The role of stem cells in the prevention and treatment of radiation-induced xerostomia in patients with head and neck cancer

Abstract

Xerostomia is an important complication following radiotherapy (RT) for head and neck cancer. Current treatment approaches are insufficient and can only temporarily relieve symptoms. New insights into the physiopathology of radiation-induced xerostomia might help us in this regard. This review discusses the current knowledge of salivary gland stem cells in radiation-induced xerostomia and their value in the prevention and treatment of this complication. Salivary gland stem cell transplantation, bone marrow-derived cell mobilization, molecular regulation of parotid stem cells, stem cell sparing RT, and adaptive RT are promising techniques that are discussed in this study.

This review discusses the current knowledge of salivary gland stem cells in radiation-induced xerostomia and their value in the prevention and treatment of radiation-induced xerostomia.

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A novel approach to predict cetuximab-induced hypersensitivity reaction: detection of drug-specific IgE on basophils

Abstract

Cetuximab is remarkable for the relatively high rate and severity of hypersensitivity reactions (HR) being reported in the literature. Screening for cetuximab-specific IgE in serum via immunoassay has been found to be useful in preventing HR; however, these tests are known to have a low positive predictive rate. In an attempt to remedy this, we evaluated the interaction between cetuximab and IgE on basophils for predicting severe cetuximab-induced HR. Twelve head and neck cancer patients were enrolled in this single-institution study: four with a history of cetuximab-induced HR and eight with no such history. Cetuximab-specific and galactose-α-1,3-galactose (α-gal) specific IgEs in serum were measured in vitro using an enzyme-linked immunosorbent assay (ELISA). IgE-cetuximab binding on basophils was also analyzed to evaluate the decrease in cetuximab molecules on basophils after dissociation of IgE from FcεRI. The positive predictive value associated with the presence of cetuximab- or α-gal-specific IgE in serum was found to be only 0.67, whereas the negative predictive value was 1.00. On the other hand, in all four patients who developed HR, the cetuximab molecules on basophils were decreased significantly due to the dissociation of IgE from basophils (P < 0.05). However, this was not the case in patients who did not develop HR. In conclusion, our results strongly imply that the IgE-cetuximab interaction on basophils may be key to developing improved methods for predicting severe cetuximab-induced HR.

We indicated for the first time that a quantification of the interaction between cetuximab and IgE on basophils, the site responsible for IgE-mediated allergy, allows a more precise definition of the clinical presentation of allergic reaction due to cetuximab.

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Glycosylation status of serum immunoglobulin G in patients with prostate diseases

Abstract

Occurrences of high values in patients with benign prostate disease and low values in patients with highly suspicious cancer have diminished the trustworthiness of prostate-specific antigen as an early diagnostic marker of prostate cancer. In the search for other complimentary markers, we focused on serum IgG from patients with prostate diseases as well as normal subjects. IgG purified from the sera of normal control subjects and patients with prostate diseases, was digested with peptide N-glycanase. Released glycans were quantified using MALDI-time of flight mass spectrometry. We report that N-linked (N-acetylhexosamine)₂(deoxyhexose)(mannose)₃(N-acetylglucosamine)₂ was significantly increased in the IgG heavy chains of patients with prostate cancer compared with that of either benign prostatic disease patients or healthy subjects, whereas (hexose)(N-acetylhexosamine)₂(deoxyhexose)(mannose)₃ (N-acetylglucosamine)₂ was more abundant in the heavy chains of healthy subjects and benign prostatic disease patients. Thus, an absence of the terminal hexose of N-linked glycans has been closely connected to the progression of prostate cancer. Furthermore, surface plasmon resonance analyses have revealed that IgG from patients with prostate cancer has a decreased binding for Sambucus nigra lectin, compared with that from the benign prostatic disease patients or from normal subjects, suggesting lower levels of (N-acetylneuraminic acid)(α2-6)galactose/N-acetylgalactosamine groups in the N-linked glycans of patient IgG. Meanwhile, wheat germ agglutinin binding to IgG of the cancer group was significantly larger than that for the benign prostatic disease group but smaller than that for normal subjects. Our study indicates that the glycosylation changes in IgG can become useful diagnostic parameters for prostate cancer.

