Synchronous Malignancies Research Articles

Synchronous Second Primary Cancers of Hypopharyngeal Carcinoma in the Image-Enhanced Endoscopy Era.

To explore the prevalence of hypopharyngeal carcinoma (HPC) with synchronous second primary malignancies (Syn-SPMs), their impact on clinical outcomes, and associated risk factors in the image-enhanced endoscopy era. We retrospectively analyzed 673 patients newly diagnosed with HPC at our cancer center between 2009 and 2019. The patients were divided into three groups: (a) no second primary malignancies (N-SPMs, n= 533); (b) synchronous carcinoma in situ (Syn-Tis, n= 60); (c) synchronous invasive tumors (Syn-invasive, n= 80). Propensity score matching was conducted to balance the N-SPMs and Syn-invasive groups at a 3:1 ratio. Most (96.1%) underwent pretreatment esophagogastroduodenoscopy evaluation with image-enhanced endoscopy. The incidence rates were: Syn-SPMs, 20.8%; Syn-Tis, 8.9%; Syn-invasive, 11.9%. At a median follow-up of 66.7 months, the Syn-Tis and N-SPMs groups had a similar 5-year overall survival (OS; 45.6% vs. 44.5%; hazard ratio [HR], 0.956; 95% confidence interval [CI], 0.660-1.385; p=0.806). Compared to the N-SPMs group, the Syn-invasive group had poorer 5-year OS (27.0% vs. 52.9%; HR, 2.059; 95% CI, 1.494-2.839; p < 0.001). Alcohol consumption was significantly associated with Syn-SPMs occurrence (odds ratio, 2.055, 2.414, and 3.807 for light, intermediate, and heavy drinkers, respectively). The prevalence of Syn-SPMs among patients with HPC was high. Syn-invasive SPMs decreased the survival of patients with HPC. Routine screening with image-enhanced endoscopy should be recommended to detect early-stage SPMs, especially for heavy alcohol drinkers. 3 Laryngoscope, 133:1906-1913, 2023.

Incidental findings on staging CT for rectal cancer: Frequency, clinical significance and outcomes

AimTo assess the prevalence, clinical significance, and outcomes of incidental findings in CT studies performed for rectal cancer staging. MethodThis retrospective study was performed at a tertiary colorectal imaging institution. Institutional review board approval was obtained. Consecutive patients who had a CT of the chest, abdomen and pelvis for rectal cancer staging between March 2014 and March 2021 were identified. Patients with a pathologically confirmed primary rectal cancer were included. The imaging reports were reviewed for incidental findings (IFs), which were classified into high, moderate, and low categories, according to their clinical significance. Medical records were reviewed to assess the clinical outcomes of the highly significant IFs. ResultsThere were 241 eligible patients with a mean age of 67 years (92 females). A total of 942 IFs were found in 235 patients (97.5 %). There were 91 IFs (10 %) of high clinical significance, 371 (39 %) of moderate clinical significance, and 480 (51 %) of low clinical significance. There were 8 synchronous malignancies, all of which were highly clinically significant IFs. There were 4 lung adenocarcinomas, 1 bladder urothelial carcinoma, and 3 renal cell carcinomas. Six patients did not have any IFs (2.5 %). ConclusionIFs were seen in 97.5 % of staging CT scans for rectal cancer, 10 % of which were of high clinical significance. Importantly, these included 8 synchronous malignancies. The results highlight the wide range of potential IFs, which can be encountered in staging rectal cancer scans, and raise awareness as to their potential clinical relevance and impact on the healthcare system.

Treatment Outcomes for Radiation Therapy with Concurrent Carboplatin and Paclitaxel for Locally Advanced Head and Neck Cancer

