Effectiveness of Gefitinib as additional Radiosensitizer to Conventional Chemoradiation for Locally advanced non-metastatic Squamous Cell Carcinoma of Head and Neck. Prospective interventional Randomized Controlled Study

Approximately 90% of head and neck squamous cell carcinoma (HNSCC) overexpress epidermal growth factor receptor (EGFR). EGFR plays a role in predict­ing and modulating the response of HNSCC patients to radiation. Cetuximab is established as potent radiosensitizer.  However data regarding use of tyrosine kinase inhibitors like gefitinib is limited. Aim of this study is to establish the radiosensitizer efficacy of daily gefitinib with concurrent chemoradiotherapy in patients with locally advanced non metastatic HNSCC (LAHNSCC). Between July, 2008 to October, 2011, 104 patients with LAHNSCC were randomized into two arms; in Arm A (experimental arm), patients received gefitinib (250 mg orally daily along with cisplatin based chemoradiation) and Arm B (control arm), patients received concurrent cisplatin based chemoradiation with Cisplatin dose of 100mg/m2 intravenous infusion given on Days 1 and 22 with conventional fractionated radiation of 60-66 Gray. Response assessments were done using RECIST and adverse events by NCI-CTCAE version 3. The median follow-up time was 26 months (range 2-35 months). There was statistical difference in overall response between the two arms (p value 0.041) in favour of gefitinib arm (n=48) with overall response (ORR=CR+PR) of 91.6 % versus 69.5% in conventional cisplatin chemoradiation (n=46). Disease Free Survival favored the Gefitinib arm with Log Rank p value of 0.008. Gefitinib arm resulted in more grade 2 and 3 dermatitis, mucositis and diarrheal events. Adding Gefitinib to conventional chemoradiation in treatment of LAHNSCC improves ORR and DFS, with an increase in incidence of manageable toxicity. Keywords: Chemoradiation, Gefitinib, Radiosensitizer

Hepatoid Adenocarcinoma of the Stomach: a rare histology of Gastric Adenocarcinoma in an adolescent: a case report

Hepatoid adenocarcinoma is a rare subtype of extra-hepatic adenocarcinoma generally characterized by hepatocellular carcinoma like foci in the background of adenocarcinoma. Stomach is the most frequent site where hepatoid adenocarcinoma occurs, although it has been described in many other organs. We describe a case of 16 years old adolescent girl who was diagnosed as a case of “hepatoid adenocarcinoma of stomach, an unlikely presentation at this young age. Keywords: Hepatoid adenocarcinoma, stomach, adolescent

Thiourea: A Novel Cleaving Agent for 1,3-Dioxolanes

One of the most common methods of protecting aldehydes, ketones, and vicinal diols involves the formation of acetals. Aldehydes and ketones are usually protected as their 1,3-dioxolane derivatives, and vicinal diols such as those present in carbohydrate derivatives are protected as 2,2-dimethyl-1,3-dioxolanes. Several methods are available for deprotecting these types of acetals, which mostly utilize acidic cleaving methods.1 Other cleaving methods involving the use of silica gel2 or lithium tetrafluoroborate in wet acetonitrile3 and some nonaqueous cleaving methods have also been reported for this purpose.4-6 Herein we report that thiourea can effect the cleavage of 1,3-dioxolanes derived from aldehydes and ketones, as well as the selective cleavage of the 5,6-O-isopropylidene moiety in 1,2:5,6-di-O-isopropylidene hexose derivatives, leading to good to excellent yields of the parent compounds

Synthesis of Chiral 10, 11 and 12-Membered Nitrogen and Oxygen Heterocycles by Intramolecular Nitrile Oxide Cycloaddition of Tethered N- and O-Allyl Carbohydrate Derivatives

ÐChiral 10 to 12-membered nitrogen and oxygen heterocycles fused to isoxazoline rings have been prepared in a highly regioselective and stereoselective manner by intramolecular nitrile oxide cycloaddition of tethered N- and O-allyl carbohydrate derivatives. The use of a ±Y±Ar-CH2 tether containing a 1,2-disubstituted aromatic ring between the heteroatom attached to the nitrile oxide-bearing carbohydrate scaffold, and the allyl group, facilitates the formation of the medium-sized rings. The cycloaddition afforded bridged isoxazolines in the cases of O-tethered allyl carbohydrate derivatives, whereas a fused isoxazoline resulted when a N(Ts)-tethered allyl derivative was used

Original Article - A prospective and randomized study of radiotherapy, sequential chemotherapy radiotherapy and concomitant chemo therapy-radiotherapy in unresectable non small cell carcinoma of the lung

