Primary pulmonary mucoepidermoid carcinoma: an analysis of 21 cases

Background: The optimal treatment for pulmonary mucoepidermoid carcinoma (MEC), a rare type of tumor, has not been established yet. This study analyzed the survival of pulmonary MEC patients and attempted to find clues for optimal treatment. Methods: A total of 21 patients with pulmonary MEC from November 2004 to January 2011 were included in the investigation. Immunohistochemistry, epidermal growth factor receptor (EGFR) mutation, and survival were retrospectively studied. Results: Among the 21 pulmonary MEC patients, 17 were diagnosed with low-grade malignancy and 4 with high-grade malignancy through pathological examination. The prognosis was found to be poor in the presence of lymph nodes. The expression rates of EGFR and HER2 were 28.6% and 0%, respectively, which correlated with neither grade nor prognosis. The mutation rate of EGFR was 0. Log-rank test results indicated that age, grade, lymph node metastasis, and tumor-node-metastasis stage were prognostic factors. Conclusion: Age, grade, lymph node metastasis and tumor-node-metastasis stage correlate with the survival of pulmonary MEC patients.Trial registrationThis study was approved and registered by the Ethics Committee of Zhongshan Hospital. Written informed consent was obtained from all participants prior to treatment.

via World Journal of Surgical Oncology

Metastatic lobular carcinoma of the breast masquerading as a primary rectal cancer

Background: Colorectal metastasis of lobular carcinoma of the breast is a diagnostic challenge. It may macroscopically simulate primary colon cancer or inflammatory bowel disease. In some cases, the interval between the primary breast cancer and metastatic colorectal lesions is so long that the critical records for diagnosis including history might be lost or missed.Case presentationReported herein is a case of metastatic lobular carcinoma of the breast masquerading as a primary rectal cancer developed in a 62-year-old Japanese woman. The case initially presented as a circumferential rectal lesion, and information on the patient's history of breast cancer was not noted. As the result of endoscopic biopsy, diagnosis of poorly differentiated rectal adenocarcinoma was made. The lesion was surgically resected after chemo-radiotherapy. Histopathological examination of the resected specimen with hematoxylin and eosin (HE) stain revealed a single-file arrangement of the tumor cells, reminiscent of lobular carcinoma of the breast. Immunohistochemical analysis revealed an immunophenotype consistent with lobular carcinoma of the breast. Because further review of the patient's history revealed an occurrence of 'poorly differentiated adenocarcinoma of the breast', which she had experienced 24 years earlier, the final diagnosis of the lesion was made as rectal metastasis from lobular breast carcinoma. Conclusions: Poorly differentiated adenocarcinoma of the colorectum is rarer than that of the stomach. Linitis plastica-type cancer of the colorectum is also rarer than that of the stomach. A lesson from the present case is that before we conclude a linitis plastica-type cancer of poorly differentiated type as a primary colorectal cancer, it is critical to exclude a possibility of metastatic colorectal cancer.

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Biomarker discovery offers hope for lung cancer blood test

Blood levels of a variant form of the nuclear matrix protein Ciz1 are significantly higher in individuals with early- and late-stage lung cancer than in lung cancer-free individuals, researchers report.

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Gene variant predicts lymphoma treatment response

German researchers have identified a gene variant that significantly influences the outcome of methotrexate therapy for primary central nervous system lymphoma.

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Prognostic impact of Gleason score modernization undetermined

A review of contemporary grading systems for prostate cancer has found that modernization of the Gleason grading system results in more accurate grading for radical prostatectomy than older systems.

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Recurrence risk can be identified before hepatectomy

Patients who are likely to experience disease recurrence after undergoing hepatectomy for hepatocellular carcinoma can be identified by factors that are available preoperatively, indicate the results of a Hong Kong study.

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Long term survival results for gastric GIST: is laparoscopic surgery for large gastric GIST feasible?

Background: Recently, laparoscopic resection for relatively small sized gastric gastrointestinal stromal tumors (GISTs) has been widely accepted as minimally invasive surgery. However, no report on the long-term safety and efficacy of this surgery for large sized gastric GISTs has been published to date. Methods: Between July 1998 and January 2011, 104 consecutive patients who underwent resection for gastric GISTs were enrolled in this retrospective study. We assessed the clinicopathological characteristics, postoperative outcomes, patient survival, and tumor recurrence. Results: Of the 104 patients with gastric GISTs who were included in the study, there were 47 males and 57 females whose mean age was 59.8 years. Sixty-four patients (61.5%) had symptoms associated with tumor. Ten patients included in the group 1, 49 in the group 2, 15 in the group 3a, 9 in the group 5, 14 in the group 6a, and 7 in the group 6b. There was one minor complication and no mortalities. Recurrence was noted in 5 patients, with a median follow-up period of 49.3 months (range, 8.4 to 164.4). The 5-year overall and disease free survival rates of 104 patients were 98.6% and 94.8%, respectively. When comparing large tumor (5-10 cm) between laparoscopic and open surgery, there were statistically differences in age, tumor size, tumor location, and length of hospitalization. There were no statistical differences in the 5-year survival rate between laparoscopic and open surgery for large tumor (5-10cm). Conclusion: Laparoscopic surgery is feasible and effective as an oncologic treatment of gastric GISTs. Moreover, laparoscopic surgery can be an acceptable alternative to open methods for gastric GISTs of size bigger than 5 cm.

via World Journal of Surgical Oncology

Primary gastric cancer presenting with a metastatic embolus in the common carotid artery: a case report

Although about 30% of gastric cancers have distant metastasis at the time of initial diagnosis, metastatic tumor embolus in the main blood vessels is not common, especially in the main artery. The report presents, for the first time, an extremely rare clinical case of a metastatic embolus in the common carotid artery (CCA) from primary gastric cancer. Metastatic embolus from the primary tumor should be considered when patients present with gastric cancer accompanied by intravascular emboli. The patient should be actively examined further so as to allow early detection and treatment.

via World Journal of Surgical Oncology

Inhibition of Jak-STAT3 pathway enhances bufalin-induced apoptosis in colon cancer SW620 cells

Background: The purpose of the research is to investigate the roles of Jak-STAT3 signaling pathway in bufalin-induced apoptosis in colon cancer SW620 cells. Methods: The inhibitory effects of bufalin on cell proliferation were determined by MTT (Methyl thiazolyltetrazolium) assay. The morphological changes of cells were measured by Wright-Giemsa staining. The cell cycle arrest and apoptosis were tested by flow cytometry analysis. Western Blot was used to determine the protein expression of the apoptosis inhibitors livin and caspase-3, the apoptosis-related proteins Bax and Bcl-2, as well as the key protein kinases in the Jak-stat3 signaling pathway, stat3 and p-stat3. Results: (1) Bufalin inhibited the proliferation of SW620 cells. IC50 at 24 h, 48 h and 72 h were 76.72 +/- 6.21 nmol/L, 34.05 +/- 4.21 nmol/L and 16.7 +/- 6.37 nmol/L. (2) Bufalin induced SW620 cell cycle arrest and apoptosis, indicated by the appearance of apoptotic bodies; (3) The results from flow cytometry demonstrated that there was cell cycle G2/M phase arrest in 20 nmol/L bufalin treatment group (36.29 +/- 2.11% vs 18.39 +/- 1.74%, P<0.01); there was a sub-diploid apoptosis peak in 80 nmol/L bufalin treatment group (19.69 +/- 1.63% vs 0.99 +/- 0.23%, P <0.01). The apoptosis rate was 34.63 +/- 2.57% (vs 19.69 +/- 1.63%, P = 0.002) in JAK kinase inhibitor AG490 plus bufalin treatment group. (4) During the process of bufalin-induced apoptosis in SW620 cells, transient activation of p-stat3 inhibited the activation of stat3, up-regulated Bax expression, down-regulated livin and Bcl-2 expression (P<0.01), and activated caspase-3. Inhibition of Jak-stat3 signaling pathway by pre-treatment with AG490 significantly enhanced the bufalin-induced apoptosis (P<0.01), further up-regulated Bax protein expression, down-regulated livin and Bcl-2 protein expression and enhanced caspase-3 activation. Conclusions: Bufalin not only inhibited the growth of colon cancer SW620 cells, but also induced apoptosis of SW620 cells. Activation of caspase-3, up-regulation of Bax, down-regulation of livin and Bcl-2, as well as inhibition of Jak-stat3 signaling pathway might be the important mechanisms for the bufalin-induced apoptosis.

via World Journal of Surgical Oncology

Nasolabial flap reconstruction in oral cancer

Background: The nasolabial flap is a simple flap used for reconstructing small intraoral defects created after the excision of malignant tumors. Methods: A retrospective analysis of 26 cases of oral cancer treated with primary excision and nasolabial flap reconstruction was carried out. In 22 cases, the excision was combined with neck dissection and facial artery ligation. Results: Good cosmetic and functional results were obtained in almost all cases. Wound dehiscence developed in three patients, while one patient developed a persistent orocutaneous fistula. Disease recurrence occurred in one patient. Conclusions: The nasolabial flap is a good flap for the reconstruction of small oral defects after excision of primary tumors and results in good overall cosmetic and functional outcome.

via World Journal of Surgical Oncology

Experience and analysis of Delphian lymph node metastasis in patients with papillary thyroid carcinoma

Background: Recently, lymph node metastasis (LNM) has been regarded as an important factor influencingloco-regional recurrence and survival rate in papillary thyroid cancer (PTC) patients. Theaims of this study were to investigate the detection rate and metastasis rate of the Delphianlymph node (DLN) and clinical patterns related to regional LNM, and to examine how DLNmetastasis affects PTC treatment. Methods: We reviewed the medical records of 413 patients with pathologically confirmed PTC fromamong 452 patients who underwent thyroid surgery between January 2010 and October 2010in the Department of Endocrine Surgery at Kosin University Gospel Hospital in Busan, SouthKorea. Results: Multivariate analyses revealed a significantly higher proportion of cases with lymphovascularinvasion (56.6% vs. 12.5%, P <0.001), central neck node metastasis (88.6% vs. 34.5%, P<0.001) and lateral neck node metastasis (47.2% vs. 10.2%, P <0.005) among cases withDLN metastasis compared to those without. The negative predictive value (NPV) of DLNmetastasis with regard to the presence of contralateral central LNM for cases with a tumorsize 1 cm or smaller than 1 cm was found to be 93.3% (127/136). Conclusion: When DLN metastasis is not detected in papillary thyroid microcarcinomas (PTMC), thyroidlobectomy on the affected side and ipsilateral central neck lymph node dissection should besufficient. In addition, even in cases where lateral neck LNM is not detected on preoperativeexamination, if DLN metastasis is detected postoperatively, more careful attention should bepaid to the lateral neck nodes during follow-up.

