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  Citation statistics : Table of Contents
   2010| October-December  | Volume 6 | Issue 4  
    Online since February 24, 2011

 
 
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ORIGINAL ARTICLES
Distinctive microRNA signature of medulloblastomas associated with the WNT signaling pathway
Amit Gokhale, Ratika Kunder, Atul Goel, Rajiv Sarin, Aliasgar Moiyadi, Asha Shenoy, Chandrasekhar Mamidipally, Santosh Noronha, Sadhana Kannan, Neelam Vishwanath Shirsat
October-December 2010, 6(4):521-529
DOI:10.4103/0973-1482.77072  PMID:21358093
Aim: Medulloblastoma is a malignant brain tumor that occurs predominantly in children. Current risk stratification based on clinical parameters is inadequate for accurate prognostication. MicroRNA expression is known to be deregulated in various cancers and has been found to be useful in predicting tumor behavior. In order to get a better understanding of medulloblastoma biology, miRNA profiling of medulloblastomas was carried out in parallel with expression profiling of protein-coding genes. Materials and Methods: miRNA profiling of medulloblastomas was carried out using Taqman Low Density Array v 1.0 having 365 human microRNAs. In parallel, genome-wide expression profiling of protein-coding genes was carried out using Affymetrix gene 1.0 ST arrays. Results: Both the profiling studies identified four molecular subtypes of medulloblastomas. Expression levels of select protein-coding genes and miRNAs could classify an independent set of medulloblastomas. Twelve of 31 medulloblastomas were found to overexpress genes belonging to the canonical WNT signaling pathway and carry a mutation in CTNNB1 gene. A number of miRNAs like miR-193a, miR-224/miR-452 cluster, miR-182/miR-183/miR-96 cluster, and miR-148a having potential tumor/metastasis suppressive activity were found to be overexpressed in the WNT signaling associated medulloblastomas. Exogenous expression of miR-193a and miR-224, two miRNAs that have the highest WNT pathway specific upregulation, was found to inhibit proliferation, increase radiation sensitivity and reduce anchorage-independent growth of medulloblastoma cells. Conclusion: Expression level of tumor/metastasis suppressive miRNAs in the WNT signaling associated medulloblastomas is likely to determine their response to treatment, and thus, these miRNAs would be important biomarkers for risk stratification within the WNT signaling associated medulloblastomas.
  76 15,451 1,464
REVIEW ARTICLES
High intensity focused ultrasound ablation: A new therapeutic option for solid tumors
Franco Orsi, Paolo Arnone, Wenzhi Chen, Lian Zhang
October-December 2010, 6(4):414-420
DOI:10.4103/0973-1482.77064  PMID:21358073
Surgery has been the standard of care in selected cases with solid tumors. However, a majority of patients are unable to undergo surgical resection because of the tumor sites, advanced stages, or poor general condition. High intensity focused ultrasound (HIFU) is a novel non-invasive technique that is capable of producing coagulative necrosis at a precise focal point within the body, without harming overlying and adjacent structures even within the path of the beam. Diagnostic ultrasound was the first imaging modality used for guiding HIFU ablation in the 1990s. Over the last decade, thousands of patients with uterine fibroids, liver cancer, breast cancer, pancreatic cancer, bone tumors, renal cancer have been treated with ultrasound imaging-guided HIFU (USgHIFU) worldwide. This USgHIFU system [Chongqing Haifu (HIFU) Tech Co., Ltd., Chongqing, China] was first equipped in Asia, now in Europe. Several research groups have demonstrated that HIFU is safe and effective in treating human solid tumors. In 2004, the magnetic resonance guided focused ultrasound surgery (MRgFUS) was approved by the United States Food and Drug Administration (FDA) for clinical treatments of uterine fibroids. We conclude that HIFU offers patients another choice when no other treatment available or when patients refused surgical operation. This technique may play a key role in future clinical practice.
  58 17,385 1,695
ORIGINAL ARTICLES
Hyperthermia with radiation in the treatment of locally advanced head and neck cancer: A report of randomized trial
Nagraj G Huilgol, Sapna Gupta, CR Sridhar
October-December 2010, 6(4):492-496
DOI:10.4103/0973-1482.77101  PMID:21358087
Background: Head and neck cancer is the leading cause of male mortality due to cancer in India. Surgery, radiation alone or in combination has been the backbone of treatment strategies. Chemo-radiation has emerged as the standard of care in most types of head and neck cancer. This strategy has the advantage of maintaining both structure and functions, albeit with increased acute and delayed side effects. Radiation with hyperthermia can achieve the same objective without additional toxicities. Materials and Methods: A total of 56 patients were randomized to radiation therapy (RT) alone or RT-hyperthermia (RT-HT) arm. Twenty-six patients were included in RT alone arm and 28 patients in the RT-HT arm. Both groups were evenly matched for age, sex, and stage. Patients in both the arms received radiation to a dose of 66-70 Gy in 6.5-7 weeks. Patients in the study group received weekly HT. HT was started after impedance matching to last for 30 minutes. Results: Complete response was seen in 42.4% of RT alone group compare to 78.6% in the HT group. The difference was statistically significant ( < 0.05). Kaplan-Meir analysis of survival also showed a significant improvement in favor of RT-HT. No dose limiting thermal burns and excessive mucosal or thermal toxicity were recorded. Conclusion: Radiofrequency (RF) based heating and radical radiation of head and neck cancers is better than in RT alone group. HT should be considered as a valid option wherever the facility for HT is available. This report should infuse greater confidence in radiation Oncologists to practice HT as an adjuvant treatment modality.
  38 6,854 558
Estimation of serum malondialdehyde in oral cancer and precancer and its association with healthy individuals, gender, alcohol, and tobacco abuse
Revant H Chole, Ranjitkumar N Patil, Anjan Basak, Kamlesh Palandurkar, Rahul Bhowate
October-December 2010, 6(4):487-491
DOI:10.4103/0973-1482.77106  PMID:21358086
Background: Tobacco and alcohol induces generation of free radicals and reactive oxygen species, which are responsible for high rate of lipid peroxidation. Malondialdehyde is the most widely used marker of lipid peroxidation. The aim of the study was to estimate serum malondialdehyde level in oral precancer, oral cancer, and normal individuals. Materials and Methods: In this study serum malondialdehyde was measured according to the method of Ohkawa et al in 30 normal individuals and 30 patients each with histopathologically diagnosed oral precancer, and oral cancer. Results: The mean serum malondialdehyde level in the control group was found to be 5.107 ± 2.32 ηmol/ml, whereas it was 9.33 ± 4.89 ηmol/ml and 14.34 ± 1.43 ηmol/ml in oral precancer and oral cancer, respectively. There was statistically significant increase in serum malondialdehyde levels in the oral precancer and oral cancer patients compared with the control group. Conclusion: Increased serum malondialdehyde in oral cancer and oral precancer would serve as a valuable marker for both preventive and clinical intervention, and may deserve further investigation for the early diagnosis, treatment, and prognosis.
