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Advancements in surgical and radiotherapy techniques have enhanced locoregional control (LRC) in head and neck squamous cell carcinoma (HNSCC), yet 30–40% of patients still experience recurrence within 2–3 years. Salvage surgery can result in significant morbidity and often fails to achieve optimal LRC as a standalone treatment. Modern radiotherapy (RT) techniques support highly conformal re-irradiation for small local recurrences with acceptable toxicity. The role of positron emission tomography (PET-CT) based contouring is under evaluation for re-irradiation settings. This retrospective study included patients treated with re-irradiation at a tertiary care center, focusing on those with prior HNSCC in the oral cavity, pharynx, or larynx, who had received radical or adjuvant RT and presented with biopsy-confirmed recurrences or second primary tumors. PET-CT was used for metastatic workup, with rigid image registration on planning CT scan employing a significant 40% SUVmax cut-off for tumor delineation. From January 2019 to June 2022, 85 patients underwent re-irradiation, with a median RT dose of 60 Gy (range: 44–66 Gy); 32 patients received concurrent chemoradiotherapy (CRT). Treatment planning used the volumetric modulated arc technique (VMAT), with the median Dmax for critical structures ranging from 7 Gy to 63 Gy. Acute grade 3 or higher mucositis, dysphagia, and odynophagia were observed in up to 23.5% of cases. At a median follow-up of 23 months, the 2-year disease-free survival (DFS) and overall survival (OS) rates were 55.2% and 63.5%, respectively. These promising results support PET-CT contouring-based planning as a potential standard of care in re-irradiation.

HER2-positive metastatic breast cancer (MBC) represents a challenging subtype of breast cancer, characterized by aggressive disease and poor clinical outcomes. Trastuzumab emtansine (TDM1), an antibody–drug conjugate combining trastuzumab and emtansine, has demonstrated efficacy in clinical trials as a second-line treatment for patients progressing after prior therapies. This study aims to provide real-world evidence on the efficacy and safety of TDM1 in HER2-positive MBC patients. A retrospective analysis was conducted on 70 HER2-positive MBC patients treated with TDM1 at our centre between January 2020 and December 2022. Clinical characteristics, progression-free survival (PFS), overall survival (OS), response rates, and toxicity were evaluated using hospital records. PFS and OS were calculated using Kaplan–Meier methods, and survival curves were compared with log-rank tests. The median age of patients was 47 years, with a majority presenting with advanced disease and prior treatment lines. The median PFS was 6.1 months (95% CI, 4.5–7.6), and the median OS was 14.4 months (95% CI, 10.2–18.0). The objective response rate was 75.7%, with 12.8% achieving a complete response and 62.8% a partial response. PFS was significantly longer in hormone receptor-positive patients compared to hormone receptor-negative patients (8.1 vs. 4.1 months, p = 0.035). Toxicity was manageable, with grade 3–4 adverse events including elevated transaminases (8.5%), thrombocytopenia (5.7%), and anemia (4.2%). The efficacy of TDM1 in this real-world cohort aligns with clinical trial data, though PFS and OS were somewhat lower compared to trials, likely due to the inclusion of patients with more extensive disease and prior treatments. Notably, TDM1 demonstrated activity against CNS metastases and a manageable safety profile, with higher incidence of hepatic and hematologic toxicities. Our study supports the use of TDM1 as a viable option for treating HER2-positive MBC in routine clinical practice, confirming its effectiveness and safety profile observed in clinical trials.

