Estimation of genetic distance based on RAPDs between 11 cotton accessions varying in heat tolerance

The genetic distance of 11 cotton genotypes varying in heat tolerance was studied using RAPD markers. Fifty-three random decamer primers were used for the estimation of genetic distance. Among the 53 RAPD primers, which were custom synthesized by GeneLink Inc., UK, 32 were polymorphic and 21 were monomorphic. The 32 polymorphic primers produced 273 fragments, with a mean of 8.3 fragments per primer. The number of polymorphic bands produced in the 11 cotton accessions ranged from 1 to 31. Primer GLC-20 produced 31 polymorphic bands, while two primers, GLB-5 and GLC-12, produced one polymorphic band each. A range of 88.89 to 42.48% genetic similarity was observed among the 11 cotton accessions. The highest genetic similarity was observed between FH-945 and BH-160 (88.89%), whereas the lowest value was found between NIAB-801/2 and FH-945 (42.48%). Unique amplification profiles were produced by most of the cultivars; the differences were sufficient to distinguish them from other genotypes. This confirms the efficacy of RAPD markers for the identification of plant genotypes. An accumulative analysis of amplified products generated by RAPDs was sufficient to assess the genetic diversity among the genotypes. This information should be helpful for formulating breeding and genome mapping programs.

Abstract PD09-08: Obesity in Long-Term Disease Free Survivors of Invasive Breast Cancer

Background: As the number of breast cancer survivors increases due to improvements in screening and treatment for breast cancer, there is a particular interest in identifying lifestyle factors associated with long-term survival. Obesity may be one of the modifiable risk factors that can play a role in the outcome of breast cancer patients however studies shown controversial results. Besides, little is known about the role of obesity in long-term survivors. The objective of this study is to examine the role of obesity in breast cancer patients who remained disease free at least 5 years after diagnosis.

Methods: We reviewed the medical records of all women with invasive breast cancer diagnosed at LSUHSC between 1980 and 2005. The patients with stage IV breast cancer at diagnosis were excluded from the analysis. For this study we selected patients whom were disease free at least five years after the breast cancer diagnosis. We classified our patients by body mass index (BMI) at the time of breast cancer diagnosis into: normal weight (BMI <25 kg/m2), overweight (BMI 25-29 kg/m2), and obese (BMI >30 kg/m2). Data on demographics clinical characteristics, tumor characteristic, breast cancer therapy, and relapse were analyzed within BMI classes. Results: A total of 967 patients were diagnosed with invasive breast cancer between 1980 and 2005. Out of those 49% were African American, 29% were overweight, and 49% were obese. From this population 597 (62%) patients were disease free more than 5y: 217 (49%) obese, 113 (26%) overweight, 112 (25%) normal weight. Obese breast cancer survivors in comparison to overweight and normal weight survivors were more likely to: be African American (61%, P<0.01), received Medicaid coverage (14.2%, p=0.05) and to have lower rates of mastectomy (p=0.017). There was not difference in tumor characteristics (ER status, Nodal status, Tumor size) and adjuvant treatment (chemotherapy, radiotherapy and hormonal therapy) between obese and non-obese patients. One hundred and ten patients (19%) developed a recurrence 5 years after diagnosis (48 obese and 33 overweight): 65 local (48 obese and 33 overweight) and 45 systemic (21 obese and 10 overweight).

Discussion: Our study has some limitations typical of retrospective studies and the generalization of the results may be limited. Our analysis suggests that in long-term disease free survivors obesity and race might be associated. To further clarify the role of obesity in long-term breast cancer survivors prospective studies with long term follow up are warranted.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD09-08.

