Indian Journal of Cancer
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   2017| January-March  | Volume 54 | Issue 1  
    Online since December 1, 2017

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Survival and prognostic factors for glioblastoma multiforme: Retrospective single-institutional study
M Ghosh, S Shubham, K Mandal, V Trivedi, R Chauhan, S Naseera
January-March 2017, 54(1):362-367
DOI:10.4103/ijc.IJC_157_17  PMID:29199724
INTRODUCTION: Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor in adults. The standard management has been maximum surgical resection followed by adjuvant radiotherapy with concurrent chemotherapy followed by adjuvant chemotherapy. Although the survival rate of patients with GBM has improved with recent advancements in treatment, the prognosis remains generally poor. The median survival rates are in the range of 9–12 months and 2-year survival rates are in the range of 8%–12%. MATERIALS AND METHODS: A single-institution retrospective review of 61 patients of GBM from 2012 to 2014. Data regarding patient factors, disease factors, and treatment factors were collected and survival has been calculated. RESULTS: A total of 61 patients with GBM were analyzed. GBM is commonly seen in sixth decade of life. Male to female ratio is 2.6:1. The right side of the brain is commonly involved with right frontal lobe being the most common site. The median follow-up was 4.6 months. The median survival of our patients was 8 months. The 1-year and 2-year survival rates were 20% and 3.27%, respectively.CONCLUSIONS: The overall survival and prognosis in patients with GBM remains poor despite of constant research and studies. Concurrent chemoradiotherapy followed by adjuvant chemotherapy with temozolomide should be used after maximal resection to improve the survival.
  5,636 241 -
Evolving epidemiology of lung cancer in India: Reducing non-small cell lung cancer-not otherwise specified and quantifying tobacco smoke exposure are the key
H Kaur, IS Sehgal, A Bal, N Gupta, D Behera, A Das, N Singh
January-March 2017, 54(1):285-290
DOI:10.4103/ijc.IJC_597_16  PMID:29199707
BACKGROUND: Adenocarcinoma is the most prevalent histological type of lung cancer (LC) in developed countries while squamous cell carcinoma (SqCC) has so far been the most common type at our center. Herein, we report our continued assessment of the epidemiological trend of LC aimed at determining any change in the histological distribution. METHODS: Retrospective analysis involving all consecutive newly diagnosed LC patients over a 4-year period (March 2011–February 2015). Demographic characteristics, histology, and staging data for current data set were compared with our previously published data (2008–2011). As before, smoking index (SI) was used to group patients as never (SI = 0), light (SI = 1–100), moderate (SI = 101–300), and heavy (SI ≥301) smokers. RESULTS: Majority of 1301 patients had advanced disease (Stages IIIB = 30.1%; IV = 53.3%), were males (82.3%) and current/ex-smokers (76.9%). Adenocarcinoma and SqCC (36.4% each) were equally prevalent. As compared to our previous study, adenocarcinoma increased (36.4% vs. 27.5%) and nonsmall cell lung cancer-not otherwise specified (NSCLC-NOS) decreased (5.1% vs. 10.9%) significantly (P < 0.001). The current study had more heavy smokers (68.3% vs. 61.1%; P = 0.013) and median SI was also higher (500 vs. 400; P = 0.001). Among SI-based groups, significant differences were observed for age, gender, body mass index, histology, TNM stage, and metastatic disease distribution. CONCLUSION: Reduction in NSCLC-NOS has led to adenocarcinoma and SqCC being equally prevalent at our center in North India despite an increase in heavy smokers. Accurate histological NSCLC subtyping is necessary for optimal epidemiological assessment.
  3,967 346 2
Indian consensus statement for treatment of advanced non small cell lung cancer: First line, maintenance, and second line
Under the aegis of Lung Cancer Consortium Asia (LCCA) , Indian Cooperative Oncology Network (ICON) , Indian Society of Medical & Pediatric Oncology (ISMPO) , Molecular Oncology Society (MOS) and Association of Physicians of India API)
January-March 2017, 54(1):89-103
DOI:10.4103/ijc.IJC_136_17  PMID:29199671
The management of advanced nonsmall cell lung cancer (NSCLC) patients is becoming complex with the identification of driver mutations and targeted therapies. The expert group of academic medical oncologists used data from published literature, practical experience to arrive at practical consensus recommendations to treat advanced NSCLC for use by the community oncologists.
  3,722 390 -
Multiple myeloma: Experience of an institute in limited resource setting
Linu Abraham Jacob, MC Suresh Babu, KC Lakshmaiah, K Govind Babu, D Lokanatha, LK Rajeev, KN Lokesh, AH Rudresha, Ankit Agarwal, Sunny Garg
January-March 2017, 54(1):340-342
DOI:10.4103/ijc.IJC_87_17  PMID:29199718
INTRODUCTION: Multiple myeloma (MM) is a plasma cell dyscrasias and an incurable clonal B-cell malignancy, with an annual incidence of 1% of all malignancies. The mainstay of treatment of myeloma is induction treatment followed by consolidation with autologous stem cell transplant (ASCT). However, still in a developing country like India where affordability is a major hurdle for health care, a number of MM patients are not able to undergo ASCT. AIM: To study the epidemiological features and outcome of MM patients treated in a limited resource setting. MATERIALS AND METHODS: We conducted a retrospective study at our institute to identify patients diagnosed as MM from 2005 to 2016. We studied the epidemiological profile and the outcome of the treatment in terms of response rates and overall survival. STATISTICAL ANALYSIS: Survival analysis was performed using Kaplan–Meier curve. RESULTS: Median age at diagnosis is 54 years (range: 39–85 years). IgG myeloma was the most common type seen in 72% of patients. The International Staging System (ISS) was ISS I (31%), ISS II (30%), and ISS III (39%). The median duration of treatment for thalidomide + dexamethasone (TD) and bortezomib + TD (VTD) was 9 and 7 months, respectively. Median survival for the TD versus VTD regimen (in a nontransplant setting) for the ISS I, ISS II, and ISS III groups was 49 and 55 months (P = 0.056), 42 and 48 months (P < 0.05), 21 and 27 months (P < 0.05), respectively. CONCLUSION: Proteasome inhibitors significantly improved the median survival for patients with MM (ISS II and ISS III) treated in a limited resource setting.
  3,624 252 4
Targeted therapy in nonsmall cell lung cancer
T Puri
January-March 2017, 54(1):83-88
DOI:10.4103/ijc.IJC_258_17  PMID:29199670
Activating mutations in the epidermal growth factor receptor gene and rearrangement of the anaplastic lymphoma kinase gene exemplify the molecular characterization of nonsmall cell lung cancer (NSCLC), particularly adenocarcinoma, and its therapeutic relevance. Several genetic alterations with prognostic and predictive role, including ROS, RET, MET, KRAS, have now been identified in adenocarcinoma and some such as DDR2 and fibroblast growth factor receptor 1 in squamous cell carcinoma. This has heralded the development of agents targeted against these aberrations. Better knowledge of tumor biology and development of targeted agents has ushered an era of personalized treatment strategies in NSCLC, leading to improvements not only in tumor control and duration of life but also in quality of life.
  2,553 306 1
Venous thromboembolism in cancer patients – magnitude of problem, approach, and management
G Singh, AK Rathi, K Singh, D Sharma
January-March 2017, 54(1):308-312
DOI:10.4103/ijc.IJC_101_17  PMID:29199711
Cancer is hypercoagulable state. Patients with cancer are at high risk to develop venous thromboembolism (VTE). Relative risk of developing VTE is approximately seven times higher in patients with active cancer. The incidence of occult malignancy is 7%–12% in patients with idiopathic deep vein thrombosis (DVT). However, little research has been focused on cancer with thromboembolism. Lowmolecularweight heparin most frequently used pharmacologic agents as recommended by established guidelines. The aim was to evaluate the magnitude of problem in cancer patients and treatment option as per established guidelines. EMBASE, MEDLINE, and PubMed search of the literature were done to evaluate the association of DVT with various malignancy, magnitude of problem, approach, and various guidelines for the management of DVT. References of all publication were also searched to enrich this article for recent update. Thromboprophylaxis in cancer patient is gray zone area. This need lot of investigational work to find highrisk patients who would benefit from primary thromboprophylaxis.
  2,553 300 1
Retrospective analysis of palliative metronomic chemotherapy in head and neck cancer
VM Patil, V Noronha, A Joshi, L Nayak, N Pande, A Chandrashekharan, S Dhumal, A Bhattacharjee, S Banavali, K Prabhash
January-March 2017, 54(1):25-29
DOI:10.4103/ijc.IJC_161_17  PMID:29199656
BACKGROUND: Metronomic chemotherapy has shown promising results in selected patients of head and neck cancer in a small randomized study. This retrospective analysis was done to see whether the efficacy of metronomic chemotherapy in an unselected cohort of head and neck cancer patients is similar to that reported in the randomized study and the influence of the site and subsite of head and neck cancer on survival. MATERIALS AND METHODS: This was a retrospective analysis of head and neck cancer patients who received palliative metronomic chemotherapy between January 2013 and February 2015. The data of these patients were collected from our palliative chemotherapy database maintained in medical oncology outpatient department. The overall survival (OS) was calculated in days from the date of start of chemotherapy to the date of death. Patients who had not expired at last follow-up were censored during estimation of OS by Kaplan–Meier method. Factors affecting OS were identified by COX regression analysis. RESULTS: Over the stipulated time period, 340 patients received palliative metronomic chemotherapy. The median age of these patients was 48 years (22–90 years). The sites of tumor origin were oral cavity in 281 patients (82.6%), oropharynx in 33 patients (9.7%), larynx in seven patients (2.1%), hypopharynx in 12 patients (3.5%), and maxilla in seven patients (2.1%). Previous treatment was received by 286 patients (84.1%). The median time to failure was 3.5 months (interquartile range 2.0–6.0 months). The overall median survival was 155 days (95% confidence interval 140.2–169.8 days). Failure within 6 months of previous treatment was the most important factor influencing OS. There was a trend toward lower OS in patients with oral cancers (139 days vs. 210 days). Among the various oral cancer subsites, oral tongue primary had a lower OS. CONCLUSION: Oral metronomic chemotherapy has promising results when used in a selected cohort of patients but has dismal results in patients who failed within 6 months of previous treatment.
  2,368 224 1
Oral health-related quality of life in patients treated for oral malignancy at Kanchipuram district, India: A cross-sectional study
K Indrapriyadharshini, PD Madankumar, GR Karthikeyan
January-March 2017, 54(1):11-15
DOI:10.4103/ijc.IJC_116_17  PMID:29199653
BACKGROUND: The modern-day onco-surgical therapy is now concerned on the overall Quality of Life after treatment of the patient. There is need to evaluate final outcome following the different combination of treatment modalities available to make better therapeutic treatment decisions. AIM: The aim of this study was to assess Oral health related quality of life (OHRQoL) in patients with oral malignancies who had undergone various treatments. SETTINGS AND DESIGN: A Cross sectional study was conducted among 90 patients between October 2016 to January 2017 in private hospitals, kanchipuram, India. MATERIALS AND METHODS: Participants were grouped based on the treatment they had undergone into Group I - Surgery alone, Group II - Surgery and Radiotherapy, Group III- Surgery, chemotherapy and radiotherapy and assessed for OHRQoL using the shorter version of Oral health impact profile -14 (OHIP-14) questionnaire. STATISTICAL ANALYSIS: Descriptive analysis of socio demographic variables and OHIP 14 was performed using Chi-square test and one way ANOVA. RESULTS: Among the 90 participants, 43.3% belonged to upper lower class and 38.3% to lower class. Buccal mucosa (58.9%) was found to be the most frequent site. Among the clinical staging, Stage II (33.33%) oral cancer was more prevalent. No statistically significant differences in the OHIP mean score for Groups, I, II, III. Among the domains functional limitation was significantly different in the three groups. CONCLUSION: Patients with oral malignancies who had been treated surgically alone had better Quality of life when compared to the combined treatment modalities.
  2,237 196 1
Evaluation of dose conformity and coverage of target volume for intensity-modulated radiotherapy of pelvic cancer treatment
M Atiq, A Atiq, K Iqbal, Q Shamsi, F Andleeb, SA Buzdar
January-March 2017, 54(1):379-384
DOI:10.4103/ijc.IJC_80_17  PMID:29199727
BACKGROUND: Better conformity may help in delivering minimum dose to organs at risk (OARs) and maximum dose to planning target volume (PTV). As per the requirements of modern radiotherapy, 95% isodose should cover the PTV, so conformity indices (CIs) are used for evaluating quality of conformation of treatment plans. AIM: This study aimed to investigate degree of conformity for pelvic patients using intensity-modulated radiotherapy (IMRT) technique. Three formulas of CIs described in literature were analyzed in this study. SETTINGS AND DESIGN: This study was performed to evaluate degree of conformity of 18 patients treated with radiotherapy treatment plan using cumulative dose volume histogram. Effectiveness of different CIs was explored for IMRT plans using 15 MV photon beam. Doses delivered to OAR were also studied. STATISTICAL ANALYSIS USED: CI suggested by the International Commission on Radiation Units and Measurements, radiation CI and CI prescription isodose to target volume (PITV) had mean ± standard deviation values of 1.02 ± 0.018, 0.98 ± 0.017, and 1.63 ± 0.333, respectively. RESULTS AND CONCLUSION: Dose distribution for all patients was highly conformal and clinically acceptable. Values of CI PITV exceeded acceptable value for 27% patients with minor deviation. No statistically significant differences were observed for three CIs reported. Target volume lies between 95% and 107% of prescribed dose which shows ideal target coverage. This simple parameter is advantageous since it is easy to interpret and helped determine quality of treatment plan. This study clearly demonstrated that favorable dose distribution in PTV and OARs is achieved using IMRT technique, and hence, the risk of damage to normal tissues is reduced.
  2,261 111 -
Lung cancer: Presentation and pattern of care in a cancer center in South India
C Krishnan Nair, AP Mathew, PS George
January-March 2017, 54(1):164-168
DOI:10.4103/ijc.IJC_56_17  PMID:29199682
BACKGROUND: In India lung cancer is the most commonly diagnosed malignancy in males and an increasing trend in the incidence is reported from the National Cancer Registry programme. AIMS: The aim of this study is to find out the recent trends in presentation and management of lung cancer at Regional Cancer Centre, Trivandrum. METHODS: Published reports of hospital based cancer registries (HBCR) and population based cancer registries (PBCR) of Trivandrum were compared with reported statistics from other parts of India and global data. RESULTS: Lung is the leading site of cancer in males (15%) getting treatment at Regional Cancer Centre , Trivandrum in 2013 as per the HBCR. There is an increase in the age adjusted incidence rate of lung cancer among males in the Trivandrum PBCR from 14.6 to 18.5 during 2012 -2014. Among the patients who were treated at the Center majority (55.2%) presented with distant metastases with adenocarcinoma as the most common histological type (28.5%) and only 15.7% had undergone treatment with curative intent. CONCLUSIONS: Lung cancer is the major cancer affecting males in India with a high incidence in Trivandrum and a very low percentage of patients receiving curative treatment which could be due to the high prevalence of tuberculosis and scarce availability of facilities and trained manpower for thoracic oncology.
