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2006| January-March | Volume 2 | Issue 1
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Brain metastasis-Evidence based management
G Biswas, R Bhagwat, R Khurana, H Menon, N Prasad, PM Parikh
January-March 2006, 2(1):5-13
Advances in cancer management have resulted in a significant increase in median survival of number of diseases. Consequently we are seeing more patients living long enough to develop symptomatic brain metastases. The management of such patients will be discussed here. The most important definitive investigation is contrast enhanced MRI scan of brain. Management consists of supportive care and disease directed treatment. Surgical resection remains the gold standard for the treatment of solitary brain metastases. Whole brain radiotherapy is considered standard treatment for all patients with brain metastases. The role of chemotherapy was limited in the past. Recently several new agents have been identified as potentially useful. Preliminary results indicate that drugs like temozolomide and topotecan have antitumor activity against the brain metastases as well as the primary systemic malignancies. The goal of multimodality treatment for brain metastases is to palliate local symptoms and prevent consequences of neurological involvement.
Chemotherapy related toxicity in locally advanced non-small cell lung cancer
Amit Bahl, DN Sharma, PK Julka, GK Rath
January-March 2006, 2(1):14-16
For inoperable non-small cell lung cancer combined chemotherapy and radiotherapy plays an important role as a therapeutic modality. The aim of the present study was to analyze neoadjuvant chemotherapy related acute toxicity in locally advanced lung cancer (stage IIIA and IIIB) in Indian patients using Cisplatin and Etoposide combination chemotherapy.
Material and methods:
Forty patients of locally advanced Non small cell lung cancer received three cycles neoadjuvant chemotherapy using Injection Cisplatin and Etoposide. The patients were taken for Radical radiotherapy to a dose of 60 Gray over 30 fractions in conventional fractionation after completing chemotherapy. Chemotherapy associated toxicity was assessed using common toxicity criteria (CTC v2.0)
Forty patients were available for final evaluation. Median age of presentation of patients was fifty-six years. Thirteen patients had Non small cell lung cancer stage IIIA while twenty-seven patients had Stage IIIB disease. Anemia was the most common hematological toxicity observed (seen in 81% of patients). Nausea and vomiting were the most common non -hematological toxicity seen. Sensory neuropathy was seen in 38%of patients. 88% patients developed alopecia. Seven patients developed febrile neutropenias.
Neo-adjuvant chemotherapy using Cisplatin and Etoposide continues to be a basic regimen in the Indian set up despite availability of higher molecules, since it is cost effective, well tolerated and therapeutically effective. Blood transfusions, growth factors and supportive care can be used effectively to over come toxicity associated with this regimen.
Brain tumor and role of β-carotene, a- tocopherol, superoxide dismutase and glutathione peroxidase
Sarita Aggarwal, Manju Subberwal, Sushil kumar, Meenakshi Sharma
January-March 2006, 2(1):24-27
The erythrocyte levels of the antioxidant enzymes SOD and GPx,
and serum levels of antioxidants vitamins β -carotene and β -tocopherol were
estimated in various types of brain tumors, and were compared with the levels in controls. Statistically significant (P<.001) diminished levels of
β - carotene, β -tocopherol, SOD and GPx, were observed in all the brain tumor patients as compared to controls. Malignant tumor also showed a relative decrease in antioxidant levels as compared to benign tumors. Comparison of histopathological sections of brain tumors also suggested a inverse relationship between antioxidant level and grades of malignancy. Marked decrease in antioxidant levels may have a role in genesis of considerable oxidative stress in brain tumors. Further more, the degree of decline in antioxidant levels may indicate severity of malignancy in brain tumors.
Isolation and antimicrobial susceptibility of bacteria from external ear canal of cancer patients at shafa cancer hospital -Ahwaz
E Kalantar, M Mosaei, A Ekrami, M Pedram
January-March 2006, 2(1):17-19
A bacteriological study of external ear canal was performed in 52 hospitalized cancer patients and 42 non hospitalized cancer patients at Shafa hospital, Ahwaz. Study was under taken to find out the normal flora changes in the external ear canals and to observe the prevalence of external otitis among these cancer patients. The control group consisted of 40 non-cancer patients. We observed the following bacteria among hospitalized cancer patients. Staphylococcus Coagulase negative (51.9 %), Staphylococcus aureus (15.7%) and Streptococcus pneumoniae (11.9 %). Similarly, among non hospitalized cancer patients, Staphylococcus Coagulase negative (45.2 %), S. aureus (9.5%) and Streptococcus pneumomiae (4.7 %). Incidence of Staphylococcus Coagulase negative and Streptococci pneumoniae is higher in control group than that in cancer patients. We have concluded that cancer patients probably suffer from external otitis more frequently because of enhanced colonization by S. aureus (P <0.05). The antimicrobial susceptibility of these organisms to various antibiotics was determined by disk diffusion method using Muller Hinton agar. In hospitalized cancer patients Staphylococcus Coagulase negative was 25% and 85% resistant to Vancomycin and Penicillin G and in non hospitalized cancer patients, Staphylococcus Coagulase negative were 45% and 80% resistant to Vancomycin and Penicillin G. S. aureus of both the groups (hospitalized & non hospitalized) were resistant to Penicillin G. Similarly, both the groups were 55% and 50 % resistance to Vancomycin.
Prognostic and predictive value of c-erbB2 overexpression in osteogenic sarcoma
Vasishta Rakesh Kumar, Nalini Gupta, Nandita Kakkar, SC Sharma
January-March 2006, 2(1):20-23
Osteogenic sarcoma (OS) is a highly malignant tumor of the bone. There are few reports in the literature regarding determination of c-erb B-2 (HER-2/neu) expression in cases of OS and also the results are quite variable.
The present study was undertaken to correlate the expression of c-erbB2 with the survival of patients of OS.
Settings and Design:
A retrospective study of cases of OS, in which the expression of c-erbB-2 by immunohistochemistry (IHC) was studied and correlated with the survival rate of the patients.
Materials and Methods:
Out of a total of 49 cases, proper follow up data in the form of total and disease free survival was available in only 20 cases. IHC for c-erb-B2 was carried out in these 20 cases.
The staining pattern was as follows: no staining in 3 cases, 1 + in 5 cases, 2 + in 3 cases, 3 + in 3 cases and 4 + cytoplasmic positivity in 6 cases.
Spearman rank correlation test was used to correlate the intensity of cytoplasmic staining of c-erbB-2 with survival rate of the patients, response to chemotherapy and metastasis.
Previous studies have shown that c-erbB-2/ HER-2 is an independent prognostic factor in osteogenic sarcoma, but in the present study, its expression was not seen to be correlating with survival rate of the patients. Therefore, further studies are needed to reach a consensus regarding the reliability of c-erbB-2 as an independent prognostic factor in OS.
The journey of biospecimens: mortuaries to biorepositories
January-March 2006, 2(1):3-4
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