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Establishment and characterisation of two human breast carcinoma cell lines by spontaneous immortalization: discordance between Estrogen (ER), progesterone (PR) and HER2/neu receptors of breast carcinoma tissues with derived cell lines

Background: Breast cancer is one of the most common cancers among women throughout the world. Therefore, established cell lines are widely used as in vitro experimental models in cancer research. Methods: Two continuous human breast cell lines, designated MBC1 and MBC2, were successfully established and characterized from invasive ductal breast carcinoma tissues of Malaysian patients. MBC1 and MBC2 have been characterized in terms of morphology analysis, population doubling time, clonogenic formation, wound healing assay, invasion assay, cell cycle, DNA profiling, fluorescence immunocytochemistry, Western blotting and karyotyping. Results: MBC1 and MBC2 exhibited adherent monolayer epithelial morphology at a passage number of 150. Receptor statuses of MBC1 and MBC2 were (ER+, PR+, HER2+) and (ER+, PR-, HER2+), respectively. These results are in discordance with histopathological studies of the tumoral tissues, which were triple negative and (ER-, PR-, HER2+) for MBC1 and MBC2, respectively. Both cell lines were capable of growing in soft agar culture, which suggests their metastatic potential. The MBC1 and MBC2 metaphase spreads showed an abnormal karyotype, including hyperdiploidy and complex rearrangements with modes of 52--58 chromosomes per cell. Conclusions: Loss or gain in secondary properties, deregulation and specific genetic changes possibly conferred receptor changes during the culturing of tumoral cells. Thus, we hypothesize that, among heterogenous tumoral cells, only a small minority of ER+/PR+/HER2+ and ER+/PR-/HER2+ cells with lower energy metabolism might survive and adjust easily to in vitro conditions. These cell lines will pave the way for new perspectives in genetic and biological investigations, drug resistance and chemotherapy studies, and would serve as prototype models in Malaysian breast carcinogenesis investigations.

via Cancer Cell International

Decreased expression of microRNA let-7i and its association with chemotherapeutic response in human gastric cancer

Background: MicroRNA let-7i has been proven to be down-regulated in many human malignancies and correlated with tumor progression and anticancer drug resistance. Our study aims to characterize the contribution of miRNA let-7i to the initiation and malignant progression of locally advanced gastric cancer (LAGC), and evaluate its possible value in neoadjuvant chemotherapeutic efficacy prediction. Methods: Eighty-six previously untreated LAGC patients who underwent preoperative chemotherapy and radical resection were included in our study. Let-7i expression was examined for pairs of cancer tissues and corresponding normal adjacent tissues (NATs), using quantitative RT-PCR. The relationship of let-7i level to clinicopathological characteristics, pathologic tumor regression grades after chemotherapy, and overall survival (OS) was also investigated. Results: Let-7i was significantly down-regulated in most tumor tissues (78/86: 91%) compared with paired NATs (P < 0.001), and low levels of let-7i were significantly correlated with local invasion, lymphatic metastasis, and poor pathologic tumor response. Multivariate Cox regression analysis revealed that low let-7i expression was an unfavorable prognostic factor of OS (hazard ratio (HR) = 2.316, P =0.024) independently of other clinicopathological factors, including tumor node metastasis (TNM) stage (HR = 3.226, P = 0.013), depth of infiltration (HR = 4.167, P < 0.001), and lymph node status (HR = 2.245, P = 0.037). Conclusions: These findings indicate that let-7i may be a good candidate for use a therapeutic target and a potential tissue marker for the prediction of chemotherapeutic sensitivity and prognosis in LAGC patients.

via World Journal of Surgical Oncology

Prognostic significance of muc4 expression in gallbladder carcinoma

Background: Mucins are high molecular glycoproteins and play protective and lubricating roles in various epithelial tissues. Deregulated expression of mucins is involved in carcinogenesis and tumor invasion. MUC4 expression has been identified as a poor prognostic factor in pancreatobiliary carcinomas. To date, the relation between MUC4 expression and prognosis in gallbladder carcinoma remains to be determined. Authors examined MUC4 expression in gallbladder carcinoma and investigated its impact on prognosis. Methods: The expression profiles of MUC4, MUC1, MUC2 mucins in gallbladder carcinoma tissues from 63 patients were investigated using immunohistochemical staining. Results: For gallbladder carcinoma, positive staining of MUC4, MUC1, and MUC2 was 55.6%, 81.0%, 28.6%, respectively. There was a significant correlation between the expression of MUC4 and the expression of MUC1 or MUC2 (p = 0.004, p = 0.009, respectively). Univariate analysis showed that MUC4 expression (p = 0.047), differentiation (p < 0.05), T-stage (p < 0.05) and lymph node metastasis (p < 0.001) were significantly associated with poor survival. Expression of MUC1 and MUC2 was not correlated to survival. The backward stepwise multivariate analysis showed that MUC4 expression (p = 0.039) and lymph node metastasis (p = 0.001) were significant independent risk factors. In combined assessment of MUC4 and MUC2 expression, MUC4 positive and MUC2 negative group showed a significantly worse outcome than MUC4 negative groups(MUC4-/MUC2+ and MUC4-/MUC2-) and MUC4/MUC2 co-expression group(MUC4+/MUC2+) (p < 0.05). Conclusions: MUC4 expression in gallbladder carcinoma is an independent poor prognostic factor. Therefore, MUC4 expression may be a useful marker to predict the outcome of patients with surgically resected gallbladder carcinoma. MUC2 expression may have prognostic value when combined with MUC4 expression.

via World Journal of Surgical Oncology

Application of binding pancreatogastrostomy in laparoscopic central pancreatectomy

Background: The feasibility of binding pancreaticogastrostomy in laparoscopic central pancreatectomy is not known. Methods: In October 2011, a female patient with a pancreatic neck mass received laparoscopic central pancreatectomy with binding pancreaticogastrostomy. Results: The operation was successful. No complications occurred. The operative time was 210 min. Blood loss was 120 ml. On day 11 after the operation, the patient was discharged. The postoperative pathological result showed a 2 x 2 x 2-cm solid pseudopapillary tumor of the pancreas with intrapancreatic infiltration. The surgical margin was negative. Conclusions: Laparoscopic central pancreatectomy with binding pancreaticogastrostomy might be feasible, facilitating further study in laparoscopic pancreatoduodenectomy.Trial registrationThis study was waived from trial registration because it is a retrospective analysis of medical records.

via World Journal of Surgical Oncology

‘Postcode lottery’ sheds light on low-grade glioma strategy

Survival of adult patients with low-grade gliomas is better if they are admitted to a hospital that favors early resection, rather than one that opts for biopsy and watchful waiting, shows a study in JAMA.

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Mucin (Muc) expression during pancreatic cancer progression in spontaneous mouse model: potential implications for diagnosis and therapy

Background: Pancreatic cancer (PC) is a lethal malignancy primarily driven by activated Kras mutations and characterized by the deregulation of several genes including mucins. Previous studies on mucins have identified their significant role in both benign and malignant human diseases including PC progression and metastasis. However, the initiation of MUC expression during PC remains unknown because of lack of early stage tumor tissues from human PC patients. Methods: In the present study, we have evaluated stage specific expression patterns of mucins during mouse PC progression in (KrasG12D;Pdx1-Cre (KC)) murine PC model from pancreatic intraepithelial neoplasia (PanIN) to pancreatic ductal adenocarcinoma (PDAC) by immunohistochemistry and quantitative real-time PCR. Results: In agreement with previous studies on human PC, we observed a progressive increase in the expression of mucins particularly Muc1, Muc4 and Muc5AC in the pancreas of KC (as early as PanIN I) mice with advancement of PanIN lesions and PDAC both at mRNA and protein levels. Additionally, mucin expression correlated with the increased expression of inflammatory cytokines IFN-gamma (p < 0.0062), CXCL1 (p < 0.00014) and CXCL2 (p < 0.08) in the pancreas of KC mice, which are known to induce mucin expression. Further, we also observed progressive increase in inflammation in pancreas of KC mice from 10 to 50 weeks of age as indicated by the increase in the macrophage infiltration. Overall, this study corroborates with previous human studies that indicated the aberrant overexpression of MUC1, MUC4 and MUC5AC mucins during the progression of human PC. Conclusions: Our study reinforces the potential utility of the KC murine model for determining the functional role of mucins in PC pathogenesis by crossing KC mice with corresponding mucin knockout mice and evaluating mucin based diagnostic and therapeutic approaches for lethal PC.

via Journal of Hematology & Oncology

En bloc resection of extra-peritoneal soft tissue neoplasms incorporating a type III internal hemipelvectomy: a novel approach

Background: A type III hemipelvectomy has been utilized for the resection of tumors arising from the superior or inferior pubic rami. Methods: In eight patients, we incorporated a type III internal hemipelvectomy to achieve an en bloc R0 resection for tumors extending through the obturator foramen or into the ischiorectal fossa. The pelvic ring was reconstructed utilizing marlex mesh. This allowed for pelvic stability and abdominal wall reconstruction with obliteration of the obturator space to prevent herniations. Results: All eight patients had an R0 resection with an overall survival of 88% and with average follow up of 9.5 years. Functional evaluation utilizing the Enneking classification system, which evaluates motion, pain, stability and strength of the affected extremity, revealed a 62% excellent result and a 37% good result. No significant complications were associated with the operative procedure. Marlex mesh reconstruction provided pelvic stability and eliminated all hernial defects. Conclusion: The superior and inferior pubic rami provide a barrier to a resection for tumors that arise in the extra-peritoneal pelvis extending through the obturator foramen or ischiorectal fossa. Incorporating a type III internal hemipelvectomy with a simple marlex mesh reconstruction allows for complete tumor resection without functional compromise, acute infectious issues or obturator or abdominal hernia defects.

via World Journal of Surgical Oncology

Antiviral therapy cuts progression to cancer in hepatitis

Antiviral therapy may prevent the most common form of liver cancer developing among patients who have hepatitis C-related fibrosis or cirrhosis, report researchers.