We report that N-linked (N-acetylhexosamine)2(deoxyhexose)(mannose)3(N-acetylglucosamine)2 was significantly increased in the serum IgG heavy chains of patients with prostate cancer compared with that of either benign prostatic disease patients or healthy normal subjects, whereas (hexose)(N-acetylhexosamine)2(deoxyhexose)(mannose)3 (N-acetylglucosamine)2 was more abundant in the heavy chains of healthy subjects and benign prostatic disease patients. Thus, an absence of the terminal hexose of N-linked glycans has been closely connected to the progression of prostate cancer.

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An evaluation of factors affecting preference for immediate, delayed or no breast reconstruction in women with high-risk breast cancer

Abstract

Objective

Women with locally advanced breast cancer face many conflicting issues affecting their choice of immediate versus delayed versus no breast reconstruction (BR). This single-centre pilot study assessed high-risk women's reasons and priorities in choosing the timing and type of BR in a setting where all clinically feasible options were discussed with all women.

Methods

Fifty-one women from a metropolitan breast oncology practice, who were likely to require post-mastectomy radiotherapy (PMRT), were recruited after making their decision about BR. Participants completed a questionnaire (69% preoperatively), adapted from Reaby (1998), evaluating the factors affecting their decision. Responses were subsequently classified into eight issue-based domains (feeling normal, feeling good, being practical, influence of others, expectations, fear, timing and unnecessary). Demographic and clinical data were also collected.

Results

There were 32 immediate BR (IBR = 63%), seven delayed BR (DBR = 13%) and 12 no BR (NBR = 23%). Analysis using the chi square test showed women over 60 were more likely to choose NBR (p = 0.005), while women living with a partner were more likely to choose IBR (p = 0.032). The most relevant domains for both IBR and DBR were 'feeling good' and 'feeling normal'; and for NBR were 'unnecessary' and 'being practical'. Although all women understood pre-operatively the potential aesthetic limitations of PMRT, 63% still chose IBR.

Conclusions

These data will enable clinicians, researchers and women with breast cancer to gain a clearer understanding of the factors that impact on the choice and timing of BR in women requiring PMRT, a major breast cancer survivorship decision. Copyright © 2016 John Wiley & Sons, Ltd.

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Cancers, Vol. 8, Pages 21: Nephrotoxicity as a Dose-Limiting Factor in a High-Dose Cisplatin-Based Chemoradiotherapy Regimen for Head and Neck Carcinomas

Purpose: Loco-regional control and organ preservation are significantly improved with concomitant cisplatin/radiotherapy and are compromised with less than 5% grade 3 nephrotoxicity (creatinine clearance 15–29 mL/min). However, although clinically important, in none of the randomized trials is grade 2 nephrotoxicity (defined as creatinine clearance 59–30 mL/min) mentioned. In this study, we assessed nephrotoxicity in daily practice among patients treated with high-dose cisplatin (100 mg/m2 on days 1, 22, and 43), concurrently with chemoradiotherapy (CCRT) and the impact on treatment modifications. Methods: 208 patients with advanced-stage malignancies of the head and neck region were evaluated. All patients were treated with high-dose cisplatin CCRT. The main outcome parameters were nephrotoxicity (defined as creatinine clearance grade 2 or more) and cumulative doses of cisplatin and radiation. Results: 133 patients (64%) completed all pre-planned courses of cisplatin. Nephrotoxicity was the main reason to discontinue the chemotherapy. Grade 3 nephrotoxicity was seen in 16 patients (8%) while grade 2 nephrotoxicity was seen in 53 patients (25%). Thirty six patients (17%) could not complete the pre-planned chemotherapy due to nephrotoxicity. Conclusions: In head and neck cancer patients, nephrotoxicity grade 2 is under-reported but is the major factor for discontinuing cisplatin during CCRT.

