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   2015| January-March  | Volume 11 | Issue 1  
    Online since April 16, 2015

 
 
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ORIGINAL ARTICLES
Risk of oral cancer associated with gutka and other tobacco products: A hospital-based case-control study
Sandeep Mahapatra, Ramachandra Kamath, Bharatesh K Shetty, VS Binu
January-March 2015, 11(1):199-203
DOI:10.4103/0973-1482.143332  PMID:25879362
Background: Although tobacco deaths rarely make headlines, tobacco kills one person every six seconds. Tobacco kills a third to half of all people who use it, on average 15 years prematurely. Aim of the Study: To study the risk of oral cancer associated with gutka consumption and other tobacco products. Objective: (1) To find the association between gutka consumption and oral cancer. (2) To study the association between oral cancer and other tobacco products. Methodology: A case-control study of 134 cases and 268 controls, over a period of 5 months, from March 2013 to July 2013, was carried out at the Kasturba medical hospital in Manipal, India. The participants were personally interviewed by the investigator using a structured questionnaire on consumption of tobacco, poly-ingredient dip products, alcohol, dietary practices, oral hygiene practices and demographic status. Results: Univariate logistic regression followed by multivariate logistic regression was done for identifying the risk factors and adjusted for the confounding variables. Analysis showed that gutka (<0.001, OR = 5.1 95% CI = 2.0-10.3), chewing tobacco (P < 0.001, OR = 6.0 95% CI = 2.3-15.7), supari (P < 0.001, OR = 11.4 95% CI = 3.4,38.2), betel quid (P < 0.001, OR = 6.4 95% CI = 2.6-15.5), bidi (P < 0.05, OR = 2.3 95% CI = 1.1-4.8) and alcohol (P < 0.001, OR = 3.7 95%CI = 1.8-7.5) had strong association with oral cancer upon adjustment. Conclusion: The study provided strong evidence that gutka, supari, chewing tobacco, betel quid, bidi and alcohol are independent risk factors for oral cancer.
  5,029 568 -
Feasibility study of robotic hypofractionated lung radiotherapy by individualized internal target volume and XSight Spine Tracking: A preliminary dosimetric evaluation
Mark KH Chan, Dora LW Kwong, Venus WY Lee, Ronnie WK Leung, Mathew YP Wong, Oliver Blanck
January-March 2015, 11(1):150-157
DOI:10.4103/0973-1482.138220  PMID:25879354
Aim: To investigate the dosimetric impacts of lung tumor motion in robotic hypofractionated radiotherapy for lung cancers delivered through continuous tracking of the vertebrae by the XSight Spine Tracking (XST) mode of the CyberKnife. Materials and Methods: Four-dimensional computed tomography (4DCT) scans of a dynamic thorax phantom were acquired. Three motion patterns (one-dimensional and three-dimensional) of different range were investigated. Monte Carlo dose distributions were generated with 4DCT-derived internal target volume (ITV) with a treatment-specific setup margin for 12.6 Gy/3 fractions. Six-dimensional error correction was performed by kV stereoscopic imaging of the phantom's spine. Dosimetric effects of intrafractional tumor motion were assessed with Gafchromic films (Ashland Inc, Wayne, NJ, USA) according to 1) the percent measurement dose points having doses above the prescribed (P > Dpres ), mean (P > Dm ), and minimum (P > Dmin ) ITV doses, and 2) the coefficient of variation (CV). Results: All plans attained the prescription dose after three fractions despite marked temporal dose variations. The value of P > Dpres was 100% after three fractions for all plans, but could be smaller (~96%) for one fraction. The values of P > Dmin and P > Dm varied drastically interfractionally (25%-2%), and could be close to 0% after three fractions. The average CV ranged from 2.8% to 7.0%. Correlations with collimator size were significant for P > Dmin and P > Dm (P <<sub> 0.05) but not P > Dpres (P > 0.05). Conclusions: Treating lung tumors with CyberKnife through continuous tracking of the vertebrae should not be attempted without effective means to reduce the amplitude and variability of target motion because temporal dose variations owing to the intrafractional target motion can be significant.
  4,956 102 -
Expression of BRCA1 and BRCA2 proteins and their correlation with clinical staging in breast cancer
Suresh Hedau, Madhu Batra, Usha Rani Singh, Alok C Bharti, Amitabha Ray, Bhudev C Das
January-March 2015, 11(1):158-163
DOI:10.4103/0973-1482.140985  PMID:25879355
Objectives: The purpose of this study was to evaluate the level of expression of the BRCA1 and BRCA2 proteins in sporadic breast cancer cases to determine the functional role of these genes in breast carcinogenesis. Materials and Methods: Paraffin embedded histologically proven invasive breast tissue sections that were obtained from 40 patients and the adjacent normal breast tissue sections used as controls to determine breast carcinoma specific changes in the expression of BRCA1 and BRCA2 by immunohistochemistry (IHC). Results: Majority of the cases express either low or no detectable level of BRCA1 expression in tumor tissues in comparison with control; the decline in BRCA1 expression was found to be more prominent in advanced grade 3 disease. On the other hand, the expression of BRCA2 protein was moderate or low in breast cancer cases and its overall distribution did not show significant difference when compared with controls. Interestingly, those breast cancer cases, which were found to express low or no BRCA1 expression, demonstrated a higher protein level of BRCA2. The inverse correlation of BRCA1 and BRCA2 expression was more prominent in post-menopausal patients. Conclusions: Our results demonstrate in a subset of cases that decline in BRCA1 expression that may be associated with potentially compensatory increase in BRCA2 protein, which may depend on tumor grade as well as menopausal status.
  4,633 382 -
Responding to family requests for nondisclosure: The impact of oncologists' cultural background
Mahati Chittem, Phyllis Butow
January-March 2015, 11(1):174-180
DOI:10.4103/0973-1482.140836  PMID:25879358
Context: Nondisclosure of cancer diagnosis is common in many Eastern countries. Consequently, immigrant families often approach oncologists with requests for nondisclosure in Western countries. Aims: To explore differences in the attitudes and practices of Western-born and nonWestern born oncologists in Australia when faced with a nondisclosure request. Settings and Design: Using a cross-sectional design, oncologists were interviewed over the telephone. Methods: Using the snowball method, 14 Australian (Western = 9, non-Western = 5) oncologists were recruited. Oncologists participated in a semi-structured interview exploring their experiences of, and response to, a request for nondisclosure, and their perceptions of how their cultural background influenced these attitudes and responses. Analysis: The interviews were transcribed and analyzed using interpretative phenomenological analysis. Results: Six main themes emerged from the study: (1) Barriers to truthful communication, (2) an ethical and moral dilemma, (3) high costs of nondisclosure, (4) cultural influences on interpretation and understanding of requests for nondisclosure, (5) emotional impact of bad news on patients, families and oncologists, and (6) truthful disclosure as a gentle balancing act. Conclusions: All oncologists felt that the family request for nondisclosure was difficult, with many cultural and emotional nuances to take into consideration. Some immigrant Australian oncologists who had a similar cultural background as the patient/family, felt they could better understand the desire for nondisclosure. Irrespective of their cultural background, all oncologists acknowledged that breaking bad news had to be done in a gentle, gradual manner. The study suggests a need to develop a culturally sensitive cancer communication model.
  4,358 174 -
Evaluation of effect of transcutaneous electrical nerve stimulation on salivary flow rate in radiation induced xerostomia patients: A pilot study
Anusha Rangare Lakshman, G Subhas Babu, Suresh Rao
January-March 2015, 11(1):229-233
DOI:10.4103/0973-1482.138008  PMID:25879367
Context: Xerostomia is a common sequel in patients undergoing irradiation of malignant tumors of the head and neck. Palliative treatments of xerostomia like topical agents such as ice-chips, saliva substitutes, systemic sialogogues like pilocarpine and cevimeline work well for some patients. Electrostimulation was studied in the past and showed moderate promise but never became part of the mainstream therapy for better management of xerostomia patients. Aims: The aim of the following study is to evaluate the effectiveness of a transcutaneous electrical nerve stimulation (TENS) unit in stimulating the whole salivary flow rate in radiation induced xerostomia patients. Materials and Methods: A total of 40 subjects were included in the study. The study group consisted of 30 individuals and was divided into Group S1 (n = 20), which was further subdivided into Group S1A (n = 10) subjects complaining of dry mouth who were undergoing head and neck radiotherapy with TENS stimulation during the commencement of radiotherapy, on the 3 rd , 6 th week and after a month of completion of radiotherapy and Group S1B (n = 10) with TENS stimulation daily during the full course of radiotherapy and Group S2 (n = 10) subjects complaining of dry mouth who had undergone head and neck radiotherapy that ended 1 month prior to their entry into the study. The control group (n = 10) consisted of healthy individuals not complaining of dry mouth and who have not undergone head and neck radiotherapy. Whole saliva was collected without stimulation for 10 min and after electrostimulation with TENS unit for additional 10 min in a graduated test tube. The results were statistically analyzed using Mann-Whitney U-test and Kruskal-Wallis's test. Results: The data analysis revealed that control and S1B group showed increased salivary flow rate after stimulation by TENS therapy compared with the unstimulated salivary flow, whereas in S1A and S2 group it was found to be statistically non-significant. Conclusion: The present study gave us an insight about the effectiveness of TENS therapy in stimulating salivary flow in healthy subjects and it is very effective when used in conjunction with radiation therapy by reducing the side-effects of radiation therapy. Hence, TENS therapy can be used as an adjunctive method for the treatment of xerostomia along with other treatment modalities.