  25 6,877 717
Fluorescence spectroscopy for noninvasive early diagnosis of oral mucosal malignant and potentially malignant lesions
Pankaj Chaturvedi, Shovan K Majumder, Hemant Krishna, Sidramesh Muttagi, Pradeep K Gupta
October-December 2010, 6(4):497-502
DOI:10.4103/0973-1482.77097  PMID:21358088
Background: We report the results of a clinical in vivo study to evaluate the potential of fluorescence spectroscopy for differential diagnosis of oral mucosal malignant and potentially malignant lesions. Materials and Methods: The study involved 26 healthy volunteers and 144 patients enrolled for routine medical examination of the oral cavity at the outpatient department of the Tata Memorial Hospital, Mumbai. In vivo autofluorescence spectra were recorded using a N 2 laser based portable fluorimeter developed in-house. The different tissue sites investigated belonged to either of the four histopathologic categories: 1) squamous cell carcinoma (SCC), 2) oral sub-mucous fibrosis (OSMF), 3) leukoplakia (LP) and 4) normal squamous tissue. A multivariate statistical algorithm capable of direct multi-class classification was used to predict pathological designations. Results: With respect to histopathology as the "gold standard", the diagnostic algorithm was found to provide an accuracy of 82, 76, 81 and 85% based on leave-one-patient-out cross-validation in classifying the oral tissue spectra into four different pathology classes - SCC, OSMF, LP, and normal squamous tissue - respectively. When the algorithm was employed for delineating the normal oral tissues from all the abnormal oral tissues including SCC, OSMF and LP put together, a sensitivity of 98% and a specificity of 100% were obtained. Conclusion: The results suggest that it is possible to objectively classify the oral tissue into different pathology classes based on their in vivo autofluorescence spectra. Thus, the technique can potentially improve oral screening efforts in low resource settings where clinical expertise and resources are limited.
  15 6,781 646
Evaluation of natural killer cell activity in pre and post treated breast cancer patients
Ahmad Piroozmand, Zuhair M Hassan
October-December 2010, 6(4):478-481
DOI:10.4103/0973-1482.77110  PMID:21358084
Aim: To evaluate natural killer (NK) cells activity in breast cancer patients and its comparison with normal individuals. Settings and Design: Breast cancer is the most prevalent type of spontaneous tumor in humans, and NK cells are the first line defense against such tumors. There is a reverse correlation between NK activity and metastasis and reducing the tumor mass by surgery may be monitoring the NK activity. In this study, we evaluate NK activity in pre and post mastectomy patients. Materials and Methods: Eighteen patients with invasive ductal carcinoma attended to cancer research institute were included in this study. NK cells were evaluated in pre and post mastectomy patients. PBMCs were isolated by ficoll hypaque. NK cell activity (% lysis of K562) was evaluated by flowcytometer. Statistical Analysis Used: One way analysis of variation (ANOVA) and KruskalWallis nonparametric test were employed using SPSS software. Results: While NK cell activity was greatly impaired in breast cancer patients (average lysis of K562 target cells: 24.4% vs. 62.5% in healthy controls, n = 18), it was found to be significantly increased after mastectomy (37.7%). Conclusions: Mastectomy may lead to increased activity of NK cells among patients suffering from breast cancer and their increased activity may produce positive therapeutic effect.
  15 5,473 538
Comparative analysis of gene expression profiles of papillary thyroid microcarcinoma and papillary thyroid carcinoma
Hoon Yub Kim, Woong-Yang Park, Kyu Eun Lee, Won Seo Park, Yoo Seung Chung, Su Jin Cho, Yeo-Kyu Youn
October-December 2010, 6(4):452-457
DOI:10.4103/0973-1482.77103  PMID:21358079
Purpose: Papillary thyroid carcinomas (PTCs) measuring 1.0 cm or less were separately defined as papillary thyroid microcarcinomas (PTMs) by the World Health Organization, emphasizing on their benign behavior. However, some reported that PTMs may have aggressive behavior, can cause regional, or even distant metastases. But till now, the characteristics of PTMs were only reviewed and described by the clinicopathological parameters, and no analysis of PTM by the gene level is available. We report on the gene expression profiles of PTMs by the oligonucleotide microarrays and the results of comparative analysis with those of PTCs. Materials and Methods: The gene expression profiles of 25 pairs of PTMs and their normal thyroid tissue counterparts, and 11 pairs of PTCs and their normal counterparts, were analyzed by Affymetrix Human Genome U133A. Data were analyzed by the SAM and the DAVID 2008 program to detect differentially expressed genes in supervised sample classification. Results: Two-hundred thirteen statistically significant up-regulated genes and -183 significant down-regulated genes of PTMs compared with their normal counterpart thyroid tissues, which were mainly cell adhesion-related genes and immune response genes, were detected. Two-hundred sixty-one up-regulated and -157 down-regulated genes of PTCs were also detected. In the comparative analyses of gene expression profiles of PTMs and PTCs, no significant difference was found. Conclusion: PTM should not be considered as the simple occult indolent thyroid cancer, but as the earlier stage of disease which eventually evolves into PTC, because the gene expression profiles of PTMs were not different from those of PTCs.
  13 4,832 494
CASE REPORTS
Squamous cell carcinoma of the renal pelvis presenting as hydronephrosis
Ranjana Bandyopadhyay, Saumitra Biswas, Dipanwita Nag, Asit Kumar Ghosh
October-December 2010, 6(4):537-539
DOI:10.4103/0973-1482.77060  PMID:21358095
Primary malignant tumors of the renal pelvis are relatively rare with squamous cell carcinoma (SCC) accounting for 0.7% to 7%. We present a case of a 58-year-old male with huge hydronephrosis on the left side where histology of the resected specimen showed features of SCC. There was no evidence of renal calculi or other predisposing factors. The case highlights the rarity of the tumor in the absence of calculi, as well as the importance of a careful study of a gross specimen and histologic sections in every case of hydronephrosis.
  11 6,136 376
ORIGINAL ARTICLES
Effectiveness of triclosan in the management of radiation-induced oral mucositis: A randomized clinical trial
PS Satheeshkumar, Moideen Sha Chamba, Anita Balan, KT Sreelatha, VN Bhatathiri, Tinky Bose
October-December 2010, 6(4):466-472
DOI:10.4103/0973-1482.77109  PMID:21358082
Introduction: Oral care in cancer patients is an important aspect in the quality of life of patients undergoing cancer therpay. Mucositis, trismus, salivary gland dysfunction are the main complications of the cancer therapy, which lead to long-term comlications such as radiation caries, poor oral hygiene and osteoradionecrosis. A timely oral evaluation and intervention in these patients can reduce the severity of the potential complications. Triclosan is an antibacterial agent widely used in periodontal therapy, the effectiveness of triclosan in the management of radiation induced oral mucositis is evaluated here. Aims: 1) To determine the effectiveness of triclosan in the management of radiation-induced oral mucositis. 2) To compare the effectiveness of triclosan mouth rinse with conventional sodium bicarbonate mouth rinse. Materials and Methods: Twenty-four patients who underwent radiation therapy for oral cancer and subsequently developed oral mucositis were included in the study. They were randomly allocated into two groups on noticing grade I mucositis (erythema). The study group was advised to use triclosan mouthwash containing triclosan 0.03% W/V and sodium bicarbonate 2 mg mouth wash for the control group. A weekly follow-up evaluation of body weight, food intake, pain and grading of mucositis were made during the radiation treatment period and post radiation treatment period. Results: Both the groups were statistically identical. All the 24 patients in both the groups passed through grade 3 mucositis on the last day of radiotherapy. However, 10 patients in the control group and only one patient in the study group entered to grade 4 mucositis. A definite change was noticed in the severity of the mucositis, food intake and weight loss. The control group took more than 45 days to resolve while the study group took only less than 28 days. Discussion: The results of the study were evaluated and tried to formulate a hypothesis so as to explain the less severity and early resolution of mucositis in the study group. Conclusion: Triclosan mouthwash was found to be effective in reducing the severity of radiation- induced oral mucositis and helped in early reversal of symptoms during post treatment period. However, further studies are necessary to confirm this observation.
