The gulf journal of oncology最新文献

Background: The parapharyngeal tumour is a rare case of head and neck tumour. Benign and malignant tumours can arise from any of the structures contained within the parapharyngeal space. Pleomorphic adenoma is the most typical salivary gland tumour that is found in this space and surgical resection is the main treatment for this tumour. Since the modern era of the medicine, different kinds of diagnostic imaging and surgical approaches have been introduced to evaluate this tumour.

Case presentation: We present a case report of a parapharyngeal space mass that was found to be pleomorphic adenoma of minor salivary gland, their clinical presentation, radiological imaging and literature review of the transoral surgical approaches for parapharyngeal tumour.

Discussion and conclusion: The transoral approach remains one of the classical and effective methods for the resection of the benign prestyloid parapharyngeal tumour. The surgeons need to have a good knowledge of diagnostic imaging and surgical techniques to determine which surgical procedure is the best for the patients in order to eradicate the diseases and minimize the complications ultimately.

Introduction: The standard treatment for unresectable stage III non-small-cell lung cancer (NSCLC) is concurrent chemoradiotherapy. This study was undertaken to evaluate whether induction chemotherapy along with concurrent chemoradiotherapy would result in better tumor control, improved symptom control and any variation in toxicity as compared to concurrent chemoradiotherapy alone.

Patients and methods: Between February 2015 to September 2016, 25 patients each were randomized to control group, in which they received concurrent chemoradiotherapy with weekly cisplatin 40 mg/m2 intravenous, during chest radiotherapy of 66Gy in 33 fractions for 6.5 weeks, and study group, in which patients received three cycles of induction chemotherapy with Cisplatin 75 mg/m2and Paclitaxel 175 mg/m2administered every 21 days followed by identical chemoradiotherapy.

Results: The two groups of patients (with induction vs. without induction chemotherapy) were similar in age, performance status, histology, grade, and stage. At 6thmonth follow-up, complete response was seen in 6 patients in control arm and 7 patients in study arm (?2 = 1.603, p = 0.205) and partial response was seen in 13 and 12 patients in control and study arms respectively (?2 = 1.932, p = 0.165). Symptom control of cough, hemoptysis, chest pain and dyspnoea were also similar in both groups.

Discussion: In our study, no difference in treatment outcome with respect to the two groups was observed, which was similar to studies which have been conducted previously. Radiation is a good modality for symptom control of cough, hemoptysis, chest pain and dyspnoea. In toxicities, pneumonitis and hematological toxicity was slightly higher in study group even at 6th month follow up.

Conclusion: Slight increase in toxicity with no added benefit in locoregional tumor control and symptom regression, was seen in patients receiving induction chemotherapy followed by chemoradiotherapy. Concurrent chemoradiotherapy alone can thus be used as only modality of treatment in unresectable stage III NSCLC.

The transarterial chemoembolization (TACE) is a firstline therapeutic option for advanced hepatocellular carcinoma (HCC). Their indications are clearly defined by learned societies but the challenge is to determine the optimal number of TACE sessions that will benefit patients before switching to other therapies. For this reason, the Assessment for Retreatment with Transarterial chemoembolization (ART) score has been developed. The objective of our work is to show the prognostic value of the ART score before the second TACE.

Methods: This is a retrospective and prospective study of patients with hepatocellular carcinoma on cirrhosis liver who received a TACE between January 2012 to July 2019. The diagnosis of HCC was made according to the non-invasive criteria of EASL with the use of histology for doubtful cases. The ART score was calculated after the first chemoembolization. Patients were divided into 2groups: group A with an ART score between 0 and 1.5 and group B with a score =2.5.

Results: During the study period, 58 patients with HCC on cirrhosis liver received a TACE: 55.17% had an ART score between 0 - 1.5 before the second session and 44.8% had an ART score =2,5. Both groups were comparable regarding age, circumstances of discovery and Child's score. The size of the HCC as well as the value of the AFP was further increased in the group B. We observed a significant difference in the radiological response, the Child score and aspartate transaminase rate between the two groups after the first TACE. The overall survival rate at 3 years was 81% in group A versus 19% in group B.

Conclusion: The ART score has an independent prognostic value and should be taken into account in the therapeutic strategy before the second TACE.

