| 1 |
Author(s):
Bianca, Miruna, Andrada , Daniel, Zsolt.
Page No :
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Recurrent high grade glioma: multiple surgeries and reirradiation
Abstract
Gliomas account for the great majority of primary tumors that arise within the central nervous system (CNS). The term "glioma" refers to tumors that have histologic features similar to normal glial cells (ie, astrocytes, oligodendrocytes, and ependymal cells). Each of these types of gliomas contains neoplasms spanning a broad spectrum of biologic aggressiveness.
Historically, the slower-growing lesions, corresponding to World Health Organization (WHO) grades 1 and 2, have been commonly referred to as "low-grade gliomas," while the more rapidly progressive, grade 3 and 4 tumors are referred to as "high-grade gliomas." The WHO classification recommends avoiding these terms since they lump together heterogenous groups of tumors, many of which have significantly different biologic properties, prognoses, and treatment approaches . Grade 4 gliomas are the most common primary malignant brain tumors in adults. They are characterized by their aggressive and invasive nature and exhibit high inter- and intratumoral heterogeneity .They commonly arise de novo, meaning they begin as a grade 4 tumor with no evidence of a lower-grade precursor. In 2021 the World Health Organization (WHO) updated CNS tumor classifications. We present the case of a 47 year old male, with the diagnosis of frontal grade III anaplastic oligoastrocytoma in 2007, who undergoes surgery and who presents a local recurrence after 4 years. After the second surgical intervention with complete removal of the tumor, the histopathological examination reveals the diagnosis of grade IV astrocytoma. Postoperatively, the patient undergoes 2 cycles of chemotherapy with Temozolomide and considering the histology, age and the patient’s comorbidities, conformal radiotherapy with curative purpose is decided, along with chemotherapy. In 2023 he has a second relapse for which he undergoes surgery. Histopathological report shows that the tumor has transformed into a grade IV astrocytoma. Following surgery, concurrent radio-chemotherapy is instituted for 6 weeks. After the completion of the radio-chemotherapy, he undergoes chemotherapy and follow-up through brain MRI.
| 2 |
Author(s):
Catalin Stefan, Mariana, Mirela, Marc Cristian, Vanessa.
Page No :
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Inflammatory pseudotumors after liver transplantation, a rare differential diagnosis with tumor recurrence: A case report
Abstract
We report the case of a 40-year-old man who was initially diagnosed with multicentric hepatocarcinoma (HCC), which was initially treated by hepatectomy, but with tumor recurrence one year later. He received a liver transplant from a living related donor and three months after the transplant developed multiple liver lesions strongly suggestive of tumor recurrence, but which turned out to be inflammatory pseudotumors that responded to conservative treatment.
| 3 |
Author(s):
Loredana, Diana.
Page No :
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AN INSIGHT INTO THE PECULIARITIES OF SIGNET-RING CELL CARCINOMA OF THE COLON. A REVIEW OF LITERATURE.
Abstract
IMPORTANCE:
Signet-ring cell carcinoma of the colon (SRCC) is a rare, distinct entity of colon cancer, harboring a poor prognosis. Despite the quick development of a variety of personalized cancer treatments, no specific therapy is recommended for this histological subtype.
OBSERVATIONS:
In the current literature review, we focus on investigating the particularities associated with this disease, with regards to clinical presentation, preoperative work-up and treatment.
Irrespective of age and gender, SRCC is located more frequently in the ascending colon, with patients having a more advanced stage at diagnosis. The ability of imaging techniques and tumor markers to indicate the full extent of the tumor is low. Consequently, a curative surgical approach is rarely possible, with many cases having an incomplete resection. Although research regarding the role of neoadjuvant therapy in SRCC is limited, adjuvant chemotherapy seems to improve the outcomes in stage III subpopulation. The incidence of BRCA1 and B-RAF gene mutations is higher compared to adenocarcinoma tumors, as well as the presence of microsatellite instability, which qualifies SRCC for a more targeted treatment.
CONCLUSIONS AND RELEVANCE:
Considering the aggressiveness of this histological subtype, the work-up of patients with SRCC needs to be improved. Additionally, further research into specific biomarkers, including circulating tumor DNA is needed for a tailored therapeutic strategy.
| 4 |
Author(s):
Teodora-Elena, Dragos, Claudia Cristina.
