Primary Diffuse Large B cell Lymphoma of the Uterus: A Case Report and Literature Review

Carcinoma of the esophagus is among the most rapidly increasing cancers in incidence. With the use of aggressive bimodality and trimodality treatment strategies, the reduction of treatment toxicity is of prime importance [1]. Radiotherapy plays a key role in definitive, adjuvant and neoadjuvant treatment for carcinoma of the esophagus. Due to extensive vascular and lymphatic drainage, and therefore tendency to present at an advanced stage, the volumes required to adequately cover gross disease are substantial. Other critical organs in close proximity are therefore at risk for radiotherapy-induced toxicity, including the lung parenchyma, heart, spinal cord, stomach and others. Conventional 3D conformal radiotherapy techniques (3 field or 4 field) have traditionally been used at our center to provide adequate coverage to the target volume of the esophageal tumor and lymph nodes; however as a consequence doses delivered to these Organs At Risk (OARs) may be high. Intensity Modulated Radiotherapy (IMRT) and Volumetric Arc Radiotherapy (VMAT) has also been considered in the past, however comparisons of these plans have shown variable results in normal tissue sparing. Furthermore these techniques may impart a higher volume of low dose radiotherapy to substantial amounts of normal tissue. We compared conventional 3D CRT plans with IMRT or VMAT plans for a series of esophageal cancer patients with tumors of varying location at our center to determine the optimal treatment planning strategy.

Background: The factors affecting survival were evaluated in patients aged ≥ 70 years with Non-Small Cell Lung Cancer (NSCLC) treated with definitive Radiotherapy (RT).

Methods: Between January 1996 and April 2012, 52 patients were treated. The median age was 73 (range 70-80) and 73% and 75% of patients with stage III according to AJCC 2002 and AJCC 2010 staging, respectively. Radiotherapy was performed median 6160 cGy (range: 3600-6660 cGy) and CHE were given 75% of the patients.

Results: Median follow-up was 12.5 (range: 2.5-103) months. Median overall (OS) and Disease-Free (DFS) Survival were 22 and 18.5 months, respectively. Radiotherapy related death was not observed. In Univariate analysis; AJCC 2002 stage I-II, RT dose, RT duration, for OS and RT dose, RT duration, neoadjuvant CHE ≤ 3 cycles, complete response, ≥ 4 cycles of CHE for DFS were significant (p <0.05). In multivariate analysis, RT duration > 49 days related with higher RT dose (≥ 60 Gy) were found a positive impact on OS (HR: 3.235, 95% CI: 1:25 to 8:32 p = 0.01).

Conclusion: In our study, elderly patients with NCSLC can be given ≥ 60 Gy without complications and was seen positively impact on survival.

High-Grade Gliomas (HGG) are the most common and aggressive primary brain malignancies in adults. Fractionated Stereotactic Radiotherapy (fSRT) and Stereotactic Radiotherapy (SRS) have emerged as a novel technique to deliver high doses of RT in the recurrent setting with aim for durable local control and potential overall survival benefit. This study evaluated the patterns of recurrence, prognostic indicators as well as the efficacy of treatment in patients with recurrent HGG treated by fSRT or SRS. Favorable outcomes were observed in patients treated with fSRT and SRS as salvage therapy. The predominant mode of failure post salvage SRS and fSRT remains in-field. Prospective trials are required to better define patient selection, tumor recurrence size, and effective dose regimen.

Radiation therapy is used for adjuvant therapy on patients with recurrence or lymphadenectomy in the malignant melanomas. Treatment is used for palliative on metastatic patients. Between 1996 and 2017, 35 patients who received adjuvant radiotherapy and 55 patients who received palliative radiotherapy were retrospectively analyzed. Of the 90 patients included in the study, 56 (62%) were men and 34 (38%) were women. Mean age of patients was 63 years (age range: 22–95 years). For all patients, the overall survival time was 32.23 months (95% CI, 16.8–47.6). As an adjuvant therapy, 48 Gy (hypofractionated) radiotherapy was used in 4 patients and 50-66 Gy radiotherapy was used in 31 patients. Overall survival in these patients was 66.14 (95% CI 36.6-95.6) months. Mean metastases that occur in patients is 37.19 months (range: 2-138 months), which are 37 (41%) patients in the brain, 12 (13%) patients in the bone and 6 (7%) patients in the non-regional lymph node metastasis. 20-30 Gy radiotherapy was used for metastasis treatment. Overall survival in brain metastasis, bone metastasis and lymph nodes metastatic patients were 4.22 (95% CI 2.62-5.82), 7.6 (95% CI 1.14-14.05) and 7.33 (95% CI 0-15.03) months respectively. Although, the regional nodal disease can be favorably controlled with lymphadenectomy and radiotherapy, the risk of distant metastases and the risk of disease-related death are high. In addition, metastasis-related symptoms (particularly pain) can be controlled by radiotherapy.

