This study evaluated the toxicity resulting from combined therapy using carboplatin and radiotherapy in 22 patients with locally advanced (stage III and IV) head and neck cancer. Carboplatin was given after radiotherapy during the first 5 consecutive days of a 16-fraction course of radiotherapy delivered in a total of 22 days. To find the acceptable toxic dose of carboplatin, the patients were treated in groups of 3 patients each. The first group received 50 mg/m2 carboplatin and the dose was increased by 10 mg/m2 in each subsequent group. Unacceptable toxicity (severe mucositis, nausea and vomiting, and/or myelosuppression) was encountered at a carboplatin dose of 80 mg/m2. A further 10 patients were then treated at a dose of 70 mg/m2. At this dose toxicity was acceptable. Although the group of 22 patients is too small for response and survival data to be meaningful, 10 complete responses were seen and median survival is in excess of 67 weeks.

Aged↗

PubMedDate not supplied

Attributions of cause and recurrence in long-term breast cancer survivors.

UNLABELLED: Women are bombarded with information about the purported causes and the prevention of breast cancer. This survey sought to determine to what women survivors of breast cancer attributed the cause and lack of recurrence of their breast cancer, and whether these views were associated with specific health behaviors. METHODS: Women who had survived breast cancer without recurrence for at least 2 years were surveyed by mail about their views on the cause and lack of recurrence of their breast cancer. They were also asked to estimate their personal risk of cancer recurrence, report on their health behaviors, describe what advice they would give to women newly diagnosed with breast cancer, and what they would change if they had to relive their breast cancer experience. RESULTS: 378 (75.6%) women breast cancer survivors responded who had been recurrence free for a mean of 8.6+/-11.8 years. Women (n=322) who responded to the question about the cause of breast cancer attributed it to stress (42.2%), genetics (26.7%), environment (25.5%), hormones (23.9%), don't know (16.5%), diet (15.5%), and breast trauma (2.8%). Women (n=330) who responded to the question about what prevented cancer recurrence attributed it to positive attitude (60.0%), diet (50.0%), healthy lifestyle (40.3%), exercise (39.4%), stress reduction (27.9%), prayer (26.4%), complementary therapies (11.2%), don't know (5.1 %), luck (3.9%), and tamoxifen (3.9%). Most women felt their recurrence risk was average (44.8%), or below average (35.8%). Some attributions of breast cancer cause or lack of recurrence were associated with specific health behaviors. The majority of women survivors would advise other women with breast cancer to be positive, and if they had to relive their cancer experience they would take more control of their treatment. DISCUSSION: Despite lack of evidence substantiating stress as a cause of breast cancer, many breast cancer survivors believed stress caused their cancer. An even higher percentage of survivors believed their positive attitude had prevented breast cancer recurrence and they would advise other women with breast cancer accordingly. Attribution beliefs clearly affected survivors' health behaviors. CONCLUSION: Healthcare providers should consider the personal beliefs of patients about cancer cause and recurrence, which may be at variance with scientific evidence. This may assist in framing the management of patients in personally meaningful ways, which may increase health behaviors, adherence, satisfaction and quality of life. Whether it will increase survival remains unknown.

Adaptation, Psychological↗

PubMedDate not supplied

Long-term breast cancer survivors: confidentiality, disclosure, effects on work and insurance.

UNLABELLED: As more women are diagnosed with breast cancer, more will survive the illness from a few years to a lifetime. This study sought to determine the experience of Canadian breast cancer survivors with respect to the impact of cancer on confidentiality, work and insurance. METHOD: Women who had survived breast cancer without recurrence for at least 2 years completed a mail survey about the effect of their illness on confidentiality, disclosure, work and insurance. RESULTS: 378 (75.6%) women breast cancer survivors responded to the survey. Their mean age was 61.0+/-10.9 years, and 67.6% had been recurrence free for more than 5 years. The majority of women rated hospital staff, family doctors, family, friends, and support groups at the highest possible level of confidentiality. Over 70% of survivors disclosed their diagnosis to friends, children, siblings, and partners, while over 50% disclosed to work colleagues and supervisors. However, over 40% felt cancer had altered their priorities or progress at work, and 5% were afraid to change jobs in case they became ill again. There was a lack of knowledge about insurance but, of the types of insurance identified, life insurance (17.9%), extended health insurance (7.7%), and private disability insurance (4.4%) were reported to have been refused or offered only with higher premiums as a result of a past diagnosis of breast cancer. DISCUSSION: A substantial minority of women perceived that cancer had substantially affected their personal and work lives. Although most felt their illness confidentiality was well protected and they disclosed freely to family, friends, and work, over 40% of women survivors reported that cancer had affected their work in various ways, and nearly 20% identified insurance problems. It appears that disclosure sometimes results in negative work and insurance experiences. CONCLUSIONS: Health professionals and cancer survivors should engage in education about the potential positive and negative effects of disclosure, and advocacy against cancer-based work and insurance discrimination.

