Wontaek Kim

Treatment Outcomes Between Concurrent Chemoradiotherapy and Combination of Surgery, Radiotherapy, and/or Chemotherapy in Stage III and IV Maxillary Sinus Cancer: Multi-Institutional Retrospective Analysis

PURPOSE The incidence of maxillary sinus cancer (MSC) is extremely rare, representing less than 1% of all cancers. Because of its rarity, the management of locally advanced MSC is a challenging issue. The objective of the present study was to retrospectively compare the efficacy of 2 traditional treatment strategies, concurrent chemoradiotherapy (CCRT) versus combination of surgery and radiotherapy and/or chemotherapy (SRCT) in MSC. PATIENTS AND METHODS From 1989 to 2010, 65 patients with histologically confirmed stage III or IVA/IVB were retrospectively analyzed. RESULTS The median age of our subjects was 60 years (range 36 to 81). The present study involved 18 women (27.7%) and 47 men (72.3%). Of the 65 patients, 52 (80.0%) had squamous cell carcinoma. The TNM stage was stage III, as determined by the American Joint Committee on Cancer, 6th edition, in 27 patients (41.5%). Stage IVA or IVB was observed in 38 patients (58.5%). Of the 65 patients, 41 underwent treatment. Of these 41 patients, 26 and 15 patients underwent SRCT and CCRT, respectively. During the 75.6 months (range 6.4 to 249.4) of median follow-up, the median progression-free survival duration was 45.1 months (95% confidence interval 0.0 to 142.7). The 5-year overall survival rate was 64.8%. However, the patients who had undergone surgery had better progression-free survival (hazard ratio 2.363, 95% confidence interval 1.098 to 5.085, P = .028) and overall survival (hazard ratio 4.989, 95% confidence interval 1.646 to 15.118, P = .004). The SRCT group had a better progression-free survival (P = .043) and overall survival (P = .029) duration than did the CCRT group. CONCLUSION SRCT might be superior to CCRT for locally advanced MSC. Additional studies comparing the treatment outcomes of CCRT with SRCT are warranted.

C-REACTIVE PROTEIN LEVELS AND RADIATION-INDUCED MUCOSITIS IN PATIENTS WITH HEAD-AND-NECK CANCER

PURPOSE To evaluate the relationship between C-reactive protein (CRP) levels or the erythrocyte sedimentation rate (ESR) and the grade of acute radiation-induced mucositis in patients with head-and-neck cancer. METHODS AND MATERIALS This study was performed in 40 patients who received intensity-modulated radiation therapy as a radical treatment of primary laryngo-pharyngeal cancer. Serum CRP level and ESR were initially checked on the day of radiotherapy simulation and were measured every week during the irradiation schedule and two times biweekly after radiotherapy. Mucosal reactions were evaluated by radiation oncologists on days of blood sampling. RESULTS The distribution of the most severe mucositis was Grade I mucositis in 10% of the patients, Grade II in 60% of the patients and Grade III in 30% of the patients. Statistical analysis indicated a significant rise in the CRP level (p < 0.001) according to radiation fraction number and grade of mucositis. A change of the mean CRP level was correlated with progression of mean grade of mucositis according to fraction number. The ESR did not show any statistically significant relationship with radiotherapy fraction number and grade of acute mucositis. CONCLUSIONS There was a significant correlation between the presence of acute mucositis and CRP level in this study. The CRP level could be conveniently determined along with evaluation of mucosal reactions during or after radiotherapy to provide further information on radiation-induced mucositis.

