Radiation dose escalation by percutaneous interstitial brachytherapy in locally advanced non-small cell lung cancer

Management of locally advanced non-small cell lung cancer is associated with a poor overall survival using concurrent chemoradiotherapy. Therefore, newer approaches to treatment which enable dose escalation are warranted. Interstitial brachytherapy in lung is a new emerging concept with many distinct advantages. We report here a case of locally advanced non-small cell lung cancer with residual disease after conventional treatment. The patient was successfully treated using percutaneous interstitial brachytherapy and is disease-free at 18-month follow-up.

Dihydrotestosterone sensitises LNCaP cells to death induced by epigallocatechin-3-Gallate (EGCG) or an IGF-I receptor inhibitor

BACKGROUND

Compelling evidence has accumulated for chemopreventive effects for the active component of green tea Epigallocatechin-3-Gallate (EGCG) particularly for prostate cancer (CaP).

METHODS

We have assessed interactions between the effects of EGCG and two main regulators of prostate cell function, dihydrotestosterone (DHT) and insulin-like growth factor-1 (IGF-I). Using LNCaP (androgen-sensitive), PC3 and DU145 (androgen-resistant) CaP cell lines, we assessed the effect of EGCG alone on growth (0-200 microM) and on cell death (0-50 microM).

RESULTS

EGCG decreased the proliferation of all the CaP cancer cells in a dose-dependent manner with an increase in apoptosis from 30 to 50 microM. With DU145 cells, a sub-apoptotic dose of EGCG (10-20 microM) reduced IGF-induced growth. With LNCaP cells, a sub-apoptotic dose of EGCG (8 microM) switched DHT from a growth promoter to a growth inhibitor. A similar reversal of DHT effect was seen in the presence of an IGF-I receptor inhibitor, AG1024 (1 microM). These responses appeared to be due to DHT sensitizing the cells to apoptosis by EGCG and AG1024 (P < 0.01 and P < 0.001 respectively).

CONCLUSIONS

Our data suggests that both green tea and AG1024 are effective in inhibiting cell growth and inducing death in CaP cells but the effects of both are more effective in the presence of androgen.

Normal tissue complication probability of fibrosis in radiotherapy of breast cancer: accelerated partial breast irradiation vs conventional external-beam radiotherapy

AIMS

Radiotherapy forms an integral part of breast-conserving treatment in early-stage breast cancer. Subcutaneous fibrosis of the treated breast is an important late effect in whole-breast irradiation. The aim of this study was to compare the normal tissue complication probability (NTCP) for radiation-induced fibrosis in treated breast using accelerated partial-breast irradiation (APBI) vs conventional treatment.

MATERIALS AND METHODS

Ten postoperative early-stage breast cancer patients (T1N0M0) were included in this dosimetric analysis. APBI treatment was planned using conformal radiotherapy technique and conventional treatment plans included two tangential portals. All the APBI treatment plans were made with five non-coplanar beams with 6 MV photons. The prescription dose was 38 Gy in 10 fractions for the APBI treatments and 50 Gy in 25 fractions, followed by a boost dose of 16 Gy in 8 fractions, for the conventional treatments. We used Lyman's relative-seriality model and the breast fibrosis NTCP model fitting parameters for the study.

RESULTS

The equivalent uniform dose (EUD) was 30.09 Gy and 50.79 Gy in APBI and conventional treatment, respectively. The mean NTCP values for ipsilateral breast fibrosis in APBI and conventional treatment were 0.51 and 25.66%, respectively. Using the paired t-test, a statistically significant difference was seen in the breast fibrosis NTCP values for APBI vs conventional treatment (P < 0.001).

CONCLUSIONS

APBI reduces the ipsilateral breast fibrosis compared to conventional whole-breast treatment in early-stage breast cancer.

