Courses Of Systemic Chemotherapy Research Articles

Stage IV anal canal squamous cell carcinoma with long-term survival: a case report

BackgroundCurrently, no established standard treatment exists for metastatic anal squamous cell carcinoma. We report a case of complete response in a patient with stage IV anal squamous cell carcinoma after undergoing multidisciplinary treatment.Case presentationA 62-year-old woman visited a nearby doctor with a chief concern of severe pain associated with a firm mass in the anus. The patient was diagnosed with anal canal squamous cell carcinoma and liver metastases and referred to First Department of Surgery Faculty of Medicine University of Fukui for treatment. The patient received a TNM classification of T4N0M1 and stage IV. Rectal amputation was performed; however, postoperative complications hindered immediate anticancer therapy and the liver metastases exacerbated. Radiofrequency hyperthermia and systemic chemotherapy were performed 3 months postoperatively. A prominent reduction in the liver metastasis was observed. Lung metastases appeared during the course of systemic chemotherapy. Radiotherapy was performed to treat the lung lesion and resolved. Radiotherapy was also performed for liver metastasis. The lesion in the liver showed resolution after 54 months postoperatively, and treatment with the anticancer drug was discontinued. Ten-year follow-up findings suggested complete resolution of the lesion in response to the treatment protocol followed in this case. This long-term survival was achieved through a multidisciplinary treatment.ConclusionsThe present case suggests that multidisciplinary treatment approach is effective for resolving stage IV anal squamous cell carcinoma, and addition of new anticancer drug therapy may improve the overall prognosis of squamous cell carcinoma.

Risk factors for in‐hospital mortality in patients with advanced lung cancer with interstitial pneumonia undergoing systemic chemotherapy: A retrospective and observational study using a nationwide administrative database in Japan

BackgroundThe safety profile of systemic chemotherapy for lung cancer patients with interstitial pneumonia (IP) in clinical practice remains unclear. Using Diagnostic Procedure Combination (DPC) data from the Japanese administrative database, we investigated the mortality of hospitalized lung cancer patients with IP as they underwent a course of systemic chemotherapy nationwide.MethodsThe DPC data of patients with stage IIIB or IV lung cancer as defined by the Union for International Cancer Control Tumor‐Nodes‐Metastases 6th and 7th editions from April 2014 to March 2016 were obtained. Among those patients, only patients with concomitant IP and receiving systemic chemotherapy without radiotherapy were included.ResultsAmong 1524 included patients, 70 (4.6%) died in the hospital. Multivariate analysis revealed that low activities of daily living (ADL) scores on admission (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.24–4.12, p = 0.008) and high‐dose corticosteroid therapy following chemotherapy (HR 2.62, 95% CI 1.44–4.77, p = 0.002) were strongly associated with in‐hospital mortality. It was determined that patients possibly received high‐dose corticosteroids for IP exacerbations; these patients had a higher in‐hospital mortality rate of 67.7% (21/31 patients) and a significantly shorter median survival time of 55 days (95% CI 31–69 days, p < 0.001) than those who did not receive high‐dose corticosteroids.ConclusionAcute exacerbation of IP treated with systemic high‐dose corticosteroids is significantly associated with in‐hospital mortality, and a low ADL score on admission is a risk factor for in‐hospital mortality in lung cancer patients with IP who undergo systemic chemotherapy.

Orbital Retinoblastoma Treated with Intra-arterial Chemotherapy

A 5-year-old boy was referred with local orbital extension of unilateral retinoblastoma (Fig A) and measurable plasma cell-free RB1 DNA (Fig B, magnetic resonance imaging [MRI]). Two years prior he had received 2 courses of systemic chemotherapy with Carboplatin, Vincristine and Etoposide but additional treatment was halted because of a war in his country. Thirteen months later, after 3 sessions of ophthalmic artery chemosurgery with Melphalan, Carboplatin, and Topotecan at our institution, there was complete resolution of the tumor (Fig C) and disappearance of cfDNA (Fig D, MRI).

