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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 56 | Issue 3
Page Nos. 195-289

Online since Friday, July 19, 2019

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EDITORIAL  

Shared decision making and cancer screening Highly accessed article p. 195
Filipe Prazeres, Elisa Martins
DOI:10.4103/ijc.IJC_574_18  PMID:31389379
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NEUROONCOLOGY Top

WT1 in astrocytomas: Comprehensive evaluation of immunohistochemical expression and its potential utility in different histological grades p. 197
Aakriti Manocha, Sunila Jain
DOI:10.4103/ijc.IJC_51_18  PMID:31389380
BACKGROUND: Wilms' tumor 1 (WT1) mutation has recently been detected in gliomas. Growing data indicate that WT1 mutation plays a causal role in gliomagenesis and is overexpressed in most glioblastomas. An emerging immunotherapy targeting WT1 has shown to be effective in resistant glioblastomas in clinical trials. WT1 expression and its potential utility in various grades of astrocytomas is still unclear and needs further elucidation. The evaluation of WT1 can be done by molecular or immunohistochemical methods. As immunohistochemistry is easier with wider routine use, immunoexpression of this biomarker was studied. AIM: The aim of this study was to characterize WT1 immunoexpression across different histological grades of astrocytomas to routinely aid in diagnosis and reproducibility and to assess the association between WT1 and immunomarker isocitrate dehydrogenase (IDH1). MATERIAL AND METHODS: This was an observational prospective study on 79 cases of astrocytomas. RESULTS: Seventy-nine astrocytomas including 11 recurrent tumors were assessed for WT1 by immunohistochemistry. WT1 expression was detected in all astrocytomas (100%). The control group of reactive gliosis was negative. WT1 score correlated with histological tumor grades (P < 0.001) with higher score in higher grade. It was also observed that different tumor grades depicted two distinct expression patterns. WT1 score and pattern were valuable in differentiating high- and low-grade astrocytomas. CONCLUSION: This study supports the oncogenic role of WT1 in astrocytomas. WT1 was found to be valuable in distinguishing different grades of astrocytomas. WT1 can aid in differentiating neoplastic process from reactive gliosis, particularly in recurrent tumors. Higher expression in glioblastomas supports its immunotherapy potential.
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Evaluatıon of hypofractıonated stereotactıc radıotherapy (HFSRT) to the resectıon cavıty after surgıcal resectıon of braın metastases: A sıngle center experıence p. 202
Ferrat Dincoglan, Omer Sager, Bora Uysal, Selcuk Demiral, Hakan Gamsiz, Esin Gündem, Yelda Elcim, Bahar Dirican, Murat Beyzadeoglu
DOI:10.4103/ijc.IJC_345_18  PMID:31389381
INTRODUCTON: Adjuvant radiotherapy after surgical resection is used for the treatment of patients with brain metastasis. In this study, we assessed the use of adjuvant hypofractionated stereotactic radiotherapy (HFSRT) to the resection cavity for the management of patients with brain metastasis. MATERIALS AND METHODS: A total of 28 patients undergoing surgical resection for their brain metastasis were treated using HFSRT to the resection cavity. A total HFSRT dose of 25–30 Gray (Gy) was delivered in 5 consecutive daily fractions. Patients were retrospectively assessed for toxicity, local control, and survival outcomes. Kaplan-Meier method and log-rank test were used for statistical analysis. RESULTS: Median planning target volume (PTV) was 27.2 cc (range: 6–76.1 cc). At a median follow-up time of 11 months (range: 2–21 months.), 1-year local control rate was 85.7%, and 1-year distant failure rate was 57.1% (16 patients). Median overall survival was 15 months from HFSRT. Higher recursive partitioning analysis class (P = 0.01) and the presence of extracranial metastases (P = 0.02) were associated with decreased overall survival on statistical analysis. There was no radiation necrosis observed during follow-up. CONCLUSION: HFSRT to the resection cavity offers a safe and effective adjuvant treatment for patients undergoing surgical resection of brain metastasis. With comparable local control rates, HFSRT may serve as a viable alternative to whole brain irradiation.
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SARCOMA Top

