Concurrent chemoradiotherapy with helical tomotherapy for oropharyngeal cancer: a preliminary result.

PURPOSE: To review the experience with and evaluate the treatment plan for helical tomotherapy for the treatment of oropharyngeal cancer. METHODS AND MATERIALS: Between November 1, 2006 and January 31, 2009, 10 histologically confirmed oropharyngeal cancer patients were enrolled. All patients received definitive concurrent chemoradiation with helical tomotherapy. The prescription dose to the gross tumor planning target volume, the high-risk subclinical area, and the low-risk subclinical area was 70 Gy, 63 Gy, and 56 Gy, respectively. During radiotherapy, all patients were treated with cisplatin, 30 mg/m(2), plus 5-fluorouracil (425 mg/m(2))/leucovorin (30 mg/m(2)) intravenously weekly. Toxicity of treatment was scored according to the Common Terminology Criteria for Adverse Events, version 3.0. Several parameters, including maximal or median dose to critical organs, uniformity index, and conformal index, were evaluated from dose-volume histograms. RESULTS: The mean survival was 18 months (range, 7-22 months). The actuarial overall survival, disease-free survival, locoregional control, and distant metastasis-free rates at 18 months were 67%, 70%, 80%, and 100%, respectively. The average for uniformity index and conformal index was 1.05 and 1.26, respectively. The mean of median dose for right side and left side parotid glands was 23.5 and 23.9 Gy, respectively. No Grade 3 toxicity for dermatitis and body weight loss and only one instance of Grade 3 mucositis were noted. CONCLUSION: Helical tomotherapy achieved encouraging clinical outcomes in patients with oropharyngeal carcinoma. Treatment toxicity was acceptable, even in the setting of concurrent chemotherapy. Long-term follow-up is needed to confirm these preliminary findings.

Sinonasal intravascular papillary endothelial hyperplasia successfully treated by endoscopic excision: a case report and review of the literature.

BACKGROUND: Intravascular papillary endothelial hyperplasia (IPEH) is an abundant, usually intravascular, benign endothelial proliferation that may mimic angiosarcoma clinically and histopathologically. Its occurrence in the sinonasal cavity is extremely rare. To the best of our knowledge, we present the first case with the most extensive IPEH ever found within the sinonasal cavity. METHODS: A 42-year-old man of intravascular papillary endothelial hyperplasia in the sinonasal cavity was reported. He complained of a 1-year history of left-sided nasal obstruction accompanied by unilateral rhinorrhea, repeated epistaxes and frontal headache. Anterior rhinoscopy demonstrated a smooth-surfaced reddish mass occupying the left nasal cavity. Endoscopic surgery was used to clear this uncommon tumor in the sinonasal cavity. A review of the pertinent literature was also presented. CONCLUSIONS: IPEH may be mistaken for an angiosarcoma clinically and histopathologically. Complete endoscope-guided surgical excision is the best choice of therapy for patients with IPEH and is both diagnostic and curative. Awareness of this lesion will prevent incorrect diagnosis and overly aggressive treatment.

Mycobacterium fortuitum-induced persistent parotitis: successful therapy with clarithromycin and ciprofloxacin.

BACKGROUND: Parotitis caused by nontuberculous mycobacteria, a very rare disease entity, has never been reported to be caused by Mycobacterium fortuitum (M. fortuitum) in the literature. METHODS AND RESULTS: An 8-year-old girl was seen with painful swelling of the right parotid gland despite antibiotic treatment of more than 1 month. Elevated serum amylase activity and diffuse contrast-enhanced CT of the parotid gland confirmed the diagnosis of parotitis. Histopathological study of specimens taken from the right parotid tail mass showed granulomatous inflammation with acid-fast positive bacilli; culture later confirmed M. fortuitum. After administration of clarithromycin and ciprofloxacin for 9 consecutive months, the parotitis and parotid tail mass were completely resolved at follow-up examination. CONCLUSION: To our knowledge, this is the first case report of parotitis caused by M. fortuitum and its successful medical treatment.