Palliative Options Research Articles

Case report: Transarterial chemoembolization for nasal hemangiosarcoma in a dog

This report outlines the use of transarterial chemoembolization (TACE) to treat a nasal tumor in a 10-year-old Welsh Corgi. The dog initially presented with persistent nasal discharge and facial deformity, which led to a diagnosis of nasal hemangiosarcoma. Although initial treatments with radiotherapy and chemotherapy provided temporary relief, the symptoms reappeared 11 months later. As a palliative measure, TACE was administered, utilizing carboplatin as the chemotherapeutic agent and gel foam as the embolic material. The procedure successfully reduced the tumor size and alleviated the dog’s symptoms. Follow-up CT scans at 1, 3, 7, and 10 months, demonstrated sustained tumor shrinkage. Interestingly, there was no reperfusion of the embolized vessels, indicating a prolonged therapeutic effect. No significant complications were observed during follow-up. This case highlights the potential of TACE as a palliative option for managing recurrent nasal tumors in dogs, especially when other treatments have limited efficacy. Further research is needed to establish TACE guidelines for treating nasal tumors in veterinary medicine.

Tumor-infiltrating plasma cells are a prognostic factor in penile squamous cell carcinoma.

Penile cancer (PeCa) is a rare disease with poor prognosis in the metastatic stage. Neither effective adjuvant nor palliative therapeutic options are available. Research efforts in this field have so far failed to establish robust predictors of survival. To identify prognostic targets in PeCa, the current project focused on characterizing the tumor microenvironment (TME). A study cohort of 93 men with PeCa was used for the construction of a tissue microarray and immunohistochemical staining for CD3, CD4, CD8, CD20, CD56, CD138, FoxP3, and PD-L1. The quantity and spatial distribution of tumor-infiltrating immune cells were analyzed using digital image analysis. PD-L1 staining of tumor and immune cells was manually scored (combined positivity score (CPS)). T cells, T helper cells, cytotoxic T cells (CTLs), and regulatory T cells were detected in > 90% of PeCa and B cells in 88%, plasma cells in 85%, and NK cells in 23%. Approximately 50% of the PeCa samples were PD-L1 positive. In the univariate survival analysis, high PD-L1 CPS, plasma cells, CTLs, and B cells were significantly associated with favorable overall survival (OS), and the latter two with adverse recurrence-free survival. In multivariate analysis, plasma cells remained a significant factor for favorable OS (p = 0.04). In this study, the immune cells in the TME, especially plasma cells, were favorably associated with patient survival compared to other established prognostic factors in PeCa. Contemporarily, plasma cells have been discussed in the light of contributing to responses to modern immunotherapies. The results of this study support this notion.

Treatment outcomes in young adults with gastric cancer

Introduction. According to global data, gastric cancer (GC) is the 5-th most common malignancy with a high cancer-related mortality rate. However, in recent decades, there has been a tendency towards an increase in the incidence of GC among young patients (18 to 40 years old), which currently amounts to 4.4–9.8%. Aim: to evaluate the effectiveness of surgical, combined and palliative treatment options in early-onset GC. Material and Methods. the study included 129 patients aged 18–45 years, who underwent radical, cytoreductive and palliative surgery with or without combination with drug therapy for localized, locally-advanced and primary disseminated GC. the patients were divided into three clinical groups: 1) the surgical group (n=27) included patients with only surgical treatment; 2) the group of combined treatment (n= 58) included patients with PCI <7 who underwent surgery with the volume of CC0 in combination with CT (neoadjuvant, adjuvant, perioperative, simultaneously with or without hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) and patients who underwent only HIPEC; 3) the additional (palliative) group (n=44) included patients with PCI>7 who underwent systemic CT in combination with pressurized intraperitoneal aerosol chemotherapy (PIPAC). Results. the median overall survival (OS) in three groups was 58, 30 and 13 months, respectively. In patients with IV stage of disease who underwent HIPEC with CC0 surgery, OS in the 2nd group was 17 in comparison with 13 months in the third group (PIPEC). Conclusion. Aggressive multimodal treatment in the absence of comorbid status in young patients will allow for intensification of both the perioperative drug therapy component and the implementation of extended multivisceral resections that facilitate radical surgical treatment to improve both DFS and OS.

Feasibility of implementing a decision aid for advanced cancer patients in a comprehensive cancer centers' outpatient setting: Valuable lessons learned.

