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Journal Issue: Vol. 12 No. 4 - October 2013

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Knowledge and Attitudes of Oncologists about Complementary and Alternative Therapies Used by Cancer Patients

Dr Linda M. Burnett, Dr Haryana Dhillon, Janette Vardy

  1. Dr Linda M. Burnett
    MBBS (Hons), BApSc (MRT) (Hons)
    Sydney Medical School, University of Sydney, Australia
  2. Dr Haryana Dhillon
    Centre for Medical Psychology and Evidence-based Decision Making, University of Sydney, Australia.rn
  3. Janette Vardy
    Concord Cancer Centre, Concord Hospital

Purpose: Up to 80% of cancer patients are estimated to use Complementary and Alternative medicines (CAM) but most do not report their usage to oncologists. Here we assess self-reported knowledge and attitudes of oncologists towards CAM use. Materials and Methods: Oncologists completed a web-based survey to determine their knowledge and attitudes towards different types of CAM (e.g. pharmacological/ingestible or non-pharmacological) in different treatment settings (curative versus palliative), their CAM education needs and personal CAM use. Results: Eighty-five oncologists participated (response rate 36%). Many oncologists acknowledged they knew little about numerous CAM treatments and most over-estimated patient usage of CAM. Oncologists reported knowing most about therapies commonly used by patients: yoga, massage, acupuncture, meditation/relaxation/visualization and antioxidants/nutritional supplements. Forty-five percent never used a CAM personally and 29% used CAM at least monthly. Oncologists were more likely to ask patients about pharmacological/ingestible CAM use than non-pharmacological CAM, especially where treatment intent was curative, but most believed CAMs were more helpful in the palliative setting. Fifty-five percent of oncologists recommended non-pharmacological CAM at least monthly: most commonly for improvement of patients’ psychosocial well-being (66%). Sixty-two percent believed more CAM educational resources should be available, particularly information about CAM efficacy and specific herb-drug interactions. Conclusion: Up to 37% of oncologists usually or always asked patients about their CAM use, and 69% have recommended a CAM, however most reported knowing nothing or very little about many CAM. More CAM education resources targeted specifically to the needs of oncologists are required.


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Clinical Evaluation of 12 Patients with Cervical Lymph Node Metastases from Squamous Cell Carcinoma of Unknown Primary: a Retrospective Review

Dr Kana Nishiyama, Dr Yoshiyuki Itoh, Dr Rie Nakahara, Dr Atsuko Asano, Dr Tohru Okada, Dr Seiji Kubota, Dr Sayo Maki, Dr Junji Itoh, Dr Yasushi Fujimoto, Dr Tsutomu Nakashima, Dr Shinji Naganawa

  1. Dr Kana Nishiyama
    Department of Radiology, Nagoya University Graduate School of Medicinern
  2. Dr Yoshiyuki Itoh
    Department of Radiology, Nagoya University Graduate School of Medicine
  3. Dr Rie Nakahara
    Department of Radiology, Nagoya University Graduate School of Medicine
  4. Dr Atsuko Asano
    Department of Radiology, Nagoya University Graduate School of Medicine
  5. Dr Tohru Okada
    Department of Radiology, Nagoya University Graduate School of Medicine
  6. Dr Seiji Kubota
    Department of Radiology, Nagoya University Graduate School of Medicine
  7. Dr Sayo Maki
    Department of Radiology, Nagoya University Graduate School of Medicine
  8. Dr Junji Itoh
    Department of Radiology, Nagoya University Graduate School of Medicine
  9. Dr Yasushi Fujimoto
    Department of Otolaryngology, Nagoya University Graduate School of Medicine
  10. Dr Tsutomu Nakashima
    Department of Otolaryngology, Nagoya University Graduate School of Medicine
  11. Dr Shinji Naganawa
    Department of Radiology, Nagoya University Graduate School of Medicine

Purpose: Carcinoma of unknown primary (CUP) is estimated to represent only 3% to 5% of all head and neck cancers, with squamous cell carcinoma accounting for 70% to 90% of these lesions. The optimal management of this type of tumor is still controversial and a standard therapy has not yet been identified. The purpose of this retrospective analysis was to assess patient outcomes in cervical CUP. Methods: Between 1998 and 2007, 12 patients (10 male and 2 female) with squamous-cell neck metastases from CUP were treated at Nagoya University Hospital. The median patient age was 63 years (range, 34–84 years). The cancer stage was N1 in 0 patients, N2a in 2 patients (16.7%), N2b in 6 patients (50.0%), N2c in 1 patient (8.3%), and N3 in 3 patients (25.0%). Two patients (16.7%) were treated with radiotherapy alone, 8 patients (66.7%) received chemoradiotherapy, and 7 patients (58.4%) underwent surgery. The median dose of radiation to the involved neck was 58.0 Gy (range, 12.0–70.0 Gy). Results: The median follow-up period in surviving patients was 21 months (range, 12–110 months) and in the entire group was 18 months (range, 5–110 months). Four patients (33.3%) remained alive at the end of the study period (May 15, 2013). Nodal recurrence was seen in 1 patient, failure of cervical nodal control was seen in 3 patients, and distant metastases were seen in 2 patients. One patient developed a primary cancer in the hypopharynx mucosa. The 3-year overall survival was 54.7% and the disease-free survival was 47.6%. Grade 3 acute toxicity included oral mucositis (5 patients; 41.7%), sore throat (1 patient; 8.3%), and dermatitis (4 patients; 33.3%). Conclusions: Although the sample size was small, the 3-year overall survival rate and the disease-free survival were similar to the current literature.


