51 research outputs found
Pediatric differentiated thyroid carcinoma in stage I: risk factor analysis for disease free survival
<p>Abstract</p> <p>Background</p> <p>To examine the outcomes and risk factors in pediatric differentiated thyroid carcinoma (DTC) patients who were defined as TNM stage I because some patients develop disease recurrence but treatment strategy for such stage I pediatric patients is still controversial.</p> <p>Methods</p> <p>We reviewed 57 consecutive TNM stage I patients (15 years or less) with DTC (46 papillary and 11 follicular) who underwent initial treatment at Ito Hospital between 1962 and 2004 (7 males and 50 females; mean age: 13.1 years; mean follow-up: 17.4 years). Clinicopathological results were evaluated in all patients. Multivariate analysis was performed to reveal the risk factors for disease-free survival (DFS) in these 57 patients.</p> <p>Results</p> <p>Extrathyroid extension and clinical lymphadenopathy at diagnosis were found in 7 and 12 patients, respectively. Subtotal/total thyroidectomy was performed in 23 patients, modified neck dissection in 38, and radioactive iodine therapy in 10. Pathological node metastasis was confirmed in 37 patients (64.9%). Fifteen patients (26.3%) exhibited local recurrence and 3 of them also developed metachronous lung metastasis. Ten of these 15 achieved disease-free after further treatments and no patients died of disease. In multivariate analysis, male gender (p = 0.017), advanced tumor (T3, 4a) stage (p = 0.029), and clinical lymphadenopathy (p = 0.006) were risk factors for DFS in stage I pediatric patients.</p> <p>Conclusion</p> <p>Male gender, tumor stage, and lymphadenopathy are risk factors for DFS in stage I pediatric DTC patients. Aggressive treatment (total thyroidectomy, node dissection, and RI therapy) is considered appropriate for patients with risk factors, whereas conservative or stepwise approach may be acceptable for other patients.</p
Fascin overexpression promotes neoplastic progression in oral squamous cell carcinoma
<p>Abstract</p> <p>Background</p> <p>Fascin is a globular actin cross-linking protein, which plays a major role in forming parallel actin bundles in cell protrusions and is found to be associated with tumor cell invasion and metastasis in various type of cancers including oral squamous cell carcinoma (OSCC). Previously, we have demonstrated that fascin regulates actin polymerization and thereby promotes cell motility in K8-depleted OSCC cells. In the present study we have investigated the role of fascin in tumor progression of OSCC.</p> <p>Methods</p> <p>To understand the role of fascin in OSCC development and/or progression, fascin was overexpressed along with vector control in OSCC derived cells AW13516. The phenotype was studied using wound healing, Boyden chamber, cell adhesion, Hanging drop, soft agar and tumorigenicity assays. Further, fascin expression was examined in human OSCC samples (N = 131) using immunohistochemistry and level of its expression was correlated with clinico-pathological parameters of the patients.</p> <p>Results</p> <p>Fascin overexpression in OSCC derived cells led to significant increase in cell migration, cell invasion and MMP-2 activity. In addition these cells demonstrated increased levels of phosphorylated AKT, ERK1/2 and JNK1/2. Our in vitro results were consistent with correlative studies of fascin expression with the clinico-pathological parameters of the OSCC patients. Fascin expression in OSCC showed statistically significant correlation with increased tumor stage (<it>P </it>= 0.041), increased lymph node metastasis (<it>P </it>= 0.001), less differentiation (<it>P </it>= 0.005), increased recurrence (<it>P </it>= 0.038) and shorter survival (<it>P </it>= 0.004) of the patients.</p> <p>Conclusion</p> <p>In conclusion, our results indicate that fascin promotes tumor progression and activates AKT and MAPK pathways in OSCC-derived cells. Further, our correlative studies of fascin expression in OSCC with clinico-pathological parameters of the patients indicate that fascin may prove to be useful in prognostication and treatment of OSCC.</p
Original Article - Squamous cell carcinoma of the maxillary sinus: A Tata Memorial Hospital experience
Background: The optimal treatment of maxillary sinus carcinoma remains
to be defined and there is a paucity of Indian studies on the subject.
Aims: To present experience of management of squamous cell carcinoma
of the maxillary sinus treated with curative intent at a single
institution. Settings and Design:Retrospective study of patients with
squamous cell carcinoma of the maxillary sinus who presented between
1994 to 1999. Materials and Methods:The records of 73 patients with
squamous cell carcinoma of the maxillary sinus were analyzed. Sixty-two
patients were evaluable. Forty patients (65%) were treated with surgery
followed by postoperative radiotherapy, five patients (8%) were treated
with radiotherapy alone, five patients (8%) were treated with surgery
alone; 12 patients (19%) received chemotherapy. Statistical analysis
used: Statistical analysis was done using Kaplan-Meier method.
Results: The majority of patients presented with locally advanced
disease (52, 84%); nodal involvement was observed in five patients
(8%). The most common site of recurrence was at the primary site, which
was observed in 28 patients (45%) and regional failures occurred in 10
(16%). The 3 and 5-year overall survival was 38% and 35% and the
disease free survival was 29% and 26% respectively. The 5-year overall
survival after surgery and postoperative radiotherapy was 42%.
Conclusions:The majority of patients present with advanced disease
resulting in poor outcomes to conventional treatment modalities.
