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Purpose: This study aimed to evaluate the clinical need for an automated decision-support software platform for adaptive radiation therapy (ART) of head and neck cancer (HNC) patients. Methods: We tested RTapp (SegAna), a new ART software platform for deciding when a treatment replan is needed, to investigate a set of 27 HNC patients' data retrospectively. For each fraction, the software estimated key components of ART such as daily dose distribution and cumulative doses received by targets and organs at risk (OARs) from daily 3D imaging in real-time. RTapp also included a prediction algorithm that analyzed dosimetric parameter (DP) trends against user-specified thresholds to proactively trigger adaptive re-planning up to four fractions ahead. The DPs evaluated for ART were based on treatment planning dose constraints. Warning (V95<95%) and adaptation (V95<93%) thresholds were set for PTVs, while OAR adaptation dosimetric endpoints of +10% (DE10) were set for all Dmax and Dmean DPs. Any threshold violation at end of treatment (EOT) triggered a review of the DP trends to determine the threshold-crossing fraction Fx when the violations occurred. The prediction model accuracy was determined as the difference between calculated and predicted DP values with 95% confidence intervals (CI95). Results: RTapp was able to address the needs of treatment adaptation. Specifically, we identified 18/27 studies (67%) for violating PTV coverage or parotid Dmean at EOT. Twelve PTVs had V95<95% (mean coverage decrease of −6.8 ± 2.9%) including six flagged for adaptation at median Fx = 6 (range, 1–16). Seventeen parotids were flagged for exceeding Dmean dose constraints with a median increase of +2.60 Gy (range, 0.99–6.31 Gy) at EOT, including nine with DP>DE10. The differences between predicted and calculated PTV V95 and parotid Dmean was up to 7.6% (mean ± CI95, −2.7 ± 4.1%) and 5 Gy (mean ± CI95, 0.3 ± 1.6 Gy), respectively. The most accurate predictions were obtained closest to the threshold-crossing fraction. For parotids, the results showed that Fx ranged between fractions 1 and 23, with a lack of specific trend demonstrating that the need for treatment adaptation may be verified for every fraction. Conclusion: Integrated in an ART clinical workflow, RTapp aids in predicting whether specific treatment would require adaptation up to four fractions ahead of time. [ABSTRACT FROM AUTHOR]

Background: Brachial plexopathy is a potentially serious complication from stereotactic body radiation therapy (SBRT) that has not been widely studied. Therefore, we compared datasets from two different institutions and generated a brachial plexus dose-response model, to quantify what dose constraints would be needed to minimize the effect on normal tissue while still enabling potent therapy for the tumor.Methods: Two published SBRT datasets were pooled and modeled from patients at Indiana University and the Richard L. Roudebush Veterans Administration Medical Center from 1998 to 2007, as well as the Karolinska Institute from 2008 to 2013. All patients in both studies were treated with SBRT for apically located lung tumors localized superior to the aortic arch. Toxicities were graded according to Common Terminology Criteria for Adverse Events, and a probit dose response model was created with maximum likelihood parameter fitting.Results: This analysis includes a total of 89 brachial plexus maximum point dose (Dmax) values from both institutions. Among the 14 patients who developed brachial plexopathy, the most common complications were grade 2, comprising 7 patients. The median follow-up was 30 months (range 6.1-72.2) in the Karolinska dataset, and the Indiana dataset had a median of 13 months (range 1-71). Both studies had a median range of 3 fractions, but in the Indiana dataset, 9 patients were treated in 4 fractions, and the paper did not differentiate between the two, so our analysis is considered to be in 3-4 fractions, one of the main limitations. The probit model showed that the risk of brachial plexopathy with Dmax of 26 Gy in 3-4 fractions is 10%, and 50% with Dmax of 70 Gy in 3-4 fractions.Conclusions: This analysis is only a preliminary result because more details are needed as well as additional comprehensive datasets from a much broader cross-section of clinical practices. When more institutions join the QUANTEC and HyTEC methodology of reporting sufficient details to enable data pooling, our field will finally reach an improved understanding of human dose tolerance. [ABSTRACT FROM AUTHOR]

