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Respiratory disease
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
SCLC All patients offered multidrug platinum-based chemotherapy.In limited disease: consider radiotherapy as well as chemotherapy +/- prophylactic cranial irradiation if tumour responds to initial treatment.
Lung Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Up to 50% of SCLC patients achieving remission develop brain metastases within 2 years. A meta-analysis of 987 patients in seven randomized controlled trials comparing prophylactic cranial irradiation (PCI) with no PCI in patients with complete response following induction chemotherapy and limited-stage SCLC reported that survival was significantly increased in the patients receiving PCI, with a 16% reduction in risk of death and a 5.4% increase in survival at 3 years.49 The risk of brain metastases was reduced by 54%. There was no significant difference between doses of radiation received, although there was a trend towards better survival in patients receiving higher radiation doses.
Lung cancer and mesothelioma
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Of those with controlled local, regional or visceral disease, 60% will sustain an intracerebral relapse within 2 years. This is often the sole site of disease relapse and frequently proves to be a fatal manifestation of their disease. Prophylactic cranial irradiation (PCI) decreases the incidence of cerebral metastases by approximately 50%. Meta-analysis data suggest a 5% absolute 3-year survival advantage for PCI. There is evidence suggesting some neuropsychiatric sequelae from PCI, and the dose and fractionation of PCI is such as to make this risk as low as possible.
Anti-programmed death ligand 1 immunotherapy in patients with limited-stage small cell lung cancer: a real-world exploratory study
Published in Journal of Chemotherapy, 2023
Nan Yao, Zhaohui Qin, Ji Ma, Jiaying Lu, Kaiguo Sun, Yiqing Zhang, Wanxi Qu, Li Cui, Shiwang Yuan, Aijun Jiang, Na Li, Shaodong Tong, Yuanhu Yao
Atezolizumab (at a dose of 1200 mg, administered intravenously on day 1 of each cycle) or durvalumab (at a dose of 10 mg/kg, administered intravenously on day 1 of each cycle) was given concurrently with CRT and was continued in 21-day cycles after completion of CRT until unacceptable toxic effects, disease progression, or no additional clinical benefit were observed. (Given the cost of immunotherapy, the possibility of late toxicity, and the quality-of-life implications, patients who derived durable disease control could discontinue receiving atezolizumab/durvalumab at the physician’s discretion.) Thoracic radiotherapy was given to 60 to 70 Gy in once-daily fractions as CT-planning-based intensity-modulated radiation therapy and was begun on the first or second cycle of chemotherapy in the concurrent arm and after the completion of chemotherapy in the sequential arm. Chemotherapy consisted of four to six 21-day cycles of platinum plus etoposide. Patients who have a good response to initial therapy could receive prophylactic cranial irradiation (25 Gy in 10 fractions) at the treating physician’s discretion.
Treatment and outcome of Philadelphia chromosome-positive acute lymphoblastic leukemia in adults after relapse
Published in Expert Review of Anticancer Therapy, 2020
Marie Balsat, Victoria Cacheux, Martin Carre, Emmanuelle Tavernier-Tardy, Xavier Thomas
Central nervous system (CNS) relapses are a critical issue while treating Ph-positive ALL [76]. Although CNS relapses after HSCT is a major problem in the management of Ph-positive ALL, effective therapeutic modalities for the prevention of CNS relapse have not currently been well established. Up to 20% of patients treated with imatinib monotherapy experience CNS relapses. Poor penetration of imatinib through the blood-brain barrier with inadequate concentrations for kinase inhibition may be associated with an elevated risk of CNS relapse if no additional prophylaxis is given [77]. Prophylactic cranial irradiation effectively reduces the risk of CNS leukemia in Ph-positive ALL patients who received imatinib without any additional CNS-directed treatment [76]. Among TKIs, dasatinib has been shown to have substantial clinical activity in extramedullary leukemia with CNS involvement [78,79]. Stabilization and regression of CNS disease were achieved with continued dasatinib administration. Dasatinib appears to reach the cerebrospinal fluid (CSF) better than other TKIs [80]. However, the CNS penetrance of dasatinib is still low compared with other agents known to have good penetration of the blood-brain barrier, such as cytarabine [81]. Because CSF is a low-protein environment where dasatinib is likely to exist as a free drug, dasatinib concentrations achieved, even low, are sufficient for antitumor activity. The optimal type of CNS-directed treatment and the expansion of protection afforded by prophylactic cranial irradiation remain to be defined.
T-cell lymphoblastic lymphoma involving the ocular adnexa: report of two cases and review of the current literature
Published in Orbit, 2019
Lucy Sun, Alan H. Friedman, Rand Rodgers, Matthew Schear, Giovanni Greaves, Kathryn B. Freidl
T-LBL is a rare cause of orbital or ocular adnexal lymphoma. Despite its indolent presentation, it has an aggressive course and carries a poor prognosis. When encountered with symptoms such as painless conjunctival redness with underlying mass, proptosis, upper eyelid edema, ptosis, and restricted eye movement, clinicians should have a high index of suspicion for malignancy and consider T-LBL in the differential. Our two reported cases highlight the importance of timely diagnosis by the ophthalmologist and co-management with hematology-oncology involving blood work, imaging, and biopsy. Prompt treatment with intensified chemotherapy regimens followed by autologous or allogeneic BM transplantation in high-risk patients is imperative to improve outcome. The role of prophylactic cranial irradiation or mediastinal RT remains a subject of debate and its adverse effects especially in the pediatric population need to be weighed. Following remission, regular follow-up is essential to monitor disease relapse. In patients with relapsed or refractory disease, the salvage rate is extremely poor. Alternative salvage therapy with cytostatic drugs such as nelarabine has shown promising results in limited number of patients and warrants further research.