Fred Chen, C. Chi, H. Shieh, Chin-Ping Lin, C. Ko, Y. Chung, Jerry Cheng-Yen Lai, H. Tai, Yu-Jen Chen
Background: Neoadjuvant chemoradiation is the standard of care for locally advanced rectal cancer, however, pathological complete response (pCR) rate remains unsatisfactory. Tumor hypoxia in rectal cancer might be one factor of radioresistance. Mitomycin C (MMC), a hypoxia-activated prodrug (HAP), enhances radiosensitivity and is the standard adjunct to radiotherapy (RT) in anal cancer. Our study evaluated the effect of MMC and RT on rectal cancer and its tumor microenvironment (TME). Methods: In vitro hypoxia was induced by 1% O2 culture for CT26 rectal adenocarcinoma cells and HIF-1α expression was validated with Western blotting. Clonogenicity and MTT assays were used for radiation and drug survival. In syngeneic CT26 model, tumors were treated as follows: control, MMC (2 mg/kg/day), RT (2 Gy × 2 fractions), and combination with MMC 2 h prior to RT. Tumor volume, body weight, and white blood cell count were monitored for 1 month. Immune cells in TME were analyzed using flow cytometry. Results: MMC inhibited cell viability and enhanced radioresponse in CT 26 cells with delayed repair of DNA double strand break (P Ifnb1 was augmented by RT and upregulated with addition of MMC. In vivo treatment using MMC plus RT suppressed tumor growth with durable effect in comparison to MMC or RT alone (P Conclusions: The combination of MMC and RT may have synergistic therapeutic effect accompanied by modulation of TME towards favorable anti-tumor immunity.
{"title":"Mitomycin C modulates tumor microenvironment and enhances radiosensitivity in rectal cancer","authors":"Fred Chen, C. Chi, H. Shieh, Chin-Ping Lin, C. Ko, Y. Chung, Jerry Cheng-Yen Lai, H. Tai, Yu-Jen Chen","doi":"10.21037/tro.2019.07.05","DOIUrl":"https://doi.org/10.21037/tro.2019.07.05","url":null,"abstract":"Background: Neoadjuvant chemoradiation is the standard of care for locally advanced rectal cancer, however, pathological complete response (pCR) rate remains unsatisfactory. Tumor hypoxia in rectal cancer might be one factor of radioresistance. Mitomycin C (MMC), a hypoxia-activated prodrug (HAP), enhances radiosensitivity and is the standard adjunct to radiotherapy (RT) in anal cancer. Our study evaluated the effect of MMC and RT on rectal cancer and its tumor microenvironment (TME). \u0000 Methods: In vitro hypoxia was induced by 1% O2 culture for CT26 rectal adenocarcinoma cells and HIF-1α expression was validated with Western blotting. Clonogenicity and MTT assays were used for radiation and drug survival. In syngeneic CT26 model, tumors were treated as follows: control, MMC (2 mg/kg/day), RT (2 Gy × 2 fractions), and combination with MMC 2 h prior to RT. Tumor volume, body weight, and white blood cell count were monitored for 1 month. Immune cells in TME were analyzed using flow cytometry. \u0000 Results: MMC inhibited cell viability and enhanced radioresponse in CT 26 cells with delayed repair of DNA double strand break (P Ifnb1 was augmented by RT and upregulated with addition of MMC. In vivo treatment using MMC plus RT suppressed tumor growth with durable effect in comparison to MMC or RT alone (P Conclusions: The combination of MMC and RT may have synergistic therapeutic effect accompanied by modulation of TME towards favorable anti-tumor immunity.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48243602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Brachial plexopathy is a known issue following axillary radiotherapy in locally advanced breast cancer (LABC). We attempted to adapt Radiation Therapy Oncology Group (RTOG) guidelines on brachial plexus (BP) contouring (head and neck cancer) to breast cancer patients receiving post-mastectomy locoregional radiotherapy (LRRT), to determine (I) feasibility of identifying BP in the treatment position for breast cancer, and (II) radiation therapy dose received by BP with respect to the planned dose. Methods: Planning computed tomography (CT) sets (non-contrast) of 10 LABC patients, who had undergone mastectomy and subsequently completed LRRT including posterior axillary boost, were retrieved. Treatment included chest wall irradiation [50 gray (Gy) in 25 fractions, 6–10 Mega-electronVolt (MeV) electrons, 80–100% isodose], and supraclavicular and axillary RT with an anterior photon field [6 megavolts (MVs), 40 Gy in 20 fractions] and a posterior axillary field (6 MVs, 10 Gy in 5 fractions). Vertebral bodies C5–T1, anterior and middle scalene muscles (MS) were contoured and used as guide to identify probable location of BP. Results: Ten LABC patients received LRRT (50 Gy). Mean ipsilateral BP volume was 13.8 cc. Medians of maximum and mean BP doses were 54.65 and 36.62 