Complete Tumor Resolution Research Articles

Treatment of ocular surface squamous neoplasia in an Indian rural facility: a study of 38 eyes

PurposeTo report the demographic profile, clinical presentation, and management outcomes of ocular surface squamous neoplasia (OSSN) treated with primary topical chemotherapy in a limited resource secondary eye care facility in rural parts of South India.MethodsRetrospective interventional study of 38 eyes of 37 patients with OSSN treated with topical 1% 5-Fluorouracil (5FU), over a period of two years.ResultsThe median age at presentation with OSSN was 44 years (mean, 46 years; range 13 to 74 years). Majority (76%) were males. The most common morphological variant was placoid OSSN (18, 47%). Limbus was the most common epicenter (31, 82%). Corneal OSSN was the most initially misdiagnosed variant (n = 3). Of the 38 eyes receiving one week on and 3-weeks off cycles of 5FU regimen, complete tumor resolution was achieved in 36 (95%) eyes. The median number of topical 5FU cycles for tumor resolution was 2 (mean, 2; range, 1 to 4). Over a median follow-up period of 5 months (mean, 6 months; range, 1 to 27 months), tumor recurrence was noted in 3 eyes (8%), of which one case had xeroderma pigmentosum with bilateral multifocal recurrence. Complication rate was 5% (n = 2), which included transient conjunctival hyperemia (n = 1), and bacterial keratitis (n = 1) which resolved with fortified antibiotics.ConclusionPrimary chemotherapy with topical 1% 5FU is a safe and effective management modality for OSSN at limited resource settings in rural India.

Abstract B039: A phase 1/2 study of dendrimer-enhanced (DEP) SN38 (SN38-SPL9111/DEP irinotecan) in patients with advanced solid tumours

Abstract Background: Dendrimers are highly branched nanoparticles that achieve significant tumor targeting of cytotoxic drugs. DEP SN38 (or DEP irinotecan) is a highly optimised dendrimer conjugate of the irinotecan active metabolite, SN38. We report initial results of a phase 1/2 trial evaluating the safety, tolerability and preliminary efficacy of DEP SN38 in patients (pts) with advanced solid tumors, including colorectal (CRC) and platinum-resistant high-grade serous ovarian carcinoma (HGSOC). Methods: Solid tumor pts who had exhausted standard therapy were enrolled (EudraCT2019-001318-40). DEP SN38 given IV 3-weekly (Q3W) was escalated to identify a recommended phase 2 dose (RP2D). Additional dose assessment/expansion cohorts followed at Q3W or Q2W (2-weekly) alone or in combination with 5-fluorouracil and leucovorin (5FU/LV). Efficacy was assessed via RECIST 1.1 criteria and serum tumor biomarkers. Results: Dose escalation (N=7) confirmed a Q3W RP2D of 12.5 mg/m2 SN38 with 1 pt having a dose limiting toxicity (DLT) of grade 4 neutropenia for >7d. Following successful dose expansion, additional dose exploration confirmed a Q2W RP2D of 12.5 mg/m2 SN38 alone or in combination with 5FU/LV. DEP SN38 was well-tolerated for all dose regimens (N=101) with mostly mild/moderate treatment-related adverse events (TRAEs), with no new events compared to those observed with conventional irinotecan. Notably, there were no reports of severe (≥ grade 3) diarrhea with DEP SN38 and no reports of cholinergic symptoms, both being common with conventional irinotecan (~20% and 47% pts, respectively). Moreover, with DEP SN38, severe nausea (2.2% pts) and vomiting (1.1% pts) occurred less frequently than with irinotecan (both ~10% pts). While febrile neutropenia was observed as a DLT at 15 mg/m2 Q2W monotherapy (2 pts), neutropenia was otherwise uneventful and managed with G-CSF.CRC pts: 38 heavily pre-treated CRC pts were dosed (N=31 evaluable); pts had an average ~4 prior treatment lines with 97% having received at least 1 irinotecan containing line. DEP SN38 achieved a disease control rate (DCR) of 48%, with stable disease up to 72 weeks.HGSOC pts: 23 platinum-resistant HGSOC pts were dosed (N=18 evaluable); pts had received an average ~6 prior treatment lines. DCR for pts dosed Q2W was 100% with 33.3% objective response rate, and 72% DCR for all HGSOC pts. There were 3 partial responses (PR), for up to 27 wks with 1 pt achieving complete tumour and ascites resolution with pts ongoing. 75% of pts achieved CA-125 reductions of up to 98% vs baseline. For DEP SN38 in combination with 5FU/LV, in a cohort of mainly CRC pts (N=6), DCR is 100% including 1 PR, with pts ongoing. Conclusions: DEP SN38 was very well-tolerated with significantly fewer severe gastrointestinal TRAEs compared to conventional irinotecan. Encouraging anti-tumour activity, including prolonged disease control in heavily pre-treated CRC and HGSOC pts, demonstrates promising clinical utility of DEP SN38, both as a monotherapy and as a combination therapy. Recruitment is ongoing. Citation Format: Jia Liu, Anna R Minchom, Alastair Greystoke, Thomas R J Evans, Debashis Sarker, Anthony M Joshua, Cienne Morton, Aisha Gaus, Wing Yau, Rasha Cosman, Dominika Chwialkowska, Jeremy R A Paull, Bernadette M Jean-Francois, Jacinth K Fairley, Nicola J Main, Stephanie R Edmondson, Natalie Cook. A phase 1/2 study of dendrimer-enhanced (DEP) SN38 (SN38-SPL9111/DEP irinotecan) in patients with advanced solid tumours [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2023 Oct 11-15; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2023;22(12 Suppl):Abstract nr B039.