The Case Report of Malignant Pericardial Effusion in Recurrent Endometrial Cancer: An Emergency Treatable Condition

Malignant-related pericardial effusion from endometrial cancer is a considerably rare condition. Massive fluid accumulation can cause a cardiac tamponade, which could lead to a life threatening condition. Here, the author presented a case of 45-year-old woman diagnosed of stage IIIC2 endometrial cancer, with para-aortic lymph nodes metastases. Fourteen months after completion of systemic chemotherapy and adjuvant sequential radiotherapy, she had been suffering from acute shortness of breath, tachypnea, tachycardia, and hemodynamic instability. Massive pericardial effusion was confirmed by echocardiogram. Malignant tumor cells were found on the cytological analysis. Beside pericardial effusion, computed tomography scan also demonstrated pleural effusion and multiple enlarged para-aortic lymph nodes. Pericardial window was done on the second day of admission after the diagnosis was confirmed by pericardiocentesis. Six courses of systemic chemotherapy, carboplatin and paclitaxel, were administered, followed by hormonal therapy. The patient was scheduled for follow up, every month, for 10 consecutive times. Her physical performance was in good condition without any clinical potential recurrence. Pericardial window is a palliative surgical treatment in emergency circumstance and systemic chemotherapy should be considered with clinical response result. Keywords: Malignant pericardial effusion, Endometrial cancer, Treatment

Intrathecal (IT) Chemotherapy for Central Nervous System (CNS) Prophylaxis in Diffuse Large B-Cell Lymphoma (DLBCL): A Single Centre Retrospective Observational Study

