Tongue: the unusual site in malignant pleural mesothelioma.

Malignant mesotheliomas (MMs) are malignancies of the mesothelium, with primary deposits originating in the pleura, peritoneum, pericardium and the tunica vaginalis (ie, testicular). Metastatic spread is commonly reported to affect the liver, adrenal glands, kidney and contralateral lung (in cases of malignant pleural mesothelioma). Metastases to distant sites are uncommon. Spread to the oral cavity in particular is very rare. A total of 23 cases of metastatic spread to the oral cavity have been reported in the literature to date; of those, 9 cases have been to the tongue. Given the rarity of the site of metastasis, the management remains challenging. This case highlights a rare site of metastasis in MM, discusses treatment options available and briefly talks about technical limitations in treating a mobile structure such as the tongue. Good palliative and supportive care is crucial in managing cases where no curative treatment is possible.

Evolution of Stereotactic Ablative Radiotherapy in Lung Cancer and Birmingham's (UK) Experience.

Stereotactic ablative radiotherapy (SABR) has taken a pivotal role in early lung cancer management particularly in the medically inoperable patients. Retrospective studies have shown this to be well tolerated with comparable results to surgery and no significant increase in toxicity. Paucity of randomized evidence has dictated initiation of several trials to provide good quality evidence to steer future practice. This review summaries salient developments in lung SABR, comparisons to surgery and other platforms and our local experience at University Hospitals Birmingham, UK of lung SABR since its initiation in June 2013.

Outcomes Following Interval Debulking Surgery in Primary Peritoneal Carcinoma.

AIM: Primary peritoneal carcinoma (PPC) has a poor prognosis, with a median survival of 11-24 months. Unlike ovarian cancer, there exist no published data on the effectiveness of interval debulking surgery (IDS) in PPC and it is not routine practice. Our series compared outcomes in patients with PPC treated with IDS following chemotherapy versus patients treated with chemotherapy alone. PATIENTS AND METHODS: A retrospective case-note analysis was undertaken of all patients diagnosed with PPC in the Pan-Birmingham network between May 2000 and October 2008. Data were analysed for age, performance status, response to chemotherapy, surgical outcomes, subsequent treatments, site of relapse, median progression-free (PFS) and overall (OS) survival. Analysis for PFS and OS was undertaken using both Kaplan-Meier and log-rank analysis. RESULTS: A total of 44 patients with histologically-proven PPC were identified: 41 patients received chemotherapy with platinum combination or alone; 17/44 (39%) of patients underwent IDS following chemotherapy and 15 of these had optimal debulking; 3/15 (20%) had a complete pathological response. The recurrence rate for the surgical group was 11/17 (65%) including those with suboptimal debulking, whereas disease recurred in 25/27(93%) of the non-surgical group. The median PFS was 25 months (range=8-33 months) in the IDS group compared to 9 months (range=0-30 months) in the non-surgical group (p=0.001). The median OS was 48 months in the IDS group compared to 18 months in the non-surgical group (p=0.0016). The median OS for the whole patient cohort was 32 months. CONCLUSION: The median OS for the whole cohort compares favourably with previously published survival data of 11-24 months. IDS in selected cases of PPC appears to improve median OS and PFS in PPC and we would recommend that surgery is considered as a treatment option in all patients who have a good response to chemotherapy or entry into a clinical trial.

Survival and Toxicity Following Chemoradiation for Carcinoma of the Cervix - Impact of Multiple-phase Treatment and Shielding.

AIM: We report on outcomes and significant grade 3-4 late toxicities between January 1999 and October 2006 following introduction of multi-phase treatment and effect of shielding in treatment of cervical cancer with concurrent chemoradiation. PATIENTS AND METHODS: Radiotherapy dose by phase, recurrence, survival and toxicity data was collated by a retrospective review of clinical notes. Shielding information was retrieved from original planning films. RESULTS: 3-year survival for stages I, II and III disease were 89%,76% and 51% respectively. Local pelvic failure was 9%. Overall significant late toxicity (SLT) rate was 13%, with lower rates for post-operative treatment than primary chemoradiation (4% vs. 16%). SLT with single phase treatment was 29% versus 12% following multiphase EBRT and 16% when <2 areas were shielded versus 6% with ≥3 shielded areas (p=0.01). CONCLUSION: Shielding and multi-phase treatment not only reduce dose to organs at-risk but can also reduce late toxicity without compromising local control or survival.