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In today’s era, limb salvage surgery is the procedure of choice and current standard of care in appropriately selected patients of bone sarcomas. For adequate oncologic clearance, preoperative evaluation of the extent of tumor is mandatory. The present study was done to compare measurements of bone sarcomas (osteosarcoma, Ewing’s sarcoma, and chondrosarcoma) as determined by magnetic resonance imaging (MRI) with the histopathological extent seen on resected specimens. We prospectively evaluated 100 consecutive patients with a diagnosis of bone sarcoma who underwent limb salvage surgery between May 2014 and December 2014. The maximum longitudinal (cranio-caudal) dimension of tumor on the noncontrast T1-WI sequence of MRI (irrespective of whether it was pre/postchemotherapy) was compared with the gross dimensions of the tumor on histopathology. The arithmetic mean difference, Wilcoxon signed-rank test, and Spearman’s correlation analysis were used to test the differences and correlation between groups. Mean tumor size on MRI based on the largest extent on MRI was 12.1 ± 4.85 cm (mean ± standard deviation), while it was 10.77 ± 4.6 cm (mean ± standard deviation) on histopathology. In 79 cases, MRI overestimated the extent of disease; the mean was 1.79 cm with a standard deviation of 1.56 cm. When the disease extent was underestimated on MRI (13 cases), the mean was 0.58 cm with a standard deviation of 0.43 cm. In 8 cases (osteosarcoma (7), Ewing’s sarcoma (1)), MRI measurement was equal to histopathology. The Spearman correlation analysis showed a high correlation of tumor length on histopathology with the MRI for all patients (R = 0.948, P<0.0001). We thus conclude that MRI is accurate in delineating the extent of bone sarcomas. A margin of 2 cm from the maximum tumor extent is adequate to ensure appropriate surgical resection.

The objective of the study was to undertake pilot plant scale-up batches of paracetamol immediate release tablets by designing, optimizing and validating the tablet manufacturing process. A process design was developed to define the critical process variables and monitor it throughout the manufacturing process. Critical processes such as blending of intragranular ingredients, drying of the granules, lubrication and tablet compression were optimized. The process optimization was carried out based on the critical quality attributes of the formulation and their predetermined limits. Process validation was carried out to assure reproducibility in the quality of the product. The scale-up process produced batches showing good reproducibility with a relative standard deviation of less than 2%.

Head and neck malignancies constitute a major cause of morbidity and mortality all over the world. Radiotherapy plays a pivotal role in the management of these tumours; however, it has associated complications, with mandibular osteoradionecrosis (ORN) being one of the gravest orofacial complications. Early diagnosis, extent evaluation, and detection of complications of ORN are imperative for instituting an appropriate management protocol. ORN can closely mimic tumour recurrence, the differentiation of which has obvious clinical implications. The purpose of the present review is to acquaint the radiologist with the imaging features of mandibular ORN and the ways to differentiate ORN from tumour recurrence.

BACKGROUND: Often, it is difficult to assess the presence of residual disease after an unplanned excision in soft-tissue sarcomas. Inadequate excision leads to disease recurrence and inferior oncological outcomes while unnecessary excision may lead to additional surgical procedures with inherent morbidity and increased cost of treatment. There is a paucity of literature comparing the preoperative imaging findings with the final histopathology report to accurately assess the presence of residual disease. MATERIALS AND METHODS: The clinical details of 55 patients who had oncological scar excision after unplanned prior excision were retrieved. Histopathological evaluation of scar was compared with presurgery magnetic resonance imaging (MRI) for the presence of residual disease. Sensitivity, specificity, and positive and negative predictive value (NPV) of MRI for detection of residual disease were calculated. RESULTS: On MRI, residual disease was seen in 28 cases, no disease in 24 cases whereas findings of three patients were indeterminate. On final histopathology, residual disease was present in 30 (55%) patients whereas no residual tumor was seen in 25 (45%) patients. Two patients in whom MRI suggested the presence of residual disease had no tumor on final histopathology. No evidence of residual disease was reported in MRI of 24 patients. Of these, twenty patients were confirmed to have no tumor on final histopathology, whereas four patients had a residual tumor. Sensitivity: 86.66%, specificity: 90.90%, positive predictive value (PPV): 92.85%, NPV: 83.33%. CONCLUSION: MRI can aid in preoperative planning by identifying the site and extent of the previous surgery. It has a high PPV (92%) for detection of residual disease. However, a negative scan (NPV 83%) does not reliably exclude the presence of residual disease.