Topical 1% 5-fluorouracil eye drops as primary treatment for ocular surface squamous neoplasia: Long-term follow-up study.

To determine the efficacy and safety of topical 1% 5-fluorouracil (5FU) eye drops as primary treatment of ocular surface squamous neoplasia (OSSN). Patients were diagnosed with OSSN based on slit-lamp examination and anterior segment optical coherence tomography (AS-OCT). In ambiguous cases an incisional biopsy was performed. All were treated with 5FU eye drops as primary therapy and retrospectively reviewed. Data on demographics, tumor characteristics, treatment outcome, and side effects were collected. The primary outcome measures were resolution frequency and recurrence rate of OSSN. Secondary outcomes were risk factors for resolution and recurrence, and side effects of treatment. The mean age of 251 subjects (258 eyes) was 67.5±11.7 years, 182 were male. Patients were followed up on average for 752±580 days. Overall, 87% of patients experienced complete tumor resolution. Multivariable analysis revealed that superior tumor location (HR: 0.62, 95% CI: 0.41-0.93, p=0.02) and leukoplakia (HR: 0.65, 95% CI: 0.41-0.93, p=0.02), decreased the likelihood of tumor resolution. The recurrence rate was 4% at six months, 8% at one year, and 19% at two years. Larger tumor area increased chances of tumor recurrence (HR: 1.01, 95% CI: 1.00-1.02 p=0.03). The most common side effects of 5-FU were mild hyperemia and pain, which occurred in 26% and 23% of patients, respectively. Among the sight-threatening side effects, limbal stem cell deficiency occurred in only 3% of patients. Topical 1% 5FU eye drops are a safe and effective medication for OSSN. Superior tumor location and leukoplakia decreased the chance of tumor resolution.

Long term study of topical interferon α-2b eye drops as primary treatment of ocular surface squamous neoplasia

PurposeTo assess the efficacy of topical interferon α-2β(IFN) eye drops as a primary treatment for ocular surface squamous neoplasia(OSSN) and evaluate factors that impact response to treatment and recurrence of OSSN. MethodA retrospective study of 143 OSSN patients treated with topical IFN(1MIU/ml) from January 1998 to June 2021. The diagnosis was based on clinical examination and anterior segment optical coherence tomography, with histologic confirmation was present in 46.2% of patients. Data on demographic, tumor characteristics, treatment outcome, and side effects were collected. The primary outcomes were tumor resolution frequency and recurrence rate. Secondary outcomes were predictive factors for resolution and recurrence and side effects of treatment. ResultParticipants were mostly older (mean age, 69 years, SD 12.9, range 29–97), white(89%) males (74%). Complete tumor resolution was achieved in 80.4% of individuals with a mean time to resolution of 4.2 months (SD 2, range 0.5–12.3 months). On multivariable analysis, history of skin cancer (HR: 0.66, p = 0.05, 95%CI: 0.44–0.99) and immune system abnormalities (HR: 0.37, p = 0.009, 95%CI: 0.18–0.79) reduced the risk of tumor resolution, while a prior history of OSSN (HR: 3.49, p < 0.001, 95%CI: 1.76–6.93) increased the risk of resolution. With a mean follow-up time of 44.3 months (SD 50.9, 0–290 months), the recurrence rate was 0%, 2.3% and 3.1% at 1, 2, and 5 years respectively. Mild hyperemia(18.9%) and pain(10.6%) were the two most common side effects. ConclusionTopical IFN eye drops are a safe and effective primary treatment modality for OSSN with a reasonable side effect profile.

