Kambiz Dowlatshahi

Laser Therapy of Breast Cancer with 3-Year Follow-up

Abstract:  Breast cancer is the commonest female malignancy in the United States and is increasingly being detected at a non‐palpable stage by annual mammography. Minimally invasive methods of its local treatment have been recently introduced as alternative to its surgical removal. The case reported in this article illustrates the advantages of in‐situ ablation with minimal discomfort to the patient and deformity of the breast. More importantly, it demonstrates the absence of any adverse effect on health and survival of the patient during this intermediate period of follow‐up.

Positron emission tomography with fluorine-18 fluorodeoxyglucose to evaluate response of early breast carcinoma treated with stereotaxic interstitial laser therapy.

Stereotaxic interstitial laser therapy is a promising new alternative to surgery to treat early-stage breast cancer. With this, laser energy coagulates the tumor with controlled heat, leading to fibrosis. Fluorodeoxyglucose positron emission tomography (FDG PET) scanning was performed in four patients treated by this technique to determine the degree of necrosis after interstitial laser therapy. The results showed that FDG PET scanning was in close agreement with histopathologic findings, confirming complete necrosis in one patient and variable response in the other three patients. Uptake of FDG appears to be a reliable means to monitor treatment response after interstitial laser therapy and may be useful in the management of breast cancer when used with this new procedure.

Retinoic‐acid‐binding protein in normal and neoplastic human esophagus

The concentration of cellular retinoic acid binding proteins (CRABP) was determined in the cytosol of normal esophageal tissue and in esophageal carcinomas. Unlike the reported results for human breast, colon, melanoma, or oropharynx cancers, the CRABP levels in esophageal cancers were either undetectable or contained levels of CRABP which were significantly lower than that of adjacent histologically disease‐free tisse (P < 0.005). Moreover, there was no difference between the normal mucosa of cancer or noncancer patients with regards to the CRABP concentration. The absence of CRABP in the cancer tissue was not dependent on the degree of differentiation. These results indicate that the CRABP disappears when the normal mucosa becomes malignant. If such a change is also demonstrated in known premalignant conditions of the esophagus, CRABP could serve as a diagnostic biochemical marker for early detection of this cancer.

Brush cytology for the early detection of esophageal carcinoma among patients with upper aerodigestive malignancies

The incidence of associated esophageal carcinoma (EC) among patients with upper aerodigestive tract malignancies is high. Esophageal brush cytology, as developed and evaluated as a screening device for early detection of EC among villagers of northeastern Iran,1 was employed to examine 56 clinic patients with known tumors of the upper aerodigestive tract on 106 occasions. Two asymptomatic EC were detected and are presented. The procedure was also used as an adjunct to endoscopy in order to monitor the response of tumors under treatment. Sensitivity of 40% and specificity of 90% were found and could be improved with more judicious application of the procedure. The use of this simple test for early detection of EC among this high risk subset of clinic patients is recommended.

Stereotaxically guided interstitial laser therapy (ILT) of nonpalpable breast cancers

Widespread screening mammography has led to detection of small tumors allowing breast conservation in women. We investigated in-situ treatment of well-defined mammographically-detected breast cancers employing stereotaxically-guided interstitial laser therapy as an alternative to lumpectomy. Patients & Methods: Prior to laser therapy, histologic diagnosis and prognostic factors of breast tumors were determined by stereotaxic needle core biopsy. Using stereotaxic technique, ablative diode laser energy at 5 - 10 W was delivered through a 400 μm fiber placed inside a 19-gauge needle into the center of the tumor. The treatment adequacy was monitored by a multisensory thermal needle inserted into the breast adjacent to the laser needle recording temperatures exceeding 60°C. All treated tumors were subsequently excised as part of planned definitive treatment of the patient. Results: ILT treated tumors of the first 4 patients revealed residual malignancy at the margins. With technical improvement including better laser energy delivery and temperature monitoring, coagulation necrosis extended beyond the tumor margins in the next 8 patients. All treatments were given in the outpatient facility under local anesthesia with minimal sedation. Patients experienced transient pain but no other side-effects during a mean follow-up of 9 months. Conclusion: Stereotaxically-guided ILT is a minimally invasive method of ablating small, well-defined breast cancers which offers an alternative to lumpectomy prior to radiation therapy.