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INTRODUCTION: Nasopharyngeal carcinoma (NPC) is a rare malignancy in India except in north-eastern states. We present our institutional experience of 16 years highlighting management, outcomes, responses and toxicities. MATERIALS AND METHODS: NPC patients registered at our center during the period of 2000-2015. The primary objective of the study was to assess the overall survival (OS). Secondary outcome included determinations of response rates, progression free survival (PFS) and to assess treatment-related toxicity (CTCAE v4.0). Institute ethics committee approval was obtained prior to initiation of this study. RESULTS: Data was retrieved from complete records of 222 patients out of 390 registered during study period. There were 163 males (73.4%) and 59 females (26.6%) with a male to female ratio of 2.8:1. The median age was 35 years (range 6-73). Only 5.6% (n = 12) presented in early-stage disease (stage I and II) while 89.6% (n = 199) were advanced stage (stage III, IVA, IVB). Five patients (2.2%) presented as metastatic disease. Majority of patients were treated with induction chemotherapy followed by concurrent chemoradiation (CCRT) {76.1%, n = 169}. Relapses were documented in 10.4% patients. 5% patients had loco-regional relapse while distant metastases were seen in 4% patients. The 3-year PFS and OS rates are 60.9% and 68.4%, respectively. Achieving a CR predicted superior OS on multivariate analysis. CONCLUSIONS: NPC is a rare malignancy and majority presented with advanced stages. This data outlines our experience and outcomes with a predominantly induction chemotherapy followed by definitive CCRT based approach.
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Quimioterapia de Indução , Neoplasias Nasofaríngeas , Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Carcinoma Nasofaríngeo/tratamento farmacológico , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias Nasofaríngeas/patologia , Recidiva Local de Neoplasia/tratamento farmacológico , Resultado do Tratamento , Quimiorradioterapia , Hospitais de Ensino , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoRESUMO
BACKGROUND: Metastases account for 6-25% of parotid tumors, often presenting dilemmas in their diagnosis. METHODS: Parotid metastases diagnosed on histology/cytology were retrieved. MUC2, MUC5AC, androgen receptor immunohistochemistry was performed in select cases. RESULTS: Fifty-one samples were identified from 42 patients, including 14 aspirates, 7 biopsies and 30 parotidectomies. Previous history was available in 17 cases, 13 parotidectomies accompanied excision of the primary, and relevant clinical data was unavailable for 12 patients. Majority (81%) had head and neck primaries; eye and ocular adnexa were the commonest subsite (52.4%), and sebaceous carcinoma the commonest histology (33%). When history was unavailable, most metastases were initially diagnosed as poorly differentiated carcinoma/malignant tumor, or mucoepidermoid carcinoma on cytology. CONCLUSIONS: Intraparotid metastases encompass a wide spectrum, often mimicking primary salivary gland neoplasms, particularly on limited samples. Metastases should be considered when histological/cytological features are unusual; detailed clinical information and ancillary techniques aid in arriving at an accurate diagnosis.
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Carcinoma , Glândula Parótida , Humanos , Centros de Atenção TerciáriaRESUMO
INTRODUCTION/BACKGROUND: With the advent of TransOral Robotic Surgery (TORS) the ease of transoral procedures has been dramatically improved. TORS is already established for its feasibility, functional and oncological outcomes for selected lesions of oral cavity, oropharynx and laryngopharynx. This study reports on preliminary results with TransOral UltraSonic Surgery (TOUSS) for oncologic resections of oral cavity, oropharyngeal and supraglottic malignancies. MATERIALS AND METHODS: Eighteen patients with malignancies of oral cavity, oropharynx and supraglottis underwent TOUSS with simultaneous neck dissection and adjuvant therapy as indicated, from January 2018 to April 2019. Essential equipment included the FK-retractor (Gyrus Medical, Tuttilngen, Germany) for TransOral exposure, the Olympus ENDOEYE Flex 5 mm 2D/10 mm 3D deflecting tip video laparoscopes, and 35 cm long ultrasonic harmonic scalpel (Thunderbeat). Parameters evaluated include tumor staging, mouth opening, TOUSS setup time, TOUSS primary removal time, surgical margins, blood transfusions, tracheostomy, postoperative complications, enteral feeding