Indian Journal of Cancer
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   Table of Contents - Current issue
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January-March 2019
Volume 56 | Issue 1
Page Nos. 1-95

Online since Thursday, April 4, 2019

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WHAT IS NEW?  

What's new at the Indian Journal of Cancer? Highly accessed article p. 1

DOI:10.4103/0019-509X.255493  PMID:30950433
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EDITORIAL Top

Testing alternate biochemotherapy combinations in recurrent/metastatic head and neck cancer - Putting the best foot forward p. 2
HS Darling
DOI:10.4103/ijc.IJC_746_18  PMID:30950434
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HEAD AND NECK CANCER Top

Biweekly cetuximab in combination with platinum and 5-fluorouracil in metastatic head and neck carcinoma p. 4
Zeki G Surmeli, Ahmet Ozveren, Cagatay Arslan, Mustafa Degirmenci, Burcak Karaca, Ruchan Uslu
DOI:10.4103/ijc.IJC_355_18  PMID:30950435
Background and Aim: The combination of cetuximab with platinum and 5-fluorouracil (5-FU) chemotherapy prolongs survival in patients with metastatic or recurrent squamous-cell carcinoma of the head and neck (SCCHN). Biweekly (once in 2 weeks) administration of cetuximab requires fewer hospital visits and decreases treatment costs; therefore, it is more convenient both for the patients and for the healthcare providers. Here, we assessed the efficacy, safety, and tolerability of an alternative biweekly regimen of cetuximab in combination with platinum and 5-FU chemotherapy as a first-line treatment for these patients. Methods and Materials: Medical records of patients with metastatic or recurrent non-nasopharyngeal SCCHN who were treated with a biweekly regimen of cetuximab (500 mg/m2 on day 1), cisplatin (40 mg/m2 on day 1) or carboplatin (target area under the curve 3.5 mg/ml × min on day 1), folinic acid (400 mg/m2 on day 1), and 5-FU (400 mg/m2 bolus on day 1 followed by continuous infusion of 2,400 mg/m2 5-FU over 46 h) were retrospectively reviewed. Survival estimates were calculated with the Kaplan–Meier method. Results: In total, 60 patients were included. The median age of the patients was 60.5. The objective response rate was 53.3% (95% confidence interval [CI] = 40.7–65.9). The median progression-free survival duration was 6.8 months (95% CI = 5.5–8.1) and the median overall survival duration was 13.3 months (95% CI = 8.4–18.2). The most common grade 3 or 4 adverse events were neutropenia (28.3%) and leucopenia (13.3%). Grade 3 or 4 rash was observed in 3.3% of the patients. Conclusion: Biweekly administration of cetuximab, cisplatin, and 5-FU is an effective regimen with a favorable toxicity profile for the first-line treatment of metastatic or recurrent SCCHN. These results warrant further evaluation of this regimen in prospective trials.
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Oncological outcome following TORS in HPV negative supraglottic carcinoma p. 9
Surender Dabas, Karan Gupta, Reetesh Ranjan, Ashwani K Sharma, Himanshu Shukla
DOI:10.4103/ijc.IJC_172_18  PMID:30950436
Objective: The aim of this study was to determine the oncological and functional outcomes following transoral robotic surgery (TORS) in human papilloma virus negative supraglottic cancers. Study Design: A prospective observational study at a tertiary cancer care center, New Delhi, India. Materials and Methods: From February, 2013 to December, 2015, 45 patients with supraglottic lesions underwent TORS using the da Vinci® surgical system. Results: Forty-five patients underwent TORS for supraglottic laryngectomy (SGL), with all patients undergoing bilateral neck dissection. The most common site was Ary-epiglottic fold. 47.9% were cT1 and 52.1% were cT2. Average robotic set-up time was 8.8 min and average robotic operative time was 42.9 min. A positive or close margin was seen in 12 patients (26.7%) on frozen, which were revised intraoperatively. On final histology, 3 (6.7%) patients had a margin of <5 mm. The average closest margin was 5.7 mm. Patients tolerated oral feeds within 2 weeks of procedure. All patients were HPV negative. Postoperatively, all patients had adequate swallowing and speech. Follow-up ranged from 24 to 58 months. Thirty-eight (84.4%) patients were alive and disease free. Conclusion: TORS is a safe, feasible, minimally invasive, and oncologically safe procedure in patients with early HPV supraglottic cancers. It has less morbidity and offers benefits in terms of early airway and feeding rehabilitation and avoids complications resulting from radiation therapy for these patients.
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Prevalence of oromucosal lesions in relation to tobacco habit among a Western Maharashtra population p. 15
KA Kamala, S Sankethguddad, Ajay G Nayak, Abhijeet R Sanade, SR Ashwini Rani
DOI:10.4103/ijc.IJC_231_17  PMID:30950437
OBJECTIVES: This study was conducted to determine the number and types of oromucosal lesions (OMLs) in relation to tobacco habits in patients who attended the outpatient department. METHODOLOGY: A total of 1730 patients visiting the Department of Oral Medicine and Radiology were interviewed and screened for tobacco habits (smoking and smokeless). Clinical oral examination was conducted with diagnostic instruments using the Color Atlas of Common Oral Diseases as a guide for diagnosis. When clinical features were not diagnostic, a biopsy was done. RESULTS: Of the 1730 outpatients, 975 (56.3% ) individuals used tobacco in one or other forms and 687 (70.4%) of these had OMLs. CONCLUSION: The results of this study provide important information on the prevalence of OMLs in patients seeking dental care. This provides baseline data for future studies on the prevalence of oral lesions in the general population.