  2,172 156 2
Incidence and characteristics of Epidermal Growth Factor Receptor (EGFR) mutation in non-small-cell lung cancer (Adenocarcinoma histology): A report of 106 patients from Kolkata
K Chatterjee, A Ray, B Chattopadhyay
January-March 2017, 54(1):305-307
DOI:10.4103/ijc.IJC_239_17  PMID:29199710
CONTEXT: Regional epidemiological data regarding the epidermal growth factor receptor (EGFR) mutation status in non-small-cell lung cancers (NSCLC) is an unmet need from the eastern part of India. AIMS: To report the incidence of EGFR mutation and its correlation with the phenotypical characteristics, in NSCLC patients from Kolkata. SUBJECTS AND METHODS: NSCLC patients, with adenocarcinoma histology, whose tissues had been tested for EGFR mutational status between March 2014 and February 2017, were considered for this study. The testing methods used were Real-time-based amplification refractory mutation system, polymerase chain reaction (ARMS PCR), PCR and gene sequencing, and cell-free DNA (CTDNA). Clinical characteristics and treatment details were collected from the patient's medical records in a de-identified manner. STATISTICAL ANALYSIS USED: Data were analyzed using simple descriptive statistical methods. RESULTS: Between March 2014 and February 2017, 108 samples were tested and two were deemed inadequate for reporting. Of the remaining 106 patients, 65 (61.3%) were males, and 41 (38.6%) were females. Median age was 56 years (42–72), 59 years for males and 52 years for females. 73.6% were nonsmokers. 87.7% tests were done using the real-time ARMS-PCR; 9.4% underwent PCR and gene sequencing and 2.8% using CT-DNA. Of 106 patients, 35 (33%) patients were found to be EGFR mutation positive. Ratio of male:female was 16 (45.7%):19 (54.3%). Ratio of nonsmoker: smoker was 30 (85.7%):5 (14.3%). 18 patients had exon 19 deletion (51.4%), 15 had L858R exon 21 mutation (42.9%), 1 patient (2.9%) had mutation in S7681 exon 20 along with L858R 21 and one patient (2.9%) had a T790m mutation without any other detectable EGFR mutation. CONCLUSIONS: The incidence of EGFR mutation in NSCLC is 33% from Kolkata and is typically more common in females and nonsmokers.
  2,118 183 1
Retrospective study of efficacy and safety of neoadjuvant docetaxel, carboplatin, and trastuzumab in HER2-positive locally advanced and oligometastatic breast cancer: An Indian experience
A Tiwari, A Gogia, SVS Deo, NK Shukla, S Mathur, DN Sharma
January-March 2017, 54(1):343-346
DOI:10.4103/ijc.IJC_152_17  PMID:29199719
BACKGROUND: The neoadjuvant chemotherapy in HER2-positive breast cancer consists of a chemotherapy backbone and HER2-directed therapy. The increase in cardiotoxicity by the use of trastuzumab with an anthracycline-based regimen has led to the use of nonanthracycline-based alternative regimens. The docetaxel, carboplatin, and trastuzumab (TCH) are one such regimen. The efficacy and toxicity of this regimen have not been widely studied in Indian patients. AIMS: This retrospective study aims to evaluate the efficacy and toxicity of neoadjuvant TCH regimen in locally advanced and oligometastatic HER2-positive breast cancer in Indian patients. METHODOLOGY: The hospital records between January 2014 and December 2016 were reviewed to identify patients with locally advanced and oligometastatic HER2-positive breast cancer treated with uniform 3-weekly neoadjuvant chemotherapy protocol-containing docetaxel (75 mg/m2), carboplatin (AUC = 6), and trastuzumab (8 mg/kg loading followed by 6 mg/kg) (TCH). The primary outcome was the pathologic complete response (pCR), which was defined as an absence of invasive and noninvasive cancer in breast or lymphnode. RESULTS: Thirty-two patients with mean age 46 years met our inclusion criteria, of these 24 patients had locally advanced breast cancer, and eight patients had oligometastatic breast cancer. 13 (40.6%) patients had hormone-positive breast cancer. The objective response rate as assessed clinically was 100%, and pCR rate was 36.3%. The patients with oligometastatic breast cancer also showed a good response to chemotherapy with three patients showing pCR and four patients showing resolution disease at metastatic sites. The patients experienced very few Grade III/IV toxicities, and no patient had clinical congestive heart failure. CONCLUSION: The TCH protocol is an efficacious neoadjuvant chemotherapy regimen for locally advanced and oligometastatic breast cancer and is safe and well tolerated in this population.
  1,985 249 1
Is pulmonary metastasectomy beneficial in head and neck squamous cell carcinoma? A review of literature
NR Subramaniam, R Reddy, D Balasubramanian, K Thankappan, S Iyer
January-March 2017, 54(1):2-5
DOI:10.4103/ijc.IJC_170_17  PMID:29199651
Metastatic head and neck squamous cell carcinoma (HNSCC) has traditionally carried a dismal prognosis; however with advances in care, it has been shown that pulmonary metastasectomy is a viable therapeutic option in selected patients, palliating symptoms and improving survival. With the increasing incidence of human papilloma virus-related HNSCC and better availability of minimal access surgery, there is a need to better understand the role of pulmonary metastasectomy in the treatment of HNSCC. This article summarizes the literature on indications, results, surgical options and approaches, clinical dilemmas, and controversies associated with pulmonary metastasectomy in HNSCC, to identify suitable candidates and optimize outcomes.
  1,988 221 -
Testicular seminoma: Are clinical features and treatment outcomes any different in India?
M Anjanappa, A Kumar, S Mathews, J Joseph, KM Jagathnathkrishna, FV James
January-March 2017, 54(1):385-387
DOI:10.4103/ijc.IJC_100_17  PMID:29199728
AIM: This study aims to identify clinical features, treatment outcomes, and prognostic factors for relapse and survival in patients with testicular seminoma. MATERIALS AND METHODS: Retrospective analysis of all patients with pure seminoma treated at our center during over a decade (January 2005–December 2014) was carried out. Patient demographics, tumor characteristics, and treatment details and pattern of recurrence were recorded in a structured format, and disease-free survival and overall survival were calculated. RESULTS: Sixty-three patients' case records were included in the analysis. Ten patients developed disease in the undescended testis. All patients underwent orchiectomy as the initial treatment procedure. Majority of the patients were Stage I (57.14%) followed by Stage II (39.6%). Among the patients with Stage I, 55.5% received adjuvant chemotherapy while 22.2% received adjuvant radiation and the rest opted for surveillance. The compliance for active surveillance was very poor. Among patients with Stage II disease, majority (80%) were treated with adjuvant chemotherapy and the rest with radiation. At a median follow-up of 49 months, there were four recurrences of which three were salvaged successfully, and one patient remained alive with disease. There were no disease-related deaths. CONCLUSIONS: Testicular seminoma remains to be relatively low and majority of them presented with Stage I disease and single agent carboplatin appeared to be the preferred adjuvant treatment. Advanced disease patients were treated with etoposide and cisplatin/bleomycin, etoposide and cisplatin chemotherapy and the clinical outcome is comparable with the Western literature.
  2,024 130 -
Role and relevance of BRAF mutations in risk stratifying patients of papillary thyroid cancers along with a review of literature
A Krishnamurthy, V Ramshankar, K Murherkar, S Vidyarani, GC Raghunandhan, A Das, PB Desai, K Albert
January-March 2017, 54(1):372-378
DOI:10.4103/ijc.IJC_182_17  PMID:29199726
INTRODUCTION: Molecular markers are increasingly being explored as a potential diagnostic and prognostic tool in patients with well-differentiated thyroid cancers and B-type Raf kinase (BRAF) V600E mutation has received a wide attention in this regard. Many clinical studies have demonstrated an association of BRAF V600E mutation with aggressive clinicopathologic characteristics and high tumor recurrence and mortality in patients with papillary thyroid cancers. Papillary thyroid cancers has been abbreviated and PTCs. AIM: The present single center study aims to assess the biological behavior of conventional papillary thyroid cancers. (PTC) with somatic BRAF V600E mutation. MATERIALS AND METHODS: Patients who were managed for well differentiated thyroid cancers during 2005–2006 were included in the study. BRAF V600E mutation analysis was done by real time polymerase chain reaction after extracting genomic DNA from the representative archived formalin fixed paraffin embedded tumor tissue. RESULTS: Of the 79 patients of well-differentiated thyroid cancers included in the study, 31% harbored BRAF V600E mutation; the mutation prevalence was 39.6% in the cohort of conventional PTCs. Our study emphatically states that BRAF V600E mutation status is a significant predictor of adverse outcomes in patients with conventional PTCs. CONCLUSION: Our study further suggests a possible risk-stratified approach using age, BRAF V600E mutation status, and extrathyroidal spread, and this approach can be used to personalize the management of patients with conventional PTCs. The result of our study adds to the growing consensus that BRAF V600E mutational status should be analyzed in correlation with other molecular and clinicopathological prognostic factors for a better risk stratification.
  1,964 182 2
Epidemiology of gynecological cancers in Kamrup Urban District cancer registry
D Barman, JD Sharma, D Barmon, AC Kataki, A Sharma, M Kalita
January-March 2017, 54(1):388-391
DOI:10.4103/0019-509X.219590  PMID:29199729
BACKGROUND: Cancers of the female reproductive system - namely cancer of the cervix, corpus uteri, ovarian, vulvar, vaginal, fallopian tube cancers and choriocarcinoma are an important cause of cancer morbidity and mortality among women worldwide. It is estimated to be the third most common group of malignancies in women. The comprehensive global cancer statistics from the International Agency for Research on Cancer indicate that gynaecological cancers accounted for 20% of the 14.1 million estimated new cancer cases and 8.2 million cancer deaths among women in the world in 2012. The estimation of cancer burden is necessary to set up priorities for disease control. Gynaecological cancers have increased in India and are estimated to be around 182,602 by the year 2020 constituting about 30% of the total cancers among women in India. Among these, cancer of the uterine cervix followed by ovary and corpus uteri are the major contributors. METHODS AND MATERIALS: Cancer is not notifiable in India, so method of collecting information on cancer was active with voluntary participation of different sources including major hospitals, diagnostic centers, state referral board and birth and death registration centers within registry area. RESULTS: A total of 3767 (44%) cases were registered in women out of the total number of 8561 cancer cases during the period from 2010-2014. In case of gynaecological cancers a total of 661 cases of cervical, ovarian and corpus uterine cancers were registered out of the total 3767 female cancer cases (17.5%) for the year 2010-2014.The annual average crude rate in women for all sites of cancer was 117.4 per 100000 population. The corresponding AARs was 166.6. CONCLUSIONS: Women's health issues have attained high concern in recent decades. Utmost efforts should be made to educate women in early cancer detection by creating awareness on risk factors and symptoms.
  1,987 149 2
Mediastinal staging for non-small cell lung cancer revisited. It is being done under aegis of ICON and Lung cancer consortium asia
D Pandey, P Ramanathan, R Pandey, K Prabhash
January-March 2017, 54(1):68-72
DOI:10.4103/0019-509X.219579  PMID:29199667
Mediastinal staging is a crucial factor in the decision making in patients with non-metastatic non-small cell lung cancer (NSCLC). Mediastinoscopy has historically been the gold standard for this purpose. With the advent of PET-CT, the role of an invasive staging modality like mediastinoscopy has been diminishing. Newer developments in endoscopic staging like EBUS and EUS-FNA have also provided means to get a cytological diagnosis of enlarged lymph nodes. With the meta-analyses showing encouraging results of neoadjuvant chemotherapy in operable lung cancers including the early stage disease, the sanctity of invasive mediastinal staging for the sole purpose for selecting patients for upfront surgery is debatable. This article discusses the various modalities for mediastinal staging in NSCLC. We also present our perspective regarding the need for a balanced approach between the accuracy of mediastinal staging, invasiveness of the staging modalities, and alternate staging methods. With the liberal use of neoadjuvant chemotherapy in operable NSCLC, the role of invasive mediastinal staging procedures is likely to get limited further, giving way to non-invasive staging modalities like PET-CT.
  1,932 193 1
Metformin use and survival of lung cancer patients: Meta-analysis findings
S Zhong, Y Wu, X Yan, J Tang, J Zhao
January-March 2017, 54(1):63-67
DOI:10.4103/0019-509X.219582  PMID:29199666
Previous studies on the association between metformin use and lung cancer survival have yielded mixed results. We aimed to perform a metaanalysis to assess the association with all available studies. Relevant studies were identified by searching PubMed and EMBASE to July 2016. We calculated the summary hazard ratios (HRs) and 95% confidence intervals (CIs) using randomeffects models. Twelve cohort studies involving 124,533 participants were included in this study. The results showed that metformin use was not associated with the overall survival of lung cancer patients (HR = 0.79, 95% CI: 0.62–1.02). In the subgroup analyses by country or subtype of lung cancer, although a beneficial effect of metformin use on overall survival was found in patients with smallcell lung cancer or in lung patients from China, it may be inappropriate draw a final conclusion considering small sample size, low study quality, and the limited number of studies in the subgroups. Further analyses found that metformin use after diagnosis showed a beneficial effect on both over survival (HR = 0.79, 95% CI: 0.72–0.87) and progressionfree survival (PFS; HR = 0.62, 95% CI: 0.39–0.96) of lung cancer patients. In conclusion, metformin use after diagnosis is associated with improved overall survival and PFS of lung cancer patients. Nevertheless, this effect of metformin use is needed for further assessment.
  1,871 249 5
Predicting loco-regional recurrence risk in T1, T2 breast cancer with 1–3 positive axillary nodes postmastectomy: Development of a predictive nomogram
T Wadasadawala, S Kannan, S Gudi, A Rishi, A Budrukkar, V Parmar, T Shet, S Desai, S Gupta, R Badwe, R Sarin
January-March 2017, 54(1):352-357
DOI:10.4103/ijc.IJC_178_17  PMID:29199721
BACKGROUND: Role of postmastectomy radiotherapy (PMRT) in early breast cancer with 1–3 positive axillary nodes is still controversial. Hence, there is a need to identify subgroup of patients who have sufficiently high risk of disease recurrence to benefit from PMRT. AIM: The aim is to evaluate clinical outcomes of patients postmastectomy having pathological T1–T2 tumors with 1–3 positive axillary lymph nodes (LNs) treated with adjuvant systemic therapy and develop a predictive nomogram. MATERIALS AND METHODS: Data collected retrospectively from eligible patients from 2005 to 2011. Kaplan–Meier survival analysis was used for all time-to-event analysis. Various known clinical and pathological risk factors were correlated with outcome using uni- and multi-variable analysis in SPSS version 21. All comparisons were two-tailed and P < 0.05 were considered statistically significant. The nomogram to predict the risk of loco-regional control (LRC) was developed using least absolute shrinkage and selection operator shrinkage model in software. RESULTS: 38/242 (15.7%) patients had recurrent disease at loco-regional (10 patients), distant sites (22 patients) and simultaneous loco-regional and distant sites (6 patients) at a median follow-up 59.5 (range 4–133) months. Five years estimate of LRC, distant disease-free survival (DFS), DFS, cause-specific survival and overall survival was 87.8%, 85.4%, 84.2%, 93.1%, and 91.5%, respectively. Pathological tumor size, margin status, LN ratio as continuous variables and grade and triple negative breast cancer status as categorical variables were the risk factors included in the model for building nomogram. CONCLUSION: The nomogram developed based on institutional data can be a valuable tool in guiding adjuvant PMRT depending on the risk of 5 years loco-regional recurrence.
  1,918 194 2
The increasing challenge of never smokers with adenocarcinoma lung: Need to look beyond tobacco exposure
A Das, A Krishnamurthy, V Ramshankar, TG Sagar, R Swaminathan
January-March 2017, 54(1):172-177
DOI:10.4103/ijc.IJC_33_17  PMID:29199684
BACKGROUND: Lung cancer continues to remain as one of the leading causes of morbidity and mortality worldwide, despite the decreasing trends in smoking prevalence worldwide. An earlier study from the authors' institute reported the increasing trends of “Nonsmoking associated lung cancers.” MATERIALS AND METHODS: All consecutive histologically confirmed patients with lung cancer who presented to the outpatient department over a year (November 2014–October 2015) were included in this current prospective study. RESULTS: Seven hundred and thirteen patients presented with clinicoradiologically suspicious findings of lung cancer in the said period. A pathological confirmation of lung cancer could be ascertained in 495 patients, and this cohort was further analyzed. The mean age of presentation was 57.76 years; the male to female ratio was approximately 2.5:1. Interestingly, 55.35% of the patients were nonsmokers. Adenocarcinoma (63%) was the predominant histology. Never smokers, both among men (P = 0.02) and women (P = 0.001), presented more frequently with adenocarcinoma histology. Further, 84.9% (45/53) of rural and 76.1% (19/25) of urban women who were never smokers reported exposure to indoor air pollution (secondhand smoke/fuel used for cooking purposes) which was significantly associated with adenocarcinoma histology. CONCLUSION: Our study confirmed our initial observation of the changing epidemiology of lung cancer in the Indian subcontinent, paralleling the global trends of rise in adenocarcinoma. Lung cancer in never smokers outnumbering that among smokers was another interesting observation. The take-home message for both the clinicians as well as the policymakers is to study factors beyond tobacco exposure to understand the direction of the current lung cancer epidemic.