Pazopanib efficacy and toxicity in a metastatic sarcoma cohort: Are Indian patients different? p. 207
Aparna Sharma, Ilavarasi Vanidassane, Aditi Aggarwal, Asit Ranjan Mridha, Rambha Pandey, Ekta Dhamija, Adarsh Barwad, Sameer Rastogi
DOI:10.4103/ijc.IJC_105_18  PMID:31389382
PURPOSE: There is no study till date determining the spectrum of adverse events of pazopanib in Indian patients with advanced sarcoma. MATERIALS AND METHODS: We conducted a retrospective study by analyzing the case records of metastatic sarcoma patients treated with pazopanib from January 2016 to July 2017 in sarcoma medical oncology clinic. Toxicity was assessed according to CTCAE v.4.03 criteria. SPSS version 23 was used for statistical evaluation. RESULTS: A total of 33 patients received pazopanib. The median age was 41 years (range, 19–75 years), with a male predominance (54.5%). Twenty-six patients (78.8%) had ECOG performance status 1 at the time of pazopanib initiation. The most common type of sarcoma was synovial sarcoma, and the mean duration of pazopanib intake in patients was 4.12 months. The median follow-up was 13 months. Median progression-free survival was 5 months, and median overall survival was 18 months. Overall response rate was 6.0%. Out of the 33 patients, 42.4% (n = 14) received it after first line of therapy. Six patients (18.2%) required dose reductions due to toxicity. Thirteen (39.4%) patients experienced CTCAE grade 3 or 4 toxicities. Most common grade 3 and 4 toxicities experienced among patients were hand–foot skin reaction (18.2%) and proteinuria (9.1%). No significant difference was seen when analyzed for variables such as age, sex, ECOG performance status, comorbidities, and number of previous lines received in patients experiencing grade 3 and 4 toxicities. CONCLUSIONS: The spectrum of adverse events in Indian patients at doses lower than the recommended dose is distinctly different from the western population. However, this unique toxicity profile needs to be validated in prospective studies.
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HEMATOLOGY Top

A prospective, randomized study to compare the combination of imatinib and cytarabine versus imatinib alone in newly diagnosed patients with chronic phase chronic myeloid leukemia p. 211
Priyanka Samal, Prantar Chakrabarti, Uttam K Nath
DOI:10.4103/ijc.IJC_303_18  PMID:31389383
INTRODUCTION: To compare the efficacy and safety of imatinib and cytarabine (ara-c) combination versus imatinib monotherapy in newly diagnosed patients with chronic phase chronic myeloid leukemia (CML-CP). MATERIALS AND METHODS: This prospective, randomized study included adult patients (age >18 years) with newly diagnosed CML-CP. Patients received either a single oral dose of imatinib 400 mg/day in combination with a subcutaneous injection of ara-c 20 mg/m2/day (imatinib + ara-c) or a single oral dose of imatinib 400 mg/day. Primary endpoints were hematological and molecular responses at 3 months and cytogenetic responses at 6 and 12 months. Secondary endpoints included grade 3/4 hematological and nonhematological adverse events (AEs). RESULTS: Of 30 patients included, 14 were randomized to imatinib + ara-c and 16 to imatinib alone. Complete hematologic response (CHR) at 3 months was higher with imatinib + ara-c vs. imatinib alone (100% vs. 87.5%, P = 0.48). The median time to achieve CHR was significantly (P < 0.001) lower with imatinib + ara-c (32.07 vs. 23.43 days). Molecular response at 3 months was significantly higher (P = 0.04) with imatinib + ara-c vs. imatinib alone (100% vs. 68.75%). Complete cytogenetic response was also higher with imatinib + ara-c vs. imatinib alone (42.85% vs. 25% at 6 months and 71.4% vs. 62.5% at 12 months). Neutropenia followed by thrombocytopenia and anemia were the most common AEs. Grade 3/4 hematological and nausea events were significantly (P < 0.05) higher with imatinib + ara-c. Other nonhematological events were not significantly different between the treatments. The median follow-up duration was 20 months (range: 15–23 months). CONCLUSION: Imatinib with low-dose ara-c can be considered as a potential first-line treatment option for CML-CP.
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FEMALE GENITAL TRACT Top

