|Year : 2016 | Volume
| Issue : 6 | Page : 66-68
|Date of Web Publication||30-Nov-2016|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Lungs. J Can Res Ther 2016;12, Suppl S2:66-8
Primary adenoid cystic carcinoma of lung: A case report
Aneesha Babu , S. Roshni, A. L. Lijeesh, Rari P. Mony, M. Preethi, P. G. Jayaprakash
Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India, E-mail: [email protected]
Primary adenoid cystic carcinoma of lungs accounts for 0.09% of all primary lung cancers. Most of these neoplasms are located in the central airways and peripherally situated adenoid cystic carcinomas are rare. We present here an unusual case of peripherally located primary adenoid cystic carcinoma of lung in this report. This 37-year-old gentleman was evaluated elsewhere for an incidentally detected consolidation in the right lower zone of lung in 2005 with a CT scan which showed a primary mass lesion in right lower lobe, with metastatic nodules in bilateral lung fields. Cytology was suggestive of adenoid cystic carcinoma. PET CT showed no evidence of extrathoracic disease. Patient underwent right lower lobectomy, wedge resection of right upper lobe lesion and metastatectomy of left lung nodules and was kept on followup. In 2007 he developed recurrence in lung and scalp. He was started on Erlotinib but was discontinued due to skin reaction. In 2009 he presented to us with a recurrent scalp soft tissue swelling. CT evaluation showed multiple parenchymal lung metastasis. Palliative RT of 800c Gy was given to the scalp swelling and was started on Geftinib. Reassessment CT done in 2015 revealed metastasis in both lungs, liver and right kidney with renal vein thrombosis. Biopsy confirmed adenoid cystic carcinoma. Patient was not keen for any active intervention and continues to remain relatively asymptomatic on Geftinib. This report reaffirms the indolent nature of metastatic adenoid cystic carcinoa.
Role of gefitinib in nonsmall cell lung carcinoma: A retrospective study
A. K. Arya, L. Pandey , K. N. Pradeep, A. Mudgal
Department of Radiotherapy, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, E-mail: [email protected]
Background: Lung cancer is the leading cause of cancer among men in India. We analysed 24 patients of lung cancer, receiving oral Gefitinib for advanced NSCLC in radiotherapy department. Materials and Methods: Patients who were diagnosed from January 2012 to June 2016 were included. 24 patients were found suitable for analysis. Gefitinib was administered 250 mg/day until disease progression, unacceptable toxicity, or death occurred. Response of treatment was evaluated by chest X-ray. Symptomatic improvement as evaluated according to the clinical judgment and KPS scoring. Results: Out of 24 patients, 15 were male and male to female ratio was 5:3. The mean age at the time of diagnosis was 60.94 yr (range 40-75 yr). 3 (12%) of the patients were non smoker. Out of 21 smokers, 11 patients have history of alcohol consumption. Mean year of smoking was 28 yr. Majority of the patients had advanced disease, 54% patient presented with Squamous Cell Carcinoma and 46% Adenocarcinoma. The mean duration of treatment was 177 days (range 90-270 days). Out of 24, 9 Patient had received prior chemotherapy in form of Cisplatin and Etoposide. Follow-up duration ranges from 105-452 days (mean 275 Days). PFS was 122 days (range 90-252 days). 19/24 (79%) patient shows better response to treatment. Conclusion: In case of advanced and recurrent NSCLC patients, Tab. Gefitinib is better option. It is well tolerated and toxicity profile is also low.
Paratesticular lymphoma masquerading metastasis from EGFR positive primary adenocarcinoma lung
Akanksha Chhabra , Sameer Khatri, Sandeep Agarwal
Department of Radiotherapy, Max Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India, E-mail: [email protected]
Introduction : Paratesticular lymphoma is rare, accounting for <1% of all NHL. We present a rare case of primary adenocarcinoma lung having EGFR mutation with metachronous paratesticular lymphoma. Case Report: A 65-years-old male presented in December, 2014 with complaints of breathlessness, chest pain and cough of 1 month duration. Investigations revealed massive left pleural effusion with lung collapse and mediastinal lymph nodes. Pleural biopsy reported metastatic adenocarcinoma lung. EGFR mutation analysis showed deletion of exon 19. He was put on tablet Erlotinib 150 mg once daily with good clinical and radiological response after 3 months. Tablet Erlotinib was continued. PETCT scan, in February 2016, showed decrease in the activity of lung lesion but there was increased FDG uptake in right testis/paratestis. USG scrotum revealed 3.1 × 2.9 × 2.5 cm lesion in right scrotal sac. He underwent right high inguinal orchidectomy. Postoperative histopathology reported paratesticular diffuse large B-cell lymphoma infilterating testis. He was started on R-CHOP based chemotherapy. To the best of our knowledge, present case is the first case of its kind to describe primary adenocarcinoma lung with metachronous paratesticular lymphoma. Conclusion: The possibility of second malignancy should be considered in cases with primary lung cancer presenting as paratesticular/testicular mass during follow up.
