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Burgess BA, Wang RJ, Owen JL. Same-site transdifferentiation of basal cell carcinoma to squamous cell carcinoma as a mechanism of vismodegib treatment resistance: Two cases requiring multimodal and multidisciplinary limb-sparing techniques. JAAD Case Rep 2024; 44:17-19. [PMID: 38292569 PMCID: PMC10824672 DOI: 10.1016/j.jdcr.2023.12.001] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Affiliation(s)
- Brooke A. Burgess
- Division of Dermatology, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Rebecca J. Wang
- Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Joshua L. Owen
- Division of Dermatology, University of Texas Health Science Center San Antonio, San Antonio, Texas
- Dermatology Service, South Texas Veterans Health Care System, San Antonio, Texas
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Liu EK, Daniels TB, Lischalk JW, Oh C, Haas JA, Evans AJ, Byun DJ. Risk and Prognostics of Second Primary Cancer After Prostate Radiation Therapy. Urol Pract 2024; 11:146-152. [PMID: 37917577 DOI: 10.1097/upj.0000000000000479] [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: 06/27/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION As overall survival in prostate cancer increases due to advances in early detection and management, there is a growing need to understand the long-term morbidity associated with treatment, including secondary tumors. The significance of developing radiation-associated secondary cancers in an elderly population remains unknown. METHODS Patients diagnosed with prostate cancer between 1975 and 2016 in one of 9 Surveillance, Epidemiology, and End Results registries were included in this study. Risk of second primary pelvic malignancies (SPPMs) were assessed with death as a competing risk using the Fine-Gray model. Time-varying Cox proportional hazard models were employed to analyze risk to overall mortality based on secondary tumor status. RESULTS A total of 569,167 primary prostate cancers were included in analysis with an average follow-up of 89 months. Among all prostate cancer patients, 4956 SPPMs were identified. After controlling for differences in age, year of diagnosis, and surgery at time of prostate cancer treatment, radiation receipt was associated with a significantly higher incidence of SPPMs (1.1% vs 1.8% at 25 years). Among those who received radiation during initial prostate cancer treatment (n = 195,415), developing an SPPM is significantly associated with worse survival (adjusted hazard ratio = 1.76), especially among younger patients (under age 63, adjusted hazard ratio = 2.36). CONCLUSIONS While developing a secondary malignancy carries a detrimental effect on overall survival, the absolute risk of developing such tumors is exceedingly low regardless of radiation treatment.
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Affiliation(s)
- Elisa K Liu
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York
| | - Thomas B Daniels
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York
| | - Jonathan W Lischalk
- Department of Radiation Oncology, NYU Long Island School of Medicine, Mineola, New York
| | - Cheongeun Oh
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Jonathan A Haas
- Department of Radiation Oncology, NYU Long Island School of Medicine, Mineola, New York
| | - Andrew J Evans
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York
| | - David J Byun
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York
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Abstract
While cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome are well-recognized acute toxicities of chimeric antigen receptor (CAR) T cell therapy, these complications have become increasingly manageable by protocolized treatment algorithms incorporating the early administration of tocilizumab and corticosteroids. As CAR-T cell therapy expands to new disease indications and the number of long-term survivors steadily increases, there is growing recognition of the need to appropriately evaluate and manage the late effects of CAR-T cell therapy, including late-onset or persistent neurotoxicity, prolonged cytopenias, delayed immune reconstitution and infections, subsequent malignancies, organ dysfunction, psychological distress, and fertility implications. In this review, we provide a practical approach to the long-term survivorship care of the CAR-T cell recipient, with a focus on the optimal strategies to address the common and challenging late complications affecting this unique population.
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Affiliation(s)
- Robert Puckrin
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Kareem Jamani
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Victor H Jimenez-Zepeda
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
- Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada
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Farooq MZ, Shafiq MB, Rafi I, Ali S. Limb Salvage Surgery in a Voluminous Malignant Quadriceps Tumor. Cureus 2023; 15:e45717. [PMID: 37868574 PMCID: PMC10590199 DOI: 10.7759/cureus.45717] [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: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
It is uncommon for soft tissue sarcomas to develop after adenocarcinoma of the rectum. In a treated rectal adenocarcinoma patient, we encountered a huge malignant quadriceps tumor as leiomyosarcoma and salvaged the limb. A 49-year-old male known case of treated moderately differentiated adenocarcinoma of the rectum presented in the Orthopedic Clinic with a new swelling in his left thigh. MRI of the left lower limb was obtained, and it demonstrated a large 15.8 x 13.2 x 30 cm well-defined mixed solid cystic lesion in the anterolateral aspect of the left mid-thigh without the involvement of adjacent bony cortex. Limb salvage surgery with wide local excision of the tumor was done. The patient was ambulated full weight from the very next day with a Musculoskeletal Tumor Society Score (MSTS) score of 20. Despite the massive size of the tumor, limb salvage was attempted successfully and achieved good functional status.
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Affiliation(s)
- Muhammad Z Farooq
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad B Shafiq
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Ilyas Rafi
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Sajid Ali
- Paediatric Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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5
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Mishra A, Singh V, Khandelwal Y, Smitha AM, Kavali DJP, Barai S. Incidentally Detected Metachronous Malignancy in Patients of Papillary Carcinoma of Thyroid Posthigh-Dose Radioiodine Therapy. Indian J Nucl Med 2023; 38:264-269. [PMID: 38046960 PMCID: PMC10693376 DOI: 10.4103/ijnm.ijnm_188_22] [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: 11/22/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 12/05/2023] Open
Abstract
Thyroid cancer is one of the most common endocrine cancers. The most common histological subtypes are papillary and follicular variants; these are "differentiated thyroid cancers" and are associated with an excellent prognosis. The exact mechanism of thyroid cancer is not known. Several genetic alterations and environmental factors are found to be associated with this cancer. Patients with differentiated thyroid cancer are treated with postoperative radioactive iodine (RAI) therapy to ablate residual thyroid tissue and metastatic micro-foci. It is thought that after RAI, there is an increased risk of secondary malignancies such as lung, renal, and stomach cancer and lymphomas. However, the risk of secondary malignancy is not clear. They may be associated with genetic syndromes, environmental factors, and radiation exposure. The secondary malignancy may be detected incidentally during follow-up or present with signs and symptoms of that malignancy. There is no direct association between second malignancy and radiation exposure in I-131 therapies. We present a case series of five patients treated with high doses of I-131 for the remnant. The patients developed metachronous malignancies later in life.
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Affiliation(s)
- Ayush Mishra
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Vijay Singh
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Yogita Khandelwal
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | | | - Sukanta Barai
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
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Fu S, Li M, Wang H. BCR-ABL1-positive acute lymphoblastic leukemia following successful treatment of acute promyelocytic leukemia: case report. Front Pharmacol 2023; 14:1141311. [PMID: 37397496 PMCID: PMC10311545 DOI: 10.3389/fphar.2023.1141311] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Acute promyelocytic leukemia (APL) is currently considered a disease with a higher cure rate. And cases of secondary malignant tumors following successful APL treatment are rare. Here we described a rare case of a 29-year-old man who was treated for APL in 2019 and developed BCR-ABL1-positive acute lymphoblastic leukemia 2 years later. The patient responded well to tyrosine kinase inhibitors and chemotherapy, and achieved a molecular remission. Although APL usually has a good prognosis, the prognosis of its secondary malignancies is uncertain. There are no effective measures to prevent the occurrence of secondary tumors. Continuing to increase the monitoring frequency of laboratory tests, especially the molecular biomarkers, is essential for the diagnosis and treatment of secondary malignancies after the patients achieving complete remission.
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Affiliation(s)
- Shuang Fu
- Department of Hematology Laboratory, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mengqi Li
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hongtao Wang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
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Bao A, Barsky AR, Both S, Christodouleas JP, Deville C, Tochner ZA, Vapiwala N, Maxwell R. Case-Matched Outcomes of Proton Beam and Intensity-Modulated Radiation Therapy for Localized Prostate Cancer. Int J Part Ther 2023; 10:1-12. [PMID: 37823012 PMCID: PMC10563661 DOI: 10.14338/ijpt-23-00002.1] [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: 02/06/2023] [Accepted: 03/16/2023] [Indexed: 10/13/2023] Open
Abstract
Purpose Although both intensity-modulated radiation therapy (IMRT) and proton beam therapy (PBT) offer effective long-term disease control for localized prostate cancer (PCa), there are limited data directly comparing the 2 modalities. Methods The data from 334 patients treated with conventionally fractionated (79.2 GyRBE in 44 fractions) PBT or IMRT were retrospectively analyzed. Propensity score matching was used to balance factors associated with biochemical failure-free survival (BFFS). Age, race, and comorbidities (not BFFS associates) remained imbalanced after matching. Univariable and covariate-adjusted multivariable (MVA) Cox regression models were used to determine if modality affected BFFS. Results Of 334 patients, 176 (52.7%) were included in the matched cohort with exact matching to National Comprehensive Cancer Network (NCCN) risk group. With a median follow-up time of 9.0 years (interquartile range [IQR]: 7.8-10.2 years), long-term BFFS was similar between the IMRT and PBT matched arms with 8-year estimates of 85% (95% CI: 76%-91%) and 91% (95% CI: 82%-96%, P = .39), respectively. On MVA, modality was not significantly associated with BFFS in both the unmatched (hazard ratio [HR] = 0.75, 95% CI: 0.35-1.63, P = .47) and matched (HR = 0.87, 95% CI: 0.33-2.33, P = .78) cohorts. Prostate cancer-specific survival (PCSS) and overall survival (OS) were also similar (P > .05). However, in an unmatched analysis, the PBT arm had significantly fewer incidences of secondary cancers within the irradiated field (0.6%, 95% CI: 0.0%-3.1% versus 4.5%, 95% CI: 1.8%-9.0%, P = .028). Conclusions Both PBT and IMRT offer excellent long-term disease control for PCa, with no significant differences between the 2 modalities in BFFS, PCSS, and OS in matched patients. In the unmatched cohort, fewer incidences of secondary malignancy were noted in the PBT group; however, owing to overall low incidence of secondary cancer and imbalanced patient characteristics between the 2 groups, these data are strictly hypothesis generating and require further investigation.
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Affiliation(s)
- Alicia Bao
- Ohio State College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Andrew R. Barsky
- Department of Radiation Oncology, Lynn Cancer Institute, Baptist Health South Florida, Boca Raton, FL, USA
| | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Zelig A. Tochner
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Russell Maxwell
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Spasic M, Zaric D, Mitrovic M, Milojevic S, Nedovic N, Sekulic M, Stojanovic B, Vulovic D, Milosevic B, Milutinovic F, Milosavljevic N. Secondary Breast Malignancy from Renal Cell Carcinoma: Challenges in Diagnosis and Treatment-Case Report. Diagnostics (Basel) 2023; 13:diagnostics13050991. [PMID: 36900135 PMCID: PMC10000768 DOI: 10.3390/diagnostics13050991] [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: 01/30/2023] [Revised: 02/11/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Renal cell carcinoma represents about 2% of all malignant tumours in adults. Metastases of the primary tumour in the breast make up to about 0.5-2% of the cases. Renal cell carcinoma metastases in the breast are extremely rare and have been sporadically recorded in the literature. In this paper, we present the case of a patient with breast metastasis of renal cell carcinoma 11 years after primary treatment. Case presentation: An 82-year-old female who had right nephrectomy due to renal cancer in 2010 felt a lump in her right breast in August 2021, whereby a clinical examination revealed a tumour at the junction of the upper quadrants of her right breast, about 2 cm, movable toward the base, vaguely limited, and with a rough surface. The axillae were without palpable lymph nodes. Mammography showed a circular and relatively clearly contoured lesion in the right breast. Ultrasound showed an oval lobulated lesion of 19 × 18 mm at the upper quadrants, with strong vascularisation and without posterior acoustic phenomena. A core needle biopsy was performed, and the histopathological findings and obtained immunophenotype indicated a metastatic clear cell carcinoma of renal origin. A metastasectomy was performed. Histopathologically, the tumour was without desmoplastic stroma, comprising predominantly solid-type alveolar arrangements of large moderately polymorphic cells, bright and abundant cytoplasm, and round vesicular cores with focally prominent nuclei. Immunohistochemically, tumour cells were diffusely positive for CD10, EMA, and vimentin, and negative for CK7, TTF-1, renal cell antigen, and E-cadherin. With a normal postoperative course, the patient was discharged on the third postoperative day. After 17 months, there were no new signs of the underlying disease spreading at regular follow-ups. Conclusion: Metastatic involvement of the breast is relatively rare and should be suspected in patients with a prior history of other cancers. Core needle biopsy and pathohistological analysis are required for the diagnosis of breast tumours.
