Impact Of Various Treatment Modalities Research Articles

Molecular Scarring in Relapsing Psoriasis: Crosstalk of Keratinocytes and Immune Cells

Abstract Introduction/Objective Psoriasis is a chronic skin disorder with a tendency for relapse, characterized by immune- mediated mechanisms leading to papulosquamous lesions. Despite advances in treatment, many patients experience relapse, particularly in previously healed areas, referred to as “molecular scarring.” This scarring suggests a complex interaction between keratinocytes and immune cells, including tissue-resident memory T cells (TRMs), cytokines, and epigenetic modifications, contributing to the pattern-specific recurrence of psoriasis. Methods/Case Report After reviewing 31 articles on PubMed, we focused on the immunopathogenesis of psoriasis, examining the role of TRMs, the balance between regulatory T cells (Tregs) and Th17 cells, and the impact of various treatment modalities on disease recurrence. It evaluates the expression of TRM markers and the effectiveness of treatments such as anti-IL-17 agents and phototherapy in altering disease progression. The study also explores the genomic characteristics of psoriatic lesions post-treatment and the duration of clinical remission associated with different therapeutic approaches. Results (if a Case Study enter NA) The findings demonstrate a significant role of TRMs in psoriasis relapse, with environmental triggers reactivating these cells and leading to the production of inflammatory cytokines. Treatments targeting IL-17 showed a rapid decrease in TRM markers, particularly in the dermis, and were associated with different durations of disease remission based on the therapeutic approach. The study also found that the genomic profile of treated lesions does not fully normalize, with variations in gene expression linked to the type of treatment and possibly influencing the size of the molecular scar and relapse duration. Conclusion Psoriasis relapse is intricately linked to the presence of TRMs and the molecular scarring of previously healed lesions, influenced by various treatment modalities. The study underscores the importance of targeting TRMs and adjusting therapeutic strategies to extend the period of clinical remission and prevent the transition to more severe disease forms. Future research should focus on elucidating the detailed mechanisms of psoriasis relapse and developing targeted treatments to normalize the genomic profile of healed skin, ultimately improving patient outcomes and management of the disease.

Impact of Various Treatment Modalities on Long-Term Quality of Life in Cervical Cancer Survivors.

Introduction Given treatment advancements and the long life expectancy of mostly young patients with cervical cancer, their post-treatment quality of life (QoL) is essential to consider. This study aimed to evaluate the long-term QoL in cervical cancer survivors treated with various approaches. Methods We conducted a cross-sectional survey-based study using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Cervical Cancer Module 24 (EORTC-QLQ-CX24) questionnaires and involved members of the online cervical cancer patient support group (01/2024-02/2024). Eligible participants were ≥18 years old, diagnosed with stage IA2-IIB cervical cancer, and had completed their treatment. Respondents were stratified into four management groups: neoadjuvant chemotherapy + surgery +/- radiation therapy (RT), surgery + RT, RT alone, and surgery alone. Results Overall, 173 patients participated: 20 (11.6%) received neoadjuvant chemotherapy + surgery +/- RT, 50 (28.9%) had surgery + RT, 69 (39.9%) had RT alone, and 34 (19.7%) had surgery alone. Patients after surgery alone had significantly better global QoL (p<0.001). Their physical (p<0.001), role (p=0.037), emotional (p=0.024), and social (p=0.006) functioning were also substantially better. This group also reported the lowest severity of fatigue (p=0.001), nausea and vomiting (p<0.001), and diarrhea (p<0.001). Sexual functioning was better in the surgery-alone group in almost all aspects. There were no major differences in QoL among the groups, receiving RT alone or combined with other treatments. Conclusions Cervical cancer survivors who underwent surgery alone reported the highest QoL and lower symptom intensity compared to those treated with RT or treatment combinations. RT combined with other modalities did not appear to substantially decrease QoL compared to RT alone.

Evaluating the Impact of Various Treatment Modalities on the Chewing Efficiency of Anterior Disc Displacements of Temporomandibular Joint Disorder Cases: A Comparative Study.

