SummaryBackgroundThe use of prophylactic radiotherapy to prevent procedure-tract metastases (PTMs) in malignant pleural mesothelioma remains controversial, and clinical practice varies worldwide. We aimed to compare prophylactic radiotherapy with deferred radiotherapy (given only when a PTM developed) in a suitably powered trial.MethodsWe did a multicentre, open-label, phase 3, randomised controlled trial in 22 UK hospitals of patients with histocytologically proven mesothelioma who had undergone large-bore pleural interventions in the 35 days prior to recruitment. Eligible patients were randomised (1:1), using a computer-generated sequence, to receive immediate radiotherapy (21 Gy in three fractions within 42 days of the pleural intervention) or deferred radiotherapy (same dose given within 35 days of PTM diagnosis). Randomisation was minimised by histological subtype, surgical versus non-surgical procedure, and pleural procedure (indwelling pleural catheter vs other). The primary outcome was the incidence of PTM within 7 cm of the site of pleural intervention within 12 months from randomisation, assessed in the intention-to-treat population. This trial is registered with ISRCTN, number ISRCTN72767336.FindingsBetween Dec 23, 2011, and Aug 4, 2014, we randomised 203 patients to receive immediate radiotherapy (n=102) or deferred radiotherapy (n=101). The patients were well matched at baseline. No significant difference was seen in PTM incidence in the immediate and deferred radiotherapy groups (nine [9%] vs 16 [16%]; odds ratio 0·51 [95% CI 0·19–1·32]; p=0·14). The only serious adverse event related to a PTM or radiotherapy was development of a painful PTM within the radiotherapy field that required hospital admission for symptom control in one patient who received immediate radiotherapy. Common adverse events of immediate radiotherapy were skin toxicity (grade 1 in 50 [54%] and grade 2 in four [4%] of 92 patients vs grade 1 in three [60%] and grade 2 in two [40%] of five patients in the deferred radiotherapy group who received radiotherapy for a PTM) and tiredness or lethargy (36 [39%] in the immediate radiotherapy group vs two [40%] in the deferred radiotherapy group) within 3 months of receiving radiotherapy.InterpretationRoutine use of prophylactic radiotherapy in all patients with mesothelioma after large-bore thoracic interventions is not justified.FundingResearch for Patient Benefit Programme from the UK National Institute for Health Research.

Survival in patients with cervical esophageal carcinoma remains poor. Further studies should define the use of RT, surgery, and chemotherapy.

Lung cancer was relatively uncommon at the turn of the 20th century, and has increased in prevalence at alarming rates, particularly because of the augmented trend in smoking, so that it is now the most common cause of cancer death in the world. As almost a quarter of these cancers are of small cell in origin, it seems only appropriate that small cell lung cancer receives ample attention, rather than seemingly to have been overlooked over the last 10-15 years. Despite its generally late presentation and high risk of dissemination, it is exceptionally sensitive to chemo-radiotherapy. This review looks at the diverse options of treatment that have been used over the last few years and tries to highlight the best available. As more than 50% of patients diagnosed with lung cancer are over 70 years of age and various studies have shown that older people respond just as well as their younger counterparts, with similar results in response rates, toxicity and outcomes, it is imperative that the older generation are not disregarded in terms of age being a contraindication to therapy.Key words: lung cancer, small cell lung cancer, treatment. PREVALENCEGlobally, lung cancer is the most common malignancy in men, and the leading cause of cancer death in both men and women, overtaking breast cancer as the commonest cause of death from cancer in women in many countries. In 2000, more than one million people died from lung cancer worldwide. Overall, women accounted for just more than one quarter of all lung cancer deaths.1 Small cell carcinomas, account for approximately 20-25% of all lung cancers.2 It is almost entirely related to smoking and is the most aggressive of all the lung cancer cell types, with a median survival time without treatment of 2-4 months. 3,4 In the mid-1970s small cell lung cancer (SCLC) seemed treatable and even curable as new chemotherapy regimens were developed, and singleagent therapy became double or triple drug therapy combinations. The median survival increased from 6 months to 18 months for limited disease presentations and to 9 months for those with extensive disease. However, since the mid-1980s there has been almost no progress in survivorship of this cell type. This review will detail the past, but there is too little to say for the last 15 years as interest has switched to the much less chemo-sensitive non-small cell lung cancers (NSCLC), which although four times more common than SCLC, still seems a less attractive tumour when one considers the potential for cure. Nevertheless, the overall 5-year survival for 100 new cases of either cell type remains at approximately 5% overall, with surgery being the only curative treatment for NSCLC, and chemotherapy for SCLC. SYMPTOMS AND SIGNSSmall cell lung cancer presents late with obviously abnormal chest radiographs and with bulky, usually mediastinal, involvement. The length of symptoms is short, approximately 8-12 weeks prior to presentation. The symptoms can result from local intrapulmonary tumour growth (cough, wheeze, dyspnoea, haemopt...

No abstract

Rosai-Dorfman disease (RDD) is a rare histiocytic disorder most often characterized by painless cervical lymphadenopathy, but it may also present with orbital disease. The clinical course of RDD is variable; it can be either relapsing-remitting or progressive, and the outcome relates to clinical location and treatment response. Orbital RDD can have an insidious onset and similar presentation to other ophthalmic conditions; this can result in a delayed diagnosis. Nearly all cases of orbital RDD cause visual disturbances and require treatment. Because orbital RDD is an uncommon presentation, a variety of interventions have been employed, including surgery, immunotherapy, chemotherapy, and radiotherapy. We present a case of salvage radiotherapy for progressive orbital RDD refractory to surgery and chemotherapy in a pediatric patient.