M. Ali

A rationale for chemoradiation (vs radiotherapy) in salivary gland cancers? On behalf of the REFCOR (French rare head and neck cancer network)

BACKGROUND Salivary gland carcinomas constitute a heterogeneous group of tumors, with over 20 histological subtypes of various prognoses. The mainstay of treatment is surgery, with radiotherapy advocated for unresectable disease or postoperatively in case of poor prognostic factors such as high grade, locally advanced and/or incompletely resected tumors. Concurrent chemotherapy is sometimes advocated in routine practice based on criteria extrapolated from squamous cell carcinomas of the head and neck, on radioresistance of salivary gland tumors and on results obtained in the metastatic setting. The aim of this review was to identify situations where chemotherapy is advocated. MATERIAL AND METHODS A search of literature was performed with the following key words: parotid, salivary gland, neoplasm, cancer, malignant tumor, chemoradiation, chemotherapy, radiotherapy and treatment. Case report and studies published before 2000 were not included. RESULTS Platinum-based regimens were the most frequent. Other regimens were reported and seemed dependent on histology. The level of evidence for the concurrent delivery of chemotherapy with radiation therapy is supported by a low level of evidence. Prescribing chemotherapy mostly relies on poor prognostic factors similar to those used to indicate high dose radiotherapy. Protocols vary with histology. CONCLUSION The rationale for adding chemotherapy to radiotherapy remains to be demonstrated prospectively. Although the type of systemic treatments used may be adapted on histology, the strongest rationale remains in favor of cisplatin.

The Role of Radiation Therapy in Pediatric Mucoepidermoid Carcinomas of the Salivary Glands

OBJECTIVE To investigate the role of radiation therapy in rare salivary gland pediatric mucoepidermoid carcinoma (MEC). STUDY DESIGN A French multicenter retrospective study (level of evidence 4) of children/adolescents treated for MEC between 1980 and 2010 was conducted. RESULTS Median age of the 38 patients was 14 years. Parotid subsite, low-grade, and early primary stage tumors were encountered in 81%, 82%, and 68% of cases, respectively. All except 1 patient were treated by tumoral surgical excision, and 53% by neck dissection (80% of high grades). Postoperative radiation therapy and chemotherapy were performed in 29% and 11% of cases. With a median 62-month follow-up, overall survival and local control rates were 95% and 84%, respectively. There was 1 nodal relapse. Lower grade and early stage tumors had better survival. Postoperative radiation therapy and chemotherapy were associated with similar local rates. Patients with or without prior cancer had similar outcomes. CONCLUSIONS Pediatric salivary gland MEC carries a good prognosis. Low-intermediate grade, early-stage tumors should be treated with surgery alone. Neck dissection should be performed in high-grade tumors. Radiation therapy should be proposed for high grade and/or advanced primary stage MEC. For high-grade tumors without massive neck involvement, irradiation volumes may be limited to the primary area, given the risk of long-term side effects of radiation therapy in children. Pediatric MEC as second cancers retain a similar prognosis. Long-term follow-up is needed to assess late side effects and second cancers.

Low or High Fractionation Dose B-Radiotherapy for Pterygium? A Randomized Clinical Trial: In Regard to Viani GA et al. (Int J Radiat Oncol Biol Phys 2010;10.1016/j.ijrobp.2010.11.017)

To the Editor: We read with interest the randomized clinical trial that compared lowversus high-dose fractionation b-radiotherapy for pterygium (1). This is the largest prospective randomized trial that addressed the value of beta irradiation after surgical excision of pterygium after that of Jurgenliemk, 86 cases (2), Nakamatsu , 73 cases (3), and De Keizer, 57 cases (4). It is also the first one that compared low-dose fractionation (20 Gy/10 fractions) with higher dose per fraction regimens (35 Gy/7 fractions). The rate of pterygium control was 93.9% with 20 Gray/10 fractions arm versus 92.3% with the 35 Gray/7 fractions arm which was not far from local control rates reported by Jurgenliemk (2) with single dose of 25 Gray (93.2%) and the 90% local control rate reported by De Keizer (4) using 27–30 Gray/3 fractions. In view of the significant difference between both arms in the incidence of photophobia, irritation, postoperative granuloma, cosmoses, and scleromalacia in favor of the low dose per fraction regimen along with the no difference in the pterygium control rate, the authors recommended the use of low dose per fraction regimen rather than the hypofractionated ones. This may be understandable in the light of radiobiological work conducted by Brenner andMerriam (5), who estimated large value of a/b ratio of nonrecurrence that suggests improved therapeutic ratio from fractionated application of b irradiation. But practically speaking, application of high dose per fraction regimens with doses from 30–60 Gray in three to six fractions or even a single high dose (2, 6, 7) was not reported to be associated with high incidence of late complications (e.g., scleromalacia, sclera ulcers, corneal ulcerations, necrotizing scleritis, maculopathy) that could occur even with surgery alone without radiotherapy (2, 8, 9). In the light of the above mentioned discussion, and the many studies that used high dose per fraction regimens reported in our review article (10), we recommend the use of the hypofractionated regimens from the prospective of better patient compliance, especially in centers with limited resources and personnel.

(2E)-2-(1,3-Benzo­thia­zol-2-yl)-3-(di­methyl­amino)­prop-2-ene­nitrile

The molecular conformation of title compound, C12H11N3S, is almost planar [maximum deviation = 0.063 (2) Å]; an intramolecular C—H⋯N hydrogen bond is noted. In the crystal, molecules interact with each other via π–π stacking interactions between thiazole rings [centroid–centroid distance = 3.7475 (9) Å] and methyl-H⋯π(C6) interactions, forming columns along the a axis.

N-(2-Hy­droxy­phen­yl)-4-methyl­benzene­sulfonamide

In the title compound, C13H13NO3S, the dihedral angle between the benzene rings is 64.15 (7)° and the C—S—N—C torsion angle is −57.18 (12)°. An intramolecular N—H⋯O hydrogen bond closes an S(5) ring. In the crystal, O—H⋯O hydrogen bonds link the molecules into C(8) chains propagating in [100]. Weak C—H⋯π interactions are also observed.

Amino-[(1H-benzimidazol-2-yl)amino]-methaniminium 4-methyl-benzene-sulfonate.

The asymmetric unit of the title salt, C8H10N5 +·C7H7O3S−, consists of two amino[(1H-benzimidazol-2-yl)amino]methaniminium cations and two 4-methylbenzenesulfonate anions. The cations are each stabilized by intramolecular N—H⋯N hydrogen bonds between the free amino groups and the imine N atoms of the benzimidazole units, forming S(6) ring motifs. In the crystal, cations and anions are linked by N—H⋯O and C—H⋯O hydrogen bonds, forming a three-dimensional supramolecular framework. Two strong π–π stacking interactions [centroid–centroid distances = 3.4112 (14) and 3.4104 (14) Å] also occur between the centroids of the imidazole rings of like cations.