Indian Journal of Cancer
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   Table of Contents - Current issue
Coverpage
July-September 2018
Volume 55 | Issue 3
Page Nos. 207-313

Online since Monday, January 28, 2019

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EDITORIAL  

After the supreme court judgment on autonomy: What the oncologist needs to know Highly accessed article p. 207
Roop Gursahani, Sri Nagesh Simha, Raj K Mani
DOI:10.4103/ijc.IJC_39_19  PMID:30693879
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BREAST CANCER Top

Clinicopathological profile of breast cancer: An institutional experience Highly accessed article p. 210
Ajay Gogia, S VS Deo, NK Shukla, Sandeep Mathur, DN Sharma, Akash Tiwari
DOI:10.4103/ijc.IJC_73_18  PMID:30693880
INTRODUCTION: This study was undertaken to evaluate the clinicopathological characteristics of patients with breast cancer at our institute, a tertiary-care cancer center in northern India. MATERIALS AND METHODS: This retrospective study included all patients with breast cancer registered at our institute from January 1st, 2014 to December 31st, 2016. We retrieved data (demographic, baseline clinical characteristics, pathology, and treatment details) from prospectively maintained clinical case records. Patients with incomplete case records or missing baseline information were excluded. RESULTS: We included 550 patients with breast cancer. The median age was 48 years (23–85). The median clinical tumor size was 5.0 cm. The TNM (AJCC-7th edition) stage distribution was stage I, 22 (4%); stage II, 182 (33%); stage III, 247 (44.9%); and stage IV, 99 (18%). Locally advanced breast cancer constituted 40% of the cases. Bone (48 [48.5%]) was the most common site for metastasis followed by lung. Infiltrating ductal carcinoma (528 [96%]) was the most common histologic subtype. Majority of patients, 325 (59%), were positive for estrogen receptor/progesterone receptor whereas 160 (29%) patients were HER2/neu positive. Triple negative breast cancer (TNBC) constituted 28% (154) of patients. In the nonmetastatic subgroup, 343 (76%) patients underwent modified radical mastectomy. Neoadjuvant chemotherapy (NACT) was given in 120 (26.6%) patients, of these 23 (19%) achieved pathological complete remission. Sequential anthracyline and taxane were used as NACT/adjuvant chemotherapy in most cases. Of the eligible patients, 48 (30%) received anti-HER2/neu therapy. CONCLUSION: This is one of the largest comprehensive data from a single center in India. Majority of our patients are younger in age and have advanced disease. TNBC and HER2/neu positive breast cancer are more common in our population.
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CNS ONCOLOGY Top

Reappraisal of morphological and immunohistochemical spectrum of intracranial and spinal solitary fibrous tumors/hemangiopericytomas with impact on long-term follow-up p. 214
Prakriti Shukla, Hanni V Gulwani, Sukhpreet Kaur, Devika Shanmugasundaram
DOI:10.4103/ijc.IJC_631_17  PMID:30693881
BACKGROUND: Hemangiopericytomas (HPCs) and solitary fibrous tumors (SFTs) are unique entities in the central nervous system (CNS) and even rarer in the spine with propensity to recurrence and metastasis. Both these tumors were detected to share the NAB2–STAT6 fusion gene with frequent morphologic overlap that necessitated the need for the combined term SFT/HPC in the CNS by the World Health Organization (WHO) in 2016. AIMS: This study aims to describe the clinical outcome of intracranial and spinal SFT/HPCs based on detailed histomorphologic and immunohistochemical features. MATERIALS AND METHODS: A retrospective analysis of these tumors was conducted over a period of 10 years from January 2006 to January 2017 at our institute. Based on the elaborative assessment of morphology and immunohistochemistry, these tumors were categorized into three grades as per WHO criteria. RESULTS: A total of 13 cases were encountered involving mainly extra-axial and supratentorial regions. Among intracranial HPCs, anaplastic subtypes constituted significantly higher proportion (39%) when compared with peripheral HPCs. Peculiar morphological patterns like micropapillae and pseudoangiomatous arrangement of tumor cells were observed in high-grade tumors. A panel of immunomarkers were used to confirm the diagnosis and rule out other mimickers. Gross total resection was achieved in 54% (7/13) of the cases with local recurrence observed in 31% (4/13). Grade II tumors showed recurrence in 28% cases. No case showed distant metastasis. CONCLUSION: To conclude, not just clinical parameters but morphologic features such as unusual patterns, mitosis, and proliferative index also play a pivotal role in predicting the clinical behaviour of SFT/HPC.
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GI ONCOLOGY Top

