Phase I-II studies on accelerated IMRT in breast carcinoma: technical comparison and acute toxicity in 332 patients.

BACKGROUND AND PURPOSE: To evaluate the results in terms of dosimetric parameters and acute toxicity of two clinical studies (MARA-1 and MARA-2) on accelerated IMRT-based postoperative radiotherapy. These results are compared with historical control group (CG) of patients treated with "standard" 3D postoperative radiotherapy. MATERIALS AND METHODS: Prescribed dose to the breast was 50.4Gy in the CG, 40Gy in MARA-1 (low risk of local recurrence), and 50Gy in MARA-2 (medium-high risk of recurrence). The tumor bed total dose was 60.4Gy (sequential 10Gy electron boost), 44Gy (concomitant 4Gy boost), and 60Gy (concomitant 10Gy boost) in CG, MARA-1 and MARA-2 studies, respectively. Overall treatment time was of 32 fractions for CG (6.4weeks); 16 fractions for MARA-1 study (3.2weeks) and 25 fractions for MARA-2 study (5weeks). RESULTS: Three hundred and thirty two patients were included in the analysis. Dosimetric analysis showed D(max) and V(107%) reduction (p<0.001) and D(min) improvement (p<0.001) in the PTV in patients treated with IMRT. Grade 2 acute skin toxicity was 33.6%, 13.1%, and 45.1% in the CG, MARA-1, and MARA-2, respectively (p<0.001), and grade 3 acute skin toxicity was 3.1%, 1.0%, and 2.0%, respectively. Similarly, larger PTV and use of chemotherapy with anthracyclines and taxanes were associated with a greater acute toxicity. With a median follow-up of 31 months, no patients showed local or nodal relapse. CONCLUSIONS: A simplified step and shoot IMRT technique allowed better PTV coverage and reduced overall treatment time (CG, 6.6weeks; MARA-1, 3.2weeks; MARA-2, 5weeks) with acceptable short-term toxicity.

Cryptococcus laurentii Diarrhea in a Neoplastic Patient.

We present a rare case of diarrhea and neutropenia caused by Cryptococcus laurentii (C. laurentii) infection in old patient with metastatic rectal cancer who underwent FOLFOX plus Cetuximab chemotherapy. C. laurentii is an extremely rare human pathogen. To the best of our knowledge, here, we report the first case of diarrhea and neutropenia caused by C. laurentii in a 74-year-old man with metastatic rectal cancer and hepatic metastases who underwent FOLFOX plus Cetuximab chemotherapy.

A case report of HCC cutaneous metastasis.

INTRODUCTION: Hepatocellular carcinoma (HCC) is one of the most common solid tumors in the world. HCC muscle and cutaneous metastases are rare and can occur by hematogenous spread or following surgical procedures performed for diagnostic or therapeutic aims. CASE STUDY: We present a 47-year-old man underwent liver biopsy followed by surgical resection for moderately differentiated HCC in January 1999. In February 2010 the patient presented with HCC cutaneous metastases in the surgical scare and with HCC metastases of the right abdominal rectus muscle. En bloc tumor resection with the right abdominal rectus muscle was performed. In March 2011 the patient underwent resection of a locoregional muscle relapse. In November 2011 we started Sorafenib for intraepatic recurrence. DISCUSSION: This case suggests that in the follow-up of patients who underwent surgical resection or diagnostic and therapeutic procedures for HCC should be considered the possibility of abdominal wall metastasis even after many years, particularly in the cases with favorable evolution.