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Frozen section is not cost beneficial for the assessment of margins in oral cancer p. 19
Sourav Datta, Aseem Mishra, Pankaj Chaturvedi, Munita Bal, Deepa Nair, Yogesh More, Pranav Ingole, Sandeep Sawakare, Jai Prakash Agarwal, Shubhada V Kane, Poonam Joshi, Sudhir Nair, Anil D'Cruz
DOI:10.4103/ijc.IJC_41_18  PMID:30950438
BACKGROUND: Routine use of frozen section (FS) is a costly procedure and sparsely available in resource poor countries. A proper cost benefit analysis may help to reduce its routine use and would empower surgeons to perform oral cancer surgeries without having FS facility. FS is performed to identify microscopic spread beyond gross disease that cannot be assessed clinically. OBJECTIVE: Our primary aim was to determine the cost benefit analysis of FS in the assessment of margins in oral cavity squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Retrospective study of prospectively collected data of 1311 consecutive patients who were operated between January 2012 and October 2013. The gross and microscopic margin status of each patient was extracted from the patient's chart. The cost estimates were performed to calculate the financial burden of FS as well as expenses incurred on adjuvant treatment resulting from inadequate margins. RESULT: Microscopic spread changed the gross margin status in 5.2% (65/1237) patients. Of this entire cohort of 1237 patients, FS helped 29 (2.3%) patients to achieve tumor free margin, and it changed the adjuvant treatment plan in 9 (0.7%) patients. The cost of FS for each patient was INR 11052. The cost-benefit ratio of FS was 12:1. Gross examination alone could have identified majority of the inadequate margins. CONCLUSION: Frozen section for assessment of margin status bears poor cost-benefit ratio. Meticulous gross examination of the entire surgical specimen is sufficient to identify majority of inadequate margins.
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Multiple logistic regression analysis predicts cancer risk among tobacco usage with glutathione S-transferase p1 genotyping in patients with head and neck cancer p. 24
Argi Anuradha, Veerathu L Kalpana, Natukula Kirmani
DOI:10.4103/ijc.IJC_277_17  PMID:30950439
INTRODUCTION: Numerous studies have been investigated to understand the association between glutathione S-transferase P1 (GSTP1) polymorphism and risk of head and neck cancer (HNC) but yielded contradictory results, and no studies could confirm polymorphism in GSTP1 and that tobacco usage increases the risk of HNCs. Therefore, this study aimed to understand the association of GSTP1 Ile105Val polymorphism with or without tobacco usage in carcinogenesis and clinicopathological characteristics of patients with HNC. MATERIALS AND METHODS: Binary logistic regression analysis was performed to predict HNC risk with tobacco use and GSTP1 genotyping. Five predictor variables such as gender, age, tobacco usage, familial, and GSTP1 genotypes were included in the model. RESULTS: The results of the logistic regression analysis show that the full model which considered all the five independent variables together was statistically significant, log-likelihood = −111.820, and all slopes are zero: G = 74.297, degree of freedom (DF) = 5, P = 0.000. The strongest predictor in this model is tobacco usage (odds ratio = Z = −5.16, P = 0.000). CONCLUSION: The study concludes that multiple logistic regression analysis model could predict the risk factors in case–control studies where control samples are compromised.
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Second primary malignancies in laryngeal carcinoma patients treated with definitive radiotherapy p. 29
Yurday Ozdemir, Erkan Topkan
DOI:10.4103/ijc.IJC_273_18  PMID:30950440
INTRODUCTION: Second primary malignancy (SPM) is associated with decreased overall survival (OS) in laryngeal carcinomas (LC). METHODS: One hundred eighty three LC patients were analyzed retrospectively. The primary and secondary endpoints were the incidence of SPM and the OS difference between patients with and without SPM. RESULTS: SPM developed in 22 (12.0%) patients at median 52 months (range, 4–131 months), with a yearly 2.8% incidence, of which 19 (10.4%) and 3 (1.6%) were metachronous and synchronous, respectively. Lung was the commonest SPM (72.7%). Of 47 deaths, 12 (25.5%) were SPM related. Comparatively SPM patients had significantly shorter median OS (68.0 months vs. median not reached; P = 0.005), with lower 5-year (67.0% vs. 78.9%) and 8-year (32.6 vs. 69.8%) survival rates. CONCLUSION: The present findings suggested the SPM as a competing risk factor for death in index LC patients with its annual incidence rate of 2.8% and for accounting one of every four deaths in this patients group. Emergence of lung carcinoma as the most frequent type of SPM and the ability to treat >50% of them with an estimated long-term outcomes emphasizes the importance of early diagnosis and curative treatment of SPMs.
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COMMENTARY Top