Gemcitabine with carboplatin for advanced intrahepatic cholangiocarcinoma: A study from North India Cancer Centre p. 222
Venkata Pradeep K Babu, Vineet Talwar, Shubhra Raina, Varun Goel, Prasanta K Dash, Rajat Bajaj, Manish Sharma, Pavani Medisetty, Dharma Ram, Chaturbhuj Agrawal, Koundinya Desiraju, Dinesh C Doval
DOI:10.4103/ijc.IJC_622_17  PMID:30693882
BACKGROUND: Gemcitabine plus cisplatin has been established as a standard chemotherapy regimen for advanced biliary tract cancers (BTCs) based on the phase III UK ABC-02 study, which included all types of biliary cancers. There is very limited data regarding the effectiveness of known chemotherapeutic regimens especially in IHCC. METHODS: Records of 63 patients diagnosis of IHCC who received Gemcitabine and Carboplatin (G-C Regimen) chemotherapy as a first line were retrospectively reviewed. The primary aim of this study was to assess the response rate of gemcitabine carboplatin-based chemotherapy as a first line therapy in advanced intrahepatic cholangiocarcinoma (IHCC). The secondary objectives were to assess toxicity, progression free survival and overall survival. RESULTS: There were 38 men and 25 women in our study with a median age of 56.75 years (range 31–78 years). Of the 38+25= 63 patients, 21 patients (33.8%) progressed, 5 patients (8.06%) had complete response, 25 patients (40.3%) had partial response, 12 patients (19.3%) had stable disease. Overall response rate was 48.36% and tumor control rate was 67.6%. Progression free survival was 5.3 months and overall survival of 10.3 months was seen. The most common grade 3–4 toxicities were anemia, neutropenia, and thrombocytopenia. Most common nonhematological toxicity was fatigue. CONCLUSION: Gemcitabine in combination with carboplatin has activity against advanced IHCC. Our results are comparable with other gemcitabine carboplatin studies as well as gemcitabine cisplatin-based studies.
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Effectiveness of abdominal compression in reducing internal target motion during conformal radiotherapy for carcinoma stomach – A pilot study p. 226
Jomon C Raphael, Mathew K Varghese, Paul G Gopu, K Venkatesan, AD Jimson, Antony Febin
DOI:10.4103/ijc.IJC_95_18  PMID:30693883
AIM: To assess the effectiveness of abdominal compression in reducing internal target motion during conformal radiotherapy for stomach cancer. MATERIALS AND METHODS: A pilot study was conducted on five patients who received adjuvant radiotherapy for stomach cancer. All the patients had surgical clips and were offered radiotherapy and concurrent chemotherapy as per the institutional protocol. An abdominal compression device was developed consisting of a triangular Styrofoam's plate and an inflatable air bladder that was positioned over the patients' abdomen. The pneumatic pressure was set according to the patients' comfort. On the simulation day, patients had two computed tomography (CT)-scanning sessions, with and without abdominal compression. Target volumes and organs at risk (OAR) were delineated on the CT images without compression. On the treatment day, fluoroscopy was acquired with onboard imager (OBI) and movements of surgical clips with and without compression analyzed with the help of a tracker software. Observed values with and without abdominal compression were compared. RESULTS: Abdominal compression usage has reduced the mean breathing excursion (MBE) in medio lateral(ML) direction from 5.92mm to 4.15 mm and in cranio caudal direction (CC) from 11.3mm to 7.2mm. The range of reduction by 29.85% in the ML and 36.86% in CC direction. The average residual breathing excursion was 1.766 mm (SD = 1.33 mm) in the ML and 4.02 mm (SD = 2.18 mm) in the CC direction, respectively. CONCLUSION: Abdominal compression was useful in reducing internal target motion during stomach cancer conformal radiotherapy. The device we developed is patient friendly and cost-effective.
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GYNEC ONCOLOGY Top