Role of serum HE4 as a prognostic marker in carcinoma of the ovary p. 216
Manikandan Lakshmanan, Vijay Kumar, Arun Chaturvedi, Sanjeev Misra, Sameer Gupta, Naseem Akhtar, Shiv Rajan, Kavitha Jain, Sudeep Garg
DOI:10.4103/ijc.IJC_305_18  PMID:31389384
BACKGROUND: Epithelial ovarian cancer is the second most common gynecological cancer. Human Epididymis Protein 4 is a novel biomarker for ovarian cancer. This study aims to explore the role of HE4 in monitoring recurrence and prognostication of ovarian cancer by predicting overall survival (OS) and progression-free survival (PFS). MATERIALS AND METHODS: In total, 149 patients with ovarian carcinoma were enrolled in the study. Baseline and post-treatment 3 monthly biomarker levels were recorded. For analysis, patients were divided into primary debulking surgery (PDS) and interval debulking surgery (IDS) groups. Statistical analysis was done using SPSS 24. RESULTS: Median age of patients at diagnosis was 45 (19–75) years. Recurrence was seen in 68.5% (n = 102) patients. The sensitivity of serum HE4 in detecting recurrence was 85.3% (95%CI: 76.95%–91.5%) and specificity was 91.5% (95%CI: 89.5%–98.2%). A >80% decline in HE4 levels during treatment indicated a better PFS, which was statistically significant in both groups (P = 0.04 in PDS and P = <0.001 in IDS group). Multivariate analysis suggested that OS was influenced by optimal cytoreduction in both groups of patients and stage in the IDS group. On the contrary, PFS was influenced by stage and response in HE4 levels in both groups. CONCLUSION: HE4 levels have similar sensitivity but more specificity when compared with CA125 in diagnosing recurrent ovarian cancer. A >80% decline in HE4 levels during treatment predicts better PFS and can help in prognostication.
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BREAST CANCER Top

Community engaged breast cancer screening program in Kannur District, Kerala, India: A ray of hope for early diagnosis and treatment p. 222
Neethu Ambali Parambil, Sairu Philip, Jaya Prasad Tripathy, Phinse M Philip, Karthickeyan Duraisamy, Satheesan Balasubramanian
DOI:10.4103/ijc.IJC_397_18  PMID:31389385
INTRODUCTION: Community based programs can assist in early detection and improved survival of breast cancer. AIMS: To assess the feasibility and explore challenges of a district-wide door-to-door breast cancer screening program “ASWAS” conducted in Kannur district, Kerala, India from 2011 to 2014. METHODS: Aggregate data from survey records were collected in terms of the population screened, referred, diagnosed, and treated. Case records of breast cancer patients who were identified were reviewed and updated. In-depth interviews were conducted with program stakeholders. The contents of the interview were organized into a strength, weakness, opportunity and threat (SWOT) matrix to describe the screening program. RESULTS: A total of 1,049,410 eligible women above 30 years residing in 81 panchayats were visited door-to-door by 8,200 community volunteers; of them, 93% were screened using a symptom-risk factor checklist. Of those referred with symptoms (n = 5353), 81% attended the cancer camp. In total, 23 breast cancer cases were confirmed. 14 (61%) were in early stages, treated, and are disease free at 3-year follow-up. Those in the advanced stage and old age had poor outcomes. SWOT analysis identified political support, female volunteers, community engagement, dedicated fund for treatment, and teamwork as strengths. Weaknesses included poor healthcare access, maintaining volunteer motivation, and issues around sustainability. CONCLUSION: Community participation with the engagement of the health system and local self-government are required for implementing a comprehensive cancer screening strategy. Breast-cancer screening program using local volunteers for early detection is feasible in low-income settings, thereby improving survival.
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Prognostic significance of residual nodal burden using lymph node ratio in locally advanced breast cancer after neoadjuvant chemotherapy p. 228
Reshu Agarwal, Arun Philip, Keechilat Pavithran, Anupama Rajanbabu, Gaurav Goel, DK Vijaykumar
DOI:10.4103/ijc.IJC_652_18  PMID:31389386
OBJECTIVE: To investigate the prognostic value of lymph node ratio (LNR) after neoadjuvant chemotherapy (NAC) according to breast cancer molecular subtypes. METHODS: From 2004 to 2014, patients with definitive surgery after NAC were identified. LNR was calculated for node positive patients who underwent axillary dissection and at least 10 nodes (LNT) were removed. Disease free and overall survivals were analysed using Kaplan-Meier test and compared using log rank test for ypN0-3, LNR categories (LNRC) ≤0.2 (low), 0.21-0.65 (intermediate), >0.65 (high), and single LNR cut-off value. RESULTS: Of 224 analysed patients: ypN0 72 (32.1%), ypN+ 152 (67.9%). Of 118 LNT ≥10 ypN+ patients LNRC: Low risk 48 (40.7%), intermediate risk 36 (30.5%), high risk 34 (28.8%). Factors significantly different in LNR categories were ypN (P < 0.001); extranodal extension (P < 0.001); present status of patients (P < 0.001); and disease status (P = 0.029). LNRC was inversely associated with 5-year DFS: Low 52.3%, intermediate 40%, and high 12.2% (log rank P < 0.001); and OS: Low 64.4%, intermediate 58.3%, and high 13.6% (log rank P < 0.001). Significant association of LNRC and DFS and OS were demonstrated in TNBC (P < 0.001) and HER2 subtypes (P = 0.045 and 0.005 respectively). A single value of LNR = 0.25 in node positive was found significant for DFS and OS in TNBC (P < 0.001) and Her2+ (P = 0.013 and P = 0.001 respectively) but not for HR+ (DFS: P = 0.132; OS: P = 0.144). CONCLUSION: Residual nodal disease after NAC analysed by LNRC or LNR = 0.25 cut-off value, is prognostic and can discriminate between favourable and unfavourable outcomes for TNBC and Her2+ breast cancers.
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LUNG CANCER Top