Introduction: CNS relapse of DLBCL is associated with poor prognosis. Estimated incidence varies between 1.9 and 8.4%1. The CNS-International prognostic index (IPI)2 help risk stratify and estimate the 2-year risk of CNS relapse in DLBCL patients treated with R-CHOP chemotherapy. CNS prophylaxis is indicated in patients with a high risk of CNS relapse (a score of ≥4 equated to a 10.2% risk). High-risk DLBCL patients outside the CNS-IPI system include double/triple-hit (MYC/BCL-2/BCL-6 translocations) lymphoma, HIV lymphoma, testicular lymphoma, primary cutaneous lymphoma-leg type, stage IE breast lymphoma3. IT methotrexate or cytarabine administered during the course of systemic chemotherapy has been the most widely employed method of CNS prophylaxis but there is paucity of data validating its efficacy. Aim: The primary aim of the study was to evaluate the CNS relapse rates in DLBCL patients who received CNS prophylaxis. Patients and Methods: This was a single-centre retrospective observational study conducted in a district general hospital. Data was extracted from the regional (Dorset Cancer Network) DLBCL database and laboratory reports for CSF analysis at the time of the first intrathecal chemotherapy. Medical records of patients with DLBCL who received CNS prophylaxis were evaluated for the following patient-related and disease-related demographics: age at diagnosis, gender, stage, systemic treatment, CNS prophylaxis, treatment response, remission duration, systemic relapse rates, CNS relapse rates and survival. CNS-IPI scores were retrospectively calculated and additional indications evaluated for patients who received CNS prophylaxis. Results: Between 2013 and 2018, 178 patients were diagnosed with DLBCL. All patients were treated with RCHOP chemo-immunotherapy. CNS prophylaxis was administered in 47 (26%) patients. Median age was 69 years (range 20-86 years) and 62% were males. All 47 patients (100%) received IT methotrexate as CNS prophylaxis, with 43 (91%) receiving all of the planned 4 doses of IT methotrexate 12.5 mg each. A CNS-IPI score of ³4 was present in 31 (66%) patients, and a score of 2-3 in 9 (19%) patients. Additional risk factors identified included testicular lymphoma in 3 patients, breast lymphoma in 2 patients and oropharyngeal lymphoma in 2 patients. Ten (21%) patients received their treatment at the outset with courses 1-4 of R-CHOP. Of the 47 patients who received CNS prophylaxis, 5 (10%) relapsed; all had isolated CNS lymphoma at relapse. Median time to CNS relapse was 25 months (range 12-36 months) from initial diagnosis of DLBCL. Median survival after CNS relapse was 5 months (range 2-9 months). Of the remaining 141 patients, 2 patients relapsed with isolated CNS lymphoma. Conclusion: Although the overall incidence was low (4%), CNS relapse was observed in 10% of high-risk patients all of whom received CNS prophylaxis with IT methotrexate. The efficacy of CNS prophylaxis with IT chemotherapy remains unproven. There is no randomised study to show that IT prophylaxis alone is effective. Current British guidelines recommend high-dose intravenous methotrexate over IT methotrexate if patient's physiological fitness and renal function are acceptable4. The median age in our cohort was 69 years which makes it challenging to deliver dose-intensive systemic therapy concurrently with intravenous high-dose methotrexate. The role of CNS prophylaxis in high-risk patients including its efficacy and safety in older patients need further evaluation in prospective randomised studies. References Eyre T et al.Efficacy of central nervous system prophylaxis with stand-alone intrathecal chemotherapy in diffuse large B-cell lymphoma patients treated with anthracycline-based chemotherapy in the rituximab era: a systematic review. Hematologica. 2019;105(7):1914-1924.Norbert Schmitz et al.CNS International prognostic Index: A risk model for CNS relapse in patients with diffuse large B-cell lymphoma treated with R-CHOPJ Clin Oncol 2016; 34:3150-3156.Andrew D Zelenetz et al.National Comprehensive Cancer Network (NCCN) Guidelines: B-Cell Lymphomas.Version 2.2020.Pamela McKay et al.The prevention of central nervous system relapse in diffuse large B-cell lymphoma: a British Society for Haematology good practice paper. Onlinelibrary.wiley.com. 2020. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/bjh.16866 Disclosures Hall: Janssen:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: sponsored for educational meetings;Karyopharm:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: sponsored for educational meetings;Takeda:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: sponsored for educational meetings;Celgene:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: sponsored for educational meetings.Killick:Celgene:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending educational meetings;Jazz Pharmaceuticals:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending educational meetings;Novartis:Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending educational meetings;Gilead:Honoraria, Other: Support for attending education meetings.McCarthy:Janssen:Honoraria;Abbvie:Membership on an entity's Board of Directors or advisory committees.Walewska:AbbVie:Other: sponsored for educational meetings, Speakers Bureau;Janssen:Other: sponsored for educational meetings, Speakers Bureau;Gilead:Speakers Bureau;Astra Zeneca:Membership on an entity's Board of Directors or advisory committees.Chacko:Astellas:Honoraria;Daiichi-Sankyo:Honoraria;Novartis:Honoraria, Other: Travel Grants;Gilead:Other: Travel grants;Jazz Pharmaceuticals:Other: Travel grants;Celgene:Other: Travel grants.

A Case of Central Nervous System Metastasis of Anaplastic Lymphoma Kinase Positive Anaplastic Large Cell Lymphoma Manifested as Central Nervous System Vasculitis

Introduction: Anaplastic Large Cell Lymphoma (ALCL) is a rare distinct subset of T-cell non-Hodgkin lymphomas (T-cell NHL). Anaplastic Lymphoma Kinase (ALK) positive ALCL patients are generally associated with younger age and have a better prognosis. While Central Nervous System (CNS) involvement in T-cell NHL is rare and has a dismal prognosis. There was no report about ALK + ALCL and CNS vasculitis. Case presentation: A 17-year-old boy who was diagnosed ALK + ALCL and underwent six courses of systemic chemotherapy presented as severe CNS vasculitis in the beginning, but eventually he was diagnosed CNS metastasis of ALCL by the presence of cranial nerve palsy, the demonstration of lesions on MRI and PET-CT, and Flow cytometry detection of tumor cells in Cerebrospinal Fluid (CSF). Conclusion: We first present a case of CNS metastasis of systemic ALK + ALCL accompanied with CNS vasculitis. When an ALK + ALCL patient had CNS symptoms while imaging revealed CNS vasculitis, we need to be vigilant that the patient may have CNS involvement.

