RESUMO
Penile cancer is a rare genitourinary malignancy for which limited treatment options exist beyond primary surgical resection. Metastatic lymphadenopathy represents a particularly poor prognosis with a lack of literature to suggest the effectiveness of radiation or systemic therapies. Our case documents an inguinal recurrence of penile squamous cell carcinoma not amenable to surgical intervention demonstrating complete response to salvage radiotherapy in the palliative setting. These observations propose the need for further research around the utility of radiotherapy in the management of metastatic penile malignancies.
RESUMO
Meningiomas are tumors that originate from the meningeal or dural cover of the brain and are the most common primary benign brain tumors. Currently, the accepted management of these tumors is attempted total surgical excision when technically possible and associated with an acceptable risk. However, radiation therapy has been shown to provide excellent local control when used either as an adjunct to surgery or as a primary treatment. We present a case report of a 46-year-old female patient with an unresectable left foramen magnum meningioma resulting in headaches, neck pain, and swallowing difficulty. The patient underwent CyberKnife (Accuray Incorporated, Sunnyvale, CA) radiosurgery to a dose of 3,000 cGy in five fractions in March 2011. The patient tolerated treatment without complications and has remained clinically well with no ongoing cranial nerve deficits as of the last examination in late 2019. This demonstrates the excellent local control obtained when using radiosurgery as both a surgical adjunct and a primary treatment for meningiomas.
RESUMO
Radiosurgery (RS) can offer excellent local control in the management of both benign and malignant tumors measuring less than 3 cm in size. A known late complication of radiosurgery is radiation necrosis which generally occurs within 6-18 months following treatment and has an increased risk of occurrence with higher radiation doses. The lower dose used to treat vestibular schwannomas (VS) makes this complication less frequent. Tumors that do not respond to radiosurgery and continue to grow may require surgical intervention. We report a case of a young male who received radiosurgery (18 Gy in 3 fractions) in February 2016 for a recurrent VS following initial debulking surgery in 2008. Follow-up imaging revealed an interval decrease in size by May 2017; however, by April 2018, there was significant interval increase in the cisternal components of the tumor. By September 2018, the lesion had increased by >50% (to a size of 29 mm) compared to May 2017. The patient agreed to undergo repeat surgical debulking. Upon review of the preoperative MRI, the cisternal component of the tumor had substantially decreased in size. Although uncommon, this reflects delayed, pseudoprogression which, in our case, was self-limiting. This raises a question regarding when to proceed with surgical intervention of growing VS following radiosurgery given the potential for delayed resolution of radiation necrosis and demonstrates a gap in our current literature involving surgery of VS following radiosurgery.
