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Kwon J, Kim BH. Long-term toxicities after allogeneic hematopoietic stem cell transplantation with or without total body irradiation: a population-based study in Korea. Radiat Oncol J 2024; 42:50-62. [PMID: 38549384 PMCID: PMC10982063 DOI: 10.3857/roj.2023.00871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 04/04/2024] Open
Abstract
PURPOSE To compare long-term toxicity incidences, including secondary cancer (SC) with or without total body irradiation (TBI), in Asian patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) using a nationwide database. MATERIALS AND METHODS We identified 4,554 patients receiving HSCT for leukemic disease from 2009 to 2016 using the healthcare bigdata system of Korea. Incidence rate ratios (IRRs) for SC, cataracts, hypothyroidism, chronic kidney disease (CKD), myocardial infarction, or strokes were compared, and standardized incidence ratios (SIR) of SC was also estimated. RESULTS TBI was conducted on 1,409 patients (30.9%). No overall survival differences based on TBI were observed. With a median follow-up duration of 58.2 months, 143 patients were diagnosed with subsequent SC (3.4%). Incidence rates per 1,000 person-year were 6.56 (95% confidence interval [CI], 4.8-8.8) and 7.23 (95% CI, 5.9-8.8) in the TBI and no-TBI groups, respectively (p = 0.594). Also, the SIR (95% CI) was not significantly increased by TBI (1.32 [0.86-1.94] vs. 1.39 [1.08-1.77] in the no-TBI group). In the young age group (0-19 years), SIRs were increased in both groups regardless of TBI (8.60 vs. 11.96). The IRRs of cataracts (1.60; 95% CI, 1.3-2.0), CKD (1.85; 95% CI, 1.3-2.6), and hypothyroidism (1.50; 95% CI, 1.1-2.1) were significantly increased after TBI. However, there were no significant differences in the occurrence of myocardial infarction and stroke according to TBI. CONCLUSION Our results suggest that modern TBI may not additionally increase the risk of SC after allogeneic HSCT, although increased risks of other diseases were noted. Physicians should carefully consider individualized risks and benefits of TBI, with a particular focus by age group.
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Affiliation(s)
- Jeanny Kwon
- Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Byoung Hyuck Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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Maier FI, Schulz A, Furlan I, Felgentreff K, Jacobsen EM, Sirin M, Schwarz K, Pannicke U, Stursberg J, Debatin KM, Hönig M. Chemotherapy for a secondary malignancy nearly restores complete chimerism in an SCID-patient after HSCT. Clin Immunol 2024; 259:109891. [PMID: 38185266 DOI: 10.1016/j.clim.2024.109891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
For patients with inborn errors of immunity (IEI) and other inborn diseases, mixed donor chimerism is a well-accepted outcome of hematopoietic stem cell transplantation (HSCT). Cytoreductive chemotherapy for a secondary malignancy is a potential challenge for the stability of the graft function after HSCT. We report on a boy with X-SCID who developed Ewing sarcoma ten years after HSCT which was successfully treated with cytoreductive chemotherapy, surgery and local radiation. Surprisingly, this treatment had a positive impact on mixed chimerism with an increase of donor-cell proportions from 40% for neutrophils and 75% for non-T-mononuclear cells (MNCs) to >90% for both. T-cell counts remained stable with 100% of donor origin. This is -to our knowledge- the first report on the impact of cytoreductive chemotherapy on post-HSCT mixed chimerism and provides an important first impression for future patients.
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Affiliation(s)
- Felix I Maier
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstraße 24, 89075 Ulm, Germany.
| | - Ansgar Schulz
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstraße 24, 89075 Ulm, Germany
| | - Ingrid Furlan
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstraße 24, 89075 Ulm, Germany
| | - Kerstin Felgentreff
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstraße 24, 89075 Ulm, Germany
| | - Eva-Maria Jacobsen
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstraße 24, 89075 Ulm, Germany
| | - Mehtap Sirin
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstraße 24, 89075 Ulm, Germany
| | - Klaus Schwarz
- Institute for Transfusion Medicine, University of Ulm, Helmholtzstraße 10, 89081 Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Württemberg-Hessen, Helmholtzstraße 10, 89081 Ulm, Germany
| | - Ulrich Pannicke
- Institute for Transfusion Medicine, University of Ulm, Helmholtzstraße 10, 89081 Ulm, Germany
| | - Jana Stursberg
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstraße 24, 89075 Ulm, Germany
| | - Klaus-Michael Debatin
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstraße 24, 89075 Ulm, Germany
| | - Manfred Hönig
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Eythstraße 24, 89075 Ulm, Germany
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Park B, Lee E, Yoon J, Park Y, Eom HS. Secondary Malignancies in Multiple Myeloma in Korean Patients: A Nationwide Population-Based Study. Cancer Res Treat 2023:crt.2023.843. [PMID: 38147819 DOI: 10.4143/crt.2023.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose This study investigated the incidence of secondary malignancy in multiple myeloma (MM) patients compared with that in the general population using a population-based database covering all residents in Korea. Materials and Methods Based on the national health insurance system in Korea, all people primarily diagnosed with MM between January 1, 2010 to December 31, 2018 were identified. A total of 9,985 MM patients aged ≥20 years in Korea were included. Results Among them, 237 (2.4%) developed secondary malignancies by 2018. The standardized incidence rates (SIRs) of all secondary malignancies in MM patients were 0.87 (95% confidence interval [CI]=0.76-0.98), with a higher incidence of hematologic malignancies than in the general population with an SIR of 3.80 (95% CI=2.61-5.00). The incidence rates of both lymphoid malignancy (SIR=3.56; 95% CI=2.31-4.82) and myeloid malignancy (SIR=3.78; 95% CI=1.16-6.39) were higher in MM patients than in the general population. In contrast, a lower incidence of solid cancer was observed in MM patients than in the general population (SIR=0.76, 95% CI=0.65-0.86). There was no significant difference in survival in MM patients without secondary malignancies, with hematologic malignancy, and with solid cancer (p-value=0.413). Conclusion MM patients had a greater risk of secondary malignancies, especially hematologic malignancies, than the general population. Future studies with a focus on analyzing patients' history, treatment details, and genetic information in various stages of MM patients are needed to better understand the mechanism behind this increased risk.
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Affiliation(s)
- Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Korea
| | - Eunyoung Lee
- Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea
| | - Junghyun Yoon
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | | | - Hyeon-Seok Eom
- Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea
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Juarso AE, Entz S, Weissinger F. Durable response from fibroblast growth factor receptor inhibition in intrahepatic cholangiocarcinoma terminated by metachronous acute myeloid leukemia: a case report. J Med Case Rep 2023; 17:550. [PMID: 38098111 PMCID: PMC10722808 DOI: 10.1186/s13256-023-04231-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/28/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Advances in the treatment of biliary tract cancer have been made possible through gains in genomic and epigenetic tumor understanding. The use of fibroblast growth factor receptor inhibitor has enabled significant clinical improvement in a specific group of patients with intrahepatic cholangiocarcinoma, some of whom with very durable responses. CASE PRESENTATION We present the case of a 69-year-old Caucasian patient with advanced intrahepatic cholangiocarcinoma who received the therapy with selective oral inhibitor of fibroblast growth factor receptor 1, 2, and 3 pemigatinib after multiple previous chemotherapies. This resulted in a durable stable disease condition for 15 months with good tolerability. The diagnosis of acute myeloid leukemia was an unanticipated serious adverse event, in which the impact of fibroblast growth factor receptor inhibition could not yet be determined due to inadequate data. CONCLUSIONS It is still possible to achieve durable tumor response in advanced previously treated intrahepatic cholangiocarcinoma through targeted therapies. The prolonged progression free survival means that there could be an increased risk of secondary malignancy in this patient group, which necessitates diagnostic and therapeutic strategies.
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Affiliation(s)
- Andreas Edwin Juarso
- Department of Internal Medicine, Haematology/Oncology, Stem Cell Transplantation and Palliative Medicine, Evangelisches Klinikum Bethel, Schildescher Straße 99, 33611, Bielefeld, Germany
| | - Stefanie Entz
- Department of Internal Medicine and Gastroenterology, Evangelisches Klinikum Bethel, Schildescher Straße 99, 33611, Bielefeld, Germany
| | - Florian Weissinger
- Department of Internal Medicine, Haematology/Oncology, Stem Cell Transplantation and Palliative Medicine, Evangelisches Klinikum Bethel, Schildescher Straße 99, 33611, Bielefeld, Germany.
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Abalo KD, Smedby KE, Ekberg S, Eloranta S, Pahnke S, Albertsson-Lindblad A, Jerkeman M, Glimelius I. Secondary malignancies among mantle cell lymphoma patients. Eur J Cancer 2023; 195:113403. [PMID: 37952281 DOI: 10.1016/j.ejca.2023.113403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE With modern treatments, mantle cell lymphoma (MCL) patients more frequently experience long-lasting remission resulting in a growing population of long-term survivors. Follow-up care includes identification and management of treatment-related late-effects, such as secondary malignancies (SM). We conducted a population-based study to describe the burden of SM in MCL patients. METHODS All patients with a primary diagnosis of MCL, aged ≥ 18 years and diagnosed between 2000 and 2017 in Sweden were included along with up to 10 individually matched population comparators. Follow-up was from twelve months after diagnosis/matching until death, emigration, or December 2019, whichever occurred first. Rates of SM among patients and comparators were estimated using the Anderson-Gill method (accounting for repeated events) and presented as hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age at diagnosis, calendar year, sex, and the number of previous events. RESULTS Overall, 1 452 patients and 13 992 comparators were followed for 6.6 years on average. Among patients, 230 (16%) developed at least one SM, and 264 SM were observed. Relative to comparators, patients had a higher rate of SM, HRadj= 1.6 (95%CI:1.4-1.8), and higher rates were observed across all primary treatment groups: the Nordic-MCL2 protocol, R-CHOP, R-bendamustine, ibrutinib, lenalidomide, and R-CHOP/Cytarabine. Compared to Nordic-MCL2, treatment with R-bendamustine was independently associated with an increased risk of SM, HRadj= 2.0 (95%CI:1.3-3.2). Risk groups among patients were those with a higher age at diagnosis (p < 0.001), males (p = 0.006), and having a family history of lymphoma (p = 0.009). Patients had preferably higher risk of melanoma, other neoplasms of the skin and other hematopoietic and lymphoid malignancies. CONCLUSIONS MCL survivors have an increased risk of SM, particularly if treated with R-bendamustine. The intensive treatments needed for long-term remissions are a concern, and transition to treatment protocols with sustained efficacy but with a lower risk of SM is needed.
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Affiliation(s)
- Kossi D Abalo
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Sweden; Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
| | - Karin E Smedby
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Ekberg
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Simon Pahnke
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Sweden
| | - Alexandra Albertsson-Lindblad
- Division of Oncology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Mats Jerkeman
- Division of Oncology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Sweden; Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
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Araie H, Arai Y, Kida M, Aoki J, Uchida N, Doki N, Fukuda T, Tanaka M, Ozawa Y, Sawa M, Katayama Y, Matsuo Y, Onizuka M, Kanda Y, Kawakita T, Kanda J, Atsuta Y, Yanada M. Poor outcome of allogeneic transplantation for therapy-related acute myeloid leukemia induced by prior chemoradiotherapy. Ann Hematol 2023; 102:2879-2893. [PMID: 37477669 PMCID: PMC10492731 DOI: 10.1007/s00277-023-05356-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Abstract
Therapy-related acute myeloid leukemia (t-AML) is a therapeutic challenge as a late complication of chemotherapy (CHT) and/or radiotherapy (RT) for primary malignancy. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) presents itself as a curative approach. To establish the optimal allo-HSCT strategy for t-AML, we evaluated the relationship between characteristics of primary malignancy and allo-HSCT outcomes. Patients with t-AML or de novo acute myeloid leukemia (AML) who underwent first allo-HSCT in Japan from 2011 to 2018 were identified using a nationwide database. The detailed background of t-AML was obtained by additional questionnaires. Multivariate analysis and propensity score matching (PSM) analysis were performed to detect the prognostic factors associated with t-AML and compare outcomes with de novo AML. We analyzed 285 t-AML and 6761 de novo AML patients. In patients with t-AML, receiving both CHT and RT for primary malignancy was an independent poor-risk factor for relapse and overall survival (OS) (hazard ratio (HR) 1.62; p = 0.029 and HR 1.65; p = 0.009, reference: CHT alone group), whereas other primary malignancy-related factors had no effect on the outcome. Compared to the CHT alone group, complex karyotypes were significantly increased in the CHT + RT group (86.1% vs. 57.5%, p = 0.007). In the PSM cohort, t-AML patients with prior CHT and RT had significantly worse 3-year OS than those with de novo AML (25.2% and 42.7%; p = 0.009). Our results suggest that prior CHT and RT for primary malignancy may be associated with increased relapse and worse OS of allo-HSCT in t-AML.