Objective: To determine the long-term normal tissue complication probability with stereotactic body radiation therapy (SBRT) treatments for targets that move with respiration and its relation with the type of respiratory motion management (tracking vs. compression or gating). Methods: A PubMed search was performed for identifying literature regarding dose, volume, fractionation, and toxicity (grade 3 or higher) for SBRT treatments for tumors which move with respiration. From the identified papers logistic or probit dose-response models were fitted to the data using the maximum-likelihood technique and confidence intervals were based on the profile-likelihood method in the dose-volume histogram (DVH) Evaluator. Results: Pooled logistic and probit models for grade 3 or higher toxicity for aorta, chest wall, duodenum, and small bowel suggest a significant difference when live motion tracking was used for targeting tumors with move with respiration which was on the average 10 times lower, in the high dose range. Conclusion: Live respiratory motion management appears to have a better toxicity outcome when treating targets which move with respiration with very steep peripheral dose gradients. This analysis is however limited by sparsity of rigorous data due to poor reporting in the literature. [ABSTRACT FROM AUTHOR]

Curcumin, the active component of Curcuma longa L. (Zingiberaceae), exhibits a wide variety of biological activities including vasodilation and anti-inflammation. The relaxant effect of curcumin in tracheal smooth muscle (TSM) was not examined so far, thus, this study was designed to assess the relaxant effect of curcumin on rat TSM and examine the underlying mechanism(s) responsible for this effect. TSM was contracted by KCl (60 mM) or methacholine (10 μM), and cumulative concentrations of curcumin (12.5, 25, 50, and 100 mg/mL) or theophylline (0.2, 0.4, 0.6, and 0.8 mM, as positive control) were added to organ bath. The relaxant effect of curcumin was examined in non-incubated or incubated tissues with atropine (1 μM), chlorpheniramine (1 μM), indomethacin (1 μM), and papaverine (100 μM). In non-incubated TSM, curcumin showed significant relaxant effects on KCl-induced contraction in a concentration-dependent manner (p < 0.001 for all concentrations). The relaxant effects of curcumin 12.5, 25, and 50 mg/mL were significantly lower in atropine-incubated tissue compared to non-incubated TSM (p < 0.05 to p < 0.001). A significant difference was observed in EC50 between atropine-incubated (48.10 ± 2.55) and non-incubated (41.65 ± 1.81) tissues (p < 0.05). Theophylline showed a significant relaxant effect on both KCl and methacholine-induced contraction in a concentration-dependent manner (p < 0.001 for all cases). The results indicated a relatively potent relaxant effect of curcumin on TSM, which was less marked than the effect of theophylline. Calcium channel blocking and/or potassium channel opening properties of curcumin may be responsible for TSM relaxation. [ABSTRACT FROM AUTHOR]

High-dose hypofractionated SBRT and SRS indirectly kills substantial fractions of tumor cells via causing vascular damage. The LQ formula may work well for certain clinical cases of SBRT and SRS when the indirect/additional tumor cell death secondary to vascular damage is small. However, when the indirect cell death is extensive, the LQ model will underestimate the clinical outcome of SBRT and SRS. [ABSTRACT FROM AUTHOR]

Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumour of the skin. While localised disease carries an overall favourable prognosis, metastatic disease is associated with poor clincal outcomes. Most cases of metastatic MCC are managed with systemic chemotherapy or immunotherapy, though 5-year survival for these patients remains a dismal 17%. Here, we present the case of a 79-year-old man with MCC of the right ear with metastases to regional lymph nodes, ipsilateral parotid gland and thoracic spine. He was treated with a combination of first-line radiotherapy and concurrent immune checkpoint inhibition (avelumab), which led to complete clinical regression of disease with minimal adverse effects. This observation suggests that combined radio-immunotherapy warrants larger-scale investigation for use in patients with unresectable MCC. [ABSTRACT FROM AUTHOR]

