Environmental assessment of cytotoxic drugs in the Oncology Center of Cyprus.

BACKGROUND: Cytotoxic drugs constitute an important workplace hazard in the hospital environment. Our aim was to conduct an environmental assessment of hazardous drugs in the Oncology Center of Cyprus. METHODS: Wipe samples were obtained from 42 workplace areas of the Oncology Center including two pairs of gloves in an initial assessment, while 10 samples were obtained at follow-up 3 years later. Potential contamination with cyclophosphamide (CP), ifosphamide (IF) and 5-fluorouracil (5-FU) and other cytotoxic medications was examined using the GC-MSMS system (CP, IF) and the HPLC system with UV detection (5-FU) method, respectively. RESULTS: Wipe sample contamination was detected at 11.9% and 15% in the initial and follow-up assessment, respectively. Both pairs of gloves assessed were free from contamination. The results showed contamination with cyclophosphamide on the work space inside the isolator, on a day-care office phone and on the central pharmacy bench. Ifosphamide was only detected on the floor of a patient's room. Contamination with 5-fluorouracil was found only on the surface of a prepared IV infusion bag. The levels of contamination in the positive samples ranged from 0.05 to 10.12 ng/cm2. CONCLUSIONS: The overall percentage of sample contamination at the Oncology Center was very low compared to other centers around the world. In addition, the detected levels of contamination with cytotoxic drugs were relatively low with the exception of the workspace inside the biological safety cabinet. These results in both assessments may reflect the implementation of comprehensive control measures including employee training, technological equipment and effective cleaning procedures.

Prognostic factors and significance of the revised 6th edition of the AJCC classification in patients with locally advanced nasopharyngeal carcinoma.

PURPOSE: To compare the 4th edition 1992 and 6th edition 2002 of the American Joint Committee on Cancer (AJCC) staging systems, to evaluate the paranasopharyngeal structures and lymph node involvement, and to define the prognostic significance of the above factors to overall survival (OS) in patients with locally advanced nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS: CT images of 162 patients, who were diagnosed with NPC and received irradiation alone or chemotherapy and irradiation, were retrospectively reviewed. CT scans, performed prior to and after the completion of treatment, were reviewed. RESULTS: The parapharyngeal space was found to be involved very commonly (98%). 50 of 162 patients (31%) displayed parapharyngeal extension of the tumor to degree A, 59 patients (36%) showed degree B, and 50 patients (31%) degree C nasopharyngeal extension. According to the AJCC 6th edition 2002, patients were distributed into stages IIA, IIB, III, IVA, and IVB. By contrast, using the AJCC 4th edition 1992, patients were distributed into stages III and IV only. After a median follow up of 71.1 months, median survival was 60.7 months, with a 2-year survival rate of 71.3% and a 3-year survival rate of 62.2%. Multivariate analysis identified age, degree of parapharyngeal lateral extension, cavernous-sinus-infiltration, and size of infiltrated lymph nodes as independent prognostic factors for OS. CONCLUSION: The 6th revision of TNM staging reported herein, provides a more uniform distribution of patients between stages. The degree of tumor extension into the parapharyngeal space should be considered in future TNM staging revisions.