Radiotherapy for marginally resected, unresectable or recurrent giant cell tumor of the bone: a rare cancer network study

The role of radiotherapy for local control of marginally resected, unresectable, and recurrent giant cell tumors of bone (GCToB) has not been well defined. The number of patients affected by this rare disease is low. We present a series of 58 patients with biopsy proven GCToB who were treated with radiation therapy. A retrospective review of the role of radiotherapy in the treatment of GCToB was conducted in participating institutions of the Rare Cancer Network. Eligibility criteria consisted of the use of radiotherapy for marginally resected, unresectable, and recurrent GCToB. Fifty-eight patients with biopsy proven GCToB were analyzed from 9 participating North American and European institutions. Forty-five patients had a primary tumor and 13 patients had a recurrent tumor. Median radiation dose was 50 Gy in a median of 25 fractions. Indication for radiation therapy was marginal resection in 33 patients, unresectable tumor in 13 patients, recurrence in 9 patients and palliation in 2 patients. Median tumor size was 7.0 cm. A significant proportion of the tumors involved critical structures. Median follow-up was 8.0 years. Five year local control was 85% . Of the 7 local failures, 3 were treated successfully with salvage surgery. All patients who received palliation achieved symptom relief. Five year overall survival was 94%. None of the patients experienced grade 3 or higher acute toxicity. This study reports a large published experience in the treatment of GCToB with radiotherapy. Radiotherapy can provide excellent local control for incompletely resected, unresectable or recurrent GCToB with acceptable morbidity

WATER QUALITY MODELS: A REVIEW

Maintaining water quality and predicting the fate of water pollutants are one of the important tasks of present environmental problems. The best tool for predicting different pollution scenarios are the simulation of mathematical models which can provide a basis and technical support for environmental management

Leprosy in Pregnancy: Obstetric Diligence is the Key

Leprosy in pregnancy is a rarely encountered event. Out of the 2000 patients detected of leprosy annually, two to three are pregnant women and majority of them are diagnosed in the third trimester. We, hereby, report a case of borderline tuberculoid leprosy with Type I lepromatous reaction in a 26-year-old pregnant woman in early second trimester with a large raised red coloured lesion over the forehead and six other small lesions involving the trunk and limbs with reduced sensory perception over involved skin. Occurrence of leprosy in an obstetric patient belonging to low prevalence area of India is infrequent especially in the post elimination era. However, we do need to have a high index of suspicion in lesions suggestive of the disease

Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma: The Mayo Clinic experience (1975-2005)

Purpose: To determine prognostic factors and impact of adjuvant chemotherapy (CT) and radiotherapy (RT) on overall survival (OS) after resection of pancreatic adenocarcinoma. Patients and Methods: We performed a retrospective review 472 consecutive patients who underwent complete resection with negative margins (R0) for invasive carcinoma (T1-3N0-1M0) of the pancreas between 1975 and 2005 at the Mayo Clinic in Rochester, MN. Exclusion criteria included metastatic or unresectable disease at surgery, positive surgical margins, and indolent tumor types (islet cell tumors and mucinous cystadenocarcinoma). Median RT dose was 50.4 Gy in 28 fractions; 98% of RT patients also received concurrent fluorouracil-based CT. Results: Six patients died within 30 days of surgery. For the 466 surviving patients, median follow-up was 32.4 months; median OS was 21.6 months. Median OS after adjuvant CT-RT was 25.2 versus 19.2 months after no adjuvant therapy (P = .001). Two-year OS was 50% versus 39%, and 5-year OS was 28% versus 17%. Adverse prognostic factors identified by univariate and multivariate analysis included positive lymph nodes (risk ratio [RR] = 1.3; P \u3c .001), high histologic grade (RR = 1.2; P \u3c .001), and no adjuvant therapy (RR = 1.3; P \u3c .001). Tumor extension beyond the pancreas was an adverse prognostic factor by univariate analysis alone (P = .03). Patients receiving adjuvant therapy had more adverse prognostic factors than those not receiving adjuvant therapy (P = .001). Conclusion: This study represents one of the largest, single-institution, retrospective reviews of adjuvant therapy in patients after R0 resection of carcinoma of the pancreas. Overall survival was better in patients who received adjuvant CT-RT. © 2008 by American Society of Clinical Oncology

