Purpose To evaluate the incidence of oral cavity squamous cell carcinoma (OCSCC) and oral tongue ... more Purpose To evaluate the incidence of oral cavity squamous cell carcinoma (OCSCC) and oral tongue squamous cell carcinoma (OTSCC) in young white women, age 18 to 44 years. Patients and Methods We analyzed incidence and survival data from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute from 1975 to 2007 for OCSCC and OTSCC. Three cohorts were examined: all ages, age 18 to 44 years (ie, “young”), and age > 44 years. Individuals were stratified by sex and/or race. Percentage change (PC) and annual percentage change (APC) were calculated. Joinpoint regression analyses were performed to examine trend differences. Results Overall, incidence of OCSCC was decreasing for all ages. However, incidence was increasing for young white women (PC, 34.8; APC, 2.2; P < .05). Incidence of OTSCC was decreasing for all ages except in the age 18 to 44 years group (PC, 28.8; APC, 1.8; P < .05). Young white individuals had increasing incidence trends o...
Conservative management of acute Achilles tendon ruptures in a plantarflexed short leg cast or fu... more Conservative management of acute Achilles tendon ruptures in a plantarflexed short leg cast or functional brace is a viable alternative to surgery. The ideal plantarflexion angle to allow the free ends of the tendon to oppose one another has not been clearly defined. The purpose of this cadaveric study was to define a plantarflexion angle where the free Achilles tendon ends reliably oppose one another. Ten cadaveric legs amputated at the distal femur were obtained. A laceration of the Achilles tendon was made 4 cm above the calcaneal insertion. A joint-spanning external fixator was placed across the knee. With differing degrees of knee flexion (0, 45, and 90 degrees), the diastasis between the free ends of the Achilles tendon was measured as the ankle was moved from 20 degrees of dorsiflexion to 30 degrees of plantarflexion (-20, -10, neutral, 10, 20, and 30 degrees). Regardless of knee flexion angle, the ankle plantarflexion angle where the free ends of the Achilles tendon opposed ...
ABSTRACT Radiation recall is a localized inflammatory reaction triggered by the use of cytotoxic ... more ABSTRACT Radiation recall is a localized inflammatory reaction triggered by the use of cytotoxic agents in an area previously irradiated. While usually limited to the superficial tissues and manifesting as a cutaneous reaction, cases of deeper inflammation involving the muscles have been reported, particularly following the use of gemcitabine. We report a case of gemcitabine-induced radiation recall myositis in a patient with dermatomyositis associated with two primary malignancies. A 44-year-old woman with biopsy-proven dermatomyositis was diagnosed with primary lung adenocarcinoma and anal squamous cell carcinoma (SCC). The dermatomyositis had been diagnosed 12 months previously following a presentation with proximal muscle weakness, typical cutaneous features and a positive anti-Ro52 antibody. Serum creatine kinase (CK) was normal at the time of diagnosis at 131 U/L (normal range &lt; 270 IU/L); however, systemic corticosteroids had been commenced prior to the initial rheumatological assessment. Prednisolone 50 mg daily and azathioprine were commenced and following an improvement in muscle strength and cutaneous lesions the dose of prednisolone was weaned down over time to 10 mg daily. Due to the development of alopecia after 5 months of therapy, azathioprine was changed to hydroxychloroquine 400 mg daily. Following the initial diagnosis of dermatomyositis, further clinical assessment to look for the presence of an associated malignancy revealed metastatic primary lung adenocarcinoma and anal SCC. While the association between lung malignancy and dermatomyositis has been well established, ano-rectal cancers have been less commonly reported.[1] Fluorouracil + mytomicin C chemotherapy with local pelvic irradiation was given for the symptomatic anal SCC. Two months following the completion of therapy, repeat imaging showed local progression of the lung adenocarcinoma and hence, carboplatin + gemcitabine chemotherapy was commenced. Within 2 months the patient presented with progressive severe pelvic pain. On examination she was febrile with erythema, swelling, palpable warmth and tenderness of the buttocks and groin area. Investigations revealed a mild neutrophilia, C-reactive protein (CRP) = 140 mg/L (normal range &lt; 8 mg/L) and elevation of serum creatine kinase (CK) of 1261 U/L (normal range &lt; 270 IU/L) (CK 70 U/L 3 months earlier). Magnetic resonance imaging (MRI) with gadolinium of the pelvis revealed changes in the musculature consistent with a local myositis within the previously irradiated field (Fig. 1). To avoid potential problems with wound healing associated with open biopsy, a radiologically guided trocar