Case report of radiation-induced lung injury with trastuzumab emtansine: the lung also matters

With an increase in the number of agents used concurrently with radiotherapy (RT), a new research area has emerged regarding toxicity. Here, we present a case of a 47-year-old woman presenting with radiation-induced lung injury (RILI) that occurred six months after the end of RT with concomitant and sequential use of trastuzumab-emtansine (T-DM1) with RT. The patient’s T-DM1 treatment was discontinued because of RILI. Antibiotic and methylprednisolone treatments were started. The steroid dose was gradually tapered and completely discontinued after full recovery. If new agents are used concurrently with RT, the toxicity profile of new agents should be kept in mind

Leptomeningeal metastasis in primary uterine cervical cancer: a rare case and review of the literature

Objectives. Leptomeningeal metastasis (LM) of primary uterine cervical cancer is rare and treatment options are limited. In this case report and literature review, we aimed to present a patient with cervical cancer with LM and discuss previously reported cases in the literature.  Case presentation. Our case was a 58-year-old patient who was initially diagnosed with metastatic primary uterine cervical cancer and treated with chemotherapy and chemoradiotherapy. During follow-up, she developed neurological symptoms, and LM was detected in the craniospinal regions. Cerebrospinal fluid cytology examination has confirmed metastatic disease. The patient was treated with concurrent intrathecal methotrexate and whole-brain radiotherapy (WBRT). A good clinical and cytological response was obtained. However, while intrathecal methotrexate was being continued after WBRT, she succumbed to hematological toxicity before the radiological response could be evaluated. Conclusions. LM is an extremely rare and catastrophic distant spread pattern in patients with cervical cancer. In the literature, a total of 26 patients were reported up to date. Median survival after detection of LM was nine weeks, including our case. Multimodal treatment combinations such as systemic and intrathecal chemotherapy and radiotherapy (RT) were used. However, most of these reports did not have detailed information about toxicity. Despite the combined use of aggressive treatment modalities, patients have limited survival and very high risks of hematologic toxicity. Concurrent use of intrathecal chemotherapy and radiotherapy should be avoided due to increased risk of morbidity

Direct and Indirect Effects Between First Literacy Errors, Visual Perception, and Phonological Awareness Variables

This research is a descriptive study in the survey model to determine the direct and indirect effects between visual perception, phonological awareness, and literacy errors. The design of the study is exploratory correlational design. 552 first-grade primary school students participated in the study. The data were collected using measurement tools named phonological awareness, visual perception, word-sentence writing/spelling, and reading errors. According to the findings, visual perception affects sentence writing/spelling both directly and through word-writing-reading errors. Visual perception affects reading errors both directly and through word-sentence writing errors. The results show that the development of prerequisite skills and reading are mediated by writing, writing/spelling are mediated by reading, and learning develops in a spiral manner. It can be said that children’s reading-writing/spelling errors increase because they have difficulty in converting from sound to the letter, from letter to sound, and in synthesizing and analyzing according to their initial level of phonological awareness and visual perception development

Management of Ductal Carcinoma in Situ Patients Receiving Postoperative Radiotherapy After Breast Conserving Surgery: Hacettepe Experience

We retrospectively evaluated our therapetic results in ductal carcinoma in situ (DCIS) patients treated with postoperative radiotherapy following breast-conserving surgery (BCS). Sixty-seven DCIS patients were treated with curative radiotherapy (RT) after BCS, in our department from December 1998 to January 2008. All patients have been treated with 6 MV photon energy on lineer accelerator machine. Radiotherapy treatment fields were opposed tangential to the whole breast. A total dose of median 50 Gy (48-50 Gy) was delivered in five fractions in a week. In twenty patients, boost dose to the tumour region was applied. Fifty patients received systemic hormonotherapy. Median follow-up time was 44 moths (range 12-122 months). Five-year OS, DFS and local control rates were found as 96%, 97% and 97%, respectively. There was only one ipsilateral breast recurrence in our study (2%). Two patients died due to other causes except disease (3%). Grade III dermatitis was seen in only one patient (2%), and there was no serious acute side effects in 41 patients (63%). There was no late side effect in our patients. Sixty-two patients were alive without evidence of tumour recurrence, with their intact breast and with good cosmesis. Our survival rates and side effects were in consistent with literature, and RT is an effective option for DCIS patients following BCS.WoSScopu

