Letters to the Editor
a good coordinated approach. The clinicians and laboratory personnel’s should take help of all available resources to create awareness about cervical cancer, Pap smear test, proper follow‑up, and counseling of the patients. Only then, we could hope to restrain this potentially curative malignancy. Amitabh Jena, Rashmi Patnayak1, Siva Kumar Reddy Department of Surgical Oncology, 1Pathology, Sri Venketaswar Institute of Medical Sciences, Tirupati, Andhra Pradesh, India For Correspondence: Dr. Amitabh Jena, Department of Surgical Oncology, Sri Venketaswar Institute of Medical Sciences,
Tirupati, Andhra Pradesh, India. E-mail: [email protected]
REFERENCES 1. Hoque ME. Awareness of cervical cancer, Papanicolau’s smear and its utilization among female, final year undergraduates in Durban, South Africa. J Cancer Res Ther 2013;9:25‑8. 2. Jena A, Bharathi T, Reddy SK, Manilal B, Patnayak R, Phaneendra BV. Papanicolaou (Pap) test screening of staff members of a tertiary care teaching hospital in South India. J Clin Sci Res 2012;1:174‑7. 3. Sankaranarayanan R, Nene BM, Dinshaw K, Rajkumar R, Shastri S, Wesley R, et al. Early detection of cervical cancer with visual inspection methods: A summary of completed and ongoing studies in India. Salud Publica Mex 2003;45:S399‑407.
Clarifications concerning the case report on “extra‑skeletal ewings sarcoma of the sinonasal tract” Access this article online Website: www.cancerjournal.net
Quick Response Code:
DOI: 10.4103/0973-1482.131436 PMID: ***
Sir, We the authors of the article titled “Rare case of extra‑skeletal Ewings sarcoma of the sinonasal tract” published in January‑March issue 2012, appreciate the queries raised by our fellow colleagues in the issue October‑December 2012.[1] In response to their letter titled Requesting clarifications concerning the case report on“extra‑skeletal Ewing sarcoma of the sinonasal tract,” we would like to give the following clarifications.[2] 1. Regarding the query, whether the tumor is osseous or extraosseous, on studying multiple axial and coronal computed tomography sections of the nose and paranasal sinuses, we noticed that major bulk of the tumor was situated in the right nasal cavity and maxillary antrum. However, little bony erosions were seen only in the posterior and medial aspect of right maxillary antrum without destruction or infiltration of the bone. Even on excision, the tumor was easily removed enmasse like a polyp from the eroded area. On microscopy also, no bony tissue were seen infiltrated by the tumor. Hence, the diagnosis of “ extra‑skeletal sinonasal Ewing’s sarcoma” was offered. However, both osseous and extraosseous sinonasal Ewings sarcoma with this clinical presentation has similar treatment[1] 2. Regarding chemotherapy, 14 cycles of vincristine, adriamycin and cyclophosphamide were given alternated with ifosfamide and etoposide. After 10 cycles, adriamycin
was replaced with D‑actinomycin to prevent cardiotoxicity of the former. This regime is called the VACA‑IE regime (vincristine, adriamycin, cyclophosphamide, D‑ actinomycin‑ ifosphamide, etoposide) Our patient tolerated chemotherapy very well[3] 3. Regarding radiotherapy, a total dose of 50 Gy was administered at 2 Gy/day for 5 days in a week for 5 weeks continuously.[4] The radiotherapy technique used was intensity guided radiation therapy with linear accelerator machine; however, 3D image guided radiation therapy can also be used.[4] Careful precautions were taken to safeguard the adjacent vital structures such as eye, brainstem, optic nerve and chiasma. Patient tolerated radiotherapy very well and after completion of the entire dose, the gross tumor volume reduction was more than 90%. Post‑treatment surgical resection was not done, since the patient was not willing. However, on regular follow‑up, she is asymptomatic and doing well without any recurrence or metastasis. ACKNOWLEDGMENTS We would like to thank (1) Dr. Padmapriya, Associate Professor of Pathology, KMC Manipal, (2) Dr. Harish S Permi, Associate Professor of Patholoogy, Kshema.