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Affiliation(s)
- Marko Spasic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Clinic for General Surgery, University Clinical Centre, 34000 Kragujevac, Serbia
| | - Dusan Zaric
- Clinic for Urology, Clinical Hospital Centre “Dragisa Misovic”, 11000 Belgrade, Serbia
| | - Minja Mitrovic
- Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Sanja Milojevic
- Centre for Radiology, University Clinical Centre, 34000 Kragujevac, Serbia
| | - Nikola Nedovic
- Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Marija Sekulic
- Department of Hygiene and Ecology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Bojan Stojanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Clinic for General Surgery, University Clinical Centre, 34000 Kragujevac, Serbia
| | - Dejan Vulovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Centre for Plastic Surgery, University Clinical Centre, 34000 Kragujevac, Serbia
| | - Bojan Milosevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Clinic for General Surgery, University Clinical Centre, 34000 Kragujevac, Serbia
- Correspondence:
| | - Filip Milutinovic
- Clinic for Urology, University Clinical Centre, 34000 Kragujevac, Serbia
| | - Neda Milosavljevic
- Centre for Radiation Oncology, University Clinical Centre, 34000 Kragujevac, Serbia
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Czogała M, Czogała W, Pawińska-Wąsikowska K, Książek T, Bukowska-Strakova K, Sikorska-Fic B, Łaguna P, Skalska-Sadowska J, Wachowiak J, Rodziewicz-Konarska A, Moj-Hackemer M, Kałwak K, Muszyńska-Rosłan K, Krawczuk-Rybak M, Fałkowska A, Drabko K, Kozłowska M, Irga-Jaworska N, Bobeff K, Młynarski W, Tomaszewska R, Szczepański T, Chodała-Grzywacz A, Karolczyk G, Mycko K, Badowska W, Zielezińska K, Urasiński T, Bartoszewicz N, Styczyński J, Balwierz W, Skoczeń S. Pediatric Acute Myeloid Leukemia Post Cytotoxic Therapy-Retrospective Analysis of the Patients Treated in Poland from 2005 to 2022. Cancers (Basel) 2023; 15. [PMID: 36765692 DOI: 10.3390/cancers15030734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Acute P./myeloid leukemia post cytotoxic therapy (AML-pCT) is rare complication of cancer treatment in childhood. The objective of the study was to identify clinical characteristics and provide an analysis of the outcomes in pediatric AML-pCT. We retrospectively analyzed the data of 40 children with AML-pCT, treated from 2005 to 2020 within the Polish Pediatric Leukemia and Lymphoma Study Group. The most common primary malignancies were acute lymphoblastic leukemia (32.5%) and brain tumors (20%). The median latency period was 2.9 years (range: 0.7-12.9). Probabilities of overall (OS), event-free (EFS), and relapse-free survival (RFS) in the whole cohort were 0.49 ± 0.08, 0.43 ± 0.08, and 0.64 ± 0.10, respectively. Significant improvements in outcomes were observed in patients treated from 2015-2022 (two induction cycles followed by stem cell transplantation-SCT in 69% of patients) compared to 2005-2014 (four induction cycles followed by SCT in 49% of patients). The probability of EFS increased from 0.30 ± 0.10 to 0.67 ± 0.12 (p = 0.07) and RFS increased from 0.46 ± 0.11 to 1.0 (p = 0.01). The poorest outcome (OS and EFS 0.25 ± 0.20) was in AML post brain tumor, mainly due to deaths from toxicities. To conclude, treatment results achieved in patients with AML-pCT treated from 2015-2022, with two induction cycles followed by immediate SCT, were better than those reported by other authors, and comparable to the results in de novo AML.
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White D, Sadough Shahmirzadi M, Boulmay B. Multi-Phenotypic Breast Cancer Post-Radiotherapy for Hodgkin Lymphoma: A Case of Secondary Malignancy. J Investig Med High Impact Case Rep 2023; 11:23247096231188251. [PMID: 37480256 PMCID: PMC10363863 DOI: 10.1177/23247096231188251] [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: 05/26/2023] [Revised: 06/14/2023] [Accepted: 06/29/2023] [Indexed: 07/23/2023] Open
Abstract
Morbidity and mortality associated with radiation-induced secondary malignancies (RISMs) have shifted treatment paradigms to minimize or eliminate radiation from treatment regimens. In this case, a 48-year-old woman was diagnosed with Hodgkin lymphoma (HL) and treated with radiotherapy in 2000. In 2018, she was diagnosed with ductal carcinoma in situ (DCIS) of the right breast and treated with a mastectomy. Soon after, she developed triple-negative invasive ductal carcinoma (IDC) in her reconstructed breast. The patient underwent a left lumpectomy, and pathology showed ER-/PR-/HER2+ IDC. This patient's multi-phenotypic DCIS and IDC presentation are suspected to be RISM due to her previous HL treatment regimen.
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Affiliation(s)
- Donnell White
- Louisiana State University Health Sciences Center New Orleans, USA
| | | | - Brian Boulmay
- Louisiana State University Health Sciences Center New Orleans, USA
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11
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Muacevic A, Adler JR, Wasson A, Farmand F. Incidental Splenic Marginal Zone Lymphoma With Extreme Macrocytosis After Hydroxyurea Use: A Case Report. Cureus 2023; 15:e33462. [PMID: 36751210 PMCID: PMC9899520 DOI: 10.7759/cureus.33462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/07/2023] Open
Abstract
Splenic marginal zone lymphoma (SMZL) is a low-grade mature B-cell lymphoma that typically presents in the form of splenomegaly and lymphocytosis. The diagnosis is traditionally made through splenic histology, the presence of circulating villous lymphocytes, or bone marrow biopsy. Its treatment can be in the form of chemotherapy, such as rituximab, or active surveillance. This case presentation discusses a 76-year-old female with a long history of hydroxyurea use for an unknown reason presenting with atypical symptoms requiring bone marrow biopsy to diagnose SMZL. This unique case demonstrates the importance of further research and studies into atypical SMZL presentations and hydroxyurea's potential in precipitating secondary malignancies.
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Zöllner SK, Kauertz KL, Kaiser I, Kerkhoff M, Schaefer C, Tassius M, Jabar S, Jürgens H, Ladenstein R, Kühne T, Haveman LM, Paulussen M, Ranft A, Dirksen U. Ewing Sarcoma as Secondary Malignant Neoplasm-Epidemiological and Clinical Analysis of an International Trial Registry. Cancers (Basel) 2022; 14. [PMID: 36497417 DOI: 10.3390/cancers14235935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/17/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Ewing sarcoma (EwS) is the second most common bone and soft tissue tumor, affecting primarily adolescents and young adults. Patients with secondary EwS are excluded from risk stratification in several studies and therefore do not benefit from new therapies. More knowledge about patients with EwS as secondary malignant neoplasms (SMN) is needed to identify at-risk patients and adapt follow-up strategies. Epidemiology, clinical characteristics, and survival analyses of EwS as SMN were analyzed in 3844 patients treated in the last three consecutive international EwS trials, EICESS 92, Euro-E.W.I.N.G. 99, and EWING 2008. Forty-two cases of EwS as SMN (approximately 1.1% of all patients) were reported, preceded by a heterogeneous group of malignancies, mainly acute lymphoblastic leukemias (n = 7) and lymphomas (n = 7). Three cases of EwS as SMN occurred in the presumed radiation field of the primary tumor. The median age at diagnosis of EwS as SMN was 19.4 years (range, 5.9-72) compared with 10.8 years (range, 0.9-51.2) for primary EwS. The median interval between first malignancy and EwS diagnosis was 7.4 years. The 3-year overall survival (OS)/event-free survival (EFS) was 0.69 (SE = 0.09)/0.53 (SE = 0.10) for localized patients and 0.36 (SE = 0.13)/0.29 (SE = 0.12) for metastatic patients (OS: p = 0.02; EFS: p = 0.03). Survival in patients with EwS as SMN did not differ between hematologic or solid primary malignancies. EwS as SMN is rare; however, survival is similar to that of primary EwS, and its risk-adjusted treatment should be curative, especially in localized patients.
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13
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Kaiser I, Kauertz K, Zöllner SK, Hartmann W, Langer T, Jürgens H, Ranft A, Dirksen U. Secondary Malignancies after Ewing Sarcoma-Epidemiological and Clinical Analysis of an International Trial Registry. Cancers (Basel) 2022; 14:cancers14235920. [PMID: 36497401 PMCID: PMC9740851 DOI: 10.3390/cancers14235920] [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: 09/28/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022] Open
Abstract
Ewing sarcoma (EwS) represents highly aggressive bone and soft tissue tumors that require intensive treatment by multi-chemotherapy, surgery and/or radiotherapy. While therapeutic regimens have increased survival rates, EwS survivors face long-term sequelae that include secondary malignant neoplasms (SMNs). Consequently, more knowledge about EwS patients who develop SMNs is needed to identify high-risk patients and adjust follow-up strategies. We retrospectively analyzed data from 4518 EwS patients treated in five consecutive EwS trials from the Cooperative Ewing Sarcoma Study (CESS) group. Ninety-six patients developed SMNs after primary EwS, including 53 (55.2%) with solid tumors. The latency period between EwS and the first SMN was significantly longer for the development of solid SMNs (median: 8.4 years) than for hematologic SMNs (median: 2.4 years) (p < 0.001). The cumulative incidence (CI) of SMNs in general increased over time from 0.04 at 10 years to 0.14 at 30 years; notably, the specific CI for hematologic SMNs remained stable over the different decades, whereas for solid SMNs it gradually increased over time and was higher for metastatic patients than in localized EwS patients (20 years: 0.14 vs. 0.06; p < 0.01). The clinical characteristics of primary EwS did not differ between patients with or without SMNs. All EwS patients received multi-chemotherapy with adjuvant radiotherapy in 77 of 96 (80.2%) patients, and the use of radiation doses ≥ 60 Gy correlated with the occurrence of SMNs. The survival rate after SMNs was 0.49, with a significantly better outcome for solid SMNs compared with hematologic SMNs (3 years: 0.70 vs. 0.24, respectively; p < 0.001). The occurrence of SMNs after EwS remains a rare event but requires a structured follow-up system because it is associated with high morbidity and mortality.
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Affiliation(s)
- Isabelle Kaiser
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
| | - Katja Kauertz
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
| | - Stefan K. Zöllner
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
| | - Wolfgang Hartmann
- Gerhard Domagk Institute for Pathology, University Hospital Muenster, 48149 Muenster, Germany
| | - Thorsten Langer
- Pediatric Hematology and Oncology, LESS Group, University Medical Center Schleswig-Holstein, 23538 Luebeck, Germany
| | - Heribert Jürgens
- Pediatric Hematology and Oncology, University Children’s Hospital Münster, 48149 Münster, Germany
| | - Andreas Ranft
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
| | - Uta Dirksen
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Correspondence:
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14
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Kósa F, Nečasová T, Špaček M, Giannopoulos K, Hus I, Jurková T, Koriťáková E, Chrápavá M, Nováčková M, Katinová I, Krejčí D, Jujka A, Mátrai Z, Vályi‐Nagy I, Robak T, Doubek M. Secondary malignancies and survival of FCR-treated patients with chronic lymphocytic leukemia in Central Europe. Cancer Med 2022; 12:1961-1971. [PMID: 36205198 PMCID: PMC9883578 DOI: 10.1002/cam4.5033] [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: 01/25/2022] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 02/02/2023] Open
Abstract
This is the first large-scale cross-country analysis of patients with chronic lymphocytic leukemia (CLL) aimed to evaluate the incidence, types, and key prognostic factors of secondary malignancies, and to assess the impact on overall survival based on retrospective claims data from three Central European countries. We analyzed 25,814 newly diagnosed CLL patients from Czechia, Hungary, and Poland; 10,312 (39.9%) patients were treated for CLL in study periods between 2004 and 2016. Out of the treated patients, 1986 (19.3%) received the FCR therapy in the first line and 779 (7.6%) received FCR in subsequent lines. We observed that 33.7% of treated patients developed secondary malignancies during the study. Based on country estimates, the probability to develop a secondary malignancy within 4 years since starting the first-line FCR therapy ranged between 28.0% and 36.8%. We found the age at diagnosis, male gender, any malignancy prior to the CLL diagnosis, and the CLL treatment to be the key risk factors for developing secondary malignancies. Specifically, the FCR therapy was a statistically significant (p < 0.001) prognostic factor for risk increase with the hazard ratio between 1.46 and 1.60. Across the three Central European countries, we observed consistent results indicating FCR increased the risk of secondary malignancies in CLL patients. We conclude that secondary malignancies are clearly an undervalued burden for CLL patients, caregivers, and the healthcare system. When evaluating new therapies in regulatory and reimbursement decision making, the factor of secondary malignancies deserves deeper considerations.