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Affiliation(s)
- Hiroaki Araie
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Yasuyuki Arai
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Michiko Kida
- Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Jun Aoki
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations TORANOMON HOSPITAL, Tokyo, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Masatsugu Tanaka
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Aichi, Japan
| | - Yuta Katayama
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Yayoi Matsuo
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Makoto Onizuka
- Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Toshiro Kawakita
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masamitsu Yanada
- Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan
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Monda S, Pratsinis M, Lui H, Noel O, Chandrasekar T, Evans CP, Dall'Era MA. Secondary Bladder Cancer After Prostate Cancer Treatment: An Age-matched Comparison Between Radiation and Surgery. Eur Urol Focus 2023:S2405-4569(23)00199-2. [PMID: 37722954 DOI: 10.1016/j.euf.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/18/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Secondary malignancy is a long-term risk of radiation. External beam radiation therapy (EBRT) for prostate cancer treatment has been associated with later development of bladder cancer and worse bladder cancer features. OBJECTIVE We sought to provide an updated comparison of the long-term risk of bladder cancer after different localized prostate cancer treatments. DESIGN, SETTING, AND PARTICIPANTS Using the Surveillance, Epidemiology, and End Results (SEER) cancer registry, we compared an age-matched subset of patients who underwent radical prostatectomy (RP) with those who underwent EBRT, brachytherapy (BT), EBRT + BT, and RP followed by EBRT (RPtoEBRT) between 2000 and 2018. Our final cohort included 261 609 patients with a median follow-up of 11.6 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Our primary outcomes were time to bladder cancer diagnosis, muscle-invasive bladder cancer diagnosis, and bladder cancer death. We used cause-specific hazard models considering death as a competing event. A similar analysis was performed on lung cancer, as a surrogate marker for smoking. We also compared proportions of variant histology, high-grade, and invasive disease among bladder cancers that occurred after radiation versus RP using chi-square testing. RESULTS AND LIMITATIONS All radiation groups were associated with bladder cancer diagnosis; hazard ratios (HRs) were 1.72, 1.85, 1.80, and 1.53 for EBRT, BT, EBRT + BT, and RPtoEBRT, respectively, using RP as a referent (all p < 0.001). HRs for bladder cancer death were even higher: 2.39, 2.57, and 3.02 for EBRT, BT, and EBRT + BT, respectively (all p < 0.001), except for RPtoEBRT (HR 1.43, p = 0.28). Lung cancer diagnosis was also associated with radiation but at lower HRs-1.63, 1.32, 1.42, and 1.30 for EBRT, BT, EBRT + BT, and RPtoEBRT, respectively (all p < 0.001). There were a higher proportion of ≥T2, ≥T3, and sarcomatoid variant bladder cancers after radiation (all p < 0.01) CONCLUSIONS: The risk of developing and dying from bladder cancer is increased in patients treated with radiation compared with those treated with RP. The risk was similar for BT and EBRT. Bladder cancers after radiation are more likely to be sarcomatoid variant and present as muscle invasive. PATIENT SUMMARY We observed the rates of bladder cancer after patients had undergone surgery or radiation for prostate cancer, and found higher rates of bladder cancer after radiation. We also observed that bladder cancers that occur after radiation tend to be more aggressive.
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Affiliation(s)
- Steven Monda
- Department of Urologic Surgery, University of California Davis, Sacramento, CA, USA.
| | - Manolis Pratsinis
- Department of Urologic Surgery, University of California Davis, Sacramento, CA, USA; Department of Urology, St. Gallen Hospital, St. Gallen, Switzerland
| | - Hansen Lui
- Department of Urologic Surgery, University of California Davis, Sacramento, CA, USA
| | - Onika Noel
- Department of Urologic Surgery, University of California Davis, Sacramento, CA, USA; Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
| | | | - Christopher P Evans
- Department of Urologic Surgery, University of California Davis, Sacramento, CA, USA
| | - Marc A Dall'Era
- Department of Urologic Surgery, University of California Davis, Sacramento, CA, USA
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Hensley PJ, Duan Z, Bree K, Sood A, Zhao H, Lobo N, Contieri R, Campbell MT, Guo CC, Navai N, Williams SB, Dinney CP, Kamat AM. Competing mortality risk from second primary malignancy in bladder cancer patients following radical cystectomy: Implications for survivorship. Urol Oncol 2023; 41:108.e11-108.e17. [PMID: 36404232 DOI: 10.1016/j.urolonc.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/16/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Muscle-invasive bladder cancer (BC) often occurs in patients with competing mortality risks, while also being associated with the highest rate of second primary nonurothelial cancers (SNUC) of all solid malignancies. We investigated the incidence, risk factors, and timing of SNUC as a competing mortality risk factor in patients with BC who were treated with curative intent radical cystectomy (RC). METHODS We performed a retrospective cohort study assessing patients who underwent RC for cT2-4 N0M0 BC from January 1, 2005 to December 31, 2018 at a single, high volume tertiary care referral center. The Fine-Gray multivariable regression model was used to evaluate predictive factors for SNUC. Cumulative incidence of mortality (CIM) was estimated with modified Kaplan-Meier analysis. RESULTS The median follow-up time for the 693 patients who underwent RC was 3.7 years (interquartile range [IQR] 1.9-5.9 years). SNUC developed in 85 (12.3%) patients at a median 3.0 years post-RC (IQR 1.2-5.5 years). On multivariable analysis, the only significant predictor for developing SNUC was freedom from BC recurrence or metastasis (HR 1.54, 95% CI 1.12-1.76, P = 0.019). The most common SNUCs were primary lung cancer (24, 3.2% of cohort) and colon cancer (9, 1.3% of cohort). BC surveillance imaging diagnosed SNUC in 35/52 (67.3%) patients with solid-organ visceral primaries. The overall mortality rate for any SNUC was 38.8%, with the 3 most lethal cancer types being pancreatic, lung, and colon (62.5%, 54.2%, and 44.4% mortality, respectively). The incidence of SNUC uniformly increased postoperatively, with a cumulative incidence of 22.1% (95% CI, 16.8-27.9%) at 12-years post-RC. 163 patients (23.5%) died from BC, 33 patients (4.8%) died from SNUC, and 94 patients (13.6%) died from other causes. While the CIM for BC plateaued around 5-years post-RC at 24%, the incidence of other-cause mortality uniformly rose throughout the postoperative period. By post-RC year 9 there was no significant difference in CIM between BC (CIM 27.2%, 95% CI, 23.5-31.1%) and other-causes (CIM 20.0%, 95% CI, 15.8-24.6%). CONCLUSIONS The cumulative incidence of SNUC at 12-years post-RC was 22%, with the majority identified on BC surveillance imaging. While BC mortality plateaued around 5-years post-RC, mortality related to SNUC or other causes rose steadily in the postoperative period. These data have clinical significance with regards to patient counseling, survivorship and oncologic surveillance in the highly comorbid muscle-invasive BC population.
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Affiliation(s)
- Patrick J Hensley
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zhigang Duan
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelly Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hui Zhao
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Niyati Lobo
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roberto Contieri
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew T Campbell
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles C Guo
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Neema Navai
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen B Williams
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Colin P Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX.
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Nyeko R, Geriga F, Angom R, Kambugu JB. Oral-visceral iatrogenic Kaposi sarcoma following treatment for acute lymphoblastic leukemia: a case report and review of the literature. J Med Case Rep 2022; 16:405. [PMID: 36329498 PMCID: PMC9635084 DOI: 10.1186/s13256-022-03620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background There have hardly been any reported cases of children presenting with Kaposi sarcoma as a second malignancy following treatment for acute lymphoblastic leukemia outside a transplant setting. Case presentation We report a case of a 5-year-old boy of Bantu origin, which, to our knowledge, could be only the second reported case of oral–visceral Kaposi sarcoma after acute lymphoblastic leukemia treatment. The patient presented with a 1-month history of progressive, non-painful, soft tissue oral mass, 1 month after completing treatment for high-risk acute lymphoblastic leukemia. He was successfully treated for Kaposi sarcoma on a two-drug regimen (bleomycin and vincristine) with good clinical response. Conclusion Visceral Kaposi sarcoma as a second malignancy may occur after pediatric acute lymphoblastic leukemia treatment, but its rarity makes it unlikely to raise suspicion among clinicians, thus precluding early diagnosis and treatment. We recommend routine evaluation for Kaposi sarcoma lesions in children undergoing long-term surveillance following treatment for childhood acute leukemia. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-022-03620-3.
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Affiliation(s)
- Richard Nyeko
- grid.512320.70000 0004 6015 3252Department of Paediatric Oncology, Uganda Cancer Institute, P.O. Box 3935, Kampala, Uganda ,Department of Paediatrics and Child Health, Lira University, P.O. Box 1035, Lira, Uganda
| | - Fadhil Geriga
- grid.512320.70000 0004 6015 3252Department of Paediatric Oncology, Uganda Cancer Institute, P.O. Box 3935, Kampala, Uganda
| | - Racheal Angom
- grid.512320.70000 0004 6015 3252Department of Paediatric Oncology, Uganda Cancer Institute, P.O. Box 3935, Kampala, Uganda
| | - Joyce Balagadde Kambugu
- grid.512320.70000 0004 6015 3252Department of Paediatric Oncology, Uganda Cancer Institute, P.O. Box 3935, Kampala, Uganda
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10
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Toppila I, Kysenius K, Miettinen T, Lassenius MI, Lievonen J, Anttila P. Comorbidity characteristics of multiple myeloma patients diagnosed in Finland 2005-2016. Ann Hematol 2022; 101:2485-2495. [PMID: 36098791 PMCID: PMC9546994 DOI: 10.1007/s00277-022-04959-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/14/2022] [Indexed: 11/03/2022]
Abstract
Multiple myeloma (MM) patients are predominantly elderly with comorbidities that have an impact on patient mortality and treatment decisions. We previously reported the patient characteristics and overall survival outcomes of the Finnish MM cohort diagnosed between 2005 and 2016 in a nationwide retrospective registry study comprising 3,851 adults. Here, we report detailed comorbidity characteristics for this real-world Finnish MM population at cohort entry and during follow-up. Data on diagnoses and causes of death were obtained from Finnish healthcare data registries and interrogated using various multistate time-to-event models. In the year preceding MM diagnosis, comorbidities (as per Charlson Comorbidity Index definition) were recorded in 38.0% of the cohort, of which 27.9% presented with pre-existing cardiovascular disease (CVD) and 4.8% had suffered a major adverse cardiac event (MACE). At 2 years post-MM diagnosis, cumulative incidence for CVD and MACE more than doubled to 57.1% and 11.4%, respectively, and only 31.9% of the cohort remained CVD-free. Prevalent secondary malignancies were recorded in 16.8% of the patient population at MM diagnosis, with cumulative incidence increasing steadily to 27.5% at 2 years and 33% at 5 years post-diagnosis. The main cause of mortality attributed to MM, CVD, secondary malignancy, or other causes remained stable throughout the follow-up, at an average of 74.2%, 9.4%, 9.8%, and 6.5%, respectively. Prevalence of CVDs and secondary malignancies is high in Finnish patients at MM diagnosis, with older male patients suffering from higher MACE and mortality risk. Proper recording and management of comorbidities alongside novel treatments remain crucial for optimal MM management.
