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: Staging of oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMDs) is considered as the most important prognostic indicator, but salivary proteins such as interleukins (ILs) can serve as potential biomarkers. The aim of this study was to assess the presence of salivary IL-10 and IL-17 in OSCC and OPMD (oral submucous fibrosis and oral leukoplakia).

Materials and methods: This was a hospital-based, in vivo, cross-sectional, comparative study. A total of 90 patients (N = 90) were included in the study. Whole unstimulated saliva was collected and subjected to enzyme-linked immunosorbent assay (ELISA): 30 from histopathologically confirmed OSCC (Group 1, n = 30), 15 from clinically diagnosed OSMF (Group 2, n = 15), 15 from clinically diagnosed OL (Group 3, n = 15), 15 from patients who had tobacco habits but no clinical lesions of OSCC/OL/OSMF (Group 4, n = 15), and 15 from healthy controls (Group 5, n = 15).

Results: Statistical analysis was performed by SPSS®25.0 (analysis of variance [ANOVA], Tukey's post hoc test, and Mann-Whitney U test). Both IL-10 and IL-17 were found in saliva. One-way ANOVA between groups showed IL-10 did not vary significantly within groups (P = 0.853), but IL-17 varied significantly between groups (P = 0.000). Mann-Whitney U test used to compare IL-10 and IL-17 between stage III and IV of OSCC showed that they did not vary significantly.

Conclusion: IL-17 can indicate the presence of ongoing inflammation toward developing OPMD/OSCC, proving it as a potent diagnostic biomarker. An increase in IL-17 with successive stages of OSCC proves it as a prognostic biomarker for OSCC.