  11 8,484 896
Pattern of malignant tumors registered at a referral oral and maxillofacial hospital in Sudan during 2006 and 2007
Tarig A Osman, Asim A Satti, Olav E Bøe, Yi-Hsin Yang, Salah O Ibrahim, Ahmed M Suleiman
October-December 2010, 6(4):473-477
DOI:10.4103/0973-1482.77112  PMID:21358083
Background: A progressive increase in the incidence and mortality of oral cancer is expected in Sudan. However, updated information on the epidemiology and pattern of the disease in the country is needed to draw the attention of the local authorities. Aim: The aim of this study has been to describe the pattern of cancer cases attending a referral oral and maxillofacial hospital in Sudan during the period 2006-2007. Settings and Design: The investigation was conducted as a cross-sectional study using the hospital records. Materials and Methods: From the hospital database, all cancer cases registered during the study period have been reported and their demographic characteristics, clinical information and history of oral habits were included. Statistics: Statistical Package for Social Sciences (version 12) was used for data analysis. Frequency distributions of the study variables were made and the association between pairs of variables was examined using the Chi-square test with a level of significance of 0.01. Results and Conclusion: Of the 261 cases included in this study, the most common pattern was found to be an intraoral squamous cell carcinoma (73.6%). The male to female ratio was approximately 3:2. Dropout rates were alarmingly high regardless of the patient's state of residence. The observation of this study indicated that most of the patients seek treatment when the tumor reaches late stage. More public health efforts are therefore needed to investigate the current impact of the problem as well as for prevention and early detection of the cases.
  10 5,027 409
Apoptosis induced by Magnolia Grandiflora extract in chlorambucil-resistant B-chronic lymphocytic leukemia cells
Gustavo Horacio Marin, Eduardo Mansilla
October-December 2010, 6(4):463-465
DOI:10.4103/0973-1482.77107  PMID:21358081
Background: B-cell chronic lymphocitic leukemia (B-CLL) still remains as an uncurable disease. Even the newest antineoplastic agents have demonstrated limitations in their efficacy. For this reason, further research of new compounds must be done. New pharmacological properties can be obtained from a great diversity botanical species. Among these products, Magnolia Grandiflora receives our attention since it mainly contains Honokiol which had demonstrated effect against B-CLL cells activating different cell death pathways. Aim: To test the ability of Magnolia Grandiflora extracts to induce apoptosis of B-CLL cells in vitro. Materials and Methods: Herb's extraction: Twenty grams of powdered material were submitted to three consecutives decoctions with 500 ml of distilled water (96 °C), filtered and followed by ultrafiltration with cellulose membrane, lyophilized and reconstituted in AIM-V medium at a final concentration of 10 mg/ml solution. B-CLL chlorambucil- resistant cells were separated and cultivated in the presence of Magnolia's extract. Samples of cells were taken from the cultures at 24, 48 and 72 h for apoptosis analysis by flow cytometry measuring positive annexin V (0.1 μg/ml) cells. Statistics: Apoptosis values were represented by the mean plus or minus SD (± SD) for five independent experiments. Statistical significance was determined by Student's t -test. A P value of 0.05 or less was considered as significant. Results and Conclusion: This article discusses the apoptosis properties of Magnolia on B-CLL cells. The evidence suggests a potentially effective repertoire for B-CLL treatment. This herb extract might have promising therapy strategies in treating B-CLL or other hematological disease resistant to alkylating agents in clinical practice.
  9 5,958 451
Dosimetric risk estimates of radiation-induced malignancies after intensity modulated radiotherapy
Vijay M Patil, Rakesh Kapoor, Santam Chakraborty, Sushmita Ghoshal, Arun S Oinam, Suresh C Sharma
October-December 2010, 6(4):442-447
DOI:10.4103/0973-1482.77082  PMID:21358077
Context: The increasing popularity of intensity-modulated radiotherapy (IMRT) stems from its ability to generate a more conformal plan than hitherto possible with conventional planning. As a result, IMRT is in widespread use across diverse indications. However, the inherent nature of IMRT delivery makes it monitor unit inefficient and leads to increased normal tissue integral dose. This in turn may result in an increased risk of radiation-induced second malignancies. Aim: To calculate the risk of second malignancy post-IMRT. Settings and Design: Observational study in a tertiary care institute. Materials and Methods: Eighteen previously untreated patients with head and neck cancers (n = 10) and prostate cancer (n = 8) were selected. In these patients, selected infield organs around the planning target volume were contoured, viz. brain and thyroid in patients with head and neck cancer and bladder, rectum and small intestine in patients with carcinoma prostate. The estimates of radiation-induced malignancies in these organs and the whole of the body were derived using the concept of Organ Equivalent Dose. Statistical Analysis Used: Descriptive statistics (SPSS version 12). Results: The modal estimated incidence of radiation-induced malignancies was 129.87, 1.4, 0.10, 3.42, 7.789 and 129.85 per 10,000 person-years for the brain, thyroid, bladder, rectum, small intestine and whole body respectively. Conclusions: The estimated risk of radiation-induced malignancies in the thyroid and rectum was similar to the available literature, while the risk for bladder carcinomas was lower than that reported. However, the calculated risk of radiation-induced tumors of the brain was more than that reported with conventional radiation therapy. We propose that estimation of the risk of radiation-induced malignancies should be a part of the plan evaluation process and special care should be taken before using this modality in young patients with benign tumors in the head and neck region.