Conjunctival papilloma treatment outcomes: a 12-year-retrospective study.

Conjunctival papilloma is often resistant to treatment. Various therapies have been reported with no gold standard. The purpose of this study was to compare treatment outcomes after various therapies. A retrospective chart review of 30 conjunctival papilloma patients from 2009-2020. Data on demographics, tumour characteristics, primary treatment and outcomes were collected. The primary outcome was the frequency of complete tumour resolution and recurrence rate of each primary therapy. The secondary outcome was treatment related side effects. The mean age was 57.5 years (3-93 years) with male predominance (n = 22, 73.3%). Eleven eyes were treated with interferon α-2b (IFN), seven with 5-fluorouracil (5FU), and 10 with excision biopsy and cryotherapy (6 with adjuvant therapy with IFN). The frequency of tumour resolution was 36.4% (4/11), 28.5% (2/7), and 100% (10/10) in each group, respectively. The mean time to resolution was faster in the surgical group compared to the medical group (1 day vs 159 days, p < 0.001). There was higher tumour recurrence with 11% in the surgical vs 0% in the medical group at 6 months and at 12 months, 22% recurrence in the surgical and 0% in the medical group (p = 0.52). However, the differences were not statistically significant. Papilloma resolution is faster with surgical excision as compared to medical therapy. However, recurrences are more frequent after surgical versus medical treatment.

Periosteal Ewing Sarcoma: Imaging Features and Clinical Outcomes in 7 Patients.

The aim of this study was to describe imaging features, treatment, and prognosis of patients with periosteal Ewing sarcoma (PES). Seven patients with PES treated between 2001 and 2020 were studied retrospectively for presenting symptoms, imaging features, treatment, and prognosis. Among the 7 patients (mean age, 27.3 years) with local pain and/or mass of less than 6 months duration, 4 were males and 3 females (1.3:1). These surface tumors involved 3 long bones and 4 pelvic bones. Radiographs showed cortical erosions with 2 and CT with 4 long bone tumors. All 7 surface tumors showed normal marrow on MRI, and 4 tumors demonstrated normal marrow activity on 18FFDG fluorodeoxyglucose PET-CT. The only exception was a PES involving iliac bone with thin cortex and marrow extension, which demonstrated hypermetabolic marrow activity. All patients were treated initially with chemotherapy and optional radiation treatment with complete tumor resolution of a tibial PES in 1 patient. The remaining 2 patients with long bone PES had tumor resection and limb-salvage surgery and the 4 patients with pelvic bone PES had hemipelvectomy after chemotherapy/radiation treatment. Five patients were disease-free with long-term survival. A patient with a long bone PES and solitary lung metastasis at onset had tumor resection and metastasectomy with complete recovery without tumor recurrence. The 2 patients with pubic bone PES had complete recovery without tumor recurrence; however, the remaining 2 patients with iliac bone PES developed distant metastases and died within 2 years of diagnosis. Periosteal Ewing sarcoma arises in periosteum of bone and spares medullary cavity. As compared with its intramedullary counterpart, the tumor has better prognosis with long-term survival. Rarely, the surface tumor arising at a bone with thin cortex, such as iliac bone or scapula, may have medullary involvement. We have described our experience in diagnosis and clinical management in 7 patients of this rare surface variant of the more common intramedullary Ewing sarcoma.

Complications of congenital portosystemic shunts: liver tumors are affected by shunt severity, but pulmonary and neurocognitive associations are not.

Congenital portosystemic shunts (CPSS) are associated with multisystem complications, with the most common being liver tumors. The purpose of this study is to investigate the incidence of complications of CPSS, and to determine the natural history of liver tumors and their relationship with shunt closure. Single-center retrospective cohort study of patients with CPSS referred from 1990 to 2020. Data on demographics, laboratory, radiological and histological investigations, clinical evolution, and surgery were reviewed. Mann-Whitney for continuous data and Fisher's exact test for categorical data were used. A p value of 0.05 was considered significant. 54 patients were investigated for CPSS with a median age of 1.1years (IQR 0.2-11.8years) at presentation-7 intrahepatic shunts resolved spontaneously and were excluded. Type 1 (without intrahepatic portal flow) had a higher rate of all hepatic tumors than Type 2 (partial intrahepatic portal flow) [18/22(82%) vs. 9/25(36%); p = 0.003); and malignant tumors (6/22(27%) vs 1/25(4%); (p = 0.04). Following shunt closure, 4/11(36%) of patients experienced partial and 3/11(27%) complete tumor regression. Pulmonary hypertension and hepatopulmonary syndrome affected 4(9%), and 3(6%) patients, respectively. Pulmonary complications affected 1 patient with Type 1 and 6 with Type 2 shunts (p = 0.1). Neurocognitive anomalies were identified in 16/47(34%) patients, 8/22(35%) with Type 1 shunts and 8/25(32%) with Type 2 shunts (p = 0.76). 9/47 (19%) required special needs schooling. Severity of portal venous deprivation (Type 1 CPSS) increases the risk of hepatic tumors and surgical closure is associated with a reduction in size or complete resolution of benign tumors.

