Purpose: To investigate enlargement of prostate volume by edema during brachytherapy seed implantation and develop a nomogram model to calculate air-kerma strength (AKS) required for implantation of the enlarged transient prostatic volume.

Materials and Methods: The prostate volume was measured prior and after seed implantation using trans-rectal ultrasound imaging in the operating room to obtain volume enlargement. A nomogram model was developed that calculates AKS required for implantation of the enlarged transient prostate volume with optimal dose coverage.

Results: The measured prostate enlargement in this study was up to 60% of the initial volume. The effective prostatic volume enlargement was calculated for three isotopes: 125I, 103Pd and 131Cs. The effective volume enlargement for 125I implants was relatively small (< 10%) because of its long half-life. For 103Pd and 131Cs with short half-lives, additional AKS up to 20% and 30%, respectively, might be required to provide appropriate dose coverage of possible enlarged prostatic volumes.

Conclusions: Prostate volume enlargement should be considered to obtain optimal dose coverage particularly for short half-life isotopes such as 131Cs and 103Pd. The nomogram model developed in this work provides the AKS required for implants with a wide range of prostatic volume enlargements (5-100%) for three isotopes.

Keywords: prostate brachytherapy; nomogram; air-kerma strength; edema; volume enlargement.

Background and Objectives: The aim of this study was to evaluate the efficacy, safety and toxicity of docetaxel as first line chemotherapy or previously treated patients (one regimen) in patients with recurrent or metastatic endometrial cancer.

Patients and Methods: Prospective phase II, in patients referred to the Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Egypt.  Fifty patients with advanced or metastatic endometrial cancer were enrolled to receive docetaxel 70 mg/m2 administered intravenously on day 1 of a 3-week cycle. If patients responded well to docetaxel, additional cycles were administered until progressive disease or unacceptable toxicity occurred. Therapy response was evaluated every 6-week.

Results: Fifty patients with a median age of 60 years (range, 40–70 years) who entered the study, 17 patients (34%) had received one prior chemotherapy regimen. All patients were evaluable for efficacy, yielding an overall response rate of 34% (95% confidence interval, 14.8–55.6%); complete response and partial response (PR) were 4 and 30%, respectively. Of 17 pretreated patients, five (29%) had a PR. The median duration of response was 2 months. The median time to progression was 4 months and the median survival time was 18 months . The predominant toxicity was grade 3–4 neutropenia, occurring in 92% of the patients, although febrile neutropenia arose in 10% of the patients. Oedema was mild and infrequent. Conclusion: This prospective phase II trial, clearly demonstrated that docetaxel is active in the treatment of endometrial cancer. Toxicity was manageable and predominantly haematologic.

 Keywords: docetaxel; advanced or metastatic endometrial cancer; phase II

Dosimetric comparison between bone marrow sparing intensity-modulated radiation therapy and conventional techniques in the treatment of cervical cancer: a retrospective study  

Purpose: To investigate enlargement of prostate volume by edema during brachytherapy seed implantation and develop a nomogram model to calculate air-kerma strength (AKS) required for implantation of the enlarged transient prostatic volume.

Materials and Methods: The prostate volume was measured prior and after seed implantation using trans-rectal ultrasound imaging in the operating room to obtain volume enlargement. A nomogram model was developed that calculates AKS required for implantation of the enlarged transient prostate volume with optimal dose coverage.

Results: The measured prostate enlargement in this study was up to 60% of the initial volume. The effective prostatic volume enlargement was calculated for three isotopes: 125I, 103Pd and 131Cs. The effective volume enlargement for 125I implants was relatively small (< 10%) because of its long half-life. For 103Pd and 131Cs with short half-lives, additional AKS up to 20% and 30%, respectively, might be required to provide appropriate dose coverage of possible enlarged prostatic volumes.

Conclusions: Prostate volume enlargement should be considered to obtain optimal dose coverage particularly for short half-life isotopes such as 131Cs and 103Pd. The nomogram model developed in this work provides the AKS required for implants with a wide range of prostatic volume enlargements (5-100%) for three isotopes.