<h3>Purpose/Objective(s)</h3> There is a lack of consensus on what is the preferred systemic regimen in combination with radiation therapy for cisplatin-ineligible patients with locally advanced head and neck squamous cell carcinoma (HNSCC). We report the outcomes of cisplatin-ineligible patients with HNSCC treated with definitive radiation therapy and weekly concurrent carboplatin and paclitaxel at our institution. <h3>Materials/Methods</h3> We included consecutive HNSCC patients treated from 2013 to 2021 that received definitive radiation therapy with weekly carboplatin and paclitaxel for oropharynx, larynx, hypopharynx and unknown primary cancers. We excluded patients who received induction chemotherapy or re-irradiation and patients who had multiple or synchronous primary malignancies. Locoregional control (LRC) and distant control (DC) were estimated using cumulative incidence functions while progression free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier methods. <h3>Results</h3> Sixty-six patients were identified with median age of 70 years (range 44 – 85). Disease sites included oropharynx (n=44), larynx (n=15), hypopharynx (n=5), and unknown primary cancer (n=2). Thirty-five patients (53%) had HPV+ disease. Thirty-three patients had T3 or 4 disease (50%) and 48 (72.7%) had N2 or 3 disease. Median radiation dose received was 70 Gy and the median doses of carboplatin and paclitaxel were AUC 1 and 40 mg/m². Patients received a median of 7 cycles of chemotherapy. At a median follow up of 22 months (range 0.5 – 83.6), the 2-year rates of LRC, DC, PFS, and OS rates were 90.4%, 93.5%,78% (95% CI: 67% – 90%) and 88% (95% CI: 80% - 97%), respectively. There were 4 locoregional failures, 5 distant metastases, and 11 deaths. However, 9/11 deaths occurred in patients without local or distant recurrence. The majority of these deaths were attributed to other medical causes such as upper gastrointestinal bleeds, severe ulcerative colitis, and myocardial infarction. There was one patient with difficulty breathing due to prominent treatment related mucosal edema, which resulted in sudden expiration. <h3>Conclusion</h3> Radiation therapy with weekly carboplatin and paclitaxel is an option for HNSCC patients who are cisplatin-ineligible. Randomized trials are needed to compare carboplatin and paclitaxel with other systemic regimens for this population.

Synchronous Second Primary Malignancies in Hypopharyngeal Carcinoma: Prevalence, Clinical Outcomes and Risk Factors

<h3>Purpose/Objective(s)</h3> Hypopharyngeal carcinoma (HPC) is one of the most devastating malignancies among head and neck cancers. Our aim is to explore the prevalence of hypopharyngeal carcinoma (HPC) with synchronous second primary malignancies (Syn-SPMs) and its impact on clinical outcomes and risk factors in the image-enhanced endoscopy era. <h3>Materials/Methods</h3> Totally, 673 consecutive patients who were newly pathologically confirmed HPC were retrospectively reviewed in our center. Patients were classified as two groups: (a) N-SPMs group, (No-second primary malignancies, n=593), or (b) Syn-SPMs group (n=80). The N-SPMs group were defined as patients had no SPMs within 6 months of the index tumor. While for the Syn-SPMs group, patients developed SPMs within 6 months of the index tumor. <h3>Results</h3> The median follow-up time of the whole cohort (n=673) was 66.7 months. The 5-year OS and DSS of the whole cohort were 42.5% and 48.5%, respectively. There were 11.9% (80/673) patients diagnosed with Syn-SPMs. Among these, esophagus was the most frequent site (58/80, 72.5%), followed by head and neck region [HN-region, 16.3% (13/80)], lung (6.3%, 5/80), thyroid (2.5%, 2/80), stomach (1.2%, 1/80) and rectum (1.2%, 1/80). The Syn-SPMs group had a significantly worse 5-year OS of 27.5% compared with that of 44.7% (P<0.001) in N-SPMs group. Moreover, the 5-year DSS between the Syn-SPMs and N-SPMs groups was 40.4% versus 49.5%, though without significantly difference (P=0.297). The baseline were unbalanced between the two groups, we use six factors to balance. The adjusted 5-year OS was 27.0%, significantly worse than that of 52.9% (P<0.001) in N-SPMs group. Likewise, the 5-year DSS in Syn-SPMs was 40.3%, still lower than 58.8% in N-SPMs group (P=0.019). In multivariate analysis, ECOG scores(P<0.001), had Syn-SPMs (P=0.008), clinical stage of HPC (P<0.001) and BMI (P=0.001) were still independently factors associated with OS. <h3>Conclusion</h3> The total incidence of Syn-SPMs with HPC was 11.9%. Routine screening like image-enhanced endoscopy should be recommended to screen for synchronous second primary malignancies in HPC patients.

