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Ciammella P, Cozzi S, Borghetti P, Galaverni M, Nardone V, Ruggieri MP, Sepulcri M, Scotti V, Bruni A, Zanelli F, Piro R, Tagliavini E, Botti A, Iori F, Alì E, Bennati C, Tiseo M. Redetermination of PD-L1 expression after chemio-radiation in locally advanced PDL1 negative NSCLC patients: retrospective multicentric analysis. Front Oncol 2024; 14:1325249. [PMID: 38357196 PMCID: PMC10866304 DOI: 10.3389/fonc.2024.1325249] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024] Open
Abstract
Background Chemoradiation therapy (CRT) is the treatment of choice for locally advanced non-small cell lung cancer (LA-NSCLC). Several clinical trials that combine programmed cell death 1 (PD1) axis inhibitors with radiotherapy are in development for patients with LA-NSCLC. However, the effect of CRT on tumor cells programmed cell death ligand-1 (PD-L1) expression is unknown. Methods In this multicentric retrospective study, we analyzed paired NSCLC specimens that had been obtained pre- and post-CRT. PD-L1 expression on tumor cells was studied by immunohistochemistry. The purpose of this study was to evaluate the feasibility, risk of complications, and clinical relevance of performing re-biopsy after CRT in patients with PD-L1 negative LA-NSCLC. Results Overall, 31 patients from 6 centers with PD-L1 negative LA-NSCLC were analyzed. The percentage of tumor cells with PD-L1 expression significantly increased between pre- and post-CRT specimens in 14 patients (45%). Nine patients had unchanged PD-L1 expression after CRT, in five patients the rebiopsy material was insufficient for PD-L1 analysis and in two patients no tumor cells at rebiopsy were found. The post-rebiopsy complication rate was very low (6%). All patients with positive PD-L1 re-biopsy received Durvalumab maintenance after CRT, except one patient who had a long hospitalization for tuberculosis reactivation. Median PFS of patients with unchanged or increased PD-L1 expression was 10 and 16.9 months, respectively. Conclusion CRT administration can induce PD-L1 expression in a considerable fraction of PD-L1 negative patients at baseline, allowing them receiving the maintenance Durvalumab in Europe. Hence, after a definitive CRT, PD-L1 redetermination should be considered in patients with LA-NSCLC PD-L1 negative, to have a better selection of maintenance Durvalumab candidates.
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Affiliation(s)
- Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Salvatore Cozzi
- Radiation Oncology Department, Centre Lèon Bèrard, Lyon, France
| | - Paolo Borghetti
- Dipartimento di Radioterapia Oncologica, Università e ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marco Galaverni
- Radiation Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Valerio Nardone
- Dipartimento di Medicina di Precisione, Università degli Studi della Campania “L. Vanvitelli, Napoli, Italy
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matteo Sepulcri
- Radiation Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Vieri Scotti
- Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessio Bruni
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Francesca Zanelli
- Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Piro
- Pulmonology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Tagliavini
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Emanuele Alì
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Bennati
- Department of Hematology-Onco, S Maria delle Croci Hospital, Ravenna, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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2
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Shrestha P, Eineichner T, Wilson B, Lam NS. Intradural Intramedullary Spinal Cord Glioblastoma: A Case Report. Cureus 2023; 15:e43580. [PMID: 37593069 PMCID: PMC10430890 DOI: 10.7759/cureus.43580] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 08/19/2023] Open
Abstract
Primary spinal cord glioblastoma multiforme (GBM) remains uncommon and typically affects males and patients during their fifth decade of life. Our case demonstrates a 77-year-old woman who initially presented with right arm paresthesia and limited range of motion and was subsequently diagnosed with primary spinal cord GBM. Our case illustrates an atypical and nonspecific neurological presentation highlighting that spinal cord GBM can have a more indolent course, unlike what current literature suggests. It also emphasizes the importance of considering a multimodal approach when managing atypical neurological symptoms and considering an early intervention, including magnetic resonance imaging, to rule out occult neoplasm in an appropriate clinical setting, thus preventing delay in the diagnosis. This case further emphasizes the role of molecular biomarkers of tumors, including isocitrate dehydrogenase mutation as well as methylguanine-DNA methyltransferase promoter methylation status, that can independently guide and affect the treatment outcomes in this patient population.
