Primary Intra-Abdominal Rhabdomyosarcoma in an Adult: an Unusual Presentation and Review of Literature

Rhabdomyosarcomas, the commonest soft tissue sarcoma in paediatric age group, represent 5-10 % of all solid tumors in childhood. These tumors are rare in adult population. There are sporadic case reports of intra-abdominal rhabdomyosarcoma, but mostly in paediatric age group. Here we are reporting an unsual case of intra abdominal rhabdomyosarcoma in an elderly which presented with acute intestinal obstruction. CECT abdomen showed a solid mass in retroperitoneum compressing adjacent bowel loops. Upon emergency exploratory laparotomy a hard mass was found to be compressing the ascending colon and infiltrating into duodenum, pancreas and liver. No specific organ of origin could be identified. Biopsy was taken, as the mass was unresectable and ileostomy was done. Histopthological examination revealed embryonal rhabdomyosarcoma. Rarity of this disease and unusual presentation prompted us to report this case.

Preliminary report of the Asian-Oceanian Clinical Oncology Association randomized trial comparing cisplatin and epirubicin followed by radiotherapy versus radiotherapy alone in the treatment of patients with locoregionally advanced nasopharyngeal carcinoma. Asian-Oceanian Clinical Oncology Association Nasopharynx Cancer Study Group

BACKGROUND

The aim of this trial was to compare the outcome achieved with neoadjuvant chemotherapy followed by radiotherapy to that achieved with radiotherapy alone for patients with locoregionally advanced undifferentiated or poorly differentiated nasopharyngeal carcinoma (NPC) meeting one of the following criteria: Ho's T3 disease, Ho's N2-N3 disease, or lymph node size > or =3 cm.

METHODS

Between September 1989 and August 1993, 334 patients were enrolled in the study, with equal numbers of patients randomized to the neoadjuvant chemotherapy arm (CT arm) and the radiotherapy arm (RT arm). Neoadjuvant chemotherapy consisting of 2-3 cycles of cisplatin (60 mg/m2 on Day 1) and epirubicin (110 mg/m2 on Day 1) followed by radiotherapy was given to the CT arm. For radiotherapy, a dose of 66-74 gray (Gy) (median, 71 Gy) was delivered to the primary tumor and 60-76 Gy (median, 66 Gy) to the neck. Two hundred eighty-six eligible patients completed the treatment and were evaluable for treatment response (134 in the CT arm, 152 in the RT arm). All patients were included in the survival analysis based on the intention to treat. The median follow-up was 30 months for the whole cohort and 41 months for the surviving patients.

RESULTS

Analysis of the 334 patients based on the intention to treat showed no significant difference in relapse free survival (RFS) or overall survival (OS) between the 2 treatment arms (3-year RFS rate: 48% in the CT arm vs. 42% in the RT arm, P = 0.45; 3-year OS rate: 78% vs. 71%, P = 0.57). In an efficacy analysis based on only the 286 evaluable patients, a trend of improved RFS favoring the CT arm was observed (3-year RFS rate: 58% vs. 46%, P = 0.053), with again no significant difference in OS (3-year OS rate: 80% vs. 72%, P = 0.21). In the subgroup of 49 patients with bulky neck lymph nodes >6 cm, improved RFS (3-year RFS rate: 63% vs. 28%, P = 0.026) and OS (3-year OS rate: 73% vs. 37%, P = 0.057) were observed, favoring the CT arm.

CONCLUSIONS

This multicenter randomized study did not demonstrate any benefit with the addition of cisplatin-epirubicin neoadjuvant chemotherapy for patients with locoregionally advanced nasopharyngeal carcinoma; therefore routine administration of neoadjuvant chemotherapy to this target group cannot be recommended. Although the overall incidence of recurrence was reduced with the addition of chemotherapy in the efficacy analysis, the overall survival was not affected. A more effective chemotherapy regimen, the selection of an appropriate target group, and the use of an alternative strategy for combining chemoradiotherapy should be explored in future trials.