Definitive Treatment For Locally Advanced Cervical Cancer: A Retrospective Analysis From A Singe Institution

The primary aim of this study was to evaluate the long-term treatment outcomes of definitive chemoradiotherapy (CRT) of locally advanced cervical cancer and beside this to identify prognostic factors and related toxicities. Between February 2001 and September 2013, 327 patients were retrospectively evaluated. The median age was 56 years (range, 24-82 years). Ninety-five percent of patients had >= Stage IIB disease. External pelvic radiotherapy (RT) (45-50.4 Gy) and concomitant chemotherapy followed by 28 Gy in 4 fractions high dose rate brachytherapy was administered. Boost doses of 10-15 Gy were administered to < 2 cm lymph nodes (LNs) or distal parametrial involved sites. The median follow-up time was 68 months (range, 45-90 months). Two-, 5- and 10-year cancer specific survival (CSS) rates were 80%, 68%, and 65%; disease-free survival (DFS) rates were 73%, 66%, and 64%; local recurrence-free survival (LRFS) rates were 94%, 92%, and 91%; loco-regional recurrence-free survival (LRRFS) were 92%, 89%, and 86%; distant metastases-free survival (DMFS) were 81%, 76%, 75%, respectively. In multivariate analysis, age, clinical stage and LN metastasis at diagnosis were independent prognostic factors for both CSS and DFS. Third month response to treatment was the most important prognostic factor for all end points in univariate and multivariate analysis. With the aggressive radiotherapeutic approach, it seems that distant metastases rather than locoregional recurrence determines the survival rates. Consolidation chemotherapy may be a good option after definitive CRT which needs to be supported with future phase III studies.WoSScopu

Stereotactic body radiotherapy boost in patients with cervical cancer

Our aim was to evaluate the oncological outcomes of stereotactic body radiotherapy (SBRT) boost in patients with cervical cancer. The data of 21 patients who received SBRT boost after definitive radiotherapy (RT) or chemoradiotherapy (CRT) between March 2012 and April 2019 were retrospectively evaluated. External beam radiotherapy (EBRT) was applied to patients with a total dose of 50.4 Gy in 28 fractions. Kaplan–Meier method was used for survival analysis (IBM SPSS 23 software) and p < .05 value was considered significant. After definitive RT or CRT, there was a complete response in 9 (43%) patients, partial response in 11 (52%) patients and stable disease in 1 (5%) patient. The median follow-up period was 28 months (range, 7.5–88 months). Two-years cancer-specific survival rate was 80%. While 2-year LC rate was 75% in patients with residual tumour size <4 cm, it was 50% when there was ≥4 cm residual tumour after definitive CRT (p = .1). The treatment was well-tolerated and no acute or late toxicity was observed. Although brachytherapy (BRT) is an essential part of the treatment in locally advanced cervical cancer, SBRT may be used in patients with small residual disease who are not candidate for BRT. IMPACT STATEMENT Cervical cancer is one of the most common cancers in the world, and external beam radiotherapy (EBRT) and brachytherapy (BRT) are the main treatment options. However, in rare cases where BRT is not feasible, it has been questioned whether stereotactic body radiotherapy (SBRT) as an alternative to BRT. What is already known on this subject? Nowadays, BRT still appears to be the gold standard treatment. However, studies with a small number of patients and short follow-up periods in the literature show that SBRT can be a good alternative in cases where BRT cannot be performed. What do the results of this study add? Our study is one of the series with the largest number of patients in the literature and with the longest follow-up period. In this area where there is no prospective study, we think that retrospective data with high patient numbers are enlightening. What are the implications of these findings for clinical practice and/or further research? Our study shows that SBRT is an alternative option in cases with small residual disease where BRT cannot be applied, and it provides a basis for a prospective randomised study