Anti EGFR therapy in the treatment of non-metastatic head and neck squamous cell carcinoma: The current evidence

Head and neck squamous cell carcinoma (HNSCC) accounts for a large oncologic burden in the developing countries. In patients with locally advanced head and neck cancer multimodality treatment is warranted. Radiation therapy with concurrent chemotherapy has long been considered the standard for patients with disease involving the oropharynx, larynx and hypopharynx. However, addition of chemotherapy to radiotherapy increases treatment related toxicity by many folds and compliance rates decrease. In this context a systemic therapy, which when used concurrent with radiation with favorable toxicity profile is of great importance for improving disease control in locally advanced HNSCC. Anti-epithelial growth factor receptor targeted therapy emerged as a potential treatment option. In recent years many trials were conducted to find the optimum treatment option with the combination of these targeted agents. The initial trials showed excellent results with minimal morbidity and led to great enthusiasm across the globe to incorporate these regimens as a standard of care. However, subsequently many trials failed to maintain such results and now there is little agreement to the initial results achieved with these drugs. Based on the current evidence we cannot recommend the replacement of cisplatin with targeted therapy in concurrent setting. It may be considered in patients with altered renal parameters, hypersensitivity or intolerance to cisplatin. The addition of targeted therapy in addition to chemotherapy in the concurrent setting can’t also be recommended as the benefit is doubtful and is associated with a significant increase in toxicity

Porocarcinoma scalp with high risk features treated with surgery and adjuvant radiotherapy: A case report and review of literature

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

Outcome of primary orbital lymphoma treated with induction chemotherapy followed by conformal radiotherapy

Purpose: To analyze the clinical outcome of primary orbital lymphoma (POL) patients treated with a combined modality approach with local radiotherapy after induction chemotherapy. Methodology: We retrospectively retrieved demographic, treatment and outcome data of patients treated for POL from 2000 to 2010. The charts were reviewed and the data were tabulated in a predesigned pro-forma. Results: 23 patients of POL were found evaluable. Median age was 55 years (range 24–70 years). Of 23 patients, 15 were male and 8 female, making the male:female ratio approximately 1.9:1. Patients were thoroughly evaluated and staged. All but one patient received multi agent chemotherapy. Radiotherapy was delivered for all cases. Radiation was delivered by 3DCRT technique. Median dose of radiation was 45 Gy (range 20–45 Gy). Median follow up was 26.8 months. None of the patients had any evidence of local failure or systemic progression. Conclusion: A combined modality therapy with a combination of CHOP/COP based chemotherapy and moderate dose of radiotherapy imparts excellent long term local and systemic disease control

Altered fractionation radiotherapy in head and neck squamous cell carcinoma

AbstractIntroductionFractionation plays a pivotal role in determining the effectiveness of radiation and follows the principle of 4 “R” of radiobiology. The various altered fractionation schedules used are hyper-fractionation, accelerated fractionation, and hypo fractionation.MethodsWe reviewed the landmark articles published in the peer reviewed journals to summarize the beneficial role of altered fractionation in the treatment of head and neck carcinoma.ResultsHyper-fractionation definitely gives very good overall survival benefit for locally advanced head and neck patient’s equivalent to survival benefit to that of concurrent chemoradiotherapy. Adding concomitant chemotherapy to altered fractionation is a logical approach to improve survival in locally advanced head and neck cancer patients, but it may be at a cost of higher toxicity. Mild hypo fractionation may be beneficial in early laryngeal cancers and may help in achieving better local control.ConclusionAltered fractionation is a very important treatment schema and requires the reinforcement of its use

Primary splenic follicular lymphoma treated with splenectomy and adjuvant chemotherapy; a case report

Primary splenic lymphoma is a rare low-grade non-Hodgkin's lymphoma. This is a case of a 52-year-old woman who had an incidental detection of a lesion in the spleen during evaluation for fever which was found to be a case of primary grade III follicular lymphoma of the spleen. The patient was started on rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy postsplenectomy. Rituximab was not added initially as the patient had a high viral load of hepatitis B virus (HBV). The patient completed six cycles of chemotherapy and rituximab added after four cycles when HBV DNA titer became negative. The outcome in patients with primary follicular lymphoma is good with splenectomy followed by multi-agent chemotherapy

Laryngeal soft tissue sarcoma: A systematic review and individual patient data analysis of 300 cases

BACKGROUND: Laryngeal sarcoma is rare. We performed a systematic review and individual patient analysis to evaluate the patterns of care, prognostic factors, and role of radiotherapy in laryngeal soft tissue sarcoma. METHODS: A systematic search on PubMed and Google scholar was done. An individual patient data analysis was done. RESULTS: Of the 300 cases of laryngeal sarcoma, 80% underwent surgery. 44% underwent larynx preservation surgery and 25% received radiotherapy with surgery. Median progression free survival (PFS) was 48 months and overall survival (OS) of 224 months for the entire cohort. Patients with large primary, cartilage invasion, and positive margins had numerically worse PFS. Cartilage invasion and primary tumor size \u3e3 cm were the most common risk factors for adjuvant radiation therapy. Patients receiving radiotherapy were not associated with better survival. CONCLUSION: Laryngeal sarcoma associated with a good survival. Larynx preservation surgery is feasible in nearly half patients. Adjuvant radiotherapy may be warranted in patients poor prognostic factors

Re-irradiation for head and neck squamous cell carcinoma

Introduction: Local recurrences after curative treatment have a potential for cure with salvage surgery or with re-irradiation. Methods: We reviewed the PubMed for articles published in English with key words squamous cell carcinoma, recurrent, re-irradiation, prognostic factors to find relevant articles describing prognostic factors, re-irradiation, and outcome for recurrent head and neck squamous cell carcinoma. Results: Various factors including age, performance status, time for recurrence, previous radiation dose volume and site of recurrence, previous use of chemotherapy are all prognostic factors in recurrent head and neck squamous cell carcinoma. Surgery is feasible in very select subgroup of patients and must be done when feasible. Re-irradiation with the aid of modern sophisticated technology is safe and confers durable and clinically meaningful survival benefit. Re-irradiation in head and neck recurrent squamous cell carcinoma may provide an expected median survival of 10–12 months. Chemotherapy may be added along with radiation in the recurrent setting. Conclusion: Treatment approaches may have to be personalized. Re surgery must be done in all patients in whom it is feasible. In patients in whom surgery is not feasible, re-irradiation must be evaluated as a therapeutic option especially in patients with limited volume recurrence