Descriptive Statistics for Patients with Glioblastoma Associated with Germline Mismatch Repair Gene Mutation

<h3>Purpose/Objective(s)</h3> Hereditary Nonpolyposis Colorectal Cancer (HNPCC), also known as Lynch Syndrome, is a genetic mismatch repair mutation associated with increased risk for development of glioblastoma (GBM). There is a paucity of data describing the clinical outcomes of GBM patients with HNPCC. We aim to describe tumor characteristics, treatment patterns, and outcomes. <h3>Materials/Methods</h3> IRB approved retrospective review of consecutive patients with a diagnosis of both HNPCC and GBM at a single institution. <h3>Results</h3> Nine patients with a diagnosis of HNPCC and GBM were treated at a single institution from 2001-2022. Six patients were male. Median age at GBM diagnosis was 61 (range 21-84). Median follow up from the time of GBM diagnosis was 7.83 months. Eight patients had prior malignancies: n=7 with colon adenocarcinoma, n=1 with Burkitt lymphoma. Two patients had active synchronous cancers with GBM. The most common presenting symptoms were facial droop (n=3) and cognitive changes (n=2). Others include headache, gait change, visual field defect, and seizures with n=1 each. All patients underwent surgery: n=2 gross total resection, n=4 subtotal resection, and n=3 biopsy alone. There were 3 temporal lobe, 3 parietal lobe, 2 frontal lobe, and 1 frontoparietal lobe tumors. Two patients had multifocal disease at diagnosis. One patient had a giant cell variant GBM. Seven patients had MSH6 mutations and 2 had MSH2 mutations. Two patients progressed rapidly after surgery and were unable to receive RT. Seven patients received adjuvant radiation therapy (RT): n=5 received concurrent TMZ- 1 with concurrent bevacizumab, 5-fluorouracil, and leucovorin due to synchronous metastatic colon cancer, 1 received no chemotherapy. The most common dose and fractionation schedules were 60 Gy in 30 fractions (fx) (n=3), 40.05 Gy in 15 fx (n=3), and n=1 received 30 Gy in 10 fx due to poor performance status and large tumor volume. One patient received proton therapy for active MS, n=8 received IMRT. Two patients initiated tumor treating fields following RT completion. The median time to progression after RT was 3.35 months, and all progressed within the radiation field. Median survival from diagnosis was 6.5 months (range 1.2-15.5). No patients received immune checkpoint inhibitors. One patient was alive at the time of data collection. Seven died due to GBM progression, and n=1 died from progression of a synchronous malignancy. <h3>Conclusion</h3> In this small series, patients with mismatch repair mutation associated glioblastoma had especially poor outcomes and a rapidly progressive disease course.

Early-Stage epithelial ovarian cancer: Predictors of survival

BackgroundOne fifth of patients with epithelial ovarian cancers (EOC) present at an early stage (FIGO stage I & II). However, there is scarcity of literature on the outcomes and its predictors. The aim of the study was to assess relapse free survival (RFS), overall survival (OS) and its predictors in early stage EOC. Patients and MethodsIn this retrospectively study, we included all patients with early-stage EOC diagnosed between January 2010 and December 2018. Patients with synchronous malignancies were excluded. Clinical profile, clinico-pathological characteristics and treatment details were recorded. Patient underwent initial surgery followed by adjuvant chemotherapy in high-risk disease. Patients with stage IC, or stage II or clear cell histology or high-grade histology irrespective of stage/histological subtype were defined as high-risk disease. Fertility sparing surgery (FSS) [unilateral salpingo-oopherectomy with complete surgical staging] was performed in patient willing to preserve fertility. Primary objective was to assess RFS and OS in all patients with early stage EOC. Secondary objectives were to assess RFS and OS in early stage EOC with high-risk disease, predictors of RFS and OS, and outcomes of FSS. Survival probabilities were estimated according to Kaplan-Meier and compared by the log rank test. Cox's regression model was used to analyze the significance of various factors affecting relapse free survival (RFS) and overall survival (OS). Results195 patients with early stage EOC were recruited with median age of 47 years (range, 16–80 years). FIGO stage I and stage II were seen in 72 % and 18 % patients respectively. Serous subtype was reported in 58 % and high-grade histology in 66 %. 184 patients (94.0%) underwent optimal staging surgery, including 27 (14%) with fertility sparing surgery (FSS). 133 (91.7 %) of 145 patients with high-risk disease received adjuvant chemotherapy (paclitaxel and carboplatin), while 12 (8.3 %) patients opted to remain on observation. At median follow up of 56 months (95 % CI, 46–64 months), 49 (25 %) patients relapsed [including 3 of 27 (11.1 %) who underwent FSS], 18 patients died of progressive disease, while 31 patients were alive and disease free. Estimated OS at 5 years is 87.6 % (95 % CI 79.9–92.5) and RFS is 73.2 % (95 % CI 64.7–80.0). On multivariate analysis tumor grade was predictive of RFS (HR 2.9, p < 0.04) and OS (HR 9.4, p < 0.02). ConclusionsThis study confirms the excellent outcome for patients with early stage EOC. Histological grade of tumor is a significant predictor of OS and RFS. FSS is feasible in selected patients with early EOC.