A dosimetric comparison between applicators used for brachytherapy in carcinoma cervix – A single-institute prospective study p. 230
Aparna Suryadevara, M Vijay Kumar, E Vasundhara, Krishnam R Alluri, Shabbir Ahamed, Srikanth Guduru
DOI:10.4103/ijc.IJC_659_17  PMID:30693884
INTRODUCTION: Cervical cancer is the second most common cancer among Indian women. Radical radiotherapy with external beam radiation therapy (EBRT) and brachytherapy is the standard treatment for FIGO stage IB2 to IVA. An appropriate selection of brachytherapy applicator is needed according to the patient's anatomy. The two most commonly used applicators for intracavitary radiotherapy (ICR), Fletcher's and Henschke, have dosimetric differences which are not well studied with two-dimensional (2D)-based planning which is the most common method used for women with carcinoma cervix in India. The purpose of our study was to compare and evaluate the dosimetric differences between these two applicators, which would help in better selection of the applicator in cervical cancer patients. MATERIALS AND METHODS: This is a single-institute prospective study. Fifty patients randomly included in the study received EBRT and ICR by Ir192 HDR remote afterloading technique with computer-based 2D planning. Fletcher's and Henschke applicators were used alternately for first two fractions. RESULTS: The results of the study showed lower bladder and rectal doses with Fletcher's applicator and similar doses to point A for both applicators. However, point B doses are lower with Fletcher's applicator. CONCLUSION: Our results showed a favorable dosimetry with Fletcher's applicator in ICR of carcinoma cervix. The feasibility of placement is much better for Henschke but dosimetric advantages of Fletcher's encourage use of Fletcher's applicator for patients with favorable anatomy to reduce organs at risk doses but with the disadvantage of lower dose to point B.
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Cervical cancer awareness and HPV vaccine acceptability among females in Delhi: A cross-sectional study p. 233
Jyoti Singh, Brototi Roy, Anshu Yadav, Shumaila Siddiqui, Aarzoo Setia, Ramya Ramesh, Kritika Singh
DOI:10.4103/ijc.IJC_28_18  PMID:30693885
AIMS: The aim of this study is to assess the awareness about cervical cancer and the acceptability of cytological screening and vaccine against human papilloma virus (HPV) among women in Delhi, the national capital of India. MATERIALS AND METHODS: A cross-sectional survey of women was conducted in Delhi to assess the awareness of cervical cancer and acceptability of Papanicolaou (Pap) test and HPV vaccine. The sample size of the population was 450, and a pre-tested questionnaire was administered to them. RESULTS: Majority of the participants (85.11%) were aware of cervical cancer and were willing to undergo diagnosis by Pap test (84.6%). As far as vaccination was concerned, 63.14% found the HPV vaccine acceptable for their daughters. However, very few participants were willing to vaccinate themselves against HPV. CONCLUSION: The high awareness among females in Delhi about cervical cancer and acceptability of screening programs, if done free of cost, shows a positive trend. The only inhibition about HPV vaccine was primarily due to concerns about postvaccination complications. However, inclusion of HPV vaccine in Government-sponsored immunization program would go a long way in increasing the acceptability of the vaccine.
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Calculation of dose volume parameters and indices in plan evaluation of HDR interstitial brachytherapy by MUPIT in carcinoma cervix p. 238
Jyoti Poddar, Ashutosh Das Sharma, U Suryanarayan, Sonal Patel Shah, Ankita Parikh, Vimesh Mehta, Tarun Kumar
DOI:10.4103/ijc.IJC_643_17  PMID:30693886
BACKGROUND: Evaluation of a HDR- interstitial brachytherapy plan is a challenging job. Owing to the complexities and diversity of the normalization and optimization techniques involved, a simple objective assessment of these plans is required. This can improve the radiation dose coverage of the tumour with decreased organ toxicity. AIM: To study and document the various dose volume indices and parameters required to evaluate a HDR interstitial brachytherapy plan by Volume normalization and graphical optimization using MUPIT (Martinez Universal Perineal Interstitial Template) in patients of carcinoma cervix. SETTINGS AND DESIGN: Single arm, retrospective study. METHODS AND MATERIALS: 35 patients of carcinoma cervix who received EBRT and HDR brachytherapy using MUPIT, were selected. The dose prescribed was 4 Gray/Fraction in four fractions (16Gy/4) treated twice daily, at least 6 hours apart. CTV and OARs were delineated on the axial CT image set. Volume normalization and graphical optimization was done for planning. Coverage Index (CI), Dose homogeneity index (DHI), Overdose index (OI), Dose non-uniformity ratio (DNR), Conformity Index (COIN) and dose volume parameters i.e. D2cc, D1cc, D0.1cc of rectum and bladder were evaluated. STATISTICAL ANALYSIS: SPSS version 16 was used. RESULTS AND CONCLUSION: CI was 0.95 ± 1.84 which means 95% of the target received 100% of the prescribed dose. The mean COIN was 0.841 ± 0.06 and DHI was 0.502 ± 0.11. D2cc rectum and bladder was 3.40 ± 0.56 and 2.95 ± 0.62 respectively which was within the tolerance limit of this organs. There should be an optimum balance between these indices for improving the quality of the implant and to yield maximum clinical benefit out of it, keeping the dose to the OARs in limit. Dose optimization should be carefully monitered and an institutional protocol should be devised for the acceptability criteria of these plans.
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HEAD AND NECK CANCER Top