Second primary malignancies in patients with radiotherapy-treated laryngeal carcinoma - A commentary p. 35
Deepti Sharma, Neha Sharma, Vineeta Goel
DOI:10.4103/ijc.IJC_518_18  PMID:30950441
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BREAST CANCER Top

Neoadjuvant concurrent chemoradiation in male breast cancer: Experience from a tertiary cancer center p. 37
Priya Iyer, Ananthi Balasubramanian, Ganesarajah Selvaluxmy, V Sridevi, Arvind Krishnamurthy, Venkatraman Radhakrishnan
DOI:10.4103/ijc.IJC_44_18  PMID:30950442
BACKGROUND: Male breast cancers (MBC) account for 1% of all breast cancers. Neoadjuvant concurrent chemoradiation (CTRT) is not the standard of care for treating breast cancer. However, in our center, it has been routinely used in patients with locally advanced breast cancer to downsize the tumor and make it amenable to surgery. AIM: This study was conducted to examine the clinical and pathological profile and outcomes of patients with MBC treated at our institute with neoadjuvant CTRT. SETTINGS AND DESIGN: The study was conducted at a tertiary cancer center and was retrospective in nature. MATERIALS AND METHODS: All MBC patients treated with neoadjuvant CTRT at our center between 2001 and 2016 were enrolled in the study. Data were retrospectively extracted from the patients' case records. STATISTICAL ANALYSIS: Kaplan–Meier method was used for survival analysis and the outcome variables were compared using the log-rank test. RESULTS: Thirty-one MBC patients who received neoadjuvant CTRT were analyzed in this study. The median age of the patients was 53 years. Stage IIB disease was observed in 8/31 (26%) patients, stage III in 20/31 (64%), and stage IV in 3/31 (10%) patients. There was no grade 3 or 4 toxicity due to CTRT. Surgery was performed in 29/31 (94%) patients and none of the patients had a pathological complete response. The median duration of follow-up was 95.3 months. The 8-year event-free survival and overall survival for stage IIB, III, and IV were 75%, 50%, and 0% and 87.5%, 69%, and 0%, respectively. CONCLUSION: This is the first study to report on the use of neoadjuvant CTRT in MBC. Prospective evidence from phase-3 randomized controlled trials on the safety and efficacy of CTRT in breast cancer is required before its routine use can be recommended.
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Oxidative stress in relation to obesity in breast cancer p. 41
R Sateesh, Aparna Rajeshwar Rao Bitla, Sandya Rani Budugu, Y Mutheeswariah, H Narendra, BV Phaneedra, AY Lakshmi
DOI:10.4103/ijc.IJC_247_18  PMID:30950443
PURPOSE: Breast carcinoma is one of the most common neoplasms in women and is a leading cause of cancer-related deaths worldwide. Obesity-induced chronic inflammation promoted by adipose tissue dysfunction is a key feature, which is thought to be an important link between obesity and cancer. Oxidative stress (OS) has been suggested to play an important role in carcinogenesis. Obese women have been shown to have higher levels of OS markers. The study was performed to know the influence of obesity on OS to be replaced with OS markers in patients with breast cancer. MATERIALS AND METHODS: Thirty women attending the outpatient Department of Surgical Oncology and Surgery at Sri Venkateswara Institute of Medical Science, Tirupati, who were clinically diagnosed and histologically confirmed with breast cancer were considered as the patients and 30 healthy women were included as controls. Malondialdehyde (MDA), protein carbonyls (PCC), and advanced oxidation protein products (AOPP) as oxidative markers along with protein thiols and ferric-reducing ability of plasma (FRAP) were studied as markers of antioxidant status. RESULTS: Patients with breast cancer had significantly higher levels of MDA (P = 0.005), PCC, and AOPP compared to controls (P = 0.001) and significantly lower levels of thiols and FRAP compared to controls (P = 0.001). No significant correlation was found between OS markers and indices of obesity. A significant association was found between OS markers (P = 0.005), PCC (P = 0.002), AOPP (P = 0.002), and breast cancer. CONCLUSIONS: Patients with breast cancer have increased OS as evidenced by an increase in oxidant markers and a decrease in antioxidant markers. OS is not related to their adiposity but is related to the presence of breast cancer.
