Radiotherapy For Carcinoma Research Articles

Correlation between family care and stigma in patients undergoing radiotherapy for nasopharyngeal carcinoma: a retrospective observational analysis

Correlation between family care and stigma in patients undergoing radiotherapy for nasopharyngeal carcinoma: a retrospective observational analysis

Effect of segmental tongue function training on tongue pressure attributes in individuals with dysphagia after receiving radiotherapy for nasopharyngeal carcinoma

ObjectiveThis study aimed to assess the impact of segmental tongue function training on tongue pressure characteristics in nasopharyngeal carcinoma after radiotherapy(NPCR) patients who experience dysphagia. The findings of this research are crucial in understanding the potential benefits of tongue rehabilitation exercises for individuals with NPC patients. Hence, it is essential to explore the effects of this type of training on tongue pressure and its associated characteristics.MethodsA group of eighteen NPCR dysphagia patients underwent a two-week segmental tongue function training. The researchers assessed their tongue motor function by measuring the tongue pressure (P) and endurance time (ET) in three different regions of the tongue-the anterior tongue region (TAR), central tongue region (TCR), and posterior tongue region (TPR). To gather accurate data, a new flexible tongue pressure sensor with 9 measuring sites arranged in a 3 × 3 configuration was used to measure the pressure exerted by the tongue on the palate. The measurements were taken both before and after the segmental tongue function training.ResultsThe segmental tongue function training resulted in significant improvements in tongue pressure for the anterior(PTAR) and central(PTCR) parts of the tongue(P < 0.05). However, there was no significant change in tongue pressure for the posterior(PTPR) part of the tongue(P > 0.05). Additionally, there were no significant differences in the endurance time for each part of the tongue(P > 0.05).ConclusionsSegmental tongue function training improved the PTAR and PTCR in NPCR dysphagia patients within 2 weeks, and the improvement gradually decreased from the anterior part of the tongue to the posterior part of the tongue. Meanwhile, there were no significant differences in PTPR and ET of between each part before and after treatment. This suggests that a longer duration weeks of training may be needed to improve the PTPR and ET in these patients, or alternatively, more targeted training programs could be designed.

Innovations in radiotherapy for tongue squamous cell carcinoma

Radiotherapy sensitivity is associated with the prognosis of patients with tongue squamous cell carcinoma (TSCC). In the present study, we proposed to explore the specific mechanism of interventional radiology (IR) therapy for TSCC in vitro and in vivo. TSCC cells were treated with 6 Gy IR and tumor bearing mice were treated with 20 Gy × 1 IR. DIA quantitative proteomics along with bioinformatics analysis were conducted in TSCC cells to investigate differential proteins related to IR and relation of which involved in TMEM147 and SPHK1 was confirmed by immunoprecipitation. Cell proliferation, apoptosis, autophagy& autophagy flux along with calcium signaling pathway detection were performed in vitro and in vivo. Our results showed that IR induced increasing calcium levels accompanied by up-regulated TMEM147 and down-regulated SPHK1 along with enhancing autophagy together with apoptosis. The effect of calcium overloading induced by IR on autophagy and apoptosis was dependent on increasing TMEM147 and decreasing SPHK1. However, IR-induced autophagy and apoptosis tended to be independent of only increasing calcium levels when down-regulating TMEM147 or up-regulating SPHK1 expression in vitro and in vivo. Our study suggested that calcium-mediated TMEM147/SPHK1 may promote autophagy and apoptosis to improve radiotherapy sensitivity in TSCC.

Angiosarcoma of the Breast: Case Report

Angiosarcoma is a rare and aggressive tumor of the breast arising from endothelial cells. It is usually associated with chronic lymphedema or radiation therapy. The diagnosis is made by biopsy and there is no specific finding on mammography. In this study, we report a 59-year-old woman with a history of radiotherapy for invasive ductal carcinoma who subsequently developed primary angiosarcoma of the breast. Angiosarcoma of the breast was first documented in 1887 and is classified as primary and secondary. While surgical R0 resection is recommended for the treatment of these tumors with unclear etiology, the significance of axillary lymph node dissection remains uncertain. Adjuvant radiotherapy has been shown to reduce the local recurrence rate, but adjuvant chemotherapy and radiotherapy have no significant effect on 5-year survival. Although there is no consensus on treatment regimens, it is concluded that more comprehensive studies should be conducted in a larger sample.

