Indian journal of cancer最新文献

Abstract: Twenty-five percent of all aggressive angiomyolipomas (AMLs) are related to tuberous sclerosis. Our patient was a 42-year-old man with tuberous sclerosis and a medical history of a benign AML in the left kidney. Presently, an epithelioid AML was detected in his right kidney and, despite our conducting extensive surgery, a large pulmonary metastasis with mediastinal lymph node involvement followed 20 months later. Close follow-up of the patient is advised when epithelioid cells are observed in angiomyolipoma. Immunohistochemistry for mismatch repair proteins showed that PMS2, MSH2, and MSH6 were absent in both the tumor and normal kidney. Microsatellite instability may contribute along with a mutation of TSC gene to the oncogenic events leading to AML.

Abstract: Germ cell tumors are native to the testis, retroperitoneum, and mediastinum. Here, we report our experience on rare scenarios in this entity. The first patient presented with a primary mediastinal germ cell tumor with 2° hemophagocytosis. This dysregulated immune milieu portends a dismal outcome irrespective of treatment. Gastrointestinal involvement in germ cell tumor accounts for only 5% of cases. The Second case with duodenal involvement and hematemesis is believed to be due to contiguous infiltration of the retroperitoneal node. Another case with bleeding ileal intussusception was seen after high-dose chemotherapy in a relapsed non-gestational choriocarcinoma. Bone metastases are exceptional in seminomas and we report such a case as well. Our next patient had thrombotic cardiac involvement which is scarce in the literature. Last patient in this series is an 81-year-old man with sertoli leydig cell tumor. This rare disease in elderly should be differentiated from other entities as the management for each differs.

Background: Gastrointestinal cancer (GI) is one of the most common and deadly cancers worldwide. In the present study, we assessed the association between single nucleotide polymorphisms (SNPs) within nucleotide excision repair (NER) pathway genes (xeroderma pigmentosum complementation group C [XPC], xeroderma pigmentosum complementation group G [XPG], and xeroderma pigmentosum complementation group D [XPD]) and the GI cancer risk in the rural population of Maharashtra.

Methods: The genotyping of XPC, XPD, and XPG genes was studied by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method using 200 clinically confirmed GI cancer cases and equal number of healthy controls. The association of polymorphisms was confirmed by odds ratio (OR) with 95% confidence interval (CI).

Results: The frequency distribution of XPD gene (C22541A) polymorphism showed that variant A/A genotype increased four times (OR = 4.08; 95% CI = 2.14-7.77; P: < 0.0001) and G23591A polymorphism with heterozygous G/A genotype showed significant correlation (OR = 6.90; 95% CI = 4.28-11.11; P < 0.0001) with risk of GI cancer compared to variant A/A genotype (OR = 1.92; 95% CI = 1.00-3.69; P = 0.04). The results of genetic association analysis of XPC at codon 939 of exon 15 and XPG at codon 1104 of exon 15 showed no association with GI cancer risk in the studied population.

Conclusion: Our results indicated that XPD Arg156Arg and Asp312Asn polymorphisms were significantly associated with GI cancer risk whereas XPC Lys939Gln and XPG His1104Asp polymorphisms were not statistically significant.

Abstract: Neutropenia is a common side effect in hyperthyroid patients with long-term use of antithyroid drugs. Antithyroid drugs have been used for the management of hyperthyroidism and rarely may cause life-threatening side effects such as pancytopenia and very rarely may cause acute leukemia. The current case report is of a 34-year-old man diagnosed with hyperthyroidism who presented with pancytopenia after treatment with carbimazole for past 7 months; he initially improved with supportive treatment. The patient restarted treatment with carbimazole but with a reduced dose. He was readmitted for fever and high total leukocyte counts after 3 months of restarting carbimazole. The patient was thoroughly investigated, and bone marrow aspiration examination showed acute myeloid leukemia. This presentation of acute myeloid leukemia was likely attributed to the reexposure to carbimazole, although the association of acute myeloid leukemia with autoimmune thyroid disease cannot be denied.

