Showing papers in "Journal of Cancer Research and Therapeutics in 2011"
TL;DR: Mature teratoma was found to be the second most common benign tumor (after serous cystadenoma) and a lower percentage of endometrioid tumors was noted, with a significant number of malignant ovarian tumors presenting at an earlier age.
Abstract: Objective: The aim was to study the distribution of morphological pattern of benign and malignant ovarian neoplasms in different age groups in eastern India and to determine the likelihood of bilateral involvement in different morphologic subtypes. Materials and Methods: 957 cases of ovarian tumors were studied over a period of 10 years (from January 2001 to December 2010). Results: Most of the benign tumors occurred between 20 and 40 years of age, while the malignant lesions presented commonly between 41 and 50 years. The most common histological types were serous cystadenoma (29.9%), followed by mature teratoma (15.9%) and mucinous cystadenoma (11.1%). Major proportion of malignant ovarian tumors was contributed by surface epithelial tumors (60.9%). Serous cystadenocarcinoma was the predominant malignant tumor (11.3%). Metastatic tumors were found to involve the bilateral ovaries in 72%, while 49.5% of malignant serous tumors were bilateral. Borderline serous tumors showed bilateral involvement more commonly (27.4%) than borderline mucinous tumors (15.7%). Most of the malignant tumors presented as stage III (60%) or stage II (20%) disease. The overall survival rate was 85% for stage I tumors, 65% for stage II, 30% for stage III and 15.5% for stage IV tumors. Conclusion: We noted an earlier age at presentation of malignant tumors. Mature teratoma was found to be the second most common benign tumor (after serous cystadenoma). We also noted a lower percentage of endometrioid tumors. Lower number of stage IV tumors was noted, with a significant number of malignant ovarian tumors presenting at an earlier age.
112 citations
TL;DR: The primary objective was to identify the survival benefit of the primary medical modalities in HCC, as more trials were uncovered between 2005 and 2010, and to conduct a meta-analysis, which found RFA should be the first-line treatment in patients with a single small HCC tumor ≤ 3 cm.
Abstract: Introduction: An increasing trend of incidence in hepatocellular carcinoma (HCC) has been recorded in most developed countries. HCC ranks among the ten most common cancers worldwide. The health costs and burden to the economy implicated by HCC are huge. In recent years, the surveillance programs and screening for the disease, in addition to increasing awareness, led to the detection of smaller precursor lesions of HCC in the liver. The rise of molecular-targeted therapies and the publication of various conflicting guidelines on the management of the disease demand a review of evidence into the curative therapies and medical management of HCC. Aims: The primary objective was to identify the survival benefit of the primary medical modalities in HCC, as more trials were uncovered between 2005 and 2010. The secondary objective was to conduct a meta-analysis. Selection criteria were implemented to select randomized controlled trials (RCTs), to include in this study. After selection, all the articles were ranked according to their strength. Materials and Methods: The MEDLINE, CANCERLIT, Embase databases, and the Cochrane Library were reviewed using the national library of health website. The time limit used for searching for RCTs was between January 2005 and December 2010. Overall survival and the cumulative probability of no recurrence were the primary endpoints considered in the studies to be assessed. These endpoints were measured over one, two, or three years, depending on the size of the study and the length of follow-up. The software package comprehensive meta-analysis ver 2.0.exe (Biostat, USA) was used to comply with the results, to conduct the meta-analysis, and help with analyzing the data. Results: The original general search yielded 193 RCTs between 2005 and 2010. Only 32 studies met the inclusion criteria. However, after the ranking of the studies according to strength, only 17 studies were eventually selected. The 17 studies were subsequently classified according to the following; surgical resection (n = 2); percutaneous treatments (n = 5); chemoembolization (n = 1); systemic treatments (n = 8); and other treatments (n = 1). Randomized studies comparing the percutaneous ethanol injection (PEI) to the surgical resection were inconclusive. However, percutaneous treatments showed results similar to surgical resection in terms of overall survival. The meta-analysis comparing PEI to radiofrequency ablation (RFA) showed RFA to be superior to PEI in terms of overall survival at three years (odds ratio 1.698; 95% CI 1.206 - 2.391; P = 0.002). When adverse events were considered there was no statistically significant difference between the RFA and PEI groups (odds ratio 1.199; 95% CI 0.571- 2.521; P = 0.632). Conclusion: RFA should be the first-line treatment in patients with a single small HCC tumor ≤ 3 cm. Careful patient selection is crucial prior to transarterial chemoembolization (TACE), as the procedure may be associated with an increased risk of liver failure. Tamoxifen has no role to play in the treatment of HCC. Sorafenib should be the first-line treatment in patients with advanced and inoperable HCC. The role of Sorafenib in the management of early stage HCC remains to be determined.
106 citations
TL;DR: HPV is been proved to be the causative agent in causation of cervical cancers without doubt, but its role as a etiologic agent in causing oral cancers needs to be evaluated and studied more to come into any conclusion.
