Clinical target volume [CTV] in postoperation radiotherapy of esophageal squamous cell carcinoma could benefit from the detection of telomere length in lymph node

Background: This study evaluated the relation between telomere length in lymph node [LN] and prognosis of esophageal squamous cell carcinoma [ESCC]

Materials and Methods: LNs collected from 50 patients were assessed by pathological examination and quantitative reverse transcription polymerase chain reaction [qRT-PCR], which was used for detecting telomere length. The relation between clinical factors and the number of lymph node metastasis [LNM] identified were analyzed by the x2 test. The comparison of the pattern of LNM identified by pathological examination and detection of telomere length was assessed by Wilcoxon signed-rank test. Overall survival was assessed using the Kaplan-Meier method, and Cox proportional hazard regression analysis was used to evaluate the relationship between survival and the number of LNM

Results: The best threshold values, which could define the positive metastasis by detecting the telomere length, were 1.50, using the critical value method of statistic. Length of tumor, depth of tumor invasion and differentiation of tumor correlated closely with LNM were identified by detecting telomere length. The rates of LNM identified by detecting telomere length were 34.4%, 22.4%, 22.9%, 5.0% in 108,107, 7, and 3 LN station, respectively. The number of LNM identified by detecting telomere length was more closely related to the prognosis of ESCC than that of pathological examination [HR: 1.23 VERSUS 1.04]

Conclusion: The change of telomere length in LN was closely related to the prognosis of ESCC. Delineation of clinical target volume [CTV] may benefit from the detection of telomere length in regional LN

Effect of oral zinc sulphate in prevention of radiation induced oropharyngeal mucositis during and after radiotherapy in patients with head and neck cancers

Mucositis is a disturbing side effect of radiotherapy treatment for head and neck cancer. To date, no effective modality for its prophylaxis and treatment has been found. We performed this study to evaluate the efficacy of oral zinc sulphate in delaying the onset of oral and pharyngeal mucositis and decreasing their severity. A total of 58 patients who were treated for head and neck squamous cell carcinoma with radiotherapy or chemoradiotherapy were randomly assigned to receive oral zinc sulphate [220 mg] or an oral placebo 3 times a day during their radiotherapy course. Total radiation dose was 6000 cGy to 7000 cGy by conventional radiotherapy. Seventy nine percent of the patients also received concurrent chemotherapy. Oral and pharyngeal mucositis were scored according to an RTOG protocol. Time to onset of mucositis did not vary between the two groups. However, oral mucositis scores were less severe in the zinc group in weeks 4 to 6. The difference was statistically significant and the P values for weeks 4, 5 and 6 were 0.02, 0.007, and 0.012, respectively. Treatment interruptions in both groups were the same [four cases each] and all were due to dysphagia [pharyngeal mucositis]. Our results suggest that zinc is effective in reducing the severity of oral mucositis but not pharyngeal mucositis. Treatment interruptions were more frequently caused by pharyngeal mucositis which presented as dysphagia, rather than oral pain that was a manifestation of oral mucositis

Radiumterapia pré-operatória e histerectomia radical no tratamento do câncer do colo uterino IB, IIA e IIB inicial / Preoperative radiumtherapy and radical histerectomy in the treatment of cervical cancer stage IB, IIA and initial IIB

Pacientes com câncer do colo uterino, estádios IB, IIA e IIB inicial, randomizadas, foram submetidas a tratamento combinado com uma ou duas aplicaçoes de radium, seguidas pela operaçao de Wertheim Meigs, 40 dias mais tarde. As pacientes com linfonodos foram seqüencialmente tratadas com telecobaltoterapia. Após alta do hospital, as pacientes foram examinadas quatro vezes no primeiro ano e duas vezes por ano, nos anos subseqüentes. Foram avaliadas as complicaçoes precoces e tardias do tratamento, tumor residual pós-radiumterapia e sobrevida sem recidiva. O projeto iniciou-se em 1965 e finalizou em 1986. Todas as cirurgias foram realizadas por um dos autores, sendo analisadas 116 pacientes. A faixa etária oscilou de 21 a 75 anos, com média de 44,18 anos. Durante o ato cirúrgico, 31 (26,72 por cento) pacientes necessitaram de transfusao sangüínea igual ou superior a l5OOcc e houve três lesoes das grandes veias. No manuseio dos ureteres, procuramos deixar a fáscia posterior o mais intacta possível. As complicaçoes pós-operatórias variaram das mais simples (febre, infecçoes pélvicas localizadas, paralisia do ciático popliteo externo) até a evisceraçao (três pacientes), trombose venosa profunda (três pacientes) e duas fístulas urinarias prematuras. As complicaçoes tardias foram observadas em pacientes submetidas à irradiaçao ionizante seqüencial. Uma fístula uretero-vaginal ocorreu dez meses após o tratamento, uma outra, sete anos mais tarde, e uma terceira, 24 anos depois. Uma paciente desenvolveu hidronefrose e enterocolite após irradiaçao de 7000 centigrays e outra fístula reto-vaginal 13 anos apos a terapia inicial. Observou-se coalescência da vagina, impossibilitando relaçao sexual, em sete pacientes. Pelo exame histológico, a cérvice estava livre de neopiasia em 73,3 por cento das pacientes. A cérvice tinha aparência clínica normal em todos os casos. O achado de câncer residual pós-radiumterapia, foi proporcional ao tamanho do tumor e estadiamento da doença. Analisando as combinaçoes entre câncer residual do colo linfonodos positivos ou negativos, o ponto crítico foi ter a associaçao cervice positiva e linfonodos positivos. A sobrevida de cinco anos (metodologia life table) para lesao de estadiamento I foi 96 por cento e 67 por cento para o estadiamento II. Após dez anos, o índice de sobrevida foi ligeiramente diferente. Com linfonodos positivos, a sobrevida foi de 47,38 por cento. Acreditamos que a terapêutica combinada ocupa lugar importante no tratamento do câncer de colo uterino estadiamento I, IIA e IIB inicial.

Prognostic value of initial mononucleated cell counts in patients with stage III squamouns cell carcinoma of the larynx and hypopharynx

The prognostic value of initial mononucleated cell counts has been evaluated in 48 patients with stage 3 and 4 squamous cell carcinoma of the larynx and hypopharynx. The patients were treated with synchronous 5 - fluorouracil weekly infusions and radiation therapy. Twenty-four patients [50%] were considered to have abnormal counts. The abnormal counts were significantly correlated to both T and N stages. All complete responders and 12 out of 17 partial responders had their counts within normal limits. The nonresponders group were 12 patients, normal-counts were fo++ und in 1 patient of them. Mononucleated cell counts abnormalities seem to have an important prognostic value