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Low-dose gemcitabine in long infusion: When less is more

M Zwitter



Indian Journal of Cancer 2012 49(2):199-201







via Indian Journal of Cancer

Gemcitabine in brief versus prolonged low-dose infusion, both combined with carboplatin for advanced non-small cell lung cancer

SK Beniwal, KM Patel, S Shukla, BJ Parikh, S Shah, A Patel



Indian Journal of Cancer 2012 49(2):202-208



Purpose: Gemcitabine in low-dose prolonged infusion is a treatment with documented activity against a variety of tumors. The present study was conducted to evaluate the efficacy and safety of the combination of gemcitabine at a low-dose prolonged infusion in comparison with standard dose gemcitabine with carboplatin in chemonaive patients with advanced non-small cell lung cancer (NSCLC). Materials and Methods: Sixty chemonaive patients with stage IIIB or IV NSCLC were included. Patients were randomly assigned 1:1 to receive 350mg/m 2 gemcitabine in a 6-h infusion on days 1 and 8 and carboplatin area under the serum concentration time curve (AUC) 5 on day 1 versus gemcitabine 1000mg/m 2 on days 1 and 8 and carboplatin AUC 5 on day 1 (3-week cycle both). A total of 118 chemotherapy cycles, with a median of 4 cycles per patient (range 2-6), and 134 chemotherapy cycles, with a median of 4.47 cycles per patient (range 3-6) were administered in standard and low infusional dose arm, respectively. Results: Among patients in the standard arm, 40% had overall response rate (ORR), 33.3% had stable disease and 26.6% had progressive disease, while in low-dose infusional arm, 36.6% had ORR, 36.3% had stable disease and 26.6% had progressive disease (P = 0.992). Median progression-free survival was 5.5 months and 5.4 months, median overall survival was 9.7 months and 10.7 months, and 1-year survival was 33.7% and 36.6% in standard arm and low-dose infusion arm, respectively. Grade 3/4 toxicity was rare. Conclusion: In NSCLC, gemcitabine low-dose prolonged infusion with carboplatin has low toxicity, especially thrombocytopenia, and has an activity comparable with gemcitabine given in higher dose in standard infusion.



via Indian Journal of Cancer

Preservation of palatal mucoperiosteum for oronasal separation after total maxillectomy

Charles Paki Molumi, Siba Prasad Dubey, Matupi Lorenzz Apaio



Indian Journal of Cancer 2012 49(2):209-214



Background: Oronasal communication occurs after total maxillectomy for advanced sinonasal cancers. This results in feeding, breathing and cosmetic impairment. Various methods have been described to close off the palatal defect from the oral cavity to improve the function of speech and deglutition. Aims: The object of this article is to describe our experience of preservation of palatal mucoperiosteum for oronasal separation. Materials and Methods: Retrospective review of clinical and operative records of 31 total maxillectomy patients where oronasal separation was achieved by the conventional technique of applying a maxillary obturator. The postoperative complications arising from the use of maxillary obturator for oronasal communication after total maxillectomy in these 31 patients were analysed. To avoid the complications encountered in these 31 patients we preserved and used the ipsilateral palatal mucoperiosteum for oronasal separation. This new technique was applied in 12 patients. The results are presented and compared. Results : A total of 43 patients underwent total maxillectomy for advanced sinonasal tumors. In 31 patients the conventional maxillary obturator was used for oronasal separation. Among these patients, 30 had crustation of the maxillary cavity, nasal regurgitation and cheek skin retraction in 15 each, trismus in eight, infection of skin graft donor site in seven, cheek movement during respiration in five and ill-fitting prosthesis in three. In 12 patients palatal mucoperiosteum was preserved and used for oronasal separation. The complications encountered in oronasal separation by palatal prosthesis were avoided in the modified procedure. Conclusions: We found that oronasal separation by preservation of palatal mucoperiosteum following total maxillectomy allowed excellent palatal function, prompt rehabilitation and minimal complications without compromising the prognosis.



via Indian Journal of Cancer

Risk factor profiles of head and neck cancer patients of Andhra Pradesh, India

L Addala, C Kalyana Pentapati, PK Reddy Thavanati, V Anjaneyulu, MD Sadhnani



Indian Journal of Cancer 2012 49(2):215-219



Objective: To define the demographic risk profile and stage at diagnosis among the head and neck cancer (HNC) patients reported in two hospital-based cancer registries in Andhra Pradesh. Materials and Methods: A cross-sectional study was conducted in patients with histologically confirmed diagnosis of squamous cell carcinoma of the head and neck during 2002-2006. Data on the demographic profile and clinical information were obtained from hospital and clinical records. Staging was based on the American Joint Committee on Cancer and included primary tumor size (T), regional neck status (N), and group stage. The site of cancer was classified based on the International Classification of Disease for oncology (ICD-02). Results: A total of 5458 cases of HNC were included in this study. Majority of the subjects were in the age range of 40-69 years with a significant male preponderance in all the age groups (P<0.001). The most common habit was the combination of smoking, alcohol, and chewing in both males and females (20.1 and 35.1%, respectively) (P<0.001). Tongue and buccal mucosa were the most common sites of cancer in both males (26.8 and 12.8%, respectively) and females (22.9 and 19.8%, respectively) (P<0.001). Tongue was the commonest site of cancer occurrence with respect to all the habits (both singly and in combination) except for chewing tobacco where buccal mucosa was the most common site. Males were more likely to be diagnosed in stage 3 (37.6%) and 4 (20.6%), while females were diagnosed in stage 1 (36.3%) and 2 (32.7%) (P<0.001). Conclusion: A male preponderance of cancer occurrence and combination of all the three habits (smoking, alcohol, and chewing) were found to be the significant risk factors. Males were more likely to be diagnosed later than females.



via Indian Journal of Cancer

Carcinoma base of tongue: Single institution 15 year experiences

RPS Banipal, MK Mahajan, G George, J Sachdev, P Jeyaraj



Indian Journal of Cancer 2012 49(2):220-224



Aims: To report the outcome with radiotherapy and concomitant chemoradiotherapy in patients with locally advanced squamous cell carcinoma base of tongue treated and followed up at single institution over a period of 15 years. Materials and Methods: This study was carried out by auditing the medical records of 103 patients treated at our institution between 1991 and 2006. Mean age with standard deviation of patients in the Radiotherapy only (group I) and chemoradiotherapy (group II) was 55.26 &#177; 14.16 and 49.81 &#177; 12.16 years. 46 patients were treated with radiotherapy alone and 57 patients were treated with concurrent chemo radiotherapy using infusion cisplatinum 3 weekly and 5 fluorouracil twice weekly. Mean follow up was 13.35 months. All the patients characteristic and treatment characteristics were recorded. Results: There were 81 men and 22 women in the study. Group I contains 15 and 31 cases of stage III and IV tumors while group II contains 19 and 38 cases of stage III and IV respectively. Group II has shown improved loco regional control rate for the T3 and T4 tumors as compared to group I. Disease free survival and overall survival in the group II is 25.51 months and 22.53 months while group I has 8.67 months and 6.74 months respectively. Grade III mucosal toxicity incidence was higher in group II as compared to group I. Conclusions: In locally advanced squamous cell carcinoma of base of tongue tumors concomitant chemoradiotherapy with infusional cisplatinum and 5 fluorouracil results in higher disease free and overall survival as compared to radiotherapy as single modality. This better tumor response with chemoradiotherapy comes at cost of higher incidence of mucosal toxicity.



via Indian Journal of Cancer

Optimizing multimodality treatment for head and neck cancer in rural India

NP Trivedi, P Trivedi, H Trivedi, S Trivedi, N Trivedi



Indian Journal of Cancer 2012 49(2):225-229



Background: Multimodality treatment of head and neck cancer in rural India is not always feasible due to lack of infrastructure and logistics. Aim: To demonstrate the feasibility of multimodality treatment for head and neck cancer in a community setting in rural India. Setting and Design: Community cancer center, retrospective review. Materials and Methods: This article focuses on practice environment in a cancer clinic in rural India. We evaluated patient profile, treatment protocols, infrastructure availability, factors impacting treatment decisions, cost estimations, completion of treatment, and major treatment-related complications for the patient population treated in our clinic for a 2-year period. Results: A total of 230 head and neck cancer patients were treated with curative intent. Infrastructure support included basic operating room facility (cautery machine, suction, drill system, microscope, and anesthesia machine without ventilator support), blood bank, histopathology laboratory, and computerized tomography machine. Radiation therapy (RT) facility was available in a nearby city, about 75 km away. One hundred and fifty-four (67%) patients presented at an advanced stage, with 138 (60%) receiving multimodality treatment. One hundred and eighty-four (80%) patients underwent primary surgery and 167 (73%) received radiotherapy. Two hundred and twelve (92%) patients completed the treatment, 60 (26%) were lost to follow-up at 18-month median follow-up (range 12-26 months), with 112 patients (66%) being alive, disease free. Totally 142 were major head neck surgeries with 25 free flap reconstructions and 41 regional flaps. There were 15 (6%) major post-op complications and two perioperative mortalities. Average cost of treatment for single modality treatment was approximately 40,000 INR and for multimodality treatment was 80,000 INR. Conclusions: This study demonstrates that it is feasible to provide basic multimodality treatment to head and neck cancer patients in the community.



via Indian Journal of Cancer

The effect of intraarterial high-dose cisplatin on lymph nodes in oral and oropharyngeal cancer