CTNI-69. A FIRST-IN-HUMAN FEASIBILITY STUDY TO EVALUATE THE SAFETY OF SELECTIVE YTTRIUM-90 ENDOVASCULAR RADIOTHERAPY IN PATIENTS WITH RECURRENT GBM: INTERIM RESULTS FROM THE FRONTIER TRIAL

Abstract BACKGROUND Yttrium-90 (Y90) microsphere treatment is an FDA-approved endovascular radiotherapy for Hepatocellular Carcinoma; however, extra-hepatic experience is limited. The FRONTIER trial (NCT05303467) is a first-in-human study conducted under an IDE from the FDA evaluating the safety and feasibility of intra-arterial Y90 endovascular radiotherapy in patients with recurrent glioblastoma (rGBM). METHODS The primary endpoint is the incidence of treatment-related limiting toxicities through 30 days, in 12 patients with rGBM. Eight subjects (50% male) with non-dominant hemisphere rGBM have been enrolled to date, with 6 patients reported herein. The treatment region, encompassing the recurrent lesion, excluding eloquent regions, and defined using cerebral angiography-MRI fusion, was selectively targeted with 40±4Gy. Immediate post-treatment imaging included MRI to evaluate acute treatment-related effects and Y90-PET to evaluate the absorbed dose distribution. Neurological assessments were performed pre- and post-treatment. Analysis of post-contrast T1w enhancing tissue volume (T1wvol) inside and outside the treated region was performed longitudinally. RESULTS All patients tolerated the procedure well and were discharged the following day. No decrease in neurological function and no limiting toxicities were reported through 30 days. Post-treatment MRI revealed no device-related acute ischemia or hemorrhage. Mean absorbed dose to the treatment region was 42.1±2.4Gy, within 3% of the targeted value, suggesting technical feasibility. Mean tumor absorbed dose within the treatment region was 65.1±22.6Gy most likely due to increased tumor perfusion in the treatment region. A reduction in T1wvol at 2m was observed in 4/6 patients, with the remaining 2 patients showing increased T1wvol. Disease progression by T1wvol occurred more rapidly outside the treatment region than within. All patients received subsequent therapy, with 2 patients receiving surgery 82 and 120 days post Y90 treatment. CONCLUSION Interim results in this first-in-human feasibility study demonstrated technical feasibility and no limiting toxicities through 30 days. Enrollment is ongoing. These data warrant additional investigation.

Highlights of the 2024 ASCO Annual Meeting: radiotherapy of head and neck cancer

At the 2024 Annual Meeting of the American Society of Clinical Oncology (ASCO), several important studies on radiotherapy for head and neck squamous cell carcinoma (HNSCC) were presented. There were two Chinese phaseIII trials on treatment escalation for locally advanced nasopharyngeal carcinoma: adjuvant immune checkpoint inhibition with camrelizumab after induction chemotherapy and cisplatin-based chemoradiotherapy (RCT) in the DIPPER trial reached the primary endpoint of improved event-free survival (EFS) but did not improve overall survival (OS). Simultaneous and adjuvant administration of the angiogenesis inhibitor endostar in addition to cisplatin-based RCT for locally advanced nasopharyngeal carcinoma led to asignificant improvement in progression-free survival (PFS) and OS. Another major focus was on treatment optimization and deintensification for oropharyngeal cancer (OPC): using intensity-modulated proton therapy (IMPT), aphaseIII trial demonstrated noninferiority in definitive RCT for OPC compared to photon-based intensity-modulated radiotherapy (IMRT). In adjuvant treatment of human papillomavirus-positive (HPV+) OPC, the long-term results of the E3311 phaseII study confirmed that individually deintensified radiotherapy is feasible. Lee etal. showed with the results of aphaseII study that HPV+ OPC might be treatable with chemoradiotherapy to atotal dose of only 30 Gy if no hypoxia is detected in the 18F‑fluoromisonidazole positron-emission tomography-computed tomography (F-MISO-PET) scan. Both the deintensified treatment of HPV+ OPC as well as additive immune checkpoint and angiogenesis inhibition in chemoradiotherapy of nasopharyngeal carcinoma require further studies before they can be recommended in clinical practice.