Comparing consistency of gamma results in Mobius 3D/FX of lung SBRT with three different pretreatment verification approaches
Mohandass Palanisamy 1,2,3 , D. Khanna 1 , Orest Ostapiak 2 , Kevin Dimond 2 , Durai Manigandan 3 , Narendra Kumar Bhalla 3 , Abhishek Puri 3
1 Department of Physics, Karunya University, Coimbatore, Tamil Nadu, 3 Department of Radiation Oncology, Fortis Hospital, Mohali, Chandigarh, India, 2 Department of Radiation Oncology, Juravinski Cancer Center, Hamilton, Canada, E-mail: [email protected]
Introduction: Four Lung SBRT VMAT plans were selected from a clinical patient database. RapidArc plans were developed using the Eclipse treatment planning system. Dose was calculated using the AAA algorithm. Model RA-8 set a dosimetric leaf gap (DLG) of 0.8 mm and model (RA-16) set a dosimetric leaf gap of 1.6 mm which were used for the final dose calculation. Using in-house python script converted Eclipse RapidArc plans into Pinnacle SmartArc plan. The conversions preserved control points and monitor units. A Pinnacle machine model (SA-16) was developed for calculation of SmartArc plans. The model mimics the Eclipse model in that the leaf offset table is replaced with a single dosimetric leaf gap equal 1.6 mm, consistent with the Eclipse RA-16 model. Each of the three machine models were used to calculate four different patients subjected to 3 different QA methods. Materials and Methods: Treatments were delivered with a 6MV photon VARIAN 21EX Unit. Mobius 3D/FX, 2D ion chamber array (MatriXXEvolution), stereotactic dose verification phantom with Exradin-A16 ion chamber were used for QA measurement. Results: Observed >95% gamma pass results in all three models subjected to three QA approaches. Comparatively, found higher pass rate in RA-16, SA-16 models than RA-8. Similar results were observed in point dose measurement. Conclusions: In all three QA approaches, gamma pass results were found in good agreement as per TG 119 (>95%; 3%, 3 mm, Threshold dose: 5%; Point dose: <3.5%). The consistency of higher gamma pass rate was found in RA-16, SA-16 (1.6 mm) models as compared to RA-8 model due to large DLG (0.8 mm).
Whether VMAT is superior to 3DCRT in locally advanced lung cancer: A dosimetric analysis
Department of Radiotherapy, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India, E-mail: [email protected]
Background: There have been recent advances in external beam radiotherapy moving from conventional to conformal therapy. Currently VMAT has increasing interest due to shorter treatment time and less number of MU. There is several evidence which is in favour of VMAT especially in lung, prostate, anal cancer etc. Introduction: VMAT simultaneously deals with changing gantry position, dose rate and multileaf-collimator (MLC) position. It allows escalating dose to tumour volume and minimises to OARs in shorter treatment duration when compared with IMRT. Objective: To analyse dosimetric differences between 3DCRT and VMAT techniques in planning for locally advanced lung cancer. Materials and Methods: 10 patients were retrospectively studied. In each patient parameter were analysed based on dose volume histogram of 3DCRT and VMAT. Parameters included were PTV, total Lung-PTV and others OARs. All patients have been treated with 3DCRT. Results: The mean doses to PTV, 95% isodose line conformity and homogeneity was equal in both the arms [(96.076% Vs 98.68%) (P = 0.231)]. The mean value of achieved constraint of the OARs were also equal excepting mean dose to brachial plexus, (29.53 Gy Vs 48.87 Gy) and total lung-PTV (12.32 Gy Vs 14.32 Gy), (P = 0.21) which were better in VMAT arm but not statistically significant. Conclusion: Single arc VMAT may be a valid option in achieving highly conformal dose distribution and considerable dose reduction in OARs. Volumetric arc therapy seems to be better option for treating locally advanced NSCLC however we need clinical feasibility.
Stereotactic body radiation therapy for early stage primary lung cancer, is an active breath coordinator necessary?