AF Kovács, N Döbert, K Engels



Indian Journal of Cancer 2012 49(2):230-235



Aim of Study: To assess the effect of strictly local treatment [intraarterial chemotherapy (iaCHT) with high-dose cisplatin and parallel neutralization] in the primary oral and oropharyngeal cancer (OOSCC) on the dependent cervical lymph nodes. Patients and Methods: Seventeen consecutive patients with OOSCC and clinically positive necks underwent a prospective blinded comparison of two pre-surgical fluor18-deoxyglucose (FDG)-positron emission tomography (PET) examinations: baseline examination 1 week before and follow-up examination 3 weeks after iaCHT. Maximal standardized uptake (SUVmax) values of lymph nodes were measured and compared with each other and histopathology. Results: The SUVmax value of the primary and all neck lymph nodes with uptake decreased significantly. Twelve/17 patients having metastases revealed significant decrease (P = 0.03), and benign lymph nodes showed non-significant decrease of the SUVmax. All neck lymph nodes with uptake and nodal metastases showed a significant reduction (P = 0.004) of standard uptake values (SUV). Conclusion: A regional effect of intraarterial cisplatin is proven. To date, it is not clear whether this is due to decreasing inflammatory reaction or a translymphatic anti-neoplastic effect.



via Indian Journal of Cancer

Early stage squamous cell carcinoma of the pyriform sinus: A review of treatment options

V Krstevska



Indian Journal of Cancer 2012 49(2):236-244



The purpose of this review of the literature was to present treatment options for early stage pyriform sinus cancer. Squamous cell carcinoma of the pyriform sinus, as the most frequent cancer arising from the hypopharynx, is rarely diagnosed in its early stage. Based on evidence from retrospective studies, conservation surgery and definitive radiotherapy are considered the available treatment modalities for patients presenting with stage T1 and T2 pyriform sinus carcinomas without clinical evidence of neck lymph node metastases, offering similar results with respect to disease control and functional organ preservation. Also, the high risk of occult metastatic nodal disease even in the earliest stage of pyriform sinus cancer entails elective neck dissection or elective neck irradiation to be considered mandatory. However, for patients with early stage pyriform sinus cancer, no level 1 study exists in which conservation surgery is compared with radiotherapy alone for the evaluation of local control or survival. Randomized multicenter controlled trials evaluating efficacy of conservation surgery and definitive radiotherapy, and correctly interpreting functional outcome for each of the treatment procedures examined are necessary to obtain sufficient evidence to influence the decision in the choice of the most effective treatment for early pyriform sinus cancer.



via Indian Journal of Cancer

Risk factors and survival analysis of the esophageal cancer in the population of Jammu, India

S Sehgal, S Kaul, BB Gupta, MK Dhar



Indian Journal of Cancer 2012 49(2):245-250



Objective: To identify the risk factors of esophageal cancer and study their effect on the survival rates patients of Jammu region, India. Materials and Methods: Detailed information was collected on socio-demographic, dietary and clinico-pathological parameters for 200 case control pairs. Discrete (categorical) data of 2 independent groups (control and cases) were summarized in frequency (%) and compared by using Chi-square (&#967;2 ) test. The mean age of two independent groups was compared by independent Student's t-test. To find out potential risk factor (s), the variable (s) found significant in univariate analysis were further subjected to multivariate logistic regression analysis. The association of potential risk factors with patients survival (3-year overall survival) was done by Kaplan-Meier survival curve analysis using Log-rank test. A 2-tailed (a = 2) P < 0.05 was considered statistically significant. Results: Out of the 63 response parameters, seven were found highly significant on multivariate analysis. The mean (&#177; SD) age was 56.74 &#177; 10.76 years, the proportions of males were higher than females, mostly illiterate and lower income group. Among dietary characteristics, snuff was highest (OR = 3.86, 95% CI = 2.46-6.08) followed by salt tea (OR = 2.53, 95% CI = 1.49-4.29), smoking (OR = 1.97, 95% CI = 1.18-3.30), sundried food (OR = 1.77, 95% CI = 1.10-2.85) and red chilly (OR = 1.76, 95% CI = 1.07-2.89). Probability of survival lowered significantly (P < 0.05 or P < 0.01 or P < 0.001) in those consuming tobacco in the form of snuff (Log-rank c 2 = 24.62, P = 0.000) and smoking (Log-rank c 2 = 5.20, P = 0.023) as compared to those who did not take these. Conclusions: The analysis finally established snuff (smokeless tobacco) as the most powerful risk factor of esophageal cancer in Jammu region, followed by the salt tea, smoking and the sundried food.



via Indian Journal of Cancer

The feasibility and advantages of billroth-I reconstruction in distal gastric cancers following resection

MS Ganesh, KG Reddy, DS Venkata Subbareddy



Indian Journal of Cancer 2012 49(2):251-253



Background: Gastric carcinomas are common malignancies in southern India and distal stomach remains the commonest site in low socio economic groups. Surgery still remains an important modality of treatment to achieve local control and also relieve obstructive symptoms. In this study we investigated the feasibility of performing a gastrectomy and billroth-1 type of anastomosis in a rural cancer center setting, with parameters like adequacy of margins, ease of anastomosis and its functional results were analysed Materials and Methods: Eight patients presenting to a rurally based cancer center underwent a distal gastrectomy and billroth-1 type of anastomosis for continuity restoration Results: All the patients had adequate proximal and distal marg. The surgical time varied between-hrs. The anastomosis was constructed without any tension on bowel ends in all patients. The average time to start oral feeds varied between- None of the patients showed symptoms of bile reflux nor dumping. The average hospital stay varied between- Conclusions: Billroth-1 anastomosis is a physiologically more natural way of restoring continuity following a gastrectomy and it is a procedure which would be technically more simpler and decrease per and post operative complications and allow speedier post operative recovery following surgery on distal gastric cancers.



via Indian Journal of Cancer

Low-dose gemcitabine in long infusion: When less is more

M Zwitter



Indian Journal of Cancer 2012 49(2):199-201





via Indian Jounal of Cancer

Gemcitabine in brief versus prolonged low-dose infusion, both combined with carboplatin for advanced non-small cell lung cancer

SK Beniwal, KM Patel, S Shukla, BJ Parikh, S Shah, A Patel



Indian Journal of Cancer 2012 49(2):202-208



Purpose: Gemcitabine in low-dose prolonged infusion is a treatment with documented activity against a variety of tumors. The present study was conducted to evaluate the efficacy and safety of the combination of gemcitabine at a low-dose prolonged infusion in comparison with standard dose gemcitabine with carboplatin in chemonaive patients with advanced non-small cell lung cancer (NSCLC). Materials and Methods: Sixty chemonaive patients with stage IIIB or IV NSCLC were included. Patients were randomly assigned 1:1 to receive 350mg/m 2 gemcitabine in a 6-h infusion on days 1 and 8 and carboplatin area under the serum concentration time curve (AUC) 5 on day 1 versus gemcitabine 1000mg/m 2 on days 1 and 8 and carboplatin AUC 5 on day 1 (3-week cycle both). A total of 118 chemotherapy cycles, with a median of 4 cycles per patient (range 2-6), and 134 chemotherapy cycles, with a median of 4.47 cycles per patient (range 3-6) were administered in standard and low infusional dose arm, respectively. Results: Among patients in the standard arm, 40% had overall response rate (ORR), 33.3% had stable disease and 26.6% had progressive disease, while in low-dose infusional arm, 36.6% had ORR, 36.3% had stable disease and 26.6% had progressive disease (P = 0.992). Median progression-free survival was 5.5 months and 5.4 months, median overall survival was 9.7 months and 10.7 months, and 1-year survival was 33.7% and 36.6% in standard arm and low-dose infusion arm, respectively. Grade 3/4 toxicity was rare. Conclusion: In NSCLC, gemcitabine low-dose prolonged infusion with carboplatin has low toxicity, especially thrombocytopenia, and has an activity comparable with gemcitabine given in higher dose in standard infusion.

via Indian Jounal of Cancer

Preservation of palatal mucoperiosteum for oronasal separation after total maxillectomy

Charles Paki Molumi, Siba Prasad Dubey, Matupi Lorenzz Apaio



Indian Journal of Cancer 2012 49(2):209-214



Background: Oronasal communication occurs after total maxillectomy for advanced sinonasal cancers. This results in feeding, breathing and cosmetic impairment. Various methods have been described to close off the palatal defect from the oral cavity to improve the function of speech and deglutition. Aims: The object of this article is to describe our experience of preservation of palatal mucoperiosteum for oronasal separation. Materials and Methods: Retrospective review of clinical and operative records of 31 total maxillectomy patients where oronasal separation was achieved by the conventional technique of applying a maxillary obturator. The postoperative complications arising from the use of maxillary obturator for oronasal communication after total maxillectomy in these 31 patients were analysed. To avoid the complications encountered in these 31 patients we preserved and used the ipsilateral palatal mucoperiosteum for oronasal separation. This new technique was applied in 12 patients. The results are presented and compared. Results : A total of 43 patients underwent total maxillectomy for advanced sinonasal tumors. In 31 patients the conventional maxillary obturator was used for oronasal separation. Among these patients, 30 had crustation of the maxillary cavity, nasal regurgitation and cheek skin retraction in 15 each, trismus in eight, infection of skin graft donor site in seven, cheek movement during respiration in five and ill-fitting prosthesis in three. In 12 patients palatal mucoperiosteum was preserved and used for oronasal separation. The complications encountered in oronasal separation by palatal prosthesis were avoided in the modified procedure. Conclusions: We found that oronasal separation by preservation of palatal mucoperiosteum following total maxillectomy allowed excellent palatal function, prompt rehabilitation and minimal complications without compromising the prognosis.

via Indian Jounal of Cancer

Risk factor profiles of head and neck cancer patients of Andhra Pradesh, India

L Addala, C Kalyana Pentapati, PK Reddy Thavanati, V Anjaneyulu, MD Sadhnani



Indian Journal of Cancer 2012 49(2):215-219



Objective: To define the demographic risk profile and stage at diagnosis among the head and neck cancer (HNC) patients reported in two hospital-based cancer registries in Andhra Pradesh. Materials and Methods: A cross-sectional study was conducted in patients with histologically confirmed diagnosis of squamous cell carcinoma of the head and neck during 2002-2006. Data on the demographic profile and clinical information were obtained from hospital and clinical records. Staging was based on the American Joint Committee on Cancer and included primary tumor size (T), regional neck status (N), and group stage. The site of cancer was classified based on the International Classification of Disease for oncology (ICD-02). Results: A total of 5458 cases of HNC were included in this study. Majority of the subjects were in the age range of 40-69 years with a significant male preponderance in all the age groups (P<0.001). The most common habit was the combination of smoking, alcohol, and chewing in both males and females (20.1 and 35.1%, respectively) (P<0.001). Tongue and buccal mucosa were the most common sites of cancer in both males (26.8 and 12.8%, respectively) and females (22.9 and 19.8%, respectively) (P<0.001). Tongue was the commonest site of cancer occurrence with respect to all the habits (both singly and in combination) except for chewing tobacco where buccal mucosa was the most common site. Males were more likely to be diagnosed in stage 3 (37.6%) and 4 (20.6%), while females were diagnosed in stage 1 (36.3%) and 2 (32.7%) (P<0.001). Conclusion: A male preponderance of cancer occurrence and combination of all the three habits (smoking, alcohol, and chewing) were found to be the significant risk factors. Males were more likely to be diagnosed later than females.

