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October-December 2016
Volume 53 | Issue 4
Page Nos. 471-622

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HEAD AND NECK CANCER SYMPOSIUM - REVIEW ARTICLE  

Current status of systemic therapy for recurrent and/or metastatic squamous cell carcinoma of the head and neck Highly accessed article p. 471
LA Jacob, T Chaudhuri, KC Lakshmaiah, KG Babu, L Dasappa, MCS Babu, AH Rudresha, KN Lokesh, LK Rajeev
DOI:10.4103/0019-509X.204786  PMID:28485332
Head and neck squamous cell carcinoma (HNSCC) is now the seventh most common cancer worldwide. The median overall survival for patients with recurrent and/or metastatic (R/M) HNSCC remains <1 year despite modern systemic chemotherapy and targeted agents. Palliative systemic therapy for patients with R/M HNSCC typically includes a platinum-based doublet, with an understanding that the increase in efficacy compared with single agents is primarily related to improved response rate, and not survival. Till date, the only systemic therapy regimen to demonstrate survival superiority over platinum-5-fluorouracil (5-FU) doublet is platinum, FU, and cetuximab. Epidermal growth factor receptor inhibitors, including monoclonal antibodies and tyrosine kinase inhibitors, have achieved only a modest success in R/M HNSCC. Immunotherapy represents an attractive treatment option for R/M HNSCC, with encouraging preliminary data from studies involving immune checkpoint inhibitors (e.g., pembrolizumab, nivolumab) and toll-like receptor agonists (e.g., motolimod). Given the poor prognosis of R/M HNSCC, enrollment of patients into clinical trials to investigate novel systemic agents, is necessary for further improvement of oncologic outcomes in this patient population.
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HEAD AND NECK CANCER SYMPOSIUM - ORIGINAL ARTICLE Top

Tumors and tumor-like conditions of the nasal cavity, paranasal sinuses, and nasopharynx: A study of 206 cases p. 478
RN Satarkar, S Srikanth
DOI:10.4103/ijc.IJC_551_16  PMID:28485333
INTRODUCTION: The nasal cavity, paranasal sinuses, and nasopharynx though in continuity form a complex system of upper respiratory tract; this region is endowed with a variety of elements such as epithelial, glandular, lymphoid, cartilage, and bone and is also exposed to a variety of infections, tumor-like and true neoplastic conditions. AIMS AND OBJECTIVES: To find out the frequency of various tumors and tumor-like conditions of the nasal cavity, paranasal sinuses, and nasopharynx. MATERIALS AND METHODS: The present study is an analysis of 206 tumors and tumor-like conditions of the nasal cavity, paranasal sinuses, and nasopharynx diagnosed during a period of 5 years. RESULTS: The patients' age ranged from 14 months to 85 years. Benign lesions were predominant in the second and third decades, with 30 cases (68.1%) occurring in that age group. Malignancies occurred predominantly in the sixth and seventh decades with 28 (60.9%) cases in this age group. Benign lesions in the nasopharynx comprised 75% cases and malignancies 25%. Eighty-three (71.5%) tumor-like conditions occurred in the nose and antrochoanal region. CONCLUSION: Angiofibroma was the most common benign tumor accounting for 25.55% of all neoplastic lesions. Squamous cell carcinoma was the most common malignancy at this site constituting 50% of all malignancies.
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LETTER TO THE EDITOR Top

Palliative hypofractionated radiation therapy in a patient of locally advanced nasopharyngeal cancer with cardiac implantable electronic device (CIED): Management of a challenging case p. 482
SA Varughese, SJ Bharti, A Biswas, S Verma
DOI:10.4103/0019-509X.204768  PMID:28485334
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HEAD AND NECK CANCER SYMPOSIUM - ORIGINAL ARTICLES Top

Radical chemo-irradiation using intensity-modulated radiotherapy for locally advanced head and neck cancer in elderly patients: Experience from a tertiary care center in South India p. 483
JR Chalissery, PC Sudheeran, KM Varghese, K Venkatesan
DOI:10.4103/ijc.IJC_78_17  PMID:28485335
OBJECTIVE: To assess the feasibility, tolerance and response of radical chemo irradiation using Intensity modulated Radiotherapy [IMRT] in elderly patients [age >65] with locally advanced head and neck cancer. MATERIAL AND METHODS: Patients aged 65 and above [range 65 to 84years] registered in oncology outpatient unit in our institution between December 2011 to 2014, with stage III and IV head and neck cancer were treated with radical dose of radiotherapy using IMRT and concurrent chemotherapy with cisplatin 40mg/sq.m weekly. Response evaluation and toxicity profile assessment was done 6 to 8 weeks after completion of treatment and 3 monthly thereafter with median follow up of 3 years. RESULTS: Total number of patients analysed were 47. 43(91.5%) patients tolerated 66-.70Gy of radiotherapy and 4 or more cycles of weekly chemotherapy with cisplatin. First follow up evaluation at 6 to 8 weeks showed 81% patients having complete loco regional response. Grade III skin reaction and mucositis was noticed in 24% and 47% respectively. No grade III neutropenia observed. Median follow up of 3 years showed a complete local control in 53% and overall survival of 60%. CONCLUSION: Radical chemo irradiation with IMRT in elderly patients is a feasible option. Long term local control and overall survival benefits needs to be followed up.
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Efficacy and toxicity of cetuximab with chemotherapy in recurrent and metastatic head and neck cancer: A prospective observational study p. 487
S Tiwari, V Goel, MC John, N Patnaik, DC Doval
DOI:10.4103/ijc.IJC_7_17  PMID:28485336
BACKGROUND: In squamous cell carcinoma of the head and neck (SCCHN), epidermal growth factor receptor is expressed at very high levels. Hence, we have done this study to assess the response and tolerability of cetuximab and platinum-based chemotherapy in recurrent and metastatic (R/M) head and neck squamous cell cancer (HNSCC) in view of paucity of data from the Indian subcontinent. MATERIALS AND METHODS: In this prospective study, patients of R/M SCCHN were randomly enrolled from September 2012 to April 2015. Chemotherapy (cisplatin/carboplatin/5-fluorouracil) and cetuximab-based treatment were administered up to 6 cycles or unacceptable toxicity. The response rates (RRs), progression-free survival (PFS), and overall survival (OS) were analyzed. RESULTS: In total, fifty patients were enrolled. The median age was 51.0 years. A total of 255 cycles of treatment were administered (median = 6 cycles/patient). Four patients (8.0%) experienced complete response and 21 (42.0%) experienced partial response. Twenty-one patients (42.0%) had stable disease and four patients (8.0%) experienced progressive disease. The disease control rate was 92.0%. Median PFS was 5.3 months (95% confidence interval [CI]: 4.52–6.14 months). Median OS was 9.933 months (95% CI: 8.58–11.28 months). There was statistically significant correlation between overall response and Eastern Cooperative Oncology Group performance status (P = 0.014), site of tumor (P = 0.027), and histological grade of tumor (P = 0.001). The main Grade 3/4 side effects seen were hematological in 44 (88%) and gastrointestinal in 28 (56%) patients. CONCLUSIONS: The RR of cetuximab plus chemotherapy of >45% and the promising PFS rates are strong arguments for clinically testing this combination and this treatment schedule further in R/M HNSCC.
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Outcomes in nasopharyngeal carcinoma: Results from a nonendemic cohort p. 493
SG Laskar, L Gurram, T Gupta, A Budrukkar, V Murthy, JP Agarwal
DOI:10.4103/0019-509X.204762  PMID:28485337
INTRODUCTION: The treatment of nasopharyngeal carcinoma (NPC) has come a long way from treatment with conventional radiotherapy (RT) alone for the use of concurrent chemoradiotherapy (CCRT) and sequential chemotherapy (CT). We report the outcomes of patients treated with combined modality at a tertiary cancer center in India over a period of 10 years. MATERIALS AND METHODS: A total of 206 patients with NPC between 1994 and 2004, who completed planned treatment, were retrospectively analyzed. Demographic features, disease, and treatment-related factors were analyzed for their impact on loco-regional control (LRC), disease-free survival (DFS), and overall survival (OS). RESULTS: Most patients had Stage III or IV (70.8%) disease. Twenty-six percent received RT alone, 37% received neoadjuvant chemotherapy (NACT) followed by RT alone, 29% received NACT + CCRT, and 8% received CCRT alone. Median RT dose was 64 Gy with 84% receiving RT doses of ≥60 Gy. At a median follow-up of 29 months, 112 (54.4%) patients were alive and disease free. Three-year DFS and OS were 64% and 82.3%, respectively. LRC at 3 years was 71.1%. Independent factors for significantly better LRC and DFS were younger age at presentation, RT dose of more than 64 Gy, and immediate response to RT. The use of CCRT in advanced nodal stages (N2–N3) resulted in significantly better LRC and DFS on multivariate analysis. CONCLUSIONS: Combined modality treatment in advanced stage NPC results in favorable outcomes. RT doses of more than 64 Gy should be considered in all patients, respecting normal tissue tolerances. The role of NACT remains debatable.
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GI CANCER SYMPOSIUM - ORIGINAL ARTICLES Top