The targeted SMAC mimetic SW IV-134 augments platinum-based chemotherapy in pre-clinical models of ovarian cancer

BackgroundOvarian cancer is initially responsive to frontline chemotherapy. Unfortunately, it often recurs and becomes resistant to available therapies and the survival rate for advanced and recurrent ovarian cancer is unacceptably low. We thus hypothesized that it would be possible to achieve more durable treatment responses by combining cisplatin chemotherapy with SW IV-134, a cancer-targeted peptide mimetic and inducer of cell death. SW IV-134 is a recently developed small molecule conjugate linking a sigma-2 ligand with a peptide analog (mimetic) of the intrinsic death pathway activator SMAC (second-mitochondria activator of caspases). The sigma-2 receptor is overexpressed in ovarian cancer and the sigma-2 ligand portion of the conjugate facilitates cancer selectivity. The effector portion of the conjugate is expected to synergize with cisplatin chemotherapy and the cancer selectivity is expected to reduce putative off-target toxicities.MethodsOvarian cancer cell lines were treated with cisplatin alone, SW IV-134 alone and a combination of the two drugs. Treatment efficacy was determined using luminescent cell viability assays. Caspase-3/7, − 8 and − 9 activities were measured as complementary indicators of death pathway activation. Syngeneic mouse models and patient-derived xenograft (PDX) models of human ovarian cancer were studied for response to SW IV-134 and cisplatin monotherapy as well as combination therapy. Efficacy of the therapy was measured by tumor growth rate and survival as the primary readouts. Potential drug related toxicities were assessed at necropsy.ResultsThe combination treatment was consistently superior in multiple cell lines when compared to the single agents in vitro. The expected mechanism of tumor cell death, such as caspase activation, was confirmed using luminescent and flow cytometry-based assay systems. Combination therapy proved to be superior in both syngeneic and PDX-based murine models of ovarian cancer. Most notably, combination therapy resulted in a complete resolution of established tumors in all study animals in a patient-derived xenograft model of ovarian cancer.ConclusionsThe addition of SW IV-134 in combination with cisplatin chemotherapy represents a promising treatment option that warrants further pre-clinical development and evaluation as a therapy for women with advanced ovarian cancer.

Diffusion Weighted and Dynamic Contrast Enhanced Magnetic Resonance Imaging in Carcinoma of Cervix: Role of Apparent Diffusion Coefficient Value and Time Intensity Curve Pattern in Chemoradiotherapeutic Response Evaluation

Introduction: Magnetic resonance imaging (MRI) is a widely used imaging modality in the imaging evaluation of carcinoma of cervix. The aim of our study was to evaluate the response in carcinoma cervix patients following chemoradiotherapy by Diffusion weighted (DW-MRI) and Dynamic contrast enhanced-MRI (DCE-MRI). Methods: 21 inoperable biopsy proven patients (mean age 48.43 years) of carcinoma cervix were included in the study. All patients underwent MRI (conventional, DW and DCE) of the pelvis thrice. Baseline MRI, Post chemotherapy MRI after neoadjuvant chemotherapy and Post chemoradiotherapy MRI after completion of concurrent chemoradiotherapy. Post treatment apparent diffusion coefficient(ADC) values and Time intensity curve(TIC) pattern were compared with baseline values. Results: Baseline meanADC value of all patients was 0.82 x10-3 mm2/s. After completion of treatment, 18 patients showed complete resolution of tumor and showed 0.50 x10-3 mm2/s increase in meanADC value from baseline MRI which was significantly higher than remaining 3 patients with residual tumor (0.50 x10-3 mm2/s v/s 0.17 x10-3 mm2/s). ADC threshold value of 1.15 x10-3 mm2/s was defined, differentiating the residual tumor from the healthy cervical tissue after chemoradiation. On post treatment MRI, 17 out of 18 patients with complete resolution of tumor showed increasing trend of enhancement on TIC and only one patient showed plateau pattern. 2 of the 3 patients with residual tumor showed washout pattern and one patient showed plateau pattern. Conclusion: ADC values and TIC pattern differ in patients with complete response to chemoradiotherapy from patients with residual tumor, so helps in differentiating residual tumor from cancer free cervix. Keywords: Carcinoma of cervix; Chemoradiotherapy; Diffusion weighted MRI; Dynamic contrast enhanced MRI; Time intensity curve.

