Aim: Oral submucous fibrosis (OSMF) is a high-risk premalignant condition predominantly seen in the Indian subcontinent. The aim of the present study was to evaluate the efficacy of oxitard capsules in the management of OSMF. Materials and Methods: Total of 120 subjects with clinico-pathologically diagnosed OSMF were included in the study and divided equally in 2 groups; Group A (oxitard group) and Group B (placebo group). Group A was administered 2 oxitard capsules twice daily and Group B was given placebo tablets twice daily, for 3 months. Evaluation for different clinical parameters was done at regular intervals and data was analyzed using the Student's paired t test and Chi-square test. P < 0.001 was considered to be statistically significant. Results: Clinical improvements in mouth-opening and tongue protrusion were significant in the Group A (P < 0.001). Subjective symptoms of burning sensation (P = 0.0001), pain associated with the lesion (P = 0.000), difficulty in swallowing (P = 0.0003) and speech (P = 0.0005) also significantly improved in the Group A. There was a mild to moderate decrease in the size of the lesion. Conclusion: Though there is no definitive treatment for the condition; however, oxitard capsules can bring about significant clinical improvements in the symptoms like mouth-opening, tongue protrusion, burning sensation, difficulty in swallowing and speech and pain associated with the lesion, thereby improving the quality of life of the affected individuals.

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Aim of study: In the present study, we evaluated the effect of ribavirin and metformin on the sensitivity of oxaliplatin and 5-fluorouracil (5-FU) on colon cancer. Materials and Methods: Cell viability of two commercially available colon cancer cell lines (HT29 and HCT116) were analyzed by sulforhodamine B (SRB) assay. Results: A clinically achievable and nontoxic concentration of ribavirin and metformin showed a significant synergistic effect on oxaliplatin in HT29 and HCT116 cell lines. Ribavirin showed a synergistic effect on oxaliplatin in HT29 (R = 2.93, P < 0.001) and HCT116 (R = 1.71, P < 0.001), while only in HT29 metformin synergized with oxaliplatin by 2.66 (± 0.28, P < 0.01). In addition, both cell lines showed significant differences in response to Compound 968, inhibitor of mitochondrial glutaminase activity. Conclusion: The data suggested that these cell lines not only turn to metabolic different sustainability process after oxaliplatin treatment but that they also have different basal metabolic requirements of glutamine in vitro which can be exploits in the future for colorectal cancer (CRC) treatment and further studies are required.

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Background: Inflammation and cell necrosis are one of the consequences that accompany breast cancer. However, inflammation and cell necrosis are well known to be involved in stimulation of cellular and humeral immunity. Objectives: The aim of this study is to investigate the immune response to the inflammation that accompanies cancer through measuring plasma concentration of antinuclear antibodies (ANAs) and anti-double stranded deoxyribonucleic acid antibodies (ADSDAs). Materials and Methods: Thirty-five newly diagnosed breast cancer patients were involved in this study from the Radiation Isotopes Center Khartoum (RICK) compared to 18 age- and sex-matched control subjects. Intravenous blood sample was obtained from each study subject and Enzyme Linked Immuno Sorbent Assay (ELISA) technique was used to determine the concentration of the two antibodies. Results: Regarding the ANA concentration in the patients; the range was 0.7-1.8 IU/ml, mean was 0.96, and the standard deviation (SD) was 0.25; while the range of theconcentration in the control subjects was 0.3-0.6 IU/ml, mean was 0.47, and SD was 0.07. However, when the means of patients and controls were compared, the difference was significant (P < 0.000). Concerning the result anti-double stranded DNA (anti-dsDNA), its concentration range in the patients was 2.6-151.9 IU/ml, themean was 55.2, and SD was 25.6, while in healthy people concentration range was 26.1-97.3 IU/ml, the mean was 50.3, and SD was 16.9. There was no significant change between the patients and controls (P = 0.46). Conclusion: The ANA concentration in the patients was significantly increased, while there was no significant difference between the results of ADSDAs in the patients and the control subjects.

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Background: Collagen is a part of structural connective tissue in every organ of the body. Study of collagen brings into focus the current knowledge of biosynthesis and degradation as a complex mechanism. One of the major aspects of tumor cell invasion and metastasis is the interaction between cancer cells and extracellular matrix component. Property of picrosirius red to enhance the birefringence is the result of basic protein nature of collagen molecules. There exists a direct relationship between the presence of type IV collagen and degree of differentiation in squamous cell carcinoma (SCC) cells as they lose their capability to form the basement membrane. Materials and Methods: Thirty cases of oral SCC (OSCC) were evaluated for standard staining protocol of picrosirius red to analyze collagen fibers in different grades of OSCC under polarizing microscopy. Results: In this study, moderately to poorly differentiated OSCC cases showed a gradual change in polarizing colors from yellowish orange to greenish yellow particularly in the vicinity of invading tumor islands. Thick collagen fibers forming bundles in parallel disposition were found around the neoplastic areas in discontinuous fashion. Type I collagen fibers of different lengths were strongly birefringent and swirl pattern, parallel orientation was evident. Conclusion: An observable stromal change with the progression of neoplasm was evinced with picrosirius red stain in different thickness of collagens with a significant change in the arrangement from the early stage to the advanced stage according to tumorogenesis.

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Aim of the Study: Oral leukoplakia (OL) is the most common potentially malignant disorder that may transform into oral carcinoma. By treating leukoplakia in its incipient stage, the risk of occurrence of oral carcinoma can be prevented. In this aspect, photodynamic therapy (PDT) can serve as a useful treatment modality. The aim of the study is to treat patients with OL using PDT in which 5-aminolevulinic acid (ALA) is used as a photosensitizer. Materials and Methods: Five patients with OL were included in the study. They were treated with 10% ALA mediated PDT (light source: Xenon lamp, power: 0.1 W, wavelength: 630 ± 5 nm, total dose: 100 J/cm ² per session) for 6-8 sessions. Follow-up was done for a period of 1 year. Results: One month (4 weeks) after ALA-PDT, the response was evaluated based on clinical examination. It was as follows: Complete response: Two patients; partial response: Two patients; and no response: One patient. There was no recurrence in any of the cases. Conclusion: There was satisfactory reduction in the size of the OL lesion without any side-effects. Thus, ALA mediated PDT seems to be a promising alternative for the treatment of OL.

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To analyze the therapeutic effect of bevacizumab on radiation-induced brain necrosis. Four radiation-induced brain necrosis patients, administered with bevacizumab at a dose of 7.5 mg/kg every 3 weeks, 2 times. One case of brain metastasis of lung cancer and one case of nasopharyngeal carcinoma with brain necrosis after radiotherapy. However, their physical signs disappeared after the treatment with bevacizumab. One case of brainstem lesion and one case of brain glioma patient showed a transient improvement in signs and symptoms after treatment with bevacizumab. Bevacizumab can significantly alleviate the radiation-induced brain edema, and can improve the symptoms successively.

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The present study was undertaken with an aim of determining the cytological features observed in mucosal smears of oral submucous fibrosis (OSF) patients and comparing them with that of features of normal mucosal cells. The observed features were than analyzed for their reliability in detecting malignant changes in this premalignant condition. Objective of the study was to conduct an oral exfoliative cytology (OEC) study on 30 clinically diagnosed cases of OSF and 30 cases of clinically normal mucosa with no other systemic disease. We observed that all the smears from clinically normal buccal mucosa showed Class I cytology. The exfoliated cells were of normal size and shape with normal staining intensity and normal nuclear characteristics. All the 30 cases of our study group showed features suggestive of benign atypical cytological changes (Class II cytology). In the present study, despite the small number of cases, cytological features consistently observed in all the cases, were indicative of a premalignant change and emphasized a regular follow-up of patients. Early detection of a premalignant oral lesion promises to improve the survival rate of patients suffering from these conditions.

