Gynecological radiotherapy in people living with human immunodeficiency virus: a semi-systematic literature review.

Appropriate diagnosis and treatment of gynecological cancers in people living with human immunodeficiency virus (HIV) remains a clinical challenge given rapid changes in both HIV and cancer management and a lack of prospective clinical trial data inclusive of the HIV population. A semi-systematic literature review was performed to identify published studies addressing risk factors, screening, treatment efficacy, treatment toxicity, and prognosis for people living with HIV diagnosed with gynecological malignancies, with a focus on radiotherapy and cervical cancer, given the relative paucity of literature on uterine, ovarian, and vulvovaginal cancers in people living with HIV. People living with HIV are more likely to be co-infected with human papilloma virus and more likely to develop human papilloma virus-associated malignancies. People living with HIV are less likely to receive cancer treatment compared with HIV-uninfected cancer patients, even after adjusting for differences in clinical features and sociodemographic variables. The literature on cervical cancer outcomes is mixed, with some studies demonstrating that people living with HIV have inferior treatment tolerability, response rates, and survival following chemoradiotherapy, and others showing no difference in these outcomes, particularly in patients receiving antiretroviral therapy. Importantly, even in the series showing inferior outcomes in people living with HIV, there were long-term survivors after administration of curative therapy. Consistent with published cancer management guidelines, people living with HIV diagnosed with gynecological cancers should be treated with standard cancer therapy. Co-management with the patient's HIV specialist is critical to avoid overlapping toxicities and provide optimal supportive care. The morbidity and mortality caused by gynecologic cancers in this population can be mitigated by early diagnosis, appropriate treatment delivery including inclusion of people with HIV in cancer clinical trials, and diligent HIV management.

Stent Placement Across the Renal Vein Inflow in Patients Undergoing Venous Reconstruction Preserves Renal Function and Renal Vein Patency: Experience in 93 Patients.

PURPOSE: To determine if stent placement across the renal vein inflow affects kidney function and renal vein patency. METHODS: Between June 2008 and September 2016, 93 patients (mean age 39 years, range 15-70; 54 women) with iliocaval occlusion underwent venous stent placement and were retrospectively reviewed. For this analysis, the patients were separated into treatment and control groups: 51 (55%) patients had suprarenal and infrarenal iliocaval venous disease requiring inferior vena cava stent reconstruction across the renal vein inflow (treatment group) and 42 (45%) patients had iliac vein stenting sparing the renal veins (control group). Treatment group patients received Wallstents (n=15), Gianturco Z-stents (n=24), or suprarenal and infrarenal Wallstents such that the renal veins were bracketed with a "renal gap" (n=12). Stenting technical success, stent type, glomerular filtration rate (GFR), and creatinine before and after stent placement were recorded, along with renal vein patency and complications. RESULTS: All procedures were technically successful. In the 51-patient treatment group, 15 (29%) patients received Wallstents and 24 (47%) received Gianturco Z-stents across the renal veins, while 12 (24%) were given a "renal gap" with no stent placement directly across the renal vein inflow. In the control group, 42 patients received iliac vein Wallstents only. Mean prestent GFR was 59±1.8 mL/min/1.73 m2 and mean prestent creatinine was 0.8±0.2 mg/dL for the entire cohort. Mean prestent GFR and creatinine values in the Wallstent, Gianturco Z-stent, and "renal gap" subgroups did not differ from the iliac vein stent group. Mean poststent GFR and creatinine values were 59±3.3 mL/min/1.73 m2 and 0.8±0.3 mg/dL, respectively. There were no differences between mean pre- and poststent GFR (p=0.32) or creatinine (p=0.41) values when considering all patients or when comparing the treatment subgroups and the control group. There were no differences in the poststent mean GFR or creatinine values between the Wallstent (p=0.21 and p=0.34, respectively) and Gianturco Z-stent (p=0.43 and p=0.41, respectively) groups and the "renal gap" group. One patient with a Wallstent across the renal veins developed right renal vein thrombosis 7 days after the procedure. CONCLUSION: Stent placement across the renal vein inflow did not compromise renal function. A very small risk of renal vein thrombosis was seen.

Evaluating patterns of care for early-stage low-grade follicular lymphoma in the rituximab era.

