Minimally invasive treatment of oligometastasis in the liver in recurrent nasopharyngeal carcinoma

published_or_final_versio

Role of surgery in the treatment of radiation-induced sarcomas of the head and neck

Introduction: Radiation-induced sarcoma (RIS) is a well-known complication of radiotherapy. It is an aggressive tumour and the prognosis is often poor, despite radical treatment. We aim to investigate the role of surgery in the treatment of patients with RIS of the head and neck region. Method: We conducted a retrospective review of records of patients whom were treated for radiation-induced sarcoma at Queen Mary Hospital, Hong Kong, between the period 1999 to 2010. Data collected included patient age, gender, latency period for the development of RIS, site of RIS, symptoms, treatment given, pathology and survival. Results: Nineteen patients were included, (M=11, F=8). Eighteen received radiotherapy for treatment of primary nasopharyngeal carcinoma. One received radiotherapy for carcinoma of the parotid. The medial latency period for the development of sarcoma was 11.1 years (range 5.3-25.1). The most common site for development of RIS was the neck (n=8), followed by the oropharynx/oral cavity (n=4), nasopharynx (n=3) nasal cavity (n=2), maxilla (n=1) and mandible (n=1). The most common histology was undifferentiated sarcoma (n=6). Nine patients underwent surgical resection of the RIS with curative intent, three and six patients achieved R0 and R1 resection respectively. Chemotherapy was used in eleven instances after surgery. Radiotherapy was used in seven instances, three through brachytherapy, four through external beam irradiation. Overall medial survival from diagnosis of RIS was 1.74 years (95% CI 0.60-2.87), which improves to 2.47 years (95% CI 0.97-3.97) when only calculating those whom surgery was performed. Conclusions: Patients suffering from radiation-induced sarcomas have a poor prognosis, in keeping with existing literature. Treatment is mainly by surgery aiming at resection with a curative intent. If curative resection is impossible, surgery may still have a role in palliating the patients’ symptoms such as bleeding, fungation, or painpublished_or_final_versio

The role of elective neck dissection during surgical salvage for recurrent nasopharyngeal carcinoma

published_or_final_versio

Review of salivary gland neoplasms

Salivary gland tumours most often present as painless enlarging masses.Most are located in the parotid glands andmost are benign. The principal hurdle in their management lies in the difficulty in distinguishing benign from malignant tumours. Investigations such as fine needle aspiration cytology and MRI scans provide some useful information, but most cases will require surgical excision as ameans of coming to a definitive diagnosis. Benign tumours and early low-grademalignancies can be adequately treated with surgery alone, while more advanced and high-grade tumours with regional lymph node metastasis will require postoperative radiotherapy. The role of chemotherapy remains largely palliative. This paper highlights some of the more important aspects in the management of salivary gland tumours.published_or_final_versio

Epidermal cooling in improving the patient tolerability of Q-switched laser for the treatment of nevus of Ota

published_or_final_versio

Treatment outcome of rhabdomyosarcoma in Hong Kong Chinese children

Objectives: To review the treatment outcome of rhabdomyosarcoma in Hong Kong Chinese children. Design: Retrospective review. Setting: University teaching hospital, Hong Kong. Patients: Consecutive cases of rhabdomyosarcoma diagnosed and treated by the Department of Paediatrics and Adolescent Medicine of Queen Mary Hospital between 1989 and 2005. Each patient was staged and treated according to the Intergroup Rhabdomyosarcoma Study guidelines. Main outcome measures: Overall and event-free survival rates, and toxicity data. Results: Of 19 patients (8 males and 11 females), 14 (74%) were younger than 10 years old. The median age at diagnosis was 6 (range, 0.5-17) years. Primary sites of rhabdomyosarcoma included: the head and neck (n=8; 6 classified as cranial parameningeal), genitourinary (3), extremity (3), pelvis (3), and trunk (2). Thirteen (68%) had embryonal and six (32%) had alveolar histology. Two, 2, 9, and 6 were classified as belonging to Intergroup Rhabdomyosarcoma Study groups 1, 2, 3, and 4, respectively. Respective 5-year overall and event-free survival rates of the entire cohort were 49% (95% confidence interval, 26-73%) and 32% (10-55%), with a median follow-up of 3.4 (range, 0.2-16.7) years. In non-metastatic cases (Intergroup Rhabdomyosarcoma Study groups 1-3), the 5-year overall survival rate was 66% (95% confidence interval, 39-93%) and in metastatic cases (group 4) it was 17% (0-46%). The 5-year overall survival rate for patients aged less than 10 years was 60% (95% confidence interval, 33-87%) compared to 20% (0-55%) in those aged 10 years and over. Significant treatment-related toxicities including myelosuppression, infections, peripheral neuropathy, and second cancers were encountered. Conclusions: Treatment outcome of rhabdomyosarcoma in this cohort of Chinese children was less favourable than that reported in international studies. Whilst the main reason could have been related to the high proportion of metastatic cases, also non-metastatic cases faired worse. Improved outcomes may be achieved by advances in multidisciplinary (paediatric oncology, pathology, radiotherapy, and surgery) management and supportive care.published_or_final_versio