and resumption of oral diet, duration of hospital stay, and survival outcomes. RESULTS: Eighteen patients underwent complete TransOral UltraSonic Surgery (TOUSS), with simultaneous unilateral or bilateral neck dissection. No procedure was abandoned intraoperatively due to difficulty in extirpation of the tumor. Margins were negative for ten patients (55.6%), close in five (27.8%), and positive in three patients (16.7%). Average TOUSS set-up time was 22.5 min (range, 10-30 min) and average TOUSS primary tumor removal time was 35.3 min (range, 15-60 min). Patients started tolerating oral feeds even in the second post op day (mean 6 days), and transitioning to complete oral feeds with removal of the nasogastric tube was achieved in all (mean, 16 days). The average hospital stay was 7.4 days (range 2-16 days). Secondary hemorrhage occurred in two cases and required an emergency tracheostomy and ligation of lingual artery. Minor cervicopharyngeal fistula occurred in four cases and settled in all with conservative non-surgical treatment. Overall survival at 3 years was 70.5%, and disease-specific survival was 94.4%. CONCLUSION: TransOral UltraSonic Surgery (TOUSS) is a safe and sound alternative method of endoscopic surgical treatment of oral cavity, oropharynx and supraglottic neoplasms. Advantages of this technique include faster resection time, intraoperative assistance from Narrow Band Imaging, easy affordability compared to TORS, and excellent functional outcomes.
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Neoplasias Laríngeas , Neoplasias Orofaríngeas , Procedimentos Cirúrgicos Ultrassônicos , Estudos de Viabilidade , Humanos , Neoplasias Laríngeas/cirurgia , Margens de Excisão , Boca/cirurgia , Neoplasias Orofaríngeas/cirurgia , Orofaringe , Estudos Prospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Gingivo-buccal complex cancers (GBCC) have an aggressive clinical course in the presence of skin and bone involvement. OBJECTIVE: This study intends to analyze the clinico-pathological factors affecting local control and survival outcomes in GBCC. METHODS: This is a retrospective study conducted on 125 GBCC cases from January 2011 to April 2016. RESULT: Univariate analysis revealed lymphovascular invasion (LVI) and skin involvement as predictors of poor overall survival (OS) and disease- free survival (DFS). Multivariate analysis showed skin involvement and LVI to be independent prognostic factors towards poor OS. Corresponding results in case of DFS showed skin involvement to be the single most important prognostic factor. With a median follow up of 24 months, the median survival of patients with skin involvement, skin and mandible invasion and isolated mandible invasion, respectively, were 18 months, 12 months and 22 months. CONCLUSION: GBCC with skin involvement portends poor outcome in terms of survival. In the presence of skin invasion, treatment entails liberal soft tissue and bone margin followed by adjuvant treatment.
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Carcinoma , Humanos , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos RetrospectivosRESUMO
Introduction: Gingivo-buccal complex cancers (GBCC) have an aggressive clinical course in the presence of skin and bone involvement.ObjectiveThis study intends to analyze the clinico-pathological factors affecting local control and survival outcomes in GBCC.MethodsThis is a retrospective study conducted on 125 GBCC cases from January 2011 to April 2016.ResultUnivariate analysis revealed lymphovascular invasion (LVI) and skin involvement as predictors of poor overall survival (OS) and disease- free survival (DFS). Multivariate analysis showed skin involvement and LVI to be independent prognostic factors towards poor OS. Corresponding results in case of DFS showed skin involvement to be the single most important prognostic factor. With a median follow up of 24 months, the median survival of patients with skin involvement, skin and mandible invasion and isolated mandible invasion, respectively, were 18 months, 12 months and 22 months.ConclusionGBCC with skin involvement portends poor outcome in terms of survival. In the presence of skin invasion, treatment entails liberal soft tissue and bone margin followed by adjuvant treatment. (AU)
