ecancermedicalscience最新文献

Collaborative trials of co-operative groups have currently established interval compressed chemotherapy (ICC) as the standard of care, though there are concerns regarding the application of the same in low middle-income countries (LMICs). This study is a retrospective analysis of the long-term outcomes of a follow-up cohort (n = 200), constituted by patients (<15 years) with Ewing sarcoma (ES) treated with curative intent (including localised and metastatic patients) during January 2013-June 2017 on a non-dose dense chemotherapy protocol, EFT-2001. Local therapy was planned at 9-12 weeks of therapy and was delivered in all but three patients who had events before local control. At a median follow-up of 97 months (95%CI:91-103 months), 7-year event-free survival (EFS) and overall survival (OS) of the whole cohort were 55% (95%CI:49%-63%) and 69% (95%CI:63%-76%), respectively. Seven-year EFS and OS for the localised cohort were 60% (95%CI:53%-69%), 73% (95%CI:66%-80%) and for metastatic cohort were 37% (95%CI:24%-55%) and 53% (95%CI:39%-72%), (p = 0.003, p = 0.015), respectively. Non-relapse mortality was 8% (n = 16). Anthracycline dose, axial location, poor histological necrosis and older age group were associated with adverse outcomes. Cardiotoxicity was reported in 13%, with one-third developing symptomatic cardiac dysfunction. Long-term outcomes for children with ES treated on a non-dose dense chemotherapy protocol, in the setting of a higher treatment-related mortality, have relatively fair outcomes, though suboptimal compared to the ICC approach. ICC could be introduced in a phased manner in high-risk subsets in LMICs with better resources and an active nutritional rehabilitation and supportive care programme, while EFT-2001 protocol still could be a practical solution in resource-constrained settings.

Synopsis: We found a significant increase in serum IL-6 levels of 214.9 ng/mL (95% CI: 60.1-369.7, p = 0.007) among women with cervical cancer (CC) compared to their cancer-free counterparts.

Objectives: Despite growing evidence of the role of interleukin-6 (IL-6) in CC, studies assessing this association among women of sub-Saharan African origin remain limited. This study investigated the association between serum IL-6 and CC and explored the effects of serum IL-6 levels on prognosis in patients with CC in Lagos, Nigeria.

Methods: We conducted a cross-sectional study among women with and without CC in two hospitals. A venous blood sample was collected from each participant for laboratory analysis of serum IL-6 levels. We performed simple and multiple linear regression analyses to compare the unit increase in serum IL-6 levels between study groups while adjusting for relevant confounders.

Results: Our study found a significant unit increase of 214.9 ng/mL (95%CI: 60.1-369.7, p = 0.007) in serum IL-6 levels among women with CC compared to their cancer-free counterparts. The area under the curve of 0.814 demonstrated a good discriminatory ability at an optimal serum IL-6 cut-off value of 365.1 ng/mL. IL-6 levels were significantly elevated in patients with advanced-stage CC compared to those with early-stage disease (156.7 (IQR: 130.4-227.6) versus 324.7 (IQR: 188.5-516.2) ng/mL) and in patients diagnosed with squamous cells carcinoma (SCC) compared to those without SCC (523.9 (IQR: 365.1-682.1) versus 203.6 (IQR: 131.3-334.3) ng/mL).

Conclusion: Our study findings highlight the potential utility of serum IL-6 as a biomarker for CC diagnosis and prognosis. However, further studies are needed to explore the utility of IL-6 as a target for therapeutic intervention and in the treatment monitoring of CC patients.

Glomus tumour is a soft tissue neoplasm that is associated with the subungual region owing to the presence of the glomus body. A 53-year-old female patient was referred to the Department of Oral and Maxillofacial Pathology with the chief complaint of a swelling on the tongue of 3 months' duration. An ultrasound of the tongue suggested a vascular malformation. Histopathology revealed a well-defined proliferation of cells around blood vessels, surrounded by muscle and collagen fibres. A majority of the cells were clear with distinct nuclei. Some cells had an eosinophilic granular cytoplasm. Histopathology was augmented with immunohistochemistry to arrive at a diagnosis of glomus tumour of the tongue. The oral cavity is an unusual site for the occurrence of glomus tumour. This case emphasises the importance of a comprehensive diagnostic work-up in the diagnosis of swellings in the head and neck region, particularly in the context of rare tumours arising from cells that are not native to this site.

Introduction: Oral cancer is a major public health issue in India. Despite various prevention strategies, the incidence of oral cancer continues to rise. This study aimed to assess awareness of tobacco's harmful effects and tobacco control measures in patients with oral cancer.

Methods: This cross-sectional study was conducted from August 2023 to June 2024. Totally, 116 adult patients with histopathologically confirmed oral cancer were recruited using convenience sampling. Data were collected using a pretested interview schedule covering sociodemographics, tobacco and alcohol use, awareness of oral cancer and tobacco control policies. Descriptive statistical methods were used to analyse the data, and chi-Square and Fisher's Exact tests were used to identify factors associated with awareness of the carcinogenic nature of tobacco.

