The role of 131I-metaiodobenzylguanidine (MIBG) therapy in unresectable and compromising localised neuroblastoma

Purpose

In patients with localised neuroblastoma without adverse genetic aberrations, observational treatment is justified. Therapy is required when organ or respiratory functions have become compromised. As the outcome is good, side effects of treatment should be prevented. The aim of this retrospective study was to evaluate response and outcome in patients treated with ¹³¹I-metaiodobenzylguanidine (MIBG) for unresectable localised neuroblastoma, with compromised organ functions.

Methods

Patients with localised neuroblastoma [median age 1.6 years (0–5.5 years)] diagnosed between 1989 and 2008 were included in this retrospective study (n?=?21). Primary tumours were unresectable and there was a compromised organ or respiratory function. Diagnosis and staging were performed according to the International Neuroblastoma Staging System. Fixed doses of ¹³¹I-MIBG therapy (50–200 mCi) were given. The median number of infusions was two (range one to seven). Response was graded according to the International Neuroblastoma Response Criteria.

Results

Of the 21 patients, 14 did not need any chemotherapy. Patients were treated with ¹³¹I-MIBG therapy and, in most cases, with additional surgery and/or chemotherapy. Sixteen achieved complete response (CR), three very good partial response (VGPR), one partial response (PR) and one progressive disease (PD). Two patients died of PD after having achieved CR initially and due to surgical complications a few months after resection. Ten-year overall survival and event-free survival were 90.5 %. The median follow-up was 8.5 years (range 0.4–19.6 years).

Conclusion

¹³¹I-MIBG therapy is an effective treatment modality for unresectable localised neuroblastoma with compromised organ functions. However, this was a small and heterogeneous cohort and further studies are needed.     

A review of thirty-three cases of ovarian dysgerminoma emphasising the role of radiotherapy.

The records of 33 cases of ovarian dysgerminoma seen in Manchester between 1943 and 1977 are reviewed, including details of presenting features, age distribution, treatment and survival. The five-year survival rate is 85%. All the Stage I cases and all patients under the age of 20 years at presentation have survived. The cases of the five patients who died are analysed in detail. From this series and review of other series it is concluded that young patients with unilateral Stage I desease who have had a total resection should be carefully followed and radiotherapy reserved for recurrent disease. This does not appear to affect their high chance of cure and enable patients who remain disease-free to retain one functioning ovary. All other patients should have surgery followed by radiotherapy to the whole abdomen. Analysis of the five deaths suggested that, even in Stage III disease a surgical attempt should be made to remove the bulk of the tumour and that the abdominal radiotherapy dose should not be less than 3000 rad in 20 treatments in 28 days.     

Radiographic findings in tuberculosis of the calvarium

We reviewed the pattern of involvement of the calvarium by tuberculosis (TB) in five patients and the role of imaging in its management. Four patients presented with localised scalp swelling and one with generalized seizures. Radiographs revealed lucent lesions with minimal surrounding sclerosis in the frontal (2), parietal (2) and occipital (1) bones. CT showed lesions involving the entire thickness of the calvarium and accompanying contrast-enhancing soft tissue. The patient presenting with seizures had a ring-enhancing lesion in the parietal lobe in addition to the extra-axial lesions. Although radiographs in all cases demonstrated calvarial TB, CT showed the extent of the defect, involvement of adjacent soft tissues, and in one case an intra-axial lesion. Radiographs suffice for follow-up of these patients. Received: 23 July 1999 Accepted: 20 September 1999     

Laryngeal squamous cell carcinoma presenting as a prelaryngeal neck abscess: report of two cases

Head and neck tumours presenting as a neck abscess are extremely rare. Two patients with laryngeal squamous cell carcinoma, presenting with a prelaryngeal abscess, are described. Although clinically and on the CT studies these cases were suspect for underlying malignancy, the initial biopsies were negative for cancer. Because of persistent suspicion, repeat biopsies finally confirmed the presence of a squamous cell carcinoma. Pathological examination after total laryngectomy showed cancer localised in one of the true vocal cords, invading the anterior commissure and thyroid cartilage. However, the prelaryngeal soft tissues were free of tumour, showing only inflammatory changes and collections of pus. These cases emphasize the importance of repeat targeted biopsies and follow-up CT-studies in patients with a prelaryngeal abscess of obscure aetiology, in order to exclude or confirm a possible underlying malignancy.     