A Stacked Multimodality Model Based on Functional MRI Features and Deep Learning Radiomics for Predicting the Early Response to Radiotherapy in Nasopharyngeal Carcinoma

BackgroundThis study aimed to construct and assess a comprehensive model that integrates MRI-derived deep learning radiomics, functional imaging (fMRI), and clinical indicators to predict early efficacy of radiotherapy in nasopharyngeal carcinoma (NPC). MethodsThis retrospective study recruited NPC patients with radiotherapy from two Chinese hospitals between October 2018 and July 2022, divided into a training set (hospital I, 194 cases), an internal validation set (hospital I, 82 cases), and an external validation set (hospital II, 40 cases). We extracted 3404 radiomic features and 2048 deep learning characteristics from MRI modalities - T1WI, CE-T1WI, T2WI, and T2WI/FS. Additionally, both the ADC and its maximum (ADCmax) from DWI imaging, along with TBF and its maximum (TBFmax) from ASL imaging were derived. We used four classifiers (LR, XGBoost, SVM and KNN) and stacked algorithm as model construction methods. The receiver operating characteristic (ROC) curve (AUC) and decision curve analysis (DCA) was used to assess models. ResultsThe manual radiomics model leveraging XGBoost and the deep learning model based on KNN (the AUCs in the training set: 0.909, 0.823, respectively) showed better predictive efficacy than other machine learning algorithms. The stacked model that integrated MRI-based deep learning radiomics, fMRI, and hematological indicators, has a large improvement of AUC in the training set [0.984 (95%CI: 0.972 - 0.996)], the internal validation set [0.936 (95%CI: 0.885 - 0.987)], and the external validation set [0.959 (95%CI: 0.901-1)]. ConclusionsOur research has developed a clinical-radiomics integrated model based on MRI which can predict early radiotherapy response in NPC and provide guidance for personalized treatment.

Evaluation of dose and anatomy variability for nasopharyngeal carcinoma radiotherapy with a new fully integrated CT-linac

The goal of this study was to investigate the variability of target volume and parotid gland dose distribution for nasopharyngeal carcinoma (NPC), and to explore the shifting patterns of parotid gland centroid and neck radius during radiotherapy. Twenty patients with NPC were enrolled. The target volume dose difference between planning dose and recalculated dose on weekly CT was analyzed. The recalculated doses on every weekly CT were cumulated to assess the difference between delivered dose and planning dose. The relationship of parotid gland centroid deviation with dose was studied, and the shrinking distances of neck radius were calculated for cervical vertebra 1, 2, 3 levels (C1, C2, C3). The ratio of GTVs and CTVs doses on weekly CTs to the doses on planning CT was all above 0.98; the dose of PTVs on weekly CT tended to decrease compared with planning. RMD was defined as the ratio of the mean dose of the left and right parotid glands (L-PG, R-PG) to the planning mean dose. The fitted relationships of RMD and the deviation of centroid (D) for L-PG and R-PG were: RMD=0.37*D+0.98 (R2 = 0.62, p < 0.001) and RMD = 0.33*D+0.97 (R2 = 0.72, p < 0.001), respectively. The order of neck radius shrinking distance at different levels was C1>C2=C3. In this study, we quantitatively analyzed the dosimetric variabilities of target volumes, and established linear models of parotid gland dose and its centroid deviation, which provides fractional and full-course dose evaluation during radiotherapy for NPC.

Endoscopic transnasal and transoral resection of the odontoid process and C1 combined with occipitocervical fusion for osteoradionecrosis of the upper cervical spine: a case report and literature review

BackgroundOsteoradionecrosis (ORN) of the upper cervical spine is a rare but severe complication of head and neck cancer radiotherapy. To raise awareness of this condition, we describe a patient with a history of nasopharyngeal carcinoma who developed ORN of the upper cervical spine and review the published literature reporting surgical management.Case presentationA 59-year-old female patient with persistent neck pain for one month and limited range of neck motion who had undergone radiotherapy for nasopharyngeal carcinoma with a total dose of 69.96 Gy 15 years ago presented to our hospital. The patient underwent endoscopic transnasal and transoral resection of the odontoid process and C1 anterior arch, combined with occipitocervical fusion. To better understand surgical management of ORN of the upper cervical spine, the literature published in the PubMed, Ovid MEDLINE, and Embase databases was reviewed. Our patient experienced alleviation of cervical pain and did not exhibit any postoperative complications. Since 2005, 11 cases of surgical management of ORN of the upper cervical spine (including the present case) have been published. Basilar invagination and/or atlantoaxial subluxation were observed in 4 /11 cases. Endoscopic procedures were performed in 4/11 cases, and occipitocervical fusion was performed in 8 /11 cases.ConclusionEndoscopic transnasal and transoral resection of the odontoid process and C1 anterior arch is a safe and effective treatment option for ORN of the upper cervical spine. Occipitocervical fusion is useful in patients with basilar invagination and atlantoaxial subluxation.