Results: The mean age of participants was 47.9 ± 11.1 years, with 87.9% male and 97.4% from upper, lower/lower socioeconomic backgrounds. 54.3% of participants used smokeless tobacco, 10.3% were smoking and 27.6% were using both. Most consumed tobacco daily, with 52.6% quitting tobacco consumption after getting diagnosed with oral cancer. 66.4% were aware of the link between tobacco and oral cancer, primarily from tobacco packaging (48.1%) and anti-tobacco advertisements (36.3%). However, all were unaware of the early symptoms of oral cancer and self-examination methods. Awareness of free government screenings was very low (0.9%), and only 7.8% knew of laws regulating tobacco. Awareness that tobacco causes cancer was significantly higher among literate participants, those who noticed the warning sign, and felt fear from the warning signs on tobacco products (p < 0.05).

Conclusion: This study reveals significant gaps in awareness regarding tobacco-related oral cancer risks and preventive measures among patients with oral cancer. Targeted awareness campaigns and improved access to screening could help reduce oral cancer in India.

Multiple myeloma (MM) represents a significant global health challenge, with its incidence and mortality rates steadily increasing over recent decades. This review critically examines the current landscape of MM management, with a specific focus on resource-limited settings, where the disparities in diagnostic capabilities and treatment options are most pronounced. A comprehensive literature search was performed using multiple databases, encompassing peer-reviewed articles, clinical guidelines and conference abstracts from 2010 to 2024. Our analysis delineates the stark differences between therapeutic approaches in high-income versus low- and middle-income countries (LMICs). In high-income settings, the standard of care involves advanced induction regimens, autologous stem cell transplantation and maintenance therapy with novel agents, which collectively have contributed to improved patient outcomes. Conversely, LMICs often rely on more affordable yet less effective treatments, such as bortezomib- or thalidomide-based regimens, largely due to limited access to advanced diagnostics and high-cost therapies. Key challenges identified include late presentation, inadequate diagnostic infrastructure, economic constraints and a paucity of trained healthcare personnel. To address these issues, we propose a multifaceted strategy that emphasises the enhancement of diagnostic capacity, the adaptation of resource-stratified treatment guidelines and the strengthening of healthcare systems through targeted policy interventions and international collaborations. By bridging the gap between evidence-based MM care and the practical realities of under-resourced healthcare systems, this review aims to inform future clinical practice and policy, ultimately improving survival outcomes and reducing global health inequities in MM management.

Introduction: Malignant ovarian germ cell tumours (MOGCTs) are rare and account for 70% of malignant ovarian tumours in adolescents. Hence, fertility preservation is an important issue among this population. In this study, we aim to analyze our experience of MOGCT treatment with special emphasis on outcomes of fertility-preserving treatment and on survival outcomes.

Materials and methodology: All patients with MOGCT who underwent treatment in our institution, from January 2010 to December 2018, were included and the clinicopathologic characteristics, chemotherapy details, recurrence characteristics and follow-up data were analysed. The patients who underwent fertility-sparing surgery were contacted over the telephone to collect reproductive and menstrual outcome details.

Results: A total of 84 patients were included in the study of which upfront surgery was followed by adjuvant chemotherapy in 44 (52.4%) patients and neoadjuvant chemotherapy was followed by interval debulking surgery and adjuvant chemotherapy in 8 patients. Fertility-sparing surgery was performed in 49 (58.3%) patients and 17 patients attempted conception and 13 (76.5%) succeeded in spontaneous pregnancy, resulting in 11 live births. All of them resumed their menstrual cycle within 1 year of treatment. With the median follow-up of 46 months, the mean 3-year disease-free survival and overall survival of 84 patients with MOGCT were 86.9% and 96.4%, respectively.

Conclusion: Fertility-preserving surgery with appropriate adjuvant treatment has excellent survival and fertility outcomes among patients with early as well as advanced-stage disease. Hence, it is a safe and effective option for young females with MOGCTs.

Introduction: Germ cell testicular tumours are rare tumours. The incidence is the lowest in India, leading to limited availability of published Indian data. We report here the 10-year survival data for patients with this curable malignancy.

Material and methods: Record-based analysis was done for testicular germ cell tumours presenting to a tertiary care referral centre in North India during the period from 2010 to 2019. A total of 44 patients were identified who were evaluated for the demographics, treatment modalities and 10-year disease-free survival and overall survival (OS).