Eighteen-year results of treatment of uveal melanoma using Ruthenium-106 + Rhodium-106 brachytherapy

The objective of the study was to evaluate the results of Ruthenium-106 (106Ru) + Rhodium-106 (106Rh) brachytherapy in uveal melanoma (UM) patients.The data for the period 2001–2018 were taken from the Belarusian Cancer Registry and medical records of patients with clinically diagnosed uveal melanoma who received treatment at the N. N. Alexandrov National Cancer Centre of Belarus. A total of 383 patients were included in the study. 106Ru + 106Rh β-ophthalmic applicators were used for brachytherapy (BT). The calculated dose to the tumor apex was 120–130 Gy, while the reduced 100–110 Gy was administered to tumors close to the optic nerve. To analyze the treatment outcomes, patients were divided into three groups based on a basal diameter of a tumor.Out of a total 383 patients, complete tumor resolution was observed in 282 (73.6 %), tumor stabilization was present in 76 (19.8 %). Continued tumor growth and tumor relapse were observed in 34 (9.13 %) and 50 (13.05 %) patients, respectively. 59 (15.1 %) patients underwent enucleation. The metastatic disease developed in 47 (12.3 %) cases. BT adverse effects were observed in 21.3 % cases. The relapse-free survival in the group of patients with a basal tumor diameter of up to 9 mm was 76.0 ± 6.3 %, which was higher than that in the groups with a large basal diameter (p = 0.002). Over a 15-year follow-up period, almost half of the patients (52.2 ± 15.6 %) with a tumor base of more than 12 mm relapsed.Considering the high rates of the continued tumor growth during treatment in patients with a basal tumor diameter of more than 12 mm, combined therapy must be used in this group.

1792P Dual targeting PD-1 and BRD4 with INTASYL self-delivering RNAi elicits persistent anti-tumor immunity in-vivo following complete resolution of tumors

Targeting the bromodomain and extra-terminal motif (BET) protein BRD4 is an attractive target for cancer immunotherapy, as it exerts impacts on both cancer cells and T cells. Preclinical data suggests added therapeutic potential in co-targeting the immune checkpoint PD-1. INTASYL™ is a self-delivering RNAi platform that provides both highly efficient delivery to target cells without need for specialized drug delivery systems and strong gene silencing of multiple targets in a single drug formulation.

Long-term efficacy and safety of imiquimod 5% and fluorouracil 1% creams in medical monotherapy of complex eyelid basal cell carcinomas.

To study the long-term efficacy and safety of local application of imiquimod 5% and fluorouracil 1% creams in complex eyelid basal cell carcinomas (BCCs). A retrospective, non-comparative study in biopsy-proven, complex (involving canthi or >50% of eyelid length) eyelid BCC patients who were medically unfit for surgical procedures. All patients were medically treated with either of the creams using fixed-dose regimens for a minimum of 3 months. All received oral vitamin C 500 mg QID for 3 months as an adjunct for collagen healing. A minimum of "post-treatment" follow-up of 12 months was observed. Of total 30 patients, imiquimod 5% and fluorouracil 1% were used in 16 and 14 patients, respectively. The mean age of our patients was 70.5 years. The co-morbidities included - severe coronary artery disease using blood-thinners (n = 19), poorly controlled diabetes (n = 12), poorly controlled hypertension (n = 6), on nebulization (n = 3), and tuberculosis with pulmonary fibrosis (n = 2). Complete clinical tumor resolution was noted in 10 and 8 patients over 12 and 16.5 weeks, respectively, in imiquimod and fluorouracil groups. Periocular skin erythema, chemical conjunctivitis, and skin depigmentation were seen in all the patients of imiquimod group. On the other hand, the local side-effect profile in fluorouracil patients was limited. The medical treatment of complex eyelid BCC is a useful alternative to surgery in the elderly with significant co-morbidities. It provides a promising long-term relief with a tolerable side-effect profile. A prospective, randomized, double-blinded trial would provide stronger evidence for the efficacy of these drugs.

Recombinant Interferon Alpha-2b as Primary Treatment for Ocular Surface Squamous Neoplasia.