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Initial presentation of hepatocellular carcinoma as soft tissue swelling of the forearm: A rare cytomorphological diagnosis

Riti Tushar Kanti Sinha, Aniruna Dey, Seema Agarwal

Journal of Cancer Research and Therapeutics 2015 11(4):1032-1032

Bone is quite an uncommon site of metastasis in patients with hepatocellular carcinoma (HCC). We report a rare case of HCC presenting as a rapidly progressive painful soft tissue swelling with isolated metastasis to the radius bone of right forearm. The present article emphasizes the point that HCC should be considered in the differential diagnosis of patients presenting with palpable soft tissue swelling with destruction of the underlying bone. Fine-needle aspiration cytology (FNAC) of the soft tissue mass revealed cytomorphological features of HCC. The primary tumor of the liver was diagnosed retrospectively, following FNAC of the osteolytic lesion in the right radius bone, which revealed HCC.

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Orbital retinoblastoma: Prosthetic frontier

Himanshi Aggarwal, Pradeep Kumar

Journal of Cancer Research and Therapeutics 2015 11(4):1047-1047



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Uncomfortable bedfellows: Whole brain radiation therapy and neurocognition in animal and human studies

Varsha Dutta

Journal of Cancer Research and Therapeutics 2015 11(4):679-683



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Congenital nasopharyngeal teratoma causing airway obstruction in the newborn

Mou Das, Debashish Mukherjee, Shatavisha Das Gupta, Suchandra Mukherjee, Uttara Chatterjee, Chhanda Datta

Journal of Cancer Research and Therapeutics 2015 11(4):1040-1040

Teratomas are the most common congenital tumors, but teratomas of the nasopharynx are rare in neonates. The present report is about an 18-day-old girl child with a nasopharyngeal teratoma protruding from the oral cavity. The tumor almost completely obstructed the airways and necessitated immediate intervention. The tumor was successfully removed by the transpalatal route. Histological examination showed that it was a mature teratoma. The case with its related differential diagnosis is discussed here.

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Is thyroid gland an organ at risk in breast cancer patients treated with locoregional radiotherapy? Results of a pilot study

Mutahir Ali Tunio, Mushabbab Al Asiri, Yasser Bayoumi, Laura G Stanciu, Naji Al Johani, Eyad Fawzi Al Saeed

Journal of Cancer Research and Therapeutics 2015 11(4):684-689

Background: Aim was to evaluate the dose distribution within the thyroid gland its association with hypothyroidism in breast cancer (BC) patients receiving supraclavicular (SC) radiation therapy (RT). Materials and Methods: Consecutive 40 BC patients with baseline normal thyroid function tests (TFTs), were randomized into two groups: (a) Adjuvant chest wall/breast with SC-RT (20 patients) and (b) control group (adjuvant chest wall/breast RT only); 20 patients. The thyroid gland was contoured for each patient. Each patient's dose volume histogram (DVH), mean thyroid volume, the volume percentages of the thyroid absorbing respectively 5, 10, 20, 30, 40, and 50 Gy (V5, V10, V20, V30, V40, and V50), and D mean (average dose in whole volume of thyroid) were then estimated. TFTs were performed at the time of the last follow-up and compared. Results: Mean thyroid volume of cohort was 19.6 cm 3 (4.02-93.52) and D mean of thyroid gland in SC-RT and control group was 25.8 Gy (16.4-52.2) and 5.6 Gy (0.7-12.8), respectively. Median values of V5, V10, V20, V30, V40, and V50 were 54%, 51%, 42.8%, 30.8%, 27.8%, and 7.64%, respectively, in SC-RT as compared to control group (V5;4.9%, V10;2.4%, V20;1.75%, V301%, V40;0%, and V50;0%, respectively) with P < 0.0001. At 52 months, a majority of patients (90%) had a normal thyroid function whereas four patients (10%) had hypothyroidism; 3/20 (15%) patients in SC-RT and 1/20 (5%) in control group with P < 0.001. Significant prognostic factors were; SC-RT (P = 0.001), V30 above 50% (P = 0.001), and smaller thyroid volume (P = 0.03). Conclusion: The risk of hypothyroidism in BC patients after SC-RT depends on the thyroid gland volume and V30 >50% and the risk can be minimized by thyroid gland shielding during RT.

