South Asian Journal of Cancer最新文献

Aims and objective: To compare the clinical outcomes of neoadjuvant chemotherapy followed by interdigitated brachytherapy versus standard chemoradiation in locally advanced cervical cancer.

Materials and methods: We enrolled 108 patients with histologically confirmed carcinoma of the cervix, at International Federation of Gynecology and Obstetrics (FIGO) stages IIB to IIIC1. They were then randomized into two groups. The study group received neoadjuvant chemotherapy with paclitaxel 175 mg/m ² and carboplatin (area under the curve [AUC]: 5) at every 3 weeks, followed by external beam radiotherapy (EBRT) 45 Gy/20 fractions and concurrent cisplatin with interdigitated high dose rate intracavitary brachytherapy (HDRICBT) 5 Gy/fraction weekly for a total of four fractions. Patients in the control group received EBRT 50 Gy/25 fractions and concurrent cisplatin with sequential HDRICBT 7 Gy/fraction weekly for a total of three fractions.

Results: At the end of the study, the results of both groups were compared in terms of response to therapy and acute toxicities. A total of 108 patients were enrolled (54 in each two arms). Ninety-three patients who completed treatment were included in the analysis. The median follow-up duration was 10 months (range: 6-18 months). Complete response was observed in 24 (53.3%) and 26 (55.3%) patients, and partial response was in 12 (26.6%) and 12 (25.5%) patients in the study and control groups, respectively. Most of the acute and late toxicities were of grades 1 and 2 and comparable in both groups.

Conclusion: In a busy department where resources are limited, neoadjuvant chemotherapy (NACT) followed by EBRT with HDRICBT is an alternative option for current standard concurrent chemoradiation (CCRT) as its tolerance and toxicity are at par with CCRT.

Background: Prostate cancer ranks as the eighth leading cause of cancer-related mortality in Thailand, exhibiting an average annual percent increase in incidence rates of 2.7%. Abiraterone acetate, an active prodrug of abiraterone, exhibits potent inhibitory activity against the enzyme CYP17A1, a crucial component in the androgenic biosynthetic cascade. This study was designed to evaluate the safety and efficacy of generic abiraterone (Abiratred) in treating metastatic prostate cancer within a real-world, retrospective observational context.

Materials and methods: Thirty-five patients diagnosed with metastatic prostate cancer who underwent abiraterone treatment at Siriraj Hospital in Thailand were enrolled in the study. Data encompassing demographics, medical history, general examination, vital signs, comorbidities, health status, and prostate cancer-related characteristics were collected. The primary outcome measure was the prostate-specific antigen (PSA) response rate (defined as a ≥ 50% decrease in PSA levels from baseline), and secondary outcomes encompassed assessing PSA progression-free survival (PFS), disease control rate (DCR), and evaluating safety.

Results: Among the 35 patients, 23 (65.7%) exhibited a PSA response. The median PSA PFS at 6 months was 65.6% (21 out of 35 patients). The DCR was determined to be 71.4% (25 out of 35 patients), with 19 (54.3%) patients experiencing stable disease and 6 (17.1%) patients showing a partial response. Adverse events were observed in 5 (14.3%) patients, but there were no deaths related to abiraterone.

Conclusion: This real-world study provides evidence that generic abiraterone (Abiratred) is both well-tolerated and effective for patients with advanced or metastatic prostate cancer, making it a promising option in real-world clinical settings.

Introduction: Chemotherapy-induced thrombocytopenia (CIT) is a frequent complication of antineoplastic therapy. The incidence of CIT varies with cancer type and regimen used. CIT can result in chemotherapy delays, dose reductions, and discontinuation, leading to reduced survival rates· Romiplostim is a thrombopoietin receptor agonist that is effective for the treatment of CIT.

Aim: This article evaluates the efficacy and safety of romiplostim in patients with CIT in a real-world setting.

Methodology: The study was a retrospective, single-center study, which enrolled patients with solid tumors or hematological malignancies with persistent thrombocytopenia who had been treated with romiplostim.