via Indian Jounal of Cancer

Carcinoma base of tongue: Single institution 15 year experiences

RPS Banipal, MK Mahajan, G George, J Sachdev, P Jeyaraj



Indian Journal of Cancer 2012 49(2):220-224



Aims: To report the outcome with radiotherapy and concomitant chemoradiotherapy in patients with locally advanced squamous cell carcinoma base of tongue treated and followed up at single institution over a period of 15 years. Materials and Methods: This study was carried out by auditing the medical records of 103 patients treated at our institution between 1991 and 2006. Mean age with standard deviation of patients in the Radiotherapy only (group I) and chemoradiotherapy (group II) was 55.26 &#177; 14.16 and 49.81 &#177; 12.16 years. 46 patients were treated with radiotherapy alone and 57 patients were treated with concurrent chemo radiotherapy using infusion cisplatinum 3 weekly and 5 fluorouracil twice weekly. Mean follow up was 13.35 months. All the patients characteristic and treatment characteristics were recorded. Results: There were 81 men and 22 women in the study. Group I contains 15 and 31 cases of stage III and IV tumors while group II contains 19 and 38 cases of stage III and IV respectively. Group II has shown improved loco regional control rate for the T3 and T4 tumors as compared to group I. Disease free survival and overall survival in the group II is 25.51 months and 22.53 months while group I has 8.67 months and 6.74 months respectively. Grade III mucosal toxicity incidence was higher in group II as compared to group I. Conclusions: In locally advanced squamous cell carcinoma of base of tongue tumors concomitant chemoradiotherapy with infusional cisplatinum and 5 fluorouracil results in higher disease free and overall survival as compared to radiotherapy as single modality. This better tumor response with chemoradiotherapy comes at cost of higher incidence of mucosal toxicity.

via Indian Jounal of Cancer

Optimizing multimodality treatment for head and neck cancer in rural India

NP Trivedi, P Trivedi, H Trivedi, S Trivedi, N Trivedi



Indian Journal of Cancer 2012 49(2):225-229



Background: Multimodality treatment of head and neck cancer in rural India is not always feasible due to lack of infrastructure and logistics. Aim: To demonstrate the feasibility of multimodality treatment for head and neck cancer in a community setting in rural India. Setting and Design: Community cancer center, retrospective review. Materials and Methods: This article focuses on practice environment in a cancer clinic in rural India. We evaluated patient profile, treatment protocols, infrastructure availability, factors impacting treatment decisions, cost estimations, completion of treatment, and major treatment-related complications for the patient population treated in our clinic for a 2-year period. Results: A total of 230 head and neck cancer patients were treated with curative intent. Infrastructure support included basic operating room facility (cautery machine, suction, drill system, microscope, and anesthesia machine without ventilator support), blood bank, histopathology laboratory, and computerized tomography machine. Radiation therapy (RT) facility was available in a nearby city, about 75 km away. One hundred and fifty-four (67%) patients presented at an advanced stage, with 138 (60%) receiving multimodality treatment. One hundred and eighty-four (80%) patients underwent primary surgery and 167 (73%) received radiotherapy. Two hundred and twelve (92%) patients completed the treatment, 60 (26%) were lost to follow-up at 18-month median follow-up (range 12-26 months), with 112 patients (66%) being alive, disease free. Totally 142 were major head neck surgeries with 25 free flap reconstructions and 41 regional flaps. There were 15 (6%) major post-op complications and two perioperative mortalities. Average cost of treatment for single modality treatment was approximately 40,000 INR and for multimodality treatment was 80,000 INR. Conclusions: This study demonstrates that it is feasible to provide basic multimodality treatment to head and neck cancer patients in the community.

via Indian Jounal of Cancer

The effect of intraarterial high-dose cisplatin on lymph nodes in oral and oropharyngeal cancer

AF Kovács, N Döbert, K Engels



Indian Journal of Cancer 2012 49(2):230-235



Aim of Study: To assess the effect of strictly local treatment [intraarterial chemotherapy (iaCHT) with high-dose cisplatin and parallel neutralization] in the primary oral and oropharyngeal cancer (OOSCC) on the dependent cervical lymph nodes. Patients and Methods: Seventeen consecutive patients with OOSCC and clinically positive necks underwent a prospective blinded comparison of two pre-surgical fluor18-deoxyglucose (FDG)-positron emission tomography (PET) examinations: baseline examination 1 week before and follow-up examination 3 weeks after iaCHT. Maximal standardized uptake (SUVmax) values of lymph nodes were measured and compared with each other and histopathology. Results: The SUVmax value of the primary and all neck lymph nodes with uptake decreased significantly. Twelve/17 patients having metastases revealed significant decrease (P = 0.03), and benign lymph nodes showed non-significant decrease of the SUVmax. All neck lymph nodes with uptake and nodal metastases showed a significant reduction (P = 0.004) of standard uptake values (SUV). Conclusion: A regional effect of intraarterial cisplatin is proven. To date, it is not clear whether this is due to decreasing inflammatory reaction or a translymphatic anti-neoplastic effect.

via Indian Jounal of Cancer

Early stage squamous cell carcinoma of the pyriform sinus: A review of treatment options

V Krstevska



Indian Journal of Cancer 2012 49(2):236-244



The purpose of this review of the literature was to present treatment options for early stage pyriform sinus cancer. Squamous cell carcinoma of the pyriform sinus, as the most frequent cancer arising from the hypopharynx, is rarely diagnosed in its early stage. Based on evidence from retrospective studies, conservation surgery and definitive radiotherapy are considered the available treatment modalities for patients presenting with stage T1 and T2 pyriform sinus carcinomas without clinical evidence of neck lymph node metastases, offering similar results with respect to disease control and functional organ preservation. Also, the high risk of occult metastatic nodal disease even in the earliest stage of pyriform sinus cancer entails elective neck dissection or elective neck irradiation to be considered mandatory. However, for patients with early stage pyriform sinus cancer, no level 1 study exists in which conservation surgery is compared with radiotherapy alone for the evaluation of local control or survival. Randomized multicenter controlled trials evaluating efficacy of conservation surgery and definitive radiotherapy, and correctly interpreting functional outcome for each of the treatment procedures examined are necessary to obtain sufficient evidence to influence the decision in the choice of the most effective treatment for early pyriform sinus cancer.

via Indian Jounal of Cancer

Risk factors and survival analysis of the esophageal cancer in the population of Jammu, India

S Sehgal, S Kaul, BB Gupta, MK Dhar



Indian Journal of Cancer 2012 49(2):245-250



Objective: To identify the risk factors of esophageal cancer and study their effect on the survival rates patients of Jammu region, India. Materials and Methods: Detailed information was collected on socio-demographic, dietary and clinico-pathological parameters for 200 case control pairs. Discrete (categorical) data of 2 independent groups (control and cases) were summarized in frequency (%) and compared by using Chi-square (&#967;2 ) test. The mean age of two independent groups was compared by independent Student's t-test. To find out potential risk factor (s), the variable (s) found significant in univariate analysis were further subjected to multivariate logistic regression analysis. The association of potential risk factors with patients survival (3-year overall survival) was done by Kaplan-Meier survival curve analysis using Log-rank test. A 2-tailed (a = 2) P < 0.05 was considered statistically significant. Results: Out of the 63 response parameters, seven were found highly significant on multivariate analysis. The mean (&#177; SD) age was 56.74 &#177; 10.76 years, the proportions of males were higher than females, mostly illiterate and lower income group. Among dietary characteristics, snuff was highest (OR = 3.86, 95% CI = 2.46-6.08) followed by salt tea (OR = 2.53, 95% CI = 1.49-4.29), smoking (OR = 1.97, 95% CI = 1.18-3.30), sundried food (OR = 1.77, 95% CI = 1.10-2.85) and red chilly (OR = 1.76, 95% CI = 1.07-2.89). Probability of survival lowered significantly (P < 0.05 or P < 0.01 or P < 0.001) in those consuming tobacco in the form of snuff (Log-rank c 2 = 24.62, P = 0.000) and smoking (Log-rank c 2 = 5.20, P = 0.023) as compared to those who did not take these. Conclusions: The analysis finally established snuff (smokeless tobacco) as the most powerful risk factor of esophageal cancer in Jammu region, followed by the salt tea, smoking and the sundried food.

via Indian Jounal of Cancer

The feasibility and advantages of billroth-I reconstruction in distal gastric cancers following resection

MS Ganesh, KG Reddy, DS Venkata Subbareddy



Indian Journal of Cancer 2012 49(2):251-253



Background: Gastric carcinomas are common malignancies in southern India and distal stomach remains the commonest site in low socio economic groups. Surgery still remains an important modality of treatment to achieve local control and also relieve obstructive symptoms. In this study we investigated the feasibility of performing a gastrectomy and billroth-1 type of anastomosis in a rural cancer center setting, with parameters like adequacy of margins, ease of anastomosis and its functional results were analysed Materials and Methods: Eight patients presenting to a rurally based cancer center underwent a distal gastrectomy and billroth-1 type of anastomosis for continuity restoration Results: All the patients had adequate proximal and distal marg. The surgical time varied between-hrs. The anastomosis was constructed without any tension on bowel ends in all patients. The average time to start oral feeds varied between- None of the patients showed symptoms of bile reflux nor dumping. The average hospital stay varied between- Conclusions: Billroth-1 anastomosis is a physiologically more natural way of restoring continuity following a gastrectomy and it is a procedure which would be technically more simpler and decrease per and post operative complications and allow speedier post operative recovery following surgery on distal gastric cancers.

