Quantitative tumor volume VS TNM staging: the impact on prognosis in head and neck cancer

OBJECTIVES

To evaluate the prognostic value of tumor volume (TV) by clinical method (CM) and Computerized Tomography (CT) scan in head and neck (H and N) cancer.

MATERIALS AND METHODS

Total 25 patients' (pts) pretreatment tumor volume (PT TV) was assessed clinically by cuboid volume method. Afterwards contrast enhanced computerized tomography (CECT) images of the pts were transferred to workstation by DICOM software. The computerized tomography tumor volume (CT TV) was obtained on Radworks 6.0, using mouse control cursor. After assessment, the patients were given 3 cycles of neoadjuvant chemotherapy followed by radiotherapy by conventional method on Co-60 Theratron 780 C. After 1 month of treatment, TV was again measured.

STATISTICAL METHOD

Statistical analysis was done on MSTAT statistical analysis software. Two-tailed student t test, chi square test and test for two proportions for significance had been used.

RESULTS

Large variations in tumor volume were found both in intra as well as inter T-stages. As the tumor size increases with T stages, the difference in measurement of TV by both methods decreases. CT TV results pre as well as post-treatment were more consistent than clinical method.

CONCLUSION

The use of TV as a prognostic factor by CT scan seems to be more useful parameter than the CM. TV should be included in the TNM (tumor, node, and metastasis) classification after setting the strict guidelines for tumor delineation, to solve the discrepancy of treatment outcome in the same clinical stage.

Role of multi-hnRNP nuclear complex in regulation of tumor suppressor ANXA7 in prostate cancer cells

Annexin-A7 (ANXA7) tumor suppressor role has been shown in various tumors, and ANXA7 expression has been particularly lost in androgen-resistant prostate cancers. In this study, we studied ANXA7 regulation in normal prostate versus androgen-sensitive and -resistant prostate cancer cells. Deletion mapping analysis showed lowest ANXA7-promoter activities in androgen-sensitive LNCaP prostate cancer cells. Genomatix analysis of ANXA7 promoter identified a cluster of steroid nuclear hormone receptor elements, including V$GREF (V$GRE.02/ARE.02). Gelshift analysis clearly indicated distinct nuclear protein occupancy at this ANXA7-promoter site (-1086/-890) in prostate cancer (LNCaP, DU145, and PC3) versus normal prostate (PrEC) cells. In matrix-assisted laser desorption time-of-flight mass spectrometry-based search for ANXA7 nuclear regulators, we identified several heterogeneous nuclear ribonucleoproteins (hnRNPs) (A1, A2/B1 and K) attached to the steroid-associated ANXA7-promoter site in the androgen-resistant PC3 prostate cancer cells with high ANXA7 gene copy number, but not in PrEC. The hnPNP role in ANXA7 regulation (that was validated by hnRNPA2/B1 antibody interference) resulted in multiple ANXA7 cDNA and protein products in PC3, but not in PrEC. Ingenuity pathways analysis showed plausible molecular paths between ANXA7 and the hnRNP-associated network in prostate cancer progression. Thus, a multi-hnRNP complex can be responsible for aberrant ANXA7 transcription and splicing, thereby affecting ANXA7 expression pattern and tumor suppressor function in prostate cancer.

Infection with Menangle virus in flying foxes (Pteropus spp.) in Australia

OBJECTIVE

To examine flying foxes (Pteropus spp.) for evidence of infection with Menangle virus.

DESIGN

Clustered non-random sampling for serology, virus isolation and electron microscopy (EM).

PROCEDURE

Serum samples were collected from 306 Pteropus spp. in northern and eastern Australia and tested for antibodies against Menangle virus (MenV) using a virus neutralisation test (VNT). Virus isolation was attempted from tissues and faeces collected from 215 Pteropus spp. in New South Wales. Faecal samples from 68 individual Pteropus spp. and four pools of faeces were examined by transmission EM following routine negative staining and immunogold labelling.

RESULTS

Neutralising antibodies (VNT titres > or = 8) against MenV were detected in 46% of black flying foxes (P. alecto), 41% of grey-headed flying foxes (P. poliocephalus), 25% of spectacled flying foxes (P. conspicillatus) and 1% of little red flying foxes (P. scapulatus) in Australia. Positive sera included samples collected from P. poliocephalus in a colony adjacent to a piggery that had experienced reproductive disease caused by MenV. Virus-like particles were observed by EM in faeces from Pteropus spp. and reactivity was detected in pooled faeces and urine by immunogold EM using sera from sows that had been exposed to MenV. Attempts to isolate the virus from the faeces and tissues from Pteropus spp. were unsuccessful.

