Stereotactic Ablative Radiotherapy for a Lung Metastasis in a Child With Ewing's Sarcoma.

Stereotactic ablative radiotherapy delivers a high dose of radiation to a small volume over several fractions. Although most commonly used as a treatment alternative to surgery in adult patients with primary lung cancer, its use has now been reported in children with metastatic disease to the lungs. We present the case of a child treated with stereotactic ablative radiotherapy to pulmonary metastases in preparation for a salvage stem cell transplant. The patient was treated to a dominant pulmonary nodule and successfully received his stem cell transplant, however he developed clinical and radiographic findings consistent with pneumonitis several months after treatment.

Acrolein inhalation prevents vascular endothelial growth factor-induced mobilization of Flk-1+/Sca-1+ cells in mice.

OBJECTIVE: Acrolein is a toxic chemical present in tobacco, wood, and coal smoke, as well as automobile exhaust. Because exposure to these pollutants is associated with an increase in cardiovascular disease risk, we studied the effects of acrolein on Flk-1(+)/Sca-1(+) cells that are involved in vascular repair. METHODS AND RESULTS: In adult male C57BL/6 mice, inhalation of acrolein (1 part per million [ppm], 6 hours/day for 4 days or 5 ppm for 2 or 6 hours) led to the formation of protein-acrolein adducts in the bone marrow and diminished levels of plasma nitric oxide metabolites and circulating Flk-1(+)/Sca-1(+) but not Sca-1(+)-only cells. Acrolein exposure increased the number of apoptotic Flk-1(+)/Sca-1(+) cells in circulation and increased bone marrow-derived cells with endothelial characteristics (DiI-ac-low-density lipoprotein [DiI-acLDL]/UE-lectin and Flk-1(+)/Sca-1(+)) in culture. Deficits in the circulating levels of Flk-1(+)/Sca-1(+) cells were reversed after 7 days of recovery in acrolein-free air. Exposure to acrolein blocked vascular endothelial growth factor (VEGF)/AMD3100-stimulated mobilization of Flk-1(+)/Sca-1(+) but not Sca-1(+)-only cells and prevented VEGF-induced phosphorylation of Akt and endothelial nitric oxide synthase in the aorta. CONCLUSIONS: Inhalation of acrolein increases apoptosis and suppresses the circulating levels of Flk-1(+)/Sca-1(+) cells while increasing these cells in the bone marrow and preventing their mobilization by VEGF. Exposure to acrolein-rich pollutants could impair vascular repair capacity.

Stereotactic Radiosurgery as Part of Multimodal Treatment in a Bulky Leptomeningeal Recurrence of Breast Cancer.

Breast cancer metastatic to the brain and/or leptomeningeal spread of disease is a frequently encountered clinical situation, especially given the extended course of disease in these patients. Systemic therapies can often effectively prolong extracranial disease control, making effective strategies to control central nervous system-based disease even more critical. We present a case of bulky leptomeningeal relapse of breast cancer in the setting of prior whole brain radiation therapy. In order to treat the patient's bulky disease and leptomeningeal spread while avoiding the potential toxicities of repeat whole brain radiation, the patient was treated with frameless stereotactic radiosurgery and intrathecal chemotherapy. This is the first report of this treatment approach for leptomeningeal relapse of breast cancer. The patient had an excellent response to treatment and durable intracranial control.

Prognostic significance of HPV status in postoperative squamous-cell carcinoma of the head and neck.

BACKGROUND: There are limited data on the prognostic significance of human papillomavirus (HPV) status in relation to traditional risk factors for head and neck squamous-cell carcinoma (HNSCC) in the postoperative setting. OBJECTIVE: To clarify the impact of HPV status on the risk for HNSCC in the postoperative setting. METHODS: We retrospectively evaluated an institutional cohort of 128 patients with HNSCC patients who had been treated with definitive surgery with or without adjuvant radiotherapy or chemoradiotherapy. Patient, disease, and treatment factors were analyzed as potential prognostic indicators. RESULTS: Lymph node extracapsular extension (ECE), perineural invasion (PNI), and lymphovascular space invasion (LVSI) positivity predicted poorer locoregional control (LRC), disease-free survival (DFS), and overall survival (OS). Positive margins related to poorer DFS and OS. HPV status alone did not predict LRC, DFS, or OS. Compared with patients who were HPV-positive and ECE-negative, both HPV-positive and HPV-negative patients with ECE experienced significantly poorer OS (78.6%, 60%, and 43.7%, respectively; 𝑃 = .010 and 𝑃 = .018, respectively). LIMITATIONS: Retrospective, single-institution study; small patient cohort; short follow-up time. CONCLUSION: The influence of HPV in postoperative HNSCC seems limited compared with traditional risk factors such as ECE, LVSI, and PNI. De-escalation of postoperative treatment based on HPV status alone should be approached with caution.

Stereotactic body radiation therapy for unbiopsied early-stage lung cancer: a multi-institutional analysis.

OBJECTIVES: Medically inoperable lung cancer patients often have comorbidities that preclude pathologic diagnosis from being attained. We perform a multi-institutional analysis to determine if unbiopsied early-stage lung carcinoma can be safely and effectively treated with stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS: Thirty-four patients with unbiopsied lung cancer were treated with SBRT at the University of Louisville or University of Virginia. Patients had computed tomography (CT) and positron emission tomography (PET) imaging clinically consistent with lung malignancy. Median SBRT dose was 50 Gy (range, 30 to 55 Gy) in a median of 5 fractions (range, 3 to 10 fractions) with static field SBRT or volumetric modulated arc therapy. RESULTS: Median follow-up is 16.7 months. Primary tumors had a median longest dimension on the original CT of 1.6 cm (range, 0.5 to 3.3 cm) and posttreatment CT scan of 1.25 cm (range, 0.0 to 4.5 cm) (P=0.025). Median pretreatment standard uptake value on initial PET scan is 4.6 mg/mL (range, 0.0 to 16.2 mg/mL), and at a median of 7.6 months after SBRT, decreased to 2.25 mg/mL (range, 0.0 to 10.9 mg/mL) on posttreatment PET (P=0.002). Crude local control is 97.1%. The estimated 2-year regional control is 80%, distant control 85%, and overall survival 85%. There were no grade 3 or greater acute toxicities and only 3 grade 3 chronic treatment-related toxicitities. DISCUSSION: In medically inoperable patients with unbiopsied lung cancer, local control can be achieved with minimal toxicity with the use of SBRT. The use of SBRT for unbiopsied early-stage lung cancer patients should be performed in a multidisciplinary setting and after detailed discussion with the patient about the risks and benefits of SBRT.