Aim To assess the diagnostic accuracy of whole-body magnetic resonance imaging (WB-MRI) for metastatic disease in patients with solid small round cell tumours (SRCT) by comparing it with routine staging procedures (standard of care). Materials and methods Eligible cases of neuroblastoma, primitive neuroectodermal tumour, and rhabdomyosarcoma were enrolled in the study after obtaining informed consent. WB-MRI was undertaken using overlapping coronal T1 and short-tau inversion recovery (STIR) sequences. Lesions were classified into skeletal, pulmonary, and soft-tissue types. Conventional staging, which consisted of combined positron-emission tomography & computed tomography (PET-CT), bone scintigraphy & bone marrow biopsy for bone metastases, CT thorax for lung metastases, combined PET-CT, metaiodobenzylguanidine (MIBG) scintigraphy (in neuroblastoma) for soft tissue metastases and clinical evaluation was used as the reference standard. Parameters for diagnostic accuracy were calculated. Results Thirty-four out of forty patients enrolled were included in final analysis, half of them having metastatic disease. The sensitivity, specificity, positive and negative predictive value, and the diagnostic accuracy of WB-MRI and PET-CT for skeletal metastases as compared to reference standard were 91.9%, 99.8%, 97.4%, 99.6%, and 95.5% and 99.1%, 99.9%, 99.1%, 99.9%, and 99.9%, respectively. The sensitivity of MRI, only PET and PET-CT with plain CT thorax was 30%, 40%, and 100%, respectively, for lung metastases. The sensitivity of MRI for soft-tissue lesions was 76.9%. Conclusion WB-MRI is a radiation-free tool with high diagnostic accuracy for the evaluation of metastatic disease to the marrow. The rate of detection of soft-tissue metastases, such as nodal metastases, is less when WB-MRI is compared with conventional staging using coronal STIR images. CT thorax is essential for accurate evaluation of lung metastases.

6000Background: We conducted an investigator-initiated, phase 3 randomized study to evaluate the efficacy and toxicity of addition of Nimotuzumab during concurrent chemoradiation in locally advance...

Forty-seven ovarian cancer cases in which 20 were previously treated with cisplatin (cisPt) based chemotherapy, were checked for in vitro chemosensitivity using MTT assay. The drugs included in the study were cisPt, adriamycin (ADR), epirubicin (EPR) and etoposide (ETO). The logarithemic concentrations (0.1, 1.0, 10.0 and 100.0 micrograms/ml) of these drugs were used in the MTT assay. The IC50 values for these drugs in the above tumor samples were calculated. The effect of pretreatment with cisPt based chemotherapy on the emergence of drug resistance, expression of p53 protein (detected using immunohistochemical method by employing monoclonal antibody to p53) and intracellular glutathione (GSH) levels was also studied. Our results demonstrated the superiority of EPR in terms of its efficacy as compared to the other drugs used in the study. EPR was effective in both, previously cisPt-exposed and cisPt-unexposed ovarian cancer cases indicating its importance as a second line chemotherapy in the refractory ovarian carcinoma cases. Pre-exposure to cisPt based chemotherapy appears to result in the emergence of cisPt resistance, elevated intracellular GSH levels as well as p53 positivity. A statistically significant correlation was also observed between ADR and EPR resistance and p53 positivity (P < 0.01 and 0.05 respectively).