Gy, respectively. Mean global dose maximum of the respective plans was 58.83 Gy. Mean BP volume receiving >50 Gy was 27.81% (range, 13.01–51.80%). Conclusions: BP contouring in LABC radiotherapy is feasible, with uncertainty in regions of altered anatomy (C5–6, shoulder). The maximum BP doses always exceeded prescribed dose, and although lower than tolerance dose (66 Gy) should be evaluated to reduce adverse events’ risk. This study establishes the feasibility of following RTOG guidelines for BP contouring even in altered treatment position in breast cancer radiotherapy planned on non-contrast CT scans. BP dose maxima in conventional radiotherapy planning are nearly 18–20% higher than prescription isodoses. Albeit safe in conventional terms, the risk of high doses leading to increased risk of plexopathy warrants consideration especially with regard to relation to tumor boost volumes as well as when using hypofractionated regimens which may be less forgiving for late effects.
{"title":"Brachial plexus doses in locoregional radiotherapy for breast cancer","authors":"S. Goyal, D. Menon, Niyas Puzhakkal, D. Makuny","doi":"10.21037/tro.2019.08.03","DOIUrl":"https://doi.org/10.21037/tro.2019.08.03","url":null,"abstract":"Background: Brachial plexopathy is a known issue following axillary radiotherapy in locally advanced breast cancer (LABC). We attempted to adapt Radiation Therapy Oncology Group (RTOG) guidelines on brachial plexus (BP) contouring (head and neck cancer) to breast cancer patients receiving post-mastectomy locoregional radiotherapy (LRRT), to determine (I) feasibility of identifying BP in the treatment position for breast cancer, and (II) radiation therapy dose received by BP with respect to the planned dose. \u0000 Methods: Planning computed tomography (CT) sets (non-contrast) of 10 LABC patients, who had undergone mastectomy and subsequently completed LRRT including posterior axillary boost, were retrieved. Treatment included chest wall irradiation [50 gray (Gy) in 25 fractions, 6–10 Mega-electronVolt (MeV) electrons, 80–100% isodose], and supraclavicular and axillary RT with an anterior photon field [6 megavolts (MVs), 40 Gy in 20 fractions] and a posterior axillary field (6 MVs, 10 Gy in 5 fractions). Vertebral bodies C5–T1, anterior and middle scalene muscles (MS) were contoured and used as guide to identify probable location of BP. Results: Ten LABC patients received LRRT (50 Gy). Mean ipsilateral BP volume was 13.8 cc. Medians of maximum and mean BP doses were 54.65 and 36.62 Gy, respectively. Mean global dose maximum of the respective plans was 58.83 Gy. Mean BP volume receiving >50 Gy was 27.81% (range, 13.01–51.80%). Conclusions: BP contouring in LABC radiotherapy is feasible, with uncertainty in regions of altered anatomy (C5–6, shoulder). The maximum BP doses always exceeded prescribed dose, and although lower than tolerance dose (66 Gy) should be evaluated to reduce adverse events’ risk. This study establishes the feasibility of following RTOG guidelines for BP contouring even in altered treatment position in breast cancer radiotherapy planned on non-contrast CT scans. BP dose maxima in conventional radiotherapy planning are nearly 18–20% higher than prescription isodoses. Albeit safe in conventional terms, the risk of high doses leading to increased risk of plexopathy warrants consideration especially with regard to relation to tumor boost volumes as well as when using hypofractionated regimens which may be less forgiving for late effects.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/tro.2019.08.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41440534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 48-year-old female patient diagnosed as olfactory neuroblastoma was treated by radiotherapy 70 Gy in 35 fractions (2 Gy per fraction) to right nasal mass, right ethmoid sinus mass, bilateral upper 2/3 neck lymphadenopathy in 2010, and concurrent intravenous Cisplatin 30 mg/m 2 for one course. Tumor was gradually decreased in size without recurrence for 9 years. The second case was a 38-year-old male patient treated with induction chemotherapy by intravenous Etoposide + carboplatin for 4 courses during March to May in 2011 and followed by radiotherapy 70 Gy in 35 fractions (2 Gy per fraction) to ethmoid mass & bilateral level IIa lymphadenopathy during June to August in 2011. He was disease free without recurrence for 8 years. These two cases demonstrated that definitive chemo-radiotherapy would be an alternative treatment option for locally advanced olfactory neuroblastoma. They received definitive chemo-radiotherapy and experienced good local control without recurrence for more than 8 years. However, the further study for optimal regimen of chemotherapy is warranted.