Background: To evaluate outcomes of postneoadjuvant chemoradiotherapy (NACTRT) wait and watch strategy (WWS) in distal rectal cancers.

Methods: All consecutive patients from December 2012 to 2019 diagnosed with distal rectal tumors (T2-T4 N0-N+) having a complete or near-complete response (cCR or nCR respectively) post-NACTRT and wished for nonsurgical treatment option of WWS were included in this study. Patients were observed with 3 monthly MRI, sigmoidoscopy, and digital rectal examination (DRE) for 2 years and 6 monthly thereafter. Organ preservation rate (OPR), local regrowth rate (LRR), nonregrowth recurrence-free survival, and overall survival (OS) were estimated using the Kaplan-Meier method, and factors associated with LRR were identified on univariate and multivariate analysis using the log-rank test (P < 0.05 significant).

Results: Sixty-one consecutive patients post-NACTRT, achieving cCR [44 (72%)] and nCR [17 (28%)], respectively, were identified. All patients received pelvic radiotherapy to a dose of 45-50Gy conventional fractionation with concurrent Capecitabine. Additional boost dose with either external beam or brachytherapy was given to 39 patients. At a median follow-up of 39 months, 11 (18%) patients had local regrowth, of which seven were salvaged with surgery and the rest are alive with disease, as they refused surgery. The overall OPR, nonregrowth recurrence-free survival, OS was 83%, 95%, and 98%, respectively. Seven (11%) patients developed distant metastasis, of which six underwent metastasectomy and are alive and well. LRR was higher in patients with nCR versus cCR (P = 0.05).

Conclusion: The wait-and-watch strategy is a safe nonoperative alternative management for selected patients attaining cCR/nCR after NACTRT with excellent outcomes.

Background: The aim of this study was to evaluate the clinicopathological features, patterns of care, and the survival outcomes of patients with medullary thyroid cancers (MTCs) treated at our tertiary care center.

Methods: We conducted a retrospective analysis of all patients with a histological diagnosis of MTC and who had been treated at our tertiary care center from August 1, 1986 through November 31, 2019.

Results: MTC in 83 patients were managed in the said period and comprised 44 men and 39 women. The median age of the patient cohort was 45 years. Seventy-seven of 83 patients underwent upfront surgery that entailed a total thyroidectomy and a central compartment neck dissection and a lateral compartment neck dissection, as was deemed appropriate. The disease-free survival rates at 5, 10, and 20 years for the present study were 62%, 51%, and 46%, respectively, and the overall survival rates for the same periods were 85%, 80%, and 76%, respectively. A formal analysis of the various prognostic factors was made. In multivariate analysis, the factors that significantly influenced the disease-free survival included gender and lymph node ratio. Furthermore, on multivariate analysis, the factors that significantly influenced the overall survival included age and gender, with male patients and patients aged >55 years faring poorly.

Conclusion: Our study has clearly demonstrated the favorable long-term survival outcomes of patients with MTCs. Furthermore, the analysis of various prognostic factors adds to our understanding of the biology of this rare form of thyroid cancer.

Background: Although using a free flap with a microvascular technique is the gold standard of care, its use is limited in underdeveloped nations due to a lack of experience and resources. As a result, alloplastic materials and pedicled musculocutaneous flaps are commonly used in mandibular repair. Although numerous alloplastic materials have been employed with this flap, the majority of research has shown that they have a negative effect. The aim of the study was to see how effective silicon spacers are as a replacement for alloplastic materials in mandibular reconstruction.

Methods: A prospective study was conducted on patients who had mandibular reconstruction using soft-tissue repair with or without the use of a silicon spacer. The study comprised a total of 82 patients, 40 of whom had a silicon spacer and 42 of whom did not. The Chi-square test was utilized to assess the functional and cosmetic outcomes in both groups by using the EORTC head-and-neck questionnaire-35 analysis.