Aim To reinvestigate the accuracy of 16 section multidetector computed tomography (MDCT) in assessing mandibular invasion in retromolar trigone (RMT) squamous cell cancers (SCC). Materials and methods A search for diagnosed cases of early RMT SCC that were both imaged and treated at Tata Memorial Centre, Mumbai, India, between 2007 and 2010, was undertaken and yielded 37 patients. The average tumour size was 2.6 cm. All patients had undergone segmental, marginal, or hemimandibulectomy within 2 weeks of imaging. Imaging records archived on the picture archiving and communication system (PACS) were analysed. Contrast-enhanced CT had been performed using a 16 section MDCT system using the puffed-cheek technique. Image acquisition was at 2.5 mm section thickness, but axial images and isotropic coronal and sagittal multiplanar reformations were generated ad hoc from 0.625 mm retro-reconstructed images. Optimal oblique reformations were generated at will by the radiologist to depict the RMT in its entirety. The soft-tissue algorithm and bone window or bone algorithm reformations and axial images were analysed on a volume viewer integrated within the PACS using triangulation. Two investigators independently studied the images and these were compared with the findings at histopathology. Results The sensitivity, specificity, and accuracy of 16 section MDCT for mandibular cortical and marrow invasion was 94, 90, and 91.8% and 83, 92, and 89%, respectively. Use of ad hoc generated oblique reformation contributed to the enhanced sensitivity and specificity. The accuracy for inferior alveolar canal invasion was 100%. There was excellent agreement between the two observers. Conclusion Sixteen-section MDCT used to its full potential has high accuracy for the detection of mandibular invasion in RMT SCC.

This study studied the coorelation between radiological response to induction chemotherapy and acheivement of pCR or near pCR. It was a retrospective analysis in which all patients who received NACT from 2008 till april 2012 were subjected to inclusion criteria. Coorelation analysis was performed between CR + PR and acheivement of pCR or near pCR. Twenty four patients were identified.The primary site of tumor was oral cavity in 19 patients (79.2%), maxilla in 2 patients (4.2%), laryngopharynx in 2 patients (4.2%) and oropharynx in 1 patient (4.2%). The clinical stage was stage IVA in 16 patients ( 66.7%) and IVB in 8 patients (33.3%). The overall response rates ie a combination of CR and PR was seen in 11patients (45.8%). The pCR was seen in 15 patients (62.5%) and rest had near pCR. There was no linear coorelation between radiological size decrement and tumor response. On coorelation analysis the spearman correlation coefficent was −0.039 (). This suggest that presently used radiological response criterias for response assesment in head and neck cancers severly limit our ability to identify patients who would have pCR or near pCR.

BACKGROUND AND PURPOSE: MR imaging is an established method for diagnosis and surgical planning of carotid body tumors (CBTs). However no studies have elaborated preoperative objective criteria to predict the Shamblin (surgical) classification of CBTs, an important predictor of vascular morbidity. The purpose of this study was to establish criteria to accurately predict the Shamblin group on preoperative MR imaging for a uniform reporting system. MATERIALS AND METHODS: MR images of 9 CBTs in 8 consecutive patients who underwent surgery between 2004 and 2007 were reviewed at a tertiary cancer hospital. The surgical records were blinded to the radiologists. A radiologic classification into 3 types (I, II, and III) based on the maximum degree of circumferential contact of the tumor with the internal carotid artery (ICA) was attempted and correlated with the Shamblin group in surgical records. RESULTS: There were 5 type III, 3 type II, and 1 type I tumors. The type I tumor had an ICA maximum circumference of contact less than or equal to 180°, type II tumors had more than 180° and less than 270°, and type III tumors had a maximum circumference of contact of 270° of more. MR imaging accurately predicted the Shamblin group in 8 (100%) of 8 operated tumors. Tumor size and Shamblin group did not have a uniformly predictable relation. CONCLUSIONS: Shamblin group can be predicted preoperatively on MR imaging, and the maximum degree of circumferential contact of the CBT with the ICA on axial images is the criterion to predict the Shamblin group.

Chloramphenicol is an antimicrobial agent having a very broad-spectrum of activity including Gram-positive bacteria, Gram-negative bacteria and anaerobes. However the use of chloramphenicol has reduced over a period of time due to the adverse effects of causing bone marrow depression or in some cases severe aplastic anaemia. As the effects are seen on the bone marrow cell, it was intended to find out if these adverse effects could be used for the benefits in leukaemia patients, using in-vitro study on leukaemic cell lines. The study showed inhibition of growth of the leukaemia cells by chloramphenicol which was comparable to or better than daunorubicin in some cell lines. The article also discusses the other adverse effect profile of chloramphenicol compared with anticancer drugs and its potential benefit in leukaemia and in neutropenic fever.

e17068 Background: HPV positive oropharyngeal cancers have been identified as a favourable prognostic subgroup. However impact of HPV positivity on prognosis is also dependent on level of tobacco e...