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Focal thyroid incidentaloma on whole body fluorodeoxyglucose positron emission tomography/computed tomography in known cancer patients: A case-based discussion with a series of three examples

Mangala Targe, Sandip Basu

Journal of Cancer Research and Therapeutics 2015 11(4):1029-1029

The importance, imaging characteristics and outcome of focal thyroid incidentaloma on fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) have been illustrated in this report. This is drawn from a series of three case examples of proven malignancy at different locations, with three different thyroid cytopathological diagnoses. Subsequently, a case-based discussion on present consensus of the management of this entity has been undertaken including certain specific aspects of PET-CT interpretation and its role in this setting.

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Evaluation of on-board imager cone beam CT hounsfield units for treatment planning using rigid image registration

Mohamathu Rafic, Paul Ravindran

Journal of Cancer Research and Therapeutics 2015 11(4):690-696

Purpose: To evaluate the on-board imager cone beam CT (OBI-CBCT) Hounsfield units (HUs) for treatment planning. Materials and Methods: The HU-electron density (eD) calibration for CBCT, the CATphan504 phantom was used, and the CBCT HU (HU CBCT ) consistency was studied by analyzing the CBCT images of Rando phantom and compared with planning CT. The latter study was also performed on CBCT images of 10 H&N patients. For comparison, the structures contoured and treatment plans generated on CT were transferred on to the CBCT after registration. The treatment plans were compared using gamma (g) index analysis and the plan comparison dose volume histograms (DVH PlanComp ). Results: Although the HU-eD calibration curves of both the planning CT and CBCT were found to be linear, differences in mean HU values were found in the region of interest (ROI) corresponding to Acrylic, Derlin, and Teflon, viz., 144 ± 11 HU, 193 ± 5 HU, and 257 ± 7 HU respectively. For all the cases, the consistency and reproducibility of HU CBCT values for low density medium agreed the HU CT except at regions of high density. Overall g-evaluation showed more than 94% pixels pass rate and DVH results showed small difference in the DVH PlanComp, Rando, and large differences in DVH PlanComp, patient for structures contoured at peripheral regions (PV) of CBCT images. Conclusions: We conclude that the pixel-to-pixel HU corrections for entire range of eD are not necessary for OBI-CBCT images. Application of local correction in the high-density and penumbral regions would facilitate the use of CBCT images for routine treatment planning.

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Discoid lupus erythematosus-related squamous cell carcinoma of the lip in an HIV-seropositive black male

Edward M Molomo, Michael Bouckaert, Razia A.G. Khammissa, Hendrick M Motswaledi, Johan Lemmer, Liviu Feller

Journal of Cancer Research and Therapeutics 2015 11(4):1036-1036

Discoid lupus erythematosus (DLE) is an autoimmune disease commonly affecting sun-exposed areas of the skin. Subjects with DLE have high-levels of plasmacytoid dendritic cells -derived interferon-a, which mediates both loss of immune tolerance to self-antigens and exaggerated inflammatory state, and supports proliferation and differentiation of hyperactive B-cells. In a few cases, DLE of the lips, scalp, ears or nose may eventually progress to squamous cell carcinoma (SCC). Photosensitivity and the long-standing immune-mediated chronic inflammation and dysregulated healing characterized by atrophy, hypopigmentation or scarring inherent to DLE are risk factors for progression to SCC. We review some aspects of the pathogenesis of DLE and the possible roles of inflammation and photosensitivity in the carcinomatous transformation of DLE keratinocytes, and present an illustrative case of DLE of the lower lip in an HIV-tuberculosis co-infected black person, that progressed to SCC.

