Indian journal of cancer最新文献

Abstract: Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the rearrangement of long arm of chromosomes 9 and 22, resulting in the Philadelphia chromosome, creating the fusion oncogene BCR-ABL1. Median age of onset of CML is 67 years. However, approximately a third of patients are of reproductive age at diagnosis. CML presenting during pregnancy is extremely rare, and there are no randomized controlled trials to address the optimal management of CML during pregnancy. We report a 38-year-old woman diagnosed with CML during her routine antenatal clinic booking visit, which was further complicated by dengue fever and pulmonary embolism during pregnancy. She was successfully managed by a multidisciplinary team, which resulted in the delivery of a healthy baby boy. This case adds to the literature on CML in pregnancy and reflects the importance of a multidisciplinary team approach when managing complicated patients who require timely rational interventions.

Objective: Our objective was to evaluate the impact of the use of a sealing device during inguinofemoral lymphadenectomy on the reduction of postoperative complications.

Methods: A single-institution, prospective, nonrandomized study was carried out. Fifteen patients with vulvar cancer underwent wide excision and inguinal lymphadenectomy between May 2017 and April 2019. Five patients underwent lymphadenectomy with a bipolar sealing device, whereas the remaining 10 patients received the standard procedure. Postoperative complications including wound infection, seroma, and lymphedema were selected as the primary outcome.

Results: Patients who underwent surgery using a sealing device showed significantly lower wound infection rate (0 cases, 0%) compared with patients who underwent the standard procedure (7 cases, 70%; P = 0.026). Incidence of seroma and lymphedema did not show statistically significant differences between groups.

Conclusions: The use of a sealing device to perform the inguinofemoral lymphadenectomy in vulvar cancer could reduce the rate of wound infection compared with the standard procedure.

Background: Palliative whole brain radiotherapy (WBRT) is an important cornerstone for the management of brain metastasis. WBRT alleviates symptoms, aiding in tapering of steroid dose. Thus, the assessment of quality of life (QoL) has become increasingly recognized as an important outcome in patients with brain metastasis. The primary objective of this study was to assess whether there was an improvement in QoL for patients with brain metastasis after radiation therapy and to evaluate the feasibility of application of shorter QoL assessment methods.

Methods: This prospective observational study included 84 patients treated for brain metastasis. QoL assessments were conducted at baseline and three months after completion of WBRT. QoL assessment was done with EORTC QOL-C15-PAL, EORTC QOL-BN20 module and Barthel index for Activities of Daily Living. Statistical analysis was done using SPSS version 21, paired sample t-tests and Spearman's correlation.

Results: The median age was 59 years (range 37-81 years). Statistically significant improvement was seen in Barthel index at three months follow-up. For C-15-PAL and BN20 questionnaires, there was a statistically significant improvement seen in the majority of post therapy QoL scores. Baseline KPS was positively correlated with baseline Barthel index, C-15PAL physical functioning scale and baseline global QoL scale, but it negatively correlated with baseline QLQ-BN20 motor dysfunction scale. Baseline KPS was positively correlated with follow-up QLQ-C15-PAL physical functioning scale.

Conclusion: Palliative therapy with WBRT for brain metastasis forms an integral support for improved quality of life. Among various assessment tools available, the shorter versions allow for better completion and compliance.

Abstract: Giant prostatic adenocarcinoma is an extremely rare scenario with only two cases reported till date. To the best of our knowledge, our patient, a 76-year-old gentleman adds to the literature as the third case of giant prostatic adenocarcinoma and the second largest in volume. In spite of high pretreatment serum prostate-specific antigen value, he had a nonmetastatic disease that was treated successfully with radical intent, and it is the highlight of this case. He completed the planned treatment and is clinically well with no progression at 3 years.