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Affiliation(s)
| | | | - Martin Špaček
- General University Hospital in PraguePragueCzech Republic
| | | | - Iwona Hus
- Medical University of Lublin, Department of Clinical TransplantologyMedical University of LublinLublinPoland,Instutute of Hematology and Transfusion MedicineWarsawPoland
| | - Tereza Jurková
- Institute of Biostatics and Analysis Ltd.BrnoCzech Republic
| | - Eva Koriťáková
- Institute of Biostatics and Analysis Ltd.BrnoCzech Republic
| | | | | | - Ivana Katinová
- Institute of Biostatistics and Analyses of the Faculty of MedicineBrnoCzech Republic
| | - Denisa Krejčí
- Institute of Biostatistics and Analyses of the Faculty of MedicineBrnoCzech Republic
| | | | - Zoltán Mátrai
- 1st Department of Internal Medicine – HaematologyUnited St István and St László HospitalBudapestHungary
| | - István Vályi‐Nagy
- 1st Department of Internal Medicine – HaematologyUnited St István and St László HospitalBudapestHungary
| | - Tadeusz Robak
- Department of HematologyMedical University of LodzLodzPoland
| | - Michael Doubek
- University Hospital Brno and CEITEC Masaryk UniversityBrnoCzech Republic
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15
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Wang X, Ding D, Liu Y. Acute myeloid leukemia secondary to acute B lymphoblastic leukemia treated with maintenance therapy in a child: A case report. Cancer Rep (Hoboken) 2022; 5:e1717. [PMID: 36164709 PMCID: PMC9675377 DOI: 10.1002/cnr2.1717] [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: 06/22/2022] [Revised: 08/06/2022] [Accepted: 09/07/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) has the highest incidence among childhood hematologic cancers. Exposure to certain cytotoxic therapies for ALL is correlated with a higher risk of secondary malignancies. CASE We report a rare case of a 6-year-old girl being diagnosed with secondary acute myeloid leukemia (AML) during her maintenance phase of treatment for ALL with TEL-AML1 fusion gene, approximately 17 months after the primary diagnosis. CONCLUSION This case indicates that we should recognize the increased risk of secondary AML for pediatric ALL patients with TEL-AML1 fusion gene if multiple alkylating drugs and inhibitors for topoisomerase II are included in induction chemotherapy.
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Affiliation(s)
- Xiaoning Wang
- Department of HematologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anPeople's Republic of China
| | - Ding Ding
- Department of PediatricThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anPeople's Republic of China
| | - Yalin Liu
- Department of HematologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anPeople's Republic of China
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16
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Parsons MW, Rock C, Chipman JJ, Shah HR, Hu B, Stephens DM, Tao R, Tward JD, Gaffney DK. Secondary malignancies in non-Hodgkin lymphoma survivors: 40 years of follow-up assessed by treatment modality. Cancer Med 2022; 12:2624-2636. [PMID: 36812123 PMCID: PMC9939160 DOI: 10.1002/cam4.5139] [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: 11/17/2021] [Revised: 05/02/2022] [Accepted: 07/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Survivors of non-Hodgkin lymphoma (NHL) have increased secondary malignancy (SM) risk. We quantified this risk by patient and treatment factors. METHODS Standardized incidence ratios (SIR, observed-to-expected [O/E] ratio) were assessed in 142,637 NHL patients diagnosed from 1975 to 2016 in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Comparisons were made between subgroups in terms of their SIRs relative to respective endemic populations. RESULTS In total, 15,979 patients developed SM, more than the endemic rate (O/E 1.29; p < 0.05). Compared with white patients, relative to respective endemic populations, ethnic minorities had a higher risk of SM (white O/E 1.27, 95% CI 1.25-1.29; black O/E 1.40, 95% CI 1.31-1.48; other O/E 1.59, 95% CI 1.49-1.70). Relative to respective endemic populations, patients who received radiotherapy had similar SM rates to those who did not (O/E 1.29 each), but irradiated patients had increased breast cancer (p < 0.05). Patients who received chemotherapy had higher SM rates than those who did not (O/E 1.33 vs. 1.24, p < 0.05) including more leukemia, Kaposi sarcoma, kidney, pancreas, rectal, head and neck, and colon cancers (p < 0.05). CONCLUSIONS This is the largest study to examine SM risk in NHL patients with the longest follow-up. Treatment with radiotherapy did not increase overall SM risk, while chemotherapy was associated with a higher overall risk. However, certain subsites were associated with a higher risk of SM, and they varied by treatment, age group, race and time since treatment. These findings are helpful for informing screening and long-term follow-up in NHL survivors.
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Affiliation(s)
- Matthew W. Parsons
- Department of Radiation OncologyHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Calvin Rock
- Department of Radiation OncologyHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Jonathan J. Chipman
- Cancer BiostatisticsHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA,Division of Biostatistics, Department of Population Health SciencesUniversity of UtahSalt Lake CityUtahUSA
| | - Harsh R. Shah
- Division of Hematology/Hematologic MalignanciesHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Boyu Hu
- Division of Hematology/Hematologic MalignanciesHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Deborah M. Stephens
- Division of Hematology/Hematologic MalignanciesHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Randa Tao
- Department of Radiation OncologyHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Jonathan D. Tward
- Department of Radiation OncologyHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - David K. Gaffney
- Department of Radiation OncologyHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
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17
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Braide K, Kindblom J, Thellenberg Karlsson C, Stattin P, Hugosson J, Månsson M. Risk of severe late toxicity after radiotherapy following radical prostatectomy - a nationwide study. BJU Int 2022; 130:799-808. [PMID: 35523728 DOI: 10.1111/bju.15769] [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: 11/29/2022]
Abstract
BACKGROUND Severe side-effects are rare but may occur years after radiation therapy following radical prostatectomy. We sought to estimate the long-term risks of severe late toxicities in an unselected, nationwide, cohort. METHODS The study population comprised all men undergoing radical prostatectomy between 1997-2016 in the Prostate Cancer database Sweden (PCBaSe) (n=40,962). By (1:2) matching, two cohorts were created: 2789 men exposed to postoperative radiation and 5578 nonexposed men with comparable age, comorbidities and year of surgery. Cumulative incidences and rate ratios were calculated for the following outcomes: symptoms and interventions of the urinary or intestinal tract demanding inpatient care, secondary malignancies and non-prostate cancer mortality. RESULTS The largest differences were seen for late toxicities affecting the urinary tract. The 10-year cumulative incidences among those exposed to postoperative radiation versus the surgery only group were: 17.8% versus 10.5% for procedures of the urinary tract (difference 7.3%, 95% confidence interval [CI] 4.4 to 10.3; relative risk [RR] 1.74, 95% CI 1.47 to 2.05); 6.0% versus 1.2% for hematuria (difference 4.8%, 95% CI 3.1 to 6.5; RR 6.50 95% CI 4.31 to 10.10); and 2.4% versus 1.1% for bladder cancer (difference 1.4%, 95% CI 0.4 to 2.3; RR 2.71 95% CI 1.72 to 4.33). The groups were similar regarding intestinal toxicity, other secondary malignancies, and non-prostate cancer mortality. Adjustments for preoperative tumor risk factors did not importantly affect the rate ratios. CONCLUSION Severe late toxicity after postoperative radiation following radical prostatectomy predominately affects the bladder and can appear many years after radiotherapy.
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Affiliation(s)
- Karin Braide
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Sweden.,Department of Oncology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden
| | - Jon Kindblom
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden.,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Sweden
| | | | - Pär Stattin
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, 751 85, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Sweden.,Department of Urology, Sahlgrenska University Hospital, Gothenburg, 413 45, Sweden
| | - Marianne Månsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Sweden
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Tsukamoto S, Righi A, Kido A, Honoki K, Tanaka Y, Fujii H, Mavrogenis AF, Tanaka Y, Errani C. Effect of adjuvant chemotherapy on periosteal osteosarcoma: a systematic review. Jpn J Clin Oncol 2022; 52:896-904. [PMID: 35485208 DOI: 10.1093/jjco/hyac059] [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: 12/16/2021] [Accepted: 04/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The effects of adjuvant chemotherapy on periosteal osteosarcoma are controversial. Therefore, we conducted a systematic review of studies comparing mortality, local recurrence, distant metastasis and secondary malignancy incidence among patients who underwent surgery and (neo-) adjuvant chemotherapy or surgery alone for periosteal osteosarcoma without distant metastases at diagnosis. METHODS Of the 210 studies identified in the search, 13 were included in this study, involving 291 patients with periosteal osteosarcoma in total. RESULTS The mortality rates in the surgery and (neo-) adjuvant chemotherapy and surgery alone groups were 11.3% (8/71) and 16.3% (16/98), respectively. The overall pooled odds ratio was 0.89 (P = 0.800). The local recurrence rate in the surgery and (neo-) adjuvant chemotherapy group was 12.1% (8/66), while that in the surgery alone group was 17.6% (13/74). The overall pooled odds ratio was 1.31 (P = 0.601). The distant metastasis rate in the surgery and (neo-) adjuvant chemotherapy group was 15.2% (10/66) and that in the surgery alone group was 10.8% (8/74). The overall pooled odds ratio was 1.51 (P = 0.444). The incidence of secondary malignancy in the surgery and (neo-) adjuvant chemotherapy group was 7.6% (9/118) and that in the surgery alone group was 2.7% (2/74). The overall pooled odds ratio was 2.29 (P = 0.187). CONCLUSIONS Adjuvant chemotherapy did not appear to improve the prognosis of patients with periosteal osteosarcoma. No association was found between the use of adjuvant chemotherapy and development of secondary malignancies.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, Nara, Japan
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Yuu Tanaka
- Department of Rehabilitation Medicine, Wakayama Professional University of Rehabilitation, Wakayama, Japan
| | - Hiromasa Fujii
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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19
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Bosma SE, van der Heijden L, Sierrasesúmaga L, Merks HJHM, Haveman LM, van de Sande MAJ, San-Julián M. What Do We Know about Survival in Skeletally Premature Children Aged 0 to 10 Years with Ewing Sarcoma? A Multicenter 10-Year Follow-Up Study in 60 Patients. Cancers (Basel) 2022; 14:cancers14061456. [PMID: 35326609 PMCID: PMC8946787 DOI: 10.3390/cancers14061456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/26/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Younger age has been associated with better overall survival (OS) in Ewing sarcoma (ES), especially under the age of 10. The favorable survival in younger patients underlines the need for minimizing treatment burden and late sequelae. Our study aimed at describing clinical characteristics, treatment and outcome of a cohort of ES patients aged 0−10. (2) Methods: In this retrospective multicenter study, all consecutive ES patients aged 0−10, treated in four sarcoma centers in the Netherlands (n = 33) and one in Spain (n = 27) between 1982 and 2008, with a minimum follow-up of 10 years, were included. OS, local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) were calculated. Potential factors of influence on OS (risk and protective factors) were analyzed. (3) Results: 60 patients with median follow-up 13.03 years were included. All patients were treated with chemotherapy in combination with local treatment, being surgery alone in 30 (50%) patients, radiotherapy (RT) alone in 12 (20%) patients or surgery plus RT in 18 (30%) patients (12 pre- and 6 postoperative). Limb salvage was achieved in 93% of patients. The 10-OS, -LRFS and -DMFS are 81% (95% CI: 71−91%), 89% (95% CI: 85−93%) and 81% (95% CI: 71−91%), respectively. Six patients developed LR, of which two developed subsequent DM; all had axial ES (pelvis, spine or chest wall), and these patients all died. Ten patients developed DM; eight died due to progressive disease, and two are currently in remission, both with pulmonary metastasis only. Negative or wide resection margin was significantly associated with better OS. Age < 6 years, tumor volume < 200 mL, absence of metastatic disease and treatment after 2000 showed trends towards better OS. Two patients developed secondary malignancy; both had chemotherapy combined with definitive RT for local treatment. (4) Conclusions: Overall survival of these youngest patients with ES was very good. Limb salvage surgery was achieved in >90% of patients. Wide resection margin was the only factor significantly associated with better survival.
