• Asian Pacific Journal of Cancer Prevention
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• v.16 no.17
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• pp.7893-7895
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• 2015

Background: Acute promyelocytic leukemia (APL) is a distinctive clinical, biological and molecular subtype of acute myeloid leukemia. However, data from Pakistan are scarce. Therefore we reviewed the demographic and clinical profile along with risk stratification of APL patients at our center. Materials and Methods: In this descriptive cross sectional study, 26 patients with acute promyelocytic leukemia were enrolled from January 2011 to June 2015. Data were analyzed with SPSS version 22. Results: The mean age was $31.8{\pm}1.68years$ with a median of 32 years. The female to male ratio was 2:1.2. The majority of our patients had hypergranular variant (65.4%) rather than the microgranular type. The major complaints were bleeding (80.7%), fever (76.9%), generalized weakness (30.7%) and dyspnea (15.38%). Physical examination revealed petechial rashes as a predominant finding detected in 61.5% followed by pallor in 30.8%. The mean hemoglobin was $8.04{\pm}2.29g/dl$ with the mean MCV of $84.7{\pm}7.72fl$. The mean total leukocyte count of $5.44{\pm}7.62{\times}10^9/l$; ANC of $1.08{\pm}2.98{\times}10^9/l$ and mean platelets count were $38.84{\pm}5.38{\times}10^9/l$. According to risk stratification, 15.3% were in high, 65.4% in intermediate and 19.2% in low risk groups. Conclusions: Clinico-epidemiological features of APL in Pakistani patients appear comparable to published data. Haemorrhagic diathesis is the commonest presentation. Risk stratification revealed predominance of intermediate risk disease.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.8
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• pp.3561-3566
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• 2014

Background: Recurrent nasopharyngeal carcinoma (NPC) after previous radiotherapy is challenging. There is no standard approach for salvage treatment. Here we present toxicity and treatment results for recurrent NFC patients who underwent fractionated stereotactic radiotherapy (FSRT) as second line radiotherapy (RT). Materials and Methods: Between April 2009 and July 2012, 24 patients, with a male to female ratio of 3:1, were treated with CykerKnife$^{(R)}$ FSRT for recurrent NFC in our institution. Seven out of 24 patients had metastatic recurrent disease. Median age was 53 years (range, 20-70 years). Initial RT dose was 70Gy. The time period between initial RT and FSRT was a median of 33.2 months. The median prescription dose for FSRT was 30Gy (range, 24-30 Gy) in a median of 5 fractions (range, 4-6). Results: The median follow-up for all patients was 19.5 months (IQR: 12.2.-29.2 months). The locoregional control; progression free survival and overall survival (OS) rates for 1-, 2- and 3-year were 64%, 38%, 21%; 60%, 30%, 17% and 83%, 43%, 31%, respectively. Median OS for the entire cohort was 22 months (95% CI: 16.5-27.5). On multivariate analysis recurrent tumor stage was the only prognostic factor for OS (p=0.004). One patient exhibited grade III temporal lobe necrosis. One died because of grade IV mucositis and overlapping infection. Conclusions: The treatment of recurrent NPC is controversial. Fractionated stereotactic radiotherapy is promising. However, the published trials are heterogeneous with respect to the selection criteria and treatment details. Prospective studies with long term follow-up data are warranted.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.2
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• pp.867-870
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• 2014

Purpose: This study used receiver operating characteristic curve to analyze Surveillance, Epidemiology and End Results (SEER) ependymoma data to identify predictive models and potential disparity in outcome. Materials and Methods: This study analyzed socio-economic, staging and treatment factors available in the SEER database for ependymoma. For the risk modeling, each factor was fitted by a Generalized Linear Model to predict the outcome ('brain and other nervous systems' specific death in yes/no). The area under the receiver operating characteristic curve (ROC) was computed. Similar strata were combined to construct the most parsimonious models. A random sampling algorithm was used to estimate the modeling errors. Risk of ependymoma death was computed for the predictors for comparison. Results: A total of 3,500 patients diagnosed from 1973 to 2009 were included in this study. The mean follow up time (S.D.) was 79.8 (82.3) months. Some 46% of the patients were female. The mean (S.D.) age was 34.4 (22.8) years. Age was the most predictive factor of outcome. Unknown grade demonstrated a 15% risk of cause specific death compared to 9% for grades I and II, and 36% for grades III and IV. A 5-tiered grade model (with a ROC area 0.48) was optimized to a 3-tiered model (with ROC area of 0.53). This ROC area tied for the second with that for surgery. African-American patients had 21.5% risk of death compared with 16.6% for the others. Some 72.7% of patient who did not get RT had cerebellar or spinal ependymoma. Patients undergoing surgery had 16.3% risk of death, as compared to 23.7% among those who did not have surgery. Conclusion: Grading ependymoma may dramatically improve modeling of data. RT is under used for cerebellum and spinal cord ependymoma and it may be a potential way to improve outcome.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.24
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• pp.10883-10885
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• 2015