Clinical observation and retrospective study of the influential factors of liver metastasis in 306 cases of colon cancer p. 499
X Lin, M Lin, X Wei, Q Chen
DOI:10.4103/0019-509X.204782  PMID:28485338
PURPOSES/OBJECTIVES: By observing and analyzing the clinical features of the colon cancer and the influence factors of liver metastasis, we try to find out independent risk factors with significant influence on colon cancer liver metastasis as well as to provide reference for clinical treatment. MATERIALS AND METHODS: A total of 306 cases of colon cancer patients' clinical data, including gender, age, primary focal size, primary focal intestinal segment, degree of differentiation, infiltration depth, level of serum carcinoembryonic antigen (CEA) before surgery, lymph node metastasis, liver basic diseases were collected and recorded. Single-factor Chi-square analysis and multifactor logistic regression analysis (SPSS 16.0 software) were used to retrospectively study the possible influence factors of colon liver metastases and to preliminary discuss the potential risk factors of liver metastasis in colon cancer patients. RESULTS: The Chi-square analysis showed that patients' primary focal segment, degree of differentiation, infiltration depth, level of serum CEA before surgery, and states of hepatitis B does 2 half-and-half had significant effect on the incidence of liver metastasis. However, in the further logistic regression analysis, it showed that only the infiltration depth and the states of hepatitis B does 2 half-and-half were the independent risk factors that influence the hepatic metastases. What was more, the both subgroups of positive hepatitis B with infection and vaccine showed significant statistical differences when comparing with hepatitis B all negative in the event of the probability of liver metastases (P = 0.011 and 0.004). CONCLUSIONS: The infiltration depth and the states of hepatitis B does 2 half-and-half were the independent risk factors on colon cancer patients' hepatic metastases. Those with the infiltration depth of T4 had a higher rate of hepatic metastases. Patients with does 2 half-and-half-positive hepatitis B (whether subgroup of hepatitis B virus infection or subgroup hepatitis B vaccine related) had a lower incidence rate of liver metastasis than those with hepatitis B all negative.
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Human epidermal growth factor receptor 2 expression in gastric carcinoma and its association with histopathological parameters in Indian population p. 505
P Gupta, S Rao, S Bhalla
DOI:10.4103/ijc.IJC_513_16  PMID:28485339
Introduction: Gastric carcinoma is a leading cause of death worldwide with a five year survival of 10-15% even after curative resection. Trastuzumab has emerged as a potential targeted therapy in treatment of Her 2 positive gastric cancer. Her2 positivity ranges from 7-34% in studies across the world. There is a paucity of Indian studies hence a need for determination of Her2 expression in Indian population for better patient management. This study was carried out to determine the frequency of Her 2 expression in gastric carcinoma by immunohistochemistry (IHC) technique and to evaluate its association with histopathological parameters. Material and Methods: A total of 110 cases of gastric adenocarcinoma diagnosed on histopathological examination from July 2013 to June 2015 were included. Of these, 40 cases were resection specimens and 70 were biopsies. Histological typing of gastric carcinoma was done on the basis of Lauren classification. IHC for Her2 was done in all 110 cases. Her 2 expression was correlated with various histopathological parameters. Results: Positive Her 2 expression (IHC 3+) was seen in 24.5% cases of gastric carcinoma. Patients in older age group(> 60 years) showed higher Her 2 positivity rate as compared to middle age (40-60 years) and younger population (<40 years). Higher percentage of Her 2 positivity was noted in male patients as compared to female patients. Her 2 positivity was seen more commonly in intestinal type of tumor as compared to diffuse and mixed types. Her 2 positivity was seen more in well differentiated carcinoma and higher stage tumors (pT3 and pT4). However, out of all, a statistically significant association of Her2 expression was found only with (intestinal) type of tumors (p= 0.005) and no significant association was seen with age, gender, site of tumor, tumor stage, lymph node status, lymphovascular, perineural and perinodal invasion or survival. Conclusion: Inspired by promising results of Trastuzumab therapy in Her 2 positive gastric carcinoma worldwide, it is recommended to routinely test all cases of gastric carcinoma for Her 2 expression and to use the targeted therapy with curative intentions in Indian population.
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LETTER TO THE EDITOR Top

Incidence and pattern of childhood cancers in India: Findings from population-based cancer registries p. 511
Abu Bashar
DOI:10.4103/ijc.IJC_54_17  PMID:28485340
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GI CANCER SYMPOSIUM - ORIGINAL ARTICLES Top