  3,928 454 -
Translation and validation of the questionnaire on current status of physiotherapy practice in the cancer rehabilitation
G Karthikeyan, Udayakumar Manoor, Sanjay S Supe
January-March 2015, 11(1):29-36
DOI:10.4103/0973-1482.146117  PMID:25879332
Background: The translation and cultural adaptation of psychometrically tested tools is an essential component of effective evaluation of the intended purpose. The English questionnaire had been designed to measure current status of physiotherapy practice in cancer rehabilitation. Aim: The aim of this study was to culturally adapt, including translation and preliminary validation of the questionnaire for the cancer patients. Materials and Methods: A custom-made, validated version of the English self-administered questionnaire consisting of 30 items was translated into Tamil, Kannada and Malayalam languages. The process of translation included recommended methodology, mandating forward translation, backward translation, reconciliation and pretesting steps, was followed. Tool validation included assessing content accuracy and clarity. Process involved 13 jurors for the translation and content validation and 30 cancer patients for the face validity. All subjects were asked to complete the translated versions of the questionnaire, which was previously validated. Analysis and Results: The psychometric properties of the three regional language versions of the questionnaire for cancer patients employed during rehabilitation were good. Cognitive debriefing showed the regional language versions to be clear, relevant and comprehensive. Conclusion: The translated and adapted versions are comparable with the original English instrument in terms of content and accuracy and it is suitable to assess the current physiotherapy practice pattern in cancer rehabilitation settings.
  3,914 307 -
Status of trace elements in saliva of oral precancer and oral cancer patients
Shishir Ram Shetty, Subhas Babu, Suchetha Kumari, Pushparaja Shetty, Shruthi Hegde, Arvind Karikal
January-March 2015, 11(1):146-149
DOI:10.4103/0973-1482.137973  PMID:25879353
Background: Several studies in recent years have linked association between micronutrient levels and various forms of cancer. Copper and zinc have been the most researched micronutrients. Aim: The aim of the study was to evaluate the levels of copper, zinc and iron in saliva of patients with oral leukoplakia, oral submucous fibrosis and oral squamous cell carcinoma. Results: There was a highly significant increase in the level of salivary copper in oral submucous fibrosis patients when compared to controls (P = 0.001). Salivary copper levels were also elevated in oral leukoplakia and oral cancer patients (P = 0.01). There was a significant decrease in the salivary zinc levels in all three study groups when compared to controls (P = 0.001). A highly significant reduction in salivary iron levels was noticed oral submucous fibrosis group. The copper to zinc ratio significantly increased in all the study groups when compared to controls. Conclusion: Results suggest that salivary copper zinc and iron could be used as biomarkers for oral precancer and cancer.
  3,576 484 -
Oral rinse-based cytology and conventional exfoliative cytology: A comparative study
Shaila Mulki, Pushparaj Shetty, Prakash Pai
January-March 2015, 11(1):129-135
DOI:10.4103/0973-1482.137910  PMID:25879350
Context: Simple screening test for resource-challenged areas. Aims: To compare specimen adequacy and diagnostic agreement between oral rinse-based smears and conventional smears in oral cancer, oral leukoplakia, and normal controls. Settings and Design: Twenty-five histologically confirmed cases of oral cancer, 29 clinically diagnosed cases of oral leukoplakia, and 54 normal controls were subjected to the oral rub-and-rinse technique and the conventional exfoliative cytology. Patients and Methods: Smears were consequently stained with the Papanicolaou (PAP) stain and were examined independently by two different cytopathologists in a double-blind fashion. The results were classified as: Negative, atypical, positive, and unsatisfactory. Furthermore, they were compared, to assess the sample adequacy, cellular distribution, staining, leucocytes/inflammation and cellular clarity in both the smears. Statistical Analysis Used: Chi square test and Wilcoxon-matched pairs signed rank test (P ≤ 0.05). Results: Among the cancer cases, 84% showed positive, 8% atypical, and 8% unsatisfactory, after using the conventional technique, whereas, the oral rinse technique showed 80% positive, 16% atypical, and 4% unsatisfactory cases. The conventional technique showed 44.82, 37.93, and 6.89% and the oral rinse technique showed 48.27, 31.03, and 20.68% negative, positive, and atypical cases, respectively, among the leukoplakia cases. Among the normal controls, 9.26 and 90.74% and with the oral rinse technique 3.70 and 96.29% showed atypical and negative cases with the conventional technique. Sample adequacy and cellular clarity showed a statistically significant difference between both techniques. Conclusions: Both smears were diagnostically reliable, however, the oral rinse-based method showed an overall improvement in sample adequacy and cellular clarity.
  3,570 300 -
Estimation of serum lactate dehydrogenase level in patients with oral premalignant lesions/conditions and oral squamous cell carcinoma: A clinicopathological study
Treville Pereira, Subraj Shetty, Svylvy Pereira
January-March 2015, 11(1):78-82
DOI:10.4103/0973-1482.150352  PMID:25879341
Background: Tumor markers are the substances, which quantitatively change in serum, during tumor development. Tumor markers have now been introduced in the diagnosis of malignant lesions. One such tumor marker is serum lactate dehydrogenase (LDH). In the present study, an attempt was made to correlate the level of serum LDH with premalignant lesions/conditions and oral squamous cell carcinoma (OSCC). Materials and Methods: This study was carried out to evaluate the role of serum LDH as a biochemical parameter in oral premalignant lesions/conditions and OSCC. Estimation of LDH level in serum was done by an autoanalyzer for spectrometry, and the Student's t-test was applied. Results: Increased levels of LDH were observed in serum; of patients with oral premalignant lesions and conditions, and OSCC. Increased serum LDH level had a positive correlation with the histologic grading of OSCC. Conclusion: Serum LDH level can serve as a biochemical tool in assessing the malignant potential of premalignant lesions. Estimation of serum LDH may be used to screen the cases of oral malignancy as an adjunct to diagnosis.
  3,410 412 -
Small field dosimetry and analysis of flattening filter free beams in true beam system
KR Muralidhar, Birendra Kumar Rout, K. K. D. Ramesh, Mirza Athar Ali, N Madhusudhan, Krishna Komanduri, M Babaiah
January-March 2015, 11(1):136-140
DOI:10.4103/0973-1482.138226  PMID:25879351
Aim of Study: The purpose of this study was to report the dosimetric characteristics of the small fields in flattening filter free (FFF) beams (output measurements, profile analysis, surface dose and consistency) generated by medical linear accelerator and its variation with respect to flattened beams (FB). Materials and Methods: Surface doses were obtained for field sizes 1 × 1-40 × 40 cm 2 . Field width and penumbra were analyzed for field sizes 1 × 1-40 × 40 cm 2 . To take output factors for small fields, diode and micro chamber were used and data was taken at a source-to-surface distance (SSD) and extended SSD. Consistency checked for the dosimetric data for 1 year. Results: Surface doses were higher in FFF compared with FB up to 20 × 20 cm 2 field size. Measured field sizes were slightly lesser in FFF and penumbra values were increased with respect to field size in both FB and FFF. For small fields, diode values have shown more promising results than micro chamber. Small field output measurements at nominal SSD and extended SSD were well in agreement with each other. FFF beams showed good data consistency in 1 year duration. Conclusion: Small field dosimetry, surface dose, profile analysis and consistency of FFF beams in FFF photon beams were derived and data shown good consistency during 1 year duration.
  3,559 250 -
REVIEW ARTICLES
HPV positive oropharyngeal cancer and treatment deintensification: How pertinent is it?
Sarbani Ghosh Laskar, Monali Swain
January-March 2015, 11(1):6-9
DOI:10.4103/0973-1482.151445  PMID:25879328
In recent years there has been change in trends in the incidence of head and neck squamous cell carcinoma (HNSCC) with oropharyngeal carcinoma (OPC) showing an increased incidence, attributable specifically to infection by human papillomavirus (HPV). At the same time there is change in demographic characteristics and prognosis of this subset of HNSCC. Considering the better prognosis, researchers are trying to reduce the acute and long-term toxicities by alteration of various components of treatment protocols. Although treatment deintensification is an option for this group of patients, there is no standard protocol available and should be tried only in the protocol setting.
