RESUMO
BACKGROUND: A meta-analysis was conducted to assess the impact of radiation-induced ovarian ablation (RT-OA) on amenorrhea cessation rates, progression-free survival, and overall survival in pre/perimenopausal women with breast cancer. MATERIALS AND METHODS: The Medline, CANCERLIT, and Cochrane Library databases and search engines were searched to identify randomized controlled studies comparing RT-OA with control for early or metastatic breast cancer. Further, radiotherapy doses, techniques, and associated side effects were evaluated. RESULTS: Six controlled trials with a total patient population of 3,317 were identified. Pooled results from these trials showed significant amenorrhea rates (P<0.00001) and increase in progression-free survival in patients treated with RT-OA (P<0.00001). However, there was no difference in overall survival (P=0.37). The majority of patients were treated with larger field sizes with parallel-opposed anteroposterior and posteroanterior pelvic fields. RT-OA was generally well tolerated. Radiotherapy doses of 1,500 cGy in five fractions, 1,500 cGy in four fractions, 1,600 cGy in four fractions, and 2,000 cGy in ten fractions were associated with excellent amenorrhea rates. The resultant funnel plot showed no publication bias (Egger test P=0.16). CONCLUSION: RT-OA is cost-effective and can safely be used in pre/perimenopausal women with metastatic breast cancer, or if luteinizing hormone-releasing hormone analogs are contraindicated, or in patients in whom fertility preservation is not an issue. Radiation dose of 1,500 cGy in five fractions, 1,500 cGy in four fractions, 1,600 cGy in four fractions, and 2,000 cGy in ten fractions showed more efficacies. However, further studies incorporating three-dimensional conformal radiotherapy and intensity-modulated radiotherapy are warranted.
RESUMO
Metastatic involvement of the optic nerve or its sheath is very rare (1.3 - 3%). The most common malignancies reported to metastasize to the optic nerve or its sheath are breast, lung, kidney, bladder, gastric and colorectal cancers. Carcinoma of uterine cervix metastatic to optic nerve and optic nerve sheath is extremely rare and is associated with grave prognosis due to underlying high tumor burden. Here in, we report a 61-year Saudi woman who was treated with concurrent chemoradiation for squamous cell carcinoma of cervix FIGO IVA 6 months back. She presented with pain and progressive visual loss in the right eye. Magnetic resonance imaging showed enhanced solid mass of the intraorbital optic nerve consistent with optic nerve sheath meningioma. Immunostaining (CK5/6, CAM 5.2, p63 and p16) confirmed the diagnosis of metastatic squamous cell carcinoma of uterine cervix.