Mary Koshy

The role of fluorodeoxyglucose positron emission tomography in cervical lymph node metastases from an unknown primary tumor

The authors performed a comprehensive review of the efficacy of fluorodeoxyglucose positron emission tomography (FDG‐PET) in the detection of primary tumors in patients with cervical metastases from unknown primary tumors.

F-18 FDG PET-CT fusion in radiotherapy treatment planning for head and neck cancer.

The fusion of fluoro‐2‐deoxy‐d‐glucose–positron emission tomography (FDG‐PET) with CT scans has been shown to improve diagnostic accuracy and staging in non‐small cell lung cancer. We report on the influence of PET‐CT fusion on the management of patients with head and neck cancer.

Oxidative Stress and DNA Damage in Agricultural Workers

ABSTRACT Oxidative stress and DNA damage have been proposed as mechanisms linking pesticide exposure to health effects such as cancer and neurological diseases. A pilot study of pesticide applicators and farm workers working in the fruit orchards of Oregon (i.e., apples, pears) was conducted to examine the relationship between organophosphate (OP) pesticide exposure and oxidative stress and DNA damage. Urine samples were analyzed for OP metabolites and 8-hydroxy-2′-deoxyguanosine (8-OH-dG). Lymphocytes were analyzed for oxidative DNA repair activity and DNA damage (Comet assay) and serum analyzed for lipid peroxides (i.e., malondialdehyde [MDA]). Cellular DNA damage in agricultural workers was validated using lymphocyte cell cultures. Urinary OP metabolites were significantly higher in farm workers and applicators (p < .001) when compared to controls. 8-OH-dG levels were 8.5 times and 2.3 times higher in farm workers and applicators, respectively, than in controls. Serum MDA levels were 4.9 times and 24 times higher in farm workers and applicators, respectively, than in controls. DNA damage and oxidative DNA repair were significantly greater in lymphocytes from applicators and farm workers when compared with controls. A separate field study showed that DNA damage was also significantly greater (p < .001) in buccal cells (i.e., leukocytes) collected from migrant farm workers working with fungicides in the berry crops in Oregon. Markers of oxidative stress (i.e., reactive oxygen species, reduced levels of glutathione) and oxidative DNA damage were also observed in lymphocyte cell cultures treated with an OP. The findings from these in vivo and in vitro studies indicate that pesticides induce oxidative stress and DNA damage in agricultural workers. These biomarkers may be useful for increasing our understanding of the link between pesticides and cancer.

Extra-target doses in children receiving multileaf collimator (MLC) based intensity modulated radiation therapy (IMRT)

To investigate the extra‐target doses using intensity modulated radiation therapy (IMRT).

Intensity modulated radiation therapy for retroperitoneal sarcoma: A case for dose escalation and organ at risk toxicity reduction

Purpose: Radiation therapy for retroperitoneal sarcoma remains challenging because of proximity to surrounding organs at risk (OAR). We report the use of intensity modulated radiation therapy (IMRT) in the treatment of retroperitoneal sarcomas to minimize dose to OAR while concurrently optimizing tumor dose coverage. Patients and methods: From January 2000 to October 2002, 10 patients (average age 56 years) with retroperitoneal sarcoma and one with inguinal sarcoma were treated with radiation at Emory University. Prescription dose to the planning treatment volume (PTV) was commonly 50.4 at 1.8 Gy/fraction. CT simulation was used in each patient, three patients were treated with 3D-conformal treatment (3D-CRT), and the remaining eight received multi-leaf collimator-based (MLC) IMRT. IMRT treatment fields ranged from eight to 11 and average volume treated was 3498 cc. Optimal 3D-CRT plans were generated and compared with IMRT with respect to tumor coverage and OAR dose toxicity. Dose volume histograms were compared for both the 3D-CRT and IMRT plans. Results: Mean dose to small bowel decreased from 36 Gy with 3D-CRT to 27 Gy using IMRT, and tumor coverage (V95) increased from 95.3% with 3D-CRT to 98.6% using IMRT. Maximum and minimum doses delivered to the PTV were significantly increased by 6 and 22%, respectively (P = 0.011, P = 0.055). Volume of small bowel receiving > 30Gy was significantly decreased from 63.5 to 43.1% with IMRT compared with conventional treatment (P = 0.043). Seven patients developed grade 2 nausea, three developed grade 2 diarrhea, one had grade 2 skin toxicity, and one patient developed grade 3 liver toxicity (RTOG toxicity scale). No other delayed toxicities related to radiation were observed. At a median follow-up of 58 weeks, there were no local recurrences and only one patient developed disease progression with distant metastasis in the liver. Conclusions: IMRT for retroperitoneal sarcoma allowed enhanced tumor coverage and better sparing of dose to critical normal structures such as small bowel, liver, and kidney. Escalation of dose has a positive impact on local control for retroperitoneal sarcoma; IMRT may be an effective method to achieve this goal. We are evaluating preoperative dose escalation to 59.4 Gy.

State of the art: Gastrointestinal malignancies in the human immunodeficiency virus (HIV) population

The gastrointestinal tract is one of the most common sites for the development of primary neoplasms arising in patients with pre-existing infection with the human immunodeficiency virus (HIV). Over the past decade, new information on the clinical manifestation, natural history, treatment options, and related toxicity have been reported, mostly notably the integration of highly active antiretroviral therapy (HAART). The following is a concise review summarizing the current state-of-the-art for GI tract malignancies in the HIV-positive patient and is designed to assist the clinical oncology team in developing a rationale plan when caring for these patients.

Early Clinical Results from Chemoradiation with 5-Fluorouracil and Oxaliplatin for Locally Advanced Rectal Cancer

PURPOSE Preoperative chemoradiation with 5-fluorouracil (5-FU) has improved local control and resectability in patients with locally advanced rectal adenocarcinoma. The possible benefit of adding oxaliplatin is being investigated. We present background on the use of oxaliplatin as well as institutional experience assessing treatment tolerability and early outcome data. PATIENTS AND METHODS From August 2001 to August 2006, 15 patients were treated with concurrent 5-FU, oxaliplatin, and radiation. Each had locally advanced rectal carcinoma with staging as follows: T3 (10 patients), T4 (5 patients), N1 (3 patients), and M1 (1 patient). Three patients were treated for local recurrence; 2 had received previous radiation therapy. All patients received continuous-infusion 5-FU at 225 mg/m2 per day. The oxaliplatin dose was 70 mg/m2 in 1 patient and 85 mg/m2 in the others, administered every other week x 3 weeks starting on day 1 of radiation. Resection followed completion of radiation by 6 weeks. RESULTS The treatment was tolerable, with the most frequent hematologic toxicity being grade 1/2 anemia. Twelve patients were evaluable, with 11 treated preoperatively. All were able to undergo resection with negative margins, with T stage at resection as follows: T4 (2 patients, 1 with 5% viable tumor), T3 (4 patients), T2 (1 patient), T1 (2 patients); there were pathologic complete responses in 4 patients. At resection, 2 patients had N2 disease; 1 of these was also found to have a peritoneal metastasis. Two patients with clinical N1 disease initially were N0 at resection. With median follow-up of 13 months (range, 4-36 months), 9 patients have clinically no evidence of disease. There have been no local recurrences and 1 death from disease. CONCLUSION We present tolerability and early clinical efficacy data for patients treated with concurrent 5-FU and oxaliplatin chemoradiation. The oxaliplatin-based regimen was tolerable. All patients were able to undergo resection with negative margins, with encouraging downstaging, local control, and survival.