Intensity Modulated Radiotherapy of Two Simultaneous Neoplasms - Cervical Carcinoma and Breast Carcinoma: A Case Report with a Review of the Literature
Keywords:Synchronous primary neoplasms, unfavorable predisposing factors, prognosis, complex treatment, intensity-modulated radiotherapy.
Concomitant expression of two neoplasms- cervical carcinoma (CC) and breast carcinoma (BC) is a relatively rare pathology. The manifestation of synchronous primary neoplasms is a challenge for the treating team as it puts a number of questions about the healing strategy.
We present a 57-year-old patient after total laparohisterectomy with lymphatic pelvic dissection on the local advanced CC/IIIB clinical stage. Intensity-modulated radiotherapy (IMRT) in the small pelvis and the upper 2/3 of the vaginal cuff with daily dose (DD) 1.8 Gy up to total dose (TD) 50.4 Gy combined with Cisplatin (50 mg/m2) once a week, was conducted. After 4 months from the diagnosis and complex treatment of CC, PET/CT establishes a second neoplasm-invasive ductal carcinoma in the left mammary gland. After the breast-conserving surgery of BC, we are currently conducting Deep Inspiration Breath-Hold (DIBH) Radiation Technique on the left breast with DD 2 Gy up to TD 50 Gy. After 1 month of pelvic RT completion, RT on the paraaortal lymph nodes with DD 1.8 Gy up to TD 50 Gy should be conducted.
The discussion focuses on the simultaneous expression of two or more neoplasms, their relationship with genetic and other unfavorable predisposing factors, as well as the expected survival after the complex treatment of the two invasive carcinomas, involving IMRT.
For the treatment of multiple malignancies, each case must be considered individually, ideally by a multidisciplinary team. If it is necessary to apply radiotherapy, the use of high-tech radiotherapeutic apparatus with the ability to perform modern radiotherapy techniques such as IMRT is required.
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