Consensus Quality Measures and Dose Constraints for Head and Neck Cancer with an emphasis on Oropharyngeal and Laryngeal Cancer from the Veterans Affairs Radiation Oncology Quality Surveillance Program and American Society for Radiation Oncology Expert Panel

PURPOSE

Safeguarding high-quality care using evidence-based radiation therapy for patients with head and neck cancer is crucial to improving oncologic outcomes, including survival and quality of life.

METHODS AND MATERIALS

The Veterans Administration (VA) National Radiation Oncology Program established the VA Radiation Oncology Quality Surveillance Program (VAROQS) to develop clinical quality measures (QM) in head and neck cancer. As part of the development of QM, the VA commissioned, along with the American Society for Radiation Oncology, a blue-ribbon panel comprising experts in head and neck cancer, to develop QM.

RESULTS

We describe the methods used to develop QM and the final consensus QM, as well as aspirational and surveillance QM, which capture all aspects of the continuum of patient care from initial patient work-up, radiation treatment planning and delivery, and follow-up care, as well as dose volume constraints.

CONCLUSION

These QM are intended for use as part of ongoing quality surveillance for veterans receiving radiation therapy throughout the VA as well as outside the VA. They may also be used by the non-VA community as a basic measure of quality care for head and neck cancer patients receiving radiation.

Penile Paget's Disease: A Case Report and Review of the Literature

Extramammary Paget's Disease (EMPD) is a rare cutaneous, slow growing, intraepithelial adenocarcinoma that can be either primary (intraepithelial arising within the epidermis) or secondary (intraepithelial spread of a visceral carcinoma). Here we present the case of a 63-year-old male with EMPD of the glans penis stemming from underlying urothelial carcinoma. Our treatment decision elected for management with chemotherapy and local treatment with radiation therapy. Subsequent, review of the literature demonstrated a rare disease with a variety of underlying malignancies causing this secondary pathology. Caregivers should be aware of the association of Paget's disease and urothelial cancer and should have a high index of suspicion that erythematous penile lesions may represent Paget's disease and that penile biopsies should be performed early in this setting.

High Dose Methylprednisolone: Effective in Pregnancy Associated Post-splenectomy Refractory Chronic Immune Thrombocytopenic Purpura

We present a case of 23 years multigravid woman (G2P0+1) with chronic idiopathic thrombocytopenic purpura (ITP), refractory to treatment in forms of oral steroid, dapsone, azathioprine and splenectomy. She presented to the hospital in third trimester of pregnancy, with reduced platelet counts and purpuric rashes over abdomen and both upper extremeties. There was a past history of spontaneous abortion at 18 weeks. The patient responded to intravenous high dose methylprednisolone (HDMP) infusion leading to delivery of full term male baby. The baby also required treatment for thrombocytopenia with intravenous immunoglobulin (IVIG). This case lays down the importance of HDMP in form of using it effectively in managing acute crisis of low platelet counts in pregnant patients with ITP refractory to splenectomy. DOI: http://dx.doi.org/10.3126/njog.v9i1.11192 NJOG 2014 Jan-Jun; 2(1):64-66

Demonstration of IgG subclass (IgG1 and IgG3) in patients with positive direct antiglobulin tests

Serologic characterization of autoantibodies helps in the management and monitoring of the course of autoimmune hemolytic anemia (AIHA). The purpose of this study was to evaluate gel centrifugation test (GCT) cards for immunoglobulin G (IgG) titer and determination of IgG subclasses IgG1 and IgG3 and their influence on hemolysis. Eighty direct antiglobulin test (DAT)-positive patients were examined with the help of GCT cards for IgG titer and IgG subclasses. The results were correlated with the presence and absence of hemolysis. A statistically significant (p < 0.005) association of hemolysis with increasing anti-IgG titer was observed. When IgG titer was 30 or less, 28 (50.91%) patients had no hemolysis, whereas 15 (93.75%) patients had features of hemolysis when titer was at least 300. Statistically significant (p < 0.005) association of subclass of IgG (IgG1, IgG3) coating the red blood cells with intravascular hemolysis was also seen. Twenty-nine (80.56%) patients had evidence of hemolysis when IgG1 or IgGl-IgG3 both were present. Gel technology is helpful to demonstrate red blood cell-bound autoantibodies and their characterization with regard to class, subclass, and titer. This information is useful to identify patients with AIHA who are at risk of severe hemolysis with adverse prognosis.

Effect of HCl on the doping and shape control of silicon nanowires

The introduction of hydrogen chloride during the in situ doping of silicon nanowires (SiNWs) grown using the vapor-liquid-solid (VLS) mechanism was investigated. Compared with non-chlorinated atmospheres, the use of HCl with dopant gases considerably improves the surface morphology of the SiNWs, leading to extremely smooth surfaces and a greatly reduced tapering. Variations in the wire diameter are massively reduced for boron doping, and cannot be measured at 600 °C for phosphorous over several tens of micrometers. This remarkable feature is accompanied by a frozen gold migration from the catalyst, with no noticeable levels of gold clusters observed using scanning electron microscopy. A detailed study of the apparent resistivity of the NWs reveals that the dopant incorporation is effective for both types of doping. A graph linking the apparent resistivity to the dopant to silane dilution ratio is built for both types of doping and discussed in the frame of the previous results.