  9 5,253 456
Risk-scoring system for predicting mucositis in patients of head and neck cancer receiving concurrent chemoradiotherapy [rssm-hn]
A.V.S Suresh, P Pratap Varma, Sudha Sinha, Satya Deepika, Raghu Raman, M Srinivasan, T Mandapal, C Obula Reddy, BB Anand
October-December 2010, 6(4):448-451
DOI:10.4103/0973-1482.77100  PMID:21358078
Background: One of the most distressing complications of head and neck cancer patients on chemoradiotherapy is mucositis. There is no proper tool to predict its occurrence in these patients. Aim: This study was conducted to develop a risk-scoring system to predict probable incidence and severity of mucositis in head and neck cancer patients on chemoradiotherapy. Materials and Methods: This is a retrospective analysis conducted at a tertiary care cancer center with approximately 2,000 new cases of head and neck cancer patients annually. We Hypothesized were age, comorbid conditions, leukocyte count, nutritional status, oral hygiene, tobacco use, erythrocyte sedimentation rate (ESR); Eastern cooperative oncology group (ECOG) performance status (PS) and TNM (tumor, node, metastasis) stage as possible risk factors. Receiver operating characteristic (ROC) curves were drawn to predict the cutoff values for risk factors, and a final scoring system was developed with sensitivity and specificity data. Results: A total of 218 patients on chemoradiation receiving cisplatin 40 mg/m 2 /week along with local radiation of 60-70 Gy depending on primary site were analyzed. Based on ROC analysis, the following cutoff values were selected: age > 40 years, ECOG PS > 2, WBC < 3000/μL, elevated ESR, albumin < 3 gm/dL and > stage III disease. The remaining factors were indicated as present or absent. A score of 1 was assigned for the above risk factors. For patients, the final score of 3 or less there is 17% probability of developing grade 3 or 4 mucositis, while patients having score of 6 or more have 76% probability. Conclusion: The current tool is fairly accurate in predicting development of mucositis in head and neck caner patients on chemoradiotherapy. This will further help clinicians to adopt preventive strategies as well as better counseling.
  9 5,641 640
Extent of surgery in the management of phyllodes tumor of the breast: A retrospective multicenter study from India
Satyajeet Verma, RK Singh, A Rai, CP Pandey, Mahendra Singh, N Mohan
October-December 2010, 6(4):511-515
DOI:10.4103/0973-1482.77085  PMID:21358091
Introduction: Phyllodes tumor (PT) is a rare tumor of the breast. Usually, difficulty in making preoperative diagnoses and unpredictable clinical outcome of this disease leads to inappropriate management. Till date, no definite conclusion regarding the appropriate surgical procedure can be drawn. Objectives: The objective of this retrospective study is to study the clinicopathological correlation of phyllodes tumors in North-Central part of the India and also to evaluate efficacy of the various surgical options available for the management of phyllodes tumors of the breast. Materials and Methods: A retrospective study of 24 cases from the archives of department of surgery of three tertiary institutes of North-Central part of India. We reviewed the clinical, pathological features of this disease entity with a view to highlight relevant features. We also analyzed various surgical options done for primary as well as recurrent PT. Results: The breast masses in our study were particularly large. The mean size of the lump was 9.5΁5.5 cm (range was 4.0-23 cm). Histopathological report was benign, borderline, and malignant PT in 62.4%, 20.8%, and 16.8% of the cases, respectively. Overall, 31 surgical procedures (24 in primary and 7 in recurrent) were performed. Simple lumpectomy, wide local excision and simple mastectomy were done in 25%, 27.4% and 27.4% of primary (non-recurrent) cases of PT, respectively. Modified radical mastectomy and simple mastectomy with LD flap reconstruction was done in 7.2% and 2.4% in primary cases, respectively in recurrent cases, simple mastectomy was done in four cases and modified radical mastectomy was done in one case. Overall, recurrence was seen in 29.2% of the cases. The median time for recurrence was 6 months (range 5.0-36 months). 90% (6/7) of recurrence occurred in lumpectomy patients. Conclusion: The unpredictable behavior of histological types and the disputable results of particular surgical procedures have contributed to the controversies. The therapeutic issue is further compounded by an imprecise preoperative diagnosis. This study shows that wide local excision for benign and borderline and simple mastectomy with or without reconstruction for the malignant PT of the breast are acceptable best surgical options.
  9 12,278 569
Treatment outcome of patients with carcinoma of vulva: Experience from a tertiary cancer center of India
Daya Nand Sharma, Goura Kisor Rath, Sunesh Kumar, Neerja Bhatla, Parmod Kumar Julka, Puja Sahai
October-December 2010, 6(4):503-507
DOI:10.4103/0973-1482.77090  PMID:21358089
Purpose: The aim of our retrospective study was to analyze and report the clinical outcome of patients with vulvar carcinoma (VC) treated at our center. Materials and Methods: We retrieved the information regarding patients' clinical details, treatment given, survival and complications from the case records of all VC patients who were treated at our center during the year 1998-2005. Overall survival (OS) was determined with respect to age, histopathological grade, stage of disease, treatment group, pathological lymph node status, etc. Results: A total of 60 case records were retrieved for this retrospective analysis. Age ranged from 24 to 92 years (median 63 years). International Federation of Gynecology and Obstetrics (FIGO) stage distribution was as follows: stage I: 2 patients; stage II: 17 patients; stage III: 31 patients; stage IV: 9 patients; and unknown stage: 1 patient. Thirty-three patients underwent surgery (wide local excision 3, radical vulvectomy 30). Eleven patients received postoperative radiation therapy (PORT), 12 received palliative radiation therapy (RT) and 15 underwent definitive RT (5 of them received concurrent chemotherapy). Median follow-up period was 23 months (range 2-144 months). The 5-year OS for all stages was 41%. FIGO stage and pathological node positivity were found to be statistically significant prognostic factors for survival. Conclusion: Despite the majority of patients presenting in advanced stage, the 5-year OS of 41% in our series reflects a decent therapeutic outcome. The results have shown FIGO stage and pathological node positivity to be significant prognostic factors for survival. The use of preoperative chemotherapy/RT needs to be studied in our setup.
  8 4,849 455
REVIEW ARTICLES
From tumor immunology to cancer immunotherapy: Miles to go
Manjul Tiwari
October-December 2010, 6(4):427-431
DOI:10.4103/0973-1482.77071  PMID:21358075
Advances in tumor immunology are supporting the clinical implementation of several immunological approaches to cancer in the clinical setting. However, the alternate success of current immunotherapeutic regimens underscores the fact that the molecular mechanisms underlying immune-mediated tumor rejection are still poorly understood. Given the complexity of the immune system network and the multidimensionality of tumor/host interactions, the comprehension of tumor immunology might greatly benefit from high-throughput microarray analysis, which can portrait the molecular kinetics of immune response on a genome-wide scale, thus accelerating the discovery pace and ultimately catalyzing the development of new hypotheses in cell biology. Although the general principles of microarray-based gene profiling with the application of DNA microarray have rapidly spread in the scientific community, the need for mastering this technique to produce meaningful data and correctly interpret the enormous output of information generated by this technology is critical and represents a tremendous challenge for investigators. To describe the sequence of events conductive to an effective immune recognition and killing of malignant cells, clinicians might use gene profiling as a powerful tool to assess the activation status of the immune system before and during immunotherapy.