{"title":"Chemo-radiotherapy for olfactory neuroblastoma: cases report and literature review","authors":"Jeng-You Wu, J. Chiou, L. Ting","doi":"10.21037/TRO.2019.07.01","DOIUrl":"https://doi.org/10.21037/TRO.2019.07.01","url":null,"abstract":"A 48-year-old female patient diagnosed as olfactory neuroblastoma was treated by radiotherapy 70 Gy in 35 fractions (2 Gy per fraction) to right nasal mass, right ethmoid sinus mass, bilateral upper 2/3 neck lymphadenopathy in 2010, and concurrent intravenous Cisplatin 30 mg/m 2 for one course. Tumor was gradually decreased in size without recurrence for 9 years. The second case was a 38-year-old male patient treated with induction chemotherapy by intravenous Etoposide + carboplatin for 4 courses during March to May in 2011 and followed by radiotherapy 70 Gy in 35 fractions (2 Gy per fraction) to ethmoid mass & bilateral level IIa lymphadenopathy during June to August in 2011. He was disease free without recurrence for 8 years. These two cases demonstrated that definitive chemo-radiotherapy would be an alternative treatment option for locally advanced olfactory neuroblastoma. They received definitive chemo-radiotherapy and experienced good local control without recurrence for more than 8 years. However, the further study for optimal regimen of chemotherapy is warranted.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/TRO.2019.07.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48225539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Chien, Chien-Yu Huang, Yu-Chang Hu, Kuo-Chen Chang, Kuo‐Ping Chang, B. Kang, Wen-Shan Liu
Background: While chemoradiotherapy being widely recognized as primary treatment for nasopharyngeal carcinoma (NPC), optimal salvage modalities for locoregionally recurrent NPC (LRrNPC) are still under debate. This study aimed to explore outcomes of different salvage modalities for LRrNPC. Methods: Non-metastatic LRrNPCs were retrospectively recruited. Clinical factors and salvage treatments were evaluated. The primary and secondary endpoint were locoregional-progression-free survival (LRPFS) and overall survival (OS), respectively. Outcomes were compared among re-irradiation (reRT), surgical resection (SR), combination therapy (SR + reRT), and systemic treatment only (STx). Results: From 2006–2017, 29 consecutive LRrNPCs were enrolled, including 37.9% rT1-2 and 62.1% rT3-4 diseases. Salvage treatments included 14 reRT, 6 SR, 6 SR + reRT, and 3 STx. All re-irradiations were intensity-modulated radiotherapy (IMRT) and 83.3% SRs were done by endoscopic approach. After median follow-up of 36 months, the 3-year LRPFS was 56.5% and 3-year OS was 64.1%. When compared to STx, reRT and SR + reRT both showed superior LRPFS (re-RT, HR: 0.06, P=0.009; SR + reRT, HR: 0.07, P=0.021, adjusted for rT), while SR revealed no significant benefit. However, there was no significant difference in LRPFS among the three local treatment modalities. Severe complication rates were 51.7% for ≥grade 3 and 6.9% for grade 5. Conclusions: For LRrNPCs, locoregional treatments including reRT and SR + reRT might have additional local control benefit from systemic therapy. The risk of fatal toxicity decreased with increasing use of IMRT and endoscopic resection. Considering the limited case number and retrospective design, prospective trials are warranted to further evaluate the efficacy and safety.