Decision aids (DAs) have been proposed as tools to empower patients in decision-making. However, implementing DA for decisions in advanced cancer is challenging. This study focuses on perspectives of oncologists and other healthcare providers on the hindering and facilitating factors for implementing a customizable DA. This DA is designed to support discussions about whether patients with advanced, incurable cancers should pursue or forgo further anticancer treatment. This qualitative study utilized content analysis following Sandelowski's approach on two different datasets derived from research projects on decision-making in advanced cancer. To inform the development of a DA and understand challenges related to its implementation, we conducted semi-structured interviews with 24 oncologists (Dataset 1) and three focus groups with various healthcare professionals (n = 19) and in addition post-implementation semi-structured interviews with oncologists who used the DA in conversations with their cancer patients (n = 5) (Dataset 2). Furthermore, the insights from process evaluation of developing and implementing the DA in an outpatients' settings was incorporated, enriching the analytical framework. Two overall themes emerged: (1) Tension between standardizing the use of a DA and responding to individual patient needs. To address this conflict, a two-part DA was developed, combining structured elements with flexibility. (2) Prerequisites for the use of the DA in outpatients' settings: Senior physicians' support, education in palliative care options and in the use of the DA, and organizational conditions. Oncologists identified both structural and content-related aspects for a successful implementation of a DA for patients with advanced cancer. While the content-related aspects were factored into the development of the DA, structural (organizational) issues need to be especially focused on during implementation.

SPLENIC RADIOTHERAPY: A CASE REPORT AND REVIEW OF THE LITERATURE

Splenic radiotherapy is a palliative treatment option in the therapeutic arsenal for symptomatic splenomegaly, a frequent complication of myeloproliferative syndromes. The main objective of this study is to report on the experience of the radiotherapy department of the (INO) National Institute of Oncology in the field of splenic radiotherapy, through an observation and review of the literature.

Endoluminal photodynamic therapy with a photoreactive stent‐based catheter system to treat malignant colorectal obstruction

AbstractPhotodynamic therapy (PDT) using photosensitizer (PS)‐embedded silicone membrane‐covered self‐expandable metallic stents (SEMSs) can function in palliative therapeutic option for malignant gastrointestinal tract obstruction. However, stent‐related complications should be considered, and accurate delivery of light sources is technically difficult. Here, a Chlorin e6 (Ce6)‐an embedded stent‐based catheter is developed to improve its therapeutic efficacy and safety. PDT using Ce6‐embedded stent successfully induced cell death of colorectal cancer cell line. PDT‐treated liver tissues showed an increase in ablation depth in proportion to irradiation energy, and 600 J/cm2 demonstrates an even and sufficient ablation depth. Endoluminal PDT using the Ce6‐embedded stent‐based catheter was technically successful in a rat colon model without procedure‐related complications such as colonic perforation or stricture formation. The results in colonoscopy, colonography, and histological examination, along with statistical analysis, suggest that a novel PDT modality using a Ce6‐embedded stent‐based catheter was safely conducted and demonstrated apoptotic cell death at 12 h after PDT, and it gradually recovered from 2 to 4 weeks. Thus, the PDT using the Ce6‐embedded stent‐based catheter may represent a promising new approach for the treatment of malignant colorectal obstruction.

Oral Metronomic Therapy: An Effective Palliative Treatment Option for Epithelial Ovarian Cancer.

Introduction The majority of the patients with advanced-stage epithelial ovarian cancer relapse within three years of standard first-line treatment. Access to novel therapies like poly ADP-ribose polymerase (PARP) inhibitors and antiangiogenic agents is limited in low- and middle-income countries. Oral metronomic therapy (OMT) may be an effective alternative treatment option in resource-limited settings. Materials and methods A retrospective study was conducted among patients with epithelial ovarian cancer who received OMT. OMT consisted of cyclophosphamide 50mg per day and tamoxifen 40mg per day which was administered continuously until unacceptable toxicity or progression was reached. OMT was given to patients with relapsed ovarian cancer and to those newly diagnosed ovarian cancer patients who were unfit for cytoreductive surgery and/or standard first-line intravenous platinum-based chemotherapy. All patients who received OMT at our center between 01-01-2017 and 31-12-2021 were included for analysis. Relevant details, as needed for the study, were collected from medical records. SPSS version 24 (IBM Corp., Armonk, NY) was used for statistical analysis. Results A total of 61 patients received OMT during the study period. The median age at diagnosis of ovarian cancer was 59 years. The median age at the start of OMT was 61 years. The majority (n= 37, 60.7%) had high-grade serous carcinoma subtype. A total of 52 patients received OMT in the relapse setting while nine received it in the first-line setting. Among relapsed ovarian cancer patients, 13 patients (21.3%) experienced platinum-sensitive relapse, 16 patients (26.2%) experienced partial platinum-sensitive relapse, and 23 patients (37.7%) experienced platinum-resistant disease. The mean duration of treatment with OMT was 7.8 months. The clinical benefit rate was 59% and the overall response rate was 22.9%. Ca-125 response was seen in 40.4% of patients. The median PFS for the overall group was 6.7 months. Median PFS was longer in patients with Ca-125 response and platinum-sensitive relapse. Only five patients (8.1%) had significant toxicity. Conclusion OMT is a safe and effective palliative treatment option for epithelial ovarian cancer, worth consideration in low- and middle-income countries.