Results: The majority of the patients were in the T3 and T4a stages. The most common sub-site was buccal mucosa. The average silicon spacer retention time was 62 days, with a retention rate of 22.5%. Infection at the local portion, with or without orocutaneous fistula, was a common reason for silicon spacer removal. Only the speech parameter improved in the silicon spacer group, according to the EORTC head-and neck-questionnaire (P = 0.0290). In 16 individuals, radiation therapy was postponed, which was also significant (P = 0.0123).

Conclusion: In patients with oral cavity squamous cell carcinoma who underwent mandibular resection, using a silicon spacer in combination with soft-tissue restoration did not improve functional or cosmetic outcomes except for speech. For comprehensive mandibular reconstruction, only a myocutaneous flap is sufficient.

Background: Cancer is the leading cause of death worldwide. However, there is not a single study that has investigated the effect of a precise management model in cancer patients. This study aimed to explore the role of precise management in maintaining central venous indwelling catheters for cancer patients.

Methods: In total, 106 patients with central venous indwelling catheters were randomly divided into observation and control groups. The control group was given routine nursing intervention. A precise management model was adopted for the observation group. The incidence of central venous indwelling catheter-associated complications, patient treatment compliance, anxiety and depression scores, and patient satisfaction with the nursing services were compared between the two groups.

Results: We noticed that the psychological state of the patients in the two groups significantly improved after the nursing intervention compared to before the nursing intervention (P < 0.05), and this effect was more prominent in the observation group than in the control group (P < 0.05). In addition, the incidence of complications in the observation group was lower than that in the control group (P < 0.05). Moreover, we observed that treatment compliance and patient satisfaction with the nursing services were much higher in the observation group than in the control group (P < 0.05).

Conclusions: In the maintenance of central venous indwelling catheters for cancer patients, the implementation of a precise management model can significantly reduce the incidence of central venous indwelling catheter-associated complications, improve treatment compliance of patients, positively modulate patients' psychological state, and harmonize the nurse-patient relationship.

Background: Childhood Ewing sarcoma (ES) - both osseous and extraosseous - has good outcomes with aggressive treatment that includes chemotherapy, surgery, and radiation therapy (RT). In this paper, we report our experience on the survival and prognostic factors of ES.

Materials and methods: Seventy-four newly diagnosed patients with ES, less than 14 years of age, registered in Pediatric Oncology Department of our center, over a period of 5 years, from July 1, 2010 to June 30, 2015, were included.

Results: Mean age at presentation was 8.93 years. Primary osseous sites were the extremity (n = 30), pelvis (n = 10), chest wall (n = 9), spine (n = 7), and skull (n = 5), and the extraosseous primary site was involved in 17.6% (n = 13). Metastatic disease was present in 17 patients (23%). Also, 52 patients received three-weekly vincristine/doxorubicin/cyclophosphamide (VDC)/ifosfamide/etoposide (IE) and 21 patients received only VDC. There was no treatment-related mortality. Local control modalities were surgery alone (n = 12), definitive RT (n = 33), surgery and RT (n = 20), palliative RT (n = 4), or none (n = 4). At a median duration of follow-up of 64 months, the 5-year event-free survival (EFS) for the entire cohort was 50.4% (60.6% for localized and 17.6% for metastatic) and the 5-year overall survival (OS) was 54.6% (64.2% for localized and 23.5% for metastatic). Among the prognostic factors analyzed (age, gender, lactate dehydrogenase [LDH] levels, site, and metastases), presence of metastases was the only factor significantly associated with poorer EFS and OS.

Conclusion: Localized ES has a favorable outcome even in resource-limited settings, and treatment intensification by interval-compressed chemotherapy may improve the outcomes further. Presence of metastasis at presentation confers a poor outcome.