Radiotherapy (RT) utilization for early-stage, low-grade follicular lymphoma (FL) is low despite treatment guideline recommendations. We compare treatment trends for early-stage FL in the era of involved-site RT and rituximab. We identified 11,645 patients in the National Cancer Database (NCDB) with stage I-II, grade 1-2 nodal or extranodal FL diagnosed 2011-2017, with median follow-up of 44 months. From 2011 to 2017, RT utilization rates decreased from 33.4% to 22.4%, observation decreased from 65.3% to 49.7%, chemoimmunotherapy increased from 0.5% to 15.0%, immuno-monotherapy increased from 0.6% to 10.2%, and RT + systemic therapy increased from 0.6% to 2.5%. RT utilization remains low in the involved-site RT and rituximab era.

Comparing adjuvant radiation to adjuvant chemoradiation in postsurgical p16+ oropharyngeal carcinoma patients with extranodal extension or positive margins.

BACKGROUND: Adjuvant guidelines in surgically resected p16+ oropharyngeal carcinoma (OPC) with positive surgical margins (PSM) or extranodal extension (ENE) are based on randomized controlled trials predating p16 status. It remains unclear if adjuvant chemotherapy is necessary in p16+ patients with these features. METHODS: The National Cancer Database was used to identify cases of nonmetastatic p16+ OPC diagnosed from 2010 to 2017. Patients treated with surgical resection followed by adjuvant radiation (aRT) or adjuvant chemoradiation (aCRT) were eligible for analysis. RESULTS: A total of 14 071 patients were eligible for analysis. Overall survival (OS) was not statistically different between aRT and aCRT in patients with PSM (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.56-1.28), ENE (HR 0.93, 95% CI 0.69-1.27) or both (HR 0.73, 95% CI 0.41-1.31). CONCLUSIONS: In patients with p16+ OPC with ENE, PSM, or both, adding chemotherapy to aRT was not associated with improved OS.

Radical trachelectomy and adjuvant vaginal brachytherapy to preserve fertility in pediatric cervical adenocarcinoma.

PURPOSE: This case report describes the use of a trachelectomy and adjuvant vaginal brachytherapy for pediatric clear cell adenocarcinoma as definitive fertility-sparing treatment. METHODS AND MATERIALS: A previously healthy 8-year-old female presented with abdominal cramping and heavy vaginal bleeding. Diagnostic imaging revealed a 3.5 cm circumscribed cervical mass, with subsequent biopsy revealing clear cell adenocarcinoma. Fertility preserving treatment was requested. RESULTS: The patient underwent a radical trachelectomy, with final pathology demonstrating a close radial margin. Due to close margin, adjuvant radiotherapy with a vaginal cylinder was delivered to a total dose of 18 Gray in three fractions prescribed to a depth of 5 mm from the vaginal surface using iridium-192. With 2 years of follow-up, the patient continues to do well with no evidence of recurrence or late toxicity from treatment. CONCLUSIONS: Pediatric clear cell adenocarcinoma of the cervix is a rare occurrence that lacks clinical trials to guide effective treatment. Adjuvant vaginal brachytherapy following trachelectomy in a pediatric patient with clear cell adenocarcinoma of the cervix is feasible and well-tolerated.

Linear Accelerator-Based Stereotactic Radiosurgery for Cranial Intraparenchymal Metastasis of a Malignant Peripheral Nerve Sheath Tumor: Case Report and Review of the Literature.

BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs) are rare, aggressive soft tissue sarcomas. MPNST intracranial metastasis is exceedingly rare with only 22 documented cases in the literature and, to our knowledge, only 1 case with intraparenchymal brain metastasis. Most have been managed surgically; however, 2 documented cases were treated with Gamma Knife radiosurgery. Excluding this case report, there are no other documented cases of linear accelerator-based stereotactic radiosurgery (SRS) to treat MPNST brain metastasis. CASE DESCRIPTION: A 41-year-old man with MPNST of the lung initially underwent tumor resection. He developed multiple systemic metastases that were managed with directed radiation therapy. A parietal brain metastasis was treated with linear accelerator-based SRS. Following SRS therapy, the patient was treated with a tropomyosin receptor kinase inhibitor. Complete resolution of brain metastasis was seen on brain magnetic resonance imaging 5 months after treatment with SRS. At 11 months after SRS, there was no evidence of recurrence or progression of the intraparenchymal disease. The patient continued to have stable extracranial disease on his ninth cycle of systemic treatment. CONCLUSIONS: This report provides important insights into efficacy of linear accelerator-based SRS to treat MPNST brain metastases.