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Affiliation(s)
| | | | | | - Naomi S Lam
- Internal Medicine, Des Moines University, Des Moines, USA
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3
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Vakil J, Cuartas-Mesa MC, Jian Hua L, Deenadayalan V, Turk E. When Radiation Therapy Becomes a Foe: A Rare Case of Radiation-Induced Angiosarcoma of Head and Neck. Cureus 2023; 15:e35122. [PMID: 36945273 PMCID: PMC10024973 DOI: 10.7759/cureus.35122] [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] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
Angiosarcomas are a rare subtype of sarcomas originating from vascular endothelial cells. Though frequently found in the head and neck area, there are minimal reports of radiation-induced angiosarcomas in this area. They have a poor prognosis due to a high rate of lymph node metastasis and, hence, require to be addressed promptly in order to improve survival. We present a rare case of radiation-induced angiosarcoma in a patient previously irradiated for squamous cell carcinoma of the neck. Due to variable and complex patient presentations of the disease, this case will help raise awareness of an uncommon complication of a common treatment offered to patients.
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Affiliation(s)
- Jay Vakil
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | | | - Liu Jian Hua
- Pathology, University of Illinois Chicago, Chicago, USA
| | | | - Ekrem Turk
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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4
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Koukourakis IM, Zygogianni A, Kouloulias V, Kyrgias G, Panteliadou M, Nanos C, Abatzoglou I, Koukourakis MI. Is Locally Advanced Head-Neck Cancer One More Candidate for Accelerated Hypofractionation? Anticancer Res 2021; 41:467-475. [PMID: 33419845 DOI: 10.21873/anticanres.14797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Hypofractionated accelerated radiotherapy (HypoAR) is widely applied for the treatment of early laryngeal cancer. Its role in locally advanced head-neck cancer (LA-HNC) is unexplored. PATIENTS AND METHODS We present results of a prospective trial on 124 patients with LA-HNC, treated with radio-chemotherapy with three different HypoAR fractionations (3.5 Gy/day × 14-15 fractions, 2.7 Gy/day × 20-21 fractions, and 2.5 Gy/day × 21-22 fractions). RESULTS Protraction of the overall treatment time due to oropharyngeal mucositis was enforced in 18/57 laryngeal, 6/19 nasopharyngeal, and 15/48 cancer patients with other tumors. Regarding late toxicities, laryngeal edema grade 3 was noted in 5/57 patients with laryngeal cancer, while severe dysphagia was noted in 4/124 and tracheoesophageal fistula formation in 1/124 patients. The complete response rates obtained were 73%, 84%, and 67% in patients with laryngeal, nasopharyngeal, and other tumors, respectively. The 3-year locoregional progression-free survival was 58%, 73%, and 55%, respectively. CONCLUSION HypoAR chemoradiotherapy is feasible, with acceptable early and late radiotherapy toxicities, response rates and LPFS.
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Affiliation(s)
- Ioannis M Koukourakis
- 1 Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Zygogianni
- 1 Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios Kouloulias
- 2 Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Kyrgias
- Department of Radiotherapy, University of Thessaly, University Hospital of Larisa, Larisa, Greece
| | - Marianthi Panteliadou
- Department of Radiotherapy/Oncology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Christos Nanos
- Department of Radiotherapy/Oncology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioannis Abatzoglou
- Department of Radiotherapy/Oncology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Michael I Koukourakis
- Department of Radiotherapy/Oncology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Simoni N, Rossi G, Benetti G, Zuffante M, Micera R, Pavarana M, Guariglia S, Zivelonghi E, Mengardo V, Weindelmayer J, Giacopuzzi S, de Manzoni G, Cavedon C, Mazzarotto R. 18F-FDG PET/CT Metrics Are Correlated to the Pathological Response in Esophageal Cancer Patients Treated With Induction Chemotherapy Followed by Neoadjuvant Chemo-Radiotherapy. Front Oncol 2020; 10:599907. [PMID: 33330097 PMCID: PMC7729075 DOI: 10.3389/fonc.2020.599907] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/28/2020] [Accepted: 10/27/2020] [Indexed: 12/04/2022] Open
Abstract
Background and Objective The aim of this study was to assess the ability of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) to provide functional information useful in predicting pathological response to an intensive neoadjuvant chemo-radiotherapy (nCRT) protocol for both esophageal squamous cell carcinoma (SCC) and adenocarcinoma (ADC) patients. Material and Methods Esophageal carcinoma (EC) patients, treated in our Center between 2014 and 2018, were retrospectively reviewed. The nCRT protocol schedule consisted of an induction phase of weekly administered docetaxel, cisplatin, and 5-fluorouracil (TCF) for 3 weeks, followed by a concomitant phase of weekly TCF for 5 weeks with concurrent radiotherapy (50–50.4 Gy in 25–28 fractions). Three 18F-FDG PET/CT scans were performed: before (PET1) and after (PET2) induction chemotherapy (IC), and prior to surgery (PET3). Correlation between PET parameters [maximum and mean standardized uptake value (SUVmax and SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG)], radiomic features and tumor regression grade (TGR) was investigated. Results Fifty-four patients (35 ADC, 19 SCC; 48 cT3/4; 52 cN+) were eligible for the analysis. Pathological response to nCRT was classified as major (TRG1-2, 41/54, 75.9%) or non-response (TRG3-4, 13/54, 24.1%). A major response was statistically correlated with SCC subtype (p = 0.02) and smaller tumor length (p = 0.03). MTV and TLG measured prior to IC (PET1) were correlated to TRG1-2 response (p = 0.02 and p = 0.02, respectively). After IC (PET2), SUVmean and TLG correlated with major response (p = 0.03 and p = 0.04, respectively). No significance was detected when relative changes of metabolic parameters between PET1 and PET2 were evaluated. At textural quantitative analysis, three independent radiomic features extracted from PET1 images ([JointEnergy and InverseDifferenceNormalized of GLCM and LowGrayLevelZoneEmphasis of GLSZM) were statistically correlated with major response (p < 0.0002). Conclusions 18F-FDG PET/CT traditional metrics and textural features seem to predict pathologic response (TRG) in EC patients treated with induction chemotherapy followed by neoadjuvant chemo-radiotherapy. Further investigations are necessary in order to obtain a reliable predictive model to be used in the clinical practice.