Peri-Interventional Hemodynamic Management Strategies for Percutaneous Chemosaturation of the Liver in Metastatic Cancer.

Background: Hepatic chemosaturation for inoperable liver tumors is a palliative treatment option with a beneficial effect on survival. However, the procedure regularly leads to circulatory failure during the filtration phase, and hemodynamic management is challenging. Our study aimed to compare two different strategies for hemodynamic management during chemosaturation to develop hypotheses for improving patient care and reducing peri-interventional morbidity. Methods: We conducted a single-center retrospective cohort study including 66 procedures of chemosaturation between May 2016 and March 2024. Procedures were divided into two groups: group 1 was managed with norepinephrine as the only vasopressor and liberal use of hydroxyethyl starch (HES). Group 2 was managed with norepinephrine and vasopressin and the preferred use of balanced crystalloids. We compared these two groups with respect to hemodynamic parameters, laboratory values, and post-interventional complications. Results: The heart rate was highest and the mean arterial pressure (MAP) was lowest during the filtration phase in both groups (p = 0.868, p = 0.270). The vasoactive inotropic score (VIS) was significantly higher in group 2 during the filtration phase (31.5 vs. 89, p < 0.001). Group 1 received significantly more HES overall (1000 mL vs. 0 mL, p < 0.001). Lactate levels at admission to the ICU were higher in group 1 (22.9 vs. 14.45 mg/dL, p = 0.041). Platelet counts were lower in group 2 from directly after chemosaturation through day 2 (p = 0.022, p = 0.001, p = 0.032). The INR differed significantly directly after chemosaturation (1.13 vs. 1.26, p = 0.015). Overall, group 1 received significantly more blood products peri-interventionally. There were two bleedings and one ischemic stroke in the overall cohort. There was no peri-interventional mortality. Conclusions: Advanced hemodynamic management ensures low peri-interventional mortality and morbidity. High-dose vasopressors, including vasopressin and the preferred use of balanced crystalloids, are sufficient to stabilize circulatory function during chemosaturation.

Hypothalamic Hyperphagia in the Hospice Patient: Case Report and Discussion

We present a case of insatiable appetite and harmful overeating in a hospice patient that showcases the burden of hypothalamic hyperphagia, a rare complication of brain cancer. While confounders exist such as progression of disease and prior tapering of dexamethasone, in this case the initiation of metformin was associated with substantial appetite reduction and resolution of our patient's debilitating food-seeking behaviors. We will explore metformin as a potential cost-effective option for palliation in a hospice setting and explore some of the physiologic mechanisms involved.

Interventional radiology procedures for metastatic spine tumors

ObjectiveInterventional radiology procedures can offer locoregional tumor control and palliative options for patients with metastatic disease to spine to relieve pain, to delay neurologic deficits, and to improve quality of life and daily function. FindingsMultiple thermal energies for percutaneous ablation of metastases to the spine exist and are chosen according to tumor characteristics, volume, and location. Vertebral augmentation is most often combined with ablation for structural stability. Intravascular embolization of metastases provides tumor palliative or presurgical devascularization. ConclusionAblation, vertebral augmentation, and intravascular embolization are efficacious minimally invasive options for the management of spinal tumors.

Palliative neurology

Palliative medicine represents the holistic multiprofessional treatment of severely and incurably ill people and their relatives, addressing their complex physical, psychological, social and spiritual needs. The central therapeutic goals are the quality of life and alleviation of suffering. In the course of many neurological diseases, high symptom burden, long and variable trajectories and unfavorable prognosis at times create aneed for palliative care even at an early stage, which is currently still inadequately met. This can be countered by qualified neuropalliative care. In addition to intensifying interdisciplinary collaboration, this requires neurologists to have core competencies in palliative care. These include ateam-oriented attitude, communication skills, expertise in symptom control and knowledge of biomedical ethics including palliative options at the end of life.