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Treatment of elderly breast cancer patients in a breast center in India p. 45
Asha Reddy, Naga Amulya Mullapudi, Kirti Katherine Kabeer, Ramesh Nimmagadda, Selvi Radhakrishna
DOI:10.4103/ijc.IJC_237_18  PMID:30950444
CONTEXT: The management of breast cancer in older patients is challenging due to factors such as comorbidities, limited mobility, functional dependence, cognitive functions, and socioeconomic aspects. Data about the outcomes in elderly patients with breast cancer in our country are sparse. AIMS: The aim of this study was to evaluate and compare the clinical and pathological variables, treatment, and survival outcomes of elderly women (those of 70 years and above) with women under 50 years and those between the ages of 50 and 69 years treated at our center. SUBJECTS AND METHODS: Prospectively collected clinical and pathological data from January 2007 to December 2014 were recorded and entered into OncoCollect™ software. Statistical analysis was done using Microsoft R Open software. Survival analysis was estimated using Kaplan–Meier curves. RESULTS: A total of 1226 Stage I–III breast cancer patients were treated between January 2007 and December 2014. Of these, 11.3% (139) were aged 70 years and above. Invasive ductal carcinoma was predominant and majority had Stage II disease and grade 1 tumors. Receptor positivity was observed in 79% of elderly patients and 9% had triple-negative disease. Primary hormone therapy was given to 7% of the patients and chemotherapy was administered to 12%. The 5-year overall survival for patients 70 years and older is 85%. CONCLUSIONS: Elderly patients are more likely to have an indolent course with low grade and estrogen receptor-positive tumors. For healthy older women, treatment according to standard guidelines including surgery, chemotherapy, and radiation should be followed. However, for those who are unfit and cannot tolerate surgery, primary endocrine therapy is a suitable option.
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Effects of chemotherapy process on postural balance control in patients with breast cancer p. 50
Umut Bahcaci, Ilksan Demirbuken
DOI:10.4103/ijc.IJC_47_18  PMID:30950445
BACKGROUND: Breast cancer (BC) is the most common type of cancer among women in the world. Patients can face musculoskeletal disorders due to treatment side effects that result in failure to walk, falling, or fractures associated with balance problems. PURPOSE: The aim of this study was to determine whether postural balance would be affected during chemotherapy (CT) in people with BC. MATERİALS AND METHODS: A total of 32 women who consulted the medical oncology department, between 31 and 63 years of age, were admitted to the study. For fear of falling, fall efficiacy scale; for static balance, double-leg, single-leg, and tandem stance tests with eyes opened and eyes closed; Romberg test; for dinamic balance, Sit To Stand (STS) test, and Time Up and Go (TUG) tests were performed in the patients. RESULTS: Reduced fear of falling between CT cycles (P < 0.0125), no change in postural sway in double-leg stance test with eyes opened (P = 0.734) and eyes closed (P = 0.127), significantly increased postural instability in single-leg and tandem stance test with eyes opened and eyes closed (P = 0.000), no change in postural stability in Romberg test (P > 0.05), significantly increased postural instability in STS (P = 0.000) and TUG tests (P = 0.000), and significantly increased time of finishing the STS (P = 0.021) and TUG tests (P = 0.010) were noted. CONCLUSİON: Patients demonstrated postural instability which can ruin the daily life activities in many parameters of measurements. Postural balance exercises should be performed by BC survivors undergoing CT.
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URO-ONCOLOGY Top

