PURPOSE: This study was undertaken to analyze the efficacy and sphincter preservation rate of platinum based neoadjuvant chemotherapy plus radiotherapy versus abdominoperineal resection and postoperative radiotherapy for anal cancer. MATERIALS AND METHODS: Data of forty-two patients with anal cancer were retrospectively analyzed. Among thirty-eight patients with epidermoid histology, four patients received radiotherapy, and nineteen patients received abdominoperineal resection and adjuvant radiotherapy with or without chemotherapy (APR+RT+/-CT), and fifteen patients received neoadjuvant chemotherapy and radiotherapy (CRT). The CRT regimen was composed of three cycles of 5-fluorouracil (1,000 mg/m2 bolus on D1-5) and cisplatin (60 mg/m2 bolus on D1) followed by 50.4 Gy to the tumor bed and regional lymphatics over 5.5 weeks. Both inguinal lymphatics were treated with an identical dose schedule. Residual disease was treated with an additional three cycles of identical adjuvant chemotherapy. An identical dose schedule was used for post-operative radiotherapy. Median follow-up period was eighty-five months. RESULTS: Overall five-year survival rates were 80.3%, 88.9 and 79.4% for entire patients, APR+RT+/-CT group, and the CRT group, respectively. No significant difference was found between the two groups (p= 0.49). Anus preservation rate for the CRT group was 86.7%. Age (p=0.0164) and performance status (p= 0.0007) were found to be significant prognostic factors by univariate analysis. Age (p=0.0426), performance status (p=0.0068), and inguinal lymph node metastasis (p=0.0093) were statistically significant prognostic factors by multivariate analysis. No case of RTOG grade 3 complication or higher was reported. CONCLUSION: This and other recent studies have shown that combined chemotherapy plus radiotherapy for anal cancer results in a high rate of anal sphincter preservation as well as local control and survival. Furthermore, neoadjuvant use of chemotherapy with a cisplatin based regimen rather than a concurrent regimen may lead to a decrease in complications.
Anal Canal ; Anus Neoplasms* ; Appointments and Schedules ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Cisplatin ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Platinum ; Radiotherapy ; Radiotherapy, Adjuvant ; Retrospective Studies ; Survival Rate

BACKGROUND AND OBJECTIVES: Angiogenesis is important both in normal and pathologic processes, including wound healing and inflammation. Because proliferating tissues require an enhanced blood supply, angiogenesis appears to be a prerequisite for expansion of cholesteatoma. This study was aimed to investigate mRNA and protein expression of angiogenic growth factors such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), transforming growth factor-alpha (TGF-alpha) and platelet derived-endothelial cell growth factor (PD-ECGF) in middle ear cholesteatoma. SUBJECTS AND METHOD: Cholesteatoma tissues and retroauricular skins were obtained from 12 patients during operation. The mRNA expression was detected by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR), and the degree of expression was measured by comparing density ratio of beta-actin by NIH imaging analysis system. The protein expression was evaluated by immunohistochemistry, and the degrees of expression in epithelial, endothelial, inflammatory cells of cholesteatoma and retroauricular skin were judged by two pathologists and then converted on a 5-grade rating scale according to intensity of expression. RESULTS: The expression rate of mRNA in cholesteatoma and retroauricular skin was 67.7 and 33.3% in VEGF, 75.0 and 50.0% in bFGF, 53.8 and 8.3% in TGF-alpha, 67.7 and 75% in PD-ECGF. There was statistically significant difference only in TGF-alpha (p<0.05). The degrees of VEGF, bFGF, and TGF-alpha mRNA expression were about 2.6, 2.1 and 5.2 times significantly higher than retroauricular skin (p<0.05). And the degree of mRNA of PD-ECGF expression was about 1.4 times higher than retroauricular skin, although there was no statistical significance (p>0.05). The degrees of VEGF, bFGF and PD-ECGF protein expression in cholesteatoma tissue were more intense at the inflammatory (p<0.05), endothelial (p<0.05) and epithelial cell (p>0.05) than in retroauricular skin. And the degree of TGF-alpha protein expression in cholesteatoma tissue was more intense at all three cells (p<0.05) than in the retroauricular skin. CONCLUSION: These results suggest that angiogenesis processes in cholesteatoma perimatrix and the expression of angiogenic growth factors are upregulated by mRNA. Further studies for evaluating the factors that can affect the expression of mRNA and also for disclosing the roles and control mechanisms of these factors in cholesteatoma angiogenesis must be followed.
Actins ; Angiogenesis Inducing Agents ; Blood Platelets ; Cholesteatoma ; Cholesteatoma, Middle Ear* ; Ear, Middle* ; Epithelial Cells ; Fibroblast Growth Factor 2 ; Humans ; Immunohistochemistry ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Pathologic Processes ; RNA, Messenger ; Skin ; Thymidine Phosphorylase ; Transforming Growth Factor alpha ; Vascular Endothelial Growth Factor A ; Wound Healing

One case of arthritis complicating leukemia is described in which leukemic cells were identified in synovial fluid by light microscopy. Although arthritis is a well-known manifestation of leukemia with an incidence of 13.5%, the pathogenesis often is unclear, and the direct demonstration of leukemic cells in synovial fluid has been very uncommon. A 16 year-old male patient was admitted due to left elbow joint pain and swelling. Synovial fluid examination revealed blast cells and this finding has directed to a final diagnosis of acute lymphoblastic leukemia.
Adolescent ; Arthritis/*etiology ; Humans ; Leukemia-Lymphoma, Adult T-Cell/*complications/diagnosis/pathology ; Male

Combined peginterferon and ribavirin therapy for chronic hepatitis C is associated with several adverse side effects, but sudden deafness is uncommon. Here we report the case of a 62-year-old female with chronic hepatitis C (genotype 1b) who developed sudden deafness after completing 12 months of treatment with peginterferon alpha2a (180 microg/week) and ribavirin (1,000 mg/day). Pure-tone audiometry revealed a right-sided sensorineural hearing loss, which did not respond to 2 weeks of systemic corticosteroid therapy. Six months after the end of treatment for chronic hepatitis C, her qualitatively determined hepatitis C virus RNA level was 121,000 IU/mL. Following therapeutic failure, the patient was observed without retreatment for chronic hepatitis C or her hearing loss for a period of 12 months, during which time her hearing recovered almost completely.
Audiometry, Pure-Tone ; Female ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Hepacivirus ; Hepatitis C, Chronic* ; Humans ; Middle Aged ; Retreatment ; Ribavirin* ; RNA