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      Treatment of Fanconi anemia patient with synchronous esophageal and tongue cancer in COVID-19 era: a case report

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          Abstract

          Although Fanconi anemia patients accompany a high risk of multiple cancers, radiation therapy on these patients has been carried out only in limited cases due to the concern for radiation toxicity that stems from their susceptibility to radiation. We report a case of a 28-year-old female patient diagnosed as synchronous esophageal and tongue cancer, and underwent two cycles of radiation therapy, inevitably in the condition of coronavirus disease 2019 infection. She received radiation therapy of 30 Gy to esophageal mass with neoadjuvant aim in her first-round radiation therapy, and later received 27 Gy to tongue cancer surgical bed with adjuvant aim in her second-round radiation therapy. With no further treatment, she has been maintaining no evidence of disease state for 7 months. Managing Fanconi anemia patients with multiple cancers using radiation therapy is feasible, in which cases a dose de-escalation may be important considering the radiation toxicity and possible future re-treatment.

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          Most cited references12

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          Pathophysiology and management of inherited bone marrow failure syndromes.

          The inherited marrow failure syndromes are a diverse set of genetic disorders characterized by hematopoietic aplasia and cancer predisposition. The clinical phenotypes are highly variable and much broader than previously recognized. The medical management of the inherited marrow failure syndromes differs from that of acquired aplastic anemia or malignancies arising in the general population. Diagnostic workup, molecular pathogenesis, and clinical treatment are reviewed. Copyright 2010 Elsevier Ltd. All rights reserved.
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            Expanded roles of the Fanconi anemia pathway in preserving genomic stability.

            Studying rare human genetic diseases often leads to a better understanding of normal cellular functions. Fanconi anemia (FA), for example, has elucidated a novel DNA repair mechanism required for maintaining genomic stability and preventing cancer. The FA pathway, an essential tumor-suppressive pathway, is required for protecting the human genome from a specific type of DNA damage; namely, DNA interstrand cross-links (ICLs). In this review, we discuss the recent progress in the study of the FA pathway, such as the identification of new FANCM-binding partners and the identification of RAD51C and FAN1 (Fanconi-associated nuclease 1) as new FA pathway-related proteins. We also focus on the role of the FA pathway as a potential regulator of DNA repair choices in response to double-strand breaks, and its novel functions during the mitotic phase of the cell cycle.
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              Practice recommendations for risk-adapted head and neck cancer radiotherapy during the COVID-19 pandemic: an ASTRO-ESTRO consensus statement

              Introduction Due to the unprecedented disruption of health care services by the COVID-19 pandemic, the American Society of Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO) identified an urgent need to issue practice recommendations for radiation oncologists treating head and neck cancer (HNC), in a time of heightened risk for patients and staff, and of limited resources. Methods A panel of international experts from ASTRO, ESTRO and select Asia-Pacific countries completed a modified rapid Delphi process. Questions and topics were presented to the group, and subsequent questions developed from iterative feedback. Each survey was open online for 24 hours, and successive rounds started within 24 hours of the previous round. The chosen cutoffs for strong agreement (≥80%) and agreement (≥66%) were extrapolated from the RAND methodology. Two pandemic scenarios: early (risk mitigation) and late (severely reduced radiotherapy resources) were evaluated. The panel developed treatment recommendations for five HNC cases. Results In total, 29/31 (94%) of those invited accepted, and after a replacement 30/30 completed all three surveys (100% response rate). There was agreement or strong agreement across a number of practice areas including: treatment prioritisation, whether to delay initiation or interrupt radiotherapy for intercurrent SARS-CoV-2 infection, approaches to treatment (radiation dose-fractionation schedules and use of chemotherapy in each pandemic scenario), management of surgical cases in event of operating room closures, and recommended adjustments to outpatient clinic appointments and supportive care. Conclusions This urgent practice recommendation was issued in the knowledge of the very difficult circumstances in which our patients find themselves at present, navigating strained health care systems functioning with limited resources and at heightened risk to their health during the COVID-19 pandemic. The aim of this consensus statement is to ensure high-quality HNC treatments continue, to save lives and for symptomatic benefit.
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                Author and article information

                Journal
                Radiat Oncol J
                Radiat Oncol J
                ROJ
                Radiation Oncology Journal
                The Korean Society for Radiation Oncology
                2234-1900
                2234-3164
                March 2024
                5 January 2024
                : 42
                : 1
                : 83-87
                Affiliations
                [1 ]Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
                [2 ]Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
                [3 ]Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
                [4 ]Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
                Author notes
                Correspondence: Hak Jae Kim Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. Tel: +82-2-2072-2520 E-mail: khjae@ 123456snu.ac.kr
                Author information
                http://orcid.org/0000-0003-3602-2263
                Article
                roj-2023-00654
                10.3857/roj.2023.00654
                10982059
                38549387
                4998e572-c7da-4c77-8ff1-696bee5fef8c
                © 2024 The Korean Society for Radiation Oncology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 4 August 2023
                : 25 October 2023
                : 27 October 2023
                Categories
                Case Report

                Oncology & Radiotherapy
                radiotherapy,head and neck neoplasms,esophageal neoplasms,radiation injuries,covid-19

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