  8 5,694 854
ORIGINAL ARTICLES
Treatment results of radical radiotherapy of carcinoma uterine cervix using external beam radiotherapy and high dose rate intracavitary radiotherapy
SK Azad, V Choudhary
October-December 2010, 6(4):482-486
DOI:10.4103/0973-1482.77108  PMID:21358085
Aim: To report the outcome of carcinoma cervix patients treated radically by external beam radiotherapy and high dose rate intracavitary radiotherapy. Material and Methods: From January 2005 to December 2006, a total of 709 newly diagnosed cases of carcinoma cervix were reported in our department. All cases were staged according to the International Federation of Gynecologist and Oncologist staging system. Out of 709 cases, 342 completed radical radiotherapy and were retrospectively analyzed for the presence of local residual disease, local recurrence, distant metastases, radiation reaction, and disease free survival. Results: There were 11(3.22%), 82(23.98%), 232(67.83%), and 17(4.97%) patients in stages I, II, III, and IV, respectively. The median follow up time for all patients was 36 months (range 3 -54 months). The overall treatment time (OTT) ranged from 52 to 69 days (median 58 days). The 3 year disease free survival rate was 81.8%, 70.7%, 40.08%, and 11.76% for stages I, II, III, and IV, respectively. There were 91 (26.6%) cases with local residual diseases, 27(7.9%) developed distant metastasis, and 18(5.26%) pts had local recurrence. Discussion: The results of this study suggest that radical radiotherapy with HDR brachytherapy was appropriate for the treatment of early staged cancer of uterine cervix. For locally advanced cancer of cervix addition of concurrent chemotherapy, higher radiation doses, reduction of overall treatment time to less than 8 weeks, and use of latest radiotherapy techniques such as IMRT is recommended to improve the results.
  7 6,454 896
CASE REPORTS
Unusual clinical and radiological presentation of metastatic choriocarcinoma to the brain and long-term remission following emergency craniotomy and adjuvant EMA-CO chemotherapy
Ravi Dadlani, Sunil V Furtado, Nandita Ghosal, KV Prasanna, AS Hegde
October-December 2010, 6(4):552-556
DOI:10.4103/0973-1482.77069  PMID:21358100
Choriocarcinoma is the most malignant tumor of gestational trophoblast origin. Metastasis to brain is considered a poor prognostic indicator. Recent advances in adjuvant radiotherapy and chemotherapy have led to an excellent outcome of these patients. Craniotomy is indicated in selected cases with cerebral metastases. The authors report an interesting case of an aggressive choriocarcinoma with multiple metastases to the brain and viscera. The patient had radiological evidence of new lesions occurring almost every week while on the initial treatment and yet had a complete long-term remission with EMA-CO therapy. The interesting presentation, radiology and adjuvant therapies are discussed.
  6 9,243 419
Good clinical and cost outcomes using dexrazoxane to treat accidental epirubicin extravasation
Patricia Araque Arroyo, Ruth Ubago Perez, Maria Amalia Fernandez Feijoo, Miguel Angel Calleja Hernandez
October-December 2010, 6(4):573-574
DOI:10.4103/0973-1482.77081  PMID:21358106
A 75-year-old man diagnosed with lower esophageal adenocarcinoma suffered from epirubicin extravasation during the second cycle of neoadjuvant chemotherapy with epirubicin and oxaliplatin. A full recovery was achieved after treatment with dexrazoxane (Cardioxane® ). This is the first time in our hospital that extravasation of an anthracycline has been treated with dexrazoxane. We used Cardioxane® , approved for the prevention of anthracycline-induced cardiotoxicity, while Savene® is indicated for the treatment of anthracycline extravasation. The treatment was effective, and the selection of Cardioxane® (seven-fold cheaper than Savene® ) yielded a cost saving. Consequently, Cardioxane® has been included in our guidelines for anthracycline extravasation.
  6 6,727 409
Interstitial lung disease associated with FOLFOX chemotherapy
Joo Han Lim, Hoon Kim, Woong Gil Choi, Moon Hee Lee
October-December 2010, 6(4):546-548
DOI:10.4103/0973-1482.77066  PMID:21358098
Currently, FOLFOX regimen has been widely used as an effective approach for treating many advanced GI tract cancers. Toxicity induced by oxaliplatin has been well known and mostly moderate and manageable. Gastrointestinal, hematological and neurosensory toxicities are the most common. However, information concerning the pulmonary toxicity of this regimen is very limited and only a few cases of severe lung toxicity associated with FOLFOX chemotherapy have been reported. Here, we report a fatal case of interstitial lung disease which was associated with FOLFOX chemotherapy in metastatic advanced gastric cancer. The patient expired from progressive respiratory failure. This case suggests that FOLFOX-induced interstitial lung disease should be considered in the differential diagnosis of new lung lesions in patients who are treated with FOLFOX chemotherapy. And further investigations of possible association that may lead to acute respiratory failure are warranted.
  5 6,796 451
A rare case of primary gastric plasmacytoma: An unforeseen surprise
Navin Krishnamoorthy, Munita M Bal, Mukta Ramadwar, Kedar Deodhar, KM Mohandas
October-December 2010, 6(4):549-551
DOI:10.4103/0973-1482.77067  PMID:21358099
Primary plasmacytoma of the gastrointestinal tract is a rare entity. We report a case of a primary gastric plasmacytoma in a 57-year-old man who presented with upper-gastrointestinal bleeding. Endoscopy showed a nodular gastric mass with central umblication. Histological examination of the gastrectomy specimen revealed a monoclonal lambda-chain extramedullary plasmacytoma. Further staging was found to be negative for multiple myeloma. As other more common pathologic processes at this site may also be endowed with numerous plasma cells, awareness of this entity and distinction using immunohistochemistry are extremely crucial. Because systemic disease ultimately develops in many patients with localized plasmacytoma, such patients should be followed closely for the appearance of clinical, biochemical, and roentgenologic evidence of multiple myeloma.
  5 6,441 501
Cystic angiomatous meningioma in the cerebellopontine angle mimicking hemangioblastoma
Prabal Deb, Hirdesh Sahni, Harjinder Singh Bhatoe
October-December 2010, 6(4):560-563
DOI:10.4103/0973-1482.77074  PMID:21358102
We hereby report an extremely unusual case of cystic angiomatous meningioma in the CPA region in a 58-year-old male patient. He presented with complaints of headache, repeated episodes of vomiting and increasing unsteadiness of gait. Neuroimaging showed a large multicystic left-sided tentorial tumor projecting into the cerebellum and CPA with contrast-enhancing peripheral solid rim. He underwent a left retromastoid craniectomy and total excision of the tumor. Histopathology revealed an angiomatous meningioma with predominant microvascular component and extensive cystic changes. Immunopositivity for epithelial membrane antigen (EMA), vimentin and S-100 protein proved vital in excluding a hemangioblastoma.