Introducción: Los cánceres del complejo gingivo-bucal (GBCC) tienen un curso clínico agresivo en presencia de afectación de la piel y los huesos.ObjetivoEste estudio pretende analizar los factores clínico-patológicos que afectan al control local y los resultados de supervivencia en GBCC.MétodosEste es un estudio retrospectivo realizado en 125 casos de GBCC desde enero del 2011 hasta abril del 2016.ResultadoEl análisis univariado reveló la invasión linfovascular (LVI) y la afectación de la piel como predictores de una supervivencia general pobre (SG) y una supervivencia libre de enfermedad (SSE). El análisis multivariado mostró que la afectación de la piel y el LVI son factores pronósticos independientes hacia una SG pobre. Los resultados correspondientes en caso de SSE mostraron que la afectación de la piel es el factor pronóstico más importante. Con una mediana de seguimiento de 24 meses, la mediana de supervivencia de pacientes con afectación cutánea, invasión de la piel y la mandíbula e invasión aislada de la mandíbula, respectivamente, fue de 18 meses, 12 meses y 22 meses.ConclusiónEl GBCC con afectación de la piel presagia un mal resultado en términos de supervivencia. En presencia de invasión de la piel, el tratamiento implica unos márgenes de tejidos blandos y oseos amplios seguido de un tratamiento adyuvante. (AU)
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Humanos , Carcinoma , Estadiamento de Neoplasias , Prognóstico , Estudos RetrospectivosRESUMO
BACKGROUND: With the termination of RTOG 1221, there remains a lacuna regarding the optimal treatment for human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma (OPSCC). METHODS: Matched pair analysis with propensity score matching (PSM) between Arm I (transoral surgery [TOS] + risk-stratified adjuvant treatment) and Arm II (nonsurgical treatment - radiation/chemoradiation) in HPV(-) OPSCC. RESULTS: Unmatched comparison of Arm I (n = 57) and Arm II (n = 89) indicated significantly better overall survival (OS) and disease-free survival (DFS) for Arm I. PSM by matched pairs (n = 48, 24 each arm) indicated 5-year OS at 80% and 72.1%, respectively, for Arm I and II (p > 0.05) and corresponding DFS at 65.3% and 33.4% (p > 0.05). Subgroup analysis did not demonstrate statistical difference in outcomes in stage II and III, but stage IV tumors had significantly better outcomes in Arm I than Arm II (4-year OS: 100% vs. 21%, p = 0.04; DFS: 75% vs. 14.3%, p = 0.04). CONCLUSIONS: TOS +/- adjuvant was found to have oncological outcomes at par with nonsurgical modalities in stage I-III OPSCC, whereas a distinct survival advantage was noted in case of stage IV tumors.
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Alphapapillomavirus , Neoplasias de Cabeça e Pescoço , Neoplasias Orofaríngeas , Infecções por Papillomavirus , Procedimentos Cirúrgicos Robóticos , Quimiorradioterapia Adjuvante , Humanos , Análise por Pareamento , Neoplasias Orofaríngeas/terapia , Carcinoma de Células Escamosas de Cabeça e PescoçoRESUMO
Treatment of maxillary sinus cancer poses several challenges because of its complex anatomy, close proximity to critical structures and majority of patients presenting at an advanced stage. Despite presence of several treatment approaches, the outcome in these cancers has remained dismal. This article examines its clinical behaviour and treatment outcome of these patients treated at our centre in past 7 years. In this retrospective study, 67 patients with carcinoma of maxillary sinus presented from January 2011 to December 2017 were analysed. All the patients reporting during this period were included except those who did not turn up after first visit. Of all the patients, 64.2% had squamous cell carcinoma. The majority of patients presented with advanced stage (IVA and IVB, 83.58%). Nodal disease at presentation was seen in seven patients (10.4%). Treatment to the primary site comprised of surgery and radiotherapy in 24 patients, radiotherapy alone in 22 patients and surgery alone in 12 patients. Statistical program for social sciences (SPSS) version 16 was used for all statistical analyses. The mean follow-up time was 25 months (range 3-72 months). Overall, 17 out of 41 patients who were treated with curative intent (41.5%) developed recurrence. Patients who underwent surgery followed by adjuvant radiotherapy did fairly better in terms of recurrence. Seven patients out of 17 (41.2%) could be salvaged by surgery or radiation. Only one patient developed distant metastasis to D8 vertebra. Patients who were treated with surgery and radiotherapy (either preoperative/adjuvant setting) had better disease-free survival. The results of the current study regarding the treatment of carcinoma of the maxillary sinus show feasibility and efficacy of multimodal therapy. Radical radiotherapy appears to be a feasible alternative in cases of inoperable tumours. Loco regional relapse remains a significant pattern of failure.