Abstract: Human papilloma virus (HPV) is one of the most common virus groups affecting the skin and mucosal areas of the body in the world today. It is also a known fact that HPV causes many lesions in the oral cavity. The most common conditions induced by oral HPV infection are usually benign-like oral papillomas, oral condylomas, and focal epithelial hyperplasia. Oral HPV infection has been found to be associated with some cases of oropharyngeal cancer, but it is not the main risk factor for this kind of cancer. HPV is been proved to be the causative agent in causation of cervical cancers without doubt, but its role as a etiologic agent in causing oral cancers needs to be evaluated and studied more to come into any conclusion. We have used review papers, case reports, cohort studies, case control studies, and various internet sources published from 1960 to 2011 to prepare this review of literature.
87 citations
TL;DR: Preoperative conditions like hypertension and higher creatinine levels predict development of cervical anastomotic leakage after esophageal cancer surgery, and cervical leakage was not associated with increased mortality rate.
Abstract: Background : Anastomotic leakage after esophagectomy remains an important source of postoperative morbidity in spite of advances in the management of these patients. The aim of this study is to identify the predictive factors of cervical anastomotic leakage and its consequences after esophagectomy in patients with esophageal cancer treated in a high volume cancer center. Materials and Methods : This retrospective study was conducted on 418 patients with esophageal carcinoma who underwent esophagectomy in a referral cancer center between 2001 and 2006. Demographic, clinicopathologic, and surgical data were collected from medical charts. Univariate and multivariate analyses were performed and odds ratio (OR) with 95% confidence intervals (CI 95% ) were calculated. Results : Predictive factors of leakage in univariate analysis were history of hypertension (P=0.003), diabetes mellitus (P=0.008), forced expiratory volume in one second percent predicted (FEV1%) (P=0.024), preoperative serum creatinine level (P=0.004), and degree of differentiation of the tumor (P=0.014); however, multivariate regression analysis identified history of hypertension (OR 7.2, [CI 95% :1.9 to 28.1]; P=0.004) and serum creatinine level > 0.85 mg/dl (OR 3.1, [CI 95% :1.04 to 9.04]; P=0.042) as independently significant risk factors. Pulmonary complications (P=0.042) and length of hospital stay (P Conclusion : Preoperative conditions like hypertension and higher creatinine levels predict development of cervical anastomotic leakage after esophageal cancer surgery. Postoperative consequences accompanying leakage include pulmonary complication and prolonged hospitalization.
51 citations
TL;DR: Since diagnostic values of VIA is comparable to Pap smear, and it performs well in detecting a high grade lesion, it is concluded that VIA can be used as a screening modality for cervical cancer in low resource settings.
Abstract: Aim: To assess the role of visual inspection with acetic acid as an alternative to Pap smear and in screening program for cervical cancer in low resource settings. Materials and Methods: A total of 225 women in the reproductive age group attending the Department of Gynecology were enrolled in the study. A Papanicolaou smear and visual inspection of the cervix with acetic acid was done. All patients who tested positive on screening then underwent a colposcopy-guided biopsy. The Pap smear of a low-grade squamous intraepithelial lesion (LSIL) and above was taken as abnormal. The statistical test used was the chi-square test and results were computed using Statistical Package for the Social Sciences (SPSS) version 12.0. Results: Out of 225 patients, acetic acid (VIA) was positive in 27 (12%) patients and the Pap smear was abnormal in 26 (11.7%). There were 15 LSIL, 6 high grade squamous intraepithelial lesions (HSIL) and 5 were squamous cell carcinoma. On biopsy, there were 15 mild dysplasia, 2 moderate dysplasia, 4 severe dysplasia, and 3 squamous cancers. The Pap smear had a sensitivity of 83%, specificity of 98%, and positive predictive value of 80% and negative predictive value of 97.9%. VIA had a sensitivity of 70.8%, specificity of 95%, and positive predictive value of 62.9% and negative predictive value of 96.5%. Conclusion: Since diagnostic values of VIA is comparable to Pap smear, and it performs well in detecting a high grade lesion, we conclude that VIA can be used as a screening modality for cervical cancer in low resource settings.
45 citations
TL;DR: Poor socio-economic status resulting in fewer intakes of fresh fruits, vegetables and fish in addition to heavy hookah smoking are suspected to be the major risk factors for the development of esophageal cancer.
Abstract: Background/Objective: Esophageal cancer has a peculiar geographical distribution and shows marked differences in incidence within a particular geographical region. Presently, as there seems little prospect of early detection of this cancer, an understanding of the etiological factors may suggest opportunities for its primary prevention. In this paper, we have tried to determine the role of diet and other life-style related factors in the etiology of cancer of esophagus. Material and Methods: A total of 100 confirmed squamous cell carcinoma of esophagus patients were enrolled for the study (Group A). 100 healthy subjects were included as controls (Group B). A predesigned questionnaire dealing with the basic patient data, dietary and smoking habits etc. was distributed among the cases in both groups. The data was thoroughly analyzed to define an association with the development of cancer of esophagus. Results: Group A patients included 71 males and 29 females in the age range of 40-70 years. Majority 37% were farmers, 29% house wives. Of the 72% smokers, 66% smoked hookah. 29% had positive family history. More than 90% took salt-tea at breakfast. Meat consumption was low, 44% took it weekly and 42% on monthly basis. 69% took fish yearly. Group B included 75 males and 25 females of which 35.7% were hookah smokers. Conclusion: Poor socio-economic status resulting in fewer intakes of fresh fruits, vegetables and fish in addition to heavy hookah smoking are suspected to be the major risk factors for the development of esophageal cancer.