  3,155 328 -
Raman spectroscopy in cervical cancers: An update
S Rubina, C Murali Krishna
January-March 2015, 11(1):10-17
DOI:10.4103/0973-1482.154065  PMID:25879329
Cervical cancer is the third most common cancer among women worldwide. Developing countries contribute more than 80% towards global burden. Over the last 2 decades, Raman spectroscopy (RS) has been actively pursued for cervical cancer detection. In view of latest development in Raman spectroscopic applications in cervical cancers, especially in vivo studies, an update of the same is presented in this article. This articles opens with a brief note on Anatomy of cervix followed by Etiology, and conventional Screening and Diagnosis of Cervical cancers. In subsequent sections, brief description of Theory and Instrumentation of RS is followed by a review of recent developments in cervical cancer detection; with emphasis on cell lines, exfoliated cells, ex vivo and in vivo, and therapeutic response monitoring applications in cervical cancer.
  3,172 301 -
ORIGINAL ARTICLES
The role of cigarette smoking and alcohol consumption in the differentiation of oral squamous cell carcinoma for the males in China
Xinhua Wang, Ji Xu, Lijuan Wang, Chao Liu, Huiming Wang
January-March 2015, 11(1):141-145
DOI:10.4103/0973-1482.137981  PMID:25879352
Background: Oral squamous cell carcinoma (OSCC) is one of the most common cancers in the world and two-thirds of the OSCC occur in developing countries. Male and female have different smoking and drinking habit. However, there is little gender-specific risk study between OSCC and the habit of drinking and smoking in China. Aims: The aim of this study was to evaluate the effects of smoking and alcohol consumption in the differentiation grade of OSCC for the male in China. Patients and Methods: Review cases of male patients who suffered from OSCC tylectomy and were pathologically confirmed the diagnosis of OSCC. Data from 210 cases, related to patient, smoking, and alcohol drinking, were collected and analyzed using multivariate conditional logistic regression models. Results: Cigarette smoking and alcohol consumption were strongly associated with differentiation of oral cancer (P = 0.013 and 0.005, respectively). The adjusted odds ratios (ORs) for smoker were 1.45 (95% confidence interval (CI) = 0.145-4.19). The ORs for drinkers were 0.56 (95% CI = 0.19-1.58). The risk of the two habits in the development of oral cancer appeared to be significant increase. Increased risk of low oral cancer differentiation was associated with increased amount of alcohol consumed. Conclusions: Heavy and long-term smoking and drinking habit might pronouncedly increase the risk of triggering OSCC. Tobacco and alcohol consumption seems to play a role in the differentiation characteristics of the tumor.
  3,168 279 -
Estimation of salivary lactate dehydrogenase in oral leukoplakia and oral squamous cell carcinoma: A biochemical study
Shrikant Patel, Rashmi Metgud
January-March 2015, 11(1):119-123
DOI:10.4103/0973-1482.138193  PMID:25879348
Background: Enzyme Lactate Dehydrogenase (LDH) is found in the cells of almost all body tissues. The profile of salivary total LDH enzymes is similar to that found in oral epithelium, indicating that the major source of salivary LDH is probably the oral epithelium-shedding cells. Consequently, LDH concentration in saliva, as an expression of cellular necrosis, could be a specific indicator for oral lesions that affect the integrity of the oral mucosa. Materials and Methods: Study comprised of three groups as follows: Group I: Comprised of 25 healthy individuals of comparable age. Group II: 25 otherwise healthy and consenting patients with oral leukoplakia (OL). Group III: 25 otherwise healthy and consenting oral squamous cell carcinoma (OSCC) patients. Biochemical estimation of LDH was done with the help of Semiautomatic Analyzer. Results: Inter comparison of salivary total LDH levels between all the three groups revealed that salivary LDH levels increase from healthy control group to Oral Leukoplakia group to further increase in OSCC group. On comparisons between the histopathological grades of OSCC group the level of LDH were found to increase from well differentiated to moderately differentiated to further increase in poorly differentiated patients. Conclusion: The present salivary analysis for LDH enzyme reveals an overall altered salivary LDH enzyme level in OL and OSCC cases.
  2,992 452 -
RESEARCH ARTICLE
The overexpression of MRP4 is related to multidrug resistance in osteosarcoma cells
Zhonghui He, Beibei Hu, Lina Tang, Shui'er Zheng, Yuanyu Sun, Zan Sheng, Yang Yao, Feng Lin
January-March 2015, 11(1):18-23
DOI:10.4103/0973-1482.143334  PMID:25879330
Doxorubicin (Adriamycin, ADM) is an antimitotic drug used in the treatment of a wide range of malignant tumors, including acute leukemia, lymphoma, osteosarcoma, breast cancer, and lung cancer. Multidrug resistance-associated proteins (MRPs) are members of a superfamily of ATP-binding cassette (ABC) transporters, which can transport various molecules across extra- and intra-cellular membranes. The aim of this study was to investigate whether there was a correlation between MRP4 and primary ADM resistance in osteosarcoma cells. In this paper, we chose the human osteosarcoma cell line MG63, ADM resistant cell line MG63/DOX, and the patient's primary cell GSF-0686. We checked the ADM sensitivity and cytotoxicity of all the three cells by cell proliferation assay. The intracellular drug concentrations were measured by using LC-MS/MS. We also examined MRP4 gene expression by RT-PCR and Western Blot. We found that the intracellular ADM concentration of the parent osteosarcoma cell line MG63 was higher than the ADM resistant osteosarcoma MG63/DOX cell line or the GSF-0686 cell after ADM treatment (P < 0.05). In addition, MRP4 mRNA and protein levels in ADM resistant osteosarcoma cells were higher than in MG63 cell (P < 0.05). Taking together, this work suggests that overexpression of MRP4 may confer ADM resistance in osteosarcoma cells.
  3,027 175 -
ORIGINAL ARTICLES
Protective effect of infliximab on methotrexate-induced liver injury in rats: Unexpected drug interaction
Erkan Cure, Aynur Kirbas, Levent Tumkaya, Medine Cumhur Cure, Yildiray Kalkan, Arif Yilmaz, Suleyman Yuce
January-March 2015, 11(1):164-169
DOI:10.4103/0973-1482.140809  PMID:25879356
Aims: Although methotrexate (mtx) is a widely used agent to treat cancer and inflammatory diseases, its hepatotoxic effect limits for clinical utility. We aimed to investigate whether infliximab (inf), an inhibitor of tumor necrosis factor-alpha (TNF-α) has a protective effect against mtx-induced hepatotoxicity. Materials and Methods: For mtx group, the animals received an intraperitoneal single dose injection of mtx at a dose of 20 mg/kg. For inf group, the animals received an intraperitoneal single dose injection of inf at a dose of 7 mg/kg. For mtx + inf group, the single dose of inf at a dose of 7 mg/kg was given 72 h prior to mtx injection. After 72 h, a single dose of mtx 20 mg/kg was given. All rats were sacrificed 5 days after mtx injection. Results: TNF-α and nitric oxide (NO) levels of mtx group was significantly higher than the control (P < 0.001), inf (P < 0.001) and mtx + inf (P < 0.001) groups. Total score of histological damage was higher in the mtx group when compared with the mtx + inf group. Arginase and carbamoyl phosphate synthetase 1 (CPS-1) of mtx group was suppressed in comparison with the control group and was markedly increased in mtx + inf group. Conclusion: Inf may partially prevent mtx-induced hepatic damage in rats. However, the combined usage of mtx and inf increases arginase and CPS-1 enzyme activities and at the same time blocks TNF-α. This combination especially in cancer patients may lead to cancer cell invasion and metastasis.
  2,915 281 -
Dose enhancement in gold nanoparticle-aided radiotherapy for the therapeutic photon beams using Monte Carlo technique
Nitin Ramesh Kakade, Sunil Dutt Sharma
January-March 2015, 11(1):94-97
DOI:10.4103/0973-1482.147691  PMID:25879344
Background: Gold nanoparticle (GNP)-aided radiation therapy (RT) is useful to make the tumor more sensitive to radiation damage because of the enhancement in the dose inside the tumor region. Polymer gel dosimeter (PGD) can be a good choice for the physical measurement of dose enhancement produced by GNP inside the gel. Materials and Methods: The present study uses EGSnrc Monte Carlo code to estimate dose enhancement factor (DEF) due to the introduction of GNPs inside the PGD at different concentrations (7 and 18 mg Au/g of gel) when irradiated by therapeutic X-rays of energy 100 kVp, 150 kVp, 6 MV, and 15 MV. The simulation was also carried out to quantify the dose enhancement in PAGAT gel and tumor for 100 kVp X-rays. Results: For 100 kVp X-rays, average DEF of 1.86 and 2.91 is observed in the PAGAT gel dosimeter with 7 and 18 mg Au/g of gel, respectively. Average DEF of 1.69 and 2.61 is recorded for 150 kVp X-rays with 7 and 18 mg Au/g of gel, respectively. No clinically meaningful DEF was observed for 6 and 15 MV photon beams. Furthermore, the dose enhancement within the PAGAT gel dosimeter and tumor closely matches with each other. Conclusion: The polymer gel dosimetry can be a suitable method of dose estimation and verification for clinical implementation of GNP-aided RT. GNP-aided RT has the potential of delivering high localized tumoricidal dose with significant sparing of normal structures when the treatment is delivered with low energy X-rays.