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Mandíbula/cirurgia , Osteotomia Mandibular/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Língua/cirurgia , Língua/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Boca , Estudos Prospectivos , Neoplasias da Língua/diagnóstico , Gravação em Vídeo/métodosRESUMO
Obesity has become epidemic both in developed and developing countries. Socio-economic (SE) development has resulted in increased prevalence of obesity across all social groups in developing countries that is contrary to the effects of rising SE status on prevalence of obesity in the developed world. Obesity is not only associated with metabolic syndrome, cardiovascular disease, diabetes but is also a risk factor for cancer and is responsible for increased cancer mortality. Published articles have reported higher rates of treatment failure and adverse events (AEs) of anti-cancer therapy in obese patients with carcinoma cervix in comparison to their normal body mass index (BMI) counterparts. Hence, there is a need to elucidate factors that may increase the risk of AEs. Aim of this paper is to discuss the delivery of radiotherapy, concurrent chemotherapy and their effect on AEs in obese patients with carcinoma cervix.
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Thyroidectomy conventionally accompanies total laryngectomy. This study intends to analyze the incidence and factors leading to thyroid gland involvement in carcinoma larynx and hypopharynx. Retrospective chart review from March 2011 to December 2016 of all patients who had undergone total laryngectomy at our institute. A total of 125 patients entered into the analysis. Subsites involved were glottis (n = 32), supraglottis (n = 28), transglottis (n = 52), pyriform sinus (n = 12), and subglottis (n = 1). TNM distribution according to AJCC 7th edition is as follows: T2 (n = 1), T3 (n = 34), T4 (n = 90); N0 (n = 97), N1 (n = 13), N2a (n = 5), N2b (n = 5), N2c (n = 4), and N3 (n = 1). Total thyroidectomy was performed in 16 patients, near total thyroidectomy in 5, and hemithyroidectomy in 104. Histopathologically thyroid gland involvement was seen in 11/125 (8.8%). The overall incidence of hypothyroidism was 48% (hemithyroidectomy, 43/104; total thyroidectomy, 16/16; near total thyroidectomy, 1/5). The incidence of permanent hypoparathyroidism was 12.8% (total thyroidectomy, 11; hemithyroidectomy, 5). On multivariate analysis (Cox proportional hazards model), extralaryngeal spread into level 6 (HR = 5.5, p = .006, C.I = 1-18.8) and extracapsular extension (HR = 9.3, p = 0.02, C.I = 1.29-67.5) were statistically significant predictors for thyroid gland involvement. Survival analysis of patients with thyroid gland involvement (n = 11) revealed 5-year overall survival (OS) of 100% and 5-year disease-free survival (DFS) of 59.3% compared with patients without thyroid gland involvement, 71% and 51.7%, respectively (median follow-up, 30 months). Thyroid gland involvement did not show a statistically significant effect on OS/DFS on multivariate analysis. In view of the endocrine abnormalities and lack of survival benefit seen, thyroidectomy should be performed judiciously during total laryngectomy.
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Epithelial myoepithelial carcinoma (EMC) is a rare biphasic tumor of salivary glands with low malignant potential. Although known to occur in submandibular gland and minor salivary glands, its most common location is parotid. Clinical and radiological findings often mimic a benign tumor. Because of rarity of EMC a standard treatment guideline is not yet known. Surgical resection is the most widely used approach. Although it is a low grade tumor, local recurrence rates of 23-50 % have been reported with 25 % chance of distant metastasis. Patients with histo-pathologic markers of aggressive disease should be considered for adjuvant radiotherapy. We report a case of epithelial myoepithelial carcinoma of parotid in a 40 year male that was treated with surgery followed by post-operative radiotherapy.