Cerebral venous congestion during cardio-pulmonary bypass: role of bispectral index monitoring

A 58-year-old male patient was posted for double valve replacement under hypothermic cardiopulmonary bypass (CPB). During aortic cross-clamp (AXC), the central venous pressure (CVP) was found to have increased to 22 mmHg. After 4 minutes of sustained increase in CVP, burst suppression (SR) started increasing. After 5 min of increase in SR, bispectral index (BIS) declined rapidly to 17. Propofol infusion was stopped and re-evaluation of signs of facial congestion showed changes to that effect. The perfusionist noted steadily decreasing venous return. As soon as the superior vena cava (SVC) cannula was withdrawn by 3 cm, CVP immediately declined to 6 mmHg. The venous return in the CPB reservoir normalized and BIS returned to 42 after a transient rise to a maximum of 58 and SR decreased to 0 within 2 min of repositioning of the venous cannula. The patient was successfully extubated after 7 hours without any sequelae.

Functional organ preservation with definitive chemoradiotherapy for T4 laryngeal squamous cell carcinoma

BACKGROUND

Randomized trials established chemoradiotherapy as standard treatment for advanced laryngeal cancer. Patients with large-volume T4 disease (LVT4) were excluded from these trials. The purpose of this study was to report T4 laryngeal cancer patient outcome, including those with LVT4 disease, treated with chemoradiotherapy.

PATIENTS AND METHODS

This study is a retrospective subset analysis of 32 patients with T4 laryngeal carcinoma including LVT4 tumors treated on three consecutive protocols investigating paclitaxel (Taxol), 5-fluorouracil, hydroxyurea, and 1.5-Gy twice daily (BID) radiotherapy (TFHX).

RESULTS

Median follow-up is 43 months. Four-year locoregional control (LRC), disease-free survival (DFS), overall survival (OS), and laryngectomy-free survival (LFS) was 71%, 67%, 53%, and 86%, respectively. Four patients required laryngectomy for recurrent or persistent disease. Of disease-free patients with >or=1 year follow-up, 90% demonstrated normal or understandable speech. None required laryngectomy for complications. Among LVT4 patients, 4-year LRC, DFS, OS, and LFS was 71%, 65%, 56%, and 81%, respectively. Induction chemotherapy improved 4-year LRC (90% versus 46%, P = 0.03) and DFS (84% versus 42%, P = 0.03).

CONCLUSIONS

Promising control and functional outcomes are achieved with TFHX for T4 laryngeal patients. LVT4 disease had outcomes similar to patients with less advanced disease treated on Radiation Therapy Oncology Group 91-11. Induction chemotherapy improved outcomes, warranting further investigation.

Sustained release implants of chloroquine phosphate for possible use in chemoprophylaxis of malaria

Implants of chloroquine phosphate (CQP) using biodegradable polymer, gelatin (G) and cross-linked gelatin (CLG) were prepared and evaluated to assess their physicochemical properties and in vitro release profile. The mechanism and kinetics of release were studied to correlate the release phenomenon with the formulation parameters. Out of many batches of the implants investigated, the implant prepared with 20% gelatin at 2:1 drug polymer ratio, 10% crosslinking agent and 2% plasticizer (Batch J) was found to provide optimum release behavior conforming to the requirements of a long term implant for a week. In vivo studies conducted on albino rats showed consistent therapeutic blood level over a period of 7 days. Mean residence time (MRT) of the drug released in the body, calculated as the ratio of the area under the first moment curve (AUMC) to area under concentration time curve (AUC) was 72 hr for implant against 2.42 hr for subcutaneous injection.

A simple synthetic liquid medium for development of yeast and mycelial form of pathogenic species of Candida

Thirty two known strains of Candida species were used for evaluation of glucose, serine, ornithine, methionine, GSOM medium and its comparison with Lee's medium for the production of yeast and mycelial phase at different temperatures and on prolonged incubation. No mycelial form was observed when various Candida species in GSOM and Lee's medium were incubated at 25 degrees C up to 72 hours. Percentage of mycelial forming cells of Candida species were more in GSOM medium than Lee's medium in 48 hours at 37 degrees C. Among various species of Candida, albicans and C. parapsilosis showed maximum mycelium formation. GSOM medium can be used for growing Candida species particularly C. albicans in mycelial phase.

Clinicomycological study of tinea capitis in desert district of Rajasthan

The clinicomycological study was conducted on 200 cases of Tinea capitis in Jodhpur. Incidence of tinea capitis among superficial mycoses was 4.43 and male to female ratio being 1.8:1. Majority of patients were from urban area (88%) and positive family history of dermatophytoses was present in 29% of cases. Majority of patients attended hospital OPD from July to October (39.%%) and January to April (49%). Persons using mustard oil as hair applicant had single or less lesions as compared to individual using other oil. Endothrix involvement of hair was seen in 78% cases and Trichophyton violaceum was predominant fungus (88.5%) recovered on culture.

Morphological identification of Candida species on glucose agar, rice extract agar and corn meal agar with and without Tween-80

A comparative study for the identification of 32 known strains of Candida species on the basis of morphology on glucose agar, rice extract agar and corn meal agar with and without Tween 80 revealed that when Tween 80 is incorporated in the media identification is possible for 96.8% of the species within 48 hours on rice extract agar and for 96.8% of the species within 48 hours on rice extract agar and for 90.6% of the species on glucose agar. The germ tubes and chlamydospores were also produced more on rice extract agar than on 0.1% glucose agar. Rice extract agar with Tween 80 can be used as single medium for morphologic identification of Candida species. The inoculated medium is first incubated at 37 degrees C for 3 hours and examined for germ tube formation and then incubated at 25 degrees C for 24 to 72 hours and examined for appearance of chlamydospores and mycelial morphology.

Modification of immune response by glycine in animals

Glycine (50, 100 and 300 mg/kg), administered daily for 10 days in rabbits challenged with typhoid 'H' antigen and sheep erythrocyte antigen, caused dose- dependent reduction of antibody titre. Inhibition of antibody titre observed with 300 mg/kg was comparable to immunosuppression observed with 1 mg/kg betamethasone.