Y. Sunil Kumar, Kurian Ninan1, Sathish Kumar Bhandary2, H. L. Kishan Prasad, K. Jayaprakash Shetty, J. H. Makannavar
Journal of Cancer Research and Therapeutics - January-March 2014 - Volume 10 - Issue 1
Departments of Pathology, 1Radiology and 2ENT, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India For correspondence: Dr. Y. Sunil Kumar, Department of Pathology, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India. E‑mail: [email protected] 211
Letters to the Editor
REFERENCES 1. Yeshvanth SK, Ninan K, Bhandary SK, Lakshinarayana KP, Shetty JK, Makannavar JH. Rare case of extraskeletal Ewings sarcoma of the sinonasal tract. JCancerResTher 2012;8:142‑4. 2. Thakur P, Revannasiddaiah S, Rastogi M, Kumar S. Requesting clarifications concerning the case report on ‘extraskeletal Ewing
sarcoma of the sinonasal tract. J Cancer Res Ther 2012;8:652. 3. Kawabata M, Yoshifuku K, SagaraY, KuronoY. Ewing’s sarcoma/ primitive neuroectodermal tumour occurring in the maxillary sinus. Rhinology 2008;46:75‑8. 4. Gray ST, Chen YL, Lin DT. Efficacy of Proton Beam Therapy in the Treatment of Ewing’s Sarcoma of the Paranasal Sinuses and Anterior Skull Base. Skull Base 2009;19:409‑16.
Bilateral sudden hearing loss following ABVD protocol Access this article online Website: www.cancerjournal.net
Quick Response Code:
DOI: 10.4103/0973-1482.131437 PMID: ***
Sir, A 26‑year‑old male patient was diagnosed with nodular sclerosing Hodgkin’s disease stage IIB in January 2012 and was treated according to (ABVD) adriamycine, bleomycine, vinblastine, dacarbazine protocol. Approximately, 1 day following administration of the first dose, he complained of sudden onset aural fullness, tinnitus, dizziness and severe bilateral hearing loss. He had no history of previous ear infections, nor had an occupation with noise exposure. He had no other significant past medical history and known allergies and denied any drug abuse. The results of his general and neurological examinations were normal except for the bilateral hearing loss. His deafness increased over 2 days becoming almost complete. Very soon after, the patient became distressed, saying he could hear nothing. He was seen in consultation by an Otorhinolaryngologist who reported that ear examination was normal. The results of brain imaging (computed tomography with contrast and magnetic resonance imaging with gadolinium) were normal. Audiometric testing performed showed severe (66‑90 dB) high‑frequency sloping sensorineural hearing loss in both ears. The only identifiable agent was vinblastine. Because of non‑improvement after two cycles of chemotherapy, this drug was interrupted and replaced by etoposide. After the fourth cycle, we observe a spectacular improvement of bilateral hearing loss completely. This patient is currently in complete remission with a good hearing. Vinca alkaloids (VA) are commonly used for the therapy of various hematological malignancies and solid tumors. VA arrest tumor cells during mitosis by binding to tubulin and depolymerization of microtubules. This leads to cell cycle arrest in mitosis. [1] It is well‑established that following intravenous administration, vinblastine has a large volume of distribution, suggesting rapid absorption of the drug into the tissues. In spite of having this biological importance, vinblastine is associated with some side‑effects such as 212
