The bottom line: Outcomes after conservation treatment in anal cancer

At the Department of Radiation Oncology, Westmead Hospital, between 1980 and 2000, 60 patients with squamous cell carcinoma of anal canal or margin (including 15 with Stage IIIA or IIIB) were treated radically; 55 received chemoradiation (89% were prescribed mitomycin C and 5‐fluorouracil). Five‐year overall survival was 64% (95% confidence interval (CI): 48–79%), with a median survival of 9.75 years (median follow up 5.6 years, range 5 months to 22.5 years). Ten patients have died of disease. At 2 years the local control rate was 86%, and colostomy‐free survival was 83%. Relapse after 2 years was uncommon. Tumour size was the main factor driving outcomes, especially survival. Patients with larger tumours (T > 4 cm) had a hazard ratio for survival of 5.7 (95% CI: 1.8–17). Fourteen (24%) patients experienced treatment interruptions as a result of acute toxicity, including one death from neutropoenic sepsis. Seven (12%) patients, in total, experienced one or more late toxicities, grade 3 or above, including four women (all postmenopausal) who developed a radiation‐induced bone injury. Most patients with anal cancer can expect to retain a functional sphincter after chemoradiation/radiation. Further studies are in progress to determine the optimal chemoradiation protocol.     

Community-acquired methicillin-resistant Staphylococcus aureus brain abscess in an immunocompetent individual

A 52-y-old woman with a community-acquired methicillin-resistant Staphylococcus aureus brain abscess who was successfully treated with surgical drainage and antibiotics is described. The increase in community-acquired methicillin-resistant S. aureus and the impact this will have on empirical treatment of such infections are discussed.     

Abnormal venous drainage in syndromic craniosynostosis and the role of CT venography

Objective  Venous hypertension is emerging as a significant contributor to intracranial pressure in children with syndromic craniosysnostosis. This is associated with jugular foramen stenosis or atresia and with the development of collateral emissary veins. We demonstrate how computed tomography venography can document the prevalence of these emissary veins and how their visualisation plays an important role in operative planning. Materials and methods  Patients with known syndromic craniosynostosis underwent computed tomography venography as part of their routine pre-operative evaluation. The venous drainage pattern was examined in these patients, with a special note of the presence of abnormal venous pathways. Results  Eleven patients were recruited into the study from ages 3 months to 22 years. All had a diagnosis of syndromic craniosynostosis with six Crouzon’s, four Pfeiffer’s and one patient with Crouzon’s and acanthosis nigricans. Nine of 11 patients had demonstrable evidences of transosseous venous drainage through an identifiable abnormal emissary vein. Four of 11 had a transosseous route as the main mechanism of drainage for the cerebral venous system. Conclusions  Patients with syndromic craniosynostosis often demonstrate abnormal venous anatomy, which can have serious consequences on craniofacial surgery, especially when a posterior decompression is being considered. Based on these findings, the authors assert that those children with some syndromic craniosynostosis being considered for surgery should undergo venographic studies as part of their pre-operative evaluation.     

Outcomes of young patients diagnosed with locally advanced rectal cancer

BackgroundThe incidence of rectal cancer is higher in the older population. In developed nations, there has been a rise in incidence in young onset colorectal cancer (CRC). We examined the outcomes of locally advanced rectal cancer (LARC) in younger patients (yRC) compared with older patients, using a retrospective audit.MethodsAll cases of LARC referred to two tertiary referral cancer centres in Western Sydney were examined. Patient demographics, presenting symptoms, treatment, relapse free survival (RFS), overall survival (OS) and progression free survival (PFS) were obtained. Under 50 years old was used as the cut-off age for defining yRC.ResultsAll 145 consecutive patients were treated for LARC, including 28 in the yRC and 117 in the older patient group. Median follow-up was 54 months. yRC were more likely to complete neoadjuvant therapy (100% vs. 86%; P=0.032) and to undergo more extensive surgical procedures (24% vs. 2%, P<0.0001). yRC were more likely to have microsatellite high (MSI) tumours (30% vs. 4.7%; P=0.003). yRC demonstrated significantly poorer RFS compared with the standard group (HR 2.79; median RFS 4.67 vs. 16.02 months; P=0.023). In the relapsed setting, yRC had poorer PFS compared with the standard group (median PFS 2.66 vs. 9.70, P=0.006, HR 3.04). A difference in OS was also seen between the two groups, with yRC demonstrating poorer OS (median OS 40.46 vs. 58.26 months, HR 3.48, P=0.036).ConclusionsPatients under 50 years with LARC are more likely to have MSI tumours with a more aggressive disease course and poorer RFS, PFS and OS. Initiatives to improve early detection of these patients may improve outcomes. Further research is necessary to understand this disease and optimise its treatment.     