S1952 An Unexpected Presentation of Synchronous Malignancies

S1952 An Unexpected Presentation of Synchronous Malignancies

Cervical metastasis masquerading as Kimura disease in a patient with nasopharyngeal carcinoma

Aim: To highlight the challenges involved in the diagnosis and management of synchronous tumours. A synchronous head and neck lesion brings the attending physician into a quandary, as there is no gold standard for managing such patients. Failure to respond to treatment should provoke physicians into considering other possible diagnoses, as often a secondary lesion may be the hidden culprit. Case report: Herein, we present a case of a synchronous cervical mass: Kimura disease and nasopharyngeal carcinoma in a 48-year-old woman. She was initially treated for Kimura disease based on fine-needle aspiration cytology evidence, and later found out to have a synchronous malignancy in the fossa of Rosenmüller. Failure of Kimura disease to respond to steroid treatment led to a repeated examination, which resulted in the diagnosis of nasopharyngeal carcinoma. The patient was treated with concurrent chemoradiotherapy. Conclusion: Kimura disease, a rare benign head and neck tumour, is treated successfully with steroids. Persistent swelling coupled with treatment failure should alert physicians to repeat patient assessment, as improper disease management leads to severe complications.

A Descriptive Study of the Types and Survival Patterns of Saudi Patients with Multiple Primary Solid Malignancies: A 30-Year Tertiary Care Center Experience.

Background and Objective: Cancer survival has improved significantly, which reflects the achievements in screening, diagnosis, and treatment. As a consequence, multiple primary malignancies are diagnosed more frequently, with an incidence ranging from 0.52–11.7%. The types of malignancy that coexist and survival patterns vary notably in different countries and geographical areas. Due to the limited literature in Saudi Arabia, a baseline of prevalent malignancy combinations and their survival patterns would support early detection and disease management. Method: This was a retrospective descriptive study conducted from 1993–2022 at King Abdulaziz Medical City, Department of Medical Oncology, Riyadh, Saudi Arabia. Patients with at least two biopsy-proven solid malignancies were included. Patients with hematological malignancies, missing data, or an uncertain or indecisive pathology report were excluded. Result: In total, 321 patients were analyzed. More than half (57.3%) of the patients were female. A third (33%) of the cases were synchronous, and 67% were metachronous. The most frequent site of the first primary malignancy was breast cancer, followed by colorectal, skin, and thyroid cancers. The most frequent site of the second primary malignancy was colorectal cancer, followed by thyroid, breast, and liver cancers. Only 4% of the cases had a third primary malignancy, with colorectal and appendiceal cancers being the most frequent. The most frequently observed histopathology in the synchronous and metachronous malignancies was adenocarcinoma. Breast–colorectal, breast–thyroid, and kidney–colorectal were the most frequently observed malignancy combinations. Conclusion: The current study offers a baseline of multiple primary malignancies in Saudi Arabia and provides supporting evidence that the pattern of multiple primary malignancies varies among different countries and ethnicities. The possibility of developing another primary malignancy should be considered when treating and monitoring cancer patients.