{"title":"The treatment modalities and outcomes of recurrent nasopharyngeal carcinoma: a retrospective cohort study in the modern era","authors":"J. Chien, Chien-Yu Huang, Yu-Chang Hu, Kuo-Chen Chang, Kuo‐Ping Chang, B. Kang, Wen-Shan Liu","doi":"10.21037/TRO.2019.07.02","DOIUrl":"https://doi.org/10.21037/TRO.2019.07.02","url":null,"abstract":"Background: While chemoradiotherapy being widely recognized as primary treatment for nasopharyngeal carcinoma (NPC), optimal salvage modalities for locoregionally recurrent NPC (LRrNPC) are still under debate. This study aimed to explore outcomes of different salvage modalities for LRrNPC. \u0000 Methods: Non-metastatic LRrNPCs were retrospectively recruited. Clinical factors and salvage treatments were evaluated. The primary and secondary endpoint were locoregional-progression-free survival (LRPFS) and overall survival (OS), respectively. Outcomes were compared among re-irradiation (reRT), surgical resection (SR), combination therapy (SR + reRT), and systemic treatment only (STx). Results: From 2006–2017, 29 consecutive LRrNPCs were enrolled, including 37.9% rT1-2 and 62.1% rT3-4 diseases. Salvage treatments included 14 reRT, 6 SR, 6 SR + reRT, and 3 STx. All re-irradiations were intensity-modulated radiotherapy (IMRT) and 83.3% SRs were done by endoscopic approach. After median follow-up of 36 months, the 3-year LRPFS was 56.5% and 3-year OS was 64.1%. When compared to STx, reRT and SR + reRT both showed superior LRPFS (re-RT, HR: 0.06, P=0.009; SR + reRT, HR: 0.07, P=0.021, adjusted for rT), while SR revealed no significant benefit. However, there was no significant difference in LRPFS among the three local treatment modalities. Severe complication rates were 51.7% for ≥grade 3 and 6.9% for grade 5. Conclusions: For LRrNPCs, locoregional treatments including reRT and SR + reRT might have additional local control benefit from systemic therapy. The risk of fatal toxicity decreased with increasing use of IMRT and endoscopic resection. Considering the limited case number and retrospective design, prospective trials are warranted to further evaluate the efficacy and safety.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/TRO.2019.07.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43937521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The landscape of lung cancer treatment is rapidly evolving with the clinical diffusion of newer surgical, medical and radiation treatment modalities. Stereotactic ablative radiotherapy (SABR, also known as stereotactic body radiotherapy or SBRT) is characterized by ultra-high doses of radiation delivered over a few fractions, largely enabled by advances in the radiation planning and delivery process. In this special issue of Therapeutic Radiology and Oncology , we discuss current paradigms and controversies on practical topics related to the use of lung SABR that face the modern oncologist in daily treatment decisions.
{"title":"Turning up the stereo in lung cancer","authors":"A. Louie, Joe Y. Chang","doi":"10.21037/TRO.2019.06.02","DOIUrl":"https://doi.org/10.21037/TRO.2019.06.02","url":null,"abstract":"The landscape of lung cancer treatment is rapidly evolving with the clinical diffusion of newer surgical, medical and radiation treatment modalities. Stereotactic ablative radiotherapy (SABR, also known as stereotactic body radiotherapy or SBRT) is characterized by ultra-high doses of radiation delivered over a few fractions, largely enabled by advances in the radiation planning and delivery process. In this special issue of Therapeutic Radiology and Oncology , we discuss current paradigms and controversies on practical topics related to the use of lung SABR that face the modern oncologist in daily treatment decisions.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46150213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Head and neck peripheral primitive neuroectodermal tumors (pPNET) are uncommon and require multimodality management including significant contribution from radiation therapy. We attempted to evaluate the outcome of non-metastatic pPNET of head and neck in our institution. Methods: We retrospectively reviewed the treatment records of 21 patients treated from 2004–2009, and describe their outcome in this report. Results: There were 13 males and 8 females, with median age of 13 years (range, 3–31 years). The most common sites were mandible (N=7), maxilla (N=5), orbit (N=4), parotid (N=2), supraclavicular region (N=2) and nasal cavity (N=1). Treatment included chemotherapy (N=21), radiotherapy (N=21) and surgery (N=5). Chemotherapy regimens were VAC/IE (N=19) and modified St Jude’s (N=2). 3D conformal radiotherapy was used, mean dose being 55 gray (range, 30–60 gray). Two patients did not complete planned treatment. Treatment responses included complete response (N=13), partial response (N=5), stable disease (N=1) and progressive disease (N=2). One patient developed local recurrence following complete response, 24.23 months following diagnosis. Mean follow-up duration was 26.7 months (range, 7.37 to 77.47 months). At last follow-up, 12 patients were disease-free, 6 were alive with disease and 1 patient had died of unrelated cause. Conclusions: Head and neck is a rare site for pPNET. Both surgery and radiotherapy pose challenges due to dose-limiting structures in immediate vicinity of tumor, difficulty in performing extensive resection and cosmesis issues. Combined modality treatment is the best curative option.