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Affiliation(s)
| | | | - Tatu Miettinen
- Medaffcon Oy, Espoo, Finland.,Takeda Oy, Helsinki, Finland
| | | | - Juha Lievonen
- Department of Hematology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pekka Anttila
- Department of Hematology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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11
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Doney K, Leisenring W, Linden H. Allogeneic hematopoietic cell transplantation in patients with a hematologic malignancy and a prior history of breast cancer. Breast Cancer Res Treat 2022; 194:507-516. [PMID: 35779160 DOI: 10.1007/s10549-022-06658-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/08/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To compare the outcome of allogeneic stem cell transplantation for myeloid malignancies in breast cancer survivors to a contemporaneous control group. METHODS Medical records of all patients with a history of breast cancer who received allogeneic stem cell transplants at a single, tertiary referral Comprehensive Cancer Center between 2002 and 2019 were reviewed. Transplant outcomes were compared to 289 control patients without a history of breast cancer from the same time period. Main outcomes included survival, disease-free survival, non-relapse mortality, relapse or progression of hematologic malignancy, and incidence of recurrent breast cancer after hematopoietic cell transplantation. Comparisons between women with a history of breast cancer and controls utilized propensity score weighting to balance patient characteristics. RESULTS Forty women, ages 30-74 years, with a history of breast cancer received an allogeneic hematopoietic cell transplant for a hematologic malignancy between December 2002 and February 2019. Twelve of the 40 patients are alive with a median survival of 7.4 years (range, 1.9-16.8 years). None of the patients had evidence of recurrent breast cancer prior to death or date of last contact. In multivariable Cox models, all transplant outcomes were similar between the patients and the control group with hematopoietic cell transplant comorbidity score as the most important confounding factor for adjustment in these models. CONCLUSION A history of treated breast cancer should not exclude patients from consideration for allogeneic hematopoietic cell transplantation.
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Affiliation(s)
- Kristine Doney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, D5-280, PO Box 19024, Seattle, WA, 98109-1024, USA. .,University of Washington Medical Center, Seattle, WA, USA.
| | - Wendy Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, D5-280, PO Box 19024, Seattle, WA, 98109-1024, USA.,University of Washington Medical Center, Seattle, WA, USA
| | - Hannah Linden
- University of Washington Medical Center, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
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12
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Sakaguchi H, Yoshida N. Recent advances in hematopoietic cell transplantation for inherited bone marrow failure syndromes. Int J Hematol 2022; 116:16-27. [PMID: 35633493 DOI: 10.1007/s12185-022-03362-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
Inherited bone marrow failure syndromes (IBMFSs) are a group of rare genetic disorders characterized by bone marrow failure with unique phenotypes and predisposition to cancer. Classical IBMFSs primarily include Fanconi anemia with impaired DNA damage repair, dyskeratosis congenita with telomere maintenance dysfunction, and Diamond-Blackfan anemia with aberrant ribosomal protein biosynthesis. Recently, comprehensive genetic analyses have been implemented for the definitive diagnosis of classic IBMFSs, and advances in molecular genetics have led to the identification of novel disorders such as AMeD and MIRAGE syndromes. Allogeneic hematopoietic cell transplantation (HCT), a promising option to overcome impaired hematopoiesis in patients with IBMFSs, does not correct nonhematological defects and may enhance the risk of secondary malignancies. Disease-specific management is necessary because IBMFSs differ in underlying defects and are associated with varying degrees of risk for clonal evolution and early or late complications after HCT. In addition, long-term follow-up is essential to detect complications related to the IBMFS or HCT. This review provides a summary of current clinical practices along with the latest data on HCT in IBMFSs.
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Affiliation(s)
- Hirotoshi Sakaguchi
- Department of Transplantation and Cellular Therapy, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Nao Yoshida
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Aichi Medical Center Nagoya First Hospital, Nagoya, Japan.
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13
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Tringale KR, Modlin LA, Sine K, Forlenza CJ, Cahlon O, Wolden SL. Vital organ sparing with proton therapy for pediatric Hodgkin lymphoma: Toxicity and outcomes in 50 patients. Radiother Oncol 2022; 168:46-52. [PMID: 35101461 PMCID: PMC9446376 DOI: 10.1016/j.radonc.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/03/2021] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE With high survival rates for pediatric Hodgkin lymphoma (HL), attention has turned to minimizing treatment-related morbidity and mortality. Chemotherapy and dose of radiation to organs at risk (OARs) contribute to elevated risks of secondary malignancy and cardiopulmonary disease. We sought to characterize the radiation dose to OARs, toxicities, and outcomes for pediatric HL patients treated with proton therapy (PT). MATERIALS AND METHODS Fifty patients aged 11-21 with HL consecutively treated with PT were evaluated 1-2 months following completion of PT and every 6 months thereafter. Acute and late toxicities were captured retrospectively using CTCAE v5. Patterns of relapse were characterized, and survival was assessed using Kaplan-Meier method. RESULTS Most (47, 94%) patients received PT to the mediastinum. Median mean heart dose was 4.3 Gy (RBE) and median bilateral lung V20Gy was 5.8%. Median integral dose was 1.7 Gy. For the 27 female patients, a median mean dose of 0.4 and 0.3 Gy (RBE) was delivered to ipsilateral and contralateral breast tissue, respectively. No on-treatment grade 3-5 toxicities were seen. At a median follow-up of 5.3 years, no PT-related grade 3-5 toxicities or secondary malignancies developed. Five patients relapsed at a median time of 9.2 months after PT (range 2.5-24.9 months; 5-year recurrence free survival 90%). Recurrences were both in- and out-of-field in all 5 cases with no marginal failures. All relapsed patients were successfully salvaged (5-year overall survival 100%). CONCLUSION For pediatric HL patients, proton treatment resulted in marked dose sparing of OARs with low rates of toxicity, no marginal failures, and excellent 5-year survival.
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Affiliation(s)
- Kathryn R. Tringale
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Leslie A. Modlin
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA,ProCure Proton Therapy Center, Somerset, NJ, USA
| | - Kevin Sine
- ProCure Proton Therapy Center, Somerset, NJ, USA
| | | | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA,ProCure Proton Therapy Center, Somerset, NJ, USA
| | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA,ProCure Proton Therapy Center, Somerset, NJ, USA
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14
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Acostamadiedo Marx AS, Avendaño-Capriles CA, Lemos JA, Gorman E, Acostamadiedo JM. Metastatic Breast Cancer Presenting as Pulmonary Nodules and Right Axillary Lymph Node in a Male with Chronic Lymphocytic Leukemia. Case Rep Oncol 2021; 14:1608-1615. [PMID: 34950004 PMCID: PMC8647123 DOI: 10.1159/000519744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022] Open
Abstract
To our knowledge, this is the first case reported in the English literature of simultaneous occult male metastatic breast cancer presenting as pulmonary nodules and right axillary lymph node metastasis in a chronic lymphocytic leukemia (CLL) patient and is the second case of simultaneous male breast cancer and CLL reported. The first case was reported by Dubashi et al. [Curr Oncol. 2011;18(2):e101–2] in 2011. This unique clinical and pathological entity presents various challenges in its management, including early detection, screening, and treatment.
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Affiliation(s)
- Ana S Acostamadiedo Marx
- Universidad Del Norte, Km.5 Vía Puerto Colombia, Barranquilla, Colombia.,Fundación Santa Fe de Bogotá, Hospital Universitario, Bogotá D.C, Colombia
| | | | - Julio A Lemos
- FitzPatrick Cancer Center, Champlain Valley Physicians Hospital, University of Vermont Health Network, Plattsburgh, New York, USA
| | - Eric Gorman
- FitzPatrick Cancer Center, Champlain Valley Physicians Hospital, University of Vermont Health Network, Plattsburgh, New York, USA
| | - Jose M Acostamadiedo
- FitzPatrick Cancer Center, Champlain Valley Physicians Hospital, University of Vermont Health Network, Plattsburgh, New York, USA
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15
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Yanagisawa K, Horiuchi T, Matsuo A, Kuraishi H, Satomi H, Ito I, Noguchi T, Sekiguchi N, Kanda S, Koizumi T. Serial Cancer Development Three Times in a Patient with Fanconi Anemia. Case Rep Oncol 2021; 14:1168-1174. [PMID: 34703432 PMCID: PMC8460962 DOI: 10.1159/000518076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/15/2021] [Indexed: 11/21/2022] Open
Abstract
Fanconi anemia (FA) is characterized clinically by bone marrow failure, congenital malformations, sensitivity to DNA cross-linking agents, and increased risk of malignancy. Hematological cancer is the best-described malignancy in patients with FA, but the susceptibility to the development of solid tumors is also well documented, especially after hematopoietic stem cell transplantation (HSCT). With regard to the development of solid tumors in patients with FA, head and neck, esophageal, and anal squamous cell carcinoma are well known, but reports of lung cancer are extremely rare. Here, we describe an FA patient with a history of HSCT that developed 3 serial cancers − oral, esophageal, and nonsmall cell lung cancer − over a period of 6 years. The third lesion was nonsmall cell lung cancer and its location corresponded closely to the field of irradiation treatment for prior esophageal cancer. The occurrence of lung cancer in patients with FA is uncommon, but FA patients should be screened regularly and serially. Our case also indicated the importance of the irradiated field as a location for subsequent cancer development.
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Affiliation(s)
- Katsuya Yanagisawa
- Department of Pulmonary Medicine, Minami Nagano Iryou Center, Shinonoi Hospital, Nagano, Japan
| | - Toshimichi Horiuchi
- Department of Pulmonary Medicine, Minami Nagano Iryou Center, Shinonoi Hospital, Nagano, Japan
| | - Akemi Matsuo
- Department of Pulmonary Medicine, Minami Nagano Iryou Center, Shinonoi Hospital, Nagano, Japan
| | - Hiroshi Kuraishi
- Department of Pulmonary Medicine, Nagano Red Cross Hospital, Nagano, Japan
| | - Hidetoshi Satomi
- Department of Pathology, Nagano Red Cross Hospital, Nagano, Japan
| | - Ichiro Ito
- Department of Pathology, Nagano Red Cross Hospital, Nagano, Japan
| | - Takuro Noguchi
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Nodoka Sekiguchi
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shintaro Kanda
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tomonobu Koizumi
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
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16
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Sekhri R, Sadjadian P, Becker T, Kolatzki V, Huenerbein K, Meixner R, Marchi H, Wallmann R, Fuchs C, Griesshammer M, Wille K. Ruxolitinib-treated polycythemia vera patients and their risk of secondary malignancies. Ann Hematol 2021; 100:2707-16. [PMID: 34462786 DOI: 10.1007/s00277-021-04647-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/16/2021] [Indexed: 01/25/2023]
Abstract
Recently, there has been increased concern about a risk of secondary malignancies (SM) occurring in myelofibrosis (MF) patients receiving ruxolitinib (RUX). In polycythemia vera (PV), on the other hand, only limited data on the risk of SM under RUX treatment are available. To investigate the association between RUX therapy in PV and SM, we conducted a retrospective, single-center study that included 289 PV patients. RUX was administered to 32.9% (95/289) of patients for a median treatment duration of 48.0 months (range 1.0–101.6). Within a median follow-up of 97 months (1.0–395.0) after PV diagnosis, 24 SM occurred. Comparing the number of PV patients with RUX-associated SM (n = 10, 41.7%) with the 14 (58.3%) patients who developed SM without RUX, no significant difference (p = 0.34, chi square test) was found. No increased incidences of melanoma, lymphoma, or solid “non-skin” malignancies were observed with RUX (p = 0.31, p = 0.60, and p = 0.63, respectively, chi square test). However, significantly more NMSC occurred in association with RUX treatment (p = 0.03, chi-squared test). The “SM-free survival” was not significantly different by log rank test for all 289 patients (p = 0.65), for the patients (n = 208; 72%) receiving cytoreductive therapy (p = 0.48) or for different therapy sequences (p = 0.074). In multivariate analysis, advanced age at PV diagnosis (HR 1.062 [95% CI 1.028, 1.098]) but not administration of RUX (HR 1.068 [95% CI 0.468, 2.463]) was associated with an increased risk for SM (p = 0.005). According to this retrospective analysis, no increased risk of SM due to RUX treatment could be substantiated for PV.
