Curr. Oncol., Volume 17, Issue 5 (October 2010) – 17 articles

Multiple myeloma metastatic to the skin is a rare occurrence that usually reflects a high tumour burden. Here, we report the case of a woman with known multiple myeloma who developed cutaneous lesions on the right leg. Limited-field radiation treatment was successfully used to decrease her tumour bulk. Unfortunately, the patient died of complications related to systemic treatment a few months after developing the cutaneous involvement. Full article

A 60-year-old woman with breast cancer metastatic to the bones experienced no adverse skin reaction at the lumbar spine after a single 8-Gy photon-beam fraction prescribed to a depth of 5 cm. However, a subsequent treatment to the thoracic spine using the same dose, fractionation, and technique resulted in skin erythema and permanent hyperpigmentation. After careful investigation, no differences were identified in her concurrent use of possibly radiosensitizing medications during the various radiotherapy treatments nor in possible errors of treatment planning and radiation delivery. To our knowledge, this is the first case report to document that, with similar medications, a previous skin response to a given radiotherapy dose, fraction, and technique may not be predictive of subsequent skin response to similar radiotherapy. Full article

Advanced hepatocellular carcinoma has a dismal prognosis, with a median overall survival of 7.9 months if untreated and of 10.7 months if treated with sorafenib. We present a case of advanced previously unresectable hepatocellular carcinoma in a 49-year-old man that achieved a pathologic complete response and was made amenable to surgery with sorafenib in combination with ⁹⁰Y radioembolization. The patient’s survival was more than double the median for patients treated with sorafenib alone. Full article

According to the published data, most primary central nervous system lymphomas (PCNSLS) are B-cell lymphomas; primary T-cell lymphomas are rare. In a search of the MEDLINE database, we found only 6 cases of primary T-cell PCNSL. Here, we present the case of a 43-year-old man with AIDS, not on highly active antiretroviral therapy, who presented with focal neurologic symptoms and was found on magnetic resonance imaging to have multiple brain lesions. A biopsy showed T-cell lymphoma, and the patient was subsequently treated with whole-brain radiation, to marked clinical response. Reported cases from the literature of primary T-cell PCNSL in AIDS patients are summarized in this review. Full article

Extraskeletal myxoid chondrosarcoma (EMS) is a rare oncologic phenomenon characterized by chondroid and neurogenic differentiation in extraskeletal locations. These tumours represent fewer than 2.5% of all soft-tissue sarcomas and are most commonly found in the lower extremities, limb girdles, distal extremities, and trunk. Their presence in cardiac tissue is exceedingly unusual; just a single case of EMS metastatic to the heart has been reported, and no cases of primary cardiac EMS are known. Here, we report the case of a 26-year-old man who presented to his physician with a chest wall mass. Further evaluation led to the discovery of a large intracardiac mass with multiple end-organ growths. Complete work-up of this patient included cardiac biopsy, echocardiography, magnetic resonance imaging, positron-emission tomography, computed tomography, and fluorescence in situ hybridization studies for the translocation involving the EWSR1 gene locus (22q12). Results of the foregoing studies confirmed the diagnosis of ems, but the origin of this patient’s tumours remains elusive and the contention between a primary cardiac source and cardiac metastasis has yet to be resolved. This article describes the histopathology, immunohistochemistry, and chromosomal aberrations common to ems, together with the common presenting features, natural history, and prognosis. Full article

Spindle-cell differentiation in ameloblastic carcinoma is a rare event. Although reported by many authors, it was first described as a separate entity in 1999 by Slater under the heading “low-grade spindle-cell ameloblastic carcinoma.” Here, we report a case of low-grade spindle-cell ameloblastic carcinoma arising in pre-existing unicystic ameloblastoma. The patient, a 60-year-old Indian woman, had a large irregular swelling in the left mandibular region. Histologically, the lesion was composed of a large cystic cavity with an ameloblastomatous lining and areas showing spindle-cell proliferation. The spindle cells showed hyperchromatism, nuclear pleomorphism, and scattered mitotic figures. To our knowledge, 6 cases of spindle-cell ameloblastic carcinoma have been published to date, and this case appears to be the first reporting malignant transformation with spindle-cell differentiation in unicystic ameloblastoma. Full article

