Indian journal of cancer最新文献

Background: The aim of this study was to document the incidence, spectrum and outcomes of Second Primary Malignancy (SPM) in a prospectively followed-up population of Head and Neck Squamous carcinoma (HNSCC) patients accrued in six prospective trials and treated with definitive radiotherapy.

Materials and methods: Patients were prospectively followed up over time and data on SPM collected after IRB approval after establishing the diagnosis of SPM based on clinical criteria. Descriptive statistics to determine clinic demographic characteristics and spectrum of SPM encountered, time to event outcomes (SPM-DFS - Disease-free survival after diagnosis of second primary, SPM-OS - Overall survival after diagnosis of second primary) and univariate analysis of factors of likely prognostic significance were performed.

Results: A total of 656 individual patient records were examined. A total of 43 SPM s were detected at a median follow-up of 62 months (IQR -39-97 months), accounting for a cumulative incidence of 6.5%. The median time to development of an SPM was 48 months. The head and neck (41.84%) and the esophagus (34.8)% were the most common sites of SPM. At a median follow-up of 7 months post-diagnosis of SPM, the 1 year estimates of SPM-DFS and SPM-OS were 37.6% and 40% respectively. Radical intent treatment emerged as a significant predictor of improved SPM-OS and SPM-DFS.

Conclusion: SPMs are a major cause of morbidity and mortality in HNSCC survivors. Timely detection allows for more cases to be treated with radical intent to offer chances for long term control and survival.

Background: Children on treatment for brain tumor are at high risk of malnutrition and have significant treatment-related toxicities. However, the impact of nutritional status on outcome and toxicity is not well understood.

Aim: The objective of this study of children with embryonal brain tumor treated at our center was to understand the impact of nutritional status on treatment-related toxicities.

Materials and methods: We undertook this retrospective audit using a risk-stratified protocol between January 2017 and December 2018. Undernutrition was defined as severe or moderate malnutrition as per the World Health Organization (WHO) criteria. Nutritional status was assessed, and treatment-related toxicity (TRT) and survival rates were analyzed in relation to nutritional status at diagnosis and follow-up.

Statistical analysis used: IBM SPSS for Windows, Version 24.0.

Results: In the cohort of 72 patients with embryonal brain tumors, 64% were undernourished (UN) at the start of chemotherapy, and 2.7% were overweight. At the end of chemotherapy, 61% were UN. During the course of chemotherapy, weight gain was documented in 25% and weight loss in 23.8%. Although chemotherapy toxicity and infection were higher in UN children with medulloblastoma, this was not statistically significant. Both overweight children experienced TRT; one relapsed and subsequently died. Nutritional status did not affect survival rates.

Conclusions: Children with embryonal brain tumor are at high nutritional risk, and undernutrition may worsen treatment-related toxicities. Proactive nutritional monitoring and intervention are needed in settings with a high prevalence of malnutrition and infections.

Background: Though anthracyclines are the commonly used chemotherapeutics for cancer treatment, close monitoring of patients is required due to its well reported cardiotoxicity. The present study evaluates the role of biomarkers [N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitivity cardiac troponin-T (hs-cTnT)] in early prediction of cardiotoxicity in patients with breast and ovarian cancer who received anthracyclines.

Methods: This was a single-center observational study conducted between August-2018 and January-2020. Doxorubicin was used as an anthracycline at a dose of 50 mg/m2 per cycle. All the patients underwent echocardiography before the start and at 3 months, 6 months and 12 months after chemotherapy. NT-proBNP and hs-cTnT levels were measured before as baseline and within 24 hours of the first and last cycle of anthracycline-based chemotherapy.

Results: A total of 72 patients with breast and ovarian cancer participated in the study. The mean age of patients was 49.4 ± 10.3 years. Sixty six (91.7%) patients had breast cancer and 9 (12.5%) patients developed cardiotoxicity. Mean age of the patients who developed cardiotoxicity was 55.00 ± 12.5 years. The level of NT-proBNP and hs-cTnT were significantly increased after the last cycle of anthracycline in patients who developed cardiotoxicity.

