Case study tumour type: 51 year old male with melanoma Case study tumour type: Melanoma Medical history prior to first course of radiowave therapy (RWT) prior to 3.07.2006 Presenting symptoms Patient is a 51 year old male who presented to his GP in 2004 with a mass in the left scapular area. Initial diagnosis – February 2004 – Melanoma Method of diagnosis – Histopathology from resected left scapula lesion (February 2004) Morphology – Ulcerated melanoma 1.25 level IV Stage – Clark level IV Grade – N/A Past medical history High cholesterol Investigations and treatments (prior to RWT) – treatments, imaging and blood tests
February 2004 – Surgery – Resection of mass in the left scapular area (no surgical report available, notes taken from specialist’s letter dated 31.03.2006). February 2004 – Histopathology from Resected Left Scapula Lesion – Confirmed Ulcerated melanoma 1.25 level IV (no histopathology report available, notes taken from specialist’s letter dated 31.03.2006). June 2004 – Surgery – Elective lymph node dissection for palpable lymph glands and biopsy performed. None of the 17 nodes had metastatic melanoma (no reports available, notes taken from specialist’s letter dated 31.03.2006). 10.03.2006 – Surgery – Left chest wall resection of lesion below left clavicle. The melanoma abutted the margins of excision. Pathology showed probable metastatic melanoma (no surgical report available, notes taken from specialist’s letter dated 31.03.2006). 13.04.2006 – CT Brain – Showed no evidence of metastatic disease. 13.04.2006 – CT Neck, Chest and Abdomen – Indicated well-defined nodular lesion in left lower lobe of lung, which measured 1.8 x 1.7cm and most likely represented metastatic deposit. Prominent lymphadenopathy was seen in left paratracheal region with one node measuring 2.0 x 1.5cm. Another prominent node was also noted in subcarinal region measuring 3.0 x 1.6cm. Radiowave Therapy – first course
From 3.07.2006 to 21.07.2006 Current medical conditions at commencement of first RWT High cholesterol Current medications at commencement of first RWT
Medication Stage of disease at commencement of first RWT Metastatic malignant melanoma with mediastinal nodes and a small volume of pulmonary nodal disease Interruptions to first RWT None Supportive therapy required during first RWT 17.07.2006 – PICC line infection, antibiotics commenced Medication
Other treatments required during first RWT
Medical history following first course of RWT – post 21.07.2006 9 week treatment response post first RWT 19.09.2006 – CT Neck, Chest, Abdomen and Pelvis – Comparison was made with the study of 13.04.2006. Showed decrease in the size and density of the nodular lesion in left lower lung. The largest node in left paratracheal region measured 1.3 x 0.8cm. No new metastatic lesion was identified. Summary of measurements of target lesions Lesion Location
Largest node in left paratracheal region
21 week treatment response post first RWT
14.12.2006 – CT Scan – Showed essentially stable appearances with no major increase of mediastinal nodes, but possible increase in the number of mediastinal nodes. The right groin node remained stable in size and there was no major increase in the pulmonary lesions (no CT report available, notes taken from specialist’s letter dated 20.12.2006).
Other treatments post first RWT None Radiowave Therapy – second course
From 16.04.2007 to 4.05.2007 Current medical conditions at commencement of second RWT High cholesterol Current medications at commencement of second RWT Medication
Stage of disease at commencement of second RWT Metastatic disease with mediastinal nodes and pulmonary lesions Interruptions to second RWT None Supportive therapy required during second RWT
None Other treatments required during second RWT None Medical history following second course of RWT – post 4.05.2007 20 week treatment responsepost second RWT 20.09.2007 – CT Chest, Abdomen and Pelvis – Indicated no convincing evidence of metastatic disease. 32 week treatment response post second RWT
13.12.2007 – Chest X-Ray – Showed no evidence of pulmonary or rib cage deposits by plain radiography. 1 year 4 months treatment response post second RWT
11.09.2008 – CT Chest, Abdomen and Pelvis – Showed no evidence of metastatic disease. 1 year 10 months treatment response post second RWT
6.03.2009 – CT Scan – Quite stable with no evidence of progressive disease (no CT report available, notes taken from specialist’s letter dated 6.03.2009). Other treatments post second RWT None Radiowave Therapy – third course Current medical conditions at commencement of third RWT High cholesterol Current medications at commencement of third RWT Medication Stage of disease at commencement of third RWT No disease Interruptions to third RWT None
Supportive therapy required during third RWT None Other treatments required during third RWT None Medical history following third course of RWT – post 10.07.2009 9 week treatment response post third RWT 10.09.2009 – CT Head, Chest, Abdomen and Pelvis – Comparison was made with the study of 5.03.2009. Conclusion showed stable appearances (no evidence of new disease). Slightly prominent central mediastinal lymph nodes and mesenteric nodes again were noted. The largest lymph node in the aortopulmonary region measured 1.7 x 1cm, however these had not changed in the past six months. Other treatments post third RWT None Current status
Disease statusas at 10.09.2009 – CT scan showed stable disease. Patient status as at 18.12.2009 – Patient works full time and states his health is good. Disclaimer Any particular case study outcome does not mean that in every case the treatment of cancer using radiowave therapy will achieve the same result
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Cairo Dental Journal (25) Number (3), 323:328 September, 2009 The INflUeNCe Of MTAD IRRIgANT ON The ApICAl MICROleAkAge Of ObTURATeD ROOT CANAlS Mohamed M. Ibrahim;(1) Naguib M. Abul Enein;(2) Abdalla M. Shahin(3) and Amany E. Badr(4)1. Assistant lecturer, Conservative Dentistry Department, Faculty of Dentistry, Mansoura Univerisity. 2. Professor, Head of Endodontic Departme