  5 5,408 419
ORIGINAL ARTICLES
Fatigue in prostate cancer patients treated with external beam radiotherapy: A prospective 5-year long-term patient-reported evaluation
Per Fransson
October-December 2010, 6(4):516-520
DOI:10.4103/0973-1482.77076  PMID:21358092
Background: Limited information is available regarding the long-term effect of external beam radiotherapy (EBRT) on fatigue in individuals with prostate cancer (PC). Materials and Methods: Men with PC treated with EBRT from January 1992 to June 2003 were enrolled in a prospective study. The QLQ-C30 questionnaire was used to evaluate pre-treatment fatigue and up to 5 years post-treatment. Results: 407 men with 5-year assessments were analyzed. Fatigue increased between pre-treatment (mean: 15.5; CI: 13.6-17.4) and 5-years post-treatment (mean: 22.8; CI: 20.5-25.1; P<0.001). Pre-treatment fatigue was absent in 206/407 (59%) patients and 5-year post-treatment was reported by 264/407 (66%). Sixteen of 407 patients (4%) reported severe fatigue after 5 years. Physical-, emotional-, cognitive function, and dyspnea were the factors that correlated most to higher level of fatigue 5-year post-treatment. Conclusions: Fatigue is a common symptom among patients with PC. A large percentage of patients reported pre-treatment fatigue. Fatigue increased over time, with the highest level seen at the end of EBRT. Severe fatigue was reported by 4% 5-year post-treatment. More work is needed in order to identify which patients are most susceptible to developing fatigue especially during radiotherapy.
  5 4,687 329
REVIEW ARTICLES
Monte Carlo and experimental dosimetric study of the mHDR-v2 brachytherapy source
Rakesh M Chandola, Samit Tiwari, Manoj K Kowar, Vivek Choudhary
October-December 2010, 6(4):421-426
DOI:10.4103/0973-1482.77068  PMID:21358074
The conventional treatment planning system (TPS) gives analytical calculations with ± 15 to 20% dose, which may lead to over exposure of critical organs or under dose of target. It is to obtain dose distribution parameters of nucletron high dose rate (HDR) microselectron v2 (mHDR-v2) 192 Ir brachytherapy source by experiment and by calculated study using Monte Carlo (MC) EGSnrc code, and to find the similarity between them, and with any past study. To validate data, another MC GEANT4 study done in this work on the same source is also presented. Different software of the computer e.g. paint, excel, etc are employed for preparation of figures and graphs. The measured study of the source was done using an in-air ionization chamber, water phantom, and measurement set-up, while the calculated study was done by modeling the set up of the measured study by using the MC EGSnrc and GEANT4. Mean and probability are used in calculation of average values, and calculation of the uncertainties in result and discussion. The measured and calculated values of dose rate constant, radial dose function, and 2D anisotropy function were found to be in agreement with each other as well as with published data. The results of this study can be used as input to TPS.
  5 7,055 384
CASE REPORTS
Endolymphatic sac papillary carcinoma treated with surgery and post-operative intensity-modulated radiotherapy: A rare case report
Rajni Gupta, AN Vaidhyswaran, V Murali, Mohan Kameswaran
October-December 2010, 6(4):540-542
DOI:10.4103/0973-1482.77062  PMID:21358096
Endolymphatic sac tumor is a rare papillary neoplasm of the temporal bone which can occur sporadically or in association with von Hippel-Lindau disease. Many cases have been reported in neurosurgical literature wherein surgical excision has proved to be the gold standard of treatment. This article highlights the rarity of the pathology and the role of radiotherapy to the residual lesion after surgery. Benefits of intensity modulated radiotherapy in such irregular-shaped tumor, which is in close vicinity to the critical structures, are also discussed.
  4 4,297 224
Acute Budd-Chiari syndrome as an initial presentation of acute promyelocytic leukemia
Sanjay Bandyopadhyay, Debottam Bandyopadhyay
October-December 2010, 6(4):567-569
DOI:10.4103/0973-1482.77077  PMID:21358104
Budd-Chiari syndrome (BCS) is the constellation of clinical signs and symptoms resulting from occlusion of two or more hepatic veins, often due to an underlying thrombophilic disorder. Acute myeloid leukemia has been rarely reported to be associated with hepatic vein thrombosis due to hyperleukocytosis, hyperfibrinolysis and disseminated intravascular coagulation. We report a case of acute promyelocytic leukemia where the clinical onset of the hematological disease was with acute BCS.
  4 5,566 299
ORIGINAL ARTICLES
Efficacy of alpha lipoic acid in adjunct with intralesional steroids and hyaluronidase in the management of oral submucous fibrosis
Prasanna Kumar Rao
October-December 2010, 6(4):508-510
DOI:10.4103/0973-1482.77087  PMID:21358090
Background and Objectives: Oral submucous fibrosis (OSF) is a chronic irreversible condition of the oral mucosa with proven malignant potential. However, till date, there has been a dearth of effective management strategies. This study used alpha lipoic acid, an antioxidant, in oral form to determine if it could be useful in managing OSF patients. Materials and Methods: A case-control study was conducted on 18 patients of OSF (9 cases and 9 controls). The case group was treated using alpha lipoic acid in addition to the intralesional steroid and hyaluronidase injections used in the control group. Results: The cases in the alpha lipoic acid group exhibited better relief of symptoms such as burning sensation of the mucosa and mouth opening, as compared to the controls. The use of alpha lipoic acid along with intralesional steroids and hyaluronidase caused reversal of higher clinical stages to lower ones. Conclusion: The use of an antioxidant, alpha lipoic acid, along with conventional therapy of intralesional steroid injections definitely seems to have a beneficial impact in the management of OSF.
  4 4,976 662
CASE REPORTS
Vocal cord schwannoma: A rare case report
SH Chandrashekhara, AS Bhalla, KV Kartikeyan, B Shukla, R Safaya
October-December 2010, 6(4):543-545
DOI:10.4103/0973-1482.77063  PMID:21358097
Schwannomas of the larynx are rare benign tumors, most commonly involving aryepiglottic folds or false vocal folds. When a tumor involves vocal cord, it causes clinical symptoms like hoarseness of voice and foreign body sensation. We report the CT and magnetic resonance imaging findings in a 19-year-old male patient with vocal cord mass histologically diagnosed as a vocal cord schwannoma.
  3 5,362 253
LETTERS TO THE EDITOR
Spontaneous regression of optic chiasmatic glioma in pediatric patients: When to intervene?