Results: Forty five percent of the patients had seminoma, while 55% had nonseminomas. Stages I-III disease was seen 41%, 23%, 36% and 67%, 17%, 17% of nonseminoma and seminoma patients, respectively. Within the seminomas, 89% patients were good risk and 11% were intermediate risk. Within the nonseminoma patients, 81% were good risk, 13% were intermediate risk and 6% were poor risk. At a median follow up of 73.4 months, 5- and 10-year OS were 88% and 77% for seminoma, while 87% and 78% for nonseminomas. The 5- and 10-year progression-free survival was 88% and 76% for seminoma patients, while 83% each for nonseminoma patients. On Cox proportional univariate analysis, none of the prognostic factors were found to be associated with OS.

Conclusion: Our patients presented with a lower metastatic disease burden, minimal violation of the scrotum and upfront orchiectomy in all patients. This resulted in better survival outcomes compared to previous Indian studies. However, the outcomes are inferior as compared to the West. Raising awareness about early diagnosis, treatment safety and curability may further save lives in these young males.

Recurrent high-grade gliomas have a dismal prognosis. This review article aimed to explore and help answer the questions about which group of patients would benefit from chimeric antigen receptor therapy (CAR-T) cell therapy in this setting, the timing of intervention and the therapeutic efficacy. CAR-T cell therapy involves the extraction of T-cells from patients, genetic modification of these cells to express chimeric antigen receptors on their cell surface, which are selectively targeted towards tumour-expressed antigens and a procedure of immune-depletion followed by re-introducing these engineered CAR-T cells into the host via infusion. Gliomas, particularly glioblastoma, present unique challenges due to their immune-evasive nature, location within the central nervous system and antigenic heterogeneity. Thus, several potential antigenic targets are being explored for CAR-T cell therapy, including B7 homolog 3, Disiloganglioside, Eph-A2, Eph-A3, IL-13Ra2, HER2, EGFRvIII and Matrix metalloproteinase-2.

Synovial sarcoma is a rare and aggressive mesenchymal neoplasm characterised by the presence of the SS18-SSX fusion oncogene, resulting from the chromosomal translocation t(X;18)(p11.2;q11.2). Although these tumours typically arise in the extremities, they have also been documented in atypical locations such as the pericardium, underscoring their versatile and aggressive nature. This case involves a 46-year-old male who presented with a 2-month history of neck and precordial chest pain, ultimately diagnosed with a biphasic synovial sarcoma of the pericardium. Initial imaging studies, including magnetic resonance imaging and transthoracic echocardiogram, revealed a large encapsulated intrapericardial mass with hemorrhagic and thrombotic components, severe pericardial effusion and biventricular dysfunction. Histopathological examination confirmed the diagnosis, with immunohistochemistry findings positive for CKAE1/AE3, TLE-1, EMA, BCL-2 and CD99, along with a proliferation index of 40%. The chemotherapy regimen of ifosfamide, mesna and doxorubicin proved effective for this condition, leading to a significant reduction in tumour size and metabolic activity. However, due to disease recurrence and the presence of a KDM5A-positive marker, second-line therapy with trabectedin and pazopanib became necessary.

Introduction: Radiation therapy (RT) is crucial in the management of cervical cancer, particularly in resource-limited settings where most patients present with advanced-stage disease. Advances in external beam radiotherapy (EBRT) planning and delivery techniques, brachytherapy (BT) and systemic therapy necessitate context-adapted guidelines to standardise care. We developed a clinical practice guideline to improve and to harmonise the multidisciplinary management of cervical cancer in Uganda.

Methods: A multidisciplinary team of Radiation Oncologists, Medical Physicists and Radiation therapists developed the guideline using a modified Delphi process. The guideline was externally reviewed by experts from the International Gynaecological Radiation Oncology Consortium.

Results: All newly diagnosed patients should undergo multisciplinary evaluation prior to radiotherapy. For early-stage cervical cancer, adjuvant radiotherapy after hysterectomy is indicated in women with intermediate-risk factors, while concurrent cisplatin-based chemoradiation is indicated in women with high-risk factors. The standard EBRT dose is 45-50 Gy; women with vaginal and/or parametrial disease should receive adjuvant vaginal vault BT to achieve an equivalent dose in 2 Gy (EQD2) of 60 Gy. For locally advanced cervical cancer, the standard of care is pelvic EBRT (45-50 Gy in 25 fractions) with concurrent cisplatin (40 mg/m² weekly for 5-6 cycles) followed by image-guided adaptive brachytherapy delivering 24-28 Gy in 3-4 fractions to achieve an EQD2 of 80-85 Gy for small tumours and 85-90 Gy for large tumours. The overall treatment time should not exceed 56 days. In recurrent disease, management depends on the location of the recurrence and the interval since the previous RT. In metastatic disease, palliative RT is directed to symptomatic sites.

Conclusion: This clinical practice guideline offers evidence-informed, context-specific recommendations for the use of EBRT and BT in cervical cancer management in Uganda. It aims to harmonise the role of RT within multidisciplinary care pathways.