PRESSURIZED INTRAPERITONEAL AEROSOL CHEMOTHERAPY COMBINED WITH SYSTEM CHEMOTHERAPY – A NEW APPROACH TO TREATMENT OF GASTRIC CANCER PATIENTS WITH PERITONAL CARCINOMATOSIS

The aim of the study was to analyze the immediate and long-term outcomes of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in gastric cancer patients with peritoneal carcinomatosis (PC). Material and methods . The treatment protocol included diagnostic laparoscopy with PCI score assessment and peritoneal biopsy and 4 courses of systemic chemotherapy with XELOX or FOLFOX followed by PIPAC with cisplatin and doxorubicin at 6–8 week intervals. Between the PIPAC cycles patients received systemic chemotherapy according to previous regimen. Each PIPAC procedure included laparoscopy, evaluation of Peritoneal Carcinomatosis Index (PCI) and peritoneal biopsies. Results . 102 (80.3 %) patients had primary gastric cancer with PC and 25 (19.7 %) had peritoneal recurrence of gastric cancer. PCI 18 in 34 (26.7 %) patients. Diffuse type of cancer was diagnosed in 114 patients (89.7 %), intestinal type in 6 (4.7 %) patients and the mixed type in 7 (5.5 %) patients. 127 patients underwent 310 PIPAC procedures. No severe complications and were observed. Pathological response (PRGC score) was evaluated in 72 patients. Partial pathological response (PRGS 2) was achieved in 40 (55.6 %) cases and complete pathological response (PRGS 1) – in 10 (13.9 %). Survival was evaluated in 63 % (n=80) patients who received more than one PIPAC. The median survival was 16.0 months and one year survival rate was 77.9 %. Conclusion . A new approach to the treatment of gastric cancer with PC combining systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy is a simple and save method allowing improvement of survival of patients with peritoneal dissemination of gastric cancer.

Safety of pembrolizumab in recurrent or advanced gastric cancer expressing PD-L1 refractory to platinum and fluoropyrimidine

ABSTRACT Introduction Pembrolizumab is a highly selective fully human immunoglobulin 4 monoclonal antibody against programmed death 1 (PD-1). Phase II and III trials have demonstrated that pembrolizumab has antitumor activity in previously treated patients with advanced gastric cancer (AGC). Area covered Pembrolizumab was approved by the US Food and Drug Administration in September 2017 as third-line or later treatment of AGC in patients positive for programmed death ligand 1 (PD-L1). In this article, we review the development of pembrolizumab, its pharmacology, and its safety profile as monotherapy in patients with PD-L1 positive previous treated AGC. Expert opinion Pembrolizumab has demonstrated durable response and acceptable safety profile in patients receiving two previous courses of systemic chemotherapy. It has become a treatment option in patients with AGC. Currently, there are several ongoing clinical trials of pembrolizumab in combination with cytotoxic chemotherapy or molecular targeting agents AGC.

Optical coherence tomography in preclinical diagnosis of optic nerve disk changes after chemotherapy in children with retinoblastoma

Purpose . Using optical coherence tomography (OCT), determine the preclinical changes in optic nerve head (ONH) after chemotherapy in children with retinoblastoma (RB). Material and methods . 38 patients (76 eyes) were examined and treated: 15 girls, 23 boys with RB averagely aged 21.0 ± 1.5 months. Of these, 58 affected eyes before treatment belonged to groups А (3), В (16), С (33), D (3), and Е (3). All tumor nodes were located on the fundus outside the optic disk. The examination of these eyes was carried out on an optical coherent tomograph SOCT Copernicus 4.2 (Poland). The 58 eyes were first tested before treatment, then after 3 or 4 courses of systemic chemotherapy (CT), once again after 6 courses of systemic CT and 1–3 courses of superselective intraarterial CT and 4–9 courses of intravitreal CT. 15 healthy children (30 eyes) of the corresponding age were examined as a control. Results . After 3 courses of systemic CT, OCT determined optic neuropathy with edema in 46.6 %. Morphometric data included parapapillary retinal cystic cavities, elevation of the contour of the optic disc towards the vitreous, increased rim volume (to 0.87 ± 0.12 mm 3 ) and average thickness of the nerve fiber layer increased to 0.39 ± 0.06 mm (p &lt; 0.01). After combined chemotherapy we revealed the thinning of the peripapillary choroid (to 80.0 ± 3.2 μm) with no retinal edema in 34.5 %, a reduction of rim volume to 0.34 ± 0.2 mm 3 and the layer of nerve fibers to 0.02 ± 0.01 mm (p &lt; 0.01). These changes are evidences of optic nerve disc atrophy. Conclusion . OCT is an informative method of examining the optic disc in children with RB at different stages of treatment, which identifies signs of edema and symptoms of atrophy more often (respectively, by 15.6 % and 17.3 %). Preclinical diagnostics of optic disc pathology with the help of OCT allows predicting visual functions in children with RB at its early stages and developing a differentiated approach to the choice of RB treatment.