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Sample size is one of the basics issues, which medical researcher including oncologist faces with any research program. The current communication attempts to discuss the computation of sample size when sensitivity and specificity are being evaluated. The article intends to present the situation that the researcher could easily visualize for appropriate use of sample size techniques for sensitivity and specificity when any screening method for early detection of cancer is in question. Moreover, the researcher would be in a position to efficiently communicate with a statistician for sample size computation and most importantly applicability of the results under the conditions of the negotiated precision.

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Objective: The aim of this study was to evaluate the therapeutic efficacy and toxicity of a combination of tegafur-gimeracil-oteracil potassium capsules (S-1) with oxaliplatin for treatment of advanced or recurrent colorectal cancer. Subjects and Methods: Between October 2009 and October 2011, 70 patients at our hospital with advanced or recurrent colorectal cancer were enrolled into our study and divided randomly into two groups: A treatment group (S-1 combined with oxaliplatin) and a control group (Xeloda combined with oxaliplatin). All patients received 130 mg/m ² oxaliplatin by intravenous infusion on day 1, every three weeks. Patients in the treatment group were treated with oral administration of 30-40 mg/m ² S-1 twice daily for 14 days. Patients in the control group were treated with oral administration of 1000 mg/m ² Xeloda twice daily for 14 days. The efficacy and toxicity of the combination therapy were evaluated after two cycles of treatment. Results: The response rates in the treatment and control groups were 54.3% and 42.9%, respectively. The disease control rates of the two groups were 80.0% and 74.3%, respectively. The 1-year and 2-year survival rates were 73.6% and 39.1% in the treatment group, respectively, compared to 73.8% and 37.8% in the control group. No statistical difference between the two groups for any of the parameters, including toxicity, was observed (P > 0.05). Conclusion: The efficacy of the S-1 and oxaliplatin combination regimen in advanced or recurrent colorectal cancer treatment is not inferior to the combination of Xeloda and oxaliplatin and does not result in additional toxicity. Therefore, S-1 could be used to substitute Xeloda in combined chemotherapy with oxaliplatin for the treatment of advanced or recurrent colorectal cancer.

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Context: The use of tobacco/betel quid can alone lead to death. India is the fourth largest consumer of tobacco/betel quid in the world and the third-largest producer of tobacco/betel quid after China and Brazil. Aims: A case-control study was carried out to assess the prevalence and various risk factors among potentially malignant disorders (PMD) and oral cancer patients of central India. Settings and Design: A total of 100 clinically and histopathologically diagnosed PMD and oral cancer patients were selected for the study. Materials and Methods: A histopathologically confirmed 100 patients who were suffering from PMD and oral cancers were selected and an equal number 100 healthy controls who were age- and sex-matched at par with the cases were also examined and interviewed. Chi-square (χ² ) test and adjusted odds ratio (ORs) with 95% confidence interval (CI) were calculated to estimate the suspected risk factors for PMD and oral cancers by using multivariate logistic regression analysis. Significance level was set at P < 0.05. Results: Statistically significant difference was observed in the age group, socioeconomic status (SES), duration, frequency, exposure time and synergistic effect of tobacco/betel quid chewing, smoking, and alcohol drinking in our study population. Conclusions: Chewing tobacco/betel quid is a strong risk factor in the development of PMD and oral cancer. Also age, gender, SES, education, and occupation influence the development of PMD and oral cancer.

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Background: Treatment of periampullary cancer involves Whipple surgery, followed by adjuvant radiotherapy and chemotherapy. Postoperative radiotherapy is particularly useful in managing high-risk patients (tumors involving the pancreas, poorly differentiated histology, involved lymph nodes and positive margins). Here, we review our results of treatment of 84 patients treated by surgery and adjuvant radiotherapy and chemotherapy. Material and Methods: A retrospective analysis of 84 patients of periampullary cancers treated in our department between January 2007 and December 2012 was carried out. All patients underwent Whipples surgery followed by postoperative radiotherapy 45-50 Gy/25-28 number in those presenting with high-risk features. Radiotherapy was delivered using three-dimensional conformal technique with 6 MV photons using three field treatment plans. Chemotherapy was given for 6 cycles using gemcitabine and oxaliplatin regimen repeated 2 weekly. Results: Eighty four postoperative patients with high-risk features were available for the final analysis. There were 69 males and 15 female patients. There were 34.5% stage I, 57.1% stage II and 8.3% stage III patients. At end of adjuvant treatment with radiotherapy and chemotherapy 70% patients had a complete response, 7.5% had residual disease, 15% showed progressive disease, 5% were dead and 2.5% defaulted the treatment. The mean number of chemotherapy cycles received was 2.6. At 1 year follow-up the probability of disease free survival was 80% for node-negative patients versus 73% for node-positive disease (P = 0.27). Patients with stage up to IIA had a 1 year disease free survival of 83% versus 40% for patients with stage beyond IIA (P = 0.024). Conclusions: Our results showed a trend favoring lymph node negative status with disease free survival. With computed tomography based planning, adequate delineation of draining nodes is possible, and radiation toxicity has significantly decreased. Adequate coverage of nodal basins during radiotherapy planning is important, and stage of the disease seems to be an important prognostic factor.

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Healthy breast tissue is sensitive to radiation fraction size, such that small changes in fraction size can lead to larger changes in radiation effects on these tissues. Conventional breast and/or chest wall irradiation uses 2 Gy daily fractions, for 5-6 weeks. Such a long treatment schedule has major implications on both patient quality of life and burden of radiotherapy (RT) departments. Some investigators have hypothesized that breast cancer is as sensitive as normal breast tissue to fraction size. According to the hypothesis, small fraction sizes of 2.0 Gy or less offer no therapeutic advantage, and a more effective strategy would be to deliver fewer, larger fractions that result in a lower total radiation dose. This short (hypofractionated) RT schedule would be more convenient for patients (especially those coming from remote areas to RT facilities) and for healthcare providers, as it would increase the turnover in RT departments. This thought has prompted us to write a systematic review on role of hypofractionated RT in breast cancer in a developing country like ours where patient burden is an alarming problem.

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Objective: The purpose of our study was to evaluate the effect of oral taurine supplementation on the incidence of chemotherapy-induced adverse drug reactions during chemotherapy in young adults with acute lymphoblastic leukemia (ALL). Materials and Methods: Forty young adult (aged over 16 years) with ALL, at the beginning of maintenance course of their chemotherapy, were recruited to the study. The study population was randomized in a double blind manner to receive either taurine or placebo. Life quality and adverse drug reactions were assessed using questionnaire. Blood cell count, hemoglobin (Hb), hematocrit (Hct), serum bilirubin, transaminases, urea, and creatinine concentrations were evaluated. Data was analyzed using Statistical Package for Social Sciences (SPSS) software. Results: Of total participants, 43.8% were female and 56.3% were male. The mean age was 19.16 ± 1.95 years (range: 16-23 years). The results indicated that the levels of white blood cells were significantly (P < 0.05) increased in taurine treated group, but other hematological values did not differ significantly in either group. Taurine administration improved liver and kidney functions, indicated by decline of serum bilirubin, transaminases, urea, and creatinine, respectively in comparison to the controls (P < 0.05). Moreover, taurine significantly reduced serum malondialdehyde (MDA) and superoxide dismutase (SOD) levels (P < 0.05). Conclusion: In conclusion our results indicated that taurine supplementation could be a protection against chemotherapy-induced toxicities probably by its antioxidant capacity. Present study showed effectiveness of taurineon the chemotherapy-related toxicities and some of the complications during the maintenance period of treatment following coadministration in young adults with ALL.

