Soft tissue sarcoma of the head and neck region in adults.

Soft tissue sarcomas (STS) are rare solid tumours accounting for less than 1% of all malignancies and are very unusual in the head and neck region. Histopathologically diagnosed cases of STS treated at Regional Cancer Centre (RCC). Trivandrum, India, between January 1989 and November 2000 were analyzed retrospectively. Survival analysis was carried out by Kaplan-Meier method and curves were compared using log rank test. A total of 22 cases were seen during the study period. The mean age of the patients was 36.4 years with male-to-female ratio of 2:1. The neck, lower jaw, tongue, cheek, scalp and maxilla were the commonest sites affected. None of the patients had palpable neck nodes or distant metastasis at presentation. All the patients were treated with primary surgical resection and this was followed by adjuvant treatment in 14 cases (63.6%). After a median follow-up of 14.5 months, two patients died, six developed local recurrence, four developed metastatic disease and another patient developed second primary sarcoma. The overall 5-year survival was 80% while the 5-year disease-free survival rate was 24.1%. The majority of the patients failed within first and second year. None of the parameters except grade of tumour (P=0.008) were found to have a significant effect on survival. The overall survival rate for patients with soft tissue sarcoma of the head and neck is good, however, disease-free survival is poor as the majority of these fail within 2 years of completing treatment.

Expression of folate sensitive and aphidicolin induced chromosomal fragile sites in familial neuroblastoma.

The expression of folate sensitive and aphidicolin induced fragile sites in the blood lymphocyte chromosomes of affected and unaffected members from 2 neuroblastoma families were studied. The subjects included 4 neuroblastoma patients, and 9 of their clinically healthy first degree relatives and corresponding number of age and sex matched controls. Lymphocytes cultured in folate deprived culture medium showed rare fragile sites at band p13.1 of chromosome 1, in a frequency of 3%-5% in all the 4 neuroblastoma patients. In aphidicolin treated cultures, the patients and unaffected members in neuroblastoma families, showed hypersensitivity to aphidicolin, as evidenced by the significant increase in percentage of aberration/cell (ab/c) and damaged cells (dc), over that of controls (P < 0.01). Aphidicolin induced fragile sites were more pronounced in chromosomes 1 and 2. A larger number of subjects have to be studied to prove whether altered fragile site expression may be a cytogenetic evidence for an individual or familial cancer predisposing genetic constitution.

Parapharyngeal metastasis from papillary microcarcinoma of thyroid: report of a case diagnosed by peroral fine needle aspiration.

A parapharyngeal metastasis from primary thyroid carcinoma is rare and a search of relevant publications disclosed only seven previous reported cases. We describe a 46-year-old man who presented with a left parapharyngeal mass that was subsequently diagnosed by peroral fine-needle aspiration as a metastasis originating from a papillary carcinoma of the thyroid gland. Metastatic thyroid cancer should be considered in the differential diagnosis of a parapharyngeal mass. Fine-needle aspiration cytology is a simple, speedy, and cost-effective method of diagnosis of parapharyngeal masses.

Cytotoxic activity of amooranin and its derivatives.

Amooranin, 25-hydroxy-3-oxoolean-12-en-28-oic acid, is a triterpene acid isolated from Amoora rohituka stem bark. The cytotoxic effects of amooranin and its derivatives were studied. Amooranin and its methyl ester showed greater cytotoxicity against MCF-7 and HeLa cells derived from tumour tissues with a 50% inhibitory concentration (IC(50)) of 1.8-3.4 microg/mL, compared with Chang liver cells from normal tissue with an IC(50) of 6.2-6.4 microg/mL, but amooranin exhibited no activity on HEp-2 and L-929 cells. However, its monoacetate derivative showed no inhibitory activity at 1-10 microg/mL dose levels. Of the cytotoxic isolates, the methyl ester derivative was inactive in in vivo evaluations in the Ehrlich ascites tumour cells at 50 and 100 mg/kg/day, demonstrating T/C values of 106% and 114%, respectively.

Squamous cell carcinoma of the tongue among young Indian adults.