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17
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Fujiwara Y, Ohmoto A, Fukuda N, Wang X, Urasaki T, Hayashi N, Sato Y, Nakano K, Yunokawa M, Ono M, Tomomatsu J, Yuasa T, Yonese J, Takahashi S. Clinical features and outcomes of metastatic pheochromocytoma treated by cytotoxic chemotherapy. Endocr J 2021; 68:671-681. [PMID: 33518616 DOI: 10.1507/endocrj.ej20-0762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cytotoxic chemotherapy, including cyclophosphamide, vincristine, and dacarbazine (CVD) therapy, is widely used to treat metastatic pheochromocytoma and paraganglioma. Because these diseases are rare, studies are needed to establish treatment strategies. This was a single-center and retrospective study to analyze the efficacy of chemotherapy for patients with metastatic pheochromocytoma and paraganglioma diagnosed in 1983-2020. Clinical characteristics, tumor volume response, biochemical response based on catecholamine level, overall survival, and progression-free survival were evaluated. Patients with a complete response or partial response in tumor volume or catecholamine level were classified as responders. Sixteen patients were administered chemotherapy for a median of 16.5 cycles (interquartile range, 10-42). The tumor volume response was classified as follows: partial response (N = 4), stable disease (N = 9), and progressive disease (N = 3) (disease control rate = 81%). The biochemical responses were as follows: complete response (N = 2), partial response (N = 5), no change (N = 3), and progressive disease (N = 1) (disease control rate = 91%). The 5-year survival rate was 50% (95% confidence interval [CI], 21-74%) and median overall survival was 4.4 years (95% CI, 2.4 years-not reached). Overall survival and progression-free survival between responders and nonresponders were not statistically different. One patient developed myelodysplastic syndrome during CVD therapy. In conclusion, chemotherapy achieved disease control among more than half of patients, although survival did not differ between responders and nonresponders. Further fundamental research and prospective trials are needed to analyze the efficacy of CVD therapy.
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Affiliation(s)
- Yu Fujiwara
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, 281 1st Avenue, New York, NY 10003, USA
| | - Akihiro Ohmoto
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Naoki Fukuda
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Xiaofei Wang
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Tetsuya Urasaki
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Naomi Hayashi
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Yasuyoshi Sato
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Kenji Nakano
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Mayu Yunokawa
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Makiko Ono
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Junichi Tomomatsu
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Takeshi Yuasa
- Department of Genitourinary Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Junji Yonese
- Department of Genitourinary Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
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18
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Dee EC, Muralidhar V, King MT, Martin NE, D'Amico AV, Mouw KW, Orio PF, Nguyen PL, Leeman JE. Second malignancy probabilities in prostate cancer patients treated with SBRT and other contemporary radiation techniques. Radiother Oncol 2021; 161:241-250. [PMID: 34171451 DOI: 10.1016/j.radonc.2021.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prostate radiotherapy has been associated with an increased risk of developing a second malignancy (SM). However, relative SM probabilities following treatment with contemporary radiation techniques such as stereotactic body radiotherapy (SBRT) or moderately hypofractionated intensity modulated radiotherapy (HF-IMRT) remain unknown. METHODS A cohort analysis was performed of men from a nationally representative database with localized prostate cancer with at least 60 months of follow-up comparing SM probability amongst men receiving either radical prostatectomy (RP), conventionally fractionated intensity-modulated radiotherapy (CF-IMRT), HF-IMRT, brachytherapy (BT), or SBRT, using multivariable logistic models, which were used to generate predicted probabilities. Additionally, propensity score-adjusted pairwise assessments of modalities were performed. RESULTS For 303,432 patients included in the study, median follow-up was 9.08 years (IQR 7.01-11.21). Predicted rates of SM by treatment modality and adjusted odds ratios (AOR) for development of SM (referent: RP) were: 6.0% for RP (AOR n/a), 7.1% for CF-IMRT (AOR 1.20, 95%CI 1.14-1.25, P < 0.001), 7.3% for HF-IMRT (AOR 1.25, 95%CI 1.01-1.55, P = 0.045), 6.6% for BT (AOR 1.11, 95%CI 1.07-1.16, P < 0.001), and 5.7% for SBRT (AOR 0.95, 95%CI 0.81-1.12, P = 0.567). On propensity score-adjusted analysis, SBRT was associated with lower odds of SM compared to CF-IMRT (AOR 0.78, 95%CI 0.66-0.93, P = 0.005); no significant difference was found when SBRT was compared to RP (AOR 0.86, 95%CI 0.73-1.03, P = 0.102). CONCLUSIONS Conventionally fractionated intensity-modulated radiotherapy, moderately hypofractionated intensity-modulated radiotherapy, and brachytherapy but not stereotactic body radiotherapy were associated with increased probability of a second malignancy compared to radical prostatectomy. Patients treated with SBRT may be at lower risk of second malignancy due to improved conformality, radiobiological differences or patient selection. The possibility that SBRT in select patients may minimize the probability of SM underscores the need for assessment of second malignancy risk in prospective studies of SBRT.
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Affiliation(s)
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Martin T King
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Neil E Martin
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Anthony V D'Amico
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Kent W Mouw
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Peter F Orio
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Jonathan E Leeman
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, United States.
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19
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Casper AC, Parsons MW, Chipman J, Burt LM, Suneja G, Maurer KA, Gaffney DK. Risk of secondary malignancies in ovarian cancer survivors: 52,680 patients analyzed with over 40 years of follow-up. Gynecol Oncol 2021; 162:454-460. [PMID: 34092413 DOI: 10.1016/j.ygyno.2021.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Survivors of ovarian cancer are at risk of developing a secondary malignancy (SM). We sought to evaluate the risk of developing SM, stratified by treatment modality. METHODS Standardized incidence ratios (SIR, observed-to-expected [O/E] ratio) were assessed in 52,680 patients diagnosed with ovarian cancer between 1975 and 2016 in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. RESULTS Of the 52,680 patients, 3366 patients (6.4%) developed SM, which was more than the endemic rate (O/E 1.13; p < .05). Patients who received any radiation (RT) had an increased risk of overall SM compared to those who didn't (O/E 1.42 vs 1.11; p < .05), and specifically, in the bladder (O/E 2.81). Patients who received any chemotherapy (CT) had an increased risk of leukemia (O/E 3.06), and a similar risk of overall SM compared to those not treated with CT (O/E 1.11 vs 1.14; p < .05). The excess risk of developing a solid tumor SM was greatest at latencies of 10-20 years. Patients younger than 50 had the highest risk of developing SM. Non-White patients had a higher risk of SM compared to White patients. CONCLUSIONS This is the largest study to examine the risk of SM in patients with ovarian cancer and has the longest follow-up. Risk of SM was increased after ovarian cancer and varied with treatment modality, race, latency, and age. These results may help inform SM screening protocols for women diagnosed with ovarian cancer.
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Affiliation(s)
- Anthony C Casper
- Rocky Vista University College of Osteopathic Medicine, 255 E Center St, Ivins, UT 84738, USA; Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
| | - Matthew W Parsons
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
| | - Jonathan Chipman
- University of Utah, Huntsman Cancer Institute, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
| | - Lindsay M Burt
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
| | - Gita Suneja
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
| | - Kathryn A Maurer
- University of Utah, Huntsman Cancer Institute, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 2000 Circle of Hope Drive #1950, Salt Lake City, UT 84112, USA.
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20
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Ino A, Sakanaka K, Inoo H, Ishida Y, Kanda J, Mizowaki T. Definitive radiotherapy for secondary esophageal cancer after allogeneic hematopoietic stem cell transplantation. Int Cancer Conf J 2021; 10:201-206. [PMID: 34221832 DOI: 10.1007/s13691-021-00479-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/13/2021] [Indexed: 01/30/2023] Open
Abstract
The reports for secondary esophageal cancer treated by radiotherapy or chemoradiotherapy is few, however they potentially yield a cure for esophageal cancer. We report a case of definitive radiotherapy for a patient with secondary locally advanced unresectable esophageal cancer after hematopoietic stem cell transplantation for acute myeloid leukemia. Definitive radiotherapy for the current patient was completed with acceptable toxicity despite the poor general condition with long-term chronic graft-versus-host disease. Radiotherapy may be the definitive treatment for this population unfit for concurrent chemotherapy or surgery.
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Affiliation(s)
- Aki Ino
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Katsuyuki Sakanaka
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Hiroyuki Inoo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Yuichi Ishida
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
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21
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Maller B, Simmons VN, Byrne MM, Tanvetyanon T. Characteristics and Outcomes of Lung Cancer Screening Among Individuals With or Without Cancer History. Clin Lung Cancer 2020; 22:e629-e636. [PMID: 33441268 DOI: 10.1016/j.cllc.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/29/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lung cancer screening with low-dose computed tomography (LDCT) can reduce mortality from lung cancer. Individuals with previous malignancy are at an increased risk of lung cancer but are often underrepresented in clinical trials. This study compares the outcomes of LDCT screening among individuals with and without cancer history. MATERIALS AND METHODS The study cohort included consecutive participants undergoing LDCT screening at a tertiary care cancer institution. Abnormal screening result was defined as having Lung-RADS 3 or 4 at baseline (T0). Participant information was prospectively collected and predicted risk of lung cancer was calculated per the PLCOm2012 model. RESULTS A total of 454 participants underwent LDCT screening. Abnormal screening result occurred in 57 (13.2%) participants at T0, and lung cancer was diagnosed in 11 (2.4%) participants. Among 153 individuals with cancer history, abnormal result occurred in 9.8%, compared with 15.4% among those without cancer history (P = .11). Lung cancer was diagnosed in 1.3%, compared with 3.5% (P = .22). The predicted risk of lung cancer at 6 years was higher among individuals with cancer history than those without: 4.8% versus 2.2% (P < .001). In a multivariable analysis, cancer history significantly reduced the likelihood of abnormal screening (odds ratio, 0.49; 95% confidence interval, 0.26-0.94; P = .03). We observed a higher proportion of participants who had a previous CT scan available for comparison at T0 among individuals with cancer history than those without: 43.1% versus 9.1% (P < .001). CONCLUSIONS In this single-institutional study, individuals with cancer history were significantly less likely to have abnormal screening results than those without cancer history.
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Affiliation(s)
- Bradley Maller
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Vani N Simmons
- Tobacco Research and Intervention Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Margaret M Byrne
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Tawee Tanvetyanon
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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22
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Rose A, Grajales-Cruz A, Lim A, Todd A, Bello C, Shah B, Chavez J, Pinilla-Ibartz J, Saeed H, Sandoval-Sus J, Isenalumhe L, Sokol L. Classical Hodgkin Lymphoma: Clinicopathologic Features, Prognostic Factors, and Outcomes From a 28-Year Single Institutional Experience. Clin Lymphoma Myeloma Leuk 2021; 21:132-8. [PMID: 32950461 DOI: 10.1016/j.clml.2020.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Classical Hodgkin lymphoma (cHL) is a curable malignancy, with a complete remission rate of approximately 90%. However, relapse remains a significant cause of mortality. Prognostic factors are useful in guiding therapy. This is a large, single-institution study defining the clinicopathologic features, prognostic factors, and treatment outcomes of patients with cHL. PATIENTS AND METHODS We reviewed 727 patients with cHL treated at H. Lee Moffitt Cancer Center and Research Institute from 1990 to 2017. Data on demographics, laboratory studies, and disease statuses were collected from the institutional database and electronic medical records. Statistical analyses, overall survival (OS), progression-free survival (PFS), and multivariate analyses were performed. RESULTS The median age was 35 years. Fifty-four percent of patients were men; 45.6% had advanced stage disease; 82% were treated with ABVD (doxorubicin hydrochloride [adriamycin], bleomycin sulfate, vincristine, and dacarbazine) as frontline therapy; and 70% achieved complete response. The median PFS after first-line treatment was 16.8 years. The median OS of patients with early stage and advanced stage cHL was 19 and 12.9 years, respectively. Poor prognostic factors for OS included older age, advanced stage disease, presence of B symptoms, and a higher International Prognostic Score. CONCLUSION Despite high cure rates, cHL accounted for the cause of death in 47% of patients who died during follow-up. Prognostic factors, such as age, stage at diagnosis, International Prognostic Score, and B symptoms, are helpful to guide treatment. Outcomes observed in this study are comparable with those reported in previously published studies.