Bladder cancer demographics and outcome data from 2013 at a tertiary cancer hospital in India p. 54
Gagan Prakash, Mahendra Pal, K Odaiyappan, Rajesh Shinde, Jeeban Mishra, Devendra Jalde, Barath Rajkumar, Kumar Prabhash, Amit Joshi, Vanita Noronha, Vedang Murthy, Rahul Krishnatry, Sangeeta Desai, Santosh Menon, Nilesh Sable, Palak Popat, Venkatesh Rangarajan, Archi Agrawal, Ganesh Bakshi
DOI:10.4103/ijc.IJC_351_18  PMID:30950446
BACKGROUND: Bladder cancer (BCa) is the ninth most common cancer accounting for 3.9% of all cancer cases as per the Indian Cancer Registry data. There is a scarcity of data on urinary Bca from India. AIM: The aim of this study was to know demographic background, stage distribution, utilization of various treatment modalities, and oncological outcome in Indian patients presenting with bladder cancer to a tertiary care cancer center in Mumbai. METHODOLOGY: We performed a retrospective audit of all patients registered as urinary BCa in our hospital from January 1, 2013 to December 31, 2013. Electronic medical records of these patients were checked for most of the information gathered. RESULTS: Median age of patients at presentation was 59 years with a range of 18–88 years. There were 84% male and 16% female patients. Forty seven percent of patients had nonmuscle invasive bladder cancer (NMIBC), 36% had muscle invasive bladder cancer and locally advanced disease, and 17% had metastatic disease. Eight patients were treated with trimodality bladder preservation protocol. Recurrence was seen in 38 (22.6%) patients with NMIBC. Out of them. 44.7% and 55.3% were in low- and high-grade tumors, respectively. Overall survival and disease-free survival estimated for 3 years were 63% and 57%, respectively. CONCLUSION: Bladder cancer has a varied spectrum of presentation. Bladder cancer patients presenting to our hospital generally have a higher stage and grade of disease compared with that in the west.
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NEUROONCOLOGY Top