Deformable dose prediction network based on hybrid 2D and 3D convolution for nasopharyngeal carcinoma radiotherapy.

Radiotherapy is recognized as the primary treatment for nasopharyngeal carcinoma (NPC). Rapid and accurate dose prediction is crucial for enhancing the quality and efficiency of radiotherapy planning. However, the current dose prediction model based on 2D architecture cannot effectively learn the spatial information among slices. Although some studies have explored the incorporation of interslice features through 3D architecture, the resolution properties of medical image anisotropy significantly limit the predictive performance. To address the issues, we propose a novel deformable dose prediction network based on hybrid 2D and 3D convolution for NPC radiotherapy. Specifically, the proposed model innovatively incorporates a 2.5D architecture based on hybrid 2D and 3D convolution, and effectively utilizes the directional information within anisotropic resolutions to achieve cross-scale feature extraction. Additionally, deformable convolution is introduced into the model to enhance the receptive field and effectively handle multi-scale spatial transformations. To improve channel correlation and reduce redundant features, we design a Residual Deformable Squeeze-and-Excitation Module. We conduct extensive experiments on an internal dataset, and the results show that the proposed model outperforms other existing methods in most dosimetric criteria. The proposed model has superior dose prediction performance in NPC radiotherapy, and has important clinical significance for assisting physicists to optimize the treatment plan and improve standardization of radiotherapy planning. The source code is available at https://github.com/CDUTJ102/2.5D-Deformable-UNet .

Perioperative Tislelizumab plus intensity modulated radiotherapy in resectable hepatocellular carcinoma with macrovascular invasion: a phase II trial

Hepatocellular carcinoma (HCC) patients with macrovascular invasion (MVI) have dismal prognosis and there are no standard perioperative therapies. This phase 2 trial (ChiCTR2000036385) aimed to investigate the activity and safety of perioperative tislelizumab plus intensity modulated radiotherapy (IMRT) for resectable HCC with MVI. Thirty treatment-naïve patients with MVI received 3 cycles of tislelizumab intravenously (200 mg, every three weeks) and concurrent IMRT (45 Gray in 15 fractions). Primary endpoints were the overall response rate (ORR) and overall survival (OS). Secondary endpoints were the proportion of patients with a complete or major pathological response (pCR or MPR), recurrence-free survival (RFS) and safety. Of patients enrolled, 15 (50%) underwent curative surgery followed by adjuvant tislelizumab. The ORR was 30.0% (90% CI 16.6%-46.5%) and the median OS was 18.7 months. Of the 15 patients underwent surgical resection, 10 (66.7%) achieved pCR or MPR and 8 (53.3%) remained recurrence-free. The median RFS were not reached with a median follow-up of 21.77 months (95% CI 12.50-31.03) post-surgery. 4 (13.3%) patients experienced grade 3 treatment-related adverse events. The most common events were thrombocytopenia, leukopenia, and anemia. The trial has met the pre-specified endpoints, and these results support further studies of perioperative immunotherapy plus radiotherapy in HCC.

Determining the gross tumor volume for hepatocellular carcinoma radiotherapy based on multi-phase contrast-enhanced magnetic resonance imaging