Intraoperative radiotherapy and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Purpose

Treatment of rectal cancer has markedly improved since the introduction of neoadjuvant strategies and better surgical techniques. However, treatment remains troublesome for patients with locally advanced rectal cancer (LARC) or with peritoneal carcinomatosis (PC). Patients presenting with LARC may now benefit from the integration of intra-operative radiotherapy (IORT) into multimodality treatment. Selected patients with PC now undergo cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) resulting in improved survival. Some patients present with locally advanced disease and synchronous peritoneal carcinomatosis and fulfill the eligibility criteria for both HIPEC and IORT, raising the question whether the combined application of both modalities within one operative procedure is feasible.

Case series

This report includes five consecutive cases of rectal cancer patients presenting with LARC and synchronous PC who were treated with a multimodality treatment including IORT and HIPEC after cytoreductive surgery. Postoperative complications and survival are described.

Results

The combination of cytoreductive surgery with HIPEC and IORT appeared to be feasible and well tolerated. The observed complications did not differ from the morbidity associated with extensive pelvic surgery without HIPEC or IORT. No inhospital mortality occurred. One patient died after 11 months of recurrent disease. All other patients are currently alive with one patient already surviving 38 months.

Conclusion

The current case series shows that a multimodality treatment containing IORT and HIPEC is feasible and safe with promising survival rates. This strategy may, therefore, be considered in selected rectal cancer patients presenting with both LARC and synchronous PC.     

Outcome following radiotherapy for loco-regionally recurrent non-small cell lung cancer

Local and regional recurrence of non-small cell lung cancer is reported to occur in 13-20% of treatment failures after resection. Reported post-recurrent median survival following radiotherapy ranges from 9 to 14 months. This study examines survival following radiotherapy alone for patients with loco-regionally recurring non-small cell lung cancer after initial surgery. Fifty-five patients, receiving radiotherapy at Westmead Hospital between 1979 and 1997, were eligible for study. Data were collected retrospectively by reviewing patient records. The end-point was overall survival. Symptom control was also recorded. Prognostic factors for analysis included age, sex, original presenting stage, disease-free interval (DFI), performance status, site of recurrence, treatment intent and dose. The median overall survival was 11.5 months (95% confidence interval: 8.1-13.0). Survival following treatment with radical intent was 26 months compared to 10.5 months for patients treated with palliative intent (P = 0.025). There was no significant difference in survival for short (< or = 2 years) or long DFI, performance status, radiation dose, age, sex, site of recurrence or stage. Most patients (55%) had partial or complete resolution of symptoms. Radiotherapy results in overall post-recurrence median survival of nearly 1 year, consistent with previous published data. Radical treatment intent predicts better prognosis as a result of patient selection and higher dose. Radiotherapy is effective at palliating symptoms of this disease.     

立体定向放射治疗配合靶向药物索拉非尼治疗复发及转移性肾细胞癌的疗效分析

目的探讨γ-体部立体定向放射治疗（stereotactic body radiation therapy withγ-knife,γ-SBRT）配合靶向药物索拉非尼（sorafenib）治疗复发及转移性肾癌的效果。方法 2007-05至2009-05收治的肾癌术后复发及转移患者45例中,26例单纯行γ-SBRT,19例行γ-SBRT配合Sorafenib治疗,比较两组的有效率、局部控制率、生存率及生存质量改善情况。结果治疗后3个月总有效率为80.0%（36/45）。单纯γ-SBRT组的1年、2年局部控制率分别为42.3%（11/26）、19.2%（5/26）;中位生存12个月;1年、2年生存率分别为46.2%、19.2%。γ-SBRT＋Sorafenib组的1年、2年局部控制率分别为47.3%（18/19）、21.1%（4/19）,中位生存18个月;1年、2年生存率分别为57.9%、26.3%。结论采用γ-体部立体定向放疗结合靶向药物索拉非尼对复发及转移性肾癌进行治疗效果较好,不良反应轻微,多数患者能耐受治疗。     

Pulmonary metastases in Wilms' tumour.