42 citations
35 citations
TL;DR: High expression level of survivin gene expression and its splice variant, survivin-deltaEx3, can be potential new markers in diagnosis of human papillary thyroid carcinoma.
Abstract: Context: The most important problem in the case of thyroid nodules is the lack of suitable criteria for detecting malignant thyroid tumors from other nodules in the early stage. Variable expressions level of survivin, an inhibitory protein in apoptotic pathway, and its splice variants in malignant carcinoma versus well-differentiated normal tissues candidate them as reliable biomarkers in cancers. Aim: To semi-quantitative detection of survivin and its splice variant, survivin-deltaEx3, in thyroid nodules. Setting and Design: We evaluated the expression level of mentioned biomarkers in thyroid nodules including carcinoma. Materials and Methods: Samples were collected from 61 thyroid nodules including malignant, adenoma, non-tumoral (goiter and thyroidities) as well as non-neoplastic normal tissues. Transcriptional levels were measured using semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and the results were normalized to b2microglubin (b2m) gene. Statistical Analysis Used: Independent sample t-test was used to assess the significant variation of expression between different groups. Result: Our data for a first time revealed that survivin-deltaEx3 is significantly up-regulated from normal to malignant thyroid carcinoma tissues (approximately ten fold). Conclusion: High expression level of survivin and survivin-deltaEx3 in malignant papillary thyroid carcinoma suggested survivin gene expression and its splice variant, survivin-deltaEx3, can be potential new markers in diagnosis of human papillary thyroid carcinoma.
34 citations
TL;DR: Stereotactic radiosurgery is a safe and effective treatment for meningioma and tumor-related symptoms often improve after treatment.
Abstract: Background: Although the vast majority of meningiomas are not malignant, their location within the cranial vault often leads to the development of symptoms. Traditional therapy has included observation, surgical resection, radiation therapy or a multimodality approach. The objective of this study is to review the outcomes in patients with meningioma treated at our institution using stereotactic radiosurgery. Materials and Methods: A total of 73 patients (median age of 59, 15 male and 58 female) with meningioma (median volume of 5.54 cc) underwent Cyber Knife TM stereotactic radiosurgery at our institution. Sixty patients had WHO grade 1 meningioma, eleven patients had WHO grade 2 meningioma, and two patients had WHO grade 3 meningioma. Treatment consisted of a median dose of 17.5 Gy (range, 6 - 27 Gy) delivered over a median of three fractions (range: 1 - 5). The patients were followed by clinical examination as well as serial imaging with magnetic resonance imaging (MRI). Results: The median follow-up was 16.1 months (range, 1.5 - 98.0). Follow-up MRI was available in all 73 patients. Local failure was documented in 11 cases. Actuarial local control at one year was 95, 71, and 0% for WHO grade 1, WHO grade 2, and WHO grade 3, respectively. There was no acute grade 3 or greater toxicity and only one episode of late grade 3 toxicity. A subjective improvement in the existing, tumor-related symptoms was noted in 60% of the patients. Conclusion: Stereotactic radiosurgery is a safe and effective treatment for meningioma. Tumor-related symptoms often improve after treatment.
31 citations
TL;DR: Focus is placed on the underlying mechanisms of progressing cognitive dysfunction in the breast cancer population, accentuating a frontosubcortical involvement and the use of competent neuropsychological batteries and structural and functional imaging techniques, to analyze the changes associated with chemotherapy.
Abstract: Chemotherapy-induced cognitive changes have come under immense speculation in recent years. This mild cognitive impairment evinced in the form of short-term memory loss, and attention and concentration problems, finds itself unavoidably attached to the terms 'chemobrain' or 'chemofog'. The predicament between chemotherapy (CT) and neurotoxicity has been considerably examined and most of its attributes have been documented through neuropsychological studies. Although a sizeable portion of literature now covers this phenomenon, certain methodological reservations come in the way of its full appreciation, limited mostly by standardization issues in neuropsychological studies. The current review discusses some of these issues, with emphasis on the underlying mechanisms of progressing cognitive dysfunction in the breast cancer population, accentuating a frontosubcortical involvement and the use of competent neuropsychological batteries and structural and functional imaging techniques, to analyze the changes associated with chemotherapy. The relevance of prospective longitudinal studies with culture-centric norms has been emphasized, with the need for clinical guidelines, to assess and follow the course of neurotoxicity. Keeping track of the patient's own perceptive cognitive loss will help harmonize the decision-making process during chemotherapy.
30 citations
TL;DR: A taxane-based regimen should be chosen for breast cancer patients based on the pharmacokinetics, dosing schedule, clinical activity and toxicity profile that best meet the patient's therapeutic needs and quality of life.