Purpose: Neutrophil-to-lymphocyte ratio (NLR) was evaluated as a potential prognostic factor in patients with myelodysplastic syndrome (MDS). Materials and Methods: Between December 2009 and April 2014, 14 female (35%) and 26 male (65%) MDS patients who were followed up in our hematology clinic were included in the study for NLR during diagnosis. Division was into two groups according to the NLR, and the correlation with mortality was evaluated. The prognostic significance of NLR regarding treatment outcome was also evaluated with adjustment for known confounding risk factors. Results: The mortality rate of the patient group was 55%, and median survival was 18 months. There was no significant correlation between mortality and NLR at a median value of 1.8 (p=0.75). Thrombocytopenia was observed to increase mortality (p=0.027), and there was a significant correlation between mortality and pancytopenia (p=0.017). Conclusions: This first study of NLR and mortality did not show any significant correlation. In centres with limited access to genetic evaluation for the presence of pancytopenia and/or thrombocytopenia at the time of diagnosis, a platelet level less than $50{\times}10^9/l$ may be poor prognostic markers in MDS patients.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.15 no.2
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• pp.8-14
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• 2009

Purpose: to apply lymph massage to the patients that contracted lymphedema after mastectomy to resolve blood congestion, stimulate circulation, and control swelling long-term. Methods: The subjects include 20 female patients that were diagnosed with breast cancer histologically and contracted lymphedema within one to two years after mastectomy. They received lymph massage from March to August, 2008. Using a measuring tape(capable of measuring mm), the arm circumference was measured in both the sick and normal arm. Only the data from the sick arm were compared before and after the treatment. The measuring points were five; the back of the hand(a certain distance[about 10cm] was set between the end of the middle finger to the center of the palm), the wrist(the smallest section), the lower arm(at a certain distance[about 10cm] from the internal bending part of the elbow), the elbow(the bending part), and the upper arm(at a certain distance[about 10cm] from the internal bending part of the elbow). Collected data were analyzed using the SPSS/WINDOWS Version 12.0 program. Results: There was a reduction of lymphedema observed in all the points including 10cm in the upper arm, the elbow, 10cm in the lower arm, the wrist and the back of the hand after lymph massage, and the reduction had statistically significant differences(p<.05). Conclusion: Those results indicate that lymph massage has effects on the reduction of lymphedema in the early patients that contracted it after mastectomy.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.16
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• pp.6887-6892
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• 2014

The oncogenic role of human papillomavirus (HPV) in triggering cervical cancer, the second most common cancer in women worldwide, is well established. Romania ranks in first place in Europe in terms of the incidence of cervical cancer. Geographical widespread data on HPV type-distribution are essential for estimating the impact of HPV vaccines and cervical cancer screening programmes. In this study we aimed to identify the prevalence of HPV genotypes and to establish correlations with abnormal cervical cytology among the female population of Brasov County, Romania. A total of 1,000 women aged 17.3-57 years, attending routine cervical examination in the Obstetrics and Gynecology Hospital of Brasov, Romania, and undergoing both cytological examination and HPV genotyping were screened. Infection with 35 different HPV genotypes was detected in 39.6% of cytological specimens. Overall HPV infections were highest in young women under 25 years (p<0.0001), in which cervical cytological abnormalities also reached the highest prevalence. Patients infected by HPV-16 or HPV-18 showed the highest prevalence of cervical cytological abnormalities. Some 48.2% of women with abnormal cytology were infected with high-risk HPV types whereas less than 3% of them were infected only with low-risk HPV types. Our study showed that the prevalence of high-risk HPV infection among Romanian women is higher compared to other studies in other geographic areas. Thus, we consider that in areas where there is an increased prevalence of high-risk HPV infections, HPV genotyping should be performed in all women aged between 18 and 45 years, and Pap test should be performed every 6 months in women with high-risk HPV infection, even those with previous normal cervical cytology.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.4
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• pp.1633-1637
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• 2014

Background: Lymphoma is a malignant neoplasm of lymphoid tissue classified into Hodgkin's and non- Hodgkin's types. It mostly affects lymph nodes although a considerable proportion of Non-Hodgkin's cases occur in extranodal sites. Materials and Methods: Selected cases diagnosed as non-Hodgkin's lymphoma (NHL) during the period of 1980 to 2012 were retrieved from the archives of the Oral Pathology Diagnostic Laboratory, Faculty of Dentistry, University of Malaya. The sections from the formalin-fixed paraffin embedded tissue blocks were stained with H&E as well as with LCA, CD20, and CD3. Results: The mean age was 41.6 years with a male: female ratio of 1.3:1. Out of the forty two cases, nineteen were Malays, eighteen were Chinese, followed by Indians (3) and Indonesians (2). The most common site of involvement was the mandible (22.2%), followed by the maxilla and palate (19.4% each). Most of the lesions presented as a painless progressive swelling. Only thirty six cases were further subdivided into B or T cell types. The majority were B-cell type (26 cases), of these 6 cases were Burkitt's lymphomas. Only ten cases were T-cell lymphoma, with three cases of NK/T-cell lymphoma. Conclusions: In this series of 42 patients diagnosed as extranodal non-Hodgkin's lymphoma, the lesions appeared as painless swellings, mostly in men with the mandible as the most frequent site of involvement. Majority were B-cell lymphomas with Malays and Chinese being equally affected whereas lymphomas were rare in the Indian ethnicity. T-cell lymphomas were found to be common in the Chinese ethnic group.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.14
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• pp.5883-5888
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• 2014