Eluation of adjuvant chemoradiation therapy for ampullary adenocarcinoma: the Johns Hopkins Hospital - Mayo Clinic collaborative study

<p>Abstract</p> <p>Background</p> <p>The role of adjuvant chemoradiation therapy for ampullary carcinoma is unknown. Previous literature suggests that certain populations with high risk factors for recurrence may benefit from adjuvant chemoradiation. We combined the experience of two institutions to better delineate which patients may benefit from adjuvant chemoradiation.</p> <p>Methods</p> <p>Patients who underwent curative surgery for ampullary carcinoma at the Johns Hopkins Hospital (n = 290; 1992-2007) and at the Mayo Clinic (n = 130; 1977-2005) were reviewed. Patients with <60 days of follow-up, metastatic disease at surgery, or insufficient pathologic data were excluded. The final combined study consisted of 186 patients (n = 104 Johns Hopkins, n = 82 Mayo). Most patients received 5-FU based chemoradiation with conformal radiation. Cox proportional hazards models were used for survival analysis.</p> <p>Results</p> <p>Median overall-survival was 39.9 months with 2- and 5-year survival rates of 62.4% and 39.1%. On univariate analysis, adverse prognostic factors for overall survival included T3/T4 stage disease (RR = 1.86, p = 0.002), node positive status (RR = 3.18, p < 0.001), and poor histological grade (RR = 1.69, p = 0.011). Patients who received adjuvant chemoradiation (n = 66) vs. surgery alone (n = 120) showed a higher rate of T3/T4 stage disease (57.6% vs. 30.8%, P < 0.001), lymph node involvement (72.7% vs. 30.0%, P < 0.001), and close or positive margins (4.6% vs. 0.0%, P = 0.019). Five year survival rates among node negative and node positive patients were 58.7% and 18.4% respectively. When compared with surgery alone, use of adjuvant chemoradiation improved survival among node positive patients (mOS 32.1 vs. 15.7 mos, 5 yr OS: 27.5% vs. 5.9%; RR = 0.47, P = 0.004). After adjusting for adverse prognostic factors on multivariate analysis, patients treated with adjuvant chemoradiation demonstrated a significant survival benefit (RR = 0.40, P < 0.001). Disease relapse occurred in 37.1% of all patients, most commonly metastatic disease in the liver or peritoneum.</p> <p>Conclusions</p> <p>Node-positive patients with resected ampullary adenocarcinoma may benefit from 5-FU based adjuvant chemoradiation. Since a significant proportion of patients develop metastatic disease, there is a need for more effective systemic treatment.</p

Influence of Nanoclay Localization on Structure-Property Relationships of Polylactide-Based Biodegradable Blend Nanocomposites

This article highlights the recent research achievements regarding the development of nanoclay-containing biodegradable composites of polylactide (PLA)-based immiscible blends. The structure?property relationships of particular blends, namely, PLA/poly(ε-caprolactone), PLA/poly(butylene succinate), and PLA/poly[(butylene succinate)-adipate], are studied with respect to the nanoclay incorporations. For different nanoclay types and concentrations, the morphologies of these nanocomposites are probed and correlated to their viscoelastic, mechanical, and thermal properties, along with their crystallization behavior and kinetics and gas permeability. The nanoclay dispersion and distribution characteristics are found to be key parameters influencing the final properties. In particular, nanocomposites with a higher degree of nanoclay dispersion exhibit significant enhancement in their mechanical, thermal, and barrier properties, and some agglomerations are effective as regards favorable crystallization behavior. In terms of the clay localization, the positioning of nanoclays at the interface reduces the minor phase size remarkably, because of the droplet encapsulation that counteracts coalescence. However, for improved understanding of the influence of nanoclay localization on the structure?property relationships of these blends, further systematic study is required. That is, nanocomposites with different localizations but the same nanoclay loads should be compared. This can be achieved by tuning the processing protocols and the nanoclay inclusion orders in the blends