Synthesis,Linear and Nonlinear Optical Properties of Ag/Al2O3 Nanocomposites

This work reports a detailed study of the synthesis, characterization and third-order nonlinear optical properties of Ag and Al₂O₃ nanoparticles and their polymer nanocomposites. Ag and Al₂O₃ nanoparticles were prepared by the chemical precipitation method. The X-ray diffraction studies confirmed the purity and the crystalline nature of the sample and revealed the crystallite size. The linear optical properties and the structural morphology of the nanoparticles were confirmed using UV–visible spectroscopy and SEM analysis. The prepared nanoparticles were introduced into the polymer matrix by the spin-coating technique. Open-aperture and closed-aperture Z-scan technique was used to study the nonlinear absorption and nonlinear refraction of the samples under a Q-switched Nd:YAG laser at 532 nm. The observed third-order nonlinear optical susceptibility (χ⁽³⁾) was on the order of 10⁻⁶ esu, which indicates that these materials are potential candidates for photonic applications.     

Clinical features,management and prognosis of multifocal primary bone lymphoma: a retrospective study of the international extranodal lymphoma study group (the IELSG 14 study)

‘Multifocal bone lymphoma’ or ‘polyostotic lymphoma’ is a neoplasm with exclusive multifocal involvement of the skeleton, without affecting lymph nodes or other soft tissues. Knowledge on this uncommon condition is limited because the related literature is sparse and fragmentary. We reviewed cases of multifocal bone diffuse large B‐cell lymphoma (MB‐DLBCL) registered in a clinico‐pathological database of the International Extranodal Lymphoma Study Group that includes 499 cases of bone lymphoma. Clinical features, management and prognosis of 37 MB‐DLBCL patients and 63 ‘controls’ (stage‐IV DLBCL and skeletal involvement) were analysed. Presentation and treatment of MB‐DLBCL and controls were identical. At a median follow‐up of 52 months (10–189), MB‐DLBCL patients exhibited a significantly better response rate (92% vs. 65%; P = 0·002), progression‐free survival (5‐year: 56 ± 9% vs. 34 ± 6%; P = 0·003) and overall survival (5‐year: 74 ± 8% vs. 36 ± 7%; P = 0·002). Among MB‐DLBCL patients, the use of post‐chemo radiotherapy was associated with better overall survival (5‐year: 83 ± 12% vs. 55 ± 16%; P = 0·003). Two MB‐DLBCL patients (5·4%) with spine and skull involvement experienced central nervous system (CNS) relapse. Thus, MB‐DLBCL patients exhibit a significantly better prognosis compared to patients with advanced‐stage DLBCL, and should be treated with conventional anthracycline‐based chemotherapy, keeping intensified treatment for relapsing cases, considering involved‐field radiotherapy, and CNS prophylaxis in high‐risk patients.     

Driving and patients with brain tumours: a postal survey of neurosurgeons, neurologists and radiation oncologists.

This study was aimed at evaluating the consistency of driving advice given by treating clinicians to patients diagnosed with brain tumours. Secondary aims include assessing the awareness of current driving guidelines and whether or not there was a need for more specific guidelines in this group of patients. This was undertaken utilizing a scenario-based postal survey. The results show an overall poor consistency in the answers provided for each case scenario. 73.1% respondents were not aware of any current driving guidelines. Of those who were aware of driving guidelines, 67.7% wanted more specific guidelines to be developed. Possible explanations for this are a lack of awareness of the existence of any driving guidelines and a lack of objective criteria in the current driving guidelines. The authors recommend that the current driving guidelines be comprehensively distributed to clinicians who treat patients with brain tumours, as well as forming a multi-disciplinary working party to develop more specific and objective driving guidelines.