Microsatellite instability in stage II colorectal cancer: An Indian perspective p. 513
AP Dubey, S Vishwanath, P Nikhil, A Rathore, A Pathak
DOI:10.4103/0019-509X.204772  PMID:28485341
INTRODUCTION: Around 80% of colorectal carcinoma are associated with chromosomal instability (CIN) while rest of 20 % are euploid, possessing defect in mis match repair system (MMR) quintessential for surveillance and correction of errors in introduced into microsatellites. MATERIALS AND METHODS: We analyse all stage II CRC for MSI who presented at MDTC at Army hospital (research and refrral) new delhi during last 2 years (Jan 14 to Dec 2015). RESULTS: We found that 22.2% patients out of 45 patients with stageII CRC being MSI-. high. We also noticed all suchcases were associated with loss of expression of PMS2 & MLH1, that was in contrast other studies where loss of MLH1 and MSH@, MSH6 were seen more commonly. CONCLUSION: MSI occurs in a significant proportion of colorectal cancers in young (<50 years old) patients. Young age at colorectal cancer diagnosis, proximal tumor location, family history of colorectal cancer were independent predictors of MSI status in our patients. In a proportion of these young patients with MSI tumors, loss of expression of proteins by 2 MMR genes PMS2 and hMLH1 has been identified.
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Preoperative long-course chemoradiation for localized rectal cancer: A retrospective comparison of response and outcome between 5-fluorouracil/leucovorin versus capecitabine p. 518
B Kunheri, B Gurram, R Madhavan, D Makuny
DOI:10.4103/0019-509X.204777  PMID:28485342
BACKGROUND: Preoperative concurrent chemoradiation therapy (CRT) with either capecitabine or 5-florouracil/leucovorin (5 FU/LV) is the standard of care in locally advanced rectal cancer (LARC). Literature comparing the toxicity and response of these two regimens in Indian patients is sparse. Our objective was to compare the pathological response (PR) and clinical outcome of capecitabine versus 5 FU/LV in CRT for LARC. MATERIALS AND METHODS: Sixty patients with LARC treated with preoperative CRT with capecitabine or 5FU/LV from January 2009 to May 2014 were analyzed. Ryan's tumor regression grading was used for PR assessment and tumor downstaging was defined as a reduction in the T and N stages by at least one level. Toxicity was assessed with RTOG acute toxicity assessment criteria and CTCAE 4.0 version. Statistical analysis was done using IBM SPSS 20 software. Percentage of patients with respect to response rates and toxicities was computed in each of the treatment groups. To test the statistical significance of the difference in PR rates and toxicities between the two groups, Chi-square test was used. Kaplan–Meier estimate of survival rate was computed for each group. To test the statistical significance of the difference in survival rate, the log-rank test was applied. RESULTS AND CONCLUSION: The two groups (5 FU/LV vs. capecitabine) were comparable with respect to pathological complete response (20% vs. 24%), pathological downstaging (76% vs. 69%), sphincter preservation rates, and acute complication rates. Both regimens were well tolerated. Overall survival and disease-free survival also did not show a statistically significant difference between the two groups (P values 0.720 and 0.255, respectively). In summary, our analysis showed the equivalence of both regimens in the preoperative CRT setting.
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Evaluation of deletion polymorphisms of glutathione S-transferase genes and colorectal cancer risk in ethnic Kashmiri population: A case–control study p. 524
S Nissar, AS Sameer, R Rasool, NA Chowdri, F Rashid
DOI:10.4103/ijc.IJC_17_17  PMID:28485343
AIM: Glutathione S.transferases. (GSTs) are known to play a pivotal role in the detoxification of potential carcinogens, and their gene variation may alter susceptibility to colorectal cancer. (CRC). The aim of the study was to evaluate the genetic association of GSTM1 and GSTT1 gene deletion/null polymorphism with disease susceptibility and risk development in CRC patients of ethnic Kashmiri population. MATERIALS AND METHODS: Genotype frequencies of GSTM1 and GSTT1 gene deletion/null polymorphism were compared between 160 CRC patients and 200 healthy controls using polymerase chain reaction multiplex. RESULTS: The frequency of GSTM1-null was found to be 76.2% in cases and 81.5% in controls and odds ratio. (OR) = 1.37 (95% confidence interval. [CI]: 0.82–2.28). Likewise, the GSTT1-null genotype was found in 75.5% of cases and 77.5% of controls and the OR = 1.14 (95% CI: 0.76–1.8). The overall association between the GSTM1-null and GSTT1-null polymorphism and the CRC cases was found to be insignificant (P < 0.05). However, individuals with double-null genotype (GSTM1-/GSTT1-) were found to have 3.5-fold increased risk for the development of CRC. Further, the risk genotype (null) of GSTT1 was found to be associated with tumor grade (P = 0.001) and GSTM1 (null) genotype was significantly associated with smoking status (P = 0.004), when compared to the (present) genotype in CRC cases. CONCLUSION: Our results suggest that GSTM1 and GSTT1 gene deletion/null gene polymorphisms are not a key modulators of the risk of developing CRC in Kashmiri population.
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Plasmablastic lymphoma of the gastrointestinal tract: A rare entity with a dismal prognosis p. 529
AS Komaranchath, RA Haleshappa, LC Kuntegowdenahalli, RV Kumar, L Dasappa, G Babu
DOI:10.4103/0019-509X.204756  PMID:28485344
INTRODUCTION: Plasmablastic lymphoma (PBL) is a rare and aggressive type of mature B-cell lymphoma, which is usually associated with HIV infection. The most common site of PBL is the oral cavity. Involvement of the gastrointestinal (GI) tract is rare, and literature is limited to few case reports and case series. AIMS: To retrospectively analyze the presentation, clinical findings, and outcome of patients presenting to our institute with a diagnosis of PBL involving the GI tract. MATERIALS AND METHODS: A retrospective observational study was conducted at our institute from February 2008 to January 2015 on consecutive patients presenting with PBL involving the GI tract. The data were compared to various case reports and series published in peer-reviewed journals. RESULTS: There were four patients diagnosed with PBL of the GI tract; three male and one female. The location of involvement was in the stomach, ileocecal junction, ascending colon, and rectum. Only one patient was HIV-positive and was on combination antiretroviral therapy since 2 years. Among the three immunocompetent patients, only one survived with therapy; however, the patient relapsed within 6 months of completion of treatment. CONCLUSION: PBL was seen to have a uniformly aggressive clinical course with poor outcomes even with optimal treatment. The prognosis of immunocompetent patients appears to be worse than that of HIV-AIDS patients. Although the most common histologies seen with GI lymphomas are mucosa-associated lymphoid tissue type lymphomas or diffuse large B-cell lymphoma, rarer and more aggressive histologies like PBL need to be kept in mind.
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Assessment of safety and efficacy of an indigenous self-expandable fully covered esophageal metal stent for palliation of esophageal cancer p. 534
RK Padhan, SK Nongthombam, A Venuthurimilli, R Dhingra, Shalimar , P Sahni, PK Garg
DOI:10.4103/0019-509X.204760  PMID:28485345
BACKGROUND: Patients with unresectable esophageal cancer require palliation for dysphagia. Placement of a self-expandable metal stent (SEMS) is the procedure of choice for palliation of dysphagia. OBJECTIVE: To evaluate the safety and efficacy of an indigenous fully-covered SEMS in patients with esophageal cancer. METHODS: Eligible patients with unresectable esophageal cancer requiring palliation for dysphagia were included in the study. An indigenous fully covered SEMS of appropriate length was placed under endoscopic and fluoroscopic guidance. Outcome measures assessed were adverse events and improvement in dysphagia. RESULTS: Twenty one patients (mean age 57.71±13.14 years; 17 males) were included. After stenting, dysphagia score decreased from 3.2+0.4 to 0.35+0.74 at 4 weeks. Adverse events included retrosternal pain, respiratory distress and aspiration pneumonia in 12, 2 and 1 patients respectively. Five patients required repeat stenting due to stent migration in 4 (following radiotherapy in 3) and tumour ingrowth in 1. There was primary stent malfunction in one patient. The median survival of patients was 140 (76-199) days, which was higher in those who received radiotherapy. CONCLUSION: The stent was reasonably safe and effective to relieve dysphagia due to unresectable esophageal cancer.
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Squamous cell carcinoma of the upper aerodigestive tract in exclusive smokers, chewers, and those with no habits p. 538
S Nair, S Datta, S Thiagarajan, S Chakrabarti, D Nair, P Chaturvedi
DOI:10.4103/0019-509X.204759  PMID:28485346
BACKGROUND: Tobacco consumption is the major risk factor for developing head and neck squamous cell cancer (SCC). The site of development of HNSCC may depend on the way the tobacco is consumed. While laryngeal cancers are more common among smokers, oral cancers are more common among tobacco chewers. Since the use of smokeless tobacco is increasing, it is important to know whether this difference is restricted only to site wise distribution or it has other clinical and pathological implications. PATIENTS AND METHODS: We analyzed a prospectively collected dataset of HNSCC patients other than nasopharyngeal cancers attending our outpatient department at a single unit of the head and neck services at Tata Memorial Hospital, Mumbai, India, between January 2010 and September 2011. There were 747 eligible patients and were divided into three groups: Those with chewing as the only habit (chewers), those with smoking as the only habit (smokers), and those with no habits. Patients with regular use of alcohol were excluded from the study. The clinical and pathological parameters were analyzed. RESULTS: Of the 747 patients, the tobacco chewers formed 69.3% followed by smokers (19.5%) and patients with no habits (11.1%). Majority of smokers were men (98%). Site distribution revealed patients with chewing as the only habit had oral cancers (most commonly gingivobuccal complex cancers) as the most common site and those with smoking as the only habit had larynx as the most common site. In patients with no habits, oral tongue was found to be the most common site. No statistically significant pathological differences were observed in between these groups in patients who underwent surgery (n = 366) at the initial modality of treatment. CONCLUSIONS: There is a direct relationship between the form of tobacco use and site of appearance of HNSCC. However, there are no differences in clinical or pathological parameters between HNSCC caused by tobacco chewing or tobacco smoking.
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Vascular endothelial growth factor: Evidence for autocrine signaling in hepatocellular carcinoma cell lines affecting invasion p. 542
BK Sharma, R Srinivasan, YK Chawla, A Chakraborti
DOI:10.4103/0019-509X.204765  PMID:28485347
BACKGROUND AND AIM: Vascular endothelial growth factor (VEGF) is a well-known pivotal regulator of tumor angiogenesis. Apart from endothelial cells, it is also expressed in nonendothelial cells, including tumor cells themselves. Hence the aim of this study was to investigate the autocrine effects of VEGF in hepatocellular carcinoma (HCC) -derived cell lines. MATERIALS AND METHODS: Two hepatocellular carcinoma cell lines (Hep3B and HepG2) were screened for expression of VEGF by quantitative real-time polymerase chain reaction (PCR) and its receptors VEGF-R1, VEGF-R2, and neuropilin-1 expression by reverse transcriptase-PCR, respectively. Furthermore, VEGF transcript was silenced by siRNA and the effects on cell migration, viability, and proliferation were determined by the wound healing assay, MTT assay, and propidium iodide staining, respectively. RESULTS: Both Hep3B and HepG2 cell lines expressed VEGF and all the three receptors at high levels. VEGF siRNA inhibited VEGF expression significantly in both Hep3B and HepG2 cell lines. Silencing of VEGF showed decreased migration in the Hep3B cell line. In both cell lines tested, there was decreased cell viability but no effect on cellular proliferation. CONCLUSION: Our data indicates that autocrine signaling of VEGF through its receptors exists in HCC cell lines, which has important implications for tumor invasion, metastasis, and for designing interventional strategies.
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The role of COX-2 and Ki-67 over-expression in the prediction of pathologic response of rectal cancer to neoadjuvant chemoradiation therapy p. 548
AH Jafarian, A Taghizadeh Kermani, J Esmaeili, NM Roshan, M Seilanian-Toosi, AA Omidi, M Karimi Shahri
DOI:10.4103/0019-509X.204770  PMID:28485348
BACKGROUND: The response to neoadjuvant chemoradiotherapy (CRT) is not the same among all cases with advanced rectal cancer. AIMS: This study investigated the association between over-expression of the two molecular markers (Cyclooxygenase-2 [COX-2] and Ki-67) and tumor response to neoadjuvant therapy. MATERIALS AND METHODS: In a retrospective cohort study, 55 patients with stage II-III rectal carcinoma were enrolled. All patients were treated with neoadjuvant therapy (45-50.4 Gy plus Capecitabine) between 2002 and 2009 in our institute. The pretreatment specimens were immunohistochemistry (IHC) stained for COX-2 and Ki-67 markers. The tumor response to neoadjuvant treatment was evaluated using a 5-point tumor regression grade (TRG) system. The induced inflammation and necrosis after CRT were also investigated. Statistical analysis was performed using SPSS version 11.5 and statistical significance was determined at P < 0.05. RESULTS: The pathologic response to neoadjuvant treatment from complete response as (TRG = 1) through no response as (TRG = 5) was found in 10 (22.2%), 8 (17%), 6 (13.3%), 16 (35.6%), and 5 (11.1%) cases. In comparison with poor responders (TRG: 4, 5), patients with good response to neoadjuvant treatment (TRG: 1, 2) were associated with lower pretreatment mean COX-2 staining extent (72.9% vs. 22.8%, P < 0.001) as well as lower mean Ki-67 staining extent (70.7% vs. 28.5%, P < 0.001). High COX-2 staining and high Ki-67 index were significantly associated with more inflammation. CONCLUSIONS: Over-expression of COX-2 and high Ki-67 index were associated with a poorer response to neoadjuvant CRT. These markers might be helpful to define those patients with rectal carcinoma who benefit more from neoadjuvant treatments.
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Analysis of wedge resection of gallbladder bed and lymphadenectomy on adequate oncologic clearance for gallbladder cancer p. 552
M Tewari, S Kumar, S Shukla, HS Shukla
DOI:10.4103/ijc.IJC_88_17  PMID:28485349
BACKGROUND: Surgery (R0 resection) is the mainstay of treatment of gallbladder cancer (GBC) as GBC is relatively resistant to currently known chemotherapy and radiotherapy regimens. AIM: to assess if wedge resection of the gallbladder bed achieves an adequate oncological clearance in GBC (namely T1 and T2) and some T3 GBC with minimal liver infiltration. PATIENTS AND METHODS: Patients with GBC who underwent radical cholecystectomy (en bloc cholecystectomy, wedge resection of the gallbladder fossa with a ≥2 cm rim of nonneoplastic liver tissue, and regional lymph node dissection) between October 2012 and June 2015 after obtaining informed consent. RESULTS: Of thirty patients, mean age of 52 years, 5 had T1b, 13 T2, and 12 T3 GBC. R0 resection was achieved in all thirty GBC patients. Hepatic invasion was found in seven patients. The depth of hepatic invasion ranged from 0 to 9 mm. Follow-up ranged from a minimum of 12 to 43 months. Nineteen (63%) patients had N0 and 11 (37%) had N1 GBC. Total lymph node (TLND) count ranged from 1 to 12/patient with a median of 3. There was no local recurrence or systemic relapse of the disease. CONCLUSION: Wedge resection of the gallbladder bed achieves an adequate oncological clearance in early GBC. TLND counts remain poor even after a thorough standard lymph node dissection for resectable GBC.
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CNS TUMORS SYMPOSIUM - ORIGINAL ARTICLES Top

