Small cell carcinoma of the bladder: a search of the current literature.

PURPOSE: Small cell carcinoma of the urinary bladder (SCC-BL) is an extremely rare malignancy, accounting for < 1% of all bladder tumors. Its prognosis is very poor because of its highly aggressive behavior and high metastatic potential. This study aimed to update the management and outcome of SCC-BL by searching the relevant international literature. METHODS: Relevant studies were identified by searching MEDLINE and the Cochrane Central Register of Controlled Trials using a combination of terms such as small cell carcinoma, bladder cancer, therapeutic approach, radical cystectomy, radiation therapy and chemotherapy. Additional papers were identified from reviewing references of relevant articles. RESULTS: Previously published series have shown that SCC-BL has a significant male predominance, occurs mainly during the 7th and 8th decade of life and macroscopic hematuria is the most common presenting symptom. According to the most important studies, cystectomy alone seems not to be efficient enough for the management of the disease. On the other hand, radiation therapy when combined with chemotherapy is highly effective with increased survival rates. CONCLUSION: Poor prognosis and rarity render disease management complicated. A definitive treatment is not yet established but combined therapy with systemic platinum-based chemotherapy and adjuvant local radiotherapy seems to be the most effective therapeutic approach for limited-stage SCC-BL. Further research is required in order to clarify whether prophylactic cranial irradiation (PCI) should be performed on a regular basis.

Ultrasound-assisted endocavitary HDR-Ir192 brachytherapy for unresectable locally advanced uterine cervix carcinoma: retrospective analysis focusing the efficacy and tolerability

PURPOSE: To evaluate the impact of uterine cavity's ultrasound to final selected length of intracavitary tandem. The efficacy and tolerability of external beam radiation plus HDR-Ir(192) brachytherapy in our cohort of patients were also estimated. MATERIALS AND METHODS: 48 women with locally advanced unresectable uterine cervix carcinoma were treated by HDR-Ir(192) endocavitary brachytherapy between January 2007 and January 2009. The median age was 63 (range 38-74). The distribution according to Federation of Gynaecology and Obstetrics (FIGO) staging system was as follows: Stage IIB, 54.16 %; IIIA, 10.4 %; IIIB, 27.0 %; and IVA, 8.3 %. HDR intracavitary brachytherapy was given weekly, beginning at the last week of whole pelvis irradiation, with a dose of 7 Gy to point A for three to four fractions. The median overall treatment time was 50 days (range 42-73 days). The median follow-up time was 2.7 years (range 3 months to 4.9 years). Multivariate analysis was performed using the Cox regression proportional hazards model. RESULTS: The complete remission rate after radiotherapy was 93.75 % (45/48). The 5-year actuarial major complication rates (Grade 3 or above) were 6.3 % overall (2.1 % proctitis, 2.1 % cystitis and 2.1 % enteritis). Estimation of the length of uterine cavity by ultrasound helped decisively in the proper placement of the intrauterine tandem inserted. CONCLUSIONS: Prior knowledge of the length of uterine cavity can facilitate the decisions regarding the proper insertion length of the tandem. Results of cervical cancer treatment with external beam radiation and HDR intracavitary brachytherapy in our hospital are encouraging (AU)

Ameloblastoma, a rare benign odontogenic tumour: an interesting tumour review targeting the role of radiation therapy.

Ameloblastoma is known as a benign, slow-growing, rare, odontogenic neoplasm. The solid/multicystic, the unicystic with a fibrous connective-tissue capsule and the peripheral ameloblastoma represent the three well distinguished clinical types of ameloblastoma. Surgical resection with an attempt to achieve adequate free margins constitutes a well documented and accepted treatment modality. Controversies exist, however, with regard to the extent of operative intervention. Patients with inadequate or positive surgical margins or unresectable lesions can be treated with radiation or combined radiation and chemotherapy. The authors present a review of this sparse disease focusing on the special role and efficacy of radiation therapy in its management.