Prise en charge des tumeurs primitives et métastatiques du péritoine en période de pandémie CoViD-19. Pistes de réflexion et de priorisation du groupe RENAPE et BIG-RENAPE

RésuméLa pandémie de COVID-19 modifie profondément l’organisation et l’accès aux soins, en particulier pour les pathologies néoplasiques péritonéales, dont la prise en charge curative mobilise des moyens importants en personnel, bloc opératoire et réanimation. Les groupes BIG-RENAPE et RENAPE proposent des pistes de réflexion et de priorisation pour leur prise en charge. Un renforcement des critères habituels de sélection est nécessaire pour une prise en charge à visée curative : patients jeunes, avec peu de co-morbidités et une extension péritonéale limitée. Il est souhaitable de prioriser les pathologies pour lesquelles la chirurgie de cytoréduction associée ou non à une chimiohyperthermie intrapéritonéale (CHIP) est le traitement de référence et celles pour lesquelles la chimiothérapie systémique ne peut être une alternative temporaire ou prolongée : pseudomyxomes péritonéaux ; mésothéliomes péritonéaux malins résécables ; métastases péritonéales d’origine colorectale si résécables, non répondeuses à la chimiothérapie systémique et/ou après 12 cures, carcinoses ovariennes en 1re intention si résécables et limitées ou en situation intervallaire après un maximum de 6 cycles de chimiothérapie systémique. L’adjonction d’une CHIP devra être discutée au cas par cas, en centre expert. La priorisation des indications devra prendre en considération les conditions locales et la phase de la période épidémique pour permettre une prise en charge péri-opératoire optimale.

Treatment of primary and metastatic peritoneal tumors in the Covid-19 pandemic. Proposals for prioritization from the RENAPE and BIG-RENAPE groups.

SummaryThe Covid-19 pandemic is profoundly changing the organization of healthcare access. This is particularly so for peritoneal neoplastic diseases, for which curative treatment mobilizes substantial personnel, operating room and intensive care resources. The BIG-RENAPE and RENAPE groups have made tentative proposals for prioritizing care provision. A tightening of the usual selection criteria is needed for curative care: young patients with few or no comorbidities and limited peritoneal extension. It is desirable to prioritize disease conditions for which cytoreduction surgery with or without associated hyperthermic intraoperative peritoneal chemotherapy (HIPEC) is the gold-standard treatment, and for which systemic chemotherapy cannot be a temporary or long-term alternative: pseudomyxoma peritonei, resectable malignant peritoneal mesotheliomas, peritoneal metastases of colorectal origin if they are resectable and unresponsive to systemic chemotherapy after up to 12 courses, first-line ovarian carcinomatosis if resectable or in interval surgery after at most six courses of systemic chemotherapy. Addition of HIPEC must be discussed case by case in an expert center. The prioritization of indications must consider local conditions and the phase of the epidemic to allow optimal peri-operative care.

