Clinical Research of a Modified Midfacial Degloving in a Maxillectomy （with a Report of a Typical Case）

OBJECTIVE To investigate the feasibility of employing a modified midfacial degloving in maxillectomy. METHODS Eight patients with carcinoma of the maxillary sinus underwent a modified midfacial degloving operation.The tumors were classified according to the 2002 AJCC system.The TNM staging of the cases was as follows:1 T4aN0M0,2 T3N0M0 and 5 T2N0M0.Of the 8 cases,1 patient underwent extended maxillectomy;exenteration of the orbit;tumorectomy of the sphenomaxillary and infratemporal fossae.Two patients received a total maxillectomy,and 5 a partial resection of the maxilla. Postoperative pathological report:4 well-di?erentiated squamous carcinoma,2 moderately-differentiated squamous carcinoma,1 mucoepidermoid carcinoma and 1 adenoid cystic carcinoma. RESULTS A modified midfacial degloving operation can sufficiently expose a field of operation,resect the tumor within a safe margin,and leave no facial cicatricles.One patient died of intracranial metastasis 8 months a er operation.We observed no recurrences or metastasis in other patients during the period of follow-up. CONCLUSION The major advantages of employing the modified midfacial degloving in maxillectomy is that a facial incision can be avoided.It has an advantage of minimal invasive surgery.     

Time for a re-evaluation of mammography in the young? Results of an audit of mammography in women younger than 40 in a resource restricted environment

Mammography in younger women is considered to be of limited value. In a resource restricted environment without access to magnetic resonance imaging (MRI) and with a high incidence of breast cancer in the young, mammography remains an important diagnostic tool. Recent technical advances and better regulation of mammography make a reassessment of its value in these conditions necessary. Data of all the mammograms performed at a tertiary hospital and private breast clinic between January 2003 and July 2009 in women less than 40 years of age were collected. Indications were the presence of a mass, follow-up after primary cancer therapy, and screening for patients perceived at high risk due to a family history or the presence of atypical hyperplasia. Data acquired were as follows: Demographics, prior breast surgery, indication for mammography, outcome of mammography, diagnostic procedures, and their results. Of 2,167 mammograms, 393 were performed for a palpable mass, diagnostic mammography. In these, the overall cancer detection rate was 40%. If the mammography was reported as breast imaging reporting and data system (BIRADS^®) 5 versus BIRADS^® 3 and 4 versus BIRADS^® 1 and 2, a final diagnosis of malignancy was established in 96, 48, and 5%, respectively. Of 367 mammograms done for the follow-up after primary treatment of breast cancer, seven cancers were diagnosed for a detection rate of 1.9%. Of 1,312 mammograms performed for screening, the recall rate was 4%; the biopsy rate 2%, and the cancer diagnosis rate 3/1,000 examinations. In contrast to past series, this series has shown that recent advances in mammography have made it a useful tool in the management of breast problems in young women, notably in a resource-restricted environment. Women for screening should be selected carefully.     

The beginning of a decline in breast cancer incidence in Italy?

The incidence of invasive breast cancer in Turin, Italy, showed a statistically significant decrease during 1999-2003 overall (estimated annual percent change -2.6; 95% CL -8.52; -0.78) and in women aged over 50, similar to the recently documented trend in American data. This represents the first demonstration of a decline in breast cancer incidence in the early years of this decade outside the United States. In our population, the drop in the usage of hormone replacement therapy which occurred after 2002 is unlikely to be at the origin of this declining incidence trend, which is largely explained by a screening effect. This observation may be relevant to other geographical areas where organized or spontaneous screening reached a plateau after an increase in the preceding years.     

Role of HIF-1α in response of tumors to a combination of hyperthermia and radiation in vivo

Purpose: Mild temperature hyperthermia (MTH) increases blood flow and oxygenation in tumours. On the other hand, high-dose-per-fraction irradiation damages blood vessels, decreases blood flow and increases hypoxia in tumours. The radiation-induced hypoxia in tumours activates hypoxia-inducible factor-1α (HIF-1α) and its target genes, such as vascular endothelial growth factor (VEGF), promoting revascularization and recurrence. In the present study, we examined the hypothesis that MTH inhibits radiation-induced upregulation of HIF-1α and its target genes by increasing tumour oxygenation.