Background: Breast cancer is the most common cancers in female populations. The exact cause is not known, but is most likely to be a combination of genetic and environmental factors. Log-logistic model (LLM) is applied as a statistical method for predicting survival and it influencing factors. In recent decades, artificial neural network (ANN) models have been increasingly applied to predict survival data. The present research was conducted to compare log-logistic regression and artificial neural network models in prediction of breast cancer (BC) survival. Materials and Methods: A historical cohort study was established with 104 patients suffering from BC from 1997 to 2005. To compare the ANN and LLM in our setting, we used the estimated areas under the receiver-operating characteristic (ROC) curve (AUC) and integrated AUC (iAUC). The data were analyzed using R statistical software. Results: The AUC for the first, second and third years after diagnosis are 0.918, 0.780 and 0.800 in ANN, and 0.834, 0.733 and 0.616 in LLM, respectively. The mean AUC for ANN was statistically higher than that of the LLM (0.845 vs. 0.744). Hence, this study showed a significant difference between the performance in terms of prediction by ANN and LLM. Conclusions: This study demonstrated that the ability of prediction with ANN was higher than with the LLM model. Thus, the use of ANN method for prediction of survival in field of breast cancer is suggested.

• Journal of Sasang Constitutional Medicine
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• v.26 no.2
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• pp.205-212
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• 2014

Objectives Adverse reactions can becaused by contrast media used in computed tomography. The aim of this study was to report the improvement of allergic response caused by contrast media after treatment with Modified Hyeongbangpaedok-san, histamine antagonists and steroids. Methods We retrospectively reviewed the medical records. The patient's subjective symptoms such as rash and pruritus were evaluated by the range of rash and numeric rating scale(NPS). Results All symptoms showed nearly complete remission with continued Korean traditional medical treatment. Conclusions A female patient had been injected with contrast media for Computed tomography(CT) evaluation of lung cancer. Rash and pruritus appeared 1 day after injection. We prescribed Modified Hyeongbangpaedok-san. Patients were treated with both Korean medicine and Western medicine. Consequently, the symtoms were improved significantly after combination treatment of Korean medicine and Western medicine.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.15
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• pp.6267-6272
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• 2015

Background: Extra nodal lymphoma (ENL) constitutes about 33 % of all non-Hodgkin's lymphoma. 18-28% develops in the head and neck region. A multimodality treatment with multi-agent chemotherapy (CT) and radiotherapy (RT) is considered optimum. Materials and Methods: We retrieved the treatment charts of patients of HNENL treated in our institute from 2001-2012. The charts were reviewed and the demographic, treatment details and outcome of HNENL patients were retrieved using predesigned pro-forma. Results: We retrieved data of 75consecutive patients HNENL. Median age was 47years (Range: 8-76 years). Of the 75 patients 51 were male and 24 were female. 55patients were evaluable. The patient and tumor characteristics are summarized in Table 1. All patients were staged comprehensively with contrast enhanced computed tomography of head, neck, thorax, abdomen, pelvis and bone marrow aspiration and biopsy 66 patients received a combination multi-agent CT with CHOP being the commonest regimen. 42 patients received 4 or lesser number of cycles of chemotherapy whereas 24received more than 4 cycles chemotherapy. Post radiotherapy, 41 out of 42 patients had a complete response at 3 months. Only 21patients had a complete response after chemotherapy. All patients received radiation (mostly involved field radiation) as a part of the treatment. The median radiation dose was 45 Gray (Range: 36 Gray-50 Gray). The radiation was planned by 2D fluoro simulation based technique in 37cases and by 3 Dimensional conformal radiation therapy (3DCRT) in 36 cases. Two patients were planned by the intensity modulated radiation therapy (IMRT) technique. IMRT was planned for one thyroid and one nasal cavity primary. 5 patients experienced relapse after a median follow up of 19 months. The median survival was not reached. The estimated two and three year survival were 92.9% (95%CI- 68.6- 95.35) and 88% (95%CI- 60.82 - 92.66) respectively. Univariate analysis revealed higher stage and poorer baseline performance status to be significantly associated with worse progression free survival. 5 patients progressed (relapse or primary disease progression) after treatment. Of the 5 patients, two patients were primary orbital NHL, two patients had NHL nasal cavity and one was NHL thyroid. Conclusions: Combined modality treatment in HNENL confers excellent disease control with acceptable side effects.