  2,943 233 -
BRIEF COMMUNICATIONS
Inverted papilloma of lacrimal sac invading into the orbit: Case report and review of literature
Alistair W Hardy, Raghav C Dwivedi, Liam Masterson, Faruque Riffat, Alison Marker, Simon A Woodruff, Piyush Jani
January-March 2015, 11(1):238-240
DOI:10.4103/0973-1482.155111  PMID:25879369
Inverted papilloma (IP) is a sinonasal tumor of benign etiology with local invasion and malignant potential. IP arising in lacrimal sac invading the orbit is extremely rare with only one case reported so far. The presented case appears to be the second such case reported in the literature. A 60-year-old Caucasian male presented with a medial canthal mass and epiphora. Incisional biopsy confirmed a transitional neoplasm. The lesion was completely excised enbloc with clear margins by using a Weber-Ferguson incision; orbital clearance and nasolacrimalfossa clearance was achieved via a medial maxillectomy. Enbloc resection of orbital and nasolacrimal parts of the tumor with clear margins is recommended.
  2,939 177 -
ORIGINAL ARTICLES
Contrast-enhanced ultrasound in the diagnosis of solitary thyroid nodules
Zhang Yuan, Jiang Quan, Zhang Yunxiao, Chen Jian, He Zhu
January-March 2015, 11(1):41-45
DOI:10.4103/0973-1482.147382  PMID:25879334
Objectives: The aim was to study the patterns of solitary thyroid nodule with real-time contrast-enhanced ultrasound (CEUS) and assess its value in differentiating between malignant and benign thyroid nodules. Materials and Methods: Seventy-eight patients with solitary thyroid nodule (37 malignant, 41 benign) underwent real-time CEUS. The patterns of their enhancement were assessed from six aspects: Degree of enhancement, process of enhancement, homogeneity of enhancement, completeness of enhancement, boundary of the enhanced lesions, and shape of the enhanced lesions. Results: Contrast-enhanced patterns were significantly different between benign and malignant thyroid nodules (P < 0.05), except for process of enhancement. The shape of most malignant lesions was irregular (94.59%), the boundary was unclear (86.49%) and had no significantly enhanced (78.38%). Most malignant lesions became inhomogeneously (78.38%) and incompletely enhanced (70.27%). Conclusions: The patterns of real-time CEUS are significantly different between benign and malignant thyroid nodules, and have important clinical value.
  2,941 157 -
Atypical meningioma: Randomized trials are required to resolve contradictory retrospective results regarding the role of adjuvant radiotherapy
Hannah Yoon, Minesh P Mehta, Karthikeyan Perumal, Irene B Helenowski, Richard J Chappell, Erinc Akture, Yunzhi Lin, Mary Anne H Marymont, Samir Sejpal, Andrew Parsa, James R Chandler, Bernard R Bendok, Joshua Rosenow, Shahriar Salamat, Priya Kumthekar, Jeffrey K Raizer, Mustafa K Baskaya
January-March 2015, 11(1):59-66
DOI:10.4103/0973-1482.148708  PMID:25879338
Background: The role of postoperative radiation (RT) in atypical meningioma remains controversial. Materials and Methods: We report a retrospective review of outcomes and prognostic factor analysis in 158 patients treated between 2000 and 2010, and extensively review the literature. Results: Following resection, 23 patients received immediate RT, whereas 135 did not. Median progression-free survival (PFS) with and without RT was 59 (range 43-86) and 88 (range 64-123) months. For Simpson grade (G) 1-3 resection, with and without RT, median PFS was 48 (2-80) versus 96 (88-123) months and for Simpson G4, it was 59 (6-86) versus 47 (15-104) months (P = 0.4). The rate of 5-year overall survival (OS) with and without RT was 89% and 83%, respectively. On univariate analysis, Simpson G4 (HR 3.2, P = 0.0006) and brain invasion (HR 2.2, P = 0.03) were significantly associated with progression, whereas age >60 years (HR 9.7, P = 0.002), mitoses >5 per 10 high-power field (0.2, P = 0.0056), and Simpson G4 (HR 2.4, P = 0.07) were associated with higher risk of death. We summarized 22 additional reports, which provide very divergent results regarding the benefit of RT. Conclusions: In our series, adjuvant RT is surprisingly associated with worse PFS and OS, and this is more likely to be due to selection bias of referring tumors with more aggressive characteristics such as elevated Ki-67 and brain invasion for adjuvant RT, rather than a direct causal effect of adjuvant RT. Although there is a trend toward improved PFS with adjuvant RT after subtotal resection, no improvement was noted in OS. Multivariate analysis did not yield statistical significance for any of the factors including Simpson grades of resection, adjuvant RT, or six pathological defining features. The relatively divergent results in the literature are most likely explained by patient selection variability; therefore, randomized trials to adequately address this question are clearly necessary.
  2,879 164 -
A comparative study on efficacy of different treatment modalities of oral submucous fibrosis evaluated by clinical staging in population of Southern Rajasthan
Saurabh Goel, Junaid Ahmed
January-March 2015, 11(1):113-118
DOI:10.4103/0973-1482.139263  PMID:25879347
Aim: To compare the efficacy of oral lycopene and injection betamethasone with control group in the management of oral submucous fibrosis. Materials and Methods: A hospital based longitudinal study, conducted on 270 patients over a period of 2 years (September 2010-September 2012). Results: Out of 270 cases 223 (82.59%) were males and 47 (17.40%) were females which showed a male predominance and the ratio was 5:1. In stage I it was found that both the test groups, i.e., injection betamethasone and capsule lycopene had a significant improvement in mouth opening than control group. In stage II, it was found that the test group injection betamethasone showed 24 better results as compared to capsule lycopene this could be because of better accessibility of the fibrotic bands for injecting betamethasone solution at the site of the lesion and showed highly significant difference (P < 0.0001). In stage III, it was found that the capsule lycopene showed better results as compared to injection betamethasone and the difference was highly significant (P < 0.0001). This could be because of restricted mouth opening and inability to reach the site for injecting betamethasone solution. Conclusion: It is evident from the study that capsule lycopene and injection betamethasone hold good promise in the treatment of this multifactorial crippling disease.
  2,687 301 -
Prognostic factors in malignant pleural mesothelioma: A retrospective study of 60 Turkish patients
Adem Koyuncu, Deniz Koksal, Ozlem Ozmen, Funda Demirag, Hulya Bayiz, Koray Aydogdu, Mine Berkoglu
January-March 2015, 11(1):216-222
DOI:10.4103/0973-1482.138094  PMID:25879365
Aim: Malignant pleural mesothelioma (MPM) is an aggressive tumor with poor prognosis. The study aims to examine the effect of certain clinical, laboratory, radiologic, and pathologic characteristics on survival. Patients and Methods: Sixty patients who had undergone PET/CT evaluation at initial diagnosis were included. We investigated the effect of certain clinical, laboratory, radiologic characteristics, SUVmax of the tumor, and pathological characteristics such as histological subtype, mitotic activity index (MAI), tumor necrosis, and inflammation on survival. The pathological slides of each patient were re-evaluated for MAI, presence of necrosis, and inflammation. The patients were grouped based on number of mitosis as MAI 1:≤9, MAI 2:10-19, MAI 3: >19 mitosis. Results: There were 34 male and 26 female patients with a mean age of 53.6 ΁ 10.6 years. Mean and median survival time was 14.83 ΁ 10.75 and 11.95 (min 0.43-max 48.10) months, respectively. Using univariate analysis leukocytosis (P = 0.009), rind-like pleural thickening (P = 0.037), advanced disease stage (P = 0.004), best supportive therapy alone (P = 0.004), SUVmax higher than 8 (P = 0.023), MAI higher than 1 (P = 0.033), and presence of tumor necrosis (P = 0.037) were found as poor prognostic factors. At multivariate analysis, leukocytosis (P = 0.026, HR: 2.27), advanced disease stage (P = 0.021, HR: 2.46), best supportive therapy alone (P = 0.029, HR: 5.12), and MAI higher than 1 (P = 0.01, HR: 3.01) were independently associated with survival, whereas SUVmax of the tumor failed to enter the model (P = 0.07, HR: 1.89). Conclusion: Presence of leukocytosis, advanced disease stages, supportive therapy alone, and higher MAI were found to be negative prognostic factors in patients with MPM.