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Objectives: Acute Myeloid Leukemia (AML) therapy continues to be a daunting challenge. Cytosine Arabinoside (Ara-C) is widely used to treat hematological malignancy in humans, but often becomes ineffective because of increased resistance to the drug which may lead to a worse prognosis. Therefore new strategies are needed to understand the mechanism responsible for drug resistance and to develop new therapies to overcome it. Research evidence based on natural compounds used alone or in combination with current chemotherapeutic agents proved their efficacy to treat and prevent cancer. Hesperidin and Silibinin displayed anti-cancer activity against various types of cancers and cell lines and can be used in combination with Cytarabine with the aim to increase cytotoxicy profile and reduction in drug resistance. Experimental Work: Primary cells obtained from AML patient's bone marrow were used to develop in-vitro model and further exposed to various concentration of Cytarabine (10 nM-5000 nM), Hesperidin (0.5 μM-100 μM) and Silibinin (0.5 μM-100 μM) alone and in combination with Cytarabine (Hesperidin-25 μM, Silibinin10 μM) to check cytotoxicity using MTT assay. Synergistic effect was evaluated by Combination Index method. Result and Conclusion: In-vitro study of Hesperidin and Silibinin indicated their cytotoxicity at IC ₅₀ value 50.12 μM and 16.2 μM, respectively. Combination Index study revealed Hesperidin and Silibinin both showed synergistic potential and decreased the IC ₅₀ value of Cytarabine by ~5.9 and ~4.5 folds, respectively. Both natural compounds showed potential anti-leukemic activity hence may be used for AML therapy alone or in combination with other chemotherapeutic agents.

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We proposed a method to reduce the volume of normal tissues irradiated by low doses in patients receiving CSI with RapidArc (RA) using Avoidance-Sector technique (RA+AS) and to compare its dosimetric implications with RA using full-arc (RA+FA) and 3D conformal technique (3DCRT). Four patients of CSI were retrospectively planned with 3DCRT, RA+FA, and RA+AS. Conformity-Index (CI), Homogeneity-Index (HI), and Paddick Gradient-Index (GI) were calculated. Quantitative evaluation was done using DVH analysis for PTVs and OARs. When compared with 3DCRT, GI, CI, and HI were favorable to RA based techniques. In comparison with 3DCRT the doses to OARs were lower with RA+AS with the difference being statistically significant in most instances. RA+AS significantly decreases the dose to OARs and their volumes receiving low doses in comparison with RA+FA and 3DCRT.

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Objective: This work was aimed at studying the inhibitory activity of metformin combined with the commonly used chemotherapy drug cisplatin in human lung cancer xenografts in nude mice. We also examined the combined effects of these drugs on the molecular expression of survivin, matrix metalloproteinase-2 (MMP-2), vascular endothelial growth factor-C (VEGF-C), and vascular endothelial growth factorreceptor-3 (VEGFR-3) to determine the mechanism of action and to explore the potential applications of the new effective drug therapy in lung cancer. Materials and Methods: The nude mice model of lung cancer xenografts was established, and mice were randomly divided into the metformin group, the cisplatin group, the metformin + cisplatin group, and the control group. The animals were killed 42 days after drug administration, and the tumor tissues were then sampled to detect the messenger ribonucleic acid (mRNA) and protein expression levels of survivin, MMP-2, VEGF-C, and VEGFR-3 by immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR). Results: The protein and mRNA expression levels of survivin, MMP-2, VEGF-C, and VEGFR-3 in the cisplatin group and the combined treatment group were lower than that in the control group (P < 0.05). In the metformin group, the expression of MMP-2 protein and mRNA was lower than that in the control group (P < 0.05). The protein and mRNA expression levels of survivin, MMP-2, VEGF-C, and VEGFR-3 in the combined treatment group were lower than that in the cisplatin group and the metformin group (P < 0.05). Conclusions: Metformin inhibited the expression of MMP-2, cisplatin and the combined treatment inhibited the expression of survivin, MMP-2, VEGF-C, and VEGFR-3, and the combined treatment of metformin with cisplatin resulted in enhanced anti-tumor efficacy.

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Purpose: Endometrial carcinoma is the most common gynecologic malignancy which is associated with a poor prognosis when diagnosed at an advanced stage; therefore, the discovery of efficacious new drugs is required to reinforce conventional chemotherapy. Short-term cultures of primary cells from endometrial tumors could be used for testing new anticancer therapeutics as well as for the development of personalized cancer therapy strategy. Here, the antitumor effect of a recombinant analogue of lactaptin (RL2), a new potential anticancer molecule, was examined against primary human endometrial cancer cells. Materials and Methods: Primary cell cultures of malignant and normal human endometrium were performed by enzymatic digestion of endometrial tissue from biopsy material. Real-time quantitative reverse transcription polymerase chain reaction (RT-PCR) was performed to determine the messenger ribonucleic acid (mRNA) state of estrogen (ERs) and progesterone (PRs) hormone receptors and aromatase (Cyp 19) in cell cultures. Dynamic monitoring of cell adhesion and proliferation was made using the iCELLigence system (ASEA Biosciences). The sensitivity of cell cultures to conventional anticancer drugs and the lactaptin analog was estimated by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay, flow cytometry, and the iCELLligence system. Results: Established short-term primary cultures of endometrial cancer cells were ERα/ERβ/PR-positive and sensitive for RL2. The IC ₅₀ values of doxorubicin and cisplatin were determined for all of the primary cultures designed. KE normal cells displaying low Cyp19 mRNA levels and high ERβ and PR mRNA levels were more resistant to RL2 treatment as well as to cisplatin and doxorubicin. Conclusions: Our results indicate that the recombinant analog of lactaptin, RL2, exerts cytotoxic effects against primary hormone-dependent endometrial tumor cells in vitro with features of apoptosis.

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Aims: To evaluate current focal high precision radiotherapy (RT) techniques to spare hippocampi most optimally, in view of mounting clinical evidence to preserve neurocognition. Materials and Methods: Computed tomography/magnetic resonance imaging (CT/MRI) datasets of 10 patients with benign/low-grade brain tumors, treated with focal conformal RT were replanned with helical tomotherapy (Tomo), intensity-modulated radiotherapy (IMRT) with high definition multileaf collimator (HD-MLC), and forward planning stereotactic conformal radiotherapy (SCRT). The primary planning objective was to encompass 99% of planning target volume (PTV) by 95% of prescribed dose (54 Gy/30#). Assessments included target coverage (TC), homogeneity index (HI), and maximum (max) and minimum (min) dose. Hippocampal dose was assessed with mean, maximum, minimum, median dosem and various dose levels. Results: Mean V ₉₅ for PTV coverage in Tomo, IMRT, and SCRT were 99.7, 99.4, and 98.3%, respectively. PTV coverage was significantly better in Tomo and IMRT compared to SCRT (P = 0.03). Tomotherapy (HI ≤ 0.06) and IMRT (HI ≤ 0.06) plans were more homogenous than SCRT (HI > 0.7) (P = 0.00). Right hippocampus mean dose with Tomo (20Gy) was 18.5% less than SCRT (30 Gy); but for left hippocampus, difference decreased to 3.3% (Tomo-32.2Gy and SCRT-34Gy). At 30% dose level, 9% more volume of right hippocampus was treated in IMRT and 20% in SCRT when compared to Tomo plan. At 80% dose, 6 and 12% more volumes were treated with IMRT and SCRT, respectively, in comparison to Tomo plan. For left hippocampus all three techniques were comparable. Conclusion: Tomotherapy and Linear accelerator (LINAC)-based IMRT achieved significantly better PTV coverage than forward planned SCRT. Tomo as compared to SCRT and IMRT plans showed trend towards significant sparing of the contralateral hippocampus, in eccentrically located tumors.