Purpose:To investigate the effects of topical and perilesional interferon alpha-2b as primary treatment for ocular surface squamous neoplasia (OSSN).Methods:In this prospective interventional case series, topical interferon alpha-2b (3 MIU/mL) was used as the initial treatment of OSSN, with perilesional interferon alpha-2b (3 MIU/mL) added based on clinical response. The primary outcome was complete tumor resolution. Spearman's rank correlation test was used to investigate the association of complete tumor resolution and time to resolution with baseline tumor characteristics and the American Joint Committee on Cancer (AJCC) classification for OSSN.Results:Ninety-two patients (92 OSSN tumors) were included in the study. The total follow-up duration was 13.57 ± 2.14 months (median: 12, range: 3–23). The median basal tumor diameter was 4 mm (mean: 4.13 ± 1.37). Complete tumor resolution was achieved in 89 cases (96.73%), with a median time to complete tumor resolution of 5 months (mean: 4.64 ± 1.92). Complete tumor resolution was 57 of 57 in T1 (100%), 8 of 9 in T2 (88.88%), and 21 of 23 in T3 (91.30%). There were statistically significant correlations between AJCC classification and complete tumor resolution (Spearman's r = −0.22, P = 0.03) and maximal basal tumor diameter and the time to complete resolution (Spearman's r = 0.35, P = 0.001). There were no recurrences during the study follow-up period.Conclusion:Topical interferon alpha-2b is effective and well tolerated as a primary treatment for OSSN, with a high rate of tumors responding completely to therapy.

Wound formation, wound size, and progression of wound healing after intratumoral treatment of mast cell tumors in dogs with tigilanol tiglate

BackgroundTigilanol tiglate (TT) is a novel small molecule for intratumoral treatment of nonmetastatic mast cell tumors (MCTs) in dogs. In a randomized controlled clinical study, 75% of dogs that received a single TT treatment achieved complete resolution of the MCT by 28 days, with no recurrence in 93% of dogs at 84 days. Critical to TT's efficacy was the area of the wound (tissue deficit) after slough of the necrotic tumor relative to pretreatment tumor volume.ObjectivesTo analyze data collected during the previous study to (a) describe wounds after slough of treated MCTs and (b) identify determinants of wound area and speed of wound healing.MethodsWound presence, condition, and area were determined from clinical records of 117 dogs over 84 days after a single intratumoral TT treatment.ResultsTumor slough occurred 3 to 14 days after treatment, exposing granulation tissue in the wound bed. Wound area after tumor slough in general was related to pretreatment tumor volume, with maximal recorded wound area fully evident in 89% of dogs by day 7. In dogs achieving complete tumor resolution, all wounds were left to heal by secondary intention. Bandaging and other wound management interventions only were required in 5 dogs. Time to healing (ie, full re‐epithelialization of treatment site) depended on wound area and location on the body, with most wounds being fully healed between 28 and 42 days after treatment.ConclusionsWound area and healing after slough of TT‐treated tumors follow a consistent clinical pattern for most dogs.

755-nm Alexandrite Laser for the Treatment of Non-Facial Superficial and Nodular Basal Cell Carcinoma

Background: There is emerging literature regarding laser therapy as a treatment for non-melanoma skin cancer, with reports of vascular selective lasers and ablative lasers showing promise in basal cell carcinoma (BCC). Objectives: To assess the efficacy of the 755-nm laser in the treatment of non-facial BCC of the superficial and nodular subtypes. To provide patients with a non-surgical option for the treatment of BCC. Methods: Nineteen veterans, each with at least one biopsy proven superficial or nodular BCC on the trunk or extremity, agreed to participate in our IRB-approved, prospective, non-randomized, open-label clinical trial. A total of 21 BCC were treated, after local anesthetization, using the 755-nm Alexandrite laser (Gentle-Lase, Candela Corporation) in a single session with a 4 mm margin. Treatment sites were re-biopsied approximately six weeks later. Results: Twenty-one of 21 treated BCC demonstrated complete histologic tumor resolution at 6-week follow-up. At six weeks, all patients had a scar, and some patients had associated crusting, scaling or ulceration. The high energy and absence of dynamic cooling in our study likely resulted in additional thermal damage to the tumors. Healing times and scar appearance were comparable to electrodesiccation and curettage sites. Limitations: Our study was limited by a small sample size, lack of a control group, and sampling of treatment sites with shave removal rather than complete excision. Conclusion: The 755-nm laser has vessel-selective properties and a greater depth of penetration compared to vascular selective lasers. Our study results suggest that the 755-nm Alexandrite laser may be an effective treatment for superficial and nodular BCC on the trunk and extremities. Further investigation is warranted.