Background: Neoadjuvant chemoradiation followed by surgery is the standard of care in locally advanced rectal tumors. Better pathologic response after chemoradiation is associated with better outcomes. Pathologic response may depend on various, patient and tumor related factors. The aim of our study was to assess the pathological response using a modified Ryan scoring system and to study various factors which influence the response.

Materials and methods: This is a retrospective study carried out at a tertiary cancer centre in India. Patient details and histopathology reports of rectal cancer patients who took neoadjuvant chemoradiation from January 2016 to December 2018 were analyzed. Demographic details, pathological response assessed by modified Ryans tumor regression grade (TRG) score and various factors which influence the pathological response were studied. Those with TRG score 0 (complete response) and1(near complete response) were grouped together as good responders and those with score 3 (partial response) and 4 (poor or no response) as poor responders. Univariate and multivariate analyses were performed using logistic regression to determine factors which influence pathologic response.

Results: There were a total of 83 patients. Males and females were equally distributed. 43.4%(n=36) of patients had lower rectal tumors,32.5%(n=27) had midrectal tumors and 24.1%(n=20) had upper rectal tumors. 46% of patients were good responders which includes complete responders ,17% (n=14) and those with a near complete response,29% (n=24). 54% of patients were poor responders,which includes those with incomplete response,36% (n=34) and with no or poor response,18% (n=15). Among the upper rectal tumors, only 20% had good response and among the mid and lower rectal tumors 54% had good response.(p value 0.02).63% of males were good responders in comparison to 37% among females (p value 0.05).

Discussion: Response to neoadjuvant chemoradiation with capecitabine in locally advanced rectal tumors in our institute is similar to the literature data with a complete response in 16.9%, near complete response in 28.9% partial response in 36.1% and no response in 18.1% of patients, according to modified Ryan score. It was found that upper rectal tumors had a poorer response when compared to mid and lower tumors and females had a poorer response compared to males.

Conclusion: Even though neoadjuvant chemoradiation remains the standard of care in locally advanced rectal carcinomas, its benefit in upper rectal tumors needs to be validated in larger studies.

Background: Oral mucositis is a common complication induced by radiation in head and neck cancer patients. OM can cause pain, dysphagia, dehydration and impaired quality of life. The main objective of this study was to assess the effectiveness of licorice mucoadhesive film on symptoms of head and neck radiotherapy-induced mucositis.

Methods: sixty head and neck cancer patients who have been scheduled to undergo radiotherapy were randomly assigned to receive radiotherapy plus licorice mucoadhesive film (30) or radiotherapy plus placebo mucoadhesive film. In this double blinded randomized clinical trial, oral mucositis was estimated by world health organization scales, a quantitative scale, and symptoms were evaluated by visual analog scale.

Results: The results showed a meaningful difference in pain score between two groups in third and fourth weeks (P-value <0.05). Also, there was a significant difference in scale of mucositis between the two groups in weeks 3 and 4 (P-value <0.05). However, there were no meaningful differences with regard to pain and scale of mucositis in weeks 0, 1, 2. (P-value>0.05).

Conclusion: This study showed that licorice mucoadhesive film can be effective in decreasing pain and level of radiation-induced mucositis and it could be administered as an alternative agent in OM management. Key words: Oral mucositis, Radiotherapy, Licorice, Mucoadhesive film, Placebo.

Soft tissue sarcoma, especially synovial sarcoma is extremely rare in infancy. Only few cases were reported, and challenges lies in disease eradication and subsequent adjuvant therapy. Due to particularly small size of head and neck region with important structures are in intimate location with each other, surgical resection is very challenging, in order to ensure total disease resection as well as maintaining function and cosmetic outcome post-operatively. We present an uncommon case of synovial sarcoma of infratemporal fossa diagnosed in a 3-month-old infant. Due to extreme age, it poses difficulty to the managing team with regards to surgical intervention and oncological regimes. Keywords : Synovial sarcoma; infratemporal fossa; infant.

