BackgroundSalivary ductal carcinoma (SDC) of parotid gland is a rare and aggressive entity; accounting for 1–3 % of all malignant salivary gland tumors, 0.2 % of epithelial salivary gland neoplasms, 0.5 % of salivary gland carcinomas, and 1.1 % of parotid gland carcinomas. Here in we aimed to evaluate the clinico-pathological features and treatment outcomes of parotid gland SDC in Saudi population.MethodsAmong 38 patients with parotid malignancies, who were treated in two major tertiary care referral cancer centers between December 2007 and December 2014, seven cases (18.4 %) were found to have SDC, which were investigated for clinicopathological features, locoregional recurrences (LRRs), distant metastasis (DM) and survival rates.ResultsMean age of cohort was 62.3 years (range: 41–83) and female predominant (71.4 %). All patients underwent total parotidectomy and ipsilateral neck dissection. Mean tumor size was 3.4 cm (range: 2.1–5.3); perineural invasion (85.8 %); lymph node involvement (42.9 %); and HER-2 neu overexpression (28.6 %). Postoperative radiation therapy (PORT) was given to six patients (dose: 50–66 Gy). Median follow-up was 20.2 months (range: 11–48). LRRs were seen in five (71.4 %) patients (base of skull, 3 patients; cervical nodes, one patient; parotid bed, one patient). LRRs were salvaged with resection (two patients) and re-irradiation (one patient with base of skull). DM in lungs was seen in three patients (42.8 %); one treated with carboplatin/paclitaxel based chemotherapy. The 4-year disease free and overall survival rates were 16.7 % and 40 % respectively.ConclusionSDC of parotid gland is a rare and aggressive entity, and most of LRRs were seen in the base of skull, which warrants inclusion of base of skull in clinical target volume in PORT planning. Role of anti HER-2 targeted therapy in SDC with HER-2 neu overexpression needs further investigations.
Introduction:Spinal cord compression secondary to extramedullary hematopoiesis (EMH) is a rare condition. Variable treatment options have been reported with different efficacy and recurrence rate. Due to its rarity, no clear optimal management guidelines have been established yet.Patient concerns and diagnosis:We report a recurrence of spinal cord compression secondary to EMH in a 19-year-old male, with a background of transfusion-dependent beta-thalassemia on luspatercept, who presented with weakness in both lower limbs.Interventions and outcomes:He was treated successfully both times with radiotherapy.Conclusion:Early diagnosis and management of EMH compressing the spinal cord are essential to prevent permanent neurological damage. Diagnosis should be suspected based on the clinical presentation and magnetic resonance imaging findings in a patient with a history of ineffective hemopoiesis. Treatment option remains controversial. Radiotherapy option seems effective, even in recurrent cases, and valid, particularly for those at high risk of surgery or who do not prefer it.
The control of bleeding is of paramount importance in the management cancer patients. This study was undertaken to explore the outcomes after hemostatic radiation therapy (HRT) in advanced stage malignancies presenting with bleeding. Materials/Methods: Patients treated by HRT between 2014 and 2015 were analyzed retrospectively after obtaining approval from the Institutional Review Board. The degree of bleeding was assessed per the World Health Organization (WHO) scale (grade 0 Z no bleeding, 1 Z petechial bleeding, 2 Z clinically significant bleeding, 3 Z bleeding requiring transfusion, 4 Z bleeding associated with fatality). Our primary endpoint was bleeding at the end of radiation therapy, while the secondary endpoint was acute toxicity. Comparison was made for the bleeding scale before and after HRT using the Wilcoxon signed rank test. Results: A total of 28 patients with advanced malignancies that presented with bleeding were analyzed. Median age was 59 years (range, 30 e 92 years). Before treatment with HRT, bleeding was recorded as grade 2 in 15 (53%) and grade 3 in 13 (47%) patients. A median dose of 20 Gy (range, 8e40 Gy) of HRT was used to stop the bleeding. At the end of HRT, the results were promising with a statistically significant difference in bleeding (p < 0.001). Post HRT bleeding score was recorded as grade 0 in 68% (n Z 19), grade 1 in 21% (n Z 6), grade 2 in 7% (n Z 2), grade 3 in 4% (n Z 1) and grade 4 in none (n Z 0). An improvement was also noted in the median hemoglobin, which improved from 9.05 g/dL pre-HRT to 10.0 g/dL post-HRT. The median follow-up in our study was 1 month (range, 1 e 5 months), since most of the patients were discharged after palliative radiation therapy. Toxicity profile was reasonable with no grade 3 or above acute toxicity being observed in the study. Conclusion: HRT appears to be a safe and effective treatment modality for securing hemostasis in clinically bleeding patients.
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