Results of radiotherapy for T2N0 glottic carcinoma: does the "2" stand for twice-daily treatment?

PURPOSE: Radiotherapy (RT) is often the therapy of choice for patients with Stage T2 glottic carcinoma. This retrospective study updated the results of RT for patients treated at our center. The primary focus of this study was whether a policy of using hyperfractionated RT for these patients resulted in a therapeutic gain.METHODS AND MATERIALS: A search of the database of patients treated in the Department of Radiation Oncology at The University of Texas M. D. Anderson Cancer Center was performed to identify patients with Stage T2 glottic carcinoma treated with RT alone between 1970 and 1998. A total of 230 patients formed the study cohort.RESULTS: The median follow-up for all patients was 82 months. Of the 230 patients, 180 were treated with parallel-opposed fields, and the median field size was 30 cm(2). Eighty-one patients (36%) were treated with twice-daily fractionation to 74-80 Gy. Eighty-nine patients (38%) were treated with 32-75 Gy at 2-Gy per fraction once daily, and 57 patients (25%) were treated with 2.06-2.26 Gy, once daily, to 66-70 Gy. The 2- and 5-year actuarial local control rate was 75% and 72%, respectively. After salvage therapy, the ultimate 5-year local control and disease-specific survival rate was 91% and 92%, respectively. The presence of subglottic extension and treatment with a daily dose of < or =2 Gy were associated with poorer local control (p <0.01) on both univariate and multivariate analyses. The 5-year local control rate for patients treated with twice-daily and once-daily RT was 79% and 67%, respectively (p = 0.06).CONCLUSION: The 5-year local control rates with hyperfractionated RT for Stage T2 glottic carcinoma approach 80%. Patients treated with twice-daily fractionation to a median dose of 77 Gy had an improvement in local control compared with patients treated with 70 Gy in 35 fractions. The Radiation Therapy Oncology Group is testing these two fractionation schedules in a randomized study. High control rates were also seen in selected patients treated with hypofractionated schedules, leaving the question of the optimal schedule for patients with Stage T2 disease unanswered.     

Silent polymorphisms within the coding region of human sodium/hydrogen exchanger isoform-1 cDNA in peripheral blood mononuclear cells of leukemia patients: A comparison with healthy controls

We have examined the sequence of the cDNA encoding the sodium/hydrogen exchanger isoform 1 (NHE1), from 23 bases upstream of the start codon to 28 bases downstream of the stop codon. Template was prepared from (1) peripheral blood mononuclear cells (PBMC) isolated from 10 healthy unrelated Caucasian volunteers; (2) PBMCs isolated from 6 leukemic patients (acute lymphoblastic leukemia [ALL], n = 3; chronic lymphocytic leukemia [CLL], n = 1; chronic myelogenous leukemia [CML], n = 2); and (3) samples of 4 leukemic cell lines (ALL: CEM, MOLT4; AML: KG1a; CML: K562). NHE1 cDNA in normal PBMCs showed silent polymorphism of nucleotides 112 (N1: T, frequency 0.70; C, frequency 0.30; prevalence of heterozygosity 0.42); 2248 (N2: G, frequency 0.90; A, frequency 0. 10; heterozygosity 0.18); and 2493 (N3: G, frequency 0.90; A, frequency 0.10; heterozygosity 0.18). Deduced primary structure of NHE1 protein in all normal volunteers was identical to that previously published for NHE1 from renal and cardiac tissue. Similar to normal PBMCs, NHE1 cDNA from leukemic cells showed polymorphism of nucleotides N1, N2, and N3, but failed to demonstrate leukemia-specific sequence differences. We conclude that the coding region of NHE1 cDNA shows a greater level of polymorphism than is currently recognized, but that sequence mutation of NHE1 is not a key event in the pathogenesis of leukemia.     

Organ preservation for carcinoma of the larynx and hypopharynx

Treatment of laryngeal and hypopharyngeal cancers often necessitates total laryngectomy. This article reviews approaches of curing patients with these diseases while preserving their larynx. Strategies include radiation alone, neoadjuvant chemotherapy with radiation for responders, or concurrent chemotherapy and radiation. Both retrospective experiences and randomized trials evaluating differing therapies in an effort to achieve voice preservation are reported and analyzed.     

Follow-up and outcomes for resection of colorectal liver metastases in Edinburgh.

AIM: The aim of this study was to assess the value of a defined follow-up protocol for patients undergoing potentially curative hepatic resection for colorectal hepatic metastases. METHODS: A standard protocol for the duration of the study consisted of clinical assessment, serum carcinoembryonic antigen (CEA) and computed tomography. Patterns of recurrence, method and timing of diagnosis and outcome were recorded. RESULTS: One hundred and ninety-one patients underwent potentially curative resection from 1989 to 2004 of whom 103 developed recurrence. The median (inter-quartile range) follow-up was 24.4 (6.5-42.3) months. The median (IQR) time to recurrence and overall survival was 25.0 (10 -not yet reached) and 45.2 (21-123) months, respectively. Seventeen patients (8.9%) underwent further surgery with curative intent. Fifty-five patients (57.9%) had recurrence diagnosed at routine follow-up with 71% (44/62) being diagnosed by CEA and CT. The CEA was elevated in 85.7% (72/84 patients) at the time of diagnosis of recurrence. CONCLUSION: Although the detection of recurrent disease is common during follow-up after hepatic resection for colorectal metastases, few patients will be suitable for further intervention with curative intent. The exact nature of the follow-up protocol remains to be determined but if it is going to be performed it should be most intensive within the first 3 years.     