A case of successful maintained pregnancy after neoadjuvant chemotherapy plus radical surgery for stage IB3 cervical cancer diagnosed at 13\u2009weeks

BackgroundCervical cancer during pregnancy is rare. The management for stage IB3 during pregnancy remains unclear and challenging. We report a successful preserved pregnancy in a stage IB3 patient who was treated with neoadjuvant chemotherapy (NACT) plus radical surgery.Case presentationA 36-year-old pregnant woman was diagnosed with a 5-cm-diameter stage IB3 squamous cell carcinoma of the uterine cervix at 13 gestational weeks. The patient received 5 courses of systemic chemotherapy with carboplatin and paclitaxel every 3 weeks, followed by caesarean section and radical hysterectomy. Both the mother and infant are in good general condition.ConclusionThis case suggests that NACT plus radical surgery could be one method to maintain pregnancy in stage IB3 cervical cancer diagnosed as early as 13 gestational weeks.

Successful Treatment of a Mixed Neuroendocrine-Nonneuroendocrine Neoplasm of the Colon with Metastases to the Thyroid Gland and Liver

Patients with mixed neuroendocrine-nonneuroendocrine neoplasms (MiNENs) of the colon have poor prognosis. Herein, we report a patient with MiNEN of the colon with metastases to the liver and the thyroid gland, with long-term survival. A 45-year-old man presented with anterior neck swelling. Histopathological examination of the thyroid tumor revealed neuroendocrine carcinoma (NEC), suggesting that a primary NEC in another organ had metastasized to the thyroid gland. Computed tomography to identify a primary NEC revealed two tumors: one in the liver and one in the transverse colon. A biopsy revealed that the histopathology of the liver and colon tumors was NEC and adenocarcinoma, respectively. Thereafter, the patient underwent surgical resection of the colon tumor and was finally diagnosed as colon MiNEN with metastases to the thyroid and liver. The surgical resection of the metastatic liver tumor was performed after several courses of systemic chemotherapy, and the patient survives presently without any recurrence for approximately seven years after the diagnosis. Surgical resection of each metastatic lesion combined with systematic chemotherapy apparently improved the prognosis of MiNEN of the colon with distant metastases.

Trifluridine/tipiracil for the treatment of metastatic gastric cancer

ABSTRACTIntroduction: Trifluridine/tipiracil is a novel oral cytotoxic chemotherapy consisting of a thymidine-based nucleoside analog, trifluridine, and a thymidine phosphorylase inhibitor, tipiracil. Trifluridine/tipiracil was approved for the treatment of metastatic colorectal cancer refractory to standard therapies. A phase II trial in Japan demonstrated that this therapy has antitumor activity and is tolerated by patients with advanced gastric cancer (AGC); as a result, the phase III TAGS trial (Trifluridine/tipiracil versus placebo in patients with heavily pretreated metastatic gastric cancer) was initiated.Area covered: Trifluridine/tipiracil has proved effective for heavily pretreated AGC and has thus been approved for use in the United States in February 2019, Japan in August 2019 and the European Union in September 2019. Detail of the phase III TAGS trial is discussed in this review.Expert opinion: Trifluridine/tipiracil after at least two previous courses of systemic chemotherapy improved rates of survival of gastric cancer; thus it has become one of the treatment options in affected patients. Currently, several clinical trials of trifluridine/tipiracil in combination with other anticancer agents such as ramucirumab (an anti-vascular endothelial growth factor receptor 2 monoclonal antibody) for patients with AGC are ongoing.

MACULOPATHY AND CHORIORETINOPATHY IN CHILDREN WITH RETINOBLASTOMA RECEIVING CHEMOTHERAPY: CLINICAL TRIALS AND MORPHOMETRIC ANALYSIS

