Clinical significance of P-glycoprotein immunohistochemistry and histomorphologic factors in patients with osteosarcoma

Osteosarcoma is the most frequent highly malignant bone tumor with a peak incidence in the second decade of life. Although survival rate increased up to 60-70% within the last 10 years, the problem of unresponsiveness to chemotherapy remains. In this study, we sought to determine the prognostic significance of P-glycoprotein as a tumor marker for osteosarcoma. In a retrospective study, we correlated P-glycoprotein immunostaining with clinicopathologic and histomorphologic features of the tumor and the patient outcome in 30 cases with primary, non-metastatic, highgrade osteosarcoma who were homogeneously treated. P-glycoprotein positivity was found in 14 of 30 cases and was significantly associated with a higher incidence of adverse events and relapse rate. No relationship was found between p-glycoprotein immunostaining and clinicopathologic features such as age, sex, tumor site, histologic subtype, osteoid content, osteoid pattern, pretreatment necrosis, pleomorphism of the cells, and presence of prominent nucleoli, except for mitotic activity per 10 HPF. P-glycoprotein positivity in immunohistochemistry should be taken into consideration to identify a subgroup of osteosarcoma patients with poor outcome at the time of diagnosis. So it might be an important marker in planning innovative chemotherapeutic regimens

optimal time of adjuvant radiation therapy in locoregional breast cancer

The optimal time and sequence of adjuvant radiation therapy and chemotherapy after breast surgery is controversial. Radiation therapy is the most effective method for preventing locoregional recurrence following primary surgery for invasive breast cancer. Delay in radiation therapy after surgery can lead to increased local recurrence and delay in chemotherapy after surgery is associated with an increasing rate of failure in the systemic control of breast cancer. This study was undertaken to determine the optimal sequencing of adjuvant chemotherapy and radiotherapy for patients with locoregional breast cancer after modified radical mastectomy. Additionally, this study aimed at determining the possible effect of time of radiotherapy on local and distant cancer control and the overall survival in these patients. Over a 2.5 year period, 100 patients received chemotherapy and radiation therapy for a locoloregional breast cancer after modified radical mastectomy. The population was randomly divided into two equal groups based on the timing of radiation treatment. Fifty patients [Group I] began their radiation after completion of chemotherapy and about 21 weeks after surgery. Group II began their radiation therapy about 3 weeks after surgery in combination with chemotherapy. There was no statistically significant difference between the two groups with respect to nodal status, stage of breast cancer, age, sex and type of surgery performed. Comparison of local and distant failure and overall survival rate between the delayed radiation group [Group I], and early radiation group [Group II] was not significant. In patients who require both chemotherapy and radiation therapy for a localoregional breast cancer, a delay in the initiation of radiotherapy for completion of adjuvant chemotherapy appears safe and may be preferable in patients with high risk of dissemination

Reproductive behaviour in women in Shiraz, Islamic Republic of Iran

Data on the reproductive behaviour of women in Shiraz are presented. A total of 9934 randomly selected women aged >/= 35 years of all socioeconomic levels were interviewed. The mean age at menarche +/- standard deviation was 13.96 +/- 1.23 years, mean age at first marriage was 17.10 +/- 4.24 years and mean age at first pregnancy was 19.50 +/- 3.90 years. The mean number of children was 4.56 +/- 1.70 children, although for illiterate women it was 6.76 +/- 1.76 children and for high-school or university-educated women it was 3.36 +/- 1.70 children. The mean age at menopause was 47.80 +/- 3.78 years

Neoadjuvant combination chemotherapy and radiation therapy in the treatment of stage 111B carcinoma of the cerzix

Between 1982 and 1991, forty patients with high risk stage IIIB carcinoma of the cervix with bilateral parametrial involvement received a combination chemotherapy consisting of intravenous vincristine, methotrexate, bleomycin and cisplatin, followed by intracavitary brachytherapy of 30 Gy to point A and whole pelvis external irradiation of 50 Gy. The mean age of the patients was 55 with a range of 30-70 years. The mean follow-up was 57 with a range of 12-120 months. Five patients were lost to follow-up after the first year. The 5-year disease-free survival of 42.8% and pelvic failure rate of 17.1% compare favorably with the literature, perhaps indicating some improvement over radiotherapy alone and potentiating effect of neoadjuvant chemotherapy. High extra-pelvic failure rates of 14.1% in the para-aortic nodes and 25.7% as distant metastases were noted. Relevant factors and literature are discussed. Prophylactic para-aortic node irradiation is recommended in these patients, and it is suggested that neoadjuvant chemotherapy may be of value in improving survival and disease control, particularly in the developing countries, where sophisticated radiotherapy sources and techniques may not be available. The use of tumor markers in monitoring tumor response to chemotherapy is also suggested