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Affiliation(s)
- Nicola Simoni
- Department of Radiation Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Gabriella Rossi
- Department of Radiation Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Giulio Benetti
- Department of Medical Physics, University of Verona Hospital Trust, Verona, Italy
| | - Michele Zuffante
- Department of Nuclear Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Renato Micera
- Department of Radiation Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Michele Pavarana
- Department of Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Stefania Guariglia
- Department of Medical Physics, University of Verona Hospital Trust, Verona, Italy
| | - Emanuele Zivelonghi
- Department of Medical Physics, University of Verona Hospital Trust, Verona, Italy
| | - Valentina Mengardo
- Department of General and Upper G.I. Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Jacopo Weindelmayer
- Department of General and Upper G.I. Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Simone Giacopuzzi
- Department of General and Upper G.I. Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni de Manzoni
- Department of General and Upper G.I. Surgery, University of Verona Hospital Trust, Verona, Italy
| | - Carlo Cavedon
- Department of Medical Physics, University of Verona Hospital Trust, Verona, Italy
| | - Renzo Mazzarotto
- Department of Radiation Oncology, University of Verona Hospital Trust, Verona, Italy
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Lee JY, Cutts RJ, White I, Augustin Y, Garcia-Murillas I, Fenwick K, Matthews N, Turner NC, Harrington K, Gilbert DC, Bhide S. Next Generation Sequencing Assay for Detection of Circulating HPV DNA (cHPV-DNA) in Patients Undergoing Radical (Chemo)Radiotherapy in Anal Squamous Cell Carcinoma (ASCC). Front Oncol 2020; 10:505. [PMID: 32363162 PMCID: PMC7180612 DOI: 10.3389/fonc.2020.00505] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/20/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Following chemo-radiotherapy (CRT) for human papilloma virus positive (HPV+) anal squamous cell carcinoma (ASCC), detection of residual/recurrent disease is challenging. Patients frequently undergo unnecessary repeated biopsies for abnormal MRI/clinical findings. In a pilot study we assessed the role of circulating HPV-DNA in identifying "true" residual disease. Methods: We prospectively collected plasma samples at baseline (n = 21) and 12 weeks post-CRT (n = 17). Circulating HPV-DNA (cHPV DNA) was measured using a novel next generation sequencing (NGS) assay, panHPV-detect, comprising of two primer pools covering distinct regions of eight high-risk HPV genomes (16, 18, 31, 33, 35, 45, 52, and 58) to detect circulating HPV-DNA (cHPV DNA). cHPV-DNA levels post-CRT were correlated to disease response. Results: In pre-CRT samples, panHPV-detect demonstrated 100% sensitivity and specificity for HPV associated ASCC. PanHPV-detect was able to demonstrate cHPV-DNA in 100% (9/9) patients with T1/T2N0 cancers. cHPV-DNA was detectable 12 weeks post CRT in just 2/17 patients, both of whom relapsed. 1/16 patients who had a clinical complete response (CR) at 3 months post-CRT but relapsed at 9 months and 1/1 patient with a partial response (PR). PanHPV-detect demonstrated 100% sensitivity and specificity in predicting response to CRT. Conclusion: We demonstrate that panHPV-detect, an NSG assay is a highly sensitive and specific test for the identification of cHPV-DNA in plasma at diagnosis. cHPV-DNA post-treatment may predict clinical response to CRT.