Background: We performed an analysis of the National Cancer Database (NCDB) to evaluate overall survival (OS) in patients with base of tongue (BOT) cancer treated with external beam radiation therapy (EBRT) combined with brachytherapy (BT). Methods: The tongue NCDB Participant User File was used to obtain demographic and clinical patient data. The Kaplan–Meier method was used to determine OS. Significance was determined using univariable and multivariable Cox proportional hazards models. Results: At 3 years, OS was 69.6%, 77.1%, and 63.7% for patients treated with EBRT (n = 27 954), EBRT + BT (n = 209), or BT alone (n = 154), respectively (P = .01). On multivariable analysis, the instantaneous hazard of death for patients receiving EBRT + BT was 25% (Hazard ratio [HR] = 0.75, 95% CI: 0.58‐0.98) lower than patients receiving only EBRT (P = .03). Conclusions: The addition of BT to EBRT in BOT cancer has an OS benefit. [ABSTRACT FROM AUTHOR]

Background: Rosa damascena (R.D) is an aromatic plant with numerous therapeutic effects including cardiovascular effect. The mechanism cardiovascular effect of R.D is unclear and suggested mediated through renin--angiotensin system (RAS). Therefore, in this study, the role of hydroalcoholic extract of R.D on acute hypertension induced by AngII was evaluated. Methods: After anesthesia, femoral artery and vein of rats were cannulated for recording cardiovascular responses and drug injection, respectively. Systolic blood pressure (SBP), mean arterial blood pressure (MAP), and heart rate (HR) were recorded continuously by power lab software. Rats were divided into saline, AngII (50 ng/kg), AngII + Losartan (10 mg/kg), and three groups of R.D extract (250, 500, and 1000 mg/kg). Losartan and AngII were administered intravenously and the other ones intraperitoneal. In the R.D groups, 30 min after injection of the extract, AngII was injected and the maximum changes in SBP, MAP, and HR were calculated and compared to that in control and AngII groups. Results: Results show that AngII significantly increased SBP, MAP, and decreased HR than the control group which was blocked by losartan. SBP and MAP in R.D + AngII groups were significantly lower than AngII alone (P < 0.05 -P < 0.001). Only MAP in higher dose (1000 mg/kg) was significantly lower than low dose (250 mg/kg; P < 0.05). Two higher doses also significantly decreased bradycardia induced by AngII (P < 0. 01). Conclusions: The preventive effect of hydroalcoholic extract of R.D on cardiovascular parameters maybe is mediated by suppression of AngII activity. [ABSTRACT FROM AUTHOR]

Cutaneous T-cell lymphoma (CTCL) is a chronic, debilitating disease that has a severe impact on quality of life. We present a patient with multiple CTCL lesions on the bilateral feet, which impaired his ability to ambulate. His lesions on both feet were successfully treated with a total of 8 Gy in two fractions via high-dose-rate surface brachytherapy using the Freiburg Flap applicator. The deeper aspects of the bulkier lesions on the left foot were boosted with electron beam therapy. The radiation therapy was well tolerated, and the patient was able to regain his mobility after completing radiation therapy. To our knowledge, there are few reports utilizing brachytherapy in treating CTCL. Our case describes treatment of larger, more extensive CTCL lesions than previously reported. [ABSTRACT FROM AUTHOR]

Purpose: As an angiotensin converting enzyme (ACE) inhibitor, the effects of captopril on inflammation has been previously examined. Captopril has been shown to have anti-inflammatory and antioxidant effects. Imbalance in the oxidant/antioxidant system is one of the major causes of inflammation. In the present study, the effects of captopril on total and differential white blood cells (WBC), oxidative stress andlung histopathological changes produced by lipopolysaccharide (LPS) were investigated in rat. Materials and Method: The rats were divided into: control (saline-treated), LPS (1 mg/kg), 12.5, 25 or 50 mg/kg captopril-treated before LPS administration (LPS+Cap12.5, LPS+Cap25 and LPS+Cap50) and Cap-treated, 50 mg/kg before saline administration (as positive control group)groups. The levels of total and percentage of differential WBC in blood, and the oxidative stress index in the serum were evaluated. Lung histopathological changes were also examined. Results: In the LPS group, total WBC count, percentage of neutrophils, basophils, eosinophils, and monocytes in the blood, oxidative stress indices in serum, lung pathological changes were significantly higher than the control group (p < 0.05 to p < 0.001). Pathological changes of lung, serum oxidative stress indices of LPS+Cap50 group, total WBC counts of LPS+Cap25 and LPS+Cap50 groups, as well as percentage of neutrophils, monocytes, and basophils in LPS+Cap50 group and percentage of eosinophils in LPS+Cap50 and LPS+Cap25 groups, were significantly decreased compared to the LPS group (p < 0.05 to p < 0.001). Conclusion: The results of this study showed that captopril dose-dependently reduced total and differential WBC counts, while it improved serum oxidant/antioxidant biomarkers and histopathological changes in LPS-treated rats. These results indicate a therapeutic potential for captopril on systemic inflammation and oxidative stress against LPS-induced lung injuries. [ABSTRACT FROM AUTHOR]

