Journal of cancer research and therapeutics最新文献

Purpose: Operating for partial nephrectomy in complex renal tumor is always challenging. A wide variation in vascular architecture, depth of tumor, relation with the collecting system, and hilar location make it further difficult to finish the procedure with minimum complications and negative surgical margin. Our aim in this study is to share the benefits of combined use of Indocyanine Green (ICG), intraoperative ultrasound (USG), and three-dimensional (3D) modeling of kidney in complex robotic-assisted partial nephrectomy (RAPN) and also demonstrate various methods of using ICG in renal tumors.

Materials and methods: This is a retrospective study done in our institute from January 2020 to July 2023; a total of 70 cases identified with renal tumor were operated for RAPN in hospital records. Intraoperative USG is a standard procedure in RAPN in our department combined with ICG in 23 complex renal tumor patients, and eight patients had 3D model printing. Various parameters and data are collected from the department record.

Results: 48 male patients and 22 females among the total 70 patients underwent RAPN during this period. The tumor size ranges from 2 to 8.5 cm, which has a mean of 4.52 ± 1.42 cm, in vivo USG alone (n = 37), USG combined with intraoperative ICG (n = 23), and USG combined with 3D model printing (n = 8). The mean warm ischemia time was 24.97 minutes, and the median blood loss and total operative time were 200 [interquartile range (IQR): 150-305] mL and 180 (IQR: 150-187) minutes, respectively.

Conclusion: Combined use of ICG, intraoperative USG, and 3D kidney modeling in RAPN can be highly valuable in complex renal tumors. As per our observation, it is a better strategy in achieving trifecta outcomes in these complex cases. However, in our small study, statistical significance from either of the modality alone is lacking.

Introduction: Surgery, stereotactic radiosurgery (SRS), whole brain radiotherapy (WBRT), or a combination of any of these are all local therapy options for brain metastasis. In this study, we report outcomes of patients with brain metastasis from breast cancer.

Materials and methods: This was a retrospective single-institution study. Records of patients with breast cancer registered in our department from 2016 to 2023 were evaluated. Patients with radiological or histopathological proof of brain metastasis who had received any form of cranial radiotherapy were included in the study. Various patient-related, disease-related, treatment-related, and dosimetric variables were recorded in this study. For the patients receiving WBRT, time dose and fractionation were recorded. Patients were stratified into WBRT group and SRS group for the purpose of survival analysis. Survival analysis was performed using Kaplan-Meir method, and survival between groups was compared using the log rank test.

Results: A total 98 patients were included for analysis in the study. The mean age of the study population was 46.42 years. All were female. Forty-four (45%) patients were Stage III at diagnosis, and 46 (47%) patients were metastatic at diagnosis. The median interval from diagnosis to brain metastasis was 18.1 months (IQR 9.5-34.4 months). Fourteen (14.3%) patients presented with brain metastasis at diagnosis. Sixty-eight (69.4%) patients had less than or equal to 5 lesions. Fourteen (14.3%) patients underwent surgery for brain metastasis. All patients received some form of cranial radiotherapy. Forty-seven (48%) patients received SRS, and 51 (52%) received WBRT. Twenty-nine (61.7%) patients received single-fraction SRS, whereas 18 (18.3%) received fractionated SRT. The 1-year event-free survival (EFS) was 41% in the WBRT group and 49% in the SRS group (P = 0.410). The 1-year overall survival (OS) was 49% in the SRS group and 54% in the SRS group (P = 0.293).

Conclusion: In this retrospective study, there was no significant difference in survival outcomes with SRS or WBRT in breast cancer patients with brain metastasis. There is a need for dedicated prospective randomized trials to determine the optimal treatment sequence in metastatic breast cancer with brain metastasis.

Abstract: Schwannoma is a benign mesenchymal tumor that arises from the Schwann cells. It can occur in both males and females with an equal incidence (M: F-1:1), with the most common age being the third to fourth decade. The tumors show a predilection for the head and neck region, flexural surfaces of extremities, posterior mediastinum, and retroperitoneum. However, the external female genitals are an extremely rare anatomical site for their occurrence. Herein, we outline one such rare case of a benign vulvar schwannoma on the labia minora in a 34-year-old woman. Most patients of vulvar schwannoma present with a characteristically painless mass, making clinical diagnosis difficult. Hematoxylin and Eosin staining of a conventional schwannoma reveals a characteristic pattern of Antoni type A and B areas along with Verocay bodies. On IHC, schwannomas characteristically stain positive for S-100, indicating the neural origin of the tumor. Surgical removal of the mass is the standard treatment of choice with an excellent prognosis.