The words “personalized medicine” are used daily now in cancer care and research conversations. But what do those words really mean to us as patients, caregivers, physicians, managers of the health system, or researchers? Do we know how personalized medicine will affect us over the next decade? Are we prepared?Those and other questions are part of a continuing conversation that the Terry Fox Research Insti-tute is having with the Canadian public in 2010 as part of its public research and outreach project, The Pan-Canadian Dialogue Series on Cancer: Let’s Get Personal. The first dialogue was held in St. John’s, Newfoundland and Labrador, April 12, to coincide with the 30th anniversary of the Terry Fox Marathon of Hope. It featured speakers and panellists from Newfoundland and Labrador, Nova Scotia, New Brunswick, and Prince Edward Island. Three core issues framed the Atlantic discussion: cancer and population health, cancer and the health system, and the science behind cancer care. Full article

Extramammary Paget disease (EMPD) is a rare skin disease commonly found in the anogenital region. In this study, we aimed to identify EMPD patients seen in the non-melanoma skin cancer clinic at Odette Cancer Centre and to describe the treatments delivered and outcomes achieved. From 2000 to 2009, 14 patients were seen. Initial treatment recommendations included imiquimod and surgical excision, although half the patients required more than one treatment modality, highlighting the difficulty of achieving complete eradication of this disease. Full article

In 1976, Peter Nowell, following observations of cytogenetic heterogeneity in a population of cancer-ous cells, proposed that this genetic diversity could be explained by hypothesizing that these cells are subject to evolutionary forces[...] Full article

Interest has been increasing in the use of androgen deprivation therapy (adt) combined with radiation therapy (rt) in the management of localized prostate cancer. Preclinical studies have provided some rationale for the use of this combination. In patients with high-risk disease, the benefit of a combined approach, with the addition of adjuvant hormonal therapy, is supported by results of randomized trials. In contrast, for patients with low-risk disease, there is no obvious therapeutic advantage except for cytoreduction. The usefulness of short-term hormonal therapy in association with rt for intermediate-risk patients is still debatable, particularly in the context of dose-escalated rt. The optimal timing and duration of adt, in the neoadjuvant and adjuvant settings alike, are still under investigation. In view of the potential side effects with adt, further studies are being performed to better identify subsets of patients who will definitely benefit from this therapy in combination with rt. Full article

Purpose: Radiation-induced dermatitis is a common side effect of breast irradiation, with hypofractionation being a well-known risk factor. In the context of the widespread adoption of hypofractionated breast radiotherapy, we evaluated the effect of hypofractionated radiotherapy on the incidence of skin toxicity in patients receiving adjuvant chemotherapy. Patients and Methods: We retrospectively reviewed the records of patients with breast cancer treated from 2004 to 2006 at a single institution. Patients undergoing lumpectomy with or without adjuvant chemotherapy followed by hypofractionated radiotherapy consisting of 42.4 Gy in 16 fractions were included in the study. Using cosmetic and skin toxicity scales, all patients were evaluated weekly during treatment and at scheduled follow-up visits with the radiation oncologist. Results: During the study period, 162 patients underwent radiotherapy, and 30% of those (n = 48) received chemotherapy. Radiotherapy boost to the tumour bed was more common in the chemotherapy group [n = 20 (42%)] than in the radiotherapy-alone group [n = 30 (26%)]. We observed no statistically significant difference between the groups with regard to acute skin toxicity of grade 3 or higher (2.1% in the chemotherapy group vs. 4.4% in the radiation-alone group, p = 0.67) or of grades 1–2 toxicity (62.5% vs. 51.7% respectively, p = 0.23). There was also no significant difference in late grade 3 or higher skin toxicity between the groups (2.1% vs. 0% respectively, p = 0.30) or in grades 1–2 toxicity (20.8% vs. 25.5% respectively, p = 0.69). Similarly, excellent or good cosmetic result scores were similar in both groups (p = 0.80). Conclusions: In our single-institution review, we observed no adverse effects of chemotherapy in combination with hypofractionated whole-breast irradiation. Further investigations are necessary to better elucidate the effects of chemotherapy on skin toxicity in the context of hypofractionated irradiation. Full article

Purpose: Most male breast cancer tumours are hormone receptor–positive; the patients therefore receive endocrine therapy. There is, however, a paucity of published data on toxicities experienced by male breast cancer patients who are prescribed endocrine therapy. In the present study, we examined rates of adherence to and toxicity from endocrine treatments in male breast cancer patients treated at a single institution. Patients and Methods: We conducted a retrospective study of male patients diagnosed with breast cancer at The Ottawa Hospital Cancer Centre during 1981–2003. Data collected included patient age, hormone receptor status, therapy adherence, self-reported toxicities, and type and duration of endocrine therapies. Results: The review located 59 cases of early-stage and metastatic male breast cancer. Median patient age was 68.0 years. Tamoxifen was given to 38 patients (64.4%), anastrozole to 8 (13.6%), and letrozole to 5 (8.5%). Of patients who received endocrine therapy, 10 (25%) received adjuvant systemic chemotherapy. Toxicity was reported by 19 patients taking tamoxifen (50%), with hot flashes being the most common complaint (18.4%). Decreased libido, weight gain, and malaise were reported by 5 patients (13.2%). Rash and erectile dysfunction were reported by 3 patients (7.9%). Increased liver enzymes, pulmonary embolism, superficial thrombophlebitis, myalgia, depression, visual blurring, and loose stools were each reported in 1 patient (2.6%). Tamoxifen therapy was discontinued secondary to toxicity in 9 patients (23.7%). Of the patients treated with anastrozole, 3 (37.5%) reported toxicity, with 1 report each of decreased libido, leg swelling, and depression (12.5%). Toxicity was reported in 2 patients taking letrozole (40%), with both reporting peripheral edema, and 1 reporting hot flashes. No patient discontinued anastrozole or letrozole because of toxicity. Conclusions: Few studies specifically report data on adherence to and toxicities from endocrine therapies in male breast cancer patients. The rate of discontinuation at our institution because of toxicity (23.7%) is similar to that reported in the female breast cancer population. Future prospective studies should explore strategies to improve adherence to endocrine therapy in this population. Full article

Background: In 2005, bevacizumab was approved by Health Canada for patients with metastatic colorectal cancer (mcrc). Newfoundland and Labrador was one of the first Canadian provinces to fund this agent in combination with FOLFIRI (irinotecan, 5-fluorouracil, leucovorin) chemotherapy. In this analysis, the entire provincial bevacizumab sample for the first 2 years was assessed for overall safety and efficacy. Methods: The medical records of 43 patients with mcrc who had received FOLFIRI with bevacizumab were identified and reviewed. The longitudinal data collection format that was adopted assessed occurrences of adverse events after each cycle of treatment. Toxicity outcomes such as gastrointestinal (GI) perforations, bleeding, diarrhea, myelosuppression, proteinuria, and venous thromboembolic events (VTES) were collected and graded using the U.S. National Cancer Institute’s Common Terminology Criteria for Adverse Events, version 3.0. Time to treatment failure (TTF) and overall survival (os) were determined using the Kaplan–Meier method. Results: Overall, the 43 study patients received 398 cycles of anticancer therapy (median: 6 cycles; range: 1–24 cycles). No GI perforations were identified. However, 4 bleeding events occurred (9.3%), 3 requiring permanent discontinuation of bevacizumab. Also, 6 grade 3 or 4 VTES occurred (14.0%), 3 of which required a hospital admission. In addition, grades 3 and 4 diarrhea, febrile neutropenia, and proteinuria showed cumulative incidences of 11.6%, 2.3%, and 2.3% respectively. Median TTF was 6.3 months; median os was 24.4 months. Conclusions: Bevacizumab in combination with FOLFIRI appears to be well tolerated, and efficacy is consistent with trial reports. However, patients should be closely monitored to avoid potentially serious events such as bleeding and VTES. Full article

Defects in lipid metabolism have been found to be linked to several diseases, among which atherosclerosis, hypertension, obesity, and diabetes are the most important. Although cancer is chiefly a genetic disease, dietary lipid intake and metabolism are related to some cancer risks, including the risk for ovarian cancer. Higher intake of dietary lipids, systemic lipid metabolism malfunction, and abnormal serum lipid levels are somehow related to ovarian cancer. Overexpression of some lipid metabolic enzymes are also found in ovarian cancer. In this review article, we summarize the relationships between lipid intake, lipid metabolism, and ovarian cancer. Full article

Imagine a society in which patients are routinely euthanized—whether they want their lives to end or not—if their suffering cannot be alleviated without dulling their consciousness, eliminating their in-dependence, or threatening their dignity.[...]
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