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Affiliation(s)
- Sarah E. Bosma
- Department of Orthopedic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (S.E.B.); (L.v.d.H.)
| | - Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (S.E.B.); (L.v.d.H.)
| | - Luis Sierrasesúmaga
- Department of Pediatrics, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
| | - Hans J. H. M. Merks
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.M.M.); (L.M.H.)
| | - Lianne M. Haveman
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (H.J.H.M.M.); (L.M.H.)
| | - Michiel A. J. van de Sande
- Department of Orthopedic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (S.E.B.); (L.v.d.H.)
- Correspondence: ; Tel.: +31-71-526-3606
| | - Mikel San-Julián
- Department of Orthopedic Surgery and Traumatology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
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20
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Çetin M, Katipoglu K, Türk İ, Özkara Ş, Kosemehmetoglu K, Bıçakçıoğlu P. Endobronchial Primary Pulmonary Angiomatoid Fibrous Histiocytoma in a Patient with Testicular Germ Cell Tumor: An Evidence Against Somatic Transformation. Int J Surg Pathol 2022; 30:662-667. [PMID: 35118896 DOI: 10.1177/10668969221076548] [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: 11/15/2022]
Abstract
Primary Pulmonary Angiomatoid Fibrous Histiocytoma is a recently described soft tissue tumor with challenging differential diagnosis both clinically and pathologically due to its rarity in this location. It may also occur as a secondary malignancy and its occurrence either as a somatic malignancy arising in the germ cell tumor or as a secondary malignancy after chemotherapy is questionable. In this report, we present a 29-year-old male patient with a mass in the lower lobe of the left lung, who underwent orchiectomy and received adjuvant chemotherapy due to a mixed germ cell tumor 8 years ago. Morphology, immunophenotype, and molecular findings were consistent with the diagnosis of primary pulmonary angiomatoid fibrous histiocytoma. Fluorescent in situ hybridization was unable to demonstrate the presence of 12p amplification or isochromosome 12p, which is known as the key event in the development of testicular germ cell neoplasia even present in somatic malignancies arising in germ cell tumors. Our results support that angiomatoid fibrous histiocytoma arising as a secondary malignancy does not represent the somatic transformation of germ cell tumors.
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Affiliation(s)
- Mehmet Çetin
- 598724Department of Thoracic Surgery, Omer Halisdemir University Training and Research Hospital, Niğde, Turkey
| | - Kubra Katipoglu
- 536164Department of Pathology, Ankara City Hospital, Ankara, Turkey
| | - İlteriş Türk
- 146990Department of Thoracic Surgery, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Şeref Özkara
- 146990Department of Chest Diseases and Tuberculosis, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | | | - Pınar Bıçakçıoğlu
- 146990Department of Thoracic Surgery, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
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Abstract
Metastases to the thyroid gland, while rarely seen in clinical practice, can pose a diagnostic and therapeutic challenge. Most commonly, they originate from lung, renal, and breast cancer, and are generally a sign of multiorgan metastatic disease. In most cases, metastases to the thyroid gland are diagnosed incidentally on imaging studies, since they are rarely symptomatic and often do not influence thyroid function tests. Thyroid ultrasonography and fine-needle aspiration biopsy play a pivotal role in their evaluation, as both classic immunocytochemical features, and more novel molecular markers can help in the differential diagnosis. Prognosis mainly depends on the biology of the primary tumor and its extension. Communication between clinicians is essential in such patients, in order to ensure that the treatment options are carefully balanced, thus raising the need for multidisciplinary teams in their management.
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Affiliation(s)
| | | | - Teodor Dumitraș
- Department of Endocrinology, Elias University Emergency Hospital, Bucharest, Romania
| | - Carmen Sorina Martin
- Department of Endocrinology, Elias University Emergency Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Simona Fica
- Department of Endocrinology, Elias University Emergency Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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22
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Lewis L, Kreinbrink P, Richardson M, Westerfield M, Doberstein M, Zhang Y, Redmond K, Takiar V. Intensity Modulated Proton Therapy Better Spares Non-Adjacent Organs and Reduces the Risk of Secondary Malignant Neoplasms in the Treatment of Sinonasal Cancers. Med Dosim 2021; 47:117-122. [PMID: 34952761 DOI: 10.1016/j.meddos.2021.11.002] [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: 05/28/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
This study compare dosimetric parameters and secondary malignancy risk (SMN) using intensity modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) plans for the treatment of sinonasal cancer (SC). After IRB-approval, 10 patients previously treated with IMPT for cancers of the ethmoid, sphenoid, maxillary, or frontal sinuses were identified. Dosimetrists blinded to the IMPT plans generated VMAT plans for comparison. Volume coverage and dose to organs at risk (OAR) were recorded and compared. Organ equivalent dose (OED) of tissues outside of the treatment volume was used to define the excess absolute and relative risk of SMNs. In all cases, both VMAT and IMPT provided acceptable target volume coverage and were able to meet OAR constraints. IMPT was superior for brain V10, V30, and mean, brainstem D0.01 ipsilateral cochlea V30, contralateral cochlea mean, contralateral lacrimal gland mean, contralateral parotid mean, spinal cord D0.01 and body outside of the CTV V10, V20, and V30. VMAT was superior for ipsilateral eye mean, ipsilateral lens mean, CTV V100 and maximum hotspot. The relative risk of SMNs with VMAT compared to IMPT is 3.35 (95% CI, 1.92-5.89). For the treatment of SC, IMPT spares OARs that are not immediately adjacent to the treatment volume and reduces the risk of SMNs when compared to VMAT. VMAT spares OARs abutting the target volume better than IMPT and has more homogenous target coverage. Tumors of the ethmoid sinus, benefit more from IMPT, while tumors located elsewhere require application of our findings on a case by case basis.
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Affiliation(s)
- Luke Lewis
- University of Cincinnati, Department of Radiation Oncology, Barrett Cancer Center, ML 0757, 234 Goodman Street, Cincinnati, Ohio 45219, USA
| | - Paul Kreinbrink
- University of Cincinnati, Department of Radiation Oncology, Barrett Cancer Center, ML 0757, 234 Goodman Street, Cincinnati, Ohio 45219, USA
| | - Max Richardson
- University of Cincinnati, Department of Radiation Oncology, Barrett Cancer Center, ML 0757, 234 Goodman Street, Cincinnati, Ohio 45219, USA
| | - Morgan Westerfield
- University of Cincinnati, Department of Radiation Oncology, Barrett Cancer Center, ML 0757, 234 Goodman Street, Cincinnati, Ohio 45219, USA
| | - Madeline Doberstein
- University of Cincinnati, Department of Radiation Oncology, Barrett Cancer Center, ML 0757, 234 Goodman Street, Cincinnati, Ohio 45219, USA
| | - Yongbin Zhang
- University of Cincinnati, Department of Radiation Oncology, Barrett Cancer Center, ML 0757, 234 Goodman Street, Cincinnati, Ohio 45219, USA
| | - Kevin Redmond
- University of Cincinnati, Department of Radiation Oncology, Barrett Cancer Center, ML 0757, 234 Goodman Street, Cincinnati, Ohio 45219, USA
| | - Vinita Takiar
- University of Cincinnati, Department of Radiation Oncology, Barrett Cancer Center, ML 0757, 234 Goodman Street, Cincinnati, Ohio 45219, USA; Cincinnati VA Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA.
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23
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Berthold F, Rosswog C, Christiansen H, Frühwald M, Hemstedt N, Klingebiel T, Fröhlich B, Schilling FH, Schmid I, Simon T, Hero B, Fischer M, Ernst A. Clinical and molecular characterization of patients with stage 4(M) neuroblastoma aged less than 18 months without MYCN amplification. Pediatr Blood Cancer 2021; 68:e29038. [PMID: 33826231 DOI: 10.1002/pbc.29038] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/23/2021] [Accepted: 03/13/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The survival of children with stage 4(M) neuroblastoma without MYCN amplification and below the age of 18 months is considered better than the still dismal outcome of older high-risk neuroblastoma patients. This study analyzes the impact of clinical and molecular characteristics on the long-term outcome. PATIENTS AND METHODS Clinical presentation, survival, and recurrence patterns of patients enrolled onto trials NB90, NB97, and NB2004 were retrospectively analyzed. Gene expression signatures based on RNA microarrays (TH10) were investigated if tumor material was available. RESULTS Between 1990 and 2015, 177 patients with stage 4(M) MYCN nonamplified neuroblastoma aged less than 18 months at diagnosis were eligible. After a median follow-up of 9.7 years (IQR 5.0, 13.4), the proportions of 10-year event-free survival (EFS) and overall survival (OS) were 73% (95% confidence interval [CI] 67-79%) and 86% (95% CI 80-92%), respectively. Of the 27 neuroblastoma recurrences, 44% occurred in more than one site. Four additional patients presented histologically mature ganglioneuroma at recurrence. Six patients developed a secondary malignancy. The secondary 5-year EFS and OS of the 27 patients with neuroblastoma recurrence were 44% and 59%, respectively. TH10 gene expression signature was not prognostically predictive in the investigated subcohort. CONCLUSION The outcome of patients with stage 4(M) neuroblastoma aged less than 18 months is favorable when treated with high-risk or otherwise intensive therapy. The development of secondary malignancies and the potential of maturation to ganglioneuroma call for a controlled stepwise reduction of treatment intensity.
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Affiliation(s)
- Frank Berthold
- Department of Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
| | - Carolina Rosswog
- Department of Experimental Pediatric Oncology, University of Cologne, Cologne, Germany.,Center for Molecular Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Holger Christiansen
- Department of Pediatric Oncology and Hematology, University of Leipzig, Leipzig, Germany
| | - Michael Frühwald
- Swabian Children's Cancer Center, Children's Hospital, University Hospital Augsburg, Augsburg, Germany
| | - Nadine Hemstedt
- Department of Experimental Pediatric Oncology, University of Cologne, Cologne, Germany.,Center for Molecular Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Thomas Klingebiel
- Department of Children and Adolescents, University Hospital, Goethe University Frankfurt (Main), Frankfurt, Germany
| | - Birgit Fröhlich
- Department of Pediatric Oncology and Hematology, University of Munster, Munster, Germany
| | - Freimut H Schilling
- Department of Pediatric Oncology and Hematology, Olgahospital Stuttgart, Stuttgart, Germany
| | - Irene Schmid
- Department of Pediatric Hematology and Oncology and Hematology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Thorsten Simon
- Department of Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
| | - Barbara Hero
- Department of Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
| | - Matthias Fischer
- Department of Experimental Pediatric Oncology, University of Cologne, Cologne, Germany.,Center for Molecular Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Angela Ernst
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
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Yan J, Cui F, Zhao S. Small lymphocytic lymphoma secondary to young patient with a history of classical Hodgkin Lymphoma. Int J Lab Hematol 2021; 44:31-33. [PMID: 34216429 DOI: 10.1111/ijlh.13642] [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: 01/30/2021] [Revised: 05/11/2021] [Accepted: 06/04/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Jiaqi Yan
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Futao Cui
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Sha Zhao
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
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25
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Lynch KT, Kane WJ, Fleming MA, Desai RP, Showalter SL, Slingluff CL, Levin DE, Hedrick TL. Childhood cancer survivors face markedly worse overall survival after diagnosis with breast cancer, melanoma, or colorectal cancer. J Surg Oncol 2021; 124:16-24. [PMID: 33788957 DOI: 10.1002/jso.26478] [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: 03/10/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Childhood cancer survivors (CCS) are at elevated risk of secondary malignancies (SM). Enhanced screening for SM is recommended, but compliance is poor. We hypothesized that CCS with adult-onset SM (colorectal cancer [CRC], melanoma, or breast cancer [BC]) would present with more advanced disease and have decreased overall survival (OS). METHODS The Surveillance, Epidemiology, and End Results Program was queried for patients diagnosed with cancer at age less than or equal to 18 also diagnosed with adult-onset CRC, melanoma, or BC. A cohort without a history of prior malignancy was likewise identified. Tumor features and clinical outcomes were compared. RESULTS CCS with a SM (n = 224) were compared with patients without a childhood cancer history (n = 1,392,670). CCS were diagnosed younger (BC = 37.6 vs. 61.3, p < 0.01, CRC = 35.0 vs. 67.1, p < 0.01, melanoma = 29.6 vs. 61.3 years old, p < 0.01). CCS with BC were more likely to have Stage III or IV disease (25.2% vs. 16.5%, p = 0.01). Hormone-receptor expression also differed; CCS were less likely to develop Luminal A-type tumors (48.6% vs. 66.9%, p = 0.01). After age-adjustment, CCS had worse OS (Hazard ratio: CRC = 2.449, p < 0.01, melanoma = 6.503, p < 0.01, BC = 3.383, p < 0.01). CONCLUSION CCS were younger when diagnosed with a SM. After age-adjustment, OS was diminished. Heightened surveillance may be necessary for CCS diagnosed with SM.