Conclusion: The measurement of NT-proBNP and hs-cTnT levels after anthracycline administration helps detect early sub-clinical cardiotoxicity and thus can assist in modification of therapeutic regimens and initiation of heart failure therapy to prevent future cardiac events.

Background: The current study analyzes the pattern of recurrence/relapse in breast cancer patients belonging to different receptor subtypes to help enhance therapeutic and surveillance methods.

Methods: This is an observational prospective study of a cohort of 543 patients from South India. Associations between various factors and their significance in relapse were assessed by odds ratio (OR), Chi-square test, and two-sided P value.

Results: Relapse of cancer in all receptor subtypes was significantly associated with stage III (P = 0.0029). Of the 48 patients who had a relapse of cancer, 42% had relapsed at a distance recurrence (DR), 23% (P = 0.02) had loco/locoregional recurrence (LLR) and the rest had relapsed at distant and loco/locoregional sites. HER2+ (human epidermal growth factor receptor) (83%) and hormone receptor (HR+/HER2-) (77%) patients had higher DR rates with an OR of 2 (95% Confidence Interval, 0.6-6) and 0.47 (95% CI, 0.1-2.1), respectively compared to TNBC (triple-negative breast cancer) patients. TNBCs (80%) had higher LLR rates over HER2+ (50%) and HR+/HER2- (44%) with an OR of 2 (95% CI, 0.6-6) and 2.1 (95% CI, 0.47-9.3), respectively. Bones and lungs in HR+/HER2- patients, liver and lungs for HER2 + patients, and bones in TNBC patients were the preferred sites for metastasis. The number of metastatic sites followed the order, TNBCs > HER2+>HR+/HER2-.

Conclusions: HR+/HER2- and HER+ patients were more associated with DRs and TNBC patients were associated with LLR. TNBC patients recurred at multiple sites compared to the other two subtypes. Overall, there seems to be a trend in the recurrence across receptor subtypes. Understanding this recurrence pattern will help in enhancing therapeutic and surveillance methods.

Abstract: Isolated vaginal metastasis from colorectal cancer is a rare entity with very few reports in the literature. Here we report a patient who presented with bleeding per vagina from a vaginal mucosal lesion. Biopsy of the vaginal lesion indicated a metastatic adenocarcinoma from a colorectal primary. Further workup of the patient with colonoscopy and Positron emission tomography (PET CT) indicated a primary in the sigmoid colon. As the patient had a single site of metastasis, she was planned for definitive management. The colonic primary, as well as the vaginal deposit were managed surgically. Further, the patient received adjuvant chemotherapy as well as adjuvant external beam radiation to the site of the vaginal lesion. Vaginal metastases from colorectal primary are usually part of systemic dissemination with multiple metastatic sites and hence has poor prognosis. When the patient presents with an isolated metastasis in the vagina., the survival appears reasonable as per the few reports available in the literature. Due to the rarity of the presentation, there are no standard treatment guidelines available. Surgical management, radiation and adjuvant chemotherapy have been used in varying combinations in the reports available in the literature. To conclude, vaginal metastasis should be included in the differential diagnosis of patients presenting with vaginal bleeding, especially with a history of colorectal carcinoma. Available limited evidence suggests that isolated vaginal metastasis from colorectal cancer that is amenable to local surgical resection has a reasonable outcome. Hence, isolated vaginal metastasis should be treated with curative intent in a multidisciplinary context like other sites of oligometastatic disease.

Abstract: KIT is a gene coding for tyrosine kinase receptor, which was identified as the ligand of stem cell factor. Its role in disease was first identified in gastrointestinal stromal tumor. However, later, this gene was found to be implicated in many other benign and malignant tumors. C-KIT has been studied as the first biomarker for targeted therapy. Herein we review its structure, function and role in various non-neoplastic and neoplastic diseases.