Sarcomatoid squamous cell carcinoma of uterine cervix: pathology, imaging, and treatment

Sarcomatoid squamous cell carcinoma of the cervix is a rare tumor. Only 16 cases have so far been reported in literature. We report here one such tumor occurring in a 54-year-old postmenopausal woman. Our case report describes the clinical, pathological, and PET scan characteristics of this tumor. The patient was treated with concurrent chemoradiotherapy and is disease free at 6-months follow-up.

Sweat gland carcinoma with lung metastases

Sweat gland carcinoma is a rare skin tumor. The tumor has propensity to spread to lymph nodes and distant metastases has been reported. Their exact incidence in the Indian setting is not known. Aspects related to treatment are also not clearly defined. Though surgery forms the initial treatment approach, adjuvant treatment has not been properly explored. We report here a case of sweat gland carcinoma with bilateral lung metastases.

ToxoDB: an integrated Toxoplasma gondii database resource

ToxoDB (http://ToxoDB.org) is a genome and functional genomic database for the protozoan parasite Toxoplasma gondii. It incorporates the sequence and annotation of the T. gondii ME49 strain, as well as genome sequences for the GT1, VEG and RH (Chr Ia, Chr Ib) strains. Sequence information is integrated with various other genomic-scale data, including community annotation, ESTs, gene expression and proteomics data. ToxoDB has matured significantly since its initial release. Here we outline the numerous updates with respect to the data and increased functionality available on the website.

Concomitant chemoradiation versus radiotherapy in advanced squamous cell carcinoma of oropharynx and nasopharynx using weekly cisplatin: Final result of a phase III trial

6030

Background: Studies have confirmed the role of concomitant chemoradiation (CTRT) in the treatment of advanced SCCHN, however, there is no large study reported from India. Consensus about type and schedule of the chemotherapy is unclear e.g. single agent Vs combination; daily/weekly/three weekly. This study was undertaken to know effectiveness of weekly Cisplatin (DDP). Methods: prospective randomized phase III study. 153 untreated stage II-IV oropharyngeal and nasopharyngeal cancer patients were randomly assigned to one of the two treatment arm; Arm (A) Radical radiotherapy 70 Gy/ 35# over 7 weeks; Arm (B) CTRT; Cisplatin 40mg/m2 weekly for 6 doses beginning day 1 of radiation treatment plus radiotherapy as in arm (A). The objective endpoints were- to know (i) the responses, (ii) toxicity profile and (iii) overall survival in the two treatment groups. Protocol was approved by local ethics committee. Study period was from June 2003 to July 2005. Results: Number of patients were 76 (A) and 77 (B) in two arms respectively. CR was 70.7 Vs 78.9% in arm A and B. Toxicity- grade III and IV toxicities were 16% and 40% respectively in 2 arms (p=<0.05). There were more frequent interruptions (9.3% Vs 28.9%) and hospitalization (20% Vs 40.8%) (p=<0.05) in CTRT arm. Survival- with median follow up of 17 months overall survival was significantly higher in CTRT arm (p=0.024); 27 months (95%CI 15.2–36.8) for RT Vs not reached (NR) for CTRT group. Three year OS was 42% Vs 62% respectively. Conclusion: This trial confirms that CTRT using single agent weekly DDP is safe and superior to RT in advanced SCCHN but treatment interruptions and toxicities are of concern for developing country’s cancer care infrastructures.

No significant financial relationships to disclose.

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Toxicity of concurrent radiotherapy with CMF chemotherapy in the E-CMF adjuvant breast carcinoma regimen