A Sordid Tale of Bile and Bowel

Synchronous tumors of gall bladder and colon cancer are rare, and the underlying genetic, environmental, and immunological factors could play a role in the development of such tumors. Till date, only a few cases of synchronous gall bladder and colonic malignancies have been reported. A 60-year-old lady presented with sub-acute onset of colicky pain in the abdomen and vomiting. Imaging showed the presence of thickening in the ileocecal junction along with a thickened gall bladder. A provisional diagnosis of gall bladder tumour with ileocecal tuberculosis or a synchronous colonic malignancy was made. Laparotomy revealed synchronous tumors in the gall bladder and caecum. Radical cholecystectomy with radical right hemicolectomy was performed. The final histopathology report confirmed the presence of two independent malignancies. A tailored treatment approach for both sites based on clinical findings and anticipated outcomes must be considered. Further immunohistochemical studies must be conducted to confirm the presence of dual malignancies. Metastases from one site to the other should be ruled out.

An Ordeal of Multiple Pathologies in a 45-Year-Old Homemaker in a Developing Country

Globally, breast cancer is the most frequently diagnosed cancer in females and a leading cause of cancer death. On the other hand, cervical cancer is the fourth most common cancer among females worldwide. In the less developed countries, it is the second most diagnosed cancer and third leading cause of cancer death in women. Synchronous malignancy of the breast and cervix is rare due to different etiological factors. Comorbidities such as hypertension and diabetes are frequent findings in patients with cancer. In a study in this environment, diabetes mellitus was the second most common comorbidity in the elderly cancer patients. This is the case report of a 45-year-old homemaker with cervical cancer and incidental finding of a synchronous breast cancer.

An exceedingly rare simultaneous incidental occurrence of synchronous primary malignancies; Invasive Ductal Carcinoma and Renal Cell Carcinoma in a male - A Case Report.

Introduction and importanceSynchronous malignancies are defined as the emergence of one or more tumors which either occur simultaneously or within 6 months of each other. Populations older than 50 years of age are the most vulnerable. Documented prevalence rates of synchronous neoplasia are 4.5–11.7 %. To the best of our knowledge, ours is the first documented case of synchronous primary incidental occurrence of Invasive Ductal Carcinoma (IDC) and Renal Cell Carcinoma (RCC) in a Middle Eastern male. This type of co-occurrence must be borne in mind because such neoplastic occurrence is potentially fatal. Documentation is essential to raise awareness and to decrease the resultant morbidity and mortality.Case presentationWe present a case of a 61-year-old male who presented to our clinic with a 22-day-history of gradual, painless, and disproportionate hypertrophy of his left breast. CT scan revealed incidental breast and right kidney masses. Therapeutic intervention included a modified radical mastectomy with Sentinel lymph node excision along with right radical nephrectomy.Clinical discussionTreatment of our patient was multimodal. Accurate radiological studying together with clinical examination helped us in making a diagnosis. Treatment options for this pathology consist of a combination of surgery and/or adjuvant therapy.ConclusionSynchronous IDC and RCC are an extremely rare co-occurrence, especially in males, particularly Middle Eastern males, and more specifically, those presenting asymptomatically as incidental findings. It is vital to further document and study such cases to establish innovative surgical techniques, screening modalities for males, and to overcome the consequential morbidity and mortality.

Double Primary Malignancies Involving Cutaneous Carcinoma.

Multiple primary malignancies (MPMs) refer to the presence of 2 or more histologically distinct malignant tumors in the same individual. The prevalence of MPMs has increased owing to earlier detection of tumors by screening tests and improved treatment modalities for primary tumors. Although any combination of malignant tumors is possible, reports of MPMs involving cutaneous carcinoma are uncommon in the literature. Herein, we present 2 uncommon cases of synchronous double primary malignancies involving basal cell carcinoma and primary cutaneous mucinous carcinoma as the index tumors, accompanied by a thyroid carcinoma and a thymoma as the second malignancy, respectively. The authors also describe the usefulness of positron emission tomography/computed tomography for detecting occult primary tumors in patients with cutaneous malignancies.

Soft Tissue Sarcoma in a Malignancy Prone Patient: An Update

It is possible to encounter a patient who might have more than one type of a primary malignant tumor. The literature supports increasing tendencies for subsequent development of malignancies within same individual. A case example of a young woman is given who was diagnosed with a pleomorphic Liposarcoma, while she is been followed up for metastatic ductal breast carcinoma and with a past history of treated acute lymphoblastic Leukemia. As per our review, various associations of malignant conditions are encountered, but are more likely to be metachronous rather than synchronous. The duration between diagnosing a second and third malignancy tends to be relatively short. Soft tissue sarcoma as a synchronous malignancy has been shown to be associated with breast cancer more often. Patients diagnosed with new subsequent malignancy including soft tissue sarcomas must be managed holistically and with full measures; as per current data, their prognosis is not necessarily poorer than regular cancer patients.