muscle biopsy from the gluteus maximus was undertaken. No infective organisms were seen on microscopy or culture. Specimen quality was insufficient to define histological structure. A clinical diagnosis of gemcitabine-induced radiation recall myositis was thus made on the basis of clinical and MRI findings and chemotherapy was discontinued. Prednisolone was increased to 50 mg daily and within 5 days partial clinical improvement was observed accompanied by a reduction in serum CK to 351 U/L. Due to concerns of steroid-related adverse effects, the prednisolone dose was reduced to 10 mg daily. Her condition was subsequently slow to improve, requiring ongoing inpatient pain management with opiate analgesia. The patient was discharged home with ongoing analgesic requirements following a 23-day hospital admission. The CK normalized to 115 U/L 1 month after her initial presentation. While multiple cytotoxic agents have been associated with radiation recall reactions, the vast majority of cases have been attributed to anthracyclines and taxanes. Cutaneous reactions have been the most commonly reported manifestations. Muscles and internal organs appear to be less commonly affected. The reaction generally occurs within days to weeks after exposure to the precipitating agent and usually within months of radiotherapy, although delayed reactions (up to 15 years) have been reported.[2, 3] A number of case reports have described radiation recall myositis associated with the use of gemcitabine. The reaction is characterized by local pain and swelling in an area of previous irradiation, an elevated CK level and edema and enhancement of the underlying musculature on MRI occurring within weeks to months of commencing gemcitabine. Improvement has been reported following the cessation of gemcitabine with or without the addition of non-steroidal anti-inflammatory drugs or corticosteroids; however, details on treatment, the response observed and long-term outcomes are sparce.[2, 4, 5] The time frame between radiotherapy and chemotherapy in cases of gemcitabine-induced radiation recall myositis varies from weeks to months but appears to be shorter than radiation recall reactions seen with other chemotherapeutic agents.[2] The etiology of this condition remains unclear. Proposed mechanisms have included…
D2cc were calculated for the above OAR. Other contributing factors including the use of foley, bl... more D2cc were calculated for the above OAR. Other contributing factors including the use of foley, bladder volume, rectal volume, and cylinder size were also recorded. As different dose fractionations were used, the OAR doses were tabulated as a percent of the dose prescribed to 0.5cm. All patients were treated to 4cm of vaginal length. Results: Median BMI in this cohort was 31.7 kg/m 2 (IQR 27.5-38.3 kg/m 2). Higher BMI was associated with lower dose to the bladder and bowel as a percent of prescription for D0.1cc, D1cc and D2cc (p#0.006 for all, table 1). There were no significant correlations in sigmoid (pO0.7) or rectal dose (pO0.2), with the exception of rectal D0.1cc (p50.04). In linear regression, accounting for cylinder size, bladder/rectal volume, and the use of a foley cather, higher BMI remained a significant predictor of lower bladder D2cc, and bowel D2cc (p!0.001 for both). Conclusions: Women with a lower BMI receive higher doses to the bladder and bowel compared to those with a higher BMI. Further analysis is necessary to determine if this translates into greater toxicity.
Objective: Evaluate the impact of radiotherapy on cause specific survival (CSS) and overall survi... more Objective: Evaluate the impact of radiotherapy on cause specific survival (CSS) and overall survival (OS) for stage (I-III) clear cell, mucinous, and endometriod ovarian cancer. Methods: We analyzed incidence, survival, and treatments from the Surveillance, Epidemiology, and End Results (SEER) Program from 2004 to 2011 for clear cell, mucinous, and endometriod histologies of the ovary for stages (I-III). We examined CSS and OS for all three histologies combined and each histology with relation to the use of adjuvant radiation therapy (RT). Survival analysis was calculated by Kaplan-Meier and log-rank analysis. Results: CSS was higher in individuals not receiving RT at 5 years (81% vs. 74%) and 10 years (74% vs. 65%, p=0.003). OS was higher in individuals not receiving RT at 5 years (76% vs. 73%) and 10 years (64% vs. 59%, p=0.039). Stage III patients receiving RT had a higher OS at 5 years (54% vs. 44%) and 10 year intervals (36% vs. 30%, p=0.037). Stage III patients with mucinous histology receiving RT had a higher OS at 5 years (50% vs. 36%) and 10 years (45% vs. 26%, p=0.052). Conclusion: Those receiving RT had a lower CSS and OS at 5 and 10 years. However, subgroup analysis revealed a benefit of RT in terms of OS for all stage III patients and for stage III patients with mucinous histology.