  2,722 158 -
Castleman's disease and radiotherapy: A single center experience
Bora Uysal, Selcuk Demiral, Hakan Gamsiz, Ferrat Dincoglan, Omer Sager, Murat Beyzadeoglu
January-March 2015, 11(1):170-173
DOI:10.4103/0973-1482.140766  PMID:25879357
Context: The role of radiotherapy (RT) in the management of Castleman's disease (CD) is analyzed. Aims: The main goal of this study is to examine the efficiency of RT in the treatment of unresectable and recurrent CD. Settings and Design: Retrospective study. Subjects and Methods: Between 1980 and 2012, 11 CD patients referred and treated at our clinic were studied. Three of the patients were female, and eight of them were male. Four patients had multicentric (MC) and seven patients had unicentric CD. Five patients were managed with incisional biopsy and RT; three unicentric patients underwent total excision followed by RT, and three unicentric patients had total excision and chemotherapy. Patients were retrospectively evaluated. Median follow-up time was 36 (24-60) months with median age 41 (24-52) years and RT dose 30 (30-45) Gy. Statistical Analysis Used: Kaplan-Meier method. Results: About 72.7% of patients were male, and 27.3% were female. 63.6% of the patients were unicentric, and 36.4% were MC CD. 54.5% of the patients were managed with total excision, and 45.5% underwent incisional biopsy. About 63.6% of CD patients received RT and 27.3% were given only chemotherapy, whereas one patient (9.09%) received both RT and chemotherapy. Three-year survival was 83%, and 3-year disease free survival was 91%. No late toxicity was noted with. Acute toxicity was noted in two patients who received 45 Gy and no late radiation-induced toxicity was observed. Conclusions: RT is an effective treatment option for CD recurrences and sole treatment for unresectable CD.
  2,629 145 -
A prospective dosimetric and clinical comparison of acute hematological toxicities in three-dimensional conformal radiation therapy and intensity modulated radiation therapy with concurrent chemotherapy in carcinoma cervix
HU Avinash, TR Arul Ponni, MG Janaki, AS Kirthi Koushik, S Mohan Kumar
January-March 2015, 11(1):83-87
DOI:10.4103/0973-1482.151864  PMID:25879342
Background and Objectives: Acute hematological toxicities are an important cause of morbidity in patients receiving concurrent chemoradiation to pelvis in carcinoma cervix. The objective of this study was to evaluate the role of intensity-modulated radiotherapy (IMRT) in reducing the dose to the bone marrow as compared with three-dimensional conformal radiotherapy (3DCRT) and hence its impact on reducing the acute hematological toxicities. Materials and Methods: Eleven consecutive patients treated with IMRT and 12 patients treated with 3DCRT to the whole pelvis along with concurrent chemotherapy were selected. Bone marrow was delineated. V10 Gy, V20 Gy, V95%, and Dmean of bone marrow were recorded. Weekly blood counts were recorded and graded as per Common Terminology Criteria version 4.0 for all the patients. Results: The dose to the bone marrow V20 Gy was 206.78 ± 57.10 cc (75%) and 251.70 ± 40.45 cc (91%) for IMRT and 3DCRT, respectively (P = 0.04) and V95% was 23.30 ± 8.34% and 46.76 ± 6.71% for IMRT and 3DCRT, respectively (P = 0.001). The grade of toxicities during each week did not show the difference in either arm. However, the total count and Neutrophil counts during the 2nd week showed statistical significance between IMRT and 3DCRT. Conclusion: IMRT significantly reduces the dose to the bone marrow as compared to 3DCRT. The reduction of the dose did not translate into a decrease in acute hematological toxicities. Concurrent platinum-based chemotherapy is the probable cause for the hematological toxicities.
  2,515 222 -
Squamous carcinoma coexistent with teratoma of ovary: A clinicopathological study of 12 cases diagnosed over a 10-year period at a tertiary cancer referral center
Bharat Rekhi, Pinki Parikh, Kedar K Deodhar, Santosh Menon, Amita Maheshwari, Rajendra Kerkar, Sudeep Gupta
January-March 2015, 11(1):211-215
DOI:10.4103/0973-1482.138083  PMID:25879364
Background: Somatic malignancy in an ovarian teratoma including a squamous carcinoma (SCC) is rare. Clinicopathological features of 12 ovarian teratomas with coexistent SCCs are presented. Materials and Methods: Over a 10-year-period, 12 ovarian teratomas with coexistent SCCs were reviewed and analyzed. Results: The age range was 31-68 years (median, 49), and the tumor size (nine cases) varied from 10 to 18 cm (mean, 12.4). Stage-wise (10 cases), 7 cases (70%) were in stage I; a single case (10%) in stage II, and two (20%) cases were in stage III. Microscopically, all 12 tumors revealed mature teratoma with SCC, as a discrete tumor (6, 50%), or arising from the epithelium of the teratoma in six (50%) cases. SCC component was commonly moderately differentiated (eight cases) or poorly differentiated (three cases). P63 immunostaining reinforced squamous differentiation in a single poorly differentiated SCC and CK5/6 in another tumor. All patients underwent surgery. Two cases revealed positive lymph nodes and contiguous colonic involvement. Three patients (stages II and III) underwent adjuvant chemotherapy (CT). Outcomes (seven patients) (3-58 months) included five patients who are free-of-disease (all stage I) and two patients who are alive-with-disease (stages I and III). Conclusion: SCC and coexistent ovarian teratomas are rare. Most cases present at an early stage, commonly in perimenopausal women. Teratomas occurring in such patients should be optimally sampled for SCC. Teratomas coexistent with SCC are invariably mature-type. P63 is useful in differentiating poorly differentiated SCC from germ cell tumor components. Surgery forms the treatment mainstay. Adjuvant CT may be offered in high-stage that forms as an adverse prognostic parameter.
  2,544 182 -
Comparison of primary radiation versus robotic surgery plus adjuvant radiation in high-risk prostate cancer: A single center experience
Prabhsimranjot Singh, Prashant Desai, Shruthi Arora, Anthony H Pham, A Gabriella Wernicke, Michael Smith, Dattatreyudu Nori, KS Clifford Chao, Bhupesh Parashar
January-March 2015, 11(1):191-194
DOI:10.4103/0973-1482.139601  PMID:25879360
Objective: The objective of this study was to compare robotic-prostatectomy plus adjuvant radiation therapy (RPRAT) versus primary RT for high-risk prostate cancer (HRPCa). Materials and Methods: A retrospective chart review was performed for the HRPCa patients treated in our institution between 2000 and 2010. One hundred and twenty-three patients with high-risk disease were identified. The Chi-square test and Fisher's exact test were used to compare local control and distant failure rates between the two treatment modalities. For prostate-specific antigen comparisons between groups, Wilcoxon rank-sum test was used. Results: The median follow-up was 49 months (range: 3-138 months). Local control, biochemical recurrence rate, distant metastasis, toxicity, and disease-free survival were similar in the two groups. Conclusions: Primary RT is an excellent treatment option in patients with HRPCa, is equally effective and less expensive treatment compared with RPRAT. A prospective randomized study is required to guide treatment for patients with HRPCa.
  2,582 140 -
Survival trends in metastatic bladder cancer in the United States: A population based study
Binay Kumar Shah, Rakesh Mandal
January-March 2015, 11(1):124-128
DOI:10.4103/0973-1482.140982  PMID:25879349
Background: To evaluate the relative survival rates for patients with metastatic bladder cancer (MBC) over the last two decades in the United States: 1991-2000 and 2001-2010. Materials and Methods: We used the Surveillance, Epidemiology, and End Results (SEER*Stat) Program to analyze 6-month and 12-month relative survival rates of American Joint Committee on Cancer (AJCC) Stage IV bladder cancer patients included in the SEER database. We used Z-test in the SEER*Stat Program to compare relative survival rates among cohorts of patients categorized by race, gender, and age groups (<60 and ≥60 years). Results: The dataset comprised 4195 and 7629 patients with AJCC Stage IV bladder cancer in the periods 1991-2000 and 2001-2010, respectively. There were statistically significant decreases in relative survival rates for pooled data across all races (67.8 ± 0.7% in 1991-2000 vs. 64.7 ± 0.5% in 2001-2010, P < 0.01), among Caucasian (CC) and other races (Oth) men + women, among CC and Oth men, and several cohorts among men and 60 + Oth-women when categorized by age. African American patients did not show significant changes in survival. Conclusions: This population-based study shows that decreases in 6-month and 12-month relative survival rates among patients with MBC in 2001-2010 compared to 1991-2000, specifically, more pronounced among CC men and Oth men.