Internal disc displacement of the temporomandibular joint (TMJ) is identified by an anomaly between the condylar-disc assembly, which, in many cases, may lead to discomfort and malfunction of the chewing function. The study's objective was to assess the effects of four distinct treatment approaches on temporomandibular disorder cases with anterior disc displacements focusing on their chewing efficiency. One hundred participants suffering from reducible TMJ disc displacement were selected for enrollment in the study. Subjects were divided equally into four groups: group I patients were treated with behavioral therapy; group II patients were treated with low-level laser therapy (LLLT); group III patients were treated with anterior repositioning splints; and group IV patients were treated with flat plane splints. Chewing efficiency was assessed utilizing the fractional sieving method and a synthetic food substitute was created using silicon impression material. The statistical analysis encompassed comparisons of chewing efficiency between groups and between baseline and posttreatment within each group, employing analysis of variance (ANOVA) and paired t tests, respectively. Using the paired t test, a significant difference in chewing efficiency values as expressed by the median particle size was observed between the baseline and 6-month values in all groups (P < 0.05), except for group I where no significant change was noted over the 6 months (P > 0.05). The one-way ANOVA test revealed a statistically significant difference among groups following therapies (P ˂ 0.05). The post hoc Tukey test was employed for pairwise comparisons and revealed statistically significant variances in the main values of chewing efficiency among all groups at a 95% confidence level (P ˂ 0.05). The study's results suggest that occlusal splints and LLLT are more effective in improving chewing efficiency than behavioral interventions.

Meta-analysis of multi-modality therapies in sinonasal undifferentiated carcinoma-A timely update.

Sinonasal undifferentiated carcinoma (SNUC) is a rare but aggressive tumour with very poor prognosis. There are currently no well-established clinical trials to guide therapy and the impact of various treatment modalities on survival is not well defined. We aim to provide an updated systematic review on current treatment modalities on survival outcomes. Individual patient data were extracted, and survival data pooled in a one-stage meta-analysis. Descriptive statistics were analysed using the Kaplan-Meier method. Patient-level comparisons stratified by treatment modalities, adjusted for demographics, were conducted using shared-frailty Cox regression. Participants include all patients diagnosed with SNUC based on histological evidence. We looked at the overall cumulative survival outcome for different treatment modalities and overall survival by treatment modality in low versus high stage SNUC patients. Seventeen studies were identified, comprising 208 patients from 1993 to 2020. There was no significant difference in cumulative overall survival in low versus high stage patients, and no significant difference in outcomes by treatment modality. The overall cumulative survival of SNUC is 30% at 95 months. Among patients treated with various combinations of treatment modalities, patients with chemoradiotherapy had the highest cumulative survival of 42% at 40 months. Definitive chemoradiotherapy was associated with improved disease survival rate. Regardless of tumour stage, patients should be treated early and aggressively, with no superiority of one treatment regimen over another. Trimodality treatment does not confer survival advantage over bimodality treatment.

Abstract 5868: Factors associated with exercise participation in patients with breast cancer

Abstract BACKGROUND: The American Cancer Society recommends at least 150 minutes of moderate and/or strenuous exercise and muscle-strengthening activities each week for adults. Exercise has been associated with decreased breast cancer mortality and adverse symptoms. This study’s purpose is to understand prevalence and predictors of inadequate aerobic exercise in patients recently diagnosed with breast cancer to inform interventions to increase exercise participation. METHODS: Patients seen at least once at Mayo Clinic Rochester were prospectively enrolled within one year of an initial breast cancer diagnosis in the Mayo Clinic Breast Disease Registry after providing informed consent. This analysis includes those who completed a baseline survey with self-reported exercise data using the Godin Leisure-Time Exercise Questionnaire. This longitudinal cohort study was approved by the Mayo Clinic institutional review board. RESULTS: 1,738 participants reported their usual weekly quantity of moderate and strenuous exercise an average of 95 days (SD 71 days, range 0-365) after diagnosis. Table 1 displays participant characteristics overall and by whether participants reported at least 150 minutes of moderate and/or strenuous activity weekly (“met guidelines”) or not (“did not meet guidelines”). Overall, 39% of participants met guidelines, including 56% of those aged 18-39 years, 40% of those aged 40-69 years, and 27% of those aged 70+ years. CONCLUSION: Older age was associated with less likelihood of meeting exercise guidelines (all age groups vs 70+, p &amp;lt; 0.05). A more diverse cohort will be needed to evaluate differences by gender and race/ethnicity. There did not appear to be any obvious impact on exercise level by time since diagnosis (during the first year after diagnosis) or educational status, though substantial missing data limit conclusions related to the latter. Additional research is needed to assess exercise levels later in survivorship and the impact of various treatment modalities on exercise habits Table 1. Patient and tumor characteristics Citation Format: Paulina S. Marell, Janet E. Olson, Joerg Herrmann, Nicole L. Larson, Nathan K. LeBrasseur, Stacy D. D'Andre, Andrea L. Cheville, Toure Barksdale, Charles L. Loprinzi, Fergus J. Couch, Kathryn J. Ruddy. Factors associated with exercise participation in patients with breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5868.