Use of interventional bronchoscopic treatment in small cell lung cancer p. 236
Cengiz Ozdemir, Sinem N Sökücü, Ayşegül Berk, Levent Dalar
DOI:10.4103/ijc.IJC_45_18  PMID:31389387
AIMS: Small cell lung cancer (SCLC) constitutes 15%-25% of all lung cancers. Their treatment approach is different from nonsmall cell lung cancer. Central airway obstruction develops at the time of diagnosis or eventually at some time as the disease progress. Quick relief of symptoms with chemotherapy will cause to postpone interventional bronchoscopy which divest patient from benefits of this procedure. There is a few data about the use of interventional bronchoscopy in SCLC. SUBJECTS AND METHODS: Between January 2005 and December 2012, rigid bronchoscopy under general anaesthesia was done in a total of 944 cases. Among them, 52 consecutive SCLC cases were evaluated retrospectively. STATISTICAL ANALYSIS: Survival was calculated from the date of application of therapeutic bronchoscopy using statistical software. RESULTS: From the 52 cases (41 males) mean age of the patients were 56,87 ± 10,16 (range 34-78). Most common obstruction areas were distal trachea and carina invasion involving both main bronchus (n: 12; 23%). Most common method used was mechanical desobstruction after coagulation with diode diode laser or APC. A total of 16 stents was applied to 15 of the cases from 52 cases (28.8%). Most common used stent was silicon Y stent (n: 11). Most common complication during the procedure was bleeding that was mild in 11 cases and massive in 1. One patient died during the procedure (1.9%). CONCLUSIONS: Multimodal interventional bronchoscopic methods seem to be a last option but may be useful in the management of advanced airway obstruction in the setting of SCLC. The choice of modality may be chosen depending upon individual patient characteristics as appropriate.
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GI CANCER Top