Retrospective comparison of standard and escalated doses of radiotherapy in newly diagnosed glioblastoma patients treated with concurrent and adjuvant temozolomide p. 59
Ozan Cem Guler, Berna Akkuş Yıldırım, Cem Önal, Erkan Topkan
DOI:10.4103/ijc.IJC_128_18  PMID:30950447
BACKGROUND: To compare the efficacies of standard dose-(SDRT) and escalated dose radiotherapy (EDRT) in newly diagnosed glioblastoma (GBM) with concurrent and adjuvant temozolomide (TMZ). MATERIALS AND METHODS: Outcomes of 126 newly diagnosed GBM patients who received SDRT (60 Gy, 30 fractions) or EDRT (70 Gy, 30 fractions) with concurrent plus adjuvant TMZ were retrospectively analyzed. Both groups received concurrent TMZ (75 mg/m2) during the course of RT and at least one course of adjuvant TMZ (150–200 mg/m2), thereafter. Overall survival (OS) and local progression free survival (LPFS) constituted the primary and secondary endpoints, respectively. RESULTS: At median 14.2 months follow-up, 26 (20.6%) patients were alive. Median LPFS and OS were 9.2 [95% confidence interval (CI); 8.4–10.0] and 15.4 months (95% CI; 12.1–18.8), respectively, for the entire cohort. Although the median OS was numerically superior in the EDRT this difference could not reach statistical significance (22.0 vs. 14.9 months; P = 0.45), Likewise, LPFS was also (9.9 vs. 8.9 months; P = 0.89) not different between the two treatment groups. In multivariate analysis, better recursive partitioning analysis class (3–4 vs. 5; P = 0.044) and extensive surgery (gross total resection vs. subtotal resection/biopsy only; P= 0.021) were identified to associate significantly with superior OS times, irrespective of the RT protocol. CONCLUSIONS: Although the current median OS of 22 months of the EDRT group is promising, no statistically significant survival advantage for EDRT was observed even in the presence of TMZ. Randomized studies with larger population sizes and available genetic markers are warranted to conclude more reliably on the fate of EDRT plus TMZ.
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Cell-free circulating tumor DNA in patients with high-grade glioma as diagnostic biomarker – A guide to future directive p. 65
Khaleel Ibrahim Ahmed, HB Govardhan, Manisha Roy, T Naveen, P Siddanna, P Sridhar, MN Suma, Noopur Nelson
DOI:10.4103/ijc.IJC_551_17  PMID:30950448
BACKGROUND: Owing to the aggressive nature of high-grade gliomas (HGGs), its early diagnosis holds the key to a favorable prognosis. Currently, tissue biopsy is the gold standard to verify HGG's initial diagnosis and can be challenging due to its invasive nature. In this study, our objective was a noninvasive panel for timely detection of HGG and its progression using cell-free circulating tumor DNA (cfTDNA). MATERIALS AND METHODS: Twenty-seven patients with HGG were tested with a 50-gene tumor panel. cfTDNA isolated from serum was checked for single-nucleotide variations (SNVs) or copy number alterations using targeted next-generation sequencing, with further validation of results by checking respective formalin-fixed paraffin-embedded tumor tissues for the same genetic alterations. RESULTS: About 88.8% of the patients were detected with HGG-associated cfTDNA. Around 25% patients were detected with one, 25% patients had three, 25% patients had four, and 12.5% patients each had five and six genetic alterations. About 12 of 50 genes were detected in the serum samples. The SNVs detected included TP53 in 87.5% of patients; PIK3CA and EGFR in 50% of patients; PTEN in 37.5%; KIT and VHL in each 25% of patients; and RB1, NF2, MET, ATRX, CDK2A, and CTNNB1 each in 8.3%–16.6%. On combining EGFR, KIT, PTEN, PIK3CA, TP53, and VHL genes (Govardhan Diagnostic Genetic Module for high-grade glioma), at least one of the genetic alterations was found in 100% of patients. Conclusion: These findings illustrate that cfTDNA is easily demonstrable and can be used as a surrogate to tissue biopsy in brain tumor.
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METASTASES Top

Every distant deposit is not a metastasis: Synchronous primaries do exist p. 70
Govind Babu, Vikas Asati, KC Lakshmaiah, D Lokanatha, Linu Abraham Jacob, Suresh Babu, KN Lokesh, AH Rudresh, LK Rajeev, Smitha Saldanha, R Chethan, Deepak Koppaka, CS Premalata
DOI:10.4103/ijc.IJC_637_17  PMID:30950449
BACKGROUND: Synchronous occurrence of two malignant tumors is a rare event. With increasing use of sophisticated imaging modalities for staging, synchronous multiple tumors are more commonly detected now. Assuming the second primary malignancy as metastasis will change the intent of treatment from curative to palliative, greater awareness among oncologists is of paramount importance. This study is an example where thorough clinical examination and proper judgment resulted in correct diagnosis and appropriate treatment. MATERIALS AND METHODS: This is a prospective descriptive study. Patients diagnosed with synchronous primary tumors from January 2016 to November 2017 at our center were reviewed. RESULTS: Ten cases of synchronous primary malignancies were detected during this period. A total of 20 primary tumors were diagnosed. Lung carcinoma and gastrointestinal malignancies were the most common (five patients each). The median age was 59.5 years. Seven patients were male. Second primary tumor was suspected in four patients during clinical examination, while in six patients it was suspected on imaging. Even in the presence of two primary tumors, three patients were treated with curative intent. CONCLUSION: Possibility of synchronous second primary malignancy should always be kept whenever a distant deposit is detected at an unusual site. Histopathological evaluation of the lesion before assuming a metastasis will lead to accurate diagnosis, staging, and appropriate treatment.
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GI ONCOLOGY Top