via Indian Jounal of Cancer

Optimal surgical extent of lateral and central neck dissection for papillary thyroid carcinoma located in one lobe with clinical lateral lymph node metastasis

Background: The indications and extent of cervical lymph node dissection in papillary thyroid carcinoma (PTC) are still being debated. The aim of this study was to analyze the patterns of cervical lymph node metastasis in the lateral and central compartment and related factors and suggest the optimal extent of lateral and central neck dissection for PTC patients with clinical lateral lymph node metastasis. Methods: We retrospectively analyzed 72 patients with unilateral PTC who underwent therapeutic lateral neck dissections with concomitant total thyroidectomy and central neck dissection between January 2001 and December 2009. Results: The 72 patients underwent 79 sides of therapeutic lateral neck dissection. The most frequent metastatic level in the ipsilateral lateral compartment was level IV (75.0%), followed by level III (69.4%), level II (56.9%) and level V (20.8%). Multiple level metastases were common (77.8%) and were correlated with tumor size (>= 10 mm). The central compartment lymph node metastasis rate was 87.5%, including 26.4% of contralateral central compartment metastases. Conclusion: In PTC patients with clinical lateral lymph node metastasis, the optimal extent of lateral and central neck dissection should include levels II, III, IV and V as well as the bilateral central compartment.

via World Journal of Surgical Oncology

Long-term survival of patients suffering from glioblastoma multiforme treated with tumortreating fields

Glioblastoma multiforme (GBM) is the most common and malignant primary intracranialtumor, and has a median survival of only 10 to 14 months with only 3 to 5% of patientssurviving more than three years. Recurrence (RGBM) is nearly universal, and furtherdecreases the median survival to only five to seven months with optimal therapy. Tumortreatingfields (TTField) therapy is a novel treatment technique that has recently received CEand FDA approval for the treatment of RGBM, and is based on the principle that lowintensity, intermediate frequency electric fields (100 to 300 kHz) may induce apoptosis inspecific cell types. Our center was the first to apply TTField treatment to histologicallyproven GBM in a small pilot study of 20 individuals in 2004 and 2005, and four of thoseoriginal 20 patients are still alive today. We report two cases of GBM and two cases ofRGBM treated by TTField therapy, all in good health and no longer receiving any treatmentmore than seven years after initiating TTField therapy, with no clinical or radiologicalevidence of recurrence.

via World Journal of Surgical Oncology

Medication at end of life indicates care quality

Medication given to patients at the end of life varies according to whether they are being cared for in a hospice or hospital, and has the potential to indicate the quality of their care, suggest researchers.

via Med Wire News

The role of the 5-hydroxytryptamine pathway in reflux-induced esophageal mucosal injury in rats

Background: Dysfunction of the 5-hydroxytryptamine (5-HT) signaling pathway can lead to gastrointestinal motility and secretion abnormalities and to visceral hypersensitivity. The aim of this study is to investigate the role of 5-HT in reflux-induced esophageal mucosal injury. Methods: Fifty 8-week-old male Sprague-Dawley (SD) rats were randomly divided into a gastroesophageal reflux (GER) model group (30 rats) and a sham surgery control group (20 rats). Four weeks after surgery, the esophageal mucosa was collected for histological evaluation, 5-HT concentrations, and 5-HT selective reuptake transporter (SERT) mRNA and 5-HT4 receptor (5-HT4R) protein expressions. Results: Twenty-seven rats in the GER model group survived, and three rats died. Histologically, in the GER model group, 20 rats had reflux esophagitis (RE group), and 7 rats had non-erosive reflux disease (NERD group). The 5-HT levels in the esophageal tissue from the RE group were significantly higher than those from the control and NERD groups. Both the RE and NERD groups showed significant increases in SERT mRNA expression of the esophageal mucosa than that of the controls, and the SERT mRNA level in the RE group was significantly higher than that in the NERD group. The 5-HT4R protein level of the esophageal mucosa in the RE group was significantly lower than that in the controls and the NERD group. Conclusions: We conclude that a 5-HT signaling pathway disorder could be a major factor in the pathogenesis of GER and RE.

via World Journal of Surgical Oncology

Elderly female cancer survivors reap benefits of following prevention advice

Elderly female cancer survivors who adhere stringently to national and international recommendations for cancer prevention have a reduced risk for all-cause mortality compared with their peers who are less adherent, show US study results.

via Med Wire News

Multivitamin use may protect men from cancer

Men who take a daily multivitamin supplement have a modest reduction in their risk for developing cancer, suggest results from the Physicians’ Health Study II.

via Med Wire News

Methylation provides clues to gastric cancer subtypes

Research published in Science Translational Medicine shows that many gastric cancers are associated with significant epigenetic alterations along the DNA triggered by methylation.

via Med Wire News

Bortezomib plus rituximab versus rituximab in patients with high-risk, relapsed, rituximab-naive or rituximab-sensitive follicular lymphoma: subgroup analysis of a randomized phase 3 trial

Background: The randomized phase 3 LYM3001 trial in relapsed follicular lymphoma (FL) demonstratedhigher overall (ORR) and complete response (CR) rates and prolonged progression-freesurvival (PFS) with bortezomib-rituximab versus rituximab. We report findings in high-riskpatients (FL International Prognostic Index [FLIPI] score [greater than or equal to]3, and high tumor burden bymodified Groupe d'Etude des Lymphomas Folliculaires [GELF] criteria). Methods: Patients aged [greater than or equal to]18 years with grade 1/2 FL, [greater than or equal to]1 measurable lesion, and documented relapse orprogression following prior therapy, rituximab-naive or rituximab-sensitive, were enrolled at164 centers in 29 countries across Europe, the Americas, and Asia-Pacific. Patients wererandomized (1:1) to five 5-week cycles of bortezomib-rituximab (bortezomib 1.6 mg/m2,days 1, 8, 15, and 22, all cycles; rituximab 375 mg/m2, days 1, 8, 15, and 22, cycle 1, and day1, cycles 2-5; N=336) or rituximab alone (N=340). Randomization was stratified by FLIPIscore, prior rituximab, time since last dose of anti-lymphoma therapy, and geographicalregion. The primary endpoint of the study was PFS. Results: 103 bortezomib-rituximab and 98 rituximab patients had high-risk FL. The ORR was 59%versus 37% (p=0.002), the CR/CRu rate was 13% versus 6% (p=0.145), and the durableresponse rate was 45% versus 26% (p=0.008) with bortezomib-rituximab versus rituximab.Median PFS was 9.5 versus 6.7 months (hazard ratio [HR] 0.667, p=0.012) with bortezomibrituximabversus rituximab; median time to progression was 10.9 versus 6.8 months (HR0.656, p=0.009); median time to next anti-lymphoma treatment was 14.8 versus 9.1 months(HR 0.762, p=0.103); and the 1-year Overall Survival rate was 83.1% versus 76.6%. Overall,51% of bortezomib-rituximab and 32% of rituximab patients reported grade [greater than or equal to]3 adverseevents, including neutropenia (18%, 6%), anemia (4%, 5%), diarrhea (8%, 0%),thrombocytopenia (5%, 2%), and sensory neuropathy (1%, 0%). Conclusions: High-risk FL patients treated with bortezomib-rituximab had significantly higher ORR andlonger PFS than patients receiving rituximab alone, with greater clinical benefit than in theoverall study population; additional toxicity was acceptable and did not affect treatmentfeasibility.Trial registrationThe phase 3 LYM3001 trial is registered with ClinicalTrials.gov, with the identifierNCT00312845.

via Journal of Hematology & Oncology

Case of spontaneous regression of carotid body tumor in a SDHD mutant: a discussion on potential mechanisms based on a review of the literature

Background: Head and neck paragangliomas are tumors associated with the parasympathetic nerve system and typically show an indolent growth pattern. Therefore a conservative management strategy is considered in selected cases.Methods and resultsWe present a case of a female patient who presented in 2003 with bilateral carotid body tumors and a tympanic tumor, associated with a mutation in the succinate dehydrogenase -sub-unit-D (SDHD). She was operated on the right carotid body tumor and the tympanic tumor. Thereafter the follow-up was performed with MR examinations at 2-year intervals. After an initial stable phase, over the last 3 years a spontaneous near-total regression of the contralateral carotid body tumor was observed, with only subtle rest-abnormalities visible in 2011. Conclusions: The present case underlines the indolent growth pattern of head and neck paragangliomas and for the first time describes a rare manifestation of spontaneous regression of a carotid body tumor. The literature was reviewed to discuss this phenomenon.

via World Journal of Surgical Oncology

MicroRNAs and Toll-like Receptor/Interleukin-1 Receptor Signaling

The discovery of miRNAs has revolutionized the way we examine the genome, RNAproducts, and the regulation of transcription and translation. Their ability to modulate proteinexpression through mRNA degradation and translation repression resulted in avid scientificinterest in miRNAs over the past decade. This research has led to findings that indicatemiRNAs can regulate an array of cellular functions such as cellular apoptosis, proliferation,differentiation, and metabolism. Specifically, the capability of miRNAs to finely-tune geneexpression naturally lends itself to immune system regulation which requires precise controlfor proper activity. In fact, abnormal miRNAs expression is often seen with inflammatorydisorders like rheumatoid arthritis, systemic lupus erthematosus, experimental autoimmuneencephalomyelitis, and inflammatory cancers. As a result, research investigating miRNAsmodulation of immune cell proliferation, differentiation, and cellular signaling has yieldedfruitful results. Specifically, in this review, we will examine the impact of miRNAs on tolllikereceptor (TLRs) and interleukin-1beta (IL-1beta) signaling, which are integral in the properfunctioning of the innate immune system. These signaling pathways share several keydownstream signaling adaptors and therefore produce similar downstream effects such as theproduction of pro-inflammatory cytokines, chemokines, and interferons. This review willexamine in depth the specific interactions of miRNAs with receptors, adaptor molecules, andregulator molecules within these cellular pathways. In addition, we will discuss themodulation of miRNAs' expression by TLR and IL-1R signaling through positive andnegative feedback loops.

