Ajay Tejwani

Management of Acral Myxoinflammatory Fibroblastic Sarcoma

Acral myxoinflammatory fibroblastic sarcoma (AMFS) is a rare, low‐grade sarcoma that commonly affects the distal extremities. From the published cases, therapy for AMFS to date has been comprised of excision or amputation, with limited use of radiotherapy (RT) or chemotherapy. In this report, the outcome of 17 patients with AMFS treated at the study institution was reported.

Case series analysis of post-brachytherapy prostate edema and its relevance to post-implant dosimetry. Post-implant prostate edema and dosimetry

Purpose We evaluated the post-operative pattern of prostate volume (PV) changes following prostate brachytherapy (PB) and analyzed variables which affect swelling. Material and methods Twenty-nine patients treated with brachytherapy (14) or combined brachytherapy and external beam radiotherapy modality (15) underwent pre- and post-implant computed tomography (CT). Prostate volume measurements were done on post-operative days 1, 9, 30, and 60. An observer performed 139 prostate volume (PV) measurements. We analyzed the influence of pre-implant PV, number of needles and insertion attempts, number and activity of seeds, Gleason score, use of hormonal therapy and external beam radiation therapy on the extent of edema. We computed a volume correction factor (CF) to account for dosimetric changes between day 1 and day 30. Using the calculated CF, the dose received by 90% (D90) of the prostate on day 30 (D90Day30) was obtained by dividing day 1 (D90Day1) by the CF. Results The mean PV recorded on post-operative day 1 was 67.7 cm3, 18.8 cm3 greater than average pre-op value (SD 15.6 cm3). Swelling returned to pre-implant volume by day 30. Seed activity, treatment modality, and Gleason score were significant variables. The calculated CF was 0.76. After assessment using the CF, the mean difference between estimated and actual D90Day30 was not significant. Conclusions We observed maximum prostate size on post-operative day 1, returning to pre-implant volume by day 30. This suggests that post-implant dosimetry should be obtained on or after post-operative day 30. If necessary, day 30 dosimetry can be estimated by dividing D90Day1 by a correction factor of 0.76.

Cardiotoxicity with fluorouracil and capecitabine revisited

A relatively rare but potentially fatal toxicity that has been observed in patients predominantly receiving intravenous fluorouracil (5-FU)–based chemotherapy is cardiotoxicity. Here we present two cases in which patients were treated with 5-FU–based chemotherapy and subsequently developed cardiotoxicity, in the setting of recently being exposed to continuous 5-FU. Our first patient had no history of major cardiac events but did have cardiac risk factors of tobacco use, hypercholesterolemia, and hypertension. The timing of chemotherapy and the cardiac event in this patient makes it more likely that the incident is due to 5-FU use. Interestingly, the second patient had a history of cardiac disease and had been previously treated with intravenous 5-FU and oral capecitabine with no untoward effects. However, after later exposure to continuous infusion 5-FU, he developed cardiotoxicity. Thus, the question remains as to whether or not continuous infusion 5-FU is more of a cardiotoxic risk than bolus injection 5-FU or oral capecitabine.