Role of narrow band imaging in the diagnosis of laryngeal lesions: Pilot study from India p. 242
Pirabu Sakthivel, Kapil Sikka, Alok Thakar, Chirom A Singh, Suresh C Sharma, Madhu Rajeshwari, Aanchal Kakkar
DOI:10.4103/ijc.IJC_590_17  PMID:30693887
INTRODUCTION: Narrow band imaging (NBI) is a new imaging technique developed to improve the diagnostic accuracy of head and neck cancers by depiction of tumor-specific neo-angiogenesis. The purpose of this study was to assess the value of NBI in the diagnosis of laryngeal lesions. AIM: To assess the sensitivity and specificity of combined white light endoscopy (WLE) and NBI compared with WLE alone in the diagnosis of laryngeal lesions. SETTINGS AND DESIGN: Prospective study. MATERIALS AND METHODS: Thirty consecutive patients with various laryngeal lesions scheduled for microlaryngoscopic evaluation underwent WLE followed by NBI. Endoscopic NBI findings were classified into five types (I–V) according to the intraepithelial papillary capillary loop features. Types I–IV are considered benign, whereas type V is considered malignant. The observations were compared with histopathology. STATISTICAL ANALYSIS: Sensitivity, specificity, and positive and negative predictive values for the diagnosis of malignancy (i.e., invasive carcinoma and carcinoma in situ) by means of NBI with WLE were calculated. RESULTS: The sensitivity of WLE combined with NBI (100%) was higher than WLE alone (82.6%) in detecting laryngeal cancers. NBI helped in identifying four malignant lesions missed by WLE alone. Two children with respiratory papillomatosis also demonstrated type V pattern, a potential pitfall, leading to an overall positive predictive value of 92% and a negative predictive value of 100%. CONCLUSION: Combining NBI with WLE increases the sensitivity of detection of laryngeal cancer and its precursor lesions. NBI is also useful in some benign lesions as well as in post-radiotherapy patients.
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The effectiveness of therapeutic ultrasound in patients with oral submucosal fibrosis p. 248
Vyoma Bharat Dani, Swati H Patel
DOI:10.4103/ijc.IJC_611_17  PMID:30693888
CONTEXT: Oral submucosal fibrosis (OSMF) is a chronic disease occurring due to a reduction in fibroelasticity of the oral mucosa leading to trismus and inability to open the mouth that mostly affects habitual betel quid chewers. AIMS: The present study aims to find the effectiveness of therapeutic ultrasound (US) in addition to conventional exercises in patients with OSMF. SETTINGS AND DESIGN: It was a randomized controlled trial, carried out at KM Patel Institute of Physiotherapy, Shree Krishna Hospital, Karamsad, Anand, India. Both males and females with the confirmed diagnosis of OSMF and who were referred for physiotherapy treatment were included. MATERIALS AND METHODS: A total of 20 patients were randomized by using shuffling cards into two groups (10 in each): experimental (ultrasound and jaw opening exercises) and control (jaw opening exercises). The maximal mouth opening was measured before and after intervention in both the groups. STATISTICS: The maximal mouth opening was compared within the group before and after the treatment using paired t-test and the improvement in mouth opening between the groups was measured using unpaired t-test (P < 0.05). RESULTS: The results showed significant improvement in mouth opening in both groups that is increased mouth opening by 0.47 ± 0.09 cm (P = 0.002)* in the experimental group and 0.25 ± 0.05 cm (P = 0.003)* in the control group. However, patients in the experimental group had more improvement by about 0.22 cm (P = 0.006)* compared to the control group (*P < 0.05). CONCLUSION: Therapeutic US and conventional jaw opening exercises prove more beneficial compared to only jaw opening exercises in OSMF.
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Dental management prior to radiation therapy in patients with head and neck cancer p. 251
Paula Bonar Alvarez, Mario Perez-Sayáns, Mônica Ghislaine Oliveira Alves, Mercedes Gallas Torreira, María Elena Padín Iruegas, Andrés Blanco Carrión, Abel García-García
DOI:10.4103/ijc.IJC_20_18  PMID:30693889
INTRODUCTION: Patients diagnosed with head and neck tumors, are treated by surgery, radiation therapy (RT), chemotherapy (CT) or a combination thereof. The goal is to describe the management protocol for patients subjected to radiation therapy (RT) and to study their long-term oral health status. MATERIALS AND METHODS: A retrospective study was performed in a sample of 50 patients. We analyzed the oral health status and all the variables included applying the adapted protocol of pre-RT. RESULTS: Prior to RT, 84% of patients required scaling and 32% conservative treatment. Around 74% of patients required at least one exodontia. The mean of exodontias for patients presenting Grade 3 of oral hygiene was 6.50 per person (p<0.0001). The pre-RT study of possible candida infection showed that 78% of patients were negative for this infection. The mean resting saliva production was 39.10 (SD: 23.30; range: 13-145), with a stimulated value of 64.78 (SD: 33.92; range: 16-200). CONCLUSIONS: All patients should be protocoled to ensure that they present optimal oral conditions prior to initiating RT treatment.
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Induction chemotherapy in locoregionally advanced nasopharyngeal carcinoma in adults: Results from a nonendemic region p. 257
KN Lokesh, Tamojit Chaudhuri, KC Lakshmaiah, K Govind Babu, D Lokanatha, Linu A Jacob, MC Suresh Babu, AH Rudresha, LK Rajeev
DOI:10.4103/ijc.IJC_115_18  PMID:30693890
BACKGROUND: Recently published prospective clinical trials and two meta-analyses have shown that addition of induction chemotherapy (IC) to concurrent chemoradiation (CRT) could potentially improve outcomes in comparison to CRT alone, in locoregionally advanced nasopharyngeal carcinoma (LANPC). Although it remains unclear which is the best IC regimen to be offered and for how many cycles. Unfortunately, till date, there are no published data from India regarding the outcomes of various commonly used IC regimens before CRT, in LANPC. MATERIALS AND METHODS: Patients diagnosed with LANPC from January 2012 to December 2017, who received three cycles of IC before definitive CRT were reviewed retrospectively. Patients' profile, toxicity of IC, response rates, failure-free survival, and overall survival (OS) were evaluated. RESULTS: A total 34 patients with LANPC who received IC were reviewed. The median age at diagnosis was 36 years, and the majority were males (67.6%, n = 23). Nineteen patients received IC with paclitaxel plus cisplatin regimen (TP) and the remaining 15 patients received IC with docetaxel/paclitaxel plus cisplatin plus 5-FU regimen (TPF). The overall response rates after three cycles of TP and TPF IC were 68.4% and 80%, respectively, and the corresponding rates were 84.2%and 93.3%, respectively, 2 months after completion of CRT. At a median follow-up of 24 months, 2-year failure-free survival and OS for TP arm were 78.9% and 89.5%, and the corresponding rates for TPF arm were 86.7% and 93.3%, respectively. All Grade III–IV toxicities were numerically higher with triplet IC regimen in comparison to doublet regimen. CONCLUSION: In this retrospective analysis, there was no significant difference between taxane-based doublet and triplet IC regimens, in terms of survival outcomes, although Grade III–IV toxicities were numerically higher with triplet IC regimen. Clearly, these hypothesis-generating findings should be tested in a prospective randomized setting.
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Hookah products and online retail marketing strategies in India: A content analysis p. 261
Kavita Rijhwani, Sumbul Hashmi, Vikrant R Mohanty, Aswini Y Balappanavar, Shivam Kapoor
DOI:10.4103/ijc.IJC_142_18  PMID:30693891
INTRODUCTION: Hookah smoking is becoming increasingly popular among the youth. Evidence shows that exposure to marketing of the unhealthy products through social media platforms may impact adolescent health behaviors. The aim of the study was to perform a content analysis of online portals selling hookah products. MATERIALS AND METHODS: A content analysis of online retail market was conducted on Google India using three keywords hookah, hookah products, and shisha. Retail websites popular in India that were selling hookah products were randomly selected and explored. A total of 15 themes were developed and used to describe various promotional strategies for hookah products. RESULTS: In all, 41 (19.2%) products claimed to be tobacco/nicotine-free and only 14 products (6.5%) displayed age/health-specific warnings. About 86% of products were available at discounted rates; glamorizing words for describing products in form of superior, premium, and legendary were found on 189 (88.3%) products. Phrases such as “ultimate way to celebrate,” “perfect excuse to chill with your friends,” and “now enjoy the world of smoking without any doubt of harm” are commonly used to promote hookah products. CONCLUSION: Easy availability of newer forms of smoking at online markets could play a role in promoting the use of hookah among the youth. Most products are being sold without any warnings and there is no means to control the selling of the products to minors. There is a need to raise the issue of hookah products in the same tune as done for other forms of tobacco.
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Odontogenic tumors: A 35-year retrospective study of 250 cases in an Indian (Maharashtra) teaching institute p. 265
Manisha S Ahire, Jagdish V Tupkari, Tabita J Chettiankandy, Arush Thakur, Ruchika R Agrawal
DOI:10.4103/ijc.IJC_145_18  PMID:30693892
CONTEXT: This retrospective study was planned to ascertain the relative frequency of odontogenic tumors (OTs) in an Indian population in the light of the latest World Health Organization (WHO) classification. AIM: To compare data with various reports from other parts of the world. STUDY DESIGN: Retrospective study. MATERIALS AND METHODS: The histopathology records and archived slides of all lesions diagnosed as “OT” in the Department of Oral Pathology and Microbiology of Government Dental teaching institute, Mumbai, Maharashtra, India, were recovered from the period January 1981–December 2016. A total of 250 lesions thus classified were reviewed for age, gender, site of tumor, and histopathologic typing. The tumors were reclassified according to the WHO 2017 criteria. STATISTICAL ANALYSIS: Microsoft Excel 2010 was used for statistical analysis. RESULTS: In all, 250 cases of OTs were reported in a 35-year period. OTs in this study constituted 7.14% of all the 6797 registered biopsies. The most frequent histological type was ameloblastoma (AML) (30.8%), followed by odontoma (19.2%), unicystic ameloblastoma (18.4%), adenomatoid OT (14%), cementifying fibroma (6%), odontogenic myxoma and cementoblastoma (2.4% each), calcifying epithelial OT and odontogenic fibroma (2% each), ameloblastic fibroma (1.2%), squamous OT, dentinogenic ghost cell tumor, peripheral ameloblastoma, ameloblastic carcinoma and ameloblastic fibrosarcoma (odontogenic sarcoma) (0.4% each). CONCLUSION: A frequency of 7.14% of OTs was observed in this study. AML comprised the single most common tumor of all OTs. This study observed geographic variations in the frequency and distribution of OTs.
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LUNG CANCER Top