A case series of salvage CCNU in high-grade glioma who have previously received temozolomide from a tertiary care institute in Mumbai p. 558
VM Patil, R Abhinav, R Tonse, S Epari, T Gupta, R Jalali
DOI:10.4103/0019-509X.204774  PMID:28485350
INTRODUCTION: In our center, we routinely use CCNU (Lomustine) as salvage treatment in high-grade glioma patients who cannot afford bevacizumab. This exploratory analysis was done to report the efficacy and toxicity associated with this regimen. METHODS: Patients who were treated with salvage CCNU (postexposure to temozolomide) between January 2015 and August 2016 were included for this retrospective analysis. SPSS version 16 was used for this analysis. Time-to-event analysis was performed using the Kaplan–Meier method. Progression-free survival (PFS) and overall survival (OS) were estimated. The maximum grade of toxicity during salvage CCNU was noted in accordance with CTCAE version 4.02. RESULTS: In the stipulated period, 16 patients were selected for the analysis. The median age of patients was 43 years (range 15–63 years), and 12 (80.0%) patients were males. The Eastern Cooperative Oncology Group performance status was 0–1 in 11 patients (73.3%) and 2–4 in 4 patients (26.7%). The tumor histopathology at diagnosis was glioblastoma in ten patients (66.6%), anaplastic astrocytoma in four (26.7%) patients, and anaplastic oligodendroglioma in one patient (6.7%). Grade 3–4 myelosuppression was seen in five patients (33.3%). The median PFS and OS were 192 days (95% confidence interval [CI]: 156.0–227.5 days) and 282 days (95% CI: 190.9–373.1 days), respectively. CONCLUSION: CCNU is associated with modest treatment outcomes in recurrent/relapsed high-grade gliomas. The high rate of myelosuppression is a concern. Urgent efforts are required to improve upon these results.
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Pediatric brain tumors: An analysis of 5 years of data from a tertiary cancer care center, India p. 562
R Madhavan, BP Kannabiran, AM Nithya, J Kani, P Balasubramaniam, S Shanmugakumar
DOI:10.4103/ijc.IJC_66_17  PMID:28485351
BACKGROUND: Pediatric brain tumors are the most common solid tumors in children and a leading cause of mortality and morbidity in children worldwide. Even though there are enough data about the epidemiology of pediatric brain tumors in western population, there are only a few reports from developing countries like India. AIMS: To study the epidemiological patterns of brain tumors in children, to study the patterns of care, and to assess the treatment response. MATERIALS AND METHODS: A retrospective epidemiological approach is used. The records of children <18 years registered in our department from August 2006 to July 2011 diagnosed as primary brain tumors are selected. Data regarding age, sex, site of the tumor, clinical features, histology, treatment plan, and treatment response are collected. The World Health Organization classification of neoplasms was adopted. RESULTS: Of 250 cases, females (57%) slightly outnumbered males. The present study revealed that astrocytoma (52%) is the most common brain tumor in childhood. Surgery was the main modality of treatment. Chemotherapy was given to 16% of patients. Even though radiation therapy was offered to 74% of patients, only 42% completed radiotherapy. There was subjective clinical improvement in 68% of patient population after treatment. CONCLUSIONS: This is the second study from Tamil Nadu that deals with epidemiology of brain tumors. Multimodality management including surgery, chemotherapy, and radiation therapy remains the cornerstone in the management of pediatric brain tumors.
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BREAST CANCER ARTICLE - ORIGINAL ARTICLE Top

