Ca tongue pTxpN2b with polycystic kidney disease bilaterally with renal calculi

Ca tongue pTxpN2b with polycystic kidney disease bilaterally with renal calculi

Dr Nilesh Mahale 11 Jun 2010 11:27

42/F
Left Lateral Border tongue lesion
Biopsy: Squamus cell Ca
Dec 09 Lt Hemiglossectomy done
HPR: MDSCC pT not reported but depth 3 mm. All cut margins and base free
Neck observed as USG neck was normal
No adjuvant treatment
Lt nodal recurrence
Lt Modified neck dissection
HPR 2 LN at level III involved with Perinodal extension and 1 at level I involved
Patient also has polycystic kidney disease bilaterally with renal calculi ( s Creat Normal) hence concurrent cisplatin/ carboplatin deemed not suitable by med onco
Would like to discuss if there is any role for altered fractionation (On lines of OCAT trial at Tata Memorial )

Re: Ca tongue pTxpN2b with polycystic kidney disease bilaterally with renal calculi

Ashwini Budrukkar 11 Jun 2010 17:08

I am not sure. Nilesh can you look up the literature and get back to us.

Re: Ca tongue pTxpN2b with polycystic kidney disease bilaterally with renal calculi

Rohit Malde 11 Jun 2010 18:42

This is a classical indication for concurrent cetuximab + RT (where Cisplatin is contraindicated) as per the Bonner study.

But i presume,the next thing you would say is pt cant afford it.

To answer your specific question on Fractionation,
In this post-operative setting where you are irradiating microscopic disease,

i m afraid, Accelerated fractionation does not seem to be worthwhile for squamous cell carcinoma of the head and neck after resection; however, Accelerated Fractionation might be an option for patients who delay starting RT.
This is the conclusion of a Ph III trial.

http://www.ncbi.nlm.nih.gov/pubmed/15708255

Re: Ca tongue pTxpN2b with polycystic kidney disease bilaterally with renal calculi

Nikhilesh Patil 11 Jun 2010 22:37

Hi Nilesh,
Treat with our standard good old PORT 6000 cGy/30 #'s.
Iam yet to find another trial after this landmark paper for PORT in Head Neck cancers by Peters L et al.,
http://www.ncbi.nlm.nih.gov/pubmed/8482629 .
If possible yes Cituximab. Altered fractionation = don't know, Rohit has already quoted a study.
If anyone has any other trial please update us.

Re: Ca tongue pTxpN2b with polycystic kidney disease bilaterally with renal calculi

AAM 12 Jun 2010 00:36

link to OCAT trial at Tata Memorial possible?

Re: Ca tongue pTxpN2b with polycystic kidney disease bilaterally with renal calculi

Rohit Malde 12 Jun 2010 00:58

http://clinicaltrials.gov/ct2/show/NCT00193843

The only thing that surprises me is

Study Start Date: June 2005
Estimated Study Completion Date: June 2017

Sample size= 900

I wonder what would be std of care for H & N Cancers in 2018
4 D and 5 D RT.