Treatment in resectable non-metastatic adenocarcinoma of stomach: Changing paradigms p. 74
Prameela G Chelakkot, Rahul Ravind, K Sruthi, Durgapoorna Menon
DOI:10.4103/ijc.IJC_375_18  PMID:30950450
Adjuvant treatment in gastric adenocarcinoma has been a challenge for the treating specialists, and despite several trials, a clear consensus is yet to be defined. The higher propensity for lymph nodal involvement and locoregional recurrences led to the hypothesis that locoregional and systemic treatments need to be equally aggressive to achieve better outcomes in the management of gastric adenocarcinoma. Regional, ethnic, and biological differences between the Eastern and Western population are also found to reflect in the tumor behavior and its response to treatment. The MAGIC (Medical Research Council Adjuvant Gastric Infusional Chemotherapy), Intergroup 0116, ACTS-GC (Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer), CLASSIC (Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer), ARTIST (Adjuvant Chemoradiation Therapy in Stomach Cancer), and the recently published CRITICS (Chemoradiotherapy after Induction Chemotherapy in Cancer of the Stomach) trials were a few of the randomized controlled trials that tried to give a clearer perspective of this tumor, though it still remains a dilemma. A study incorporating the tumor and demographic factors along with the availability of skilled talent and resources might generate an answer.
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MCQS Top

MCQs for “Treatment in resectable non-metastatic adenocarcinoma of stomach: Changing paradigms” p. 81
HS Darling, Senguttuvan Jayalakshmi, Pradeep Jaiswal
DOI:10.4103/ijc.IJC_210_19  PMID:30950451
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CASE REPORTS Top

Portal vein leiomyosarcoma: A rare case of hepatic hilar tumor with review of the literature p. 83
Elodie Gaignard, Damien Bergeat, Nathalie Stock, Fabien Robin, Karim Boudjema, Laurent Sulpice, Michel Rayar, Bernard Meunier
DOI:10.4103/ijc.IJC_199_18  PMID:30950452
Portal vein leiomyosarcoma (LMS) is a very rare entity with poor prognosis. Only few cases have been reported in the literature. We report the case of a 53-year-old man with portal vein LMS presenting as a hilar tumor and causing cholestasis. The tumor measured 10 cm and was responsible for right portal vein thrombosis and compression of the biliary convergence. A right hepatectomy with hilar en bloc resection was performed with portal vein and biliary reconstruction. Pathology confirmed the complete resection of a well-differentiated leiomyosarcoma of the portal vein. The postoperative outcome was uneventful and the patient received no adjuvant treatment. Six months after the procedure, the patient is doing well with a normal quality of life and without any sign of recurrence. Aggressive and radical surgery should be proposed in first intention for the treatment of portal vein LMS.
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Primary cardiac osteosarcoma: A rare cause of chest pain in a young man p. 86
Rambod Mozafari, Zahra Mohebbi, Tina Shooshtarizadeh, Hamed Sotoude
DOI:10.4103/ijc.IJC_259_18  PMID:30950453
Although primary cardiac osteosarcoma is uncommon, cardiac neoplasms should be in the differential diagnosis of cardiac complaints. We present a case of a 35 year old man with recurrent episodes of exertional chest pain and who was diagnosed with primary cardiac osteosarcoma. Cardiac osteosarcomas are rare but must be suspected.
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COMMENTARY Top

Cardiac sarcomas: A gist p. 88
Pradeep Vaideeswar
DOI:10.4103/ijc.IJC_545_18  PMID:30950454
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NARRATIVE Top

A glass of water Highly accessed article p. 89
Neha Chauhan
DOI:10.4103/ijc.IJC_72_19  PMID:30950455
In large cities, cancer management has moved to highly specialized centers that provide holistic care. Hence, freelance consultants very occasionally encounter cancer patients. Sometimes due to a variety of reasons, one may not have much to offer to a patient in terms of medical management. However, empathy and small acts of kindness can have a major impact on patients going through tough times and must be always remembered. A glass of water is a true narrative of how seemingly benign words can make a patient aloof when one least expects and how small acts of kindness can change their equation with the doctor. It reinforces the fact that the art of medicine is still the better half of the science of medicine and must be practiced at all times.
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COMMENTARY Top

Comment on “A glass of water” p. 92
BC Rao
DOI:10.4103/ijc.IJC_127_19  PMID:30950456
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NEWS IN BRIEF Top

News p. 93

DOI:10.4103/ijc.IJC_251_19  
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