Indian Journal of Cancer
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   2004| July-September  | Volume 41 | Issue 3  
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Pelvic exenteration: A perspective from a regional cancer center in India
Durgatosh Pandey, Shuaib Zaidi, Vikas Mahajan, Ravi Kannan
July-September 2004, 41(3):109-114
BACKGROUND : Pelvic exenteration is an extensive surgical procedure performed for locally advanced cancers in the pelvis. AIMS: The twenty-year experience with this procedure at the Cancer Institute has been analyzed for morbidity, failure pattern and survival. SETTINGS AND DESIGN : The case records of all the patients who had undergone pelvic exenteration between 1981 and 2000 at Cancer Institute (WIA), Chennai were retrieved from Tumor Registry and were analyzed. METHODS AND MATERIAL : Forty-eight patients underwent Pelvic Exenteration from 1981 to 2000 at the institute. Twenty-nine of them had rectal cancer, 15 had cervical cancer, 3 had bladder cancer, and 1 had ovarian cancer. There were 43 women and 5 men with a median age of 45 years. STATISTICAL ANALYSIS : The survival rates were calculated by Kaplan-Meier method using EGRET statistical software package. RESULTS : The operative mortality and postoperative morbidity were 10.42% and 62.50% respectively. The 5-year overall survival for the patients with Ca rectum and Ca cervix were 54.2% and 77.6% respectively. All 4 patients with Ca bladder or Ca ovary survived for more than 5 years. On multivariate analysis, nodal involvement and number of positive nodes emerged as significant prognostic factors for patients with Ca rectum. Although no factor reached statistical significance for patients with Ca cervix, those with adjacent organ invasion had a trend towards poorer survival. CONCLUSIONS : For carefully selected locally advanced cancer in the pelvis, pelvic exenteration may provide the opportunity of long-term survival.
  7,535 267 7
Patient profile and treatment outcome of rectal cancer patients treated with multimodality therapy at a regional cancer center
Suryanarayana Deo, Sunil Kumar, Nootan K Shukla, Madhabananda Kar, Bidhu K Mohanti, Atul Sharma, Vinod Raina, Goura K Rath
July-September 2004, 41(3):120-124
BACKGROUND : Incidence of rectal cancer has wide geographical variation. Disease pattern in developing countries is different from developed countries as majority of the patients present in advanced stage because of delayed referral and lack of uniform treatment practices. AIMS : Present study describes the patient profile and treatment results from a tertiary care cancer center in India. SETTING AND DESIGN : Tertiary care Regional cancer center. Retrospective analysis 89 patients with rectal adenocarcinoma treated between 1995 and 2002 were analyzed. METHODS: Patients with adenocarcinoma rectum were evaluated in a G.I. Oncology clinic and were treated using multimodality protocols involving surgery, radiotherapy and adjuvant chemotherapy. STATISTICAL ANALYSIS : A descriptive analysis of patient and disease profile,treatment patterns and out come was performed. Survival analysis was performed using Kaplan-Meier method. RESULTS : Mean age of the patients was 45.4 years and majority of them had tumor in lower third of rectum with evidence of extrarectal spread. Seventy five percent of the patients underwent curative resection with abdominoperineal resection being the commonest procedure. Forty seven percent of patients were given short course preoperative radiotherapy and the remaining received postoperative radiotherapy. Sixty four percent of patients could complete planned adjuvant chemotherapy. Operative mortality was 2% and 23% had morbidity. Local recurrence rate was 8.9%. 5-year disease free and overall survival was 54% and 58% respectively. CONCLUSION : Majority of rectal cancer patients present with locally advanced and low rectal growths leading to low sphincter salvage rates. Despite the advanced stage of presentation optimal oncologic results can be obtained by using a good surgical techniques in combination with adjuvant radiotherapy and chemotherapy. Short course preoperative radiotherapy seems to be more feasible in Indian context. Timely referral and uniform treatment guidelines throughout the country are needed for optimal management of rectal cancer in India.
  7,176 288 7
Polymorphism of GSTM1 and GSTT1 genes in prostate cancer: A study from North India
Rama Devi Mittal, D SL Srivastava, A Mandhani, A Kumar, B Mittal
July-September 2004, 41(3):115-119
BACKGROUND : Glutathione-S-transferases (GSTs) are active in the detoxification of wide variety of endogenous or exogenous carcinogens. The genetic polymorphisms of GSTM1 and GSTT1 genes have been studied earlier to evaluate the relative risk of various cancers. AIM, SETTING AND DESIGN : In the present study, we examined the association of the GSTM1 and GSTT1 gene polymorphisms with sporadic prostate cancer patients in north Indian population. MATERIAL AND METHODS : This case control study was undertaken over a period of 24 months and included 103 prostate cancer patients and 117 controls; both patients and controls originated from northern part of India. The GSTT1 and GSTM1 genotypes were identified by multiplex PCR in peripheral blood DNA samples. STATISTICAL ANALYSIS : Difference in genotype prevalence and association between case and control group were assessed by the Chi square and Fisher Exact tests. RESULTS : Frequencies of null genotypes in GSTT1 and GSTM1, was 11% (13/117) and 30% (35/117) respectively in control individuals. The frequencies of GSTT1 and GSTM1 null genotypes in prostate cancer patients were 34% (35/103) and 53% (55/103) respectively. CONCLUSION : Our study demonstrates that the null genotypes of GSTT1 and GSTM1 are substantially at higher risk for prostate carcinoma as compared to the normal healthy controls. The GSTT1 and GSTM1 null genotypes did not show significant association with tobacco usage in prostate cancer patients. However, the null genotypes were significantly stratified in 50-60 year-old patients when incidence of prostate cancer is high.