Purpose: We evaluate dose characteristics and clinical applications of treatment accessories used in intraoperative radiotherapy (IORT) and make site-specific recommendations for their optimal use. Methods and materials: Dose measurements were performed for a low energy (50 kV) X-ray INTRABEAM source. For spherical, flat, surface, and needle applicators, the following dosimetric parameters were measured: depth-dose (DD) profiles, surface dose (Ds), output factors (OF), and target dose homogeneity (DH). Optical density versus exposure calibration films were employed to obtain 2-dimensional dose distributions in planes parallel and perpendicular to beam direction. Film results were verified via repeat dose measurements with a parallel-plate ionization chamber in a custom water tank. The impact of applicator design on dose distributions was evaluated. results: Spherical applicators are commonly used for treating the inner-surface of breast lumpectomy cavity. Flat and surface applicators provide uniform planar dose for head and neck, abdomen, and pelvis targets. Needle applicators are designed for kypho- IORT of spinal metastasis. Typically, larger applicators produce a more homogeneous target dose region with lower surface dose, but require longer treatment times. For 4-cm diameter spherical, flat, and surface applicators, dose rates (DR) at their respective prescription points were found to be: 0.8, 0.3, and 2.2 Gy/min, respectively. The DR for a needle applicator was 7.04 Gy/min at 5 mm distance from the applicator surface. Overall, film results were in excellent agreement with ion-chamber data. conclusion: IORT may be delivered with a variety of site-specific applicators. Appropriate applicator use is paramount for safe, effective, and efficient IORT delivery. Results of this study should help clinicians assure optimized target dose coverage and reduced normal tissue exposure. [ABSTRACT FROM AUTHOR]

Context:Turmeric is a spice obtained from the root ofCurcuma longaL. (Zingiberaceae) with anti-aging, anticancer, anti-Alzheimer’s disease, antioxidant and other medicinal properties. Objective:The relaxant effect ofC. longaon rat tracheal smooth muscle and its possible mechanisms were investigated in this study. Materials and methods:The relaxant effects of four cumulative concentrations of hydro-ethanol extract ofC. longa(6.25, 12.5, 25, 50 mg/mL) were studied on tracheal smooth muscle precontracted by methacholine or KCl in non-incubated or incubated with different substances including propranolol, diltiazem,L-NAME, glibenclamide, atropine, chlorpheniramine, indomethacin and papaverine. The duration of the study was 84 days. Results:In non-incubated tracheal smooth muscle, the extract ofC. longashowed significant concentration-dependent relaxant effects (p < 0.001 for all concentrations on both KCl and methacholine-induced contraction). There was no significant difference in the relaxant effects betweenC. longaand theophylline in both methacholine and KCl-induced contraction conditions. In tissues incubated with propranolol, diltiazem,L-NAME and glibenclamide on methacholine-induced contraction and in tissues incubated with atropine, chlorpheniramine, indomethacin and papaverine on KCl-induced contraction, the extract also showed significant concentration-dependent relaxant effects (p < 0.001). EC50values ofC. longabetween non-incubated (16.22 ± 0.62) and incubated tissues (atropine: 13.03 ± 0.55, chlorpheniramine: 12.94 ± 0.68, indomethacin: 14.80 ± 0.57 and papaverine: 16.16 ± 1.42) were not significantly different. Conclusions:Tracheal smooth muscle relaxant effects ofC. longa, were comparable to those of theophylline, which could be due to the presence of methylxanthines or its possible interaction with non-adrenergic non-cholinergic nervous system. [ABSTRACT FROM PUBLISHER]