Purpose: To report the survival benefit of Radiation Therapy (RT) in Leptomeningeal Carcinomatosis (LMC) patients with different primary cancers and to identify the factors of LMC patients that had survival benefit from Whole Brain Radiation Therapy (WBRT).

Methods and Materials: Systematic literature review was performed. Search terms included ‘Leptomeningeal’, ‘prognostic factors’ and ‘lung’ or ‘breast’. Literatures were included if patient profile was reported. Specifically, age, median survival, diagnosis time line, type of cancer, received treatments, performance score, and systemic disease were sought after. Literatures were excluded if they were a) case reports, b) written in language other than English, or c) not including patient profile.

Results: RT treatment has survival benefit for LMC patients with CSF obstruction. For LMC patients with primary breast cancer, 7 studies were found since 1991 that met searching criteria. Factors which would allow breast cancer-caused LMC patients to benefit from WBRT with survival are identified with statistical significance. They include KPS>60, Intrathecal (IT) chemotherapy, systemic therapy, hormonal receptor status and severity of systemic disease. Patients who met aforementioned criteria and received WBRT had longer median survival (17 weeks vs. 11.9weeks, p=0.015). Similarly, 10 studies were found that met searching criteria for Non-Small Cell Lung Cancer (NSCLC) caused LMC. Beneficial factors for NSCLC-caused LMC are identified. They include IT chemotherapy, KPS > 60, and EGFR TKI treatment. Patient who met these criteria had longer median survival when received WBRT (17.6 weeks vs 12.2 weeks, p = 0.0412).

Conclusion: Profiles of LMC patients that can benefit with longer survival by receiving WBRT are identified for breast cancer and NSCLC. Algorithms in identifying such patients are provided.

Background and objectives: Combined chemo radiation is the standard of care for treatment of squamous cell carcinoma of the anal canal. Our objective was to analyze the treatment results of patients with squamous cell carcinoma of the anal canal treated at our institution.

Methods: We identify patients with confirmed diagnoses of anal canal squamous cell carcinoma treated in our institution (KFSHRC), Riyadh between1994-2017. We retrospectively reviewed their pattern of recurrence and survival rate.

Results: 35 males (70%) and 15 females (30%) were identified. Median age at diagnosis was 58 years. 5(10%) patients underwent initial Abdomino Perineal Resection (APR) while 45 patients (90%) received definitive concurrent chemo radiation (30 using 2D/3DCRT and 15 patients using IMRT). All patients completed their planned treatment course except 4 patients (in 2D/3DCRT arm). IMRT resulted in significant decrease in all toxicity grades in comparison to 2D/3DCRT arm (p value 0.035). After median follow up of 13months, two out of the 5 patients (40%) who underwent initial APR had local recurrence; while after 18 months median follow up 8(19.6%) patients who underwent definitive chemo radiation had local recurrence. The 2 and 5 years Disease Free Survival (DFS) were 79.4% and 53% respectively in IMRT group vs 64% and 55% respectively in 2D/3DCRT group (p value 0.79). Regarding Overall survival (OS), the 2 and 5 years OS were 82% and 41% respectively in IMRT vs 66% and 44% respectively in the 2D/3DCRT group(p value 0.36). In Univariate analysis, only number of chemotherapy cycles was statistically correlated with DFS and OS with (p value of 0.02 and <0.0001) respectively.

Conclusion: Combined chemo radiation therapy for anal canal squamous cell carcinoma is effective treatment in term of local control and survival. The recurrence and survival pattern of our patients’ cohort compare favorably to the international results. Radiation therapy using IMRT resulted in significant decrease of all toxicity grades over 2D/3DCRT, with improvement of the 2 years DFS and OS in comparison to the 2D/3DCRT although it was not statistically significant. In Univariate analysis initial Hb level was not significantly correlated with DFS or OS at 5 years, only number of chemotherapy cycles was statistically correlated with survivals at 5 years