The role of high-risk features in stage II colon cancer after surgical treatment

BackgroundA proportion of patients ⁎Given his role as Editor of this journal, Patricio B. Lynn had no involvement in the peer-review of this article and has no access to information regarding its peer-review.with stage II colon cancer treated surgically will have either local or distal recurrence; this group is not well identified. High-risk features (HRF) have been proposed to aid in the determination of which patients would benefit from additional treatment and surveillance. In this study, we analyzed the relationship between HRF in resected stage II colon cancer patients and long-term outcomes. MethodsA single institution colorectal database from 2011 to 2017 was queried and patients undergoing resection for stage II colon cancer were included. Analyzed HRF included: lymphovascular invasion, perineural invasion, tumor perforation, differentiation, and T4 status. Patients younger than 18 years, synchronous malignancy, inflammatory bowel disease, or rectal cancer were excluded. Statistical analysis included frequency testing and regression modeling for recurrence and survival. ResultsOf the 165 included patients; 108 (65%) presented with at least one HRF. Overall 28 patients (17%) received adjuvant chemotherapy (ACT) Disease free survival (DFS) was 89% at 3 years; there was no significant difference in DFS between patients with or without HRF. On univariable analysis, only the presence of T4 tumor and older age were associated with worse DFS. Neither the presence nor number of high-risk features significantly affected overall survival (OS). ACT did not significantly affect OS or DFS in patients with or without HRF. ConclusionsIn this cohort of stage II colon cancer patients, only T4 tumor status and older age were associated with worse DFS, while OS was similar between low- and high-risk groups. ACT was under-indicated and did not significantly affect DFS or OS. Improved risk-stratification strategies are necessary for this special population.

18F]FDG-PET/CT improves the detection of synchronous malignancies at primary staging of oral squamous cell carcinoma – A retrospective study

The purpose of this study was to show the non-inferiority of [18F]FDG-PET/CT compared with panendoscopy with regards to secondary malignancies of the UADT, and to evaluate the diagnostic performance of PET/CT for detecting synchronous malignancies.Patients with newly diagnosed OSCC and both panendoscopy and [18F]FDG-PET/CT at primary staging were enrolled in this retrospective study. The accuracy in detecting synchronous malignancies was assessed for both modalities, and their diagnostic measures for the detection of malignancies within the UADT were compared. Histopathological analysis and clinical follow-up served as reference standards.In total, 182 patients were enrolled in this study. Eighteen patients (9.9%) had in total 22 synchronous malignancies, of which eight were located within the UADT. [18F]FDG-PET/CT detected all malignancies within the whole body (sensitivity: 100%) and yielded false-positive results in four cases (specificity: 97.6%). Sensitivity ([18F]FDG-PET/CT: 100% vs panendoscopy: 87.5%), specificity (99.4% vs 100%), negative predictive value (100% vs 99.4%), and positive predictive value (88.9% vs 100%) for detecting secondary UADT malignancies did not differ between modalities (all p = 0.32).Within the limitations of the study it seems that [18F]FDG-PET/CT detects synchronous malignancies of the UADT with an accuracy comparable to panendoscopy, and enables highly sensitive whole-body tumor screening in patients with newly diagnosed OSCC. This could be a relevant factor for therapeutic decision making in clinical routine.

Synchronous Clear Cell Renal Carcinoma And Bilateral Invasive Duct Carcinoma Breast- Rare association

Occurrence of multiple primary malignant tumors is very uncommon .Co occuring tumors can be synchronous or non synchronous.Tumors presenting within a period less than or equal to 6 months are called synchronous and if they occur after 6 months they are termed as metachronous. Synchronous malignancies are rarer than metachronous. For defining tumors as synchronous both the tumors should show criteria of malignancy, possibility of metastasis must have been ruled out and both the tumors should be pathologically distinct. Breast cancer is the commonest tumor to be associated with other malignancies such as colorectal, endometrial, ovarian carcinoma, yet occurrence of invasive ductal carcinoma with clear cell renal carcinoma is rare. We present a 70 year old female with synchronous Breast carcinoma and Renal clear cell carcinoma .