582

Background: In the adjuvant management of breast cancer although delivery of radiotherapy (RT) concurrently with anthracyclines is contraindicated, toxicities are acceptable when the chemotherapy regimen used is CMF. The NEAT trial (NEJM 2006; 355:1851- 1862), presented at ASCO in 2003 demonstrated a significant survival advantage for sequential 4x epirubicin and 4x CMF chemotherapy (E- CMF) compared with 6x CMF and was adopted in the UK as a standard regimen. In order to limit treatment duration, RT may be given concurrently with chemotherapy during the CMF phase of treatment. We have reviewed the toxicity associated with this approach. Methods: Retrospective review of all patients treated with concurrent breast RT and CMF chemotherapy as part of the E-CMF regimen in our institution. Toxicities were graded according to the Radiation Therapy Oncology Group (RTOG) toxicity criteria. Confidence intervals were calculated by the binomial method using Stata version 9. Results: 77 patients received concurrent therapy between March 2004 and May 2006. Baseline characteristics; median age: 48, ER positive: 63.5%, HER2 positive: 11.7%, node positive disease: 85.7%. Type of surgery; lumpectomy: 61.0%, mastectomy: 39.0%, nodal dissection: 100%. Chemotherapy delivery; completed without delay: 35.1%, completed therapy with dose reduction/delay: 48.1%, discontinued therapy prematurely due to toxicity 16.8%. Sites of RT; breast: 62.3%, chest wall: 35.1%, axillary nodes: 45.5%, supraclavicular fossa: 36.4%. Schedule of RT; 50Gy/25#: 18.2%, 46/45Gy/20#: 67.6%, 45Gy/15#: 14.3%. Median interval between final dose of epirubicin and start of RT: 55 days. Toxicity; cutaneous grade 3–4 acute radiotherapy toxicity: 31.2% (95%CI 21.1–42.7%); cutaneous infective cellulitis: 14.3% (95%CI 7.4–21.1%); grade 3–4 neutropenia: 54.4% (95%CI 42.8–65.9%); febrile neutropenia requiring hospitalisation: 22.1% (95% CI 13.4–33.0%). The median duration of stay in hospitalised patients was 8 days (range 3–23 days). Conclusions: Toxicities were significantly greater than documented previously for concurrent therapy. RT should not be given concurrently with CMF chemotherapy as part of the E-CMF regimen.

No significant financial relationships to disclose.

Clinical review – Small cell carcinoma of the bladder

OBJECTIVES

To review the published literature on the diagnosis and management of small cell carcinoma of the bladder (SCCB).

METHODS

Papers were identified by searches of PubMed using the terms "small cell", "bladder" and "carcinoma". Additional papers were identified from review of references of relevant articles.

RESULTS

SCCB comprises less than 1% of bladder malignancies. It is an aggressive tumour that commonly presents at an advanced stage, in an elderly population. Consequently, patients are often not fit for anti-neoplastic therapy. In fit patients, the bedrock of treatment in the majority of cases is platinum-based systemic chemotherapy, which was the only factor predictive of improved outcome on multivariate analysis in one large review. The use of neoadjuvant chemotherapy has been associated with favourable results and may therefore be the preferred approach when scheduling treatment. Options for local management comprise surgery or radiotherapy (sequentially or concurrently with chemotherapy), both of which are potentially curative in selected cases. However, the subsequent frequent development of urothelial malignancies with bladder-sparing approaches should be considered when planning treatment, particularly in younger patients. Prognosis of SCCB overall is poor, the median survival of all cases varies from 4 to 23 months, and overall survival at 5 years from 10% to 40% of patients.

CONCLUSIONS

SCCB is a rare and aggressive tumour with a poor prognosis. Future efforts should be directed at its early detection and the development of more effective systemic therapies.

HER2-positive breast cancer brain metastases: multiple responses to systemic chemotherapy and trastuzumab--a case report

Brain metastases from metastatic breast cancer typically occur in 10-15% of patients and are associated with survival of 3-6 months. Recent series have shown that women with HER2-positive metastatic breast cancer receiving the drug trastuzumab develop brain metastases more frequently than this, but also that continuation of trastuzumab after diagnosis of brain metastases in such patients is associated with extended survival. Authors have speculated that this is due to improved systemic control of disease; however, a possibility is that trastuzumab may have a beneficial effect on cerebral metastases themselves. We report the case of a woman with HER2-positive metastatic breast cancer who developed multiple brain metastases while on trastuzumab, in whom the addition of systemic chemotherapy to continued trastuzumab has produced multiple treatment responses associated with prolonged survival. This is the first report of its kind.