Recent updates in the management of merkel cell carcinoma

Merkel cell carcinoma is an aggressive non-melanomatous cutaneous tumour of neuroendocrine origin with an increasing incidence in the recent years. It is a tumour of the elderly and immunosuppressed, which most often appears on sun-exposed areas of the body. The clinical features of the cutaneous or subcutaneous lesions hardly contribute to the diagnosis, and, hence, histopathology and immunohistochemistry play a vital role in diagnosis. The latest staging system by the American Joint Committee on Cancer includes non-nodal invasion to adjacent structures i.e. bone, muscle, fascia, or cartilage into the criteria, in additionto size and depth of invasion. The management reliesheavily on a multidisciplinary approach due to rarity of incidence of this disease. According to the international guidelines, surgical management is still the preferred choice. The beneficial role of adjuvant radiotherapy has now been more clearly documented. Data is insufficient to assess whether chemotherapy improves disease-free or overall survival

Frequency and severity of acute toxicity of pelvic radiotherapy for gynecological cancer

Objective: To determine the frequency and severity of acute toxicity of pelvic radiotherapy for gynecological cancer.STUDY Design: A case series.PLACE AND DURATION OF STUDY: Department of Oncology, The Aga Khan University Hospital, Karachi, from March 2011 to June 2012.METHODOLOGY: A total of 99 patients with histologically proven uterine and cervical cancer, receiving radiation therapy, were enrolled into the study after informed consent on justification of inclusion and exclusion criteria. Patients were evaluated for the frequency and severity of pelvic radiotherapys side effects according to toxicity criteria based on RTOG/EORTC and CTC version 2 criteria at the start, during and at the end of treatment. The data was analyzed by using SPSS version 16.Results: Out of the 99 enrolled patients, 58 (58.6%) had uterine and 41 (41.4%) had cervical cancer. Mean age was 54.54 ± 10.29 years. Thirty-five (35.4%) patients received chemotherapy with RT. Mean RT dose was 60.72 ± 7.15 Gy. The most common gastrointestinal adverse effect was diarrhea in 64 (64.6%) followed by proctitis in 55 (55.5%), nausea in 33 (33.3%) and vomiting in 16 (16.2%) patients. Grade (G) 1 was the most frequently observed severity. The most common hematological toxicity was anemia in 37.8% (n=31/82) {(G1=18 (21.9%), G2=11 (13.4%), G3=2 (2.4%)} followed by thrombocytopenia in 22.8% (21/92) {(G1=16 (17.3%), G2=2 (2.1%), G3=3 (3.2%)} and neutropenia in 21 (21.2%) {(G1=12 (12.1%), G2=5 (5%), G3=3 (3%), G4=1 (1%)}. Urinary toxicity was observed in 49 (49.5%) patients. On stratification, chemotherapy and higher RT dose were strong predictor of increased hematological and upper gastrointestinal toxicity (p \u3c 0.05) and age \u3e 60 years for diarrhea (p \u3c 0.05).CONCLUSION: The frequency and severity of acute toxicity of pelvic radiotherapy in women with gynecologic cancers was found intermediate to high

Role of metastasectomy and chemotherapy in carcinoma of uterine cervix

Squamous cell carcinoma of uterine cervix is potentially a curable disease; however, many patients treated with definitive chemoradiotherapy develop distant metastases, with few of them having a single metastatic deposit. There are no guidelines for the treatment of patients with oligometastatic cervical cancer.We present a case of a patient with International Federation of Gynecology and Obstetrics (FIGO) Stage IIB squamous cell carcinoma of uterine cervix. She was successfully treated with concurrent chemoradiotherapy with definitive intent. One year later, she developed a solitary pulmonary nodule for which she underwent resection followed by chemotherapy. She is free of any local or distant disease at 5 years of regular follow-up

An improved non-dimensional model of wet-cooling towers

Abstract: A general non-dimensional mathematical model of cooling towers is improved by including evaporation of water. The solution still consists of adjusting the assumed straight air-saturation line to the real air-saturation data, but a new constant (H) is added as well. Two solutions are proposed and the accuracy of each method is checked against data from the literature and also compared with the original solution. The first method shows a maximum decrease of 4.4 per cent in error, whereas in the second method, the maximum error was found to be 3.3 and 6.8 per cent when the inlet air was unsaturated and saturated, respectively. Keywords: cooling tower, non-dimensional model, evaporatio