Background: Intraoperative evaluation of axillary sentinel lymph node (SLN) in patients with breast carcinoma reduces the need of re-operations for axillary lymph node dissection. Various methods such as touch imprintcytology (TIC) and frozen section histology (FS) have been used to determine the SLN status intra-operatively. The sensitivity of intraoperative TIC examination on SLN is not consistent and varies in different studies. The aim of this study was to determine the specificity and sensitivity of TIC, and its feasibility in clinical use.

Methods: A prospective study was conducted on 24 female and 1 male patients with histologically proven breast carcinoma and an at most clinical stage of cT2N0, between March 2017 and 2020. Axillary lymph nodes were not detected/palpable on physical examination. The patient underwent breast-conserving surgery i.e. quadrantectomy with sentinel lymph node biopsy. The intact lymph nodes were sent to histopathology laboratory for intraoperative TIC. The nodes were bisected, touch smears made and stained using the H&E and may Grunwald - Giemsa methods. The remaining tissue was processed in formalin fixed paraffin-embedded blocks and the slides were stained with H&E.

Results: In the three- year period (2017-2020), sentinel lymph node intraoperative touch imprint cytology was performed on 25 patients' lymph nodes with primary breast cancer and clinically negative axillary lymph nodes in Muscat Private Hospital, Muscat, Oman. The average age of the patients was 54.69 year. SLN- TIC revealed 88.9% sensitivity, 93.75% specificity, 11.1% false negative rate and 6.25% false positive with an overall accuracy 92%.

Conclusion: Touch imprint cytology has high sensitivity and specificity with an accepted accuracy. Intraoperative TIC is practical, time-efficient, and cost-effective procedure requiring minimal tissue preparation for SLN evaluation especially in clinical practice where FS is unavailable. Intraoperative touch imprint cytology can detect macrometastasis and micrometastasis to a lesser extent. Key words: breast carcinoma, sentinel node biopsy, intraoperative diagnosis, touch imprint cytology, micrometastasis.

Endometrial Stromal Sarcoma (ESS) are very uncommon malignant tumors that make around 0.2% of the entire uterine related malignancies. They represent the endometrial stromal cells in the proliferative stage. The annual incidence of ESS is 1-2 per million women. We present an unusual case of ESS, which originates from the uterine artery through the Inferior Vena Cava (IVC) and extends to the right atrium. A 48 years old woman presented with menorrhagia and right flank pain for seven months. Physical examination was normal except for a palpable suprapubic mass. Computed tomography (CT) showed the right gonadal vein and IVC tumoral thrombus extending into the right atrium. An echocardiogram and Transesophygeal echocardiogram revealed a large non-mobile echogenic density in the right atrium. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. Extensive myometrial and vascular invasion was noted along with the extensive lymphovascular invasion of the uterus. Eventually, distal IVC resections were done, and there was no chance to remove the tumor because it was too attached and invaded the IVC filter. Owing to the unresectability of the tumor, the patient was assigned for palliative chemotherapy. Keywords: Endometrial Stromal Sarcoma, Right Atrium, Inferior Vena Cava, Spindle Cell Sarcoma.

Background: Glutaredoxin-1, as a component of antioxidant system, plays a crucial role in pathogenesis of some cancers and pre-malignant lesions. The aim of this study is to assess salivary levels of glutaredoxin-1 in oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC) patients compared with healthy controls.

Methods & materials: This cross-sectional study was conducted on 28 OLP patients, 20 OSCC cases, and 40 healthy subjects. Their salivary glutaredoxin-1 was assessed by the enzyme-linked immunosorbent assay (ELISA).

Results: Regarding the glutaredoxin-1 level, there was no significant difference between the three studied groups (p=0.073); however, the salivary glutaredoxin-1levels were higher in the healthy subjects than the OLP and OSCC patients. Among OSCC patients, the salivary glutaredoxin-1 levels were significantly higher in the males (p=0.03). According to glutaredoxin-1 levels, the difference between keratotic and non-keratotic OLP lesions were not significant (p=0.98). Furthermore, there was no significant difference between various clinical manifestations and grades of OSCC, (p=0.08, p=0.56, respectively).

Conclusion: Salivary glutaredoxin-1 levels were lower in OLP and OSCC patients compared to the normal volunteers; therefore the role of glutaredoxin-1 in the pathogenesis of these diseases could be proposed.