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Affiliation(s)
- Kevin T Lynch
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - William J Kane
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark A Fleming
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Raj P Desai
- Department of Public Health Sciences, University of Virginia Cancer Center, Charlottesville, Virginia, USA
| | - Shayna L Showalter
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Craig L Slingluff
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Daniel E Levin
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Traci L Hedrick
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
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26
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Nakashima K, Demura Y, Oi M, Tabata M, Tada T, Shiozaki K, Akai M, Ishizuka T. The Association between Malignant Pleural Mesothelioma and Thoracic Radiation Therapy for Hodgkin's Lymphoma: The First Case Report in Japan. Intern Med 2021; 60:771-775. [PMID: 33055477 PMCID: PMC7990650 DOI: 10.2169/internalmedicine.5134-20] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is mostly observed in patients with a history of asbestos exposure. Although other causes are rare, there are several reports of MPM induced by therapeutic radiation, mainly in Europe and North America. However, no such case has been reported in Japan. We herein report a 50-year-old Japanese woman who developed MPM 25 years after thoracic radiation therapy for Hodgkin's lymphoma. The patient had no history of exposure to asbestos; therefore, her history of radiation therapy was considered to be the cause of MPM. Clinicians should consider secondary MPM in patients with a history of thoracic radiation therapy.
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Affiliation(s)
- Koki Nakashima
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
- Third department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Yoshiki Demura
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
| | - Masahiro Oi
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
| | - Mio Tabata
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
| | - Toshihiko Tada
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
| | - Kohei Shiozaki
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
| | - Masaya Akai
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
| | - Tamotsu Ishizuka
- Third department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan
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27
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Tran S, Lim PS, Bojaxhiu B, Teske C, Baust K, Zepter S, Kliebsch U, Timmermann B, Calaminus G, Weber DC. Clinical outcomes and quality of life in children and adolescents with primary brain tumors treated with pencil beam scanning proton therapy. Pediatr Blood Cancer 2020; 67:e28465. [PMID: 32902137 DOI: 10.1002/pbc.28465] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/14/2020] [Revised: 05/01/2020] [Accepted: 05/15/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term treatment-related toxicity may substantially impact well-being, quality of life (QoL), and health of children/adolescents with brain tumors (CBTs). Strategies to reduce toxicity include pencil beam scanning (PBS) proton therapy (PT). This study aims to report clinical outcomes and QoL in PBS-treated CBTs. PROCEDURE We retrospectively reviewed 221 PBS-treated CBTs aged <18 years. Overall-free (OS), disease-free (DFS), and late-toxicity-free survivals (TFS), local control (LC) and distant (DC) brain/spinal control were calculated using Kaplan-Meier estimates. Prospective QoL reports from 206 patients (proxies only ≤4 years old [yo], proxies and patients ≥5 yo) were descriptively analyzed. Median follow-up was 51 months (range, 4-222). RESULTS Median age at diagnosis was 3.1 years (range, 0.3-17.7). The main histologies were ependymoma (n = 88; 39.8%), glioma (n = 37; 16.7%), craniopharyngioma (n = 22; 10.0%), atypical teratoid/rhabdoid tumor (ATRT) (n = 21; 9.5%) and medulloblastoma (n = 15; 6.8%). One hundred sixty (72.4%) patients received chemotherapy. Median PT dose was 54 Gy(relative biological effectiveness) (range, 18.0-64.8). The 5-year OS, DFS, LC, and DC (95% CI) were 79.9% (74-85.8), 65.2% (59.8-70.6), 72.1% (65.4-78.8), and 81.8% (76.3-87.3), respectively. Late PT-related ≥G3 toxicity occurred in 19 (8.6%) patients. The 5-year ≥G3 TFS was 91.0% (86.3-95.7). Three (1.4%) secondary malignancies were observed. Patients aged ≤3 years at PT (P = .044) or receiving chemotherapy (P = .043) experienced more ≥G3 toxicity. ATRT histology independently predicted distant brain failure (P = .046) and death (P = .01). Patients aged ≥5 years self-rated QoL higher than their parents (proxy assessment). Both reported lower social functioning and cognition after PT than at baseline, but near-normal long-term global well-being. QoL was well below normal before and after PT in children ≤4 years. CONCLUSIONS The outcome of CBTs was excellent after PBS. Few patients had late ≥G3 toxicity. Patients aged <5 years showed worse QoL and toxicity outcomes.
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Affiliation(s)
- Sebastien Tran
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Pei S Lim
- Department of Radiation Oncology, University College London Hospitals, London, United Kingdom
| | - Beat Bojaxhiu
- Department of Radiation Oncology, Triemli Hospital, Zurich, Switzerland.,Department of Radiation Oncology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Carmen Teske
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Stefan Zepter
- Center for Proton Therapy (CPT), Paul Scherrer Institute (PSI), ETH Domain, Villigen, Switzerland
| | - Ulrike Kliebsch
- Center for Proton Therapy (CPT), Paul Scherrer Institute (PSI), ETH Domain, Villigen, Switzerland
| | - Beate Timmermann
- Department of Particle Therapy, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Damien Charles Weber
- Department of Radiation Oncology, Inselspital, University Hospital Bern, Bern, Switzerland.,Center for Proton Therapy (CPT), Paul Scherrer Institute (PSI), ETH Domain, Villigen, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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Abstract
Cure rates of childhood cancer need to be improved in low-income countries and vulnerable populations such as refugees. We aimed to compare the outcome and associated factors in Syrian refugee and Turkish children with cancer treated at our hospital.Files of patients were reviewed for age, tumor type, stage, treatment, compliance to treatment, relapse or progression status, outcomes, secondary malignancy (SM) and treatment-related mortality (TRM). Overall (OS) and event-free survival rates (EFS) were analyzed.105 refugees and 304 Turkish children were treated between January 2012 and January 2019. Median age and median follow-up time were significantly lower in the Syrian group (p=0.046, p<0.001, respectively). Metastatic or advanced-stage disease was significantly more frequent in refugees (p=0.002). Relapse or progression and poor compliance to treatment were more common in refugees (p=0.01, p<0.001, respectively). Rates of OS were 55.7% and 69.7%, EFS were 28.9% and 55.7% in Syrian and Turkish patients. OS and EFS were lower in refugees compared to Turkish patients (p=0.01, p<0.001, respectively). EFS was significantly lower in refugees with poor compliance to treatment (p<0.001). TRM was reported in 12 (8 Syrian, 4 Turkish) patients. SM was detected in 3 (2 Turkish, 1 Syrian) children.Inferior survival rates were detected in Syrian refugee children compared to Turkish children. Besides from cancer-specific factors such as stage and tumor type, a series of barriers in accessing cancer care resulting in poor compliance to treatment might have been responsible from lower survival rates in Syrian children.
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Affiliation(s)
- Begül Yağcı-Küpeli
- Department of Pediatric Hematology/Oncology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Ayşe Özkan
- Department of Pediatric Hematology/Oncology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
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29
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Di M, Panagiotou OA, Reagan JL, Niroula R, Olszewski AJ. Adjuvant chemotherapy administration and survival outcomes of lymphoma survivors with common solid tumors: a population-based study†. Leuk Lymphoma 2020; 61:3360-3368. [PMID: 32915087 DOI: 10.1080/10428194.2020.1817433] [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: 10/23/2022]
Abstract
Using the Surveillance, Epidemiology, and End Results database (2004-2015), we compared adjuvant chemotherapy use and survival for three common solid tumors in patients with and without history of lymphoma (DLBCL: diffuse large B cell, HL: Hodgkin lymphoma). Among patients with breast (n = 531,243), colon (n = 108,196), and lung (n = 23,179) cancers, we identified 361, 134, and 37 DLBCL survivors, and 349, 73, and 25 HL survivors, respectively. We found no significant difference between lymphoma survivors and controls in the use of adjuvant chemotherapy, except HL survivors with colon cancer, who had a lower rate. Among chemotherapy recipients, OS was significantly worse among HL survivors with all three cancers, and DLBCL survivors with breast cancer (hazard ratio [HR] 1.57-2.28). HL survivors had significantly higher mortality from cardiovascular diseases in breast and lung cancers (sub-HR, 7.96-9.64), which suggests that worse survival in this population might be due to late or cumulative toxicities of cancer-directed treatment.
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Affiliation(s)
- Mengyang Di
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Orestis A Panagiotou
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.,Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - John L Reagan
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Rabin Niroula
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
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30
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Rivas AM, Larumbe-Zabala E, Diaz-Trastoy O, Schurr RN, Jones C, Abdulrahman R, Dar N, Lado-Abeal J. Effect of chemoradiation on the size of the thyroid gland. Proc AMIA Symp 2020; 33:541-545. [PMID: 33100524 DOI: 10.1080/08998280.2020.1786227] [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] [Indexed: 10/23/2022] Open
Abstract
We aimed to evaluate changes in thyroid gland size during the treatment of malignancies outside the head and neck with chemotherapy and/or external beam radiation. We performed a retrospective review of records of adult patients treated at our institution with external beam radiation to the chest and/or chemotherapy with taxanes, alkylating agents, and/or a topoisomerase II inhibitor. Neck and chest computed tomography (CT) images were used to calculate thyroid gland volume before and after therapy, using Vitrea® software or the volumetric ellipsoid method. Thirty-seven patients were included. After treatment, there was a significant reduction in thyroid gland volume of 14.0% (P < 0.01) using Vitrea and 17.1% (P < 0.05) using the volumetric ellipsoid method. Exposure to radiation or chemotherapy was not found to be associated with the degree of thyroid gland reduction, nor was the number of days between CT scans or the stage of the malignancy being treated. Finally, the degree of thyroid gland size reduction did not predict mortality. Our results showed that the treatment of malignancies outside the head and neck with chemotherapy and/or external beam radiation results in a reduction in thyroid gland size. The impact on thyroid gland function remains unknown.
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Affiliation(s)
- Ana Marcella Rivas
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Eneko Larumbe-Zabala
- Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Olaia Diaz-Trastoy
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Ryan Nicholas Schurr
- CTSI Oncology Solutions, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Catherine Jones
- Division of Medical Oncology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Ramzi Abdulrahman
- Division of Radiation Oncology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Nabeel Dar
- Department of Pathology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Joaquin Lado-Abeal
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.,Division of Endocrinology, Department of Internal Medicine, Truman Medical Center, University of Missouri-Kansas City, Kansas City, Missouri
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31
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Good ML, Malekzadeh P, Kriley IR, Shah NN, Kleiner DE, Calvo K, Hernandez JM, Davis JL. Intrahepatic cholangiocarcinoma as a rare secondary malignancy after allogeneic hematopoietic stem cell transplantation for childhood acute lymphoblastic leukemia: A case report. Pediatr Transplant 2020; 24:e13653. [PMID: 31944498 PMCID: PMC8453586 DOI: 10.1111/petr.13653] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/19/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
Secondary malignancies are a significant cause of non-relapse mortality in patients who undergo allogeneic HCT. However, secondary liver cancer is rare, and ICC following HCT has never been reported in the literature. Secondary solid cancers typically have a long latency period, and cholangiocarcinoma is classically a malignancy occurring in older individuals. Here, we report the first case of secondary ICC, which presented just 3 years after HCT in a young adult with a history of childhood ALL. A 26-year-old male with history of precursor B-cell ALL presented with asymptomatic elevated liver function tests 3 years after HCT. Laboratories were indicative of biliary obstruction. ERCP showed focal biliary stricturing of the common and left hepatic ducts. MRCP revealed left intrahepatic duct dilatation, suggestive of intrahepatic obstructing mass. Additional workup lead to a clinical diagnosis of ICC. The patient underwent left hepatectomy with extrahepatic bile duct resection and portal lymphadenectomy. Surgical pathology was consistent with moderately differentiated cholangiocarcinoma. Our case illustrates a rare SMN following HCT for ALL. It is the first case report of ICC occurring as a secondary cancer in this patient population. Although cholangiocarcinoma is characteristically diagnosed in the older population, it must remain on the differential for biliary obstruction in post-HCT patients.