Ram Madhavan , Haridas Mohanachandran Nair, Arun Lal, Raghavendra Holla, Dinesh Makuny
Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India, E-mail: [email protected]
Objectives: An audit of SBRT in Primary Lung cancer treated in our Centre with and without an Active Breath Coordinator was undertaken to evaluate its impact on target volumes and clinical outcomes. Materials and Methods: 9 patients with lung carcinoma were treated from January 2014 to August 2016. 5 patients were simulated using ABC and 4 patients with free breathing. In cases with ABC, PTV was generated by 5 mm uniform expansion of GTV. In free breathing an ITV was created using Maximum Intensity projection generated by 4D CT simulator. PTV was generated by 3 mm uniform expansion of ITV. Volumetric modulated Arc Therapy plans were generated using Monaco treatment planning software. Three patients were treated with a dose of 54 Gy in 3 fractions and 6 patients with a dose of 48 Gy in 4 fractions. Response assessment was done after 3 months with CT scan using RECIST criteria. Results: The median age was 72. The mean PTV volumes in ABC and free breathing groups were 42.19cc and 60.17cc respectively. The mean V20, V10 and V5 in ABC group was 5.37cc, 10.49cc and 18.45cc where as in free breathing 6.63cc, 12.74cc and 20.64cc respectively. The set up errors in ABC group was higher compared to free breathing. There were 5 complete responses, 2 partial responses and 2 stable diseases. At a median follow up of 18 months, there were 3 local recurrences. No significant toxicity occurred in our series. Conclusion: Our initial results show that SBRT is well tolerated with good local control. In free breathing group the patient compliance is more and over all treatment time is less. Although the PTV volume and irradiated normal lung volume was higher in this group compared to ABC group, this did not translate to any added clinical toxicity.
Palliative radiotherapy with concomitant and maintenance gefitinib for the management of locally advanced adenocarcinoma lung: Early outcome
Vikas Verma , Ashok Chauhan, Paramjit Kaur, Anil Khurana,
Yashpal Verma, Nupur Bansal
Department of Radiotherapy, PGIMS, Rohtak, Haryana, India, E-mail: [email protected]
Purpose: To evaluate the feasibility and role of palliative radiotherapy and concomitant Gefitinib and maintenance in locally advanced adenocarcinoma lung with respect to symptomatic relief, tolerability, local control and toxicity. Materials and Methods: We present early outcomes of an ongoing prospective feasibility trial in the Department of Radiotherapy, PGIMS Rohtak. Since December 2014, thirty (30) patients with stage III/IV non-metastatic adenocarcinoma lung have been accrued in this study up to May 2016. Presenting symptoms were cough in 21, breathlessness in 24, expectoration with blood in 6 and chest pain in 20 patients. Male:female was 19:11. All accrued patients had KPS 70 or 80. These patients have been treated with palliative EBRT 30 Gy in 10 fractions over 2 weeks and oral Gefitinib 250 mg once a day, from the first day of radiotherapy, concomitant & continued thereafter till disease progression. Median follow-up was 6 months (range 4-11 months). The patients were assessed for symptomatic relief, tolerability, local control and toxicity. Results: Six deaths have been observed, all during the natural course of disease and none was related to treatment toxicity. All other patients have tolerated the treatment well and no significant drug induced toxicity has been observed. More than 50% relief in cough, chest pain, hemoptysis, dyspnoea is observed in 57%, 75%, 50% & 100% of patients respectively. Partial response was observed in 14 patients, 6 having stable disease and 4 patient has got progression of disease. Diarrhoea and skin rashes were two toxicities which were observed in 6 (25%) and 4 (16.6%) patients. Managed with symptomatic care and if required by withholding Gefitinib for maximum one week. Conclusion: Palliative radiotherapy and concomitant and maintenance Gefitinib in locally advanced adenocarcinoma lung seems feasible and effective regimen with acceptable toxicity.