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Affiliation(s)
- Jen Y. Lee
- Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Rosalind J. Cutts
- Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Ingrid White
- Department of Clinical Oncology, The Royal Marsden Hospital, London, United Kingdom
| | - Yolanda Augustin
- Department of Clinical Oncology, St. Georges Hospital NHS Trust, London, United Kingdom
| | | | - Kerry Fenwick
- Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Nik Matthews
- Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Nicholas C. Turner
- Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Clinical Oncology, The Royal Marsden Hospital, London, United Kingdom
| | - Kevin Harrington
- Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Clinical Oncology, The Royal Marsden Hospital, London, United Kingdom
| | - Duncan C. Gilbert
- Department of Clinical Oncology, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Shreerang Bhide
- Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Clinical Oncology, The Royal Marsden Hospital, London, United Kingdom
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Khan M, Siddiqui SA. Concurrent chemoradiotherapy with or without induction chemotherapy for the management of cervical lymph node metastasis from unknown primary tumor. J Cancer Res Ther 2018; 14:1117-1120. [PMID: 30197359 DOI: 10.4103/0973-1482.203594] [Citation(s) in RCA: 5] [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] [Indexed: 11/04/2022]
Abstract
Background To determine the impact of concurrent chemoradiotherapy (CCRT) with or without induction chemotherapy over radiation alone for the treatment of patients of cervical lymph node metastasis from an unknown primary tumor. Materials and Methods A total of 96 patients with squamous cell histology of cervical lymph node metastases from unknown primary tumor were retrospectively reviewed. About 12 patients were treated with radiation alone (RT alone), 45 with CCRT, and 39 with induction chemotherapy followed by CCRT (ICCRT). Results Overall response rate (ORR) obtained with RT alone arm was 75%, whereas for CCRT, it was 86.7%. About 15.4% had a complete response (CR) after induction chemotherapy with 92.3% ORR after the completion of CCRT. At 2 years, the disease free survival (DFS) was 50% in RT alone, 73% with CCRT, and 62% with ICCRT, while the corresponding rates at 5 years were 50% for RT alone, 45% with CCRT, and 54% in ICCRT arm. Conclusion Though we obtained a high ORR with concurrent or induction chemotherapy arm over RT alone, there is no clear advantage in the DFS. The nonrandomized nature of this trial and the potential for selection bias should definitely be taken into account while drawing comparisons from this trial.
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Affiliation(s)
- Mohsin Khan
- Department of Radiotherapy, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Shahid A Siddiqui
- Department of Radiotherapy, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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8
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Abstract
RATIONALE Primary osteosarcomas of the skull and skull base are rare, comprising <2% of all skull tumors. Primary osteosarcomas of the skull are aggressive neoplasms composed of spindle cells producing osteoid which have poor outcome. PATIENT CONCERNS A 33-year-old woman was admitted to our hospital with a major complaint of a growing mass on her left frontal region of the skull for 10 months. Prior to the accurate diagnosis, the mass on her skull was considered to be eosinophilic granuloma. DIAGNOSES Computerized tomogram (CT) scan of skull revealed a lytic lesion causing destruction of left frontal bone with surrounding soft tissue mass. The histological examination of the lesion showed typical features of osteosarcoma. INTERVENTIONS The patient received 3 surgeries and adjuvant chemotherapy and radiotherapy for the frontal bone lesion. OUTCOMES At the last follow-up, after 4 years, the patient was free of disease both clinically and on imaging by magnetic resonance imaging (MRI) scan after 4 years. LESSONS Because osteosarcoma of skull is a rare disease, the early recognition and correct diagnosis are very important for a better prognosis. It is therefore imperative that clinicians recognize osteosarcoma early to make an accurate diagnosis and complete surgical resection followed by combined chemo-radiation is proved to be one of the most optimal treatment regimens.
