title: Radioprotectant and Cytotoxic Effects of Spirulina in Relapsed Verrucous Vulvar Cancer: A Case Report.
abstract: BACKGROUND
  The treatment of relapsed verrucous vulvar cancer (VVC) is difficult. When vulvar cancer relapses, the treatment response is low for second-line treatments. Conversely, toxicity is high. Therefore, scientists need to identify different treatment methods.
  
  
  OBJECTIVE
  The case study was intended to examine the benefits of combining treatment with microalgae and metronidazole with radiotherapy to increase the response to treatment.
  
  
  METHODS
  The study took place in the Department of Radiation Oncology at Bezmialem Vakif University, in Istanbul, Turkey.
  
  
  METHODS
  The case study involved an 81-y-old female patient whose vulvar tumor was excised and who came to the research team's radiation oncology service for postoperative radiation. She had 2 comorbid disorders: Alzheimer's disease and cardiovascular disease.
  
  
  METHODS
  A relapse had occurred in the 15-d postoperative period. Because of the patient's age and comorbid disorders, the research team decided to treat the new tumor only with concurrent radiochemotherapy and a weekly dose of cisplatin that contained chemoradiotherapy, for a total of 25 mg. At the 52.2 Gy dose level, grade 3 radiation skin toxicity occurred in the radiated area, although the research team had obtained an 80% response to the radiochemotherapy. The treatment was interrupted because of toxicity but also due to a deterioration in the patient's general health. Progression of the tumor continued, and the tumor's diameter increased to 7 cm after a 4-mo period. The research team then initiated radiotherapy again, combining it with spirulina in a 750 mg/dose at 2 doses/d and metronidazole in a 500 mg/dose at 3 doses/d, to decrease radiation toxicity and increase radiosensitivity. Radiotherapy was applied at 200 cGy per fraction with a total dose of 2400 cGy, with only 1 anterior local-tumor field.
  
  
  RESULTS
  The patient showed a complete response to radiotherapy, and the tumor disappeared at the 2400 cGy radiation dose. No toxicity occurred related to the skin or the woman's general health. Her Karnofsky performance score increased to 90% from 50%, which was the initial score of the second treatment.
authors: Huriye Senay
authors: HS
authors: Kiziltan
authors: Ayse
authors: A
authors: Gunes Bayir
authors: Ozgur
authors: O
authors: Taspinar
authors: Gul
authors: G
authors: Yucesan
authors: Didem
authors: D
authors: Tastekin
authors: Fatma Cavide
authors: FC
authors: Sonmez
authors: Ganime
authors: G
authors: Coban
authors: Gokhan
authors: G
authors: Kilic
authors: Ali Hikmet
authors: AH
authors: Eris
authors: Teoman
authors: T
authors: Aydin
authors: Adem
authors: A
authors: Akcakaya
authors: Alpaslan
authors: A
authors: Mayadagli
mesh_terms: D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use*; D018289:Carcinoma, Verrucous / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D058086:Microalgae; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D053545:Spirulina; D014421:Turkey; D014846:Vulvar Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*
chemical_list: D000890:Anti-Infective Agents; D001688:Biological Products; D008795:Metronidazole