1/14. Testicular lymphoma: a literature review and report of a case with a zoster-like cutaneous recurrence.Testicular lymphoma accounts for approximately 1% of all cases of non-Hodgkin's lymphoma. This distinct clinical entity can have an aggressive course with a high rate of systemic relapse. We describe a unique case of a diffuse large B-cell lymphoma, t-cell-rich variant with cutaneous dermatomal zosteriform recurrence presenting as neuralgia. This case represents a unique pattern of treatment failure in this aggressive extranodal lymphoma.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
2/14. Intradermal 5-fluorouracil in the treatment of basal cell carcinoma of the face.The intradermal or infiltrative use of 5-fluorouracil by hypodermic syringe has resulted in the salvage of treatment failures of multifocal basal cell carcinoma of the face. This method is simple and safe, and the initial results have been excellent. It is an effective modality, especially in infiltrating lesions, and it produces little desquamation or side effects and no damage to the surrounding normal skin. Four cases are presented to illustrate how this method has eliminated the need for ablative surgery.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
3/14. Salvage chemotherapy with donor lymphocyte infusion and STI 571 in a patient relapsing with B-lymphoblastic phase chronic myeloid leukemia after allogeneic bone marrow transplantation.Relapse is the main cause of treatment failure following hematopoietic stem cell transplantation for blastic phase chronic myeloid leukemia. Treatment options including donor lymphocyte infusion, second transplantation, interferon- and re-induction chemotherapy are often unsuccessful. We report a patient with blastic phase chronic myeloid leukemia relapsing after allogeneic stem cell transplantation. The post-transplant leukemia was characterized with B-lymphoid markers and multiple genetic abnormalities including double Ph-chromosomes. The disease was treated with three courses of salvage chemotherapy combined with donor lymphocyte infusion and bcr-abl tyrosine kinase inhibitor. The leukemia proved to be non-responsive both to immune therapy and STI 571. The presented case demonstrates the need for combination approaches in post-transplant relapsed leukemia and discusses the possible contributing mechanisms of STI-571 resistance.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
4/14. Recurrent, isolated factor x deficiency in myeloma: repeated normalization of factor X levels after cytostatic chemotherapy followed by late treatment failure associated with the development of systemic amyloidosis.We describe the case of a 64-year-old woman with isolated severe factor x deficiency associated with kappa light chain myeloma. At the time of diagnosis there was no evidence for amyloidosis. Complete remission (CR) of myeloma as well as normalization of factor X levels were achieved after cytostatic chemotherapy. Subsequently, factor x deficiency recurred twice without any evidence for relapse of myeloma. The first time factor X normalized again following cytostatic treatment, the second time, however, factor x deficiency was refractory to chemotherapy. Finally, relapse of myeloma became evident associated with rapidly progressing, systemic amyloidosis, which was fatal within a few months. Initially, factor X infusion studies showed a normal recovery, but when amyloidosis became overt the recovery decreased to 0%. We assume that factor x deficiency was due to a binding of factor X to kappa light chains associated with the proliferation of the malignant myeloma cell clone.- - - - - - - - - - ranking = 4keywords = treatment failure (Clic here for more details about this article) |
5/14. Unresectable primary facial cutaneous carcinoma.Over 500,000 nonmelanoma skin cancers are diagnosed and treated in this country each year. All treatment modalities quote a 90% or greater cure rate. Even with high cure rates, thousands of patients will require secondary treatment. Some nonmelanoma skin cancers are very aggressive and may not be resectable following single treatment failure. Recurrent tumors in critical anatomic locations require a multidisciplined approach. Combined tumor board evaluation and management are advocated.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
6/14. Paget's disease of the nipple as local recurrence after breast-conservation treatment for early-stage breast cancer.breast conservation treatment (BCT) for early-stage breast cancer is associated with survival rates comparable with mastectomy but has the risk of ipsilateral breast tumor recurrence, including Paget's disease of the nipple. A small number of cases of Paget's disease presenting as local recurrence following BCT for breast cancer have been previously reported. Between 1977 and 2002, 2181 women with early-stage breast cancer were treated with BCT at the Hospital of the University of pennsylvania. In this cohort, there were 183 local treatment failures, 4 of which were cases of Paget's disease (2.2%), which are reported herein. These local recurrences developed 1.8, 3.8, 7.3, and 9.7 years after diagnosis of the patients' primary tumors. Three of the 4 primary cancers were invasive ductal carcinomas, with an associated intraductal component, and 1 was ductal carcinoma in situ. All 4 patients were successfully given salvage therapy consisting of mastectomy with or without tamoxifen, with follow-up times of 20.9, 10.6, 3.1, and 3.8 years. Paget's disease as local recurrence after BCT is uncommon and can be treated with salvage therapy if detected early.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