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BACKGROUND: The treatment of primary CNS lymphoma (PCNSL) comprises high dose methotrexate (HDMTX) based chemotherapy followed by whole brain radiotherapy (WBRT), the major drawback of which is long term neurotoxicity. We intended to assess the feasibility of response adapted WBRT in PCNSL in the Indian setting. METHODS: We screened 32 patients and enrolled 22 eligible patients with PCNSL from 2015 to 2017 in a prospective phase II trial. The patients underwent five 2-weekly cycles of induction chemotherapy with rituximab, methotrexate, vincristine, procarbazine. Patients with complete response(CR) to induction chemotherapy were given reduced dose WBRT 23.4 Gy/13 fractions/2.5 weeks while those with partial response (PR), stable or progressive disease (SD or PD) were given standard dose WBRT 45 Gy/25 fractions/5 weeks. Thereafter two cycles of consolidation chemotherapy with cytarabine were given. The primary endpoints of the study were assessment of response rate (RR) and progression free survival (PFS). The secondary endpoints of the study were assessment of overall survival (OS), toxicity profile of treatment and serial changes in quality of life and neuropsychological parameters. RESULTS: Out of 19 patients who completed HDMTX based chemotherapy, 10 (52.63%) patients achieved CR, 8 (42.11%) patients had PR and 1 patient had PD. After a median follow-up period of 11.25 months, the estimated median OS was 19 months. The actuarial rates of PFS and OS were respectively 94.1 and 68.2% at 1 year and 50.2 and 48.5% at 2 years. Three patients in reduced dose WBRT arm had recurrence and two of them died of progressive disease, whereas there was no recurrence or disease related death in standard dose WBRT arm. On univariate analysis of PFS, age ≤ 50 years and use of standard dose WBRT (45 Gy) led to significantly improved outcome (p value 0.03 and 0.02 respectively). CONCLUSION: In patients with PCNSL, reduced dose WBRT after CR to HDMTX based chemotherapy may lead to suboptimal clinical outcome due to higher risk of recurrence, progression and early death. Trial Registration No CTRI/2015/10/006268.
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Antimetabólitos Antineoplásicos/uso terapêutico , Neoplasias do Sistema Nervoso Central/terapia , Irradiação Craniana , Linfoma/terapia , Metotrexato/uso terapêutico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias do Sistema Nervoso Central/mortalidade , Neoplasias do Sistema Nervoso Central/psicologia , Quimiorradioterapia/efeitos adversos , Irradiação Craniana/efeitos adversos , Fracionamento da Dose de Radiação , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Linfoma/mortalidade , Linfoma/psicologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do TratamentoRESUMO
AIMS AND OBJECTIVES: Oral cancer is one of the most common cancers in Indian subcontinent with alveobuccal complex as most common cancer sub site. Cancers of Alveobuccal complex provides maximum challenge and management guidelines are not clear. The aim of the present study is to provide comprehensive demographic, clinical and treatment outcome data of alveobuccal squamous cell carcinoma (SCC) patients treated at a tertiary care cancer center in North India. MATERIALS AND METHODS: An analysis of prospectively maintained database in department of surgical oncology at Dr BRA-IRCH, AIIMS, Delhi, India was performed. All alveobuccal cancer patients who had undergone surgery from 1995 to 2010 were included for analysis. RESULTS: A total of 353 patients were included for analysis. Mean age was 49.75 years (SD ±12.04) with male and female ratio of 4:1. Composite resection without mandible was done in 25 % patients and 75 % underwent mandibular resection. Neck dissection was performed in 347 patients. Nodal deposits were identified in 124 (35.73 %) neck dissection specimens. Margin negative resection was performed in 89.5 % cases. After a median follow up of 30 months, 87 (24.64 %) patients developed disease relapse and 25 (7.08 %) patients developed second primaries. Overall 5-year disease free survival (DFS) was 57.65 % and 5 year overall survival (OS) was 59.86 %. CONCLUSION: Among Indian oral cancer patients alveobuccal complex is most common sub site. Majority presents in locally advanced stage and reasonably good outcomes can be achieved with quality control surgery and judicious use of radiotherapy.
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Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/terapia , Países em Desenvolvimento , Feminino , Humanos , Índia/epidemiologia , Programas de Rastreamento , Mastectomia Radical/estatística & dados numéricos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Estudos Retrospectivos , Fatores SocioeconômicosRESUMO
BACKGROUND: This study compared 2 sequential cohorts to identify the postoperative radiotherapy (PORT) dose requirement for head and neck squamous cell carcinoma (HNSCC). METHODS: Two distinct PORT dose regimens were prescribed over 11 years; group 1 received 56 Gy or less, and group 2 received 60 Gy or more. The 2D and 3D techniques were used. RESULTS: Two sequential cohorts consisted of 478 patients, with mean and median follow-up for group 1 and 2 as: 37.0 versus 28.5 months and 13.8 versus 13.1 months, respectively. Grades 3-4 mucosal toxicities (11.4% vs 28.3%), hospitalization (3.2% vs 17.4%), and nasogastric feeding (11.9% vs 29.7%) were higher in group 2. The 2-year disease-free survival (DFS) was higher with PORT >60 Gy for the following factors: age ≤ 50 years (P = .041); ≥ 4 positive nodes (P = .029); and overall treatment time (OTT) ≥ 100 days (P = .042). CONCLUSION: Except for the benefit of doses >60 Gy for limited parameters, a lower PORT dose did not compromise the results and can potentially reduce the morbidities and healthcare costs.
