Successful management of rare gingival metastasis from gastric adenocarcinoma: a case report and literature review

Abstract

Background

Gastric cancer rarely metastasizes to the oral cavity, especially to gingiva. Only 18 cases have been reported worldwide to date. This paper herein presents the nineteenth case of gingival metastasis from gastric cancer.

Case presentation

A 75-year-old man who underwent a radical gastrectomy for gastric adenocarcinoma was admitted to clinical oncology center for gingival mass which was originally diagnosed as epulis. The subsequent positron emission tomography-computed tomography (PET-CT) and histopathological examination revealed a gingival metastatic adenocarcinoma originated from gastric carcinoma. Then three-dimensional conformal radiotherapy (3D–CRT) with synchronization and sequential chemotherapy demonstrated clinical benefit in this patient. Furthermore, this research reviewed the records of 18 cases of gingival metastasis from gastric carcinoma in English, Japanese, and Chinese literature, and summarized the clinicopathologic features of the disease based on previously published papers.

Conclusion

This case suggests that gingival metastasis from gastric cancer is worthy of vigilance. Biopsy and immunohistochemical (IHC) staining should be used for the final diagnosis. Moreover, the patient with uncommon gingival metastatic lesion can be successfully treated by radiotherapy with adjuvant chemotherapy.

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Title: Local control outcomes using stereotactic body radiation therapy for liver metastases from colorectal cancer

Publication date: Available online 31 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Ji Hyeon Joo, Jin-hong Park, Jin Cheon Kim, Chang Sik Yu, Seok-Byung Lim, In Ja Park., Tae Won Kim, Yong Sang Hong, Kyu-pyo Kim, Sang Min Yoon, Jongmoo Park, Jong Hoon Kim
PurposeTo evaluate the effective dose and patterns of recurrence after stereotactic body radiation therapy (SBRT) for hepatic metastases that arise from colorectal cancer.Methods and MaterialsA cohort of 70 patients with 103 colorectal liver metastases were treated with SBRT at a single institution. The prescribed doses were 45 – 60 Gy in 3–4 fractions, but these were modified based on the tolerance of the adjacent normal tissue. To allow for dose comparisons, a biological equivalent dose (BED) was calculated.ResultsThe median follow-up period was 34.2 months (range, 5.3–121.8). The 2-year overall survival and progression-free survival rates were 75% and 35%, respectively. In subgroups, the 2-year local control rates for BED ≤80 Gy (Group 1), 100-112 Gy (Group 2), and ≥ 132 Gy (Group 3) were 52%, 83%, and 89%, respectively. Cox proportional hazards model revealed a significant difference between groups (HR=0.44, P=0.03 for Group 2; HR=0.17, P=0.17 for Group 3; P=0.01 for total). The major pattern of failure was a new liver metastasis out-of the SBRT field. There was no ≥G3 toxicity.ConclusionsSBRT of liver metastases derived from colorectal cancer offers a locally effective treatment without significant complications. Longer local control can be expected if higher doses are used. Further studies will be needed to compare the efficacies of SBRT with those of surgical resection or radiofrequency ablation.

Teaser

The optimal stereotactic body radiation therapy (SBRT) dose and fractionation schedule for hepatic metastases from colorectal cancer has not yet been determined. Thus, we evaluated the effective dose by reviewing treatment results of 103 lesions. When compared with biological equivalent dose (BED), longer local control was expected if higher doses were used, with optimal BED greater than 132 Gy.


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Development and internal validation of a clinical risk score to predict pain response after palliative radiotherapy in patients with bone metastases

Publication date: Available online 31 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Joanne M. van der Velden, Max Peters, Jorrit-Jan Verlaan, Anne L. Versteeg, Liying Zhang, May Tsao, Cyril Danjoux, Elizabeth Barnes, Marco van Vulpen, Edward Chow, Helena M. Verkooijen
PurposePain is a common and debilitating consequence of metastatic bone disease, affecting many patients with end-stage cancer. Radiation treatment for pain control is only effective in about 60% of patients. The aim of this study was to identify patient and tumor characteristics associated with response to radiotherapy, and to develop a risk score for response prediction.Material and MethodsA total of 965 patients with painful bone metastases undergoing palliative radiotherapy at a tertiary referral center between 1999–2007 were identified. Pain scores were measured at 1, 2, and 3 months after radiotherapy. Pain response was defined as at least 2 points decrease on a 0–10 scale in pain score, without increase in analgesics, or an analgesic decrease of at least 25% without an increase in pain score. Thirteen candidate predictors were identified from the literature and expert experience. After multiple imputation, final predictors were selected using stepwise regression and collapsed into a prediction model. Model performance was evaluated by calibration and discrimination and corrected for optimism.ResultsOverall, 462 patients (47.9%) showed a response. Primary tumor site, performance status, and baseline pain score were predictive for pain response with a corrected c-statistic of 0.63. The predicted response rates after radiotherapy increased from 37.5% for patients with the highest score to 79.8% for patients with the lowest score and were in good agreement with the observed response rates.ConclusionsA prediction score for pain response after palliative radiotherapy was developed. The model performance was moderate, showing that prediction of pain response is difficult. New biomarkers and predictors may lead to improved identification of the large group of patients who are unlikely to respond and who may benefit from other or innovative treatment options.

