Urachal carcinoma is a rare malignancy constituting <1% of bladder malignancies. The disease arises from a malignant transformation of rests of enteric epithelium in the urachus. Most common sites of metastasis are lung, liver, and bone. We report a postoperative case of urachal carcinoma presenting with distant metastasis to lung and skip lesions in colon. As both urachal and colon carcinoma share common histopathological features, most of the literature suggested using chemotherapy regimens similar to those recommended for colon malignancies. There are no randomized trials till date regarding the management of urachal adenocarcinomas except for the primary treatment being surgery.
BACKGROUND Single modality treatment for stage I and stage II squamous cell carcinomas of glottis region gave excellent results. Since a long time these are treated either with definitive radiation therapy or surgical excision with endoscopes. There was not much difference with regard to voice preservation, local recurrence and disease-free survival period. Our aim was to study the clinical presentation and management protocol of glottis carcinoma in a tertiary hospital and observe the final outcome of stage II (T2N0M0) glottis carcinoma and specific factor for survival in patients treated with surgery, radiotherapy and concurrent chemoradiation. METHODS 43 patients of glottis carcinoma stage II (T2N0M0) attending a tertiary teaching hospital between May 2015 and April 2017 were included in the study. Demography and smoking status of subjects were recorded. Staging of the disease was according to American Joint Committee on Cancer (AJCC) Staging System 7th edition. Paraglottic space infiltration was taken as a criteria to upgrade the staging. The overall survival rate, recurrence free survival, disease specific survival rate and laryngeal function preservation rate were calculated. RESULTS Out of 43 patients, males were 90.69 % and 09.30 % were females. Male to female ratio was 10.57 : 1. Mean age was 58.62 ± 2.35 years. 67.44 % were current smokers, 27.90 % were former smokers and 02.32 % were non-smokers. The overall survival scores and disease specific survival was 100 % with 11.62 % locoregional recurrences. The voice preservation was 86.04 %. Radiotherapy was used in 72.09 %, chemoradiation in 18.60 % patients and 11.62 % patients underwent surgery. 11.62 % patients presented with locoregional recurrence during 24 months of follow up. 02.32 % patients had to undergo tracheostomy. CONCLUSIONS The overall survival scores and disease specific survival were 100 % with 11.62 % loco-regional recurrence. Voice preservation was 86.04 %. Proactive prevention rather than escalation of treatment protocol gives better prognosis. KEYWORDS Glottis, Larynx, Supra Glottis, Sub Glottis, Squamous Cell Carcinoma, Chemo Radiation and Trans Oral Laryngeal Surgeries
BACKGROUND Cervical cancer is one of the commonest malignancies among women in India. The main stay of treatment is the combination of External Beam Radiation Therapy (EBRT) and Intracavitary Brachytherapy (ICBT) in these patients. We compared conventional point A based treatment planning and MRI based volume optimized planning in ICBT of cervical carcinoma along with doses to organs at risk in both plans. We also compared the radiation doses to organs at risk in both the plans by International Committee on Radiation Units (ICRU) recommended points and dose volume histograms. METHODS Eighteen Patients with cancer cervix (72.22% with stage IIB) received EBRT on linear accelerator by four field technique using 15 MV energy for a dose of 46 Gray (Gy) – 50 Gy in 23-25 fractions 2.0 Gy per fraction, five days per week, for 5 weeks to whole pelvis. Most of the patients received at least three doses of chemotherapy. A total of 50 high-dose rate intracavitary brachytherapy (HDR-ICBT) applications done in 18 patients were used for analysis in the study. Clinical history, gynaecology examination and punch biopsy were undertaken. The patients were assessed during EBRT after 2 weeks, for ICBT application and suitable patients were selected for the procedure. CT based point A planning and MRI based volume optimised planning were done for each ICBT application before intracavity brachytherapy. Contouring of rectum, bladder, right and left femoral heads, and small bowel were done. RESULTS The median age of patients in this study was 50.4 ± 03.25 years. 72.22% (13/18) of the patients were of stage IIB. The mean dose delivered to 90% high-risk clinical target volume (D90- HR-CTV) for all 50 applications by volume optimized planning was 06.87 ± 0.942 Gy. The mean D90-HR-CTV by point A based conventional planning was 13.69 ± 1.06 GY. The mean D100-HR-CTV by volume optimized planning was 05.30 Gy (± 0.20). The mean D100-HR-CTV by point A based conventional planning was 08.91 ± 0.74 Gy. Maximum doses in the bladder and rectum were significantly lower (p<0.05) for MRI planning than for the conventional approach (06.49 GY Vs. 07.45 GY) for bladder; (04.57 GY vs. 05.06 GY) for rectum respectively. Both bladder (D2cc) and rectum (D2cc) doses could be reduced significantly by volume optimization. CONCLUSIONS D90-HR-CTV adequately covered by MRI based volume optimized planning was superior to conventional point A based planning in terms of both conformity of target coverage and evaluation of Organ at Risk (OARs), including the rectum and bladder. Both bladder and rectum doses in the most irradiated 2cc volume are significantly reduced in volume optimized planning. Hence, volume optimized planning would be more beneficial in large volume diseases to get better target coverage at the same time sparing the organs in small volume diseases. Hence, the use of MRI-based volume optimization brachytherapy for patients with large volume tumours with parametrial invasion is beneficial. KEYWORDS Cancer, Cervix, Woman, Radiotherapy, Brachytherapy, EBRT, ICBT, Prognosis
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