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Affiliation(s)
- Meghan L. Good
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA,Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Parisa Malekzadeh
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA,Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Isaac R. Kriley
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nirali N. Shah
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - David E. Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Katherine Calvo
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan M. Hernandez
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeremy L. Davis
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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32
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Siontis BL, McHugh JB, Roberts E, Zhao L, Thomas DG, Owen D, Baker LH, Biermann JS, Schuetze SM, Chugh R. Differential Outcomes and Biologic Markers of Radiation-Associated vs. Sporadic Osteosarcoma: A Single-Institution Experience. Front Oncol 2020; 9:1523. [PMID: 32039013 PMCID: PMC6987384 DOI: 10.3389/fonc.2019.01523] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/18/2019] [Indexed: 01/19/2023] Open
Abstract
Background: Radiation-associated osteosarcoma (RAO) is a rare, life-threatening complication from radiation. Many physicians presume RAO has a worse prognosis than sporadic osteosarcoma (SO), although limited objective data exist. We conducted a retrospective study comparing these entities. Methods: We identified adults treated at our institution with osteosarcoma (1990-2016) and categorized tumors as SO or RAO based on location within a prior radiation field. We extracted data on demographics, treatment and primary malignancy and examined available tumor samples for MTA-1 and ezrin using immunohistochemistry (IHC). Results: Of 159 identified patients, 28 had RAO, diagnosed at a median interval from radiation of 11.5 years (1.5-28 years). Median follow-up was 2.8 years (0.1-19.6 years). Median progression free survival (PFS) and overall survival (OS) were not significantly different in the small population of patients with metastases, SO (n = 20) vs. RAO (n = 6): PFS 10.3 months vs. 4.8 months (p = 0.45) and OS 15.6 months vs. 6.1 months (p = 0.96), respectively. For the larger group with localized disease, median relapse-free survival (RFS) and OS were significantly different, NR vs. 12.2 months (p < 0.001) and NR vs. 27.6 months (p = 0.001) in SO (n = 111) vs. RAO (n = 22), respectively. On IHC, there were significant differences in distribution of high, intermediate or low MTA-1 (p = 0.015) and ezrin (p = 0.002) between RAO and SO tumors. Conclusions: Patients with metastases at diagnosis fared poorly irrespective of prior radiation. RAO patients with localized disease had worse outcomes without detectable differences in therapy rendered or treatment effect in resected specimens. Higher expression of MTA-1 in RAO patients may suggest an underlying difference in tumor biology to explain differences in outcomes.
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Affiliation(s)
- Brittany L Siontis
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
| | - Emily Roberts
- Biostatistics Department, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lily Zhao
- Biostatistics Department, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Dafydd G Thomas
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
| | - Dawn Owen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Laurence H Baker
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - J Sybil Biermann
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Scott M Schuetze
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Rashmi Chugh
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
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33
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Dutta SW, Aliotta E, Alonso CE, Bliley RC, Romano KD, Libby B, Showalter TN, Showalter SL, Janowski EM. Normal tissue dose and risk estimates from whole and partial breast radiation techniques. Breast J 2019; 26:1308-1315. [PMID: 31876106 DOI: 10.1111/tbj.13735] [Citation(s) in RCA: 4] [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: 10/30/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare radiation dose to organs at risk in patients with early-stage breast cancer treated with lumpectomy and intraoperative radiation therapy with CT-guided HDR brachytherapy (precision breast IORT; PB-IORT) and those treated with external beam whole breast irradiation (WB-DIBH) or partial breast irradiation (PB-DIBH) with deep inspiratory breath hold. METHODS We retrospectively identified 52 consecutive patients with left-sided breast cancers treated with either PB-IORT (n = 17, 76% outer breast) on a phase I clinical trial, adjuvant PB-DIBH (n = 18, 56% outer breast, 6% cavity boost), or WB-DIBH (n = 17, 76% outer breast, 53% with lumpectomy cavity boost). Conventional (2 Gy/fraction) or moderate hypofractionation (2.66 Gy/fraction) was prescribed for the external beam cohorts and 12.5 Gy in 1 fraction to 1 cm from the balloon surface was prescribed to the HDR brachytherapy cohort. CT-based planning was used for all patients. Organ at risk doses and excess risk ratios (ERR) for secondary lung cancers, contralateral breast cancers, and cardiac toxicity were compared between treatment techniques. RESULTS Compared to WB-DIBH and PB-DIBH, PB-IORT resulted in lower ipsilateral lung V5, V10, V20, mean, and max dose (P < .05). Mean ipsilateral lung BED3Gy was as follows: 1.32 Gy for PB-IORT, 4.33 Gy for WB-DIBH, 3.35 Gy for PB-DIBH. The ERR for lung cancer was lowest for PB-IORT (P < .001). There was significantly higher contralateral breast max dose but lower mean BED3Gy for WB-DIBH compared with PB-IORT (P = .012, P = .011, respectively). Mean contralateral breast BED3Gy was as follows: 0.10 Gy for PB-IORT, 0.06 Gy for WB-DIBH, and 0.08 Gy for PB-DIBH. The ERR for contralateral breast cancer was low for all breast techniques, but WB-DIBH showed lower ERR compared to PB-IORT (P = .019). Mean heart BED2Gy was higher with PB-IORT at 1.26 Gy compared to 0.48 Gy and 0.24 Gy for WB-DIBH and PB-DIBH, respectively (P < .001). CONCLUSIONS Patients with early-stage breast cancer treated with PB-IORT and with tissue-sparing external beam techniques all received low organ at risk doses, but PB-IORT resulted in far lower ipsilateral lung dose compared with external beam techniques. Our data indicate the lowest mean contralateral breast BED in the WB-DIBH group, likely due to the simplicity of the field design in low-risk patients using tangential whole breast radiation. External beam using DIBH results in lowest heart dose, but all techniques were well within recommended heart constraints.
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Affiliation(s)
- Sunil W Dutta
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - Eric Aliotta
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - Clayton E Alonso
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - Roy C Bliley
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - Kara D Romano
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - Bruce Libby
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | | | - Einsley M Janowski
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
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Moses LE, Rotsides JM, Balogun FO, Persky MS, Muggia FM, Persky MJ. Oral Squamous Cell Carcinoma as a Complication of Treatment for Recurrent High-Grade Serous Cancer. Laryngoscope 2019; 130:2607-2610. [PMID: 31800100 DOI: 10.1002/lary.28451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/26/2019] [Revised: 11/03/2019] [Accepted: 11/13/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Advances in cancer treatment have increased survival for many patients, prompting a need for greater recognition of the long-term complications of treatment. Chemotherapy agents have the potential to induce carcinogenesis and can increase the risk of secondary malignancy. Pegylated liposomal doxorubicin (PLD) used for maintenance treatment of recurrent high-grade serous cancers has been associated with the development of oral cavity squamous cell carcinoma (SCC). STUDY DESIGN Retrospective review. METHODS Cases of oral cavity SCC in patients with recurrent high-grade serous cancer treated with PLD between 1997 and 2017 at a single institution were reviewed. RESULTS Eight of 16 patients treated with PLD developed oral cavity SCC. The duration of PLD use ranged from 1.3 to 15 years (mean = 5.8 years) and cumulative dose ranged from 405 to 3,000 mg/m2 (mean = 1,542 mg/m2 ). Seven patients tested positive for BRCA mutations (four BRCA 1+, three BRCA 2+). No patients had a history of alcohol or tobacco use. All had early-stage oral cavity disease; five were T1N0, two were T2N0, and one had carcinoma in situ. All patients underwent surgery, and two received adjuvant radiation. Four developed locoregional recurrence requiring additional treatment. Of these, one patient died from complications of oral SCC, one developed recurrent ovarian cancer, and two had no evidence of disease of the oral cavity or ovarian cancer at the last follow-up. CONCLUSIONS Long-term PLD therapy may be associated with the development of oral cavity SCC. A high index of suspicion and routine head and neck examination should be included in follow-up for exposed patients. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2607-2610, 2020.
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Affiliation(s)
- Lindsey E Moses
- Department of Otolaryngology, New York University Langone Health, New York, New York, U.S.A
| | - Janine M Rotsides
- Department of Medical Oncology, New York University Langone Health, New York, New York, U.S.A
| | - Fiyinfolu O Balogun
- Department of Medical Oncology, New York University Langone Health, New York, New York, U.S.A
| | - Mark S Persky
- Department of Otolaryngology, New York University Langone Health, New York, New York, U.S.A
| | - Franco M Muggia
- Department of Medical Oncology, New York University Langone Health, New York, New York, U.S.A
| | - Michael J Persky
- Department of Otolaryngology, New York University Langone Health, New York, New York, U.S.A
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Millett R, Aggarwal A, Tabbara I, Nassereddine S. Chronic Myeloid Leukemia as Secondary Malignancy Following the Treatment of Hodgkin Lymphoma: A Case Series. Anticancer Res 2019; 39:4333-4335. [PMID: 31366526 DOI: 10.21873/anticanres.13600] [Citation(s) in RCA: 5] [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] [Received: 06/10/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 11/10/2022]
Abstract
Secondary malignancies are relatively common and clinically important phenomena following both chemotherapy and radiotherapy. The majority of these cases are acute leukemias, the occurrence of which have been thoroughly documented and studied. More rarely, chronic myeloid leukemias (CML) may arise subsequent to treatment of a primary malignancy. Literature review on such developments following treatment of Hodgkin's Lymphoma (HL) is scant. Herein, the authors present three cases of CML diagnosed within five years of treatment initiation for Hodgkin's Lymphoma (HL); one of the three patients had CML with atypical variant carrying a rare mutation with BCR-JAK2 fusion.
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Affiliation(s)
- Ralph Millett
- The George Washington University School of Medicine, Washington, DC, U.S.A
| | - Anita Aggarwal
- The Department of Veteran Affairs Medical Center, Washington, DC, U.S.A
| | - Imad Tabbara
- The George Washington University School of Medicine, Washington, DC, U.S.A.,The George Washington Cancer Center, Washington, DC, U.S.A
| | - Samah Nassereddine
- The George Washington University School of Medicine, Washington, DC, U.S.A. .,The George Washington Cancer Center, Washington, DC, U.S.A
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Hasan S, Metzger A, Wegner R, Verma V, Hilton C, Julian T, Trombetta M. Management trends and outcomes of breast angiosarcoma: Is breast conservation feasible? Breast J 2019; 25:1230-1234. [PMID: 31301088 DOI: 10.1111/tbj.13439] [Citation(s) in RCA: 4] [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: 02/25/2019] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 11/29/2022]
Abstract
We queried the National Cancer Database for nonmetastatic breast angiosarcoma, yielding 808 patients (202 de novo, 606 secondary). The median survival was 53.7 months. Secondary tumors were more likely to undergo mastectomy than de novo lesions (OR = 3.99, P < 0.001). Treatments included lumpectomy (10%), lumpectomy/radiation (3%), mastectomy alone (73%), or mastectomy/radiation (14%), with no difference in survival (P = 0.68). Lumpectomy correlated with positive margin rate (OR 3.29), which was a predictor for death (HR = 2.37, P < 0.01), along with older age, higher comorbidity scores, size >5 cm, and high-grade disease (P < 0.05). While breast angiosarcoma is usually treated with mastectomy, lumpectomy may be feasible for well-selected tumors.