CONCLUSION

Serological evidence of infection with MenV was detected in Pteropus spp. in Australia. Although virus-like particles were detected in faeces, no viruses were isolated from faeces, urine or tissues of Pteropus spp.

Application of the linear interaction energy method for rational design of artemisinin analogues as haeme polymerisation inhibitors

The anti-malarial activity of artemisinin-derived drugs appears to be mediated by an interaction of the drug's endoperoxide bridge with intra-parasitic haeme. The binding affinity of artemisinin analogues with haeme were computed using linear interaction energy with a surface generalised Born (LIE-SGB) continuum solvation model. Low levels of root mean square error (0.348 and 0.415 kcal/mol) as well as significant correlation coefficients (r(2) = 0.868 and 0.892) between the experimental and predicted free energy of binding (FEB) based on molecular dynamics and hybrid Monte Carlo sampling techniques establish the SGB-LIE method as an efficient tool for generating more potent inhibitors of haeme polymerisation inhibition.

Successful pregnancy with frozen embryo transfer into a gestational carrier from eggs obtained from a woman in premature menopause

PURPOSE

To describe a unique case of a successful gestational carrier pregnancy in a woman with premature ovarian failure using her own oocyte.

METHODS

Despite amenorrhea, failure to have menses to progesterone withdrawal and resistance to gonadotropin stimulation, ovulation induction was attempted by restoring down-regulated follicle stimulating hormone (FSH) receptors by lowering the elevated serum FSH and allowing stimulation by endogenous or exogenous gonadotropins. Oocyte retrieval was attempted if a mature follicle was obtained. GnRH antagonist was used to prevent premature oocyte release. Tapering prednisone was used for the first five days of the cycle due to patient's history of autoimmune disease (vasculitis and Crohn's disease). IVIG was given 8/2003 for vasculitis.

RESULTS

The patient underwent a total of 19 attempted retrievals during continuous natural cycles from 3/2003 to 2/2007. Oocyte retrieval required traversing the uterus with the retrieval needle because of ovarian position after multiple surgeries for bilateral endometriomas and Crohn's disease. Empty follicle syndrome was encountered in four retrieval attempts. In 15 attempts, an oocyte was obtained. The sole attempt at natural fertilization failed. ICSI and assisted hatching were used in all subsequent attempts, and were successful in all but one attempt which led to a 3 pronuclei embryo which was discarded. The first four single embryos retrieved (7, 4, 6 cells and morula) were all A1 or A2 and transferred fresh to the patient, but no pregnancy resulted. All subsequent embryos were cryopreserved. The transfer of four embryos (6-cell and 7-cell and 3-cell and 8-cell) in two cycles to two different gestational carriers resulted in a successful delivery of a full-term healthy female infant 3.3 kg. Genetic testing confirmed maternal identity to be the patient, not the carrier.

CONCLUSIONS

This is the first reported case of a successful gestational carrier pregnancy after reversing ovarian failure, inducing ovulation, and transferring a frozen-thawed embryo.

Timing of phosphate application affects arsenic phytoextraction by Pteris vittata L. of different ages

The effects of timing in phosphate application on plant growth and arsenic removal by arsenic hyperaccumulator Pteris vittata L. of different ages were evaluated. The hydroponic experiment consisted of three plant ages (A45d, A90d and A180d) and three P feeding regimens (P200+0, P134+66 and P66+134) growing for 45 d in 0.2-strength Hoagland-Arnon solution containing 145 microg L(-1) As. While all plants received 200 microM P, P was added in two phases: during acclimation and after arsenic exposure. High initial P-supply (P200+0) favored frond biomass production and plant P uptake, while split-P application (P134+66 and P66+134) favored plant root production. Single P addition favored arsenic accumulation in the roots while split-P addition increased frond arsenic accumulation. Young ferns (A45d) in treatment P134+66 were the most efficient in arsenic removal, reducing arsenic concentration to below 10 microg L(-1) in 35 d. The results indicated that the use of young ferns, coupled with feeding of low initial P or split-P application, increased the efficiency of arsenic removal by P. vittata.

