Total neoadjuvant treatment (TNT) has become a standard treatment approach for locally advanced rectal cancer (LARC). Patients achieving pathological complete response (pCR) following TNT have better outcomes (overall survival, relapse free survival). However, not all patients treated for LARC with neoadjuvant treatment achieve pCR. The aim of our study was to assess the rate and predictors of pCR. We performed a retrospective study at medical oncology unit in a tertiary care teaching hospital. All consecutive LARC patients without any evidence of distant metastasis who underwent neoadjuvant chemoradiotherapy and surgery between June 2020 and January 2023 were included in the research. Pathological response to neoadjuvant treatment was assessed using Mandard grading system and response was categorized as pCR or not‑pCR. Two different standardized protocols for the neoadjuvant treatment were used: the first group was treated with induction chemotherapy followed by short course radiotherapy and the second group was treated with the RAPIDO protocol. Correlation between different studied parameters and pCR was determined using univariate and multivariate logistic regression analysis. The mean age of the 91 included patients (46 men and 45 women) was 58.53 ± 10.3 years. Twenty (22
Adrenal extramedullary plasmacytoma (EMP) is an exceptionally rare plasma cell neoplasm with fewer than 20 documented cases worldwide. The clinical presentation, optimal management strategies, and long-term outcomes remain poorly defined. We report the case of a 51-year-old woman with synchronous bone and adrenal EMP, without multiple myeloma. The initial presentation involved pathological humeral fracture following minor trauma, with the subsequent discovery of a 40 mm left adrenal mass on staging CT. Emergency orthopedic fixation and bone biopsy confirmed the diagnosis of EMP. Immunohistochemical findings showed CD138, MUM1, and kappa light-chain restriction positivity, with negative lambda staining. After declining initial surgical intervention, the patient was lost to follow-up for two years, during which the adrenal lesion enlarged to 70 mm. Comprehensive staging including bone marrow biopsy, FDG-PET/CT, and laboratory workup confirmed absence of multiple myeloma features according to International Myeloma Working Group criteria. Complete laparoscopic left adrenalectomy was successfully performed, with uncomplicated recovery. Histopathological examination revealed a 75 × 55 × 30 mm encapsulated mass with characteristic plasma cell morphology and extensive hemorrhagic foci. The Ki-67 proliferation index was < 10
INTRODUCTION:Gastric squamous cell carcinoma (GSCC) is a rare condition. We present the case of a locally advanced GSCC with dissociated response after neoadjuvant chemotherapy. CASE REPORT:We present the case of a 34-year-old female patient who presented with a two-month history of epigastric pain and vomiting. Esophagogastroduodenoscopy identified a fundic lesion. Biopsy revealed a GSCC. CT scan showed a locally advanced expansile nodular process on the greater curvature of the stomach. Due to the locally advanced nature of the tumor, surgery was deemed excessively mutilating, and chemotherapy was initiated. The endoscopic evaluation showed complete resolution of the fundic mass. CT imaging demonstrated a 37 % reduction in the volume of target lesions. The patient subsequently underwent diagnostic laparoscopy, revealing a locally advanced unresectable tumor accompanied by diffuse peritoneal carcinomatosis. Palliative chemotherapy was initiated. The patient passed away two months after surgery. DISCUSSION:GSCC is a rare condition. The exact origin of this tumor remains unclear. Clinically, GSCC presents similarly to other gastric tumors. Due to its rarity, there is no consensus on the optimal treatment for primary gastric squamous cell carcinoma, and the existing evidence is primarily based on case reports and small case series. Radical surgical excision with lymph node dissection remains the primary therapeutic approach. While neoadjuvant chemotherapy appears beneficial and effective, the available data remain limited. GSCC is known for its locally aggressive behavior and poor short-term prognosis. CONCLUSION:Additional research is crucial to establish the most effective treatment strategies.
Introduction:Reirradiation for recurrent adenoid cystic carcinoma (ACC) of the head and neck poses significant clinical challenges, particularly in low- and middle-income countries where access to advanced radiation modalities such as proton or carbon ion therapy is limited. Given the tumor's radioresistant nature and the risk of cumulative toxicity to critical structures, reporting experiences with accessible and precise photon-based techniques remains essential. This case highlights the potential of volumetric-modulated arc therapy (VMAT) as a feasible reirradiation option in such settings. Case Presentation:We report the case of a 79-year-old male with a history of left ethmoidal sinus ACC initially treated with surgery followed by cobalt-based radiotherapy. Eighteen years later, the patient presented with an inoperable local recurrence. A multidisciplinary tumor board recommended reirradiation using VMAT. A total dose of 60 Gy in 30 fractions was delivered, with careful dosimetric planning to respect cumulative tolerance thresholds of organs at risk (OAR). The treatment was well-tolerated, with no acute grade ≥3 toxicities. Post-treatment imaging showed a marked reduction in tumor volume, and the patient had no severe late toxicity during follow-up or distant metastasis. Conclusions:This case illustrates the potential role of VMAT as a viable reirradiation strategy for head and neck ACC, particularly in resource-limited settings. It emphasizes the importance of individualized treatment planning, accurate dose delivery, and multidisciplinary evaluation in achieving tumor control while minimizing toxicity. Such experiences contribute valuable insights into the management of complex recurrent tumors, where therapeutic options are limited.