  1,889 179 2
The single-incision versus multiple-incision video-assisted thoracoscopic surgery in the treatment of lung cancer: A systematic review and meta-analysis
X Zhang, Q Yu, D Lv
January-March 2017, 54(1):291-300
DOI:10.4103/ijc.IJC_229_17  PMID:29199708
OBJECTIVE: We conducted this meta-analysis to compare the clinical outcomes of single-incision and multiple-incision video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer patients. METHODS: A literature search was conducted of the Cochrane Controlled Trials Register Databases, Medline, EMBASE, Web of Science databases, and Chinese Biomedical Literature Database. Eleven studies that compared single-incision VATS with multiple-incision VATS in the treatment of lung cancer were analyzed. Statistical analysis was carried out using RevMan 5.1 software. RESULTS: Eleven trials totaling 1273 patients were included. There were statistically significant differences in the duration of chest tube (standardized mean difference [SMD] = −0.42; 95% confidence interval [CI] [−0.78, −0.07], P < 0.02), hospital stays after surgery (SMD = −0.28; 95% CI [−0.41, −0.15], P < 0.0001), hospital stays after surgery in the subgroup analysis of lobectomy (SMD = −0.28; 95% CI [−0.42, −0.14], P < 0.0001), length of wound (P < 0.05), and pain visual analog scale (VAS) in the postoperative 1 day (SMD = −1.19; 95% CI [−1.94, −0.44], P = 0.002) between single-incision VATS group and multiple-incision VATS group. Compared with patients receiving multiple-incision VATS group, there were no statistically significant differences between the two groups with regard to the operative time (OT), blood loss (BL), rate of conversion to thoracotomy, and complication. CONCLUSION: Compared with multiple-incision VATS on the condition of same lymph nodes retrieved number, single-incision VATS reduced the length of wound, shortened the duration of chest tube, cut down the hospital stays after surgery, alleviated the pain VAS in the postoperative 1 day, did not significantly increase the OT and the BL in operation, and did not increase the rate of conversion to thoracotomy and complication.
  1,840 216 -
Pattern of distant metastasis in molecular subtypes of carcinoma breast: An institutional study
SU Kunikullaya, J Poddar, AD Sharma, S Patel
January-March 2017, 54(1):327-332
DOI:10.4103/ijc.IJC_177_17  PMID:29199716
BACKGROUND: Molecular subtypes of carcinoma breast show a particular pattern of distant metastasis, the knowledge of which can help to diagnose and intervene early in the course of the disease. AIM: The aim of this study was to investigate and establish an association between the molecular subtypes of carcinoma breast and the pattern of distant metastasis. SETTINGS AND DESIGN: Single arm, retrospective study. MATERIALS AND METHODS: Totally 400 patients of carcinoma breast (Stage I and II) were selected who were treated between January 2010 and December 2013. All these patients were treated with the standard treatment protocol for breast cancer. The estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 (HER-2) Neu status, and Ki-67 were done, and patients were classified into luminal A/B, HER-2 enriched, luminal/HER-2, and triple-negative subtypes. All patients were followed up until December 2015, and the pattern of local failure as well as distant metastasis was correlated with the molecular subtypes. RESULTS: A total of 143 patients developed distant metastasis and local recurrence. Bone was the most common site of metastasis overall. It was the most common type of metastasis in luminal A/B (53.3%) and luminal-HER (57.1%). Brain metastasis was most common in HER-2-enriched subtype (30.3%), whereas liver was the most common site of metastasis in HER-2-enriched subtype (45.45%). The incidence of brain metastasis was comparatively lower in luminal A/B subtype. Local recurrence was most common in HER-2-enriched subtype. The results were statistically significant for lung metastasis and local recurrence (with P = 0.004 and 0.047, respectively). CONCLUSION: A strong association exists between the molecular subtypes and the site of distant metastasis in breast cancer which can be used for greater vigilance to detect site-specific distant metastasis beforehand.
  1,853 202 1
A study of changes in the oral fungal flora of patients on radiotherapy for head and neck malignancies and their correlation with funguria and fungemia
S Raj, D Sharma, P Mate, MR Capoor, KT Bhowmik
January-March 2017, 54(1):39-42
DOI:10.4103/ijc.IJC_155_17  PMID:29199660
BACKGROUND: Patients of head and neck malignancies often develop oral mucositis and invite various pathogens to colonize over it. OBJECTIVES: The objective of this study is to identify the fungi isolated from patients undergoing radiotherapy (RT) for head and neck cancer, to determine the antifungal susceptibility of these isolates and to determine the time and week of fungal colonization. PATIENTS AND METHODS: Three specimens (throat, urine, and blood) were collected from each of the head and neck cancer patients, who were advised RT. These specimens, which were collected before the start of RT, during RT (2nd and 6th week), and post-RT (8th week) were inoculated into fungal culture media. Candida species were identified by standard methods and antifungal susceptibility of the candidal isolates was done. RESULTS: Candida infection was found in 24/42 patients (57.14%) out of which Candida albicans was isolated in 14.28%, Candida tropicalis (28.57%) and Candida parapsilosis (14.28%). Maximum isolation of yeast was in the 6th week of RT. Fungemia was found in 3/42 patients. All the yeast isolates were sensitive to fluconazole except two. CONCLUSION: Prophylactic antifungal therapy in patients undergoing RT for head and neck malignancy is particularly important to prevent intraoral colonization and infection by Candida. Screening of such patients on RT for fungal infections can prevent fatal mold infections.
  1,830 171 -
Demographic, clinical, biochemical, radiological and etiological characteristics of malignant pleural effusions from Eastern India
K Saha, MK Maikap, A Maji, M Moitra, D Jash
January-March 2017, 54(1):257-261
DOI:10.4103/0019-509X.219575  PMID:29199701
CONTEXT: There are very limited data regarding clinical, radiological and etiological aspects of malignant pleural effusion (MPE) from Eastern India. AIMS: To review natural history, clinical features, radiological features and etiology of MPEs. SETTING AND DESIGN: Hospital based cross-sectional descriptive study. MATERIALS AND METHODS: We had reviewed166 diagnosed cases of MPEsregarding demography; clinical, radiological and biochemical characteristics, diagnostic modalities and etiologies. RESULTS: Out of 166 patients, 72.89% were males and 27.11% were females. Mean age of presentation among males was 64.3 ± 12.7 and among females was 52.5 ± 14.8. Most common presenting symptom was dry cough (87.9%) and most common presenting sign was clubbing (54.5%). Massive effusion was found in 45.78% of cases. Pleural fluid macroscopic appearance was haemorrhagic in 54.82% of cases. Mean adenosine deaminase activity in MPE was 24.05 U/L. Mean pleural fluid/serum protein ratio was 0.65, mean pleural fluid/serum lactate dehydrogenase ratio was 1.01. Most of the cases (84.94%) were diagnosed by pleural fluid cytology for malignant cells. Primary cancer was diagnosed in 136 (81.93%) cases; among which 121 (88.97%) cases were lung cancers, among which adenocarcinoma (52.89%) was the most common histology. CONCLUSIONS: Pleural fluid cytologies for malignant cells are usually sufficient to diagnose MPE in nearly 85% of cases and in remaining cases if thoracoscopyis not available, blind pleural biopsy can be helpful. The most common primary in cases of MPE is lung cancer with adenocarcinoma being the commonest culprit.
  1,813 146 -
Effect of tyrosine kinase inhibitors on the glucose levels in diabetic and nondiabetic patients
EY Romero-Ventosa, L Otero-Millán, S González-Costas, P Vilasoa-Boo, A Silva-López, C Arroyo-Conde, G Piñeiro-Corrales
January-March 2017, 54(1):136-143
DOI:10.4103/ijc.IJC_190_17  PMID:29199677
CONTEXT: Tyrosine kinase inhibitors (TKIs) are used in different types of cancers due to their good profile of adverse reactions and their convenience in the oral administration. Some studies describe that certain TKIs are associated with changes in the glycemic profile of the patients. AIMS: This study aims to determine if treatment with ITK affects to serum glucose levels in clinical practice. SETTINGS AND DESIGN: A retrospective study was carried out in 136 episodes (112 patients treated with sorafenib, sunitinib, imatinib, dasatinib, or nilotinib). SUBJECTS AND METHODS: The serum glucose levels were analyzed before treatment and after months 1, 2, 3, 6, 9, and 12 of treatment. STATISTICAL ANALYSIS USED: Statistical analysis was completed with SPSS version 20 for Windows. RESULTS: There were significant differences in the serum glucose levels before treatment between diabetic and nondiabetic patients, but not between the average blood glucose readings before treatment and the average of the subsequent readings, once their treatment had begun. CONCLUSIONS: The results of this study do not reproduce the results of the literature since changes in the serum glucose levels have not been found in this sample of patients.
  1,792 160 1
New insights into anaplastic lymphoma kinase-positive nonsmall cell lung cancer
AP Dubey, N Pathi, S Viswanath, A Rathore, A Pathak, R Sud
January-March 2017, 54(1):203-208
DOI:10.4103/ijc.IJC_72_17  PMID:29199691
BACKGROUND: A novel fusion gene of echinoderm microtubule-associated protein-like 4 (EML4) and anaplastic lymphoma kinase (ALK) has been identified in a subset of non-small-cell lung cancers (NSCLCs). Patients with the ALK-EML4 fusion gene demonstrate unique clinicopathological and physiological characteristics. Here we present an analysis of clinicopathological profile of patients of metastatic adenocarcinoma harboring the ALK-EML4 fusion gene and their response to targeted therapy in the form of crizotinib. METHODS: A retrospective analysis of advanced ALK positive NSCLC, who presented at this tertiary care hospital of armed forces from September 2014 to December 2016 was conducted. The primary goal was to evaluate demographic and clinicopathological profile of ALK positive advanced NSCLC. Detection of ALK fusion was done by IHC on formalin fixed paraffin embedded cell blocks. Out of 20 ALK positive patients, ten patients received upfront cytotoxic chemotherapy, and rest received crizotinib. Patients progressing on cytotoxic chemotherapy received crizotinib as subsequent therapy. RESULTS: Out of 270 patients of NSCLC, fifteen(7.4%) tested positive for ALK-EML4 fusion. Rate of positivity was higher in females(13.7%) than in males (5%). The correlation of the ALK-EML4 fusion gene and clinicopathological characteristics of NSCLC patients demonstrated a significant difference in smoking status, histological types, stage, & metastatic pattern. Median PFS with first line cytotoxic chemotherapy was 5.9 months. Median PFS with upfront crizotinib was not reached, but was significantly superior than cytotoxic chemotherapy. CONCLUSION: Our analysis indicated that ALK-EML4 positive NSCLC comprised a unique subgroup of adenocarcinomas with distinct clinicopathological characteristics. Incidence of ALK positivity was found to be higher in females and never smokers. These patients have distinct pathological and radiological characteristics. Crizotinib, whether used upfront or as subsequent therapy was found to be superior in PFS (not yet reached at the time of writing this article), and maintaining quality of life as compared to cytotoxic chemotherapy.
  1,737 183 3
Comparison of paclitaxel-cetuximab chemotherapy versus metronomic chemotherapy consisting of methotrexate and celecoxib as palliative chemotherapy in head and neck cancers
VM Patil, V Noronha, A Joshi, V Agarwala, V Muddu, A Ramaswamy, A Chandrasekharan, S Dhumal, S Juvekar, A Arya, A Bhattacharjee, K Prabhash
January-March 2017, 54(1):20-24
DOI:10.4103/ijc.IJC_160_17  PMID:29199655
BACKGROUND: The present match pair analysis was planned to compare the efficacy of cetuximab-paclitaxel-based chemotherapy versus metronomic therapy. MATERIALS AND METHODS: Sixty patients with metastatic/recurrent head and neck squamous cell cancer treated with weekly paclitaxel (80 mg/m2) and cetuximab were matched with sixty patients treated with oral metronomic chemotherapy consisting of methotrexate and celecoxib. The progression-free survival (PFS) and overall survival (OS) between the cohorts were compared using log-rank test. Cox proportional regression model was used to identify independent factors affecting PFS and OS. RESULTS: The median OS was 191 days (95% confidence interval [CI]: 122.2–259.8 days) in metronomic cohort and 256 days (95% CI 177.0–334.9 days) in cetuximab cohort (hazard ratio: 0.58, 95% CI: 0.35–0.95, P = 0.031). On Cox proportional hazard model, Eastern Cooperative Oncology Group Performance Status (0–1 vs. 2) and therapy (cetuximab versus metronomic) had a statistically significant impact on OS. CONCLUSION: Cetuximab-based chemotherapy leads to a significant improvement in OS in the match pair analysis in comparison to metronomic chemotherapy.
  1,710 183 1
Tuberculosis in epidermal growth factor receptor mutation in lung adenocarcinoma on treatment with gefitinib/erlotinib
D Gothi, S Spalgais
January-March 2017, 54(1):1-1
DOI:10.4103/ijc.IJC_503_16  PMID:29199650
  1,642 245 -
Chemosuppressive effect of plumbagin on human non-small lung cancer cell xenotransplanted zebrafish
R Vinothkumar, SA Ceasar, A Divyarupa
January-March 2017, 54(1):253-256
DOI:10.4103/0019-509X.219580  PMID:29199700
BACKGROUND: Plumbagin (5-hydroxy-2-methyl-1,4-napthoquinone) derived from Plumbago species is a potential anti-tumour agent. Plumbagin has been tested for anti-cancer activity in vitro and in vivo using mice model. AIM: To study the tumour suppressing efficacy of plumbagin using zebrafish model. MATERIALS AND METHODS: Human Non-small lung cancer cell line were cultured in vitro and transplanted in to zebrafish. The development of tumour was confirmed by performing histology. The tumour was then allowed to progress in vivo and the fishes were administered with plumbagin orally for three continuous days. The tumour suppression capacity was monitored subsequently using transcriptosome analysis. STATISTICAL METHODS: The pixel integrated density obtained was converted into relative gene expression using IBM SPSS. RESULTS: The administration of plumbagin had an ability to suppress tumour and the size of the tumour were relatively lesser when compared with the control sample; it has also increased p53 gene expression. CONCLUSION: The study helps to conclude that plumbagin is an effective anti-tumour agent against human cancer cells based on the study in vivo in zebrafish.
  1,740 130 2
Robotic resections in hepatobiliary oncology – initial experience with Xi da Vinci system in India
M Chandarana, S Patkar, A Tamhankar, S Garg, M Bhandare, M Goel
January-March 2017, 54(1):52-55
DOI:10.4103/ijc.IJC_132_17  PMID:29199663
INTRODUCTION: Minimal invasive surgery has proven its advantages over open surgeries in the perioperative period. Food and Drug Administration approved da Vinci robot in 2000. The latest version, da Vinci Xi system has a mobile tower-based robot with several modifications to improve the functionality, versatility, and operative ease. None of the centers have reported exclusively on hepatobiliary oncology using the da Vinci Xi system. We report our initial experience. AIMS AND OBJECTIVES: To study the feasibility, advantages, and discuss the operative technique of da Vinci Xi system in hepatobiliary oncology. MATERIALS AND METHODS: Data were analyzed retrospectively from a prospectively maintained database from June 2015 to October 2016. Twenty-five patients with suspected or proven hepatobiliary malignancies were operated. Total robotic technique using da Vinci Xi system was used. Demographic details and perioperative outcomes were noted. RESULTS: Of the 25 surgeries, 14 patients had a suspected gallbladder malignancy, 11 patients had primary or metastatic liver tumor. Median age was 53 years. The average duration of surgery was 225 min with a median blood loss 150 ml. The median postoperative stay was 4 days. The median nodal yield for radical cholecystectomy was seven. Five patients required conversion. Two of these developed postoperative morbidity. CONCLUSION: Robotic surgery for hepatobiliary oncology is feasible and can be performed safely in experienced hands. Increasing experience in this field may equal or even prove advantageous over conventional or laparoscopic approach in future. A cautious approach with judicious patient selection is the key to establishing robotic surgery as a standard surgical approach.