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Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Estudos de Coortes , Terapia Combinada , Intervalo Livre de Doença , Relação Dose-Resposta à Radiação , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Dosagem Radioterapêutica , Radioterapia Adjuvante , Estudos Retrospectivos , Medição de Risco , Carcinoma de Células Escamosas de Cabeça e Pescoço , Análise de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVES: The aim of the study was to evaluate the outcome and treatment-related morbidity in pediatric patients with nasopharyngeal carcinoma (NPC) treated with chemoradiotherapy. METHODS: We did a retrospective review of 41 pediatric patients diagnosed with NPC between 2000 and 2013. The majority of the patients were treated with neoadjuvant chemotherapy followed by concurrent chemoradiation with the dose of 70 Gy in 35 fractions. Eight patients were treated with intensity-modulated radiation therapy, while the remaining with three-dimensional conformal radiation therapy or two-dimensional simulation technique. RESULTS: The median age of the patients was 14 years (range 6-20 years). Most of the patients had locoregionally advanced disease (stage III/IVA/IVB). The histology of all the cases was undifferentiated carcinoma. Immunohistochemistry for the Epstein-Barr virus-Latent membrane protein 1 was positive in nine of the 13 tested cases. The median follow-up for all and the surviving patients was 26.6 months (range 2-140.8) and 51.2 months, respectively. The 3-year overall survival (OS) and event-free survival (EFS) rates were estimated at 83.7% (95% confidence interval [CI]: 64.8-93%) and 55.8% (95%CI: 38.7-69.8%), respectively. Distant metastases were the predominant pattern of failure. Treatment response showed an independent association with OS. T classification (T1/T2 vs. T3/T4) was significantly associated with EFS. Xerostomia, hypothyroidism, dental caries, neck fibrosis, trismus, and dysphagia were the common late effects in survivors. Radiation myelitis was observed in one patient. CONCLUSIONS: Treatment with neoadjuvant chemotherapy followed by concurrent chemoradiation provides good survival outcomes in pediatric NPC. The quality of life of the survivors is a pertinent area that necessitates consideration.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/mortalidade , Neoplasias Nasofaríngeas/terapia , Terapia Neoadjuvante/mortalidade , Adolescente , Adulto , Criança , Cisplatino/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Humanos , Masculino , Neoplasias Nasofaríngeas/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Adulto JovemRESUMO
Eccrine porocarcinoma is a rare malignant sweat gland tumor arising from the intra dermal part of the gland and accounts for only 0.005% of all epithelial cutaneous tumors. Commonly involved site includes extremities and face. Scalp is a rare site for porocarcinoma with less than 20 reported cases so far. Wide local excision with clear margins remains the treatment of choice. Review of literature revealed a local recurrence rate of 37.5% and a nodal involvement risk of 20%. Porocarcinoma of the scalp is peculiar in that the primary tumor may be large at presentation, making surgery with adequate margins difficult. Adjuvant radiotherapy must be considered in a case to case basis due to the high local recurrence rates compared to other sites of porocarcinoma and should be given to all patients with close margins and extra capsular extension.
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Porocarcinoma Écrino/patologia , Couro Cabeludo/patologia , Neoplasias Cutâneas/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Adulto , Porocarcinoma Écrino/diagnóstico por imagem , Porocarcinoma Écrino/radioterapia , Humanos , Masculino , Recidiva Local de Neoplasia/patologia , Radioterapia Adjuvante , Fatores de Risco , Couro Cabeludo/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/radioterapia , Neoplasias das Glândulas Sudoríparas/diagnóstico por imagem , Neoplasias das Glândulas Sudoríparas/radioterapiaRESUMO
INTRODUCTION: Esthesioneuroblastoma is a rare tumour of the sino-nasal tract. One-third cases present with intracranial extension. However, treatment options are limited for such cases. METHODOLOGY: We herein report a case with large intracranial extension treated with Induction chemotherapy, de-bulking surgery, and image guided intensity modulated radiotherapy. RESULTS: The patient was treated with IGIMRT technique to a dose of 64 Gy in 32 fractions. Cone bean CT verification was done twice a week to eliminate set up error. The patient achieved complete resolution of the disease and was disease free 6 months after completion of treatment. CONCLUSION: IGIMRT even after a de-bulking surgery may help to achieve long-term disease control for patients with large intracranial extension with minimal morbidity.