Purpose To develop a novel method to monitor external anatomical changes in head and neck cancer patients in order to triage possible adaptive radiotherapy needs. Methods The presented approach aims to provide information on internal anatomical changes based on variations observed in external anatomy. Setup Cone Beam Computed Tomography (CBCT) images are processed to produce an accurate external contour of the patient's skin. After registering the CBCTs to the reference planning CT, the external contours from each CBCT are transferred to the initial - first week - CBCT. Contour radii, defined as the distances between an external contour and the isocenter projection in each CBCT slice, are calculated for each scan over the full 360 degrees. The changes in external anatomy are then quantified by the difference in radial distance between the external contours of any secondary CBCT relative to the initial CBCT. Finally, the radial difference is displayed in cylindrical coordinates as a 2D intensity map to highlight regions of interests with significant changes. Weekly CBCT scans from 15 head and neck patients were retrospectively analyzed to demonstrate the utility of this approach as a proof of principle. External changes suggested by the 2D radial difference map of an example patient after 23 fractions were then correlated with the changes in the gross tumor volumes and organs at risks. The resulting dosimetric effects were evaluated. An interactive standalone software application has been developed to facilitate the generation and the interpretation of the 2D intensity map. Results The 2D radial difference maps provided qualitative and quantitative information, such as the location and the magnitude of external contour changes and the rate at which these deviations occur. Out of the 15 patients, 10 presented clear evidence of general external volume shrinkage due to weight loss, and nine patients had at least one site of local shrinkage. Only two patients showed no signs of anatomical change during their entire treatment course. For the example patient, the mean (±σ) radial difference was 6.7 (±3.0) mm for the left parotid and 7.3 (±2.5) mm for the right parotid. The mean dose to the left and right parotids increased from 20.1 Gy to 30 Gy and from 16.3 Gy to 29.6 Gy, respectively. Conclusion This novel method provides an efficient tool to visualize 3D external anatomical changes on a single 2D map. It quickly pinpoints the location of differences in anatomy during the course of radiotherapy, which can help physicians determine if a treatment plan needs to be adapted. The interactive graphic user interface developed in this study will be evaluated in an adaptive radiotherapy workflow for head and neck patients in a future prospective trial. [ABSTRACT FROM AUTHOR]

