We compared the cumulative incidence of local recurrence in young patients (≤40 years) with breast cancer between breast conserving therapy (BCT) and mastectomy alone. Among 428 women with early-stage breast cancer who were treated between 2001 and 2012, 311 underwent BCT and 117 underwent mastectomy alone. Adjuvant systemic treatments were administered to 409 patients (95.6%). We compared the cumulative incidence of LR and survival rates between two groups. During a median follow-up period of 91 months, the 10-year cumulative incidence of LR was 9.3% (median interval of 36.5 months from surgery). Patients treated with BCT tended to have a higher risk for local recurrence (11.1% for BCT vs. 4.1% for mastectomy alone, p = 0.078). All patients with isolated LR after BCT (n = 23) underwent salvage mastectomy followed by systemic treatments. The 5-year distant metastasis-free survival and overall survival of patients with isolated LR after BCT were 44.2% and 82.2%, respectively. The BCT group exhibited an approximately 2.5-fold higher risk of LR than mastectomy alone group. Patients with isolated LR after BCT showed poor prognosis despite undergoing aggressive salvage treatments. The development of novel treatments should be investigated to reduce LR for improving prognosis and preserving cosmetic outcomes in young women.
Background: Carcinoma showing thymus-like differentiation (CASTLE) in the thyroid gland is a rare disease with generally a favorable prognosis. Treatment with surgery and adjuvant radiotherapy has been shown to improve local control and long-term survival rates. In this report, we present a case of a recurrent thyroid gland CASTLE and review the literature on the diagnosis and treatment of this disease. Case presentation: A 60-year-old woman, who was diagnosed with a CASTLE thyroid tumor in 2015, had a total thyroidectomy and was maintained on thyroid hormone replacement (levothyroxine). After 5 years, the patient had a recurrence, in an advanced stage unsuitable for surgery. As the patient declined to undergo radiotherapy, she was followed up without intervention and is currently stable after 15 months. Conclusions: CASTLE is a rare disease, diagnosed based on postoperative pathology and immunohistochemistry analysis, especially upon CD5 marker. In case of relapse, treatment options include surgery and radiotherapy; however conservative management without intervention is an acceptable alternative in some cases.
Objectives: Evaluation of the hemostatic effect of trans-arterial embolization on patients with advanced oral cavity cancer who had bleeding complications while undergoing definitive concurrent chemoradiotherapy (CCRT). Additionally, assess the effect of trans-arterial embolization on treatment response following concurrent chemoradiotherapy, as well as overall survival (OS) and progression-free survival (PFS) in the group of patients following the intervention. Method: From September 2018–June 2021, a retrospective descriptive study was conducted on 16 patients with inoperable, locally advanced oral cavity cancer who received definitive concurrent chemoradiotherapy, experienced acute bleeding complications, and received selective intravascular intervention with various embolization materials at Vietnam National Cancer Hospital. Results: After selective embolization, 16/16 patients ceased bleeding; 1 patient re-bled for the second time after 3 weeks. The average duration of chemoradiotherapy interruption due to intervention was 6.7 days. After CCRT, 15/16 (93.75%) patients achieved a response, with 9/16 (56.25%) patients achieving a complete response. The median OS was 14 months (range, 3–26 months), and the median PFS was 10 months (range, 3–20 months). There were no significant complications, particularly neurological side effects. ConclusionsTumor bleeding is a common and serious complication of CCRT treatment in patients with locally advanced oral cavity cancer. Embolization is a safe and effective method of controlling acute bleeding that has no adverse effect on the outcome of definitive concurrent chemoradiotherapy.
1 January 2020 in International Journal of Surgery Case Reports
Chondrosarcoma is a malignant tumor originated from cartilage cells. The most common sites of chondrosarcoma are pelvis, femur and ribs. The temporo-mandibular joint (TMJ) chondrosarcoma is extremely rare, with approximately 30 cases reported in worldwide. In this report, we present a case of chondrosarcoma in the left TMJ, which was successfully treated with surgery and radiation therapy. A 47 year-old women was admitted to our hospital with a mass in left pre-auricular region. On examination and para-clinical test results, the initial diagnosis was parotid gland cancer. In operation, the lesion was a mass originating from the left TMJ. Tumor resection was performed with close margin. The post-operative pathological result was well-differentiated chondrosarcoma. She was indicated adjuvant radiation therapy due to inadequate surgical therapy. There was no evidence of recurrence after 6 months follow-up. The TMJ chondrosarcoma is needed to distinguish from other diseases especially parotid gland tumor. Surgery and adjuvant radiation therapy are standard care with the aim of preserving joint function.
Nasopharyngeal carcinoma (NPC) is amongst the most common malignancies of head and neck cancers. Most patients are admitted to the hospital with advanced disease. NPC has a tendency toward early metastatic spread to cervical lymph nodes, and levels II and III are most commonly involved. A few reports have indicated specific metastatic sites of nasopharyngeal cancer, including lymph node metastasis and distant metastasis. Evidence of histopathology and immunohistochemistry is required to prove NPC origin. In many cases, surgery can be performed to obtain accurate evidence of the pathology. However, surgery can also affect the overall treatment plan and strategy for NPC and should be considered in the specific circumstances of the disease. Multidisciplinary consultation is required for these uncommonly specific metastases. Paying attention to the specific lymph node metastasis sites of NPC plays an important role in accurately diagnosing the stage, thereby giving an appropriate treatment strategy. It is also important in determining radiotherapy volumes because radiotherapy is the standard therapy for this disease. Herein, we are reporting 2 cases of NPC with clinical metastasis to unusual lymph node sites such as the parotid salivary gland and the cheek. Histological analyses from the resected specimens confirmed its nasopharyngeal origin. Lymph node metastases in the parotid gland and the cheek are unusual. In diagnosis and follow-up, it is necessary to evaluate carefully to make an accurate diagnosis and appropriate treatment plans for patients as well as early detect recurrent metastases at uncommon sites of lymph nodes.
Minor salivary gland cancer is a relatively uncommon disease of head and neck, arising across the upper aerodigestive tract. This is a malignant neoplasm with diverse clinical behaviors and histological types which are prognostically significant. Although complete surgical resection, with adequate free margin, is currently the treatment of choice for locoregional diseases, the optimal treatment is still not standardized. We presented here a case of locally advanced minor salivary gland cancer that was treated by radical resection, reconstruction, and adjuvant radiation therapy at Vietnam National Cancer Hospital and had promising outcomes.