PurposeThe aim of this study was to quantitatively analyze of the differences in determining the gross tumor volume (GTV) for hepatocellular carcinoma (HCC) radiotherapy using multi-phase contrast-enhanced magnetic resonance imaging (CE-MRI) and provide a reference for determining the GTV for radiotherapy of HCC. MethodsThis retrospective study analyzed 99 HCC patients (145 lesions) who underwent MR simulation. T1-weighted imaging (T1WI), contrast-enhanced T1WI (CE-T1WI) at 15 s, 45 s, 75 s, 150 s, and 20 min after contrast agent injection were performed, comprising a total of six imaging sequences. The GTVs identified on different sequences were grouped and fused in various combinations. The internal GTV (IGTV), which was the reference structure, was obtained by the fusion of all six sequences. Mean signal intensity (SI), volume, shape, and fibrous capsule (FC) thickness among GTVs were compared. Results(1) The mean SI value of GTV-T1WI, GTV-15s-GTV-20min in patients with transarterial chemoembolization (TACE) was lower by 14.09 % (GTV-T1WI) to 31.31 % (GTV-15s) compared with that in patients without TACE. Except for GTV-T1WI, the differences in SI values between the two groups for other GTVs were statistically significant (p < 0.05). (2) The volumes of GTV-T1WI, GTV-15s-GTV-20min ranged from 32.66-34.99 cm3. The volume differences between GTV-45s and the other GTVs were statistically significant (p < 0.05), excluding the GTV-T1WI. (3) Compared with the IGTV, the change trend of GTV volume reduction rate is consistent with that of dice similarity coefficients (DSC). (4) In the CE-T1WI sequences (except for CE-T1WI-15s), FC measurement was possible in 39.31 % of lesions (57/145), with the largest mean thickness observed at 75 s. ConclusionAlthough single-phase CE-MRI introduces uncertainty in HCC GTV determination, combining different phases CE-MRI can enhance accuracy. The CE-T1WI-45s should be routinely included as a necessary scanning sequence.

AdipoRon Alleviates Liver Injury by Protecting Hepatocytes from Mitochondrial Damage Caused by Ionizing Radiation

Radiation liver injury is a common complication of hepatocellular carcinoma radiotherapy. It is mainly caused by irreversible damage to the DNA of hepatocellular cells directly by radiation, which seriously interferes with metabolism and causes cell death. AdipoRon can maintain lipid metabolism and stabilize blood sugar by activating adiponectin receptor 1 (AdipoR1). However, the role of AdipoRon/AdipoR1 in the regulation of ionizing radiation (IR)-induced mitochondrial damage remains unclear. In this study, we aimed to elucidate the roles of AdipoRon/AdipoR1 in IR-induced mitochondrial damage in normal hepatocyte cells. We found that AdipoRon treatment rescued IR-induced liver damage in mice and mitochondrial damage in normal hepatocytes in vivo and in vitro. AdipoR1 deficiency exacerbated IR-induced oxidative stress, mitochondrial dynamics, and biogenesis disorder. Mechanistically, the absence of AdipoR1 inhibits the activity of adenosine monophosphate-activated protein kinase α (AMPKα), subsequently leading to disrupted mitochondrial dynamics by decreasing mitofusin (MFN) and increasing dynamin-related protein 1 (DRP1) protein expression. It also controls mitochondrial biogenesis by suppressing the peroxisome proliferator-activated receptor-gamma coactivator-1 alpha (PGC1α) and transcription factor A (TFAM) signaling pathway, ultimately resulting in impaired mitochondrial function. To sum up, AdipoRon/AdipoR1 maintain mitochondrial function by regulating mitochondrial dynamics and biogenesis through the AdipoR1-AMPKα signaling pathway. This study reveals the significant role of AdipoR1 in regulating IR-induced mitochondrial damage in hepatocytes and offers a novel approach to protecting against damage caused by IR.

Long-term outcomes of more than a decade treating patients with stereotactic body radiation therapy for hepatocellular carcinoma

Purpose/Objective(s)To evaluate if stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) has a durable effect on tumor control and can be delivered safely. Materials/MethodsPatients included in this retrospective study have been treated at our institution from January 2008 to December 2022. Eligibility criteria were diagnosis of HCC, BCLC stage 0-A-B, non-cirrhotic liver or liver with cirrhosis Child-Pugh class A, and a maximum of three lesions with a cumulative diameter of ≤ 6 cm. Patients with relapses after surgery, thermal ablation or TACE or patients awaiting transplant were also candidates for SBRT. SBRT was delivered in 6 fractions of 8 or 9 Gy. The primary endpoint was local (target) control (LC). Secondary endpoints were time to progression (TTP), overall survival (OS), response rate (RR) and toxicity. ResultsA total of 52 patients received SBRT at our institution and 51 were included in this study. One patient objected and was excluded. Median follow-up was 2.1 years for LC and 2.3 years for OS. Median tumor size was 26 mm. LC rates at 1, 2, and 5 years were 100 %, 95 % and 95 % respectively. Median TTP was 45.6 months. Median OS was 7.1 years. RR was 96 %. No patients in this study have experienced SBRT related CTC AE grade ≥ 3 toxicity. ConclusionSBRT resulted in excellent long-term local control rates and absence of severe toxicity in a group of HCC patients. The reported outcomes compare favorably with other local therapies. SBRT should be considered as one of the available local treatment options for HCC.