via Journal of Hematology & Oncology

Pain relief from palliative RT for bone metastases improves QoL

Cancer patients who experience pain relief after palliative radiation therapy for bone metastases report a better quality of life on specific bone metastases measures than their peers who do not respond to treatment, show study results.

via Med Wire News

Longer period of formula feeding may increase ALL risk

Prolonged formula feeding and older age at introduction of solid foods may increase a child’s risk for developing acute lymphoblastic leukemia, suggests research.

via Med Wire News

Quitting smoking may improve HRQoL in advanced lung cancer

The health-related quality of life of patients with advanced-stage lung cancer is worsened if they smoke, report UK researchers.

via Med Wire News

Tool reveals myeloproliferative neoplasm patient burden

Researchers have devised a tool to accurately assess the extent of symptoms in patients with myeloproliferative neoplasms.

via Med Wire News

The differential expression pattern of the BMI-1, SALL4 and ABCA3 genes in myeloid leukemia

Background and methodsIn order to characterize the expression pattern of SALL4, BMI-1 and ABCA3 genes in patients with myeloid leukemia and those who achieved complete remission (CR) after chemotherapy. Real-time PCR was used to determine the expression level of these genes in peripheral blood mononuclear cells from 24 patients with AML, eight patients with AML-CR, 13 patients with CML in the chronic phase (CML-CP), 12 patients with CML in blast crisis (CML-BC), 13 patients with CML-CR and 11 healthy individuals (HI). Results: Overexpression of the BMI-1 gene was found in the AML, CML-CP and CML-BC groups as compared with HI group, while the BMI-1 expression level was lower in patients who achieved CR. In contrast, significantly increased SALL4 expression was only found in AML group, additionally, SALL4 expression was lower in the CML-CP and CML-CR groups compared with the HI group, while the SALL4 expression level in the CML-BC group was higher and significantly greater than that in the CML-CP and CML-CR groups. Moreover, a positive correlation between the expression of SALL4 and BMI-1 genes was found in samples from most groups. There was no significant difference of ABCA3 expression level in AML and CML-BC group in comparison with HI group. Interestingly, the ABCA3 expression level was significantly decreased in the CML-CP, AML-CR and CML-CR in comparison with the HI group. Moreover, the ABCA3 expression level in all of the CR groups was lower than that in their corresponding groups. Conclusions: These results describe the altered SALL4, ABCA3 and BMI-1 expression pattern in different phases of myeloid leukemia, which may relate to the development and progression to different diseases. SALL4 expression was strongly correlated with BMI-1 in most of the myeloid leukemia patient groups, providing a potential link between SALL4 and BMI-1 in leukemogenesis.

via Cancer Cell International

HIV agent offers HER2-positive breast cancer hope

A drug used to treat HIV infection may be a new treatment line for patients with an aggressive type of breast cancer, US researchers believe.

via Med Wire News

Therapeutic HPV16 and HPV18 vaccine ‘may eliminate infection’

A candidate vaccine against human papillomavirus serotypes 16 and 18 appears to induce robust immune responses to antigens, potentially leading to the elimination of virus-infected cells and regression of dysplasia, say US investigators.

via Med Wire News

The unfolded von Willebrand factor response in bloodstream: the self-association perspective

von Willebrand factor (vWF) is a multimeric glycoprotein essential for hemostasis aftervascular injury, which modulates platelet-surface and platelet-platelet interactions by linkingplatelet receptors to the extracellular matrix and to each other. The crucial role of vWF inplatelet function is particularly apparent when hemodynamic conditions create blood flowwith high shear stress. Through multiple functional domains, vWF mediates the attachment ofplatelets to exposed tissues, where immobilized vWF is able to support a homotypic and/orheterotypic self-association. The self-association of vWF is also supported by a rapidlyexpanding reservoir of novel evidences that the thiol/disulfide exchange regulates vWFmultimer size in the blood circulation. Moreover, in addition to proteolysis and reduction ofADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif,member 13), the regulation of vWF multimer size and self-association may depend on adisulfide bond reductase activity ascribed to thrombospondin-1 (TSP-1). Along with theclassical signaling pathways in activated platelets, evidence is emerging that lipid rafts alsoplay important roles in various phases of hemostasis and thrombosis and facilitate theinteraction between the key signaling molecules. Developments in these areas will refine ourunderstanding of the role played by vWF self-association in physiological hemostasis andpathological thrombosis.

via Journal of Hematology & Oncology

Lenalidomide worsens survival, adverse events in prostate cancer

A combination of lenalidomide plus docetaxel and prednisone treatment in patients with chemotherapy-naive prostate cancer leads to worse overall survival rates and increased toxicity compared with placebo, show study results.

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Further evidence against sun bed use

Results from a systematic review and meta-analysis published in the BMJ confirm those from previous studies linking sun bed use with an increased risk for skin cancer.

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Correction:Primary malignant non-Hodgkin's lymphoma of the breast: a study of seven cases and literature review

After publication of this work (Mouna et al, 2012), we noted that we had inadvertently included Bodmer Alexandre, Castiglione-Gertsch Monica and Pierre Yves Dietrich as authors of the study. The list of authors has now been corrected and the Authors' contributions and Competing interests section modified accordingly.

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Tissue test detects oral cancer risk

A molecular diagnostic scoring system based on patients’ FOXM1-associated gene messenger RNA expression levels is able to quantitatively diagnose and stratify oral carcinoma and its aggressiveness, show UK and Norwegian study results.

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Novel CD20 monoclonal antibodies for lymphoma therapy

Rituximab (RTX), a monoclonal antibody (mAb) against CD20, has been widely used forlymphoma therapy. RTX in combination with cyclophosphamide /doxorubicin /vincristine/prednisone (R-CHOP) remains the standard frontline regimen for diffuse large B-celllymphoma. However, suboptimal response and /or resistance to rituximab have remained achallenge in the therapy of B-cell non-Hodgkin's lymphoma (NHL). Novel agents are underactive clinical trials. This review will summarize the latest development in new mAbs againstCD20, which include second-generation mAbs, ofatumumab, veltuzumab (IMMU-106),ocrelizumab (PRO70769), and third-generation mAbs, AME-133v (ocaratuzumab),PRO131921 and GA101 (obinutumumab).

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Angiogenesis in metastatic colorectal cancer and the benefits of targeted therapy

The diverse pathways and molecules involved in angiogenesis, the formation of new bloodvessels, have been targeted for the treatment of colorectal and other cancers. Vascularendothelial growth factor (VEGF)-A binding to VEGF receptor (VEGFR)-2 is believed to bethe key signaling pathway mediating angiogenesis. Other VEGF pathways involved inangiogenesis include VEGF-A, VEGF-B, and placental growth factor binding to VEGFR-1,and VEGF-C and VEGF-D binding to VEGFR-2 and VEGFR-3. VEGF signaling alsointersects with other pathways, including angiopoietin/Tie, Notch, hypoxia-inducible factor,and integrin pathways. The roles of these pathways in tumor angiogenesis and in varioushuman cancers will be explored in this article. In addition, preclinical and clinical data onbevacizumab, aflibercept (known as ziv-aflibercept in the US), and investigationalantiangiogenic agents in development for the treatment of colorectal and other cancers will bereviewed.

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Endoscopically observable white nodule caused by distal intramural lymphatic spread of rectal cancer: a case report

This report describes a case of rectal cancer with endoscopically observable white nodules caused by distal intramural lymphatic spread. A 57-year-old female presented to our hospital with frequent diarrhea and hemorrhoids. Computed tomography showed bilateral ovarian masses and three hepatic tumors diagnosed as rectal cancer metastases, and also showed multiple lymph node involvement. The patient was preoperatively diagnosed with stage IV rectal cancer. Colonoscopy demonstrated that primary rectal cancer existed 15 cm from the anal verge and that there were multiple white small nodules on the anal side of the primary tumor extending to the dentate line. Biopsies of the white spots were performed, and they were identified as adenocarcinoma. The patient underwent Hartmann's procedure because of the locally advanced primary tumor. The white nodules were ultimately diagnosed as being caused by intramural lymphatic spreading because lymphatic permeation was strongly positive at the surrounding area. Small white nodules near a primary rectal cancer should be suspected of being intramural spreading. Endoscopic detection of white nodules may be useful for the diagnosis of distal intramural spread.

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Can EGFR-TKIs be used in first line treatment for advanced non-small cell lung cancer based on selection according to clinical factors ? -- A literature-based meta-analysis

Background: In the first line treatment of non-small cell lung cancer (NSCLC), several clinical trials haveshown that not all NSCLC patients can benefit from treatment with tyrosine kinase inhibitors(TKIs) than receiving chemotherapy. Some trials treated patients with TKI according to theirclinical characteristics. A few studies only chose patients with an epidermal grouth factorreceptor (EGFR) mutation for TKI therapy. We aimed to determine whether patients could betreated with TKIs based on clinical factors in the first-line setting. Methods: We performed a meta-analysis of randomized trials involving patients with advanced NSCLCtreated with chemotherapy or TKIs by different selections. Efficacy outcomes of interestwere the objective response rate (ORR), progression-free survival (PFS) and the overallsurvival (OS) of each treatment arm. Results: Four trials enrolled unselected patients, and two trials selected East Asian patients using theclinical factors of gender and smoking history. Five trials chose patients with an EGFRmutation who were randomized for treatment with TKI or chemotherapy. For unselectedpatients, the risk ratio (RR) of the ORR was 3.52, the hazard ratio (HR) of the PFS was 1.29and the HR of the OS was 1.35. For the clinically selected patients, the RR of the ORR was0.64. The HRs of the PFS and OS were 0.83 and 0.92, respectively. The ORR and PFS werebetter for TKIs than for chemotherapy in patients with an EGFR mutation. The ORR was0.47, and the HRs of the PFS and OS were 0.36 and 1.00, respectively. Conclusions: Advanced NSCLC patients with an EGFR mutation benefit most from TKIs. EGFR-TKItreatment is justified for patients with unknown EGFR status,and those who cannot toleratechemotherapy owing to age, poor performance status (PS) or other medical conditions, whenselected according to clinical factors in the first-line setting.

