Single-Fraction Stereotactic Ablative Body Radiotherapy for Primary and Extracranial Oligometastatic Cancers.

Stereotactic ablative body radiotherapy (SABR) consists of delivering high doses of ionising radiation, typically across three to eight fractions with high precision and conformity. SABR has become increasingly commonplace throughout the last quarter of a century and is offered for the treatment of various primary and metastatic tumour types. Delivering SABR in a single fraction has arisen as an appealing possibility for several reasons. These include fewer hospital visits, greater patient convenience, improved sustainability and lower costs. However, these factors must be balanced against considerations such as toxicity, side-effects and, most importantly, progression-free and overall survival. In this review we seek to analyse the results of studies looking at the efficacy of single-fraction SABR for lung, prostate, renal and pancreas primary tumours, as well as oligometastases. The tumour type to be most widely treated with single-fraction SABR is lung, but its remit continues to expand. We also look at the biological rationale underpinning SABR and how this can be extended to single-fraction regimens. Finally, we turn our attention towards the future directions of SABR and specifically single-fraction regimens. These include the possibility of combining SABR with immunotherapy and technological advances in the field, which could serve to expand the scope of SABR. We conclude by summarising the current clinical studies of single-fraction SABR.

Multidisciplinary management of malignant ovarian germ cell tumours.

OBJECTIVES: Malignant ovarian germ cell tumours (MOGCT) are rare cancers of young women. Limited prospective trials exist from which evidence-based management can be developed. This review summarizes the available literature concerning MOGT in order to provide the clinician with information relevant to their multidisciplinary management. METHODS: MEDLINE was searched between 1966 and 2010 for all publications in English where the studied population included women diagnosed with malignant ovarian germ cell tumours. RESULTS: The majority of patients can be cured with fertility-preserving surgery with or without combination chemotherapy. Long term survival approaches 100% in early stage disease and is approximately 75% in advanced stage disease. Most studies suggest that the treatment has little, if any, effect on future fertility and limited data suggest that there is no adverse effect on the future quality of life. CONCLUSION: MOGCTs are rare tumours of young women the majority of which can be successfully treated with fertility-preserving surgery with or without chemotherapy with preservation of reproductive function. Minimisation of chemotherapy in good prognostic groups and improved treatment in resistant and relapsed MOGCT are important goals for the future. Further studies are needed to quantify the late adverse effects of treatment in long term survivors.

Primary fallopian tube carcinoma.

UNLABELLED: Primary fallopian tube cancer constitutes 1% of gynecologic malignancies. Early clinical manifestation and prompt investigations lead to diagnosis in the early stage of disease accounting for a better survival compared with ovarian cancer. Principles of management generally follow that of epithelial ovarian cancer. This article reviews the current understanding of this rare cancer. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the clinical features of a patient with fallopian tube carcinoma, to list the prognostic factors associated with fallopian tube cancer, and to outline the treatment options for a patient with fallopian tube cancer.

Placental site trophoblastic tumor.

Placental site trophoblastic tumor (PSTT) is an uncommon form of gestational trophoblastic disease (GTD) with variable spectrum of clinical behavior. PSTT can occur after a normal pregnancy, spontaneous abortion, termination of pregnancy, ectopic pregnancy or molar pregnancy. Surgery is the primary treatment. Chemotherapy has an established role in loco-regionally advanced and metastatic disease. Many studies indicate that mitotic index is an important prognostic indicator. This article reviews the literature on this rare disease.

Bone marrow relapse in primary mucinous carcinoma of skin.

Primary mucinous carcinoma of skin is a rare adnexal tumor arising from the eccrine sweat gland. The tumors grow slowly and have low rates of local recurrence and rare chances of distant metastasis. The authors report a 70-year-old man with primary mucinous skin carcinoma who had a relapse in bone marrow 19 months after initial treatment.

Osteosarcoma arising in a mature cystic teratoma of the ovary.

A 80-year old woman was found to have an osteosarcoma arising within a mature cystic teratoma of the ovary. To the Author's knowledge, this is the fourth reported case of osteosarcoma arising within a teratoma.

'Metastatic invasive mole' causing paraplegia.

We report a rare case of 'metastatic invasive mole' to the spinal cord causing paraplegia in a 19-year-old woman. There are no such histologically proven reports in the literature since the use of the tumour marker, beta-subunit of human chorionic gonadotrophin (beta-HCG) and chemotherapy. We stress the importance of considering this rare possibility in young woman with compressive myelopathy.

Intensive chemotherapy in children with stage IV neuroblastoma.

A retrospective analysis of effectiveness of sequential chemotherapy with cyclophosphamide, doxorubicin, cisplatin and etoposide in children with stage IV neuroblastoma was undertaken. Study group included 17 children of mores than one year old with median age of 3 years (range 18 months to 7 years). Fourteen were males and three females. Sites of primary tumor were abdomen in 12 patients, pelvis in 3, paravertebral in 1 and unknown in 1. Metastatic sites included bone marrow (88%), bone (82%), orbit (29.4%) and lymph node (11.7%). One patient had brain parenchymal disease and another had cerebrospinal fluid positivity for malignant cells. Fifteen of the 17 patients had major response with chemotherapy (complete response in two and partial response in 13). Ten of the 15 patients completed four courses of chemotherapy and five patients progressed while on chemotherapy and died. Only two of the ten patients, who had four courses chemotherapy are alive after 2 years. Hence the 2-year survival in this series is 11.7%. There was no toxic death in this study.

Pattern and outcome of neuroblastoma. A 10 year study.

OBJECTIVE: To determine the clinical pattern and outcome of children with neuroblastoma. DESIGN: Retrospective analysis. SETTING: Hospital based information from the case sheets. SUBJECTS: 91 children with age upto 14 years treated in the Regional Cancer Center, Trivandrum. METHODS: Clinical presentation, metastatic pattern and treatment outcome were analyzed. RESULTS: Median age of the study group was 2.5 years with a male:female ratio of 1.6:1. Fifteen per cent children had early stage disease and 85% advanced disease. Five children with stage III and 22 with stage IV disease did not receive may active treatment. The remaining 64 children were evaluated for this analysis with a survival rate of 25%. Two of the four (50%) stage I, four of the six (83.3%) stage II, five of the 18 (27.7%) stage III, three of the 32 (9%) stage IV and two of the four (50%) stage IVs patients are long term survivors. CONCLUSIONS: Majority of the children (> 80%) presented with advanced disease and outcome remained poor. Only 27% of stage III and 9% of stage IV patients are long term survivors in our series. In future, approaches to detect disease at an early stage and aggressive therapeutic strategies in selected patients may improve survival.

Orbital multiple myeloma: case report and review of computed tomography features.

Orbital involvement at diagnosis in multiple myeloma is rare. Only a few a cases are reported with computed tomographic features. We report a case of orbital myeloma, and relevant medical reviews on computed tomography features are discussed.

Ovarian carcinoma relapsing as a cerebellopontine angle tumour.

Involvement of the central nervous system in epithelial ovarian carcinoma is rare. A 46-year-old woman with ovarian carcinoma relapsing with brain metastasis is described. She received radiotherapy for the metastasis and survived for 18 months.