Who may benefit from prophylactic cranial irradiation amongst stage III non-small cell lung cancer patients?

PURPOSE: To identify a high risk group of non-small cell lung cancer (NSCLC) patients who may benefit from preventive strategies in order to reduce the rate of brain metastasis. METHODS: Two-hundred stage IIIA (47.5%) and IIIB (52.5%) NSCLC patients were analysed (median age 61 years, range 29-82). Pathological diagnosis consisted of 27% adenocarcinomas, 48.5% squamous cell carcinomas, and 24.5% non-small cell lung carcinomas. Brain metastasis rate was calculated and compared in relation to age, gender, stage, histology, chemotherapy and surgery. RESULTS: Median follow-up was 15 months (range 2-65), and the 2-year survival rate was 35%. Two-year incidence of brain metastasis was 23%. In univariate analysis, 32.9% of the patients younger than 60 years of age developed brain metastasis, in contrast to 15.3% of those older than 60 years (p=0.003). Brain was the first metastatic site in younger patients (44.4%) which was significantly higher than in the older age group (23%) (p=0.03). Adenocarcinoma had higher risk (39.6%) than squamous cell carcinoma (15.7%) for brain metastasis (p<0.0001). Patients 60 years old or younger with adenocarcinoma (53.3%) had higher risk for brain metastasis than all the others (18%; p<0.0001). CONCLUSION: In locally advanced NSCLC patients, age and adenocarcinoma histology represent high risk factors for early development of brain metastasis. Many of the failures are isolated brain lesions and future studies are required to assess the benefit of preventive strategies in selected patients.

Adenoid cystic carcinoma of the Bartholin's gland: case report and systematic review of the literature.

Adenoid cystic carcinoma (ACC) of the Bartholin's gland is a rare malignancy of the female genital tract. Seventy-nine cases have been reported in the literature. A 40-year-old women presented to our clinic with twice locally recurrent ACC of Bartholin's gland of the left vulva despite hemivulvectomy. Adjuvant radiotherapy was delivered after the third resection. There was no local recurrence after three years follow-up, although she developed lung metastases that remain under control with oral cyclophosphamide. Our case confirms the literature review, which indicates a slow growing tumor with frequent local recurrences (30%) and distant metastases (31%). Adjuvant radiotherapy and/or chemotherapy should be considered in the management of ACC of Bartholin's gland.

Concurrent chemoradiotherapy with low dose weekly gemcitabine in medically inoperable muscle-invasive bladder cancer patients.

PURPOSE: We aimed to determine the efficacy and the toxicity of low dose weekly gemcitabine with radiation therapy in medically unfit muscle-invasive bladder cancer patients. METHODS: Twenty-six patients were included into the retrospective analysis. Weekly gemcitabine was administered 75 mg/m(2) with a median dose of 63 Gy radiation therapy. Clinical target volume was defined as the urinary bladder only in conformal treatment planning. RESULTS: Median follow-up was 51 months (range 14-118 months). Complete response rate was 62.5 %. The 5-year local progression-free survival, disease-specific survival and overall survival rates were 40.6, 59.5 and 58.5 %, respectively. Concurrent chemotherapy was continued in 80.7 % of patients without any interruption. Gemcitabine was stopped due to grade 3 thrombocytopenia (n = 1), cardiac angina (n = 1), chronic obstructive pulmonary disease exacerbation (n = 1) or patients' reluctance (n = 2). CONCLUSIONS: Low dose weekly gemcitabine with concurrent radiotherapy is a tolerable regimen and have comparable outcomes with platinum-based combined treatments in muscle-invasive bladder cancer. Prospective randomized trials can help in understanding the safety and efficacy of this treatment specially in medically unfit patients.