IntroductionThe revision of International Federation of Gynaecology and Obstetrics staging in 2018 with recommendations to include cross-sectional imaging and a separate stage for node positive disease have opened a lot of uncertainties in implementing the correct treatment approach in these patients. While studies have suggested higher chances of occult para-aortic lymph node (PALN) even with advanced imaging, especially in pelvic node positive disease which tend to recur after pelvic radiation therapy. This study intends to study these patients and isolate the subset who will benefit most from elective PALN irradiation.Methods and analysisThis is an ongoing multicentric phase III randomised controlled trial with a sample size of 274 subjects in two arms (137 in each arm) to determine the superiority of limited elective para-aortic irradiation compared with no irradiation. Arm one includes radiation to the lower PALN and pelvis; Arm two includes radiation to the pelvis. Concurrent chemotherapy followed by brachytherapy is standard in both arms. Patients with cervical cancer and radiologically positive pelvic LNs aged>18 years and<70 years are screened for the study. The primary endpoint of this study is 3-year disease-free survival. The secondary endpoints include 3-year para-aortic recurrence-free survival, 3-year distant metastasis-free survival, 3-year overall survival, acute and late toxicity, quality of life. Translational study to evaluate systemic immune response by FAPI-PETCT (fibroblast activator protein inhibitor positron emission tomography) and assessment of p16, L1 cell adhesion molecule (L1CAM) and protein death ligand-1 (PDL-1) expression by immunohistochemistry.Ethics and disseminationThe study has been approved by the institutional ethics committee and will be routinely monitored according to standard guidelines. The results of the study will be published in peer-reviewed scientific journals, presented at conferences and submitted to regulatory authorities.Trial registration numberThe study was registered on 17 January 2022 under CTRI/2022/01/039495 (http://ctri.nic.in).

Background Metaplastic breast cancer with heterologous mesenchymal differentiation, known earlier as carcinosarcoma, consists of both infiltrating ductal carcinoma cells and mesenchymal cells, and is associated with an aggressive course. The mesenchymal component is rarely endothelial, with only two previously reported cases. The present case is the third among those. Moreover, the disease outcome was good, unlike the usual course of carcinosarcoma. Case presentation A 59-year-old multiparous woman of Indo-aryan ethnicity developed a lump in her left breast and was diagnosed with breast carcinosarcoma having an endothelial component, with the help of histopathological examination and immunohistochemistry. The tumor was surgically removed; then the patient received adjuvant chemotherapy, epirubicin, and cyclophosphamide, followed by adjuvant radiotherapy to the whole breast, followed by tumor bed boost. The patient was clinic-radiologically disease-free even at 26 months post-treatment. Conclusion Surgery followed by adjuvant chemotherapy and radiotherapy gives better outcomes compared with surgery alone, with a doubtful role of neoadjuvant chemotherapy. Targeted therapies can be considered in patients not responding to conventional treatment.

Rhabdomyosarcomas (RMS) are pediatric soft-tissue sarcomas arising from immature mesenchymal cells that are intended to form striated skeletal muscles. Brachytherapy delivers high-dose of precised radiation to the target tissue with high conformity, sparing the nearby normal tissues, hence allowing dose escalation and reducing the likelihood of normal tissue toxicity. There is a scarcity of reports on the use of brachytherapy for extremity RMS. We report the case of pediatric extremity RMS treated with re-brachytherapy in recurrent setting. A 4-year-old boy diagnosed with RMS of right upper arm underwent local excision of the lesion. Postoperative magnetic resonance imaging showed suspicious residual lesion. Revision surgery followed by brachytherapy with 30 Gy in 10 fractions twice a day over 5 days was delivered. The child developed local recurrence after 12 months. Reexcision and re-irradiation with brachytherapy were done delivering 27 Gy in 9 fractions twice a day over 5 days. The child is disease-free 18 months posttreatment with no significant disparity in limb length suggestive of successful preservation of growth epiphysis. Re-irradiation with interstitial brachytherapy can be considered as an option for the treatment of recurrent pediatric extremity rhabdomyosarcoma, in conjunction with surgery and chemotherapy, despite treated previously with brachytherapy.

