Synovial sarcoma is a rare and aggressive high-grade neoplasm with poor prognosis. It is usually encountered in the lower extremities of young adults; only a few cases have been reported in the head and neck region. We report the fourth case of synovial sarcoma of the nasopharynx, treated with neoadjuvant chemotherapy, complete surgical excision and adjuvant radiation with extensive review of literature.
EJOHG IntroductIonEsophageal carcinoma is one of the commonly occurring cancers in India accounting for 7.4% of male and 5.9% of female cancers. 1 Radiation therapy has become a cornerstone of treatment for most of esophageal cancer patients.Chemoradiation has shown a superior overall survival when compared with radiation alone in esophageal carcinoma. 2Currently, definitive chemoradiotherapy (CRT) based on the 5-fluorouracilcisplatin (5FU-CDDP) regimen has been considered for curative intent in locally advanced or inoperable nonmetastatic esophageal cancer.Radiation therapy in patients with esophageal cancer is a challenge, because these OriGinal articlE10.5005/
Concurrent chemoradiation causes toxicities such as enteritis, hematologic toxicities which may lead to treatment interruptions, and therefore inferior outcomes. Adequate supportive care is very important to complete the scheduled protocol. Most of our patients are from rural background with a heterogeneous social background (nutrition and social support). There is paucity of literature to evaluate the tolerance of this intense treatment in these groups of patients, and hence, this study was undertaken. In this observational study, 30 rural women having carcinoma cervix treated with concurrent chemoradiation between January and July 2013 were reviewed retrospectively. They were assessed weekly for dyselectrolytemia, enteritis, and hematologic toxicity using Radiation Therapy Oncology Group Acute Radiation Morbidity Scoring Criteria. Treatment gaps along with reasons were recorded and correlated. Median age of patients was 54 years. Of the patients, 43.3% were International Federation of Gynecology and Obstetrics stage II and 46.7% stage III. Grade 3 enteritis was seen in 7 of 30 patients (23.3%). None (0%) had grade 3 or higher hematologic toxicity. Dyselectrolytemia–hyponatremia (46.66%), hypokalemia (26.66%), hypocalcemia (6.66%), and hypomagnesemia (10%) were noted. Two of thirty patients (6.66%) received the planned 5 cycles, cisplatin 40 mg/m2 weekly. There were treatment interruptions in radiation in 6 (20%) and treatment delays in chemotherapy in 10 (33.33%) patients. Concurrent chemoradiation for patients from rural areas is associated with higher acute toxicities. Regular monitoring for enteritis and dyselectrolytemias and timely intervention can help improve compliance and decrease treatment interruptions and thereby achieve the optimum treatment outcome.
Malignant peripheral nerve sheath tumors are aggressive sarcomas with poor prognosis. It is usually encountered in lower extremities. Only a few cases have been reported in head and neck region with buccal mucosa being an unusual site.
Central venous catheter-associated bacteraemia caused by Nocardia species is very rare; the diagnosis of nocardiosis in patients with cancer is challenging because its clinical presentation is varied, sometimes mimicking metastases, and the high index of clinical suspicion is required for prompt institution of therapy. Herein, we report a case of nocardial sepsis with native aortic valve endocarditis in a patient with breast cancer in whom multidisciplinary team involvement and prompt initiation of therapy have led to successful outcome.
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