Randomized trial of epirubicin and cisplatin chemotherapy followed by pelvic radiation in locally advanced cervical cancer. Cervical Cancer Study Group of the Asian Oceanian Clinical Oncology Association

PURPOSE

Pelvic radiation is standard treatment for women with stage IIb to IVa cervical cancer, but treatment results are disappointing, particularly for women with bulky tumors. We investigated the role of primary chemotherapy followed by pelvic radiotherapy in a randomized trial.

PATIENTS AND METHODS

Two hundred sixty patients with stage IIb and IVa cervical cancer received either standard pelvic radiotherapy or primary chemotherapy with cisplatin 60 mg/m2 and epirubicin 110 mg/m2 administered at 3-week intervals for three cycles, followed by pelvic radiotherapy.

RESULTS

Ninety-nine patients have relapsed with a median follow-up duration of 1.3 years; in 62 patients, the first site of progressive disease was the pelvis. Patients who received primary chemotherapy had a significantly higher pelvic failure rate than those who received radiotherapy alone (P < .003). Seventy-six patients have died, and those who received primary chemotherapy had significantly inferior survival compared with those who received radiotherapy alone (P = .02). Tumor response following chemotherapy was observed in 63%. After radiotherapy, tumor response occurred in 72% of those who received combined modality treatment, compared with 92% of those who received radiotherapy alone.

CONCLUSION

Primary chemotherapy with epirubicin and cisplatin, although resulting in tumor response in a significant proportion of patients, is accompanied by an inferior local control rate and survival compared with standard pelvic radiotherapy alone.

High dose rate intracavitary radiation therapy of carcinoma of the cervix using a linear source

One hundred patients with carcinoma of the cervix stages 1B to 4A were treated with intracavitary high dose rate radiation using a linear cobalt source. All cases have received external beam pelvic irradiation to 4500cGy mid plane in twenty fractions over four weeks. The results in terms of patient compliance and convenience were good while acute and late morbidities were comparable to standard Manchester technique of low dose rate intracavitary therapy as practised in the Institute of Radiotherapy and Oncology General Hospital Kuala Lumpur. The four year actuarial survival rate is 76% for stage II and 48% for stage III. All three stage IV patients died within 1 year. Four out of seven stage I patients are alive (minimum follow-up 18 months, longest 43 months). One died of systemic spread at 33 months while one is lost to follow up.

Disseminated carcinoma of the breast with malignant pericardial tamponade and complete heart block--a case report

A 49 year old Malay women presented with pericardial tamponade 18 months following left segmentectomy and local irradiation for carcinoma of the breast. Subsequently she developed complete heart block terminating in cardiac arrest.

Clinical patterns and treatment complications of 1000 cases of carcinoma of the uterine cervix

One thousand consecutive cases of carcinoma of the uterine cervix treated in the General Hospital Kuala Lumpur between January 1977 to December 1979 were studied. Epidemiological breakdown by race, age, parity, occupation, stage and histology of the disease were obtained. Treatment complications in survivors available for follow-up were analysed. The Chinese had the highest incidence, followed by the Indians and the Malays. Ninety six percent were squamous cell cancers, the remaining were adenocarcinomas. Eighty percent of patients were seen at an advanced stage (Stage IIB-IV). Late radiation complications were mainly proctitis, cystitis and fistula; (5%, 7.2% and 1.4% respectively). These figures are comparable to many centres but the incidence of cystitis is relatively higher. This is believed to be related to irradiation techniques in these cases.

Assessment of permanent hearing impairment following radical megavoltage radiotherapy

Twenty patients who had received unilateral radical megavoltage radiotherapy to the temporal bone had their hearing assessed by pure tone audiometry between 2 and 16 years after completion of treatment. Hearing loss was not detected in the irradiated ear when compared with the non-irradiated ear of each patient.