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Affiliation(s)
| | - Qi Liang
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Yu Liu
- Department of Neurosurgery
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9
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Formenti SC, Golden EB, Goldberg JD, Li X, Taff J, Fenton-Kerimian MB, Chandrasekhar S, Demaria S, Novik Y. Results of a phase I-II study of adjuvant concurrent carboplatin and accelerated radiotherapy for triple negative breast cancer. Oncoimmunology 2016; 6:e1274479. [PMID: 28405497 DOI: 10.1080/2162402x.2016.1274479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 12/31/2022] Open
Abstract
Purpose: To determine feasibility and explore the clinical efficacy of concurrent radiotherapy and carboplatin as adjuvant treatment of triple negative breast cancer (TNBC). Patients and Methods: Women with Stage I-II TNBC were treated after surgery in a phase I-II prospective trial [NCT01289353]. Weekly carboplatin (AUC = 2.0) was delivered for 6 weeks. Concurrent radiotherapy was delivered in the prone position during weeks 2-4, for a total dose of 40.5 Gy in 15 fractions to the breast, and 46.5 Gy in 17 fractions to the tumor bed. Adverse events (AE) were assessed weekly during treatment, once at 45-60 d, and every 6 mo thereafter, using the Common Terminology Criteria for AE (CTCAE) v3.0. Results: A total of 39 patients accrued and 36 received treatment. Eight patients (22%, exact 95% CI: 10%, 39%) developed grade 2 or greater acute radiation dermatitis. Overall, grade 2 AE were seen in nine and grade 3 in two patients. Twenty-three patients (64%) received additional adjuvant chemotherapy. With a median follow-up of 48 mo, 34/36 (94%) are alive and disease free. One patient died of pulmonary failure with possible but unproven breast cancer recurrence, and one patient died of pelvic malignancy. One patient recurred locally and is alive and disease free after surgical management. Brisk lymphocytic infiltrate was present pre-treatment in 39% of 18 patients with evaluable tumor. Conclusions: Adjuvant concurrent carboplatin and prone accelerated radiotherapy is a well-tolerated and promising treatment of early stage TNBC. The observed 3% compares favorably with the expected 30% recurrence rate within 1-4 y from treatment, warranting further studies.
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Affiliation(s)
- Silvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine , New York, NY, USA
| | - Encouse B Golden
- Department of Radiation Oncology, Weill Cornell Medicine , New York, NY, USA
| | - Judith D Goldberg
- Departments of Population Health and Environmental Medicine, New York University School of Medicine , New York, NY, USA
| | - Xiaochun Li
- Departments of Population Health and Environmental Medicine, New York University School of Medicine , New York, NY, USA
| | - Jessica Taff
- Department of Medicine, New York University School of Medicine , New York, NY, USA
| | | | | | - Sandra Demaria
- Department of Radiation Oncology, Weill Cornell Medicine , New York, NY, USA
| | - Yelena Novik
- Department of Medicine, New York University School of Medicine , New York, NY, USA
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10
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Purkayastha A, Pathak A, Sharma N, Viswanath S, Dutta V. Primitive neuroectodermal tumor of lungs in adults: a rare series of three cases treated with upfront chemo-radiation. Transl Lung Cancer Res 2016; 5:350-5. [PMID: 27413716 DOI: 10.21037/tlcr.2016.06.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 11/06/2022]
Abstract
Primitive neuroectodermal tumors (PNETs) are highly malignant small round blue cell tumors of neuroectodermal origin belonging to either central nervous system, autonomic nervous system or peripheral Askin's or Ewing's group of neoplasms. The latter generally arise in soft tissues of trunk or axial skeleton in children and early adolescents. However in adults this entity is very uncommon. Of all peripheral entities, primary PNET of lungs without chest wall or pleural involvement in adults are extremely rare and have been scarcely reported in world literature as single case reports. We hereby report a series of three interesting cases of adult PNET of lung diagnosed and treated in our institute. The chief presenting complaints of these patients were of chest pain, cough and dyspnea. The cases were diagnosed on the basis of imaging and biopsy which confirmed these lesions to be of PNET histology, confirmed by immunopositivity for neuron specific enolase (NSE), synaptophysin, chromogranin, CD 99 and vimentin on immunohistochemistry (IHC). All three were deemed unresectable in view of infiltration of nearby vital organs and high chances of morbidity. They were treated with upfront chemotherapy followed by conformal radiotherapy (RT) to the residual disease to which they showed significant response both clinically and radiologically. Presently these patients are on regular follow-up for over 6 months without any evidence of progression of disease or distant metastasis.
