South Asian Journal of Cancer最新文献

In this article, the Asian Geriatric Oncology Society provides an overview on how to develop geriatric oncology services in the clinical setting. This overview gives an insight into the rationale; key stakeholders; four essential components of the services; multidisciplinary team and tumor boards; assessment and screening protocols; data, research, and audit; professional education, development, and training; and communication, awareness and social medial utilization. In the second part of the article, we focus on optimizing resource utilization in constrained settings-dividing them into "must have" and "good to have."

Background: Transitional cell carcinoma of the urinary bladder is one of the most common malignancies affecting the urinary tract. Genomic instability is one of the most important common features of urothelial cancers of the bladder. Gene polymorphisms of the SLC14A1 gene are known to be related to carcinogenesis of the bladder in humans. Similarly, the use of tobacco products including chewing and smoking is an established risk factor for bladder cancer in both men and women. The primary aim of the study was to assess the relationship between bladder cancer and polymorphisms of the SLC14A1 gene (rs17674580) in our patients with image and histologically confirmed bladder cancer and secondarily to assess if use of tobacco products in these patients further accentuated the risk of bladder cancer.

Patients and methods: All patients aged ≥18 years with images (ultrasonography/computed tomography) and histologically confirmed bladder cancer formed the study group. Age- and gender-matched individuals aged ≥18 years, genetically unrelated, formed the controls. A 2-mL blood sample was collected from patients as well as controls, for genotyping of SLC14A1C/T gene polymorphisms. Demographic data were obtained from all the participants, and individuals who smoked once a day for more than 5 years were defined as smokers. Similarly, patients who chewed tobacco for more than 5 years were defined as tobacco users.

Results: During the study period, 107 patients (84 males and 23 females) with image and histologically confirmed bladder cancer formed the study group. The mean age of the patients with bladder cancer was 58.47 ± 14.5 years and that of the controls was 60.01 ±  12.5 years. Among patients with bladder cancer, 28 (26.2%) showed no polymorphisms (rs17674580) of the SLC14A1 gene, whereas 79 (73.8%) patients showed polymorphisms. Heterozygous variations (CT) were noted in 46 (42.9%) patients, whereas homozygous variations were noted in 33 (30.9%) patients with the odds ratio being 2.772 (1.459-3.247) and 3.349 (1.610-6.922), respectively. The use of tobacco (smoking/chewing) was also found to modulate risks of bladder cancer in SLC14A1 variants.

Conclusion: Gene polymorphisms of SLC14A1C/T are associated with a high risk of bladder cancer in our group of patients in South India. Moreover, the use of tobacco, be it smoking or chewing, further increases the risk of bladder cancer in these patients.

Background: The study aims to evaluate the survival outcomes, survival-related prognostic factors, and treatment compliance in cancer patients aged ≥80 years treated with radiotherapy (RT).

Methods: The records of 76 patients who received RT at a single center between August 2021 and May 2024 were retrospectively evaluated. Patient and tumor characteristics and treatment details were collected from medical records.

Results: The median age of the patients was 83 years (range: 80-92 years). According to the purpose of RT, palliative (53.8%), definitive (18.4%), and adjuvant (15.8%) RT were most frequently administered, respectively. The median overall survival (OS) in all patients was 10 months. The median OS in patients receiving curative (definitive and adjuvant RT) and palliative RT was 25.1 and 7.2 months, respectively. Poor performance status (PS), leukocyte count prior to RT, compliance, and hospitalization status in the curative group and poor PS, RT compliance, hospitalization status, and new distant recurrence in the palliative group were associated with decreased OS. The majority of patients showed full compliance with the RT process (69.7%). The rate of full compliance with the treatment process was significantly higher in patients with good PS and receiving outpatient treatment. RT-related high-grade toxicity (grade 3-4) was not observed.

Conclusion: This study demonstrates that RT can be used effectively and safely for both palliative and curative purposes in cancer patients aged ≥80 years. The optimization of patient selection and ultimately improvement of treatment outcomes will be facilitated by the support of these results with multicenter studies.

Introduction: The diagnosis of cutaneous T-cell lymphoma (CTCL) is sometimes difficult. Detection of monoclonal T-cell receptor gamma (TCRG) gene rearrangement by polymerase chain reaction (PCR) has become an important adjunct to the diagnosis of CTCL. This study was designed to explore the concordance in terms of the diagnostic value of BIOMED-2 TCRG PCR protocol with the histological diagnosis.

Methods: Confirmed and doubtful CTCLs were included in this descriptive cross-sectional study performed in the Habib Thameur Hospital in 2021. These cases were followed in the department of dermatology from 2012 to 2021. PCR tests were performed with TCRG BIOMED-2 clonality methods followed by capillary electrophoresis and GeneScan analysis. Clonality and statistical results were analyzed.

