh pain and limited hip motion. Since childhood, the patient had a mass on their thigh, accompanied by café-au-lait spots. Upon admission, a biopsy confirmed MTT that had metastasized to the lungs. Preoperative radiation therapy was administered to reduce the tumor size; however, the tumor did not shrink. Extensive resection was not feasible because of the tumor size and location, prompting a decision to perform volume reduction surgery aimed at alleviating the patient's pain and improving mobility. Although the surgery provided temporary relief from the symptoms, the patient died two weeks later.

Conclusion: MTT requires a multidisciplinary approach that includes surgery, chemotherapy, and radiation therapy; however, in advanced cases such as this one, palliative measures may be more appropriate. This case underscores the challenges in managing MTT and highlights the potential role of volume reduction surgery in improving the quality of life of patients with significant symptoms. Despite the poor prognosis, symptom palliation during the two weeks leading up to the patient's death was significant, illustrating the importance of addressing pain and mobility issues while considering overall treatment strategies in such complex cases. These findings emphasize the need for further research on effective management options for MTT to improve patient outcomes.

Background/aim: Lymphocyte-to-C-reactive protein ratio (LCR) is a useful biomarker for predicting the prognosis of various cancers. This study examined the effect of LCR on the oncological prognosis of patients with gastric cancer who underwent curative resection at our institution and considered the mechanisms involved.

Patients and methods: In this retrospective cohort study, 258 subjects were selected from the medical records of patients who underwent curative resection for gastric cancer at Yokohama City University between 2005 and 2020. The LCR was calculated using the following formula: LCR=lymphocyte count (number/μl)/C-reactive protein (mg/dl).

Results: The cutoff value for LCR was set at 9,000, and 258 patients were classified into the LCR-low (<9,000) (58 patients) and LCR-high (>9,000) (200 patients) groups. The overall survival (OS) and recurrence-free survival (RFS) rates of the two groups were compared. The 5-year overall survival rate was 54.2% in the LCR-low group and 75.2% in the LCR-high group (p<0.001), and a multivariate analysis showed that it was a useful prognostic factor [hazard ratio (HR)=1.744, 95% confidence interval (CI)=1.009-3.014, p=0.046]. In addition, with regard to RFS, there was a significant difference in the 5-year RFS between the LCR-low group (50.4%) and the LCR-high group (72.3%) (p<0.001). Regarding the comparison of the postoperative clinical course between the two groups, the peritoneal recurrence rate was 24.1% in the LCR-low group and 7.5% in the LCR-high group (p<0.001).

Conclusion: Preoperative LCR is a useful prognostic factor for predicting the oncological prognosis of patients with gastric cancer undergoing curative resection. Thus, the LCR may be a useful tool for the treatment and perioperative management of patients with gastric cancer.

Background/aim: Pneumocystis pneumonia (PCP) can be a life-threatening fungal infection for immunocompromised individuals. We report a case of PCP in a 75-year-old male with colorectal cancer receiving bevacizumab plus mFOLFOX6 (oxaliplatin, leucovorin, and 5-fluorouracil) therapy.

Case report: The patient, diagnosed with unresectable advanced colorectal cancer, developed fever and neutropenia during the 40th course of bevacizumab plus mFOLFOX6 therapy and was diagnosed with febrile neutropenia. Moreover, laboratory tests and imaging studies indicated PCP. Although initial treatment with corticosteroids and trimethoprim-sulfamethoxazole temporarily improved the patient's condition, the patient later developed acute respiratory distress syndrome and succumbed to the disease. Lymphocytopenia associated with the prolonged bevacizumab plus mFOLFOX6 therapy may have contributed to the onset of PCP.

Conclusion: This case reaffirms that advanced age, immunosuppression, and cumulative steroid exposure are critical risk factors for PCP. Early imaging and prophylactic TMP-SMX administration should be considered in high-risk patients. Early intervention is crucial to prevent PCP progression to ARDS in patients with solid tumors.