The use of operative ultrasound in surgery of primary liver tumors

Operative ultrasound was evaluated in 77 patients submitted for surgery of primary liver tumors over a 3-year period. Preoperative ultrasonography, computed tomography, and selective hepatic arteriography were performed in all patients before 79 surgical interventions. Peroperative ultrasonography provided additional information to that obtained from preoperative investigations in 26 cases (33%). This information modified the intended surgical procedure in 21 cases and, in 10 patients, subsegmental resection was facilitated by ultrasonically guided cannulation of the portal venous branch. Operative ultrasonography provides more detailed information about liver tumors and their topography than can be obtained by intensive preoperative investigations. This information may avoid unnecessary trial dissection of apparently operable tumors and enables more precise and limited resection of those lesions shown to be resectable by operative ultrasonography.

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Resumen El uso intraoperatorio del ultrasonido fue valorado en 77 pacientes sometidos a cirugía por tumores primarios del hígado en un período de 3 años. Se realizó ultrasonografía, tomografía computadorizada, y arteriografía hepática preoperatorias en todos los pacientes antes de emprender la realization de 79 intervenciones quirúrgicas. En 26 casos (33%) la ultrasonografía peroperatoria suministró información adicional a la obtenida mediante las investigaciones preoperatorias. Esta información modificó el procedimiento quirúrgico planeado en 21 casos y en 10 pacientes se facilitó la resección subsegmentaria mediante la canulación dirigida por ultrasonido de una rama de la vena porta.La ultrasonografía operatoria provee una información más detallada sobre los tumores del hígado y su topografía que la que puede lograrse mediante intensas investigaciones preoperatorias. Tal información puede evitar innecesarias disecciones de ensayo en casos de tumores aparentemente operables y hace posible la resección más limitada y precisa de aquellas lesiones que demuestran ser resecables en la ultrasonografía operatoria.

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Résumé L'échographie opératoire a été étudiée chez 77 malades qui ont été opérés pour une tumeur primitive du foie au cours d'une période de 3 ans. L'échographie pré-opératoire, la tomodensitométrie, et l'artériographie sélective hépatique avaient été pratiquées chez les 77 malades avant l'intervention. Dans 26 cas (33%) l'échographie per-opératoire apporta des données supplémentaires aux renseignements fournis par les explorations pré-opératoires. Les données entrainèrent le changement de la tactique opératoire envisagée et chez 10 opérés la résection sous segmentaire du parenchyme hépatique fut possible grâce à l'échographie guidée par le cathétérisme d'une branche du système porte.L'échographie opératoire apporte des données supérieures aussi bien en ce qui concerne les tumeurs hépatiques et leur situation dans le foie que celles obtenues par toutes les autres explorations pré-opératoires. Ces données permettent d'éviter des tentatives inutiles de dissection de tumeurs qui paraissaient opérables et elles permettent aussi de limiter la résection du parenchyme hépatique lorsque l'échographie opératoire a démontré que les tumeurs sont accessibles à l'éxérèse.

     

Vasodilator agents and supracollicular transection fail to inhibit cortical spreading depression in the cat

It remains an open question as to whether cortical spreading depression (CSD) is the pathophysiological correlate of the neurological symptoms in migraine with aura. In the experimental animal, CSD is an electrophysiological phenomenon mainly mediated via NMDA receptors. However, according to case reports in humans, visual aura in migraine can be alleviated by vasodilator substances, such as amyl nitrite and isoprenaline. There is also circumstantial evidence that brainstem nuclei (dorsal raphe nucleus and locus coeruleus) may play a pivotal role in the initiation of aura. In this study, CSD was elicited in alpha-chloralose anesthetized cats by cortical needle stab injury and monitored by means of laser Doppler flowmetry. Topical application of isoprenaline (0.1-1%) and amyl nitrite (0.05%) onto the exposed cortex had no effect on the elicitation or propagation of CSD. Also, after supracollicular transection, subsequent CSDs showed no differences in the speed of propagation and associated flow changes. We conclude from these data that--given CSD probably exists in humans during migraine--spreading neurological deficits during migraine aura are independent of brainstem influence and have a primarily neuronal rather than vascular mechanism of generation.     

Ankle: surface coil MR imaging at 1.5 T

High-field surface coil magnetic resonance (MR) images were obtained of 12 ankles: two from healthy volunteers, seven from patients, and three from fresh cadavers. The cadaver ankles were sectioned in the coronal, sagittal, and axial planes for direct comparison with the MR images. Plain film confirmation of pathologic conditions was obtained in all patients, and five underwent arthroscopy or surgery, or both. MR imaging provided excellent delineation of ligaments and cartilaginous structures in all cases.