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Purpose: The purpose of this study was to evaluate the prognostic factors affecting overall survival (OS), cause-specific survival (CSS), progression-free survival (PFS), and survival among patients undergoing adjuvant radiotherapy (RT) for stage-1 seminoma. Materials and Methods: Between August 1997 and May 2013, 68 patients diagnosed with stage-1 seminoma were retrospectively evaluated. The median age was 39 (24-74) years. All patients received adjuvant RT after inguinal orchiectomy. Fifty-eight (85.3%) patients received paraaortic RT; 10 (14.7%) received dog-leg field RT. The median RT dose was 23.4 (23.4-30.6) Gy. Results: The median follow-up period was 77.5 (6.7-198.5) months. During the follow-up period, two patients developed distant metastasis, and none developed local recurrence. Two patients died from seminoma, and three died for other reasons. The 5, 10, and 15-year OS rates were 94.7%, 89.6%, and 89.6%, respectively. The 5, 10, and 15-year CSS rates were 98.5%, 96%, and 96%, respectively. The 5, 10, and 15-year PFS rate was 96.1%. The univariate analysis showed that only histological subtype was significant for OS. The 10-year survival rate was 100% among patients with seminoma histology, 90.8% among patients with a classic seminoma histology, and 50% among patients with an anaplastic seminoma histology (P < 0.001). A multivariate analysis showed that the anaplastic seminoma was a negative prognostic indicator for OS (P = 0.042). Conclusion: Adjuvant RT resulted in excellent long-term survival and local control in patients with stage-1 seminoma after orchiectomy. During a short follow-up, secondary malignancy (SM) and late cardiovascular morbidity were not observed. Despite those results, concern of SM and late cardiovascular morbidity remains.

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Background: We aimed to assess the efficacy of a metronomic regimen with cyclophosphamide and etoposide in heavily treated patients with metastatic breast cancer (MBC). Materials and Methods: A total of 77 patients with MBC used continuous oral cyclophosphamide 50 mg/day and oral etoposide given as 2 × 50 mg/day for 2 days per week, were analyzed retrospectively from Akdeniz University and Selcuk University. The patients with MBC are predominantly refractory to antracyclines, taxanes, and antimetabolites. Results: The patients were treated and followed between May 2005 and June 2014. The median progression-free and overall survival (PFS and OS) were 7.03 (5.06-8.99) and 32.5 (22.5-42.4) months, respectively. No prognostic factor was found for OS. Conclusions: Metronomic treatment regimen with cyclophosphamide and etoposide is a novel and effective strategy in heavily pretreated MBC patients. This regimen can be used in early or late steps as independently from prognostic factors. Moreover, it has very low toxicity and is cheap. Impressive survival data and low cost may make this regimen a highly preferable option.

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Introduction: The prognostic role of pathologic fracture in osteosarcoma has not been settled down, as previous researches have reached contradictory results. This study is prepared to clarify whether pathologic fracture predicts a poor prognosis of patients with osteosarcoma. Materials and Methods: After completely retrieved databases including China National Knowledge Infrastructure (CNKI), PubMed, Highwire, EMBASE and Science Direct, all eligible articles were included based on inclusion/exclusion criteria. And we performed a meta-analysis to calculate the pooled prognostic role of pathologic fracture in osteosarcoma. Results: Finally, a total of 8 articles met the inclusion/exclusion criteria, involving 1,677 subjects. We found that the pooled hazard ratios (HRs) with 95% confidential interval (CI) of pathologic fracture in osteosarcoma for overall survival (OS) and disease-free survival (DFS) are 2.13 (1.43, 3.15) and 1.58 (1.11, 2.24), respectively. Conclusion: This meta-analysis demonstrated that presentation with a pathologic fracture in osteosarcoma was correlated with a poor prognosis. And pathologic fracture might be a poor predictor of survival in osteosarcoma.

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Context: The insulin-like growth factor (IGF) and insulin receptors' (IR) axes play important roles in both breast cancer and diabetes mellitus. Aim: We tend to explore the expression characteristics of proteins in IGF/IR axis in breast cancer with type 2 diabetes mellitus (T2DM). Settings and Design: We conducted a case-control investigation of T2DM and non-diabetes (n = 40, 1:1) in breast cancer patients. Materials and Methods: Some important molecules of IGF/IR axis were detected in breast cancer tissues by immunohistochemical staining. The multivariable analyses of the relationship of clinicopathological characters with the significant molecules were also detected. Statistical Analysis Used: The results were statistically evaluated by Statistical Package for the Social Sciences (SPSS version 17.0) software. Chi-square test and logistic regression are used. Results: Higher expression of IGF 1 receptor (IGF1R) was found in breast cancers of patients with T2DM, compared those without diabetes (P = 0.044). Negative expression of human epidermal growth factor receptor 2 (Her2) was found to be associated with higher expression of IGF1R in the breast cancers of patients with T2DM. There were no differences found in the expression of proteins of IGF-1, IGF-2, IGF-binding protein 3 (IGFBP3), IR, insulin receptor substrate (IRS)-1, IRS-2 and mammalian target of rapamycin (mTOR) between T2DM group and non-diabetes group. Conclusion: Our study found that breast cancer with T2DM had a higher expression of IGF1R, and the higher IGF1R was associated with negative Her2 expression.

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Elekta AB, Sweden has recently propagated the Elekta Compact - a low-cost, small-footprint, single energy (6MV), linear accelerator, in India. The absence of electron beams and the inability to seamlessly deliver inverse planned intensity modulated radiotherapy (IMRT) segments, mean that some out-of-the-box thinking is mandatory for the full range of required treatments in different clinical settings, but is ultimately very rewarding. Our department started off in July 2011, with the Elekta Compact, equipped with MLCi2 and a camera-based electron portal imaging device. For head-neck cancers, we have successfully utilized a 3D conformal class-solution of eight-to-nine oblique beams, with multiple segments, to deliver an adequate dose to the posterior neck, respecting spinal cord tolerance. Parotid gland sparing is possible in selected node-negative hypopharyngeal/laryngeal cancers. For prostate cancers, we have developed a forward-planned IMRT protocol to routinely deliver 76-80 Gy to the prostate, with margins, while conforming to the same rectal dose-volume constraints as in inverse IMRT. Response and tolerance have been excellent so far. In head-neck cancers, the majority (71%) of patients was locally advanced; however, complete response was achieved in 75% of the cases. Grade 3 acute toxicities were seen in only 7% of the cases and compliance overall was excellent, with no patients requiring a gap in treatment. We achieved biochemical control in 100% of the prostate cancer patients; no patients had grade 3 acute toxicities, and with a median follow-up of 12 months, have yet to see any late rectal bleeding. Although engineered for simplicity and versatility, the Compact requires some innovative thinking by clinicians/physicists to optimize the full range of its possibilities. However, upgrades like inverse IMRT delivery, which are in the pipeline, are urgently needed for it to be viable, especially in a single-accelerator department.