Quantification of bone mineral density to define osteoporosis in rat

The diagnosis of osteoporosis centers on assessment of bone mass and quality. In the absence of evidence-based guidelines to assess bone status in laboratory animals and unsuitability of use of T-/Z-scores meant for clinical application in animal studies, most investigators involved in new drug research and development employ clinical biomarkers and kits to assess bone turnover rate and portray change in bone mineral density (BMD) as percentage of increase/decrease, making comparative assessment of the effect highly impractical. This study proposes threshold boundaries of BMD (rT-score) in colony-bred Sprague-Dawley rats, distinct from those used clinically. Boundaries were obtained keeping fixed Type-I error (alpha=0.025). Femur neck was considered best for defining bone status using BMD measured by dual-energy X-ray absorptiometry. Findings demonstrate that BMD<or=-1.96 rT-score signifies osteoporosis and BMD between >-1.96 and <-0.80 rT-score as osteopenia. Performance of boundaries to ascertain bone status was examined through simulation under different physiological/ hormonal states viz. estrogen deficiency, ageing, estrus cycle, pregnancy, and lactation. The Area Under the Receiver Operating Characteristic curve of 0.98 obtained using BMD of femur neck, being close to unity, shows excellent ability of the proposed rT-score to effectively identify osteoporosis. Further studies using certain hierarchical measures of bone quality such as histomorphometry, mechanical testing etc. could supplement these findings. Since, unlike humans, most laboratory animals including rats only exhibit osteopenia and do not fracture their bones, the proposed thresholds are intended to serve as categorical tools to define bone quality and not to predict fracture risk.

Trajectory of an oil spill off Goa, eastern Arabian Sea: field observations and simulations

An oil spill occurred off Goa, west coast of India, on 23 March 2005 due to collision of two vessels. In general, fair weather with weak winds prevails along the west coast of India during March. In that case, the spill would have moved slowly and reached the coast. However, in 2005 when this event occurred, relatively stronger winds prevailed, and these winds forced the spill to move away from the coast. The spill trajectory was dominated by winds rather than currents. The MIKE21 Spill Analysis model was used to simulate the spill trajectory. The observed spill trajectory and the slick area were in agreement with the model simulations. The present study illustrates the importance of having pre-validated trajectories of spill scenarios for selecting eco-sensitive regions for preparedness and planning suitable response strategies whenever spill episodes occur.

Evaluation of gemcitabine versus cisplatinum as an adjunct to radiotherapy in locally advanced carcinoma uterine cervix

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Background: Locally advanced carcinoma cervix patients are treated by a combination of external beam radiation and brachytherapy. Concurrent chemo-radiotherapy has been an active area of investigation in such patients. In this present study, we have compared two chemotherapy drugs- cisplatinum vs gemcitabine along with radiotherapy in loco-regionally advanced carcinoma cervix with the purpose of evaluating loco-regional disease control and tolerability of these combinations. Methods: This study was undertaken on 65 biopsy-proven patients with stage IIb- IIIb carcinoma cervix. All patients were treated with 50 Gy of external beam radiation with 2 Gy per fraction, 5 days a week followed by intra-cavitary radiotherapy (ICRT). Dose of ICRT delivered by high dose rate brachytherapy was 18 Gy by either of the two schedules, viz. 3 fractions of 6 Gy at weekly interval or 2 fractions of 9 Gy each at one week apart. The concurrent chemotherapy was either inj. Cisplatinum 35 mg/m2 IVI weekly (control group), or inj. gemcitabine 150 mg/m2 IVI weekly (Study group). Results: A total of 65 age and stage matched patients were recruited in the two arms of the study. We analyzed sixty patients who completed the above treatment protocol with 32 patients in control group and 28 in study group. Eighty-nine percent patients in study group had complete response (CR) to the above combination treatment vs. 72% CR in control arm (p< 0.05). However, overall response rate (CR+ PR) was similar in both the groups (96% in study group vs. 100% in control group). No patient in both the groups had grade IV skin reaction with only one patient in study group developing grade III skin toxicity. Grade III gastrointestinal (GI) toxicity was higher in study group as compared to controls (14% vs. 3%) with none of the patients experiencing grade IV GI toxicity. No other significant toxicity was encountered in this study. Conclusions: We can conclude that synchronous chemo-radiotherapy using either gemcitabine or cisplatinum as radiation sensitizer is feasible in locally advanced carcinoma cervix with similar overall response rate and acute toxicity profile with a significantly higher complete response rate when gemcitabine is used as a chemotherapeutic drug.

