Change in the Quality of Life in Oropharyngeal, Laryngeal and Hypopharyngeal Cancer Patients treated with Volumetric Modulated Arc-Based Concomitant Boost Radiotherapy.

OBJECTIVE: To assess the change in the quality of life (QOL) in Oropharyngeal, Laryngeal and Hypopharyngeal cancer patients treated with concomitant boost radiotherapy by Volumetric Intensity Modulated Arc Therapy (VMAT) technique. METHODS: Thirty patients with oropharynx, larynx or hypopharynx cancers of stage II to IVA were treated with an Accelerated fractionation schedule using Concomitant boost. The dose given was 1.8Gy/fraction daily, 5 days a week to the large field for 28 fractions and a daily concomitant boost of 1.5Gy/fraction to the boost field over the last 12 treatment days for a total dose of 68.4Gy/40 fractions/5½weeks by VMAT technique with concurrent chemotherapy (in stage III and IV patients) using Cisplatin 100mg/m2 IV three weekly during week 1 and week 4 of irradiation. QOL was assessed using the European Organization of Research and Treatment of Cancer Quality of Life Core Questionnaire, version 3.0 (EORTC QLQC30) and EORTC head and neck module (EORTC QLQ-HN35) before treatment, at the end of treatment, 1 month, 3 months and 6 months post treatment. The QOL scores and their evolution over the five measurements were calculated. RESULTS: The change in the QOL scores was acceptable in general. There was a significant reduction in quality of life scores at the end of treatment. The QOL improved in the followup period; and by 3 months post irradiation, there was a return of QOL scores to the baseline value. CONCLUSION: The QOL scores indicate that concomitant boost radiotherapy by VMAT is well tolerated and helps in rapid return to baseline quality of life scores. We believe that this is one of the first papers which have combined concomitant boost radiotherapy with VMAT technique in head and neck cancers. VMAT based concomitant boost radiotherapy helps in rapid return to baseline quality of life.

A single institution 18-years retrospective analysis of malignant melanoma.

UNLABELLED: Melanoma accounts for about 2% of all cancer-related mortality in western populations. Surgical excision of localized disease is curative in many patients with 80% overall 5-year survival rate. There are many indicators of prognosis of which tumor burden is predicted by primary site with nodal status being the next most important variable. Patients with advanced stage have very high risk of developing distant metastases and should receive systemic therapy. Despite treatment, majority of locally advanced patients develop metastatic disease. MATERIALS AND METHODS: A retrospective analysis of cases of malignant melanoma registered over a period of eighteen years, from October 1990 to September 2007 was done. Patient profile, presentation, disease load, treatment protocols and response on or after treatment were analyzed. RESULTS: The median age at diagnosis in men was 48 years and 50 years in women. At presentation, more than half of studied cases (56.5%) presented with nodal metastases at diagnosis while about three fourths (74%) had distant metastases (stage IV disease). More than half (56%) of the patients had superficial spreading type. The most common presenting complaints were swelling (70% of patients), ulcer (50% of patients) or pain (50%). Primary sites included extremities, central nervous system, abdomen, trunk, and bones. Liver, brain, abdomen and lungs were common metastatic sites. Surgical excision of primary lesion was done in about half of the cases. Four patients subsequently received palliative radiotherapy and two more received adjuvant radiotherapy. Another six patients received adjuvant chemotherapy and radiotherapy. Among treated patients, 26% showed partial response and another 8% have stable disease while 65% patients progressed on or after initial treatment. CONCLUSION: Malignant melanoma carries an overall poor prognosis especially in advanced stages. Multimodality therapy with surgery, radiotherapy and chemotherapy may provide local or nodal remission but cannot improve long term survival in advanced cases.

Case report: recurrent olfactory neuroblastoma nasal cavity in young boy refractory to chemotherapy with remission after radiotherapy and sparing of left eye.

Olfactory neuroblastomas make up about 3-5% of malignant intra-nasal tumors and originate from the olfactory neuroepithelium lining the roof of the nasal vault. There exist no optimum treatment guidelines from randomized data due to paucity of patients. Treatment options range from minimal surgery to extensive cranio-facial resections and adjuvant radiotherapy. In this case a tumor engulfing optic nerve and globe was safely treated by 3D-CRT with complete remission and relative sparing of the eye as well as late toxicities were avoided. 3D-CRT permits increased dose to tumor sparing critical areas and is a feasible option in centres without IMRT.

A retrospective study of 18 cases of adenoid cystic cancer at a tertiary care centre in Delhi.