Results: Monoclonality was identified in 51% of confirmed CTCL cases (16/28 cases with confirmed mycosis fungoides and 2/7 other CTCL cases) and in 63% of doubtful cases, which were converted to malignant diagnosis. The results of TCRG clonality demonstrated a significant correlation with histopathology diagnoses of specimens. A moderate concordance was found between histology and molecular clonality.

Conclusion: Results from this molecular clonality emphasize the importance of interpreting data in association with histopathological features of the lesions.

Purpose: Generic versions of bevacizumab are commonly used in India in patients with advanced/metastatic colorectal cancers (mCRCs), but there is limited real-world evidence (RWE) about their efficacy in comparison to the innovator bevacizumab.

Methods: Patients diagnosed with mCRC between January 2017 and January 2022 and receiving a combination of chemotherapy and bevacizumab were retrospectively analyzed for demographic variables and survivals. The primary endpoint of the study was the estimation and comparison of median progression-free survival (mPFS) between patients receiving innovator versus generic bevacizumab as first-line therapy (CT1) by the Kaplan-Meier method.

Results: A total of 944 patients were included in the analysis, of whom 652 patients (69%) received bevacizumab as CT1, 449 patients (48%) during second-line chemotherapy (CT2), and 74 patients (8%) during third-line therapy (CT3). The innovator was administered to 132 patients (14%), while the remaining 812 patients (86%) received a generic molecule. With a median follow-up of 18 months, there was no difference in mPFS between patients receiving the innovator or biosimilar (10 vs. 9.3 months, p  = 0.62). Similarly, there was no difference in median overall survival (mOS) between patients receiving the innovator or biosimilar during CT1 (17.8 vs. 18 months, p  = 0.85). Among the patients who received bevacizumab during CT2, there was no statistically significant difference in mPFS between the innovator and the biosimilar (5.5 vs. 5.8 months, p  = 0.97), nor was there a difference in mOS between patients receiving the innovator or biosimilar during CT2 (8.15 vs. 8.58 months, p  = 0.16).

Conclusion: The current study offers RWE to suggest similar outcomes with innovator and generic bevacizumab when combined with chemotherapy in mCRCs. This has significant implications in India and other low- and middle-income countries besides providing oncologists with greater confidence to use these molecules in their clinical practice.

Introduction: Patient perspectives on breast cancer surgical techniques are influenced by various factors. The time given by the care providers to patients for appropriate decision-making is minimal in the developing world. Effective presurgical counseling is crucial for empowering patients, managing expectations, promoting informed decision-making, and optimizing outcomes. This study employed animation storytelling technique and clay model on patients to understand breast surgical techniques.

Aims and objectives: To evaluate the use of animation video and clay model in counseling patients eligible for breast conservation surgery (BCS) on the differences between modified radical mastectomy, BCS, and oncoplasty.

Methods: A prospective observational study was undertaken including 40 patients under 60 years of age, eligible for BCS, at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. Patients viewed a 4-minute animation video and a clay model demonstrating tissue displacement and reconstruction techniques. Responses from a three-question questionnaire were analyzed using SPSS 23 and compared with historical controls adapted from the study of Bothra et al.

Results: Scores assessing awareness, understanding of surgical techniques, and interest in BCS among patients who underwent mastectomy, BCS, and oncoplasty were comparable. Patients exposed to both animation and clay models showed slightly higher scores across all groups, compared with historic controls, though not statistically significant ( p  = 0.144, 0.199, and 0.198). Overall, patients and relatives expressed satisfaction with the educational tools, finding them helpful in decision-making.

Conclusion: Animation video and clay model are valuable tools in modern surgical education and patient care, enhancing understanding and facilitating informed decision-making. These visual aids empower patients and support health care providers in delivering comprehensive counseling on surgical options for breast cancer treatment.

A significant number of patients with colorectal cancer (CRC) benefit from adjuvant therapy. While 6 months of FOLFOX is standard of care, newer regimens like CAPOX and SOX allow for shorter durations. Trials of importance include SCOT (U.K., Denmark, Spain, Sweden, Australia, New Zealand), TOSCA (Italy), Alliance/SWOG80702 (U.S., Canada), IDEA (France), ACHIEVE (Japan), and HORG (Greece). Management recommendation is also based on patient preferences, dividing them into fighters and fatalists. Better patient selection is possible with the use of novel molecular-based biomarkers and circulating tumor deoxyribonucleic acid monitoring of minimal residual disease. There also needs to be special consideration for the geriatric patients-especially due to their limited mobility, comorbidities, and polypharmacy.