No significant financial relationships to disclose.

Evidence that progesterone receptor antagonists may help in the treatment of a variety of cancers by locally suppressing natural killer cell activity

PURPOSE

To propose a novel concept that progesterone receptor antagonists, e.g., mifepristone, may prove effective in treating a variety of cancers--even those not shown to be hormonally dependent or possessing progesterone receptors.

METHODS

Multiple human leukemia cell lines were evaluated for mRNA expression of an immunomodulatory protein called the progesterone-induced blocking factor (PIBF) that suppresses natural killer (NK) cell activity during normal pregnancy. Furthermore, we evaluated the effects of progesterone (P) and mifepristone in PIBF protein expression. Finally, the effect of mifepristone treatment of mice with advanced leukemia was evaluated.

RESULTS

All tumor cell lines evaluated were found to express mRNA for PIBF and some were found to even express the PIBF protein. The addition of P to the media increased the expression of PIBF and mifepristone downregulated its expression. Treatment of mice with spontaneous leukemia when they already had extensive disease seemed to increase the length and quality of their life.

CONCLUSIONS

These data and other experience with mice with lung cancer and some anecdotal human cancer experience suggest that various cancers may utilize similar mechanisms used by the fetus to escape NK cell surveillance. Mifepristone and other progesterone receptor antagonists may deserve a clinical trial in human cancer even where there is no knowledge of the presence of progesterone receptors.

Letrozole for brain and scalp metastases from breast cancer—a case report

Brain metastases from breast cancer have a poor prognosis. There have been reports of patients with breast cancer and brain metastases responding well to tamoxifen therapy. We report a very unusual case of intact breast carcinoma with brain as well as scalp metastasis responding well to letrozole (aromatase inhibitor) therapy for a prolonged period of time.

ARK, the Apaf-1 related killer in Drosophila, requires diverse domains for its apoptotic activity

In mammals and Drosophila, apoptotic caspases are under positive control of the CED-4-like proteins Apaf-1 and ARK, respectively. In an EMS-mutagenesis screen, we isolated 33 ark mutants as recessive suppressors of hid-induced apoptosis. The ark mutants are loss-of-function alleles characterized by reduced developmental apoptosis. Using the phenotypic series of these alleles, we identified helical domain I in the nucleotide oligomerization domain as critical for ARK's apoptotic activity. Interestingly, the WD40 region may also have an unanticipated positive requirement for the apoptotic activity of ARK. Considering structural information, we discuss the roles of these domains for assembly and activity of the ARK apoptosome, and propose that the WD40 region is anti-apoptotic in the absence of apoptotic signals, and pro-apoptotic in the presence of such signals. Furthermore, a defined null allele reveals that ark is required for most, but not all apoptosis suggesting the existence of an ARK-independent apoptotic pathway.

Incisional skin metastasis of a squamous cell cervical carcinoma 3.5 years after radical treatment-a case report

Metastatic carcinoma in an abdominal wall incision from internal malignant neoplasm is an uncommon and often a preterminal event. Most commonly metastatic skin incisional cancers have been reported with cancers of colon, kidney, and bladder. Incisional metastasis from postoperative case of carcinoma cervix is very rare. It has been reported in few patients with adenocarcinoma and poorly differentiated histopathology, more so at drain site postoperatively. We report a postoperative case of squamous cell carcinoma cervix FIGO stage IIA in a patient who after 3.5 years of completion of radical treatment (postoperative external and intravaginal radiation therapy) developed incisional skin metastasis followed by extensive subcutaneous metastasis in the vulval region. She received salvage chemotherapy; however, she did not show any response and finally succumbed to the disease. The outcome of patients with incisional skin metastasis is usually poor as they are often associated with locoregional recurrence. The intent of treatment remains palliation either by radiation/chemotherapy/surgery alone or in combinations. As far as we know, this is the first case of squamous cell carcinoma cervix stage IIA having incisional scar recurrence 3.5 years after postoperative radiotherapy.