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Neoplasias Encefálicas , Estesioneuroblastoma Olfatório , Quimioterapia de Indução/métodos , Cavidade Nasal , Neoplasias Nasais , Radioterapia Guiada por Imagem/métodos , Adulto , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/terapia , Terapia Combinada/métodos , Dissecação/métodos , Estesioneuroblastoma Olfatório/patologia , Estesioneuroblastoma Olfatório/fisiopatologia , Estesioneuroblastoma Olfatório/terapia , Humanos , Masculino , Cavidade Nasal/patologia , Cavidade Nasal/cirurgia , Invasividade Neoplásica , Neoplasias Nasais/patologia , Neoplasias Nasais/fisiopatologia , Neoplasias Nasais/terapia , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos , Resultado do TratamentoRESUMO
Myoepithelial carcinoma has rarely been reported in the oral cavity and oropharynx. We found only 6 cases of myoepithelioma of the tongue reported till date. Two cases had a benign myoepithelioma; four had epithelial-Myoepithelial carcinoma. The present case had malignant myoepithelioma, a distinct entity from other histologies.
Assuntos
Carcinoma/terapia , Mioepitelioma/terapia , Segunda Neoplasia Primária , Carcinoma de Pequenas Células do Pulmão/diagnóstico , Carcinoma de Pequenas Células do Pulmão/etiologia , Neoplasias da Língua/terapia , Adulto , Biópsia , Carcinoma/diagnóstico , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Humanos , Imunofenotipagem , Masculino , Mioepitelioma/diagnóstico , Tomografia Computadorizada por Raios X , Neoplasias da Língua/diagnóstico , Adulto JovemRESUMO
OBJECTIVE: Carcinoma of external auditory canal (EAC) is a rare disease with variable management strategies and prognosis. We aimed to analyze treatment modalities, prognostic factors and survival outcomes in patients of squamous cell carcinoma of EAC treated at our institution. METHODS: Forty-three patients of squamous cell carcinoma of EAC were analyzed for clinical presentation, stage, surgical procedures and radiotherapy (RT) modalities employed. Stell and McCormick staging system was used for staging of the patients. Progression free survival (PFS) was estimated by the use of Kaplan-Meier product-limit method. Log rank test was used to assess the impact of prognostic variables on PFS. Multivariate analysis was performed using the Cox hazard regression model. p value of <0.05 was considered significant for all statistical analysis. RESULTS: Median age was 56 years (range: 12-84 years). Male to female ratio was 31:12. Stage was T1, T2 and T3 in 2, 17 and 18 patients respectively. Sixteen patients underwent surgery. Thirty-six patients received RT (14 received definitive RT, 11 had post-operative RT and 11 had RT with palliative intent). Eight patients (16%) received chemotherapy (5 received concurrent with RT, 2 had adjuvant and 1 had neo-adjuvant chemotherapy). Nine patients (of 11 patients) achieved a complete response (CR) and 2 achieved a partial response (PR) after surgery plus post-operative RT. Nine patients and 5 patients respectively achieved CR and PR after definitive RT (with or without concurrent chemotherapy). Of the 11 patients who received palliative RT, 2 had very good objective response (>50%) and 7 patients had PR to palliative RT. After a median follow-up of 16 months, median PFS for the entire cohort was 14 months. Two-year PFS rates were 85.7%, 46.9% and 0% for patients treated with surgery and post-operative RT, definitive RT and palliative RT respectively. On univariate analysis, higher stage (p=0.05) and facial nerve palsy at presentation (p=0.0008) were significant predictors of inferior PFS. CONCLUSION: Patients with carcinoma of EAC present mostly in advanced stage at our centre. Combined higher stage (T3) and facial nerve palsy at presentation portend poorer outcome. Combined modality treatment with surgery and radiotherapy should be advocated and palliative RT remains a reasonable treatment option in patients with advanced incurable disease.