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Background: Although squamous cell anal carcinomas are relatively rare, their incidence has been increasing steadily. Because of the limited data, treatment of metastatic disease is a major therapeutic challenge. In this study, we report the safety and efficacy of epidermal growth factor receptor (EGFR) inhibitors in patients with advanced squamous cell anal carcinomas. Method: A retrospective analysis was conducted using the Moffitt Cancer Tumor Registry from January 2009 to January 2014. Eligible patients had diagnosis of advanced squamous cell anal carcinomas and received an EGFR inhibitor as part of their treatment. Result: A total of 13 patients were identified for analysis. All of them received concurrent chemoradiation as initial treatment and subsequently had recurrence. Five patients received single agent cetuximab or panitumumab, and the others received cetuximab or panitumumab with irinotecan or FOLFIRI. The objective response rate was 30.8% including 1 complete response, and the disease control rate was 46.2%. With a median follow-up of 9.6 months, the median progression-free survival and median overall survival were 4.4 months and 11.4 months, respectively. Conclusion: Our analysis suggests that EGFR inhibitors have potential efficacy and are reasonably well tolerated in patients with squamous cell anal carcinomas. These findings warrant further evaluation in a large prospective trial.

Background: The development of distant metastases of squamous cell carcinoma of the anal canal (SCCA) is rare but has a poor prognosis. A combination of carboplatin and paclitaxel is commonly used for treating squamous cell cancer in different organs, but its efficacy in advanced SCCA is unclear. The objective of this study is to determine the tolerability and outcome of patients with advanced SCCA on carboplatin plus paclitaxel treatment at the Moffitt Cancer Center. Methods: Retrospective analysis was conducted by looking at records from the Moffitt Cancer Center Tumor Registry from January 2007 to January 2012. Eligible patients had to have a diagnosis of SCCA and have received carboplatin plus paclitaxel every 3 weeks as part of the treatment plan. Results: Eighteen patients fulfilled the criteria; 14 were initially diagnosed with early-stage disease and received concurrent chemoradiation, but then relapsed. Median age was 56 years. Upon diagnosis of metastatic disease, 12 patients received carboplatin plus paclitaxel as a first-line treatment. Five patients had received prior systemic chemotherapy regimens and 1 had received prior local regional therapy. The response rate was high at 53% including 3 patients who achieved a complete response. Median overall survival was 12.19 months. Conclusions: Carboplatin and paclitaxel treatment shows encouraging activity in advanced SCCA.

Objectives: Brain metastases originating from primary cervical carcinoma are very rare. Despite surgery and adjuvant therapy, patient prognosis is extremely unfavorable. Prior studies have reported that the median time from the primary disease’s diagnosis to development of CNS metastases is approximately 18 months. Case Report: A 60-year-old woman was initially diagnosed and treated for FIGO clinical stage IB2 cervical carcinoma in March 2007. She underwent a radical hysterectomy, bilateral salpingo-oophorectomy and peri-aortic lymphadenectomy. Two weeks later, the patient presented with dysmetria and homonymous hemianopsia, which was related to a large right occipital CNS metastasis. The patient had surgery to resect the brain tumor and then received Gamma Knife stereotactic radiosurgery and chemotherapy. The neurological deficits were resolved and the patient’s disease status has since remained stable, with five months of follow-up. Conclusion: The incidence of brain metastases originating from primary cervical carcinoma is very rare. Furthermore, the occurrence of CNS metastatic disease manifesting itself within a couple weeks following diagnosis of the primary disease is even more unusual. Since the presenting symptoms of CNS metastatic disease are not well characterized and patient prognosis is very poor, oncology physicians should anticipate the presence of this condition in order to provide prompt and comprehensive treatment.

Until recently, intra-axial brainstem tumors were traditionally regarded as surgically inaccessible lesions with a uniformly poor prognosis. However, increasing data indicate that distinct subgroups of brainstem tumors exist that are amenable to surgical intervention. To address this question, we reviewed our experience in the operative management of 39 consecutive patients, in the magnetic resonance imaging (MRI) era, with intra-axial cervicomedullary tumors, in order to determine those factors associated with long-term outcome. Thirty-nine patients (26 male, 13 female) underwent surgery by a single surgeon (F.J.E.) between 1985 and 1994. Mean age of diagnosis was 14 years (range 3 months - 60 years); mean duration of preoperative symptoms was 24 weeks (range 1-168). Twenty patients presented with lower cranial nerve dysfunction and 19 presented with motor and/or sensory dysfunction. All patients were graded according to the McCormick Scale, pre- and postoperatively, and at the time of follow-up. All patients were evaluated with MRI scanning. Twenty-three patients had either previous biopsy or subtotal resection, 13 previous radiation therapy, and 6 previous chemotherapy. The mean time to follow-up was 48 months (range 7-138). Twelve patients underwent gross total resection, 7 near total resection (>90%), 15 subtotal resection (50-90%), and 5 partial resection (< 50%). Histologically, there were 15 low-grade fibrillary astrocytomas, 9 ependymomas, 7 gangliogliomas, 3 anaplastic astrocytomas, 3 juvenile pilocytic astrocytomas, and 2 mixed gliomas. Although the vast majority of tumors were low grade histologically, a higher proportion of the patients with high-grade lesions experienced tumor progression when compared to low-grade tumors (75 vs. 30%). Overall, the 5-year progression-free and total survivals were 60 and 89%, respectively. There was 1 death within the first postoperative month. Preoperative duration of symptoms greater than 15 weeks was associated with a longer progression-free survival. There was a trend for preoperative neurologic grade to predict functional neurologic outcome at follow-up. In summary, intra-axial tumors of the cervicomedullary junction are a distinct subset of brainstem tumors, predominantly of low-grade histology, with favorable long-term progression-free and total survivals following surgical resection. A long duration of preoperative symptoms may indicate an indolent clinical course and a more favorable prognosis. Our data also indicate that early surgical intervention is warranted prior to neurologic deterioration.