Background: Granulocytic sarcoma (GS) or myeloid sarcoma (MS) is a tumor of hematopoietic stem cell origin composed of myeloblasts or immature myeloid cells presenting as tumor masses in an extramedullary site. The tumor can affect any site of the body but are commonly seen in the skin, bone and lymph node. It may develop de novo or concurrently with acute myeloid leukemia (AML), myeloproliferative disorder (MPD) or myelodysplastic syndrome (MDS). MS may precede AML by months or years or present as an initial manifestation of relapse in a previously treated AML in remission. On light microscopic examination, based on histological features cases of MS are frequently erroneously diagnosed, more so in non-leukaemic patients, as non-Hodgkin lymphoma (NHL) or undifferentiated carcinoma. Immunophenotyping is needed for a diagnosis of MS. A variety of chromosomal abnormalities are reported; particularly t(8;21)(q22;q22), which is regarded as a recurrent aberration in MS. Only a few cases of MS of the small intestine in non-leukaemic patients, defined by the absence of a history of leukemia, myelodysplastic syndrome (MDS), or myeloproliferative neoplasm along with a negative bone marrow biopsy, are described in literature. Treatment strategies are still not well defined.

Methods: We analyse and describe 3 cases of patients with MS involving the intestine and describe the histological diagnostic pointers, clinicopathologic and immunophenotypic features.

Results: Granulocytic sarcoma has definite well recognisable diagnostic features. The characteristic features include: tumor cells arranged in sheets and in occasional infiltrating singles; absence of necrosis; starry-sky appearance; scattered eosinophils & promyelocytes; tumor cells negative for CD3, CD20, while being positive for CD45 (patchy) and CD19.

Conclusions: Granulocytic sarcoma is a rare disease and a high index of suspicion is needed for making a correct diagnosis. Judicious use of immunohistochemistry helps in coming to a diagnosis. We propose a diagnostic algorithm for making a diagnosis of granulocytic sarcoma.

Background: We aimed to evaluate the data of perioperative 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy regimen in locally advanced gastric cancer (LAGC) patients with real-life experience.

Methods: In this retrospective study, LAGC patients who received perioperative FLOT chemotherapy regimen between 2017 and 2020 were included. The patients were grouped according to tumor regression grade (TRG): histopathological responders (complete/moderate response) and histopathological non-responders (minimal/poor response). The factors affecting TRG were evaluated and its relationship to clinical outcome was analyzed by disease-free survival (DFS) and overall survival (OS).

Results: A total of 141 LAGC patients were included. Median age of patients was 62 (range: 35-75) years of whom 69.5% were men. According to TRG, 41 (29.1%) patients were histopathological responders (College of American Pathologists (CAP)-TRG 0/1). Grade, perineural and lymphovascular invasion, clinical stage, tumor markers (Carcinoembryonic antigen (CEA) and Carbohydrate antigen (CA)19-9), radiological response, and ypTNM stage were statistically significant in univariate analysis and lymphovascular invasion was detected as an independent factor in multivariate analysis for TRG. Grade 3-4 toxicities were observed in only 28 (19.9%) patients. Two years DFS and OS rates were higher in the histopathological responder group (100% and 100%) compared to the histopathological non-responder group (59% and 52.9%) (P = 0.01 and P = 0.02, respectively).

Conclusion: In our study, it was found that the FLOT regimen had a favorable TRG and a safe toxicity profile in gastric cancer patients. In addition, while lymphovascular invasion could predict TRG, the survival and disease recurrence were positively affected by the favorable TRG response.

Background: Oral cancer is a major health problem in India. Recently an increase in the oral cancer incidence among young individuals without any habits was observed, which may be due to Human Papilloma Virus (HPV). However, information on the prevalence of HPV in oral cancer in India is sparse. This study aims to document the frequency of HPV16 infection in oral squamous cell carcinoma (SCC) and to study its correlation with treatment outcome.

Methods: Paraffin-embedded tissue blocks of 183 patients with SCC of the oral cavity were studied. HPV16 prevalence was detected by a polymerase chain reaction and expression of p16INK4a was analyzed by immunohistochemistry. This was correlated with clinical outcomes.

