Trichilemmal pilar tumor of the scalp: a case report.

Proliferating trichilemmal tumors (PTTs) are uncommon exuberant growths of cells derived from the external root sheath. They tend to occur in older women, with a predilection for the scalp. Wide local excision has been the standard treatment. Recent reports have described a rare malignant variant with an aggressive clinical course and a propensity for nodal and distant metastases which, therefore, merits aggressive treatment.

Hyperfractionated radiation therapy and concurrent chemotherapy for advanced head and neck cancer.

PURPOSE: To investigate the feasibility of combining hyperfractionated radiotherapy regimen with concomitant chemotherapy and to assess its toxicity in patients with advanced head and neck carcinoma (HNC). Progression free survival (PFS) and overall survival (OS) were set as secondary end points. PATIENTS AND METHODS: Between November 2003 and November 2007, 48 patients with stage III and IV HNC who met the eligibility criteria were enrolled in the study. Hyperfractionated Radiation consisted of 120 Gys twice daily, 6 hours apart, for a total of 69.6 Gys in 58 fractions over 6 weeks and boost of 6 Gys in 3 fractions in case of residual disease. Three cycles of concurrent chemotherapy in the form of Cisplatin 75 mg/ m² on day 1 and Fluorouracil 750 mg/m² 24 hour infusion on day 1-4 during weeks 1, 4 and 6 of irradiation. RESULTS: 48 patients have completed the treatment to date. The median radiation dose was 72 Gys including the boost to residual lymph node or primary site. The treatment was delivered in a median overall period of 54 days, with a recorded median delay of 7 days. Grade 4 skin toxicity was experienced by 4.1% of patients only. Therapy was well tolerated (grade 3 mucositis in 21%, grade 4 in 26%, grade 3 leukopenia in 10%). Weight loss of more than 10 kg was reported in 10 (16.7%) of the cases. The most common late toxicity was mild to moderate xerostomia which was encountered in 34 (70.8%) cases and improved thereafter. Hypothyroidism was encountered in 7 (14.6%) of the cases. Complete response (CR) was observed in 40 patients (83.3%). Partial response (PR) was achieved in the remaining 8 patients (16.7%). Disease relapse occurred in 9 patients (18.8%) after complete response and 2 patients developed progressive disease after partial response. 3 patients relapsed locally, 5 patients developed distant metastasis and 1 patient developed both local and distant metastasis. 2 patients (4.1%) died of treatment complications, 8 patients (16.7%) died with progressive locoregional, and metastatic disease. The 2- year disease free survival was 77% and the 2- year overall survival was 79%. CONCLUSION: Hyperfractionated radiotherapy and concurrent chemotherapy is tolerable. Results regarding LC and OS are encouraging as compared to conventional radiotherapy and concurrent chemotherapy.

Comparison of sequential chemoradiation with radiation alone in the treatment of advanced head and neck cancers.

OBJECTIVES: To compare locoregional control with alternating chemo radiation and radiation alone in patients with locally advanced head and neck carcinoma. STUDY DESIGN: A prospective randomized study. SETTING: Tertiary academic referral center. PATIENTS: 50 patients of biopsy proven locally-advanced carcinoma of head and neck. INTERVENTION: 25 patients were kept in Group I or study group (i.e. alternating chemo-radiation) and 25 patients in Group II or control group (i.e. radiation alone). In the study group, patients were given 3 cycles of chemotherapy (Cisplatin 20 mg/m([2]) and Inj. 5-FU 200mg/m([2]) from day 1-5 of each week) during weeks 1,5 and 9 alternated with radiation dose of 10Gy/week was given during weeks 2,3,4 and 6,7,8. In the control group, patients were given a total dose of 60Gy in 6 weeks. OUTCOME MEASURES: The response rate at the primary site and nodal site was better in study group as compared to control group. RESULTS: On comparing the response at the primary and nodal site together, 72% (18/25) patients of group I and 44% (11/25) patients of group II showed CR. PR was seen in 28% (7/25) and 36% (9/25) patients in group I and II respectively. No response was seen in 5/25 (20%) of patients in Group II. CONCLUSION: Our study has revealed that alternating/ sequential chemoradiation is a promising and feasible approach for patients in advanced head and neck cancer.

Clinical evaluation of human placental extract (placentrex) in radiation-induced oral mucositis.