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23
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Hamza A, Hwang MJ, Czerniak BA, Guo CC. Secondary tumors of the bladder: A survival outcome study. Ann Diagn Pathol 2020; 48:151593. [PMID: 32836180 DOI: 10.1016/j.anndiagpath.2020.151593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/20/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
Abstract
The urinary bladder may be involved by a variety of secondary tumors that originate from other organs. Bladder secondary tumors are rare and may be mistaken as bladder primary tumors because of their overlapping morphologic features. To avoid the diagnostic pitfalls, we analyzed the clinicopathologic features of bladder secondary tumors in a large cohort of patients. Our patient cohort consisted of 45 females and 38 males with a mean age of 58.7 ± 15.4 years (range 10-87 years). The tumors involved the bladder via direct extension from adjacent organs (n = 42) and distant metastasis (n = 41). In females, the majority of secondary tumors originated from the gynecologic tract (n = 25), and other common origins included the colon/rectum (n = 5) and breast (n = 4). In males, the most common origin was the prostate (n = 18), followed by the colon/rectum (n = 4) and kidney (n = 3). 75.9% of the secondary tumors were adenocarcinoma (n = 63), and other common tumor types included sarcoma (n = 6), squamous cell carcinoma (n = 5), melanoma (n = 4), and neuroendocrine carcinoma (n = 3). 67.5% of patients (n = 56) died of the disease with a median overall survival of 23 months from the time of secondary involvement of the bladder. Patients with secondary tumors via direct extension had a median survival time of 20 months, which was not significantly different from that for patients with secondary involvement via distant metastasis (24 months) (p = 0.83). Median survival in cases with prostate primary was 20 months as compared to 23 months for all other tumor types (p = 0.68). The majority of secondary tumors are composed of adenocarcinoma, which highlights the importance of differentiating primary from secondary involvement in bladder adenocarcinoma. Regardless of the origin, bladder secondary tumors are associated with a poor prognosis.
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Affiliation(s)
- Ameer Hamza
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
| | - Michael J Hwang
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Charles C Guo
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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24
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Ghasemi-Jangjoo A, Ghiasi H. Monte Carlo study on the secondary cancer risk estimations for patients undergoing prostate radiotherapy: A humanoid phantom study. Rep Pract Oncol Radiother 2020; 25:187-192. [PMID: 32021575 PMCID: PMC6994283 DOI: 10.1016/j.rpor.2019.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/04/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022] Open
Abstract
AIM The aim of this study was to estimate the secondary malignancy risk from the radiation in FFB prostate linac-based radiotherapy for different organs of the patient. BACKGROUND Radiation therapy is one of the main procedures of cancer treatment. However, the application the radiation may impose dose to organs of the patient which can be the cause of some malignancies. MATERIALS AND METHODS Monte Carlo (MC) simulation was used to calculate radiation doses to patient organs in 18 MV linear accelerator (linac) based radiotherapy. A humanoid MC phantom was used to calculate the equivalent dose s for different organs and probability of secondary cancer, fatal and nonfatal risk, and other risks and parameters related to megavoltage radiation therapy. In out-of-field radiation calculation, it could be seen that neutrons imparted a higher dose to distant organs, and the dose to surrounding organs was mainly due to absorbed scattered photons and electron contamination. RESULTS Our results showed that the bladder and skin with 54.89 × 10-3 mSv/Gy and 46.09 × 10-3 mSv/Gy, respectively, absorbed the highest equivalent dose s from photoneutrons, while a lower dose was absorbed by the lung at 3.42 × 10-3 mSv/Gy. The large intestine and bladder absorbed 55.00 × 10-3 mSv/Gy and 49.08 × 10-3, respectively, which were the highest equivalent dose s due to photons. The brain absorbed the lowest out-of-field dose, at 1.87 × 10-3 mSv/Gy. CONCLUSIONS We concluded that secondary neutron portion was higher than other radiation. Then, we recommended more attention to neutrons in the radiation protection in linac based high energy radiotherapy.
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Affiliation(s)
- Amir Ghasemi-Jangjoo
- Medical Radiation Sciences Research Team, Imam Hospital, Tabriz University of Medical Sciences, Imam Hospital, Tabriz, Iran
- Department of Radiology and Radiotherapy, Medicine School, Tabriz University of Medical Sciences, Imam Hospital, Tabriz, Iran
| | - Hosein Ghiasi
- Medical Radiation Sciences Research Team, Imam Hospital, Tabriz University of Medical Sciences, Imam Hospital, Tabriz, Iran
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25
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Zhang YY, Xue S, Wang ZM, Jin MS, Chen ZP, Chen G, Zhang Q. Thyroid metastasis from breast cancer presenting with enlarged lateral cervical lymph nodes: A case report. World J Clin Cases 2020; 8:838-847. [PMID: 32149069 PMCID: PMC7052554 DOI: 10.12998/wjcc.v8.i4.838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/01/2020] [Accepted: 01/11/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Secondary malignancy of the thyroid occurs infrequently and mainly originates from malignant tumors of the kidney, gastrointestinal tract, lungs, breast, and skin. The correct diagnosis is important but difficult. Importantly, there are major differences in the treatment of primary and metastatic thyroid cancer, which has a significant impact on prognosis and survival. Therefore, how to diagnose thyroid metastasis (TM) correctly before surgery is a major concern for surgeons.
CASE SUMMARY We report a 38-year-old woman who presented with palpable cervical lymph nodes after breast cancer (BC) surgery 2 years ago. Ultrasonography and computed tomography revealed thyroid nodules with irregular margins and enlarged cervical lymph nodes. Biopsy was performed for the right largest cervical lymph node, and immunohistochemical analysis revealed negativity for thyroglobulin, estrogen receptor, and progestin receptor and positive for human epidermal growth factor receptor 2. The diagnosis was TM from BC with cervical lymph node metastasis. Total thyroidectomy with bilateral central and lateral neck lymph node dissection was performed. After a 5-mo follow-up, no recurrence or novel distant metastasis was identified.
CONCLUSION TM from BC is a rare secondary malignancy. Broad differential diagnosis by biopsy and immunohistochemical analysis needs to be considered.
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Affiliation(s)
- Yan-Yan Zhang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Shuai Xue
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zheng-Min Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Mei-Shan Jin
- Department of Pathology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zhong-Ping Chen
- Department of Radiology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Guang Chen
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Qiang Zhang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Abstract
Approximately half of all cancer patients receive radiation therapy as part of their oncologic treatment. Radiation-associated sarcomas occur in fewer than 1% of patients who receive radiation therapy but account for up to 5% of all sarcomas. As the use of radiation has increased in the past few decades and overall oncologic outcomes are improving, the incidence of radiation-associated sarcomas is also expected to increase. Historically, radiation-associated sarcomas have been associated with poor outcomes but recent data suggest the prognosis is improving. Distinguishing the sarcoma from the primary malignancy is a major diagnostic criterion.
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Affiliation(s)
- Jeffrey K Mito
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Devarati Mitra
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Leona A Doyle
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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27
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López GY, Van Ziffle J, Onodera C, Grenert JP, Yeh I, Bastian BC, Clarke J, Oberheim Bush NA, Taylor J, Chang S, Butowski N, Banerjee A, Mueller S, Kline C, Torkildson J, Samuel D, Siongco A, Raffel C, Gupta N, Kunwar S, Mummaneni P, Aghi M, Theodosopoulos P, Berger M, Phillips JJ, Pekmezci M, Tihan T, Bollen AW, Perry A, Solomon DA. The genetic landscape of gliomas arising after therapeutic radiation. Acta Neuropathol 2019; 137:139-150. [PMID: 30196423 DOI: 10.1007/s00401-018-1906-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/31/2018] [Accepted: 09/01/2018] [Indexed: 11/26/2022]
Abstract
Radiotherapy improves survival for common childhood cancers such as medulloblastoma, leukemia, and germ cell tumors. Unfortunately, long-term survivors suffer sequelae that can include secondary neoplasia. Gliomas are common secondary neoplasms after cranial or craniospinal radiation, most often manifesting as high-grade astrocytomas with poor clinical outcomes. Here, we performed genetic profiling on a cohort of 12 gliomas arising after therapeutic radiation to determine their molecular pathogenesis and assess for differences in genomic signature compared to their spontaneous counterparts. We identified a high frequency of TP53 mutations, CDK4 amplification or CDKN2A homozygous deletion, and amplifications or rearrangements involving receptor tyrosine kinase and Ras-Raf-MAP kinase pathway genes including PDGFRA, MET, BRAF, and RRAS2. Notably, all tumors lacked alterations in IDH1, IDH2, H3F3A, HIST1H3B, HIST1H3C, TERT (including promoter region), and PTEN, which genetically define the major subtypes of diffuse gliomas in children and adults. All gliomas in this cohort had very low somatic mutation burden (less than three somatic single nucleotide variants or small indels per Mb). The ten high-grade gliomas demonstrated markedly aneuploid genomes, with significantly increased quantity of intrachromosomal copy number breakpoints and focal amplifications/homozygous deletions compared to spontaneous high-grade gliomas, likely as a result of DNA double-strand breaks induced by gamma radiation. Together, these findings demonstrate a distinct molecular pathogenesis of secondary gliomas arising after radiation therapy and identify a genomic signature that may aid in differentiating these tumors from their spontaneous counterparts.
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Affiliation(s)
- Giselle Y López
- Department of Pathology, University of California, San Francisco, CA, USA
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Jessica Van Ziffle
- Department of Pathology, University of California, San Francisco, CA, USA
- Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, USA
| | - Courtney Onodera
- Department of Pathology, University of California, San Francisco, CA, USA
- Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, USA
| | - James P Grenert
- Department of Pathology, University of California, San Francisco, CA, USA
- Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, USA
| | - Iwei Yeh
- Department of Pathology, University of California, San Francisco, CA, USA
- Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, USA
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Boris C Bastian
- Department of Pathology, University of California, San Francisco, CA, USA
- Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, USA
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Jennifer Clarke
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Nancy Ann Oberheim Bush
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Jennie Taylor
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Susan Chang
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Nicholas Butowski
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Anuradha Banerjee
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Sabine Mueller
- Department of Neurology, University of California, San Francisco, CA, USA
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Cassie Kline
- Department of Neurology, University of California, San Francisco, CA, USA
- Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Joseph Torkildson
- Department of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - David Samuel
- Department of Hematology/Oncology, Valley Children's Hospital, Madera, CA, USA
| | - Aleli Siongco
- Department of Pathology, Valley Children's Hospital, Madera, CA, USA
| | - Corey Raffel
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Nalin Gupta
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Sandeep Kunwar
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Praveen Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Manish Aghi
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Philip Theodosopoulos
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Mitchel Berger
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Joanna J Phillips
- Department of Pathology, University of California, San Francisco, CA, USA
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Tarik Tihan
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Andrew W Bollen
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Arie Perry
- Department of Pathology, University of California, San Francisco, CA, USA
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, CA, USA.
- Clinical Cancer Genomics Laboratory, University of California, San Francisco, CA, USA.
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Khattab MH, Sherry AD, Ahlers CG, Kirschner AN. Radiation-associated epithelial-myoepithelial carcinoma among five secondary malignancies: A case report and review of literature. World J Clin Oncol 2018; 9:200-207. [PMID: 30622928 PMCID: PMC6314863 DOI: 10.5306/wjco.v9.i8.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Epithelial-myoepithelial carcinoma (EMC) is a rare, low-grade, malignant tumor that constitutes less than one percent of all salivary gland tumors. To date, only one other case report has described radiation-associated EMC in the English language medical literature.
CASE SUMMARY In this report, we describe the case of a 56-year-old male patient who presented with a neck mass diagnosed as EMC of the left submandibular gland approximately 30 years after mantle field radiation and chemotherapy for Hodgkin lymphoma. Treatment included resection, re-resection with nodal dissection, and adjuvant chemoradiotherapy. This patient was also diagnosed with 4 other secondary malignancies, including stage IV diffuse large B cell lymphoma in the abdomen with subsequent brain metastases, low-grade neuroendocrine carcinoma of the lung, Hurthle cell adenoma, and small B cell lymphoma before the patient expired. This case provides important information regarding the pathology, clinical sequelae, and management of a patient diagnosed with radiation-associated EMC amidst four concurrent malignancies.
CONCLUSION Further investigation is needed on the efficacy of adjuvant radiotherapy in EMC, especially atypical EMC.
