Case Study: Rosai-Dorfman Disease and Its Multifaceted Aspects.

Rosai-Dorfman Disease (RDD) is a rare non-Langerhans histiocytosis, usually self-limited and presenting with massive, painless, bilateral cervical lymphadenopathy, with or without constitutional symptoms. Extranodal disease is frequently present, and may happen in the absence of lymph node involvement, symptomatology and differential diagnosis will depend on the site affected and fatal cases may occur. The authors present two cases of Rosai-Dorfman disease (RDD), diagnosed through immunohistochemistry, with different progressions, one with complete remission and one culminating in death, highlighting the variety of presentations and the diagnostic difficulty. RDD is a rare condition with clinical presentations similar to several diseases, and should be considered in the differential diagnosis of lymphadenopathy with extranodal lesions.

Health-Related Quality of Life Outcomes in Head and Neck Cancer: Results From a Prospective, Real-World Data Study With Brazilian Patients Treated With Intensity Modulated Radiation Therapy, Conformal and Conventional Radiation Techniques.

PURPOSE: To compare global health-related quality of life (HRQoL) and overall survival (OS) in patients with head and neck cancer treated with intensity modulated radiation therapy (IMRT), conformal radiation therapy (3DCRT) or conventional radiation therapy (2DRT). METHODS AND MATERIALS: In this real-world, multi-institutional and prospective study, HRQoL outcomes were assessed using the European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire Core 30 (EORTC QLQ-C30) and European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire Head and Neck 43 (H&N43) questionnaires. Item response theory was used to generate a global HRQoL score, based on the 71 questions from both forms. The effect of treatment modality on HRQoL was studied using multivariate regression analyses. Survival was estimated using the Kaplan-Meyer method, and groups were compared by the log-rank test. RESULTS: Five hundred and seventy patients from 13 institutions were included. Median follow-up was 12.2 months. Concerning the radiation technique, 29.5% of the patients were treated with 2DRT, 43.7% received 3DCRT, and 26.8% were treated with IMRT. A higher proportion of patients receiving 2DRT had a treatment interruption of more than 5 days (69% vs 50.2% for 3DCRT and 42.5% for IMRT). IMRT had a statistically significant positive effect on HRQoL compared with 3DCRT (ß= 2.627, standard error = 0.804, P = .001) and 2DRT had a statistically significant negative effect compared with 3DCRT (ß= -5.075, standard error = 0.926, P < .001). Patients receiving 2DRT presented a worse OS (P = .01). There were no differences in OS when IMRT was compared with 3DCRT. CONCLUSIONS: IMRT provided better HRQoL than 3DCRT, which provided better HRQoL than 2DRT. Patients receiving 2DRT presented a worse OS, which might be related to more frequent treatment interruptions.

Organ preservation protocols in developing countries.

PURPOSE OF REVIEW: Conservative surgical procedures, radiotherapy and chemoradiotherapy can all be considered in organ preservation strategies for patients with head and neck squamous cell carcinoma. In spite of the contribution of well designed clinical trials, in clinical practice, especially in developing countries, results are related to variables that were usually not considered in such trials. RECENT FINDINGS: The results of most organ preservation studies are focused on survival and larynx preservation, but an evaluation of quality of life and function of the organ is still lacking. We performed a systematic search on the MEDLINE database and could not find any such studies conducted in developing countries. In the present review we consider the possible problems associated with the application of organ preservation strategies in developing countries in some critical areas: advanced stage, comorbidities, nutritional status, long distance to travel, availability of chemotherapy and radiotherapy facilities, tolerance, adherence to protocol standards and expertize in performing salvage surgery. Recent publications strongly suggest that chemoradiation should not be indicated in all patients with advanced laryngeal and hypopharyngeal cancer, but that an individualized treatment strategy should be recommended. SUMMARY: Organ preservation treatments depend on factors related to the physician and the institutions providing healthcare, and also on patients and health systems and socioeconomic factors that make it impossible to extrapolate these results. Only after a meticulous evaluation of the final results of the application of these protocols in each specific environment can they be recommended for carefully selected patients.