Oral cancer is one of the commonest cancers among males in India. This study was carried out to evaluate the demographics, risk profile, clinicopathologic features, and treatment outcome in young patients with squamous cell carcinoma (SCC) of the tongue. Patients under the age of 35 years with SCC of the tongue presenting between 1982 and 1996 were identified using institutions centralized electronic database. Demographic, clinical, and pathologic characteristics were abstracted from the case records. Survival was calculated by Kaplan-Meier method. One hundred and fifteen patients with histologically confirmed SCC of the tongue were analyzed. The mean age at presentation was 30.5 years with a 1.7:1 male to female ratio. Prior exposure to tobacco and alcohol was noted in 58 (50.5%) patients. At presentation, 70 (60.9%) were in stages III and IV, and 59 (51.3%) patients had regional lymph node involvement. The overall disease-free survival (DFS) at 3 and 5 years were 63% and 54.9%, respectively. A statistically significant difference in DFS was seen between patients with N(0) and N(1) disease compared to N(2) or N(3) disease. Various other factors like age, sex, habits, and stage of the disease were found to have no significant effect on DFS. Results of the present study suggest that contrary to the belief, the survival among young patients is almost similar to that in older patients.

Serum levels of copper, zinc, iron and ceruplasmin in oral leukoplakia and squamous cell carcinoma.

Trace elements have been extensively studied in recent years to assess whether they have any modifying effects in the etiology of cancer. In the present study serum levels of copper, zinc, ceruloplasmin, total iron and total protein were estimated in 92 patients with oral leukoplakia and squamous cell carcinoma and 45 age and sex matched controls. Copper was significantly increased in oral leukoplakia and cancer in both sexes. The level of zinc decreased significantly only in male patients with leukoplakia and cancer. Copper zinc ratio was found significantly elevated in oral leukoplakia and cancer. A marked increase in serum ceruloplasmin was seen in oral leukoplakia and cancer in both sexes. A significant decrease of serum total iron and proteins were observed only in carcinomas. These findings suggest that reduction in the serum total iron and total protein may be due to malnutrition caused, on its turn, by tumour burden. Serum ceruloplasmin level and copper-zinc ratio demonstrated significant differences in the patients of both sexes from those of controls, while, comparing leukoplakia with cancer, a significant difference is only observed in male patients. Thus, the present study shows that these factors have diagnostic value only in differentiating malignancies from normal and a little value as biomarkers of disease progression. However, the exact mechanism responsible for the alteration of these factors in oral lesions is still not clear and a detailed study on large sample size is therefore needed.

Evaluation of local control, survival and pattern of failure with radiotherapy in cancer of the tongue.

105 patients with cancer of the tongue were treated with radical radiotherapy in 1982 at the Regional Cancer Centre, Trivandrum, India. The overall local control rate was 55% and the 3-year actuarial disease-free survival was 36% with radiotherapy. The analysis revealed a close correlation between stage of the disease and local control as well as survival. 45% of the patients with clinically positive cervical nodes had their disease controlled by radiotherapy. Since the best results were obtained with early disease, the need for clinical downstaging by early detection is stressed.

Interleukin 2 and alpha interferon induced in vitro modulation of spontaneous cell mediated cytotoxicity in patients with cancer of the uterine cervix undergoing radiotherapy.

In vitro modulation of spontaneous cell mediated cytotoxicity by interferon and interleukin 2 was carried out using peripheral blood lymphocytes from patients with cancer of the uterine cervix before and at different intervals after commencement of radiation treatment. A total of 150 patients with various stages of the disease were included and cytotoxicity was measured using the single cell cytotoxic assay. These results indicate a beneficial effect in vitro of interleukin 2 and interferon in augmenting spontaneous cell mediated cytotoxicity, a possibly vital antitumour immune mechanism in patients with relatively early cervix cancer. Natural killer cell, lymphokine activated killer cell and interferon activated killer cell activity was depressed immediately following radiotherapy. The activity of these cell types later on increased above pretreatment levels in patients with stages I, IIA and IIB. A similar rebound above pretreatment levels was not observed in patients with stages III and IV.