Materials and methods: FSaII fibrosarcoma tumours grown subcutaneously in the legs of C3H mice were used. Tumours were irradiated with 15?Gy using a ⁶⁰Co irradiator or heated at 41?°C for 30?min using an Oncothermia heating unit. Blood perfusion and hypoxia in tumours were assessed with Hoechst 33342 and pimonidazole staining, respectively. Expression levels of HIF-1α and VEGF were determined using immunohistochemical techniques. Apoptosis of tumour cells was quantitated via TUNEL staining and the effects of treatments on tumour growth rate were assessed by measuring tumour diameters.

Results: Irradiation of FSaII tumours with a single dose of 15?Gy led to significantly decreased blood perfusion, increased hypoxia and upregulation of HIF-1α and VEGF. On the other hand, MTH at 41?°C for 30?min increased blood perfusion and tumour oxygenation, thereby suppressing radiation-induced HIF-1α and VEGF in tumours, leading to enhanced apoptosis of tumour cells and tumour growth delay.

Conclusion: MTH enhances the anti-tumour effect of high-dose irradiation, at least partly by inhibiting radiation-induced upregulation of HIF-1α.     

Experimental Study of Ultrasound on MDR in a Human Tumor in Vivo

OBJECTIVE To evaluate the potential efficacy of low-intensity ultrasound(US)in combination with anticancer drugs to reverse multidrug resistance(MDR)in nude mice. METHODS A total of 40 male and female athymic nude mice were inoculated subcutaneously with 5x106 HepG 2 /ADM and HepG 2 cells.Ultrasound with pulsed irradiation at an average intensity of 0.5 W/cm2 was given to the tumor area 10 min after administration of adriamycin(ADM).The tumor 3 dimensional diameters were measured by calipers before and after treatment, and the tumor growth indexes(TGI)calculated.RT-PCR was used to detect the gene levels of the HepG 2 /ADM cells.Immunohistochemical analyses for MDR proteins were conducted on the tumor tissues. RESULTS The ultrasonic treatment resulted in an average reduction in the tumor volume of 62%one month later.The relative mRNA levels of MDR1 and MRP were significantly different among the folowing 4 groups: untreated group as control,ADM treated;US treated;and ADM plus US treated.The mRNA levels of mdr1 and mrp were down-regulated in the US groups compared to those of the non-ultrasound groups by multiple com- parisons.The relative mRNA levels of lrp expression were not significantly changed.The results of immunohistochemistry indicated that tumor tissue from animals treated with US had remarkably low mdr1 and mrp expression. CONCLUSION The results showed that low-intensity US can effectively reduce the size of adriamycin-resistant human hepotacarcinoma in a nude mouse model,and support the efficacy of US to overcome multiple mechanisms of drug resistance.     

Exprimental Study of Ultrasound on MDR in a Human Tumor in Vivo

Objective To evaluate the potential efficacy of low-intensity ultrasound (US) in combination with anticancer drugs to reverse multidrug resistance (MDR) in nude mice. Methods A total of 40 male and female athymic nude mice were inoculated subcutaneously with 5×10⁶ HepG₂/ADM and HepG₂ cells. Ultrasound with pulsed irradiation at an average intensity of 0.5 W/cm² was given to the tumor area 10 min after administration of adriamycin (ADM). The tumor 3 dimensional diameters were measured by calipers before and after treatment, and the tumor growth indexes (TGI) calculated. RT-PCR was used to detect the gene levels of the HepG₂/ADM cells. Immunohistochemical analyses for MDR proteins were conducted on the tumor tissues. Results The ultrasonic treatment resulted in an average reduction in the tumor volume of 62% one month later. The relative mRNA levels of MDR1 and MRP were significantly different among the following 4 groups: untreated group as control, ADM treated; US treated; and ADM plus US treated. The mRNA levels of mdr1 and mrp were down-regulated in the US groups compared to those of the non-ultrasound groups by multiple comparisons. The relative mRNA levels of lrp expression were not significantly changed. The results of immunohistochemistry indicated that tumor tissue from animals treated with US had remarkably low mdr1 and mrp expression. Conclusion The results showed that low-intensity US can effectively reduce the size of adriamycin-resistant human hepotacarcinoma in a nude mouse model, and support the efficacy of US to overcome multiple mechanisms of drug resistance. This work was supported by a grant from the National Natural Science Foundation of China (No. 30200060).     