The impact of kidney function on colorectal cancer patients with localized and regional diseases: An observational study from Taiwan p. 241
Sum-Fu Chiang, Jinn-Shiun Chen, Reiping Tang, Chien-Yuh Yeh, Pao-Shiu Hsieh, Wen-Sy Tsai, Jeng-Fu You, Hsin-Yuan Hung, Cheng-Chou Lai, Jr-Rung Lin, Jy-Ming Chiang
DOI:10.4103/ijc.IJC_294_18  PMID:31389388
BACKGROUND: Impaired kidney function is associated with different diseases. However, its impact on colorectal cancer has not been clarified. In order to understand the effect of preoperative kidney function on the outcome of patients with cancer, we analyzed colorectal cancer patients with localized or regional diseases. MATERIALS AND METHODS: In total, 3731 stage I to III colorectal cancer (CRC) patients were analyzed in Chang Gung Memorial Hospital. Modification of Diet in Renal Disease (MDRD) formula was used for estimated glomerular filtration rate (eGFR). Receiver operating characteristic (ROC) analysis for kidney function cut-off value; Chi-square method, independent t test, or analysis of variance (ANOVA) method for clinicopathological factors; Kaplan–Meier method for disease-free survival (DFS); Cox proportional hazard model for multivariate analysis. RESULTS: Among colon cancer patients, low eGFR (MDRD <70) was associated with more male patients, T2 stage, patients without adjuvant chemotherapy, and patients with elevated creatinine level. Low eGFR is a significant risk factor only for stage III colon cancer (hazard ratio 1.70, 95% CI: 1.28–2.26; P < 0.001). Furthermore, postoperative adjuvant chemotherapy did not significantly increase 5-year DFS for both high and low eGFR groups in stage II patients (5 yrs DFS, 94.8% vs. 84.1%, P = 0.098 for high eGFR subgroup; and 75.0% vs. 75.8%, P = 0.379 for low eGFR subgroup). However, significant improvement of 5-yrs DFS after chemotherapy was found in low eGFR stage III colon cancer patients (64.7% vs. 39.4%, P < 0.001 for low eGFR subgroup). In contrast, no significant DFS difference was caused by chemotherapy for high eGFR stage III subgroup (70.5% vs. 63.9%, P = 0.110). CONCLUSIONS: Although low eGFR is an independent risk factor for stage III colon cancer. However, the adjuvant chemotherapy impacts on stage III colon cancer patients differently according to eGFR status.
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Promoter methylation and Ile105val polymorphism of GSTP1 gene in the modulation of colorectal cancer risk in ethnic Kashmiri population p. 248
Saniya Nissar, Aga Syed Sameer, Roohi Rasool, Nissar A Chowdri, Fouzia Rashid
DOI:10.4103/ijc.IJC_11_18  PMID:31389389
BACKGROUND: Glutathione-S-transferases (GSTs) are the most important phase II enzymes of the xenobiotic pathway responsible for the detoxification of carcinogens. GSTP1 gene polymorphisms are mostly associated with a lack or an alteration of enzymatic activity toward several substrates thus resulting in increased cancer susceptibility. GSTP1 promoter methylation is also frequently associated with tumor development or poor prognosis in a wide range of tumors. AIM: In this study, we examined the role of genetic polymorphism and promoter methylation of GSTP1 gene in the context of modulation of risk of colorectal cancer (CRC) in Kashmiri population. METHODS: This study used tissue tumor samples (114) and blood samples from (160) patients with CRC and 200 blood samples from healthy donors. GSTP1 polymorphism was studied using polymerase chain reaction (PCR)-restriction fragment length polymorphism and methylation using methylation-specific PCR. RESULTS: There was no significant association between GSTP1 I105V genotypes and the CRC (P>0.05). However, we found a significant association of the Val/Val variant genotype with the dwelling and smoking status (P-value < 0.05). Overall, the homozygous variant Val/Val genotype was associated with a modestly elevated risk for CRC (OR = 1.57; 95% CI = 0.67–3.57). Methyl-specific-PCR analysis revealed 25.4% methylation of the GSTP1 promoter in CRC cases and was not found to be statistically significantly associated with clinicopathological parameters of the CRC cases (P>0.05). Also, no significant associations of any of the three genotypes with promoter hypermethylation were observed. CONCLUSION: We conclude that promoter hypermethylation in homozygous GSTP1 mutants did not elevate the risk of CRC in Kashmiri population.
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URO-ONCOLOGY Top