S1811 A Rare Case of Synchronous Squamous Cell Tumors of the Rectum: Diagnosis and Management

INTRODUCTION: Colorectal squamous cell carcinoma (SCC) is an extremely rare form of colon cancer, accounting for 0.1–0.2% of the cases. It has a female predominance, with a mean age of 57 years old at diagnosis. It is often diagnosed at an advanced stage. We present a case of two simultaneous SCC tumors of the rectum which were managed successfully with multidisciplinary approach. CASE DESCRIPTION/METHODS: A 65 year old female with remote history of left breast ductal carcinoma in situ, in remission after lumpectomy and adjuvant chemoradiation therapy several years ago, presented with intermittent hematochezia. She denied having any constitutional symptoms. Her previous colonoscopy was eight years prior and was unremarkable. There was no family history of gastrointestinal cancer. She rarely drank alcohol and did not smoke cigarettes. During rectal exam, a large mass was palpated in the rectum, without any palpable anal abnormalities. Labs showed normal CBC, LFTs and renal function. She underwent a colonoscopy which revealed an exophytic and friable 4 cm mass in the distal rectum. A separate subepithelial mass was seen at the rectosigmoid junction, with ulcerated mucosa overlying the lesion. The intervening rectum between the 2 distinct masses and the portion of the rectum distal to the rectal mass were both normal. Separate biopsies were taken of the two masses, and pathology revealed invasive, moderately differentiated squamous cell carcinoma with HPV positivity (Image 1). Imaging for staging did not reveal any metastases. The patient received neoadjuvant radiation and chemotherapy (Mitomycin C and 5-Fluorouracil). Post-treatment abdominal imaging showed significant response to therapy (Image 2). Subsequently, the patient underwent a laparoscopic hand assisted proctosigmoidectomy with colonic pouch anal anastomosis and diverting loop ileostomy. Pathology showed complete resolution of tumor at primary sites while carcinoma cells were found in one of the resected lymph nodes (Image 3). DISCUSSION: Colorectal SCC occurs mostly in the distal half of the colon, mainly at the rectosigmoid junction. While isolated colorectal SCCs are rare, our case is even more unique given the presence of synchronous colorectal SCC tumors. HPV infection is associated with colorectal SSC in past literature. To decrease the risk of SCC recurrence, neoadjuvant chemoradiation followed by surgical resection is the mainstay of treatment while recent evidence suggests that chemoradiation alone may be definitive therapy in some cases.Figure 1.: Colonoscopy showing submucosal mass with overlying ulcerated mucosa (arrow) at the rectosigmoid junction (A) and exophytic, friable mass seen in the distal rectum (B). Rectal mass biopsy H & E stain (20X) showing full thickness squamous atypia with lack of maturation consistent with squamous cell carcinoma (C) while diffuse nuclear p40 stain positivity (10X) supporting squamous origin (D) and strong p16 staining (10X) indicative of HPV-associated squamous cell carcinoma (E).Figure 2.: MRI abdomen showing submucosal mass (see arrow) at rectosigmoid junction with compression of lumen (A) and intraluminal mass (see arrow) in distal rectum (B). After chemotherapy and radiation, the mass at rectosigmoid has reduced to scar tissue with T2 hypointensity (C) while mass in distal rectum has completely resolved (D).Figure 3.: H & E stain (20X) showing no residual tumor identified in treated colon of patient with history of squamous cell carcinoma in (A) while treatment effect shown with numerous macrophages, few multinucleated giant cells (black arrow), lymphocytes and small vessel with hyaline changes (blue arrow) in B, and CD68 stain highlights macrophages within the area of treatment response (C). H & E stain (20X) showing lymph node with metastatic carcinoma showing treatment effect and viable tumor cells (arrows) within necrotic debris in lymph node in (E) while CK AE1/3 immunohistochemistry stain (20X) highlighting/confirming metastatic carcinoma with both viable tumor cells and necrotic cells expressing pancytokeratin.

Interferon Alfa-2b for Pigmented Ocular Surface Squamous Neoplasia: A Report of 8 Lesions.

To study the efficacy of interferon alfa-2b (IFN-a2b) on pigmented ocular surface squamous neoplasia (p-OSSN) and assess the resolution of the pigment to the treatment. A retrospective case series of 8 tumors in 7 patients. The mean age at diagnosis of p-OSSN was 65 years (median, 61 years; range, 51-84 years), and all patients were men. The mean duration of symptoms was 2 months (median, 1 month; range, 1-4 months). One patient had 2 distinct lesions in the same eye. Tumor epicenter was located at the limbus (n = 5) or bulbar conjunctiva (n = 2). Complexion-associated melanosis was noted in all eyes. The mean basal dimension of the tumor was 8 mm (median, 7 mm; range, 5-12 mm). The mean % of tumor pigmentation was 47% (median, 30%; range, 10%-100%). The treatment details included topical IFN-a2b (n = 1) or a combination of topical and subconjunctival injection of IFN-a2b (n = 7). All patients with p-OSSN showed excellent response to IFN-a2b with complete tumor regression and resolution of tumor-associated pigment with a mean number of 2 subconjunctival IFN-a2b injections (median, 2; range, 0-3) and topical IFN-a2b for an average of 2 months (median, 2 months; range, 1-3 months). There was no change in the complexion-associated melanosis with IFN-a2b. IFN-a2b is very effective in the management of p-OSSN. There is a complete resolution of the pigment along with the tumor.

