Reliability of MRI in measuring tongue tumour thickness: a 1.5T study.

BACKGROUND: Tongue tumour thickness has been shown to have a correlation with neck nodal metastasis and hence patient survival. Current AJCC guidelines recommend inclusion of tongue tumour thickness measurement in routine radiologic staging. Several studies have attempted to define the accuracy of MRI in measuring tongue tumour thickness. The aim of our study was to compare tongue tumour thickness measured at T2-weighted and STIR sequences with histologic tongue tumour thickness. METHODS: Twenty-eight consecutive patients of tongue cancer who had undergone glossectomy were selected retrospectively. Tumours were measured in both STIR axial and T2-weighted coronal images and compared with histologic tumour thickness on resected specimens. Pearson's analysis was performed to determine the degree of correlation. Paired samples t-test was also used for comparison of mean tumour thicknesses measured on MRI with mean histologic tumour thickness. RESULTS: Pearson correlation analysis showed good correlation of tumour thickness measured on MRI with actual histologic tumour thickness (R=0.876). CONCLUSION: MRI provides a satisfactory prediction of tongue tumour thickness which in turn can be used todetermine the need for elective neck dissection in these patients.

Bleomycin induced pulmonary toxicity in patients with germ cell tumours.

BACKGROUND: Bleomycin is a cytotoxic drug used in treatment of Germ Cell Tumours (GCTs) and is associated with pulmonary toxicity. Bleomycin pulmonary toxicity (BPT) manifests predominantly as pulmonary fibrosis, organising pneumonia (OP) or Nonspecific Interstitial Pneumonitis (NSIP). Our objectives were to determine the incidence of BPT, describe the common HRCT patterns of pulmonary toxicity and to find out the correlation of variables (cumulative dose of bleomycin, age and glomerular filtration rate) with pulmonary toxicity. METHODS: The study included the data of 96 patients from March 2006 to September 2008. All patients had histologically proven GCT and received bleomycin containing regimes. Variables age, GFR at the time of initial presentation along with cumulative dose of bleomycin at completion of chemotherapy or at the time of BPT were recorded. The High resolution CT chest (HRCT) of these patients was independently reviewed by two radiologists. Bleomycin toxicity was reported on the radiologic features of pulmonary fibrosis, OP or NSIP. RESULTS: Fourteen patients (14.6%) developed BPT. Common patterns of BPT were, pulmonary fibrosis (5.2%), OP (5.2%) and NSIP (4.2%). Using the Univariate regression analysis there was significant relationship between BPT and age, cumulative bleomycin dose and initial GFR at the beginning of treatment. CONCLUSIONS: Because BPT can be progressive and fatal, early recognition is important. The diagnosis of pulmonary toxicity should be considered in any patient with new or progressive respiratory complaints. BPT can be difficult to diagnose; therefore, knowledge and understanding of radiologic manifestations of toxicity caused by Bleomycin are necessary for institution of appropriate treatment. There is increasing incidence of BPT with increasing age, cumulative dose and decreasing GFR.

Survival from hepatocellular carcinoma at a cancer hospital in Pakistan.

OBJECTIVES: To determine the tumour and general characteristics, especially survival, of patients presenting with hepatocellular carcinoma at our tertiary care cancer hospital. PATIENTS AND METHODS: We retrospectively studied 584 charts of patients consecutively registered between 1995 and 2004 at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, in Lahore, Pakistan. Descriptive statistics were obtained for gender, age, tumour size and morphology, alpha fetoprotein level, means of diagnosis, Child-Pugh status, risk factors, treatment given and follow-up. Survival analysis was conducted using the Kaplan-Meier method. RESULTS: Mean age at presentation was 56 years. Four hundred and forty four (76%) were male. Average tumour diameter evaluable in 412 patients was 8 cm. HCC was unifocal in 194 (33%), multifocal in 303 (52%) and unevaluable in 106. Mean AFP was 4,198 u/ml (range 1 - 278,560). Methods of diagnosis were FNA in 71, biopsy in 26, imaging/AFP > 200 in 70, lipiodol angiogram in 42, combinations of two of these in 365 and biphasic CT scans in 10. Initial Child-Pugh available for 400/584 was A in 216, B in 147 and C in 37. Evidence of prior hepatitis B infection was found in 114, and for hepatitis C in 254. Other than the four patients who had TACE followed by surgical resection, treatment was offered to 79/584 patients: among the 48 who had TACE, 26 experienced cancer progression whereas 11 had stable disease ranging from 6 - 20 months; another 11 were lost to follow-up. Of the 14 patients who underwent local resection, 2 were lost to follow-up, 7 developed recurrences but 5 remained disease free for a mean of 33 months. Following ethanol ablation in 17 patients, disease progressed in 5 but remained stable in 2 for a mean of 13 months; 10 were lost to follow-up. At the time of writing, 56 patients are alive (mean follow-up 20 months), 210 are known to have died (mean follow-up 9 months), and 318 were lost to follow-up within 3 months. Median overall survival was 10.5 months, death being the point of interest for survival analysis. Child-Pugh class stratified analysis (400/584) revealed median survival of 12 months for class A, 7.7 months for class B and 4 months for class C (p < 0.001). CONCLUSIONS: Most patients present with large, multifocal tumours, with poor liver function. Sixty one percent had evidence of prior infection with hepatitis B or C. The advanced stage at presentation, poor background liver function in many and the absence of a national liver transplantation program limit treatment options. Only 14% of patients were considered suitable for definitive treatment. Survival correlated with Child-Pugh status at presentation. Overall prognosis remains bleak. There is an urgent need to educate the public about the risks of hepatitis B and C and health professionals about early diagnosis and treatment, including possible development of a sustainable national liver transplant program.

Third world issues in breast cancer detection.

OBJECTIVE: To determine the statistics for age, distributions of the type of mammography, ultrasonic evaluation, laterality, assessment category, risk factors, and financial status, amongst females undergoing mammography. METHODS: A descriptive review of consecutive records of women undergoing mammography during Janurary and February 2005 at a tertiary care cancer facility, the Shaukat Khanum Memorial Cancer Hospital and Research Center in Lahore, Pakistan. RESULTS: Of a total of 87 patients, only 12 had attended the hospital for mammographic screening. These 12 females could financially afford the cost of their images. The median age of all the females at the time of mammography was 47 years and the mode was 40 years. Of the total, 40 and 32 patients were found in assessment categories 1 and 2 respectively. Only 19 females underwent bilateral mammography whereas forty were evaluated further by ultrasound imaging. Sixteen women had family history of breast cancer among their first degree relatives, twenty eight gave history of Hormone Replacement Therapy and fifty could afford their entire imaging expenses. CONCLUSION: Most patients received their first mammograms when they already had clearly palpable disease. This was partly be due to economic reasons and mainly because of low level of awareness.