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Affiliation(s)
- Abhishek Purkayastha
- 1 Department of Radiation Oncology, 2 Department of Medical Oncology, 3 Department of Pathology and Molecular Science, Army Hospital Research and Referral, New Delhi, India
| | - Abhishek Pathak
- 1 Department of Radiation Oncology, 2 Department of Medical Oncology, 3 Department of Pathology and Molecular Science, Army Hospital Research and Referral, New Delhi, India
| | - Neelam Sharma
- 1 Department of Radiation Oncology, 2 Department of Medical Oncology, 3 Department of Pathology and Molecular Science, Army Hospital Research and Referral, New Delhi, India
| | - Sundaram Viswanath
- 1 Department of Radiation Oncology, 2 Department of Medical Oncology, 3 Department of Pathology and Molecular Science, Army Hospital Research and Referral, New Delhi, India
| | - Vibha Dutta
- 1 Department of Radiation Oncology, 2 Department of Medical Oncology, 3 Department of Pathology and Molecular Science, Army Hospital Research and Referral, New Delhi, India
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Kobayashi S, Gotoh K, Takahashi H, Akita H, Marubashi S, Yamada T, Teshima T, Nishiyama K, Yano M, Ohigashi H, Ishikawa O, Sakon M. Clinicopathological Features of Surgically-resected Biliary Tract Cancer Following Chemo-radiation Therapy. Anticancer Res 2016; 36:335-342. [PMID: 26722062] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM We retrospectively investigated surgery following chemo-radiation in patients with biliary tract cancer (BTC) treated at our Institution. PATIENTS AND METHODS Among 339 patients, 44 patients underwent chemo-radiation prior to surgery. Chemo-radiation entailed 2-3 months of standardized chemotherapy and 50-60 Gy radiation at the main tumor and regional and para-aortic lymph nodes. RESULTS Thirty-one BTC cases were classified as initially resectable (IR) and 13 as initially un-resectable (UR). Eighty percent of the BTCs were diagnosed as extrahepatic bile duct cancers. Gemcitabine (1,000 mg/m(2)) and radiation was used to treat 59% of patients. Thirty percent of patients underwent hemi-hepatectomy, and 50% underwent pancreatoduodenectomy. The R0 resection rate was 90% among IR and 54% among UR, and 3-year survival rates were 82% for IR and 17% for UR, respectively. CONCLUSION This retrospective analysis suggests that surgery after chemoradiation may contribute to R0 resection rate and survival for initially resectable BTC.
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Affiliation(s)
- Shogo Kobayashi
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Osaka, Japan
| | - Kunihito Gotoh
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Osaka, Japan
| | - Hidenori Takahashi
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Osaka, Japan
| | - Hirofumi Akita
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Osaka, Japan
| | - Shigeru Marubashi
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Osaka, Japan
| | - Terumasa Yamada
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Osaka, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Osaka, Japan
| | - Kinji Nishiyama
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Osaka, Japan
| | - Masahiko Yano
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Osaka, Japan
| | - Hiroaki Ohigashi
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Osaka, Japan
| | - Osamu Ishikawa
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Osaka, Japan
| | - Masato Sakon
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Osaka, Japan
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Abstract
Primary squamous cell carcinoma of the prostate is a unique and rare clinicopathological entity with fewer than 100 cases reported in the literature. Because of its rarity, the optimal management is not well known. Here, we report a case of primary squamous cell carcinoma of the prostate which was treated with definitive concurrent chemo-radiotherapy with excellent outcome along with a brief review of the literature. This is a case report about a rare form of prostate cancer called squamous cell cancer. It behaves more aggressively compared with more common types of prostate cancer. The treatment is controversial due to its rarity, but is different than that of the common variety of prostate cancer. From available limited information, it can be treated either with combined chemotherapy and radiotherapy or radical surgery for early stage disease.
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13
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Abstract
Invasive, clinically non-metastatic bladder cancer has a cure rate of only 50% , when all T stages are considered. The pattern of relapse is dominated by systemic spread, provided that optimal surgery is practiced. Occult metastases are thus most likely to be present at first presentation. For more than 30 years, therapeutic strategies have focused on the use of systemic chemotherapy before, during or after loco-regional therapy to produce cure. More aggressive surgery and more precise radiation techniques in addition to improved chemotherapy have also been tested to improve cure rates. Genetic analysis has focused on prediction and prognostication, without yet having a major impact on outcomes. New agents have been tested in the neoadjuvant and adjuvant setting, but have not yet proven superior to standard algorithms, such as neoadjuvant MVAC chemotherapy. Many studies have tested ineffective metastatic regimens in the neoadjuvant setting without success, giving rise to the maxim that ignoring logical rules of investigation will not advance clinical practice. Leveraging molecular prognostication and immune responsiveness of urothelial cancer may produce the next era of progress. Five simple rules are proposed to guide the development of future studies.
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Affiliation(s)
- Derek Raghavan
- President, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
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14
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Maingon P, Govaerts AS, Rivera S, Vens C, Shash E, Grégoire V. New challenge of developing combined radio-drug therapy. Chin Clin Oncol 2015; 3:18. [PMID: 25841414 DOI: 10.3978/j.issn.2304-3865.2014.05.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 05/26/2014] [Indexed: 11/14/2022]
Abstract
Combined modality treatment can be used to improve control of the local disease at the expense of increased toxicity. Several randomized trials have demonstrated that this combined modality therapy is better than radiotherapy alone or chemotherapy alone in the treatment of locally advanced diseases. Several new targets as well as potential new radio-sensitizers have been identified. To speed-up the process of developing new combined modality treatments, good preclinical models for optimization of the ratio between efficacy and toxicity and a well established methodology within a network of advanced high-tech laboratories and clinical departments devoted to early phase trials, are mandatory. The Synergy of Targeted Agents and Radiation Therapy (STAR) platform of the European Organisation for Research and Treatment of Cancer (EORTC) is gathering these tools.