  1,699 169 4
A comparative analysis of immunohistochemistry and fluorescent in situ hybridization assay to detect anaplastic lymphoma kinase status in lung adenocarcinoma cases: A search for a testing algorithm
PB Wagle, NA Jambhekar, R Kumar, K Prabhash, CS Pramesh, SB Desai, V Noronha, G Karimundackal, A Shah, A Joshi, SG Laskar, S Jiwnani, T Pai, JP Agarwal
January-March 2017, 54(1):148-154
DOI:10.4103/ijc.IJC_202_17  PMID:29199679
INTRODUCTION: Testing for echinoderm microtubule-associated protein-like 4 (EML4) anaplastic lymphoma kinase (ALK) translocation by fluorescence in situ hybridization (FISH) is well established whereas the Food and Drug Administration (FDA) ALK immunohistochemical (IHC) test is relatively new. AIMS AND OBJECTIVE: The aim of this study is to compare FDA-approved ALK IHC test (D5F3 clone) with the standard ALK FISH test. MATERIALS AND METHODS: A validation and a test arm with 100 and 200 cases of Formalin-Fixed, Paraffin-embedded blocks of lung adenocarcinoma, respectively, comprised the material. All cases had ALK IHC test on automated Ventana Benchmark XT IHC slide stainer using anti-ALK D5F3 rabbit monoclonal primary antibody; when positive tumor cells (any percentage) showed strong granular cytoplasmic staining. For the FISH test, Vysis ALK Dual Color Break Apart Rearrangement Probe (Abbott Molecular Inc.,) was used to detect ALK gene 2p23 rearrangements; when positive the red and green signals were split two signal diameter apart and/or isolated 3'red signal were detected in more than 15% tumor cells. The ALK FISH results were available in all 100 validation cases and 64-test arm cases which formed the basis of this analysis. RESULTS: The ALK IHC test was positive in 16% cases; four discordant cases were ALK IHC positive but ALK FISH negative, but no case was ALK IHC negative and ALK FISH positive. There was 100% sensitivity, 90.5% specificity, and 93.75% accuracy. CONCLUSION: A negative ALK IHC result obviates the need for a FISH test barring those with a strong clinical profile, and a positive ALK IHC result is sufficient basis for the initiation of treatment.
  1,672 155 2
Comparison of conventional fractionation (five fractions per week) and altered fractionation (six fractions per week) in stage I and II squamous cell carcinoma of oropharynx: An institutional study
J Poddar, AD Sharma, SU Kunikullaya, JP Neema
January-March 2017, 54(1):6-10
DOI:10.4103/ijc.IJC_144_17  PMID:29199652
BACKGROUND: The radiotherapy (RT) dose and fractionation schedule for head and neck cancers for locoregional control and acceptable organ toxicity are still debatable. Accelerated RT includes administration of six fractions per week with the same dose per fraction. AIM: Comparison of conventional versus accelerated RT in terms of locoregional control, and acute and late radiation toxicity in squamous cell carcinoma oropharynx (stage I and II). SETTINGS AND DESIGN: Prospective, double arm, phase 2, randomized study. MATERIALS AND METHODS: Sixty patients of squamous cell carcinoma oropharynx (stage I and II) were randomized in two arms (accelerated fractionation, arm 1 and conventional fractionation, arm 2). All patients received RT dose of 66 Gray (Gy) in 33 fractions (#). The patients in arm 1 received six fractions per week with 2 Gy/# (Monday–Saturday) and in arm 2, five fractions per week with 2 Gy/# (Monday–Friday). No chemotherapy was administered. During and after the treatment, locoregional control, and acute and late radiation toxicity were assessed. RESULTS: At 1-year follow-up, 76% patients in arm 1 and 64% patients in arm 2 had complete response. The recurrence rate at the end of 1 year in arm 1 was 12% and it was 20% in arm 2.The acute Grade 2 and 3 toxicities were higher in the accelerated arm and no significant difference in late toxicities was found. SPSS version 4.0 was used for statistical analysis. CONCLUSION: Accelerated fractionation provides better locoregional control with higher but acceptable acute and equal late radiation toxicity in squamous cell carcinoma oropharynx.
  1,674 144 -
Clinical profile and outcomes of patients with Stage IV adenocarcinoma of lung: A tertiary cancer center experience
P Paliwal, S Rajappa, A Santa, MVTK Mohan, S Murthy, N Lavanya
January-March 2017, 54(1):197-202
DOI:10.4103/0019-509X.219595  PMID:29199690
BACKGROUND: There is limited Indian data on clinical profile and treatment outcomes for patients with Stage IV adenocarcinoma of lung. AIM: We aimed to prospectively study the clinical profile and treatment outcomes for patients with Stage IV adenocarcinoma of lung at a tertiary cancer center. MATERIALS AND METHODS: One hundred and ninetyfour patients with Stage IV adenocarcinoma of lung were prospectively analyzed for demographic and molecular profile (epidermal growth factor receptor [EGFR] and echinodermal microtubuleassociated proteinlike 4anaplastic lymphoma kinase [EML4ALK] mutations). Patients with EGFR and EML4ALK mutations were treated with tyrosine kinase inhibitors. Patients without these mutations were treated with standard chemotherapy regimens. Maintenance chemotherapy was offered to patients as per standard guidelines. Clinical outcomes measured were response rate (RR), progressionfree survival (PFS), and overall survival (OS). RESULTS: Median age of patients was 56 years (range, 26–82) with a male:female ratio of 2.3:1. EGFR and ALK mutation testing was feasible in 169 (87.1%) and 164 (84.5%), respectively, and detected in 37.9% and 5.5% patients, respectively. Overall RR, PFS and OS of whole cohort were 44.3%, 6.9, and 15.5 months, respectively. PFS and OS of mutated group (EGFR, EML4ALK) were longer than nonmutated group (10.5 vs. 5.4 months, P < 0.0001 and 21.5 vs. 11 months, P = 0.0001, respectively). PFS and OS of patients who received pemetrexed maintenance were longer than those who did not receive maintenance (8.5 vs. 6.5 months, P = 0.1613 and 18.5 vs. 12.5 months, P = 0.0219, respectively). CONCLUSIONS: Mutation testing at diagnosis is feasible in the vast majority of patients with Stage IV adenocarcinoma of the lung. Patients with EGFR or EML4ALK mutation and those who received pemetrexed maintenance had better clinical outcomes.
  1,651 166 -
Related factors of postoperative gallstone formation after distal gastrectomy: A meta-analysis
Y Chen, Y Li
January-March 2017, 54(1):43-46
DOI:10.4103/ijc.IJC_91_17  PMID:29199661
Aim: The aim of this study was to evaluate the risk factor of gallstone occurrence after distal gastrectomy (DG) for gastric cancer. Methods: Relevant documents published from 2000 to 2016 were retrieved in PubMed, Web of Knowledge, and Ovid's database, and a metaanalysis was performed with RevMan 5.0 software for odds ratios (ORs) and 95% confidence intervals (CIs). Results: Eight studies met the final inclusion criteria. From the pooled analyses, nonphysiological reconstruction (OR = 1.51; 95% CI = 1.10–2.08; P = 0.01) and vagus nerve resection (OR = 2.79; 95% CI = 1.57–4.96; P = 0.0005) were significantly associated with increased risk of gallstone after DG. Conclusion: Our analysis indicated that digestive tract reconstruction and vagus nerve resection were strongly and consistently associated with gallstone formation after DG.
  1,604 192 5
A meta-analysis: Evaluation of safety and efficacy of the epidermal growth factor receptor-tyrosine kinase inhibitor monotherapy versus platinum-based doublets chemotherapy in East Asia
XF Zhang, LV De-Sheng, M Li, GE Sun, CH Liu
January-March 2017, 54(1):104-114
DOI:10.4103/0019-509X.219586  PMID:29199672
OBJECTIVE: Several clinical trials have shown that advanced nonsmall cell lung cancer (NSCLC) patients can benefit from treatment with epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) monotherapy than receiving platinum-based doublets chemotherapy in the first-line treatment of advanced NSCLC; the objective of this study was to evaluate whether patients could be treated with EGFR-TKI for advanced NSCLC in the first-line setting. PATIENTS AND METHODS: A literature search was conducted on the Cochrane Controlled Trials Register Databases, MEDLINE, EMBASE, Web of Science databases, and Chinese Biomedical Literature Database without exclusion of material published in any language. We performed a meta-analysis of five randomized studies that compared EGFR-TKI with platinum-based doublets chemotherapy for the patients of advanced NSCLC in the first-line setting. The primary end-point was the progression-free survival (PFS) of each treatment arm. The secondary end-points were overall survival (OS), objective response rate (ORR), adverse effects, and quality of life (qol). RESULTS: Five randomized controlled trials totaling 2080 patients were included in the review. Meta-analysis results are as follows: There were statistically significant differences in overall PFS (hazard ratio [HR] =0.47; 95% confidence interval [CI]: [0.27, 0.83], P = 0.009) and the PFS of the EGFR-M + subgroup (HR = 0.29; 95% CI: [0.17–0.51], P < 0.0001). Compared with patients receiving the platinum-based doublets chemotherapy group, there were no statistically significant differences between the two groups with regard to overall OS (HR = 0.92; 95% CI: [0.80–1.06], P = 0.25). CONCLUSION: Compared with the platinum-based doublets chemotherapy, EGFR-TKI significantly prolonged PFS, increased ORR, improved qol, not significantly increased the nonhematologic toxicity and at the same time decreased the nonhematologic toxicity but not significantly increased the transaminase toxicity for advanced NSCLC patients in East Asia. Although there is convincing evidence to confirm the results mentioned herein, they still need to be confirmed by large-sample trials.
  1,591 191 1
Nivolumab instills hope in a hopeless situation in advanced nonsmall cell lung cancer with poor performance status
MV Chandrakanth, V Noronha, A Joshi, V Patil, A Mahajan, K Prabhash
January-March 2017, 54(1):55-56
DOI:10.4103/ijc.IJC_10_17  PMID:29199664
  1,577 200 2
Solitary pulmonary nodule evaluation in regions endemic for infectious diseases: Do regional variations impact the effectiveness of fluorodeoxyglucose positron emission tomography/computed tomography
NC Purandare, CS Pramesh, JP Agarwal, A Agrawal, S Shah, K Prabhash, G Karimundackal, S Jiwnani, S Tandon, V Rangarajan
January-March 2017, 54(1):271-275
DOI:10.4103/0019-509X.219563  PMID:29199704
BACKGROUND: Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become a preferred imaging modality for the evaluation of solitary pulmonary nodule (SPN), particularly in the developed world. Since FDG can concentrate in infective/inflammatory lesions, the diagnostic utility of FDG-PET can be questioned, particularly in regions endemic for infectious decisions. AIM: To evaluate the accuracy of FDG-PET/CT in evaluation of SPNs in a population endemic for infectious disease and to assess if regional variations have an impact on its effectiveness. MATERIALS AND METHODS: All patients who underwent an FDG/PET-CT with a clinico-radiological diagnosis of SPN categorized as indeterminate were included. Based on a maximum standardized uptake values (SUVmax) cut-off of 2.5, lesions were classified as benign (<2.5) or malignant (>2.5) and compared with gold standard histopathology. The diagnostic accuracy of PET-CT to detect malignancy was calculated. On the basis of final histopathology, lesions were grouped as (a) malignant nodules (b) infective/granulomatous nodules with a specific diagnosis and (c) nonspecific inflammatory nodules. The SUVmaxbetween these groups was compared using nonparametric statistical tests. RESULTS: A total of 191 patients (129 males, 62 females) with a median age of 64 years (range: 36–83) were included. Totally, 144 nodules (75.3%) were malignant and 47 were benign (24.7%). Adenocarcinoma (n = 84) was the most common malignancy. Tuberculosis (n = 16) and nonspecific infections (n = 24) were the two most common benign pathologies. There was a significant overlap in the metabolic uptake of malignant (median SUVmax-11.2, range: 3.3–34.6) and tuberculous nodules (median SUVmax-10.3, range: 2.7–22.5) with no statistically difference between their SUVmaxvalues (P = 0.43). The false-positive rate was 65.2% and the false-negative rate was 5.5%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET/CT for detecting malignancy were 94.4%, 34.7%, 81.9%, 66.6%, and 79.5%, respectively. CONCLUSIONS: Though FDG-PET scans show a very high sensitivity for malignant nodules, it has a high false-positive rate and reduced specificity when characterizing SPNs in an infectious endemic region. Physicians must be aware of this limitation in the workup of lung nodules, and regional variations must be considered before further management decisions are taken.
  1,599 176 -
Retrospective analysis of icotinib neoadjuvant therapy of 63 lung cancer patients
T Wang, Y Liu, B Zhou, S Hao, Z Wang, N Liang, J Liu, S Wang
January-March 2017, 54(1):215-222
DOI:10.4103/0019-509X.219585  PMID:29199694
OBJECTIVE: This study aims to explore the feasibility of icotinib neoadjuvant therapy for nonsmall cell lung cancer (NSCLC). MATERIALS AND METHODS: This was a retrospective analysis of the clinical data for 63 NSCLC patients (61 cases of adenocarcinoma and two cases of squamous cell carcinoma) receiving surgical resection of lung lesions after oral intake of icotinib from December 2011 to November 2013 in the PLA General Hospital. Preoperative oral intake of the patients was icotinib 125 mg tid, drug side effects were evaluated according to the American National Cancer Institute Common Toxicity Criteria Version 4.0; computed tomography scan was done on the day taking medicine and 2 weeks later to determine tumor changes. After oral intake of Icotinib for 2 to 22 weeks (5 cases for 2 weeks,13 cases for 3 to 22 weeks), all patients receive surgical resection of lung cancer lesions, and testing of removed tumor to evaluate the epidermal growth factor receptor (EGFR) gene mutation status was performed by fluorescence polymerase chain reaction. The patients with sensitive EGFR mutations receive Icotinib as postoperative adjuvant therapy. RESULTS: Side effects of medication within 2 weeks included rash (44.4%, 28/63), dry skin (34.9%, 22/63), diarrhea (14.3%, 9/63), and oral ulcer (1.6%, 1/63); there were no icotinib-associated thoracic surgery complications during the perioperational period. 71.4% patients (45/63) achieve an average reduction of 23.5% ±10.7%(10%-53.5%) after 2 weeks medication of Icotinib(regressive tumor[RT]) .28.6% patients(18/63) achieve stable tumor(ST),enlargement of 8.7% to reduction of 8.7% of the maximum diameter of lung cancer after 2 weeks medication of Icotinib. Of the RT group, 68.9% (31/45) of the tumors were detected with EGFR-sensitive mutation (exon 19 or 21 mutation), 24.4% (11/45) with wild-type EGFR, and three cases of exon 20 mutation. Of the ST group, 77.8% (14/18) were detected with wild-type EGFR, three cases of exon 20 mutation, and one case of exon 19 deletion mutation (tumor reduction by 7.9%). 45 cases in RT group and 1 case with EGFR 19 exon metation in ST group receive Icotinib as adjuvant therapy. Among 45 cases in RT group and 18 cases in ST group, there was no difference in gender, age, smoking history, tumor diameter, tumor differentiation degree, and incidence of side effects (P = 0.076). There was significant difference (P < 0.0001) in terms of symptom remission rate after medication and EGFR gene-sensitive mutation rate in RT and ST groups. CONCLUSION: Icotinib neoadjuvant therapy for NSCLC is safe and feasible, and the reactivity of lung cancer patients to icotinib can be determined within 2 weeks of medication. People sensitive to preoperative selection of drugs can more accurately determine the sensitivity of tumors to drugs, thus providing evidence for postoperative adjuvant therapy.
