1,720,975 research outputs found
Reversibility of castration resistance status after Radium-223 dichloride treatment: clinical evidence and review of the literature
No full textIn the history of prostate cancer, some of patients progresses to castration resistant prostate cancer (CRPC) stage and, although new drugs and treatment protocols have been introduced, CRPC presents poor prognosis. This review focused on biological mechanisms, underlying CRPC described in scientific literature in order to explain the reversion of resistance to castration. We present the case of a 73 years-old man, affected by bone metastatic CRPC, early treated with Radium-223 with a complete response. After 15 months from Radium-223 treatment, PSA increased with radiological progression. ADT was again performed and was effective, despite previous CRPC condition and none known mechanisms that may explain the reversion of this condition. Therefore, to our knowledge, he is the unique described case of reversion of resistance to castration. Nevertheless, promising aspects may be lack of intrametastatic production of androgen or the suppression of bypass AR signaling pathways. Furthermore the cytotoxic action of Radium-223 on Cancer stem cell (CSC) , due to surrounding clones with high bone turnover, or the immune response that underlying the Abscopal effect, may also modulate the reversion of CRPC after Radium-223
Impact of induction chemotherapy in locally advanced HPV-negative oropharyngeal cancer. A propensity score-matched analysis
No full textAim: To estimate the clinical outcomes of
induction chemotherapy (IC) followed by standard
chemoradiotherapy (CRT) and CRT alone in patients with
locally advanced human papilloma virus (HPV)-negative
oropharyngeal squamous cell carcinoma. Patients and
Methods: Consecutive patients with histologically-proven
HPV-negative squamous cell carcinoma of the oropharynx
were included and treated with IC-CRT or CRT alone. In
order to compare treatment outcomes and toxicity between
groups, patients were matched by primary tumor site and
clinical disease stage. Overall survival (OS), disease-free
survival (DFS) and metastasis-free survival (MFS) curves
were calculated with the Kaplan–Meier method. Results: Nine
IC patients and 18 CRT patients were included. All patients
completed the programmed treatment. The median follow-up
was 38 months. There were no statistically significant
differences in OS and DFS between groups. The 5-year MFS
was 88.9% and 50.8% in the IC-CRT group, respectively.
There was no meaningful difference in toxicity between
patients. Conclusion: In HPV-negative patients with locally
advanced oropharyngeal cancer, adding IC to standard CRT
may increase the MFS rate. However no significant
differences in OS and DFS were observed. More studies are
needed to better elucidate the role of IC in this setting
Prognostic Significance of the Neutrophil/Lymphocyte Ratio in Patients with Non-Human Papilloma Virus-Related Oropharyngeal Cancer: A Retrospective Cohort Study
No full textPurpose: To investigate the effects of the pretreatment neutrophil-to-lymphocyte ratio (N/L) on non-human papilloma virus (HPV)-related oropharyngeal cancer. Materials and Methods: N/L was calculated by dividing the neutrophil count by the lymphocyte count. Survival outcomes were estimated using the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate analyses were performed to evaluate the prognostic impact of N/L and other clinical factors on survival outcomes. High/low N/L groups were defined as > 4.7 and ≤4.7, respectively. Results: Data of 57 consecutive patients with non-HPV-related oropharyngeal cancer were analyzed. The 3-year disease-free survival was 79 versus 36.9% in favor of the low N/L group (p = 0.04). The 5-year overall survival was 71.6 versus 53.3% in the low N/L and high N/L group, respectively (p = 0.07). Conclusion: N/L could play an important role in non-HPV-related oropharyngeal cancer progression and indicate prognosis
Target volume delineation based on diffusion-weighted magnetic resonance imaging for locally advanced head and neck cancer
No full textTo compare gross tumor volume (GTV) definition in locally advanced head and neck squamous cell carcinoma (LAHNSCC) using diffusion-weighted magnetic resonance imaging (DW-MRI) and computed tomography (CT) with intravenous contrast
Successful Treatment of Anal Canal Cancer Metastasis to the Cranial Bones: A Case Report and Literature Review
No full textSingle metastasis to the cranial bone represents a very uncommon occurrence that can arise from an anal canal cancer. No cases of cranial bone metastasis from anal canal carcinoma are available in the literature. Herein, we present a case of a unique metastatic lesion to the right parietal bone that occurred after curative chemoradiotherapy of primary squamous cell anal canal carcinoma. The patient received radiotherapy and systemic platinum-based chemotherapy, with optimal local control, high compliance and a well tolerable level of toxicity
Influence of organ invasion in clinical outcomes for locally advanced rectal cancer
No full textAIM: To evaluate whether patients with external sphincter invasion have a better prognosis than patients with invasion of other organs.