Abstract: Background: Docetaxel and paclitaxel are likely to have different toxicity profiles, dose reduction and delays despite their similar medical results in breast cancer patients. Aims: This study examined retrospectively the incidence and severity of certain toxicities, dose reduction and delay of two taxanes. Materials and Methods: From January 2009 to June 2010, the incidence and severity of toxicities as well as the dose reduction, dose delay, granulocyte colony stimulating factor (G-CSF) in 54 patients with operable lymph node-positive (tumor stage T1, T2, or T3 and nodal stage N1 or N2) and high risk, node-negative (T2 or T3, N0) breast cancer without a distant metastases who received adjuvant chemotherapy - adriamycin, cyclophosphamide, docetaxel (TAC) and adriamycin, cyclophosphamide, paclitaxel (ACP)- were evaluated. Statistical Analysis Used: Mann-Whitney test and Fisher's exact test. Results and Conclusion: The patients in the ACP group experienced more frequent peripheral neuropathy (P=0.025), nausea (P=0.033) than those in the TAC group. Febrile neutropenia was significant in TAC (P=0.001). Increasing age was associated with an increased risk of anemia (P=0.004), fatigue (P=0.009) and pain (P=0.003), and a decreasing body mass index was associated with an increased risk of febrile neutropenia (P=0.009). Dose reduction and delay occurred due to febrile neutropenia and an increase in aspartate aminotransferase (AST)/alanine aminotransferase (ALT). The dose reduction was only significant in the TAC group (P= 0.001). A taxane-based regimen should be chosen for breast cancer patients based on the pharmacokinetics, dosing schedule, clinical activity and toxicity profile that best meet the patient's therapeutic needs and quality of life.
TL;DR: Administration of a dose of 100 mg/kg/day of the diosmin + hesperidin resulted in decreased morphologic inflammatory changes and may have protective effects against radiation-induced acute proctitis in an experimental rat model.
Abstract: Background: To explore the protective effect of a flavonoid fractions diosmin + hesperidin (Daflon), against radiation-induced acute proctitis in an experimental rat model. Materials and Methods: Thirty four rats were divided into four groups. The rats in Group 1 received Daflon and underwent irradiation. The rats in Group 2 received no Daflon and underwent irradiation. The rats in Group 3 received Daflon and underwent sham irradiation. The rats in Group 4 received no Daflon and underwent sham irradiation. Daflon emulsion (100 mg/kg/day) was administered via an orogastric feeding tube to the rats in groups 1 and 3 starting from 1 day prior to irradiation until the euthanasia day (day 15 following irradiation). Radiation therapy was delivered on a cobalt-60 unit using a single fraction of 17.5 Gy defined at a depth of 1 cm through an anterior portal. Slides were examined by the same pathologist under a light microscope two times in a blinded manner. Results: When compared to group 2, the rats of Group 1 showed less glandular distortion and less mucosal inflammation with less infiltration of the crypt epithelia by the inflammatory cells (P Conclusions: Administration of a dose of 100 mg/kg/day of the diosmin + hesperidin resulted in decreased morphologic inflammatory changes. This drug may have protective effects against radiation-induced acute proctitis.
TL;DR: The case of large-cell neuroendocrine carcinoma (LCNEC) of the endometrium in a 70-year-old female is described for its rarity and shows that a high index of suspicion can help the pathologist to use immunohistochemistry and in turn help in selection of appropriate chemotherapy.
Abstract: Neuroendocrine carcinomas (NEC) of the female genital tract are aggressive and uncommon tumors. They usually involve the cervix and ovary, and are seen very rarely in the endometrium. The overwhelming majority of endometrial NECs are of conventional small cell type (up to 60 cases). Only seven cases of large cell type NEC of the endometrium have been reported. We report a case of large-cell neuroendocrine carcinoma (LCNEC) of the endometrium in a 70-year-old female. The case is described for its rarity and shows that a high index of suspicion can help the pathologist to use immunohistochemistry and in turn help in selection of appropriate chemotherapy.
TL;DR: Stereotactic body radiotherapy for presacral recurrence of rectal adenocarcinoma is an efficacious and well-tolerated treatment modality which allows for palliation of pain.
Abstract: Purpose: Management of recurrent presacral rectal cancer is often not amenable to curative surgery. The goal of this study is to evaluate the safety and efficacy of cyberknife stereotactic body radiotherapy (SBRT) in the management of presacral recurrences. Materials and Methods: Between April 2003 and October 2008, 14 patients with presacral tumors from rectal adenocarcinoma were SBRT treated. Eleven patients were treated with 36 Gy in 3 fractions and 3 patients were treated with single fraction of 12, 16 or 18 Gy. Tumor response was assessed using response evaluation and criteria in solid tumor (RECIST) criteria. Toxicities were assessed with common terminology criteria adverse events v 3.0. Pain control was assessed. Results: One patient (6.7%) received SBRT as boost therapy. All patients had prior radiotherapy [median 50.4 Gy (20 - 81 Gy)]. Median tumor volume was 52.5 cc (19 - 110 cc). At initial follow-up of a median 4.9 months (1 - 16.3 months), treatment responses were complete response (n=3) and stable disease (n=8). With a median follow-up of 16.5 months (6 - 69 months), the one- and two-year LC rates were 90.9 and 68.2%, respectively, and the one- and two-year OS rates were 90 and 78.8%, respectively. No factors were significantly predictive of LC and OS. There were no grade 3 or 4 toxicities. Fifty percent (n=7) of our patients experienced pain with recurrence before treatment and 4 (57.1%) of them reported no pain after completion of their SBRT. Conclusions: Stereotactic body radiotherapy for presacral recurrence of rectal adenocarcinoma is an efficacious and well-tolerated treatment modality which allows for palliation of pain.
TL;DR: The addition of celecoxib to concurrent chemoradiation was associated with improved 2-year locoregional control rate from 84% to 100% (P = 0.039).
