Introduction. Angiosarcomas (AS) arising from vascular tissue, accounting for 3.3% of all sarcomas, have a poor prognosis. Radiation-induced AS is a rare late complication of radiotherapy treatment and is characterized by a gene expression profile such as amplification of the MYC oncogene, by which we can distinguish primary from the secondary induced tumor. Case report, At 77-year-old patient, with early-stage endometrial adenocarcinoma, the radical hysterectomy with bilateral salpingo-oophorectomy was initially done. According to pathological risk factors, the postoperative external beam conformal radiotherapy (CRT) of the pelvis was administered with concomitant brachytherapy. Six years after the treatment, on the anterior abdominal wall, in the region of the postoperative irradiation field and surgical scar, an infiltrative angiosarcoma of the skin and subcutaneous adipose tissue, was histologically confirmed. The patient received six cycles of mono-Adriamycin chemotherapy with verified partial regression. Additional immunohistochemical analysis (IHH) of c-MYC, Ki67 and CD34 expression showed a high proliferative index (Ki67 around 60%) and c-MYC positivity indicating the molecular pattern of radiation-induced AS. Furthermore, the high proliferative index could explain a good response to chemotherapy. Conclusion. The novel postoperative radiotherapy techniques provide better survival and local control in risk- endometrial cancer groups with a decrease of irradiation complications. These patients with longer survival, are in a higher risk of developing radiation-induced tumours as late side-effects of radiotherapy. When assessing the probability of radiation-induced AS, IHH analysis of c-MYC expression could distinguish secondary from others AS if Cahan?s criteria are fulfilled.
Introduction. Colorectal cancer is the third most common cancer and one of the leading causes of cancer-related deaths in men and women worldwide. The contemporary multidisciplinary approach has decreased rates of local recurrence and improved outcomes in metastatic colorectal cancer. We present a case of a primarily metastatic rectal cancer patient who underwent multidisciplinary planned treatment and showed complete response with now three years disease-free survival. Case outline. A 61-year-old female was diagnosed with a T4N2M1a rectal adenocarcinoma at the age of 58. She underwent six cycles of systemic chemotherapy capecitabine-oxaliplatin plus bevacizumab with partial response confirmed by diagnostic imaging procedures. According to multidisciplinary board decision, preoperative radiotherapy treatment was administered with concomitant Capecitabine-based chemotherapy. A 50.4 Gy total dose was delivered with 1.8 Gy fraction dose. After concomitant chemoradiotherapy treatment, two more cycles of systemic chemotherapy Capecitabine-Oxaliplatin plus Bevacizumab were administered. One month after completion of systemic chemotherapy, primary rectal cancer was operated with a complete response on histopathologic specimens. Six weeks following previous surgery, metastasectomy of lung deposits was performed; histopathology confirmed metastatic adenocarcinoma of colorectal origin. Three more cycles of postoperative chemotherapy capecitabine-oxaliplatin plus bevacizumab were administered. Conclusion. On regular follow-up, no evidence of disease was shown, with disease-free survival of three years. The treatment improved the patient?s quality of life.
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