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Affiliation(s)
- Mohamed H Khattab
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Alexander D Sherry
- Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | - Carolyn G Ahlers
- Vanderbilt University School of Medicine, Nashville, TN 37232, United States
| | - Austin N Kirschner
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
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29
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Hwang K, Lee KS, Choe G, Cho BG, Kim CY. Secondary glioblastoma after treatment of intracranial germinoma - would radiation-only therapy still be safe? Case report. BMC Cancer 2018; 18:1119. [PMID: 30445947 PMCID: PMC6240271 DOI: 10.1186/s12885-018-5073-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACK GROUND Intracranial germinomas are one of the most radiosensitive tumors and are curable by radiotherapy (RT) alone. RT-only therapy without chemotherapy is effective. But, as patients with germinoma can expect long-term survival, the adverse effects of RT and late sequelae in survivors are of most concern. So, recently, standard treatment protocol of combination with chemotherapy and reduced dose of RT could be widely acceptable. CASE PRESENTATION We report a patient with germinoma who developed RT-induced glioblastoma. He was diagnosed as biopsy-proven germinoma at the age of 12. Postoperatively, he underwent RT alone without chemotherapy and remained free of tumor without recurrence during long-term follow up. However, after almost 20 year, he developed RT-induced glioblastoma. CONCLUSIONS Although RT has the highest priority among treatments on intracranial germinomas, RT-only therapy with full dose for germinoma can have delayed severe complications. So, chemotherapy prior to reduced dose RT is more desirable.
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Affiliation(s)
- Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Kyu Sang Lee
- Department of Pathology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Byung-Gyu Cho
- Department of Neurosurgery, Korean Armed Forces Capital Hospital, Seongnam-si, South Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea. .,Seoul National University College of Medicine, Seoul, South Korea.
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Kushner CJ, Hwang WT, Wang S, Solin LJ, Vapiwala N. Long-term risk of second malignancies in women after breast conservation therapy for ductal carcinoma in situ or early-stage breast cancer. Breast Cancer Res Treat 2018; 170:45-53. [PMID: 29488126 DOI: 10.1007/s10549-018-4729-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/19/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE Women with ductal carcinoma in situ (DCIS) or early-stage breast cancer have an excellent prognosis, but their risk of developing second malignant neoplasms (SMNs) is not well established. We analyzed SMNs in a large cohort with long follow-up after breast conservation therapy. METHODS The study population comprised 755 women with DCIS (n = 135) or stage I-II breast carcinoma (n = 620). Subjects were aged 25-89 (median 55) years when they underwent breast-conserving surgery followed by radiotherapy to the entire breast (60-68Gray) between 1992 and 2001. Additional treatment included hormonal therapy and/or chemotherapy based on clinical characteristics. SMNs were grouped by site. The rate of SMNs over time was determined using the Kaplan-Meier method. To compare the probability of developing SMNs overall and for specific organs or sites, probability estimates were obtained for a 55-year-old female from the Surveillance, Epidemiology, and End Results Program (SEER). RESULTS Median follow-up from radiotherapy was 13.8 years. The 15-year age-adjusted probability of developing any SMN was 12.0%, close to the SEER rate of 12.1% for a non-breast malignancy. Systemic therapy and higher-dose radiotherapy (> 63 Gray) were not associated with significantly increased risks of SMNs. Compared to SEER, significantly increased risk was noted for gynecologic cancers and melanoma. CONCLUSIONS Most SMNs were unrelated to treatment, and the 15-year incidence was similar to that of cancer in the SEER control group-findings that should be reassuring to patients. Further risk reduction is expected from prophylactic gynecologic surgery. Continued investigations into genetic links with melanoma are warranted.
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Affiliation(s)
- Carolyn J Kushner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wei-Ting Hwang
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Shiyu Wang
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence J Solin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Radiation Oncology, Albert Einstein Healthcare Network, Philadelphia, PA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.
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Abstract
It has been known that urinary diversions juxtaposing the urinary and intestinal tracts lead to increased incidence of secondary malignancies. Although tumorigenesis in ureterosigmoidostomies follows the typical course from adenomas to adenocarcinomas, secondary malignancies arising from isolated intestinal diversions are much more heterogeneous. Research over the last half century has unveiled patterns of incidence and progression, while also uncovering possible mechanisms driving the neoplastic changes. In this review, we summarize the current understanding of these unique tumors, with the hope that the knowledge gained may shed light on the etiologies of other cancers arising from the urinary and intestinal tracts.
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Affiliation(s)
- Roger Li
- Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1373, Houston, TX 77030, USA
| | - Janet E Baack Kukreja
- Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1373, Houston, TX 77030, USA
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1373, Houston, TX 77030, USA.
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Novaković S, Kovač Peić A, Holik H, Coha B. Neuroendocrine tumor of cecum in patient treated with imatinib mesylate for blastic phase of chronic myeloid leukemia. Acta Clin Belg 2017; 72:461-464. [PMID: 28420292 DOI: 10.1080/17843286.2017.1316005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Imatinib mesylate (IM), a tyrosine kinase inhibitor, is the treatment of choice in patients with chronic myeloid leukemia (CML). It is considered a very safe drug, with mostly mild and reversible side effects. Lately, it has been suggested that adverse events may occur after a long term. We report a case of a 72-year-old woman diagnosed with blastic phase of Philadelphia chromosome positive CML treated with IM for 28 months. The patient presented first with ascites as a side effect of the drug. When the ascites re-occurred, it was caused by neuroendocrine tumor (NET) with peritoneal carcinomatosis. We believe this is the first case of a NET as a secondary malignancy (SM) after IM treatment. SM have been described in patients on IM before. It is unclear whether these tumors are caused by imatinib or found more easily because of close follow-up.
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Affiliation(s)
| | - Anamarija Kovač Peić
- b Hematology Department , General Hospital dr. Josip Bencevic , Slavonski Brod , Croatia
| | - Hrvoje Holik
- b Hematology Department , General Hospital dr. Josip Bencevic , Slavonski Brod , Croatia
| | - Božena Coha
- b Hematology Department , General Hospital dr. Josip Bencevic , Slavonski Brod , Croatia
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Redmond EJ, Dolbec KS, Fawaz AS, Flood HD, Giri SK. Hospital burden of long-term genitourinary and gastrointestinal toxicity after radical radiotherapy for prostate cancer. Surgeon 2017; 16:171-175. [PMID: 28988618 DOI: 10.1016/j.surge.2017.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/06/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Treatment options for prostate cancer (PCa) include radical radiotherapy (RT) and radical prostatectomy, both of which have comparable oncological outcomes. The aim of this study was to investigate the hospital burden of long-term genitourinary and gastrointestinal toxicity among patients with PCa who were treated with radiotherapy at our institution. METHODS The radiotherapy department database was used retrospectively to identify all patients who underwent radiotherapy for PCa from January 2006 to January 2008. The patient administration system from each public hospital in the region was interrogated and all patient points of contact were recorded. Minimum follow up was 5 years. Individual patient charts were reviewed and factors that might influence outcomes were documented. RESULTS We identified 112 patients. The mean age at diagnosis was 66 (44-76) and the median PSA was 12.1 (3.2-38). The mean duration of follow-up was 7.8 yrs. Twenty-three patients (20%) presented to the Emergency Department (ED) with late onset toxicity. Nine patients had more than 2 ED attendances. Twenty-five patients (22%) were investigated for genitourinary toxicity. Forty-seven patients (42%) underwent investigation for gastrointestinal side-effects and 45% of these required argon therapy (21/47). CONCLUSION We found a significant hospital burden related to the management of gastrointestinal and genitourinary toxicity post radical radiotherapy for prostate cancer. As health care reforms gain momentum, policy makers must take into account the considerable longitudinal health care cost related to radiotherapy. It is also important that patients are counselled carefully in relation to potential long-term side-effects.
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Affiliation(s)
- Elaine J Redmond
- Department of Urology, University Hospital of Limerick, Limerick, Ireland.
| | | | - Aisling S Fawaz
- Graduate Entry Medical School, University of Limerick, Ireland
| | - Hugh D Flood
- Department of Urology, University Hospital of Limerick, Limerick, Ireland
| | - Subhasis K Giri
- Department of Urology, University Hospital of Limerick, Limerick, Ireland
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Lobeck I, Rymeski B, Burns K, Nagarajan R, Correll J, Kent D, Dasgupta R. Long-term morbidity after staging laparotomy for Hodgkin lymphoma. J Pediatr Surg 2017; 52:1430-2. [PMID: 27939180 DOI: 10.1016/j.jpedsurg.2016.11.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/21/2016] [Accepted: 11/28/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND A large cohort of Hodgkin lymphoma (HL) survivors exist. With patients transitioning from pediatric to adult care, practitioners should be aware of potential complications. The aim of this study was to describe the long-term complications of patients who had staging laparotomy for the treatment of HL. METHODS After institutional review board approval, a retrospective review of hospital records at our institution was performed. Data extracted included demographics, treatment course and long-term postoperative complications. RESULTS 24 patients with HL underwent staging laparotomy from 1971 to 1994 with median follow-up of 27.9years. Six (33%) had intraabdominal disease. Three patients (17%) required four repeat laparotomies for bowel obstruction. Of these, one had radiation to the inguinal region for local control, one had mantle radiation. Five patients developed a second malignancy. There were no documented cases of postsplenectomy sepsis. Other late effects that were unlikely related to surgery included pulmonary fibrosis (4), heart failure (2), hypothyroidism (4), and dysphagia (3). One patient died of metastatic adenocarcinoma. CONCLUSIONS Long-term follow-up of patients who underwent staging laparotomy for HL revealed an increased incidence of repeat laparotomy and secondary malignancy. This underscores the importance of a high index of suspicion and screening in this population. LEVEL OF EVIDENCE Level III.
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Kato M. Donor cell-derived hematological malignancies after allogeneic hematopoietic stem cell transplantation. Rinsho Ketsueki 2017; 58:813-817. [PMID: 28781279 DOI: 10.11406/rinketsu.58.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Donor cell-derived leukemia/lymphoma (DCL) is an extremely rare outcome after allogeneic hematopoietic stem cell transplantation (allo-SCT). Owing to the rarity of DCL, most available data have been limited to case reports or small case series. Two previous large surveys assessed the frequency of DCL; the European Group for Blood and Marrow Transplantation identified 14 DCL cases from 10,489 allo-SCTs, and the University of Minnesota reported eight cases from 2,390 engrafted allo-SCTs. Recently, a Japanese survey identified 40 DCL cases from 36,870 allo-SCTs, and the incidence of DCL was estimated as 0.16% at 15 years. Through these analyses, cord blood was considered as a risk factor for DCL development compared to other stem cell sources, and it should also be noted that donor age was positively correlated with DCL incidence. Further molecular and immunological investigations would clarify the pathogenesis of DCL and may provide additional clues for understanding the underlying mechanisms of typical hematological malignancies.
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Affiliation(s)
- Motohiro Kato
- Department of Transplantation and Cell Therapy, Children's Cancer Center, National Center for Child Health and Development
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Zhu J, Tucker M, Wang E, Grossman JS, Armstrong AJ, George DJ, Zhang T. Acute Myeloid Leukemia After Olaparib Treatment in Metastatic Castration-Resistant Prostate Cancer. Clin Genitourin Cancer 2017; 15:e1137-e1141. [PMID: 28780018 DOI: 10.1016/j.clgc.2017.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/09/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Jason Zhu
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Matthew Tucker
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Joel S Grossman
- Florida Cancer Specialists and Research Institute, Naples, FL
| | - Andrew J Armstrong
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Daniel J George
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Tian Zhang
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, NC.
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Patel HD, Srivastava A, Alam R, Joice GA, Schwen ZR, Semerjian A, Allaf ME, Pierorazio PM. Radiotherapy for stage I and II testicular seminomas: Secondary malignancies and survival. Urol Oncol 2017; 35:606.e1-606.e7. [PMID: 28712791 DOI: 10.1016/j.urolonc.2017.06.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/26/2017] [Accepted: 06/20/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Testicular seminoma affects relatively young men with excellent survival outcomes. There has been increasing concern that radiotherapy (RT) leads to secondary malignant neoplasms (SMNs) and subsequent mortality. We evaluated the effect of RT on incidence of SMNs and quantified cancer-related mortality and other causes of death for patients with stage I and II testicular seminoma. MATERIAL AND METHODS A national sample of men (1988-2013) diagnosed with stage IA/IB/IS/IIA/IIB/IIC testicular seminomas from Surveillance, Epidemiology, and End Results were evaluated. Use of RT over time and survival curves (5/10/15-year) was stratified by stage. Log-binomial regression determined relative risk of developing SMNs. Incidence rate ratios (IRR) and age-adjusted Cox proportional hazards models compared overall, cancer-specific survival (CSS), and other cancer-specific survival. Competing-risks regression generated cumulative incidence functions. Prevalence ratios explored excess deaths owing to specific causes. RESULTS A total of 16,463 men were included with 9,126 (55.4%) undergoing RT with markedly decreased use for stage I seminoma in recent years (<20%) and ~50% for stage IIA. RT increased risk of SMNs (relative risk = 1.84 [95% CI: 1.61-2.10, P<0.01]). Survival rates were excellent (15-year CSS for stage I [≥99%], stage IIA [98.1%], stage IIB-C [96%-97%]). RT was associated with improved CSS for stage IB and IIA, but demonstrated less benefit for stage IA (IRR = 0.63 [95% CI: 0.35-1.14, P = 0.10]) with worse other cancer-specific survival (IRR = 1.80 [95% CI: 0.97-3.59, P = 0.05]). Gastrointestinal, respiratory, urinary, and hematologic malignances accounted for 84% of SMN deaths. CONCLUSIONS RT offers excellent CSS for men with stage I/II seminoma and an increased risk of SMN later in life. Future studies should better evaluate risk-stratification for stage IB patients.