Abstract: Background: This is the first study that aimed to determine the efficacy and safety of concurrent chemoradiation with weekly cisplatin ± celecoxib 100 mg twice daily in locally advanced undifferentiated nasopharyngeal carcinoma. Materials and Methods: Eligible patients had newly diagnosed locally advanced (T3-T4, and/or N2-N3, M0) undifferentiated nasopharyngeal carcinoma, no prior therapy, Karnofsky performance status ≥ 70, and normal organ function. The patients were assigned to receive 7 weeks concurrent chemoradiation (70 Gy) with weekly cisplatin 30 mg/m 2 with either celecoxib 100 mg twice daily, (study group, n = 26) or placebo (control group, n = 27) followed by adjuvant combined chemotherapy with cisplatin 70 mg/m 2 on day 1 plus 5-fluorouracil 750 mg/m 2 /d with 8-h infusion on days 1-3, 3-weekly for 3 cycles. Results: Overall clinical response rate was 100% in both groups. Complete and partial clinical response rates were 64% and 36% in the study group and 44% and 56% in the control group, respectively ( P > 0.25). The addition of celecoxib to concurrent chemoradiation was associated with improved 2-year locoregional control rate from 84% to 100% ( P = 0.039). Conclusions: The addition of celecoxib 100 mg twice daily to concurrent chemoradiation improved 2-year locoregional control rate.
TL;DR: It is suggested that a combination of KPS <70 and elevated LDH might better predict short survival than any of the GPA scores, and this hypothesis should be confirmed in larger studies.
Abstract: Purpose: We evaluated the performance of the new 4-tiered melanoma-specific graded prognostic assessment (GPA) score and the previously published general GPA score in patients with brain metastases from malignant melanoma managed with different approaches including best supportive care. Materials and Methods: Retrospective analysis of 51 patients. Compared with the original analysis of the melanoma-specific GPA score, these patients were more representative of the general population of patients with brain metastases from this disease. Results: The present data confirmed that both scores identify patients with favorable prognosis who might be candidates for focal treatments. However, survival in the 2 unfavorable prognostic subgroups defined by the melanoma-specific GPA was not significantly different. Median survival in the melanoma-specific GPA classes was 3.1, 3.7, 7.5, and 12.7 months. Karnofsky performance status (KPS) and serum lactatdehydrogenase (LDH) level significantly predicted survival. Conclusion: In order to select the right patient to the right treatment and avoid overtreatment and suboptimal resource utilization in patients with very limited survival, improved prognostic tools are needed. The melanoma-specific GPA does not include extracranial disease extent or surrogate markers such as LDH. We suggest that a combination of KPS <70 and elevated LDH might better predict short survival than any of the GPA scores. This hypothesis should be confirmed in larger studies.
TL;DR: The results of this study suggest that high dose rate interstitial brachytherapy was appropriate for the treatment of early staged carcinoma of eye lid.
Abstract: Aim: The aim of this study was to evaluate the response of high dose rate interstitial brachytherapy in carcinoma eye lid. Materials and Methods: From January 2004 to December 2008, 20 diagnosed cases of carcinoma eye lid were reported in our department. Lower eye lid was involved in 11 patients and upper eye lid in 9 patients. All cases were staged clinically according to the TNM staging system. All patients were treated with high dose rate interstitial implant and analyzed for presence of residual disease, local recurrence, distant metastasis, radiation reaction and disease free survival. Results: There was 18 (90%) and 2 (10%) patients in stage I and II, respectively. Histological 10 (50%) cases were of squamous cell carcinoma, 8 (40%) cases were of sebaceous carcinoma and 2 (10%) cases were of basal cell carcinoma. All patients received six fraction of 6.5 Gy in 6 days. Complete response was seen in all patients. The median follow up time for all patients was 39.5 months with 95% confidence interval of 30.1 to 62.6 month. The 5-year disease free survival rate was 90%, 57.14%, and 50% for squamous cell carcinoma, sebaceous cell carcinoma and basal cell carcinoma, respectively. No isolated regional lymph node metastasis and distant metastases were seen. No visual complication was seen. Discussion: The results of this study suggest that high dose rate interstitial brachytherapy was appropriate for the treatment of early staged carcinoma of eye lid.
TL;DR: Percutaneous cryoablation appears to be an effective alternative to neurolytic celiac plexus block for palliative treatment of celiacplexus involvement and further study with larger number of patients is needed to evaluate the safety and efficacy.
Abstract: Computed Tomography (CT)-guided percutaneous cryoablation was performed in a 43-year-old patient with intractable epigastric abdominal pain caused by advanced adenocarcinoma of the pancreas and extensive celiac trunk involvement. Initial treatment with celiac plexus nerve neurolysis using local ethanol injection was unsuccessful. A 17-gauge 17-cm cryoablation probe (Galil Medical Inc. Plymouth Meeting, PA) was placed into the expected location of the celiac plexus through a left paraspinal approach under CT guidance and two cycles of freeze-thaw were performed. Patient's pain decreased from 10 of 10 (subjective pain scoring using a visual analog scale; VAS; 0-10) to 3. No post-procedure complication was observed. His pain has remained stable after 6 months of follow up. Percutaneous cryoablation appears to be an effective alternative to neurolytic celiac plexus block for palliative treatment of celiac plexus involvement. Further study with larger number of patients is needed to evaluate the safety and efficacy.