Outcomes of HeartMate 3 in pediatric patients with end-stage heart failure: a single-center preliminary experience from Turkey.

We aim to evaluate our initial experience with the HeartMate 3 (HM3) device (Abbott, USA) for palliating pediatric patients with end-stage heart failure (ESHF). We conducted a retrospective review of clinical data from pediatric patients (aged 7-18 years) who underwent HM3 implantation for ESHF at our institution between 2022 and 2024. Patient demographics and follow-up data were comprehensively analyzed. We identified 11 patients (45% males) with a median age of 14 years (IQR 11-17), a median weight of 47 kg (IQR 28-50), a median height of 159 cm (IQR 135-165), and a median body surface area of 1.36 m2 (IQR 1.07-1.53) at the time of the intervention. All patients were diagnosed with dilated cardiomyopathy and categorized with PEDIMACS profiles ranging from one to three. The median ICU stay was 14 days (IQR 6-32), with 11 patients receiving inotropic support for a median of four postoperative days (IQR 3-8). The median follow-up period was 150 days (IQR 90-210). Early complications included two cases of pleural effusion, 1 case of cardiac tamponade, 3 cases of polyuria, and one instance of positive blood cultures. One patient, who was non-compliant with warfarin therapy, developed a thrombus in the right atrium that was resolved with a revision of anticoagulant therapy, and did not experience pump thrombosis. During follow-up, one patient died after 28 days from sepsis, one underwent heart transplantation after 10 days, and nine patients remained alive on the device. Notably, there were no reported cases of pump thrombosis, ischemia, or stroke post- implantation. The HM3 device appears to be a safe and effective palliative option for pediatric patients with ESHF.

Endoscopic Ultrasound-Guided Radiofrequency Ablation (EUS-RFA) for Pancreatic Adenocarcinoma: A Review.

Pancreatic ductal adenocarcinoma (PDAC) is still one of the deadliest neoplasms in the world. Although various advancements in the treatment and management of this disease have been made, no significant overall survival benefit has been achieved. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has been proposed as a treatment for patients who are unfit for surgery or with inoperable PDAC. We conducted a literature review of the PubMed and Embase databases to identify and analyze studies on the use of EUS-RFA in inoperable PDAC. Eleven studies with a total of 122 patients were analyzed to assess the population characteristics, feasibility and safety of the procedure, and overall survival of the population. Technical success was achieved in 95.1% of cases, and no intraoperative complications were reported. The most common early complication reported was abdominal pain (21 out of 122 patients) with a total early complication rate of 29.6%, and none of these complications affected hospital stays or post-procedure recovery. Late complications were reported in four patients (3.2%). Post-procedure cytoreduction was achieved in all patients, although disease progression was reported in 119 of 122 patients. The overall survival rate did not differ from that reported in the literature. We found that EUS-RFA could be a valid palliative option for inoperable patients,a bridge for surgeryreducing the size of the tumor and its vascular relationship, or a first-line therapy in a subset of selected patients. Larger cohort and prospective studies should be conducted to establish guidelines for this procedure.

Novel vaccines against lung cancer.

Despite recent advances in immunotherapy treatment for metastatic, early-stage nonsmall cell lung cancer (NSCLC), palliative, adjuvant, neoadjuvant, and perioperative treatment options, further development is needed. Exploring new frontiers of immuno-oncology is necessary. Researchers are interested in a therapeutic vaccination model. In this paper, we provide a review of the latest lung cancer therapeutic vaccines.We describe strategies for antigen selection and delivery platforms. As of 5th of August 2024, we have reviewed ongoing clinical trials and results.We summarize most of the important clinical trials of novel vaccines, the way of action, and available clinical data. We also discuss the pros and cons of various types of therapeutic vaccines. Until recently, clinical trial results were mixed regarding the efficacy of therapeutic vaccines in lung cancer.Developing next-generation sequencing and bioinformatic technologies has helped identify suitable antigens. New personalized vaccines are based on neoantigens specific to unique tumor mutations.Neoantigens, instead of tumor-associated antigens, better delivery systems and adjuvants will improve antigen presentation and immune system activation.Combining these therapeutic vaccines with other therapeutic approaches will improve and prolong the response.

Are histomorphological patterns a predictor for survival in uveal melanoma patients with hepatic metastases undergoing hepatic artery infusion chemotherapy?