Keywords: prostate brachytherapy, nomogram, airkerma strength, edema, volume enlargement

Trends in oesophagus and Stomach cancer incidence in Bangalore, India

Background: During recent decades, an increase in the incidence of certain oesophago-gastric cancer has been reported in some countries and in India. This study sought to analyze oesophageal and gastric cancer incidence trends in Bangalore by sex and morphology for the period 1982–2007.

Patients and methods: Oesophageal and gastric cancer cases were drawn from Bangalore population-based cancer registry locating in Kidwai memorial Institute of Oncology started in 1982 under national cancer Registry Programme funded by Indian Council of Medical Research. Time trends in sex- and age-standardized cancer incidence rates were analyzed by site and histology over the study period, using relative change.

Results: Age-standardised oesophageal cancer incidence rates increased in males, in females failed to register a significant trend over the study period. Overall, gastric cancer decreased from 9.81 and 5.48 rates per 100 000 person-years in 1982–86 to 9.45 and 5.25 in 2002–07, among men and women, respectively. Where as oesophageal adenocarcinomas increased sharply in both sex, among men, oesophageal squamous cell cancer rates increased steadily from the mid-1982s onwards a bit decline was observed from 1997, the same trend observed in females. The gastric cancer decreased over the study period. There was a marked decrease in the incidence of oesophago-gastric cancer presenting with unknown and unspecified morphology reported.

Key words: adenocarcinoma, Oesophageal and stomach, incidence, age specific rate, age adjusted rate, population-based registry, trends.

Clinical significance of telomerase genes (hTERC and hTERT) amplification in patients with acute myeloid leukemia

Acute myeloid leukemia (AML) describes a heterogenous group of hematological disorders. Cytogenetic and molecular assays have allowed patients’ follow up aiming for detection of minimal residual disease, prediction of patients’ outcome, in addition to providing the rationale for designing novel molecular-targeted therapeutic strategies. Human telomerase reverse transcriptase (hTERT), encoded by the hTERT gene and the telomerase RNA component (hTERC) genes are frequently amplified in human tumors, which may indicate that the hTERT and the hTERC genes may be target for amplification during the transformation of human malignancies including hematological malignancies. This genetic event has implications in diagnosis, prognosis and therapeutics of cancer. To evaluate the hTERC and hTERT genes as a prognostic marker in patients with AML, hTERC and hTERT gene amplification was studied in 20 adult AML patients using a commercial FISH probes (Kreatech) designated to detect the copy numbers of the genes. They were 12 males and 8 females. Their ages ranged from 16 to 67 years. The patients were further divided into two groups; group I (12 patients) includes newly diagnosed AML patients and group II (8 patients) includes patients taken at 28th day of chemotherapy. The hTERC amplification was detected in 19/21 cases (90.5%). The copy number of the gene ranged from 2-5 copies per interphase cell. For the hTERT gene, the amplification was found in the same percent of the patients. The copy number of the gene ranged from 2-9 copies per interphase cell. On comparing the group I with group II there was a highly statistical significant difference regarding the percent of amplification of both genes. The percent of amplification of hTERT gene was found to be higher among patients with poor outcome of the disease than in patients with good outcome. On the contrary the hTERC gene amplification did not exhibit such a correlation. In conclusion, hTERT and hTERC genes amplification were detected in patients with AML; therefore telomerase can be a good cancer marker which may be involved in carcinogenesis of leukemia. Higher amplification was found in de novo cases than cases in remission which emphasize its role in clinical analysis, disease monitoring and detection of minimal residual disease.

