Induction chemotherapy with paclitaxel and cisplatin to concurrent radiotherapy and weekly paclitaxel in the treatment of loco-regionally advanced, stage IV (M0), head and neck squamous cell carcinoma. Mature results of a prospective study

<p>Abstract</p> <p>Background</p> <p>to evaluate activity and toxicity of a sequential treatment in advanced, non metastatic, mostly unresectable, head and neck squamous cell carcinoma.</p> <p>Methods</p> <p>Patients with loco-regionally advanced or unresectable, head and neck cancer, were prospectively treated with 3 courses of induction chemotherapy followed by concurrent chemoradiation. Induction chemotherapy consisted of paclitaxel 175 mg/m2 day 1 and cisplatin 75 mg/m2 day 2, given every 3 weeks, to a total of three courses. Curative radiotherapy started 4 weeks after the last cycle of chemotherapy with the goal of delivering a total dose ≥ 66 Gy. During RT weekly paclitaxel (40 mg/m2) was administered.</p> <p>Results</p> <p>The trial accrued 43 patients from January 1999 to December 2002. All patients received 3 courses of induction chemotherapy and the planned dose of radiotherapy. Thirty-eight patients were able to tolerate weekly paclitaxel during irradiation at least for 4 courses. After induction therapy there were 32 overall responses, 74.4% (23 partial and 9 complete); at completion of concomitant treatment overall responses were 42, 97.7% (20 partial and 22 complete). Median time to treatment failure was 20 months and the disease progression rate at 3 and 5 years was 33% and 23%, respectively. The median overall survival time was 24 months and 3 and 5 years overall survival rates were 37% and 26%, respectively. The major toxicity was mucositis.</p> <p>Conclusions</p> <p>This combined treatment was found to be feasible and active in advanced or unresectable, head and neck squamous cell carcinoma patients. Long-term results observed in this trial encourage to consider this approach in further investigation using newer radiation delivering technique and new molecularly agents.</p

Recurrent primary leiomyosarcoma of the seminal vesicle treated with curative radiotherapy.

A case of locally recurrent leiomyosarcoma of the left seminal vesicle, previously surgically resected, is described in a 65-year-old man. The patient underwent curative radiation therapy (61 Gy/33 fractions). Initially, he experienced a complete response after irradiation, but 15 months after treatment, progressive disease was recorded both in lung and bone, without evidence of local recurrence. The lack of efficient systemic therapies leads to a poor prognosis in this disease; clinical outcome in this patient seems to suggest the utility of radiotherapy in the very rare scenario of locally recurrent seminal vesicle leiomyosarcoma. Bangladesh Journal of Medical Science Vol.18(1) 2019 p.156-15

Patient dose in image guided radiotherapy: Monte Carlo study of the CBCT dose contribution

Image Guided RadioTherapy (IGRT) is a technique whose diffusion is growing thanks to the well-recognized gain in accuracy of dose delivery. However, multiple Cone Beam Computed Tomography (CBCT) scans add dose to patients, and its contribution has to be assessed and minimized. Aim of our work was to evaluate, through Monte Carlo simulations, organ doses in IGRT due to CBCT and therapeutic MV irradiation in head-neck, thorax and pelvis districts. We developed a Monte Carlo simulation in GAMOS (Geant4-based Architecture for Medicine-Oriented Simulations), reproducing an Elekta Synergy medical linac operating at 6 and 10 MV photon energy, and we set up a scalable anthropomorphic model. After a validation by comparison with the experimental quality indexes, we evaluated the average doses to all organs and tissues belonging to the model for the three cases of irradiated district. Scattered radiation in therapy is larger than that diffused by CBCT by one to two orders of magnitude

Vaginal Mucosal Melanoma: a Complete Remission after Immunotherapy and '0-7-21' Radiotherapy Regimen (24 Gy/3 fractions/21 days)

We present the case of a patient with vaginal mucosal melanoma who underwent complete remission after immunotherapy and ‘0-7-21’ radiotherapy regimen (24 Gy/3 fractions/21 days). An 80-year-old woman had a biopsy of a voluminous vaginal lesion and received a histological diagnosis of melanoma with angiomatoid aspects. The patient underwent immunotherapy with pembrolizumab 2 mg/kg every 3 weeks and was sent to our attention for planning radiotherapy as the extent of the lesion did not make it susceptible to surgery.Considering the concomitant administration of pembrolizumab, we chose to treat this patient with a modulated intensity radiation therapy technique delivering a hypofractionated dose of 24 Gy in 3 fractions delivered on days 0, 7, and 21. We observed a complete clinical remission of the melanoma 12 months after radiotherapy and she has been alive for 18 months with no clinical signs of local recurrence