Key words: Adenocarcinoma, concomitant, gefitinib, lung, palliative, radiotherapy
A case of pitutary metastasis from lung cancer presenting with polydipsia and polyuria
Sandeep Bhaskar, R. K. Spartacus, Rohitashwa Dana, Sandeep Jain, Shantanu Sharma, Neeraj Sharma, Daleep Sihag, Kartick Rastogi, Ajay Choudhary, Kampra Gupta, Nikesh Agarwal, Sushil Saini
Department of Radiotherapy, S.M.S. Medical College, Jaipur, Rajasthan, India, E-mail: [email protected]
Introduction: The pituitary gland is an uncommon site for metastasis. Metastatic pituitary tumours are detected in less than 1% of patients undergoing surgery for sellar/parasellar tumors. Typically, they affect elderly patients in the sixth or seventh decade. Breast and lung are the most common sites of primary. The reported survival ranges from 6 to 22 months. Case Presentation: A 55 year old woman presented with complaints of excessive thirst, excessive urination, and headache for two months duration. MRI brain showed a 29 × 24 × 39 mm lobulated sellar, suprasellar mass causing enlargement/ballooning of sella with erosion of dorsum sella, displacing optic chiasm. There was bilateral parasellar and retroselar extension, erosion of floor of sella and extension into sphenoid sinus. Biopsy of this suprasellar mass reported a metastatic pituitary adenocarcinoma. On immunohistochemistry (IHC), neoplastic cells were positive for CK, CK7 and TTF. IHC was negative for P63, synaptophysin and prolactin. A primary from lung was suspected. CECT thorax showed 30 × 27 mm mass in left postero-basal segment of the lung infiltrating adjacent pleura. A CT guided biopsy of this lung mass suggested adenocarcinoma. Breast and systematic examination was normal. Further metastatic workup (CT abdomen, CT Head & Neck, Bone Scan) revealed no abnormality. Hormonal levels were normal. She was started on palliative radiotherapy to the sellar mass considering her symptoms and palliative chemotherapy. Conclusion: Isolated metastasis to the pituitary from adenocarcinoma lung is unusual. The treatment is usually conservative, ranging from surgical removal, radiation surgery, or systemic chemotherapy depending on the extent and condition of the primary.
A case report of transformation of congenital cystic adenomatoid malformation of lung to pleuro pulmonary blastoma
Priyanka Das , Md. Arshad Mollah, Suranjan Moitra
Department of Radiotherapy, NRS Medical College and Hospital, Kolkata, West Bengal, India, E-mail: [email protected]
Introduction: Pleuropulmonary Blastoma is a rare malignant mesenchymal pediatric tumour with a well recognized association with congenital cystic adenomatoid malformation (CCAM). We describe a similar case of PPB arising in association with CCAM which showed excellent response with chemotherapy after surgical excision. Materials and Methods: A full term 1 yr and 4 month old child, suffering from recurrent pneumothorax underwent a CT thorax which showed a cystic lesion in right lung. Surgical excision done and HPE report showed CCAM. Then he was kept in follow up but symptoms again recurred after 6 months. HRCT showed infected cystic lesion in right hemithorax. Tru-cut biopsy and IHC was done and it revealed PPB. Then he was prescribed chemotherapy containing Ifosfamide, carboplatin and etoposide. Results: Patient received 4 cycles of chemotherapy. His SOB improved dramatically and follow up imaging also showed excellent response. Conclusions: PPB is a highly aggressive childhood tumor offen in association with CCAM that needs multimodality approach in its management and regular screening for possible recurrence should continue for 48-60 months after diagnosis.
A prospective comparative study on changes in quality of life in patients with nonsmall cell lung cancer treated with palliative course of radiotherapy
Indranil Khan, Pandimit Lepcha , Amitava Manna, Pronoy Kanti Mondal, Mannavi Suman, Sourav Sinha, Shyamal Kumar Sarkar
Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India, E-mail: [email protected]
Introduction: Lung cancer is the most common cause of cancer-related deaths worldwide. Around 40% of lung cancer patients present at a very advanced stage with general condition not permitting surgery or concurrent chemoradiotherapy. The primary objective of this study is to assess whether there is any any improvement in quality of life in very advanced non small cell lung cancer (NSCLC) patients with performance status ECOG 3, as measured 6 weeks after a palliative course of thoracic radiotherapy. Materials and Methods: Since December 1, 2015 till May 31, 2016, 30 patients presenting with advanced non small cell lung cancer, having performance status ECOG 3 at a tertiary cancer care centre in India were incorporated into the study. All these patients were asked to fill out the Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaire independently at the time of initial presentation, following which they were treated with palliative thoracic radiotherapy of 17 Gy in 2 fractions, delivered on two consecutive Saturdays. The same FACT-L was again conducted at 6 weeks after completion of thoracic radiotherapy. Sign test was performed to detect significant changes in global quality-of-life scores. Results: It was observed that, at 6 weeks after treatment there was statistically significant change in Quality of Life of these NSCLC patients with poor general condition. Conclusions: Palliative course of thoracic radiotherapy does improve the Quality of Life in patients with non small cell lung cancer with poor general condition, who would have otherwise been declared unfit for chemoradiotherapy and offered best supportive care at home.
| Article Access Statistics|
| Viewed||1037 |
| Printed||16 |
| Emailed||0 |
| PDF Downloaded||92 |
| Comments ||[Add] |