RESUMEN
OBJECTIVE: Presentation of primary malignant melanoma of the vagina. Summary of clinical findings and management. DESIGN: Case report. SETTING: Nemocnice Pardubického kraje a.s., Porodnicko-gynekologická klinika, Pardubice. OBSERVATION: We report a case of primary malignat melanoma in a 44 year old woman, with symptoms of abnormal vaginal bleeding and painful intercourse. CONCLUSION: Primary malignant melanoma of the vagina is rare disease. Goal of therapy is complete removal of primary tumor.
Asunto(s)
Melanoma/patología , Hemorragia Uterina/etiología , Neoplasias Vaginales/patología , Adulto , Femenino , Humanos , Melanoma/cirugía , Resultado del Tratamiento , Vagina , Neoplasias Vaginales/cirugíaRESUMEN
BACKGROUND: The goal of this study is to examine the effect of neoadjuvant radiochemotherapy on the density of CD8(+) tumor infiltrating lymphocytes (TILs) in endoscopical biopsies and resection specimens from patients with rectal adenocarcinoma before and after therapy. PATIENTS AND METHODS: In total, 53 patients with locally advanced rectal cancer were studied. RESULTS: The median density of CD8(+) TILs in pretreatment biopsies was 12 (1-â232) and that in surgical specimens after radiochemotherapy was 18 (1-â319). During radiochemotherapy, the density of CD8(+) TILs increased in 30 patients (57%), decreased in 18 (34%), and did not change in one. It was not possible to assess the dynamics of CD8(+) TILs density in four patients. The increased density of CD8(+) TILs after radiochemotherapy was associated with a median survival rate 2.5 times longer than that associated with no increase in density. CONCLUSION: In the present study, the density of CD8(+) TILs in endoscopical biopsies before radiochemotherapy, the density in resection specimens after radiochemotherapy, or in changes in the density after radiochemotherapy showed no predictive or prognostic significance. However, studying a larger number of patients may show that CD8(+) TILs density is of predictive or prognostic significance.
Asunto(s)
Adenocarcinoma/terapia , Linfocitos T CD8-positivos/inmunología , Quimioradioterapia , Linfocitos Infiltrantes de Tumor/inmunología , Neoplasias del Recto/terapia , Adenocarcinoma/inmunología , Adulto , Anciano , Humanos , Persona de Mediana Edad , Terapia Neoadyuvante , Pronóstico , Neoplasias del Recto/inmunologíaRESUMEN
PURPOSE: The aim of the present study was to examine the effect of neoadjuvant chemoradiation on tumor epidermal growth factor receptor (EGFR) expression in patients with locally advanced rectal adenocarcinoma. PATIENTS AND METHODS: A total of 53 patients with rectal adenocarcinoma (clinical stages II and III) were studied. Neoadjuvant treatment consisted of 50.4 Gy/28 fractions external radiation with concomitant continuous 5-fluorouracil. Surgical resection was performed 4-6 weeks after the chemoradiation. EGFR expression in the pretreatment biopsies and in the resected specimens was assessed with immunohistochemistry. RESULTS: Patients with an increase of EGFR expression during chemoradiation had significantly shorter disease-free survival (DFS; p = 0.003) and overall survival (OS; p = 0.005) compared to patients with either no change or decrease in EGFR expression. The 5-year DFS in patients with increased EGFR expression was only 29% compared to 61% in patients without an increase of EGFR expression. Similarly, the 5-year OS of the patients with increased EGFR expression was 29% compared to 66% in patients without an increase of EGFR expression. All recurrences in patients who had an increase of EGFR expression occurred within the first 2 years after the treatment. The increase in EGFR expression was the only significant predictor of DFS (p = 0.007) and OS (p = 0.04) using multivariate Cox regression analysis. CONCLUSION: An increase of EGFR expression during chemoradiation may be associated with significantly shorter DFS and OS. The increase of EGFR could identify a population of patients in whom the effect of the treatment with anti-EGFR therapy should be studied.
Asunto(s)
Adenocarcinoma/metabolismo , Adenocarcinoma/terapia , Biomarcadores de Tumor/metabolismo , Quimioradioterapia Adyuvante , Receptores ErbB/metabolismo , Neoplasias del Recto/metabolismo , Neoplasias del Recto/terapia , Adenocarcinoma/diagnóstico , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Proteínas de Neoplasias/metabolismo , Pronóstico , Neoplasias del Recto/diagnóstico , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
Epidermal growth factor receptor (EGFR) plays an important role in cell-cycle regulation, proliferation, differentiation, and surviving of epithelial tissues. Aberrant overexpression of EGFR can initiate uncontrolled cell proliferation with subsequent formation of epithelial carcinomas. Correlation between EGFR overexpression and increased resistance of tumor tissues to ionizing radiation has been described by many authors. Strategy of tumor radiosensitization by EGFR inhibition seems to have a great potential in the treatment of epithelial cancers. Rationale for EGFR inhibition in combination with ionizing radiaton arises from published results of many radiobiological studies, which describe the role of EGFR in cytoprotective and pro-proliferative reactions of human tumor cells, induced by irradiation. These reactions result in accelerated tumor repopulation, which is subsequently counter-productive to the effect of radiotherapy. Presented article is an overview of EGFR and its function in healthy and tumor tissues; likewise, it describes the relation of EGFR to ionizing radiation; therapeutic approaches to EGFR function modulation in combination with radiotherapy in preclinical and clinical use.