This study was conducted to describe a retropharyngeal myxoma and discuss clinical concerns regarding this pathology and a retropharyngeal site of occurrence. We present a case report and review of literature. A 71-year-old woman presented with mild right neck pressure for 3 weeks. Imaging studies and head neck examination confirmed a 5.3 × 3.1 × 1.0 cm retropharyngeal mass with no communication to the vertebral column but was intimately involved with the pharyngeal mucosa. A transoral fine needle aspiration biopsy suggested a possible spindle cell neoplasm. A presurgical swallowing consultation was obtained. A transoral excision of the tumor was possible with no intraoperative complications. Histopathology was a cellular myxoma. Postoperative dysphagia required swallowing therapy and nasogastric tube feeding for 2 weeks before oral intake was possible. The patient has no evidence of clinical or radiological recurrence more than 1 year after surgical intervention. We present the second case of a myxoma in the retropharynx reported in English literature. Transoral excision was safe, feasible, and cosmetically appealing option in our patient. Additional clinical data are required to valid its safety and utility as an approach to tumors in the retropharynx. Postoperative dysphagia can be significant and consequently we recommend preoperative swallowing evaluation and counseling.

Purpose/Objective(s): Currently, there is no consensus fractionation scheme for spine SBRT. We report mature outcomes for a cohort of patients with no prior radiation (de novo) treated with 24 Gy in 2 daily fractions, which represents an emerging Canadian standard. Materials/Methods: The cohort consisted of 279 de novo spinal metastases in 145 consecutive patients treated with 24 Gy in 2 SBRT fractions, between 2009 and 2015, identified from a prospective database. All vertebral segments were treated with an institutionally standardized Linacbased approach using cone-beam CT image guidance and six degrees-offreedom online setup correction. The endpoints were overall survival (OS), local control (LC), and the rate of vertebral compression fractures (VCF). OS rates were obtained using Kaplan-Meier methods and cumulative incidences of LC and VCF were obtained from competing risk analysis using death as a competing risk event. Evaluation of tumor control was based on serial spine magnetic resonance imaging (MRI) as per the SPIne response assessment in Neuro-Oncology (SPINO) criteria recommendations. Results: The median follow-up was 17.0 months (range, 0.1e71.6 months). The 1-year and 2-year OS rates were 73.1% and 60.7%, respectively. Presence of epidural disease (P < 0.0001), lung (P Z 0.0415) and renal cell (P < 0.0001) primary histologies and diffuse spinal metastatic disease as opposed to oligometastatic disease (P Z 0.0034) were significant prognostic factors. The 1-year and 2-year LC rates were 90.3% and 82.4%, respectively, and the median time to local failure (LF) was 9.2 month (range, 0.4e31.3 months). Only the presence of epidural disease predicted for LF (P < 0.0001). The cumulative risk of VCF at 1 and 2 years were 8.5% and 13.8%, respectively. Lytic (P Z 0.0143) or mixed lytic/blastic (P Z 0.0214) lesions, spinal misalignment (P Z 0.0121), and the dose to 90% of the planning target volume (PTVD90) (P Z 0.0085) were significant predictors of VCF. Conclusion: Twenty-four Gy in 2 daily fractions is safe and effective in achieving high tumor control rates for de novo spinal metastases. This fractionation scheme is currently the standard SBRT arm on an ongoing Phase 3 randomized Canadian national trial (CCTG-SC 24) comparing it to a conventional radiation dose of 20 Gy delivered in 5 daily fractions.

This study was conducted to describe a retropharyngeal myxoma and discuss clinical concerns regarding this pathology and a retropharyngeal site of occurrence. We present a case report and review of literature. A 71-year-old woman presented with mild right neck pressure for 3 weeks. Imaging studies and head neck examination confirmed a 5.3 Â 3.1 Â 1.0 cm retropharyngeal mass with no communication to the vertebral column but was intimately involved with the pharyngeal mucosa. A transoral fine needle aspiration biopsy suggested a possible spindle cell neoplasm. A presurgical swallowing consultation was obtained. A transoral excision of the tumor was possible with no intraoperative complications. Histopathology was a cellular myxoma. Postoperative dysphagia required swallowing therapy and nasogastric tube feeding for 2 weeks before oral intake was possible. The patient has no evidence of clinical or radiological recurrence more than 1 year after surgical intervention. We present the second case of a myxoma in the retropharynx reported in English literature. Transoral excision was safe, feasible, and cosmetically appealing option in our patient. Additional clinical data are required to valid its safety and utility as an approach to tumors in the retropharynx. Postoperative dysphagia can be significant and consequently we recommend preoperative swallowing evaluation and counseling.