  1,609 165 2
The comparison of thoracoscopic-laparoscopic esophagectomy and open esophagectomy: A meta-analysis
B Wang, Z Zuo, H Chen, B Qiu, M Du, Y Gao
January-March 2017, 54(1):115-119
DOI:10.4103/ijc.IJC_192_17  PMID:29199673
OBJECTIVE: The objective of this study was to perform a meta-analysis to evaluate the effects of thoracoscopic-laparoscopic esophagectomy (TLE) and open esophagectomy (OE) in the treatment of esophageal cancer. METHODS: A literature search was performed using PubMed, Embase, and Google Scholar databases for relevant keywords and the medical subject headings. After we had screened further, 13 clinical trials were included in the final meta-analysis. Specific odds ratios (ORs), standardized mean differences (SMDs), mean differences (MDs), and confidence intervals (CIs) were calculated. RESULTS: The outcomes of treatment effects included anastomotic leakage, blood loss, number of lymph nodes harvested, and operating time. Comparing OE for esophageal cancer patients, the pooled OR of anastomotic leakage was 0.89 (95% CI = [0.47, 1.68]), the pooled SMD of blood loss was − 0.56 (95% CI = [−0.77, −0.35]), the pooled MD of lymph nodes harvested was − 0.93 (95% CI = [−2.35, 0.50]), and the pooled SMD of operating time was 0.31 (95% CI = [0.02, 0.59]). CONCLUSION: TLE was found to significantly decrease patients' blood loss. There is no difference of anastomotic leakage and the number of lymph nodes harvested between TLE and OE.
  1,606 160 -
Efficacy and safety of first-line systemic chemotherapy with epirubicin, cisplatin plus 5-fluorouracil and docetaxel, cisplatin plus 5-fluorouracil regimens in locally advanced inoperable or metastatic gastric or gastroesophageal junction adenocarcinoma: A prospective phase II study from South India
KG Babu, T Chaudhuri, KC Lakshmaiah, L Dasappa, LA Jacob, MCS Babu, AH Rudresha, KN Lokesh, LK Rajeev
January-March 2017, 54(1):47-51
DOI:10.4103/ijc.IJC_168_17  PMID:29199662
BACKGROUND: Patients with locally advanced inoperable or metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma have a poor prognosis. The maximum benefit of systemic chemotherapy is usually achieved in the first-line setting. Even though systemic chemotherapy has been used for long time, in view of unsatisfactory results, no standard regimen has been emerged. Unfortunately, till date, there is no published prospective data from India, comparing the two most commonly used triplet regimens, epirubicin, cisplatin plus 5-fluorouracil (ECF) and docetaxel, cisplatin plus 5-fluorouracil (DCF), in this patient population. MATERIALS AND METHODS: The present study aimed to compare the efficacy and safety of the first-line systemic chemotherapy with ECF and DCF regimens in locally advanced inoperable or metastatic gastric or GEJ adenocarcinoma. The primary endpoint was overall survival (OS). The secondary endpoints were overall response rate, progression-free survival (PFS), and toxicity profile. RESULTS: Between January 2015 and December 2016, 58 patients were assigned and treated with ECF (n = 30) or DCF (n = 28) regimens. The median OS was 9.4 months with ECF and 12.5 months with DCF regimen (log-rank, P = 0.000), while median PFS was 5.8 and 7.5 months, respectively (log-rank, P = 0.002). Patients in the DCF arm had more frequent reductions in chemotherapy doses than those of the ECF arm (28.6% vs. 16.7%; P = 0.54). As compared with the ECF, the DCF regimen was associated with more frequent Grades 3–4 toxicities-neutropenia (16.7% vs. 39.3%, P = 0.17), febrile neutropenia (13.3% vs. 25%, P = 0.52), mucositis (6.7% vs. 17.8%, P = 0.43), and diarrhea (6.7% vs. 14.3%, P = 0.67). CONCLUSIONS: In comparison to ECF, the DCF regimen was associated with a statistically significant 3.1 months longer median OS without any significant increase in Grades 3–4 toxicities. DCF can be considered as one of the reference regimens, in properly selected patients with advanced/metastatic gastric or GEJ adenocarcinoma.
  1,601 154 1
Chemo port insertion through femoral vein approach: A rare indication and a rare complication
SG Dholaria, D Yadav, AK Gupta
January-March 2017, 54(1):361-361
DOI:10.4103/ijc.IJC_193_17  PMID:29199723
  1,613 122 -
Clinical profile of nonsmall cell lung carcinoma patients treated in a single unit at a tertiary cancer care center
DC Doval, R Sinha, U Batra, KD Choudhury, S Azam, A Mehta
January-March 2017, 54(1):193-196
DOI:10.4103/0019-509X.219591  PMID:29199689
BACKGROUND: Recent advances and understanding in the field of lung cancer and advent of newer treatments have shown a significant improvement in survival in the patients. The present study was conducted to analyze the clinical profile of nonsmall cell lung cancer (NSCLC) patients treated in a single unit at a tertiary cancer care center. MATERIALS AND METHODS: In this retrospective analysis, 322 consecutive NSCLC patients from the year 2011 to 2012 treated in a single unit were included in the study. Patients with proven NSCLC were included in the study. The details of the patients included the demographic profile, pathological diagnosis as well as imaging data, tumor profile, details of treatment, and follow-up information. RESULTS: The majority of the patients (95.6%) were in the age group >40 years. A large group of the patients (57.1%) were present/reformed smokers. The major histological type was adenocarcinoma (60.9%), of which 22.8% patients were found to be epidermal growth factor receptor positive. Anaplastic lymphoma kinase rearrangement positivity rate was 4.8%. Furthermore, 68% patients had Stage 4 disease. Upfront palliative chemotherapy (CT) was offered in 61.8% patients and pemetrexed with platinum compounds was the main CT regimen (46.6%). Partial response was achieved in 45.7% patients, whereas stable disease was observed in 10.9% cases. Median progression-free survival was 5 months and overall survival was 55% at 36 months. CONCLUSION: NSCLC forms the largest subgroup of lung cancer with the patients presenting with advanced stages of disease. This area needs to be explored for the early detection and subsequently the radical treatment of the patients. Personalized approach may be considered for the management of lung cancer by identifying new predictive and prognostic biomarkers of this disease.
  1,574 153 -
Prognostic factors and treatment of patients with advanced synovial sarcoma: A single-center experience
O Ates, S Aksoy, H Yeter, V Sunar, N Kertmen, O Dizdar, A Turker, A Kars
January-March 2017, 54(1):321-325
DOI:10.4103/ijc.IJC_169_17  PMID:29199714
BACKGROUND: Synovial sarcoma (SS) is a malignant mesenchymal tumor, which comprises 5%–10% of all the sarcomas. There is insufficient information on prognostic factors and salvage treatments of advanced SS. In this study, we aimed to further clarify the clinicopathological features, prognostic factors, and treatment modalities in advanced SS. MATERIALS AND METHODS: A total of 45 SS patients followed up between 2001 and 2015 at our cancer institute, Department of Medical Oncology, were retrospectively evaluated. Eleven patients were initially metastatic, and remaining patients developed metastasis or became inoperable due to locally advanced disease. Overall survival was evaluated by Kaplan–Meier analysis. RESULTS: The median age of patients was 37 (17–70) years and 60% (n = 26) of them were female. SS was most commonly localized in the lower extremity and abdomen-pelvis (29% and 29%, respectively). Median follow-up time was 33 (6–175) months. Patients were treated with a median of two (1–5) line chemotherapies at metastatic stage. Ifosfamide plus adriamycin (IMA) (49%, n = 22) and cisplatin-etoposide (13%, n = 6) were the most often used chemotherapy regimen as first line in metastatic stage. Partial response was obtained in 32% of the patients treated with IMA chemotherapy. Furthermore, median progression-free survival was 6 (1–123) months. Median survival of metastatic stage at diagnosis or in follow-up was 21 months (14–27) and 21 (12–29) months (P = 0.53), respectively. Most metastatic locations were lung (75%) and bone. Factors influencing survival at metastatic stage were evaluated; statistically significant longer survival was observed in patients with lung metastasis, primary tumor size smaller than 10 cm, patients who underwent surgery for the metastasis, and development-to-metastasis period longer than 12 months. CONCLUSION: Median survival of patients in metastatic stage SS was 21 months. Lung was the most common metastatic site.
  1,551 169 -
Ceritinib in anaplastic lymphoma kinase-positive nonsmall cell lung cancer among patients who were previously exposed to crizotinib: Experience from the Indian subcontinent
AP Joshi, MV Chandrakanth, V Noronha, V Patil, A Chougule, A Mahajan, AK Janu, R Chanana, K Prabhash
January-March 2017, 54(1):144-147
DOI:10.4103/ijc.IJC_186_17  PMID:29199678
Ceritinib is a novel ALK inhibitor approved for advanced stage NSCLC with ALK gene rearrangement, progressed and/or intolerant to crizotinib. 13 patients were included in our study who received ceritinib. Majority of them were women and never smokers with a median age of 47 yrs. Nearly half of them had a compromised performance status and received ceritinib in third line and beyond. Ceritinib showed nearly 50% response rates. With a median follow up of 9 months for the entire cohort, median PFS and OS were not reached. However, the mean values for PFS and OS were 10.9 and 14.8 months,with an estimated 1 year PFS and OS being 56% and 78% respectively.1/3 of the patients had gastrointestinal and liver toxicities. Metabolic abnormalities were seen in 1/4 th of them. ceritinib was permanently discontinued in one patient due to pneumonitis. In conclusion, ceritinib has a favorable efficacy and side effect profile in our patient population., similar to that reported in large clinical trials. It has shown promising efficacy even in patients with compromised performance status; presence of brain metastases and heavily pre-treated disease.
  1,542 161 1
Induction chemotherapy in locally advanced T4b oral cavity squamous cell cancers: A regional cancer center experience
AH Rudresha, T Chaudhuri, KC Lakshmaiah, KG Babu, L Dasappa, LA Jacob, MC Suresh Babu, KN Lokesh, LK Rajeev
January-March 2017, 54(1):35-38
DOI:10.4103/ijc.IJC_131_17  PMID:29199659
OBJECTIVES: The present study aimed to investigate the efficacy, toxicity, and impact of induction chemotherapy (IC) in locally advanced T4b oral cavity squamous cell cancers (OSCCs). MATERIALS AND METHODS: Patients diagnosed with locally advanced T4b OSCC from January 2013 to October 2016 at our center, who received 2–3 cycles of IC and then assessed for resectability, were reviewed retrospectively. Patients' profile, response, and toxicity of IC, resectability status, and overall survival (OS) were evaluated. Statistical analyses were performed by SPSS software version 17. RESULTS: A total of 116 patients received IC, and out of them 90 (77.6%) were males. Median age at diagnosis was 43 years (range 31–62 years). Nearly 103 (88.8%) of our patients received doublet chemotherapy and the rest of the patients received triplet regimen. Majority of the patients had buccal mucosa cancers (71.6%), followed by gingivobuccal complex (21.6%) and oral tongue (6.9%) primaries. After IC, partial response was achieved in 20 (17.3%) patients, stable disease in 68 (58.6%) patients, and disease progression was noted in 28 (24.1%) patients. Post-IC, resectability was achieved in 22 (19%) of 116 patients, but 6 of them did not undergo surgery due to logistic and personal reasons. The median OS of patients who underwent surgery followed by adjuvant local therapy (n = 16) was 19.7 months (95% confidence interval [CI]: 16.0–22.8 months) and for those treated with nonsurgical local therapy (n = 100) was 7.1 months (95% CI: 5.8–8.2 months) (log-rank P = 0.000). CONCLUSIONS: IC had a manageable toxicity profile and achieved resectability in 19% of our patients with T4b OSCC. Patients underwent resection had a significantly better median OS than those who received nonsurgical local treatment.
  1,534 147 -
A prospective randomized trial comparing capecitabine-based chemoradiotherapy with 5-FU-based chemoradiotherapy in neoadjuvant setting in locally advanced carcinoma rectum
K Singh, MK Gupta, RK Seam, M Gupta
January-March 2017, 54(1):347-351
DOI:10.4103/ijc.IJC_174_17  PMID:29199720
INTRODUCTION: Fluorouracil (FU)based chemoradiotherapy is regarded as a standard perioperative treatment in locally advanced rectal cancer. Capecitabine is an oral fluoropyrimidine that generates 5FU preferentially at the tumor site by exploiting the higher activity of the enzyme thymidine phosphorylase in tumor tissue compared with healthy tissue. As an oral agent, capecitabine can be administered in the outpatient setting, potentially providing FU exposure similar to a lowdose continuous infusion of 5FU. AIMS AND OBJECTIVES: To compare capecitabine with 5FU, with regard to efficacy and toxicity when used in neoadjuvant setting along with radiotherapy for locally advanced carcinoma rectum. MATERIALS AND METHODS: Thirty patients were enrolled, 14 in 5FU and 16 in capecitabine arm. All patients were planned for 45 Gy/25#/5 weeks pelvic radiotherapy followed by a boost of 5.4 Gy/3#/3 days. 5FU was prescribed at a dose of 500 mg/m2 #1–#5 and #21–#25 of RT and capecitabine was given at 1650 mg/m2 on RT days throughout the course of radiotherapy. A magnetic resonance imaging/computerized tomography scan was done at the start of treatment and 1 month after completion of treatment, followed by surgery. Toxicity was assessed weekly during treatment and on the first followup. RESULTS: Response rates and toxicity profile of capecitabinebased cathode ray tube (CRT) was similar to 5FUbased CRT with nonsignificant P values. CONCLUSION: Capecitabine may be used as an alternative in patients who do not tolerate 5FU.
  1,458 168 -
Actual gains in dosimetry and treatment delivery efficiency from volumetric modulated arc radiotherapy for inoperable, locally advanced lung cancer over five-field forward-planned intensity-modulated radiotherapy
RK Shrimali, M Arunsingh, GD Reddy, S Mandal, B Arun, S Prasath, S Sinha, I Mallick, R Achari, S Chatterjee
January-March 2017, 54(1):155-160
DOI:10.4103/ijc.IJC_79_17  PMID:29199680
AIMS: Volumetric modulated arc radiotherapy (VMAT) is used for inoperable, locally advanced nonsmall cell lung cancer, where three-dimensional conformal radiotherapy (3D-CRT) cannot yield an acceptable plan. METHODS: The planning and treatment data were prospectively collected on the first 18 patients treated using VMAT plans. We analyzed the actual dosimetric gain and impact on treatment, compared with complex multisegment 3D-CRT (five-field forward-planned intensity-modulated radiotherapy [IMRT]) that were generated for treatment. Proportion of planning target volume (PTV) receiving 95% dose (PTV-V95%) conformity index (CI), conformity number (CN), dose homogeneity index (DHI), monitor units (MUs), and treatment time were also analyzed. RESULTS: The PTV coverage (PTV-V95%) was improved from a median of 91.41% for 5-F forward-IMRT to 98.25% for VMAT (P < 0.001). The CI improved with a mean of 1.12 for VMAT and 1.31 for 5-F forward-IMRT (P < 0.001). The mean DHI improved from 1.15 for forward-IMRT to 1.08 for VMAT (P < 0.001). The mean CN improved from 0.62 for forward-IMRT to 0.87 for VMAT (P < 0.001). No significant increase in the low-dose bath (V5, V10 and mean lung dose) to the lung was seen. Significantly higher number of MUs (P < 0.001) and shorter treatment delivery times (P = 0.03) were seen with VMAT. CONCLUSION: VMAT resulted in improvement in target volume coverage, demonstrated by PTV-V95%, CI, CN, and DHI, without any increase in the low-dose bath to the lung. For conventional fractionation, VMAT requires more MUs (P < 0.001) but has a shorter treatment delivery time (P = 0.03) per fraction.