Abstract: Malignant peripheral nerve sheath tumors (MPNST) are mesenchymal tumors that develop or differentiate from cells of the peripheral nerve sheath. Intraosseous MPNST is extremely uncommon and usually results from secondary invasion. A 17-year-old male presented with pain and swelling over the left collar bone. Imaging revealed an expansile lytic lesion involving the subarticular region of the clavicle with a cortical break and infiltration of the adjacent soft tissues. Biopsy findings were consistent with cellular nerve sheath tumor with significant atypia and mitoses, along with S100 protein immunopositivity indicative of MPNST. The patient was treated with neoadjuvant radiotherapy, followed by wide local excision. To the best of our knowledge, the present case constitutes the first case of a primary intraosseous MPNST involving the clavicle. The case is presented in view of its rarity and with relevant review.

Background: Postoperative pulmonary complications (PPCs) are defined heterogeneously and have major adverse effects in increasing morbidity. Oncosurgeries themselves are complex, are of long duration, and extensive handling of body tissues occurs in them, leading to various complications including PPCs. So, we conducted this prospective study intending to find the incidence and risk factors for PPCs in patients undergoing major oncosurgeries.

Methods: This prospective observational study was conducted after obtaining institutional ethical approval in patients undergoing major oncosurgeries. The demographic, preoperative, and intraoperative details were noted, and patients were followed in the postoperative period for the occurrence of PPC till discharge. Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score was used to predict the occurrence of PPC. Data were analyzed using multivariable regression analysis for the risk factors, and the Chi-square trend was used to see the trend of PPC with the change in ARISCAT score.

Results: The overall incidence of PPC in patients undergoing major oncosurgeries was 28.05%. The most common PPCs were respiratory insufficiency (19.2%) and atelectasis (17.6%). The highest incidence of PPC was found in thoracotomies (41.6%), followed by cytoreductive surgeries (40.6%). The risk factors for PPCs included body mass index (BMI) <18.5 or >25 kg/m2, smoking, use of nasogastric tube, age >60 years, and albumin <3.5 g/dL. Patients with low ARISCAT scores had a low incidence of PPC compared to those with high and intermediate ARISCAT scores.

Conclusion: The incidence of PPC in patients undergoing major oncosurgeries was 28.05% in our study. The independent risk factors for PPC in oncological surgeries were BMI <18.5 kg/m2 or >25 kg/m2, use of nasogastric tube, age <60 years, serum albumin <3.5 g/dL, and smoking.

Background: The impact of surgical compliance on survival outcomes in patients with Ewing sarcoma (ES) is unclear, so this study was performed to explore the association between them.

Methods: We used the SEER*Stat software (version 8.3.6.1) to extract information on ES patients from the SEER database. Patients were divided into two groups based on their adherence to surgical recommendations: the surgical compliance group and the surgical noncompliance group. Categorical variables were expressed as percentages. Multivariate logistic regression and Chi-square test were used to explore variables related to surgical compliance. Univariate Cox regression analysis was used to initially select potential prognostic factors, and then the factors selected in the univariate Cox regression analysis were further analyzed in a multivariate Cox proportional risk model to ultimately determine the risk prognostic factors significantly related to the survival of patients with ES.

Results: Multiple logistic regression analysis suggested that adults (OR = 0.373, 95% confidence interval (CI): 0.164-0.849), Grade IV (OR = 0.373, 95% CI: 0.164-0.849), and unmarried patients (OR = 0.568, 95% CI: 0.339-0.954) were more inclined to accept surgery recommendations, while patients from 2001 to 2010 were less compliant with surgery. Multifactorial Cox regression analysis suggested that surgical compliance was an independent prognostic factor for patients with ES. Through the Kaplan-Meier survival curves, we could clearly observe that the overall survival was higher in the surgical compliance group than in the surgical noncompliance group. Furthermore, subgroup analysis also reached similar conclusions.

Conclusion: In this study, we found that surgical compliance was an independent predictor of patient prognosis. Furthermore, we found that age, tumor grade, year of diagnosis, and marital status may be related to surgical compliance.