Abstract: Primary ovarian rhabdomyosarcoma (RMS) is an extremely rare and aggressive malignancy, with limited reported cases and no standardized treatment protocol. We present the case of a 17-year-old female who initially presented with progressive abdominal distension and was diagnosed with ovarian RMS. Imaging revealed a large solid-cystic pelvic mass, and histopathological evaluation, along with immunohistochemical markers such as desmin, myogenin, and WT1, confirmed the diagnosis. The patient underwent surgical resection, but recurrence occurred within 3 months, necessitating further evaluation. Early relapse suggested the aggressive nature of the tumor, requiring chemotherapy with VAC (vincristine, actinomycin D, and cyclophosphamide). This case highlights the importance of early diagnosis, and the urgent need for standardized therapeutic approaches to improve patient outcomes in ovarian RMS.

Purpose: To determine the cause and effects of sparing normal brain using a distance driven normal tissue dose gradient function for static field intensity modulated stereotactic radiosurgery planning of single brain metastasis (SBM).

Materials and methods: Twenty seven SBM cases were planned for a dose of 20 Gy using 6 MV beams, to examine the cause and effects of dose gradients due to six NTO combinations formed from fall-off = 0.2, 0.6, and 1.0 mm-1, final-dose + priority = 10% +100 and 30% + 200. For comparative analysis, NTO combination of fall-off = 1.0 mm-1, final-dose + priority = 10% +100 was chosen as the control. Each combination was assessed for changes in field size (FS), high-to-low brain dose volumes (V14, V12, and V8), gradient index (GI), conformity index (CI), prescription isodose level (PIDL), and MU/Gy. Correlational analysis was performed to find meaningful relationships between FS, V12 and GI for all NTO combinations.

Results: Groups with fall-off ≥0.6 mm-1 plus priority = 200 showed considerable reductions for FS, V14, V12, V8, GI and PIDL (P < 0.0001). Substantial high-to-low brain dose volume decrease was observed because of increasing fluence conformity and consequent FS regression. CI was constant (±0.01), while GI improved significantly and PIDL decreased with associated MU/Gy increase, (P < 0.0001). Strong positive correlation between FS and V12 (r > 0.9) was observed meaning GI correlated inversely (r < -0.7).

Conclusion: NTO strictness causes fluence contraction that spares normal brain, yielding better dose metrics to attain balanced plan goals.

Background: The aim of this study was to report the acute toxicity, quality of life (QoL), and cosmesis in patients treated with moderate hypofractionated radiotherapy following breast-conserving surgery.

Materials and methods: This prospective cohort study included consecutive female breast cancer patients who underwent adjuvant moderate hypofractionated radiotherapy following breast-conserving surgery from April 2021 to October 2022. Acute toxicity was documented using the Radiation Therapy Oncology Group (RTOG) criteria and Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 (NCI). At baseline, 3 months, and 6 months, QoL was documented using the European Organization for the Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ). C30 and BR-23, and cosmesis was assessed using the Harvard Cosmesis Scale.

Results: Two hundred and eleven patients were included, among whom 149 (71%) were treated with three-dimensional conformal radiotherapy (3DCRT) and 62 (29%) with image-guided radiotherapy (IGRT). Twenty patients (9.5%) had Grade 2 skin reaction, and one patient (0.5%) had Grade 3 skin reaction. Skin toxicity was not significantly different between 3DCRT and IGRT (P = 0.20). At baseline, the worst QoL scores were sexual function, emotional function, upset by hair loss, and fatigue. All QoL scores improved at 3 and 6 months, except the mean breast symptom score, which slightly worsened at 3 months, then improved at 6 months. The mean Global Health Status Score at baseline was 69.87 ± 12.76 and improved to 85.89 ± 9.45 at 6 months (P < 0.001). Fourteen patients (6.6%) had a change in cosmesis to "fair" at 6 months.

Conclusion: Significant acute skin reactions are less after moderate hypofractionated breast radiotherapy, and cosmesis is good to excellent in the majority of patients. Overall QoL is not affected and is preserved after radiotherapy.

Abstract: The Radiation Oncology Department serves as a vital barometer for a cancer center's overall health. Its performance reflects the entire institution's efficacy, technological commitment, and collaborative spirit. Patient volume indicates referral efficiency and reputation, while investment in cutting-edge technology signals a commitment to excellence. As a hub for multidisciplinary collaboration and a model of operational efficiency, this department's function reveals the quality of care provided by the entire cancer center. To truly understand an oncology program, one must first look at its Radiation Oncology Department.