The gestational age and time gained from initiation of maintenance therapy to delivery were longer in women receiving oral maintenance tocolysis with nifedipine. However, maintenance therapy did not decrease the recurrence of preterm labor episodes or improve perinatal outcomes.

The purpose of this study was to evaluate the role of combined modality treatment in patients with paediatric nasopharynx cancer (NPC). Forty-six patients with paediatric NPC were retrospectively analysed. Forty-four of 46 patients received combined modality treatment. Five-year overall survival and progression-free survivals were 70% and 72% for the whole group, and only three of 46 patients had loco-regional relapse. Complete remission was obtained in 18 of 45 patients (40%), and the overall survival (94% vs. 62% and 19%, p = 0.0009) and disease-free survivals (93% vs. 70% and 16%, p = 0.0002) were significantly better in complete responders when compared with the patients who had partial response or stable disease. The 5-year overall survival and disease-free survivals of the patients who received neoadjuvant chemotherapy (CT) and radiotherapy (RT) followed by CT were superior to the other groups (77% and 80%, respectively). The number of total CT cycles (p = 0.0001), nodal stage (p = 0.05) and treatment response (p = 0.0009) were significant prognostic factors for overall survival. The treatment type (p = 0.02), the number of total CT cycles (p = 0.0006), nodal stage (p = 0.05) and treatment response (p = 0.0002) were found as significant prognostic factors for disease-free survival. The survival of patients receiving six or more CT cycles was also significantly better than that of patients receiving less than six cycles (p = 0.0001). In patients with locally advanced paediatric NPC, CT should be added to RT to improve outcome. However, a standard protocol is yet to be identified, and further studies evaluating the addition of interferon or immunotherapy to CT and RT shall be performed.

Dear Editor, Bisphosphonates are analogs of inorganic pyrophosphate. They are potent inhibitors of osteoclast-mediated bone resorption, and are shown to be effective in reducing skeletal complications such as bone pain, pathologic fracture, bone surgery, and hypercalcemia [1][2][3][4][5]. Zoledronic acid is a new long-acting and highly potent biphosphonate. We report a patient who developed hyperparathyroidism secondary to zoledronic acid treatment.A 57-year-old female patient was referred to the hospital with abdominal pain in 1997. Subtotal gastrectomy and splenectomy were performed with a diagnosis of stomach cancer. The pathological examination revealed that she had intermediate-grade lymphoma. Following the surgery, six cycles of CHOP and nine cycles of POCEF chemotherapy were administrated. She was then followed-up without any intervention until 2006 when she complained of leg pain. Multiple lytic lesions in fifth, sixth, ninth, tenth costae, and bilateral femurs were observed in scintigraphic examination. Thoracic and abdominal computed tomographies were reported to be normal. In the bone scintigraphy performed in January 2007, there was progression in lytic lesions. A single dose of 800 cGy radiotherapy was applied to femurs to reduce her pain, and zoledronic acid 4 mg, every 4 weeks was initiated. Calcium was also started with zoledronic acid but experienced gastric side effects. After the fourth administration of zoledronic acid, she complained of cramps in the legs. The biochemical examinations revealed that the blood calcium level was 7.5 mg/dl and the corrected calcium level was 7.91 mg/dl (8.8−10.5 mg/dl). Upon these findings, calcium carbonate (2,500 mg) and vitamin D3 (880 IU) were started. She used the prescribed drug for 1 month and the serum calcium level increased to 8.7 mg/dl (corrected calcium level, 9.1 mg/ dl), however, she complained of diffuse bone pain. Vitamin D3 and parathormone levels were found to be 457 pg/ml (4.7−114 pg/ml), and 13.2μg/L (20−120μg/ L), respectively. The renal and liver function tests were in normal limits. Parathyroid scintigraphy was normal. It was thought that the hyperparathyroidism could be secondary to the D hypovitaminosis and calcitriol (0.5 mcg, 2×1) treatment was started. After 3 weeks of calcitriol treatment, the parathormone level decreased to 312 pg/ml (4.7−114 pg/ml). She continued using calcitriol and zoledronic acid. However, after 3 months of calcitriol and zoledronic acid treatment, the parathormone level again increased and was found to be 526 pg/ml (4.7−114 pg/ml). Considering that hyperparathyroidism might be secondary to zoledronic acid treatment, we discontinued its application. Two months after the cessation of zoledronic acid treatment, the parathormone level decreased to 176 pg/ml (4.7−114 pg/ml).The most common electrolyte abnormality associated with zoledronic acid infusion is hypocalcemia [6]. Among breast cancer patients treated in a phase III study of zoledronic acid, hypocalcemia was observed in 39% of patients compared to 7% in the ...

In this prospective study, we investigated the effects of hypofractionated radiotherapy for patients with high-grade gliomas. About 31 patients with glioblastoma multiforme or anaplastic astrocytoma were studied between October 2003 and December 2004. Hypofractionated radiotherapy (3 Gy/fraction/day) was delivered to a total dose of 45 Gy in 15 fractions in 10 patients (32%) who had total excision before radiotherapy and to a total dose of 54 Gy in 18 fractions in 21 patients (68%) who had subtotal excision or biopsy alone. Sex, age, type of surgery, tumor grade, Karnofsky performance status, time between surgery and initiation of radiotherapy, and total radiotherapy dose were analyzed as potential prognostic factors for survival using the univariate log-rank method. The median follow-up was 15 months (4-16 months). A total of 15 patients (48%) died of their illness; 16 patients (52%) were still alive at the last follow-up. The median survival time was 8 months. Actuarial 1-year overall survival was 40%. Type of surgery, timing of radiotherapy after surgery, and initial Karnofsky performance status were significant prognostic factors for survival. No grade 3-4 acute or late neurotoxicity was observed. The tolerance of patients to hypofractionated RT was not different from that for conventional radiotherapy. This treatment schedule can be used for patients with high-grade gliomas. Future investigations are needed to determine the optimal fractionation for high-grade gliomas.

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