An institutional analysis of clinicopathological features of triple negative breast cancer p. 566
D Sharma, G Singh
DOI:10.4103/ijc.IJC_534_16  PMID:28485352
AIM: Most common breast cancer in India among female is breast cancer. This is heterogeneous disease, one of the subtypes, triple negative breast cancer (TNBC) defined as no expression of estrogen, progesterone receptor and neither expression nor amplification of human epidermal growth factor receptor 2/neu. TNBC is more frequent and aggressive in younger age group. The aim of this study was to evaluate clinicopathological features and outcome in TNBC versus non-TNBC group of patients. MATERIALS AND METHODS: Medical record of 373 patients diagnosed with invasive breast cancer from January 2011 to December 2014 was retrieved. The last follow-up was done in December 2015. Patients were evaluated and grouped on the basis of receptor status (TNBC vs. non-TNBC). Baseline categorical variables were analyzed using the Chi-square test or Fisher's exact test. Noncategorical variables were analyzed using t-test. RESULTS: Out of 373 cases, 149 (39.94%) were diagnosed as TNBC. Patients with TNBC had a significantly lower median age (45 vs. 48 years). Data analysis revealed significant difference in number of metastasis in TNBC as compared to non-TNBC group (45.6% vs. 25.6%, P = 0.001). In the present study, mean disease-free survival was 14.73 versus 17.03 months (P = 0.22, not significant) and mean overall survival was 24.71 versus 27.38 months (P = 05, significant) in TNBC versus non-TNBC group, respectively. CONCLUSION: TNBC represented 39.94% which is higher than the range normally reported in literature. TNBC is associated with younger age, high-grade tumors, and a higher rate of distant metastasis.
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GENITOURINARY CANCER SYMPOSIUM - ORIGINAL ARTICLES Top