Teaser

Radiotherapy is effective in reducing pain in about 60% of patients with bone metastases. We developed a prediction model to help identify patients who are unlikely to respond to palliative radiotherapy. Primary tumor site, performance status, and baseline pain score were associated with pain response, and were modestly able to discriminate good and poor responders.


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Towards personalized dosimetry with 32P microparticle therapy for advanced pancreatic cancer

Publication date: Available online 1 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Yaser Hadi Gholami, Nicole Wilson, David James, Zdenka Kuncic
PurposeThe aim of this study was to develop a Monte Carlo model for patient-specific dosimetry of ³²P microparticle Localized Internal Radionuclide Therapy (LIRT) for advanced pancreatic cancer.Methods and MaterialsSpherical tumor geometries and a pancreatic phantom were modeled, as well as different 3D non-uniform clinical pancreatic geometries based on patient-specific ultrasound images. The dosimetry simulations modeled the dose distribution due to the energy spectrum of emitted beta particles.ResultsThe average dose for small (3 cm diameter) and large (6 cm diameter) spherical tumors was 111 Gy (for 7.6 MBq administered activity) and 128 Gy (for 58 MBq), respectively. For the clinical 3D geometries, based on patient data, the mean doses delivered to the tumor were calculated to be in the range 102-113 Gy, with negligible dose to the pancreas for the smallest tumor volumes. The calculated dose distributions are highly non-uniform. For the largest tumor studied, the pancreas received ≈6% of the tumor dose (5.7 Gy). Importantly, we found that as the smallest tumor studied exhibited the most dynamic changes in volume in response to the treatment, the dose to tumor and pancreas is significantly underestimated if a static tumor volume is assumed.ConclusionThese results demonstrate the dosimetry of ³²P microparticle LIRT for pancreatic cancer and the possibility of developing personalized treatment strategies. The results also highlight the importance of considering the effects of non-uniform dose distributions and dynamic change of tumor mass during treatment on the dosimetry of the tumor and critical organs.

Teaser

A Monte Carlo particle simulation platform was developed to model the dosimetry of ³²P microparticle internal radionuclide treatment for advanced pancreatic cancer. Patient-specific dosimetry simulations based on data from previous ³²P microparticle clinical studies demonstrated the importance of considering non-uniform dose distributions as well as relative dynamic changes in tumor volume and dose rate during treatment. These results will be valuable in designing future personalized treatment strategies.


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Lack of Benefit from the Addition of External Beam Radiotherapy to Brachytherapy for Intermediate- and High-Risk Prostate Cancer

Publication date: Available online 31 July 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): David D. Yang, Vinayak Muralidhar, Paul L. Nguyen, Ivan Buzurovic, Neil E. Martin, Kent W. Mouw, Phillip M. Devlin, Quoc-Dien Trinh, Peter F. Orio, Martin T. King
PurposeA recent randomized controlled trial demonstrated that the addition of external beam radiotherapy (EBRT) to brachytherapy did not improve progression-free survival in select patients with intermediate-risk prostate cancer. We evaluated whether the addition of EBRT to brachytherapy improves prostate cancer-specific mortality (PCSM) for intermediate- and high-risk disease using a large national database.Methods and MaterialsWe identified 5836 patients in the Surveillance, Epidemiology, and End Results-Medicare linked database diagnosed from 2004 through 2009 with National Comprehensive Cancer Network intermediate- (Gleason 7, prostate-specific antigen 10-20 ng/mL, or cT2b-T2c) or high-risk (Gleason 8-10 or prostate-specific antigen >20 ng/mL and ≤cT3a) prostate cancer and treated with brachytherapy, with or without EBRT and androgen deprivation therapy (ADT). Intermediate-risk patients with Gleason ≤3+4 and one intermediate-risk factor were considered favorable and all others unfavorable. We used multivariable Fine-Gray competing risks regression to study PCSM while adjusting for sociodemographic and clinical factors along with ADT use.ResultsOverall, the 50.3% of intermediate- and high-risk patients treated with brachytherapy and EBRT did not have a significantly improved PCSM compared to patients treated with brachytherapy alone (adjusted hazard ratio [AHR] 1.46, 95% CI 0.69-3.11, p=0.322; 5-year PCSM 2.4% vs. 1.0%). This lack of benefit was seen among favorable intermediate-risk (AHR 2.66, 95% CI 0.93-7.62, p=0.069; 1.3% vs. 0.6%), unfavorable intermediate-risk (AHR 0.68, 95% CI 0.16-2.96, p=0.612; 1.0% vs. 1.2%), and high-risk subgroups (AHR 1.82, 95% CI 0.67-4.98, p=0.242; 5.3% vs. 2.1%).ConclusionsThese results suggest that certain patients with intermediate- or high-risk prostate cancer treated with brachytherapy may not benefit from the addition of EBRT. A randomized controlled trial of brachytherapy plus ADT with or without EBRT for unfavorable intermediate- and favorable high-risk organ-confined prostate cancer should be undertaken.

