South Asian Journal of Cancer最新文献

Objectives: Giant cell tumor of bone (GCTB) is a locally aggressive tumor with a high recurrence rate. Using denosumab or its biosimilar in a neoadjuvant setting can facilitate limb-preserving surgery and reduce recurrence rates, with minimal side effects.

Material and methods: In this clinical audit, we retrospectively analyzed the impact of denosumab biosimilar (DB) on Campanacci grade 3 GCTB, the most aggressive form of these tumors.

Statistical analysis: Means and standard deviations were used for normally distributed continuous variables, medians and ranges for nonnormal continuous variables, and percentages for categorical variables.

Results: All cases received two doses of DB on days 0 and 14, resulting in a mean lesion size reduction of 17.75%.

Conclusion: Our findings suggest that this treatment regimen can significantly improve outcomes for patients with aggressive GCTB, aiding orthopaedic oncologists in managing these challenging cases more effectively.

Background: Renal cell carcinoma (RCC) is the 12th highest cause of cancer mortality in Malaysia with 532 deaths recorded in 2020. This study aims to determine the prognostic significance of the clinicopathological factors among RCC patients at a Malaysian hospital.

Methods: Medical records of 104 patients with confirmed primary RCC who underwent nephrectomy from 2015 to 2020 at our center were retrospectively reviewed. The relationship between clinical and histopathological data and survival was studied using univariate and multivariate Cox regression analyses to determine prognostic significance. Kaplan-Meier and log-rank tests were employed for survival analysis.

Results: The 5-year cancer-specific survival was 71.2% with a median follow-up of 14 months (interquartile range 5-38 months). Symptoms of loin pain ( p  = 0.004, hazard ratio [HR] 2.9) or anemia ( p  = 0.001, HR: 3.6), lower body mass index ( p  = 0.001, HR 0.88), smoking ( p  = 0.002, HR 3.3), larger tumors ( p  < 0.001, HR 1.2), nodal involvement ( p  < 0.001, HR 7.6), higher International Society of Urological Pathology (ISUP) grade ( p  < 0.001, HR 2.7), and sarcomatoid features ( p  < 0.001, HR 16.6) have worse prognosis. Multivariate analysis, adjusted for TNM stage, found smoking ( p  = 0.002, HR 3.3), larger tumor size ( p  = 0.048, HR 1.1), nodal involvement ( p  = 0.009, HR 2.8), higher ISUP grade ( p  = 0.010, HR 2.0), and sarcomatoid histology ( p  = 0.001, HR 5.8) to be independent prognostic parameters for overall survival.

Conclusion: Detection and treatment of RCC before symptomatic onset or metastases confer a better prognosis. A history of smoking negatively affects survival. Presence of nodal involvement, venous infiltration, or sarcomatoid component in histopathological study was significantly associated with increased mortality.

Objective: Geriatric oncology in India is still in infancy. With the aging population emerging as one of the most significant global demographic shifts, primarily driven by increased life expectancy, increasing incidence of cancer among older adults is concerning. Further age-related comorbidities, treatment intolerance, and toxicities often affect treatment decisions for older cancer patients. Punjab being labeled as cancer capital of India must have dedicated registry for such patients.

Materials and methods: One year retrospective observational study to evaluate the spectrum of malignancies in elderly population was conducted at a tertiary care hospital in Punjab.

Results: Out of 955 cancer cases, 608 (63.6%) were in individuals aged 60 and above, with 326 (53.6%) cases in males and 282 (46.4%) cases in females. A significant gender difference was noted, with higher breast cancer prevalence in women ( n  = 85, 30.1%) and hematolymphoid cancers ( n  = 97, 29.7%) in men.

Conclusion: With the aging population, there is a critical need for cancer prevention, screening, and treatment strategies for the elderly, addressing age- and gender-specific risk factors for better outcomes in geriatric oncology.

Background: Advanced/metastatic ALK-mutated lung cancer has excellent long-term survival due availability of multiple targeted drugs. Alectinib is one of the preferred first-line therapies based on the Alex trial data. We present a real-world outcome with alectinib in first-line setting in low- and middle-income country (LMIC) like India.

Methods: We conducted a retrospective audit of ALK positive patients who received alectinib in first-line setting at the Medical Oncology Department, Tata Memorial Hospital, Mumbai, Maharashtra, India. We included patients who were started on alectinib between January 2018 and March 2022. The patients underwent routine blood and radiological evaluation every 2 to 3 months. We analyzed the data for progression-free survival (PFS), overall survival (OS), and safety profile.

Results: A total of 50 patients received alectinib in the specified period. The median age was 52.5 years (range: 28-81 years), 72% of the patients were 60 years or less; 54% of patients being male and 46% female. Eastern Cooperative Oncology Group-Performance Status (PS) 0 to 1 70%, PS 2 24%, and PS ¾ 6%. Methods for ALK testing were immunohistochemistry 92%, fluorescence in situ hybridization 2%, and next-generation sequencing 6%. The most common sites of metastasis before starting alectinib were bone (52%), pleura (42%), brain (30%), and lung (28%). Note that 66 and 33% patients received brain radiotherapy or bone-modifying agent for the central nervous system or bone metastasis, respectively. The median follow-up period was 18 months (13.1-22.8 months). Objective response rate was 76%, with partial response 74%, complete response 4%, and stable disease 16%. Median PFS and median OS were not reached, yet the expected 3-year PFS rate was 69.3% and 3-year OS rate was 85.7%, respectively. The most common sites of progression were the pleura and liver. Majority of side effects were grade 1 or 2 only with the most common being anemia, only one patient had grade 3 side effect (anemia). No drug interruption or dose modifications were needed in any patient.

Conclusion: This real-world data from LMIC confirm the safety and efficacy of alectinib in the first-line setting matching that of registration studies with similar safety and tolerance, without any new alarm.

Objective: We report the patterns of failure and survival with carcinoma of unknown primary of the head and neck (CUP-HN).

Materials and methods: This is a retrospective audit of CUP-HN patients treated with curative radiotherapy (RT) between January 2006 and December 2020. All patients received RT to the neck-definitive RT (DRT) or surgery (Sx) + adjuvant RT (ART), ± chemotherapy.

Results: Of the 108 eligible patients, 81 (75%) used tobacco. Positron emission tomography with computed tomography was performed in 102 patients (94.4%). Seventy-five patients (69.4%) were treated with DRT ± chemotherapy, while 33 (30.6%) underwent Sx + ART ± chemotherapy. Median lymph node size was significantly different between DRT and ART groups (5 vs. 3.5cm, p  = 0.001). At a median follow-up of 60 months, 35.1% patients had a neck failure (within treatment portal 37, outside portal 1). Nine patients (8.3%) developed 10 sites of subsequent mucosal primary (SMP)-all occurred in the oral cavity, six of whom had received comprehensive mucosal irradiation (CMI). Three-year survival outcomes were significantly better with Sx + ART compared to DRT (local control in neck: 96.8 ± 3.2 vs. 50.6 ± 6.2, p  < 0.001, locoregional control: 89.7 ± 5.7 vs. 48.6 ± 6.3, p  < 0.001), progression-free survival: 80.7 ± 7.1 vs. 38.7 ± 6, p  < 0.001, and overall survival [OS]: 67.2 ± 8.5 vs. 41.9 ± 6.2, p  = 0.01), respectively. After propensity score matching, all survival outcomes (except OS) were better with Sx + ART compared to DRT.

Conclusion: All SMPs developed in the oral cavity in this tobacco-driven population. Inclusion of oral cavity for CMI may be considered in tobacco-driven populations; however, this has to be weighed against the toxicity involved.