Occurrence of carcinoma prostate in the Pune Metropolitan Region: A 5-year study from 2007 to 2011 p. 569
SS Bapat, BD Kashyapi
DOI:10.4103/0019-509X.204781  PMID:28485353
BACKGROUND: A retrospective study was carried out to know only the occurrence of carcinoma prostate (CAP) in the Pune Metropolitan Region (PMR) over a period of five years (January 01, 2007 to December 31, 2011). All the histopathological (HPE) reports of all prostate specimens were collected from 23 medical colleges, private institutions and stand-.alone HPE laboratories in PMR. MATERIALS AND METHODS: Four types of prostate specimens were examined – endoscopic resection, open prostatectomy, transrectal needle biopsy of prostate and prostate from the cystoprostatectomy specimen (surgery carried out for primary carcinoma bladder). Specimens of radical prostatectomy were excluded as the biopsy was carried out earlier. RESULTS: A total of 5006 reports of the prostate specimens were examined out of which 779 showed the presence of CAP. Analysis of annual occurrence of CAP revealed that there was no significant variation in the CAP cases. Thus giving an average of CAP cases of 155.8 per year in PMR. Population data of the PMR was obtained from the official Government of India Census department for the year 2011. Total population of PMR in 2011 was 5,049,968 out of which the male population was 2,659,484. Thus the occurrence of CAP in the PMR works out to 5.86/100,000 male population. Results were compared with the published reports of CAP by the Indian Council of Medical Research (ICMR) of 7.2/100,000 and Globocon of 4.2/100,000 males. CONCLUSIONS: Occurrence of CAP in PMR is low at 5.86/100,000 male population is comparable with published figures of ICMR & Globocon 2012.
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Detailed study of survival of patients with renal cell carcinoma in India p. 572
GP Abraham, T Cherian, P Mahadevan, TS Avinash, D George, E Manuel
DOI:10.4103/0019-509X.204758  PMID:28485354
PURPOSE: Renal cell carcinoma (RCC) accounts for approximately 90% of all renal malignancies. The rates of kidney cancers are high in developed countries and low in eastern countries and Africa. The objective was to conduct a survival study among Indian population following nephrectomy for RCC as there was a paucity of Indian studies in medical literature. MATERIALS AND METHODS: We conducted a follow-up study of eighty RCC patients who had nephrectomy between January 2003 and December 2010. These patients had pathological diagnosis after nephrectomy. The follow-up was done up to December 2015. The survival statistics were compiled according to Kaplan–Meier survival curves. RESULTS: The overall survival of eighty patients was 77%. The patients with tumor size ≤7 cm and the patients with tumor size >7 cm showed significant statistical difference at 5-year survival (P < 0.0001). The patients with low nuclear grade (1 and 2) and the patients with high nuclear grade (3 and 4) showed significant statistical difference at 5-year survival (P < 0.0001). The patients with tumor node metastasis stage below T3 and the patients with clinical stage above or equal to T3 showed significant statistical difference at 5-year survival (P = 0.003). CONCLUSION: This study has demonstrated the importance of factors such as tumor size, nuclear grade, and stage in the assessment of prognosis of RCC patients. More studies in India with more patients are needed to demonstrate the importance of these prognostic factors.
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Initial experience with first-line pazopanib in the treatment of metastatic renal cell carcinoma: A single institution data p. 575
A Joshi, V Agarwala, A Ramaswamy, V Noronha, VM Patil, S Menon, P Popat, N Sable, K Prabhash
DOI:10.4103/0019-509X.204769  PMID:28485355
INTRODUCTION: Pazopanib is one of the recently introduced first-line therapeutic options in the treatment of metastatic renal cell carcinoma (mRCC). There is no published literature from India on the use of pazopanib in mRCC. MATERIALS AND METHODS: We report the efficacy and toxicity analysis of first-line pazopanib therapy administered for patients with mRCC at our institute. It is a retrospective analysis of a prospectively maintained continuous data. RESULTS: Between March 2013 and December 2015, 28 patients have been treated with pazopanib. The median age was 56.5 years with 23 males and five females. Sixty-eight percent patients had clear-cell histology. The most common site of metastasis was lung (75%), followed by bone (36%), liver (25%), and brain (14%) with 43% having more than one metastatic site. Partial response, stable disease, and progression were observed in 3 (11%), 10 (36%), and 4 (14%) cases, respectively, and the response was not evaluable in 11 patients. The median follow-up duration was 11.8 months, and progression-free survival was 5.9 months. Most of the toxicities were Grade I–II except in three patients who experienced Grade III hand-foot syndrome (HFS) and one patient who had Grade III anemia. Common side effects were hypertension, HFS, fatigue, transaminitis, hyperglycemia, dyslipidemia, and proteinuria which were quite manageable. No patient required treatment discontinuation due to toxicity. CONCLUSION: Based on this initial experience at our center, pazopanib seems a feasible first-line treatment for mRCC due to its well-tolerable toxicity profile. However, larger data are required to confirm its efficacy in Indian patients.
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Patterns of care and outcomes for second-line targeted therapy in metastatic renal cell carcinomas: A registry based analysis p. 579
S Zanwar, A Joshi, V Noronha, VM Patil, N Sable, P Popat, S Menon, R Kothari, P Bhargava, A Kapoor, K Prabhash
DOI:10.4103/ijc.IJC_25_17  PMID:28485356
AIM: Patterns of care for metastatic renal cell carcinomas (mRCC) have seen tremendous reform in the last decade. Here, we present our pattern of care in second-line targeted therapy for mRCC. METHODS: Patients with mRCC treated with second-line therapy were included from a prospective database. Demographics, risk stratification, and treatment details were noted. Event-free survival (EFS) and overall survival (OS) was calculated using Kaplan–Meier method. Log-rank test was used to identify factors affecting EFS and OS. Multivariate analysis was performed using cox regression. RESULTS: Nearly 21.7% (46/212) of patients received second-line targeted treatment. Heng score for risk stratification showed 21.7% of patients in low risk, 36.9% in intermediate, and 34.8% in high risk group. Everolimus followed by pazopanib were the most common second-line therapies used in 65.2% and 13% of patients, respectively. The estimated median EFS was 3.5 months (95% confidence interval [CI] 2.7–4.26 months) and estimated median OS from the start of second-line therapy was 6.2 months (95% CI 3.4–9.0 months) with a median follow-up of 4.3 months. On univariate log-rank analysis, EFS of more than 6 months with first-line therapy was associated with improvement in EFS with second-line therapy (9.5 vs. 2.0 months; hazard ratio (HR) 0.364; P = 0.002). There was no factor independently associated with EFS or OS on multivariate analysis. CONCLUSION: Patterns of care for second line targeted therapy tend to vary with setting. A longer EFS with first-line therapy predicts improved outcomes with second-line treatment.
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INFECTION IN CANCER - ORIGINAL ARTICLES Top