PATIENTS AND METHODS: Patients with cT4b adenocarcinoma of the rectum were treated with a tri-modality approach, including neo-adjuvant chemoradiotherapy (CRT), surgery and adjuvant chemotherapy. Patients with external sphincter invasion were classified as cT4b1, whereas patients with invasion of other organs as cT4b2. Survival curves were compared for cT4b sub-stage.
RESULTS: Between January 2008 and December 2014, a total of 21 consecutive patients with cT4b disease (14 with cT4b1 and seven with cT4b2) were treated with CRT, followed by surgery and adjuvant chemotherapy. In total, the overall survival rate at 5 years was 57.4%, whereas 5-year disease-free survival was 52%. The 5-year overall survival rates were 65.3% and 44.4% for patients with cT4b1 and cT4b2 disease, respectively.
CONCLUSION: External sphincter invasion seems to be associated with a better prognosis when compared to primary lesion with extension to other organs
Disease control, survival, and toxicity outcome after intensified neoadjuvant chemoradiotherapy for locally advanced rectal cancer: a single-institution experience
No full textDevelopment of distant metastasis remains high in locally advanced rectal cancer patients treated with a
trimodal approach. We intensified the neoadjuvant treatment regimen by adding oxaliplatin to the standard 5-
fluorouracil. Five-year follow-up data were encouraging, with excellent disease control rates and long-term
survival. An oxaliplatin-based combination in the neoadjuvant setting could be a valid treatment option.
Purpose: To report the long-term follow-up data and determine the toxicity rate concerning patients with locally
advanced rectal cancer (LARC) treated with an intensified neoadjuvant treatment regimen. Patients and Methods:
Patients with histologically proven stage II to III adenocarcinoma of the rectum were included and treated with a
trimodal approach. Intensified neoadjuvant treatment (chemoradiotherapy [CRT]) consisted of radiotherapy (total dose
50.4/54 Gy) and concomitant oxaliplatin (50 mg/m2
/week) and 5-fluorouracil (200 mg/m2
/5 daily continuous infusion).