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Affiliation(s)
- Philippe Maingon
- Radiotherapy Department, Centre Georges-François Leclerc, Dijon, France
| | | | - Sofia Rivera
- Radiotherapy Department, Gustave Roussy, Paris, France
| | - Conchita Vens
- Radiobiology Department, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | | | - Vincent Grégoire
- Radiation Oncology Department, Université Catholique de Louvain, Brussels, Belgium
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15
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Kaur J, Roy S, Mallick SR, Mathur S, Sharma A, Bhasker S, Mohanti BK. Squamous cell carcinoma of larynx in an 8-year-old child: successful management with chemo-radiation. Pediatr Blood Cancer 2014; 61:1481-3. [PMID: 24453121 DOI: 10.1002/pbc.24952] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 12/30/2013] [Indexed: 11/09/2022]
Abstract
Incidence of laryngeal squamous cell cancer (SCC) in childhood is rare, more so in children below 10 years of age. Due to the rarity of the disease and nonspecific symptoms diagnosis often gets delayed. Treatment is challenging and demands expert multi-modality care. We describe the clinico-pathologic findings and management of laryngeal cancer with chemo-radiation in an 8-year-old male. After 18 months of completion of treatment the child is in complete remission clinically and radiologically. This report aims at increasing awareness of head and neck SCC in paediatric population and also underscores the importance of multi-modality care in managing such cases.
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Affiliation(s)
- Jaspreet Kaur
- Department of Radiation Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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16
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Min KJ, Kim YS, Hong JH, Lee JK, Yang DS. Primary malignant melanoma of uterine cervix: a suggestion of new scheme of treatment combination. Chin J Cancer Res 2014; 26:351-4. [PMID: 25035664 DOI: 10.3978/j.issn.1000-9604.2014.06.03] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/31/2014] [Indexed: 11/14/2022] Open
Abstract
Historically, the lack of melanocytes in the vaginal and cervical mucus membranes has deterred the findings of primary melanomas. Mainly due to its rarity, difficulty to diagnose, and poor prognosis, there has been no absolute agreement on comprehensive treatment so far. In this case report, we present a case of a 46-year-old woman with primary malignant melanoma of uterine cervix. She underwent neo-adjuvant chemotherapy initially followed by a radical hysterectomy. After adjuvant concurrent chemo-radiation, the patient has been followed up for 24 months. So far, she has not shown any symptoms or signs of recurrence. Further studies with more cases based on variable combinations of treatment regimen have been on the way.
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Affiliation(s)
- Kyung-Jin Min
- 1 Department of Obstetrics and Gynaecology, 2 Department of Radiation Oncology, Korea University Medical Centre, Seoul 152-703, South Korea
| | - Yeun-Sun Kim
- 1 Department of Obstetrics and Gynaecology, 2 Department of Radiation Oncology, Korea University Medical Centre, Seoul 152-703, South Korea
| | - Jin-Hwa Hong
- 1 Department of Obstetrics and Gynaecology, 2 Department of Radiation Oncology, Korea University Medical Centre, Seoul 152-703, South Korea
| | - Jae-Kwan Lee
- 1 Department of Obstetrics and Gynaecology, 2 Department of Radiation Oncology, Korea University Medical Centre, Seoul 152-703, South Korea
| | - Dae-Sik Yang
- 1 Department of Obstetrics and Gynaecology, 2 Department of Radiation Oncology, Korea University Medical Centre, Seoul 152-703, South Korea
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17
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Donato V, Arcangeli S, Monaco A, Caruso C, Cianciulli M, Boboc G, Chiostrini C, Rauco R, Pressello MC. Moderately Escalated Hypofractionated (Chemo) Radiotherapy Delivered with Helical Intensity-Modulated Technique in Stage III Unresectable Non-Small Cell Lung Cancer. Front Oncol 2013; 3:286. [PMID: 24303369 PMCID: PMC3831267 DOI: 10.3389/fonc.2013.00286] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 07/25/2013] [Accepted: 11/04/2013] [Indexed: 12/25/2022] Open
Abstract