Background: Cervical cancer requires multimodality therapy, resulting in acute toxicities. Intensity-modulated radiation therapy (IMRT) is postulated to spare bone marrow (BM) and bowel to reduce acute hematological and gastrointestinal (GI) toxicities of chemoradiotherapy. Patients and Methods: This is a prospective randomized phase III study enrolling patients with Stage IB to IVA cervical carcinoma in two arms receiving either three-dimensional conformal radiotherapy (3DCRT) or IMRT from December 2017 to December 2019. The primary objective was to compare the hematologic toxicities (Grade 2 or more neutropenia as the primary factor) and the secondary objectives were to compare GI toxicities, and dosimetric analysis for volumes of BM, and bowel irradiated. SPSS version 20 was used for all statistical calculations. Results: Eighty patients with histopathologically confirmed cervical cancer were randomized to receive IMRT or 3DCRT (40 in each arm). The median age of the patients was 56.5 (36-67) and 59.5 (37-68) years, respectively, in IMRT and 3DCRT arms. The median dose of external radiation was 50 Gy in 25 fractions, and of brachytherapy was 24 Gy in 3 fractions in both the arms. The incidence of grade ≥2 neutropenia was 42.5% and 15% in the 3DCRT and IMRT arms, respectively (P < 0.001). All patients received concurrent chemotherapy with cisplatin, with the median number of cycles being 5 (range 3-5) in both the arms. All five cycles of concurrent chemotherapy could be completed in 25 (62.5%) patients in the IMRT arm and 24 (60%) patients in the 3DCRT arm. Conclusions: IMRT significantly reduces acute hematologic and GI toxicities compared with 3DCRT with a better dosimetry profile.

Rhabdomyosarcomas (RMS) are pediatric soft-tissue sarcomas arising from immature mesenchymal cells that are intended to form striated skeletal muscles. Brachytherapy delivers high-dose of precised radiation to the target tissue with high conformity, sparing the nearby normal tissues, hence allowing dose escalation and reducing the likelihood of normal tissue toxicity. There is a scarcity of reports on the use of brachytherapy for extremity RMS. We report the case of pediatric extremity RMS treated with re-brachytherapy in recurrent setting. A 4-year-old boy diagnosed with RMS of right upper arm underwent local excision of the lesion. Postoperative magnetic resonance imaging showed suspicious residual lesion. Revision surgery followed by brachytherapy with 30 Gy in 10 fractions twice a day over 5 days was delivered. The child developed local recurrence after 12 months. Reexcision and re-irradiation with brachytherapy were done delivering 27 Gy in 9 fractions twice a day over 5 days. The child is disease-free 18 months posttreatment with no significant disparity in limb length suggestive of successful preservation of growth epiphysis. Re-irradiation with interstitial brachytherapy can be considered as an option for the treatment of recurrent pediatric extremity rhabdomyosarcoma, in conjunction with surgery and chemotherapy, despite treated previously with brachytherapy.

Metastatic breast cancer (MBC) patients have numerous options for treatment. However, it is essential to consider treatments with favorable toxicity profiles and convenient modes of administration. Eribulin has shown effectiveness in aggressive MBC, but there is a lack of sufficient real-world data specific to Indian patients. We conducted a retrospective audit of patients with MBC who received intravenous Eribulin between 2019 and 2023 at a dosage of 1.4 mg/m on days 1 and 8 every 3 weeks. The median Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. During the specified time, 107 consecutive patients with MBC received Eribulin treatment. The median age was 52 years (range, 28-75 years) with 3 patients with male breast cancer. The median number of prior chemotherapy lines and involved sites were 3 (range, 2-5) and 3 (range, 1-6), respectively. Visceral involvement was present in 84 (78.5%) patients. A median of 3 cycles of Eribulin (range, 1-11) was administered. Eribulin resulted in partial responses in 49 (45.8%) patients, stable disease in 11 (10.3%) patients and progressive disease in 47 (43.9%) patients. The median PFS was 4.0 months (95% CI: 3.4-4.6), and the median OS was 10.0 months (95% CI: 8.3-11.7). For patients with triple-negative breast cancer (TNBC), the median OS was 8 months (95% CI: 5.6-10.4), whereas non-TNBC patients had a median OS of 11 months (95% CI: 9.1-12.8) (hazard ratio, 1.9, 95% CI: 1.2-3.1, = 0.002). Eribulin was well-tolerated, with dose reduction was needed in 9 (8.4%) of the patients in the overall cohort. Eribulin is a viable and safe option for treating heavily pre-treated MBC in real-world settings. The study found comparable efficacy in both TNBC and non-TNBC patients.