Prognostic impact of molecular markers in a series of 220 primary glioblastomas

BACKGROUND： In contrast to ofigodendrogliomas, molecular predictors of prognosis have not been consistently found in glioblastomas. However, genetic studies show that glioblastomas consist of several genetic subtypes and raise the possibility that molecular alterations could be predictive of survival. METHODS： A search for loss of heterozygosity （LOH） on chromosome 1p, 9p, 10q, 19q, EGFR （epidermal growth factor receptor）, CDK4, and MDM2 （mouse double minute） amplifications, CDKN2A （INK4A/ARF） homozygous deletions, p53 expression, was performed in a series of 220 primary glioblastomas.     

Correlation of FDG-PET interpretation with survival in a cohort of glioma patients

Adult supratentorial gliomas continue to be one of the most challenging diagnostic and therapeutic problems for the neuro- oncologist. Despite a variety of therapeutic approaches, local control and survival rates remain disappointingly low, largely due to a relative inability to localize diffusely infiltrating glial tumor cells.     

Rhabdoid Meningioma in a Child： Report of a Case and Literatures Review

Meningiomas occur in 1%-4% of primary intracranial tumors in the pediatric group, and is increasing in incidence with age. Some authors have reported that meningioma is more prevalent among adult males, but there is no gender prevalence. The accepted origin of meningiomas is from the arachnoid ceils lining the meninges, or the choroid plexuses. Since Beckwith and Palmer introduced the term ＇rhabdoid tumor＇ in 1978 in reference to a subgroup of childhood malignant renal tumors, many tumors with a rhabdoid morphology have been reported in various sites, including the central nervous system. In 1998 Kepes et al.     

Participating in a cancer clinical trial? The balancing of options in the loneliness of autonomy: a grounded theory interview study

Cancer patients asked to participate in a randomised trial including chemotherapy at two university centres and a satellite centre were interviewed about perceptions and experiences (14 trial participating and 15 trial declining patients). The central phenomenon was a constant, cautious balancing of personal options searching for maximised effect, personal safety, trust, confidence and being cared for. Almost all developed a treatment preference and this was decisive for choices. Trial participants strongly wished to get the experimental treatment perceived as superior. They felt their freedom of choice being limited by randomisation. In contrast, trial decliners almost all focused on graver adverse effects related to the experimental treatment. A trusting and confident doctor-patient relationship was valued strongly. Yet, most breast cancer patients treated at the two large centres experienced a general lack of personal trust, confidence and being taken care of. The major reason was patients meeting too many physicians perceived as incompetent and unprepared. In contrast, the ovarian cancer patients treated at the satellite centre were content and satisfied with the main reason being the low number of physicians who were perceived as prepared, empathetic and knowledgeable. All patients expressed a feeling of “loneliness of autonomy” lacking sufficient knowledge and other resources to make educated choices.     