A clinicopathological and immunohistochemical study of non-urothelial bladder tumours p. 254
Sukhpreet Kaur, Avinash Gupta, Hanni V Gulwani
DOI:10.4103/ijc.IJC_459_17  PMID:31389390
BACKGROUND: Non-urothelial bladder tumors (NUBTs) are uncommon accounting for approximately 10% of the total urinary bladder tumors while 90% are urothelial in origin. There are very limited comprehensive studies on NUBTs. AIMS AND OBJECTIVES: The objectives of the study were to analyze the clinicopathological and immunohistochemical features of NUBTs. MATERIALS AND METHODS: This is a retrospective study of NUBTs diagnosed over a period of 9 years. Patients' files were retrieved from the archives. Gross and microscopic features were recorded. Simple percentage and frequencies were used to interpret the data. RESULTS: A total 16 cases (10.8% of all bladder tumors) of NUBT were found. Patients' ages ranged from 19 to 87 years with a male: female ratio of 4.3:1. The most common presenting symptom was gross hematuria (81.2%), and the most common location was posterolateral bladder wall. Muscle invasion was seen in 81.2% of cases, and large areas of necrosis were observed in 62.5%. There were two cases of squamous cell carcinoma, five cases each of adenocarcinoma (four secondary and one urachal) and mesenchymal tumors (four malignant and one benign), two cases of amyloid, and one case each of plasmacytomas and paraganglioma. Large areas of necrosis and muscle invasion were noted in high-grade and advanced staged tumors. In all, 43.7% had poor survival. CONCLUSION: NUBTs present with similar clinicoradiological findings; however, their histological features along with immunohistochemistry help in the definite diagnosis. One should be aware of these tumors as they frequently present diagnostic and therapeutic challenge. Most of these neoplasms present at an advanced stage. Large or multicentric randomized controlled studies are needed to know the exact behavior and prognosis of these tumors.
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HEAD AND NECK CANCER Top

Concurrent chemoradiotherapy for head and neck cancers in older patients: Outcomes and their determinants p. 261
Vijay K Srinivasalu, Narayana Subramaniam, Deepak Balasubramanian, Narender Kumar, Arun Philip, Annu Susan, KU Pushpaja, Anoop R Nair, Krishnakumar Thankappan, Wesley Jose, Subramania Iyer, Pavithran Keechilat
DOI:10.4103/ijc.IJC_725_18  PMID:31389391
INTRODUCTION: Meta-analyses have shown concurrent chemoradiotherapy (CCRT) provides no survival benefit over radiotherapy in patients of head and neck squamous cell carcinoma (HNSCC) aged over 70 years. This study was performed to determine the adverse-effect profile, compliance, functional and oncological outcomes in patients of HNSCC over 70 years of age treated with CCRT. MATERIALS AND Methods: Retrospective analysis of stage III/IV HNSCC in patients above 70 years of age who received CCRT at our institution (n = 57). Cox-proportional hazards regression model was used for statistical analysis. RESULTS: There were 57 patients of stage III/IV HNSCC who underwent curative CCRT. 61% completed chemotherapy with no deaths and acceptable toxicity. The predictors of recurrence were poorer performance status (P = 0.031) and treatment breaks (P = 0.04). Tube dependence was associated with 2.7 times higher risk of mortality (P = 0.005). CONCLUSION: CCRT should be considered standard of care in those over seventy with good performance status. Patients with tube dependence have a higher risk of persistent disease or treatment related mortality.
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MCQS Top

MCQs for “Concurrent chemoradiotherapy for head and neck cancers in older patients: Outcomes and their determinants” p. 267
HS Darling, S Jayalakshmi, Pradeep Jaiswal
DOI:10.4103/ijc.IJC_571_19  PMID:31389392
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VIEW POINTS Top