  6,989 385 24
Epithelial-myoepithelial carcinoma of the base of tongue: Pathology and management
Tarun Puri, Kishore Singh, Daya Nand Sharma, Nita Khurana
July-September 2004, 41(3):138-140
Epithelial-myoepithelial carcinoma is a rare tumor which makes up about 0.2% of epithelial neoplasms of the salivary glands; parotid gland being the most common primary site of origin. The tumor may also very rarely originate in minor salivary glands of the base of the tongue. Due to rarity of its occurrence, histogenesis and clear cut therapeutic guidelines are not defined. The present report describes the case of a 48 year old male who was diagnosed to have a tubular variant of epithelial-myoepithelial carcinoma of the base of tongue, Stage T3 N0 M0 (Stage group III). The patient was treated with neoadjuvant chemotherapy followed by radical radiotherapy (Rt) and is alive with no evidence of disease 14 months following end of treatment.
  6,206 273 8
Why is high grade squamous intraepithelial neoplasia under-diagnosed on cytology in a quarter of cases? Analysis of smear characteristics in discrepant cases
Sanjay Gupta, P Sodhani
July-September 2004, 41(3):104-108
BACKGROUND : The accuracy of cervical cytology has been quwstioned due to high false negative rate. In order to improve the sensitivity of cytology it is prudent to analyze the factors which hamper with the diagnosis of high grade lesions. AIMS : To study the cyto-histologic agreement in High grade squamous intraepithelial lesions (HSIL) of uterine cervix and to analyze the smear characteristics in discrepant cases. SETTINGS AND DESIGN : Cervical smears of 100 histology proven cases of Cervical intraepithelial neoplasia III ( CIN III ) were retrieved and reviewed to study cyto-histologic agreement in the diagnosis of high grade lesions.. The discrepant smears, undercalled on cytology, were further analyzed to determine the reasons for misinterpretations. Statistical analysis was performed to find out any significant factors for discrepancies. RESULTS : Cytology was able to correctly identify 74 HSILs while in 26 cases a diagnosis of Low grade squamous intraepithelial lesions (LSIL) or below was given. On review, 16 of these non correlating cases could be reclassified as HSIL on cytology while in 10 the diagnosis of LSIL or less persisted. 12/16 (75%) discrepant cases, reclassified as HSIL represented interpretive errors. Sampling errors (7/10) and air drying (5/10) were more frequent in under diagnosed cases. The statistical analysis did not yield any significant differences in the two review groups. CONCLUSION : 26% of HSIL cases were underdiagnosed on cervical smears. The major confounding factors responsible for under interpretation on cytology included air drying artifacts and metaplastic maturation of abnormal cells.
  5,763 225 10
Prognosticfactors in patients with renal cell carcinoma: Is TNM (1997) staging relevant in Indian subpopulation?
A Srivastava, Anil Mandhani, R Kapoor, M Jain, D Dubey, A Srivastava, M Raghavendra, A Kumar
July-September 2004, 41(3):99-103
BACKGROUND : RCC (Renal Cell Carcinoma) is a common genitourinary malignancy, but its behavior has not been studied in the Indian Subpopulation. AIMS : The aim of this study was to assess the validity of 1997 AJCC TNM staging in Indian subpopulation and also to identify independent predictors for survival in patients having RCC. SETTING AND DESIGN : Retrospective uncontrolled analysis of patients with RCC was performed at our centre. MATERIAL AND METHODS : Medical records of patients of undergoing radical nephrectomy at our center between 1994 to August 2003 were identified retrospectively. Medical records of 178 patients were available for analysis. Patient characteristics, preoperative imaging and surgical details were reviewed. Each tumor was staged according to the 1997 AJCC TNM classification. Nuclear grade was assigned according to the Fuhrman's grading system. STATISTICAL METHODS : Statistical analysis was performed using statistical software and descriptive statistics and survival functions were obtained. Univariate and multivariate analysis of factors affecting outcome of the patient were performed. RESULTS : Mean follow up period was 42.3 months (range 3 to 108 months). Stage wise 5-year Cancer specific survival was 87.2% in stage 1 disease, 74.3% in stage 2, 36.4% in stage 3 and 3.1% in stage 4. Univariate analysis revealed that stage, grade and lymph node status were statistically significant (P=0.009, 0.007 and 0.003 respectively). Sub-classifying stage 1 tumors between tumor of less than 4 cm. and more than 4 cm. did not reveal any statistically significant difference in survival (P=0.32). Multivariate analysis model revealed that Fuhrman's grade and lymph node status were statistically significant (P=0.007 and 0.002 respectively). CONCLUSION : This study validates the TNM (1997) staging for RCC as having significant survival impact in the Indian subpopulation. Sub-classifying stage 1 tumors between tumor of less than 4 cm. and more than 4 cm is not of much importance. Nuclear grade and lymph node involvement are important independent predictors of survival. Organ confined tumors with high nuclear grades need to be followed up more rigorously.