Teaser

The efficacy of brachytherapy monotherapy for unfavorable-risk prostate cancer is unknown. Using a cohort of 5836 patients with intermediate- or high-risk disease treated with brachytherapy, we found the addition of external beam radiotherapy to not improve prostate cancer-specific mortality. This lack of benefit was observed for favorable intermediate-, unfavorable intermediate-, and high-risk subgroups. These results suggest that certain patients with unfavorable-risk disease treated with brachytherapy may not benefit from the addition of external beam radiotherapy.


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Doses dans les organes à risque en radiothérapie conformationnelle et en radiothérapie en conditions stéréotaxiques : os et moelle osseuse

Publication date: Available online 31 July 2017
Source:Cancer/Radiothérapie
Author(s): A. Schernberg, C. Hennequin
Les structures osseuses, médullaires hématopoïétiques et corticales de soutien, sont souvent négligées en tant qu'organes à risque lors des traitements par irradiation externe. À tort, puisque les effets indésirables sont nombreux, et potentiellement graves. La toxicité induite par l'irradiation de ces structures va d'une majoration du risque de neutropénie fébrile en cas de chimioradiothérapie pelvienne à une augmentation du risque de fracture vertébrale compressive en cas de radiothérapie en conditions stéréotaxiques d'une lésion secondaire rachidienne. Cet article propose une revue de la littérature, définissant les règles pour la délinéation des structures osseuses et hématopoïétiques, et des contraintes de dose telles que recommandées actuellement. Cette synthèse se concentre tout d'abord sur l'irradiation en fractionnement classique, avec ou sans modulation d'intensité, puis sur la radiothérapie en conditions stéréotaxiques avec hypofractionnement (une à cinq séances). Les organes considérés seront en premier lieu les structures hématopoïétiques, puis les structures osseuses. Une synthèse des recommandations actuelles est proposée sous forme d'un tableau.In patients undergoing external radiation therapy, bone marrow and cortical bone structures are all often neglected as organs at risk. Still, from increased febrile neutropenia risk in patients undergoing chemoradiation for a pelvic tumour to increased risk of vertebral fracture when undergoing hypofractioned stereotactic radiotherapy of a spinal metastasis, adverse effects are frequent and sometimes serious. This literature review first defines the rules for contouring these structures, then the dose constraints currently recommended. This article focuses first on conventional irradiation or intensity modulation radiotherapy considering classical fractionation. Secondly, it focuses on stereotactic radiotherapy. The considered organs will be haematopoietic structures, and bone cortical structures. Current recommendations are summarised in a table.



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Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women

Abstract

Background

Concurrent chemoradiotherapy (CCRT) is the standard treatment for local advanced cervical cancer. However, for elderly patients, studies are limited and the outcomes are controversial. We retrospectively analyzed the efficacy and tolerance of radical radiotherapy (RT) or CCRT in elderly cervical cancer patients and performed comparisons between them.

Methods

We retrospectively analyzed the elderly cervical cancer patients (≥70 years old) treated with radical RT or CCRT between January 2006 and December 2014. For external beam radiotherapy, 50Gy in 25 fractions or 50.4Gy in 28 fractions were delivered via 3-dimensional conformal radiation therapy or intensity modulated radiation therapy. High-dose-rate intracavitary brachytherapy was performed with a dose of 30-36Gy in 5–7 fractions to point A. Concurrent chemotherapy regimens included weekly cisplatin and paclitaxel.

Results

Seventy-three patients were eligible for this study. Twenty-one(28.8%) and 52(71.2%) patients suffered with FIGO stage IB-IIA and IIB-IVA disease, respectively. Twenty-four (32.9%) patients received CCRT. The median duration of follow-up was 32.4 months (4.8–118.8 months). The 3-year overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) were 64.9%, 67.8% and 66.5%, respectively. By multivariate analysis, CCRT was a significant predictive factor of OS(p = 0.023, 95% confidence interval [CI]: 1.172–8.860), CSS(p = 0.031, 95% CI: 1.131–13.908)and DFS(p = 0.045, 95% CI: 1.023 ~ 6.430). The 3-year OS of patients received RT and CCRT were 54.3% and 83.1%, CSS were 56.8% and 87.1%, DFS were 57.6% and 83.3%. There was no treatment related death. Grade 3–4 acute hematological, gastrointestinal and urinary toxicity incidences were 31.5%, 19.1% and 12.3%, respectively. For grade 3–4 chronic gastrointestinal and genitourinary toxicities, the incidences were 4.1% and 2.7%, respectively. Compared with RT, CCRT was related with high grade 3–4 hematological toxicity (16.3% and 62.5% respectively, p < 0.001), respectively. However, acute nonhematological toxicity and chronic toxicity were not significantly different.

Conclusion

Elderly cervical cancer patients could tolerate radical RT and CCRT very well and get a favored survival. Compared with RT, CCRT could improve the survival of elder cervical cancer patients with similar nonhematological toxicity. CCRT should be considered in elderly cervical cancer patients.

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