Debnarayan Dutta, V Chendil, Anusheel Munshi, Tejpal Gupta, Rakesh Jalali
October-December 2010, 6(4):591-593
DOI:10.4103/0973-1482.77096  PMID:21358114
  3 3,922 285
ORIGINAL ARTICLES
Changes in salivary flow rates in head and neck cancer after chemoradiotherapy
Punita Lal, Ranjeet Bajpai, Rohini Khurana, KJ Maria Das, Prabhat Kumar, Anu Tiwari, Neha Gupta, Shaleen Kumar
October-December 2010, 6(4):458-462
DOI:10.4103/0973-1482.77105  PMID:21358080
Background: Changes in salivary flow rate were studied in head and neck (H and N) cancer patients who, after receiving moderately accelerated radiotherapy (RT) and concurrent chemotherapy (CT), were free of disease at 1 year. Materials and Methods: Between July 2003 and July 2005, saliva estimation was performed for 36 patients of locally advanced (AJCC stages III and IV) squamous cell carcinoma of the H and N. RT, moderately accelerated (70Gy/35 fx/6 weeks) along with concurrent weekly cisplatin at 35 mg/m 2 (capped at 50 mg) with standard hydration and anti-emetic cover, was planned using conventional planning on telecobalt or 6 MV photons. The saliva flow rate was estimated for 5 min at rest (unstimulated) and after using lemon drops (stimulated) for the next 5 min at baseline (pre-treatment), 3, 6 and 12 months following treatment. Results: The median follow-up of this study was 29 months. Compared with baseline, by 3 months, a significant reduction in unstimulated (0.35 ml/min and 0.10 ml/min) and stimulated (0.97 ml/min and 0.28 ml/min) salivary flow rate was observed, respectively. This continued to decrease further till 6 months (0.06 ml/min and 0.17 ml/min) and, by 12 months, a minimal and non-significant recovery was observed in both unstimulated (0.08 ml/min) and stimulated salivary flow rates (0.22 ml/min), respectively. Conclusions: Salivary flow rates fall to a fourth of the baseline value with the above CT + RT protocol, with minimal recovery at 12 months following completion of treatment.
  3 4,276 393
REVIEW ARTICLES
AIDS: A radiation oncologist's perspective
Suman Mallik, Kaustav Talapatra, Jyotirup Goswami
October-December 2010, 6(4):432-441
DOI:10.4103/0973-1482.77078  PMID:21358076
While HIV is often associated with tuberculosis and a number of opportunistic infections, the spectrum of diseases of patients with HIV infection encompasses a number of malignancies as well. Typically, these are the AIDS-defining malignancies, though other malignancies also comprise a significant caseload. Radiotherapy plays an integral part in anti-cancer treatment and its tolerance and efficacy in HIV+ patients are therefore important. The patient's level of immunity as manifested by the CD4 count has a significant bearing on treatment outcomes. In some cases, like primary central nervous system lymphoma (PCNSL), the occurrence of the malignancy itself is tied to the patient's immunity with increased incidence in patients with CD4 counts less than 50/mm 3 . The success of highly active antiretroviral therapy (HAART) has allowed administration of standard doses of radiotherapy and even chemotherapy in recent times leading to improved outcomes. In general, standard radiotherapy and concomitant chemo-radiotherapy protocols should be used wherever possible, so as not to compromise disease control. Local control and disease-specific survival rates in HIV patients are no worse than in HIV? patients, but this is only true for CD4 counts above 200/mm 3 . In certain situations like cervical intraepithelial neoplasia CIN, HAART itself is associated with disease regression. The question of increased radiosensitivity in HIV patients remains unresolved in most diseases and there are sparse data with regard to non-HIV associated malignancies in these patients. Greater caution and emphasis on good supportive care and HAART would appear to be essential when treating the malignancies in HIV+ patients with standard anti-cancer regimens.
  3 6,191 712
BRIEF COMMUNICATION
Integral dose to the carotid artery in intensity modulated radiotherapy of carcinoma nasopharynx: Extended field IMRT versus split-field IMRT
A Bahl, K.S.J. Basu, DN Sharma, GK Rath, PK Julka, S Thulkar
October-December 2010, 6(4):585-587
DOI:10.4103/0973-1482.77089  PMID:21358110
Aim : To evaluate the integral dose to carotid vessels in extended field intensity modulated radiotherapy (IMRT) (including the lower neck nodes in IMRT field) and split field IMRT (using separate single anterior field to treat lower neck nodes) in cancer nasopharynx. Materials and Methods : Dosimetric data from 10 patients of carcinoma nasopharynx, undergoing IMRT, were evaluated in this prospective study. The carotid vessels were contoured from sternoclavicular joints upto the base of skull. IMRT plans were generated for all patients with extended field and split field IMRT techniques using nine coplanar beams with 6 MV photons. A dose of 70 Gy to planning target volume (PTV) 70Gy , 59.4 Gy to PTV 59.4Gy and 54 Gy to PTV 54Gy was delivered in 33 fractions. The dose constraints were similar for both the techniques. The integral dose to the carotid arteries was calculated as the mean dose times the volume (mean dose Χ volume) in units of liter-gray. Results : The mean dose to the carotid vessels in the extended field IMRT was 63.88 ± 0.97 Gy (mean dose ± SD) and it was 64.43 ± 0.73 Gy for the split field technique. The integral dose in the extended field versus split field technique was 0.29 ± 0.0207 and 0.32 ± 0.0213 liter-gray, respectively. The difference was statistically significant (P < 0.013). Conclusions : Extended field IMRT delivers a slightly lower integral dose to carotid arteries in treatment of cancer nasopharynx while maintaining good dose homogeneity to the PTV 54Gy and can be preferred over split field radiotherapy.
  2 4,049 293
CASE REPORTS
Posterior mediastinal biphasic synovial sarcoma in a 12 year-old boy: A case report and review of literature
Madhumay Pal, Bidisha Naskar Ghosh, Chhaya Roy, Asim Kumar Manna
October-December 2010, 6(4):564-566
DOI:10.4103/0973-1482.77075  PMID:21358103
We report a case of biphasic synovial sarcoma of the mediastinum, a very rare tumor, in a 12-year-old boy with left-sided chest pain of 3 years duration at presentation. Chest X-ray showed left-sided opacity with loss of cardiac silhouette and the mediastinum deviated to the opposite side. Computed tomography (CT) of thorax showed left-sided posterior mediastinal mass with left-sided pleural effusion and pleural thickening. CT guided fine needle aspiration cytology (FNAC) from the mass reported it as spindle cell variant of adenocarcinoma. Ultrasonography (USG) of the whole abdomen revealed no abnormality. The mediastinal tumor was resected by left thoracotomy and histopathological report confirmed it to be a biphasic synovial sarcoma with capsule invasion at places.
  2 4,735 354
Capecitabine-related intracranial hypotension syndrome mimicking dural metastasis in a breast cancer patient: Case report and review of the literature
Rusen Cosar-Alas, Aykan Alas, Alaattin Ozen, Bengu Denizli, Mert Saynak, Sernaz Uzunoglu, Nurettin Aydogdu, Hakan Karagol, Cem Uzal, Zafer Kocak
October-December 2010, 6(4):557-559
DOI:10.4103/0973-1482.77070  PMID:21358101
Spontaneous intracranial hypotension (SICH) is an entity, which is secondary to iatrogenic manipulation and breaching of dura. Postural headache in patients should be suspected, cranial magnetic resonance imaging (MRI) is essential for precise diagnosis. Hallmark of MRI is regular shape of pachymeningeal gadolinium enhancement and subdural effusion. It may mimic central nervous system (CNS) metastasis. Prevention of such cases from receiving cranial radiotherapy by misinterpretation of the gadolinium enhancement as CNS metastasis is an important issue. Capecitabine is an antineoplastic agent, of which metabolites can cross blood-brain barrier in CNS via epithelial tissue. It may cause decrease in CSF production. SICH might be the clinical reflection of this decrease in CSF production. Review of the English literature revealed limited data because of the very little experience with oncologic patients suffering from intracranial hypotension. We report a case of spontaneous intracranial hypotension during capecitabine treatment. Patient was completely well following drug discontinuation and supportive treatment.