The evolving landscape of practice pattern and survival outcomes in the management of localized low-risk prostate cancer.

e17057 Background: The majority of patients with low-risk prostate cancer (LRPC) are candidates for active surveillance (AS) or definitive local treatment, which may include radical prostatectomy (RP), external beam radiotherapy (EBRT), or prostate seed implant (PSI). In the recent edition of the National Comprehensive Cancer Network (NCCN) guidelines, the “preferred” status was removed for AS, which rekindled a debate and interest in the management of LRPC. In this study, we analyzed the treatment pattern and impact of various treatment modalities on the survival of patients with LRPC using a large patient population provided by the National Cancer DataBase (NCDB). Methods: Patients with LRPC, as defined by the NCCN criteria, between 2004 and 2015 from NCDB were analyzed. Patients are categorized by treatment modalities, including RP, EBRT, PSI, and those who received no local therapy (NLT). Only patients with low Charlson-Deyo comorbidity score, 0 or 1 were included to ensure comparability between treatment groups. A multivariable Cox regression model was developed to determine the adjusted odds of patients' survival. The Kaplan Meier survival plots stratified by treatment were generated to establish the median overall survival (OS). The log-rank test was used to determine significance between treatment groups. Cox regression models were used to produce parameter estimates and hazard ratio (HR) for each age group. Results: A total of 195,452 patients with LRPC were identified from 2004 to 2015. There was a significant practice pattern change with increased utilization of NLT over time, from 11.3% in 2004 to 53.5% in 2015, with a turning point in 2009. The utilization was peaked for RP at 41.6% in 2008, EBRT at 24.3% in 2006, and PSI at 35.3% in 2004, but dropped to 17.6%, 18.1%, and 10.8%, respectively, in 2015. Of different treatment modalities, compared to NLT, RP provided a superior OS with a HR of 0.662, p &lt; .0001; PSI also improved OS with an HR of 0.795, p &lt; .0001. However, EBRT did not improve OS and was potentially detrimental, HR = 1.049, p = 0.01. With age-matched subgroup analysis, the survival advantage based on HR of RP relative to NLT favors RP until the age of 74 but diminishes as age increases. In patients younger than 70, NLT provided comparable survival to EBRT or PSI. The survival advantage of EBRT or PSI is only seen in older patients, at age of 75 or older for EBRT and 70 or older for PSI. Conclusions: There has been a significant treatment pattern change between 2004 and 2015. AS, as represented by the NLT in this study, has become the dominant choice of treatment for LRPC. However, of different treatment modalities, both RP and PSI improve OS. The patients managed with AS had comparable OS to those who received EBRT. The survival benefit of RP is mostly seen in younger patients. Only older patients benefit from PSI or EBRT. This study is limited by its retrospective nature and inherent bias in NCDB.

The analysis of breast cancer survival in East Azerbaijan province of Iran; prognostic impact of chemotherapy and hormone therapy protocols

BackgroundThe global cancer pattern indicated that there were about 2.3 million newly diagnosed breast cancer cases in 2020 worldwide, and was the most common cancer incident in the world. The aim of the study was to assess the prognostic impact of various treatment modalities and cancer-specific overall and disease-free survival rates. MethodsOne, 5-, 10-, and 15 -years survival rates were calculated; furthermore, overall survival (OS) and disease free survival (DFS) rates were obtained using Kaplan Meier method. To assess the effects of different treatment methods and all clinico-pathological variables with OS and DFS, cox-regression method was used to achieve adjusted hazard ratios of mortality and recurrence rates. ResultsDuring the study period, 504 primary breast cancer cases were evaluated, with mean age of 49.69(± 10.68) years. The one, 5-, 10-, and 15- year survival rates were 98.21%, 87.39%, 68.17% and, 60.60%, respectively. Tamoxifen + GnRh Agonist and Tamoxifen protocols decreased the hazard of relapse 46% and 84%, respectively. The best one-year OS was obtained for patients treated with Tamoxifen with an aromatase inhibitor (AI) for about 100% overall survival rate. The breast cancer mortality rate was lower than relapse rate in the first and 5thyears of disease, but 10- and 15- year mortality were higher than 10- and 15 -year relapse rates. ConclusionOur results revealed better overall survival and disease- free survival among primary breast cancer patients in East Azerbaijan; consequently, this underscores establishing and using better chemotherapy and hormone therapy protocols and sufficient follow-ups.