In a series of 87 patients with a diagnosis of Wilms' tumour seen at the Great Ormond Street Hospital for Sick Children between 1960 and 1973, 15 patients had pulmonary metastases at the time of diagnosis and a further 22 patients developed pulmonary metastases within 18 months of their initial nephrectomy. The incidence of later development of metastases was very much greater in those patients with locally advanced primary tumours than in those with a completely resectable, encapsulated tumour. In both groups of patients the disease-free survival rate was closely related to initial local tumour staging. In the whole series there were 11/37 (42-5%) patients with pulmonary metastases who survived disease-free for two or more years following treatment. The survival rate was highest in those patients who had a solitary pulmonary metastasis which was surgically resected (5/6); this type of lesion was seen only in those patients who had a localised primary tumour. In those patients with multiple pulmonary metastases, treated with irradiation to the whole lungs and single-agent chemotherapy, there were only 6/31 disease-free survivors; this group of patients all had advanced primary tumours and there was a high incidence of associated abdominal recurrence. The need for multiple agent chemotherapy in conjunctin with surgery and radiotherapy, both as prophylaxis against and in the treatment of metastases from Wilms' tumour is stressed.     

Twenty years of treating decompression sickness

Twenty years of treatment records were searched for cases of serious decompression sickness (DCS). Spinal cord DCS was the most common presentation. The efficacy of various treatment tables were compared. Oxygen tables were found to be as effective as long air tables in treating cases presenting within 12 h of the onset of symptoms and were superior for cases presenting later. Using RN 61 (USN 5) to treat serious decompression sickness resulted in a high post-treatment relapse rate. Other inappropriate practices such as in-water air treatment and nontreatment of spontaneously recovering cases resulted in a high incidence of deterioration or relapse.     

2001-2017年我院原发性肝癌流行病学特征分析

目的：分析我院原发性肝癌患者的流行病学特征及综合防治效果。 方法：分析2001年1月至2017年12月在首都医科大学石景山教学医院住院的358例肝癌患者的资料。按治疗方法分为姑息治疗组148例和综合治疗组210例,比较两组的一般病理资料和生存情况。 结果：本组358例患者中,男298例（83.2%）,女60例（16.8%）;年龄23~92（64.9±10.3）岁,乙型肝炎病毒感染者293例（81.84%）,丙型肝炎病毒感染者23例（6.42%）,酒精性肝硬化者29例（8.10%）,非酒精性脂肪性肝炎者13例（3.63%）,有肝癌家族史者66例（18.44%）。两组的肿瘤直径、Child-Pugh分级、ECOG评分、有无门脉癌栓、BCLC分期差异均有统计学意义（P<0.05）,两组的年龄、性别、户籍、肝炎病毒感染情况、负性生活事件、嗜酒史、家族史、肿瘤数目、血清AFP水平差异均无统计学意义（P>0.05）。姑息治疗组患者的1、2、3年生存率分别为60.1%、14.2%和4.1%,低于综合治疗组患者的1、2、3年生存率（77.1%、42.4%和33.3%）,差异有统计学意义（P<0.001）。 结论：本研究为临床制订原发性肝癌的预防和控制措施提供证据,为肝癌的治疗模式提供参考,综合治疗方法能显著改善患者生存质量、提高生存时间。     

Role of radiotherapy in cancer of the ethmoid. Retrospective study of a series of 24 cases]

From april 1978 to december 1988, 24 patients were treated were by radiotherapy at the Bergonié Foundation cases were for ethmoidal cancer cases. Twenty two for initial treatment and two refermed for local recurrence. The mean age was 51.4 years and the sex ratio was 5.2 (21 men/4 women). Histologically there were 15 adenocarcinomas, 3 squamous carcinomas, 4 undifferentiated carcinomas and 2 esthesioneuroblastomas. According to the classification of the University of Florida, they were retrospectively classified as stage I = 9 pts, stage II = 5 and stage III = 10. Twenty one patients had postoperative radiotherapy and 3 had exclusive radiotherapy. The average dose was 55.3 Gy. Local control was obtained in 12 pts. Seven patients have recurred locally (within an average period of 12 months) and 5 patients showed progression of disease after treatment. The overall actuarial survival and the disease free survival at 5 years were respectively 50% and 53%. The actuarial survival by stage at 2 years and 5 years was: stage I (88% and 61%), stage II (100% and 50%), stage III (0%). The prognosis of ethmoidal cancer is strictly correlated to local control. For this reason, radiotherapy (with or without surgery) remains important in the treatment of this disease.     