Promoter DNA Methylation of DNA Repair Genes in Cancer

Shilpa V.

  1. Shilpa V.
    Doctoral Scholar
    Department of Biochemistry, Kidwai Memorial Institute of Oncologyrn

“Epigenetics has always been all the weird and wonderful things that cannot be explained by genetics” a famous quote by Denise Barlow. Coining the term epigenetics is credited to Conrad Waddington who describes it as a “branch of biology which studies causal interactions between genes and their products, which bring the phenotype into being”. Epigenetics adds a new stratum of events between genes and their expression. It proposes a control system of “switches” that turn genes on or off causing heritable effects in humans. Thousands of DNA damaging events take place every day in our body but efficient DNA repair systems prevent that. Accumulation of DNA damage has been linked to cancer and genetic deficiencies in specific DNA repair genes are associated with tumor prone phenotypes. Epigenetic silencing of DNA repair genes may promote tumorigenesis. This review summarizes current knowledge of the epigenetic inactivation of DNA repair components in cancer.


Designing and Development of Solasodine Nanoparticles for Cancer Therapy (Part A)

Sarthak Bhattacharya, Seema Kohli, Amar Singh Chaudhary

  1. Sarthak Bhattacharya
    Guru Ramdas Khalsa Institute of Science & Technology (Pharmacy
  2. Seema Kohli
    Department of Pharmacy, Kalaniketan Polytechnic College, Jabalpur, India.rn
  3. Amar Singh Chaudhary
    College of Pharmacy, Bramhanand Group of Institutions, Bulandsahar, India

Context: Solanum xanthocarpum Schrad & Wendl. (Solanaceae) grows as wild plant in many parts of India. Solasodine (aglycone) obtained from Solanum xanthocarpum Schrad & Wendl. (Solanaceae) shows various therapeutic effects on different body systems. Cytotoxicity of solasodine against two human cancer cell lines- HeLa and human myeloid leukaemia (U937) has been established. Objective: To develop nanosolasodine, nanoparticles formulations of solasodine using micro-emulsion crosslinking technique. Materials and methods: Gelatin (type B) based nanoparticles loaded with solasodine were prepared using glutaraldehyde as crosslinker. 8 mg, 11 mg and 13 mg of solasodine were incorporated in the preparation of solasodine nanoparticle formulations (S-NPs). The in vitro drug release has also been investigated and the release data were analyzed using KinetDS 3 rev 2010 for various kinetics models in PBS (pH~7.4). Results: Loading for all the solasodine nanoparticles were more than 90%. Swelling ratio of all solasodine nanoparticles were within 3.00 ± 0.5. In vitro release profile for all three solasodine nanoparticles indicated Fickian based diffusion controlled system. The diffusion coefficients (DC) were 2.471×103 for SNP3: 13, 2.777×103 for SNP1: 8 and 0.645×103 for SNP2: 11. The release kinetics for all three solasodine nanoparticles were studied using KinetDS 3 rev. 2010 software and confirmed drug release kinetics correspond best to Korsmeyer-Peppas model. FESEM photomicrograph of best formulation (13 S-NPs) revealed spherical shape and smooth surface of SNP3: 13 with average size of 50 - 110 nm and zeta potential of SNP3: 13 was recorded -25.9 mV. Discussion and conclusions: Our study for first time shows nanosolasodine, promising potential as nanocarriers for the treatment of cancer. ‘HNPT’-herbal nanoparticles technology is coined for the first time in Pharmaceutical ‘Nano-biotechnology’ by authors and will open up new era in cancer herbal chemo-formulation research techniques.


VEGF - A Precis’

Bhaskari Janardhanan, Dr Lakshmi Krishnamoorthy

  1. Bhaskari Janardhanan
    M.Sc. Biotechnology, (Currently pursuing PhD in medical biochemistry at KMIO, Bangalore, India after working as JRF for 2 years in IITM)
    Kidwai Memorial Institute of Oncology
  2. Dr Lakshmi Krishnamoorthy
    Retd Prof, Dept. of Biochemistry & nbsp;Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India.

Vascular Endothelial Growth factor (VEGF), a term coined by Napolean Ferrera in 1989, is a molecule of great impact in the physiological event of angiogenesis. VEGF shot to prominence in research in the past score of years but there have been earlier reports that have had a seminal impact on the run-up to its discovery and extensive study. Among the various studies, the works of Warren Lewis (1927), J.C. Sandison and Gordon Ide (1939) lead to the identification of a potential tumour derived growth factor. Glenn Algire and team in 1945 then put forward the proposal that neovascularization was essential to tumorigenesis. These works were followed by a slew of experimental research trying to identify or purify mitogenic factors involved in neovascularization. In 1971, Folkman. J in a novel attempt to isolate a specific proangiogenic factor, identified a soluble endothelial mitogen terming it as “tumour angiogenic factor”. Independent research groups led by Donald senger and Harold dvorak further identified and purified what they termed the “Vascular Permeability factor” in 1983. Eventually, Napolean Ferrera et.al. isolated and cloned the endothelial mitogenic protein naming it as the Vascular Endothelial Growth factor. Two decades later, we are yet exploring the genetic and molecular events occurring in the VEGF signal transduction and its pathogenesis. This review makes a modest attempt to put in a nutshell the vast research done in the turf of VEGF and its implications in angiogenesis.


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