Primary mucoepidermoid carcinoma of the bulbar conjunctiva

A 58-year-old male presented with redness for 1 year and dimness of vision for 2 years in his left eye. Excision biopsy from an inferotemporal conjunctival mass revealed high-grade mucoepidermoid carcinoma (MEC) with lymphovascular invasion and positive margins. The tumor bed was irradiated to 80 Gy using strontium 90 β-applicator. After 13 months, fine-needle aspiration cytology from a suspicious preauricular lymphadenopathy found metastatic cells. Ipsilateral supra-omohyoid neck dissection showed three positive nodes out of 15, and the left neck was irradiated. He is disease free at present, 12 months from external beam radiation therapy completion. With 48 cases reported in the literature, conjunctival MEC remains a rare condition, possibly in part due to clinicopathological underdiagnosis. This is unfortunate, given that this cancer is more aggressive, has a poorer prognosis, and warrants more vigorous treatment than squamous cell carcinoma, which it may be misdiagnosed as in the absence of appropriate staining and pathological review

Simultaneous isolated bilateral facial palsy : A rare vincristine-associated toxicity.

We describe a case of a 15-year-old boy with vincristine-induced simultaneous isolated bilateral facial palsy. The boy presented with superior vena caval syndrome (SVC syndrome), right-sided pleural effusion and anterior mediastinal lymphadenopathy. Histopathological examination of left axillary lymph node was suggestive of lymphoblastic lymphoma. We started chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisolone. SVC syndrome disappeared completely after the 1st cycle, and he achieved remission after the 3rd cycle of chemotherapy. He noticed that he could not close his eyes. Neurological examination revealed bilateral lower motor neuron facial palsy. Findings from examination of other cranial nerves and peripheral nerves were normal. Results of MRI of brain and cerebrospinal fluid examination were normal. He received 6 mg vincristine before developing toxicity.

Role of chemoradiotherapy in advanced carcinoma cervix.

Carcinoma cervix is the commonest female malignancy in India. In advanced stages radiotherapy was the only treatment options available. Recently there is interest in chemotherapy but the combination, dosage and timing are not well standardised. With this background a trial was undertaken to evaluate the role of chemotherapy along with radiotherapy in advanced carcinoma cervix. One hundred and sixty patients of stages II B-IV A carcinoma cervix were randomised into two arms. Patients of radiotherapy alone arm were treated by external radiotherapy of 5000 cGy in conventional fractionation followed by brachytherapy. The second group received the same schedule of radiotherapy plus chemotherapy with injection cisplatin 30 mg/m2 once weekly for 5 weeks during the course of external radiotherapy. Patients were well matched in both the arms. Compliance rate is similar. The complete response rate was 83% with chemoradiotherapy arm while it was 73% with radiotherapy (p-value > 0.1). Neutropenia was the major dose limiting toxicity, the incidence and severity being more in chemoradiotherapy arm (grade 3 neutropenia 12% versus 0%). Radiation proctitis was the commonest late effect observed. In the median follow-up of 54 months, there is an increased overall survival (56% versus 47%); p-value > 0.1) and disease-free survival (51% versus 37%; p-value > 0.05) in the chemoradiotherapy arm.

Radiation therapy: experience in lndian patients.

Radiotherapy is an essential component along with surgery and other modalities of treatment in cancer therapy. The authors have briefly described the subject along with their experience in Indian perspective. The current literature has been reviewed.

Neo-adjuvant chemotherapy with cisplatin and short infusional 5-FU in advanced head and neck malignancies.

BACKGROUND: Combination of radical surgery and radiotherapy is the standard management of head and neck malignancies. But due to considerable morbidity of surgery and associated cosmetic and functional deficiencies, often aggravated by adjuvant radiotherapy, many patients prefer only radiotherapy with its' decreased chance of survival. Proper surgical facilities are also not accessible to most of our patients. Neo-adjuvant chemotherapy and loco-regional management by surgery and / or radiotherapy have emerged as a viable alternative. AIMS: The purpose of this study is to find out the survival outcome as well as toxicity profile of Neo-adjuvant chemotherapy with cisplatin and short infusional (3 hours) 5-FU followed by radiotherapy in advanced head and neck malignancies. MATERIALS AND METHODS: From June 2002 to December 2003, seventy four patients with advanced head and neck malignancies were planned to be treated with Cisplatin (50 mg / sq. meter) on Days 1 and 2 and 5 - FU (600 mg / sq. meter) on Days 1, 2 and 3 by 3 hour infusion on Day care basis. On completion of four cycles of chemotherapy at 21 days interval, all patients were destined to receive 6000 cGy of radiotherapy to the loco - regional site. RESULTS: At one year follow up on completion of therapy, 57% patients were alive and 31% patients were disease free. These 31% patients enjoyed a good quality of life in terms of cosmetic and functional deficits. Toxicities were moderate and easily manageable. CONCLUSION: The study indicated that neo-adjuvant chemotherapy with Cisplatin and short infusional 5 - FU may be delivered on day care basis and results are comparable with Cisplatin and 96 hours continuous infusional 5 - FU. Thus avoiding the continuous infusional 5 - FU, 7 to 10 days in-patient hospitalization during each cycle may be avoided which is a constrain in developing countries like us.