Transformer-Integrated Hybrid Convolutional Neural Network for Dose Prediction in Nasopharyngeal Carcinoma Radiotherapy.

Radiotherapy is recognized as the major treatment of nasopharyngeal carcinoma. Rapid and accurate dose prediction can improve the efficiency of the treatment planning process and the quality of radiotherapy plans. Currently, deep learning-based methods have been widely applied to dose prediction for radiotherapy treatment planning. However, it is important to note that existing models based on Convolutional Neural Networks (CNN) often overlook long-distance information. Although some studies try to use Transformer to solve the problem, it lacks the ability of CNN to process the spatial information inherent in images. Therefore, we propose a novel CNN and Transformer hybrid dose prediction model. To enhance the transmission ability of features between CNN and Transformer, we design a hierarchical dense recurrent encoder with a channel attention mechanism. Additionally, we propose a progressive decoder that preserves richer texture information through layer-wise reconstruction of high-dimensional feature maps. The proposed model also introduces object-driven skip connections, which facilitate the flow of information between the encoder and decoder. Experiments are conducted on in-house datasets, and the results show that the proposed model is superior to baseline methods in most dosimetric criteria. In addition, the image analysis metrics including PSNR, SSIM, and NRMSE demonstrate that the proposed model is consistent with ground truth and produces promising visual effects compared to other advanced methods. The proposed method could be taken as a powerful clinical guidance tool for physicists, significantly enhancing the efficiency of radiotherapy planning. The source code is available at https://github.com/CDUTJ102/THCN-Net .

Sequencing microsphere selective internal radiotherapy after external beam radiotherapy for hepatocellular carcinoma: proof of concept of a synergistic combination.

This study aims to explore the synergistic effects of combining Stereotactic Body Radiation Therapy (SBRT) and Selective Internal Radiation Therapy (SIRT) in that specific sequence for treating hepatocellular carcinoma (HCC), particularly in patients at high risk of radiation-induced liver disease (RILD). We analyzed a case of a patient with HCC who was treated with SBRT at our institution. A virtual 90Y dose distribution was added using our in-house -BLINDED FOR REVIEW- model to keep a minimum dose to the healthy liver tissue. BED and EUD metrics were calculated to harmonize the dose distributions of SBRT and SIRT. Our radiation biology-based models suggest that the combination of SBRT and SIRT could maintain effective tumor control while reducing the dose to normal liver tissue. Specifically, an SBRT plan of 10 Gy x 3 fractions combined with SIRT yielded comparable tumor control probability to an SBRT-only plan of 10 Gy x 5 fractions. The combination of SBRT and SIRT is a promising treatment strategy for HCC patients at high risk of RILD. While the LQ model and associated formalisms provide a useful starting point, further studies are needed to account for factors beyond these models. Nonetheless, the potential for significant dose reduction to normal tissue suggests that this combination therapy could offer substantial clinical benefits. This article presents a proposal to combine SBRT and SIRT, in this specific order, for HCC, discussing its advantages. A framework for future research into optimizing combination therapy for HCC is provided, utilizing a novel HCC vascular model to simulate 90Y doses.

