Aloke Ghosh Dastidar

Chemoradiation in locally advanced cervical cancer : A randomized trial

Background: Radiation with concurrent chemotherapy (weekly cisplatin) is currently standard of care for locally advanced cervical cancer. Gemcitabine, a pyrimidine analogue is a potentially radio-sensitizing drug. We compared cisplatin and gemcitabine in the treatment of locally advanced cervical cancer. Methods: 90 patients with locally advanced squamous cell cancer of the cervix (stage IIB-IVA) were randomized to receive either cisplatin 40mg/m 2 weekly or gemcitabine 150 mg/m 2 weekly (45 patients in each arm) along with external beam radiation (50Gy in 25# over 5 weeks). This was followed by three insertions of high dose radiation (HDR) intracavitary brachytherapy one week apart. Results: At a median follow up of 13months, 25 (55.56%) patients were in complete response (CR) in the cisplatin arm compared to 22 patients (48.89%) [p=0.67] in gemcitabine arm. 10 patients (22.22%) in cisplatin arm had either died or lost to follow up compared to 11 patients in gemcitabine (24.44%) arm. Nausea/vomiting was higher in cisplatin arm. Diarrhea, skin reaction and hematological toxicity were more in gemcitabine arm. Conclusion: Cisplatin seems to be a better option than gemcitabine when used concurrently with radiation for locally advanced cervical cancer both in terms of response and toxicity.

Myoepithelial carcinoma in infratemporal fossa

A 20 year old female presented with swelling of right cheek and complete loss of vision in her right eye for 6 months. Lower motor neuron (LMN) palsy of facial (VII) nerve was evident. CECT scan suggested an illdefined non-enhancing mass lesion in right infratemporal fossa. The mass was excised. Histopathology confirmed diagnosis of myoepithelial carcinoma. Following surgery, patient received adjuvant chemotherapy and radiotherapy. Myoepithelial carcinoma of soft tissue is rare, and has been recognised recently. The case is being reported on account of its rarity.