TL;DR: Localization of sensitizers at sensitive targets and reduced accumulation in normal tissues with liposome encapsulation and antibody conjugation suggest that these two delivery systems can potentially enhance the efficacy of photodynamic treatment.
Abstract: Background: Efficacy of photodynamic therapy can be enhanced by improving uptake, localization, and sub-cellular localization of sensitizers at the sensitive targets. Materials and Methods: Uptake, localization, and photodynamic effects of hematoporphyrin derivative (HpD, Photosan-3; PS-3) and disulfonated aluminum phthalocyanine (AlPcS 2 ) were studied either encapsulated in liposomes or conjugated to a monoclonal antibody to carcinoembryonic antigen (anti-CEA) in a brain glioma cell line, BMG-1. Results: Although the total uptake with encapsulated or conjugated sensitizers was less than the free sensitizers, photodynamic efficiency was higher due to the localization of the sensitizer at the sensitive targets. Biodistribution of intravenously administered technetium ( 99m Tc)-labeled PS-3 analyzed by gamma camera imaging showed maximum accumulation in the liver followed by tumor. Tumor/muscle (T/N) ratio of free PS-3 was higher compared to encapsulated or conjugated PS-3 but the accumulation of PS-3 significantly reduced in brain and cutaneous tissue following modulated delivery. Pharmacokinetics suggested faster accumulation of encapsulated and conjugated PS-3 in the tumor. Conclusion: Localization of sensitizers at sensitive targets and reduced accumulation in normal tissues with liposome encapsulation and antibody conjugation suggest that these two delivery systems can potentially enhance the efficacy of photodynamic treatment.
TL;DR: A systemic review of the literature investigating issues related to bone health in survivors of breast cancer is carried out to help raise awareness of bone health concerns in this patient population.
Abstract: The objective of this paper is to carry out a systemic review of the literature investigating issues related to bone health in survivors of breast cancer. Given the fact that only a fraction of women with breast cancer receive appropriate assessment of their bone health, it is hoped that this review will help raise awareness of bone health concerns in this patient population. Articles published in the English language addressing issues related to bone health in breast cancer were accessed using Pubmed database. Studies were searched using keywords like: "Osteoporosis", "osteopenia", "bone health", "breast cancer", "denosumab" and "bisphosphonates". Current evidence suggests that women who survive their breast cancer are at high risk for significant bone loss. Recent clinical guidelines recommend assessment of bone mineral density (BMD) in high-risk patients. Nonpharmacologic interventions including lifestyle changes, vitamin D and calcium supplements are extremely important. Bisphosphonates, in both oral and parenteral formulations, are increasingly used while new agents, like denosumab, have recently been approved. Due to the widespread use of screening mammography and early detection programs leading to breast cancer diagnosis at a much earlier stage and the recent introduction of more effective anticancer therapy, more women are surviving their breast cancer, which highlights the need for survivorship programs that address issues like bone health. Many recent professional societies are addressing these issues and updating their recommendations and guidelines.
TL;DR: In vitro treatment with an aqueous extract from Paecilomyces hepiali limits cell proliferation, induces apoptosis, and causes cell cycle arrest of A549 cells; this suggests that it may have potential as a therapy for lung adenocarcinoma.
Abstract: Background: Paecilomyces hepiali (PH) is a derivative of Cordyceps sinensis (CS), a fungus that has been shown to have anti-cancer and pro-apoptotic effects. Here, we aimed to investigate the effect of in vitro PH treatment on cell proliferation, cell cycling, apoptosis, and tumor necrosis factor-alfa (TNF-α) mRNA expression in human lung adenocarcinoma A549 cells (A549). Materials and Methods: A549 cells were treated with an aqueous extract of PH at concentrations of 0.25, 0.5, 1, 2, and 4 mg/ml. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to evaluate cellular viability and proliferation, while flow cytometry (FCM) was used to examine cell cycling. Apoptosis was assayed using Annexin V Fluorescein Isothiocyanate / Propidium Iodide (V-FITC/PI) and FCM. TNF-α mRNA expression was measured with reverse transcriptase-polymerase chain reaction (RT-PCR). Results: Cell proliferation was significantly suppressed by treatment with 1, 2, and 4 mg/ml of PH extract. Furthermore, the MTT assay showed that cell proliferation was inhibited in a concentration-time-dependent manner. As the concentration of the PH treatment increased, there were fewer cells in the S phase, and more cells in the G0/G1 and G2 phases. After 24 h of treatment, apoptosis was induced by a dose of 2 mg/ml of PH. TNF-α mRNA expression was significantly higher in the intervention groups and was positively associated with treatment concentration. Conclusions: These results indicate that in vitro treatment with an aqueous extract from PH limits cell proliferation, induces apoptosis, and causes cell cycle arrest of A549 cells; this suggests that it may have potential as a therapy for lung adenocarcinoma.
TL;DR: A case of xeroderma pigmentosum is reported in an 18-year-old male presenting with multiple cutaneous malignancies: squamous cell carcinomas, malignant melanoma and pigmented basal cell carcinoma.