Type I and II DNA topoisomerases are the targets for numerous clinically efficacious antitumor agents. Over the last decade, considerable effort has been expended in developing camptothecin (CPT) derivatives that selectively target DNA topoisomerase I (TOP-I) (1). The prodrug irinotecan (CPT-11) is approved for treatment of colon carcinoma and has demonstrated significant activity against numerous other cancers in adults and children. Topotecan is approved for treatment of platinum- or taxane-resistant ovarian carcinoma and has demonstrated broad-spectrum activity (2). Other analogs are in clinical development, such as D5198f and the homocamptothecins and liposomal formulations of CPT derivatives, and offer the potential for prolonged plasma exposures.

Background: Cisplatin and 5 fluorouracil drug combination is inferior to the combination of taxane with these 2 drugs. However, often in clinical practice at our center giving TPF (docetaxel, cisplatin, 5 fluorouracil) is difficult in view of logistics and tolerance issues. In such a scenario, we prefer to use the 2 drugs combination of platinum and taxane. However, no study has addressed whether a 2 drugs combination, which includes taxane is inferior to the 3 drugs combination and which the taxane of choice is in the 2 drugs combination of taxane and platinum. Methods: This is a retrospective analysis of prospectively collected data of patients undergoing induction chemotherapy (IC) in oral cavity cancers from 2010 to 2012. We chose for analysis those patients who had a baseline scan done within 4 weeks of starting therapy and a follow-up scan done within 2 weeks of completion of the second cycle of IC. Response was scored in accordance with RECIST version 1.1. Chi-square analysis was done to compare response rates (RRs) between regimens. Results: Two hundred and forty-five patients were identified. The median age was 45 years (24–70 years), 208 (84.9%) were male patients, and 154 patients (62.9%) had primary in the Buccal mucosa. The regimens received were TPF 22 (9%), docetaxel + cisplatin 97 (39.6%), paclitaxel + cisplatin 89 (36.3%), docetaxel + carboplatin 16 (6.5%) and paclitaxel + carboplatin 21 (8.6%). The overall RRs were complete response, partial response, stable disease and progressive disease in 4 (1.6%), 56 (22.9%), 145 (59.2%) and 40 (16.3%). The 3 drugs regimen (TPF) had 50% RR as compared to 22% RR with 2 drugs regimen (P = 0.004). Docetaxel containing regimens had 30.3% RR as compared to 17.2% RR with paclitaxel containing regimens (P = 0.094). Conclusions: TPF has better RR than a 2 drugs taxane-containing regimen and docetaxel leads to a better RR than paclitaxel for IC in locally advanced oral cavity cancers.