Clinicopathological profile of lung cancer at a tertiary care center p. 273
Satya Palanki Dattatreya, Rekha Bansal, Mohana Vamsy, Salil Vaniawala, SS Nirni, Monal Dayal, Rakesh Sharma
DOI:10.4103/ijc.IJC_455_17  PMID:30693893
BACKGROUND: Lung cancer is one of the most common malignancies with high morbidity and mortality. Nonsmall cell lung cancer (NSCLC) accounts for majority of cases. AIMS: This study aims to study the clinical and pathological features of lung cancer patients treated at our institute between January 2011 and December 2016. SUBJECTS AND METHODS: It is a retrospective study. 446 patients of lung cancer were retrospectively analyzed for demographic data, history of smoking, histological type, and presence of epidermal growth factor receptor (EGFR) mutation/anaplastic lymphoma kinase (ALK) mutations. RESULTS: Of the 446 patients analyzed, 304 (68%) were males and 142 (32%) were females, with the ratio being 2:1. Most of our patients had a lesion localizing to the right side (45.7%) than left (37.8%). NSCLC was reported in 81.1% of our patients. EGFR mutation was found in 60 (24%) patients, the most common mutation being the deletion of exon 19 (73%) followed by L858R mutation (21.6%). CONCLUSIONS: EGFR and ALK mutation testing of all the lung cancer patients is to be encouraged as these mutations form druggable targets.
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The prognostic role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in patients with stage III non-small cell lung cancer treated with concurrent chemoradiotherapy p. 276
Ufuk Yılmaz, Ozer Ozdemir, Ozgur Batum, Sinem Ermin
DOI:10.4103/ijc.IJC_624_17  PMID:30693894
BACKGROUND: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been shown to be prognostic markers in various types of cancers. In this study, we retrospectively investigated the prognostic role of NLR and PLR in stage III non-small cell lung cancer patients (NSCLC) treated with concurrent chemoradiotherapy (CCRT). MATERIALS AND METHODS: Seventy-nine stage III NSCLC patients treated with definitive CCRT were retrospectively evaluated. All patients received conformal RT with a total dose of 60–66 Gy with CCRT. The optimal cutoff values identified by receiver operating characteristic curve were 155 for PLR and 3.21 for NLR for overall survival (OS) and 142 and 3.21, respectively, for progression-free survival (PFS). RESULTS: Median age of the study population was 58 years with 72 (91%) males. Stages IIIA, IIIB, and IIIC were found in 21 (26.6%), 48 (60.8%), and 10 (12.7%) patients, respectively. Patients with a PLR <155 had a significantly longer OS (P = 0.038) compared with patients who had a higher PLR. The NLR and other parameters were not found to be in correlation with OS. In multivariable analysis, the PLR and lymphocyte count were significantly associated with OS (hazard ratio [HR]: 2.29, 95% confidence interval [CI]: 1.29–4.08, P = 0.005 and HR: 2.00, 95% CI: 1.17–3.42, P = 0.011, respectively). The PLR and lymphocyte count were identified as independent prognostic factors of poor PFS (HR: 2.08, 95% CI: 1.17–3.69, P = 0.012 and HR: 1.83, 95% CI: 1.08–3.08, P = 0.024, respectively). CONCLUSION: Our results support the prognostic role of pretreatment PLR and lymphocyte count in stage III NSCLC patients treated with concurrent radiotherapy.
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Use of adjuvant chemotherapy for nonsmall cell lung cancer: Is advanced age a prognostic factor? p. 282
Ozgur Batum, Ceyda Anar, Yasemin Özdoğan, Sinem Ermin, Ufuk Yılmaz
DOI:10.4103/ijc.IJC_27_18  PMID:30693895
PURPOSE: In patients with nonsmall cell lung cancer (NSCLC), the effect of age on adjuvant chemotherapy (CT) after primary surgical treatment is controversial. The aim of this study was to investigate the effect of age and other clinical variables on survival in NSCLC patients who received adjuvant CT. MATERIALS AND METHODS: NSCLC patients who underwent primary resection and received adjuvant CT between January 2012 and January 2016 were included in the study. The patients were divided into two age groups: (1) patients >65 years old (older patient group) and (2) patients ≤ 65 years old (young patient group). The effects of clinical variables such as age, histology, pT stage, pN stage, pTNM stage, adjuvant thoracic radiotherapy, and recurrence status on survival were assessed using the log-rank test and multivariable Cox regression analysis. RESULTS: A total of 91 NSCLC patients who received adjuvant CT after complete resection were included in the study. The median age of the patients was 60 (36–73) years. Eighty-six percent of the patients were male. 49.4% had squamous NSCLC and 50.6% had nonsquamous NSCLC. 59% had stage I and II disease and 41% had stage III disease. The mean overall survival was 61.9 months [95% confidence interval (CI) 51.28–72.69] in the young patient group and 73.1 months (95% CI 60.24–85.94) in the older patient group . The mean disease-free survival was 47.0 months (95% CI 37.81–56.23) in the young patient group and 51.1 months (95% CI 40.68–57.17) in the older patient group (P = 0.119 and P = 0.407, respectively). Pathological stage III [heart rate (HR): 2.615, P = 0.014] and presence of recurrence (HR: 2.496, P = 0.019) were found to be independent risk factors. However, age did not show statistical significance (HR: 0.428, 95% CI 0.128–1.427, P = 0.167). CONCLUSION: In NSCLC patients who underwent complete resection and received adjuvant CT, advanced age had no prognostic effect on survival.
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MEDIASTINUM Top

