Recurrent malignant ovarian adenocarcinoma with central nervous system metastasis successfully treated with paclitaxel, carboplatin, capecitabine, and gemcitabine

Ovarian carcinoma is a common malignancy with a grim prognosis and a high mortality rate. Here, we report a rare case of an Iranian woman with four episodes of recurrent metastatic ovarian carcinoma. She was initially diagnosed with stage IVa high-grade serous ovarian adenocarcinoma (HGSOC), treated with paclitaxel-carboplatin and capecitabine, followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Two years later, she developed cerebellar metastasis and received whole-brain radiotherapy and paclitaxel-carboplatin. Eighteen months later, she had peritoneal metastasis and had sequential gemcitabine-carboplatin-paclitaxel. One year later, she had splenic metastasis, treated with splenectomy and adjuvant carboplatin and nano-albumin bond paclitaxel. The patient remains in remission until now, 11 months after completing the most recent regimen. This report emphasizes the potential to successfully use chemoradiotherapy with sequential courses of platinum-based agents in patients with recurrent metastatic HGSOC.

The Relationship between Lung and Heart Two-Dimensional Parameters and Three-Dimensional Dose-Volume Data in Adjuvant Radiotherapy for Breast Cancer

Background: Two-dimensional (2D) radiographic parameters have been used to estimate the amount of heart and lung irradiated for minimizing heart and lung complications in breast cancer patients. The aim of this study was to investigate the correlation between traditionally used 2D radiographic and dose-volume parameters during adjuvant radiotherapy of breast cancer.

Methods: In this cross-sectional study, we analyzed 121 female patients treated with breast-conserving surgery (BCS) or modified radical mastectomy (MRM) and 3D conformal radiotherapy (3DCRT) using two-field radiotherapy (2FRT) or three-field radiotherapy (3FRT) technique. All patients underwent computed tomography (CT)-planning. Two-D parameters, including central lung distance (CLD), maximum lung depth (MLD), maximum heart length (MHL), maximum heart distance (MHD), and chest wall separation (CWS), were measured using digitally reconstructed radiographs (DRR) and CT images. DVHs for lung, heart, and target were created. The Pearson correlation test was used to evaluate the correlation between 2D radiographic and dose-volume parameters.

Results: There was a correlation between CLD and ipsilateral lung V5-20Gy and Dmean and between MLD and ipsilateral lung V5-20Gy. In 2FRT, only moderate correlation between CLD and ipsilateral lung V20Gy (r = 0.453, P = 0.003) and between MLD and ipsilateral lung V20Gy (r = 0.593, P <0.001) were observed. Poor correlation of MHL and heart V25Gy (r = 0.409, P = 0.007) was seen only in 3FRT. There was a correlation between MHD and heart dose-volume data, with a strong correlation between MHD and heart V5-25Gy and Dmean (r = 0.875-0.934, P<0.001) in the 2FRT group. No correlation between CWS and breast Dmax was found.

Conclusion: There was a correlation between 2D parameters (i.e., CLD, MLD, and MHD) and the heart and lung dose-volume parameters during adjuvant breast radiotherapy. Although CLD was correlated to ipsilateral lung V5-20Gy and Dmean, the correlation between CLD and ipsilateral lung V20Gy was greater than other dose-volume parameters. MHD provided a close estimation of heart dose-volume parameters.

Common data elements of breast cancer for research databases: A systematic review

Background:

Common Data Elements (CDEs) are data-metadata descriptors used to collect research study data. CDEs facilitate the collection, processing, and sharing of breast cancer data. This study intended to explore the CDEs of breast cancer for research databases and primary care systems.

Methods:

This study was conducted using systematic search and review. This systematic literature review covered PubMed, Scopus, Science Direct, SID, ISC, Web of Science, and Google Scholar search engine. It included studies in English language with accessible full-text from the beginning of 2007 to September 2019.

