Prospective evaluation of the quality of life of oral cancer patients undergoing post-operative radiotherapy in a Regional Cancer Centre of central India

Background: The assessment of the quality of life (QOL) has become an important aspect of oral cancer research. It has allowed the evaluation of the impacts of the disease as well as the treatment from the patient’s perspective. Objectives: The objective of this study is to assess the QOL of oral cancer patients undergoing post-operative radiotherapy (PORT) during treatment as well as after the completion of treatment. Materials and Methods: It is a hospital-based prospective observational study. It was carried out in Regional Cancer Centre, Dr. Bhim Rao Ambedkar Hospital, Raipur, India. A total of 108 oral cancer patients with cancer-free survival after surgery who satisfied the study criteria and got registered for PORT were included as study participants. The data with regard to their QOL were collected using the European Organization for Research and Treatment of Cancer QOL Core Questionnaire-C30 and the European Organization for Research and Treatment of Cancer Head and Neck Module (QLQ-H and N35) at three time-points, i.e., just before initiation, just after completion, and 6 months after completion of PORT. Mean, median, standard deviation, standard error, and 95% confidence intervals were calculated. Statistical significance was set at P < 0.05. The association between QOL at various time points was analyzed using Wilcoxon signed-rank test and Friedman’s ANOVA. Results: It was elicited that various scales of functional and symptomatic domains of QOL were significantly impaired at the end of RT and either restored to or improved from pre-RT level, at 6 months after completion of PORT. However, social functioning, nausea vomiting, appetite loss, dry mouth, and sticky saliva remained significantly deteriorated at the final assessment as compared to pre-RT level. Conclusions: This study concludes that QOL alters significantly over a short period of time from pre-RT to subsequent post-treatment period. However, it emphasizes the all-important need for psycho-social support in addition to disease cure for oral cancer patients during their treatment as well as a later period.

Primary Intracranial Ewing's Sarcoma (Peripheral Primitive Neuroectodermal Tumour of Parietal Bone) with Spinal and Pelvic Metastasis in a Young Female Child: Rare Case Report and Review

Introduction The Peripheral Primitive Neuroectodermal Tumour (pPNET)/Ewing's sarcoma family tumor (ESFT) group is a recently redefined term which includes all small round cell tumors of bone, soft tissue, and nerve with a common neuroectodermal origin. These highly aggressive pediatric soft tissue tumors occur less frequently in the craniospinal axis. Primary cranial lesion associated with spinal and pelvic metastasis is a rare presentation. Clinical Presentation A 9-year old girl was hospitalized with features of progressive increase in intracranial pressure with quadriparesis. The patient had ⅘ quadriparesis with bilateral papilledema. Brain MRI showed a large, hetero intense, contrast enhancing right parietal bony lesion infiltrating the dura with mass effect over the brain. Brain CT showed bony expansion and multiple calvarial lytic lesions. MRI cervical spine revealed collapsed fourth cervical vertebral body with extensive paravertebral and paraspinal soft tissue components with cord compression. Metastatic workup revealed a lytic lesion in the left iliac bone and left lung. The patient underwent a surgically challenging C4 corpectomy with cage fixation followed by craniotomy and excision of parietal bony lesion with titanium mesh cranioplasty in the same sitting. Histopathology revealed pPNET and was confirmed by CD99 positivity. Conclusion This rare multiple site tumor presentation was carefully planned and effectively managed by a combined single-stage surgical approach involving total excision of primary parietal bone and metastatic cervical spine tumors with primary titanium mesh cranioplasty and cervical spine stabilization, followed with radiotherapy and chemotherapy, which resulted in good recovery and improved the overall prognosis for the patient.

Introdução O grupo 'tumor neuroectodérmico primitivo periférico (pPNET) / tumor da família dos sarcomas de Ewing (ESFT)' é um termo recentemente redefinido o qual inclui todos as pequenas arredondadas células de tumor ósseo, tecidos moles e nervos com origem neuroectodérmica comum. Estes tumores pediátricos de tecido mole altamente agressivos ocorrem com menor frequência no eixo cranioespinal. Lesões primárias do crânio associadas a metástase espinhal e pélvica são raras. Relato de Caso Criança de 9 anos de idade hospitalizada com fraturas e pressão intracraniana crescente com quadriparesia. A paciente teve ⅘ de quadriparesia com papiledema bilateral. RM do cérebro por contraste mostrou uma lesão óssea parietal direita extensa e hétero-intensa infiltrando a dura-máter com efeito maciço sobre o cérebro. TC do cérebro mostrou expansão óssea e múltiplas lesões líticas na calota craniana. RM da espinha cervical revelou colapso da quarta vertebra cervical com componentes paravertebral e paraespinal de tecido mole com compressão da medula. Workup metastático revelou uma lesão lítica no ilíaco esquerdo e pulmão esquerdo. A paciente foi submetida a difícil corpectomia da C4 com fixação de cage seguida de craniotomia e excisão da lesão parietal óssea com cranioplastia com malha de titânio na mesma posição. Histopatologia revelou pPNET, confirmada por positividade de CD99. Conclusão Este raro caso com apresentação de múltiplos tumores foi cuidadosamente planejado e eficazmente conduzido por acessos cirúrgicos combinados em fase única envolvendo excisão total do osso parietal primário e tumores metastáticos da espinhal cervical com cranioplastia com malha de titânio e estabilização da espinha cervical, seguida de radioterapia e quimioterapia, resultando em boa recuperação e melhora no prognóstico geral da paciente.

