Vessel based delineation guidelines for the elective lymph node regions in breast cancer radiation therapy - PROCAB guidelines

Objective A national project to improve the quality of breast radiation therapy was started, named PROCAB (PROject on CAncer of the Breast). One of the objectives was to reach a national consensus guideline for the delineation of the regional lymph node areas in breast radiation therapy. Methods The realization of the new guidelines was a step by step process that started with multiple expert meetings where the existing guidelines were analyzed and the delineations of the lymph node regions were performed together with a surgeon, specialized in the anatomy of the drainage of the breast. Results The delineation guidelines are vessel-based. Since the occurrence of pathological lymph nodes is typically around the veins, the cranial and caudal borders of all different nodal regions are based on a 5 mm margin around the veins, except for the parasternal lymph node area. Compared to the existing guidelines there are some major changes. Conclusion With this project a national as well as a European (ESTRO) consensus guideline for the delineation of the regional lymph node areas in breast RT is reached. The new delineation atlas is vessel-based and no longer field-based

Ewing sarcomas of the sino-nasal tract and maxillary bone

Ewing’s sarcoma is a malignant tumor belonging to the group of small round cells tumors. Histologically similar to soft tissue neoplasms originally described as primitive neuro-ectodermal tumors (PNET), in the WHO classification, Ewing’s sarcoma and PNET are labeled together under the rubric of EWS/PNET. Rarely located in the nasal cavity and the para-nasal sinuses, we report three cases of Ewing’s sarcoma of maxillary bone and sinus. Our patients, 2 males and one female, were aged 20, 16 and 13 years respectively. The chief complaint was a painful face swelling. The diagnosis was retained on histologic and immuno-histochemical results. In two cases, surgery was performed as primary treatment modality followed by chemo-radiotherapy, which was the only therapeutic modality in the remaining case. After a follow-up of 2, 3 and 8 years (for each patient), we did not report local or distant failures

Cutaneous leiomyosarcoma on the trunk: unusual presentation with an aggressive course – case report and review of literature

Primary cutaneous leiomyosarcoma (PCL) are soft-tissue sarcoma, arising in the dermis, with or without extension into the subcutis. They are thought to have an indolent course compared to their subcutaneous counterparts, they may recur but rarely metastases. We report the case of a patient with a PCL arising in the anterior trunk wall who developed pulmonary, bone and retroperitoneal metastases 6 years after wide surgical excision of the primary tumor

Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation

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Post-operative radiotherapy of conjunctival malignancies: A series of 24 cases

Objective: To assess the results of post-operative radiation therapy in the management of incompletely resected conjunctival malignancies. Methods: In this retrospective case series, we reviewed the clinical records of all cases of conjunctival tumors treated with post-operative radiotherapy in the radiation oncology department of Salah Azaïz Institute of Tunis, from January 1990 to December 2015. We focused on clinico-pathological characteristics, treatment modalities and patients’ outcome. Results: Twenty four patients were enrolled in our study: 19 men and 5 women. The mean age of our patients was 54 years (range: 20 to 84). The mean basal diameter of the tumor was 11 mm (range 6 to 20 mm). The mean tumor thickness was 4 mm (range 1 to 15 mm). The most frequent histological type was squamous cell carcinoma in 23 cases. One patient had a malignant conjunctival fibrohistiocytoma. Radiation therapy was post-operative for positive or narrow surgical margins in all cases. Eighteen patients were treated with kilovoltage radiation therapy (KVRT). The mean delivered dose to the tumor bed was 64 Gy (range: 60 to 70 Gy). Four patients were treated with an association of KVRT and Strontium 90 plaque brachytherapy. Two patients were treated only with Strontium 90 plaque brachytherapy (2 fractions of 17 Gy). After a median follow-up of 110 months, 19 patients were alive with no evidence of local recurrence in 17 patients. Two patients had a local recurrence and were referred to surgery. Two patients were lost to follow up. The 5-year relapse free survival rate was 90.9%. Radiation-induced side effects were conjunctivitis, cataract, eye watering and glaucoma. Conclusion: Post-operative radiation therapy allows good local control with acceptable toxicities in conjunctival malignancies. Management of these tumors needs a broad collaboration between ophthalmologists and radiation oncologists, to allow a conservative treatment with the lowest rates of local recurrence