Real time imaging of two-dimensional iron oxide spherulite nanostructure formation

The formation of complex hierarchical nanostructures has attracted a lot of attention from both the fundamental science and potential applications point of view. Spherulite structures with radial fibrillar branches have been found in various solids; however, their growth mechanisms remain poorly understood. Here, we report real time imaging of the formation of two-dimensional (2D) iron oxide spherulite nanostructures in a liquid cell using transmission electron microscopy (TEM). By tracking the growth trajectories, we show the characteristics of the reaction front and growth kinetics. Our observations reveal that the tip of a growing branch splits as the width exceeds certain sizes (5.5–8.5 nm). The radius of a spherulite nanostructure increases linearly with time at the early stage, transitioning to nonlinear growth at the later stage. Furthermore, a thin layer of solid is accumulated at the tip and nanoparticles from secondary nucleation also appear at the growing front which later develop into fibrillar branches. The spherulite nanostructure is polycrystalline with the co-existence of ferrihydrite and Fe3O4 through-out the growth. A growth model is further established, which provides rational explanations on the linear growth at the early stage and the nonlinearity at the later stage of growth. [Figure not available: see fulltext.]

The clinical association of programmed cell death protein 4 (PDCD4) with solid tumors and its prognostic significance: a meta-analysis

published_or_final_versio

MicroRNA 744-3p promotes MMP-9-mediated metastasis by simultaneously suppressing PDCD4 and PTEN in laryngeal squamous cell carcinoma

MicroRNA controls cancer invasion by governing the expression of gene regulating migration and invasion. Here, we reported a novel regulatory pathway controlled by miR-744-3p, which enhanced expression of matrix metallopeptidase 9 (MMP-9) in laryngeal squamous cell carcinoma (LSCC). We profiled the differential micoRNA expression pattern in LSCC cell lines and normal epithelial cultures derived from the head and neck mucosa using microRNA microarray. MiR-7-1-3p, miR-196a/b and miR-744-3p were expressed differentially in the LSCC cell lines. Subsequent validation using real-time PCR revealed that high miR-744-3p level was positively correlated with regional lymph node metastasis of LSCC. Real-time cellular kinetic analysis showed that suppressing miR-744-3p could inhibit migration and invasion of LSCC cell lines and reduce the number of lung metastatic nodules in nude mice modules. In silico analysis revealed that miR-744-3p targeted 2 distinct signaling cascades which eventually upregulated MMP-9 expression in LSCC. First, miR-744-3p could suppress programmed cell death 4 (PDCD4), a direct suppressor of NF-κB (p65). PDCD4 could also prevent AKT activation and suppress MMP-9 expression. Further, suppressing miR-744-3p expression could restore phosphatase and tensin homolog (PTEN) expression. PTEN could inhibit AKT activation and inhibit MMP-9 expression in LSCC cells. The results revealed that suppressing miR-744-3p was effective to inhibit LSCC metastasis by inactivating AKT/mTOR and NF-κB (p65) signaling cascade. Targeting miR-744-3p could be a valuable therapeutic intervention to suppress the aggressiveness of LSCC.published_or_final_versio

Microvascular free tissue reconstruction following extirpation of head and neck tumour: Experience towards an optimal outcome

Familiarity with four types of free tissues transfers allows appropriate reconstruction of most defects in the head and neck region functionally and aesthetically. These include jejunal graft, radial forearm, rectus abdominus myocutaneous and fibula osteocutaneous flaps. Free colonic and gastric patches were used occasionally. We report our experience of 215 free tissue transfers for reconstruction of defects in the head and neck region after tumour extirpation. The overall success rate was 94 per cent. The commonest cause of failure was related to arterial inflow (70 per cent). Three patients died in hospital, but their mortality was not related to the tissue transfers. Complications due to free tissue transfer at both the donor and recipient sites were few and manageable. The co-operation between the two surgical teams, together with the timely application of suitable salvage procedures, contribute to an optimal outcome.published_or_final_versio