  5,559 214 9
Retro-peritoneal plasmacytoma: A case report and review of literature
Lalit M Sharma, G Biswas, Sanjay S Rai, Reena Nair, Sudeep Gupta, Purvish M Parikh
July-September 2004, 41(3):133-134
Solitary Extramedullary Plasmacytoma (EMP) is an uncommon neoplasm. When diagnosed, head and neck region is its most likely location. Rarely, it may occur in the retro-peritoneum. We report a 44year old man with solitary extramedullary plasmacytoma in the retro peritoneum (RPEMP). The patient did not show response to three cycles of VAD chemotherapy. Thereafter Surgical excision of the mass was performed successfully. This is probably the first case report from Indian subcontinent.
  5,037 213 6
Diffuse large B-cell lymphoma arising from a multicentric mixed variant of Castleman's disease
I Venizelos, D Tamiolakis, C Simopoulos, S Nikolaidou, S Barbagadaki, M Lambropoulou, G Alexiadis, P Boglou, Nikolas Papadopoulos
July-September 2004, 41(3):135-137
This case report describes a patient with multicentric mixed type Castleman's disease and concomitant non-Hodgkin's lymphoma of diffuse large B cell type in the neck. Multicentric CD is a systemic illness with disseminated lymphadenopathy; its aggressive and usually fatal course is associated with infectious complications and risk for malignant tumors, such as lymphoma or Kaposi sarcoma.
  4,903 173 5
All-transretinoic acid and chemotherapy in the treatment of acute promyelocytic leukemia
Soad Al Bahar, R Pandita, K Bavishi, O Kreze
July-September 2004, 41(3):125-128
BACKGROUND : All- transretinoic acid (ATRA) and chemotherapy has improved complete remission rates and disease free survival in acute promyelocytic leukemia (APL). There is scanty data from Middle East. AIM : To determine the efficacy of ATRA and multi-agent combination chemotherapy in treatment of APL in a single Centre in Kuwait. SET-UPS AND DESIGN : Tertiary cancer centre, retrospective study. METHODS AND MATERIAL : All newly diagnosed APL patients were treated with oral ATRA 45mg/m2 daily until complete remission (CR), intravenous daunorubicin 50mg/m2 on days 1,3 and 5, cytosine arabinoside 100mg/m2 12hrly on days 1 through 10 and etoposide 100mg/m2 on days 1 through 5. Post remission three courses of intensive consolidation chemotherapy were administered. Since October 1999, maintenance chemotherapy consisting of oral 6 mercaptopurine 90mg/m2 daily, methotrexate 15mg/m2 weekly and ATRA 45mg/m2 for 2 weeks every three months was added. Complete remission rates and duration, relapse rate and toxicity were studied. RESULTS : 22 of 24 evaluable patients (91.6%) achieved CR. The median duration of remission was 13 months (range 2-55 months). Three patients (12.5%) relapsed. Two patients (8.3%) developed retinoic acid syndrome and responded to dexamethasone. Five patients (20.8%) died one each of refractory disease, during remission induction and of relapse. Two patients died while in remission. CONCLUSION :: ATRA and combination chemotherapy results in high complete remission rates and low relapse rate in newly diagnosed APL. Maintenance therapy may be useful in preventing relapses.
  4,220 210 4
Giant cystosarcoma phyllodes tumor of prostate: Case report of a rare entity
Dharitri M Bhat, SV Poflee, MN Kotwal, MA Pangarkar, RU Gadkari, SK Bobhate
July-September 2004, 41(3):129-132
Although glandular and stromal proliferations of prostate are very common in adult men, neoplastic proliferations of prostatic stroma are distinctly uncommon. These tumors are now grouped as Prostatic Stromal Proliferations of Uncertain Malignant Potential (PSPUMP). Phyllodes tumor of the prostate is a rare neoplasm in this group with cellular, sarcomatoid stroma and benign hyperplastic glands. It is a locally expansile tumor with clinical course varying from benign to aggressive. We report a case of a 45-year-old man presented with retention of urine and abdominal lump. On laparotomy it was a huge tumor of 4 kg and was histologicaly characterized by cellular pleomorphic stroma and hyperplastic epithelium. Immunohistochemistry demonstrated prostate specific antigen in the glands. It was diagnosed as cystosarcoma phyllodes tumor of prostate. This is extremely uncommon tumor similar in histology to that of breast and it's clinical course varies with the grade. The patient was without recurrence one year after surgery.
  3,663 159 1
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