Adaptation, Psychological↗

PubMedDate not supplied

Percutaneous ethanol injection of unresectable medium-to-large-sized hepatomas using a multipronged needle: efficacy and safety.

Fine needles with an end hole or multiple side holes have traditionally been used for percutaneous ethanol injection (PEI) of hepatomas. This study retrospectively evaluates the safety and efficacy of PEI of unresectable medium-to-large (3.5-9 cm) hepatomas using a multipronged needle and with conscious sedation. Twelve patients, eight men and four women (age 51-77 years; mean: 69) received PEI for hepatomas, mostly subcapsular or exophytic in location with average tumor size of 5.6 cm (range: 3.5-9.0 cm). Patients were consciously sedated and an 18G retractable multipronged needle (Quadrafuse needle; Rex Medical, Philadelphia, PA) was used for injection under real-time ultrasound guidance. By varying the length of the prongs and rotating the needle, the alcohol was widely distributed within the tumor. The progress of ablation was monitored by contrast-enhanced ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) after each weekly injection and within a month after the final (third) injection and 3 months thereafter. An average total of 63 mL (range: 20-154 ml) of alcohol was injected per patient in an average of 2.3 sessions. Contrast-enhanced CT, ultrasound, or MRI was used to determine the degree of necrosis. Complete necrosis was noted in eight patients (67%), near-complete necrosis (90-99%) in two (16.7%), and partial success (50-89%) in two (16.7%). Follow-up in the first 9 months showed local recurrence in two patients and new lesions in another. There was no mortality. One patient developed renal failure, liver failure, and localized perforation of the stomach. He responded to medical treatment and surgery was not required for the perforation. One patient had severe postprocedural abdominal pain and fever, and another had transient hyperbilirubinemia; both recovered with conservative treatment. PEI with a multipronged needle is a new, safe, and efficacious method in treating medium-to-large-sized hepatocellular carcinoma under conscious sedation. Its survival benefits require further investigations.

Administration, Cutaneous↗

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Clinical significance of isolated paraventricular cysts on cranial ultrasonography.

OBJECTIVES: Isolated paraventricular cysts detected on routine cranial ultrasonography in premature and full term neonates are often incidental findings. The aetiology and clinical significance of these lesions is uncertain. A case control study was designed to attempt to clarify the clinical significance of isolated paraventricular cysts in terms of growth and neurodevelopment. METHODS: Ten infants with isolated paraventricular cysts on neonatal cranial ultrasonography were identified. These were matched with 10 control infants for sex, gestational age and birthweight. All infants were assessed at a corrected age of 18-31 months for growth and neurodevelopment. Two index infants and their controls were excluded from analysis of psychometric data as the neurodevelopmental assessment tools used were different. RESULTS: There was no statistically significant difference between the index and control groups in terms of growth, motor and psychometric assessment at follow up. CONCLUSIONS: The study suggests that isolated paraventricular cysts detected on routine cranial ultrasonography have no prognostic significance. However the study involved a small sample size with limited power of study (power = 0.3). A larger prospective cohort study would help to clarify the clinical significance of this condition.

Case-Control Studies↗

PubMedDate not supplied

Presence of p53 mutation in human cervical carcinomas associated with HPV-33 infection.

In this present study, we report the mutation of the p53 gene in vivo in human primary carcinomas of cervix and cervical intraepithelial neoplasia (CIN). The association of the HPV subtypes with the tumors was determined by multiplex primer polymerase chain reaction (PCR) amplification. The mutation of the p53 gene was detected using PCR amplification of the p53 exons followed by SSCP (single strand conformation polymorphism) and DNA sequencing analysis. The p53 mutation was detected in two out of two HPV-33 positive carcinomas but was absent in the HPV-16/-18 positive carcinomas (0 out of 8 cases). The p53 mutation was also detected in one out of four HPV-negative cervical carcinomas. No mutation of the p53 gene was detected in the CIN specimens (0 out of 7 cases). The two mutations in the HPV-33 associated cervical carcinoma were detected at codon 273 (CGT to TGT; arginine to cysteine) and intron 5 (24 base pair downstream of the 3' end of exon 5). The p53 mutation at codon 273 has been previously reported in one of the HPV-negative cervical carcinoma cell line (C33A). Our results indicate that mutation of the p53 gene is not a common event in human cervical cancers (3/14), and may be related to the infection of HPV-16/18 in the tumor. However, mutation of the p53 gene was detected in cervical carcinomas associated with HPV-33 and may be an important genetic event in this subgroup of carcinomas.

Amino Acid Sequence↗