To evaluate human placental extract in the treatment of radiation mucositis involving the oral/oropharyngeal region, a prospective randomized study was carried out in 120 patients with squamous cell carcinoma of the head and neck from August 1997 to March 1999. The study was conducted in patients receiving radical external radiation therapy, planned for = > 60 Gy/30 F/6 weeks, who developed grade 2 radiation mucositis (patchy mucositis) during radiation treatment. The patients were randomized in two groups of 60 patients each to receive either placentrex treatment (placentrex group) or conventional treatment (control group). Placentrex treatment was given as Inj Placentrex 2 ml by deep intramuscular injection 5 days a week for 15 injections. Conventional treatment given in the control group was disprin gargles and betamethasone oral drops. A subjective decrease in pain was observed in 48/60 (80%) of patients in the placentrex group compared with 22/60 (36.7%) in the control group. The progression to grade 3 radiation mucositis was 24/60 (40%) in the placentrex group compared with 52/60 (86.7%) in the control group. The subjective improvement in difficulty in swallowing was seen in 56/60 (93%) of patients in the placentrex group compared with 9/60 (15%) of patients in the control group. Only one patient in the placentrex group compared with three in the control group required interruption of radiation therapy because of severe radiation reactions. Human placental extract appears to be effective in the management of radiation-induced oral/oropharyngeal mucositis and especially in controlling subjective symptoms.

Thyroid hormone status in protein energy malnutrition in Indian children.

Thyroid hormonal status was measured in 80 malnourished children of different grades (I-IV) of protein energy malnutrition (PEM). Serum levels of tri-iodo thyronine (T(3)), thyroxine (T(4)) and thyroid stimulating hormone (TSH) were measured by radioimmunoassay. The results were compared with 20 healthy, age and sex matched controls. Levels of T(3) and T(4) were significantly low in PEM cases whereas TSH levels were similar in PEM cases when compared to controls.

Comparison of two radiation dose schedules in post mastectomy carcinoma of the breast.

In 108 histopathologically proved breast cancer patients, after surgical treatment with modified radical mastectomy, two radiation dose schedules have been compared. Radiation therapy was given on a 60Co teletherapy machine using gent pair technique for chest wall irradiation and direct fields for lymphatic drainage areas. The patients were randomly divided into two groups (Group A and Group B). 54 patients were given external radiotherapy 40 Gy/17 F/3.2 weeks and remaining 54 patients were given 45 Gy/20 F/4 weeks. Results of treatment in Group A versus Group B were as follows; chest wall failure 5/50(10%) versus 3/54 (5.6%), axillary lymphnods failure 3/50(6%) versus 4/54(7%), distant metastasis 16/50(32%) versus 15/54(28%). Radiation reactions were almost similar in both the groups. Skin reactions were most common radiation effects [45/50 (90%) in Group A and 43/54 (79.6% in Group B]. Thus no statistically significant difference in local control and efficacy of these two radiation dose schedules was observed in postmastectomy carcinoma of the breast.

Correlation of lipid peroxidation and alpha-tocopherol supplementation in patients with cervical carcinoma, receiving radical radiotherapy.

UNLABELLED: Vitamin E acts as antipromoter of carcinogenesis and MDA is a byproduct of lipid peroxidation inherent in carcinogenesis. Reduced serum levels of vitamin E have been found to be associated with higher risk of oral, gastrointestinal and breast cancers. This study was designed to evaluate status of serum vitamin E levels in carcinoma cervix patients receiving radical radiotherapy (RRT). MATERIAL AND METHODS: Fifty patients with biopsy-proven carcinoma of the cervix were divided into two groups. Group I received vitamin E supplement (100 mg orally daily) in addition to RRT. Group II received RRT only. Serum vitamin E and MDA levels were compared in the two groups pre- and post-RRT using Duggans and Beuges methods, respectively. RESULTS AND CONCLUSIONS Serum vitamin E levels were statistically lower in 50 patients than in controls. Post-RRT serum vitamin E levels increased in group I (p < 0.02) and group II (p < 0. 01) while serum MDA levels decreased in group I (p < 0.01) and group II (p < 0.05) meaning thereby that oxidative stress and consequent lipid peroxidation was reduced with decrease in tumour mass. Mean post-RRT serum vitamin E levels in the two groups was not statistically different. We found that serum vitamin E levels in the patients did not correlate with oral supplementation of vitamin E.

Serum malondialdehyde levels in Indian women.

Mean MDA level in the fifty women was 3.41 +/- 0.75 nmol/ml [table: see text]