146P Impact of breast cancer treatment on sexual health in pre-menopausal women

With increasing awareness and provision of better treatment modalities, younger women with breast cancer have increased survival. However, due to long term treatment related side effects, they experience an overall decline in sexual health. The study aimed to analyze the incidence of sexual dysfunction in breast cancer survivors and the impact of various treatment modalities on female sexuality. All non-metastatic pre-menopausal women diagnosed with breast cancer or undergoing therapy for breast cancer were enrolled in the study between January to December 2020; and were assessed by Female Sexual Function Index questionnaire (FSFI) before starting therapy, immediately (4 weeks) after completion of therapy and at 3 months follow up. Comparison of FSFI scores between patients who underwent mastectomy versus breast conservation surgery (BCS) and patients on hormonal therapy versus non-hormonal therapy on follow up was done. A total of 150 patients were included in the study. Seventy percent patients underwent mastectomy (n=104) and the rest underwent BCS (n=46). Based on the cut off of 26.55, 82.6% (124) patients had persisting sexual dysfunction at 3 months post treatment. The median scores of BCS group was significantly better than mastectomy group at 3 months (22.85 +/- 2.19 versus 21.75 +/- 2.09, p= 0.002). When individual domains were compared between the two groups at 3 months, arousal, lubrication, orgasm and pain showed more reduction in patients undergoing MRM as compared to BCS, however the differences were not statistically significant. Median FSFI scores were comparable in patients receiving hormonal therapy, versus non- hormonal therapy group (22.3 +/- 2.15 versus 21.9 +/- 2.23, p=0.718). When individual domain were compared desire, arousal and pain showed more reduction in hormonal group as compared to non-hormonal group, however the differences were not statistically significant. Overall, high incidence of sexual dysfunction was seen in breast cancer survivors, which was significantly more in patients who underwent mastectomy. Further studies are needed to address sexual dysfunction in breast cancer survivors and measures to alleviate the same.

Recent treatment patterns and survival outcomes in pancreatic cancer according to clinical stage based on single-center large-cohort data.

Backgrounds/AimsWe performed a retrospective, single-center cohort study to evaluate the impact of various treatment modalities and recent changes in treatment modalities, including the increased application of chemotherapy, on survival in patients with pancreatic cancer.MethodsAll patients with pancreatic cancer who were diagnosed and treated at Seoul National University Hospital between January 2007 and December 2014 were registered in a prospective clinical database and included in this retrospective study. All patients' radiologic imaging diagnoses were re-reviewed according to the National Cancer Center Network guidelines. The patients were divided into four groups according to their clinical stage, and each clinical stage group was further divided into four groups according to treatment modality.ResultsOverall, 475 (28.9%) patients had resectable pancreatic cancer, 129 (7.8%) patients borderline resectable pancreatic cancer, 384 (23.3%) patients locally advanced pancreatic cancer, and 658 (40.0%) patients metastatic pancreatic cancer. Among the patients with borderline resectable pancreatic cancer, the median survival was significantly longer in the neoadjuvant therapy (NAT)+surgery groups (24 months) than the surgery without NAT (16 months) group (p=0.049). A multivariate survival analysis revealed that compared with the surgery group, the 5-year mortality risk was decreased by 35% in the NAT+surgery group (24 vs. 20 months, p=0.045).ConclusionsThis retrospective cohort study showed that the rates of resectable and surgically treatable pancreatic cancer were 29.1% and 32.2%, which are higher than those reported previously, and aggressive NAT for select advanced-stage patients could lead to better survival outcomes.