Keywords: Acute Myeloid leukemia, telomerase amplification, hTERC gene, hTERT gene

Chemotherapy of metastatic breast carcinoma so far, is not curative using the currently available chemotherapeutic, hormonal or biologic agents. The treatment of metastatic breast cancer is aimed mainly at alleviation of symptoms rather than cure. The first choice of therapy is dependent on patient age, performance status, hormone receptor status, human epidermal growth factor receptor-2 (HER-2), involvement of the viscera, or enrollment of patients in investigational trials. Combination of chemotherapeutic drugs showed an advantage for survival, tumor response and time to progression with adverse effects of these agents. It is very important, therefore, to balance between the benefits of treatment and the adverse effects and complication of therapy.

Keywords: chemotherapy, metastatic, HER-2, breast, combination

Extensive review in the diagnosis of the malignant transformation of pleomorphic adenoma

Background and Objectives: There is an increasing likelihood of malignant change in pleomorphic adenoma (PA) with time. This extensive review aims to highlight the current areas of difficulty or controversy in the diagnosis of malignant transformation of pleomorphic adenoma – a subject of most interest and challenge to a pathologist. It is also the objective of this review to compare the clinical and pathological points-of-view on the diagnosis of malignant transformation of pleomorphic adenoma.

Methods: A literature search using MEDLINE, accessed through the National Library of Medicine PubMed interface, for articles relating to malignant transformation of pleomorphic salivary adenoma written in the English language.

Results: The updated literature indicates that carcinomas in pleomorphic adenoma may arise in an older age group than benign lesions and are usually larger and longer standing lesions. The use of molecular changes to study malignant transformation of pleomorphic adenoma, unfortunately, have no specific expression on the tumor suppressor genes to detect the malignant transformation of pleomorphic adenoma from pathological point view.

Conclusion: The use of combined clinical evidence and pathological evidence are very important in the detection of the malignant transformation of pleomorphic adenoma.

Keywords: pleomorphic adenoma, malignant transformation of pleomorphic adenoma

Adenoid cystic carcinoma of the breast is a very rare neoplasm. We report a case of adenoid cystic carcinoma of the right breast presented with painless lump in the upper outer quadrant managed with lumpectomy, axillary lymph node staging and adjuvant local external radiotherapy to the whole breast with simultaneous integrated boost to the site of primary disease using respiratory gated intensity modulated radiotherapy. The available literature is reviewed.

Keywords: Adenoid cystic cancer breast, mastectomy, adjuvant radiotherapy

Approaches to management of adenocarcinoma following colocystoplasty

Primary adenocarcinoma of the urinary bladder is rare and more so is adenocarcinoma arising in an augmented colocystoplastic bladder. We present a case of adenocarcinoma developing in a urinary bladder after colocystoplasty which was managed by radical cystectomy with bilateral pelvic lymphadenectomy. The post-operative histopathology showed the lesion to be an Adenocarcinoma with spread to the pericolic lymphnodes and not the pelvic lymphnodes. There are no guidelines for bladder screening in these patients who appear to be at risk. Radical Cystectomy remains the treatment of choice. Though post op irradiation has been reported, its role is not clearly defined. Role of chemotherapy in the adjuvant setting is yet to be defined. Following this is the literature review and a discussion on Adenocarcinoma arising in a colocystoplastically augmented bladder.

Keywords: Adenocarcinoma, urinary bladder, cystoplastically augmented bladder, radical cystectomy

Primary Non-Hodgkin Lymphoma of frontal sinus diagnosed by fine needle aspiration cytology 

We present a rare case of primary non-Hodgkins Lymphoma of the frontal sinus diagnosed by Fine needle aspiration cytology (FNAC). FNAC is a safe, simple, rapid and effective technique that could be used to diagnose lesions even in unusual sites like paranasal sinuses with effective radiological guidance. Neoplasms of the frontal sinus could be easily misdiagnosed as an inflammatory process clinically. FNAC is a simple test to rule out a neoplasm. A review of a single case including radiographic, clinical, and pathologic findings was done, followed by a discussion on the pathological differential diagnosis highlighting relevant literature. Timely diagnosis is critical in the management of these cases.

Keywords: Fine needle aspiration cytology, non-Hodgkin lymphoma, diffuse large B cell lymphoma, frontal sinus.