Page No :
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Multiple endocrine toxicities in a patient treated with checkpoint inhibitors
Abstract
Metastatic cutaneous melanomas are treated as a first-line therapy with checkpoint inhibitors, anti-PD-1 antibody, Nivolumab and anti-CTLA-4 antibody, Ipilimumab. Immune-related adverse reactions to immunotherapy include, as the most frequent toxicities, dermatological, gastrointestinal and endocrine toxicity. We present the case of a 51-year-old female, with a medical history of Basedow`s disease and multinodular goitre, who was diagnosed with metastatic cutaneous melanoma in 2019. She underwent surgery of the metastatic lesions, but of an axillary adenopathy which was considered inoperable. She was initially treated with Nivolumab 1mg/kg in combination with Ipilimumab 3mg/kg. Under the double immune checkpoint inhibitors therapy, she developed hepatitis and primary hypothyroidism. Therefore Ipilumamb was discontinued, the patient receiving Nivolumab as monotherapy. Under Nivolumab, the patient developed type 1 diabetes mellitus and primary adrenal insufficiency as further adverse reactions. Despite experiencing multiple endocrinopathies, the patient was allowed to continue the immunotherapy, having a complete response.
| 5 |
Author(s):
Arihant, U., Shweta , N..
Page No :
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Hyperleukocytosis Unveiling in Chronic CML: A Rare Oncological Emergency
Abstract
Patients with hematologic malignancies can visit the emergency department for various reasons. The role of an emergency physician is to look for oncological emergencies in such patients and treat them. We report one such presentation of a patient with chronic myeloid leukemia (CML).
We report a case of a 46-year-old male recently diagnosed with chronic myeloid leukemia who presented to the emergency department with vertigo and breathlessness. Clinical examination showed low oxygen saturation, right sensorineural hearing loss, and splenomegaly. Hyperleukocytosis in complete blood count and clinical features suggestive of poor tissue perfusion made us suspect leukostasis. Initial brain and chest imaging were normal. We treated him with leukapheresis, cytoreduction, and tumor lysis syndrome (TLS) prophylaxis.
Leukostasis is a medical emergency, and it is essential to consider this in patients with hematologic malignancies. Early diagnosis and treatment are crucial because the mortality rate rises to 40% if left untreated.
| 6 |
Author(s):
Alexandru , Claudia, Andrei .
Page No : 12-17
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The Prognostic Role of Circulating Inflammatory Biomarkers in the Response to Cetuximab-Based Therapy for unresectable stage IV Metastatic Colorectal Cancer
Abstract
Materials and methods
A retrospective study of 213 unresectable stage IV metastatic colorectal cancer (mCRC) patients (2014-2023) undergoing first-line therapy (FOLFOX/FOLFIRI Doublet Chemotherapy + Anti-EGFR monoclonal antibodies, Cetuximab) was conducted based on ESMO and ASCO guidelines. Inclusion criteria comprised KRAS wild-type status, left-sided colorectal cancer, completion of Doublet ChT + Cetuximab cycles, and availability of CT examinations at the 3-month follow-up. Exclusion criteria aimed to eliminate factors like active infections or hematologic diseases. NLR and PLR were measured a day before therapy. After applying criteria, 38 patients were selected for further investigation. Chemotherapy response was evaluated at the 3-month checkpoint using RECIST 1.1 criteria, categorizing patients into Response (R), Stable Disease (SD), and Progressive Disease (PD). ROC curve analysis determined cut-off values for NLR (1.54) and PLR (95.90) to distinguish response groups. Stratification into NLR and PLR subsets based on median values involved testing for response differences using appropriate statistical tests.
Results
Median NLR and PLR values demonstrated an ascending trend from the Response (R) to Progressive Disease (PD) groups, indicating an association between lower NLR and PLR values and a more favorable response. ROC curve analysis suggested potential cut-off values of 1.54 for NLR and 95.90 for PLR, showing trends aligning with existing studies. Although statistical significance wasn't reached, larger sample sizes might validate these insights. Categorizing patients into subsets based on NLR and PLR median values (1.90 and 99, respectively) revealed statistically significant differences in response, supporting their potential as prognostic indicators. Chi-squared tests showed significance in both NLR and PLR subsets (p < 0.0001 and p < 0.03, respectively).