Metastatic thymic epithelial tumors: A regional cancer center experience p. 288
KC Lakshmaiah, Tamojit Chaudhuri, Govind K Babu, Lokanatha Dasappa, Linu Abraham Jacob, M C Suresh Babu, AH Rudresha, KN Lokesh, LK Rajeev
DOI:10.4103/ijc.IJC_524_17  PMID:30693896
BACKGROUND: Thymic epithelial tumors (TET) are the most common tumors of the anterior mediastinum. Patients with advanced/metastatic disease are usually treated with palliative chemotherapy (CT). Unfortunately, even though various palliative CT regimens have been used for long time, there is a real scarcity of published Indian data regarding the experience of palliative CT in metastatic TET (mTET). MATERIALS AND METHODS: This is a retrospective analysis of mTET patients treated between January 2010 and September 2017. Patients who received at least three cycles of first-line palliative CT were included for analysis of response rates, toxicity, and survival and prognostic factors. RESULTS: Of the 49 mTET patients, 27 (55.1%) were males. The median age at diagnosis was 52 years (range: 25–65). Eighteen patients (36.7%) had Masaoka Stage IVa disease, and the rest of the patients had IVb disease. The most common site of metastasis was pleuropericardium (n = 18), followed by lungs (n = 16) and lymph nodes (n = 9). The median progression-free survival and overall survival (OS) were 11.2 months (95% confidence interval [CI], 8.7–13.6) and 20.2 months (95% CI, 17.1–22.8), respectively, for the whole cohort (n = 49). The median OS of patients with Stage IVa disease was significantly better than that of the patients with Stage IVb disease (log-rank P = 0.000). Moreover, the “responders” to first-line CT had a significantly better median OS than the “nonresponders” (log-rank P = 0.000). Various first-line palliative CT regimens were well tolerated in our patients. CONCLUSION: Adriamycin Cisplatin Vincristine Cyclophosphamide (ADOC), Cyclophosphamide Adriamycin Cisplatin, and paclitaxel + carboplatin all are viable first-line palliative CT options for mTET and showed a comparable survival in Indian patients. The present study suggested that “responders” to first-line CT and those with Stage IVa disease might have a better survival than “nonresponders” and those with Stage IVb disease, respectively.
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MELANOMA Top