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Objective: To investigate the value of lysophosphatidic acid (LPA) in the diagnosis of ovarian cancer. Materials and Methods: We first performed a hospital-based, case-control study involving 123 ovarian cancer patients and 101 benign ovarian tumor patients, and then conducted a meta-analysis with 19 case-control studies to assess the correlation between ovarian cancer and plasma LPA levels. Results: The case-control study results demonstrated that ovarian cancer patients have increased LPA and cancer antigen (CA)-125 levels compared to patients with benign ovarian tumor (LPA: Ovarian cancer vs benign ovarian tumor: 5.28 ± 1.52 vs 1.82 ± 0.77 μmol/L; CA-125: Ovarian cancer vs benign ovarian tumor: 87.17 ± 45.81 vs. 14.03 ± 10.14 U/mL), which showed statistically significant differences (both P < 0.05). LPA with advanced sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of diagnosis excelled CA-125 in the diagnosis of ovarian cancer (both P < 0.05). The areas under the receiver operating characteristic (ROC) curve in the diagnosis of ovarian cancer (LPA: 0.983; CA-125: 0.910) were statistically significant compared with the reference (both P < 0.001) and the difference of the areas of ROC curve between LPA and CA-125 in the diagnosis of ovarian cancer showed statistically significant difference (P < 0.05). The meta-analysis results suggested that plasma LPA levels were higher in ovarian cancer tissues than in benign tissues (standardized mean difference (SMD) =2.36, 95% confidence interval (CI): 1.61-3.11, P < 0.001) and normal tissues (SMD = 2.32, 95% CI: 1.77-2.87, P < 0.001). Conclusion: LPA shows greater value in the diagnosis of ovarian cancer compared to CA-125 and may be employed as a biological index to diagnose ovarian cancer.

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Introduction: Ligustrazine, the active ingredient present in Umbelliferae plant roots used in Chinese medicine, plays a vital role in reversing multidrug resistance in tumors. This study aims to investigate its anticancer activity and underlying mechanisms in human breast cancer cells in vitro and in vivo. Materials and Methods: Human breast cancer cell line MDA-MB-231 was incubated with different concentrations of ligustrazine. The cell viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay; and cell apoptosis and cell cycle were assessed by flow cytometry. Subcutaneous MDA-MB-231 xenograft tumors were established in nude BALB/c mice. Ligustrazine was intraperitoneally administered. The tumor growth was monitored. Results: In vitro, ligustrazine inhibited cell survival in a dose-and time-dependent manner, and induced apoptosis, as indicated by a dramatic increase in sub-G0/G1 cells. The in vivo results were consistent with the in vitro ones: Administration of ligustrazine substantially inhibited tumor growth, which also indicated that ligustrazine inhibited proliferation of MDA-MB-231 cells in vitro. Conclusions: Ligustrazine causes apoptotic death and tumor regression in human breast cancer cells in vitro and in vivo models.

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The nonsurgical strategies for locally advanced oral cancer are desirable. Superselective intra-arterial infusion with radiotherapy was utilized for this purpose, and there are two types of superselective intra-arterial infusion methods: The Seldinger method and the retrograde superselective intra-arterial chemotherapy (HFT method). In one case, the HFT method was applied to locally advanced tongue cancer, and the Seldinger method was used for additional administration of cisplatin (CDDP) to compensate for a lack of drug flow in the HFT method. In another case, the HFT method was applied to locally advanced lower gingival cancer. The Seldinger method was applied to metastatic lymph nodes. In both cases, additional administration of CDDP using the Seldinger method resulted in a complete response. The combination of the HFT and Seldinger methods was useful to eradicate locally advanced oral cancer because each method compensated for the defects of the other.

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Aims: To identify key genes and pathways in the development of esophageal squamous cell carcinoma with RNA-seq data. Materials and Methods: RNA-seq data including three paired samples were downloaded from Sequence Read Archive database under accession number SRP007169 and differentially expressed genes (DEGs) were identified with package edge R of R. Functional enrichment analysis was performed to uncover their biological functions with the Database for Annotation, Visualization, and Integrated Discovery (DAVID) tools. Results: A total of 5561 DEGs were obtained, including1829 upregulated and 3732 downregulated. Quite a few upregulated genes were components of collagen and matrix metallopeptidases (MMPs), which are involved in cell adhesion, cell mobility and so on. Keratin, mucin and cysteine-rich secretory protein were found to be significantly downregulated. Significantly over-represented biological processes for downregulated genes were epidermis development, epidermal cell differentiation and arachidonic acid metabolism. Conclusion: These identified DEGs may be underlying targets for diagnosis and treatment of esophageal squamous cell carcinoma.

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Context: Surgery is an important part of treatment in children with neuroblastoma; however, exact timing is unclear. Both initial and delayed surgery was suggested as the best by numerous studies. Aims: Thus, we aimed to investigate the role of delayed surgery on 31 children with high-risk neuroblastoma. Materials and Methods: Thirty-one children with high-risk neuroblastoma were enrolled into the study. Statistical Analysis Used: Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) for windows 10.0. Results: There 'were 15 male and 16 female patients with a median age of 3.0 ± 3.2 years. Primary tumor site was adrenal in 27, non-adrenal in two, pelvic in one, and mediastinal in one patient. MYCN gene was amplified in four and non-amplified in 11 children on totally 15 children with available data. Lactate dehydrogenase was elevated in 30 children. The tumor volumes at diagnosis and before surgery in the whole group were 154.3 and 12.5 mL, respectively. The decline in tumor volume was statistically significant (P < 0.0001). Initial surgery was performed in three and delayed in 20 children, and eight children were inoperable. Surgical complication rate was 66.6% (two out of three patients) in initial surgery group; however, the rate was 15% (3 out of 20 patients) in delayed surgery group. The 5-year event-free survival and overall survival rates in the whole group were 44.8% and 50.8%, respectively. Primary tumor area control rate was 95% Conclusions: In conclusion, the delayed surgery with intensive chemotherapy and radiotherapy has been successful for primary control in high-risk neuroblastoma patients.

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Context: Toxoplasma gondii is a protozoan parasite with a world-wide distribution. However, the majority of infected cases remain symptomless. There are raising scientific evidences indicating that parasitic infections induce antitumor activity against certain types of cancers. The inhibitory effect of T. gondii on cancer growth has also been shown in cell culture and mouse model. Aims: Considering the anti-tumor effect of this parasite, in this study the relationship between low titer of antibodies against T. gondii and resistant to cancers has been investigated. Subjects and Methods: In two separate experiments, anti T. gondii antibody was estimated in 150 patients with cancer and 120 normal people. Statistical Analysis Used: Chi-square test was used for data analysis. Results: The frequency of low titer antibody against Toxoplasma gondii in cancer patients was significantly higher than the frequency of low-titer antibody against this parasite in normal people. Conclusions: Exposure to T. gondii may be related to resistance to cancer.