  2,501 120 -
Acute lymphoblastic leukemia: Are Egyptian children adherent to maintenance therapy?
Elhamy Rifky Abdel Khalek, Laila M Sherif, Naglaa Mohamed Kamal, Amal F Gharib, HM Shawky
January-March 2015, 11(1):54-58
DOI:10.4103/0973-1482.147698  PMID:25879337
Background, Aims, Settings and Design: Poor adherence to oral maintenance chemotherapy can cause relapse of acute lymphoblastic leukemia (ALL). A multicenter study for the evaluation of adherence to oral 6-mercaptopurine (6-MP) maintenance chemotherapy for childhood ALL in Egypt to identify contributing factors and possible steps to promote adherence. Materials and Methods: The study included 129 children with ALL in complete remission receiving 6-MP single daily oral dose in the evening. Evaluation was done through specific questionnaires for the patients as well as serum 6-MP measurements. Results: Nonadherence was detected in around 56% by questionnaires and around 50% by serum 6-MP level measurement. There was a highly significant correlation between nonadherence as found by the questionnaire and 6-MP level (P - 0.001). Nonadherence was significantly associated with low socioeconomic standard, noneducation and low educational level and large family size by both methods. High cost to come for follow-up visits was significant by questionnaire but not by 6-MP measurement. Adolescent age, the higher number of siblings, lack of written instructions, long time spent per visit, were all associated with higher rates of nonadherence, although none reached statistical significance. Conclusions: Nonadherence is a real problem in pediatric patients. Specific questionnaires can be an excellent reliable method for the routine follow-up of these children, and drug level assay can be requested only for confirmation. This protocol is especially effective in developing countries where financial resources may be limited. Every effort should be made to uncover its true incidence, contributing factors, and best methods of intervention.
  2,399 204 -
Cytotoxic potency of self-assembled Ruthenium(II)-NHC complexes with pincer type 2, 6-bis(N-methylimidazolylidene/benzimidazolylidene)pyrazine ligands
Gourisannkar Roymahapatra, Joydev Dinda, Anjan Mishra, Ambikesh Mahapatra, Wen-Shu Hwang, Santi M Mandal
January-March 2015, 11(1):105-113
DOI:10.4103/0973-1482.150416  PMID:25879346
Objective: To study the cytotoxic potency of self-assembled Ruthenium(II)-NHC complexes with 2,6-di-(N-methylimidazolylidene/benzimidazolylidene)pyrazine ligands. Materials and Methods: Ru(II)-N-heterocyclic (Ru-NHC) complexes, Bis-[2,6-di-(N-methylimidazol-2-ylidene)pyrazine]ruthenium(II) hexaflurophosphate (3), Bis-[2,6-di-(N-methylbenzimidazol-2-ylidene)pyrazine]ruthenium(II) hexaflurophosphate (4) have been synthesized from corresponding ligands 2,6-di-(N-methylimidazolium)pyrazine dichloride (1); 2,6-di-(N-methylbenzimidazolium)pyrazine dichloride (2). Complexes were studied to determine their pro-apoptotic activity against HCT15 and Hep2 cell lines, and antimicrobial activity against Pseudomonas aeruginosa, Staphylococcus epidermidis and Candida albicans. Results: Both, complex 3 and 4, formed a nanosphere structure in aqueous growth medium. Cytotoxicity study revealed that complex 3 was more effective than complex 4. Complexes mainly target cellular DNA and bacterial cell wall. Conclusion: This is the first report on the formation of nanoball structure of Ru(II)-NHC complexes. Thus, complex 3 provides a new insight to develop antitumor or antimicrobial drug.
  2,419 166 -
Expression and clinical significance of aminopeptidase N/CD13 in non-small cell lung cancer
Quan Zhang, Jinghui Wang, Haiqing Zhang, Dan Zhao, Zongde Zhang, Shucai Zhang
January-March 2015, 11(1):223-228
DOI:10.4103/0973-1482.138007  PMID:25879366
Background: The objective of this study was to analyze the expression of aminopeptidase N/CD13 (APN/CD13) in non-small cell lung cancer (NSCLC) and investigate its correlation with various clinical factors, including prognosis and efficacy of adjuvant chemotherapy. Materials and Methods: Using immunohistochemistry analysis, we analyzed the expression of CD13 in clinicopathologically characterized 127 NSCLC cases. The relationship between the expression levels of CD13 and clinical features was analyzed and presented. Statistical Analysis: The data were analyzed using statistical package for the social sciences software (Ver 13.0, IBM, USA). Those conforming to Gauss distribution criteria was represented as Mean ΁ SD and those not conforming to Gauss distribution criteria was represented as median (M). The overall survival was recorded from the date of surgery to the date of cancer-specific death. APN/CD13 expression levels and clinicopathological factors were analyzed by Chi-square test or by Fisher's exact test. The Kaplan-Meier method was used to evaluate the probability of survival data and analyzed by Log rank test. Multivariate analysis was performed by Cox regression model. P < 0.05 was considered to be statistically significant. Results: APN/CD13 was mainly expressed in the cellular membrane of cancer cells in pulmonary adenocarcinoma and in the cellular membrane of interstitial cells in squamous carcinoma. Positive APN/CD13 was detected in 62.3% (43 of 69) squamous carcinoma patients and in 50% (29/58) adenocarcinoma patients. Expression of APN/CD13 was not correlated with age, gender, tumor, node, metastasis (TNM) stage, histological type and tumor size, but with TNM stage (P = 0.041) and lymph node metastasis status (P = 0.009). As indicated by Kaplan-Meier survival curve, over-expression of APN/CD13 was significantly correlated with the low survival rate. Cox regression analysis showed that APN/CD13 expression was an independent impact factor for the survival of lung adenocarcinoma patients receiving adjuvant chemotherapy (P = 0.006). Conclusions: Expression of APN/CD13 is a potential unfavorable factor to predict the efficacy and prognosis of post-operative chemotherapy in NSCLC patients, especially in lung adenocarcinoma patients.
  2,445 101 -
Influence of selenium on radiogenic collagen destruction and the degree of collagen tissue maturation in stage III oral squamous cell carcinoma patients undergoing therapeutic irradiation
Sonaa Elango, Usha Subbiah
January-March 2015, 11(1):181-190
DOI:10.4103/0973-1482.143328  PMID:25879359
Introduction: We set out to assess whether selenium, an antioxidant mineral could influence radiogenic collagen maturation. Materials and Methods: The study comprise of normal (Group I), untreated oral carcinoma cases (Group II) (n = 20), cases who underwent radiotherapy (Group IIa) n = 10 and cases supplemented with selenium along with radiotherapy (Group IIb) n = 10. Results: Spectrophotometric estimation and luminescence spectral assignment of collagen showed improved collagen maturation status. Measurement of the mature collagen cross-links hydroxylysylpyridinoline and lysylpyridinoline by high-performance liquid chromatography on irradiated tissues showed a considerable decrease in the selenium Group IIb (P < 0.05) indicating a decrease in collagen fragments. Electron microscopic studies showed significant morphological alteration in the selenium group. The micro nucleus frequency, decreased in radiation group (P < 0.05) compared with untreated (P < 0.05). While much more decrease observed in the selenium group (P < 0.05). Discussion: The results represent the effect of selenium treatment with a bearing on carcinogenic process to curtail it, thus enhancing the maturity of collagen.
  2,386 86 -
A randomized controlled pilot study to compare capecitabine-oxaliplatin with 5-FU-leucovorin as neoadjuvant concurrent chemoradiation in locally advanced adenocarcinoma of rectum
Animesh Saha, Sajal Kumar Ghosh, Chhaya Roy, Makhan Lal Saha, Krishnangshu Bhanja Choudhury, Koushik Chatterjee
January-March 2015, 11(1):88-93
DOI:10.4103/0973-1482.150341  PMID:25879343
Context: Established as an adjuvant chemotherapy, CapeOX has recently been shown to have radiosensitizer property in a phase I and II studies, with appreciable downstaging and tolerable toxicities. Aims: The study was designed to evaluate whether the capecitabine-oxaliplatin combination was superior to 5-fluorouracil (5-FU)-leucovorin as radiosensitizer for neoadjuvant chemoradiation in downstaging locally advanced rectal adenocarcinoma and to compare the toxicities between the two arms. Settings and Design: Single institutional, double blinded, prospective, noncrossover, randomized control pilot study. Subjects and Methods: In arm A (n = 21), patients received capecitabine (1,000 mg/m 2 daily) in twice dailydoseon days 1-14 and 25-38 and oxaliplatin (85mg/m 2 ) intravenous ( IV) over 2 h, on D1 and D29. In arm B (n = 21), patients received leucovorin (20mg/m 2 ) and 5-FU (350mg/m 2 ) from D1-5 and D29-33. Patient in both the arms received concurrent radiation (50.4 Gy in 28 #, in conventional fractionation of 1.8 Gy per fraction). Six to eight weeks after concurrent chemoradiation, patients underwent assessment and surgery with total mesorectal resection. Postoperatively, adjuvant chemotherapy with m-FOLFOX 6 of 4 months was given to all patients. Statistical Analysis Used: Chi-square test was used to compare categorical variables between the groups. Results: Objective response rate (ORR) in arm A was 80.95% compared to arm B which had 66.66% (P = 0.3055). Pathological complete response (pCR) rate of arm A was comparable to arm B (23.8vs 14.28%, P value = 0.6944). Surgery with R0 resection was possible in 80.95% cases of arm A compared to 66.66% cases of arm B (P = 0.4827). Grade III toxicities were quite comparable between two treatment arms. Conclusions: In terms of ORR, pCR rate, R0 resection, and toxicity profile; both the arms were comparable.