Results:

Reviewing 25 studies revealed that 52 percent of studies were carried out in the US and most studies were conducted between 2013 and 2015. The most domains for using CDEs were: Pathology Report and Registry. The CDEs of breast cancer for research databases were categorized into three categories namely clinical, research, and non-clinical and indicate the importance of these data elements. Most of the studies focused on creating and deploying clinical CDEs as physical examination, clinical history and pathology data.

Conclusion:

The integration of biomedical and clinical data relevant to breast cancer enhances the power of research variable analysis and statistical analysis, thereby facilitating improved knowledge of effective therapeutic interventions. Also CDEs used to collect, store, and retrieve patient data in various health setting such as primary care and research databases.

A graded prognostic assessment scale to predict overall survival in patients diagnosed with brain metastases undergoing Gamma-knife radiosurgery

Background:

The present study aims to evaluate the Graded Prognostic Assessment (GPA) score for predicting overall survival in patients diagnosed with brain metastases undergoing Gamma-knife radiosurgery.

Methods:

This was a cross sectional study conducted on the patients diagnosed with brain metastases undergoing Gamma-knife radiosurgery during 2003 to 2011. Clinical and radiological parameters were evaluated, and the GPA score were determined. Kaplan–Meier and log-rank tests were used to assess prognostic factors of the GPA.

Results:

Two hundred and twenty patients were eligible to enter the study during the eight years course of study. The mean age of the patients was 54 ± 12.7 years (ranged 19 to 82 years) and were followed up for an average of 7 (range=1-25) months post Gamma-knife surgery. Median survival times according to the GPA were: GPA 0–1, 4 ± 0.4 months; GPA 1.5–2.5, 6 ± 0.7 months; GPA 3, 9 ± 0.9 months; and GPA 3.5–4.0, 12 ± 1.8 months and overall survival were 7 ± 0.6 months. The level of statistical significance among GPA groups was p less than 0.0001.

Conclusions:

It seems that the preoperative GPA is able to predict Gamma-knife radiosurgery results in patients with brain metastases. However, the results should be confirmed with further clinical trial assessments.

Keywords:

Brain metastases, GPA Score, Gamma-knife radiosurgery, Predict

Radiosurgery for glomus jugulare tumors: experience treating 16 patients in Iran

Object

Glomus jugulare tumors (GJT) have traditionally been treated by surgery or fractionated external-beam radiotherapy. The aim of this retrospective study was to determine the tumor control rate, clinical outcome, and short-term complications of stereotactic radiosurgery in subsets of patients who are poor candidates for these procedures, based on age, medical problems, tumor size, or prior treatment failure.

Methods

The Leksell Gamma Knife was used to treat 16 patients harboring symptomatic, residual, recurrent, or unresectable GJTs. The age of the patients ranged from 12 to 77 years (median 46.5 years). Gamma Knife surgery (GKS) was performed as primary treatment in five patients (31.3%). Microsurgery preceded radiosurgery in 10 patients (62.5%) and fractionated radiotherapy in three patients (18.8%). The median tumor volume was 9.8 cm3 (range 1.7–20.6 cm3). The median marginal dose applied to a mean isodose volume of 50% (range 37–70%) was 18 Gy (range 14–20 Gy).

Neurological follow-up examinations revealed improved clinical status in 10 patients (62.5%), a stable neurological status in six (37.5%), and no complications. After radiosurgery, follow-up imaging was conducted in 14 patients; the median interval from GKS to the last follow up was 18.5 months (range 4–28 months). Tumor size had decreased in six patients (42.9%), and the volume remained unchanged in the remaining eight (57.1%). None of the tumors increased in volume during the observation period.

Conclusions

According to the authors' experience, GKS represents a useful therapeutic option to control symptoms and may be safely conducted in patients with primary or recurrent GJTs with no death and no acute morbidity. Because of the tumor's naturally slow growth rate, however, long-term follow-up data are needed to establish a cure rate after radiosurgery.