Clinicopathological study of malignant melanoma in a regional cancer center p. 292
Sasmita Panda, Sashibhusan Dash, Kusumbati Besra, Sagarika Samantaray, Pramod Chandra Pathy, Niranjan Rout
DOI:10.4103/ijc.IJC_612_17  PMID:30693897
BACKGROUND: Malignant melanoma is a tumor of melanocytic origin. Although uncommon in India as compared with the west, its prevalence is increasing. OBJECTIVES: To document the pattern of clinicopathological features of malignant melanoma cases attending in a regional cancer center in eastern India. MATERIAL AND METHODS: The present study was a retrospective study of 182 cases diagnosed histopathologically as malignant melanoma during 2011–2016. RESULTS: Out of the total cases, 170 (93.4%) were cutaneous and 12 (6.6%) were noncutaneous melanoma. The most common age group was sixth decade with a male predominance. Conventional melanotic melanomas were 176 (96.70%), and only 6 cases (3.30%) were amelanotic melanoma. Among noncutaneous melanomas, 6 were in anorectum, 2 in conjunctiva, and 1 case each in nasal cavity, palate, gingivo-buccal sulcus, and vagina. The acrallentigenous type was the most common variety, and the mixed epithelioid and spindle cell type was the most common histopathological pattern. Clark's level III was the most common level of invasion. CONCLUSION: The lower extremity is the most common site for melanoma, whereas extracutaneous melanomas are exceedingly rare and aggressive neoplasms. Melanoma can metastasize to regional lymph nodes, however, visceral metastasis to liver can also occur. In the absence of pigment in amelanotic melanoma, immunohistochemical markers such as HMB 45 can be used for definitive diagnosis.
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URO-ONCOLOGY Top

