Background and purposeIn developing countries like Pakistan the cost effectiveness and patient convenience in any treatment modality is a question of major concern. The purpose of this study was two-fold; first to report our experience with a high-dose rate Iridium-192 surface mould brachytherapy of keloid scars after surgical excision, using different radiation treatment regimen and second to establish the most convenient and cost effective treatment protocol having no compromise on the treatment outcomes.Materials and methodsFrom January 2012 to April 2015 a total 51 patients with 65 keloid lesions underwent postoperative Iridium-192 high-dose rate surface mould brachytherapy. The dose regimen used was: 8 Gy in a single fraction, 10 Gy in a single fraction, 15 Gy in three fractions and 18 Gy in three fractions. The median follow-up period was 33 months (range 15–53 months).ResultsThe success rates were 57·2, 89·5, 85 and 89·5% for the treatment regimen of 8 Gy/F×1, 10 Gy/F×1, 5 Gy/F×3 and 6 Gy/F×3, respectively. Grade 2 or above radiation induced toxicity was not observed.FindingsThe results of this study show that a dose regimen of 10 Gy (biological effective dose=20 Gy) in a single fraction have comparable results with a dose regimen of 15 Gy in three fractions or 18 Gy in three fractions. 10 Gy in a single fraction is therefore the most convenient and cost effective dose regimen for the management of keloid scars in developing countries like Pakistan, while 8 Gy in a single fraction is considered suboptimal and discouraged in practice.
Associations of GSTT1, GSTM1 and CYP1A1 gene variants with risk of developing oral cancer were evaluated in this study. A case-control study was conducted in Pashtun population of Khyber Pakhtunkhwa province of Pakistan in which 200 hospital based oral cancer cases and 151 population based healthy controls exposed to similar environmental conditions were included. Sociodemographic data were obtained and blood samples were collected with informed consent for analysis. GSTM1 and GSTT1 were analysed through conventional PCR method while specific RT-PCR method was used to detect CYP1A1 polymorphisms. Results were analyzed for conditional logistic regression model by SPSS version 20. The study shows that patients with either GSTM1 or GSTT1 null genotypes have significantly higher risk of oral cancer (adjusted odds (OR): (3.019 (1.861-4.898) and 3.011(1.865-4.862), respectively), which further increased when either one or both null genes were present in combination (adjusted odds (OR): (3.627 (1.981-6.642 and 9.261 (4.495-19.079), respectively). CYP1A1 rs4646903 gene variants individually showed weak association OR: 1.121 (0.717-1.752); however, in the presence of GSTM1 and/or GSTT1 null genotypes further increasing the association (adjusted odds (ORs): 4.576 (2.038-10.273), 5.593 (2.530-12.362) and 16.10 (3.854-67.260 for GSTM/GSTT null and CYP1A1 wild type, GSTM/GSTT either null and CYP1A1 variant alleles, and all 3 gene polymorphisms combinations, respectively). Our findings suggest that presence of GSTM1 and/or GSTT1 null genotypes along with variant alleles of CYP1A1 may be the risk alleles for oral cancer susceptibility in Pashtun population.
Background: Biphasic pulmonary blastoma (BPB) is an uncommon and aggressive malignancy of the lung. Herein, we report a recurrent BPB in a young patient.
Case Presentation: A 26-year-old female patient presented with respiratory distress and cough. Radiological workup illustrated well-circumscribed mass lesion (size ~ 6 cm) in the lateral basal segment of the lower lobe of the right lung, for which the patient underwent lobectomy. Histopathology revealed BPB. The patient was kept on close follow-up without any oncological intervention and remained disease-free for 3 years. Afterward, the patient presented with recurrent disease (i.e., a pulmonary oval nodule of size ~ 1.4 ×1.2 cm) and metastasis in the right renal region with infiltration into the right T12-LV1 and LV2 vertebrae. The patient was given three courses of multi-agent chemotherapy (i.e., ifosfamide, carboplatin, and etoposide), which resolved the pulmonary lesion only.
Conclusion: Ultimately, our study indicates that BPB is an aggressive disease and demands multimodality treatment toward favorable prognosis.s.
Background: Primary malignant melanoma (PMM) of the parotid is a very rare tumor. Herein, we report a case of PMM of the parotid with extensive metastasis.
Case Presentation: A 25-year-old male patient presented with progressively enlarging firm nodule in the right parotid gland. The patient underwent total right parotidectomy. Histopathology revealed malignant melanoma of the parotid. Metastatic workup demonstrated lymphadenopathy in the ipsilateral cervical, epigasterium and para-aortic regions, metastatic spread in the liver, pancreas, and bones, and thereby, was not fit for any oncological intervention.
Conclusion: This study indicates that PMM of the parotid is a rare and highly aggressive malignancy.
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