Consolidative Proton Therapy after Chemotherapy for Patients with Hodgkin Lymphoma

Abstract

Background: We investigated early outcomes for patients receiving chemotherapy followed by consolidative proton therapy (PT) for the treatment of Hodgkin lymphoma (HL).Patients and Methods: From June 2008 through August 2015, 138 patients with HL enrolled on either IRB-approved outcomes tracking protocols or registry studies received consolidative PT. Patients were excluded due to relapsed or refractory disease. Involved-site radiotherapy field designs were used for all patients. Pediatric patients received a median dose of 21 Gy(RBE) (range, 15-36 Gy[RBE]); adult patients received a median dose of 30.6 Gy(RBE) (range, 20-45 Gy[RBE]). Patients receiving PT were young (median age, 20 years; range 6 – 57). Overall, 42% were pediatric (≤18 years) and 93% were under the age of 40 years. Thirty-eight percent of patients were male and 62% female. Stage distribution included 73% with I/II and 27% with III/IV disease. Patients predominantly had mediastinal involvement (96%) and bulky disease (57%), while 37% had B symptoms. The median follow-up was 32 months (range, 5–92 months).Results: The 3-year relapse-free survival rate was 92% for all patients; it was 96% for adults and 87% for pediatric patients (p = 0.18). When evaluated by PET/CT scan response at the end of chemotherapy, patients with a partial response had worse 3-year progression-free survival compared with other patients (78% vs. 94%; p = 0.0034). No grade 3 radiation-related toxicities have occurred to date.Conclusion: Consolidative PT following standard chemotherapy in HL is primarily used in young patients with mediastinal and bulky disease. Early relapse-free survival rates are similar to those reported with photon radiation treatment, and no early grade 3 toxicities have been observed. Continued follow-up to assess late effects is critical.

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Ameloblastic Fibroodontoma: Uncommon Case Presentation in a 6-Year-Old Child with Review of the Literature

Ameloblastic fibroodontoma is a benign mixed odontogenic neoplasm considered in patients with asymptomatic swelling and unerupted teeth that exhibit histologic features between ameloblastic fibroma and complex odontoma. Radiographically, this lesion appears as radiolucency admixed with focal radio opaque masses of irregular shapes and sizes. This lesion is confirmed by the presence of proliferating odontogenic epithelium, ectomesenchyme, and dental hard tissue formation on pathological analysis supplementing clinical and radiographic findings. As this tumour is less commonly seen in routine clinical practice, ameloblastic fibroodontoma with detailed orofacial features and periodic approach to its diagnosis is discussed. This paper reports a case of ameloblastic fibroodontoma of the mandible in a 6-year-old male patient with an uncommon case presentation and review of the literature.

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Severe Hepatopulmonary Syndrome in a Child with Caroli Syndrome

Hepatopulmonary Syndrome (HPS) is a potential complication of chronic liver disease and is more commonly seen in the adult population. Caroli Syndrome is a rare inherited disorder characterized by intrahepatic ductal dilation and liver fibrosis that leads to portal hypertension. In children with liver disease, HPS should be considered in the differential diagnosis of prolonged, otherwise unexplained, hypoxemia. The presence of HPS can improve patient priority on the liver transplantation wait list, despite their Pediatric End-Stage Liver Disease (PELD) score. We present a 6-year-old girl with Caroli Syndrome and End-Stage Renal Disease who presented with persistent hypoxemia. The goal of this report is to increase awareness of HPS in children.

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Quantitative Evaluation of Head and Neck Cancer Treatment-Related Dysphagia in the Development of a Personalized Treatment De-Intensification Paradigm

Publication date: Available online 12 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Harry Quon, Xuan Hui, Zhi Cheng, Scott Robertson, Luke Peng, Michael Bowers, Joseph Moore, Amanda Choflet, Alex Thompson, Mariah Muse, Ana Kiess, Brandi Page, Carole Fakhry, Christine Gourin, Jolyne O'Hare, Peter Graham, Michal Szczesniak, Julia Maclean, Ian Cook, Todd McNutt
ObjectiveWe hypothesize that quantifying swallow function with multiple patient-reported outcome (PRO) instruments is an important strategy to yield insights in the development of personalized de-intensified therapies seeking to reduce the risk of head and neck cancer treatment-related dysphagia (HNCTD).MethodsIrradiated HNC subjects seen in follow-up care (4/2015 to 12/2015) prospectively completed the Sydney Swallow Questionnaire (SSQ) and the MD Anderson Dysphagia Inventory (MDADI) concurrently on the web-interface to our Xxxxxxxxx database were evaluated. A correlation matrix quantified the relationship between the SSQ and MDADI. Machine-learning unsupervised cluster analysis using the elbow criterion and CLUSPLOT analysis to establish its validity was performed.ResultsWe identified 89 subjects. The MDADI and SSQ scores were moderately but significantly correlated (correlation coefficient -0.69). K-means cluster analysis demonstrated that three unique statistical cohorts (elbow criterion) could be identified with CLUSPLOT analysis confirming that 100% of variances were accounted. Correlation coefficients between the individual items in the SSQ and the MDADI demonstrated weak to moderate negative correlation except for SSQ17 (QoL question).ConclusionsPilot analysis demonstrates the MDADI and SSQ are complementary. Three unique clusters of patients can be defined suggesting that a unique dysphagia signature for HNCTD may be definable. Longitudinal studies relying on only a single PRO such as MDADI may be inadequate for classifying HNCTD.



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Long-term clinical outcomes of Pencil Beam Scanning Proton Therapy for benign and non-benign intracranial meningiomas

Publication date: Available online 12 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Fritz R. Murray, James W. Snider, Alessandra Bolsi, Antony J. Lomax, Marc Walser, Ulrike Kliebsch, Ralf A. Schneider, Damien C. Weber
Since 1996, 96 patients with complex intracranial meningiomas have been treated with pencil beam scanning proton therapy (PBSPT) at XXXX. The long-term results of the present study demonstrate PBSPT as an effective and safe treatment modality for the definitive, adjuvant, postoperative, and salvage treatment of highly complex intracranial meningiomas. In addition, multiple risk factors influencing local control and overall survival were identified.



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Solasodine inhibits human colorectal cancer cells via suppression of AKT/GSK-3β/β-catenin pathway

Summary

Solasodine is a main active component isolated from Solanum incanum L, who performs a wide range of functions containing anti-oxidant, anti-infection and neurogenesis promotion. In this study, we explored the influence of solasodine on three types of human colorectal cancer (CRC) cell lines. The consequences displayed that solasodine apparently prohibited CRC cell proliferation dose- and time-dependently and impeded CRC cell motility by downregulating Matrix metalloprotease (MMPs). Besides, solasodine was investigated to fuel caspase-cascade reaction and increase the ratio between Bax and Bcl-2 so as to induce CRC cell apoptosis. When cells got pretreated with AKT activator (IGF-1) followed by solasodine application, solasodine-induced apoptosis was partially confronted by IGF-1. Moreover, Solasodine hindered tumor development and stimulated similar mechanisms in vivo. In general, our study provides the first evidence that solasodine has a suppressive efficient on CRC cells and that this agent may have potency to be a novel therapeutic drug for CRC treatment.

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Vitreous amyloidosis with autonomic neuropathy of the digestive tract associated with a novel transthyretin p.Gly87Arg variant in a Bangladeshi patient: a case report

Hereditary transthyretin amyloidosis is an autosomal dominant inherited disorder, first described in families with sensorimotor and autonomic neuropathy. Since its first description, more than 120 amyloidogeni...

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