Locoregional tumor progression remains a significant pattern of
failure. New approaches such as neoadjuvant or concomitant
chemoradiotherapy with aggressive surgery need to be considered and
evaluated in prospective studies
A prospective study of pharyngocutaneous fistulas following total laryngectomy
Pharyngocutaneous (PC) fistula is a common complication following
laryngectomy. It leads to increased morbidity, delay in adjuvant
treatment, prolonged hospitalization and an increase in treatment
costs. Although a number of factors that result in PC fistula have been
described, there is still no agreement on the most significant factors.
We undertook a prospective study to critically analyze PC fistula and
its association with various tumors, patient and treatment related
factors. This was a prospective study that included 143 patients who
underwent laryngeal surgery for squamous cell carcinoma of the larynx
and pyriform sinus. Use of pectoralis major myocutaneous flap to
reconstruct the neopharynx, primary disease in pyriform and extensive
soft tissue infiltration were significantly associated with PC fistula.
Prior treatment (radiotherapy and chemotherapy), type of closure (T
closure, Y closure and vertical closure), Layers of closure (full
thickness interrupted, submucosal interrupted, submucosal continuous)
type of suture material (silk, vicryl ), age, sex, stage, preoperative
tracheostomy, cut margin status, pre/postoperative hemoglobin and
experience of surgeons did not relate significantly
Metastatic tumors to the jaw bones: Retrospective analysis from an Indian tertiary referral center
Aim: Being a tertiary referral center, we encounter the highest number
of oral cancer patients in India, and there is direct involvement of
the jaw bone in approximately 40% of these cases. There are no large
case series from the Indian subcontinent on metastatic tumors to the
jaw bones. With this retrospective analysis, we intend to estimate the
incidence of this rare manifestation in the jaw bones in our patients
and compare it with the available literature. Materials and Methods:
All patients with biopsy proven metastatic disease involving jaw bones
having complete clinical data were included. Results: Nineteen out of
10,411 oral cancer patients who reported between the years 2000 and
2005 were included. Breast and thyroid malignancies (5/19 each) were
commonest in the females to metastasize to the mandible, whereas in the
males, there was no predominant site that resulted in jaw bone
metastasis, although mandible was commonly affected. Neuroblastoma of
adrenal gland metastasized to maxilla in the age group ranging from 4
months to 16 years. Maxilla was the commonest jaw bone affected in this
age group. In five cases, jaw bone was found to be the first site of
metastasis. Conclusions: There is variation in the primary site that
causes metastasis to the jaw bones depending on age, sex and geographic
distribution. Jaw bone metastases are rare and can be the first site of
metastasis. We get approximately four cases in a year with metastatic
disease manifesting in the jaw bones. Metastasis to jaw bone is
associated with poor prognosis
Utility of PET in unknown primary with cervical metastasis: A retrospective study
Background: FDG-PET is recommended as an investigation in unknown
primary tumors, but its definitive role and cost effectiveness are yet
to be established. Aims: dditional value of FDG-PET over conventional
imaging in unknown primary tumors with cervical metastasis. Setting and
Design: Retrospective study in a tertiary level oncology centre.
Materials and Methods: A total of 112 patients were divided into three
groups; 53 with conventional modalities (either computed tomography or
magnetic resonance imaging) (group I), 59 with FDG-PET (group II), and
group III (subgroup of group II) with both (40 patients). Statistical
Analysis: Sensitivity and specificity of both conventional modality and
PET were calculated. Association between neck nodes and distant
metastasis was analysed using multivariate logistic regression
analysis. Results: Sensitivity and specificity for conventional
modalities was 92.3% and 50% and sensitivity and specificity of FDG-PET
was 92.8% and 71.4%, respectively. FDG-PET detected metastasis in
52.54% of patients. Multivariate logistic regression analysis showed
statistically significant association between distant metastasis and
multiplicity of nodes (N2b, N2c) (P = 0.007). Among all patients with
low neck nodes in group II, FDG-PET detected primaries in 12 patients,
9 of which were infraclavicular (75%). FDG-PET added information to
conventional imaging in 32.5% of patients and influenced an overall
change in management in 38.9% of patients. Conclusions: FDG-PET is a
valuable tool influencing change of management in unknown primary with
cervical metastasis. It is recommended especially in the presence of
low or multiple neck nodes in view of high incidence of infraclavicular
primary and distant metastasis, respectively
Metastatic tumors to the jaw bones: Retrospective analysis from an Indian tertiary referral center
Aim: Being a tertiary referral center, we encounter the highest number
of oral cancer patients in India, and there is direct involvement of
the jaw bone in approximately 40% of these cases. There are no large
case series from the Indian subcontinent on metastatic tumors to the
jaw bones. With this retrospective analysis, we intend to estimate the
incidence of this rare manifestation in the jaw bones in our patients
and compare it with the available literature. Materials and Methods:
All patients with biopsy proven metastatic disease involving jaw bones
having complete clinical data were included. Results: Nineteen out of
10,411 oral cancer patients who reported between the years 2000 and
2005 were included. Breast and thyroid malignancies (5/19 each) were
commonest in the females to metastasize to the mandible, whereas in the
males, there was no predominant site that resulted in jaw bone
metastasis, although mandible was commonly affected. Neuroblastoma of
adrenal gland metastasized to maxilla in the age group ranging from 4
months to 16 years. Maxilla was the commonest jaw bone affected in this
age group. In five cases, jaw bone was found to be the first site of
metastasis. Conclusions: There is variation in the primary site that
causes metastasis to the jaw bones depending on age, sex and geographic
distribution. Jaw bone metastases are rare and can be the first site of
metastasis. We get approximately four cases in a year with metastatic
disease manifesting in the jaw bones. Metastasis to jaw bone is
associated with poor prognosis
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