  2 5,481 477
Aneurysmal bone cyst of the calcaneum: An expansile locally destructive lesion
Ajay Malik, Prabal Deb, NS Mani, John D'Souza
October-December 2010, 6(4):570-572
DOI:10.4103/0973-1482.77080  PMID:21358105
Aneurysmal bone cyst (ABC) is a benign but locally destructive lesion affection of which in the calcaneum has rarely been reported in the literature. We report an unusual case of ABC of the calcaneum in a 17-year-old-male, who presented with painful ankle swelling with difficulty in walking. Radiology revealed benign cystic calcaneal lesion, without any evidence of fracture. Biopsy was characterized by formation of osteoid along with the presence of ecstatic blood-filled channels, consistent with ABC. However, this being an uncommon site for ABC, histopathology needs to be used to differentiate it from other benign and malignant entities, and a definitive diagnosis warrants clinical and radiological correlation. Most of the ABCs require surgical curetting and bone engraftment of the surgical defect.
  1 6,995 377
BOOK REVIEW
Specialist training in oncology
Francis James
October-December 2010, 6(4):594-594
  - 1,763 155
CASE REPORTS
Treatment options for renal cell carcinoma in patients with von Hippel-Lindau disease
Ilya Tsimafeyeu, Lev Demidov
October-December 2010, 6(4):575-577
DOI:10.4103/0973-1482.77084  PMID:21358107
We report on a family with von Hippel-Lindau (VHL) disease and atypically aggressive renal cell carcinoma. A woman and her brother had progressive VHL disease with multiple tumors in their kidneys. One patient developed pulmonary metastases. The patient who had localized disease received radiofrequency ablation with complete destruction of tumors. Cytoreductive nephrectomy was performed in the case of metastatic disease, following which sunitinib maleate (50 mg orally daily, 4 weeks on, 2 weeks off) was given. Examination after two treatment cycles showed complete regression of all metastases. For 19 months, the patients have been under active observation without disease progression. Also, we detected high immunohistochemical expression of vascular endothelial growth factor receptors 1 and 2 in the cytoplasm and nuclei of tumor cells.
  - 3,551 371
Endometrioid carcinoma of the upper urinary tract
Jagdeesh N Kulkarni, Tejal K Gorasia, Jayashree P Choudhary, Pravin P Mahajan
October-December 2010, 6(4):578-580
DOI:10.4103/0973-1482.77086  PMID:21358108
Herein, we report a second case of endometrioid carcinoma of the upper urinary tract presenting 17 years after hysterectomy for high grade adenocarcinoma of ovary. A 51-year-old nullipara presented to us with a complaint of hematuria. After complete work up, she underwent right radical nephro-ureterectomy with bladder cuff excision. The histology showed endometrioid carcinoma of upper urinary tract without any evidence of endometriosis.
  - 3,387 182
Advanced olfactory neuroblastoma treated with combined conventional and hypofractionated stereotactic radiotherapy
Satoshi Nomoto, Yoshiyuki Shioyama, Saiji Ohga, Katsumasa Nakamura, Hiroshi Honda
October-December 2010, 6(4):581-584
DOI:10.4103/0973-1482.77088  PMID:21358109
Three patients with olfactory neuroblastoma (ONB) of the nasal and/or paranasal cavity were treated with a combination of conventional radiotherapy (RT) and hypofractionated stereotactic radiation therapy (SRT). Radiation doses of 30 to 50 Gy were delivered in 12 to 25 fractions using conventional RT, and then an additional 20 to 25 Gy was delivered in 5 fractions using SRT. Follow-up time was 42, 53, 65 months, three patients were alive, and local control was obtained in all, complete response (CR) in 2 and partial response (PR) in 1. Two patients had recurrence out of the radiation field and received salvage therapy. According to the Radiation Therapy Oncology Group (RTOG) acute/late radiation morbidity scoring criteria, there were no adverse effects of grade 3 or higher. The combined treatment with conventional RT and hypofractionated SRT achieved excellent local control without serious adverse effects.
  - 4,167 311
EDITORIAL
Cancer stem cells: An enigma in head and neck cancer
Rehan Kazi, Suhail I Sayed, Raghav C Dwivedi
October-December 2010, 6(4):411-413
DOI:10.4103/0973-1482.77061  PMID:21358072
  - 3,846 629
INTERVIEW
An interview with Dr. Shelley Hukku, The new president of AROI
Sapna Gupta
October-December 2010, 6(4):595-596
  - 2,012 106
LETTERS TO THE EDITOR
Irinotecan as a maintenance therapy for hepatoblastoma: A comment
V Wiwanitkit
October-December 2010, 6(4):588-588
DOI:10.4103/0973-1482.77092  PMID:21358112
  - 2,505 214
Ameloblastoma mimicking as mucoepidermoid carcinoma on cytology
Mani Makhija, Sonal Sharma, Mrinalini Kotru
October-December 2010, 6(4):588-590
DOI:10.4103/0973-1482.77093  PMID:21358111
  - 3,934 230
Mucinous carcinoma of the male breast
Subhashish Das, Prabhakar Kalyani
October-December 2010, 6(4):590-591
DOI:10.4103/0973-1482.77094  PMID:21358113
  - 2,555 195
ORIGINAL ARTICLES
Patterns of locoregional treatment of breast cancer among radiation oncologists in India: A practice survey
Ashwini Budrukkar, Manpreet Tiwana, Rakesh Jalali, Anusheel Munshi, Rajiv Sarin
October-December 2010, 6(4):530-536
DOI:10.4103/0973-1482.77065  PMID:21358094
Background: The objective of the study was to assess and evaluate the practice patterns of locoregional treatment of early and advanced breast cancer among radiation oncologists (ROs) in India. Materials and Methods: This questionnaire-based survey was served to practicing ROs through electronic mails and personal communication between November 2006 and March 2008. Patterns of practices with respect to locoregional treatment of breast cancer in patients with ductal carcinoma in situ, early breast cancer (EBC), locally advanced and metastatic breast cancer (MBC) were studied. Results: We analyzed sixty completed forms from ROs in India. The median number of breast cancer patients evaluated per year by the treating oncologist was 130, wherein EBC comprised 30%; locally advanced breast cancer (LABC), 50%; and MBC, 20%. A median 46% of the ROs favored breast-conserving therapy (BCT) in EBC and 92% of this subgroup advised adjuvant radiation therapy (RT) in BCT. For LABC, a majority 90% of the respondents advocated a modified radical mastectomy, whereas 42% chose to include the axilla in their RT portals. Conclusions: The survey highlights the prevalent varied treatment policies followed across the country and encourages us to understand and adopt a uniform consensus for the management of breast cancer.
  - 4,313 315