Diagnostic application of patent blue V in sentinel lymph node biopsy for breast cancer – Is it time for a change? p. 269
Raghavan Vidya, Ruvinder Athwal, Aarnoud P Huissoon, Richard L Baretto, Mamidipudi Thirumala Krishna
DOI:10.4103/ijc.IJC_139_18  PMID:31389393
Sentinel lymph node biopsy (SLNB) was introduced in the 1990s, as a minimally invasive procedure for staging the axilla with less morbidity to the traditional axillary lymph node dissection and is now standard management of the axilla in the early breast cancer. SLNB using the combined technique of blue dye and radioisotope is currently the recommended method for lymphatic mapping, and studies have shown high identification rates (IR) (>95%) and low false-negative rates (FNR) 5–10%. However, there are several reports raising awareness regarding patent blue V dye-induced peri-operative anaphylaxis. The main aim of this article is to highlight the emergence of patent blue dye as a new allergen and present evidence regarding the utility of alternative safer methods of evaluation of early breast cancer without compromising IR.
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8th edition AJCC and imaging TNM: Time to break-in and assert in the staging process! p. 271
Tanvi Vaidya, Subhash Desai, Abhishek Mahajan
DOI:10.4103/ijc.IJC_528_18  PMID:31389394
The current practice of oncology focuses not only on early diagnosis, staging, and treatment of cancer but also defies the concept of “One size fits all.” This paradigm shift of the 8th edition American Joint Committee on Cancer (AJCC) manual to a “personalized medicine” approach sets the stage for introducing Imaging TNM (iTNM). The iTNM would provide physicians with a clear assessment of the disease extent derived exclusively from a combination of anatomical and functional imaging modalities and simplify decision-making in practice. Introduction of iTNM will complement the existing cTNM and pTNM and help to guide a personalized approach to patient management.
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CASE REPORT Top

TSC1/2 mutations as markers of response to everolimus in metastatic renal cell carcinoma: A case study p. 274
Linu A Jacob, Gowhar Shafi
DOI:10.4103/ijc.IJC_732_18  PMID:31389395
We report a case of a 67-year-old man with pazopanib-resistant metastatic renal cell carcinoma (mRCC) who showed an exceptional response to everolimus. Furthermore, this patient had TSC1 and TSC2 mutations. Only a subset of patients with mRCC respond to mTOR inhibitors and emerging evidences indicate that TSC1 and TSC2 mutations could be markers of response to mTOR inhibition. The current case study supports these accruing evidences.
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LETTERS TO THE EDITOR Top

Tolerance and efficacy of branded generic pemetrexed maintenance in Indian patients of metastatic non-squamous non-small-cell lung cancer p. 276
Amit Sehrawat, KM Parthasarathy, Deni Gupta, Arun Gera
DOI:10.4103/ijc.IJC_264_18  PMID:31389396
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Cervical esophagogastric anastomosis using a modified linear cutter stapler technique in esophageal cancers following neoadjuvant chemoradiation p. 278
Arvind Krishnamurthy
DOI:10.4103/ijc.IJC_665_18  PMID:31389397
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Papilloma virus infection in oral malignancies: An Italian experience p. 279
Sonia Cesaro, Vassilena Tsvetkova, Giulia Traverso, Mauro Cassaro, Massimo Rugge
DOI:10.4103/ijc.IJC_373_18  PMID:31389398
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Oral health status and prevalence of premalignant lesions in prisoners of Central Jail of Amravati, Maharashtra, India p. 280
SM Rawlani, Roshani Chawla, Sudhir Rawlani, Varsha Rathi, Ratnamala Gadge, Shashwati Choube
DOI:10.4103/ijc.IJC_520_18  PMID:31389399
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HISTORY OF CANCER Top

The founding of the Tata Memorial Hospital, 1932-1941 p. 282
Shirish N Kavadi
DOI:10.4103/ijc.IJC_13_19  PMID:31389400
This article presents a brief account of the founding of the Tata Memorial Hospital. It draws upon archival material to show that this was not a mere philanthropic act but a scheme carefully thought-out by the Trustees of the Sir Dorabji Tata Trust. It discusses the major concerns of the Trustees as they deliberated upon establishing the Hospital.
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COMMENTARY Top

The spread of radiology in India from 1941 to 1956 p. 285
Robert D Smith
DOI:10.4103/0019-509X.263039  PMID:31389401
This commentary discusses how the reasoning behind the founding of Tata Memorial Hospital (TMH), India's first specialized cancer hospital, was influential in setting up a larger infrastructure of cancer care in India. I show how the arguments that led to the use of radium at TMH enabled the value that TMH placed upon radiology to permeate other institutions around India, ultimately establishing radium as an essential element of cancer care.
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NEWS FROM THE WORLD OF ONCOLOGY Top

News from the world of oncology p. 287

DOI:10.4103/ijc.IJC_605_19  
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