Abstract: Xeroderma pigmentosum is a genodermatosis characterized by photosensitivity and the development of cutaneous and internal malignancies at an early age The basic defect underlying the clinical manifestations is a nucleotide excision repair defect, leading to defective repair of DNA damaged by ultraviolet radiation These patients exhibit enhanced sensitivity to ionizing radiation Patients with xeroderma pigmentosum who are younger than 20 years of age have a greater than 1000-fold increased risk of developing skin cancer Early detection of these malignancies is necessary because they are fast growing, metastasize early and lead to death Although, early detection and treatment of cutaneous malignancies will reduce the morbidity and mortality, genetic counseling remains the most important measure for preventing xeroderma pigmentosum We report a case of xeroderma pigmentosum in an 18-year-old male presenting with multiple cutaneous malignancies: squamous cell carcinoma, malignant melanoma and pigmented basal cell carcinoma
TL;DR: The current role of FDG PET CT in the evaluation of pulmonary nodules, diagnosis, staging and restaging of non-small-cell lung carcinoma (NSCLC), role of PET in small cell lung Carcinoma (Ca), pleural disease and its potential future applications are reviewed.
Abstract: Lung cancer has graduated from merely a reportable disease of 1912 to being the most common cause of cancer death in developed countries in recent years. The annual number of lung cancer deaths is greater than the combined cancer deaths from breast, colon and prostate. Its association with tobacco has been proved and is related to the type, amount of tobacco used, the age at initiation and duration of use. Significant advances have been made in the diagnosis and management of lung cancer over the past decade. The primary treatment of lung cancer is surgery and the best chance for a complete cure comes from the total resection of localized disease. Once nodal or distant metastases have developed, primary surgical intervention is ruled out and patient is considered for adjuvant chemotherapy with or without radiation therapy. Accurate staging and delineation of disease extent is therefore critical in the treatment planning of lung carcinoma patients. 18 F fluoro deoxy glucose (FDG) positron emission tomography (PET) has been proven to be a valuable noninvasive imaging modality in the evaluation of patients with known or suspected lung cancer and its integration with computed tomography (CT) has changed the face of PET imaging in many ways. This article will review the current role of FDG PET CT in the evaluation of pulmonary nodules, diagnosis, staging and restaging of non-small-cell lung carcinoma (NSCLC), role of PET in small cell lung Carcinoma (Ca), pleural disease and will also discuss its potential future applications.
TL;DR: This review looks at all the new frontiers that are in store in the near as well as the distant future of orbital retinoblastoma.
Abstract: Diagnosis of orbital retinoblastoma traditionally carries a dismal prognosis. Although its incidence is less in the developed countries, it continues to contribute to an epidemic of extraocular disease at diagnosis in the developing world. Orbital retinoblastoma encompasses a wide range of distinct clinical entities with varying tumor load. There are no standard treatment protocols as of now but the current preferred management is multimodal with a combination of initial high-dose chemotherapy, surgery, external beam radiotherapy and prolonged chemotherapy for 12 cycles. Though orbital retinoblastoma is a catastrophic event, rapid advances on many fronts, especially the genetic, makes the future appear brighter than what it is now. This review looks at all the new frontiers that are in store in the near as well as the distant future. Looking at the ever expanding horizons makes one believe of a definite hope that one day we will conquer this disease as we have conquered many others in the past.
TL;DR: The present study showed that SPECT was highly sensitive, but with a very low specificity due to an increase in false positive values, however, OPG and conventional CT showed an acceptable degree of sensitivity and specificity.
Abstract: Background and Objectives: One of the important factors in the pretreatment evaluation of patients with squamous cell carcinoma is the detection of the presence and extent of bone invasion by the tumor, which is significant for planning the therapy and determining the prognosis. Therefore, a study was undertaken with an objective to compare the accuracy and predictability of an Orthopantamograph (OPG), conventional Computed Tomography (CT), and Single Positron Emission Computed Tomography (SPECT) in the detection of bone invasion in squamous cell carcinoma patients scheduled to undergo surgery. Materials and Methods: A descriptive study was carried out on 15 patients with clinically and histopathologically diagnosed squamous cell carcinoma. OPG, conventional CT, and SPECT were carried out on all patients. Subsequently, the bone adjacent to the tumor was assessed histopathologically and served as a gold standard. The various imaging modalities were compared with the gold standard. Results: The study revealed that the tumor infiltration into the bone was positive in eight out of fifteen cases and seven were negative for bone invasion. OPG and conventional CT showed the presence of bone invasion in six out of eight cases with a sensitivity of 75% and a specificity of 100%. The positive predictive value for OPG was 100% and the negative predictive value was 78%. SPECT showed the presence of bone invasion in eight out of eight cases with a sensitivity of 100% and a specificity of 14.3%. The positive predictive value for SPECT was 57% and the negative predictive value was 100%. Conclusion: The present study showed that SPECT was highly sensitive, but with a very low specificity due to an increase in false positive values. However, OPG and conventional CT showed an acceptable degree of sensitivity and specificity.
TL;DR: This review summarizes the state-of-the-art MoAbs treatment, beginning with an overview of the scientific background to their synthesis, mechanism of action and choice of target antigen, mainly focusing on those antibodies that are currently in use in clinical practice.
