Reports of Radiotherapy and Oncology
Volume:2 Issue: 3, Sep 2015

Context: Sarcoma is a rare human cancer and pancreatic sarcoma is even rarer. Its treatment and clinical history and prognosis are not well described.
Evidence Acquisition: In this review, we collected all articles in the English language found in PubMed that were published between January 2000 to August 2015 to draw conclusions. We found 170 articles in total and 124 articles were excluded. The remaining 46 reports and information of 55 patients were collected and analyzed.
Mean age was 57.1 ± 16.7 years and male/female ratio was 27/28. The most common presenting symptom was pain. In 31 cases no adjuvant treatment was prescribed. Others received different chemotherapy agents and only two cases received radiotherapy. Mean tumor size was 9.0 ± 6.8 cm (1 - 27 cm) and the most common type was leiomyosarcoma (16 patients). Nine patients had carcinosarcoma and six cases had MFH. The most common site of metastasis was liver, 14 patients had liver metastasis at presentation. Median survival was 14 months. One, three and five year overall survival were 78.4, 48.5 and 48.5 percent, respectively. We found no effective clinical factor in survival.
Pancreatic sarcoma is a rare disease and an optimal treatment, such as surgery, chemotherapy or radiotherapy is not well defined.

Olfactory neuroblastoma or esthesioneuroblastoma is a rare malignant neoplasm of the olfactory neuroepithelium.
This study aimed to investigate the clinical presentation, characteristics and treatment outcome of fourteen patients with olfactory neuroblastoma.
Patients and This retrospective study reviewed and analyzed 14 patients with olfactory neuroblastoma during the last 15 years at two referral tertiary academic hospitals of Shiraz University of Medical Sciences. Patients under 16 years old were excluded from the study. Kadish classification was used for staging the tumors. In addition, the tumors were histopathologically graded according to Hyams’ grading classification.
There were 6 women (43%) and 8 men (57%) ranging from 16 to 56 years old, with a median age of 40 years at diagnosis. Nasal obstruction (93%), facial or sinus pain (57%), and nasal bleeding (43%) were the most frequent presentation. Two patients (14%) had stage A, 3 (21.5%) had stage B, 6 (43%) had stage C, and 3 (21.5%) had stage D disease. After initial treatment, five patients developed local and/or distant recurrent disease. After a median follow-up of 73 (range 14 - 108) months for surviving patients, 10 patients (71.5%) were alive and without disease, one (7%) was alive with disease, and 3 (21.5%) died due to the disease. The 5-year disease-free and overall survival rates were 71.4% and 75.7%, respectively.
At our center, patients with olfactory neuroblastoma tend to present at advanced stages; therefore, combined local treatment and incorporation of chemotherapy may improve outcome.

Radiotherapy is a high-energy ionizing radiation treatment for some kinds of cancers. Accuracy and the quality of radiotherapy treatment planning systems depend on the type of dose calculation algorithms that are utilized. There are uncertainties in the calculation of dose distribution, especially in a heterogeneous situation.
This study calculated and compared dose with model-based algorithms (superposition, collapsed cone convolution (CCC) and fast Fourier transform (FFT) and a measure-based algorithm (Clarkson in two modes: heterogeneity active and inactive).
A heterogeneous phantom was used based on a semi-anthropomorphic phantom CIRS thorax 002 LFC. All of the tests were planned according to IAEA TEC-DOC 1583. All measurements were performed with a 6 MV photon beam of a linear accelerator (ELEKTA Compact) and Farmer ionization chamber. Five methods were utilized to calculate dose and were compared with measurement results as the gold standard.
In the homogeneity media all algorithms had good accuracy and dose difference was below 3%, but in the inhomogeneity situation dose difference increased and in some cases did not achieve agreement criteria. The Superposition algorithm overall has minimum deviations in all cases. However in some cases CCC had better accuracy. The Clarkson algorithm had maximum differences, especially when inhomogeneity correction was inactive.
Dose calculation algorithms applied in radiotherapy treatment planning systems have different accuracy. Model-based algorithms have a better accuracy over measurement-based algorithms such as Clarkson. In the presence of large inhomogeneity, it is strongly recommended to activate manual inhomogeneity correction.

Stereotactic body radiation therapy (SBRT) using Cyberknife delivers high-dose fraction of radiation without increasing toxicity.
We present the follow-up outcomes and toxicities of patients with localized prostate cancer treated by use of Cyberknife as a monotherapy.
Patients and This study was based on a retrospective analysis of the 34 patients treated with SBRT using Cyberknife for localized prostate cancer (26.5% low risk, 67.6% intermediate risk, and 5.9% high risk). Total dose of 36.25 Gy in 5 fractions of 7.25Gy were administered without use of androgen deprivation therapy (ADT). The acute and late toxicities were recorded using the radiation therapy oncology group scale. Prostate-specific antigen (PSA) response was monitored.
Thirty-four patients with a median 52 months (range 12 - 71 month) follow-up were analyzed. The biochemical relapse-free survival was 93.3%. PSA fell to a median of 0.39 ng/mL at 4 years and PSA bounce occurred in 28.1% of patients. Acute side effects resolved within 1 - 2 months of treatment completion. There was no grade 3 and 4 late toxicity observed.
In this study, SBRT using Cyberknife without ADT has provided promising outcomes in localized prostate cancer with good PSA response and minimal toxicity. Hypofractionated SBRT using Cyberknife leads to long-term favorable 5-year biochemical relapse-free survival and minimal toxicity in localized prostate cancer as a monotherapy.

Gestational choriocarcinoma usually occurs following an intrauterine pregnancy. We report a case of metastatic choriocarcinoma to the left kidney and lungs with long term intermittent amenorrhea and vaginal bleeding after a normal vaginal delivery.
A 43-year-old rural woman presented with prolonged amenorrhea. Her last delivery was three years ago. She also complained of hematuria and left flank pain. Serum β-hCG level was considerably high. She underwent endometrial curettage. Pathologic examination of endometrial curettage specimen revealed choriocarcinoma. Ultrasound revealed enlarged uterus involved by an irregular mass with heterogenous echo pattern and extensive myometrial invasion. A mass with similar echo pattern was also evident in the left kidney. Computerized tomography confirmed the intrauterine mass and involvement of the left kidney. On chest X-ray, metastatic nodules were seen in both lungs and in the left retrocardiac space. The patient underwent 10 courses of chemotherapy (8 treatment courses and 2 courses for consolidation) with EMA-CO regimen (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine/oncovine). Following the fifth course of chemotherapy, she became pancytopenic and febrile. This condition was successfully managed with G-CSF, leukovorin and antibiotics. The patient is now well and still under the chemotherapy. Her serum β-hCG level has fallen to negative (3 IU/mL).
Gestational trophoblastic diseases should be considered in the differential diagnosis of prolonged amenorrhea in patients of reproductive age with a history of prior pregnancy. Moreover, symptoms related to metastatic involvement such as hematuria and flank pain may be among the first clinical manifestations of choriocarcinoma.

Extrapulmonary small-cell carcinoma, neuroendocrine type is uncommon, particularly in the head and neck region. It represents an extremely rare finding when originating from the nasopharynx, and so far only five cases have been reported.
The authors present a case of a female patient with this tumor type, and describe a treatment strategy that combined radiotherapy and chemotherapy.
Persistent disease was documented ten months after treatment completion.

Pain is the most common symptom in malignant pleural mesothelioma and can be challenging to manage. This article discusses the pathophysiology of pain in mesothelioma and provides a case history to outline management options including medication, radiotherapy, chemotherapy and cordotomy.