ABSTRACT
AIM OF WORK: : The purpose of this study is to analyze the causes of Loco-regional failure in 51 patients with tumors of the oral cavity abutting the mandible. PATIENTS AND METHODS: This cross-sectional study (27 patients were operated upon in the retrospective section and 24 patients in the prospective section of the study) was done in the department of Surgical Oncology, National Cancer Institute, Cairo University, from January 2003 to January 2008. Fifty-one patients, with oral cavity cancerous lesions abutting the mandible, were operated upon by segmental mandibulectomy en-bloc with primary tumor resection in addition to modified radical or selective neck dissection according to the status of the cervical lymph nodes. RESULTS: During a median follow-up of 2 years, 29 patients (56.8%) had local recurrences, the incidence of nodal recurrence after neck dissection was detected in 4 patients (7.8%). On multivariate analysis, tumor depth, tumor grade, oral mucosa, soft tissue and bone surgical margins in addition to metastatic lymphadenopathy were independent prognostic factors of loco-regional failure and disease-free survival. CONCLUSION: Oral cavity cancers abutting the mandible should be treated with great caution by a multidisciplinary oncology team (resection and reconstruction surgeons) as it has a very aggressive biologic behavior. Negative intraoperative pathological margins should be attempted since this is the critical point for patients with cancers abutting the mandible? Further research on the biologic margin and genetic study is required. KEY WORDS: Oral cavity cancer abutting the mandible - Predictors of loco-regional failure.
ABSTRACT
BACKGROUND: Isolation and phenotypic characterization of tumor infiltrating lymphocytes (TILs) in some malignant tumors have been shown. TILs possess a good prognostic value as well as a therapeutic effect in these solid tumors. Our preliminary work shed some light on a good possibility of synthesis and secretion of specific protease enzyme system with a dimeric structure above 92 kDa for the lytic activity of TILs against breast tumor cells propagated ex vivo. PURPOSE: This work aims at first isolation, activation and immuno-phenotypic characterization of TILs derived from malignant tumor tissues of breast cancer patients. Second, to optimize the conditions for the biological therapeutic efficiency of the identified TILs subpopulations as targeted cell therapy against breast cancer. PATIENTS AND METHODS: The present work presented twelve patients with breast cancer from NCI, Cairo. Tcell isolation, activation, immunophenotyping and immunohistochemical investigations were performed. Enzymatic digestion method, mesh with pore size 355 & 45mm and flow cytometric analysis were used. RESULTS: The results revealed that, lymphocytes infiltrating the malignant tumor tissues were mainly of the Tcell type indicated by CD45RO positive markers as shown by immunohistochemical observations. The immunophenotypic analysis of the isolated TILs obtained from breast tumor tissues specimens and activated with interleukin- 2 (IL-2), showed that the ratio of CD4+/CD8+ was 0.89 which represents helper and cytotoxic sub-populations of TILs, respectively. Meanwhile, the ratio of CD4+/CD25+ was 16.03 representing the regulatory system of TILs subpopulation. In the peripheral blood of patients, the percentages of the CDs positive cells were different and the ratio of CD4+/CD8+ was 1.14+/-0.57 whereas the ratio of CD4+/CD25+ was 18.38+/-5.95. After mixing the isolated TILs and the T-lymphocytes obtained from the peripheral blood, the ratio of CD4+/CD8+ increased insignificantly to 1.45+/-0.67. Also the ratio of CD4+/CD25+ increased rough insignificantly, to 23.64+/-9.83. CONCLUSION: The isolated and identified TILs subpopulations have to be tested for their biological therapeutic efficacy first at ex-vivo level using the cr51 release assay; second at in-vivo level using experimental animal models as a sub-clinical investigation before going further to clinical study of using TILs as targeted bio-immunotherapy against human cancers. KEY WORDS: TILs - Immunohistochemistry - Immunophenotyping - Breast cancer.
ABSTRACT
BACKGROUND AND PURPOSE: The incidence of posterior mediastinal tumors relative to all tumors of the mediastinum is 23% to 30%. The posterior mediastinum is a potential space along each side of the vertebral column and adjacent proximal portion of the ribs. Primary tumors of posterior mediastinum are usually neurogenic. The aim of this study was to evaluate different surgical approaches used for the resection of posterior mediastinal tumors, and to assess morbidity, mortality and patients' survival. PATIENTS AND METHODS: Between January 2001 and January 2004, 30 patients with posterior mediastinal tumors were included. CT scan of the chest and CT guided biopsy were done for all patients; whereas MRI was done for suspected intraspinal extension. Posterolateral thoracotomy was the approach used in most of the patients. The Akwari approach was used in most of the patients with Dumbbell tumors. RESULTS: Neurogenic tumors constituted 67% of cases, being neuroblastoma in 60%. The non neurogenic tumors included a heterogenous group of rare tumors (n=10). Dumbbell tumors were found in 10 patients. Neuroblastoma was the commonest tumor to cause intraspinal extension (40%). Wide local excision was done in 13 patients; whereas extended resection was done in the remaining 17 patients. The mean intra-operative blood loss was 800cc and the mean hospital stay was 12 days. The size of the resected tumor ranged from 3 X 4 cm to 30 X 22 cm, 80% of tumors were malignant. Morbidity in relation to the procedures developed in 8 patients (atelectasis, meningitis, paraplegia, Horner syndrome and mild wound sepsis in 4, 1, 1, 1 and 1 of the patients; respectively). One postoperative mortality, due to meningitis was recorded. The overall survival by the end of three years was 87.7% with a mean survival of 30.4 months. The overall disease free survival was 55.9% with a mean disease free survival of 26.2 months. CONCLUSIONS: Posterior mediastinal tumors may reach large size before becoming symptomatic. Complete surgical excision (including adjacent invaded organs) mainly by open technique should be the rule for these patients as there is survival benefit. Great care should be taken when dealing with Dumbbell tumors.