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Hemothorax caused by spontaneous rupture of hepatocellular carcinoma: a case report and review of the literature

We report a rare case in which hemothorax occurred in addition to hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma (HCC) originating from the caudate lobe of the liver. The case pertains to a 56-year-old female who was transported to our hospital for impaired consciousness due to hemorrhagic shock. Computed tomography (CT) demonstrated ruptured HCC originating from the caudate lobe and accompanying hemoperitoneum and right hemothorax. Hemostasis was carried out by transcatheter arterial embolization (TAE), and surgery was conducted approximately one month after TAE. In the present case, no lesions as possible sources of bleeding were observed inside the pleural cavity, and, moreover, the diaphragm had no abnormalities in the intraoperative findings, suggesting that blood from the ruptured tumor may have traversed the intact diaphragm to enter the right pleural cavity soon after the HCC rupture. However, to the best of our knowledge, no similar cases of HCC have been reported to date, and this case is thus believed to be very rare. This unusual phenomenon may therefore be strongly associated with the location of the ruptured tumor and the formation of a hematoma inside the omental bursa. We discuss the mechanism causing hemothorax in the present case and also review the previously reported cases of ruptured HCC complicated by hemothorax.

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MRI method ‘cuts breast cancer false‑positives’

Assessing apparent diffusion coefficients during dynamic contrast-enhanced magnetic resonance imaging may reduce the number of avoidable false‑positive breast cancer results and unnecessary biopsies, show findings published in Radiology.

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Myxoid liposarcoma with negative features on bone scan and [18F]-2-fluoro-2-deoxy-D-glucose-positron emission tomography

Background: Myxoid liposarcoma occurs in middle age, and is characterized by extrapulmonary metastasis, including bone metastasis. Bone scans and [18F]-2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) are widely used for assessment of tumor extension, including vertebral metastasis. However, both methods have a low positive rate with regard to vertebral metastasis arising from myxoid liposarcoma. This is particularly true for bone scans for intramedullary lesions that have no cortical involvement.Case presentationWe present the case of a 53-year-old male with myxoid liposarcoma in the leg. He had been treated for multiple metastases over a ten-year period, and was experiencing back pain due to a pathological fracture in the second lumbar vertebra (L2). Magnetic resonance imaging of all the vertebrae showed abnormal signal intensity suggestive of metastasis in eight vertebrae, and revealed extraskeletal extension in three vertebrae. Bone scans and FDG-PET were negative except for the L2 fracture which was indicated on a bone scan. Conclusions: Both bone scans and FDG-PET can be negative in cases of vertebral metastasis that arise from myxoid liposarcoma, even when extraskeletal extensions are present. . Similarly, even a fractured vertebra may not always be visible on FDG-PET.

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Arsenic trioxide improves hematopoiesis in refractory severe aplastic anemia

We investigated the efficacy of arsenic trioxide (ATO) in patients with refractory severeaplastic anemia (SAA). A total of 5 consecutive adults were enrolled. The patients receivedATO at a dose of 0.15 mg/kg intravenously daily for 5 days every week for 8 weeks. Ifnecessary, a second course was performed after an interval of one week. All patients achievedclinically significant responses to ATO. The overall complete response rate and overallresponse rate at 17 weeks were 60% (3/5) and 100%(5/5), respectively. So treatment withATO may be a feasible approach in patients with refractory SAA.

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Malignant epithelioid angiomyolipoma of the kidney with pulmonary metastases and p53 gene mutation

Angiomyolipoma (AML) is a rare tumor mainly arising in the kidney. Here we report the case of a 55-year-old woman with malignant epithelioid angiomyolipoma with p53 gene mutation. After 7 years from radical nephrectomy of the left kidney, the patient developed multiple lung metastases that showed morphologic features overlapping those of the previously lesion, which was misdiagnosed as renal cell carcinoma. Both renal and pulmonary tumors were reevaluated by immunohistochemical assay, which were showed positive for HMB-45 and p53 protein (95%), but negative for epithelial markers and S-100 protein. A correct diagnosis of malignant epithelioid angiomyolipoma was made on the basis of those results. Meanwhile exon 8 mutation of p53 gene was detected in the renal tumor by microdissectionPCR-SSCP and sequencing technique indicating that p53 gene mutation may play an important role in malignant transformation. The patient was died of respiratory failure after 15 years' follow-up. This is the second report of renal malignant angiomyolipoma with p53 gene mutation.

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HPV status predicts oropharyngeal cancer irradiation response

Human papillomavirus-positive head and neck cancer is more sensitive to the initial effects of radiation therapy than HPV-negative head and neck cancer, suggest study findings.

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High expression of CXCR4, CXCR7 and SDF-1 predicts poor survival in renal cell carcinoma

Background: Chemokines and their receptors are known to play important roles in the tumorigenesis of many malignancies. The aim of this study was to evaluate the prognostic impact of the expression of the chemokine SDF-1 and its receptors CXCR4 and CXCR7 in patients with renal cell carcinoma. Methods: The expression of CXCR4, CXCR7 and SDF-1 in specimens from 97 renal cell carcinoma patients was evaluated by immunohistochemistry on a tissue microarray. These results were correlated with the clinicopathological parameters and survival of the patients. Results: CXCR4 and CXCR7 were expressed in all patients, whereas SDF-1 was expressed in 61 patients (62.9%). No association was observed between the expression of CXCR4, CXCR7 or SDF-1 and the clinical or pathological data except between SDF-1 expression and Fuhrman's grade (P = 0.015). Patients with high expression of CXCR4, CXCR7 and SDF-1 had shorter overall survival and recurrence-free survival than those with low expression. In a multivariate analysis, the high expression of CXCR4, CXCR7 and SDF-1 correlated with poor overall survival and recurrence-free survival independent of gender, age, AJCC stage, lymph node status, metastasis, histologic variant and Fuhrman's grade. Conclusions: High levels of CXCR4, CXCR7 and SDF-1 were associated with poor overall survival and recurrence-free survival in renal cell carcinoma patients. CXCR4, CXCR7 and SDF-1 may serve as useful prognostic markers and therapeutic targets for renal cell carcinoma.

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Extragastrointestinal stromal tumor of the mesoappendix: CT findings and a review of the literature

Background: Gastrointestinal stromal tumors (GISTs) are nonepithelial, mesenchymal neoplasms that rarely occur in children.Case presentationWe present a unique case of a GIST that developed outside the gastrointestinal tract within the mesoappendix of a 6-year old boy. Computed tomography (CT) revealed a slightly lobulated, homogeneous soft-tissue mass, with marked contrast enhancement. Conclusion: This case study provides new insight into the CT appearance of extragastrointestinal stromal tumors.

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Bivalent HPV vaccine has cross-protective effect, but could wane over time

The bivalent vaccine for human papillomavirus types 16 and 18 appears to be more efficacious against outcomes associated with nonvaccine types 31, 33, and 45 than its quadrivalent counterpart, show results of a systematic review and meta-analysis.

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Age, not just comorbidity, affects breast cancer surgery rates in elderly

The high rates of elderly UK women with breast cancer who do not undergo surgical treatment are not entirely explained by the presence of comorbidities, report UK researchers.

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Prognostic significance of solitary lymph node metastasis in patients with squamous cell carcinoma of middle thoracic esophagus

Background: The aim of this study is to compare clinical outcomes between patients with solitary lymph node metastasis and node-negative (N0) patients in squamous cell carcinoma of the middle thoracic esophagus. Methods: A series of 135 patients with squamous cell carcinoma of the middle thoracic esophagus were retrospectively investigated. There were 33 patients with solitary lymph node metastasis and 102 N0 patients. Skip metastasis in 33 patients with solitary lymph node metastasis was defined according three criteria: Japanese Society for Esophageal Disease (JSED), American Joint Commission on Cancer (AJCC), and the anatomical compartment. Results: In 33 patients with solitary lymph node metastasis, skip metastasis was shown in 13, 23, and 8 patients according JSED, AJCC and anatomical compartment respectively. The 5-year survival rates for N0 patients and patients with solitary lymph node metastasis were 58 % and 32 % respectively (P =0.008). Multivariate analysis revealed that skip metastasis was not an independent prognostic factor. Conclusions: For patients with middle thoracic esophageal squamous cell carcinoma, solitary lymph node metastasis has a negative impact on survival compared with N0 disease; skip metastasis, however, is comparable to N0 diseases in predicting prognosis.

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Rectosigmoid adenocarcinoma revealed by metastatic anal fistula. The visible part of the iceberg: a report of two cases with literature review

Colonic adenocarcinoma revealed by metastatic anorectal fistula is rare, with few cases in the literature. Such lesions can be taken for the more common manifestation of a benign perianal abscess or fistula. Once diagnosed, the management of such conditions remains controversial. We herein report two cases with perianal fistula that were subsequently found to have developed perianal adenocarcinoma on biopsy. Further colonic investigation revealed a rectosigmoid adenocarcinoma. Histology and immunohistochemical staining was identical in both primary and metastatic tumors. Preoperative chemoradiation with further rectal low anterior resection and local excision of metastatic anal fistula was performed. There is no recurrence after 3 years of follow-up.

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BMI concerns raised for childhood stem cell transplantation survivors

Childhood survivors of hematologic malignancies treated with allogeneic hematopoietic stem cell transplantation should undergo long-term monitoring of their body mass index and lean body mass, US researchers recommend.

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Routine screening influences outcomes in prostate cancer after surgery

Men who undergo radical prostatectomy for a tumor that was detected by screening show better long-term outcomes than their peers who undergo the surgery after opportunistic diagnosis, study results show.

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Isolated Crohn's disease of the esophagus with esophago-mediastinal fistula formation

Isolated Crohn's disease of the esophagus is rare, and accurate diagnosis and treatment in its early course are difficult. Most cases are often found very late, when severe strictures or other complications have occurred. We report the case of a male 60-year-old patient with complaints of progressive dysphagia for more than two months and the sudden appearance of heartburn for seven consecutive days. Clinical examination revealed severe esophageal stricture with a suspected fistula and mediastinitis. The patient received a successful esophagectomy. The resected specimen and pathological results confirmed a deep linear ulcer, chronic and noncaseating granulomatous inflammation, as well as a circular stricture of the esophagus with fistula into the mediastinum due to isolated esophageal Crohn's disease.

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