Millepora species (Fire Coral) Sting: A Case Report and Review of Recommended Management.

Fire corals (Millepora spp) are the second most common reef-forming organisms and are frequently found in tropical and subtropical waters. Fire corals are not true corals but rather hydrozoans more closely related to jellyfish and sea nettles. Rigidly affixed to the reef and with a branching structure, each fire coral is a colony of numerous individual hydrozoans forming a collective symbiotic organism. It is common for divers to accidentally make contact with fire corals. Fire coral contact is characterized by the immediate onset of burning pain caused by venom discharge from numerous tiny nematocysts located externally on the creature. Treatment consists of saltwater irrigation of the wound, nematocyst removal, and supportive care of the associated symptoms of pain, dermatitis, and pruritus. Rarely, fire coral can cause systemic toxicity. We present a case report of a 30-y-old recreational diver who experienced a fire coral sting of her left anterior thigh and review the recommended prevention and management of fire coral stings.

Radiotherapy to Control Limited Melanoma Progression Following Ipilimumab.

Durable local control of irradiated cancer and distant abscopal effects are presumably immune mediated. To evaluate the role of radiotherapy (RT) for limited progression after anti-CTLA4 checkpoint inhibition, medical records of all patients with surgically incurable stage III or IV melanoma from a single institution who received ipilimumab as first-line immunotherapy and subsequent RT were reviewed. Sixteen patients who received RT to all sites of limited melanoma progression were analyzed. Eight patients with an incomplete initial response to ipilimumab received RT to new or progressive disease, whereas the remaining 8 patients with a complete initial response to ipilimumab received RT to sites of subsequent recurrence. The median interval from ipilimumab initiation to start of RT was 30 weeks (range, 15-130 wk), a timeframe where delayed response to ipilimumab is rare. The RT dose was predominantly 30 Gy in 5 fractions (41%) or 36 Gy in 6 fractions (26%). Brain radiation was limited to stereotactic radiosurgery in a single patient. The median local control with RT was 31.4 months. The median disease control was 18.7 months, defined as the interval from completion of RT to the start of additional systemic therapy known to impact survival (anti-programmed death-1 or targeted BRAF therapy), hospice enrollment, or death. The overall survival at 1 and 2 years was 87% and 61%, respectively. Seven patients (44%) had no evidence of melanoma at median follow-up of 29.5 months since completion of RT with no additional therapy. This series supports use of RT to limited sites of progression following ipilimumab as an alternative to other systemic treatments such as anti-programmed death-1 antibodies.

Endorectal MRI for risk classification of localized prostate cancer: Radiographic findings and influence on treatment decisions.

PURPOSE: To report the results of endorectal coil magnetic resonance imaging (eMRI) in patients with localized prostate cancer, and how these images influenced radiotherapeutic management. MATERIALS AND METHODS: A total of 122 men with localized adenocarcinoma of the prostate referred to radiation oncology underwent 3-T eMRI between 2010 and 2014, to evaluate candidacy for active surveillance (n = 26) and brachytherapy as monotherapy (n = 47), or to further risk stratify intermediate-risk (n = 29) or high-risk (n = 20) men before external beam radiation therapy. By National Comprehensive Cancer Network classification, men had low-risk (28%), intermediate-risk (55%), or high-risk (17%) disease. Multiparametric MRI sequences included T2-weighted, diffusion-weighted imaging, and dynamic contrast-enhanced imaging. Radiographic extracapsular extension, seminal vesicle invasion (rSVI), and pelvic lymph node involvement (LNI) were graded as negative, indeterminate, or positive. A dominant nodule was defined as a nodule≥1.5cm. Changes in management were identified comparing pre-MRI and post-MRI plan of care. RESULTS: The rates of radiographic extracapsular extension, radiographic seminal vesicle invasion, lymph node involvement, and dominant nodule were 39%, 7%, 12%, and 28%, respectively. The eMRI identified measurable disease in most patients with an increasing burden of disease (sextants involved, median nodule size) according to risk category (P<0.01). Changes in management after eMRI occurred in 18%, including 9%, 18%, and 33% of men with low-risk, intermediate-risk, or high-risk disease (P = 0.08), and 12%, 17%, and 22% of men who were candidates for active surveillance, brachytherapy as monotherapy, or external beam radiation therapy (P = 0.48), respectively. CONCLUSION: The eMRI influenced management in a risk-dependent fashion. Further study is required to determine the clinical importance of eMRI findings and to determine whether changes in management can lead to improved clinical outcome.