{"title":"Non-metastatic Ewing’s sarcoma family of tumors arising from head and neck: a single institution experience","authors":"S. Goyal, A. Biswas, B. Mohanti, S. Bakhshi","doi":"10.21037/TRO.2019.05.06","DOIUrl":"https://doi.org/10.21037/TRO.2019.05.06","url":null,"abstract":"Background: Head and neck peripheral primitive neuroectodermal tumors (pPNET) are uncommon and require multimodality management including significant contribution from radiation therapy. We attempted to evaluate the outcome of non-metastatic pPNET of head and neck in our institution. Methods: We retrospectively reviewed the treatment records of 21 patients treated from 2004–2009, and describe their outcome in this report. Results: There were 13 males and 8 females, with median age of 13 years (range, 3–31 years). The most common sites were mandible (N=7), maxilla (N=5), orbit (N=4), parotid (N=2), supraclavicular region (N=2) and nasal cavity (N=1). Treatment included chemotherapy (N=21), radiotherapy (N=21) and surgery (N=5). Chemotherapy regimens were VAC/IE (N=19) and modified St Jude’s (N=2). 3D conformal radiotherapy was used, mean dose being 55 gray (range, 30–60 gray). Two patients did not complete planned treatment. Treatment responses included complete response (N=13), partial response (N=5), stable disease (N=1) and progressive disease (N=2). One patient developed local recurrence following complete response, 24.23 months following diagnosis. Mean follow-up duration was 26.7 months (range, 7.37 to 77.47 months). At last follow-up, 12 patients were disease-free, 6 were alive with disease and 1 patient had died of unrelated cause. \u0000 Conclusions: Head and neck is a rare site for pPNET. Both surgery and radiotherapy pose challenges due to dose-limiting structures in immediate vicinity of tumor, difficulty in performing extensive resection and cosmesis issues. Combined modality treatment is the best curative option.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/TRO.2019.05.06","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41366679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yu-Hsuan Huang, Tung-hao Chang, T. Chou, Mucang Liu, C. Pi, Chia-chun Huang, L. Hung, Jhen-Bin Lin
Surgical excision is an optimal treatment option for sebaceous carcinoma of the orbital region. As tumor recurrence in this region might compromise the survival and locoregional control of patients as well as the cosmetic results, adjuvant radiotherapy is suggested to patients with adverse pathological findings. Here we report a case of sebaceous carcinoma of the eyelid that was treated using orbital exenteration and adjuvant radiotherapy. In 2011, a 54-year-old male was diagnosed with sebaceous carcinoma of the left eyelid, for which he underwent surgical excision of the lesion. After 4 years, recurrence was observed with pathological evidence. Severe deterioration of the left eye function made organ preservation of little significance to the patient himself; instead, minimizing the chances of future recurrences became his priority. The patient underwent orbital exenteration as a radical treatment approach. Postoperatively, the patient was administered adjuvant radiotherapy owing to a less than 1mm deep soft tissue margin and advanced T stage. For 3 months after radiotherapy, the patient was followed up at a radiation oncology clinic, and magnetic resonance imaging (MRI) of the orbit revealed no recurrence. The last follow-up at 15 months posttreatment revealed the stable condition of the treated area and no evidence of locoregional recurrence. This patient has been followed up for 8 years since the diagnosis in 2011. This successful treatment response indicates that surgical intervention and adjuvant radiotherapy with appropriate doses could be considered in patients with sebaceous carcinoma of the eyelid.
