Treatment outcome of maxillary sinus cancer.

The standard treatment in the early stage of maxillary sinus cancer is surgical resection followed by postoperative radiation therapy. However, for locally advanced maxillary sinus cancer, a multimodality treatment approach is strongly recommended to improve the survival rate and quality of life of the patient. We determined the treatment outcomes of induction chemotherapy, concurrent chemoradiation therapy, and surgical resection for locally advanced maxillary sinus cancer. Forty-four patients with locally advanced maxillary sinus cancer, who had been treated between January 1990 and April 2008 at Kangnam St. Mary's Hospital, were retrospectively analyzed. The objective response rates were 70%, 53%, and 57% in the intra-arterial induction chemotherapy, intravenous induction chemotherapy, and concurrent chemoradiation therapy groups, respectively. The orbital preservation rates were 83%, 100%, and 75% in the intra-arterial induction chemotherapy, intravenous induction chemotherapy, and surgical resection groups, respectively. In seven of nine patients in whom the orbit could be preserved after induction chemotherapy, the primary tumors were removed completely. However, although the orbits were preserved in three patients who underwent surgical resection as a primary treatment, all three cases were confirmed to be incomplete resections. We found that active induction chemotherapy for locally advanced cancer of the maxillary sinus increased the possibility of complete resection with orbital preservation as well as tumor down-staging.

The lesion patterns and mechanisms of ischemic stroke contralateral to the internal carotid artery occlusive disease.

BACKGROUND: In previous studies on unilateral internal carotid artery (ICA) occlusive disease, contralateral strokes have been ignored or excluded, probably because of their heterogeneity in etiology. The purpose of this study was to analyze the acute ischemic lesions contralateral to ICA occlusive disease and characterize the patterns and mechanisms of these strokes. METHODS: Eight patients, who had an acute ischemic stroke contralateral to the ICA occlusion, were enrolled. All patients underwent routine clinical evaluation including history and physical examination, laboratory tests and magnetic resonance imaging (MRI). Both magnetic resonance angiography and digital subtraction cerebral angiography, along with carotid duplex sonography, transcranial Doppler sonography, electrocardiography and echocardiography were performed to confirm the stroke subtypes. RESULTS: There were three distinctive stroke lesion patterns: (1) multiple infarcts in the border zone with or without a territorial lesion (4 patients), (2) multiple infarcts in the arterial territories sparing the border zone (2 patients), and (3) a small (<15 mm in MRI) single infarct in the internal border zone (2 patients). Overall, the patterns of ischemic lesions contralateral to the ICA occlusion were multiple and had a border zone distribution. CONCLUSION: These results suggest that the pathogenic mechanisms underlying these strokes could be the synergistic effects of both the embolism and a low flow state.

Treatment outcome of cisplatin-based concurrent chemoradiotherapy in the patients with locally advanced nasopharyngeal cancer.

PURPOSE: The standard treatment of locally advanced nasopharyngeal cancer is a concurrent chemoradiotherapy (CCRT), and cisplatin has been used as the most popular chemotherapeutic agent. But many different doses and schedules for cisplatin administration such as daily, weekly and 3 week cycles have been proposed. We compared and analyzed the tumor response, the overall survival, the toxicity and the chemotherapy dose intensity in the patients with locally advanced nasopharyngeal cancer who were treated with CCRT. MATERIALS AND METHODS: We performed a retrospective study on 55 patients with locally advanced nasopharyngeal cancer, and they were treated with CCRT as a front-line treatment from Jan 1996 to Jun 2007 at Kangnam Saint Mary's Hospital. RESULTS: The patients had a median age of 53 years (range: 19 approximately 75 years). Of the total 55 patients, a 3-week cycle of 100mg cisplatin was administered in 31 patients and 30 mg weekly cisplatin was administered in 24 patients combined with radiotherapy. Twenty one patients had a complete response and four patients had a partial response for a response rate of 71.4% (95% CI: 59.5 approximately 83.3) after CCRT and followed by adjuvant chemotherapy. The complete response rates for the 30 mg and 100 mg cisplatin groups were 72.7% (95% CI: 54.9 approximately 90.5) and 54.2% (95% CI: 36.7 approximately 71.7), respectively (p=0.23). The duration of CCRT in the 100mg cisplatin group was significantly longer than that of the 30mg cisplatin group (11.1+/-2.9 weeks vs. 9.0+/-1.2 weeks, p=0.003). The major deviation group, which was defined as prolongation of the radiotherapy duration for more than 2 weeks, had a significantly lower objective response rate than did the non-deviation group (56.3% vs 84.2%, respectively, p=0.002). The major severe toxicities were leucopenia (49.1%), pharyngoesophagitis (49.1%), anorexia (43.6%), nausea (41.8%) and vomiting (40%). CONCLUSIONS: Weekly 30mg cisplatin-based CCRT is a practical, feasible cisplatin schedule for the patients with locally advanced nasopharyngeal cancer in regard to decreasing the interruption of radiation treatment and decreasing the treatment-related acute toxicities.

Early pathological changes in the cerebellum of patients with pure cerebellar syndrome demonstrated by diffusion-tensor imaging.

We evaluated the early pathological changes in patients with sporadic cerebellar ataxia by measuring fractional anisotropy (FA) values in diffusion tensor MRIs (DTI). FA and apparent diffusion coefficient (ADC) values were compared in the brain stem and cerebellum of 5 patients with idiopathic cerebellar ataxia-C and 7 age-matched controls. Patients with sporadic cerebellar ataxia had decreased FA values in the bilateral cerebellar peduncle and cerebellar hemisphere, but normal FA values in the basis pontes. Assuming that the loss in FA parallels neuronal changes, our results suggest that the derangement and altered fiber integrity of the cerebellum are present regardless of the presence of morphological alterations on conventional MRI. Therefore, DTI may be superior to conventional MRI in the evaluation of early pathological changes in patients with sporadic cerebellar ataxia.