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Contrast-enhanced ultrasonography in qualitative diagnosis of sentinel lymph node metastasis in breast cancer: A meta-analysis

Yi-Xia Zhang, Xue-Mei Wang, Shu Kang, Xiang Li, Jing Geng

Journal of Cancer Research and Therapeutics 2015 11(4):697-703

Aim: This meta-analysis aims to determine the accuracy of contrast-enhanced ultrasonography (CEUS) in the qualitative diagnosis of metastatic sentinel lymph node (SLN) for patients with breast cancer. Materials and Methods: We screened PubMed, Embase, Web of Science, Cochrane Library, CISCOM, CINAHL, Google Scholar, CBM, and CNKI databases. All analyses were calculated using the STATA software, version 12.0 (Stata Corp, College Station, TX, USA). We calculated the summary statistics for sensitivity (Sen), specificity (Spe), positive and negative likelihood ratios (LR + /LR-), diagnostic odds ratio (DOR) and receiver operating characteristic (SROC) curve. Thirteen articles that met all inclusion criteria were included in this meta-analysis. Results: A total of 876 breast cancer patients were assessed, including 372 patients with metastatic SLN and 504 patients without metastatic SLN. All SLN were histologically confirmed after conducting CEUS. The pooled Sen was 0.80 (95%CI = 0.76-0.84); the pooled Spe was 0.94 (95% CI = 0.91-0.96). The pooled LR + was 6.28 (95%CI = 3.61-10.92); the pooled negative LR - was 0.218 (95% CI = 0.10-0.31). The pooled DOR of CEUS in qualitative diagnosis of SLN metastasis was 49.10 (95% CI = 27.89-86.45). The area under the SROC curve was 0.937 (standard error [SE] =0.0128). Conclusions: Our meta-analysis suggests that CEUS may have high a diagnostic accuracy in testing for metastatic SLN in breast cancer. Thus, CEUS may be a good tool for differential diagnosis between metastatic and non-metastatic SLN.

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Does a pathological fracture affect the prognosis in patients with osteosarcoma of the extremities?

Abhijeet Ashok Salunke, Yongsheng Chen, Chen Xi, Mark Puhaindran

Journal of Cancer Research and Therapeutics 2015 11(4):1043-1043



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Radiotherapy concurrent with weekly gemcitabine after transurethral tumor resection in muscle ınvasive bladder cancer

Umut Demirci, Omer Dızdar, M Faik Cetindag, Serkan Altınova, Atiye Ozsavran, Didem Sener Dede, Nurgul Kızılırmak, F Aysun Eraslan, Bulent Yalcın, Havva Yesil Cinkir

Journal of Cancer Research and Therapeutics 2015 11(4):704-707

Objective: In this report, we determined the efficacy and the toxicity of low dose weekly gemcitabine with radiotherapy, in medically unfit or refused surgery muscle-invasive bladder cancer (BC) patients. Materials and Methods: From 2008 to 2012, 15 patients were included into the retrospective analysis. Weekly gemcitabine was administered at a rate of 50 mg/m 2 with a median dose of 63 Gy radiotherapy. Results: The median age was 69 (range, 55-86). Median follow-up was 15 months (range, 5-53 months). A complete response was achieved in 12 patients (80%). Median progression free survival and overall survival were 15 months (range, 7-23 months) and 18 months (range not calculated), respectively. Local recurrence was found in 3 patients (20%) and distant recurrence was found in 5 patients (33.3%) for the entire group. While salvage surgery was performed on 1 patient, salvage chemotherapy was delivered for 4 patients. Treatment was well tolerated, there was no treatment interruption or instances of toxic death. A serious toxicity (grade 3) cystitis was seen in only 1 patient. Conclusions: Multimodality treatment of muscle invasive BC proved a feasible and effective treatment option. Gemcitabine based chemoradiation is an active treatment option with a low toxicity profile for patients with muscle invasive BC, who are not suitable medically or refused to surgery.