7/14. recurrence of pseudomyxoma peritonei within the inguinal canal.AIM AND BACKGROUND: Tumor appearing in an inguinal hernia sac indicates widespread carcinomatosis with ascites. A new onset hernia is a common clinical presentation of pseudomyxoma peritonei syndrome arising in an appendiceal mucinous tumor. recurrence of pseudomyxoma peritonei within the inguinal region was previously reported in only a single patient. We present five patients with a recurrence of pseudomyxoma peritonei tumor nodules in the inguinal region following cytoreductive surgery and attempt to understand the etiology of this treatment failure. methods AND STUDY DESIGN: From a database of 910 patients with mucinous appendiceal tumors with peritoneal dissemination who had definitive treatment, five patients who had disease recurrence within the inguinal region were identified. The clinical histories were studied and presented in order to make future recommendations regarding the management of these patients. RESULTS: Five patients with ages ranging 39 to 67 years had a mucinous tumor in the inguinal region as a recurrence after a previous cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. One of them had separate recurrence in both right and left inguinal regions. All these patients were made disease-free by the reoperative surgery with a sacrifice of the testicle in four. None have evidence of a recurrence of an inguinal hernia despite the lack of formal repair. CONCLUSION: At the time of initial cytoreductive surgery the surgeon should be aware of the inguinal region as a possible site of relapse. This may be more problematic in patients who have had prior surgery with mucoid fluid in a hernia as the presenting sign of pseudomyxoma peritonei. Inguinal recurrences should be removed with clear margins even if orchiectomy is required.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
8/14. Effectiveness of cetuximab/gefitinib in the therapy of a sacral chordoma.BACKGROUND: Chordomas are rare tumors of the skull base and the spine. Treatment is difficult since conventional radiotherapy or chemotherapy have only limited effects. PATIENT AND methods: A patient with a sacral chordoma and pulmonary metastases received initial surgery and radiotherapy for a local recurrence. After 11 months another local recurrence as well as a progression of the pulmonary metastases was documented. As tumor biopsies revealed the expression of the EGF receptor an individual treatment approach with a combination of cetuximab and gefitinib was performed. RESULTS: Under the treatment with cetuximab/gefitinib the local recurrence and the pulmonary metastases showed a partial response over the follow-up period of 9 months. To date no treatment failure was observed. CONCLUSIONS: The inhibition of the EGF pathway seems to be an effective measure in the treatment of a chordoma. Further follow-up will have to prove the long-term efficiency.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
9/14. Vulvovaginal melanoma: report of seven cases and literature review.Five cases of primary vaginal melanoma were treated at UCLA Medical Center between 1976 and 1986. Two additional cases of melanoma arising at the junction of the vulva and vagina are presented. One of seven (13%) patients is alive, with a median time to recurrence of 7 months, and median survival of 31 months. Four of five vaginal melanomas were located in the distal vagina, and all were advanced at diagnosis (greater than 3 mm depth). Mean size was 3 cm. Initial therapy was local excision in four patients and radical surgery in three. All patients had suboptimal surgical margins: two vaginal primaries had positive margins after local excision, both recurred vaginally within 5 months. Two patients had margins less than 1 mm, one died of distant metastases, the other is alive with disease 30 months after radical distal vaginectomy and hemivulvectomy with post-op pelvic radiotherapy. Three patients had melanoma in situ at the surgical margins, and each had pelvic recurrences between 6 and 26 months. Five of seven cases developed local recurrence as the initial site of treatment failure. All five vaginal cases ultimately developed distant disease, but only two patients had distant disease without local-regional recurrence. Chemotherapy and immunotherapy enabled disease stabilization in three patients. The vulvovaginal junction at the introitus is a high risk site for vaginal and vulvar melanoma. Intraoperative management requires assessment of lateral and deep spread of invasive and in situ melanoma.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
10/14. Intraoperative implantation radiation therapy plus lumpectomy for carcinoma of the breast.The preponderance of evidence indicates that lumpectomy plus radiation therapy produces the same survival as modified radical mastectomy in patients with early breast cancer and further suggests that the local failure rate may be lower in the patients who undergo irradiation. In this series, patients were treated with immediate implantation of the tumor bed with iridium Ir 192. There have been two recurrences in the breast from 110 breast cancers (44% had a clinical stage greater than T1, and 41% had axillary-node involvement) in 107 patients followed up for four to 52 months (25.8 /- 13.3 months [mean /- SD]). These preliminary data suggest that local treatment failure can be minimized by aggressive, immediate intraoperative implantation of the tumor bed with iridium Ir 192.- - - - - - - - - - ranking = 1keywords = treatment failure (Clic here for more details about this article) |
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