Probiotics for Rectal Volume Variation During Radiation Therapy for Prostate Cancer

PURPOSE To investigate the effect of the probiotic Lactobacillus acidophilus on the percentage volume change of the rectum (PVCR), a crucial factor of prostate movement. METHODS AND MATERIALS Prostate cancer patients managed with tomotherapy as a radical treatment were enrolled in the study to take a probiotic capsule containing 1.0×10(8) colony-forming units of L acidophilus or a placebo capsule twice daily. Radiation therapy was performed at a dose of 78 Gy in 39 fractions. The PVCR, defined as the difference in rectal volume between the planning computed tomographic (CT) and daily megavoltage CT images, was analyzed. RESULTS Forty patients were randomized into 2 groups. The L acidophilus group showed significantly lower median rectal volume and median PVCR values than the placebo group. L acidophilus showed a significant reduction effect on the PVCR (P<.001). However, the radiation therapy fraction number did not significantly influence the PVCR. CONCLUSIONS L acidophilus was useful in reducing the PVCR, which is the most important determining factor of prostate position, during radiation therapy for prostate cancer.

Cyclophosphamide Potentiates the Antitumor Effect of Immunization with Injection of Immature Dendritic Cells into Irradiated Tumor

Growth of a tumor on the left flank was suppressed by direct injection of immature DCs (iDCs) into the irradiated tumor on the right thigh (IR/DC). This antitumor immune effect of IR/DC was enhanced by pretreatment with CTX (CTX+IR/DC) and this effect was related with increased number of tumor-specific IFN-γ secreting T cells and decreased ratio of CD4+CD25+/CD4+ T cells. The treatment with CTX+IR/DC increased or decreased the levels of IL-2 or IL-10, respectively. These results demonstrated that antitumor effect of IR/DC could be augmented by pretreatment with low-dose CTX, suggesting a new antitumor therapeutic modality of chemoradioimmunotherapy.

The Effect of Probiotics for Preventing Radiation-Induced Morphological Changes in Intestinal Mucosa of Rats

Radiation therapy is an important treatment modality for abdominal or pelvic cancer, but there is a common and serious complication such as radiation-induced enteritis. Probiotics is reported to have positive effects against radiation-induced enteropathy. In this study, morphological changes of bowel mucosa were analyzed in rats to presume the effect of probiotics on radiation-induced enteritis and its correlation with radiation dose. A total of 48 adult male Sprague-Dawley rats were randomly assigned to two groups and received a solution containing 1.0×108 colony-forming units of Lactiobacillus acidophilus or water once daily for 10 days. Each of two groups was divided into three subgroups and abdomino-pelvic area of each subgroup was irradiated with 10, 15, and 20 Gy, respectively on the seventh day of feeding the solutions. All rats were sacrificed 3 days after irradiation and the mucosal thickness and villus height of jejunum, ileum and colon were measured. The morphological parameters of the small intestine represented significant differences between two solution groups irradiated 10 or 15 Gy, except for villus height of jejunum in 15 Gy-subgroup (P=0.065). There was no significant morphometric difference between two groups irradiated with 20 Gy of radiation. Probiotics appear to be effective for the morphological shortening of small intestinal mucosa damaged by radiation less than or equal to 15 Gy. Graphical Abstract

Pretreatment maximum standardized uptake value of (18) F-fluorodeoxyglucose positron emission tomography as a predictor of distant metastasis in adenoid cystic carcinoma of the head and neck.

The purpose of this study was to determine whether the maximum standardized uptake value (SUVmax) of the primary tumor on pretreatment 18F‐fluorodeoxyglucose positron emission tomography (18F‐FDG PET) has prognostic significance in patients with adenoid cystic carcinoma (ACC) of the head and neck.

Clinical characteristics of postherpetic pruritus: assessment using a questionnaire, von Frey filaments and Neurometer