Ameloblastoma, a rare benign odontogenic tumour: an interesting tumour review targeting the role of radiation therapy

Ameloblastoma is known as a benign, slow-growing, rare, odontogenic neoplasm. The solid/multicystic, the unicystic with a fibrous connective-tissue capsule and the peripheral ameloblastoma represent the three well distinguished clinical types of ameloblastoma. Surgical resection with an attempt to achieve adequate free margins constitutes a well documented and accepted treatment modality. Controversies exist, however, with regard to the extent of operative intervention. Patients with inadequate or positive surgical margins or unresectable lesions can be treated with radiation or combined radiation and chemotherapy. The authors present a review of this sparse disease focusing on the special role and efficacy of radiation therapy in its management (AU)

Primitive neuroectodermal tumour in a 60-year-old man: a case report and literature review.

Primitive neuroectodermal tumour (PNET) is very rare, especially in adults. We report a 60-year-old man presented with a PNET. The symptoms at the time of diagnosis were intense headache, Broca's aphasia and right hemiparesis. Only an open biopsy was performed. Irradiation of the primary tumour was the main treatment (total tumour dose 59.8 Gy) because of serious haematological side effects due to chemotherapy. The patient tolerated radiation therapy extremely well and his neurological symptoms were improved. 1 month after completion of radiotherapy, MRI showed no regression of the tumour. Clinical deterioration was observed 10 months after the initial diagnosis and the patient died 2 months later. In cases of PNET, initial therapy is surgical bulk reduction whenever possible. Irradiation of the cerebrospinal axis is justified as a routine treatment but, owing to the radioresistance of the tumour, the addition of multiregimen chemotherapy appears to improve survival, according to the literature.

Cytoprotective effect of amifostine in radiation-induced acute mucositis - a retrospective analysis.

PURPOSE: To study the cytoprotective impact of amifostine against acute radiation mucositis. PATIENTS AND METHODS: A total of 117 cancer patients with carcinomas localized in pelvic organs, lung and head and neck were entered into this study. In a retrospective way, and in order to minimize the bias related to the investigator, 138 patients as historical controls were randomly selected from a database in our hospital. Acute radiation-induced gastrointestinal mucositis, esophagitis and stomatitis were assessed using the common toxicity criteria scale. The most severe grade recorded was evaluated as the final morbidity score for this patient. Mean toxicity score (MTS) was the mean value of recorded acute radiation toxicity. Mean interruption time (MIT) was the mean value of recorded interruption time due to radiation toxicity. RESULTS: A significantly reduced severity of symptomatology related to oral, esophageal and rectal mucosa was noted in the amifostine group (group A) (p < 0.05, chi-square test). Furthermore, a significant reduction of MTS as well as MIT was observed in group A versus the historical controls (group B) (p < 0.05, Mann-Whitney U test). CONCLUSION: The administration of amifostine seems to protect patients against radiation-induced mucositis, but further investigation with randomized trials is needed.

Minor prognostic factors in squamous cell vulvar carcinoma.

PURPOSE OF THE STUDY: To evaluate minor prognostic factors in a patient population with squamous cell vulvar carcinoma, with particular attention to age, smoking, obesity and parity. METHODS: A total of 50 women with invasive squamous cell vulvar carcinoma were retrospectively analyzed. Factors assessed for prognostic value included age, obesity, diabetes, hypertension, smoking and parity. RESULTS: The log-rank test and the univariate regression analysis revealed that all factors decreased the overall survival. In the multivariate regression analysis only age, obesity, smoking and parity were independent predictors for survival. The relative risk of death for elderly and patients, obese smokers, and patients with more than three deliveries was 1.008, 1.159, 1.411 and 2.532, respectively. Hypertension and diabetes seemed to be questionable prognostic factors. CONCLUSION: Smokers, patients who had more than three children, body mass index >27, and were older than 73 years had a poorer survival rate.