Results: A total of 100 patients with CIT were categorized into three treatment groups: romiplostim 500 mcg ( N  = 56), romiplostim 500 mcg + 1-unit random donor platelets (RDP) ( N  = 35), and romiplostim 500 mcg + 2-unit RDP ( N  = 9). The most common malignancies were gallbladder carcinoma in the romiplostim 500 mcg group, breast cancer in the romiplostim 500 mcg + 1-unit RDP group (31.4%), and gallbladder and head and neck carcinoma in the romiplostim 500 mcg + 2-unit RDP group. Chemotherapy regimens varied, with gemcitabine + cisplatin (26.7%), Adriamycin + cyclophosphamide (31%), and paclitaxel + carboplatin (22%) being the most used in each group, respectively. Grade I thrombocytopenia was most frequent with Capox (22.2%), grade II with gemcitabine + cisplatin (42.3%), grade III with paclitaxel + carboplatin and gemcitabine + cisplatin (17.02%), and grade IV with paclitaxel + carboplatin (44.4%). Romiplostim significantly increased platelet counts across all groups ( p  < 0.001), demonstrating its effectiveness in managing CIT across all severity grades.

Conclusion: Romiplostim was effective in increasing platelet counts regardless of the grade of thrombocytopenia. Romiplostim use for the management of CIT will help in correcting CIT and allow resumption of chemotherapy without recurrence of CIT in most patients undergoing cancer chemotherapy.

Background: Colorectal cancer (CRC) is one of the most common malignancies across the world and is the fourth most common cancer among men in India as per the Global Cancer Observatory (GLOBOCAN) data 2020. Available data suggest that approximately 30% of patients present with advanced/metastatic CRC (mCRC). This publication summarizes the latest evidence with cognizance of the unique challenges faced in India by medical oncologists treating mCRC.

Methods: A panel of 38 medical oncologists held a meeting in February 2023 and reviewed the evidence available for the management of mCRC. The meeting concentrated on the recognition and management of mCRC with a focus on systemic therapeutic approaches. A literature review of these aspects of management leads to the formation of consensus statements with the level of evidence and grades of recommendation. Statements were evaluated by the modified Delphi method.

Key content and findings: The panel comprising 38 experts formulated 51 consensus statements with regard to the management of mCRC, including oligometastatic CRC, unresectable CRC, as well as various systemic therapeutic options. Resource-constrained scenarios, specifically with regard to the economic constraints and availability of drugs in India, were evaluated as part of the statements.

Conclusion: Our consensus statements offer practical, yet evidence-based management guidelines for treating mCRC in the Indian context. Stratifying and recommending treatment options in a resource-constrained scenario is an important aspect of these statements.

Objective: The main objective was to evaluate key survival results, comprising progression-free survival (PFS) and overall survival (OS), in individuals with histopathologically confirmed penile cancer, along with an assessment of clinical features, treatment strategies, and therapy-related side effects.

Materials and methods: This study comprised retrospective analyses of individuals diagnosed with penile cancer, confirmed by histology, between April 2021 and December 2024, regardless of disease stage. Case records were reviewed to gather information on demographics, clinical details, histopathology, and treatment outcomes.

Statistical analysis: As the data was collected retrospectively, no prior sample size estimate was performed. Data analysis was carried out using SPSS version 27.

Results: The most common presenting symptoms were ulcerative-proliferative growth (60%), pain (50%), dysuria (40%), and lymphedema (40%). The median age of patients in this retrospective study was 56 years (interquartile range: 49.25-59.25). Out of the 10 patients included, 9 (90%) had localized or locally advanced disease and underwent primary surgical treatment. Among them, eight patients (80%) had partial penectomy, while one patient (10%) underwent total penectomy. These patients received adjuvant chemotherapy and/or radiotherapy based on their disease stage. One patient (10%) had metastatic disease at diagnosis and was treated with upfront palliative chemotherapy. Most patients presented with advanced-stage tumors, with 60% having T3/T4 disease and 90% showing lymph node involvement (N + ). For those with nonmetastatic disease, the median disease-free survival was 14 months (95% confidence interval [CI]: 12.61-15.38). Following disease progression, patients were treated with palliative intent, achieving a median PFS of 12 months (95% CI: 11.29-12.71) and a median OS of 28 months (95% CI: 24.9-31.09). Two patients (20%) experienced grade 3 or higher neutropenia, and one patient had hypothyroidism.