Does chemotherapy-induced neutropaenia result in a postponement of adjuvant or neoadjuvant regimens in breast cancer patients? Results of a retrospective analysis

In 2005, 224 patients received adjuvant/neoadjuvant chemotherapy for breast cancer in a single institution according to daily practices. Regimens consisted of epirubicin-based chemotherapy (FEC100, four or six cycles), or three cycles of FEC100 followed by three cycles of docetaxel. An absolute blood count was carried out every 3 weeks, 1-3 days before planned chemotherapy cycle. Overall, 1238 cycles were delivered. An absolute neutrophil count (ANC) <1.5 x 10(9) l(-1) before planned chemotherapy was found in 171 cycles. Of these, 130 cycles (76%) were delivered as planned regardless of whether ANC levels recovered, and 41 (24%) were delayed. None of these patients developed a febrile neutropaenia. Haematopoietic support (granulocyte colony-stimulating factor (G-CSF)) was required in 12 cycles. We found that the majority of patients with an ANC <1.5 x 10(9) l(-1) before planned chemotherapy received planned doses, without complications and need for G-CSF.     

Internal dosimetry in the use of radiopharmaceuticals in therapy--science at a crossroads?

Because of expanding therapeutic applications, radionuclide dosimetry is in a stage of reference "man" based system to systems for "patient-specific dosimetry." Although the challenges for the latter system are substantial, patient-specific radiation dosimetry has greater relevance to treatment planning.     

602 Is There a Role for Allografting in Myeloma in the Era of New Drugs?: Long-Term Follow-Up of a Comparative Study

We conducted a trial where treatment depended on the presence of HLA-identical siblings. Induction included an autograft, followed by a non-myeloablative allograft or a second autograft. At a median of 7.1 years, OS and EFS were significantly longer in patients with HLA-matched siblings and in those who underwent the allograft.

Full Abstract

Before “new drugs” became readily available, we carried out a trial where treatment assignments were based only on the presence/absence of HLA-identical siblings (Bruno et al, NEJM 2007). Overall, 162/199 (81%) consecutive patients with siblings were HLA-typed. Induction included VAD-based regimens and a cytoreductive autograft, followed by a non-myeloablative allograft or a second melphalan-based autograft. We report an update at a median follow up of 7.1 years. Complete remissions (CR) were

     

Prospective evaluation of follow-up in melanoma patients in Germany – Results of a multicentre and longitudinal study

BackgroundPatient numbers requiring long-term melanoma surveillance are constantly rising. Surveillance is costly and guideline recommendations vary substantially.MethodsIn this German nationwide study, information on surveillance and treatment of patients diagnosed with melanoma and melanoma in situ (MMis) between April and June 2008 was prospectively collected over four years. Additionally, patient self-report questionnaires were evaluated to assess anxiety, depression, health-related quality of life, socio-demographic information and use of disease specific health information sources at year 4 after primary diagnosis.ResultsComplete data was available for 668 patients from 67 centres, of whom 96.0% were in regular melanoma surveillance. In year 3–4 of surveillance, only 55.6% of locoregionary metastases were detected during surveillance visits. Only 33.3% were self-detected by the patient even though 69.4% were documented as being clinically visible or palpable. Costs of 4 year surveillance of 550 patients without tumour recurrence (stage I–IIC and MMis) accumulated to 228,155.75 €. Guideline-adherence for follow-up frequency, lymph node ultrasound, S100 serum level tests and diagnostic imaging recommendations was approximately 60% in year 3–4 of surveillance. Multivariate regression analysis showed that certain patient/tumour characteristics and regional differences were significantly associated with guideline deviations. The percentage of patients who exceeded published cut-off scores indicating clinically relevant symptoms of anxiety and depression were significantly increased. Patients frequently reported lack of psychosocial support and education but ascribed great importance to these.ConclusionsWe recommend further reduction of melanoma follow-up in low-risk melanoma patients and improvement of psycho-social support and patient education for all melanoma patients.     