Aim: Desmoid tumors (Fibromatosis) are slow growing, locally invasive tumors with a propensity to recur despite wide excision. Data on the use of systemic therapy are sparse. Metronomic Therapy (MT) is a multi-targeted therapy with anti-angiogenic, immunomodulatory and tumor dormancy effects. This retrospective audit aims to study the efficacy, safety and need for further surgical intervention in patients of desmoid tumors treated with MT. Methods: Patients who received MT for fibromatosis between January 2002 and December 2012 were included in the study. MT protocol consisted of Methotrexate 30 mg/m2 i.v weekly and Vinblastine 6 mg/m2 i.v. weekly for 1 year along with Tamoxifen 20 mg/m2 PO BD for 2 years. Response was evaluated using Magnetic Resonance Imaging or Computed Tomography scans every 6 monthly using the Response Evaluation Criteria in Solid Tumors version 1.1. Toxicities were recorded using the National Cancer Institute Common Toxicity Criteria version 3.0. Results: 42 patients received MT for ≥6 months, median age was 30 years (range 2 - 58 years) with M:F ratio of 1:1.33. 27 (64.3%) patients had tumors arising in extremities, 8 trunk, 5 intra-abdominal and 2 in head & neck region. 26 patients had recurrent fibromatosis. The median follow up was 29 months. The mean duration for which patients received Methotrexate, Vinblastine and Tamoxifen were 9.85 months, 9.4 months and 16.92 months respectively. 4 (9.5%) cases had grade 3/4 neutropenia. Non-hematological toxicity was documented in 24 patients. Grade 3/4 toxicity consisted of nausea, peripheral neuropathy, and transaminitis in 1 each and vomiting in 2 patients. 4 patients discontinued MT due to toxicity. Response was evaluable in 38 patients- 21% had Partial Response and 79% had Stable Disease as the best response. 15 patients (35.7%) required second line therapy due to disease progression. Only 6 patients (14.28%) eventually required surgery for disease control. The median progression free survival (PFS) was 74 months (95%CI 42.45 - 105.54). The 3 year-PFS for patients with primary disease was 68.6±13.8% and for those with recurrent tumors was 87.4±6.8% (p=0.58). Conclusions: MT has reasonable efficacy and is well tolerated. The upfront use of MT in advanced desmoid tumors, with surgery being reserved for non-responders or those with progression can be a reasonable approach. Disclosure: All authors have declared no conflicts of interest.

e17033 Background: Median survival of technically unresectable oral cavity cancers (T4a and T4b) with non surgical therapy is 2-12 months. We hypothesized that neoadjuvant chemotherapy (NACT) might...

6017 Background: Cetuximab based regimen is the recommended palliative chemotherapy for head and neck squamous cell cancers. However, due to financial constraints, toxic intravenous chemotherapy wi...

Rural and urban areas of Maharashtra, a large state in Western India.To understand tuberculosis (TB) management practices among private medical practitioners (PPs) and the treatment behaviour of the patients they manage.Prospective study of help-seeking patterns and treatment behaviour among 173 pulmonary TB patients diagnosed in private clinics, and the TB management practices of 122 PPs treating these patients.The first source of help for 86% of patients was a PP. The diagnostic and treatment practices of PPs were inadequate; 15% did not consider sputum examination to be necessary, and 79 different treatment regimens were prescribed by 105 reporting PPs. Sixty-seven percent of the patients diagnosed in private clinics remained with the private sector, and the rest shifted to public health services within six months of treatment. The treatment adherence rate among the patients in private clinics was 59%. There were discrepancies between the reported management practices of the PPs and what their patients actually followed.The study identifies and highlights the need to educate PPs and their TB patients, and indicates ways in which PPs could be meaningfully involved in efforts to revitalize the national TB control programme.

Chondrosarcomas are rare skull base lesions and presenting as a mass lesion in the jugular foramen is even rarer. The clinical picture and series of scans unfolded its diverse presentation on imaging making its diagnosis very interesting. Preoperative finding and final histopathological picture were diagnostic.

e12520 Background: The use of neoadjuvant chemotherapy(NACT) in head & neck cancers is not well defined. Very few publications on this topic deal with the epidemiology ,clinical & biochemical profile. These factors have an important say in deciding the choice of regimen. Methods: An prospective analysis of oral cavity cancer patients ,who were referred for NACT at our center, was done. The analysis focussed on the demographics, clinical & biochemical parameters of these patients at presentation . Results: From 2010-2012 , 528 patients of oral cavity cancers were referred for NACT from the multidisciplinary clinic. The median age of patients was 45 years (22-78 years) ; 10.4% were above the age of 60 years and 83.7% were males. Only 16.5% of patients were from the city in which the hospital was located. 69.1% were tobacco users, 53.8% were smokers , 37.5% were alcoholic & 81.5% had in addition other local tobacco containing chewable preparations. Only 2.65% denied any addictions. Amongst the symptoms pain, facical swelling,oral ulcer , oral bleeding, foul smell, trismus & weight loss were present in 41.9%, 72.5%, 57.6% , 72.5% , 77.1%, 41.4% & 49.4% respectively. The ECOG performance status were 0,1,2 in 8.3%, 84.7%, 2.7% patients respectively. The subsite of the disease were buccal mucosa,tongue, floor of mouth, alveolus, hard palate in 67.8%, 24.4% ,4.7% , 0.9% ,1.1% respectively. 65.3% & 16.7% patients were in T4a and T4b stage. N2b(42%) and N2c (31.4% )were the most common N stage seen. All patients had stage IV disease. Comorbidites like diabetes mellitus, hypertension and cardiac disease were seen in 22.3%, 18.9% & 13.3%. The median BMI was 21.45 Kg/m2 & 24.3% had BMI below 18.5 Kg/m2 (severly malnourished). The need for NACT was mainly due to extensive disease ,edema reaching upto zygoma and edema upto hyoid bone .The regimens administered were TPF in 6.6% and Taxane with Platinum in rest others. The major reasons for not selecting TPF were logistics (75%) & malnourished status (25%). Conclusions: Patients referred for NACT at our center had locally advanced disease,nearly all were addicts, one fourth had severe malnourishment & current standard TPF could be administered in only a few of them.