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Affiliation(s)
- Hiten D Patel
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Arnav Srivastava
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ridwan Alam
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gregory A Joice
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zeyad R Schwen
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alice Semerjian
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohamad E Allaf
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Phillip M Pierorazio
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Penne M, Sarraf Yazdy M, Nair KS, Cheson BD. Extended Follow-up of Patients Treated With Bendamustine for Lymphoid Malignancies. Clin Lymphoma Myeloma Leuk 2017; 17:637-644. [PMID: 28797620 DOI: 10.1016/j.clml.2017.06.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Bendamustine, typically in combination with rituximab, is an effective treatment for chronic lymphocytic leukemia (CLL) and B-cell non-Hodgkin lymphoma. Despite its acceptable short-term toxicity profile, long-term toxicities are less well established. This study investigated the long-term adverse effects of bendamustine and responses to subsequent treatments. PATIENTS AND METHODS Charts of 194 patients were retrospectively reviewed; 54% had received prior treatment (76% attained complete response [CR] or partial response [PR]). RESULTS Patients who did not achieve a CR or PR did not respond well to subsequent treatments. Malignancies following bendamustine were diagnosed in 11% (21) of patients (first line [7] and salvage [14]), including squamous (8) or basal cell (4) skin cancers; prostate cancer (3), renal cancer (3), bladder cancer (2), melanoma (2), lung cancer (1), and histiocytic sarcoma (1). There were no occurrences of therapy-related myelodysplastic syndrome or acute myelogenous leukemia reported. Infections occurred in 63% of patients; however, no deaths were attributable to bendamustine. CONCLUSION Bendamustine is an effective therapy with limited long-term sequelae in patients with lymphoid malignancies.
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Affiliation(s)
- Mara Penne
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC
| | - Maryam Sarraf Yazdy
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC
| | - Kruti Sheth Nair
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC
| | - Bruce D Cheson
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC.
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Michelis FV, Kotchetkov R, Grunwald RM, Azeem A, Atenafu EG, Lipton JH, Loach D, Gupta V, Kuruvilla J, Kim DD, Viswabandya A, Deotare U, Messner HA. Long-Term Incidence of Secondary Malignancies after Allogeneic Hematopoietic Cell Transplantation: A Single-Center Experience. Biol Blood Marrow Transplant 2017; 23:945-51. [PMID: 28254442 DOI: 10.1016/j.bbmt.2017.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/21/2017] [Indexed: 11/24/2022]
Abstract
To review the emergence of secondary malignancies (SMs) in recipients of allogeneic hematopoietic cell transplantation (HCT), we documented the occurrence of SMs in 2415 allogeneic HCT recipients, ages 18 to 71, in a single center over 4 decades. SMs were seen in 209 patients, including 58 with nonmetastatic squamous cell (SCC) and basal cell carcinoma (BCC) of the skin. Cumulative incidence of SM was 6.3% at 10 years, 13.5% at 20 years, and 17.6% at 30 years post-HCT. Median age at diagnosis of SMs was 61 years (range, 21 to 85). By multivariable analysis, older age at HCT was the only independent prognostic factor for SM (HR, 1.39 for ages 41 to 55 and HR, 1.92 for age > 55 compared with age ≤ 40; P = .001). The rate of SM (excluding nonmetastatic SCC/BCC of skin) after HCT was 2.07 times higher (P = .01) compared with the general population. Overall survival (OS) after diagnosis of SM (excluding nonmetastatic SCC/BCC of skin) was 58% at 5 years and 50% at 10 years postdiagnosis. Eastern Cooperative Oncology Group (ECOG) score was the only independent predictor of OS on multivariable analysis, with over 2-fold increased risk of death for patients with an ECOG score of 1 and over 6-fold for ECOG scores of 2 to 4, compared with ECOG score 0 (P < .0001). Forty of 209 patients (19%) diagnosed with SMs subsequently developed another new malignancy. OS was 68% and 51% at 5 and 10 years, respectively. The survival of SM patients post-HCT is favorable, thus warranting diligent long-term cancer screening and standard of care treatment. ECOG status of these patients is a predominant prognostic factor.
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Zhang J, Yao TW, Hashizume R, Hariono S, Barkovich KJ, Fan QW, Prados M, James CD, Weiss WA, Nicolaides T. Combined BRAF V600E and MEK blockade for BRAF V600E-mutant gliomas. J Neurooncol 2017; 131:495-505. [PMID: 27848137 DOI: 10.1007/s11060-016-2333-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 11/06/2016] [Indexed: 12/31/2022]
Abstract
BRAFV600E is a common finding in glioma (about 10-60% depending on histopathologic subclassification). BRAFV600E monotherapy shows modest preclinical efficacy against BRAFV600E gliomas and also induces adverse secondary skin malignancies. Here, we examine the molecular mechanism of intrinsic resistance to BRAFV600E inhibition in glioma. Furthermore, we investigate BRAFV600E/MEK combination therapy that overcomes intrinsic resistance to BRAFV600E inhibitor and also prevents BRAFV600E inhibitor induced secondary malignancies. Immunoblotting and Human Phospho-Receptor Tyrosine Kinase Array assays were used to interrogate MAPK pathway activation. The cellular effect of BRAFV600E and MEK inhibition was determined by WST-1 viability assay and cell cycle analysis. Flanked and orthotopic GBM mouse models were used to investigate the in vivo efficacy of BRAFV600E/MEK combination therapy and the effect on secondary malignancies. BRAFV600E inhibition leads to recovery of ERK phosphorylation. Combined BRAFV600E and MEK inhibition prevents reactivation of the MAPK signaling, which correlates with decreased cell viability and augmented cell cycle arrest. Similarly, mice bearing BRAFV600E glioma showed reduced tumor growth when treated with a combination of BRAFV600E and MEK inhibitor compared to BRAFV600E inhibition alone. Additional benefit of BRAFV600E/MEK inhibition was reflected by reduced cutaneous squamous-cell carcinoma (cSCC) growth (a surrogate for RAS-driven secondary maligancies). In glioma, recovery of MAPK signaling upon BRAF inhibition accounts for intrinsic resistance to BRAFV600E inhibitor. Combined BRAFV600E and MEK inhibition prevents rebound of MAPK activation, resulting in enhanced antitumor efficacy and also reduces the risk of secondary malignancy development.
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Sahu KK, Uday Y, Bal A, Varma N, Naseem S, Khadwal A, Prakash G, Varma S, Malhotra P. CML as Part of Dual Malignancies-A Retrospective Analysis: Possible Mechanisms and Review of Literature. Indian J Hematol Blood Transfus 2016; 32:392-6. [PMID: 27812246 DOI: 10.1007/s12288-015-0621-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022] Open
Abstract
Introduction of imatinib has changed the outlook of chronic myeloid leukaemia (CML) patients with overall survival approaching general population. Long term survival in CML patients has provided an opportunity to better study natural history and long term complications of disease as well as the treatment modalities. To study the occurrence and association of other malignancies with their outcomes in patients with CML. This is a single centre retrospective study. All CML patients case records registered with haematology clinic of a tertiary care centre in North India from 2001 to 2014 were perused and evaluated for dual malignancies. Those patients with dual malignancies were personally examined and interviewed if alive. Out of 1677 patients, 15 cases had co-existent malignancies. Four of fifteen cases of dual malignancies had CML as secondary cancer. Three had synchronous and rest 12 patients had metachronous malignancies. Only one patient was in accelerated phase, rest all were in chronic phase. Median age of the dual malignancy cases was 50 years (25-66 years), much younger than reported in west. The initial dose of imatinib was 400 mg OD in all except one. We did not find any causal association between CML or imatinib therapy with development of secondary tumours. Interestingly in this series, incidence of CML as secondary or synchronous malignancy was higher than earlier published studies.
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Gillis CC, Chang EH, Al-Kharazi K, Pickles T. Secondary malignancy following radiotherapy for thyroid eye disease. Rep Pract Oncol Radiother 2016; 21:156-61. [PMID: 27601944 DOI: 10.1016/j.rpor.2016.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 12/03/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022] Open
Abstract
AIM To describe the first case of a secondary meningioma in a patient after radiation treatment for thyroid eye disease (TED). Secondarily to identify any additional cases of secondary malignancy resulting from radiotherapy for thyroid eye disease from our institutional experience. BACKGROUND Thyroid eye disease (TED) is a self-limiting auto-immune disorder causing expansion of orbital soft tissue from deposition of glycosaminoglycans and collagen, leading to significant cosmetic and functional morbidity. Established management options for TED include: glucocorticosteroids, orbital radiotherapy, and surgical orbital decompression. Two large series on radiotherapy for TED have been reported without any cases of secondary malignancy. MATERIALS AND METHODS The case of a patient with visual failure, found to have a sphenoid wing meningioma after previous TED radiotherapy is described. We then reviewed 575 patients with at least 3-year follow-up receiving radiotherapy for TED at British Columbia Cancer Agency to identify other possible secondary malignancies. RESULTS The patient had postoperative improvement in her vision without any identified complications. Three additional cases of hematologic malignancy were identified. The calculated risk in our population of developing a radiation-induced meningioma after TED with at least 3 years of follow-up of is 0.17% (1/575); with hematopoetic malignancies the risk for secondary malignancy is 0.7% (4/575). CONCLUSIONS Our calculated risk for secondary malignancy (0.17%, 0.7%) is similar to the reported theoretical risk published in the literature (0.3-1.2%). There is real risk for the development of a secondary malignancy after radiotherapy treatment of TED and treatment options should include consideration for this potential.
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Affiliation(s)
- Christopher C Gillis
- Division of Neurosurgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States; Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Eun Hae Chang
- Department of Otolaryngology, University of Nebraska Medical Center, Omaha, NE, United States; Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Khalid Al-Kharazi
- Weil Cornell Medical College at Qatar, Al Rayyan, Qatar; Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Tom Pickles
- Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, BC, Canada; Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada; Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
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Huang H, Tamboli P, Karam JA, Vikram R, Zhang M. Secondary malignancies diagnosed using kidney needle core biopsies: a clinical and pathological study of 75 cases. Hum Pathol 2016; 52:55-60. [PMID: 26980018 DOI: 10.1016/j.humpath.2015.12.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 12/19/2022]
Abstract
Involvement of the kidney by secondary malignancies is uncommon. Differentiating secondary malignancies from primary kidney/urothelial tumors can be challenging, especially on limited biopsy material. A retrospective search of our institutional archive from January 2002 to May 2015 identified 1572 cases of imaging-guided needle core biopsies of the kidney. Of these, 75 (5%) cases revealed a secondary malignancy; 48 (64%) patients had undergone the biopsy with a primary kidney tumor favored clinically. There were 39 male and 36 female patients with a mean age of 59.4 years (range, 21-83 years). The majority of the cases (n = 55, 73%) were metastases from solid tumors, with lung being the most common primary site (n = 22, 29%). Diffuse large B-cell lymphoma was the most common hematological malignancy (n = 6) secondarily involving the kidney. Radiographically, 58 (77%) cases presented as a solitary kidney mass. The primary malignancy was known prior to the kidney biopsy in 66 (88%) cases. The mean interval between diagnoses of the primary tumor and secondary involvement of the kidney was 4.5 years. Immunohistochemical stains were performed in 65 (87%) cases. Follow-up information was available for 73 patients; mean survival was 19.4 months, with 43 patients dead of their disease (mean, 12 months) and 30 patients alive at last follow-up (21 with and 9 without disease; mean, 30 months). Secondary malignancy in the kidney may clinically and pathologically mimic primary kidney tumors. Accurate diagnosis can be rendered by correlating pathological features with clinical and radiographic findings and judicious use of ancillary studies.