Abstract: Much progress has been made during the last few decades in the treatment of hematological malignancies. Monoclonal antibodies (MoAbs) represent a major advance toward a targeted therapy that can dramatically improve the antitumor effect with a substantial reduction of toxicity derived from therapy. Unlike many small molecules, MoAbs offer unique target specificity. Several MoAbs are now in clinical use for hematologic malignancies therapy, and many others are currently undergoing clinical evaluation. This review summarizes the state-of-the-art MoAbs treatment, beginning with an overview of the scientific background to their synthesis, mechanism of action and choice of target antigen, mainly focusing on those antibodies that are currently in use in clinical practice. Despite these advances, significant challenges remain in the identification of optimal cellular targets, antibody forms and treatment schedules for therapeutic applications.
TL;DR: Increased serum levels of bone sialoprotein (BSP) observed in patients suffering from metastatic bone lesions may help in assessing osteolytic bone disease, in evaluating additional prognostic information and in monitoring treatment modalities.
Abstract: The skeleton is the most common site of tumor metastasis. The detection of metastatic bone disease is critical for primary cancer staging because it will condition the therapeutic decision and the prognosis. For the diagnosis of bone metastases, imaging techniques are usually employed, even if these techniques have some limitations in terms of accuracy and costs. An innovative, cheaper method for the screening of skeletal metastases could be the measurement of bone turnover markers. This article is aimed at providing a literature review on the clinical significance of increased serum levels of bone sialoprotein (BSP) observed in patients suffering from metastatic bone lesions. In addition, we have briefly summarized recent studies reporting the biological and pathological roles of BSP in bone remodeling and bone metastasis. Some studies have demonstrated that serum BSP can be considered as an early marker and a prognostic factor for the development of bone metastases. BSP may help in assessing osteolytic bone disease, in evaluating additional prognostic information and in monitoring treatment modalities.
TL;DR: This case is the first reported case of this unique combination of multiple synchronous genital malignancies in a 76-year-old woman and is presented for its rarity and unique presentation.
Abstract: Extragenital malignant mixed Mullerian tumor (MMMT) is a rare tumor in females, and it is even more rarely encountered among the multiple genital malignancies. There are some reports of extragenital MMMTs associated with synchronous or metachronous gynecologic tumors of Mullerian duct origin. We recently encountered an MMMT of broad ligament which is associated with papillary serous cystadenocarcinoma of the ovary and endometrioid adenocarcinoma arising in atypical polypoid adenomyoma endometrium in a 76-year-old woman. This case is presented for its rarity and unique presentation. To our knowledge, ours is the first reported case of this unique combination of multiple synchronous genital malignancies.
TL;DR: The underdiagnosis that restricts the diagnostic performance of the method seems to be a major problem in the frozen section evaluation of BOTs, and a more careful approach is therefore needed, while choosing a proper surgical technique during laparotomy for ovarian masses.
Abstract: Purpose: To evaluate the accuracy of a frozen section and to analyze the factors affecting frozen section results in cases of borderline ovarian tumors (BOTs). Materials and Methods: The files and pathological reports of 82 cases diagnosed with BOT at our clinic, between January 1994 and June 2009, have been retrospectively evaluated. The frozen section results were compared to the permanent paraffin section results. Accuracy, overdiagnosis, and underdiagnosis rates were estimated. The factors affecting the diagnosis were also evaluated using logistic regression analysis. Results: The mean age was 40.16 ± 14.01 years. Of the patients, 47.6% had serous and 42.7% had mucinous histology. About 90% of the cases were in stage I. The rate of correct diagnosis with frozen section was 69.5%. The rates of overdiagnosis and underdiagnosis were 1.2 and 29.3%; respectively. The factors affecting the diagnosis were determined as, the dimension of the ovarian mass (P = 0.005), presence of a solid component (P = 0.000), preoperative CA 125 value (P = 0.016), and intraoperative rupture of the ovarian cyst (P = 0.049). Conclusion: In the frozen section evaluation of BOTs, the underdiagnosis that restricts the diagnostic performance of the method seems to be a major problem. A more careful approach is therefore needed, while choosing a proper surgical technique during laparotomy for ovarian masses. In order to reduce the false diagnosis and surgical morbidity, the frozen section analysis should be applied by experienced pathologists and the possible predictive factors affecting a false diagnosis should carefully be taken into consideration.
TL;DR: A case of axillary lymph node metastasis as a consequence of recurrent papillary thyroid carcinoma (PTC) in a 64-year-old lady who is currently on thyroxine suppression therapy and remains disease free for the past 6 months.
Abstract: We report a case of axillary lymph node metastasis as a consequence of recurrent papillary thyroid carcinoma (PTC) in a 64-year-old lady The patient initially presented in 2004 with a 10 × 10 cm size thyroid swelling of approximately 3-year duration and bilateral cervical lymphadenopathy She underwent total thyroidectomy with bilateral neck dissection then Pathological examination confirmed that the resected lesions were PTC and nodal metastases from thyroid On follow-up over the next 6 years, she underwent excisions twice for cervical nodal recurrences She presented to us in January 2010 with multiple right axillary adenopathy Therapeutic right axillary dissection was done Histopathologic examination revealed metastatic PTC with tall cell differentiation in 7 out of the 17 nodes The patient is currently on thyroxine suppression therapy and remains disease free for the past 6 months We review our experience and present a brief review of literature