The prognostic value of post thyroidectomy Tc-99m pertechnetate thyroid scan in patients with differentiated thyroid cancer.

AIM: To evaluate the prognostic value of postoperative Tc-99m pertechnetate scanning in patients with differentiated thyroid cancer (DTC). METHOD: Patients with pathologically proven low or intermediate-risk DTC were enrolled in this study. Postoperative Tc-99m pertechnetate scintigraphy was performed 20 min after IV of 185 MBq of Tc-99m pertechnetate Positive thyroid residual uptake was characterized as higher Tc-99m pertechnetate uptake at the thyroid bed than the surrounding background's activity. A negative residual was considered if there was no definite abnormal radioactivity at the thyroid bed. Follow-up by thyroglobulin, thyroglobulin antibodies (Tg Abs), neck ultrasound (US) and diagnostic I-131 WBS (Dx WBS) were considered the reference standard. Successful ablation outcome was considered if there was free Dx WBS, stimulated serum thyroglobulin < 1 ng/ml with negative Tg Abs, and free US. RESULT: Two hundred and two patients, mean age; of 38.8 years were retrospectively recruited in this study. Positive residual uptake at the thyroid scan was detected in 131 patients wherea the remaining 71 patients had no detectable uptake. According to the reference standard we encountered 114 and 88 cases with successful ablation and unsuccessful ablation respectively, Tc-99m pertechnetate scanning successfully detected 63 true positive and 46 true negative cases giving 72% sensitivity, 40% specificity, 48% positive predictive value and 56% negative predictive value. CONCLUSION: In low- and intermediate-risk DTC patients; despite the relatively high sensitivity of postoperative Tc-99m pertechnetate thyroid scan, it has low specificity and low negative predictive value so it cannot be used to predict the ablation outcome.

Chemotherapy Alone for Patients With Stage II/III Rectal Cancer Undergoing Radical Surgery.

PURPOSE: The purpose of this prospective pilot study was to determine the efficacy of preoperative chemotherapy with six cycles of FOLFOX 6 (without radiation therapy) followed by radical surgery followed by six additional cycles of FOLFOX 6 for patients with stage II/III rectal cancer. PATIENTS AND METHODS: From January 2010 to January 2014, patients with locally advanced rectal cancer who met the eligibility criteria were enrolled in this study. Patients received FOLFOX 6 chemotherapy comprising oxaliplatin and leucovorin calcium i.v. over 2 hours on day 1, then bolus, and then continuous fluorouracil i.v. over 46 hours on days 1 and 2. Treatment was repeated every 14 days for 6 courses followed by radical surgery followed by additional 6 cycles of FOLFOX 6. RESULTS: In total, 45 patients were enrolled in this study. In the preoperative re-evaluation, the overall response rate was 68.8% (clinical complete response was 4.4%, and the partial response was 64.4%). There were 14 cases (31.2%) of stable disease. No patients had progressive disease. Postoperatively, the pathologic complete response rate was 8 of 45 (17.8%; 95% confidence interval [CI]: 8.9%-28.9%). The median follow-up was 29 months (range 9-54 months). The actuarial 3-year overall survival and disease-free survival rates for all patients were 80.8% (standard error, 1.877; 95% CI: 69.3%-92.3%) and 67.9% (standard error, 2.319; 95% CI: 54.3%-81.5%), respectively. CONCLUSION: Neoadjuvant chemotherapy (FOLFOX) without radiotherapy is active and safe but cannot be considered a standard of care until the results of prospective randomized phase III trials are available. IMPLICATIONS FOR PRACTICE: Neoadjuvant radiotherapy of rectal cancer represents the current standard of care. However, its use is also associated with short-term toxicity and long-term morbidity. With the increasing use of total mesorectal resection resulting in better local control and advances in systemic therapy for colorectal cancer, this study highlights the question of whether radiation is a necessary component of neoadjuvant therapy for all patients with rectal cancer or whether select patients could be spared the additional toxicities and inconvenience of radiotherapy. This study suggests that neoadjuvant FOLFOX without radiotherapy is active and safe, but it could not be considered a standard of care till now.

Alterations of p53 and Bcl-2 protein expression in the recurrent laryngeal and pharyngeal squamous cell carcinoma.

BACKGROUND: Identification of molecular events of the recurrent squamous cell carcinoma (SCC) of the larynx and pharynx may aid in refining treatment strategies and improving outcome. The underlying molecular events of these recurrent tumors involve alterations in the tumor suppressor genes (p53) and protooncogenes (Bcl-2). We hypothesize that the development of these recurrent tumors involves alterations of the p53 and Bcl-2 proteins. METHODS: To test this hypothesis, 15 laryngeal and pharyngeal biopsy specimens obtained from 15 patients with recurrent laryngeal or pharyngeal SCC with different grades (II-IV) were immunostained for p53 and Bcl-2 protein expression. RESULTS: Examination of the percentage of positive cells in the normal mucosa and SCC, respectively, showed significant up-regulation of p53 (0.0 ± 0.0 vs 51.8 ± 5.9, P = .00) and Bcl-2 protein expression (36.5 ± 3.5 vs 74.6 ± 1.9, P = .00). CONCLUSIONS: Alterations of the p53 and Bcl-2 proteins occur during the development of recurrent SCC. Additional studies are needed to confirm and extend our results.