Abstract P6-09-07: Obesity; Not Associated with Risk of Second Malignancy in Early Stage Breast Cancer

Introduction: Early diagnosis and effective local and systemic therapy has reduced the risk of relapse and death from breast cancer; thus, patients are living longer but experience an increased risk for the development of a second malignancy (SM). Risk factors for SM may be genetic, related to environmental or behavioral factors or to breast cancer treatments such as radiotherapy, chemotherapy or hormone therapy. Controversy exists over the role of obesity and breast cancer outcomes, and there is little information on long term survivors. LSUHSC Shreveport provides care for a predominantly indigent population with high rates of obesity. This allows us to study the role of obesity and risk of SM after breast cancer diagnosis. In this study, we sought to determine the incidence and risk factors for SM in women after treatment for early stage breast cancer. Methods: We performed a retrospective analysis of all patients treated for invasive breast cancer from 1980 through 2006 at LSUHSC Shreveport. Patients with stage IV at diagnosis were excluded. Second malignancy was defined as a new diagnosis of primary malignancy at least three months after initial breast cancer diagnosis. We reviewed the demographics, smoking status, BMI at diagnosis of breast cancer, tumor characteristics, breast cancer treatments (surgery, radiotherapy, chemotherapy and hormonal therapy) and site and date of second malignancies. Descriptive statisticswere performed to characterize the group of patients who developed a SM and Cox proportional hazard regression model was used to estimate the relative risk of development of SM.

Results: Of the 1214 patients analyzed, 118 (9.72%) patients developed a SM: 54% (n=64) breast cancer, 12.7% (n=15) gynecologic cancer, 8.5% (n=10) GI malignancy, 6.8% (n= 8) lung cancer, 6.8% (n=8) hematologic malignancy and 11% (n=13) various miscellaneous cancers. The median time for the development of SM was 7.6 years. The risk for development of SM increased with longer follow up: the risk at 5 years after breast cancer diagnosis was 2.3%, at 10 years was 10% and at 20 years was 30%. Patients with SM in comparison with patients without it were more likely to be obese (57%, p=0.05) and to have received radiotherapy (60%, p=0.01). No differences were observed with age at diagnosis, race, smoking status, use of chemotherapy, ER status, or use of hormone therapy. In a multivariate analysis using the Cox regression model, after adjusting for race, age, smoking status, use of chemotherapy and ER status, radiotherapy was a significant predictor of SM (HR=2.8, p=0.01). Obesity was not associated with an increased risk of SM (HR=0.91, p=0.82). Conclusions: Our study has some limitations typical of retrospective studies and the generalization of the results may be limited. We found that obesity at diagnosis of breast cancer did not adversely affect the rate of SM while radiotherapy represents a significant risk factor. Further studies are needed to define the role of lifestyle and cancer treatments on develop of SM in patients with early stage breast cancer.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-09-07.

Formulation and evaluation of omeprazole tablets for duodenal ulcer

Omeprazole pellets containing mucoadhesive tablets were developed by direct punch method. Three mucoadhesive polymers namely hydroxypropylemethylcellulose K4M, sodium carboxy methylcellulose, carbopol-934P and ethyl cellulose were used for preparation of tablets which intended for prolong action may be due to the attachment with intestinal mucosa for relief from active duodenal ulcer. Mucoadhesive tablets were coated with respective polymer and coated with Eudragit L100 to fabricate enteric coated tablets. The prepared tablets were evaluated for different physical parameters and dissolution study were performed in three dissolution mediums like 0.1N hydrochloric acid for 2h, pH 6.5 and pH 7.8 phosphate buffer solution for 12hr. Sodium carboxymethylcellulose showed above 95% release within 10 h where as carbopol-934P showed slow release about 88% to 92% over a period of 12 h. having excellent mucoadhesive strength but ethyl cellulose containing tablets showed less than 65% release. The release mechanism of all formulation was diffusion controlled confirmed from Higuchi's plot. Thus, the present study concluded that, carbopol-934P containing mucoadhesive tablets of omeprazole pellets can be used for local action in the ulcer disease as well as for oral controlled release drug delivery.

Concomitant chemoradiation versus radical radiotherapy in advanced squamous cell carcinoma of oropharynx and nasopharynx using weekly cisplatin: a phase II randomized trial

BACKGROUND

To know the effectiveness and tolerance of weekly cisplatin added to radiotherapy (RT) in advanced carcinoma of oropharynx and nasopharynx.

PATIENTS AND METHODS

Stage II-IV cancer patients were randomly assigned to either radical RT, 70 Gy/35 fractions over 7 weeks (RT arm), or chemoradiotherapy (CRT), cisplatin 40 mg/m² weekly for seven doses plus RT. Primary end points were (i) the responses, (ii) toxicity profile, and (iii) overall survival (OS) in two groups. Study period was from June 2003 to July 2005.

RESULTS

One hundred and fifty-three patients were randomly allocated to the study, 76 in RT arm and 77 in CRT arm. Seventy-one in each arm completed the planned treatment; complete response (CR): 67.1% versus 80.5% in RT and CRT arms (P = 0.04). Grade III and IV toxicity were 16% and 40% in RT and CRT arms, respectively (P = 0.01). There were frequent treatment interruptions (9.3% versus 28.9%; P = 0.003) and hospitalization (20% versus 40.8%) in the CRT group. OS was superior in the CRT arm (P = 0.02): 27 months [95% confidence interval (CI) 15.2-36.8] for RT versus not reached for CRT. Three-year OS was 42% for RT and 62% for CRT group. CRT and CR were independent prognostic factors.

CONCLUSION

This trial on Indian head and neck squamous cell carcinoma patients confirms that the use of weekly cisplatin is safe and CRT is superior to RT alone resulting in higher OS.

Significance of promoter hypermethylation of p16 gene for margin assessment in carcinoma tongue

BACKGROUND

Loss of p16 expression by promoter hypermethylation has been reported as an early event in the development of oral cancer. The aim of our study was to explore the prognostic implications of presence of promoter hypermethylation of p16 gene in surgical margins in carcinoma tongue.

METHODS

A prospective analysis of 38 patients with resectable carcinoma tongue was carried out. DNA from tumor and the surgical margins was assessed by methylation-specific polymerase chain reaction. Follow-up duration was 17 to 37 months.

RESULTS

About 86.8% of tumors showed promoter hypermethylation of p16 gene. Out of 30 patients with histologically free margins, 43.3% showed positivity on molecular assessment. Patients with positive molecular margins had a 6.3-fold increased risk of having local recurrence as compared to patients with negative margins.

CONCLUSION

Promoter hypermethylation of p16 gene may serve as a useful molecular marker for predicting local recurrence in carcinoma tongue.

Changes in ventilatory function following surgery for bilateral abductor paralysis

Management of bilateral vocal fold immobility continues to remain a challenge for the Otolaryngologist who attempts to create a balance between creation of an adequate airway and preservation of voice. The flow volume loop obtained by spirometry provides an ideal objective assessment tool to evaluate the results of surgery for this condition. Our experience in using peak inspiratory flow rate (PIFR) and forced inspiratory flow with 50% of vital capacity (FIF(50)) in the lung in assessing the results of surgery is described. Seventeen patients were included in the study. The surgical procedures performed included laser posterior cordectomy with partial arytenoidectomy, endoscopic arytenoidectomy and posterior cordectomy-Kashima's technique. Twelve out of 17 patients were successfully decannulated, a success rate of 70.6%. All patients except one showed an increase in mid-inspiratory flow rates and peak inspiratory flow rates. The mean increase in FIF(50) was 0.44 l/sec (52.6%) and the mean increase in PIFR was 0.41l/sec (39.77%). No statistically significant difference in improvement of inspiratory flow rates was observed between the three surgical procedures used in the study.

A randomized double-blind phase III study of efficacy of lactobacillus CD2 lozenges in preventing radiation- and chemotherapy-induced oral mucositis in head and neck cancer patients: Interim analysis

6008

Background: Oral mucositis is major toxicity in patients receiving RT with or without chemotherapy (CTRT) for squamous cell carcinoma of head and neck (SCCHN). This compromises ones ability to tolerate and complete treatment. Interventions available till date to limit and restrict mucositis are unsatisfactory. This study was undertaken to test the efficacy of lactobacillus CD2 in rendering patients more tolerant to the anticancer therapy. Methods: Prospective randomized double blind phase III study. Inclusion criteria were: resectable SCCHN patients suitable for CTRT or radical RT, age group 18–70 years, KPS>70%, normal hematological and biochemical functions. Eligible patients were randomized to receive total of 6 lozenges (to be dissolved by itself in the mouth) of either study product or placebo daily from the day anticancer treatment was started until one week after completion of anticancer therapy. Randomization was done in block of 10 patients. Initially it was planned to enroll 150 evaluable patients but protocol was amended to have total of 200 patients, to have interim analysis after 150 evaluable patients. This would have α and β error of 0.05 and 0.20, respectively. RT was given as 70 Gy/ 35# over 7 weeks with cisplatin 40 mg/m2 weekly x 7. Study was started in January 2007. Primary end points are: percentage of patients able to complete anticancer treatment and incidence of grade 3 and 4 mucositis. Results: This analysis was carried out on first 150 evaluable patients (75 in each arm). 135 were stage III or IV. Forty one (54.7%) in study arm and 36 (48%) in placebo arm took lozenges as planned (p = 0.414). Sixty seven (89.3%) in study arm and 56 (74.7%) in placebo arm could complete anticancer treatment (two sided p = 0.023). Grade 3 and 4 mucositis was seen in 40 (55.6%) and 44 (58.9%) patients respectively in study product and placebo arms (two sided p = 0.062). Conclusions: Study met one of its primary endpoint. Significantly more patients could complete anticancer treatment in study product arm and there was reduction in incidence of grade III and IV mucositis. We expect final results to be available before meeting.

[Table: see text]

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.

[Table: see text]

Analysis of 2167 head and neck cancer patients' management, treatment compliance and outcomes from a regional cancer centre, Delhi, India

Head and neck cancer care was analysed in 2167 unselected patients for management compliance and outcome. Median age was 55 years, with a male to female ratio of 5.5ratio1. Major sites were oropharynx (32.4 per cent), larynx (19.8 per cent), oral (16.6 per cent) and hypopharynx (12.9 per cent). Stage-wise distribution was I-II=8.9 per cent, III=20.6 per cent and IV=60.3 per cent and unstaged=10.2 per cent. Squamous cell carcinoma was the dominant histology for 90.9 per cent. Clinic-based cancer-directed treatment decisions were made for 1905 patients: curative intent in 53 per cent, palliative in 35 per cent and for the remaining 262 (12 per cent) supportive care. Overall, 1209 (56 per cent) patients complied with the prescribed treatments; 62 per cent, 54 per cent, and 35 per cent of curative, palliative and supportive care intent groups, respectively. Modalities were radiotherapy alone (64.6 per cent), combined surgery with irradiation (17.6 per cent), and chemoradiotherapy (11.2 per cent). Median follow-up periods were 17.5 and three months in curative and palliative groups respectively. Overall, 712 (33 per cent) cases received curative therapy, with three-year disease-specific survival of 49 per cent. Patient compliance was a major obstacle. The comparison of this series with the USA, Canada and Norway showed wide disparities in stage of presentation and survival.

Improving outcomes in rhinocerebral mucormycosis - early diagnostic pointers and prognostic factors

Rhinocerebral mucormycosis is an uncommon, rapidly progressive, highly fatal sinus infection, usually occurring in immunocompromised hosts. We describe our clinical experience with nine such consecutive cases managed at our centre, with emphasis on identifying early diagnostic and prognostic features. Perinasal cellulitis/paraesthesia was the most frequent early clinical sign of disease, being evident in at least six cases. Periorbital oedema, mucopurulent rhinorrhoea and nasal crusting were the other early manifestations. Concurrent computed tomography (CT) scan at this initial stage however revealed only minimal mucosal thickening of the sinuses in all four cases wherein it was done. Intracranial extension as evident on CT was the only adverse prognostic sign (p<0.05). The present report highlights the importance of early diagnosis and prompt institution of antifungal chemotherapy in ensuring a favourable outcome in rhinocerebral mucormycosis. However, initial CT is frequently near-normal and biopsy time-consuming and often not feasible. To optimize early diagnosis therefore, the clinician should be highly alert to certain subtle clinical signs, in the appropriate setting of an immunocompromised patient.

Radiation related morbidities and their impact on quality of life in head and neck cancer patients receiving radical radiotherapy

Although 50-70% of head and neck cancer patients in India receive radiotherapy (RT), radiation-related acute and late morbidities and their impact on quality of life (QOL) are infrequently reported. Acute and late radiation morbidities and QOL were assessed in a prospective longitudinal study of 45 patients with head and neck cancers receiving radical RT to a dose of 7000 cGy in conventional fractionation. Grade II acute morbidities experienced by the largest percent of the sample during the course of RT pertained to the mucosa (66.4%), salivary gland (84%), and oesophagus (53%). These morbidities led to an increase in the symptom scores of appetite loss (76.46), fatigue (65.75) and pain (44.77). This increase in the symptom scores consequently led to a significant decline in physical, social and emotional functioning as well as global health status score during the course of RT (p < 0.001). Scores improved after 1 month of RT but did not reach the pre-RT value. Future studies may consider correlating QOL assessment to significant patient and disease related parameters such as performance status, weight loss, stage and site of disease.

Association of vitamin A, vitamin C and zinc with laryngeal cancer

BACKGROUND

The incidence of the cancers of the oral cavity, pharynx, esophagus and larynx in different population groups of India is amongst the highest reported in Asian countries. There is evidence that high dietary carotenoids and vitamin C may possibly decrease the risk of laryngeal cancer. Limited data is available from India on the association between these micronutrients and the risk of laryngeal cancer.

AIMS

To assess the levels of vitamin A, vitamin C and zinc in laryngeal cancer patients and healthy controls.

SETTING AND DESIGN

A hospital based case- control study.

MATERIAL AND METHODS

One hundred and fifty five laryngeal cancer patients and a control group of 155 healthy individuals constituted the study population. Individuals in the control group were individually matched with the patients for their age +/- 2 years, sex and place of residence. Venous blood was drawn from the cases and controls and estimations of vitamin A, zinc and vitamin C was done utilizing the standard procedures.

STATISTICAL ANALYSIS USED

Paired 't' test to compare the mean serum levels of vitamin A and zinc and plasma vitamin C between laryngeal cancer patients and controls. Univariate logistic regression analysis to calculate the odds ratios and the confidence intervals.

RESULTS

The mean serum vitamin A, zinc and plasma vitamin C levels were significantly lower in laryngeal cancer patients as compared to the controls.

CONCLUSIONS

The findings of the present study indicated a strong association of these micronutrients with laryngeal cancer in the Indian population.

Invasive sino-orbital aspergillosis: surgical decisions and dilemmas

Invasive aspergillosis, one of the common paranasal sinus fungal infections, often secondarily involves the orbit. We report six such cases with orbital extension, all occurring in apparently immunocompetent hosts, to specifically address the difficult diagnostic and therapeutic issues involved. Limited biopsy procedures were often inconclusive, necessitating wide surgical excision to establish the histopathological diagnosis. Conservative orbital debridement proved adequate for cases with disease limited to the infero-medial compartment of the orbit, but resulted in residual progressive disease in the two of the four cases with retro-orbital and apical extension. Orbital exenteration in this latter group, however, proved successful in controlling disease. The present report emphasizes the importance of near-complete extirpation and adjuvant chemotherapy in ensuring a favourable outcome in invasive Aspergillus infections. Orbital exenteration appears justified for posterior orbital disease, regardless of the functional status of the eye, but is inappropriate for anterior orbital disease.

Rhinitis caseosa, nasal cholesteatoma and allergic fungal sinusitis

The recently described Syndrome of Allergic Fungal Sinusitis (AFS) has many similarities with the previously described entity of rhinitis Caseosa (synonym-Nasal Cholesteatoma). 28 patients treated over a 6 year period with a diagnosis of rhinitis caseosa/nasal cholesieatoma have been retrospectively reviewed with regard to their clinical and radiological features, operative findings and microbiologic and histopathologual features.All cases presented with nasal obstruction and nasal polyposis. CT scanning indicated intracranil extension and intra-orbital extension m 9 cases each. Surgical debridetnent with establishment of sinus drainage led to the universal initial relief of symptoms in all cases. 26 of 28 cases have remained free of recurrence on prolonged follow-up (minimum follow-up one year).Despite these cases demonstrating clinical, radiologital, morphological and histological similarities with the Syndrome of Allergic Fungal Sinustitis, in only 2 cases was a fungal aetiology confirmed by history. The clinical syndrome of "Rhinitis Caseosa" is described and its relationship with the Allergic Fungal Sinusitis (AFS) syndrome and the "AFS-hke" Syndrome explored.

Disregulated expression of the Th2 cytokine gene in patients with intraoral squamous cell carcinoma

It has been seen that advanced stage oral squamous cell carcinoma is associated with impaired T-cell function and higher antibody response. In order to find out if such immune disregulation is associated with alteration of T-helper (Th) type CD4+ T-cell phenotype leading to altered cytokine production, we studied the Th-like cytokine profile in 35 oral squamous cell carcinoma patients and 21 normal controls. Concomitant expression of both Th1 and Th2 cytokine genes was studied by reverse transcription and Polymerase Chain Reaction (PCR) based amplification (RT-PCR) of mRNA extracted from freshly isolated peripheral blood mononuclear cells (PBMC) using specific primers for Interferon (IFN)-gamma, Interleukin (IL)-2, IL-4 and IL-10. Almost 63% of oral cancer patients showed polarization of a Th-like cytokine response as compared to 33% of the normal controls while 66.6% of normal controls showed a predominantly non-polarized Th0 response. Expression of IFN-gamma and IL-2 genes was more commonly seen in the early stage of the disease (p < 0.02) whereas majority of advanced stage tumours was associated with enhanced expression of IL-4 and IL-10 but not IFN-gamma and IL-2 genes. Patients with lymphnode metastases and poorly differentiated tumours expressed IL-4 and IL-10 more frequently with concomitant suppression of IFN-gamma and IL-2 genes. It seems therefore, that the development of oral squamous cell carcinoma leads to polarization of cytokine gene expression that is skewed towards the Th1-like response in the early stage. However, increasing tumour load and lymphnode invasion suppresses Th1 cytokine genes, thus skewing it toward a Th2-like cytokine response.

Interstitial brachytherapy with or without external beam irradiation in head and neck cancer: Institute Rotary Cancer Hospital experience

Iridium-192 interstitial brachytherapy is practiced infrequently in developing countries, even where head and neck cancer is a major neoplasm and the technique could provide good results. This report from India is presented as an audit to validate the benefit of brachytherapy. One hundred and six head and neck cancer patients were treated by interstitial brachytherapy alone (n = 29) or combined with external irradiation (n = 77). The oral cavity and the oropharynx together constituted 82% of the sites of implanted tumours; 75% were T(1-2)N0 status. Brachytherapy was carried out using afterloaded plastic catheters and the Paris dose prescription system was followed. External cobalt-60 beam portals covered the primary and the neck. The median duration of follow-up was 22 months. The median dose of brachytherapy used alone was 60 Gy. With combined treatment, the median external radiotherapy and brachytherapy doses were 50 Gy and 25 Gy respectively. The median brachytherapy dose rate was 0.5 Gy/h. Primary and nodal recurrences were recorded in 41/106 (38.7%) and 18/106 (17.0%) patients at median intervals of 15 and 13 months respectively. Implant site failure was more common after combined treatment than with brachytherapy alone (42.8% versus 27.5%), but it did not reach statistical significance in this analysis (P = 0.15). Kaplan-Meier actuarial 5-year estimates showed 52% and 87% disease-free and overall survivals. Iridium-192 interstitial implants in suitably selected head and neck cancer patients can improve the radiotherapeutic results, with the promise of organ conservation in 50%. In India, the practice should be established in more radiotherapy centres and could be utilized in 10,000-25,000 head and neck cancer patients annually.

Results of radiotherapy with, or without, salvage surgery versus combined surgery and radiotherapy in advanced carcinoma of the hypopharynx

There is considerable controversy surrounding the optimum treatment of advanced hypopharyngeal cancers. Curative radiotherapy with surgical salvage in reserve is an accepted protocol as is also a combined treatment of surgery and radiotherapy. The present study is a retrospective analysis of the survival results of 195 cases treated in a single centre. The combined surgery and radiotherapy group comprised a greater number of pyriform fossa and post-cricoid tumours whereas, the curative radiotherapy group had a higher proportion of posterior pharyngeal wall tumours. Actuarial two-year disease-free survival rates were significantly better with combined treatment when results of stage III and IV lesions (164 patients) of all sites are taken together, as compared to those obtained with curative radiotherapy without salvage (p = 0.000) or radiotherapy with surgical salvage for residual/recurrent tumours (p = 0.0021).