Conclusion: In India, penile cancer is frequently identified at an advanced stage. Patients presenting with recurrent, metastatic, or nodal disease tend to have poor OS, even with optimal palliative systemic therapy. This highlights a significant unmet need for more effective systemic treatment options in this group. Our study underscores the pressing need for region-specific research and improved access to multidisciplinary care.

Introduction: Mutation of p53 is often considered to be associated with high-grade epithelial ovarian cancer that carries a poor prognosis. The purpose of the study was to evaluate the pattern of immunohistochemical expression of p53 in epithelial ovarian carcinoma (EOC) and to find out its correlation with clinicopathological parameters of the disease.

Methods: This observational, cross-sectional study was conducted at the Department of Gynecological Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from July 2022 to June 2023. A total of 50 women diagnosed with EOCs and scheduled for primary debulking surgery were selected for the study. A semiquantitative histochemical scoring method was employed for p53 nuclear staining, with over 1,000 tumor cells assessed across multiple high-power fields for percentage and intensity of staining. Positive and negative control slides were incorporated during staining procedures to ensure reliability. Statistical analyses included chi-square or Fisher's exact tests for categorical variables, Mann-Whitney tests for nonnormally distributed continuous data, and Spearman's correlation for relationships between various parameters.

Results: Of the total 50 study participants were included, 31 (62%) exhibited p53 mutations, while 19 (38%) showed no such mutations. The presence of p53 mutation was significantly associated with a family history of ovarian cancer ( p  = 0.001) and the histological subtypes ( p  = 0.046). Regarding histological subtypes, 39 (78%) cases were serous, 9 (18%) cases were mucinous, 1 (2%) case was seromucinous, and 1 (2%) case was of endometrioid variety. Preoperative median CA-125 levels were significantly higher in advanced-stage and high-grade serous ovarian carcinomas compared with early-stage and low-grade cases ( p  = 0.016 and p  = 0.001, respectively). Although no significant association was found between p53 mutation status and serous carcinoma stage, mutation status was significantly associated with serous carcinoma grade ( p  = 0.042), with a moderate positive correlation (Spearman's correlation coefficient, ρ  = 0.364).

Conclusion: Our study highlights the significant association of p53 mutations with a family history and histological subtypes of EOC. Elevated preoperative CA-125 levels are associated with advanced-stage and high-grade serous carcinomas. Moreover, higher-grade serous ovarian carcinomas are significantly associated with the presence of p53 mutations, providing valuable insights into pathogenesis and potential treatment strategies.

Introduction: Preoperative radiotherapy (preop-RT) can be used as one strategy to improve pathological complete response rates in locally advanced breast cancer. Hence, we conducted a pilot study of preop-RT in partial responders to primary systemic chemotherapy (PST).

Methods: Standard PST comprising of four cycles of Adriamycin/cyclophosphamide followed by four cycles of taxanes (along with trastuzumab in Her2-neu enriched) was initiated. After two cycles of taxanes, partial responders (PRs) were enrolled onto preop-RT (40 Gy/15#/3 weeks to whole breast followed by boost dose of 10 Gy/4#/1 week to gross tumor with 5 mm margin [clinical target volume] and 10 mm margin [planning target volume] by three-dimensional conformal radiation therapy. Field-in-field technique was used whenever the need to correct dose heterogeneity arose. The remaining two cycles of taxanes were completed 3 weeks after the completion of RT. Surgical intervention was initiated 6 weeks after the completion of PST. The intention of such a strategy was to keep an interval of 12 weeks between completion of RT and surgery to achieve maximum downstaging. The primary endpoint was pathological complete response rate (ypCR).