convulsions, peripheral neuritis, thrombocytopenia and leucopenia.[2] Experimental studies in mammals (rabbits) support that VA (vinblastine and vincristine) may cause degeneration of hair cells.[3] A case of vinblastine‑induced tinnitus and mild high‑frequency sensorineural hearing loss has been reported in a patient suffering from Hodgkin’s disease by Moss et al. in a 29‑year‑old man treated according to ABVD regimen after each cycle, with an onset of about 6 h and duration of 7‑10 days.[4] Symptoms returned to baseline prior to the beginning of each subsequent cycle.[4] Vinblastine has never been reported as an ototoxic agent responsible for sudden, bilateral and symmetrical sensorineural hearing loss. In our patient, we feel that vinblastine was the most likely cause of his hearing loss because we have observed an improvement when we have stopped definitely vinblastine. All concomitant medications (bleomycine‑doxorubicin‑dacarbazin) were eliminated as possible causes either due to the lack of temporal association with the symptoms or no reports of ototoxicity in the literature. Acute‑onset aural fullness, dizziness, tinnitus and potentially severe hearing loss could be considered as an additional serious, albeit rare, adverse event of vinblastine therapy. Patients with pre‑existing ear pathology should be monitored audiometrically so that ototoxicity can be recognized earlier during vinblastine therapy. I. Tazi, H. Nafil, L. Mahmal Department of Hematology, CHU Mohamed VI, Cadi Ayyad University, Marrakech, Morocco For correspondence: Dr. I. Tazi, Department of Hematology, CHU Mohamed VI, Cadi Ayyad University, Marrakech, Morocco. E‑mail: [email protected]
REFERENCES 1. Okouneva T, Hill BT, Wilson L, Jordan MA. The effects of vinflunine, vinorelbine, and vinblastine on centromere dynamics. Mol Cancer Ther 2003;2:427‑36. 2. Hilkens PH, ven den Bent MJ. Chemotherapy‑induced peripheral neuropathy. J Peripher Nerv Syst 1997;2:350‑61. 3. Serafy A, Hashash M, State F. The effect of vinblastine sulphate on the neurological elements of the rabbit cochlea. J Laryngol Otol 1982;96:975‑9. 4. Moss PE, Hickman S, Harrison BR. Ototoxicity associated with vinblastine. Ann Pharmacother 1999;33:423‑5.
Journal of Cancer Research and Therapeutics - January-March 2014 - Volume 10 - Issue 1
Copyright of Journal of Cancer Research & Therapeutics is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
a good coordinated approach. The clinicians and laboratory personnel’s should take help of all available resources to create awareness about cervical cancer, Pap smear test, proper follow‑up, and counseling of the patients. Only then, we could hope to restrain this potentially curative malignancy. Amitabh Jena, Rashmi Patnayak1, Siva Kumar Reddy Department of Surgical Oncology, 1Pathology, Sri Venketaswar Institute of Medical Sciences, Tirupati, Andhra Pradesh, India For Correspondence: Dr. Amitabh Jena, Department of Surgical Oncology, Sri Venketaswar Institute of Medical Sciences,
Tirupati, Andhra Pradesh, India. E-mail: [email protected]
REFERENCES 1. Hoque ME. Awareness of cervical cancer, Papanicolau’s smear and its utilization among female, final year undergraduates in Durban, South Africa. J Cancer Res Ther 2013;9:25‑8. 2. Jena A, Bharathi T, Reddy SK, Manilal B, Patnayak R, Phaneendra BV. Papanicolaou (Pap) test screening of staff members of a tertiary care teaching hospital in South India. J Clin Sci Res 2012;1:174‑7. 3. Sankaranarayanan R, Nene BM, Dinshaw K, Rajkumar R, Shastri S, Wesley R, et al. Early detection of cervical cancer with visual inspection methods: A summary of completed and ongoing studies in India. Salud Publica Mex 2003;45:S399‑407.