In uveal melanoma (UM) patients with hepatic metastases, hepatic artery infusion chemotherapy (HAIC) is a viable, palliative treatment option. To evaluate the impact of two histomorphological patterns (spindle cell vs. epithelioid) of liver metastases on median overall survival (mOS) in UM patients undergoing HAIC. A retrospective analysis with 60 UM patients (29 females, mean age: 61.6 ± 12.1 years) with hepatic metastases was performed. Histomorphological patterns in metastases were analysed and classified as either predominant spindle cell or epithelioid pattern. mOS between both patient groups was analysed using Kaplan-Meier curves and the log-rank test. In 73.3% (44/60) of the metastases, a predominant epithelioid pattern, in 21.7% (13/60) a predominant spindle cell pattern, and in 5% (3/60) other patterns were found. No significant differences between patients with an epithelioid (mOS: 14.2 months, 95% CI: 8.8-19.6) and a spindle cell pattern (mOS: 14.4 months, 95% CI: 4.3-24.5) were detected by the log-rank test, χ2(2) = 0.22, P = 0.881. Histomorphological patterns of UM metastases do not seem to be a predictor for mOS in UM patients undergoing HAIC.

Impact of Toceranib Phosphate and Carprofen on Survival and Quality of Life in Dogs with Inflammatory Mammary Carcinomas.

Canine inflammatory mammary carcinoma (IMC) is an aggressive and rare type of mammary gland cancer in dogs where vascular endothelial growth factor and cyclooxigenase-2 overexpression usually occur, which contribute to its invasive and angiogenic nature. This study aimed to evaluate the efficacy and safety of a combined treatment regimen of toceranib phosphate and carprofen in dogs with measurable IMC. Fifteen female dogs with histopathologically confirmed IMC were included, undergoing a regimen of toceranib (2.4-2.75 mg/kg PO, three times weekly) and carprofen (4.4 mg/kg/24 h PO). Initial evaluations included physical exams, tumor measurements, complete blood count, biochemistry, urinalysis, three view thoracic radiographs, and abdominal ultrasound. Follow-up assessments of physical condition and quality of life (QOL) were conducted bi-weekly, with tumor response evaluations monthly, using RECIST v1.0 criteria. While no complete or partial responses were observed, 60% of the dogs maintained stable disease, with a median progression-free survival of 76 days and an overall survival of 90 days. Notably, 60% of the dogs showed clinical benefit through improved QOL and disease stabilization. The treatment was well-tolerated, with only grade I/II toxicities reported. Despite limited biological activity against the cancer, this protocol may enhance QOL in dogs with IMC, offering a valuable palliative option.

Characteristics of people diagnosed with dementia vs lung cancer and cardiovascular disease at commencement of community palliative care: a population–based study

BackgroundMost people diagnosed with dementia live and die in community settings. This study aimed to: (i) describe the palliative care needs of patients with dementia at commencement of community palliative care; (ii) compare palliative care needs between patients with dementia and those with lung cancer and cardiovascular disease (CVD).MethodsThis is a population-based descriptive study that involved 8,727, 7,539 and 25,279 patients who accessed community palliative care across Australia principally because of dementia, CVD and lung cancer. Patients’ functional abilities, symptom burden and clinical condition were assessed at commencement of community alliative care using five validated instruments: Resource Utilisation Groups—Activities of Daily Living, Australia-modified Karnofsky Performance Status, Symptoms Assessment Scale, Palliative Care Problem Severity Score and Palliative Care Phase. We fitted ordinal logistic regression models to examine the differences in these assessments for dementia versus CVD and lung cancer, respectively.ResultsOverall, patients with dementia generally had low levels of distress from symptoms but poor functional problems. Compared to the other two diagnostic groups, palliative care for dementia was often initiated later and with shorter contacts. Also, patients with dementia presented with poorer functional performance (adjusted OR (aOR) = 4.02, Confidence Interval (CI): 3.68 – 4.38 for dementia vs CVD; aOR = 17.59, CI: 15.92 – 19.44 for dementia vs lung cancer) and dependency (aOR = 5.68, CI: 5.28 – 6.12 for dementia vs CVD; aOR = 24.97, CI: 22.77 – 27.39 for dementia vs lung cancer), but experienced lower levels of distress and problem severity for the majority of symptoms.ConclusionCommunity palliative care is often an ideal care option for many patients, particularly for those with dementia. We call for expansion of the palliative care workforce and options for home care support to optimize accessibility of community palliative care for dementia.