  2,226 128 -
The effects of combination of gefitinib and cisplatin on tongue squamous cell carcinoma cell lines
Hussein H. S. Helal, Chang E Qi, Yan Yu Zhao, Cong Shan Yao, De Chao Li
January-March 2015, 11(1):37-40
DOI:10.4103/0973-1482.147380  PMID:25879333
Objectives: To study the inhibitory effect of combining the gefitinib with cisplatin on tongue squamous cell carcinoma cells. Materials and Methods: Two cell lines were used, tca8113 which is a cisplatin-sensitive cell line, and tca8113/CDDP which is a cisplatin-resistant cell line established in Jiamusi University Laboratories. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was performed to calculate the IC 50 values of both drugs using both cell lines. Detection of Ras, Raf and ERK1/2 was done by using western blot technique after exposure to different concentrations of gefitinib and cisplatin. Results: Tca8113/CDDP has shown more resistance to cisplatin than tca8113 and slightly more resistance to gefitinib than tca8113. Combination of the two drugs has shown to be more effective for both cell lines than when each alone even with lower concentrations. Conclusions: Combination of gefitinib and cisplatin is a better choice than using each drug alone.
  2,212 127 -
Conformal radiotherapy for locally advanced juvenile nasopharyngeal angio-fibroma
Supriya Mallick, Rony Benson, Suman Bhasker, Bidhu Kalyan Mohanti
January-March 2015, 11(1):73-77
DOI:10.4103/0973-1482.150349  PMID:25879340
Purpose: To assess the efficacy of radiation in the treatment of juvenile nasopharyngeal angiofibroma (JNA). Materials and Methods: Data were retrieved for JNA treated with radiotherapy from 1987-2012. The demographics, treatment and outcome data were recorded in predesigned proforma. Results: Data of 32 patients were retrieved. Median age was 17 years (range: 12-33 years). All patients received radiation because of refractory, residual or unresectable locally advanced disease. All patients were planned with a three-dimensional conformal technique (3DCRT). The median radiation dose was 30 Gray (range: 30-45 Gray). Median follow-up was 129 months (range: 1-276 months). At the last follow-up, 13 patients were found to have a radiological complete response. Two patients progressed 38 and 43 months after completion of treatment and opted for alternative treatment. One patient developed squamous cell carcinoma of the nasal ale 15 years after radiation. Conclusion: Conformal radiotherapy shows promise as an alternative treatment approach for locally advanced JNA and confers long-term disease control with minimal toxicity.
  2,129 190 -
In vitro analysis of particle penetration of smokeless tobacco forms using egg shell membrane as a substrate
Nithya Jagannathan, Abilasha Ramasubra manian, Pratibha Ramani, Priya Premkumar, Anuja Natesan, Herald J Sherlin
January-March 2015, 11(1):204-210
DOI:10.4103/0973-1482.138098  PMID:25879363
Aims: The aim of the following study is to determine the particle sizes of smokeless tobacco forms and thereby evaluate the degree of diffusion of the products using an egg shell membrane as a natural substrate by scanning electron microscopy (SEM). Subjects and Methods: The particle size of smokeless tobacco forms namely mawa, gutka, khaini, and tobacco leaves was determined by image analysis and the products were subjected on an egg shell membrane subjected to artificial saliva along with constant grinding force. The processed egg shell membrane was then examined by SEM to evaluate the morphology and the degree of diffusion of these particles. Results: The morphometric image analysis revealed khaini to be smallest in size followed by mawa, gutka, and tobacco leaves. The control group (egg shell membrane not subjected to any products) under SEM demonstrated intricately woven collagen meshwork, which was regular in length, branched and anastamosed with each other. Khaini exposed membrane demonstrated maximum particle diffusion with disruption of collagen meshwork. Mawa exposed membranes demonstrated minimal particle penetration which were adherent to the collagen meshwork which was irregular with increased interfibrillar space. The egg shell membrane exposed to gutka demonstrated particle penetration at higher magnification with more or less a regular collagen meshwork. The tobacco leaf exposed egg shell membrane demonstrated minimal blebs on the meshwork surface. Conclusions: The degree of diffusion gradually increased with a decrease in the particle size establishing an inverse relationship.
  2,131 127 -
Homocysteine, a biomarker of osteosarcoma
Simmi Kharb, S Kumar, ZS Kundu
January-March 2015, 11(1):51-53
DOI:10.4103/0973-1482.147697  PMID:25879336
Aim of Study: The present study was planned to analyze the status of serum homocysteine (hcy), folate, and Vitamin B 12 in patients with osteosarcoma. Materials and Methods: The present study was conducted on 60 orthopedics patients who were divided into two groups, group I with 30 patients of osteosarcoma and group II with 30 patients with musculoskeletal pain. Results: The present study indicated that serum folate and hcy levels were increased in osteosarcoma patients and decreased Vitamin B 12 in osteosarcoma patients when compared to controls. Conclusion: Lowered serum Vitamin B 12 levels are possibly due to increased metabolic demand of the tumor. Raised hcy levels could be due to the contribution from rapidly proliferating cells. The present study suggests that these parameters can serve as useful markers for diagnosis and follow-up of disease.
  2,071 152 -
EDITORIAL
Ethics and clinical utility of direct-to-consumer genetic tests
Rajiv Sarin
January-March 2015, 11(1):1-2
DOI:10.4103/0973-1482.155088  PMID:25879326
  1,916 175 -
ORIGINAL ARTICLES
Thrombocytosis as a prognostic factor in patients with renal cell carcinoma: A meta-analysis of literature
Haitao Men, Chunshui Liang, Min Yu
January-March 2015, 11(1):67-72
DOI:10.4103/0973-1482.150345  PMID:25879339
Background: The aim of this study was to analyze the prognostic implications of perioperative thrombocytosis in patients with renal cell carcinoma (RCC). Materials and Methods: We conducted search on two medical databases, PubMed and EMBASE, to identify all studies. A meta-analysis was performed to clarify the prognostic role of thrombocytosis. Results: Twelve studies (N = 8735) were included which evaluated the relation of thrombocytosis and 5-year overall survival (OS) or cancer-specific survival (CSS). One thousand and fifty-nine (12.1%) of the 8735 patients exhibited thrombocytosis, and for OS, their estimated risk of death in 5 years was 1.61-fold higher compared with the normal platelet count group [(RR = 1.61, 95% CI = (1.31-1.98), P < 0.001)]. While for CSS, the mortality was 2.56-fold higher [(RR = 2.56, 95% CI = (1.73-3.80), P < 0.00001). According to subgroup analyses, significant positive influence of thrombocytosis on 5-year OS and CSS was displayed only in patients with localized RCC and was also found in patients originated from different areas, such as Asian, Europe or North American. Conclusions: Thrombocytosis indicates worse OS and CSS for patients with RCC, and it showed stronger specificity or sensitivity for CSS. Thrombocytosis is more frequently in patients with metastatic RCC but only showed significant influence on survival of localized RCC patients.
