がんの科学と治療

Radiotherapy is a common treatment for prostate cancer, but failure is observed 30 to 40% of the time. It is more common in patients with abnormal p53. The phytochemical diferuloylmethane (curcumin) a naturally occurring fl avinoid derived from the rhizome of Curcuma longa, shows potential radiosensitizing effects. In the present study, the effect of curcumin and radiation on cell viability, apoptosis and clonogenic cell death was examined in LNCaP (wild type p53) and PC3 (mutant p53) prostate cancer cells.

The expression of p53 and p53 target genes was examined using RNase protection assay and Western blot analysis. Cell cycle and apoptosis was evaluated by fl ow cytometry. Cell viability and colony formation was examined using MTT assay and clonogenic assay respectively.

The expression of p53, p21 and gadd45 increased in LNCaP cells after radiation exposure. In PC3 cells, there was no change in expression in mutant p53 after radiation or curcumin treatment. However, the expression of p21 and gadd45 increased after curcumin treatment in PC3 cells independent of p53. Curcumin induced cell growth arrest and apoptosis in both the cell lines. The cell viability and cell proliferation decreased in presence of both curcumin and radiation as compared to curcumin or radiation alone in both the cell lines. Regardless of p53 status, combination treatment with curcumin (2.5 to 10 μM) and radiation (2 Gy) had a synergistic effect on clonogenic cell death in both LNCaP and PC3 cells.

Conclusion: Curcumin appears to radiosensitize prostate cancer cells and may be a possible adjuvant to radiotherapy in the treatment of prostate cancers.

A national survey to obtain information about the Quality Assurance (QA) procedures and methods being followed at Indian radiotherapy centers for intensity modulated radiation therapy (IMRT) was conducted. A questionnaire containing parameters relevant to IMRT QA was evolved to collect the information pertaining to the QA of IMRT delivery system, QA of IMRT treatment planning system, and patient specific IMRT QA. The questionnaire was circulated to 40 hospitals in the country and responses of 31 centers were received. Survey results showed that 71% centers are having adequate machine specifi c IMRT QA programme, 19% centers have inadequate machine specific IMRT QA programme and 9% centers have irrelevant machine specific IMRT QA programme. No specific answer for question of QA tests of TPS specific to IMRT were received from the user. Almost all the centers have programme of setup verification of the patient by means of EPID/DRR/OBI. However, 91% of centers could not provide any information about the QA methodology of the devices used for setup verification. For patient specific dosimetric QA, almost all the hospitals have the program of pre-treatment dose verification using calibrated ionization chambers of sensitive volumes in the range of 0.01 to 0.65 cc. Dosimetric verification is performed by combining dose from all gantry angles to a single gantry angle. Two dimensional (2D) dosimetry systems such as radiographic and radiochromic films, 2D array of ionization chambers/ semiconductor diodes and EPID are also used in patient specific dosimetry verifications. Majority of the centers (about 48%) accept the plan with 3% dose difference and 3 mm dose to distance agreement criteria with gamma index less than unity. However, a number of other acceptance criteria specific to institution and tumor site are being also followed. This survey reveals that a variety of IMRT QA program is being followed at the Indian hospitals. This study has brought into focus the need to evolve a national protocol for IMRT QA so that treatment outcomes of all the IMRT centers of country can be compare

Objective: To develop a reliable method of diagnosing the position of a displaced maxillary canine on the basis of a single radiograph. Study design: Based on the criteria of selection, 50 subjects [19 males and 31 females] with a total of 67 impacted canines were evaluated. The ratio of the width of the displaced canine to the width of the homo-lateral central incisor [the canine-incisor index] and the ratio of the width of the displaced canine to the width of the contra lateral canine [caninecanine index] were calculated. The height of the crown of each displaced canine was classifi ed in the vertical plane, relative to the adjacent incisor, as apical, middle or coronal. Results: The canine incisor index [CII] ranges for the labially and palatally impacted canines were 0.66-1.75 and 0.7-2.00 respectively. There was presence of an overlap in these ranges .The canine-canine index [CCI] for labially and palatally impacted canines were 0.875 -1.750 and 0.800-1.857 which again showed an overlap. A cut off point of 1.16 was determined. Conclusion: Provided that vertical restriction and the canine-incisor index were used, the panoramic radiograph can serve as a useful indicator as a single radiograph for determining the position of unerupted maxillary canines.

Adenoid cystic carcinoma (ACC) accounts for approximately 10% of all salivary gland tumors. It is the most common malignant tumor of submandibular and minor salivary glands. The most common location is the palate, generally in the area of the greater foramen. ACC is generally characterized by a slow growth rate, & it is often present for several years before the patient seeks treatment (Jindal and Joshi, 2007). A 28 year old man reported with a swelling on the left side of palate since one and a half years which was diagnosed histopathologically as ACC. A detailed description of the case along with review of literature is presented here with an aim to focus on the importance of detailed or advanced investigations as in the present case.

This prospective, non-randomized study assessed toxicity and potential efficacy of low-dose granulocytemacrophage colony-stimulating factor (GM-CSF), interferon alpha (IFN) and interleukin 2 (IL-2) postoperatively in patients with high-risk renal cell carcinoma (RCC). Eligibility requirements were resected locally advanced (T3b-4 or N1–2) or metastatic (M1) RCC, no prior systemic therapy, and excellent organ function. Patients received treatment during 6 months: GM-CSF, 1 mcg/kg, 3 tiw, s.c., first week of each month; IFN, 10 MIU, 3 tiw, s.c., second week, and IL- 2, 1 MIU, 3 tiw, i.v., third week. Fourth week of each month was free from treatment. The primary end-point was diseasefree survival (DFS). Secondary end-points were progression rate, overall survival (OS), safety, and toxicity. Using the method of Dixon and Simon, the accrual goal was 35 patients. 35 patients were enrolled onto the study (28m/7f; median age = 46, range 21-71; ECOG 0-1; 14 (40%) pts with stage III and 21 (60%) pts with stage IV). Toxicity was minimal characterized by mainly flu-like syndrome and erythema in injection site. Median DFS was 14.1 months (95% CI, 3–20.2 months). At a median follow-up time of 5.1 years, progression rate was 65.7%, and OS was 40%. The median OS was 53.0 months (95% CI, 40.6–65.4 months). 5-years DFS and OS were similar between locally advanced and N2/M1 groups. Although the toxicities seen in this trial were low grade and regimen was well tolerated, low-dose GM-CSF, IFN and IL-2 did not improve DFS in comparison with historical control in patients with resected high-risk RCC.