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Mucoepidermoid carcinoma of eyelid: A usual tumor at an unusual site

Lavleen Singh, Shuchita Singh, Deepali Jain, Suresh C Sharma

Journal of Cancer Research and Therapeutics 2015 11(4):1027-1027

Mucoepidermoid carcinoma is a malignant epithelial neoplasm comprising mucous, intermediate and epidermoid cells, arising mainly in salivary gland. It is extremely uncommon in ocular region, where it can arise in conjunctiva, lacrimal gland or lacrimal sac. The index case is being presented for its rarity and for highlighting the importance of meticulous sampling for correct diagnosis. A 68-year-old female presented with complaints of ulceration over right lower eyelid for 3 years. She underwent a local surgical excision 2 years ago after which she was asymptomatic for the following 1 year. Histopathological examination of excised specimen showed features of mucoepidermoid carcinoma. Mucoepidermoid carcinoma in ocular adnexa may be difficult to differentiate from its close mimickers like basal, squamous, sebaceous cell carcinoma and apocrine carcinoma. Meticulous sampling, judicious use of special stains and immunohistochemistry are pivotal in establishing the diagnosis.

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Tumor suppressive effects of WEE1 gene silencing could not enhance immunopotentiation effects of CD80 and 4-1BBL co-stimulation in human T cells

Naghmeh Ghiasi, Mojtaba Habibagahi, Rozita Rosli, Abbas Ghaderi, Khatijah Yusoff, Ahmad Hosseini, Syahril Abdullah, Mansooreh Jaberipour

Journal of Cancer Research and Therapeutics 2015 11(4):708-716

Background: Activation of T cells against tumors by recruiting co-stimulatory molecules has been an attractive approach for cancer immunotherapy. Reports suggested that targeting different genes in tumors might also boost T cell-mediated tumor destruction. Aims: We investigated whether in vitro WEE1 gene silencing in MDA-MB-468 and MCF7 breast cancer cell lines could enhance immunopotentiating effects of CD80 and 4-1BBL co-stimulation in human T cells. Materials and Methods: WEE1 gene was specifically silenced in the cancer cells using shRNA technology. The co-stimulatory molecules were over-expressed on the surface of the cancer cells by recombinant non-replicative adenoviruses. The immune reaction of T cells in the co-culture with tumor cells was studied. IFN-g production was assessed by intracellular staining of T cells. To assess cytotoxic activity of CD8 + T cells, the CD107a mobilization-degranulation assay was performed. Expression of granzyme B, perforin and fasl were examined by real time PCR. Results: T cell dual co-stimulation led to a significant increase in the frequency of IFN-g producing cells and higher percentages of degranulation in CD8 + T cells. It also resulted in higher expression levels of the cytotoxicity-related genes. WEE1 gene silencing in the target cells alone however, could not produce significant immune reactivation in the cultured T cells. Likewise, the immune responses of T cells neither improved nor suppressed when dually co-stimulated PBMCs were exposed to the cancer cells with silenced WEE1. Conclusions: In spite of antitumor effects of WEE1 silencing, combination of this approach with immune co-stimulation could not boost the reactivity of cultured T cells against the tested breast cancer cells.

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Primary choriocarcinoma of appendix mimicking acute appendicitis

Enam Murshed Khan, Amrita Chakrabarti, Amit Dutt Dwary

Journal of Cancer Research and Therapeutics 2015 11(4):1031-1031

Choriocarcinoma is a malignant trophoblastic cancer, the incidence of primary choriocarcinoma (PCC) of the gastrointestinal tract (GIT) being extremely rare, with only 14 cases being reported in worldwide literature. Here we present an extremely rare case of PCCof the appendix in a 32-year-old male who presented with acute pain abdomen. Histopathological examination revealed PCC of the appendix. Examination of the testis was unremarkable. Further investigations revealed a very high serum beta-human chorionic gonadotropin (b-HCG) titer with a normal carcinoembryonic antigen (CEA). Radiological imaging showed multiple areas of liver metastasis. Chemotherapy-based treatment with bleomycin, etoposide, and cisplatin (BEP) regime was advised, however the patient failed to follow-up for further management.