Results: Twenty-one women were enrolled (median age 47 years, 35% premenopausal, 50% upper outer quadrant, 65% T4, 85% node positive, 40% luminal A, 10% luminal B, 15% Her-2-neu enriched, and 35% triple-negative breast cancer [TNBC]). Twenty-eight percent underwent breast conservation and the rest modified radical mastectomy ( n  = 13) and 2 did not undergo surgery (elderly [ n  = 1], lost to follow-up [ n  = 1]). ypCR(T) rate was 53% and ypCR(N) was 59%. ypCR(T) rate was 50% in Her-2 positive and 25% in TNBC, and 33.3% in luminal A. At a median follow-up of 24 months, the median overall survival is 41 months and 2 (both TNBC, ypCR, and ypPR) developed distant metastasis (in lung and soft tissue).

Conclusion: This pilot study reveals encouraging results in high-risk subsets and this potential of preop-RT should be explored further in larger studies.

Objectives: The present study aimed to evaluate the impact, challenges, and outcome by adding bortezomib to the FLAG (fludarabine, cytarabine, and filgrastim) regimen in these populations in a resource-constraint setting.

Materials and methods: A prospective observational study was conducted at a tertiary cancer center in India from January 2022 to September 2024 involving patients diagnosed with relapsed/refractory acute myeloid leukemia (AML) receiving FLAG-bortezomib. Complete remission (CR) and associated toxicities were assessed.

Results: Out of 13 patients, 8 (61.53%) were males and 5 (38.46%) were females (range: 2-17 years). Sorafenib ( n  = 1) and midostaurin ( n  = 2) were given along with chemotherapy for children with FLT3 mutations. Myelosuppression was the most frequent toxicity, with all patients developing ≥ grade 3 pancytopenia. Five (38.46%) patients achieved CR after first cycle, two (15.39%) died during treatment, and six (46.15%) were with persistent leukemic activity. Median duration of neutrophil and platelet recovery was 22 (range: 6-65) and 24 (range: 5-70) days, respectively, in children who achieved CR. Median overall survival was 12 months. At the last follow-up, three (23.08%) patients are alive.

Conclusion: FLAG-bortezomib regimen could help in pediatric and adolescent relapsed AML to achieve a remission comparable with other regimen in low- and middle-income countries, highlighting its potential.

Background: Cancer-related fatigue (CRF) reduces quality of life and the activity level of patients with cancer. Data regarding CRF from Indian population are limited. The present study was aimed to understand the prevalence of CRF in Indian patients and its impact on quality of life.

Methodology: This prospective observational study was conducted at SVS Medical College, Telangana, India, for a duration of 6 months. The study included 100 adult patients with cancer receiving treatment at the institute and willing to consent for the study. The patients with brain metastases were excluded as it might impact their ability to complete study procedures. Patients' demographics, disease and treatment details, etc. were collected. Patients were interviewed to assess the level of fatigue using the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) scale and the National Comprehensive Cancer Network (NCCN) fatigue intensity scale. The analysis of data was performed using chi-square and analysis of variance tests.

Result: In our study of 100 Indian patients (49 males and 51 females), mean age was 43.78 years. Breast cancer and gastric cancer were the most common diagnosis, with 22 patients each. Treatment protocols included radiotherapy in 63 patients and chemotherapy in 37 patients. As per the EORTC QLQ-C30 scale, proportion of patients with normal, mild, moderate, and severe level of fatigue were 9, 15, 44, and 32%, respectively. As per the NCCN scale, proportion of patients with no or mild, moderate, and severe fatigue were 9, 47, and 44%, respectively.

Conclusion: Our study suggests that among the Indian patients with CRF, higher proportion of patients have moderate or severe level of fatigue. Appropriate assessment and management of CRF should be considered in the patients for overall management.