Background Approximately 3 to 13% of salivary carcinomas recur at the skull base. We report our experience treating these recurrences with stereotactic radiation. Methods In total, 14 patients with skull base recurrence of salivary gland carcinoma were identified. Patient characteristics, treatment parameters, response to treatment, local recurrence-free/overall survival, and patterns of failure were studied. Results All 12 symptomatic patients experienced palliation of symptoms. Two grade 3 toxicities were observed. Local recurrence-free survival after skull base treatment was 28 months (74 months after allowing for additional course of salvage radiotherapy). Overall survival was 153 months from primary diagnosis and 67 months from first skull base failure. Of 13 treatment failures, 8 occurred at margins; the rest were infield. All intracranial failures occurred along meningeal surfaces. Conclusions Stereotactic radiation provides well-tolerated palliation for the majority of patients, but with a high rate of local failure. Due to the propensity for meningeal failures, we suggest increasing margins along the meningeal surfaces when treating these patients. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to present a single institution experience with intraoperative radiation therapy (IORT) for patients with head and neck cancer (HNC). The present study included all patients with HNC treated consecutively with IORT at Loyola University Medical Center between January 2014 and December 2018. Charts were reviewed for patient and tumor characteristics, IORT technical details, IORT-induced adverse events and treatment outcomes. The study included 23 eligible patients. Median patient age was 66 years (range, 34-91 years). Tumor sites included the parotid gland (43%), lymph nodes (43%), oral tongue (9%) and ear (4%). A total of 48% of patients received IORT upfront with or without postoperative adjuvant external beam radiation therapy (EBRT), whereas 52% received salvage IORT after local tumor recurrence. The median prescribed IORT dose was 7.5 Gy (range, 5-14 Gy) in a single fraction prescribed to 5 mm depth with flat applicators (median diameter, 5 cm). A total of 92% of patients did not experience wound healing complications. One patient (4%) developed postoperative acute thromboembolic stroke and a second patient (4%) experienced protracted wound healing. At a median follow up of 36 months (range, 2-81 months), overall survival was 52%. In addition, 48% of patients were reported to have no evidence of disease, and although two had died of unrelated causes, 13% of patients were alive with disease and 39% died with the disease. The local-regional recurrence rate was 39% (median time to local recurrence, 11 months; range, 1-34 months), the rate of distant metastasis was 35% (median time to distant metastasis, 16 months; range, 4-40 months), and 21% of patients had both local-regional recurrence and distant metastases. The percentages of local-regional recurrence and distant metastases among patients receiving salvage IORT were 58 and 50% respectively, compared with 18 and 18% respectively in those receiving upfront IORT with or without adjuvant EBRT. In the present single institution retrospective study, it was concluded that IORT for patients with locally advanced and recurrent HNC was a safe treatment modality, with tumor control comparable to historical IORT data. Larger prospective studies are needed to further assess the utility of IORT in the management of locally advanced and recurrent HNC. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The study objective was to determine survival and functional results in patients who underwent transoral laser excision of base of tongue squamous cell carcinoma. Study Design: This was a case series with chart review. Subjects and Methods: Patients with biopsy-proven base of tongue squamous cell carcinoma primarily treated with transoral laser excision and followed for at least 24 months were included. Disease-specific and overall survival data were determined. Quality-of-life data were obtained using the University of Washington Quality of Life instrument. Results: Of the 71 patients treated, one (1.4%), nine (12.7%), seven (9.9%), and 54 (76.1%) were stage I, II, III, and IV, respectively, at diagnosis. At 24 months, overall survival was 90 percent; disease-specific survival was 94 percent. Locoregional recurrence occurred in 10 percent. Given the low number of deaths, no significance was detectable between survival and gender, overall stage, tumor size, nodal status, or adjuvant therapy. Quality-of-life data, obtained for 46 patients, revealed the majority of patients had mild or no pain, minimally impaired to normal swallowing, and normal speech. Conclusion: Transoral laser excision offers an acceptable treatment approach in terms of survival and quality of life for patients with base of tongue squamous cell carcinoma. [Copyright &y& Elsevier]

Objective: To review a single institution's experience with posterior marginal (ramus) mandibulectomy for mandibular preservation in the management of patients with squamous cell carcinoma of the retromolar trigone or oropharynx. To review the history and surgical technique with emphasis on functional as well as oncologic outcomes.Study Design and Setting: Retrospective review at a tertiary care academic referral center from 1996 to 2002.Results: Between 1996 and 2002, 382 patients with squamous cell carcinoma of the oral cavity and oropharynx were surgically treated at the Loyola University Medical Center. Medical records were reviewed and 152 patients were identified who had some form of mandibular procedure (segmental resection, marginal resection, or mandibulotomy) performed in conjunction with their tumor resection. Eighteen posterior marginal mandibulectomies were performed for primary cancers of the retromolar trigone, tonsillar fossa, and/or base of the tongue. All patients received adjuvant radiotherapy. Bone invasion of the marginal mandibulectomy specimens by squamous cell carcinoma was observed in 2 cases, neither of which developed a local recurrence. Mean and median overall survivals were 41.4 and 37.5 months, respectively. Functional outcomes were determined by administering the University of Washington Quality of Life instrument administered at 12 months. Patients reported significant alterations in chewing, but all were able to maintain satisfactory oral intake and no patient required a gastrosotomy tube.Conclusions: A posterior osteotomy of the mandibular ramus is a useful adjunct in the surgical treatment of cancer of the retromolar trigone or oropharynx. Negative surgical margins can be obtained even with focal invasion of mandibular bone. The loss of bone in this area does not significantly affect patients' appearance. Patients report deterioration in chewing following this procedure but are able to maintain a diet of solid food. [ABSTRACT FROM AUTHOR]