6085 Background: A variety of regimens have been used for induction chemotherapy in locally advanced head & neck cancers. Cisplatin & 5 FU drug combination is inferior to the combination of taxane & these 2 drugs. However, often in clinical practice at our center giving TPF is difficult in view of logistics & tolerance issues. In such scenarios we prefer to use 2 drug combination of platinum & taxane. However no study has addressed whether when the 2 drug combination includes taxane, is it still inferior to the 3 drug combination and which the taxane of choice is. Methods: This is a retrospective analysis of prospectively collected data of patients undergoing induction chemotherapy in oral cavity cancers from 2010-2012. We chose for analysis those patients who had a baseline scan and a follow-up scan done within 2 weeks of completion of the second cycle of induction chemotherapy. Response was scored in accordance with RECIST 1.1. Data was analyzed using SPSS, version 16. Chi- square analysis was done to compare response rates between regimens. Results: Two hundred & forty five patients were indentified. The median age was 45 years (24-70 years), 208 (84.9%) were male patients & in 154 patients (62.9%) had primary in buccal mucosa. The regimen received were TPF 22 (9%), TP (Docetaxel + cisplatin) 97 (39.6%), PP (paclitaxel+cisplatin) 89 (36.3%), TC (Docetaxel+ carboplatin) 16 (6.5%) & PC (paclitaxel + carboplatin) 21 (8.6%).The overall response rates (RR) were CR, PR,SD & PD in 4 (1.6%), 56 (22.9%), 145 (59.2%) & 40 (16.3%). On comparison, 3 drug regimen (TPF) had 50% RR as against 22% RR with 2 drug regimen (p=0.004). On comparison for taxane, docetaxel containing regimens had 30.3% RR as against 17.2% RR with paclitaxel containing regimens (p=0.018). There was no statistically significant difference in RR between patients receiving carboplatin or cisplatin. Conclusions: TPF had better RR than a 2 drug taxane-containing regimen and docetaxel leads to a better RR than paclitaxel for induction chemotherapy in locally advanced oral cavity cancers.

e16028 Background: The concept of combination of paclitaxel and cetuximab is an intersesting prospect as both these agents have single agent acitivity, minimal toxicity and hold a biological rationale for combination. The aim of our study was to see the safety,efficacy and feasibility of administration of this combination in a outpatient setting. Methods: This was a retrospective analysis of the prospectively collected data, of patients offered weekly paclitaxel and cetuximab from May 2010-May 2011. The standard schedule of cetuximab along with 80 mg/m2 of weekly paclitaxel was administered till either disease progression or withdrawl of patient's consent. The toxicity profile was noted in accordance with CTCAE version 4.02 and response in accordance with RECIST criteria. SPSS version 16 has been utilized for analysis. Descriptive statistics are been presented and analyis of estimation of overall and progression free survival has been done with Kaplan-Meier survival method. Results: 42 patients with a median age of 52 years (35-81 years) were included. The KPS score was 60 in 1 (2.4%),70 in 11 (26.2%) and 80 in 30 patients(71.4%). Nearly half of our patients 22 (52.4%) had a primary in oral cavity. Except 3 (7.1%) patients rest all had received some form of previous treatment. The median event free period(EFP) from previous first line treatment was 231 days, it was below 180 days in 38.5% of patients. Best response observed was CR in 1 patient (2.4%), PR in 11 (26.2%), SD in 17 (40.5%) and PD in 13 (30.9%). Grade 3-4 skin changes were seen in 3 patients, grade 3-4 neuropathy was seen in 3 patients and there were no episodes of grade 3-4 gastrointestinal or haematological toxicity. The overall estimated median PFS and OS were 128 and 256 days. The median estimated PFS for patients with EFP less than 6 months versus more than 6 months was 115 and 165 days respectively (p = 0.132). Conclusions: The combination of paclitaxel and cetuximab was found to be safe, feasible and appears to be clinically beneficial.