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Affiliation(s)
- Shaakir Hasan
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - April Metzger
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Rodney Wegner
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Christie Hilton
- Department of Medical Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Thomas Julian
- Department of Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Mark Trombetta
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
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Ahmad SW, Daze RP, Arvaneh S, Awad S. Painful Penile Plaques: A Rare Case Report of Rectal Adenocarcinoma with Cutaneous Metastasis to the Penis. Cureus 2019; 11:e5095. [PMID: 31523528 PMCID: PMC6728787 DOI: 10.7759/cureus.5095] [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: 05/29/2019] [Accepted: 07/08/2019] [Indexed: 12/31/2022] Open
Abstract
Despite the rich vascularization of the penis and its close proximity to other pelvic organs, cutaneous manifestations of metastatic disease to the penis are an uncommon occurrence. Penile lesions suspected for malignancy should alert clinicians to differentiate between primary and secondary tumors. While the majority of metastatic malignancies arise from the genitourinary tract, we present a unique case report of a 51-year-old male with penile metastasis of primary rectal adenocarcinoma. A thorough diagnostic evaluation was performed including imaging studies, colonoscopy, as well as penile biopsies with associated immunohistochemistry panel. The patient was diagnosed with penile metastases secondary to invasive rectal adenocarcinoma. Due to the aggressive nature of the patient's presentation, systemic chemotherapy was initiated for palliative measures as the patient declined any radical surgical intervention.
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Affiliation(s)
- Syed W Ahmad
- Medical Education, Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | | | | | - Said Awad
- Internal Medicine, Largo Medical Center, Largo, USA
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Gaut D, Bejjani A, Sasine J, Schiller G. B-cell acute lymphoblastic leukemia as a secondary malignancy following diffuse large B-cell lymphoma. Hematol Rep 2019; 11:8100. [PMID: 31285810 PMCID: PMC6589539 DOI: 10.4081/hr.2019.8100] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 05/13/2019] [Indexed: 11/23/2022] Open
Abstract
Secondary acute lymphoblastic leukemia (ALL) is a rare disease that has not been well characterized compared with secondary myelodysplastic syndrome or secondary acute myeloid leukemia. We present a report of two patients who developed ALL following complete remission of diffuse large B-cell lymphoma (DLBCL). The first case is more consistent with a therapy- related ALL as a PCR analysis of bone marrow aspirate revealed a distinct clone and the mixed-lineage leukemia gene rearrangement, commonly associated with exposure to topoisomerase II inhibitors. The second case is more consistent with clonal evolution given positive MYC and BCL2 fusion signals in the original diagnosis of DLBCL and the secondary ALL.
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Affiliation(s)
| | - Anthony Bejjani
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Joshua Sasine
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Gary Schiller
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
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Kanyilmaz G, Saricanbaz I, Bora H, Karahacioglu E, Erkal EY. Adjuvant radiotherapy for Stage I seminoma: A Single-institutional experience. J Cancer Res Ther 2019; 15:S87-S90. [PMID: 30900627 DOI: 10.4103/jcrt.jcrt_916_16] [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] [Indexed: 11/04/2022]
Abstract
Objectives There is no consensus regarding the management of Stage 1 seminomas following inguinal orchiectomy. In this study, we evaluated the treatment results and treatment-related toxicity for patients with Stage 1 seminomas treated with adjuvant radiotherapy (RT) at a single institution. Methods Sixty-five patients who underwent adjuvant RT following orchiectomy for Stage 1 seminomas between January 1996 and December 2007 were retrospectively reviewed. The age, tumor location, histopathological type, stage, tumor size, RT field, and radiation dose were recorded for all patients. Results The patients' ages ranged from 17 to 61 years (median, 37 years). Sixty-three patients (97%) were diagnosed with classical seminoma and the remaining two patients (3%) had spermatocytic seminoma. After orchiectomy, 37 patients (57%) received para-aortic RT and 28 patients (43%) received dog-leg field RT. RT was applied with 1.8-2 Gy/day fractionation and the median RT dose was 26 Gy (range, 20-38). Follow-up ranged from 0.3 to 18 years (median, 9.5 years). Local control had been achieved in all patients and all of them were alive with no evidence of disease. Fifty-one patients (77%) had at least 5 years of follow-up and 27 patients (41%) had at least 10 years of follow-up. Overall survival at 10 years was 100%. Conclusion Although retrospective in nature, this single-institutional study provides useful information about the outcomes and toxicities associated with adjuvant RT in patients with Stage 1 seminomas reporting excellent disease control and survival rates at the expense of acceptable toxicity.
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Affiliation(s)
- Gul Kanyilmaz
- Department of Radiation Oncology, Necmettin Erbakan University Meram Medicine School, Konya, Turkey
| | - Irem Saricanbaz
- Department of Radiation Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Huseyin Bora
- Department of Radiation Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Eray Karahacioglu
- Department of Radiation Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Eda Yirmibesoglu Erkal
- Department of Radiation Oncology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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Malani R, Bhatia A, Wolfe J, Grommes C. Staging identifies non-CNS malignancies in a large cohort with newly diagnosed lymphomatous brain lesions. Leuk Lymphoma 2019; 60:2278-2282. [PMID: 30628502 DOI: 10.1080/10428194.2018.1563294] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 01/17/2023]
Abstract
Lymphomatous brain lesions can represent primary central nervous system (CNS) lymphoma or secondary involvement as part of systemic disease (SCNSL). In this study, we characterize staging evaluations in a large patient cohort with newly-diagnosed brain lymphomas, to determine the frequency of SCNSL and secondary malignancies. This retrospective review includes 262 patients with newly-diagnosed lymphomatous CNS lesions evaluated at Memorial Sloan Kettering Cancer Center between 2006 and 2018. Staging procedures included PET scans in 180 (69%) patients, CT scans of chest/abdomen/pelvis (CAP) in 195 (74%) and bone marrow biopsies (BMB) in 177 (68%). PET scans were reported as abnormal in 34 of 180 (19%), CT in 50 of 195 (26%) and BMB in 15 of 177 (8.5%). A total of 24 non-CNS malignancies were identified (11.8%; 19 systemic lymphomas and 5 secondary malignancies). Thus, in patients with new lymphomatous brain lesions, performing initial systemic staging procedures can identify systemic lymphoma and additional malignancies, highlighting the importance of staging evaluations, in particular PET and BMB.
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Affiliation(s)
- Rachna Malani
- Department of Neurology, Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Ankush Bhatia
- Department of Neurology, Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Julia Wolfe
- Department of Neurology, Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Christian Grommes
- Department of Neurology, Memorial Sloan Kettering Cancer Center , New York , NY , USA.,Department of Neurology, Weill Cornell Medical College , New York , NY , USA
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Manem VSK, Dhawan A. Modelling recurrence and second cancer risks induced by proton therapy. Math Med Biol 2018; 35:347-361. [PMID: 29106564 PMCID: PMC6132082 DOI: 10.1093/imammb/dqx006] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 04/09/2017] [Accepted: 06/05/2017] [Indexed: 12/30/2022]
Abstract
In the past few years, proton therapy has taken the centre stage in treating various tumour types. The primary contribution of this study is to investigate the tumour control probability (TCP), relapse time and the corresponding secondary cancer risks induced by proton beam radiation therapy. We incorporate tumour relapse kinetics into the TCP framework and calculate the associated second cancer risks. To calculate proton therapy-induced secondary cancer induction, we used the well-known biologically motivated mathematical model, initiation-inactivation-proliferation formalism. We used the available in vitro data for the linear energy transfer (LET) dependence of cell killing and mutation induction parameters. We evaluated the TCP and radiation-induced second cancer risks for protons in the clinical range of LETs, i.e. approximately 8 $\mathrm{keV/\mu m}$ for the tumour volume and 1-3 $\mathrm{keV/\mu m}$ for the organs at risk. This study may serve as a framework for further work in this field and elucidates proton-induced TCP and the associated secondary cancer risks, not previously reported in the literature. Although studies with a greater number of cell lines would reduce uncertainties within the model parameters, we argue that the theoretical framework presented within is a sufficient rationale to assess proton radiation TCP, relapse and carcinogenic effects in various treatment plans. We show that compared with photon therapy, proton therapy markedly reduces the risk of secondary malignancies and for equivalent dosing regimens achieves better tumour control as well as a reduced primary recurrence outcome, especially within a hypo-fractionated regimen.
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Affiliation(s)
- V S K Manem
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - A Dhawan
- Department of Oncology, University of Oxford, Oxford, UK
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Yano M, Ikeda Y, Kato T, Sakaki M, Sato S, Yabuno A, Kozawa E, Yasuda M. A case of peritoneal malignant mesothelioma following radiation therapy for cervical cancer. Mol Clin Oncol 2018; 8:302-305. [PMID: 29435293 DOI: 10.3892/mco.2017.1525] [Citation(s) in RCA: 4] [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: 06/16/2017] [Accepted: 11/24/2017] [Indexed: 11/05/2022] Open
Abstract
The present study presents a case of peritoneal malignant mesothelioma (PMM) following radiation therapy for cervical cancer. A 34-year-old Japanese woman, without asbestos exposure, was referred to the Department of Gynecologic Oncology, Saitama Medical University International Medical Center due to a cervical mass, and was diagnosed with cervical squamous cell carcinoma (SCC). The serum levels of tumor markers, including SCC antigen and cancer antigen 125 (CA125) were 229.0 ng/ml and 54.4 U/ml, respectively. The patient underwent concurrent chemoradiotherapy (CCRT), and a complete response was achieved. After 54 months, ascites was found at the rectouterine pouch, but peritoneal cytology suggested reactive mesothelial cell. After 62 months of CCRT, magnetic resonance imaging revealed masses in both the salpinges. The serum levels of SCC and CA125 were 0.9 ng/ml and 506.1 U/ml, respectively. Following this, left salpingectomy and peritoneal biopsy were performed laparoscopically. Histologic examination revealed atypical mesothelial cells with no continuity of background tubal epithelium. Immunohistochemistry showed positive staining for calretinin, thrombomodulin, mesothelin and glucose transporter 1. Based on these findings, the patient was diagnosed with PMM epithelioid type and underwent systemic chemotherapy; stable disease status has been obtained for 3 months. This case demonstrates the possibility of PMM occurrence within 10 years after radiotherapy, and indicates the importance of histological and immunohistochemical examination, particularly in cases of an atypical tumorigenesis pattern from the primary cancer.
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Affiliation(s)
- Mitsutake Yano
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Yuji Ikeda
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Tomomi Kato
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Mika Sakaki
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Sho Sato
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Akira Yabuno
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Eito Kozawa
- Department of Diagnostic Radiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
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Rosenstock AS, Niu J, Giordano SH, Zhao H, Wolff AC, Chavez-MacGregor M. Acute myeloid leukemia and myelodysplastic syndrome after adjuvant chemotherapy: A population-based study among older breast cancer patients. Cancer 2017; 124:899-906. [PMID: 29236294 DOI: 10.1002/cncr.31144] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 08/09/2017] [Revised: 09/28/2017] [Accepted: 10/23/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Chemotherapy for early breast cancer is associated with a small risk of developing myelodysplastic syndrome (MDS) and/or acute myeloid leukemia (AML). The aim of this study was to determine the risk of developing AML or MDS after modern adjuvant chemotherapy in older breast cancer patients and to further define the risk of individual chemotherapy regimens. METHODS Patients diagnosed with stage I to III breast cancer from 2003 to 2009 were identified in the Surveillance, Epidemiology, and End Results-Medicare and Texas Cancer Registry-Medicare linked databases. The development of AML/MDS, chemotherapy use, and comorbidities were identified with International Classification of Diseases, Ninth Revision and Healthcare Common Procedure Coding System codes. Analyses included descriptive statistics, cumulative incidences, and Cox proportional hazards models to estimate the hazard of AML/MDS after adjustments for clinically relevant covariates. RESULTS In all, 92,110 patients were included; after a median follow-up of 85 months, the overall rates per 1000 person-years were 0.65 for AML and 1.56 for MDS. Patients who received an anthracycline (A) or anthracycline and taxane (A+T) regimen were more likely to develop AML (hazard ratio [HR] for A, 1.70; 95% confidence interval [CI], 1.16-2.50; HR for A+T, 1.68; 95% CI, 1.22-2.30) or MDS (HR for A, 2.18; 95% CI, 1.70-2.80; HR for A+T, 1.62; 95% CI, 1.29-2.03) than patients who did not receive chemotherapy. Patients using docetaxel and cyclophosphamide (TC) were not at increased risk for AML or MDS. CONCLUSIONS Adjuvant chemotherapy is associated with a small but significant increase in the risk of AML and MDS, especially with regimens that include A. Longer follow-up is needed to confirm that risk is not increased with the recently adopted TC regimen. Cancer 2018;124:899-906. © 2017 American Cancer Society.