: ObjectiveTo review a single institution''s experience with posterior marginal (ramus) mandibulectomy for mandibular preservation in the management of patients with squamous cell carcinoma of the retromolar trigone or oropharynx. To review the history and surgical technique with emphasis on functional as well as oncologic outcomes.: Study design and settingRetrospective review at a tertiary care academic referral center from 1996 to 2002.: ResultsBetween 1996 and 2002, 382 patients with squamous cell carcinoma of the oral cavity and oropharynx were surgically treated at the Loyola University Medical Center. Medical records were reviewed and 152 patients were identified who had some form of mandibular procedure (segmental resection, marginal resection, or mandibulotomy) performed in conjunction with their tumor resection. Eighteen posterior marginal mandibulectomies were performed for primary cancers of the retromolar trigone, tonsillar fossa, and/or base of the tongue. All patients received adjuvant radiotherapy. Bone invasion of the marginal mandibulectomy specimens by squamous cell carcinoma was observed in 2 cases, neither of which developed a local recurrence. Mean and median overall survivals were 41.4 and 37.5 months, respectively. Functional outcomes were determined by administering the University of Washington Quality of Life instrument administered at 12 months. Patients reported significant alterations in chewing, but all were able to maintain satisfactory oral intake and no patient required a gastrosotomy tube.: ConclusionsA posterior osteotomy of the mandibular ramus is a useful adjunct in the surgical treatment of cancer of the retromolar trigone or oropharynx. Negative surgical margins can be obtained even with focal invasion of mandibular bone. The loss of bone in this area does not significantly affect patients'' appearance. Patients report deterioration in chewing following this procedure but are able to maintain a diet of solid food. [Copyright &y& Elsevier]

From January 1975 to December 1980, 25 patients with persistent or recurrent carcinomas of the head and neck were retreated for palliation at the Division of Radiation Oncology, Mallinckrodt Institute of Radiology. These patients had all undergone extensive previous treatment by surgery and/or radiation. All were retreated with 192Ir interstitial implant with or without external radiation and/or surgical excision. Of 25 patients, 13 had complete response (CR) and 6 had partial response for a follow-up period of 1 to 7 years. Of 13 patients with CR, 6 are alive with no evidence of disease (NED) and two died NED. We present detailed results and discuss our new strategy for such patients. [ABSTRACT FROM AUTHOR]

Background: Rosa damascena (R.D) is an aromatic plant with numerous therapeutic effects including cardiovascular effect. The mechanism cardiovascular effect of R.D is unclear and suggested mediated through renin–angiotensin system (RAS). Therefore, in this study, the role of hydroalcoholic extract of R.D on acute hypertension induced by AngII was evaluated. Methods: After anesthesia, femoral artery and vein of rats were cannulated for recording cardiovascular responses and drug injection, respectively. Systolic blood pressure (SBP), mean arterial blood pressure (MAP), and heart rate (HR) were recorded continuously by power lab software. Rats were divided into saline, AngII (50 ng/kg), AngII + Losartan (10 mg/kg), and three groups of R.D extract (250, 500, and 1000 mg/kg). Losartan and AngII were administered intravenously and the other ones intraperitoneal. In the R.D groups, 30 min after injection of the extract, AngII was injected and the maximum changes in SBP, MAP, and HR were calculated and compared to that in control and AngII groups. Results: Results show that AngII significantly increased SBP, MAP, and decreased HR than the control group which was blocked by losartan. SBP and MAP in R.D + AngII groups were significantly lower than AngII alone (P < 0.05 –P < 0.001). Only MAP in higher dose (1000 mg/kg) was significantly lower than low dose (250 mg/kg; P < 0.05). Two higher doses also significantly decreased bradycardia induced by AngII (P < 0. 01). Conclusions: The preventive effect of hydroalcoholic extract of R.D on cardiovascular parameters maybe is mediated by suppression of AngII activity. [ABSTRACT FROM AUTHOR]