Inion Bony Solitary Plasmocytoma: A Case Report

ackground and Importance: Plasma Cell Dyscrasias (PCD) are a heterogeneous group of diseases having a spectrum from multiple myeloma to solitary plasmacytoma, a rare subtype, which constitutes 2 to 5% of all PCD. It typically involves axial bones but the involvement of skull bone is very rare. Case Presentation: We are reporting a case of inion bony lesion with venous sinus infiltration in a 55-year-old male patient, presented with pain, imbalance in walking, and swelling in the occipital region. Brain MRI suggested an extra-axial lesion with skull involvement and venous sinus infiltration. The tumor was infiltrating into the sinus with patent torcular venous confluence. Tumor decompression followed by radiosurgery of residual lesion was considered in pre-operative surgical planning. It was diagnosed as a case of myeloma cell disease on histopathology. Postoperative myeloma work-up confirmed the absence of any systemic involvement. The patient was given a course of radiotherapy. Conclusion: One-year follow-up with repeated MRI and myeloma investigations in the 3rd month, 6th months, and 1 year did not show any finding suggestive of progression to multiple myeloma. The follow-up of brain MRI showed a complete resolution of the residual tumor.

AS-OCT Guided Treatment Of Diffuse Conjunctival Squamous Cell Carcinoma With Resection, Amniotic Membrane Graft And Topical Mitomycin C.

PurposeTo evaluate the efficacy of combined limited surgical resection, amniotic membrane graft and topical mitomycin C in treatment of diffuse conjunctival squamous cell carcinoma (CSCC) diagnosed and followed up by anterior segment optical coherence tomography (AS-OCT).Subjects and methodsA prospective study was performed on 24 eyes with diffuse CSCC. Fifteen eyes underwent lesion limited resection followed by postoperative topical mitomycin C 0.04% eye drop (MMC group) while nine eyes underwent complete excision and cryotherapy (no MMC group). Amniotic membrane graft was applied in all cases. The diagnosis was based on clinical and AS-OCT specific criteria of CSCC and was confirmed by histopathological results.ResultsThe study population was similar between the two groups. Mean postoperative follow-up was 27.1±4.1 months. The mean extent of the limbal involvement was 7.0±0.7 and 7.25±0.6 clock hours in MMC and no MMC groups, respectively. The mean size of conjunctival defect after tumor excision in MMC group (60.8±9.2 mm2) was significantly lower than in no MMC group (92.4±17.3 mm2). Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively. Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively.ConclusionThe treatment of diffuse CSCC with AS-OCT guided combined therapy includes limited surgical resection, AMG, and postoperative topical MMC, achieves a complete tumor resolution and good functional and cosmetic outcomes minimizing the burden of surgery, and improves postoperative patient comfort in our study cohort.

Nerve root biopsy in intramedullary spinal cord lymphoma: Technical note and case report

BackgroundA case of primary lymphomatosis of the central nervous system, with involvement of the spinal cord and a spinal nerve root is described, where the diagnosis was confirmed by biopsy of the infiltrated nerve root rather than the conus medullaris. Case descriptionA 57-year-old male presented to our clinic due to new-onset left lower extremity weakness. Magnetic resonance imaging revealed an intramedullary enhancing lesion at the T12-L1 level, and a small area of enhancement in a nerve root at the L4 vertebral body level. Clinical, imaging and laboratory investigations showed no evidence of extraspinal lesions, and comprehensive studies including twice-repeated lumbar puncture cytology were non-diagnostic. The patient proceeded with L2-L5 laminectomy for nerve root biopsy. Under microscope view, the involved nerve root was successfully identified and resected. Pathology confirmed the diagnosis of neurolymphomatosis with large B-cell lymphoma. The patient received chemotherapy with complete tumor resolution, one year after surgery. ConclusionsPrimary involvement of the spinal cord in malignant lymphoma is rare. Accounting for the high risk of neurologic deficits after conus medullaris or spinal cord biopsy, we demonstrate that biopsy of the affected nerve root can be considered a safer candidate in clinically suitable cases.