Radiotherapie des kutanen malignen Melanoms

Zusammenfassung

Hintergrund

Das Melanom galt früher als strahlenresistenter Tumor. Publikationen der letzten 20 Jahre konnten zeigen, dass die Radiotherapie in der primären und in der Rezidivsituation sowie auch bei Metastasen einen wichtigen therapeutischen Beitrag leisten kann.

Material und Methode

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema „Radiotherapie und Melanom".

Ergebnisse und Schlussfolgerung

Die Radiotherapie nimmt bei der definitiven Behandlung kutaner Melanome eher eine untergeordnete Rolle ein. Eine Ausnahme stellt das Lentigo-maligna-Melanom dar, wo sich bei Patienten, die nicht operabel sind, durch eine Bestrahlung sehr gute lokale Kontrollraten erzielen lassen. In der postoperativen Situation kann bei R1- oder R2-resezierten Tumoren bzw. bei knapp resezierten desmoplastischen Tumoren eine Bestrahlung mit dem Ziel der lokalen Kontrolle durchgeführt werden. Bei Vorliegen von Risikofaktoren (Zahl und Größe der befallenen Lymphknoten, Kapseldurchbruch, Rezidiv) sollte eine adjuvante Bestrahlung der Lymphknotenregion erfolgen, um die lokale Tumorkontrollrate zu erhöhen. Bei Vorliegen von symptomatischen Knochenmetastasen lassen sich die Beschwerden durch eine palliative Radiotherapie gut kontrollieren. Bei der Behandlung einer Hirnmetastasierung sollte eine lokale Radiotherapie (z. B. Radiochirurgie) der Ganzhirnbestrahlung vorgezogen werden. Dabei kann eine Radiotherapie mit Ipilimumab auch simultan kombiniert werde; eine Kombination mit BRAF-Inhibitoren sollte dagegen sequenziell erfolgen.

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Mast Cell Interactions and Crosstalk in Regulating Allergic Inflammation

Abstract

Purpose of Review

This review summarizes recent findings on mast cell biology with a focus on IgE-independent roles of mast cells in regulating allergic responses.

Recent Findings

Recent studies have described novel mast cell-derived molecules, both secreted and membrane-bound, that facilitate cross-talk with a variety of immune effector cells to mediate type 2 inflammatory responses.

Summary

Mast cells are complex and dynamic cells that are persistent in allergy and are capable of providing signals that lead to the initiation and persistence of allergic mechanisms.

https://ift.tt/2JSXszY

A Rare Case of Multifocal Papillary Thyroid Cancer in Bilateral Thyroid Cysts

Papillary thyroid cancer (PTC) can present as a thyroid cyst. In its more aggressive form, PTC may be multifocal in nature and is associated with a poorer prognosis. In patients whom PTC is diagnosed incidentally after a diagnostic lobectomy, the decision whether to offer completion thyroidectomy is sometimes challenging to make if such patients fall in the 'low-to-intermediate' risk category. We present a case of a 55-year-old lady who had a predominantly cystic left thyroid nodule with no suspicious features on ultrasound as well as 2 subcentimetre simple right-sided cysts. She subsequently underwent left hemithyroidectomy, and this reported a T2 PTC in the thyroid cyst. This was followed by completion thyroidectomy which yielded the surprising finding of PTC in the two tiny right sided cysts. This case highlights the need for vigilance in managing patients with thyroid cysts even though thyroid ultrasound scan did not reveal any overt suspicious features.

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The Role of Adjuvant Radiotherapy for a Case of Primary Breast Sarcoma: A Plan Comparison between Three Modern Techniques and a Review of the Literature

A 65-year-old woman, affected by a malignant fibrous histiocytoma (undifferentiated pleomorphic sarcoma) of the left breast, presented to our department to receive the postoperative radiotherapy. In the absence of prospective and randomized trials and investigations on breast sarcoma irradiation in literature, due to the rarity of this pathology, the role of adjuvant radiotherapy remains unclear. To identify the best radiotherapy technique for this patient, three methods were compared: 3D conformal radiotherapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and volumetric arc therapy (VMAT) or RapidArc® (RA). 50 Gy was prescribed to the chest wall and 66 Gy to the tumor bed. Three plans were designed, and target coverage, organs-at-risk sparing, and treatment efficiency were compared. IMRT and RA improved both target coverage and dose uniformity/homogeneity. Planning objective for the lung is always satisfied comparing the different techniques, but the volume receiving 20 Gy drops to 17% by RA compared to 3D-CRT. The heart volume receiving 30 Gy was 10% by IMRT, against 13% and 16% by RA and 3D-CRT. The monitor unit (MU) required by 3D-CRT was 527 MU, followed by RA and IMRT. Treatment time was similar with 3D-CRT and RA but doubled using IMRT. Although all three radiotherapy techniques offered a satisfactory solution, RA and IMRT offer some improvement on target coverage, dose homogeneity, and conformity for this particular case of breast sarcoma.

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Bilateral Giant Hydronephrosis in a Ten-Year-Old Male

We describe a ten-year-old male with bilateral giant hydronephrosis due to pelviureteric junction obstruction presenting with abdominal distension and renal failure. The diagnosis was confirmed on computed tomography and required a two-stage procedure, initially percutaneous nephrostomy followed by Anderson–Hynes pyeloplasty with recovery of kidney function.

https://ift.tt/2ETvFeN

Mast Cell Interactions and Crosstalk in Regulating Allergic Inflammation

Abstract

Purpose of Review

This review summarizes recent findings on mast cell biology with a focus on IgE-independent roles of mast cells in regulating allergic responses.

Recent Findings

Recent studies have described novel mast cell-derived molecules, both secreted and membrane-bound, that facilitate cross-talk with a variety of immune effector cells to mediate type 2 inflammatory responses.

Summary

Mast cells are complex and dynamic cells that are persistent in allergy and are capable of providing signals that lead to the initiation and persistence of allergic mechanisms.

https://ift.tt/2JSXszY

Systematic review, meta‐analysis, and meta‐regression: Successful second‐line treatment for Helicobacter pylori

Helicobacter, EarlyView.


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