5585 Background: Locally advanced carcinoma of maxillary sinus has been historically reported to have poor prognosis. We evaluated the role of neoadjuvant chemotherapy in improving the outcome in these patients. Methods: 41 patients with locally advanced borderline resectable (stage IVa) or unresectable maxillary carcinoma (stage IVb) were treated with induction chemotherapy between 2008 and 2011. The protocol included 2 cycles of chemotherapy, response assessment and multidisciplinary clinic review for definitive local treatment. The demographic profile, response to induction therapy, toxicity of chemotherapy, definitive treatment received, time to treatment failure (TTF) and overall survival (OS) were analysed. Univariate and multivariate analysis was performed to determine factors associated with response, TTF and OS. Results: The cohort of 41 patients had a median age of 48 years (22-71) with male preponderance (80.5%). The chemotherapy included two drugs (platinum and taxane) in 34 patients (82.9%) and three drugs (platinum, taxane and 5 FU) in 7(17.1%) The taxane utilized was docetaxel in 22 patients (53.7%) and paclitaxel in 19 patients (46.3%). There was no complete response, stable disease in 18 (43.9%), partial response in 16 (39%), and progression in 7 (17.1%) patients. All patients competed two cycles of chemotherapy, adequate dose intensity was maintained in 33 patients (78%) and there were no deaths. Post-induction, the treatment planned included surgery in 12 (29.3%), CT-RT in 24 (58.5%), radical RT in 1 (2.4%), palliative RT in 1 (2.4%) and palliative chemotherapy in 3 ( 7.3%) patients. Overall, the median TTF was 10.2 months. With 16 deaths, the median OS was not reached. Only response post-induction was significantly associated with better TTF (p=0.02). Grade 3 tumor (p=0.04) and baseline serum albumin more than 4 mg/dl (p=0.02) were associated with better OS. Grade 3-4 neutropenia, febrile neutropenia and loose motions were seen in 21.1%, 23.8% and 15.8% respectively. Conclusions: In unresectable maxillary carcinoma, induction chemotherapy has clinically significant benefit with acceptable toxicity. Response to induction was the only significant factor for improved TTF.

P388/R, the adriamycin (ADR) resistant subline of murine P388 lymphocytic leukemia was cross-resistant to the drug mitoxantrone (MTN). One hour hyperthermia at 42 degrees C (HT) was employed along with ADR (10 micrograms/ml) and MTN (10 micrograms/ml) for circumventing the drug resistance of P388/R cells in in vitro-in vivo bioassays. Inhibition in the incorporation of tritiated thymidine into cellular DNA was measured to check the in vitro cytotoxic effect. Hyperthermia, ADR and MTN alone could not bring about significant degree of inhibition of DNA biosynthesis whereas the combination of ADR and MTN along with HT resulted in a synergistic cytotoxic action (p less than 0.001 and 0.01, respectively). The cells were treated with the drugs in vitro and inoculated into BDF1 mice. It was observed that ADR, MTN or HT pretreatment of the cells resulted in an increase of the life-span of the mice by 4.0-25.0%, 10-20% and 44-50%, respectively, whereas the pretreatment of cells with the combination of ADR and MTN with HT resulted in an increase by 104-125% and 212-220% in life-span of the mice, respectively. Studies revealed that the combination ADR-HT and MTN-HT resulted in circumvention of resistance of P388/R cells to ADR and MTN.