Results: The prevalence of HPV 16 was 6.6% and all were carcinoma tongue. All HPV-positive patients showed intense expression of p16INK4a. The five-year overall survival (OS) and disease-free survival (DFS) for HPV positive patients were higher compared to HPV negative patients (100% versus 74.5% and 100% versus 70.8% respectively). The five-year OS and DFS for patients with p16INK4a intense expression were also higher compared to p16INK4a weak expression (91.2% versus 57.4% and 82% versus 22.5% respectively). Five-year OS and DFS of patients with HPV16 positivity and p16INK4a intense expression were significantly higher than patients with HPV negative and p16INK4a weak expression (100% versus 54.7% and 100% versus 22.5% respectively).

Conclusion: The frequency of HPV16 positivity in oral cancer was low in this study with a site predilection to the oral tongue. p16INK4a expression did not correlate with HPV status. A better treatment outcome was observed in HPV-positive cancers. We also observed better treatment outcomes in patients with p16INK4A overexpression irrespective of HPV status.

Background: Well-defined pre-cancerous stages help early detection of uterine cervical cancer by Pap smear or human papillomavirus (HPV) analysis. HPV induces atypical squamous cells of undetermined significance (ASCUS) which can progress to higher grade lesions depending on persistence of infection with High-risk human papillomavirus (HrHPV). The HrHPV prevalence and persistence after 18-36 months, associated risk factors for persistence among women with ASCUS, and the effect of persisting HrHPV in the cytological progression upto a period of seven years are analyzed.

Methods: In the routine Pap smear clinic of a Women and Children Hospital, women who had ASCUS in Pap smear in 2009-2011 were the sample for the study. A sample of 152 women with ASCUS in Pap smear, were subjected for HrHPV (16, 18, 31, 33 and 42) analysis. These women were invited for a repeat Pap smear and HrHPV analysis after 18 months. Women with HrHPV in both the rounds were advised to come for yearly routine follow-up Pap smear upto seven years.

Results: The HrHPV prevalence was 46%, HrHPV persistence within 18-36 months was 60.8% and clearance was 39%. Among many risk factors for HrHPV persistence in univariate analysis, having more than two pregnancies and unhealthy appearing cervix were significant in multivariate analysis. 94% of the women with persistent ASCUS or higher lesion within seven years were initially persistent HrHPV positives.

Conclusion: Since persistence of HrHPV in the cervix at least for 2 years helps in the persistence or progression of ASCUS even after seven years, routine HPV analysis should be done for women with ASCUS cytology, and who have high parity and unhealthy cervix. These women should be closely followed up to identify the progression to higher grade lesions.

Background: Breast cancer and cervical cancer are the leading causes of cancer-related mortality in Indian women. As part of the Indian national guidelines for population-based cancer screening, village-level accredited social health activists (ASHAs) are the key mobilizers for encouraging women to undergo cervical and breast cancer screening. Assessing screening rates in these health workers themselves, can improve implementation of the national program by identifying some of the facilitators and barriers for screening.

Methods: A cross-sectional study was conducted among ASHAs in Puri, Odisha, in eight primary health centers (PHCs) randomly selected from 10 blocks. Of all 291 ASHAs in these PHCs, 242 (83.2%) who consented, were given a self-administered questionnaire to assess screening and its associated factors.

Results: The screening rates for cervical and breast screening in ASHA workers were 9.1% (95% CI: 5.4%-12.8%, 22/242) and 14.9% (95% CI: 10.3%-19.5%, 36/242), respectively. Having undergone screening themselves, was associated with referring others for screening (83.3% of those screened for breast cancer had referred others vs 37.4% of those never screened; 86.4% of those screened for cervical cancer had referred others vs 34.1% of those never screened).

Conclusions: ASHAs reported low rates of screening for breast and cervical cancer. History of screening significantly influenced the referral of others for screening. ASHAs need to be empowered with both educational exposure as well as motivation for health-promoting activities for themselves, in order to increase population-wide screening coverage.