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Affiliation(s)
- He Huang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Pheroze Tamboli
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Raghu Vikram
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Miao Zhang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
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Imran TF, Wang Y, Zhang S, Hussain MU, Srinivas S. A Baffled Mind: A Mysterious Presentation of Small-Cell Carcinoma of the Bladder. Clin Genitourin Cancer 2015; 13:e329-e332. [PMID: 25733058 DOI: 10.1016/j.clgc.2015.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/24/2015] [Accepted: 02/01/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Tasnim F Imran
- Department of Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ.
| | - Yucai Wang
- Department of Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ
| | - Shijia Zhang
- Department of Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ
| | - Muhammad U Hussain
- Department of Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ
| | - Shanthi Srinivas
- Department of Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ; Division of Hematology and Oncology, Department of Medicine, Veterans Affairs Medical Center, East Orange, NJ
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Popovic L, Jovanovic D, Petrovic D, Nikin Z, Matovina-Brko G, Trifunovic J, Kolarov-Bjelobrk I. Concurrent chronic lymphocytic leukemia and merkel cell carcinoma in primary skin tumor and metastatic lymph node. Indian J Hematol Blood Transfus 2014; 30:422-4. [PMID: 25332636 DOI: 10.1007/s12288-014-0447-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 08/04/2014] [Indexed: 11/25/2022] Open
Abstract
Association between chronic lymphocytic leukemia and other malignancies has been known for a long time. This epidemiological phenomenon is explained by immunosuppression caused by disease itself or by the applied therapy. Merkel cell carcinoma is a rare malignant tumor of the skin of neuroendocrine origin diagnosed almost exclusively in immunocompromised host. We presented an unique case of coexisting infiltration of chronic lymphocytic leukemia cells within primary cutaneous Merkel cell carcinoma and metastatic lymph node in young HIV-negative female patient.
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Affiliation(s)
- Lazar Popovic
- Department for Medical Oncology, Oncology Institute of Vojvodina, Put Dr Goldmana 4, Sremska Kamenica, 21204 Novi Sad, Serbia ; Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Darjana Jovanovic
- Department for Medical Oncology, Oncology Institute of Vojvodina, Put Dr Goldmana 4, Sremska Kamenica, 21204 Novi Sad, Serbia ; Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Dragana Petrovic
- Department for Medical Oncology, Oncology Institute of Vojvodina, Put Dr Goldmana 4, Sremska Kamenica, 21204 Novi Sad, Serbia
| | - Zoran Nikin
- Department for Medical Oncology, Oncology Institute of Vojvodina, Put Dr Goldmana 4, Sremska Kamenica, 21204 Novi Sad, Serbia ; Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Gorana Matovina-Brko
- Department for Medical Oncology, Oncology Institute of Vojvodina, Put Dr Goldmana 4, Sremska Kamenica, 21204 Novi Sad, Serbia ; Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Jasna Trifunovic
- Department for Medical Oncology, Oncology Institute of Vojvodina, Put Dr Goldmana 4, Sremska Kamenica, 21204 Novi Sad, Serbia ; Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Ivana Kolarov-Bjelobrk
- Department for Medical Oncology, Oncology Institute of Vojvodina, Put Dr Goldmana 4, Sremska Kamenica, 21204 Novi Sad, Serbia ; Medical Faculty, University of Novi Sad, Novi Sad, Serbia
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Demiriz IŞ, Tekgündüz E, Bozdağ SC, Altuntaş F. Chronic myeloid leukemia as a secondary malignancy following treatment of diffuse large B-cell lymphoma. Turk J Haematol 2014; 31:92-84. [PMID: 24764737 PMCID: PMC3996641 DOI: 10.4274/tjh.2013.0180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/05/2013] [Indexed: 12/11/2022] Open
Affiliation(s)
- Itır Şirinoğlu Demiriz
- Ankara Oncology Hospital, Department of Hematology and Stem Cell Transplantation Unit, Ankara, Turkey
| | - Emre Tekgündüz
- Ankara Oncology Hospital, Department of Hematology and Stem Cell Transplantation Unit, Ankara, Turkey
| | - Sinem Civriz Bozdağ
- Ankara Oncology Hospital, Department of Hematology and Stem Cell Transplantation Unit, Ankara, Turkey
| | - Fevzi Altuntaş
- Ankara Oncology Education and Research Hospital, Ankara, Turkey
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Zamora-Ortiz G, Velázquez-Sánchez-de-Cima S, Ponce-de-León S, Gutiérrez-Aguirre CH, Ruiz-Delgado GJ, Gomez-Almaguer D, Ruiz-Argüelles GJ. Secondary malignancies after allogeneic hematopoietic stem cell transplantation using reduced-intensity conditioning and outpatient conduction. ACTA ACUST UNITED AC 2014; 19:435-40. [PMID: 24552480 DOI: 10.1179/1607845414y.0000000154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Patients given allogeneic hematopoietic stem cell transplants (HSCT) may develop secondary malignant neoplasms (SMN). Several variables have been identified but there are no data about the incidence of this complication in individuals given HSCT using reduced-intensity conditioning (RIC) methods. OBJECTIVE Define the incidence of SMN in patients given HSCT using a RIC preparative regimen conducted on an outpatient basis. MATERIALS AND METHODS Patients given HSCT in two institutions between October 1998 and 2012 were analyzed. To appraise the SMN appearance, those patients dead were also regarded as censored at that moment, as well as those lost to follow up and those alive at the closing of the study. 95% Confidence intervals (CI) for the survival or failure estimate were calculated with the Greenwood's method. RESULTS A total of 416 allografted patients with a Karnofsky performance index of 100% were included in the study. All patients received peripheral blood stem cells allografts. The conditioning regimen was delivered as an outpatient procedure in all individuals. No patient was given radiotherapy nor antithymocyte globulin during the conditioning. Three hundred and sixty five patients (88%) were never admitted to the hospital, whereas 12% were admitted because of grade III-IV acute graft versus host disease (aGVHD), fever, or mucositis. Median survival time was 15.7 months. Survival at 6 months (95% CI): 66.4% (61.5-70.8%), at 12 months: 53.3% (48.1-58.1%), at 60 months: 30.6% (30.5-41.5%). Eight patients with a SMN were identified in the group of 416 allografted patients, SMN rates (95% CI) were: one year post graft: 1.9% (0.7-4.9%), 5 years: 3.8% (1.6-9.2%), 10 years: 6.8% (2.6-17.7%) and 13 years post-graft: 20.2% (5.5-59.2%), the cumulative probability of SMN being 6.8 at 10 years. Since the number of expected cases in the general population is 0.62, the ratio of observed to expected cases is 12.9 (P < 0.001). This figure means that the risk of developing a malignant neoplasm in allografted individuals using our method is 12.9 times higher than that in the general population. There were three non-Hodgkin's lymphomas, two M2 acute myelogenous leukemias, one hairy cell leukemia, one tongue epidermoid carcinoma, and one breast carcinoma. CONCLUSIONS We have found a low incidence of SMN in this group of Mexican patients allografted with the Mexican RIC method. Possible explanations for this difference are discussed, focusing on the RIC preparative regimen.
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48
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Vandenbos F, Figueredo M, Dumon-Gubeno MC, Nicolle I, Tarhini A, Butori C, Mouroux J. [Malignant pleural mesothelioma after radiation treatment for Hodgkin lymphoma]. Rev Pneumol Clin 2013; 69:291-293. [PMID: 23796498 DOI: 10.1016/j.pneumo.2013.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/15/2013] [Indexed: 06/02/2023]
Abstract
Malignant mesothelioma is a relatively uncommon malignancy. Although the pathogenesis is primarily related to asbestos, the role of ionizing radiation is more controversial. We report the case of a 41-year-old male who developed pleural mesothelioma. He had both, a prior short asbestos exposure and a thoracic radiotherapy for Hodgkin's disease 26years before. The evidence for radiotherapy as cause for mesothelioma is expanding and the diagnosis of mesothelioma in patients who had previous irradiation should be kept in mind.
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Affiliation(s)
- F Vandenbos
- Service de pneumologie, hôpital Clavary, BP 53149, 06135 Grasse cedex, France; Centre de soins de suite et de rééducation « La Maison du Mineur », 577, avenue Henri-Giraud, 06141 Vence cedex, France.
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Alkofide A, Ayas M, Khafagah Y, Rawashde A, Anas M, Barria M, Siddiqui K, AlMesfer S, Alkatan H. Efficacy of vincristine and carboplatin as chemo-reduction for advanced bilateral retinoblastoma, the Saudi experience. Saudi J Ophthalmol 2013; 27:193-6. [PMID: 24227985 PMCID: PMC3770227 DOI: 10.1016/j.sjopt.2013.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/08/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate the efficacy of a 2-drug chemotherapy regimen without external-beam radiotherapy (EBRT) and/or without enucleation in bilateral retinoblastoma. METHODS From 1996 to 2010, 79 patients were diagnosed with bilateral RB and were eligible for chemotherapy. Chemotherapy was administered prior to and/or following local therapy to the eye. All patients received 3 cycles of chemo-reduction with carboplatin and vincristine, additional cycles of the same or other chemotherapy, local therapy, EBRT and enucleation were determined according to re-evaluation by the ophthalmologist. RESULTS Advanced disease was seen in 115 (79%) eyes (group IV and V: 96, Group D and E: 19) out of 146 affected eyes. Tumor response after chemotherapy was observed in 78 patients (98.7%); complete response in 25 (32.1%), partial response in 49 (62.8%) Four (5.1%) had progressive disease. A total of 50 (63.3%) patients required EBRT; 38 for persistent disease, 4 for progressive disease, 2 for new lesions, 2 for re-activation and 4 for disease control. Enucleation was required in 15 (19%). Secondary malignancies occurred in two patients who underwent EBRT; one osteogenic sarcoma and one rhabdomyosarcoma then later osteogenic sarcoma. The 10 year overall survival was 96.3% with a median follow-up time of 3.124 ± 0.536 years (95%CI: 2.074-4.174). CONCLUSIONS The 2-drug chemotherapy regimen combined with local therapy appears to be adequate therapy for low stage disease but not in patients with advanced disease. The occurrence of secondary cancers in this group of patients is worrisome further highlighting the deleterious effects of EBRT.
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Affiliation(s)
- Amani Alkofide
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital And Research Centre, Riyadh, Saudi Arabia
- Al-Faisal University, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital And Research Centre, Riyadh, Saudi Arabia
- Al-Faisal University, Riyadh, Saudi Arabia
| | - Yasser Khafagah
- Department of Radiation Oncology, King Faisal Specialist Hospital And Research Centre, Riyadh, Saudi Arabia
| | - Ashraf Rawashde
- Nursing Affairs, King Faisal Specialist Hospital And Research Centre, Riyadh, Saudi Arabia
| | - Mohamed Anas
- Nursing Affairs, King Faisal Specialist Hospital And Research Centre, Riyadh, Saudi Arabia
| | - Mary Barria
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital And Research Centre, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital And Research Centre, Riyadh, Saudi Arabia
| | - Saleh AlMesfer
- Pediatric Ophthalmology, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hind Alkatan
- Department of Pathology, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
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50
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Abstract
Cutaneous manifestations can occur in the wide range of internal malignancy. They can occur by metastases or local spread, direct infiltration, or a site of primary malignancy itself. Sometimes these manifestations are related with an underlying malignancy but they do not contain malignant cells as paraneoplastic dermatological syndromes. Chronic lymphocytic leukemia (CLL) is the most common leukemia all over the world. Cutaneous lesions occur in up to 25% of patients. Most commonly seen cutaneous lesions in CLL are those of infectious or hemorrhagic origin. Skin cancer risk was also increased eightfold in CLL when compared with normal population, so cutaneous lesions in CLL can be the first manifestation of secondary skin malignancy. Herein, we report an interesting case of Kaposi's sarcoma which was diagnosed during the course of CLL.
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Affiliation(s)
- F Kose
- Department of Medical Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
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