Purpose. This research is to evaluate patients with retinoblastoma, who receive chemotherapy, with Spectralis optical coherence tomography with enhanced depth imaging to compare the signs of chorioretinopathy and maculopathy. Material and methods. 74 patients were examined and treated, 125 eyes with retinoblastoma in age at average of 24 ± 1.6 months. Group 1 - 31 patients, 62 eyes after intravenous chemotherapy, 2 - 24 patients, 25 eyes after intravenous and superselective intraarterial or intravitreal chemotherapy. Group 3 (control) - 19 patients (38 eyes) with primary retinoblastoma. The condition of the retina, choroid and macula was assessed using Ret Cam II and Spectralis optical coherence tomography with enhanced depth imaging. All patients had complete tumor resorption after treatment. Results. In group 1, after 3 courses of chemotherapy Spectralis optical coherence tomography with enhanced depth imaging showed a decrease of caliber of retinal vessels; wavelength of photoreceptors, hyperreflective round foci and calcinates in the retinal pigment epithelium; choriocapillary hyperreflexivity, choroid thinning; in the sclera - hyperreflective foci with visualization of the scleral vessels. In the macula - disorganization of retinal pigment epithelium, cystic edema, smoothness of the papillomacular bundle, coracoid form of the fovea, retinal thickening. After 3 courses of systemic chemotherapy and superselective intraarterial chemotherapy (group 2) - peritumoral increase in the caliber of retinal vessels. After systemic superselective intraarterial and intravitreal chemotherapy (group 2) - epiretinal membranes, punctate hyperreflective foci in the inner layers of the retina. In group 3 (control), before treatment, a normal anatomical and topographic state of the macula was observed with extracentral localization of retinoblastoma. Conclusions. Profound morphometric disturbances that come with combined chemotherapy (intravenous, superselective intraarterial and intravitreal chemotherapy treatments) call for a more careful treatment with methods selected in terms of Spectralis optical coherence tomography with enhanced depth imaging findings and specific chemotherapy contraindications.

A Case of Serous Tubal Intraepithelial Carcinoma Diagnosed by Cytology during the Operation

We experienced a case of serous tubal intraepithelial carcinoma (STIC), which is the earliest morphologically recognizable precursor of pelvic high grade serous carcinoma, diagnosed by cytology during the operation. A 48-year-old Japanese woman visited to our department because of abnormal cytological result and the left adnexal mass on female cancer screening. Pre-operatively, she was diagnosed as cervical intraepithelial neoplasia (CIN) 3, adenomyosis, and the left adnexal cystic lesion with papillary growth. At laparotomy, the left adnexal tumor turned out to be cystic fallopian tube with small papillary growth on the inner surface, but abnormal findings were not present on bilateral ovaries. The cytology of the imprint smears from the papillary projection and ascitic fluid showed positive, suggesting serous adenocarcinoma. Histopathological examination of the lesion revealed the left fallopian tube lesion was STIC with immunohistochemically positive reactivity against p53. No metastases including disseminated lesions were noted. The patient received four courses of systemic chemotherapy, and had no recurrent signs 10 months after the operation.

Bidirectional chemotherapy in gastric cancer (GC) with peritoneal carcinomatosis (PC) combining intravenous chemotherapy with intraperitoneal chemotherapy with low-dose cisplatin and doxorubicin administered as a pressurized aerosol: An open-label, phase II study.

e15532 Background: Up to 40% of GC patients show synchronous PC at time of diagnosis and peritoneal relapse develops in 10–46% of cases after radical surgery. Systemic chemotherapy is standard method of treatment with median survival of several months. Innovative therapeutic approaches are needed to improve survival. Methods:Phase-2, open label prospective clinical trial assessing safety and efficacy of bidirectional chemotherapy for treating of gastric cancer with PC. Treatment protocol for untreated patients included initial staging laparoscopy or laparotomy, 3–4 courses of systemic chemotherapy (XELOX) followed by Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) procedures every 6 weeks until progression of disease or death. Criteria of progression included 50% and more PCI increase or distant metastases. Patients with primary or recurrent GC, who received earlier one or two lines of systemic chemotherapy, didn’t receive 4 XELOX courses before PIPAC. Primary endpoints were overall survival and histological peritoneal regression grading score after rebiopsy. Results:46 patients were included (14 men, 32 women, mean age 53.5 years), 33 patients had primary GC with PM and 13 had peritoneal relapse after surgery. 15 patients had systemic chemotherapy before inclusion to the program. About one half of patients had ascites. Mean PCI was 12.1 (min-max 3-34). Altogether, 89 PIPAC procedures were performed in the 46 patients. Complete and partial pathological response was found in 91% of the 23 patients eligible for tumor response assessment (7 and 14 patients, respectively). Median survival was 14 months and one-year overall survival was 55%. The median survival was better in patients with low PCI in compare with high PCI, but the difference was not significant. Conclusions: Bidirectional chemotherapy combining XELOX with PIPAC with cisplatin and doxorubicin can induce objective tumor regression and is associated with a promising survival in GC with PC.

