Prospective Pilot Study Comparing the Need for Adaptive Radiotherapy in Unresected Bulky Disease and in Postoperative Patients With Head and Neck Cancer.

BACKGROUND: Adaptive radiotherapy is being used in few institutions in patients with head and neck cancer having bulky disease using periodic computed tomography imaging accounting for volumetric changes in tumor volume and/or weight loss. Limited data are available on ART in the postoperative setting. We aim to identify parameters that would predict the need for ART in patients with head and neck cancer and whether ART should be applied in postoperative setting. MATERIALS AND METHODS: Twenty patients with stage III-IV head and neck cancer were prospectively accrued. A computed tomography simulation was done prior to treatment and repeated at weeks 3 and 6 of concurrent intensity-modulated radiotherapy and chemotherapy. The final plan was coregistered with the subsequent computed tomography images, and dosimetric/volumetric changes at weeks 1 (baseline), 3, and 6 were quantified in high-risk clinical target volumes, low-risk clinical target volumes , right parotid , left parotid , and spinal cord . An event to trigger ART was defined as spinal cord maximum dose >45 Gy, parotid mean dose >26 Gy, and clinical target volume coverage <95%. RESULTS: Comparing the 2 groups, the proportion of patients with at least 1 event triggering ART was higher in bulky disease than in postoperative group: 72.7% versus 18.2% (P = .03) overall; 54.6% versus 1.8% (P = .064) at week 3; and 63.6% versus 18.2% (P = .081) at week 6. In the bulky disease group, 8 of 11 patients had events at week 3 and/or 6 as follows: overdose in spinal cord (n = 2), right parotid (n = 3), left parotid (n = 5), coverage < 95% seen in low-risk clinical target volumes (n = 3), and high-risk clinical target volumes (n = 5). In the postoperative group, 2 of 11 patients had events: spinal cord (n = 1) and low-risk clinical target volume (n = 1). CONCLUSION: Our study confirmed the need for ART in patients with head and neck cancer having bulky disease due to target under dosing and/or spinal cord/parotids overdosing in weeks 3 and 6. In contrast, the benefit of ART in postoperative patients is less clear.

Protective role of Juniperus phoenicea and Cupressus sempervirens against CCl(4).

AIM: To investigate the role of Cupressus sempervirens (C. sempervirens) and Juniperus phoenicea (J. phoenicea) extracts as therapeutic effect against CCl(4) with biochemical, histopathological evaluations. METHODS: A single intraperitoneal dose of 10% CCl(4) in olive oil (1 mL/kg body weight) was administered to a group of female Wister rats, sacrificed after 24 h (as the injury group). The other groups were given CCl(4) as described above and divided as follows: two groups of ten rats each were orally administered either J. phoenicea extract or C. sempervirens extract three times per week for six weeks and a further group administered CCl(4) was left for six weeks to allow self-recovery. At the end of experiment, the rats from all groups were sacrificed for sampling and for biochemical and histological analysis. RESULTS: Remarkable disturbances were observed in the levels of all tested parameters. On the other hand, rats injected with the toxic agent and left for one and a half month to self recover showed moderate improvements in the studied parameters while, treatment with both medicinal herbal extracts ameliorated the levels of the disturbed biochemical parameters. The group treated with J. phoenicea extract showed a remarkable improvement in comparison to the CCl(4) treated group. The C. sempervirens group revealing an even more remarkable effect showing histopathological liver& kidney profiles close to those of the control group. CONCLUSION: C. sempervirens and J. phoenicea leaf extracts show a remarkable effect in enhancing liver and kidney functions and may thus be of therapeutic potential in treatment hepatotoxicity and nephrotoxicity.

The effect of a herbal water-extract on histamine release from mast cells and on allergic asthma.

A water extract of a mixture of eight herbs (chamomile, saffron, anise, fennel, caraway, licorice, cardomom and black seed) was tested for its inhibitory effect on histamine released from rat peritoneal mast cells stimulated either by compound 48/80 or be IgE/anti-IgE. The effect of the herb extract was compared to that of the flavonoid quercetin. The herbal water-extract inhibited histamine released from chemically- and immunologically-induced cells by 81% and 85%, respectively; quercetin treated cells were inhibited by 95% and 97%, respectively. The clinical results showed significant improvements of sleep discomfort, cough frequency and cough intensity in addition to increased percentages of FEV1/FVC in patients suffering from allergic asthma, who used the herbal tea compared to those who used the placebo tea.