Evolving management of HER2+ breast cancer brain metastases and leptomeningeal disease.

Patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer are at a particularly high risk of breast cancer brain metastasis (BCBM) and leptomeningeal disease (LMD). Improvements in systemic therapy have translated to improved survival for patients with HER2-positive BCBM and LMD. However, the optimal management of these cases is rapidly evolving and requires a multidisciplinary approach. Herein, a team of radiation oncologists, medical oncologists, neuro-oncologists, and breast surgeon created a review of the evolving management of HER2-positive BCBM and LMD. We assess the epidemiology, diagnosis, and evolving treatment options for patients with HER2-positive BCBM and LMD, as well as the ongoing prospective clinical trials enrolling these patients. The management of HER2-positive BCBM and LMD represents an increasingly common challenge that involves the coordination of local and systemic therapy. Advances in systemic therapy have resulted in an improved prognosis, and promising targeted therapies currently under prospective investigation have the potential to further benefit these patients.

River phosphorus cycling during high flow may constrain Lake Erie cyanobacteria blooms.

Cyanobacterial harmful blooms have been increasing worldwide, due in part to excessive phosphorus (P) losses from agriculture-dominated watersheds. Unfortunately, cyanobacteria bloom management is often complicated by uncertainty associated with river P cycling. River P cycling mediates P exports during low flow but has been assumed to be unimportant during high flows. Thus, we examined interactions between dissolved reactive phosphorus (DRP) and suspended sediment P during high flows in the Maumee River network, focusing on March-June Maumee River DRP exports, which fuel recurring cyanobacteria blooms in Lake Erie. We estimate that during 2003-2019 March to June high flow events, P sorption reduced DRP exports by an average of 13-27%, depending upon the colloidal-P:DRP ratio, decreasing the bioavailability of P exports, and potentially constraining cyanobacteria blooms by 13-40%. Phosphorus sorption was likely lower during 2003-2019 than 1975-2002 due to reductions in suspended sediment loads, associated with soil-erosion-minimizing agricultural practices. This unintended outcome of erosion management has likely decreased P sorption, increased DRP exports to Lake Erie, and subsequent cyanobacteria blooms. In other watersheds, DRP-sediment P interactions during high flow could have a positive or negative effect on DRP exports; therefore, P management should consider riverine P cycles, particularly during high flow events, to avoid undermining expensive P mitigation efforts.

Recurrent High-Grade Invasive Mucoepidermoid Carcinoma of Larynx: A Case Report and Review of the Literature.

Recurrent invasive high-grade mucoepidermoid carcinoma of the larynx and hypopharynx is a rare occurrence. These tumors have been commonly associated with salivary gland tumors, most commonly the parotid gland. The patient usually presents with the following symptoms: hoarseness (if larynx is involved), or changes in voice character, sore throat, cough, odynophagia, dysphagia, otalgia, difficulty breathing, weight loss, lymphadenopathy. Here we present a case of a recurrent invasive high-grade mucoepidermoid carcinoma of larynx and hypopharynx. The patient was a 67-year-old male that originally presented in 2006. At that time he underwent a wide field laryngectomy, right thyroid lobectomy, and biopsy of the right digastric node. He was a clinical stage III, pT3N0M0. No adjuvant radiation therapy was given at that time. The patient remained asymptomatic until February 2014, when he presented with dysphagia and neck swelling. Positron emission tomography/computed tomography showed evidence of recurrence. The patient was treated with definitive intensity modulated radiation therapy (IMRT) with concurrent chemotherapy. Treatment for this disease is gathered by scattered case reports. If surgery is a possibility it is considered as first line therapy. Post-surgical radiation is then offered. However, in this case the recurrent tumor was located near the carotid artery, and thus surgery was not a possibility. Therefore, concurrent chemotherapy and radiation with IMRT and weekly cis-platinum was given. While the optimum combination of treatment has not yet been established because of the rarity of this cancer's location site, the current patient appeared to have an excellent response from the definitive IMRT and chemotherapy treatment.