The primary role of ultrasound in evaluating right-sided diaphragmatic humps and juxtadiaphragmatic masses: a review of 22 cases

Twenty-two successive patients presenting with localised humps on the right hemidiaphragm or juxtadiaphragmatic masses, as revealed on standard chest radiographs, were submitted for ultrasound examination. These were carried out irrespective of the patient's symptoms. Ultrasonography provided a useful adjunct to conventional chest radiography and accurately defined the extent of diaphragmatic humps and the contents of diaphragmatic herniations and juxtadiaphragmatic masses, clearly defining their relationship to the adjacent organs. In most cases further radiological investigations were unnecessary.     

Prognostic factors and results after the combined surgical and radiotherapy treatment of ependymomas]

Between 1978 and 1991, 31 patients with primary (n = 28) and recurrent (n = 3) ependymoma received external radiation after initial surgery. There were 26 cases of intracranial and five cases of spinal ependymoma. Histological grading revealed low-grade in 23 and high-grade tumors in eight patients. Craniospinal irradiation was given to 13 of 28 patients, whole cranial radiation with boost to posterior fossa in three and local treatment to twelve patients. Six of 28 patients received chemotherapy. Dose to the primary, tumor localisation, grading and extend of surgery did not significantly impact on survival and relapse-free survival. Age was a marginally significant prognostic factor for survival. In patients with intracranial ependymoma (n = 24) survival and relapse-free survival at five years were 54% and 42%, respectively. Patterns of recurrence showed a local recurrence alone in eight, a CNS-relapse with local recurrence in four and local recurrence with distant metastases in one case. Spinal seeding occurred in two of 13 after craniospinal irradiation and two of twelve patients after local treatment. The main problem in the treatment of ependymoma remains local control, the use of spinal irradiation does not seem to improve treatment results.     

立体定向放射治疗配合靶向药物索拉非尼治疗复发

 目的 探讨γ-体部立体定向放射治疗（stereotactic body radiation therapy with γ-knife,γ-SBRT)配合靶向药物索拉非尼 (sorafenib)治疗复发及转移性肾癌的效果。 方法 2007-05至2009-05收治的肾癌术后复发及转移患者45例中 ,26例单纯行γ-SBRT,19例行γ-SBRT配合Sorafenib治疗,比较两组的有效率、局部控制率、生存率及生存质量改善情况。 结果 治疗后3个月总有效率为80.0%(36/45)。单纯γ-SBRT组的1年、2年局部控制率分别为42.3%(11/26)、 19.2% (5/26);中位生存12个月;1年、2年生存率分别为46.2％、19.2％。γ-SBRT+Sorafenib组的1年、2年局部控制率分 别为47.3%(18/19)、21.1%(4/19),中位生存18个月;1年、2年生存率分别为57.9％、26.3％。 结论 采用γ- 体部立体定向放疗结合靶向药物索拉非尼对复发及转移性肾癌进行治疗效果较好,不良反应轻微,多数患者能耐受治疗。     

外科治疗恶性结直肠间质瘤17例报告

目的 探讨恶性结直肠问质瘤的组织学和免疫组化特点及外科治疗效果。方法 回顾性分析1990年1月-2005年3月经手术治疗的17例恶性结直肠问质瘤的临床资料和病理检查结果,分析手术切除的效果以及影响手术疗效的因素。结果 17例患者均行手术治疗,且经病理证实为恶性,其中行左半结肠切除6例,右半结肠切除3例,直肠局部切除2例,腹会阴联合切除、腹壁造口术6例．中位生存时间52．0个月,术后1、3、5年生存率分别为100％、70．6％和47．1％。结论 恶性GIST的最后诊断需依靠病理切片,CD117和CD34是确诊最有价值的依据。恶性结直肠问质瘤仍应以外科手术为主,原则上需行局部根治性切除。     

Palliative treatment with high-dose-rate endobronchial interventional radiotherapy (Brachytherapy) for lung cancer patients