CONTEXT: Adenoid cystic carcinoma (ACC) is a rare neoplasm that usually arises from the salivary, lacrimal, or other exocrine glands. It is characteristically locally infiltrative in nature and has a tendency toward local recurrence, high propensity for perineural invasion, and prolonged clinical course. AIM: To analyze the presentation and natural history of cases of adenoid cystic tumors of salivary glands in our institution; and to compare with the existing literature. DESIGN AND SETTING: Retrospective study at the Department of Radiotherapy. MATERIALS AND METHODS: Data on 18 patients of ACC of the salivary glands treated between 2004 and 2008 were reviewed with respect to clinical presentation, stage, and histology. RESULTS: There were 8 cases of major salivary gland tumors (47%), of which 2 were in the submandibular and 6 were involving the parotid. Ten patients (53%) had minor salivary gland involvement. Two patients had metastasis at the time of presentation. All patients underwent surgery. Radiotherapy was delivered to 16 patients and chemotherapy to 6 patients (concurrent, n = 3 and adjuvant, n = 3) and no adjuvant therapy was given to 2 patients. All patients were alive at a median follow-up of 3 years. No patient developed local or distant failure during the study duration. CONCLUSION: ACC has locally aggressive behavior. Radiotherapy adjuvant to surgery improves local control in locally advanced disease. Longer follow-up is mandatory in view of incidence of late metastasis.

HBx protein modulates PI3K/Akt pathway to overcome genotoxic stress-induced destabilization of cyclin D1 and arrest of cell cycle.

Growth arrest represents an innate barrier to carcinogenesis. DNA damage and replicational stress are known to induce growth arrest and apoptotic death to avert genomic instability and consequently carcinogenesis. In this study, working on the genotoxic stress induced by hydroxyurea and methylmethanesulfone, we observed a growth arrest at G1/S-phase that was mediated by destabilization of cyclin D1. The growth arrest was independent of the stability of cdc25A and preceded transcriptional up-regulation of p21(waf1). Cyclin D1 destabilization involved its phosphorylation by GSK-3beta at threonine-286, since overexpression of the kinase-dead mutant of GSK-3beta or cyclin D1T(286A) Inutant conferred stability to cyclin D1. Further, overexpression of cyclin D1(T286A) also helped in bypassing G1/S phase growth arrest. We also observed a rapid inactivation of Akt/PKB kinase in the presence of hydroxyurea. Enforced expression of the constitutively active Akt or viral oncoprotein HBx (Hepatitis B virus X protein) was sufficient to overcome growth arrest, independent of ATR signaling and stabilized cyclin D1. Thus, the present work not only establishes cyclin D1 to be a novel mediator of genotoxic stress signaling, but also explains how a deregulated mitogenic signaling or a viral oncoprotein can help bypass growth arrest.

An unusual source of Vibrio alginolyticus-associated otitis: prolonged colonization or freshwater exposure?

Otitis externa and otitis media are commonly encountered in clinical practice. We report an unusual case of otitis externa, which was caused by Vibrio alginolyticus, several months after saltwater exposure. Clinicians need to be aware of this unusual pathogen, especially in refractory cases of ear infections.

Certain biochemical responses in the air-breathing catfish Clarias batrachus exposed to sublethal carbofuran.

Biochemical changes in the air-breathing catfish, Clarias batrachus (Linn.) exposed to a sublethal level of carbofuran (2,3-dihydro-2,2-dimethyl-7-benzofuranyl methylcarbamate) at 0.5 ppm concentration in ambient water for a period of 30 days were assessed. A small reduction in growth rate was observed in the fish treated with 0.5 ppm carbofuran for 60 days although no mortality or any apparent symptom of toxicity could be noted. Studies were carried out on the activities of certain enzymes of intermediary metabolism viz., glucose 6-phosphatase, alkaline phosphatase, acid phosphatase, Na+, K+-ATPase, GOT and GPT in certain vital tissues of the fish exposed to carbofuran (0.5 ppm) for 30 days. Exposure to carbofuran resulted in sharp inhibition of acetylcholinesterase activity in brain of the fish which recovered rather rapidly after terminating pesticide treatment and maintaining the fish in clean freshwater. Ratio of the levels of calcium/phosphorus in serum showed significant diminution in experimental groups of fish compared to controls. Level of ammonia in serum of experimental fish was markedly increased while excretion of ammonia by fish showed concomitant decrease. The bioaccumulation level of the pesticide and its degraded product, 3-hydroxy-carbofuran in liver tissue was measured by gas chromatography. A rationale of the effect of carbofuran on metabolism vis-a-vis toxicity in the fish has been suggested.