  1,512 111 2
Role of pneumonectomy for lung cancer in current scenario: An Indian perspective
SH Shah, A Goel, VPP Selvakumar, S Garg, K Siddiqui, K Kumar
January-March 2017, 54(1):236-240
DOI:10.4103/0019-509X.219569  PMID:29199698
BACKGROUND: Surgical treatment for lung cancer has evolved from pneumonectomy to lobectomy/sleeve resection around the world. Although condemned for poor outcomes, pneumonectomy may still be required in a select group of patients in developing countries. With the better patient selection, optimization of medical comorbidities, better perioperative care; pneumonectomy may show better results. Thus, there is a need to reconsider the role of pneumonectomy in patients with locally advanced lung cancer in the current scenario. PATIENTS AND METHODS: The aim of this study was to analyze the demographic and clinicopathologic profile of lung cancer patients and the role of pneumonectomy at a tertiary cancer center in India. The records of patients, who underwent surgery for lung cancer at our institute from January 2011 to April 2014, were analyzed retrospectively, and various parameters in pneumonectomy were compared to lobectomy patients. RESULTS: Out of 48 patients undergoing major lung resections, nearly 80% patients were symptomatic at presentation and were mostly in advanced stages, thus requiring neoadjuvant chemotherapy in 45.8% cases and pneumonectomy in 41.6% patients. There was no difference in morbidity and mortality in pneumonectomy (25%, 5%) versus lobectomy (21.2%, 3.5%). Disease-free survival at 1, 2, and 3 years after pneumonectomy (71.8%, 51.4%, and 42.8%) was comparable to lobectomy (73.3%, 66.1%, and 55.6%). After neoadjuvant therapy, survival was not affected by the type of surgery. CONCLUSIONS: In the Indian scenario, as the majority of lung cancer patients present at an advanced stage, pneumonectomy still plays a major role, and the acceptable postoperative outcome can be achieved with aggressive perioperative management.
  1,501 121 -
Impact of induction chemotherapy to concurrent chemoirradiation over radiotherapy alone in advanced oral cavity
MS Rewadkar, VK Mahobia
January-March 2017, 54(1):16-19
DOI:10.4103/ijc.IJC_166_17  PMID:29199654
BACKGROUND: Oral and oropharyngeal carcinomas representing about 90% of all oral malignancies are the sixth most common cancers worldwide. Basic modalities of cancer treatment are surgery, radiotherapy, and chemotherapy (CT) either alone or in combination. For squamous cell carcinoma (SCC) patients, induction CT followed by radiotherapy and concurrent CT are effective methods for improving response rates. MATERIALS AND METHODS: Fifty patients with advance stage oral cavity cancer with performance status >60% on Karnofsky performance scale and having no prior exposure to CT, radiotherapy, and surgery were included in the study. CT including bleomycin, methotrexate, and cisplatin was given on day 1 and repeated at an interval of 21 days. After the completion of three cycles, two groups (n = 25 each) were formed. One group was treated with radiotherapy alone and other group of patients treated with radiotherapy and concurrent cisplatin infusion. The patient toxicities and response were evaluated. RESULTS: After completion of induction CT, both the groups responded with almost similar result. Nausea, vomiting, mucositis, and skin reactions during radiotherapy were observed in both groups but comparatively higher in Group “B.” In Group B, 84% (vs. 60% in Group A) of patients showed complete response (CR) after completion of treatment, and out of 13 patients who responded partially to induction CT, 9 patients showed CR after concurrent chemoradiotherapy. CONCLUSION: This study showed the superiority of induction followed by concurrent chemoradiotherapy over induction plus radiotherapy alone in the treatment of advanced oral cavity neck SCC.
  1,461 158 -
Is pneumonectomy a justified procedure in patients with persistent N2 nonsmall cell lung cancer disease following induction therapy
S Mitsos, M Petko, D Patrini, M Hayward, M Scarci, D Lawrence, N Panagiotopoulos
January-March 2017, 54(1):73-81
DOI:10.4103/ijc.IJC_209_17  PMID:29199668
Optimal management and the role of surgery in multimodality treatment for N2 disease nonsmall cell lung cancer (NSCLC) are controversial. In this review, we focus on the possible role of pneumonectomy as a justified procedure in patients with persistent N2 disease following induction therapy. We have conducted an OVID PubMedbased search including manuscripts published in English for relevant studies. The interpretation of these trials highlights the lack of clarity and consistency in our management and leaves areas of controversy. There are no Level 1 data to support either performing or not performing pneumonectomy in this setting. The majority of the literature reviewed stresses the high risk of mortality and morbidity following pneumonectomy as a part of a trimodality approach to Stage IIIA/N2 NSCLC disease. However, selected highvolume institutions do follow this strategy with the level of risk seemingly justifying it for a highly selected group of patients, and this approach to Stage III/N2 NSCLC can be offered safely with acceptable mortality. Patient selection, response rate to induction therapy, and R0 resection are crucial for survival in experienced centers.
  1,428 156 1
Histopathological analysis of meningioma and its variants: A study of fifty cases
S Srikanth
January-March 2017, 54(1):313-315
DOI:10.4103/ijc.IJC_119_17  PMID:29199712
  1,402 173 1
Anaplastic lymphoma kinase status in lung cancers: An immunohistochemistry and fluorescence in situ hybridization study from a tertiary cancer center in India
SS Murthy, SJ Rajappa, SD Gundimeda, KM Mallavarapu, S Ayyagari, P Yalavarthi, D Fonseca, P Paliwal, HGR Nair, V Koppula, KVVN Raju, ST Rao
January-March 2017, 54(1):231-235
DOI:10.4103/0019-509X.219533  PMID:29199697
BACKGROUND AND OBJECTIVES: Fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) have shown good concordance for the detection of echinoderm microtubule-associated protein-like 4 and anaplastic lymphoma kinase (ALK) rearrangement. Since studies reporting FISH/IHC concordance, clinicopathological features, and clinical outcomes of ALK-positive patients from India are lacking, this study was undertaken. MATERIALS AND METHODS: This is a retrospective, observational study of patients with adenocarcinoma of the lung on whom ALK test was performed between March 2013 and December 2015. ALK status was assessed in 341 patients by FISH using Vysis ALK Dual Color Break Apart Rearrangement Probe and IHC using ALK D5F3 clone. Clinicopathological features were noted. Patients were managed as per the standard guidelines. Clinical outcomes – response rate (RR) and progression-free survival (PFS) – were measured. RESULTS: ALK rearrangement was positive in 37 patients (10.9%). ALK positivity was observed more commonly in younger patients with no predilection for any gender or any specific histological subtype. ALK by IHC was highly sensitive (100%), compared to FISH with concordance rate of 94.4%. Thirty one of thirty seven (31 of 37) patients received therapy of which 3 patients received palliative chemotherapy and 28 patients received tyrosine kinase inhibitors (crizotinib/ceritinib). Overall RR observed was 77.4%, and median PFS had not been reached at a median follow-up of 12.5 months. INTERPRETATION AND CONCLUSIONS: We report higher frequency of ALK positivity (10.9%) in patients with adenocarcinoma of the lung. ALK by IHC is more sensitive than FISH for ALK detection with high concordance. These patients had good clinical outcome with TKIs targeting ALK fusion protein.
  1,414 142 -
Comparison study of quality of life in advanced lung cancer patients on tyrosine kinase inhibitor and platinum doublet chemotherapy
K Udupa, R Rajendranath, TG Sagar
January-March 2017, 54(1):161-163
DOI:10.4103/0019-509X.219558  PMID:29199681
INTRODUCTION: Lung cancer is most common cause of cancer death in the world. Most of the patient are diagnosed in the late stages and receive only palliative treatment. The main objective of the palliative chemotherapy is to improve survival as well as the quality of life (QOL). QOL is the most neglected dimension of cancer care in developing countries like India. Palliative chemotherapeutic agent which has minimum toxicity and prolongs the survival of metastatic cancer patients is the need of the day. MATERIALS AND METHODS: In this study, 43 metastatic adenocarcinoma of lung patients of South Indian origin were enrolled. Twenty patients out of this 43 were epidermal growth factor receptor (EGFR) mutation positive and were started on tyrosine kinase inhibitor (TKI). Rest 23 patients were EGFR mutation negative and were started on various platinum-based doublet chemotherapy. QOL was measured using Cancer Institute QOL Questionnaire version 2 at the beginning of therapy and at the end of 3 months. RESULTS: Our study showed that metastatic lung cancer patients had average QOL at presentation. The QOL in patients on TKI improved compared to those on platinum doublet chemotherapy during the second assessment, but this improvement was statistically not significant. CONCLUSION: In this study, the metastatic lung cancer patients had an average QOL during initial presentation. Patients on TKI had a trend toward better QOL after 3 months of treatment compared to platinum doublet chemotherapy.
  1,425 130 1
Role of crizotinib in c-mesenchymal-epidermal transition-positive nonsmall cell lung cancer patients
U Batra, A Jain, M Sharma, R Bajaj, M Suryavanshis
January-March 2017, 54(1):178-181
DOI:10.4103/0019-509X.219592  PMID:29199685
The increasing cases of NSCLC and improved understanding of its molecular biology has lead to identification of its varied driver mutations. cMET amplification has an important role as resistance mechanism for EGFR TKIs. Crizotinib is a drug which shows its anti-tumoral effect in cMET positive cases. Here we present a case series of three such patients who achieved were cMET amplified and showed partial response on Crizotinib.
  1,421 128 -
Tumor characteristics and metabolic quantification in carcinoma breast: An institutional experience
IP Dubey, A Jain, MS Chauhan, R Kumar, S Agarwal, B Kishore, MG Vishnoi, D Paliwal, AR John, N Kumar, A Sharma, AG Pandit
January-March 2017, 54(1):333-339
DOI:10.4103/ijc.IJC_121_17  PMID:29199717
BACKGROUND: In India, carcinoma breast is the most common cancer among urban women population and second most common cancer after carcinoma cervix in rural areas. One in 22 women in India develops carcinoma of the breast in their lifetime. Fluorine-18-fluoro-2-deoxy-D-glucose (18F-FDG) uptake in breast cancer usually indicates the degree of tumor metabolism and hence can predict its behavior and prognosis. On the other hand, the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2) or neu state of breast cancer is a biomarker that provides important prognostic information in addition to predicting response to therapy. AIMS: The main objective of this study is to assess whether a correlation exists between 18F-FDG uptake in untreated cases of breast cancer, their receptor status (ER, PR, and HER-2 or neu), tumor histology, and tumor size. SUBJECTS AND METHODS: Sixty consecutive female patients, with biopsy-proven primary breast cancer, were enrolled in this prospective study for whom 18F-FDG positron emission tomography-computed tomography scan was done in the Department of Nuclear Medicine. Results obtained were analyzed using appropriate statistical tests (t-test and Pearson Chi-square tests), and interpretation was made with 95% confidence level. RESULTS: In our series, a positive correlation between tumor size, high tumor grade, and standardized uptake value (SUV) was found. Tumors with positive receptor status for estrogen, progesterone, and HER-2/neu receptors had statistically insignificant lower maximum SUV (SUVmax) values than their negative counterparts. Triple-negative breast tumors (ER−, PR−, and no overexpression of HER-2/neu) are currently a subject of major interest because of their aggressiveness, poor prognosis, and lack of targeted therapy. Based on receptor status when the SUVmaxof the group with triple-negative receptor status (ER−/PR−/HER-2/neu−) was compared to rest of the patient group, it was seen that patients with negative receptor status had significantly higher mean SUVmaxvalues. CONCLUSIONS: We have inferred that in patients with breast cancer, various biological parameters such as tumor size, grade, histology, and hormonal receptor status have different impact on tumor metabolic activity.
  1,398 117 1
Stereotactic body radiation therapy for hepatocellular carcinoma: Experience from a tertiary cancer care center in India
R Madhavan, B Kunher, M Arunlal, HM Nair, UG Unnikrishnan, R Holla, D Makuny
January-March 2017, 54(1):316-320
DOI:10.4103/ijc.IJC_156_17  PMID:29199713
AIM: The aim of this retrospective study is to assess the toxicity and tumor response of stereotactic body radiation therapy (SBRT) protocol for hepatocellular carcinoma (HCC) in our institution. BACKGROUND: Hepatocellular cancer is one of the leading cancers among men in India. In recent years, SBRT has emerged as a promising tool in the treatment of HCC. MATERIALS AND METHODS: Ten patients diagnosed as HCC with Barcelona Clinic Liver Cancer Stage B and C, treated with SBRT technique from January 2013 to December 2016, were included in this study. SBRT was delivered using 6 MV photons with volumetric modulated arc therapy. Acute and late toxicities were graded, and tumor response was assessed using response evaluation criteria in solid tumors criteria. Kaplan–Meier curves were generated for progression-free survival (PFS) and overall survival (OS). RESULTS: The median age was 61.5 (52–69) years. The radiation dose ranged from 35 Gy to 60 Gy. All patients obtained partial response during assessment at 3 months after completion of treatment. The median PFS is 8 months (95% confidence interval [CI] - 5.22–10.77 months). The median OS is 51 months (95% CI - 17.64–65.10 months). The OS at 1 and 2 years is 75% and 57%, respectively. CONCLUSIONS: SBRT is well tolerated by our patients. The 1- and 2-year OS of 75% and 57% is consistent with other prospective and retrospective SBRT studies from the literature.
  1,349 153 -
Study of gefitinib maintenance in unselected patients with metastatic primary lung adenocarcinoma: A descriptive study
R Kumar, B Dubashi, S Kayal, SC Lazzar, D Barathi, V Kumar
January-March 2017, 54(1):188-192
DOI:10.4103/ijc.IJC_46_17  PMID:29199688
BACKGROUND: Maintenance treatment of patients with advanced nonsmall cell lung cancer (NSCLC) without disease progression after first-line chemotherapy is a subject of ongoing research. The aim of this study was to investigate the efficacy, safety, and tolerability of the epidermal growth factor receptor (EGFR)–tyrosine-kinase inhibitor, i.e., gefitinib in the maintenance setting irrespective of EGFR status. METHODS: Patients aged 18 years or older of Indian origin, who had a life expectancy of >12 weeks with histologically or cytologically confirmed Stage IV NSCLC, the WHO performance status of 0–2, and who had completed four to six cycles of first-line platinum-based doublet chemotherapy without disease progression or unacceptable toxic effects were included in the study. The primary endpoint of the study was progression-free survival in the intention-to-treat population. RESULTS: Twenty-five patients with a median age of 55 years (40–68) were included in the study. The median progression-free survival (PFS) for the entire group was 8 months (95% confidence interval [CI] =1.45–14.54) had not reached for EGFR-positive patient, but in the EGFR negative cohort, the PFS was 4.98 months (hazard ratio = 0.092, 95% CI = 3.4–6.5, P = 0.01). The median overall survival (OS) of the study group was 15 months (95% CI = 3.7–26.4), all patients with EGFR positive were alive (100% survival). The median OS for EGFR negative group was about 6.3 months. The major toxicity observed was rash/acne in 15 patients, pruritus in 7 patients, and one patient had Grade 4 pneumonitis. CONCLUSION: Gefitinib maintenance is safe, well-tolerated therapy, produces significant PFS and OS benefit in EGFR mutation-positive patient. It is definitely not a choice for EGFR negative group. In EGFR unknown group, the role of maintenance still needs to be explored.