Intracranial Meningiomas, WHO Grade Il : Prognostic Implications of Clinicopathologic Features

OBJECTIVE: Intracranial meningiomas are primarily benign tumors with a good prognosis. Although WHO grade II meningiomas are rare (2-10%), WHO grade II meningiomas have higher recurrence and mortality rates than benign. We evaluated the patient recurrence rate and investigated the prognostic factors of WHO grade II meningiomas. METHODS: Between 1993 and 2005, 55 patients were diagnosed with WHO grade II meningiomas in our hospital. WHO grade II meningiomas (n=55) were compared with other WHO grades meningiomas (I, n=373; and III, n=20). The patients had a median age of 48.4 years (range, 14-17 years), a male-to-female ratio of 26 : 29, and a mean follow-up time of 45 months (range, 3-175 months). RESULTS: In WHO grade II meningiomas, only the extent of resection was a significant prognostic factor. Post-operative radiotherapy had no significant influence on tumor recurrence (p=0.053). The relative risk of recurrence was significantly higher in WHO grade II meningiomas with incomplete resection (10/27, RR=37%) than in WHO grade II meningiomas with complete resection (4/28, RR=14%) regardless of post-operative radiotherapy. In the incomplete resection group, Simpson grade III or IV had a significantly high risk of recurrence regardless of post-operative RT (n=3, RR=100%) However, if the degree of resection was Simpson grade II, the recurrence rate was similar to the complete resection group even though post-operative RT was not performed. CONCLUSION: Complete resection was the most powerful independent predictive factor of the recurrence rate in WHO grade II meningiomas. Post-operative adjuvant RT was not a significant factor in this study.

Role of Postoperative Radiotherapy for Patients with Pathological Stage III Non-Small-Cell Lung Cancer after Curative Resection / 대한방사선종양학회지

PURPOSE: To evaluate the outcomes and prognostic factors of postoperative radiotherapy (PORT) for patients with pathological stage III non-small-cell lung cancer (NSCLC) at a single institution. MATERIALS AND METHODS: From 2000 to 2007, 88 patients diagnosed as having pathologic stage III NSCLC after curative resection were treated with PORT. There were 80 patients with pathologic stage IIIA and eight patients with pathologic stage IIIB in the AJCC 6th staging system. The majority of patients (n=83) had pathologic N2 disease, and 56 patients had single station mediastinal LN metastasis. PORT was administered using conventional technique (n=76) or three-dimensional conformal technique (n=12). The median radiation dose was 54 Gy (range, 30.6 to 63 Gy). Thirty-six patients received chemotherapy. Radiation pneumonitis was graded by the Radiation Therapy Oncology Group system, and other treatment-related toxicities were assessed by CTCAE v 3.0. RESULTS: Median survival was 54 months (range, 26 to 77 months). The 5-year overall survival (OS) and disease free survival (DFS) rates were 45% and 38%, respectively. The number of metastatic lymph nodes was associated with overall survival (hazard ratio, 1.037; p-value=0.040). The 5-year locoregional recurrence free survival (LRFS) and distant metastasis free survival (DMFS) rates were 88% and 48%, respectively. Multiple stations of mediastinal lymph node metastasis was associated with decreased DFS and DMFS rates (p-value=0.0014 and 0.0044, respectively). Fifty-one relapses occurred at the following sites: 10 loco-regional, 41 distant metastasis. Grade 2 radiation pneumonitis was seen in three patients, and symptoms were well tolerated with anti-tussive medication. Grade 2 radiation esophagitis was seen in 11 patients. There were no grade 3 or more severe complications associated with PORT. CONCLUSION: Our retrospective data show that PORT for pathological stage III NSCLC is a safe and feasible treatment and could improve loco-regional control. The number of metastatic lymph nodes and stations of mediastinal lymph node metastasis were analyzed as prognostic factors. Furthermore, efforts are needed to reduce distant metastasis, which is a major failure pattern of advanced stage NSCLC.

Prognostic value of WHO histological subtype and Masaoka clinical stage in postoperative radiotherapy for thymoma / 中华放射肿瘤学杂志

ween WHO histological subtype and Masaoka clinical stage, and their combination is valuable for guiding postoperative treatment in thymoma.

Postoperative radiotherapy and prognostic factors of soft tissue sarcoma / 中华放射肿瘤学杂志

Objective To study the effectiveness of postoperative radiotherapy and prognostic factors of soft tissue sarcoma. Methods Sixty-four soft tissue sarcoma patients admitted from June 1987 to May 1997 were treated by complete,partial or extended resection and postoperative external beam radiotherapy. Fourty-eight patients received 1.8～2.0?Gy/fraction,5 f/w, to a dose of 40～72?Gy (median 60?Gy). Sixteen patients received 1.2～1.5?Gy/f, bid, 6 hr interval to a dose of 64.8～85.0?Gy (median 66.5?Gy). The 5-year survival and locoregional control rates were estimated by Kaplan-Meier method. Logrank test and Cox regression were used to study the significance of predictive factors. Results The overall 5-year survival and locoregional control rates were 60.2%, 57.9% respectively. Those of the conventional group and hyperfractionated group were 54.3% and 61.9% vs 64.3% and 42.9% ,respectively. Cox regression analysis showed that histologic grade, size and site of the primary tumor, fractionation of radiotherapy were independent prognostic factors for survival. Conclusions Complete or extended resection followed by radiotherapy are satisfactory for soft tissue sarcoma. Histologic grade , size, site of the primary tumor and method of fractionation were prognostic factors.