Clarifications concerning the case report on “extra‑skeletal ewings sarcoma of the sinonasal tract” Access this article online Website: www.cancerjournal.net
Quick Response Code:
DOI: 10.4103/0973-1482.131436 PMID: ***
Sir, We the authors of the article titled “Rare case of extra‑skeletal Ewings sarcoma of the sinonasal tract” published in January‑March issue 2012, appreciate the queries raised by our fellow colleagues in the issue October‑December 2012.[1] In response to their letter titled Requesting clarifications concerning the case report on“extra‑skeletal Ewing sarcoma of the sinonasal tract,” we would like to give the following clarifications.[2] 1. Regarding the query, whether the tumor is osseous or extraosseous, on studying multiple axial and coronal computed tomography sections of the nose and paranasal sinuses, we noticed that major bulk of the tumor was situated in the right nasal cavity and maxillary antrum. However, little bony erosions were seen only in the posterior and medial aspect of right maxillary antrum without destruction or infiltration of the bone. Even on excision, the tumor was easily removed enmasse like a polyp from the eroded area. On microscopy also, no bony tissue were seen infiltrated by the tumor. Hence, the diagnosis of “ extra‑skeletal sinonasal Ewing’s sarcoma” was offered. However, both osseous and extraosseous sinonasal Ewings sarcoma with this clinical presentation has similar treatment[1] 2. Regarding chemotherapy, 14 cycles of vincristine, adriamycin and cyclophosphamide were given alternated with ifosfamide and etoposide. After 10 cycles, adriamycin
was replaced with D‑actinomycin to prevent cardiotoxicity of the former. This regime is called the VACA‑IE regime (vincristine, adriamycin, cyclophosphamide, D‑ actinomycin‑ ifosphamide, etoposide) Our patient tolerated chemotherapy very well[3] 3. Regarding radiotherapy, a total dose of 50 Gy was administered at 2 Gy/day for 5 days in a week for 5 weeks continuously.[4] The radiotherapy technique used was intensity guided radiation therapy with linear accelerator machine; however, 3D image guided radiation therapy can also be used.[4] Careful precautions were taken to safeguard the adjacent vital structures such as eye, brainstem, optic nerve and chiasma. Patient tolerated radiotherapy very well and after completion of the entire dose, the gross tumor volume reduction was more than 90%. Post‑treatment surgical resection was not done, since the patient was not willing. However, on regular follow‑up, she is asymptomatic and doing well without any recurrence or metastasis. ACKNOWLEDGMENTS We would like to thank (1) Dr. Padmapriya, Associate Professor of Pathology, KMC Manipal, (2) Dr. Harish S Permi, Associate Professor of Patholoogy, Kshema.
Y. Sunil Kumar, Kurian Ninan1, Sathish Kumar Bhandary2, H. L. Kishan Prasad, K. Jayaprakash Shetty, J. H. Makannavar
Journal of Cancer Research and Therapeutics - January-March 2014 - Volume 10 - Issue 1
Departments of Pathology, 1Radiology and 2ENT, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India For correspondence: Dr. Y. Sunil Kumar, Department of Pathology, KS Hegde Medical Academy, Deralakatte, Mangalore, Karnataka, India. E‑mail: [email protected] 211
Letters to the Editor
REFERENCES 1. Yeshvanth SK, Ninan K, Bhandary SK, Lakshinarayana KP, Shetty JK, Makannavar JH. Rare case of extraskeletal Ewings sarcoma of the sinonasal tract. JCancerResTher 2012;8:142‑4. 2. Thakur P, Revannasiddaiah S, Rastogi M, Kumar S. Requesting clarifications concerning the case report on ‘extraskeletal Ewing
sarcoma of the sinonasal tract. J Cancer Res Ther 2012;8:652. 3. Kawabata M, Yoshifuku K, SagaraY, KuronoY. Ewing’s sarcoma/ primitive neuroectodermal tumour occurring in the maxillary sinus. Rhinology 2008;46:75‑8. 4. Gray ST, Chen YL, Lin DT. Efficacy of Proton Beam Therapy in the Treatment of Ewing’s Sarcoma of the Paranasal Sinuses and Anterior Skull Base. Skull Base 2009;19:409‑16.