Phase II trial of perioperative chemotherapy of esophageal cancer: PIECE trial.

4038 Background: Neoadjuvant chemotherapy followed by surgery (NAC-S) is the standard therapy for locally advanced esophageal squamous cell cancer (ESCC) in Japan. The aim of this phase II trial was to assess the efficacy and safety of the addition of adjuvant S-1 after R0 resection in patients treated with NAC-S. Methods: Key eligibility criteria were as follows: ESCC of clinical stage IB-III (without T4 disease); aged 20 to 75 years; ECOG performance status 0 or 1; and performed neoadjuvant chemotherapy (5-FU + cisplatin). All patients registered before surgery. Patients received adjuvant therapy with 4 cycles of S-1 (80 mg/m2/day) that is administered orally for 4 weeks of a 6-weeks cycle. The primary endpoint was three-year relapse free survival (RFS). Results: A total of 52 patients were enrolled between January 2016 and January 2019. Two patients (one with small cell carcinoma and the other with synchronous malignancy) were excluded from analysis. Five patients were diagnosed as R1 or R2. Seven patients did not receive adjuvant S-1 due to adverse events of surgery in 5 patients, refusal to adjuvant S-1 in a patient, and forgot to start in a patient. Thirty-eight patients received adjuvant S-1, with 32 patients completing 4 cycles. The median relative dose intensity of adjuvant S-1 was 85.8%. Median follow-up time among survivors after surgery was 4.5 years (range 0.2-5.6). Three-year RFS in intention to treat population was 72.3% (90% confidence interval [CI] 59.9-81.5), suggesting that the primary endpoint was met, and 3-year overall survival was 85.0% (90% CI 73.9-91.6). Grade 3 or higher adverse event with an incidence 10% of greater were neutropenia (13.2%), anorexia (13.2%), and diarrhea (10.5%). There was no treatment-related death. Conclusions: Adjuvant S-1 showed promising efficacy with manageable safety profile for patients with resectable ESCC after NAC-S, and warrants further evaluation in larger studies. Clinical trial information: UMIN000020204.

Double Trouble – Synchronous Primary Malignant Neoplasms: A Case Report

Synchronous primary malignancy (SPM) is rare. We herein present a case of gastric carcinoma (GC) and renal cell carcinoma (RCC) to highlight the fact that the occurrence of RCC as a synchronous tumor along with GC is rare and that a high index of suspicion of SPM should be considered before declaring it as a metastasis. A 60-year-old male presented with abdominal pain and vomiting for 4 months, and a mass was incidentally found in the lumbar region. The patient was diagnosed with SPM of the GC and RCC. Chemotherapy was given, followed by total gastrectomy; radical nephrectomy was performed. The patient is currently on follow-up. Complete history taking and thorough physical examination of patients with malignancy is instrumental in ruling out metastasis and other synchronous lesions, especially in GC. Synchronous malignancies should be treated with the multidisciplinary team, as there is no consensus in the treatment protocol

Quadruple Primary Malignancy of the Scalp, Colon, and Prostate in a Single Patient: A Unique Case Report and Review of Literature

Multiple primary malignancies are rare but early detection can be achieved with the advent of advanced imaging techniques. Diagnosis of all synchronous malignancy is vital for planning and favorable outcome. In this study, we present a case of synchronous triple primary malignancy consisting of squamous carcinoma scalp, adenocarcinoma prostate, and adenocarcinoma ascending colon with history of sigmoid colon cancer 11 years back. There were 12 possible treatment options and three alternative treatment sequences. Multidisciplinary tumor board team decided to begin the treatment with hormonal therapy (Enzalutamide/Leuprolide) for advanced metastatic prostate cancers. This was followed by simultaneous surgery consisting of wide excision of the right scalp lesion and right hemicolectomy. After a year of follow-up, patient remained disease progression free. This is the first quadruple malignancy case described in literature with the combination of scalp, prostate, and colon cancers as triple synchronous malignancy. Each cancer had its own diagnostic and treatment dilemma. Collectively, sequence of management of each cancer was also a predicament. Multidisciplinary management plays a pivotal role in the successful management of synchronous malignant tumors.