potential. The Shh pathway has an essential role during hair follicle morphogenesis, where it is required for normal advancement beyond the hair germ stage of development. Epidermis-derived Shh functions as a paracrine signal regulating development of the mesenchymal component of the hair follicle. It is speculated that Shh may regulate early folliculogenesis through its two general targets, patched homologue 1 and the zinc finger protein GLI1, which are normally expressed at their highest levels in the dermal papilla. Mice with mutations in one of several components of the Shh and plateletderived growth factor signalling pathways exhibit defects in dermal papilla maintenance and formation. Data from multiple studies support a model in which the loss of dermal cilia results in arrested follicle development due to a dysregulated Shh signalling pathway. In our experience, the alopecia becomes apparent in the fourth month of treatment. At the time of writing there was no sign of hair regrowth in our four patients (minimum of 1 year post-treatment). To our knowledge, persistent alopecia as a side-effect of vismodegib therapy has not been reported before. Our experience suggests that the side-effects of vismodegib are reversible after treatment cessation. However, we recognize that persistent alopecia was reported in four of 65 patients (we have considered that alopecia that remained unchanged for more than 1 year is permanent). In addition, recent data suggest that amenorrhoea is a potential side-effect of unknown reversibility. These two side-effects should be considered in young subjects.

Features of Staphylococcus aureus colonization in patients with nummular eczema

therapy for chronic idiopathic urticaria: a double-blind, placebocontrolled, comparative trial. J Am Acad Dermatol 1995; 33 (2 pt 1):192–8. 9 Kocatürk E, Kavala M, Kural E et al. Autologous serum skin test vs autologous plasma skin test in patients with chronic urticaria: evaluation of reproducibility, sensitivity and specificity and relationship with disease activity, quality of life and anti-thyroid antibodies. Eur J Dermatol 2011; 21:339–43. 10 Godse KV. Autologous serum skin test at various dilutions. Indian J Dermatol 2011; 56:352–3.

Fractionated Wide-Field Radiation Therapy Followed by Fractionated Local-Field Irradiation for Treating Widespread Painful Bone Metastasis

PURPOSE Wide-field radiation therapy (WFRT) is an effective treatment for widespread bone metastasis. We evaluated local-field irradiation (LFI) after fractionated WFRT (f-WFRT) for treating the patients with multiple painful bone lesions. METHODS AND MATERIALS From 1998 to 2007, 32 patients with multiple bone metastases were treated with fractionated LFI (f-LFI) after f-WFRT. All patients initially received 15 Gy in 5 fractions to a wide field, followed by LFI (9-15 Gy in 3 Gy fractions). Response was assessed by evaluating the degree of pain relief using a visual analog scale before radiotherapy, after f-WFRT, and after f-LFI. RESULTS Fractionated LFI following f-WFRT yielded an overall relief rate of 93.8% and a complete relief rate of 43.8%. The rate of the appearance of new disease was 6.3% for the patients with complete relief, 20.5% for the patients with a partial relief, and 50% for the patients with no relief. CONCLUSION Fractionated LFI after f-WFRT is a well-tolerated and effective treatment for multiple metastatic bone disease.

Effect of Coenzyme Q10 on Radiation Nephropathy in Rats

The kidney is one of the most radiosensitive organs in the abdominal cavity and is the dose-limiting structure in cancer patients receiving abdominal or total body irradiation. In the present study, the effect of coenzyme Q10 (CoQ10) on radiation nephropathy was evaluated in rats. A total of 72 rats were equally randomized into 4 groups: Control, CoQ10, irradiation with 10 Gy (RT) + placebo, or RT + CoQ10. The 2 RT groups received single 10 Gy of abdominal irradiation. The 2 CoQ10 groups were supplemented daily with 1 mL of soybean oil containing 10 mg/kg of CoQ10. The RT + placebo and control groups received same dose of soybean oil. After 24 weeks, laboratory and histopathologic findings were compared. The 2 RT groups showed significant increases in blood urea nitrogen (BUN) and creatinine levels and significant pathologic changes such as glomerulosclerosis and tubulointerstitial fibrosis. CoQ10 supplementation resulted in significant reductions of BUN and creatinine levels compared with the RT + placebo group (P < 0.001 and P = 0.038, respectively). CoQ10 treatment significantly attenuated glomerular and tubular changes of irradiated kidney in semiquantitative analysis (P < 0.001 for both). Administration of CoQ10 can alleviate the radiation-induced nephropathy.