Purpose: To assess clinical outcomes and toxicities in patients with stage III unresectable non-small cell lung cancer (NSCLC) treated with a moderately escalated hypofractionated radiotherapy delivered with Helical Intensity-Modulated Technique in combination with sequential or concurrent chemotherapy. Materials and Methods: Sixty-one consecutive patients considered non-progressive after two cycles of induction chemotherapy were treated with a moderately escalated hypofractionated radiation course of 30 daily fractions of 2.25–2.28 Gy each administered in 6 weeks up to a total dose of 67.5–68.4 Gy (range, 64.5–71.3 Gy). Thirty-two received sequential RT after two more cycles (total = 4 cycles) of chemotherapy, while 29 were treated with concurrent chemo-radiation. The target was considered the gross tumor volume and the clinically proven nodal regions, without elective nodal irradiation. Results: With a median follow up of 27 months (range 6–40), 1-year and 2-year OS rate for all patients was 77 and 53%, respectively, with a median survival duration of 18.6 months in the sequential group and 24.1 months in the concomitant group. No Grade ≥4 acute and late toxicity was reported. Acute Grade 3 treatment-related pneumonitis was detected in 10% of patients. Two patients, both receiving the concurrent schedule, developed a Grade 3 acute esophagitis. The overall incidence of late Grade 3 lung toxicity was 5%. No patients experienced a Grade 3 late esophageal toxicity. Conclusion: A moderately hypofractionated radiation course delivered with a Helical Intensity-Modulated Technique is a feasible treatment option for patients with unresectable locally advanced NSCLC receiving chemotherapy (sequentially or concurrently). Hypofractionated radiotherapy with a dedicated technique allows safely dose escalation, minimizing the effect of tumor repopulation that may occur with prolonged treatment time.
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Affiliation(s)
- Vittorio Donato
- Department of Radiotherapy, Azienda Ospedaliera S.Camillo-Forlanini , Rome , Italy
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18
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GADDUCCI ANGIOLO, TANA ROBERTA, COSIO STEFANIA, CIONINI LUCA. Treatment options in recurrent cervical cancer (Review). Oncol Lett 2010; 1:3-11. [PMID: 22966247 PMCID: PMC3436344 DOI: 10.3892/ol_00000001] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [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: 07/31/2009] [Accepted: 09/15/2009] [Indexed: 11/06/2022] Open
Abstract
The management of recurrent cervical cancer depends mainly on previous treatment and on the site and extent of recurrence. Concurrent cisplatin-based chemo-radiation is the treatment of choice for patients with pelvic failure after radical hysterectomy alone. However, the safe delivery of high doses of radiotherapy is much more difficult in this clinical setting compared with primary radiotherapy. Pelvic exenteration usually represents the only therapeutic approach with curative intent for women with central pelvic relapse who have previously received irradiation. In a recent series, the 5-year overall survival and operative mortality after pelvic exenteration ranged from 21 to 61% and from 1 to 10%, respectively. Free surgical margins, negative lymph nodes, small tumour size and long disease-free interval were associated with a more favourable prognosis. Currently, pelvic reconstructive procedures (continent urinary conduit, low colorectal anastomosis, vaginal reconstruction with myocutaneous flaps) are strongly recommended after exenteration. Concurrent cisplatin-based chemo-radiation is the treatment of choice for isolated para-aortic lymph node failure, with satisfactory chances of a cure in asymptomatic patients. Chemotherapy is administered with palliative intent to women with distant or loco-regional recurrences not amenable by surgery or radiotherapy. Cisplatin is the most widely used drug, with a response rate of 17-38% and a median overall survival of 6.1-7.1 months. Cisplatin-based combination chemotherapy achieves higher response rates (22-68%) when compared with single-agent cisplatin, but median overall survival is usually less than one year. In a recent Gynecologic Oncology Group (GOG) trial the combination topotecan + cisplatin obtained a significantly longer overall survival than single-agent cisplatin in patients with metastatic or recurrent or persistent cervical cancer. A subsequent GOG study showed a trend in terms of longer overall survival and better quality of life for the doublet cisplatin + paclitaxel vs. the doublets cisplatin + topotecan, cisplatin + vinorelbine, and cisplatin + gemcitabine. Molecularly targeted therapy may represent a novel therapeutic tool, but its use alone or in combination with chemotherapy is still investigational.
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Affiliation(s)
- ANGIOLO GADDUCCI
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa 56127, Italy
| | - ROBERTA TANA
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa 56127, Italy
| | - STEFANIA COSIO
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa 56127, Italy
| | - LUCA CIONINI
- Department of Oncology, Division of Radiotherapy, University of Pisa, Pisa 56127, Italy
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