Conclusions
Our research validates NLR and PLR as effective biomarkers for assessing Cetuximab-based therapy in unresectable mCRC. While not offering absolute precision, their cost-effective and straightforward integration into routine clinical practice underscores their practical value. Moreover, their significance in specific patient populations within diverse healthcare settings enhances their potential utility.
| 7 |
Author(s):
Jose Ma. H. , Caissa Elvira, Manuel Martin , Juan Martin, Angela .
Page No : 18-31
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Coping Strategies Among Filipino Cancer Patients Undergoing Radiation Therapy in Two Tertiary Care Hospitals in the Philippines: An Analytical Cross-sectional Study
Abstract
Purpose
The process of coping is central in the lives and experiences of cancer patients. Foreign literature on coping strategies among cancer patients is largely qualitative in nature, in the form of thematic, grounded theory, and phenomenological analyses. Of the quantitative research that has been done, many have found varying degrees of association between certain coping strategies and improved quality of life and decreased emotional distress. However, knowledge on how coping varies and is associated with the patient’s demographics, disease characteristics, among other factors remains in its infancy. This is especially true in the Philippines.
Methods
A total of 210 Filipino patients more than 18 years of age, with histologically confirmed diagnosis of cancer, receiving radiation therapy at St. Luke’s Medical Center-Quezon City or St. Luke’s Medical Center-Bonifacio Global City from April 2022 to December 2022, were made to answer the Filipino Coping Strategies Scale (FCSS). The FCSS is a self-administered, 37-item, 4-point scale that measures the degree to which the respondent uses particular coping strategies categorized into one of nine domains: cognitive reappraisal, social support, problem-solving, religiosity, tolerance, emotional release, overactivity, relaxation and recreation, and substance use.
Results
Religiosity is the primary coping strategy in this patient population, with a composite score of 3.9214 out of 4 (SD = 0.1688). The second most utilized coping strategy is problem-solving (composite score = 3.6310; SD = 0.3162). The third most common coping strategy is cognitive reappraisal (composite score = 3.5524; SD = 0.4062). This is closely followed by relaxation and recreation (composite score = 3.5343; SD = 0.3734). The fifth most utilized coping strategy is social support (composite score = 3.3140; SD = 0.5790). Calculation of independent samples t-test revealed no statistically significant difference between the coping strategies in terms of hospital (i.e. St. Luke’s Quezon City or St. Luke’s Bonifacio Global City), sex, metastatic status, and intent of radiotherapy. Calculation of analysis of variance (ANOVA) likewise revealed no statistically significant difference in terms of age, marital status, religion, educational attainment, estimated monthly income, primary cancer diagnosis, days elapsed since primary cancer diagnosis, Wong-Baker Faces (WBF) pain rating, and Eastern Cooperative Oncology Group (ECOG) performance status.
Conclusion
The most commonly utilized coping strategies in our patient cohort are religiosity, problem-solving, cognitive reappraisal, relaxation and recreation, and social support, regardless of demographic and disease-related characteristics. To the proponents’ knowledge, our research is the first to study the coping strategies of Filipino cancer patients in a quantitative manner. Doubtless, further research is needed to shed light on this crucial but barely yet untouched aspect of cancer care.
| 8 |
Author(s):
Andrada Olivia , Teodor Marian, Bogdan Cristian , Octavia Bristena , Annamaria .
Page No : 45-50
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Multiple-focused analysis of breast cancer late recurrence – a case report and literature review
Abstract
Breast cancer is, due to its high incidence rate, one of the most studied malignancies in medical research nowadays. Thus, well-established screening schedules, targeted medical treatment options and surgical innovations are evolving at a high pace, some aspects are not yet generally concluded and one of them is the issue of late recurrence. Our case presents a patient with a 35-year relapse window after a curatively treated invasive mammary carcinoma and aspects such as the diagnostic process, therapeutical management, and immediate outcome are extensively described. Several key aspects of this issue are discussed as a brief review of the literature.