Inherited and Acquired Thrombophilia As a Modifier of Clinical Course of Chronic Idiopathic Thrombocytopenia - a Prospective Study

Background: Patients with idiopathic thrombocytopenia exhibit striking heterogeneity in bleeding manifestations even at similar platelet counts. Proposed mechanisms are generation of platelet microparticles, complement activation, NO depletion, and impact of various treatment modalities. In the present study, we studied the prevalence of thrombophilic markers in persistent and chronic ITP patients and that whether the presence of such markers modifies the clinical course of these patients.Methods: Patients diagnosed as persistent or chronic ITP (of any age group) were eligible. All patients were evaluated at baseline and at regular follow-up visits using newly available Bleeding Assessment Tool (ITP-BAT, version 1.0) proposed by International Working Group on ITP. For analyses, severity of bleeding was defined as no bleeding (bleeding score zero at all domains I.e. skin, mucosa and organ), mild bleeding (skin and mucosal bleeding score 0-2, organ bleeding score 0-1) and severe bleeding (skin and mucosa bleeding score >2, and organ bleeding score >1). Baseline thrombophilia profile was obtained for all patients, that included clot-based assays for protein C (PC), protein S (PS), ProCGlobal, FVIII levels (F8), and lupus anticoagulant assay (LA). We then compared the patients expressing atleast one thrombophilia marker (TM+) and those without (TM-), for the number of times patients in each group presented with a bleeding episode. We derived the parameter bleeding episodes per visit to estimate severity of bleeding in each group [mild bleeding episode/visit (MBE/visit) and severe bleeding/visit (SBE/visit)].Statistical analysis was done using odds ratio calculation and correlation regression analysis.Results: Of the total 88 patients enrolled, 21 were males (23.4%), and remaining 67 (76.5%) were females. Out the total, 57 patients (64.7%) tested positive for at least one thrombophilic marker, and remaining 31 patients (35.2%) were negative for all markers. Raised factor VIII was found in 36 patients (40.9%), low protein S in 29 patients (32.9%), low protein C in 14 patients (15.9%), abnormal Pro® C global in 22 patients (25%), and lupus anticoagulant positive in 9 patients (10.2%). Thirty three (37.5%) patients expressed thrombophilic markers in various combinations. Evaluation for impact of thrombophilia marker on bleeding is as shown in Table 1.Summary: Sixty-five percent of patients had thrombophilia marker positive in various combinations. Those with thrombophilia had lower bleeding tendency compared to those with none. Patients with low protein C and S, abnormal ProcGlobal and lupus positivity had significantly lower bleeding tendencies, while FVIII abundance did not impact the bleeding scores.Conclusion: We conclude that a part of the heterogeneity in the clinical presentation of persistent and chronic ITP can be explained by the presence or absence of thrombophilia, and that work-up of patients with ITP should include thrombophilia evaluation, the results of which may have a role in therapeutic decision making. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Adjuvant chemotherapy after esophagectomy: Is there a role in the treatment of the lymph node positive thoracic esophageal squamous cell carcinoma?

Esophageal squamous cell carcinoma (ESCC) patients with regional lymph node metastases have poor prognosis after surgery. The purpose of this study was to investigate the impact of various treatment modalities on survival in these patients. We retrospectively reviewed data from 349 patients who had undergone left transthoracic esophagectomy for thoracic ESCC from January 2008 to December 2010 at our institute. All patients had lesions in the mid or lower third of the thoracic segment and had pathological positive lymph node metastasis. Of these patients, 143 patients received surgery alone, 154 patients underwent postoperative radiotherapy alone, and 52 patients underwent taxane-based chemotherapy. Univariate and multivariate Cox regression analyses were used to analyze prognostic factors and survival. At a median follow-up of 53.1 months, the 3-year OS were 47.7% for the patients with surgery alone, 44.0% for the patients with adjuvant radiotherapy, and 58.9% for the patients with adjuvant chemotherapy. Multivariate analysis showed that postoperative therapy with adjuvant chemotherapy was significant positive predictor of survival. Postoperative taxane-based adjuvant chemotherapy improved survival of patients with lymph node positive thoracic ESCC compared with surgery alone. Further randomized prospective studies to confirm these findings are warranted.