Bacteriological trends and antibiotic susceptibility patterns of clinical isolates at Government Cancer Hospital, Marathwada p. 583
S Nazneen, K Mukta, C Santosh, A Borde
DOI:10.4103/ijc.IJC_34_17  PMID:28485357
INTRODUCTION: Preventing and starting early treatment of infections in patients whose immunity system is weak due to malignancies can reduce mortality. Since our hospital is a newly constructed one, this study aimed to determine microbial and antibiotic resistance patterns in clinical samples of patients with cancer at our center to start early treatment before the results of clinical tests are known. SUBJECTS AND METHODS: The study was carried out in the Department of Microbiology, Government Cancer Hospital during the period from January 2016 to December 2016. A total 170 clinical samples (urine, blood, sputum, pus, etc.) were collected and processed for culture, identification as per standard recommended procedures and antibiotic susceptibility testing were carried out on isolates as per Clinical Laboratory Standard Institute guidelines. RESULTS: A total of 170 specimens were cultured. Escherichia coli, Acinetobacter spp. , Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa were most commonly encountered. A high level of resistance to various antibiotics was noted among Gram-negative bacteria. Resistance among Gram-positive was not acute. CONCLUSION: The present study reveals microbiological profile in patients attending our hospital. Regular surveillance helps in implementing better therapeutic strategies to reduce morbidity and mortality associated in patients in health-care facility.
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Opium consumption: A potential risk factor for lung cancer and pulmonary tuberculosis p. 587
A Safari, M Reazai, A Tangestaninejad, AR Mafi, SAJ Mousavi
DOI:10.4103/0019-509X.204755  PMID:28485358
OBJECTIVE: Lung cancer is the most common malignancy, as well as the leading cause of cancer-related mortality worldwide. Several studies have shown the causative effect of cigarettes smoking in lung cancer, however, the effect of opium consumption has not yet been well studied. This study has been designed to evaluate the risk of developing lung cancer and pulmonary tuberculosis in pure opium addicts. MATERIALS AND METHODS: We designed an analytic case–control study with 490 participants. People were divided into three groups: Group A were pure opium addicts, Group B consisted of nonsmoker patients who visited the chest medicine clinic due to complaints such as asthma, respiratory tract infections, and other signs and symptoms unrelated to smoking. Group C were chosen from nonsmoker individuals who visited the Emergency Department due to nonrespiratory problems. RESULTS: Statistical analysis showed that the three groups were similar with respect to mean age and gender. In Group A, one patient was diagnosed as having bronchoalveolar carcinoma. No other case of lung cancer was found in all three groups. Furthermore, four patients in Group A (5.3%; 95% confidence interval, 1.3–10.3) were found to have pulmonary tuberculosis, as this was significantly higher as compared with groups B and C (P = 0.009 and P< 0.001, respectively). CONCLUSION: Although, owing to limited number of cases, a robust conclusion cannot be made, this study can be considered as a base for a well-designed, larger study to further clarify the potential effect of opium abuse in developing lung cancer.
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Spectrum of bacteremia in posthematopoietic stem cell transplant patients from an Indian center p. 590
A Ghafur, V Devarajan, R Raj, J Easow, T Raja
DOI:10.4103/0019-509X.204766  PMID:28485359
BACKGROUND: Despite the relatively low prevalence of Gram-positive bacteremic infections in Indian oncology patients, glycopeptides are extensively used for empirical management of febrile neutropenia. Our aim was to analyze the spectrum of bacteremia in posthematopoietic stem cell transplant (HSCT) recipients in our center and make a recommendation on glycopeptide use in this patient population. MATERIALS AND METHODS: Retrospective analysis of bacteremic data from HSCT recipients in a tertiary care oncology and transplant center from South India, between 2011 and 2013. RESULTS: In 217 patients, 52 bacteremic episodes were identified. The majority of the isolates were Gram-negatives (88.4%) with very few Gram-positives (7.69%). CONCLUSION: Glycopeptides need not be included in the empirical antibiotic regimen in post-HSCT settings with very low Gram-positive infection rates.
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Monotherapy versus combination therapy against carbapenem-resistant Gram-negative bacteria: A retrospective observational study p. 592
A Ghafur, V Devarajan, T Raja, J Easow, MA Raja, S Sreenivas, B Ramakrishnan, SG Raman, D Devaprasad, B Venkatachalam, R Nimmagadda
DOI:10.4103/0019-509X.204767  PMID:28485360
BACKGROUND: Colistin-based combination therapy (CCT) is extensively used to treat infections due to carbapenem-resistant Gram-negative bacteria (CRGNB). There are no data available from India on the usefulness of combination therapy, especially in the oncology setup. The aim of this study was to analyze the clinical effectiveness of CCT over monotherapy in patients with CRGNB. MATERIALS AND METHODS: We conducted a retrospective, observational study of patients with CRGNB bloodstream infections in our oncology and bone marrow transplant center. RESULTS: Over a 3-year study period (2011–2014), we could identify 91 patients satisfying study criteria. There was no statistically significant difference in the 28-day mortality between monotherapy and combination therapy arms (mono n = 26, mortality 10 (38.5%); combination n = 65, mortality 28 (40%); P = 0.886). Neutropenic patients with Enterobacteriaceae bloodstream infections performed better with combination therapy (mono n = 7, mortality 6 (85.7%); combination therapy n = 22, mortality 8 (36.4%); P = 0.035). There was no significant difference in the 28-day mortality between the two treatment arms in other subgroups. CONCLUSION: Our study did not find CCT superior to colistin monotherapy in patients with CRGNB blood stream infections; except in the subgroup of neutropenic patients with Enterobacteriaceae bloodstream infections, where combination therapy performed better.
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SECOND PRIMARY IN CANCER - ORIGINAL ARTICLE Top

Second primary malignancy: A retrospective analysis report from a tertiary cancer center of North India p. 595
D Sharma, G Singh, N Kakkar, S Raj
DOI:10.4103/ijc.IJC_542_16  PMID:28485361
AIM OF STUDY: We analyzed the data of second primary malignancy (SPM) from one of the tertiary cancer centers of North India, and the basic aim was to retrieve incidence, prognosis, and outcomes. MATERIALS AND METHODS: A retrospective study was conducted in the Department of Radiation Oncology in a tertiary cancer center between January 1, 2011, and December 31, 2015. A total of 6000 cases of cancer were analyzed, out of which cases who presented with histological proven synchronous SPM were included in this study. RESULTS: The present study showed three cases (8.1%) of SPM who are attributed to field carcinogenesis. There were five cases in which metachronous malignancy develops in the previous radiation therapy field. There is 26% of synchronous malignancy as compared to 74% of metachronous malignancy. In the present study, most diagnosed synchronous malignancies were carcinoma breast, while in metachronous malignancies, carcinoma breast and gynecological cancers were most common. CONCLUSIONS: SPMs are not very rare. Hence, pretreatment and follow-up evaluation should be meticulous to rule out SPMs.
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CANCER TRENDS - ORIGINAL ARTICLE Top

Cancer statistics in Kamrup urban district: Incidence and mortality in 2007–2011 p. 600
Jagannath Dev Sharma, Amal Chandra Kataki, Debanjana Barman, Arpita Sharma, Manoj Kalita
DOI:10.4103/0019-509X.204764  PMID:28485362
Purpose: The aim of this study was to report cancer statistics in Kamrup Urban District, including incidence and, mortality. Introduction: In the last five year PBCR-Guwahati witnessed a remarkable growth in cancer incidence cases. The number of new cases of all cancer was increased from 155.3 to 188.5 and 102.7 to 165.3 per 100,000 men and women respectively from the year 2007 to 2011 in KUD. The data from KUD also have shown that for some of the specific types of cancer are highest or some of the highest incidence in rates in the world; particularly cancers of upper aero-digestive tract consist of anatomical sites such as oral cavity, hypopharynx, larynx gallbladder, stomach, lung, prostate and oesophageal cancer. Materials and Methods: Age-standardized rates (ASR) (per 100,000 person-years) for incidence, mortality were calculated using the World Standard Population as proposed by Segi and modified by Doll et al. Descriptive statistics were presented by tables and figures. Results: A total of 6623 number of cases (male = 3809, female = 2814) were diagnosed with cancer in the last five years (2007-2011) period of time. The overall age standardized cancer incidence rate is almost 21% higher in men than in women. The pooled ASR for the five year period is 175.2 and 144.7 per 100,000 men and women. Conclusion: Overall cancer incidence and mortality rates have increased since 2007.
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CARCINOMA OVARY - ORIGINAL ARTICLES Top