Background/aim: Pulmonary sarcomatoid carcinoma is a rare disease known for its aggressiveness, with numerous studies evaluating the efficacy of various therapeutic approaches. However, pulmonary sarcomatoid carcinoma is histologically defined according to WHO classification based on surgical specimens, whereas in clinical practice, most cases of advanced lung cancer are diagnosed based on small biopsy specimens. This retrospective study aimed to present the clinical course of patients diagnosed with pulmonary sarcomatoid carcinoma based on small biopsy specimens.

Patients and methods: Data of patients who were diagnosed with pulmonary sarcomatoid carcinoma based on small biopsy specimens and treated with platinum-doublet chemotherapy and/or an immune checkpoint inhibitor-containing regimen between 2005 and 2022 were analyzed.

Results: Data from 12 patients were analyzed, including five patients treated with platinum-doublet chemotherapy and 11 patients treated with an immune checkpoint inhibitor-containing regimen. The median progression-free survival among the five patients treated with platinum-doublet chemotherapy was 1.5 months [95% confidence interval (CI)=0.7-4.1]. Of these, four patients subsequently received immune checkpoint inhibitor-containing therapy. The median overall survival from the initiation of platinum-doublet chemotherapy in these five patients was 14.7 months (95%CI=1.2-16.2). In contrast, 11 patients treated with immune checkpoint inhibitor therapy showed a median progression-free survival and overall survival of 8.9 months [95%CI=0.3-not estimated (NE)] and 10.8 months (95%CI=1.0-NE), respectively.

Conclusion: Pulmonary sarcomatoid carcinoma diagnosed based on small biopsy specimens is refractory to platinum-doublet chemotherapy, and immune checkpoint inhibitor therapy may improve the prognosis.

Background/aim: Robot-assisted radical prostatectomy (RARP) outcomes improve with surgical experience, but preoperative prediction of disease stage is crucial to avoid unexpected T stage upgrades, such as pT3b. This study aimed to identify preoperative predictive factors for pT3b (seminal vesicle invasion) following RARP.

Patients and methods: Out of 299 RARP performed between 2013 and 2020, 246 cases without preoperative hormone therapy were included. Of these, 19 cases (7.7%) were pT3b. T classification was performed using magnetic resonance imaging (MRI), and 12-site prostate biopsies were conducted. Cox proportional hazards, logistic regression analysis, and Kaplan-Meier analyses were used.

Results: The 3-year prostate specific antigen (PSA) recurrence-free survival rate was 87% but significantly lower at 70% for pT3b cases. Multivariate logistic regression analysis identified the International Society of Urological Pathology (ISUP) grade group at biopsy as the only significant preoperative predictor of pT3b.

Conclusion: pT3b is associated with increased postoperative biochemical recurrence risk, and ISUP grade group at biopsy serves as a significant preoperative predictive factor for pT3b.

Background/aim: This study aimed to investigate the effectiveness of sequential treatment with afatinib and osimertinib by clarifying the correlation between therapeutic effects and EGFR T790M mutant allele frequency.

Patients and methods: From August 2013 to July 2019, tumor samples from before and after epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) administration were collected from patients from eight institutions. We measured T790M mutant allele frequency using droplet digital polymerase chain reaction using biopsy specimens from patients mainly treated with afatinib and analyzed the T790M to EGFR-activating mutation ratio (T/A ratio) in pre- and post-biopsy tissue.

Results: Among 36 patients (afatinib group: n=24, first-generation EGFR-TKI group: n=12) with preserved pre- and post-biopsy tissue, the median T/A ratios before (pre-T/A ratio) and after EGFR-TKI administration (post-T/A ratio) in the afatinib group were 0.005 and 0.014, and those in the first-generation EGFR-TKI group were 0.026 and 0.352, respectively. The results of a Mann-Whitney U-test revealed that the difference between the pre-T/A and post-T/A ratios was not higher in the afatinib group than in the first-generation EGFR-TKI (p=0.0372). No significant difference in progression-free or overall survival was found between the two groups.

Conclusion: Compared with first-generation EGFR-TKI treatment, treatment with afatinib did not affect changes in the T/A ratio.