Impact of Various Treatment Modalities for Carcinoma Cervix on Sexual Function Assessed Using the LENT SOMA Scales

Impact of Various Treatment Modalities for Carcinoma Cervix on Sexual Function Assessed Using the LENT SOMA Scales

EP-1340: Impact of various treatment modalities for carcinoma cervix on sexual function assessed using the LENT SOMA scales

EP-1340: Impact of various treatment modalities for carcinoma cervix on sexual function assessed using the LENT SOMA scales

EP-1102: Impact of various treatment modalities for carcinoma cervix on sexual function assessed using the LENT SOMA scales

EP-1102: Impact of various treatment modalities for carcinoma cervix on sexual function assessed using the LENT SOMA scales

Impact of various treatment modalities on the outcome of stage IB1–IIA cervical adenocarcinoma

Objective To evaluate the outcomes of patients with stage IB1–IIA cervical adenocarcinoma treated by various modalities in order to formulate a better treatment strategy. Methods The impact of various treatment modalities on the prognosis of 258 patients with stage IB1–IIA cervical adenocarcinoma was investigated. The therapeutic modalities included radical surgery (n = 174); radical surgery followed by adjuvant radiation therapy (RT), such as RT alone or concurrent chemo-radiotherapy (CCRT) (n = 46); or primary RT or CCRT (n = 38). Results As compared with patients in the surgery-only group, patients with 1 postoperative major risk who underwent surgery followed by RT or CCRT had a significantly higher likelihood of disease relapse (2.3-fold, P = 0.041) and disease-related death (2.9-fold, P = 0.014). The likelihood of recurrence ( P = 0.32) and death ( P = 0.58) did not differ between patients who underwent adjuvant RT or CCRT for 1 major risk factor and those who underwent primary RT or CCRT. By contrast, patients with more than 1 major risk factor had a higher likelihood of disease recurrence (2.9-fold, P = 0.037) and disease-related death (3.4-fold, P = 0.051) than those who underwent primary RT or CCRT. Conclusion Radical surgery is recommended for patients with stage IB1–IIA cervical adenocarcinomas without contraindications. Those with more than 1 postoperative pathologic risk factor had the worst prognosis despite adjuvant RT or CCRT.

Comparative immunohistochemical analysis of aurora-A and aurora-B expression in human glioblastomas. Associations with proliferative activity and clinicopathological features

In the present study, we carried out a comparative immunohistochemical analysis of aurora-A and aurora-B expression in 40 patients with primary glioblastomas, and attempted to identify any associations with Ki-67 index and the patients’ clinical features. The impact of various treatment modalities and proliferative activity on patient outcome was also assessed. Immunohistochemistry was carried out using formalin-fixed and paraffin-embedded tissue sections. Aurora-A expression was higher in tumors with high Ki-67 expression ( p=0.01) and was positively, though marginally, related to aurora-B expression ( p=0.085). Aurora-B expression was not linked to Ki-67 expression ( p=0.182). Lower aurora-A immunohistochemical expression, chemotherapy administration, and tumor localization in one lobe of the brain implied a greater probability of patient survival in univariate analysis ( p=0.044, p=0.008, p=0.041, respectively). Ki-67 and aurora-B immunoreactivities were not associated with patient survival ( p=0.918 and p=0.539, respectively). To our knowledge, for the first time, the association between aurora-A and aurora-B expression, the correlation of aurora-A with Ki-67 index, and the prognostic impact of aurora-A expression were assessed in glioblastomas. Although we addressed a prognostic connotation of aurora-A, we presume that aurora-A and aurora-B play a complicated role within glioblastomas. Further examinations of larger series are required, so that definite conclusions can be drawn.

Recurrence pattern in squamous cell carcinoma of skin of lower extremities and abdominal wall (Kangri cancer) in Kashmir valley of Indian subcontinent: Impact of various treatment modalities

Background:The spectrum of skin cancer in Kashmir valley is drastically different from the rest of the country. Maxwell was the first to report skin cancer of lower extremities in Kashmiri population, developing on/over erythema ab igne, and attributed it to the use/or exposure of Kangri. These tumors have an aggressive biological behavior with a substantial risk of loco-regional metastasis in 30-50% cases. Because of unique geographical distribution of Kangri cancer, there is dearth of literature regarding the natural history, loco-regional and distant metastatic pattern and treatment recommendations in these tumors.Aims:To study the metastatic pattern of these skin tumors and to assess the impact of various treatment modalities and use of prophylactic nodal treatment in this clinical entity.Methods:The retrospective study (study period 1993-2005) included 266 patients of squamous cell carcinoma of skin of lower extremities and abdominal wall. Two hundred and forty-four cases with a follow-up of 2-7 years were included for final analysis with stress on loco-regional relapse pattern and methods of treatment evolved and used at our institute from time to time. Statistical analysis was done using yates corrected Chi-square test and odds ratio analysis.Results:Our results favor the use of post operative radiotherapy to primary and prophylactic treatment of regional nodes on the lines of head and neck tumors in these cases.Conclusion:Post operative radiotherapy significantly decreases the loco-regional recurrences and a trial of prophylactic nodal irradiation is justified in a selected group of such patients.