Not All Therapy-Related Neoplasms are Myeloid: A Case Report of Rare B-ALL With t(5;14) Following Alkylating Agent Treatment

Abstract Introduction/Objective Most therapy-related hematologic neoplasms are myeloid (t-MN). Although not recognized as a distinct entity in the WHO classification of hematologic neoplasms, therapy-related acute lymphoblastic leukemia (t- ALL) cases have been previously reported. ALL incidence increases with any previous malignancy and is higher in those with previous treatment, supporting the concept of therapy-related ALL. B lymphoblastic leukemia/lymphoma (B- ALL) with t(5:14) is a rare subtype of the ALL (&amp;lt;1%) harboring a IL-3/IGH gene translocation. We present the first case of B-ALL with t(5;14) following treatment with alkylating agents for breast carcinoma. Methods/Case Report A 79-year-old female received docetaxel, carboplatin, trastuzumab, pertuzumab, Herceptin and radiotherapy for an invasive ductal breast carcinoma. Two years later, she developed progressive pancytopenia requiring a bone marrow biopsy. Results (if a Case Study enter NA) The bone marrow aspirate smears demonstrated B-ALL with 25% blasts, limited neutrophilic maturation, moderate erythroid dysplasia, and decreased megakaryocytes with occasional atypical forms. On the biopsy, atypical megakaryocytes and lymphoblasts were positive for TP53 immunohistochemical stain. On flow cytometry, blasts were positive for CD19, cCD79a, CD22, CD10, TdT, and HLA-DR and only 6% were positive for CD34. Next generation sequencing showed TP53 and NRAS mutation. Karyotyping revealed 46, XX, t (5;14) (q33; q13) and trisomy 21. Conclusion B-ALL with t (5;14); IGH/IL3 fusion has not been previously reported following treatment with alkylating agents. The presence of morphologic myeloid dysplasia developing after chemotherapy with alkylating agents support causality being therapy related rather than an independent process. The case expands the breadth of known therapy- related hematologic neoplasms and raises questions regarding the mechanisms of leukemogenesis.

Definitive Radiotherapy in Salivary Gland Carcinoma of the Head and Neck

Definitive Radiotherapy in Salivary Gland Carcinoma of the Head and Neck

Stereotactic body radiotherapy versus lenvatinib for hepatocellular carcinoma with portal vein tumor thrombosis: a propensity matching score analysis

Background and objectivesThe purpose of this study was to investigate the survival benefit of Stereotactic Body Radiotherapy (SBRT) versus lenvatinib as first-line therapy in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT).Materials and methods147 HCC patients with PVTT were included in this retrospective study, 70 were treated with SBRT and 77 of were treated with lenvatinib. Propensity score matching (PSM) analysis was employed to balance the differences in baseline characteristics between the two groups. Overall survival (OS), progression-free survival (PFS) and objective response rate (ORR) were compared between the two groups. In addition, the safety of patients in both groups was also evaluated.ResultsAfter PSM, 38 patients were matched in each of the two groups. The median OS was 14.5 (95% CI: 10.1–18.9) and 11.1 (95% CI: 9.3–12.9) months in the SBRT and lenvatinib groups, respectively (P = 0.014). The median PFS was 6.8 (95% CI: 5.1–8.5) and 5.0 (95% CI: 3.0–7.0) months, respectively (P = 0.010). The 1-, 2-years OS rates in the two groups were 65.8% vs. 39.5% and 31.6% vs. 10.5%, respectively. The 6-, 12-months PFS rates in the two groups were 57.9% vs. 44.7% and 28.9% vs. 10.5%, respectively. In addition, the SBRT group had a better ORR than the lenvatinib group (52.6% vs. 23.7%, P = 0.009). Patients with good response to SBRT had better survival. Cox proportional hazard model showed that SBRT was an important prognostic factor for OS and PFS. The incidence of hypertension (34.2% vs. 0%) was higher in the LEN group, however, both treatment modalities were well tolerated in the two groups of patients.ConclusionIn HCC patients with PVTT, SBRT had a better survival benefit than Lenvatinib treatment as first-line therapy.

A Rare Case Report on Definitive Radiotherapy in Sebaceous Carcinoma of the Eyelid

Introduction: Sebaceous carcinomas are rare but potentially aggressive cutaneous malignancies. Surgical excision, albeit the primary modality of treatment, is associated with functional as well as cosmetic impairments. Radiotherapy offers an alternative treatment modality for those in whom surgical excision is not an option either due to medical reasons or patient preferences. Materials and Methods: Here we present a rare case report of an elderly Indian man with sebaceous carcinoma of the eyelid, for whom definitive radiotherapy was delivered as the primary modality of treatment. Results: There was a near complete response of the tumour to the definitive radiotherapy with acceptable toxicity. Discussion: Radiotherapy is a non-invasive alternative to surgical excision that has the advantage of better functional and cosmetic outcomes.