The possibility of multiple primary malignancies should always be considered during the treatment and follow-up of cancer patients. This case series could prove helpful to clinicians faced with similar, however, exceedingly rare scenarios. Due to the realistic potential for long-term survival, we recommend aggressive treatment of these patients.
BackgroundThe aim of this report is to address treatment outcomes of patients with early-stage seminoma in a single institution with special reference to patients with history of surgical violation of the scrotum.MethodsSeventy four patients with pure seminoma were treated at King Hussein Cancer Center (Amman, Jordan) between 2003 and 2010. All patients underwent orchiectomy. All but 3 patients received adjuvant radiotherapy. Patients who underwent surgical violation of the scrotum prior to referral were managed by further excision or irradiation of the scrotal scar. The follow-up ranged from 1 to 200 months (mean, 33 months).ResultsAt the time of follow-up; all but one patient remain alive. The 3-year relapse-free survival for the entire cohort was 95.9%. Three patients developed relapse, all of whom received adjuvant irradiation following inguinal orchiectomy and initially harbored tumors larger than 4 cm upon pathological examination. Median time to relapse was 14 months (range, 8–25 months). None were associated with elevated tumor markers prior to detection of relapse. All but one patient were successfully salvaged by chemotherapy.ConclusionsOur results confirm the excellent prognosis of patients with early-stage seminoma treated by orchiectomy and adjuvant radiotherapy in a developing country. Although all patients who developed relapse demonstrated adverse pathological findings upon initial assessment, no consistent predictor of relapse was found. Scrotal scar re-excision or irradiation in patients with prior history of surgical violation of the scrotum are effective measures in preventing local failure.
The incidence of multiple primary malignancies has increased over the past years secondary to the long-term survival of cancer patients due to improvements in the early detection and adequate treatment of cancer. We present a patient with eight primary malignant tumors and review the relevant literature. Our patient was a 59-year-old female with Crohn disease with an otherwise non-contributory medical history. Risk factors for multiple primary tumors were not detected in our patient. At a follow-up of 108 months from the time of diagnosis of the first malignancy, our patient was still alive. Similar long-term survival has been reported in the literature. Due to the realistic potential for long-term survival, we recommend aggressive treatment of these patients.
Palbociclib is a selective CDK4/6 inhibitor approved for metastatic ER+/HER2-breast cancer. Preclinical evidence suggests palbociclib can augment radiotherapy (RT) antitumor effect by 1) preventing cell cycle progression from G1 to the more radioresistant S phase and 2) inhibiting RT-induced DNA double-strand break repair. Despite this potential benefit, clinicians seldom use this combination due to fear that RT may exacerbate palbociclib toxicity, particularly hematologic. The aim of this study is to report the preliminary results of this novel combination in patients with metastatic breast cancer. Materials/Methods: Records of patients treated with palbociclib at our institution from 2015-2018 were retrospectively reviewed. Patients who received RT for symptomatic metastases concurrently or within 14 days of palbociclib were included. Local treatment effect was assessed by clinical exam and subsequent CT/MRI imaging. Toxicity was graded based on CTCAE v5.0. Results: A total of 16 women (median age: 59.6 years) received palliative RT in close temporal proximity to palbociclib administration. Four patients received palbociclib prior to RT (25.0%), 5 (31.3%) concurrent, and 7 (43.8%) post-RT. The median interval from closest palbociclib use to RT was five (range 0-14) days. The following sites were irradiated in decreasing order of frequency: bone (15 axial skeleton [9-vertebra; 4pelvis; 2-other]; 3-extremity), brain (4: 3-WBRT & 1-fSRS), and mediastinum (1). The most frequently used RT dose/fractionation by was 30 Gy in 10 fractions. The median follow-up time is 14.7 (range 1.7-38.2) months. Pain relief was achieved in all patients. No radiographic local failure was noted in the 13 patients with evaluable follow-up imaging. Leukopenia, neutropenia, and thrombocytopenia were seen in 4 (25.0%), 5 (31.3%), and 1 (6.3%) patients before RT. Following RT, 5 (31.3%), 1 (6.3%), and 3 (18.8%) patients were leukopenic, neutropenic, and thrombocytopenic, respectively. All but two (Grade 2) hematologic toxicities were Grade 1. No acute or late Grade 2+ cutaneous, neurological, or gastrointestinal toxicities were noted. Toxicity results did not differ based on disease site or palbociclib-RT temporal association. Conclusion: The use of RT in patients receiving palbociclib resulted in minimal Grade 2 and no Grade 3+ toxicities. This preliminary work suggests that symptomatic patients receiving palbociclib may be safely irradiated without discontinuation of systemic therapy. Further studies with larger cohorts are needed to confirm these results.
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