PURPOSE: to report on the use of high-dose-rate (HDR) endobronchial interventional radiotherapy (brachytherapy, EBIRT) for palliation of symptoms in patients with lung cancer.PATIENTS AND METHODS: retrospective review of lung cancer patients treated with HDR-EBIRT at our institution (1995–2017). Treatment results and treatment related toxicity were recorded. Clinical response was subjectively evaluated within 3 months after treatment. Overall survival (OS) was analyzed.RESULTS: 347 patients were identified. The median age was 69 years and the median follow-up time was 13.4 months. Most patients received external beam radiation therapy during the primary treatment. Within 3 months, 87.7% of the patients had complete or major response of their presenting symptoms. OS was 55.2% at 1 year, 18.3% at 2 years. Patients who had complete or major response had a longer median survival than other patients (13 versus 7 months, p = 0.03). Chronic bronchitis was found in 26.8%, while 7.8% of the patients died due to uncontrollable hemoptysis.CONCLUSION: HDR-EBIRT is a safe and effective treatment option for the palliative treatment of lung cancer patients. HDR-EBIRT is most suitable as a re-irradiation technique. Further clinical studies are needed to validate its role.     

Results of radiotherapy in the treatment of 218 carcinomas of the tonsillar area

After a brief review of the literature, the results of the treatment by radiation therapy in 218 patients with tonsillar region carcinoma are reported. The patients were treated at the Turin University Radiotherapy Department (131 cases) and at the Radiotherapy Department of the Ospedale Maggiore, Novara (87 cases) from 1976 through 1984. The series included 29 T1, 88 T2, 64 T3 and 37 T4; 86 patients (40%) were N0. Only 49 patients were stages I and II (1/4 of the total). The local control (T) rate at the end of therapy was 63.5% for the overall series (139/218) ranging from 100% in T1, 72.6% T2, 54.6% T3 to 30% T4; the regional control (N) for patients with cervical lymphadenopathy was 66% (88/132). The overall 5-year survival was 38%; the 5-year disease-free survival was 35%. The 5-year survival according to T-stage was 52% for limited cases (T1-T2) in comparison to 22% for advanced ones (T3-T4). The 5-year survival for N0 stage was 55%; when neck nodes were present (N # 0) the survival was 29% after 5 years. Complications included 6 cases of trismus and 2 osteonecroses of the mandible. Second primary malignant diseases were seen in 17 cases (7.8%). The most common cause of death was failure in primary tumour control (80% of cases). In this series the results of radiotherapy of early stage tonsillar carcinomas are quite good; patients with large tumour masses fare less satisfactorily. Better results should be obtained in the future by identifying prognostic factors, monitoring potential causes of treatment failure and optimizing the radiotherapeutic treatment plan and technique.     

Stage IV endometrial carcinoma: a 10 year review of patients.

Stage IV endometrial cancer is uncommon, often occurs in elderly patients and has a poor prognosis, which makes the choice of treatment difficult. 18 patients with stage IV endometrial cancer presenting over a 10 year period, between 1987 and 1997, were reviewed with regard to mode of treatment and response. The mean age was 65 years. Five had disease confined to the pelvis and 13 had extra pelvic disease. 15 of 18 patients had a total abdominal hysterectomy (TAH). One patient received radiotherapy alone and five received post-operative radiotherapy. Overall freedom from pelvic symptoms was achieved in seven of 18 patients. All seven had undergone TAH and two had received post-operative radiotherapy. Progestogens were given to 13 patients. Six received progestogens alone, without radiotherapy or chemotherapy. Of these, two responded, one for 9 months and one with verified lung metastases, who had a complete response, is still alive at 6.5 years. Eight patients received chemotherapy, with single agent cisplatin or carboplatin AUC 6. Three patients responded, one for 4.5 years. The overall median survival was 12 months from diagnosis. Actuarial 5 year survival was 15% (CI 3-36). There was no significant survival difference for, hormone therapy or chemotherapy. Stage IV endometrial cancer has a poor prognosis but durable response can be achieved in some patients.     

无功能胰岛细胞癌12例报告

目的　总结无功能胰岛细胞癌的诊断治疗经验。方法　对 1980年 5月— 2 0 0 3年 5月收治的 12例无功能胰岛细胞癌临床病理资料进行分析。结果　平均年龄 45岁。最常见临床表现为上腹部包块和疼痛。所有病人经超声和CT检查确定了肿瘤部位 ,但仅 2例术前考虑为内分泌肿瘤。手术证实 7例存在淋巴结转移 ,3例存在肝转移。 11例施行肿瘤切除 ,1例肿瘤无法切除 ,施行胆囊空肠吻合解除梗阻性黄疸。5和 10年生存率是 5 0 %和 17%。结论　无功能胰岛细胞癌手术切除率高 ,虽治愈率低 ,但多数病人获得较长的生存期