SMALL-CELL NEUROENDOCRINE CARCINOMA OF NASOPHARYNX: A CASE REPORT

Extra pulmonary small cell carcinomas are extremely rare, accounting for 0.1-0.4% of all malignancies and 2.5-4% of small cell carcinomas. In the head and neck region, the most common primary sites are the larynx, salivary gland, nasal cavity, paranasal sinus, tonsil, and oral cavity. Small cell carcinomas occurring in nasopharynx are extremely rare, to our best knowledge, only four cases of primary nasopharyngeal small cell carcinoma has been described in English literature. We report another case of nasopharyngeal small cell carcinoma arising in a 46-year-old woman. She accused, for five months, nasal blockage, right hypoacousia, exophthalmos and reduced visual acuity. Cerebral and facial magnetic resonance imaging showed an extensive mass of the nasopharynx with the invasion of sphenoidal body, the diagnosis of disseminated small cell carcinoma of nasopahrynx was established. The patient received three courses of systemic chemotherapy; unfortunately, she died after the third course. The prognosis of such entity is poor and is similar to that for patients with extensive small cell lung cancer.

TREATMENT OUTCOMES OF COLORECTAL CANCER WITH BILATERAL LIVER METASTASES

The purpose of the research: to develop an effective treatment regimen for patients with synchronous liver metastases from colorectal cancer. Material and methods. The study included 126 patients with colon cancer and synchronous liver metastases. The patients were divided into two groups. Group I consisted of 64 patients, who underwent resection of the colon and hepatic resection with radiofrequency ablation of metastases in the remaining portion of the liver and portal vein chemoembolization. Then, they received 4 courses of systemic chemotherapy followed by hepatic artery chemoembolization. Group II (the control group) consisted of 62 patients, who underwent resection of the colon without hepatic resection. Systemic chemotherapy was administered 3‑4 weeks after resection of the colon. Results. Postoperative complications occurred in 18 (28.1 %) patients of Group I and in 10 (16.1 %) patients of Group II. Six patients died (4 patients in Group I and 2 patients in Group II). Of the 18 postoperative complications occurred in Group I, 9 were related to hepatic resection. The median progression-free survival time was 9.0 months in Group I patients and 5.0 months in Group II patients, p=0.001. The median overall survival time was 13.8 months and 9.8 months in patients of Group I and Group II, respectively (p=0.004). Conclusion. Treatment options used for Group I patients resulted in improved survival rates.

Fever of unknown origin revealed to be primary splenic lymphoma: A rare case report with review of the literature.

Fever is a common clinical presentation of a number of diseases. A sustained unexplained fever >38.3°C lasting for >3 weeks without an established diagnosis despite intensive diagnostic evaluation is referred to as fever of unknown origin (FUO). FUO remains a clinical challenge for physicians, as it may be attributed to a wide range of disorders, mainly infections, malignancies, non-infectious inflammatory diseases and miscellaneous diseases. We herein report the case of a 59-year-old male patient who presented with prolonged unexplained fever and was found to have a diffusely enlarged hypermetabolic spleen, as shown on 18F-fluorodeoxyglucose positron emission tomography/computed tomography examination. Following splenectomy, histopathological examination revealed primary splenic lymphoma (PSL) of B-cell origin. The patient received 6 courses of systemic chemotherapy with rituximab, etoposide, cyclophosphamide, doxorubicin, vincristine and prednisone (R-ECHOP regimen) and responded well to treatment. Thus, in patients with FUO and splenomegaly, the possibility of PSL should be taken into consideration.