Purpose To evaluate the incidence of oral cavity squamous cell carcinoma (OCSCC) and oral tongue ... more Purpose To evaluate the incidence of oral cavity squamous cell carcinoma (OCSCC) and oral tongue squamous cell carcinoma (OTSCC) in young white women, age 18 to 44 years. Patients and Methods We analyzed incidence and survival data from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute from 1975 to 2007 for OCSCC and OTSCC. Three cohorts were examined: all ages, age 18 to 44 years (ie, “young”), and age > 44 years. Individuals were stratified by sex and/or race. Percentage change (PC) and annual percentage change (APC) were calculated. Joinpoint regression analyses were performed to examine trend differences. Results Overall, incidence of OCSCC was decreasing for all ages. However, incidence was increasing for young white women (PC, 34.8; APC, 2.2; P < .05). Incidence of OTSCC was decreasing for all ages except in the age 18 to 44 years group (PC, 28.8; APC, 1.8; P < .05). Young white individuals had increasing incidence trends o...
Conservative management of acute Achilles tendon ruptures in a plantarflexed short leg cast or fu... more Conservative management of acute Achilles tendon ruptures in a plantarflexed short leg cast or functional brace is a viable alternative to surgery. The ideal plantarflexion angle to allow the free ends of the tendon to oppose one another has not been clearly defined. The purpose of this cadaveric study was to define a plantarflexion angle where the free Achilles tendon ends reliably oppose one another. Ten cadaveric legs amputated at the distal femur were obtained. A laceration of the Achilles tendon was made 4 cm above the calcaneal insertion. A joint-spanning external fixator was placed across the knee. With differing degrees of knee flexion (0, 45, and 90 degrees), the diastasis between the free ends of the Achilles tendon was measured as the ankle was moved from 20 degrees of dorsiflexion to 30 degrees of plantarflexion (-20, -10, neutral, 10, 20, and 30 degrees). Regardless of knee flexion angle, the ankle plantarflexion angle where the free ends of the Achilles tendon opposed ...
ABSTRACT Radiation recall is a localized inflammatory reaction triggered by the use of cytotoxic ... more ABSTRACT Radiation recall is a localized inflammatory reaction triggered by the use of cytotoxic agents in an area previously irradiated. While usually limited to the superficial tissues and manifesting as a cutaneous reaction, cases of deeper inflammation involving the muscles have been reported, particularly following the use of gemcitabine. We report a case of gemcitabine-induced radiation recall myositis in a patient with dermatomyositis associated with two primary malignancies. A 44-year-old woman with biopsy-proven dermatomyositis was diagnosed with primary lung adenocarcinoma and anal squamous cell carcinoma (SCC). The dermatomyositis had been diagnosed 12 months previously following a presentation with proximal muscle weakness, typical cutaneous features and a positive anti-Ro52 antibody. Serum creatine kinase (CK) was normal at the time of diagnosis at 131 U/L (normal range &lt; 270 IU/L); however, systemic corticosteroids had been commenced prior to the initial rheumatological assessment. Prednisolone 50 mg daily and azathioprine were commenced and following an improvement in muscle strength and cutaneous lesions the dose of prednisolone was weaned down over time to 10 mg daily. Due to the development of alopecia after 5 months of therapy, azathioprine was changed to hydroxychloroquine 400 mg daily. Following the initial diagnosis of dermatomyositis, further clinical assessment to look for the presence of an associated malignancy revealed metastatic primary lung adenocarcinoma and anal SCC. While the association between lung malignancy and dermatomyositis has been well established, ano-rectal cancers have been less commonly reported.[1] Fluorouracil + mytomicin C chemotherapy with local pelvic irradiation was given for the symptomatic anal SCC. Two months following the completion of therapy, repeat imaging showed local progression of the lung adenocarcinoma and hence, carboplatin + gemcitabine chemotherapy was commenced. Within 2 months the patient presented with progressive severe pelvic pain. On examination she was febrile with erythema, swelling, palpable warmth and tenderness of the buttocks and groin area. Investigations revealed a mild neutrophilia, C-reactive protein (CRP) = 140 mg/L (normal range &lt; 8 mg/L) and elevation of serum creatine kinase (CK) of 1261 U/L (normal range &lt; 270 IU/L) (CK 70 U/L 3 months earlier). Magnetic resonance imaging (MRI) with gadolinium of the pelvis revealed changes in the musculature consistent with a local myositis within the previously irradiated field (Fig. 1). To avoid potential problems with wound healing associated with open biopsy, a radiologically guided trocar muscle biopsy from the gluteus maximus