The Use of Lanreotide Autogel? in the Treatment of Intestinal Obstruction in a Patient with Adenocarcinoma

Intestinal obstruction is a common complication in patients with advanced abdominal or pelvic cancer. The synthetic somatostatin analogue octreotide can help relieve nausea, vomiting and pain in patients with inoperable obstruction. Here, we report a case of recurrent intestinal obstruction in a patient with adenocarcinoma. Although the obstruction was resolved after 3 days of treatment with octreotide, new episodes of obstruction occurred, resulting in a delay of the chemotherapy treatment. After 3 episodes of obstruction, we initiated treatment with a longer-acting somatostatin analogue, lanreotide Autogel® 120 mg, administered once every 4 weeks. The treatment with lanreotide Autogel is being continued, allowing for continuation of the chemotherapy without further episodes of intestinal subocclusion or obstruction. Until November 2013, the patient received eighteen 4-weekly injections of lanreotide Autogel and did not report side effects. This case report demonstrates the successful treatment of intestinal obstruction with lanreotide Autogel in a patient with adenocarcinoma.Key words: Intestinal obstruction, Adenocarcinoma, Somatostatin analogue, Lanreotide Autogel®     

The determinants of serum vitamin D levels in participants in a melanoma case?Ccontrol study living in a temperate climate

Background

We report the determinants of serum levels of vitamin D in a UK melanoma case?Ccontrol study benefitting from detailed exposure and genotyping data.

Methods

Sun exposure, supplemental vitamin D, and SNPs reported to be associated with serum levels were assessed as predictors of a single serum 25-hydroxyvitamin D₃ measurement adjusted for season, age, sex, and body mass index.

Results

Adjusted analyses showed that vitamin D levels were sub-optimal especially in the sun-sensitive individuals (?2.61?nmol/L, p?=?0.03) and for inheritance of a genetic variant in the GC gene coding for the vitamin D-binding protein (?5.79 for heterozygotes versus wild type, p?=?<0.0001). Higher levels were associated with sun exposure at the weekend in summer (+4.71?nmol/L per tertile, p?=?<0.0001), and on hot holidays (+4.17?nmol/L per tertile, p?=?<0.0001). In smoothed scatter plots, vitamin D levels of 60?nmol/L in the non-sun-sensitive individuals were achieved after an average 6?h/day summer weekend sun exposure but not in the sun-sensitive individuals. Users of supplements had levels on average 11.0?nmol/L higher, p?=?<0.0001, and achieved optimal levels irrespective of sun exposure.

Conclusions

Sun exposure was associated with increased vitamin D levels, but levels more than 60?nmol/L were reached on average only in individuals reporting lengthy exposure (??12?h/weekend). The sun-sensitive individuals did not achieve optimal levels without supplementation, which therefore should be considered for the majority of populations living in a temperate climate and melanoma patients in particular. Inherited variation in genes such as GC is a strong factor, and carriers of variant alleles may therefore require higher levels of supplementation.     

Incidence of glioma in a northwestern region of England, 2006–2010

Background

Gliomas are important because they affect disproportionately high numbers of people of working age and have a poor prognosis. Neurosurgeons were concerned about a possible recent cluster of glioma cases in a northwestern region in England.

Methods

All patients aged 18–89 years in Lancashire and South Cumbria with a histologically confirmed glioma diagnosed at the Royal Preston Hospital between January 1, 2006, and December 31, 2010, were ascertained. Clinical information was extracted from hospital records. Completeness of case referral to Royal Preston Hospital was checked against the National Cancer Registry and National Brain Tumour Registry records for the same period. For a comprehensive assessment of regional incidence, age-standardized incidence rates of all gliomas diagnosed in adults (aged 15 years and older) in the study area were then compared with those for the North West region and England as a whole. Rates for the North West region in defined small area-units (“Middle Super Output Areas”) were also investigated to assess any small-area variation in the region during the decade to 2010.

Results

There were 435 glioma patients from Lancashire and South Cumbria diagnosed at the Royal Preston Hospital between 2006 and 2010, with case ascertainment verified to be complete by the National Cancer Registration Service. The age-standardized incidence rate of gliomas in the study area was 7.10 per 100 000 in 2006–2010, which was minimally different from the rate for all cancer networks in England over the 10 years from 2001. Small-area analysis confirmed lack of major variation in glioma rates in the North West region of England.

Conclusion

Glioma incidence rates in England have remained stable by region and over time during the last decade.