Pentoxifylline (PTX) is a methylxanthine used clinically in the treatment of intermittent claudication. It is an active hemorheological agent used for the treatment of defective microcirculation. The use of the anticancer agent vincristine is limited by its toxicity to normal body tissues. The data presented in the present paper show that it is possible to achieve greater cell-kill by using vincristine in combination with pentoxifylline. The effect of pentoxifylline alone and in combination with vincristine was studied using membrane filtration technique in P388 leukemia (P388) and its subline P388/DOX resistant to doxorubicin and cross-resistant to vincristine. Pentoxifylline (100 mumol/l) had minimal inhibitory effect on DNA biosynthesis in P388 leukemia cells. Vincristine, at the concentration employed in this study did not show significant inhibition of DNA biosynthesis confirming multidrug resistant nature of P388/DOX cells. Pentoxifylline had a dose-sparing effect, wherein it enhanced the antiproliferative activity of vincristine at a clinically achievable concentration. The studies on reversibility of inhibition of DNA biosynthesis in P388/DOX cells pretreated with vincristine and pentoxifylline showed the irreversible nature of the effect of combination of vincristine and pentoxifylline. This observation warrants the possible use of pentoxifylline as an adjuvant in cancer chemotherapy.

Adriamycin and mitoxantrone are known antitumor agents. The use of these agents is limited by their toxicity to normal body tissue. This paper shows that it is possible to achieve greater log cell-kill by using these drugs in combination with hyperthermia and diazepam. Experiments were carried out on 22 human chronic myeloid leukemia samples. 10 micrograms/ml adriamycin and 1 microgram/ml mitoxantrone were used in combination with hyperthermia 42 degrees C, for 3 h and 1 h respectively, with and without diazepam (1 microgram/ml). Inhibition of incorporation of radiolabeled nucleic acid precursor (3H-thymidine) in treated cells as compared to the untreated cells was used as a measure of cytotoxicity. The statistical evaluation of the data shows that the enhancement of drug cytotoxicity due to hyperthermia and diazepam is highly significant (p less than 0.001) in case of both the drugs.

Mitoxantrone, a new anticancer drug has DNA-binding properties similar to anthracycline antibiotics. In the present studies, effect of the drug has been tested in vitro on human chronic myeloid leukemia cells at 37 degrees C and 42 degrees C. Inhibition of 3H-tritiated thymidine incorporation in the drug-treated cells compared with untreated cells has been used as the parameter of cytotoxicity of the drug and hyperthermia. Cell samples from 11 CML patients who did not receive any chemotherapy showed less response to the drug at 0.5 micrograms/ml and 1 microgram/ml at 37 degrees C. Exposure of CML cells to 42 degrees C for 2 h indicated 13 to 44% inhibition in 3H-TdR incorporation. However, when CML cells were exposed to mitoxantrone for 2 h at 42 degrees C the 3H-thymidine incorporation was inhibited to the extent of 27 to 71%, indicating greater cellular damage with this combination.

Background We report a case of vascular malformation arising from internal jugular vein presenting as mass at root of neck with no clinical stigmata which to the best of our knowledge is the first reported case of an intrinsic vascular malformation arising from the internal jugular vein. Magnetic resonance imaging features of this new entity have been described. Case presentation A 27 year male presented with a gradually enlarging, asymptomatic swelling on left supraclavicular region with normal overlying skin. A soft mass, about 7 × 7 cm with restricted mobility was found with normal cranial nerve function. Fine needle aspiration cytology showed a hemorrhagic aspirate. Doppler showed a mass displacing left carotid artery posteriorly while left internal jugular vein was not visualized. Magnetic resonance imaging showed a well defined mass isointense to hypointense on T1 weighted and hyperintense on T2 weighted and STIR images with fluid-fluid levels. On exploration, a vascular mass arising from left internal jugular vein was found with good tissue planes, which was excised after ligating the patent internal jugular vein above and below the lesion. Histopathologic examination confirmed the diagnosis of vascular malformation. Conclusion The diagnosis of intrinsic vascular malformation arising from internal jugular vein should be kept in differential while dealing with masses at root of neck and magnetic resonance imaging features may help in the pre-operative diagnosis of this entity.