Timing of clinical improvement and symptom resolution in the treatment of major depressive disorder

The goal of the present work is to assess for the relationship between the timing of clinical improvement and the resolution of depressive symptoms in Major Depressive Disorder (MDD). 182 MDD outpatients (40.5 ± 9.7 years; 53.8% female) who responded following an 8-week, 20 mg, open trial of fluoxetine were included in the analysis. The symptoms questionnaire (SQ) and Beck hopelessness scale (BHS) were also administered to 83 and 153 of these patients, respectively. Onset of clinical improvement was defined as a 30% decrease in 17-item Hamilton depression scale (HDRS-17) scores. Controlling for baseline symptom severity, we then assessed for the relationship between the timing of clinical improvement and depressive symptom at endpoint. Earlier clinical improvement in responders predicted lower HDRS-17, BHS, SQ-depression, SQ-anxiety, but not SQ-somatic symptom or SQ-anger/hostility scores at week 8. This was true regardless of whether improvement was defined as a continuous measure (30% decrease in symptom severity), as a dichotomous measure (clinical response occurring in the first two weeks of treatment). In conclusion, earlier clinical improvement with fluoxetine treatment is predictive of greater symptom resolution at endpoint. Further studies exploring the impact of various treatment modalities and placebo on the timing of clinical improvement and symptom resolution in MDD are warranted.

Aggressive treatment for bladder cancer is associated with improved overall survival among patients 80 years old or older

Objectives To examine the impact of various treatment modalities on survival among patients with bladder cancer who were 80 years old or older compared with younger patients. A compendium of evidence suggests that bladder cancer surgery is safe among octogenarians; however, the benefit of such treatment in a population with limited life expectancy has not been well documented. Methods Subjects with the primary diagnosis of bladder cancer were identified from the National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry between 1988 and 1999. Of the 13,796 patients diagnosed with bladder cancer, 24% were older than 80 years of age. Proportional hazards regression modeling was performed to determine the independent association of treatment strategy on overall and bladder cancer survival while adjusting for multiple covariates. Results Of patients 80 years old or older, bladder cancer management included watchful waiting (7%), radiotherapy alone (1%), full or partial cystectomy (12%), and transurethral resection (79%). Patients 80 years old or older were less likely to be treated with extirpative surgery than their younger counterparts ( P <0.0001). Cox proportional hazards models demonstrated that, among patients 80 years old or older, radical cystectomy/partial cystectomy had the greatest risk reduction in death from bladder cancer (hazard ratio 0.3) and death from any cause (hazard ratio 0.4) among the primary treatment modalities (both P <0.0001). Conclusions Disparities in practice patterns between younger and geriatric patients with bladder cancer exist. We provide compelling evidence that aggressive surgical management of bladder cancer in these patients may improve survival. Risk adjustment tools should be used to identify patients (young and old) who would be better served by less aggressive management.

Functional outcomes in head and neck cancer

For advanced head and neck cancer (HNC) patients, the effects of disease and the side effects of aggressive treatments have the potential to severely affect function and quality of life. More recent treatment strategies offer patients many options and have increased rates of locoregional control. However, they have not eliminated either acute treatment side effects or the spectrum of negative late sequelae, such as eating and speech dysfunction, residual pain, and troublesome dryness of the mouth. Understanding this broad spectrum of side effects and how patients experience them as well as the functional and quality of life implications is important to treatment evaluation and patient decision making. The heterogeneity of HNC patients (in terms of tumor site), the diversity of surgical techniques and chemoradiotherapy regimens, together with individual patient differences in response to these variables, make it particularly difficult to describe precise outcomes attached to various treatment options. However, in the context of this caveat, there are increasing data documenting the impact of various treatment modalities on physical, functional, and QOL outcomes. This article presents some of these data with a focus on the performance and functional results of radiation therapy, surgery, or concomitant chemoradiation therapy.