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Affiliation(s)
- Aron S Rosenstock
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jiangong Niu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon H Giordano
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Antonio C Wolff
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Mariana Chavez-MacGregor
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Satyarth S, Parikh S, Anand A, Sawhney J, Panchal H, Patel A, Shah S. Acute Lymphoblastic Leukemia as Secondary Malignancy in a Case of Ewing's Sarcoma on Treatment. Indian J Med Paediatr Oncol 2017; 38:354-356. [PMID: 29200689 PMCID: PMC5686982 DOI: 10.4103/ijmpo.ijmpo_110_16] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The survival of Ewing's sarcoma (ES) has improved due to advances in both local and systemic therapy. This has given rise to an increased detection of second malignant neoplasms which can be in the form of solid tumors and hematological malignancies. The most common hematological malignancies are acute myeloid leukemia/myelodysplastic syndrome. Acute lymphoblastic leukemia (ALL) is relatively uncommon in occurrence in this setting. Furthermore, the average refractory period for hematological malignancies varies from 3 to 5 years. We report a case of a young female who developed ALL while on adjuvant therapy for ES.
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Affiliation(s)
- Satyam Satyarth
- Department of Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Sonia Parikh
- Department of Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Asha Anand
- Department of Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Jyoti Sawhney
- Department of Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Harsha Panchal
- Department of Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Apurva Patel
- Department of Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Sandeep Shah
- Department of Medical Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
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Abstract
Although rare, secondary tumors of the bladder can present a diagnostic dilemma to pathologists considering a differential diagnosis of primary bladder cancer. We investigated the clinicopathologic and imaging characteristics of metastatic tumors to the bladder. We retrospectively reviewed the surgical pathology databases from 2 sites from 2013 to 2016, identifying 66 cases of secondary bladder tumors. Clinical, pathologic, and imaging findings were reviewed. Mean age at diagnosis was 63 years (range = 25-87). Females had a significantly higher proportion (44/66, 66.7%) of secondary bladder tumors compared with males (22/66, 33.3%; P = .007). In total, 56/66 (84.8%) patients had a clinical history of an in situ or invasive malignancy in another organ, and 54/66 (81.8%) patients had imaging supporting a metastatic tumor. Only 2/66 (3.0%) patients had a prior history of urothelial carcinoma. In total, 4/66 (6.1%) cases (all females) were originally misdiagnosed as primary bladder malignancies and were corrected after clinicoradiologic correlation. Overall, colorectal origin was most common (15/66, 22.7%), followed by cervical and ovarian primaries (10/66, 15.2% each). Cervical and ovarian origins predominated in the female cohort (10/44, 22.7% each), followed by endometrial (8/44, 18.2%). Colorectal and prostate primaries were the most common among males (10/22, 45.5%, and 7/22, 31.8%, respectively). Secondary bladder tumors can mimic urothelial carcinomas. In our cohort, gynecological, colorectal, and prostatic origins were most common. Clinical history, imaging, and immunohistochemical studies can be useful in avoiding this diagnostic pitfall.
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Affiliation(s)
| | - Samuel Borak
- 1 University of Alabama at Birmingham, AL, USA.,2 Community Pathology Practice Program, Montgomery, AL, USA
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46
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Tanaka H, Aoki H, Sugita Y, Shimizu R, Kiko K, Mochida H, Suzuki Y. Development of Epstein-Barr Virus-related Primary Diffuse Large B-cell Lymphoma of the Central Nervous System in a Patient with Peripheral T-cell Lymphoma, Not Otherwise Specified after Mogamulizumab Treatment. Intern Med 2017; 56:2759-2763. [PMID: 28924126 PMCID: PMC5675939 DOI: 10.2169/internalmedicine.8781-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mogamulizumab is a defucosylated humanized anti-CC chemokine receptor type 4 (CCR4) antibody that exerts an anti-tumor immune effect against various tumors through a suppressive effect on regulatory T-cells. We herein report a patient with peripheral T-cell lymphoma who developed Epstein-Barr virus (EBV)-related primary diffuse large B-cell lymphoma of the central nervous system (CNS DLBCL) after mogamulizumab therapy. Our experience should alert physicians to the possibility of the development of EBV-related CNS DLBCL in patients treated for primary lymphoma and suggests that the anti-tumor immune effect of mogamulizumab is ineffective for the prophylaxis of EBV-related lymphomas.
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MESH Headings
- Aged
- Antibodies, Monoclonal, Humanized/adverse effects
- Central Nervous System Diseases/etiology
- Central Nervous System Diseases/virology
- Female
- Herpesvirus 4, Human
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, T-Cell, Peripheral/etiology
- Lymphoma, T-Cell, Peripheral/virology
- Male
- Receptors, CCR4/immunology
- T-Lymphocytes, Regulatory
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Affiliation(s)
| | - Hanako Aoki
- Department of Internal Medicine, Asahi General Hospital, Japan
| | | | - Ryo Shimizu
- Department of Hematology, Asahi General Hospital, Japan
| | - Katsunari Kiko
- Department of Neurosurgery, Asahi General Hospital, Japan
| | | | - Yoshio Suzuki
- Department of Diagnostic Pathology, Asahi General Hospital, Japan
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47
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Molitoris JK, Chhabra A, Snider JW, Harvilla N, Okonkwo N, Nichols EM, Vujaskovic Z, Ioffe OB, Kesmodel SB, Feigenberg SJ. Intensification of Treatment for Angiosarcoma of the Breast with Accelerated Hyperfractionated Radiation, Hyperthermia, and Surgical Resection. Cureus 2017; 9:e1406. [PMID: 30944783 PMCID: PMC6438684 DOI: 10.7759/cureus.1406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 12/24/2022] Open
Abstract
Angiosarcoma (AS) of the breast is a rare malignancy most commonly encountered as a secondary malignancy after the treatment of breast cancer with or without adjuvant radiation. The prognosis for secondary AS is poor, with reported five-year overall survival rates ranging from 10%-43%. The establishment of local control is vital to prognosis, yet patients often die with locally progressive disease. Multiple local therapies have been employed including surgery alone, surgery followed by radiation, and concurrent radiation and hyperthermia. Here, we report a case of secondary AS that occurred after breast conserving therapy and adjuvant radiation for ductal carcinoma in situ (DCIS). After initial surgical excision and subsequent local recurrence, our patient was treated with a novel treatment intensification strategy including neoadjuvant, accelerated hyperfractionated radiation with concurrent hyperthermia, followed by total mastectomy and flap reconstruction. The final pathologic evaluation demonstrated a near-complete response to induction thermoradiotherapy.
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Affiliation(s)
- Jason K Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Arpit Chhabra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - James W Snider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Nicole Harvilla
- Pathology, University of Maryland School of Medicine, Baltimore, USA
| | - Nkechi Okonkwo
- Pathology, University of Maryland School of Medicine, Baltimore, USA
| | - Elizabeth M Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Zeljko Vujaskovic
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Olga B Ioffe
- Pathology, University of Maryland School of Medicine, Baltimore, USA
| | - Susan B Kesmodel
- Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - Steven J Feigenberg
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
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Trajkovska I, Georgievski B, Cevreska L, Gacovski A, Hasan T, Nedeska-Minova N. Early and Late Complications in Patients with Allogeneic Transplantation of Hematopoietic Stem Cell - Case Report. Open Access Maced J Med Sci 2017; 5:340-343. [PMID: 28698754 PMCID: PMC5503734 DOI: 10.3889/oamjms.2017.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 01/23/2017] [Revised: 03/24/2017] [Accepted: 04/21/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Allogeneic hematopoietic stem cells transplantation (HSCT) is a curative intervention in patients with haematological malignant and non-malignant diseases, immunodeficiency, autoimmune, and other genetic diseases. Early complications are complications that are occurring in the first 100 days, while complications arising after the 100th day of transplantation belong to late complications. CASE REPORT Forty-nine years old patient with AML treated with allogeneic HSCT from HLA-identical (sister) donor. Ascertained and display of early (acute Graft versus host disease (GvHD) and late complications (chronic GVHD, infections, cataract, secondary malignancy with MS deposits) are made, that emerged after the patient transplantation. CONCLUSION Rapidly growing population of patients that undergo allogeneic HSCT creates an obligation to educate patients and physicians about observed late complications that occur after this therapy.
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Affiliation(s)
| | - Borce Georgievski
- University Clinic of Hematology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Lidija Cevreska
- University Clinic of Hematology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Andrijana Gacovski
- Primary Health Care "D-r Vasileva Cardio", Skopje, Republic of Macedonia
| | - Taner Hasan
- GOB "8-mi Septemvri" Skopje, Skopje, Republic of Macedonia
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Abstract
Glioblastoma (GBM) typically occurs as a primary tumour (i.e., primary GBM) and predominantly affects elderly patients. The remaining ~10% occur as a result of malignant progression from lower grade astrocytic tumours (i.e., secondary GBM). Although there are no certain causative environmental agents, prior radiation exposure may play a role. We report on a patient who had been treated six years prior for a vestibular schwannoma with high-dose conventional radiotherapy and subsequently developed a rapidly fatal glioblastoma at the same location. The diagnosis was confirmed by routine histopathology as well as more advanced techniques, such as whole genome copy number analysis.
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Affiliation(s)
- Ivy Ng
- Radiation Oncology, National University Cancer Institute, National University Hospital Singapore
| | - Char Loo Tan
- Pathology, National University Hospital Singapore
| | | | - Balamurugan Vellayappan
- Radiation Oncology, National University Cancer Institute, National University Hospital Singapore
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50
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Santoro C, Sperduti I, Latagliata R, Baldacci E, Anaclerico B, Avvisati G, Breccia M, Buccisano F, Cedrone M, Cimino G, De Gregoris C, De Muro M, Di Veroli A, Leonetti Crescenzi S, Montanaro M, Montefusco E, Porrini R, Rago A, Spadea A, Spirito F, Villivà N, Andriani A, Alimena G, Mazzucconi MG. Role of treatment on the development of secondary malignancies in patients with essential thrombocythemia. Cancer Med 2017; 6:1233-1239. [PMID: 28544749 PMCID: PMC5463060 DOI: 10.1002/cam4.1081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 09/15/2016] [Revised: 03/21/2017] [Accepted: 03/30/2017] [Indexed: 01/11/2023] Open
Abstract
Aim of this study is to explore the role of different treatments on the development of secondary malignancies (SMs) in a large cohort of essential thrombocythemia (ET) patients. We report the experience of a regional cooperative group in a real‐life cohort of 1026 patients with ET. We divided our population into five different groups: group 0, no treatment; group 1, hydroxyurea (HU); group 2, alkylating agents (ALK); group 3, ALK + HU sequentially or in combination; and group 4, anagrelide (ANA) and/or α‐interferon (IFN) only. Patients from groups 1, 2, and 3 could also have been treated either with ANA and/or IFN in their medical history, considering these drugs not to have an additional cytotoxic potential. In all, 63 of the 1026 patients (6%) developed 64 SM during the follow‐up, after a median time of 50 months (range: 2–158) from diagnosis. In univariate analysis, a statistically significant difference was found only for gender (P = 0.035) and age (P = 0.0001). In multivariate analysis, a statistically significant difference was maintained for both gender and age (gender HR1.7 [CI 95% 1.037–2.818] P = 0.035; age HR 4.190 [CI 95% 2.308–7.607] P = 0.0001). The impact of different treatments on SMs development was not statistically significant. In our series of 1026 ET patients, diagnosed and followed during a 30‐year period, the different therapies administered, comprising HU and ALK, do not appear to have impacted on the development of SM. A similar rate of SMs was observed also in untreated patients. The only two variables which showed a statistical significance were male gender and age >60 years.
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Affiliation(s)
- Cristina Santoro
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Isabella Sperduti
- Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Roberto Latagliata
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Erminia Baldacci
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | | | | | - Massimo Breccia
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | - Angela Rago
- Hematology, Polo Universitario Pontino, Latina, Italy
| | - Antonio Spadea
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Unit, Rome, Italy
| | | | - Nicoletta Villivà
- Hematology, Nuovo Regina Margherita Hospital ASL Roma 1, Rome, Italy
| | | | - Giuliana Alimena
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Maria Gabriella Mazzucconi
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
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