{"title":"Adjuvant radiotherapy for sebaceous carcinoma of the eyelid after orbital exenteration","authors":"Yu-Hsuan Huang, Tung-hao Chang, T. Chou, Mucang Liu, C. Pi, Chia-chun Huang, L. Hung, Jhen-Bin Lin","doi":"10.21037/TRO.2019.06.01","DOIUrl":"https://doi.org/10.21037/TRO.2019.06.01","url":null,"abstract":"Surgical excision is an optimal treatment option for sebaceous carcinoma of the orbital region. As tumor recurrence in this region might compromise the survival and locoregional control of patients as well as the cosmetic results, adjuvant radiotherapy is suggested to patients with adverse pathological findings. Here we report a case of sebaceous carcinoma of the eyelid that was treated using orbital exenteration and adjuvant radiotherapy. In 2011, a 54-year-old male was diagnosed with sebaceous carcinoma of the left eyelid, for which he underwent surgical excision of the lesion. After 4 years, recurrence was observed with pathological evidence. Severe deterioration of the left eye function made organ preservation of little significance to the patient himself; instead, minimizing the chances of future recurrences became his priority. The patient underwent orbital exenteration as a radical treatment approach. Postoperatively, the patient was administered adjuvant radiotherapy owing to a less than 1mm deep soft tissue margin and advanced T stage. For 3 months after radiotherapy, the patient was followed up at a radiation oncology clinic, and magnetic resonance imaging (MRI) of the orbit revealed no recurrence. The last follow-up at 15 months posttreatment revealed the stable condition of the treated area and no evidence of locoregional recurrence. This patient has been followed up for 8 years since the diagnosis in 2011. This successful treatment response indicates that surgical intervention and adjuvant radiotherapy with appropriate doses could be considered in patients with sebaceous carcinoma of the eyelid.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/TRO.2019.06.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48142051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yu-Hsuan Huang, Tung-hao Chang, Jhen-Bin Lin, Mucang Liu, C. Pi, Chia-chun Huang, L. Hung, T. Chou, P. Tseng
As small-cell carcinoma rarely occurs in the hypopharynx, limited cases have been reported to date. Here we report the case of an 81-year-old male with locally advanced small-cell carcinoma originating from the pyriform sinus. Using imaging studies, the disease was staged as cT2N3bM0 based on the American Joint Committee on Cancer 8th edition, with an enhanced heterogeneous mass lesion (15 mm × 25 mm × 29 mm) in the right pyriform sinus and confluent lymphadenopathies along the right cervical chain (up to 79 mm), encasing and compressing the right common carotid artery and right internal jugular vein. Considering his tolerance issues for concurrent chemoradiation (CCRT), instead of selecting CCRT using the etoposide and cisplatin regimen, definitive radiotherapy (RT) combined with biotherapy with cetuximab was selected. After 7-month treatment, complete response was observed on contrast-enhanced magnetic resonance image, with no enhancing lesion.
{"title":"Successful treatment of locally advanced small-cell carcinoma of the hypopharynx with radiotherapy and cetuximab combination: a case report","authors":"Yu-Hsuan Huang, Tung-hao Chang, Jhen-Bin Lin, Mucang Liu, C. Pi, Chia-chun Huang, L. Hung, T. Chou, P. Tseng","doi":"10.21037/TRO.2019.07.04","DOIUrl":"https://doi.org/10.21037/TRO.2019.07.04","url":null,"abstract":"As small-cell carcinoma rarely occurs in the hypopharynx, limited cases have been reported to date. Here we report the case of an 81-year-old male with locally advanced small-cell carcinoma originating from the pyriform sinus. Using imaging studies, the disease was staged as cT2N3bM0 based on the American Joint Committee on Cancer 8th edition, with an enhanced heterogeneous mass lesion (15 mm × 25 mm × 29 mm) in the right pyriform sinus and confluent lymphadenopathies along the right cervical chain (up to 79 mm), encasing and compressing the right common carotid artery and right internal jugular vein. Considering his tolerance issues for concurrent chemoradiation (CCRT), instead of selecting CCRT using the etoposide and cisplatin regimen, definitive radiotherapy (RT) combined with biotherapy with cetuximab was selected. After 7-month treatment, complete response was observed on contrast-enhanced magnetic resonance image, with no enhancing lesion.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49178760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chun-Chieh Wu, Y. Chou, Wei-Jia Yang, J. Hsu, H. Tseng, Yueh-Chun Lee
Diffuse-type tenosynovial giant cell tumor (D-TGCT) is a rare, benign tumor. It is locally aggressive and prone to recurrence. Extensive synovectomy followed by low dose irradiation is the common therapy. Recently, “tumor landscaping” has been demonstrated to be involved in the etiology of this disease. In addition, new drugs have been developed to block the associated pathway. Here, we present a refractory case of D-TGCT over left ankle who received marginal excision followed by adjuvant radiotherapy. Disease relapse occurred 9 years later and he received repeat operation and adjuvant radiotherapy. After 30 months of follow-up, no disease progression or distant metastasis was observed.
