Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer

The management of peritoneal metastases from gastric cancer origin has evolved considerably over the last three decades with the establishment of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) as efficacious therapies in carefully selected patients. Other approaches such as the use of prophylactic/adjuvant HIPEC in patients who are considered high-risk and those with positive peritoneal cytology will benefit from additional data before being adopted into routine clinical practice. Lastly, there are new and emerging intraperitoneal chemotherapy techniques such as early post-operative intraperitoneal chemotherapy (EPIC) for residual microscopic disease, and pressurized intraperitoneal aerosolized chemotherapy (PIPAC) for patients with advanced unresectable peritoneal carcinomatosis, which are currently under evaluation in clinical trials. The following review outlines the natural history of gastric cancer, currently available neoadjuvant and adjuvant therapies for resectable disease, and existing evidence supporting various approaches to CRS and intraperitoneal chemotherapy.

Nasopharyngeal mucoepidermoid carcinoma: a rare tumor in nasopharynx

<p class="abstract">Mucoepidermoid carcinoma (MEC) is a malignant epithelial salivary gland neoplasm which consists of a mixture of mucin-producing columnar cells, epidermoid (squamous) cells and polygonal intermediate cells. Salivary gland-type carcinomas are extremely rare to be found in the nasopharynx. A 46-year-old lady presented with bilateral progressive nasal blockage and occasional epistaxis for 3 years. However, there was no neck swelling. Nasoendoscopy revealed a huge nasopharyngeal mass. Tissue biopsy in clinic setting reported of inverted papilloma. Computed tomography shows large irregular heterogenously enhancing mass in nasopharynx. Posterior septectomy was done for the access and endoscopic excision of nasopharyngeal tumor was performed. Histopathological examination confirmed the tumor is mucoepidermoid carcinoma. Postoperative adjuvant concurrent chemoradiotherapy with total of 66 Gy was commenced in view of concern of possible residual microscopic disease. Nasopharynx is an uncommon site for MEC. MEC patients seldom has enlarged neck node at presentation.Nasopharyngeal salivary gland-type carcinomas does not commonly cause cranial nerve palsy compared to nasopharyngeal carcinoma (NPC). In cases with huge nasopharyngeal mass without neck nodes and cranial nerves involvement, MEC can be a differential diagnosis. Surgical removal of gross disease and concurrent chemoradiotherapy as an adjuvant treatment for likely residual microscopic disease is the standard treatment for nasopharyngeal mucoepidermoid carcinoma.</p>

Vinblastine and Prednisolone as Adjunctive Therapy for Canine Cutaneous Mast Cell Tumors

Twenty-seven dogs with inadequately excised, cutaneous mast cell tumors (MCT; 20 residual microscopic disease, seven marginal excision) were treated with a vinblastine and prednisolone chemotherapeutic protocol. Twenty dogs were available for follow-up examination after 12 months. One dog suffered local recurrence of the tumor, four dogs developed new cutaneous tumors, and one dog had both events. Fourteen dogs were free of MCT. There was no confirmed tumor-related mortality. Although toxicity from the chemotherapy was generally mild, one dog died of sepsis during treatment.

Primary Leiomyosarcoma of the Oral Cavity: A Case Report and Review of the Literature

Leiomyosarcoma is a malignant tumour of mesenchymal origin that is uncommon in the head and neck, and particularly uncommon in the oral cavity. This article presents a case of primary leiomyosarcoma affecting the mucosal lining of the cheek in a 35-year-old woman. The need for wide excision is emphasized, and because of the high frequency of regional lymph node metastasis, an ipsilateral neck dissection is advocated, followed by adjuvant radiotherapy for residual microscopic disease.

Brachytherapy for recurrent nasopharyngeal and nasoethmoidal tumours

Recurrent or persistent carcinoma of the nasopharynx or naso-ethmoid region occurs even after combined surgery and radical external irradiation. The confined bony access and proximity of vital structures may compromise resection margins. Brachytherapy using implantable radioactive gold or iodine seeds is a useful adjunct to the skull base surgeon in eliminating residual microscopic disease. We report nine cases with recurrent or persistent disease of the nasopharynx or naso-ethmoid regions treated with brachytherapy with encouraging results.