was undertaken. No infective organisms were seen on microscopy or culture. Specimen quality was insufficient to define histological structure. A clinical diagnosis of gemcitabine-induced radiation recall myositis was thus made on the basis of clinical and MRI findings and chemotherapy was discontinued. Prednisolone was increased to 50 mg daily and within 5 days partial clinical improvement was observed accompanied by a reduction in serum CK to 351 U/L. Due to concerns of steroid-related adverse effects, the prednisolone dose was reduced to 10 mg daily. Her condition was subsequently slow to improve, requiring ongoing inpatient pain management with opiate analgesia. The patient was discharged home with ongoing analgesic requirements following a 23-day hospital admission. The CK normalized to 115 U/L 1 month after her initial presentation. While multiple cytotoxic agents have been associated with radiation recall reactions, the vast majority of cases have been attributed to anthracyclines and taxanes. Cutaneous reactions have been the most commonly reported manifestations. Muscles and internal organs appear to be less commonly affected. The reaction generally occurs within days to weeks after exposure to the precipitating agent and usually within months of radiotherapy, although delayed reactions (up to 15 years) have been reported.[2, 3] A number of case reports have described radiation recall myositis associated with the use of gemcitabine. The reaction is characterized by local pain and swelling in an area of previous irradiation, an elevated CK level and edema and enhancement of the underlying musculature on MRI occurring within weeks to months of commencing gemcitabine. Improvement has been reported following the cessation of gemcitabine with or without the addition of non-steroidal anti-inflammatory drugs or corticosteroids; however, details on treatment, the response observed and long-term outcomes are sparce.[2, 4, 5] The time frame between radiotherapy and chemotherapy in cases of gemcitabine-induced radiation recall myositis varies from weeks to months but appears to be shorter than radiation recall reactions seen with other chemotherapeutic agents.[2] The etiology of this condition remains unclear. Proposed mechanisms have included…
D2cc were calculated for the above OAR. Other contributing factors including the use of foley, bl... more D2cc were calculated for the above OAR. Other contributing factors including the use of foley, bladder volume, rectal volume, and cylinder size were also recorded. As different dose fractionations were used, the OAR doses were tabulated as a percent of the dose prescribed to 0.5cm. All patients were treated to 4cm of vaginal length. Results: Median BMI in this cohort was 31.7 kg/m 2 (IQR 27.5-38.3 kg/m 2). Higher BMI was associated with lower dose to the bladder and bowel as a percent of prescription for D0.1cc, D1cc and D2cc (p#0.006 for all, table 1). There were no significant correlations in sigmoid (pO0.7) or rectal dose (pO0.2), with the exception of rectal D0.1cc (p50.04). In linear regression, accounting for cylinder size, bladder/rectal volume, and the use of a foley cather, higher BMI remained a significant predictor of lower bladder D2cc, and bowel D2cc (p!0.001 for both). Conclusions: Women with a lower BMI receive higher doses to the bladder and bowel compared to those with a higher BMI. Further analysis is necessary to determine if this translates into greater toxicity.
Objective: Evaluate the impact of radiotherapy on cause specific survival (CSS) and overall survi... more Objective: Evaluate the impact of radiotherapy on cause specific survival (CSS) and overall survival (OS) for stage (I-III) clear cell, mucinous, and endometriod ovarian cancer. Methods: We analyzed incidence, survival, and treatments from the Surveillance, Epidemiology, and End Results (SEER) Program from 2004 to 2011 for clear cell, mucinous, and endometriod histologies of the ovary for stages (I-III). We examined CSS and OS for all three histologies combined and each histology with relation to the use of adjuvant radiation therapy (RT). Survival analysis was calculated by Kaplan-Meier and log-rank analysis. Results: CSS was higher in individuals not receiving RT at 5 years (81% vs. 74%) and 10 years (74% vs. 65%, p=0.003). OS was higher in individuals not receiving RT at 5 years (76% vs. 73%) and 10 years (64% vs. 59%, p=0.039). Stage III patients receiving RT had a higher OS at 5 years (54% vs. 44%) and 10 year intervals (36% vs. 30%, p=0.037). Stage III patients with mucinous histology receiving RT had a higher OS at 5 years (50% vs. 36%) and 10 years (45% vs. 26%, p=0.052). Conclusion: Those receiving RT had a lower CSS and OS at 5 and 10 years. However, subgroup analysis revealed a benefit of RT in terms of OS for all stage III patients and for stage III patients with mucinous histology.
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Papers by Sagar Patel