Study of efficacy and safety of modified adjuvant intraperitoneal chemotherapy regimen in carcinoma ovary p. 607
P Dash, V Goel, V Talwar, DC Doval, S Raina, P Goyal, A Upadhyay, N Patnaik
DOI:10.4103/ijc.IJC_13_17  PMID:28485363
OBJECTIVE: It has been demonstrated in few trials that intraperitoneal and intravenous (IP/IV) chemotherapy improves survival in advanced stage ovarian cancer (OC). However, in view of high treatment-related toxicities, various modifications in treatment schedules have been tried. In this study, response and tolerability of IP paclitaxel on day 8 with IV paclitaxel on day 1 and IV cisplatin day 2 in carcinoma ovary were evaluated. PATIENTS AND METHODS: In this prospective observational study, from March 2013 to December 2015, the efficacy and tolerability of adjuvant IP/IV chemotherapy in optimally cytoreduced Stage III epithelial OC (EOC) patients were assessed. RESULTS: Totally, sixty patients were enrolled. The median age of patients was 53 years (32–67 years). Out of a total of 360 IP cycles, 316 cycles (88%) were completed. Forty-five patients (76%) received all the 6 cycles by IP route. Eight out of those 45 patients had one or more adjustment including delay or dose reduction. After median follow-up of 22 months, eight patients (14%) had local or systemic recurrence. Median progression-free survival not reached yet. Catheter block was seen in five cases. Two cases had needle displacement and extravasations of drug around the port chamber. Six patients had Grade 3 abdominal pain and cramp. Grade 3/4 leukopenia was experienced by thirty patients (50%), but febrile neutropenia occurred in only 6 (10%) patients. Renal complication present in 4 (7%) patients. CONCLUSIONS: In Indian patients, adjuvant chemotherapy with day 8 I/P paclitaxel in optimally cytoreduced EOC is associated with comparable survival outcomes, less side effects and high treatment completion rate relative to literature published from Western countries.
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A review of squamous cell carcinoma arising in mature cystic teratoma of the ovary p. 612
N Abhilasha, UD Bafna, VR Pallavi, PS Rathod, S Krishnappa
DOI:10.4103/0019-509X.204763  PMID:28485364
INTRODUCTION: Germ cell tumors account for 20-25% of ovarian neoplasms. Mature cystic teratoma (MCT) is the most common ovarian germ cell tumor. Malignancy in MCT is seen in 1-2% of the cases. Squamous cell carcinoma (SCC) accounts for 80% of the cases and carries a poor prognosis. AIM: To study the clinicopathological factors, management protocols and its outcome. MATERIALS AND METHODS: Case records reviewed from August 2006 to August 2011 at our institute identified 10 women with SCC in ovarian MCT. Staging was done according to FIGO 2009 guidelines. Primary surgery followed by adjuvant treatment with platinum based chemotherapy was given. RESULTS: Median age was 53.5 years. Six out of 10 patients were postmenopausal and aged above 50 years. Abdominal pain and abdominal mass were the most common presenting symptoms. According to FIGO: Two in stage 1, five in stage 2, two in stage 3 and one in stage 4. Among six optimally cytoreduced patients, five (83%) had no evidence of disease with a median follow up of 10 months. Whereas all four (100%) suboptimally cytoreduced patients had progressive disease within 3 to 4 months of primary surgery despite chemotherapy. CONCLUSION: Squamous cell carcinoma in MCT of ovary is a rarity. It carries a poor prognosis, especially in advanced stages and suboptimally cytoreduced patients. Platinum with or without taxane based chemotherapy may be useful as adjuvant treatment. However, further studies and standardization of treatment protocols are required for any recommendations.
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DISCLOSURE IN CANCER - ORIGINAL ARTICLE Top

Disclosure of cancer information among Saudi cancer patients p. 615
AM Al-Amri
DOI:10.4103/0019-509X.204771  PMID:28485365
BACKGROUND: Cancer has been perceived as an incurable disease, and therefore, disclosure of cancer could harm patients. Therefore, the aim of this study was to explore Saudi cancer patients' views regarding disclosure of cancer information and the impact of gender, regions, and level of education on their desire to be disclosed of the diagnosis and prognosis. MATERIALS AND METHODS: A face-to-face interview was conducted during patient's evaluation at our hospital prior to their knowledge of being diagnosed with cancer. RESULTS: Of 420 patients, 97.62% wanted to know all information about cancer and more than 96% wished to know the benefits and side effects of chemotherapy. None of the patients wanted to be treated without knowing their diagnosis, and almost all of them (94.76%) wanted to know about the prognosis. Patients from eastern region and male patients wanted to know their diagnosis more frequently than those from other regions and female patients (98.2% vs. 74.47%, P = 0.001; 97.90% vs. 92.17%, P = 0.008, respectively). Patients from Eastern Province, male patients, and educated patients wished to know their prognosis more frequently than those from other regions, female patients, and illiterate patients (94.98% vs. 68.79%, P = 0.001; 94.74% vs. 86.09%, P = 0.003; and 94.23% vs. 98.58%, P = 0.016, respectively). CONCLUSION: This study indicates that almost all the Saudi cancer patients wanted to know about their cancer diagnosis, prognosis, benefits and side effects of chemotherapy. Regions, gender, and level of education may affect patient's desire for cancer information.
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MYELOMA - ORIGINAL ARTICLE Top

Plasma cell leukemia: Single institution experience p. 619
K Govind Babu, Linu Abraham Jacob, Ankit Agarwal, KC Lakshmaiah, D Lokanatha, MC Suresh Babu, LK Rajeev, KN Lokesh, AH Rudresha
DOI:10.4103/0019-509X.204775  PMID:28485366
BACKGROUND: The first case of plasma cell leukemia (PCL) was recognized by Gluzinski and Reichentein. It is the most aggressive among the monoclonal gammopathies. It is diagnosed by the presence of more than 20% plasma cells in the peripheral blood or an absolute plasma cell count of >2000/mm3. Because of the relatively low incidence, most data come from case reports and retrospective studies. No prospective series have been published, and only seven reports including more than twenty patients have been identified. We report a retrospective series of 18 patients identified as PCL. AIM: To study the clinical features and outcome of patients with PCL. MATERIALS AND METHODS: A retrospective study was conducted from the year 2006 to 2015 wherein all the patients diagnosed with PCL were identified. Complete clinical and treatment details and outcome were obtained from the records. RESULTS: There were total 18 cases of PCL (3.7% of cases with multiple myeloma) diagnosed between the year 2006 and 2015. 16 cases (84%) were primary PCL, and two cases were secondary PCL. Twelve patients were males and six were females. The median age was 56.5 years. All patients had aggressive clinical course and median overall survival even with immunomodulatory agents was only 3 months. CONCLUSION: PCL is a very aggressive disease, and no prospective trials have been conducted. Patients with PCL require induction with immunomodulators, proteasome inhibitors, and further trials are needed to evaluate the role of autologous stem cell transplant in this disease.
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LETTER TO THE EDITOR Top

The value a radiologist brings to a multidisciplinary team: Case in point p. 621
A Mahajan, AS Kawthalkar, N Sable, M Thakur, S Desai
DOI:10.4103/0019-509X.204904  PMID:28485367
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  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow