PURPOSE: To evaluate the usefulness of positron emission tomography/computed tomography (PET/CT) for field modification during radiotherapy in esophageal cancer. MATERIALS AND METHODS: We conducted a retrospective study on 33 patients that underwent chemoradiotherapy (CRT). Pathologic findings were squamous cell carcinoma in 32 patients and adenocarcinoma in 1 patient. All patients underwent PET/CT scans before and during CRT (after receiving 40 Gy and before a 20 Gy boost dose). Response evaluation was determined by PET/CT using metabolic tumor volume (MTV), total glycolytic activity (TGA), MTV ratio (rMTV) and TGA ratio (rTGA), or determined by CT. rMTV and rTGA were reduction ratio of MTV and TGA between before and during CRT, respectively. RESULTS: Significant decreases in MTV (MTV2.5: mean 70.09%, p < 0.001) and TGA (TGA2.5: mean 79.08%, p<0.001) were found between before and during CRT. Median rMTV2.5 was 0.299 (range, 0 to 0.98) and median rTGA2.5 was 0.209 (range, 0 to 0.92). During CRT, PET/CT detected newly developed distant metastasis in 1 patient, and this resulted in a treatment strategy change. At a median 4 months (range, 0 to 12 months) after completion of CRT, 8 patients (24.2%) achieved clinically complete response, 11 (33.3%) partial response, 5 (15.2%) stable disease, and 9 (27.3%) disease progression. SUVmax (p = 0.029), rMTV50% (p = 0.016), rMTV75% (p = 0.023) on intra-treatment PET were found to correlate with complete clinical response. CONCLUSION: PET/CT during CRT can provide additional information useful for radiotherapy planning and offer the potential for tumor response evaluation during CRT. rMTV50% during CRT was found to be a useful predictor of clinical response.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Chemoradiotherapy* ; Disease Progression ; Electrons ; Esophageal Neoplasms* ; Humans ; Neoplasm Metastasis ; Positron-Emission Tomography and Computed Tomography* ; Radiotherapy ; Retrospective Studies ; Tumor Burden

OBJECTIVE: Although ovarian cancer is the leading cause of death among all cancers of the female reproductive tract, the genetic alterations involved in ovarian cancer remains largely unknown. Recently, mutations of the p53 gene have been documented in many types of human cancer including ovarian cancer. METHODS: In tbe present study, p53 gene mutation was examined in DNA samples extracted from paraffin embedded surgical specimens of ovarian cancer. Furthermore, clinicopathological parameters were examined in relation to p53 gene mutation in order to understand the role of p53 mutation in the development of ovarian cancer. Using the polymerase chain reaction(PCR) and single strand conformational polymarphism(PCR-SSCP), p53 gene mutation was examined and the mutations were confirmed by DNA scquencing in 17 cases of ovarian cancer. RESULTS: Abnormal bands indicating mutation were detected in 2/17(11.8%). DNA sequencing confirmed in 2 mutations and revealed C to T and A to T nucleotide chmges. In clinicopathological parameters, FIGO stage, grade, and recunence were not correlated with the p53 gene mutation. However, the recurrence rate was higher in patients with mutant p53 compared with those with wild type p53(50.0% vs 13.3%), altbough this is not statisticaUy significant. CONCLUSION: In conclusion, p53 gene mutation shows no correlation with stage, grade and recurrence, and p53 gene mutation does not appear to be a marker that predicts the biological behavior or the outmme of the disease. This study suggested useful data to elucidate the mechanism of chemotherapy-resistant ovarian cancer and further p53 expression assay would be mandatory for p53 nonfunctioning ovarian cancas.
Cause of Death ; DNA ; Female ; Genes, p53* ; Humans ; Ovarian Neoplasms* ; Paraffin ; Recurrence ; Sequence Analysis, DNA

PURPOSE: To evaluate the patterns of nodal failure after radiotherapy (RT) with the reduced volume approach for elective neck nodal irradiation (ENI) in nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: Fifty-six NPC patients who underwent definitive chemoradiotherapy with the reduced volume approach for ENI were reviewed. The ENI included retropharyngeal and level II lymph nodes, and only encompassed the echelon inferior to the involved level to eliminate the entire neck irradiation. Patients received either moderate hypofractionated intensity-modulated RT for a total of 72.6 Gy (49.5 Gy to elective nodal areas) or a conventional fractionated three-dimensional conformal RT for a total of 68.4-72 Gy (39.6-45 Gy to elective nodal areas). Patterns of failure, locoregional control, and survival were analyzed. RESULTS: The median follow-up was 38 months (range, 3 to 80 months). The out-of-field nodal failure when omitting ENI was none. Three patients developed neck recurrences (one in-field recurrence in the 72.6 Gy irradiated nodal area and two in the elective irradiated region of 39.6 Gy). Overall disease failure at any site developed in 11 patients (19.6%). Among these, there were six local failures (10.7%), three regional failures (5.4%), and five distant metastases (8.9%). The 3-year locoregional control rate was 87.1%, and the distant failure-free rate was 90.4%; disease-free survival and overall survival at 3 years was 80% and 86.8%, respectively. CONCLUSION: No patient developed nodal failure in the omitted ENI site. Our investigation has demonstrated that the reduced volume approach for ENI appears to be a safe treatment approach in NPC.
Chemoradiotherapy ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymph Nodes ; Lymphatic Irradiation ; Neck ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Treatment Failure

We report a case of salvage lymphadenectomy for an isolated metastatic lesion in the para-aortic lymph node (LN) in a 49-year old woman with a history of cervical cancer, initially treated with radical hysterectomy and adjuvant radiotherapy. Preoperative 3-dimensional (3D) computed tomography (CT) angiography clearly revealed a huge retro-crural metastatic LN with distinct demarcation. A metastatic lesion, more than 10 cm in size, was located behind the vena cava, aorta, and left kidney, encompassing the left renal and lumbar arteries. The metastatic LN was excised along with the left kidney. On histologic examination, the tumor was found to have invaded the pelvis of the left kidney. Compared with conventional imaging techniques, 3D CT angiography can more clearly visualize such lesions. Thus, 3D CT angiography provides useful anatomical information, such as the exact size and location, and provides clear visualization and demarcation.
Angiography* ; Aorta ; Arteries ; Female ; Humans ; Hysterectomy ; Kidney ; Lymph Node Excision* ; Lymph Nodes ; Pelvis ; Radiotherapy, Adjuvant ; Recurrence ; Uterine Cervical Neoplasms*

Nezelof's syndrome(combined immunodeficiency with immunoglobulin) is a hereditary primary immunodeficiency characterized by recurrent chronic pulmonary infections, oral and cutaneous candidiasis, failure to thrive, chronic diarrhea, skin infection, urinary tract infection, gram-negative sepsis, severe progressive varicella infection, lymphopenia, diminished lymphoid tissue, abnormal structure of the thymus, and presence of normal or increased levels of one or more of the major immunoglobulin classes, but with impaired antibody synthesis. We experienced a case of Nezelof's syndrome in 5-month-old boy who complained cough, poor feeding, vomiting and diarrhea in first admission day and discharged with recovered general condition in 38th admission day and then died of recurrent bacterial and fungal infections and malnutrition in 15-month-old age. He had no thymic shadow in chest X-ray and immunologic abnormalities including decreased lymphocyte count, decreased T cell count and function, normal number of B cell count and immunoglobulins with funtional impairment in antibody synthesis. We report a case of Nezelof's syndrome with brief review of related literatures.
Candidiasis, Cutaneous ; Cell Count ; Chickenpox ; Cough ; Diarrhea ; Failure to Thrive ; Humans ; Immunoglobulin Isotypes ; Immunoglobulins ; Infant ; Lymphocyte Count ; Lymphoid Tissue ; Lymphopenia ; Male ; Malnutrition ; Sepsis ; Skin ; Thorax ; Thymus Gland ; Urinary Tract Infections ; Vomiting

PURPOSE: This study aimed to evaluate whether prophylactic extended-field pelvic radiotherapy (EF-PRT) yields better results than standard whole pelvic radiotherapy (WPRT) in patients with pelvic lymph node-positive cervical cancer treated with concurrent chemoradiotherapy (CCRT). MATERIALS AND METHODS: A total of 126 cases of stage IB-IVA cervical cancer that had pelvic lymph node involvement in magnetic resonance imaging and were treated with CCRT between 2000 and 2016 were reviewed. None of the patients had paraaortic lymph node (PALN) metastases. The patients were classified to two groups, namely, those treated with EF-PRT, including prophylactic para-aortic radiotherapy, and those treated only with WPRT. The median dose to the PALN area in patients treated with EF-PRT was 45 Gy. All patients received concurrent cisplatin-based chemotherapy. RESULTS: Overall, 52 and 74 patients underwent EF-PRT and WPRT, respectively. Patient characteristics and irradiated dose were not significantly different, except the dose to the para-aortic area, between the two groups. The median follow-up period was 75.5 months (range, 5 to 195 months). The 10-year cumulative recurrence rate of PALN for EF-PRT vs. WPRT was 6.9% and 10.1% (p = 0.421), respectively. The 10-year disease-free survival and overall survival for EF-PRT vs. WPRT were 69.7% vs. 66.1% (p = 0.748) and 71.7% vs. 72.3% (p = 0.845), respectively. Acute gastrointestinal complications were significantly higher in EF-PRT (n = 21; 40.4%) than WPRT (n = 26; 35.1%) (p = 0.046). Late toxicities were not significantly different in both groups. CONCLUSION: In this study, prophylactic radiotherapy for PALN does not have an additional benefit in patients with pelvic lymph node-positive cervical cancer treated with CCRT.
Chemoradiotherapy ; Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Survival Rate ; Uterine Cervical Neoplasms*

Cervical large cell neuroendocrine carcinoma is rare. We experienced one case of cervical large cell neuroendocrine carcinoma with invasive mucinous adenocarcinoma in 49 years old woman. So we report the case and brief review of literature.
Adenocarcinoma, Mucinous* ; Carcinoma, Neuroendocrine* ; Cervix Uteri* ; Female ; Humans ; Middle Aged ; Mucins*

Liposarcoma in esophagus is rare, moreover the pedunculated form is very rare. We experienced a case of liposarcoma in a 36-year-old man who had intermittent swallowing difficulty for 7 months. Endoscopy and esophagography revealed that a smooth longitudinal tumor mass occupied the esophageal lumen. Esophagotomy and surgical excision was done. The tumor was 4 cm in length and 3 cm in average diameter with an obvious stalk measuring 3.5 cm in length and 1.5 cm in diameter. Microscopic examination disclosed a lipoma with focal ulceration and liposarcomatous change infiltrating into interstitial fibrous tissue at its distal end.
Adult ; Deglutition ; Endoscopy ; Esophagus* ; Humans ; Intestines* ; Lipoma ; Liposarcoma* ; Stomach* ; Ulcer

Giant hydronephrosis (GH) is a rare urological entity and usually presents with more than a liter of fluid in the collecting system. It may mimic a progressive and benign abdominal cystic tumor. We report a case of GH in an 11-year-old obese boy who presented with abdominal distension and dyspnea on exercise. Hydronephrosis was caused by ureteropelvic junction obstruction, with 2,300 mL of fluid in the collecting system. Diagnostic and therapeutic features of this case are discussed, with reference to current literature.
Child* ; Dyspnea ; Humans ; Hydronephrosis* ; Male* ; Obesity*

Giant hydronephrosis (GH) is a rare urological entity and usually presents with more than a liter of fluid in the collecting system. It may mimic a progressive and benign abdominal cystic tumor. We report a case of GH in an 11-year-old obese boy who presented with abdominal distension and dyspnea on exercise. Hydronephrosis was caused by ureteropelvic junction obstruction, with 2,300 mL of fluid in the collecting system. Diagnostic and therapeutic features of this case are discussed, with reference to current literature.
Child* ; Dyspnea ; Humans ; Hydronephrosis* ; Male* ; Obesity*