Use of the subcutaneous ureteral bypass device and urethral stenting for treatment of malignant urinary outflow tract obstructions in cats.

The aim of this study was to describe the technical success and outcomes of ureteral and urethral decompression using the subcutaneous ureteral bypass (SUB) device and transurethral self-expanding metallic stents (SEMS) as a palliative treatment option for feline malignant urinary outflow tract obstructions. A retrospective study was conducted of 14 cats with ureteral and/or urethral obstructions secondary to diagnosed or suspected transitional cell carcinoma (TCC). In all cats, a SUB device and/or a SEMS was placed to relieve the obstruction(s). Group 1 consisted of cats with ureteral obstructions, with or without concurrent urethral obstructions, and group 2 consisted of cats with only urethral obstructions. Eight cats were included in group 1 (seven with concurrent urethral obstructions) and six cats were included in group 2. TCC was confirmed in 8/14 cats. Repeat urethral obstruction due to tumor in growth occurred in 6/13 (46%) cats with a SEMS, and no cats developed recurrent ureteral obstructions after placement of the SUB device. Three cats had additional covered stents placed after urethral re-obstruction. The median survival time (MST) from the time of device placement was 52 days in group 1 (mean 92; range 14-349) and 80 days in group 2 (mean 96; range 7-209). The MST from the time of mass identification of the cats that did and did not receive adjunctive therapy was 349 days (mean 358; range 124-602) and 43 days (mean 113; range 14-423), respectively. The use of bypass devices for feline malignant urinary outflow tract obstructions is a viable option to provide immediate renal and urinary bladder decompression. TCC in cats is locally aggressive and can result in urethral re-obstruction, prompting consideration for placing a covered urethral stent. The use of adjunctive therapies for malignant neoplasia should be considered to improve overall survival once the obstruction has been relieved.

Magnetic Resonance Imaging Guided Radiation Therapy for Splenomegaly: Clinical Experiences and Technical Tips

IntroductionSplenomegaly is a common manifestation in chronic lymphoid and myeloid malignancies. While splenectomy is the preferred treatment for symptomatic splenomegaly, it carries significant risks. Radiotherapy (RT) has traditionally been considered a palliative option. This study explores the use of Magnetic Resonance-Guided Radiotherapy (MRgRT) for splenic irradiation (SI) in patients with myelofibrosis (MFI) and myelodysplastic/myeloproliferative neoplasms (MDS/MPN). MethodsThis single-center retrospective analysis includes patients with MFI and MDS/MPN who underwent MRgRT SI between 2018 and 2022. Ten 1 Gy fractions were delivered to the PTV (spleen+3/5mm margin). An adaptive online/offline strategy has been used to reduce the dose to healthy organs. Dosimetric data and clinical outcomes, including pain relief, gastrointestinal symptoms, and hematological values, were assessed. ResultsTwelve patients completed SI without interruption, with supportive transfusions as needed for cytopenias. Pain and gastrointestinal symptoms relief was observed in most cases. The mean percentage reduction in spleen volume was 53.61%, with an average cranio-caudal extension reduction of 77.78%. Twenty-nine (24.2%) out of 120 fractions were online adapted and 14 (11.7%) were replanned offline. Non-hematological toxicities were not reported. At a median follow-up of 12.9 months, 6 patients died, while 9 patients underwent hematopoietic cell transplantation, with 6 of them surviving. ConclusionThis study demonstrates MRgRT SI feasibility in MFI and MDS/MPN patients, offering symptom relief and significant spleen volume reduction. Real-time setup verification and adaptive planning allowed for tailored treatment with reduced margins, minimizing healthy tissue exposure. Larger prospective studies with longer follow-up are needed to further validate its efficacy and safety.

Management of a Case of Recurrent Cutaneous Adenoid Cystic Carcinoma of the Scalp with Radiation Therapy

Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare tumor originating within the skin, typically presenting as a solid, gradually enlarging nodule or mass. We report a unique case of recurrent PCACC of the scalp in a 90-year-old male, initially diagnosed in 2010 and managed with surgical excision. Despite initial treatment, the lesion recurred twice, necessitating re-irradiation due to ineligibility for surgical resection at the second recurrence. We discuss the treatment modalities and outcomes of this case, highlighting the importance of a multidisciplinary approach in managing rare malignancies. Our case underscores the feasibility and efficacy of radiotherapy as a palliative treatment option for recurrent PCACC, particularly in patients unsuitable for surgical intervention.