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Combination of survivin siRNA with neoadjuvant chemotherapy enhances apoptosis and reverses drug resistance in breast cancer MCF-7 cells

Honglin Dong, Luyu Yao, Weilin Bi, Fusheng Wang, Wei Song, Yonggang Lv

Journal of Cancer Research and Therapeutics 2015 11(4):717-722

Background: Chemotherapeutic resistance is a main problem in clinical breast cancer therapy. The purpose of our study is to investigate whether the combination of neoadjuvant chemotherapy and survivin siRNA treatment could enhance the therapeutic effect of neoadjuvant chemotherapy using paclitaxel or epirubicin. Materials and Methods: The molecular cloning technique was applied to construct the expression vector of siRNA against survivin. Effectene Transfection Reagent was used to transfect plasmids to MCF-7 cells. Survivin expressions were detected by quantitative real-time PCR (qRT-PCR) and Western blot methods. The effect of paclitaxel or epirubicin, with or without the combination of survivin siRNA treatment, on drug susceptibility of MCF-7 cells was detected by CCK-8 assay. MCF-7 cell apoptosis was detected by Flow Cytometry. Results: Survivin siRNA effectively inhibited the expression of Survivin RNA and protein levels (P < 0.05). Both paclitaxel and epirubicin can suppress the proliferation of MCF-7 cells and induce apoptosis to a certain degree respectively. The combination of survivin siRNA with the two chemotherapy drugs significantly enhanced both effects of the two chemotherapeutics respectively (P < 0.05). Conclusion: Survivin siRNA combined with the neoadjuvant chemotherapy can significantly enhance the sensitivity of MCF-7 cells to chemotherapeutics and cell apoptosis. This technology has important potential value in the therapeutic study of breast cancer.

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Adenosquamous carcinoma of oral cavity

Prasanth Thanakappan, Naga Sirisha Chundru Venkata, Rajesh Amudala, Meeramma Botu

Journal of Cancer Research and Therapeutics 2015 11(4):1034-1034

Adenosquamous carcinoma is a rare malignant epithelial neoplasm characterized by the presence of both areas of squamous cell carcinoma and adenocarcinoma. Only few cases of oral adenosquamous carcinoma have been previously reported in the literature. It has been described as a squamous cell carcinoma subtype with a high infiltrative capacity. This paper reports a rare case of adenosquamous carcinoma that involved the upper left buccal mucosa in a 55.year.old man.

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Prospective randomized trial to compare accelerated (six fractions a week) radiotherapy against concurrent chemoradiotherapy (using conventional fractionation) in locally advanced head and neck cancers

Manoj Gupta, Rohit Mahajan, Vikrant Kaushal, Rajeev K Seem, Manish Gupta, Tapesh Bhattacharyya

Journal of Cancer Research and Therapeutics 2015 11(4):723-729

Background: Concurrent chemoradiation (CCRT) is currently considered to be the standard of care in locally advanced head and neck cancer. The optimum radiotherapy schedule for best local control and acceptable toxicity is not yet clear. We aimed at shortening of treatment time by using accelerated radiation, thereby comparing the disease response, loco-regional tumor control and tolerability of accelerated radiation (six fractions per week) against CCRT in locally advanced head and neck cancer. Materials and Methods: We conducted the prospective randomized study for a period of 2 years from June 2011 to May 2013 in 133 untreated patients of histologically confirmed squamous cell carcinoma of head and neck. Study group (66 patients) received accelerated radiotherapy with 6 fractions per week (66Gy/33#/5½ weeks). Control group (67 patients) received CCRT with 5 fractions per week radiation (66 Gy/33#/6½ weeks) along with intravenous cisplatin 30 mg/m 2 weekly. Tumor control, survival, acute and late toxicities were assessed. Results: Median overall treatment time was 38 days and 45 days in the accelerated radiotherapy and concurrent chemoradiation arm, respectively. At a median follow up of 12 months, 41 patients (62.1%) in the accelerated radiotherapy arm and 47 patients (70.1%) in the CCRT arm were disease free (P = 0.402). Local disease control was comparable in both the arms. Acute toxicities were significantly higher in the CCRT arm as compared with accelerated radiotherapy arm. There was no difference in late toxicities between the two arms. Conclusion: We can achieve, same or near to the same local control, with lower toxicities with accelerated six fractions per week radiation compared with CCRT especially for Indian population.

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