The objective of this study is to evaluate early side effects, local control and early response rates of adjuvant or definitive radiotherapy and/or chemo radiotherapy in patients diagnosed with cervical cancer and treated in our clinic. Twenty-one patients who were admitted to our clinic with a diagnosis of stage IB-IVA cervical cancer between January 2017 and November 2018 were included in the study. Adjuvant radiotherapy was performed in 1 patient (5%), adjuvant chemo radiotherapy in 3 patients (14%) and definitive chemo radiotherapy in 17 patients (81%). All patients received intracavitary brachytherapy after radiotherapy. Median follow-up period is 13 months (range: 5-23 months). 12 patients (57%) had a complete response, in 7 patients (33%) had the partial response and in 2 patients (10%) had no response to treatment. 1 (5%) patients who did not respond to the treatment had died. One patient (5%) had lung metastasis, 1 (5%) patients had breast cancer as the second primary. Cystitis and diarrhea were the most common early side effects of radiotherapy. 8 patients (38%) had grade II diarrhea and cystitis and 2 patients (10%) had grade III diarrhea. Nine patients (43%) who received concurrent chemotherapy had grade II-III neutropenia as hematological toxicity. None of the cases had grade IV toxicity. In conclusion, concurrent radio chemotherapy or radiotherapy alone is the preferred treatment modalities in patients with adverse risk factors in stage ≥ IB cervical cancers because of high response rates and acceptable toxicity.

Nasal cavity and paranasal sinus tumors constitute 3-5% of the upper respiratory tract tumors, 0.2-0.8% of all tumors. Tumors are located approximately 40-50% in the nasal cavity, 30-40% in the maxillary sinus, 10% in the ethmoid and frontal sinuses and 5% in the sphenoid sinuses. Sixty Two patients who were admitted to our clinic with a diagnosis Nasal cavity and paranasal sinus tumors between January 1997 and December 2018 were included in the study. There were 28 (44%) females and 34 (55%) males, for a ratio of 1/1.2. Median age at presentation was 59.4 (range 32 to 87) years. The mean overall survival 59.7± 7 (95% Confidence Interval (CI), 41.3-79.6) months and the median overall survival 38 ± 7 (95% CI, 24.4-49.6) months. The -1, -3 and -5 year overall survival rates were 72.2 %, 51.4 % and 34.6% respectively. The mean disease-free survival 77.4± 8 (95% CI, 51.4-86.1) months and the median disease-free survival 36± 8 (95% CI, 7.65-78.5) months. The -1,-3 and-5 year DFS rates were 69.8%, 49.1% and 39.9% respectively. On Univariate analysis, the OS was significantly better with female sex (p<0.005), < 50 age (p<0.021), T stage (p<0.0001), the absence of lymph node involvement (p<0.0001). In conclusion, PNS/NC is a rare group of cancers. Surgical resection followed by PORT is an effective treatment. RT increases tumor control rate. Local recurrence was the main common cause of failure followed by distant metastasis and regional relapse of the lesions.

Though rare, angiosarcomas are one of the most common tumors to arise following radiation therapy for the treatment of malignancies, such as breast cancer and Hodgkin’s lymphoma. Investigation of radiation-associated angiosarcomas has always proven difficult due to the extremely low incidence. This means that case studies are the predominant type of investigation found in the literature. Breast cancer treatment can lead to chronic lymphedema due to the dissection of axillary lymph nodes, as well as radiation treatment, often following conservative breast surgery. Due to these risk factors, breast cancer patients are at an increased risk of development of angiosarcoma. We present a case of breast angiosarcoma that developed after radiation therapy for breast ductal carcinoma. In this case, there were multiple metastases and recurrences in the involved breast, as well as development of angiosarcoma in the opposite breast. We also provide a brief review of the literature.

Introduction : Throughout history it has been proven that electromagnetic fields at uncontrolled levels can be harmful to health. The Computerized Axial Tomography (CT) is a high electromagnetic field generator. In TAC areas where workers are exposed to these radiations for extended periods of time, it is necessary to keep not only ionizing radiation under control, but also non-ionizing radiation.

Goals: Carry out magnetic field measurements in a CT area in a hospital in the city of Havana, compare them with international standards and check the state of the electromagnetic environment.

Methods: The magnetic field measurements were carried out using a gaussmeter located one meter above the floor level and punctually meter by meter. To verify the state of the environment, the recommendations of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) in 2010 were used as a point of comparison.

Results: The results showed values below those recommended by the ICNIRP, but very close to those provided by some authors as causing leukemia.

Conclusions: It was concluded that the non-ionizing radiation values obtained in µT do not exceed those recommended by this commission, with respect to occupational exposure, but strict surveillance must be maintained.