Comparative study of renal cell carcinoma in patients less than 40 years of age and older age patients: A retrospective single-center study p. 297
Dilip Kumar Pal, Arun Kumar Maurya, Debarshi Jana
DOI:10.4103/ijc.IJC_636_17  PMID:30693898
BACKGROUND: Renal cell carcinoma (RCC) is typically found in the older age group between 50 and 70 years of age. However, diagnosis of renal cancer is increasing more rapidly in patients less than 40 years if age compared to older age patients. AIMS AND OBJECTIVES: To compare the clinicopathological spectrum and survival in patients with RCC in relation to age in a tertiary care hospital in eastern India. STUDY DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Patients operated between February 2008 and January 2017 for renal masses having clinical and radiological suspicion and histopathologically proven RCC were analyzed from hospital records. Clinicopathological data and survival study were compared between patients less than 40 years of age and older age patients. STATISTICAL ANALYSIS USED: Statistical and survival analysis was done using Statistical Package for the Social Sciences 20. RESULTS: Among 198 patients, 36 (18.2%) patients less than 40 years were diagnosed with RCC and 162 in older patients. In these 36 younger patients, 17 (47.2%) were male and 19 (52.7%) were female. A total of 63.8% in younger age group and 69.1% of older patients were diagnosed with stage 1 and 2 RCC; comparing younger to older patients, younger patients had high number of papillary carcinoma (22.2% vs. 11.7%, P = 0.096). Younger patients have shown marginally better 5-year overall survival and disease-free survival (P > 0.05). CONCLUSION: Our study concludes that younger age patients were more affected by RCC specially papillary RCC, when compared to western population. In addition females had more incidence of RCC. Prognosis was similar in both groups.
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CASE REPORTS Top

Isolated giant ileal neurofibroma sans neurofibromatosis p. 301
Reetu Kundu, Sanjay Gupta, Robin Kaushik, Rajpal Singh Punia, Ravinder Kaur
DOI:10.4103/ijc.IJC_121_18  PMID:30693899
Neurofibromas are benign neoplasms that are usually seen in hereditary disorders such as von Recklinghausen's disease [neurofibromatosis type 1 (NF1)]. The occurrence of isolated ileal neurofibroma in patients without the classic manifestations of NF1 or multiple endocrine neoplasia (MEN) syndromes is an extremely rare entity . We report one such case of isolated ileal neurofibroma in a 60 year old woman without any other stigmata of NF. It may be the initial manifestation of NF1 or MEN 2b or malignant transformation, all of which necessitate further follow-up of these patients.
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Gastrointestinal mucormycosis in a child with acute lymphoblastic leukemia: An uncommon but ominous complication p. 304
Sidharth Totadri, Shirley Sundersingh, Ramya Natarajan, Ramakrishnan Ayloor Seshadri, Venkatraman Radhakrishnan
DOI:10.4103/ijc.IJC_260_18  PMID:30693900
Invasive fungal infections constitute a major cause of morbidity and mortality in children undergoing therapy for hematological malignancies. We report a 1-year-old boy who was receiving chemotherapy for acute lymphoblastic leukemia. His clinical course was complicated by a clinical syndrome consistent with neutropenic enterocolitis to which he succumbed. Histopathology of the surgically resected bowel revealed evidence of mucormycosis. Gastrointestinal mucormycosis is an unusual presentation which requires high degree of clinical suspicion and aggressive management.
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LETTERS TO THE EDITOR Top

Primary borderline mucinous cystadenoma of the mesentery p. 306
Manoj Gopal Madakshira, Uma Nahar Saikia
DOI:10.4103/ijc.IJC_225_18  PMID:30693901
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Autologous stem cell transplantation in elderly myeloma patients (>65 years): Single institutional experience p. 307
Rabindra K Jena, Sudha Sethy, Ashutosh Panigrahi, Tribikram Panda
DOI:10.4103/ijc.IJC_187_18  PMID:30693902
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Unlikely cancer in young patients: A retrospective hospital-based study p. 309
Nizara Baishya, Manigreeva Krishnatreya, Amal C Kataki, Jagannath D Sharma, Munlima Hazarika, Bhrigu Mishra, Tapti Kumari, Binita Das
DOI:10.4103/ijc.IJC_331_18  PMID:30693903
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HISTORY OF CANCER Top

Cushing's abandoned brains p. 311
Sunil K Pandya
DOI:10.4103/ijc.IJC_568_18  PMID:30693904
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