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Background and Aim: In cancer patients, Candida species can cause a variety of diseases particularly oropharyngeal candidiasis which is a common infection. In this study, an attempt has been made to determine susceptibility pattern of four antifungal agents against the Candida species isolated from cancer patients with oropharyngeal candidiasis. Materials and Methods: Samples were taken from 50 cancer patients with oropharyngeal candidiasis by the physician, and isolation and identification of Candida spp. was done based on standard procedures. Antifungal resistance pattern was carried out according to CLSI guidelines, and 18s ribosomal RNA among Candida spp. was identified using multiplex polymerase chain reaction. Results: Of the 50 patients, 18 (36%) were females and 32 (64%) were males; mean age was 38.4 years. Leukemia and lymphoma were the most frequent cancer types in the studied group, accounting for 17 (34%) and 12 (24%), respectively. A total of 29 Candida spp. were isolated from 29 cancer patients, of which 17 were C. albicans and 12 were C. non-albicans. All the Candida spp. were confirmed having 18s ribosomal RNA. Among all the Candida spp., C. non-albicans showed higher resistance pattern to amphotericin B (MIC 07 μg/ml) and ketoconazole (MIC = 05 μg/ml). Conclusion: In conclusion, oropharyngeal Candidiasis is a serious infection among cancer patients. The isolated Candida spp. were resistant to common antifungal agents, which may lead to longer hospital stay, more expensive/toxic drugs and higher mortality. Therefore, interval surveillance is necessary in developing institutional guidelines.

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Objective: This study aims to compare the difference of polyunsaturated fatty acid (PUFA) between patients with colorectal cancer and healthy people and analyze the effect of PUFA on colorectal cancer by testing serum of PUFA. Materials and Methods: One hundred and fifty-six healthy people and 79 patients with colorectal cancer were randomly chosen in Beijing, China. PUFA level was measured in two groups. According to different stages, sizes, degree of differentiation, lymph node metastases from patients with colorectal cancer, we compared metabolize situation of PUFA. Results: Total omega-6 PUFA level was higher in healthy people group than that in colorectal cancer group (25.77 ± 3.21 vs. 26.86 ± 1.65, P = 0.0125); moreover, arachidonic acid (AA) level was also higher in healthy people group than that in colorectal cancer group (5.02 ± 1.32 vs. 6.08 ± 1.26, P = 0.0344); total omega-3 PUFA level was lower in colorectal cancer group than that in healthy people group; furthermore, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) was also lower in colorectal cancer group than that in healthy people group. AA and total omega-6 were significant differences between less than 5 cm of tumor size and more than 5 cm of tumor size (13.11 ± 2.91 vs. 14.44 ± 1.81, P < 0.05; 27.02 ± 4.54 vs. 28.76 ± 3.08, P < 0.05). Conclusion: PUFA level was significant difference between healthy people and colorectal cancer patients in the Chinese population. Tumor size probably had influence on the metabolism of PUFA.

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Objectives: Breast conservative therapy (BCT) is an established method of treating early stage invasive breast cancer. Survival after BCT in Pakistani population has not been reported. This study was carried out to report locoregional control and overall survival (OS) after BCT for invasive breast cancer and analyze prognostic factors in Pakistani population. Materials and Methods: Patients who received BCT between 1997 and 2009 were included in the study. Patients' follow-up, demographics, prognostic variables and treatment modalities were assessed. Data were analyzed for locoregional and distant relapse and estimated 10-year locoregional recurrence free survival (LRRFS) and OS was calculated using Kaplan Meier curves. To determine the significance of prognostic variables, univariate and multivariate analysis was performed. Results: A total of 902 patients underwent BCT. Median age was 42 (17-82) years and the median follow-up was 51 (1.4-187) months. There were 484 (53.6) poorly differentiated and 194 (21.5) triple negative tumors. T3/T4 tumors were found in 128 (14.1) patients and 441 (44.8) patients had nodal involvement. Among adverse events, 58 (6.3) locoregional failures, 152 (16.8) distant failures and 155 (17.1) deaths were observed. Estimated 10 years LRRFS- was 88% while OS was 70%. On multivariate analysis, tumor size and nodal involvement were independent predictors of locoregional recurrence-free and OS. In addition, hormonal therapy significantly affected OS. Conclusion: BCT has acceptable long-term results in Pakistani women. Tumor size and nodal involvement are independent predictors of survival.

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Objective: Technological advances have enabled clinicians to explore dose escalation strategies in various tumor sites. Intermediate and high risk oropharyngeal cancers have poor 5 year outcomes. This study aimed to assess the feasibility and dosimetric safety of 9% dose escalation in these tumors and compare the dose received by organs at risk (OAR) in escalated plans (67.2 Gy/28 fractions) versus (65 Gy/30 fractions) standard dose plans. Materials and Methods: FDG-PET fused datasets were used to delineate gross, clinical and planning target volumes. Standard dose plans were created using two non IMRT techniques (conventional and field in field plans) whilst the patient was treated using a helical tomotherapy plan. A fourth dose escalation plan was obtained allowing comparison between the 20 plans of oropharyngeal cancer patients. Results: It was feasible to escalate dose to the FDG-PET avid tumor within the set constraints to that of planning target volume and OAR. Comparison of the escalated dose to that of standard plans showed a statistically significant (P < 0.05) sparing of the mastication apparatus (MA) with escalated plans. Dose to the other critical and functional organs were comparable between the four plans. Conclusion: Hypofractionated, slightly accelerated dose escalation in oropharyngeal cancers is likely to be safe and the chance of trismus is not any higher than when standard dose radiotherapy is used. Active measures to reduce dose to the MA achieves acceptable dose volume parameters even at escalated doses.

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Purpose: The aim of this study was to compare the radioprotective efficacies of L-carnitine (LC) and amifostine against radiation-induced acute ovarian damage. Materials and Methods: Forty-five, 3-month-old Wistar albino rats were randomly assigned to six groups. Control (CONT, n = 7); irradiation alone RT: radiation therapy (RT, n = 8); amifostine plus irradiation (AMI + RT, n = 8); LC plus irradiation (LC + RT, n = 8); LC and sham irradiation (LC, n = 7); and amifostine and sham irradiation (AMI, n = 7). The rats in the AMI + RT, LC + RT and RT groups were irradiated with a single dose of 20 Gy to the whole abdomen. LC (300 mg/kg) and amifostine (200 mg/kg) was given intraperitoneally 30 min before irradiation. Five days after irradiation, both antral follicles and corpus luteum in the right ovaries were counted, and tissue levels of malondialdehyde (MDA) and advanced oxidation protein product (AOPP) were measured. Results: Irradiation significantly decreased antral follicles and corpus luteum (P: 0.005 and P < 0.0001). LC increased the median number of antral follicles and corpus luteum (P: 0.009 and P < 0.0001, respectively). Amifostine improved median corpus luteum numbers but not antral follicle (P < 0.000, P > 0.05). The level of MDA and AOPP significantly increased after irradiation (P = 0.001 and P < 0.0001, respectively). MDA and AOPP levels were significantly reduced by LC (P: 0.003, P < 0.0001) and amifostine (P < 0.0001, P: 0.018). When comparing CONT group with AMI + RT and LC + RT groups, MDA and AOPP levels were similar (P > 0.005). The levels of both MDA and AOPP were also similar when LC + RT is compared with AMI + RT group (P > 0.005). Conclusions: L-carnitine and amifostine have a noteworthy and similar radioprotective effect against radiation-induced acute ovarian toxicity.

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Objective: To explore the function of the default mode network (DMN) in the psychopathological mechanisms of theory of mind deficits in patients with an esophageal cancer concomitant with depression in resting the state. Subjects and Methods: Twenty-five cases of esophageal cancer with theory of mind deficits (test group) that meet the diagnostic criteria of esophageal cancer and neuropsychological tests, including Beck depression inventory, reading the mind in the eyes, and Faux pas, were included, Another 25 cases of esophageal cancer patients but without theory of mind deficits (control group) were enrolled. Each patient completed a resting-state functional magnetic resonance imaging. Results: The functional connectivity intensities within the cerebral regions in the DMN of all the enrolled patients were analyzed. The results of each group were compared. The functional connectivity of the bilateral prefrontal central region with the precuneus, bilateral posterior cingulate gyrus and bilateral ventral anterior cingulate gyrus in the patients of the test group were all reduced significantly (P < 0.05). In the resting state, the functional connectivity is abnormal in the cerebral regions in the DMN of esophageal cancer patients with theory of mind deficits. Conclusions: The theory of mind deficits might have an important function in the pathogenesis of esophageal cancer.