{"title":"Recurrent diffuse-type tenosynovial giant cell tumor of the left ankle: a case report","authors":"Chun-Chieh Wu, Y. Chou, Wei-Jia Yang, J. Hsu, H. Tseng, Yueh-Chun Lee","doi":"10.21037/TRO.2019.05.02","DOIUrl":"https://doi.org/10.21037/TRO.2019.05.02","url":null,"abstract":"Diffuse-type tenosynovial giant cell tumor (D-TGCT) is a rare, benign tumor. It is locally aggressive and prone to recurrence. Extensive synovectomy followed by low dose irradiation is the common therapy. Recently, “tumor landscaping” has been demonstrated to be involved in the etiology of this disease. In addition, new drugs have been developed to block the associated pathway. Here, we present a refractory case of D-TGCT over left ankle who received marginal excision followed by adjuvant radiotherapy. Disease relapse occurred 9 years later and he received repeat operation and adjuvant radiotherapy. After 30 months of follow-up, no disease progression or distant metastasis was observed.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/TRO.2019.05.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44076527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ankur Sharma, C. Simone, J. Remick, E. Kowalski, M. Mishra
Stereotactic body radiation therapy (SBRT) is regarded as a safe and effective treatment for early stage non-small cell lung cancer (NSCLC). However, the safety of SBRT has been questioned, specifically in the treatment of central tumors abutting critical organs at risk (OARs), when treating large or multiple tumors or when re-irradiating. Due to these concerns, radiation with stereotactic body proton therapy (SBPT) has emerged as a possible alternative due to its potential to decrease dose to OARs. The Particle Therapy Cooperative Group (PTCOG) recommends consideration of SBPT for large or multiple tumors, central tumors and those close to critical OARs. However, proton irradiation can be associated with significant uncertainty due to tumor motion, tissue heterogeneity, set up error, or changes in patient anatomy, as well as variations in distal range linear energy transfer values. In this review, we discuss clinical outcomes data from prospective and retrospective studies evaluating the benefits and risks of SBPT, methods to address uncertainties associated with PBT, and future directions for research.
{"title":"A proton primer to stereotactic lung radiotherapy","authors":"Ankur Sharma, C. Simone, J. Remick, E. Kowalski, M. Mishra","doi":"10.21037/TRO.2019.04.01","DOIUrl":"https://doi.org/10.21037/TRO.2019.04.01","url":null,"abstract":"Stereotactic body radiation therapy (SBRT) is regarded as a safe and effective treatment for early stage non-small cell lung cancer (NSCLC). However, the safety of SBRT has been questioned, specifically in the treatment of central tumors abutting critical organs at risk (OARs), when treating large or multiple tumors or when re-irradiating. Due to these concerns, radiation with stereotactic body proton therapy (SBPT) has emerged as a possible alternative due to its potential to decrease dose to OARs. The Particle Therapy Cooperative Group (PTCOG) recommends consideration of SBPT for large or multiple tumors, central tumors and those close to critical OARs. However, proton irradiation can be associated with significant uncertainty due to tumor motion, tissue heterogeneity, set up error, or changes in patient anatomy, as well as variations in distal range linear energy transfer values. In this review, we discuss clinical outcomes data from prospective and retrospective studies evaluating the benefits and risks of SBPT, methods to address uncertainties associated with PBT, and future directions for research.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/TRO.2019.04.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46097514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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