Surgery was planned 7 to 9 weeks after the end of CRT. Adjuvant chemotherapy was recommended in those patients
with lymph node metastasis at diagnosis. Results: One hundred patients (median age, 64 years) were eligible. Overall,
the 5-year overall survival and disease-free survival (DFS) were 76.4% and 74.5%, respectively. CRT was well
tolerated, with only 17% grade 3/4 acute toxicity. Twenty-four patients (24%) had a pathologic complete response
(pCR), and only 1 patient had perioperative metastasis. The 5-year DFS were 95.7% and 66.7% for pCR and no-pCR
tumor histology, respectively (P 1⁄4 .0275). Conclusion: Although oxaliplatin is not considered to be a standard
treatment, the high 5-year rate of overall survival and DFS, the low severe toxicity rates, and the effective benefit on
pCR and perioperative metastasis support an intensified treatment regimen for LAR
Hypofractionated radiotherapy combined with cetuximab in vulnerable elderly patients with locally advanced head and neck squamous cell carcinoma
No full textThis study was designed to evaluate the objective response after hypofractionated radiotherapy (HFRT) combined with cetuximab (HFBRT) in vulnerable elderly patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Vulnerable elderly patients with histologically proven HNSCC received HFRT (total dose 60 Gy, 3 Gy/fraction) with concurrent cetuximab (250 mg/m2 with a loading dose of 400 mg/m2 1 week before HFRT). Elderly patients were categorized as vulnerable based on mini-cog test and adult comorbidity evaluation-27 score. All patients completed the programmed HFRT and two patients received the planned cetuximab infusion. Severe acute toxicity, observed in four patients, was gastrointestinal (oral mucositis in four cases; nausea/vomiting in one case) and dermatological (acneiform eruption in three cases; radiation dermatitis in one case). Three serious adverse events were recorded in three out of six patients Overall, three patients had a partial response and three patients had progression disease 3 months after the end of the treatment. No complete response was observed. HFBRT seems to be not a safer alternative approach for vulnerable elderly patients with locally advanced HNSCC. Further prospective trials are needed to define better tumor control with less incidence of toxic effects in vulnerable elderly HNSCC patients
Definitive weekly hypofractionated radiotherapy in cutaneous squamous cell carcinoma: response rates and outcomes in elderly patients unfit for surgery
Full text linkINTRODUCTION: The optimal definitive radiotherapy (RT) scheme in cutaneous squamous cell carcinoma (cSCC) remains controversial, especially in elderly patients. METHODS: Data of elderly patients with cSCC lesion(s) treated with weekly hypofractionated RT (8 Gy per week per 7‐8 weeks) were analyzed. RESULTS: Eighteen patients (median age 89 years) with 23 cSCC lesions have been identified including nine males (50%) and nine females (50%). The most common tumor localization was the head and neck region (n = 21; 91.3%), and the majority of lesions (n = 15; 65.2%) was stage ≥ III. At diagnosis, pain and bleeding were ascribed in 13 (56.5%) and eight (34.8%) cSCC, respectively. Compliance with weekly hypofractionated RT was excellent. The overall response rate at 12 weeks after treatment was 95.7%. Bleeding and pain relief were achieved in all cases. Severe toxicity was not recorded. The 1‐year overall survival was 66.0%. The 1‐year progression‐free survival was 58.7%. CONCLUSIONS: Weekly hypofractionated RT provides a safe, efficient, and cost‐effective treatment in elderly cSCC patients with minimal side effects
Successful role of adjuvant radiotherapy in a rare case of tracheal inflammatory myofibroblastic tumor: a case report
Full text linkBACKGROUND::
Inflammatory myofibroblastic tumor (IMT) is a rare benign cancer that can express a more aggressive phenotype related to the genetic mutation of the anaplastic lymphoma kinase receptor (ALK). Involvement of trachea is extremely rare and due to the clinical and radiologic nonspecificity, the definitive diagnosis is based on the histologic evaluation of tissue specimens. Total surgical excision is curative and chemotherapy or radiotherapy has been employed in the treatment of unresectable tumors or as adjuvant therapies.
CASE PRESENTATION::
The case described here is being reported because of the rare tracheal location and the atypical treatment approach used for an ALK-positive IMT. A 7-week pregnant woman voluntary interrupted pregnancy and underwent total surgical excision that resulted to have close margins. Although ALK-positive expression indicated the use of ALK inhibitors, she refused any type of adjuvant therapy that could affect ovarian function. Thus, 3D conformational external beam radiotherapy was performed with a daily dose of 180 cGy, 5 times per week, up to 45 Gy at the level of trachea. A total of 62 months of follow-up showed and no signs of disease recurrence or late radiation therapy-related toxicity.
CONCLUSIONS:
This report describes an extremely rare case of a tracheal IMT, underlying the key role of radiotherapy as adjuvant treatment able to definitively cure IMT, limiting systemic chemotherapy-related toxicity
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