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Purpose: Tissue inhibitor of metalloproteinase-2 (TIMP-2) plays a critical role in human carcinogenesis. However, the association between TIMP-2 G-418C polymorphism and risk of cancer was reported with inconclusive results. Materials and Methods: A meta-analysis of 11 published studies involving 2,658 cases and 3,433 controls was performed to assess the strength of association using odds ratios (ORs) with 95% confidence intervals (CIs). Results: The results indicated that no significant association between TIMP-2 G-418C polymorphism and cancer risk in overall population (GC vs. GG: OR = 1.26, 95% CI = 0.87-1.83; CC vs. GG: OR = 0.90, 95%CI = 0.50-1.63; GC/CC vs. GG: OR = 1.26, 95%CI = 0.87-1.82; C vs. G: OR = 1.19, 95%CI = 0.87-1.62). However, stratified analysis by ethnicity showed that TIMP-2 G-418C polymorphism was associated with cancer risk among Caucasian population (GC vs. GG: OR = 20.00, 95%CI = 9.90-40.38; GC/CC vs. GG: OR = 10.70, 95%CI = 1.11-103.20; C vs. G: OR = 14.98, 95%CI = 7.66-29.32) but not among Asian population. Conclusions: This meta-analysis suggests that TIMP-2 G-418C polymorphism may not influence the susceptibility of total cancer in overall population, but it was associated with cancer risk among Caucasian population.

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Aim of Study: Colorectal cancer (CRC), now the third most common cancer across the world, is known to aggregate in families. Recently, genome-wide association studies have identified two single nucleotide polymorphisms (SNP) associated with CRC in Caucasians. Materials and Methods: To validate whether the same variations conferred risk to CRC in the Han Chinese population, we genotyped 760 individuals (380 controls and 380 cases samples) recruited from the Han Chinese origin. Results: We found rs11987193 in 8p12 (P = 0.0472 after correction, OR = 0.751) was significantly associated with CRC but rs12080929 in 1p33 (P = 0.0650 after correction, OR = 0.750) was not. Conclusion: Our findings supported that rs11987193 is a susceptibility locus for CRC, and gene DUSP4 was possible to play a role in the pathology of CRC.

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Context: Our previous studies showed that mesenchymal stem cells (MSCs) preferentially migrated to irradiation-damaged thymus tissue to maintain the thymus integrity and simultaneously decrease the incidence of thymoma from 57 to 37.5%. Objective: This study was designed to investigate the mechanisms by which MSCs decrease the irradiation-induced thymoma formation. Materials and Methods: Thymus genome DNA was extracted, treated with sulfite, and amplified by polymerase chain reaction (PCR) using bisulfite sequencing PCR (BSP) as primers. The PCR productions were sequenced after recovery from 1.5% agarose gel electrophoresis. These sequences were analyzed using ClustalW2-Multiple Sequence Alignment. p53 expression in thymus or thymoma was measured using immunohistochemistry. Results: Study showed the p53 methylation in irradiation alone group took place at loci +143 and -1190, which are beyond known binding motif of transcription factors. However, Matlnspector Professional Database revealed that locus -1190 is located in binding region of E2A transcription factor. In the non tumor thymus tissues from MSCs-treated irradiated mice, p53 promoter methylation existed at four loci. Three loci of them located at either negative regulation regions or their vicinity. The methylation affects the interaction between transcription factors and p53 promoter to increase the expression of p53. Indeed, an increased p53 expression was detected by immunohistochemistry in thymus tissues from MSCs-treated irradiated mice as compared to irradiated alone mice. Conclusion: MSCs decrease the incidence of irradiation-induced thymoma, which may be mediated by improving thymus microenvironment and changing the methylation of p53 promoter, and subsequently maintaining genome's stability.

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Background: p53 is a tumor suppressor encoded by the TP53 gene. It is critical in activating deoxyribonucleic acid (DNA) repair upon damage, and thus preserving genomic stability. TP53 is implicated in tumor progression. Melanoma results from transformed melanocytes in the skin. Data gathered on the association between the TP53 Arg72, Pro72 (rs1042522; G>C) polymorphism and melanoma are conflicting. Aims: To assess the relationship between the TP53 genotype and the risk of melanoma, we performed a meta-analysis. Materials and Methods: We searched on PubMed for studies of TP53 polymorphism published in English up to 12 ^th April 2014. For each study, we calculated odds ratio (OR) and 95% confidence interval (CI), assuming frequency of allele comparison, heterozygote comparison, homozygote comparison, dominant, and recessive genetic models. Seven case-control studies were carried out during the meta-analysis. Results: The TP53 Callele was not associated with the risk of melanoma in the frequency of allele comparison (C vs G: OR = 1.031; 95% CI = 0.824-1.290; P < 0.001 for heterogeneity). The TP53 GC genotype was not associated with the risk of melanoma as compared with the GG genotype (GC vs GG: OR = 0.922; 95% CI = 0.716-1.186; P = 0.010 for heterogeneity). The TP53 CC genotype was not associated with the risk of melanoma as revealed by both the homozygote comparison and the recessive genetic model. Analysis of the dominant model also did not indicate a significant association between the TP53 polymorphism and melanoma. Conclusions: This meta-analysis suggests that genotypes for the TP53 rs1042522 G>C polymorphism might not be associated with the risk of melanoma.

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Purpose: To analyze the effects of hypofractionated-simultaneous integrated boost-intensity modulated radiation therapy (Hypo-SIB-IMRT) on medically inoperable patients with special stage II (T _2b-3 N ₀ M ₀ ) non-smallcell lung cancer (NSCLC). Materials and Methods: Twenty-eight qualified patients were included. Hypo-SIB-IMRT was delivered with internal gross tumor volume (iGTV) 75Gy, clinical target volume (CTV) 60Gy, and planning target volume (PTV) 45Gy on weekdays in 3 weeks. Results: The 1-, 2-, and 3-year overall survivals (OSs) were 93, 85, and 61%, respectively, with a median survival of 46.5 months; while progression-free survivals (PFSs) were 92, 79, and 64%; and distant metastasis-free survivals (DMFSs) were 92, 84, and 77%, respectively. The cancer-specific survivals (CSS) were 93, 88, and 74%, and local control (LC) were 92, 83, and 74%, respectively. 7.1% (2/28) of patients occurred local pain, 28.6% (8/28) were with Grade 1or 2 radiation pneumonitis (RP), and 7.1% (2/28) with Grade 1 esophagitis. Of the eight patients with RP, 17.9% (5/28) developed Grade 1 radiation pulmonary fibrosis (RPF). Conclusion: Due to the favorable long-term survivals, LC, and minimal toxicities, Hypo-SIB-IMRT presented in this prospective study may be considered an option for patients with special stage II (T _2b-3 N ₀ M ₀ ) NSCLC who were medically inoperable.

