The survival outcome and patterns of failure in node positive endometrial cancer patients treated with surgery and adjuvant radiotherapy with curative intent

Objective

The purpose of this study was to evaluate the patterns of failure, overall survival (OS), disease-free survival (DFS) and factors influencing outcome in endometrial cancer patients who presented with metastatic lymph nodes and were treated with curative intent.

Methods

One hundred and twenty-six patients treated between January 1996 to December 2008 with surgery and adjuvant radiotherapy were identified from our service''s prospective database. Radiotherapy consisted of 45 Gy in 1.8 Gy fractions to the whole pelvis. The involved nodal sites were boosted to a total dose of 50.4 to 54 Gy.

Results

The 5-year OS rate was 61% and the 5-year DFS rate was 59%. Grade 3 endometrioid, serous, and clear cell histologies and involvement of upper para-aortic nodes had lower OS and DFS. The number of positive nodes did not influence survival. Among the histological groups, serous histology had the worst survival. Among the 54 patients relapsed, only three (6%) failed exclusively in the pelvis and the rest of the 94% failed in extrapelvic nodal or distant sites. Patients with grade 3 endometrioid, serous and clear cell histologies did not influence pelvic failure but had significant extrapelvic failures (p<0.001).

Conclusion

Majority of node positive endometrial cancer patients fail at extrapelvic sites. The most important factors influencing survival and extrapelvic failure are grade 3 endometrioid, clear cell and serous histologies and involvement of upper para-aortic nodes.     

The Inactivation by Curcumin-Mediated Photosensitization of Botrytis cinerea Spores Isolated from Strawberry Fruits

Photosensitization is a novel environmentally friendly technology with promising applications in the food industry to extend food shelf life. In this study, the natural food dye curcumin, when combined with visible light (430 nm), was shown to be an effective photosensitizer against the common phytopathogenic fungi Botrytis cinerea (the cause of grey mould). Production of the associated phytotoxic metabolites botrydial and dihydrobotrydial was measured by our newly developed and validated HRAM UPLC-MS/MS method, and was also shown to be reduced by this treatment. With a light dose of 120 J/cm², the reduction in spore viability was directly proportional to curcumin concentrations, and the overall concentration of both botrydial and dihydrobotrydial also decreased with increasing curcumin concentration above 200 µM. With curcumin concentrations above 600 µM, the percentage reduction in fungal spores was close to 100%. When the dye concentration was increased to 800 µM, the spores were completely inactive and neither botrydial nor dihydrobotrydial could be detected. These results suggest that curcumin-mediated photosensitization is a potentially effective method to control B. cinerea spoilage, and also to reduce the formation of these phytotoxic botryane secondary metabolites.     

Source of drinking water and other risk factors for dental fluorosis in Sri Lanka

This study was done to describe the association between source of drinking water and other potential risk factors with dental fluorosis. Prevalence of dental fluorosis among 518 14-year-old students in the south of Sri Lanka was 43.2%. The drinking water sources of the students were described and fluoride samples were taken. There was a strong association between water fluoride level and prevalence of fluorosis. Tea drinking before 7 years of age was also an independent risk factor in a multivariate analysis. Having been fed with formula bottle milk as an infant seemed to increase the risk although the effect was not statistically significant. No clear effects could be found for using fluoridated toothpaste, occupation of the father, and socio-economic status. Drinking water obtained from surface water sources had lower fluoride levels (median 0.22 mg l(-1)) than water from deep tube wells (median 0.80 mg l(-1)). Most families used shallow dug wells and these had a median fluoride value of 0.48 mg l(-1) but with a wide range from 0.09 to 5.90 mg l(-1). Shallow wells located close to irrigation canals or other surface water had lower fluoride values than wells located further away. Fluoride levels have to be taken into account when planning drinking water projects. From the point of view of prevention of dental fluorosis, drinking water from surface sources or from shallow wells located close to surface water would be preferable.