Accounting for 8.7% of global cancer deaths, colorectal cancer (CRC) is one of the leading causes of cancer-related mortality. Cytoreduction surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is part of a multimodal strategy for managing CRC. HIPEC is designed to target residual microscopic disease using heated chemotherapy. There are several techniques including the open abdomen "coliseum" technique, which uses a silastic sheet to create a perfusion chamber and allows for manipulation of contents; whereas the closed abdomen technique maintains a sterile environment and may involve abdominal wall massage for heat distribution; lastly, the laparoscopic method combines the benefits of both techniques with enhanced drug distribution through laparoscopy. Research has shown that the coliseum technique offers superior heat uniformity, while the laparoscopic method provides optimal distribution with advanced monitoring tools. We examined early trials, procedural variations, and recent clinical research to assess its efficacy. HIPEC involves the administration of heated chemotherapy directly into the peritoneal cavity after CRS in order to enhance local tumor control and survival. Various regimens that have been explored, including the Sugarbaker, triple dosing, and low dose mitomycin C regimen, report mixed results. The selection of chemotherapy drugs and their efficacy at high temperatures is crucial, with studies yielding mixed results for oxaliplatin and mitomycin C. The advantages of HIPEC, especially with oxaliplatin-based regimens, have been questioned by recent trials such as the PRODIGE 7 study because of problems like chemoresistance and greater postoperative morbidity. On the other hand, HIPEC is still supported by some as a good choice for individuals who are carefully chosen, particularly when combined with other forms of treatment. Despite being widely used in several cancer centers around the world for other pathologies, HIPEC remains a debated treatment option in CRC with peritoneal metastases. Even though the current evidence suggests that it might not provide a statistically meaningful overall survival improvement when compared to CRS alone, it might still be useful in some clinical settings or when combined with well-designed protocols. Thus, the necessity of more research and standardized protocols is paramount. Determining the role of HIPEC, maximizing patient selection, and contrasting its effectiveness with other intraperitoneal treatments such as pressurized intraperitoneal aerosol chemotherapy and early postoperative intraperitoneal chemotherapy will require ongoing trials and future research. Until clearer evidence emerges, HIPEC should be considered a therapeutic option for selected patients and offered by dedicated, experienced centers and surgical teams.

Introduction: Noninvasive colorectal cancer (CRC) screening has introduced innovative blood- and stool-based biomarkers, improving early detection and enabling personalized solutions. Global and Indian adoption of CRC screening remains a public health challenge. This study evaluates the real-world utility of screening colonoscopy, as recommended by global guidelines.

Methodology: A survey based on the American Medical Association (AMA) guidelines was designed, setting 45+ years as the cutoff age for colonoscopy screening. A Google form was shared via social media application with health care professionals. Participation was voluntary, responses were collected over 30 days, and data were analyzed.

Results: A total of 2,199 individuals' data were analyzed. Among these, 1,374 were eligible for screening colonoscopy, out of which only 7.14% (98/1,374) actually underwent the procedure.

Conclusion: Among various cancer programs, screening sigmoidoscopy has proved to improve both CRC-specific mortality and all-cause mortality. Unfortunately, its utilization is suboptimal, at best. Even among the highly educated medical community, the real-world utility was only in 7.14% of the eligible population. Barriers include invasive nature of intervention, need for appropriate bowel preparation, operator dependence, and small but significant risk of serious toxicity. An important method of increasing utility of screening colonoscopy is use of a test that can identify high-risk population, who can then be persuaded to undergo screening colonoscopy. This is the value of recently developed noninvasive blood- and stool-based tests, like Guardant Health's Shield. Being U.S. Food and Drug Administration (FDA) approved with specificity of 90% and sensitivity of 84%, it should be offered to all eligible persons who can afford it, thereby increasing colonoscopy use and potentially saving lives.

Introduction: This study aimed to determine the impact of postoperative (PO) radiotherapy (RT) dose escalation in oral cavity squamous cell carcinoma (OCSCC) patients with positive margin (PM) in terms of local control (LC), duration of RT interruption, and toxicity in a tertiary care center.

Materials and methods: Patients with OCSCC who were candidates for adjuvant RT were categorized into PM and negative margin (NM) arms depending on the margin status as per the histopathology report retrospectively. PM and NM patients received a total dose of 66 Gy to the site of the PM and 60 Gy for the NM. LC, acute and chronic toxicities, and duration of RT interruption were evaluated.

Results: A total of 56 patients were included in the study, of whom 39 had NM and 17 had PM. After propensity score matching, 11 patients were matched in each arm. The mean duration of RT treatment in the PM and NM arms were 49.5 days (standard deviation [SD] = 5.4) and 50.7 days (SD = 10.15) ( p  = 0.3), with mean interruptions of 3.9 days (SD = 3.9) and 3.8 days (SD = 6.2), respectively ( p  = 0.39). LC was 72.7% in the PM arm and 81.8% in the NM arm ( p  = 0.6). Acute and chronic toxicities were comparable between the two arms.

Conclusion: Dose escalation to 66 Gy for PM during adjuvant RT for PO OCSCC can be used as an alternative strategy to reresection, especially in patients who have poor performance status, who have negative consent for surgery, and who have more than one adverse prognostic factor with comparable LC and toxicity as in the NM. However, further prospective studies are needed to establish its role as an alternative, which is highly unlikely in modern oncology practice, as PM patients are rarely seen in clinics currently with good surgical oncology practices.