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Objective: Gastric cancer is often diagnosed at an advanced stage and surgery alone cannot guarantee satisfactory results. Both chemoradiotherapy (CRT) and chemotherapy (CT) are used in postoperative therapy. However, it is controversial whether CRT or CT is better after D2 lymphadenectomy. In this study we investigated the efficacy of adjuvant CRT versus CT in stage III gastric cancer patients treated with R0 gastrectomy and D2 lymph node dissection. Patients and Methods: Data from 92 patients diagnosed with gastric adenocarcinoma and treated with surgery followed by adjuvant treatment were retrospectively analyzed. Patients were classified into two groups depending on type of adjuvant treatment such as CT (Arm A) and CRT (Arm B). Results: Twenty-one patients in Arm A and 71 patients in Arm B were included. Median age at diagnosis was 60 years. The median follow-up time was 30 months. No difference in local recurrence (14.3 vs 15.7%, P = 0.89), peritoneal recurrence (29.4 vs 23.5%, P = 0.62), and distant metastases rates (57.1 vs 45.1%, P = 0.42) were observed between the arms. Disease-free survival (DFS) rates did not differ between Arms A and B (26 and 22 months, P = 0.80) respectively. Median overall survival (OS) in Arm A was 29 months and it was 32 months for Arm B. There was no difference in 5-year OS and DFS between Arms A and B (23.8 vs 34.4%, P = 0.74; and 24.1 vs 32.9%, P = 0.80). Conclusions: Adjuvant CRT does not appear to improve clinical outcomes compared to adjuvant CT in this study and prospective studies are required to confirm these results.

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Aim: BIM deletion polymorphism was deemed to be associated with downregulation of BIM, resulting in a decreased apoptosis induced by epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in EGFR mutation-positive non-small cell lung cancer (NSCLC). However, accumulating evidences concerning the association between BIM deletion polymorphism and efficacy of EGFR-TKI and survival in EGFR-mutation-driven NSCLC patient reported contradictory results. Materials and Methods: A meta-analysis was conducted by combing six original eligible studies including 871 NSCLC patients. Results: Our study showed that BIM deletion polymorphism was significantly associated with poor response to EGFR-TKI therapy in mutant EGFRNSCLC patients (P _h = 0.309, P _z = 0.001, OR = 0.39, 95% confidence interval (CI) = 0.23-0.67). Disease control rate (DCR) in mutant EGFRNSCLC patient with treatment of EGFR-TKI was significantly decreased in patients with BIM deletion polymorphism comparing to patients harbored BIM wild variant (P _h = 0.583, P _Z = 0.007, OR = 0.46, 95%CI = 0.25-0.85). EGFR mutation-derived NSCLC patient carrying BIM deletion polymorphism had a shorter progression-free survival (PFS; P _h < 0.001, P _z < 0.001, hazard ratio (HR) = 1.37, 95%CI = 1.09-1.71) and overall survival (OS; P _h = 0.90, P _z = 0.003, HR = 1.25, 95%CI = 1.08-1.45), than those harbored BIM wild variant. Conclusion: These results suggested that BIM deletion polymorphism might be a cause that contributes to primary EGFR-TKI resistance, and it could be used as a genetic predictor for EGFR-TKI outcome and an independent prognostic factor of EGFR mutation-driven NSCLC patient.

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Background: The cervical lymph node metastasis (CLNM) of papillary thyroid microcarcinoma (PTMC) is not uncommon. However, prophylactic cervical lymph node dissection in all PTMC is debatable. Molecular markers of predicting CLNM would help to decide to either do or not do cervical lymph node dissection which might increase morbidities. Aims: We aimed to characterize gene expression profiles and molecular markers of CLNM in PTMC. Settings and Design: The thyroid frozen tissues were obtained with from six PTMC patients, who underwent total thyroidectomy. Methods: We performed oligonucleotide microarray analysis with three PTMCs with CLNM and three without CLNM. Real-time quantitative reverse transcription-polymerase chain reaction was used to validate the gene. Statistical Analysis Used: We used linear models for microarray data. Results: We identified 12 differentially expressed gene, and most one is endoplasmic reticulum aminopeptidase 2 (ERAP2). Conclusion: ERAP2 might be associated with CLNM in PTMC.

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Objective: This study aimed to study methods for protecting the language areas during tumor surgery in Mandarin-Cantonese bilinguals (MCBs). Materials and Methods: Eleven MCB patients were positioned for awake surgery with the purpose of preserving both of their language proficiencies. All the exposed cortices were electrically stimulated 1 cm x 1 cm with anelectrode, and all the positive sites of stimulation were recorded for analyses, the tumor resection point was limited by 1cm distant from the language areas identified by electrical stimulation. Results: All patients had at least one language area identified; a total of 154 points were stimulated, with 22 positive points (14.3%), including five specific language areas, which all resulted in simple anomiain either language when stimulated. Among these, three were specific to Mandarin (1.9%), whereas two were specific to Cantonese (1.3%). Conclusions: In proficient MBCs, areas specific to each language exist. Thus, performing intraoperative bilingual tasks to locate these language areas is necessary in order to preserve language function.

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Aim: We studied the expression of elastic fiber in esophageal squamous cell carcinoma tissue in North-eastern Indian population. Materials and Methods: Archival paraffin embedded 40 esophageal carcinoma specimens were retrieved for the study. Only smokers were included in the study. Verhoeff's stain for elastic fiber was performed to demonstrate elastic fiber with positive and negative control. Result: A total of 28 (70%) tissue specimens was found to be positive for elastic fiber. Conclusion: Elastosis in esophageal carcinoma may be due to smoking. Further studies are required to rule out the etiology.

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Background: It is important to identify some tumor-related factors for early detection, treatment, and evaluation of prognosis in colorectal cancer (CRC). In our study, we inveatigated the clinical and prognostic role of activating transcription factor 7 (ATF7) in CRC. Materials and Methods: Expression of ATF7 was detected with immunohistochemistry in 72 cases with complete follow-up data and post-operation tissue specimens. Correlation between ATF7 and other clinicopathological factors was calculated with Chi-square test and the impact of ATF7 on survival were analyzed with Log-rank test and Cox regression models. Results: Among 72 cases, ATF7 expression was detected in 43 cases (59.7%) and 29 cases (40.3%) without ATF7 expression. The correlation between ATF7 expression and pathological stage was investigated (P = 0.041). The 5-year overall survival (OS) of with or without ATF7 expression was 79% versus 51% respectively (P < 0.001) and the 5-year progression free survival (PFS) was 74% versus 41% (P < 0.001). The media OS was 69 months versus 52 months (P = 0.002) and the media PFS was 65 months versus 42 months (P = 0.002). ATF7 expression and numbers of lymph nodes involvement were prognostic factors for OS according to univariated and multivariated analysis and for PFS it was ATF7 expression and lymph nodes involvement. Conclusion: It is negatively related between ATF7 expression and pathological stage and positive correlation with OS and PFS in CRC. ATF7 expression is a favorable factor for survival of patients with CRC.

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Aim of the Study: Aim was to assess the clinical significance of the rate of tumor regression in carcinoma buccal mucosa undergoing radical radiotherapy. Materials and Methods: Sixty six patients were enrolled in the study with proven buccal cancers requiring radical radiotherapy, from 1990 to 1996. Radiotherapy was delivered using a combination of external beam and brachytherapy with preloaded cesium 137 needles. The response to the radiation was assessed at the completion of external beam radiation and 6 weeks after brachytherapy. An analysis correlating various parameters influencing the long term disease free survival and overall survival was done. Results: Response assessed at the end of external beam radiation correlated strongly with the overall survival and the disease free interval (P=0.000). No other factor influenced the survival. Conclusion: The rate of the tumor regression can predict the overall outcome in patients with buccal cancers treated with radiation. Completion of the planned course of radiation in patients who do not show a substantial reduction in size by 4.5 weeks of conventional radiation does not improve the results.

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