Bilateral sudden hearing loss following ABVD protocol Access this article online Website: www.cancerjournal.net
Quick Response Code:
DOI: 10.4103/0973-1482.131437 PMID: ***
Sir, A 26‑year‑old male patient was diagnosed with nodular sclerosing Hodgkin’s disease stage IIB in January 2012 and was treated according to (ABVD) adriamycine, bleomycine, vinblastine, dacarbazine protocol. Approximately, 1 day following administration of the first dose, he complained of sudden onset aural fullness, tinnitus, dizziness and severe bilateral hearing loss. He had no history of previous ear infections, nor had an occupation with noise exposure. He had no other significant past medical history and known allergies and denied any drug abuse. The results of his general and neurological examinations were normal except for the bilateral hearing loss. His deafness increased over 2 days becoming almost complete. Very soon after, the patient became distressed, saying he could hear nothing. He was seen in consultation by an Otorhinolaryngologist who reported that ear examination was normal. The results of brain imaging (computed tomography with contrast and magnetic resonance imaging with gadolinium) were normal. Audiometric testing performed showed severe (66‑90 dB) high‑frequency sloping sensorineural hearing loss in both ears. The only identifiable agent was vinblastine. Because of non‑improvement after two cycles of chemotherapy, this drug was interrupted and replaced by etoposide. After the fourth cycle, we observe a spectacular improvement of bilateral hearing loss completely. This patient is currently in complete remission with a good hearing. Vinca alkaloids (VA) are commonly used for the therapy of various hematological malignancies and solid tumors. VA arrest tumor cells during mitosis by binding to tubulin and depolymerization of microtubules. This leads to cell cycle arrest in mitosis. [1] It is well‑established that following intravenous administration, vinblastine has a large volume of distribution, suggesting rapid absorption of the drug into the tissues. In spite of having this biological importance, vinblastine is associated with some side‑effects such as 212
convulsions, peripheral neuritis, thrombocytopenia and leucopenia.[2] Experimental studies in mammals (rabbits) support that VA (vinblastine and vincristine) may cause degeneration of hair cells.[3] A case of vinblastine‑induced tinnitus and mild high‑frequency sensorineural hearing loss has been reported in a patient suffering from Hodgkin’s disease by Moss et al. in a 29‑year‑old man treated according to ABVD regimen after each cycle, with an onset of about 6 h and duration of 7‑10 days.[4] Symptoms returned to baseline prior to the beginning of each subsequent cycle.[4] Vinblastine has never been reported as an ototoxic agent responsible for sudden, bilateral and symmetrical sensorineural hearing loss. In our patient, we feel that vinblastine was the most likely cause of his hearing loss because we have observed an improvement when we have stopped definitely vinblastine. All concomitant medications (bleomycine‑doxorubicin‑dacarbazin) were eliminated as possible causes either due to the lack of temporal association with the symptoms or no reports of ototoxicity in the literature. Acute‑onset aural fullness, dizziness, tinnitus and potentially severe hearing loss could be considered as an additional serious, albeit rare, adverse event of vinblastine therapy. Patients with pre‑existing ear pathology should be monitored audiometrically so that ototoxicity can be recognized earlier during vinblastine therapy. I. Tazi, H. Nafil, L. Mahmal Department of Hematology, CHU Mohamed VI, Cadi Ayyad University, Marrakech, Morocco For correspondence: Dr. I. Tazi, Department of Hematology, CHU Mohamed VI, Cadi Ayyad University, Marrakech, Morocco. E‑mail: [email protected]
REFERENCES 1. Okouneva T, Hill BT, Wilson L, Jordan MA. The effects of vinflunine, vinorelbine, and vinblastine on centromere dynamics. Mol Cancer Ther 2003;2:427‑36. 2. Hilkens PH, ven den Bent MJ. Chemotherapy‑induced peripheral neuropathy. J Peripher Nerv Syst 1997;2:350‑61. 3. Serafy A, Hashash M, State F. The effect of vinblastine sulphate on the neurological elements of the rabbit cochlea. J Laryngol Otol 1982;96:975‑9. 4. Moss PE, Hickman S, Harrison BR. Ototoxicity associated with vinblastine. Ann Pharmacother 1999;33:423‑5.
Journal of Cancer Research and Therapeutics - January-March 2014 - Volume 10 - Issue 1
Copyright of Journal of Cancer Research & Therapeutics is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