  1,974 106 -
INVITED EDITORIAL
The phantom breast after mastectomy, the homunculus and the hole in the cortical map
Varsha Dutta
January-March 2015, 11(1):3-5
DOI:10.4103/0973-1482.155090  PMID:25879327
  1,942 132 -
ORIGINAL ARTICLES
Significance of MDR-related proteins in the postoperative individualized chemotherapy of gastric cancer
Pengfei Yu, Xiangdong Cheng, Yian Du, Litao Yang, Ling Huang
January-March 2015, 11(1):46-50
DOI:10.4103/0973-1482.147695  PMID:25879335
Objectives: Post-operative adjuvant chemotherapy was beneficial for some patients; however, it may increase the treatment burden and reduce the immunity of other patients. Screening appropriate patients based on molecular markers for individualized adjuvant chemotherapy was necessary. Materials and Methods: Between June 2002 and June 2004, 119 patients who underwent radical gastrectomy were retrospectively analyzed. Some patients had adjuvant chemotherapy based on platinum and 5-FU for four to six cycles. Topoisomerase II (ToPo II) negative, multidrug resistance protein (MRP) positive, and glutathione S-transferase π (GST-π) positive were regarded as three risk factors that may be associated with chemotherapy resistance and poor prognosis. Patients were divided into two groups: high-risk group (≥2 risk factors) and the low-risk group (<2 risk factors), and the tumor recurrence and patient survival time of the two groups were analyzed. Results: The average recurrence time of the low-risk group was significantly longer than that of the high-risk group (21.29 ± 11.10 versus 15.16 ± 8.05 months, P < 0.01).The 3-year and 5-year survival rate of the high-risk group was 57.4% and 42.6%; however, it had no significant difference compared to 66.2% and 58.5% of the low-risk group (P > 0.05). In the high-risk group, the 3-year survival rate of patients with/without chemotherapy were 62.1% and 52.0%, 5-year survival rates were 44.8% and 40.0%, respectively, but the difference was not statistically significant (P > 0.05). In the low-risk group, the 3-year survival rate of patients with/without chemotherapy were 81.2% and 51.5%, and the 5-year survival rates were 71.9% and 45.5%, respectively, and the differences were statistically significant (P < 0.05). Conclusions: Multidrug resistance (MDR)-related proteins ToPo II, MRP, and GST-ð had great significance for the individualized post-operative chemotherapy and prognosis of gastric cancer.
  1,935 89 -
Suppression effects of negative pressure on the proliferation and metastasis in human pancreatic cancer cells
Xiujiang Yang, Bo Sun, Haihang Zhu, Ziting Jiang
January-March 2015, 11(1):195-198
DOI:10.4103/0973-1482.140802  PMID:25879361
Background and Aims: The aim was to explore the effect of negative pressure on the proliferation and metastasis of human pancreatic cancer SW1990 cells. Settings and Design: Three groups were conducted in the work: normal control group (NC group, 0 mm Hg), low negative pressure group (LN group, –300 mm Hg), and high negative pressure group (HN group, –600 mm Hg). Materials and Methods: Cell morphological assay was conducted using an inverted Nikon TE2000-S microscope. Cell viability was assayed using cell counting kit-8 solution. Cell apoptosis was evaluated with flow cytometry. Cell migration was investigated using transwell assay. Results: Compared to LN and HN groups, SW1990 cells in NC group grew quite well, showing a higher density. The NC group represented the highest cell viability. The HN group represented the lowest cell viability, which was lower than that of the LN group (P < 0.01). The apoptosis rate in NC group, LN group and HN group was 1.91% ±0.13%, 2.31% ± 0.06% and 15.22% ± 0.81%, respectively (P < 0.05). The average number of migration cells in NC group was 53.60 ± 4.14 (×200), which was decreased to 18.93 ± 3.67 and 11.07 ± 3.01 in LN group and HN group, respectively (P < 0.01). Conclusion: The negative pressure shows suppression effects on the proliferation and metastasis of human pancreatic cancer SW1990 cells. It is indicated that negative pressure may be involved in the development of human pancreatic cancer by influencing cell biological characteristics.
  1,936 81 -
Concomitant boost chemoradiotherapy in locally advanced head and neck cancer: Treatment tolerance and acute side effects
Mehrsa Majdaeen, Ali Kazemian, Mohammad Babaei, Peiman Haddad, Farnaz Amouzegar Hashemi
January-March 2015, 11(1):24-28
DOI:10.4103/0973-1482.155098  PMID:25879331
Aim: In the present study, we evaluated treatment tolerance and side effects of 6 days a week accelerated radiation therapy using concomitant boost methods with chemotherapy in locally advanced head and neck cancer. Materials and Methods: Thirty patients suffered locally advanced head and neck malignancies were included into this clinical trial. The patients were scheduled for accelerated radiotherapy with total dose of 70 Gy 6 days a week (5 days radiotherapy and 1-day concomitant boost radiotherapy) for 5 weeks and also concurrently for chemotherapy with cisplatin and also celecoxib. Results: The average age of the patients was 51.47 ΁ 11.49 years. The incidence of acute mucositis at the end of the 1st week was 33.3% that was gradually increased until the end of the 5th week (93.3%) and then had a ecreasing trend within the 6th week (70.0%). The incidence of acute dysphagia was estimated 23.3% at the end of the 1st week and reached 60% at completion of treatment. Conclusion: Scheduling a treatment approach with 6 days a week, accelerated radiation therapy using concomitant boost methods with chemotherapy, and celecoxib leads to significant reducing the incidence of complications in the final weeks of therapy in patients with locally advanced head and neck cancer
  1,708 184 -
BRIEF COMMUNICATIONS
Radiobioluminescence, cerenkov luminescence-God light in likes, a potential in radiation therapy imaging
Papineni V. L. Rao
January-March 2015, 11(1):241-242
DOI:10.4103/0973-1482.155113  PMID:25879370
  1,714 118 -
CORRESPONDENCE
Platelet-derived growth factor type BB and collagen matrix for soft tissue reconstruction after muco-epidermoid carcinoma removal: A possible therapeutic option
Marco Cicciù, Alan Scott Herford, Vecchio Giada Maria, Ennio Bramanti
January-March 2015, 11(1):234-237
DOI:10.4103/0973-1482.136033  PMID:25879368
Muco-epidermoid carcinoma (MEC) is a rare malignant tumor occurring in major and minor salivary glands. The described case shows a patient undergoing tumor resection without neck dissection. A quick diagnosis performed through clinical investigation and incisional biopsy revealed the nature of the tumor. A porcine collagen matrix was applied after the surgery in order to improve soft tissue healing. The matrix was saturated with platelet-derived growth factor type BB in order to favorite healing process and then fixed on the palate with a dental support device. Follow-up visit performed at first, second, and third weeks highlighted a quick healing of oral mucosa. Here reported is a case of a 34-year-old man who developed a muco-epidermoid oral carcinoma localized in the left upper jaw palatal side. The clinical, radiographic, and histopathologic findings, plus differential diagnoses of the case and reconstructive treatment options are also presented.
  1,249 50 -
ORIGINAL ARTICLES
Geometrical nuclear diagnosis and total paths of cervical cell evolution from normality to cancer
Javier Oswaldo Rodríguez Velásquez, Signed Esperanza Prieto Bohórquez, Sandra Catalina Correa Herrera, Darío Domínguez Cajeli, Diana Margarita Cardona Velásquez, Martha Melo de Alonso
January-March 2015, 11(1):98-104
DOI:10.4103/0973-1482.148704  PMID:25879345
Background: The diagnosis of cervix cytology has problems of inter-observer reproducibility. Methodologies based on fractal geometry objectively differentiated normal, low-grade squamous intraepithelial lesion (L-SIL) and high-grade squamous intraepithelial lesion (H-SIL) states. Aims: The aim was to develop a mathematical-physical diagnosis and a theoretical generalization of the evolution paths of cervical cells from normal to carcinoma based on their occupation in the box-counting space. Subjects and Methods: Overlaying a grid of 8x8 pixels, the a number of squares occupying the nucleus surface and cytoplasm of 5 normal cells, 5 ASCUS, 5 L-SIL and 5 H-SIL were evaluated, as well as the ratio C/N, establishing differences between states. Sensitivity, specificity, negative likelihood ratio, and Kappa coefficient over the gold standard were calculated. Also was developed a generalization of all possible paths from normality to carcinoma. Results: The occupancy spaces of the nuclear surface allow differentiating normal L-SIL and H-SIL thus avoiding the indeterminacy of ASCUS cells. Compared to the Gold Standard, this method has sensitivity and specificity of 100%, negative likelihood ratio of 0, and Kappa coefficient of 1. 62,900 possible routes of evolution were determined between normal and H-SIL, states, based on the structural basis of the cells. Conclusions: it was obtained an objective and reproducible diagnostic methodology of the development of preneoplastic and neoplastic cervical cells for clinical application. Additionally were developed all possible paths of preneoplastic cellular alteration to carcinoma which facilitates the tracking of patients over time to clinical level, warning of alterations that lead to malignancy, based on the spatial occupation measurements of the nucleus in fractal space regardless of causes or risk factors.
  1,081 55 -
IN-CONTINUATION WITH DEBATE
Rekindling the immortal debate- telecobalt versus linear accelerator
Sridhar P Susheela, Swaroop Revannasiddaiah
January-March 2015, 11(1):243-244
DOI:10.4103/0973-1482.155115  
  919 84 -
BOOK REVIEW
Dying To Be Me
Nilamani N Huilgol
January-March 2015, 11(1):245-245
  884 61 -
IN-CONTINUATION WITH DEBATE
Obsolence of telecobalt machine: Is there is a scope for resurrection?
Nagraj Huilgol
January-March 2015, 11(1):243-243
DOI:10.4103/0973-1482.155114  
  851 74 -