The Great Mimicker: Zona Zoster at the Mastectomy Site Causing Contralateral Intramammary Lymph Node Enlargement

Zona zoster is rarely observed in patients with malignancy; when present, it follows a dermatomal fashion. Involvement of widely separated regions is very rare. Hereby, zona zoster causing enlarged intramammary lymph nodes (IMLN) in the opposite breast is reported for the first time in literature. The masses were hypoechoic on US with no hilum and hypervascular on color Doppler US. MRI showed hypointense masses with type 3 time-intensity curve and adjacent vessel sign. The complete regression of the nodes after the antiviral therapy confirmed the diagnosis. In breast cancer patients, IMLN enlargements may mimic breast cancer metastasis, and zona zoster infection of the mastectomy site may present with contralateral IMLN enlargement due to altered lymphatic drainage. When breast US is not sufficient for the differential diagnosis, breast MRI may warrant proper diagnosis, and prevent unnecessary biopsies. Antiviral treatment with followup would be sufficient for management

Does radiotherapy planning without breath control compensate intra-fraction heart and its compartments' movement?

This prospective study investigated radiation dose and volume changes during breathing cycle. Ten patients with left breast carcinoma receiving radiotherapy were included. Treatment planning images were obtained as three different sets of series taken: without breath control (F), deep inspiration (I), and end of expiration (E), with 3-mm intervals. As such, whole breath cycle was simulated. CT images taken during I and E were registered to F, according to DICOM coordinates. Each patient's target and organ at risk volumes were contoured by the primary radiation oncologist except heart components which were contoured by radiologist on F, I and E series. Radiotherapy planning was done on F series, then planning and beam data were transferred from F to I and E image series. Target and organs at risk (OAR) dose distributions for E and I image series were obtained. Dose changes between F, E, and I phases for whole heart and components, namely, left ventricle (LV), right ventricle (RV), left auricle (LA), right auricle (RA), and left anterior descendent artery (LAD) were examined. Furthermore, the issue of any compartment representing the maximum heart dose was investigated. Volume and dose variations for heart, LV, RV, LA, RA, and LAD were observed during breath cycle. Exposured dose was more than defined tolerance level for LV, RV, and LAD in some patients. However, dose differences between F-I and F-E were not statistically significant. Radiotherapy planning without breath control is not capable of compensating for whole intra-fraction heart and its components' volumes and dose changes

Reducing Uncertainties About the Effects of Chemoradiotherapy for Cervical Cancer: A Systematic Review and Meta-Analysis of Individual Patient Data From 18 Randomized Trials

Background After a 1999 National Cancer Institute (NCI) clinical alert was issued, chemoradiotherapy has become widely used in treating women with cervical cancer. Two subsequent systematic reviews found that interpretation of the benefits was complicated, and some important clinical questions were unanswered. Patients and Methods We initiated a meta-analysis seeking updated individual patient data from all randomized trials to assess the effect of chemoradiotherapy on all outcomes. We prespecified analyses to investigate whether the effect of chemoradiotherapy differed by trial or patient characteristics. Results On the basis of 13 trials that compared chemoradiotherapy versus the same radiotherapy, there was a 6% improvement in 5-year survival with chemoradiotherapy (hazard ratio [HR] = 0.81, P <.001). A larger survival benefit was seen for the two trials in which chemotherapy was administered after chemoradiotherapy. There was a significant survival benefit for both the group of trials that used platinum-based (HR = 0.83, P = .017) and non-platinum-based (HR = 0.77, P <.009) chemoradiotherapy, but no evidence of a difference in the size of the benefit by radiotherapy or chemotherapy dose or scheduling was seen. Chemoradiotherapy also reduced local and distant recurrence and progression and improved disease-free survival. There was a suggestion of a difference in the size of the survival benefit with tumor stage, but not across other patient subgroups. Acute hematologic and GI toxicity was increased with chemoradiotherapy, but data were too sparse for an analysis of late toxicity. Conclusion These results endorse the recommendations of the NCI alert, but also demonstrate their applicability to all women and a benefit of non-platinum-based chemoradiotherapy. Furthermore, although these results suggest an additional benefit from adjuvant chemotherapy, this requires testing in randomized trials