  1,355 132 -
Anaplastic lymphoma kinase immunohistochemistry in lung adenocarcinomas: Evaluation of performance of standard manual method using D5F3 antibody
D Jain, K Jangra, PS Malik, S Arulselvi, K Madan, S Mathur, MC Sharma
January-March 2017, 54(1):209-213
DOI:10.4103/0019-509X.219588  PMID:29199692
OBJECTIVE: Immunohistochemistry (IHC) with anaplastic lymphoma kinase (ALK) antibodies is considered as an economical screening method in lung adenocarcinomas. Automated Ventana D5F3-IHC is approved by US Food and Drug Administration for targeted therapy; however, the automated IHC apparatus are not widely used in most laboratories. We evaluated the performance of ALK IHC using the manual semiquantitative method to assess the concordance with Ventana ALK IHC assay. MATERIALS AND METHODS: We tested 156 cases of primary lung adenocarcinomas for ALK protein expression by D5F3-IHC. The intensity of cytoplasmic staining was classified as 0 or 1+/2+/3+ (weak/medium/strong). Binary score of positive and negative was used for Ventana assay. A comparison analysis and clinicopathological features were recorded. RESULTS: ALK IHC was positive in 25 (16.02%) cases, of which 18 were men and mostly nonsmokers. The mean age for all patients was 55 years, and for ALK IHC-positive cases was 48 years. Nine of 25 (36%) ALK IHC-positive cases showed signet ring cell and mucinous morphology. On comparison, all, but one, cases positive by manual method showed positive results by automated assay. IHC negative cases by manual method were negative by Ventana assay. CONCLUSION: Manual IHC is equally effective in the detection of ALK-rearranged cases as automated methods. It can be easily integrated as a screening method into routine practice thus reducing the cost of automated systems. However, equivocal cases should be tested by approved methods.
  1,353 121 1
Metastasectomy for recurrent or metastatic biliary tract cancers: A single center experience
I Park, YS Kim, SJ Sym, HK Ahn, KK Kim, YH Park, JN Lee, DB Shin
January-March 2017, 54(1):57-62
DOI:10.4103/0019-509X.219581  PMID:29199665
PURPOSE: To assess efficacy or long-term result of metastasectomy for recurrent or metastatic biliary tract carcinoma (BTC), we conducted a retrospective review of the outcomes of metastasectomy for recurrent or metastatic BTCs, comprising intrahepatic cholangiocellular carcinoma (IHCCC), proximal and distal common bile duct cancer (pCBDC and dCBDC), gallbladder cancer (GBC), and ampulla of Vater cancer (AoVC). PATIENTS AND METHODS: The clinicopathological features and outcomes of BTC patients who underwent surgical resection for the primary and metastatic disease at the Gachon University Gil Medical Centre from 2003 to 2013 were reviewed retrospectively. RESULTS: We found 19 eligible patients. Primary sites were GBC (seven patients, 37%), IHCCC (five patients, 26%), dCBDC (three patients, 16%), pCBDC (two patients, 11%), and AoVC (two patients, 11%). Eight patients (42%) had synchronous metastasis whereas 11 (58%) had metachronous metastasis. The most common metastatic site was liver (nine patients, 47%), lymph node (nine patients, 47%), and peritoneum (three patients, 16%). Nine patients (47%) achieved R0 resection, whereas four (21%) and six (32%) patients had R1 and R2 resection, respectively. With a median follow-up period of 26.7 months, the estimated median overall survival (OS) was 18.2 months (95% confidence interval, 13.6–22.9 months). Lower Eastern Cooperative Oncology Group performance status (P = 0.023), metachronous metastasis (P = 0.04), absence of lymph node metastasis (P = 0.009), lower numbers of metastatic organs (P < 0.001), normal postoperative CA19-9 level (P = 0.034), and time from diagnosis to metastasectomy more than 1 year (P = 0.019) were identified as prognostic factors for a longer OS after metastasectomy. CONCLUSIONS: For recurrent or metastatic BTCs, metastasectomy can be a viable option for selected patients.
  1,352 120 -
Metastatic nonsmall cell lung cancer in South India: A regional demographic study
KC Lakshmaiah, MP Kamath, KG Babu, U Amirtham, D Loknatha, AS Komaranchath
January-March 2017, 54(1):267-270
DOI:10.4103/0019-509X.219566  PMID:29199703
BACKGROUND: Nonsmall cell lung cancer (NSCLC) has varying epidemiological patterns in different countries and also in different regions of each country. In a country with a high prevalence of lung cancer such as India, regional variations in demography exist. AIM: A study of unique demographic trends of metastatic NSCLC patients presenting to our regional cancer center. MATERIALS AND METHODS: We did a retrospective analysis of histologically confirmed metastatic NSCLC patients who presented to our Department of Medical Oncology between August 2012 and July 2014. RESULTS: A total of 304 patients were analyzed. About 55.6% of the patients were in the age group of 41–60 years. About 79.6% of the patients were symptomatic for <6 months before presentation. About 63.5% of the patients were smokers presenting with a median age of 59 years whereas nonsmokers formed 36.51% of the patients presenting with a median age of 47 (P < 0.001). About 82.6% of the male patients and 4.1% of female patients were smokers. Equal number of all patients had adenocarcinoma (AC) and squamous cell carcinoma (SCC) histology. AC histology was more common in the nonsmoking group (62% of patients). SCC histology was seen in 54.3% of smokers. Metastasis to the contralateral lung and pleura was seen in 58.2% of patients. CONCLUSION: NSCLC presents at a young age. Smoking is a significant risk factor and it is common in the urban populations as in the rural areas. Both AC and SCC histologies presented in equal proportions.
  1,346 116 -
Development and validation of a predictive score, for identifying poor eastern cooperative oncology group performance status (performance status 3–4) advanced nonsmall cell lung cancer patients who are likely to benefit from tyrosine kinase inhibitors
A Joshi, A Bhattacharjee, V Noronha, VM Patil, A Karpe, N Kadam, L Solanki, K Prabhash
January-March 2017, 54(1):127-131
DOI:10.4103/ijc.IJC_162_17  PMID:29199675
BACKGROUND: One of the ten advanced lung cancer patients presents with poor eastern cooperative oncology group performance status (ECOG PS). There are no clear guidelines about management of these patients. The benefit of tyrosine kinase inhibitors (TKI) in this patient population remains questionable. Hence, in this study, we attempted to develop and validate a predictive score which would predict benefit from oral TKI. METHODS: This was a prospective observational study done at Tata Memorial Hospital, India. Patients with nonsmall cell lung cancer with ECOG PS 3–4 were included in this study. All these patients had received oral TKI on compassionate grounds and were followed up till death. The overall survival (OS) was calculated from date of start of TKI to date of death. R software was used for development and validation of the predictive model. RESULTS: The median survival duration of the discovery cohort and validation cohort were 170.5 and 115 days, respectively. The model predicted OS accurately, within ±2 months in 72.1% and within ±3 months in 81.7% of patients. CONCLUSION: The current model can predict OS in poor PS patients treated with TKI within a satisfactory clinical range and can be used for decision-making of these patients.
  1,354 106 -
An audit and analysis of different causes of defaults in patients receiving radiation for head and neck cancers: A tertiary regional cancer center experience
L Pujari, S Padhi, P Meher, A Tripathy
January-March 2017, 54(1):31-34
DOI:10.4103/ijc.IJC_114_17  PMID:29199658
CONTEXT: Strict adherence and timely completion of the external beam radiation therapy (EBRT) schedule is an important prognostic factor in the survival of head and neck cancer patients. However, many patients are unable to complete the radiation treatment due to various reasons resulting in a poor outcome. AIMS: This study aims to study the pattern and various possible causes of defaults for possible intervention. SETTINGS AND DESIGN: A retrospective epidemiological analysis. SUBJECTS AND METHODS: Patients receiving EBRT for head and neck cancers with curative intent from January 2015 to December 2015 but did not complete the prescribed treatment were included. Unplanned treatment breaks in the treatment was not taken into consideration. STATISTICAL ANALYSIS USED: SPSS version 21. RESULTS: Out of 458, 92 (20.08%) patients did not complete the EBRT (P = 0.06). Fifty-six out of total 92 patients (60.9%) who defaulted stopped taking treatment within halfway of the treatment (15 fraction) and 12 out of total 92 patients (13%) just at the 22nd/23rd fraction. Defaulter rates in patients from different places are in the range of 12.8% to 33.0% but was statistically not significant (P = 0.224). There was no particular age (P = 0.966), disease site (P = 0.354) preponderance among defaulters. Use of concurrent chemo-radiation in radical or adjuvant settings was also not related to defaults (P = 0.406). CONCLUSIONS: Radiation-induced acute toxicity, socioeconomic status and distance plays minimal role as a cause of patients who stop taking EBRT. There is no particular relation between age, disease site, treatment received before radiotherapy, intent of treatment, and concurrent chemoradiation-induced acute reactions with defaults among patients. Loss of income and work in the poor population during the treatment may be an important possible cause of defaults.
  1,318 135 -
Repeat biopsy in epidermal growth factor receptor mutation-positive nonsmall cell lung cancer: Feasibility, limitations, and clinical utility in Indian patients
S Zanwar, V Noronha, A Joshi, VM Patil, A Chougule, R Kumar, S More, S Goud, A Janu, A Mahajan, K Prabhash
January-March 2017, 54(1):280-284
DOI:10.4103/ijc.IJC_215_17  PMID:29199706
INTRODUCTION: The feasibility and success rate of repeat biopsy for epidermal growth factor receptor (EGFR) mutation-positive lung cancers that have progressed on tyrosine kinase inhibitors (TKIs) are varied and merits further assessment. MATERIALS AND METHODS: EGFR mutation-positive lung cancers were offered repeat biopsy upon progression on TKIs. Two groups of patients, first one on a clinical trial and second one from a database, were included for analysis. The feasibility to perform a repeat biopsy was analyzed in the first group. Success rate of biopsy and tissue adequacy for molecular testing was analyzed in both groups. Descriptive statistics were used for analyzing the demography, EGFR mutation type, tissue adequacy, and molecular profile at repeat biopsy. Kolmogorov–Smirnov test was used to assess normality of data. Two sample t-tests were used for comparison of proportions. RESULTS: The feasibility of undergoing repeat biopsy was 77% (95% confidence interval [CI] of 69.4%–83.5%) in the first group (114/148 patients). Feasibility was not analyzed in the second group of patients. Out of 196 patients who underwent a repeat biopsy, 154 patients (78.6%; 95% CI: 72.2%–84.1%) had tumor tissue adequate for performing molecular testing. 27/196 (13.8%) patients did not have any evidence of malignancy on repeat biopsy whereas 15/196 (7.6%) patients had scanty tissue on repeat biopsy prohibiting molecular testing. Six patients (3.06%; 95% CI: 1.1%–6.5%) had small cell transformation. T790M mutation was detected in 12 out of the 42 patients (28.6%; 95% CI: 15.7–44.6) in whom EGFR testing was performed on repeat biopsy specimen. CONCLUSION: Repeat biopsy was able to provide adequate tissue acquisition in only two-thirds of the patients. Liquid biopsy represents an important tool to bridge this gap.
  1,310 135 2
Outcomes in lung cancer: An experience from routine tertiary care setting
R Thippeswamy, S Patil, P Prashanth, CT Sateesh, T Vittal, HP Shashidhara, KM Haridas
January-March 2017, 54(1):276-279
DOI:10.4103/0019-509X.219606  PMID:29199705
BACKGROUND: The aim of this study was to establish characteristics of lung cancer patients diagnosed at a tertiary care hospital in Bangalore. METHODS: The retrospective study was undertaken comprising of 202 patients diagnosed of advanced lung cancer in a tertiary care setting. Data was analyzed to identify patients' characteristics, smoking history, tumor histology, stage of the disease, treatment received, and survival rates. RESULTS: Among the 202 patients diagnosed, 134 were males, and 68 were females. Tumor histology testing revealed that 168 patients had adenocarcinoma, 24 patients had squamous carcinoma, 5 patients had small cell carcinoma, and 5 patients were poorly differentiated carcinoma. Among the patients of adenocarcinoma, complete response, partial response (PR), stable disease, and progressive disease (PD) were seen in 0.6%, 52%, 17%, and 23.2% of the patients respectively. The median progression-free survival (PFS) for first-line treatment was 6.5 months; the highest PFS was seen with nab-paclitaxel/platinum combination. The mean overall survival was 11.7 months and the highest OS of 12.3 months with gefitinib therapy. In the squamous subset of patients, PR was observed in fourteen patients, of which five patients were treated with nab-paclitaxel/platinum. The mean overall survival of 10.5 months and mean PFS was 6.2 months with the highest PFS of 6.8 months were seen with weekly nab-paclitaxel. Among the small cell lung cancer patients, nine were treated with etoposide/platinum regimen with a compliance of 6 cycles. Three patients had a PR, and one had a PD on etoposide/platinum regimen. The mean overall survival in these patients was 4.6 months.
  1,307 130 -
Rechallenge temozolomide in glioma: A case series from India
VM Patil, R Tonse, R Kothari, A Chandrasekaran, N Pande, S Epari, T Gupta, R Jalali
January-March 2017, 54(1):368-371
DOI:10.4103/ijc.IJC_173_17  PMID:29199725
INTRODUCTION: Temozolomide (TMZ) is an integral part of upfront treatment of high-grade gliomas. It is administered postsurgery as concurrent therapy with radiation and subsequently as adjuvant chemotherapy for 6–12 cycles. It is unknown whether rechallenge of salvage TMZ in previously treated high-grade glioma has any efficacy. MATERIAL AND METHODS: Patients treated with salvage rechallenged TMZ between January 2015 and August 2016 were included for this retrospective analysis. SPSS version 20 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 was noted in accordance with CTCAE version 4.02. RESULTS: A total of 23 patients were selected for analysis with the median age being 43 years (range: 26–69 years). The tumor histopathology at baseline was astrocytoma Grade 2 in 1 patient, oligodendroglioma Grade 2 in 3 patients, anaplastic astrocytoma in 7 patients, anaplastic oligodendroglioma in 2 patients, and glioblastoma in 10 patients. All of them had previously received TMZ. The median numbers of previous TMZ cycles received were 6 (4–18). The median time to failure postlast treatment was 24 months (5–72 months). The median number of cycles of rechallenged salvage TMZ administered was 6 cycles (range: 1–18). Grade 3–4 myelosuppression was seen in 3 patients (13.4%). The median PFS was 459 days (95% confidence interval: 212.1–705.9). The median OS was 25 months. Six-month OS and 1-year OS were 81.4% and 75.1%, respectively. CONCLUSION: Rechallenge with TMZ in recurrent glioma that had previously responded to TMZ is associated with improvement in PFS and OS and has a sufficiently long disease-free interval.
  1,310 121 -
First-line therapy outcomes in patients with advanced stage nonsmall cell lung cancer treated at nongovernment tertiary care centrer in India: Experience from a real world practice
SS Hingmire, MB Sambhus, DS Kelkar, SW Joshi, KS Narsinghpura
January-March 2017, 54(1):182-186
DOI:10.4103/0019-509X.219594  PMID:29199686
INTRODUCTION: Reports on first line or subsequent treatment and their outcomes for patients with advanced nonsmall cell lung cancer (NSCLC) in India are scarce. The present study is an attempt to understand real world practice scenario of first-line therapy and outcome in advanced stage NSCLC patients. METHODS: Observational study was conducted at a nongovernment tertiary cancer care center. Totally 83 patients with newly diagnosed advanced NSCLC who were evaluated for further treatment from 2008 onward were included in the study. RESULTS: Best supportive care was the only treatment received in 11/83 patients. Sixty-three patients received platinum-based doublet chemotherapy and nine received epidermal growth factor receptor tyrosine kinase inhibitor (TKI) as first-line therapy. Pemetrexed and platinum was the most common first-line chemotherapy (56%) regimen used. First-line chemotherapy had to be discontinued in these eight patients due to Grade III/IV toxicity. Disease control rate with the first-line chemotherapy was 70% (partial response 38%, stable disease 32%). Median overall survival (OS) was 17 months with OS at 1 and 2 years was 52% and 29.5%, respectively. CONCLUSION: First-line platinum-based chemotherapy is feasible and does achieve disease control in the majority of patients with advanced NSCLC. Strategies of selection of therapy based on histology and the presence of driver mutations, use of small molecule TKI, maintenance therapy and multiple lines of therapies are being increasingly implemented in clinical practice and thus improving survival of Indian patients of NSCLC.