Purpose: Treatment of advanced Non small cell lung cancer (NSCLC) often produces dismal results. Combination of available treatment modalities has reportedly improved the outcome. A prospectively randomized trial was conducted, comparing combined treatment modalities versus radiotherapy alone, in treatment of unresectable NSCLC. Materials and Methods: A total of 103 patients were randomized to three groups. In group 'A', 32 patients received radiotherapy alone (6500 cGy/30 fraction). In group 'B', 35 patients received neoadjuvant chemotherapy (Cisplatin 80 mg/m2 on day 1 and Etoposide 100 mg/m day 1-3 intravenously q3 weeks for 3 cycles), followed by radiotherapy (6000 cGy/30 fractions) and 3 more cycles of Chemotherapy, with the same regimen. In group 'C', 36 patients received radiotherapy (5000 cGy/25 fractions) with concurrent chemotherapy (ciplatin 20 mg/m2 + Etoposide 75 mg/m2 intravenously on day 1-5 and day 22-26), followed by 2 more cycles of chemotherapy,q3 weeks with the same regimen. Results: Initial treatment responses were significantly higher in group 'B' ( P < 0.05) and 'C' ( P < 0.03), compared to group 'A'. Follow- up observations showed, that addition of chemotherapy brought down distant metastasis's from 62.5% (group 'A') to 48.6% (group 'B') and 44.4% (group 'C'). The median time to tumour progression also improved from 16 months (Group 'A') to 21 months (Group 'B' and 'C'). But 2 year follow up did not show any survival benefit. Acute toxicities were more frequent in group 'B' and 'C', but were manageable. Conclusion: Addition of chemotherapy with radiation in unresectable NSCLC improves response rates, time to tumour progression and disease free survival, though the same effect is not translated in overall survival

A prospective and randomized study of radiotherapy, sequential chemotherapy radiotherapy and concomitant chemo therapy-radiotherapy in unresectable non small cell carcinoma of the lung

Purpose: Treatment of advanced Non small cell lung cancer (NSCLC) often produces dismal results. Combination of available treatment modalities has reportedly improved the outcome. A prospectively randomized trial was conducted, comparing combined treatment modalities versus radiotherapy alone, in treatment of unresectable NSCLC. Materials and Methods: A total of 103 patients were randomized to three groups. In group 'A', 32 patients received radiotherapy alone (6500 cGy/30 fraction). In group 'B', 35 patients received neoadjuvant chemotherapy (Cisplatin 80 mg/m2 on day 1 and Etoposide 100 mg/m day 1-3 intravenously q3 weeks for 3 cycles), followed by radiotherapy (6000 cGy/30 fractions) and 3 more cycles of Chemotherapy, with the same regimen. In group 'C', 36 patients received radiotherapy (5000 cGy/25 fractions) with concurrent chemotherapy (ciplatin 20 mg/m2 + Etoposide 75 mg/m2 intravenously on day 1-5 and day 22-26), followed by 2 more cycles of chemotherapy,q3 weeks with the same regimen. Results: Initial treatment responses were significantly higher in group 'B' ( P &lt; 0.05) and 'C' ( P &lt; 0.03), compared to group 'A'. Follow- up observations showed, that addition of chemotherapy brought down distant metastasis's from 62.5% (group 'A') to 48.6% (group 'B') and 44.4% (group 'C'). The median time to tumour progression also improved from 16 months (Group 'A') to 21 months (Group 'B' and 'C'). But 2 year follow up did not show any survival benefit. Acute toxicities were more frequent in group 'B' and 'C', but were manageable. Conclusion: Addition of chemotherapy with radiation in unresectable NSCLC improves response rates, time to tumour progression and disease free survival, though the same effect is not translated in overall survival

Cytology microarray on cell block preparation: A novel diagnostic approach in fluid cytology

Background: The cytological examination of serous body effusions to diagnose and stage malignancy is well accepted in clinical medicine. Conventional smear (CS) and cell block (CB) study has to be complemented with immunohistochemistry (IHC) for a definitive diagnosis of malignancy and also to differentiate it from reactive mesothelial cells. Cytology microarray (CMA) is a modification of tissue microarray which involves core needle biopsy of multiple cell blocks and embedding it in a single block. Aim: The aim of this study was to assess the effectiveness of IHC technique in CMA for rapid diagnosis of malignancy and to reduce the cost of testing. Materials and Methods: In this study, 82 pleural fluids were collected and subjected to CS and CB study followed by IHC in CMA blocks. Six commonly used antibodies were applied to confirm malignancy and diagnose the primary. Results: Nineteen cases were diagnosed as malignancy by CB method. MOC-31 confirmed adenocarcinoma deposit in 67% cases of which 44% were proved to be of lung primary by TTF1. Conclusions: IHC on CMA blocks of effusion fluids is a very effective technique that can significantly reduce the cost of testing by >70%

A Study to Assess the Barriers And Facilitators of Blood Donation Among University Students Of South India

Introduction: Donated blood is very crucial and life-saving for those who require large volumes of blood in any medical emergency. Many blood donation camps are routinely organized to fill this void of demand and supply. In a university campus associated with a hospital, it is important that student volunteers should contribute towards the increase in demand for blood during times of crisis. This makes it imperative to understand their perception of this noble cause. Methods: A descriptive cross-sectional study was conducted among 354 volunteers of a university campus using convenience sampling. The primary outcome was to assess the factors that influence voluntary blood donation among the volunteers. The adjusted association was performed using logistic regression. R Console was used for statistical analysis. Odds ratios and p-value &lt; 0.05 with 95% confidence intervals were calculated to determine the level of significance. Results: A total of 354 responses were received and analysed. Among these, 38.98%, (n=138) participants had donated blood at least once. Factors that were significantly associated with blood donation were gender, being a member of an NGO, frequency of volunteering activities, fear of needles, and belief that they would acquire the disease during blood donation. Conclusion: The majority of the participants had good knowledge of blood donation, but their attitude and practice did not fall along the same lines. The study also highlighted that attitude towards donating blood is high among the participants who are associated with the NGOs or participate in voluntary activities. Voluntary work induces a ‘sense of giving something to the society which appears to be facilitating factor and an effective measure to encourage blood donation among youth