  1,270 145 -
Composite lymphomas: Experience from a tertiary cancer center in Kerala, South India
JA Vasudevan, RA Nair, R Sukumaran, SG Nair
January-March 2017, 54(1):358-361
DOI:10.4103/ijc.IJC_89_17  PMID:29199722
OBJECTIVES: Composite tumors are defined as tumors in which there are two different intermixed histologic types. Our objective was to study the clinical and pathologic features of five cases of composite lymphoma. MATERIALS AND METHODS: Our study included five patients of composite lymphoma diagnosed over a period of 5 years. Clinical presentation, hematological parameters including peripheral smear, bone marrow aspirate, and histopathological examination of lymph node including immunohistochemistry (IHC) were studied. Treatment and follow-up details were also noted. RESULTS: All the five cases were in the adult age group ranging from 44 to 72 years. All the cases were composite follicular lymphoma (FL) and mixed cellularity classical Hodgkin lymphoma (CHL). Diagnosis in all cases was suspected on morphology by identification of distinct neoplastic follicles in FL and classic Reed–Sternberg cells in CHL and confirmed by IHC. CONCLUSION: Although rare, composite lymphomas should be kept in mind. Careful histopathological examination of lymph node with identification of distinct morphological features along with IHC helps to arrive at the definitive diagnosis.
  1,282 114 -
Gemcitabine and carboplatin in metastatic nonsmall cell lung cancer: Experience from a tertiary cancer center in South India
T Devika, B Dubashi, DG Shewade, S Kayal, RCS Kumar
January-March 2017, 54(1):169-171
DOI:10.4103/ijc.IJC_28_17  PMID:29199683
BACKGROUND: Gemcitabine and carboplatin combination is widely used as one of the first-line chemotherapeutic regimens in patients with metastatic nonsmall cell lung cancer patients. METHODOLOGY: A total of 112 patients with metastatic disease were recruited. They were on standard 21-day gemcitabine 1.2 g/m2 and carboplatin AUC 5 dosing schedule. Each patient received at least four cycles and a maximum of 6 cycles of treatment. The patients were followed up, and the demographic, efficacy and toxicity profiles were analyzed. RESULT: The mean age was 53.81±9.85 with 71 male and 41 female patients. Response assessment was done in 82 patients, and the objective response rate was found to be 47.6% with 39 partial responders, 20 patients with stable disease and 23 patients with progressive disease. The median overall survival was 12 months (95% CI 9.89-14.11). We found anemia (62.5%) to be more prominent than the other toxicities followed by thrombocytopenia and vomiting (31.3%). The nonhematological toxicities were minimal and manageable. CONCLUSION: Treatment with gemcitabine and carboplatin is efficacious with manageable toxicity profile in the real world non-clinical trial setting.
  1,275 111 -
Palliative thoracic radiotherapy in advanced lung cancer: A single institution experience
C Hotwani, JP Agarwal, K Prabhash, A Munshi, A Joshi, S Misra, D Kumar, S Das, SG Laskar
January-March 2017, 54(1):262-266
DOI:10.4103/0019-509X.219587  PMID:29199702
BACKGROUND: Majority of patients of lung cancer present with locally advanced or metastatic disease, where systemic therapy is the treatment of choice. Many of these patients have local symptoms due to thoracic disease, wherein radiotherapy is proven to be an effective modality for alleviation of symptoms. However, the optimal dose of radiotherapy for adequate palliation remains debatable. The purpose of this retrospective study was to assess the efficacy of two different schedules of thoracic radiotherapy (TRT) with respect to symptom palliation. MATERIALS AND METHODS: A total of 100 consecutively treated patients with stages III-IV lung cancer treated with two different fractionation regimens of palliative TRT, either protracted course 20 Gy/5# over 1 week or short course of 17 Gy/2# over 8 days were assessed for symptom relief and survival. Impact of patient, tumor and treatment-related factors on response and overall survival (OS) was done by univariate analysis using log-rank test. RESULTS: Median age of the entire cohort was 60 years, majority being males, smokers with low Eastern Cooperative Oncology Group performance status (performance score ≥2). Predominant symptoms were chest pain (68) followed by cough (21) and dyspnea (15). Palliative TRT was offered as either protracted course 20 Gy/5# over 1 week or short course of 17 Gy/2# over 8 days in 21 and 79 patients respectively. Median duration of symptom relief was 2 months, no differences in OS at 1 year with either regimen. CONCLUSIONS: TRT is an effective means of palliation having similar symptom relief and outcomes with weekly (17 Gy/2# over 8 days) or protracted radiotherapy regimens (20 Gy/5#over 1 week). Short TRT schedules are convenient and economical for patients as well as resource sparing for high volume centers.
  1,267 109 -
Epidermal growth factor receptor positive lung cancer: The nontrial scenario
V Noronha, VM Patil, A Joshi, N Tandon, V Sharma, A Ramaswamy, SB More, S Gaud, K Prabhash
January-March 2017, 54(1):132-135
DOI:10.4103/0019-509X.219583  PMID:29199676
PURPOSE: The aim of this study was to report the median overall survival (OS) in epidermal growth factor receptor (EGFR) mutation-positive patients who were managed out of a clinical trial. METHODS: Nonsmall cell lung cancer patients harboring activating EGFR mutations who were either ineligible or refused participation in a clinical trial were selected for this analysis. The reason for not participating in trial, staging, treatment, and outcome details were obtained from a prospective lung cancer database. The Kaplan–Meier method was used to estimate OS. Log-rank test and Cox proportion hazard model were used for univariate and multivariate analysis, respectively. RESULTS: We included 225 patients in this analysis. The median age of the cohort was 56 years (range 29–85 years). A compromised Eastern Cooperative Oncology Group performance status (PS) of >2 was the major reason (83 patients, 36.9%) for ineligibility of patients in a clinical trial. The major reason provided by eligible patients for refusal to participate in a clinical trial was long distance of travel and inability to comply with the study-mandated follow-up visits (65 patients, 28.9%). The median OS in patients with PS 0–2 was 18.17 months (95% confidence interval [CI]: 15.6–20.8 months) and it was 12.1 months (95% CI: 9.0–15.2 months) in patients with PS 3–4 (hazard ratio - 0.579 [95% CI: 0.398–0.843] P = 0.004). CONCLUSION: EGFR positive patients who were ineligible for a clinical trial due to poor PS had lower survival; however, patients with good PS treated off-trial had similar OS to that reported in multiple clinical trials.
  1,258 116 -
The efficacy and safety of preoperative chemotherapy for patients with nonsmall cell lung cancer: A meta-analysis
T Wang, T Yan, S Ma, K Wang, J Wang, J Song, W He, J Bai, L Jin
January-March 2017, 54(1):223-227
DOI:10.4103/ijc.IJC_60_17  PMID:29199695
BACKGROUND: The efficacy of surgery alone for patients with nonsmall cell lung cancer (NSCLC) is still unsatisfactory. Preoperative chemotherapy (PCT) is proven effective induction therapies followed by surgery; however, few their superiority remains uncertain. We performed a systemic review and meta-analysis to evaluate the safety and efficacy of the PCT for NSCLC patients. MATERIALS AND METHODS: A literature search was performed in the PubMed, China National Knowledge Infrastructure and Cochrane databases. NSCLC patients treated with PCT plus surgery (PCT-S) or surgery (S) alone between 2006 and 2016 were analyzed. RESULTS: A total of eleven studies, involving a total of 2999 patients, were finally enrolled in this meta-analysis. Meta-analysis shows that PCT-S might have lower recurrence rate than S (odds ratio [OR] = 0.75, 95% confidence interval [CI] [0.60, 0.94], P = 0.01). However, no differences were found between two groups in overall survival rate (OR = 1.26, 95% CI [0.92, 1.72], P = 0.15) and (OR = 1.12, 95% CI [0.93, 1.33], P = 0.23), 3-year disease-free survival rate (OR = 1.22, 95% CI [0.73, 2.04], P = 0.44) and intraoperative and postoperative complication rates (OR = 1.24, 95% CI [0.89,1.74], P = 0.20). CONCLUSIONS: Two treatments have similar safety and efficacy. However, PCT can reduce the rate of local and distant recurrence, which is an independent risk factor for NSCLC prognosis and may improve the prognosis of NSCLC.
  1,265 107 -
Sister Mary Joseph's nodule: Two rare cases of inoperable gallbladder cancer
AK Jha, SK Jha, R Kumar, U Kumar
January-March 2017, 54(1):29-30
DOI:10.4103/ijc.IJC_135_17  PMID:29199657
  1,255 108 -
Atypical lung carcinoid: An unusual presentation
MM Mohapatra, RC Mulkoju, J Joseph, D Gochhait
January-March 2017, 54(1):213-214
DOI:10.4103/ijc.IJC_150_17  PMID:29199693
  1,180 100 -
Dual mutations and complex mutations in metastatic nonsmall cell lung cancer: A single-institution experience from South India
L Kadabur, D Koppaka, GB Kanakasetty, A Usha, LC Kuntegowdanahalli, L Dasappa, LA Jacob, SMC Babu, RA Haleshappa, A Abhishek, LK Rajeev
January-March 2017, 54(1):228-230
DOI:10.4103/ijc.IJC_20_17  PMID:29199696
Wide use and incorporation of newer diagnostic tools in the management of metastatic nonsmall cell lung cancer (NSCLC) has helped in achieving the goal of personalized treatment of this disease. With the wide use of polymerase chain reaction and fluorescence in situ hybridization increasing number of patients are being diagnosed with dual and complex mutations posing a new challenge in the management of patient with metastatic NSCLC. In this article, we would like to bring forth six such cases and the varied responses to the current available treatment in patients with complex and dual mutations. The appropriate management in these groups of patients is yet to be standardized.
  1,172 108 -
A prospective study of telephonic contact and subsequent physical follow-up of radically treated lung cancer patients
AS Mathew, JP Agarwal, A Munshi, SG Laskar, CS Pramesh, G Karimundackal, S Jiwnani, K Prabhash, V Noronha, A Joshi, V Rangarajan, NC Purandare, N Jambhekar, S Tandon, A Mahajan, R Kumar, J Deodhar
January-March 2017, 54(1):241-252
DOI:10.4103/0019-509X.219599  PMID:29199699
BACKGROUND: We tested the hypothesis that telephonic follow-up (FU) may offer a convenient and equivalent alternative to physical FU of radically treated lung cancer patients. DESIGN: Prospective study carried out at a tertiary referral cancer care institute, Mumbai. MATERIALS AND METHODS: Two hundred consecutive lung cancer patients treated with curative intent were followed up regularly with telephonic interviews paired with their routine physical FU visits. Patient satisfaction with the telephonic call and the physical visit, the anxiety level of the patient after meeting the physician and the economic burden of the visit to the patient were noted in a descriptive manner. Kappa statistics was used to assess concurrence between the telephonic and physical impression of disease status. RESULTS: With a median FU duration of 21.5 months, the median satisfaction scores for telephonic and physical FU were 8 and 9, respectively. The prevalence and bias adjusted kappa (PABAK) score of the entire cohort of patients was 0.64 (95% confidence interval [CI] =0.58–0.70). Data analyzed up to first disease progression/relapse on FU had a PABAK score of 0.71 (95% CI = 0.64–0.77) indicating substantial agreement. Patients with disease controlled at the FU had a significant PABAK score of 0.88 (95% CI = 0.80–0.94) indicating excellent concurrence. On average, each patient spent Rs. 5117.10 on travel and Rs. 3079.06 on lodging per FU visit. CONCLUSION: Telephonic FU is substantially accurate in assessing disease status until the first relapse. In a resource-constrained country like India, it is worthwhile to further explore the benefits of such an alternative strategy.
  1,152 125 2
Continuous hyperfractionated accelerated radiotherapy using modern radiotherapy techniques for nonsmall cell lung cancer patients unsuitable for chemoradiation
RK Shrimali, M Arunsingh, A Das, I Mallick, A Mahata, S Prasath, R Achari, S Chatterjee
January-March 2017, 54(1):120-126
DOI:10.4103/ijc.IJC_158_17  PMID:29199674
INTRODUCTION: The continuous hyperfractionated and accelerated radiotherapy (CHART) regimen of radiotherapy (RT) for nonsmall cell lung cancer is underused outside the UK. We present the first Indian experience of using CHART for patients, who were not suitable for chemotherapy or concurrent chemo-RT. METHODS: We retrospectively reviewed the data of patients treated using CHART at our institution between January 2014 and December 2015. RESULTS: Thirty-seven patients were treated using CHART. Planning methods and dosimetry parameters are described. Three-dimensional conformal RT was used for treatment planning and delivery in 23 patients and volumetric modulated arc RT was necessary for 14 patients. Patients in our series had a median age of 70 years (interquartile range 65.50–74.00) and 86.5% had Stage III disease. Median follow-up was short at 13.0 months. Actuarial rates of 1-year progression-free survival, 1-year overall survival (OS), and 2-year OS were 31.9%, 59.5%, and 28.5%, respectively. This treatment was well tolerated with manageable and some reversible acute esophageal toxicity (91.9% CONCLUSION: Our results indicate that CHART is feasible, safe, and well tolerated in Indian patients who are clinically found to be not suitable for either sequential or concurrent chemo- RT.
  1,168 107 1
Stereotactic body radiation therapy for early-stage primary lung cancer, is an active breath coordinator necessary? An audit from a tertiary cancer care center
R Madhavan, PS Renilmon, HM Nair, A Lal, SS Nair, UG Unnikrishnan, D Makuny
January-March 2017, 54(1):301-304
DOI:10.4103/ijc.IJC_230_17  PMID:29199709
CONTEXT: The hypofractionated stereotactic body radiation therapy (SBRT) has emerged as a safe and effective treatment modality for early-stage nonsmall cell lung carcinoma. AIMS: An audit SBRT in primary lung cancer treated in our center with and without an active breath coordinator (ABC) was undertaken to evaluate its impact on target volumes and clinical outcomes. SETTINGS AND DESIGN: This was an observational study. MATERIALS AND METHODS: Nine patients with lung carcinoma were treated from January 2014 to August 2016. Five patients were simulated using ABC and four patients with free breathing. Volumetric modulated arc therapy plans were generated using Monaco treatment planning software. Three patients were treated with a dose of 54 Gy in three fractions and six patients with a dose of 48 Gy in four fractions. STATISTICAL ANALYSIS USED: The statistical analysis was performed using Kaplan–Meier survival. RESULTS: The mean planning target volumes (PTV) in ABC and free breathing groups were 42.19cc and 60.17cc, respectively. The mean volume of lung receiving 20, 10, and 5 Gy (V20, V10and V5) in ABC group were 5.37cc, 10.49cc, and 18.45cc whereas in free breathing 6.63cc, 12.74cc, and 20.64cc, respectively. At a median follow-up of 18 months, there were three local recurrences. No significant toxicity occurred in our series. CONCLUSION: Our initial results show that SBRT is well tolerated with good local control. Although the PTV volume and irradiated normal lung volume was higher in this group compared to ABC group, this did not translate to any added clinical toxicity.
  1,157 85 -
Fluorodeoxyglucose-avid pulmonary mucinous adenocarcinoma presenting with nonfluorodeoxyglucose-avid cystic brain lesions of unknown etiopathology: Brain magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography-computed tomography imaging features and additional value of whole-body positron emission tomography acquisition
V Shinde, S Basu
January-March 2017, 54(1):81-82
DOI:10.4103/0019-509X.219578  PMID:29199669
  980 103 -
Expanded panel test detecting mesenchymal-epithelial transition amplification leading to effective treatment in adenocarcinoma lung
VM Noronha, S Jandyal, A Joshi, VM Patil, A Mahajan, K Prabhash
January-March 2017, 54(1):325-326
DOI:10.4103/0019-509X.219596  PMID:29199715
  927 90 -
Practical solutions to epidermal growth factor receptor tyrosine kinase inhibitor dose modifications in resource-constrained settings: Thinking outside the (packaging) box
N Singh, KT Prasad
January-March 2017, 54(1):186-187
DOI:10.4103/0019-509X.219576  PMID:29199687
  933 73 -
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