South Asian Journal of Cancer最新文献

Aims and objective: This article studies the clinical outcome of patients with multiple myeloma who have renal failure at presentation.

Methodology: Patients with multiple myeloma presenting with serum creatinine of more than or equal to 2 mg/dL from outpatient department at Sri Ram Cancer Centre, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan, India, were screened for baseline serum creatinine and estimated glomerular filtration rate (eGFR). Assessment was done at completion of 6 months from diagnosis-patients' clinical condition, renal response (serum creatinine and eGFR), and disease response as per the International Myeloma Working Group criteria.

Results: Final response assessment was done at a follow-up of 6 months. Half of the patients achieved a renal complete response; the highest being in the lenalidomide group (83.3%). Patients with eGFR < 15 mL/min/m ² at presentation fared poorly versus those with eGFR > 15 mL/min/m ² . Patients who were dialysis-dependent at baseline had poorer renal responses as compared with those who were dialysis-independent. Out of six patients who were initially dialysis-dependent, four (66.6%) became dialysis-independent after treatment.

Evidence is mounting that circulating tumor deoxyribonucleic acid can be tested accurately, frequently, and in a noninvasive form. Its role in monitoring patients with cancer, particularly colorectal cancer, is increasing. In this brief review, we discuss its current role when measured using next-generation sequencing-based methods.

Transanal minimally invasive surgery (TAMIS) is considered a standard of care in rectal cancers. Its advantage is that it is organ preserving. Its main role is in early-stage cancers limited to the rectum (T1N0M0). Regular follow-up with computed tomography scan imaging is required. When done correctly in the right patients, the recurrence rate of rectal cancer is less than 3%. TAMIS can also be used as a salvage operation in symptomatic high-risk patients who are unable to undergo or are unfit for transabdominal resection.

Objective: There are limited data on the utility of TAS-102 plus bevacizumab in patients with chemotherapy-refractory metastatic colorectal cancer (mCRC) treated in India.

Methods: Patients diagnosed with chemotherapy-refractory mCRC, defined as having received at least prior oxaliplatin and irinotecan-based chemotherapy between January 2017 and January 2022, and who began treatment with a combination of TAS-102 and bevacizumab were retrospectively analyzed for demographic variables, survivals, and prognostic parameters. The primary endpoint of the study was estimation of the median overall survival (OS) by the Kaplan-Meier method.

Results: The data of 143 patients satisfied the prespecified inclusion criteria and were included for analysis. There was a predominance of left-sided CRCs (78%) and patients having greater than two sites of distant metastases (87%), with 41% of patients with at least two lines of prior therapy. With a median follow-up of 11.6 months, the median OS of the entire cohort was 10.9 months, while the median progression-free survival was 4.4 months. The combination was well tolerated, with the most common grade 3/4 side effects being neutropenia (25%), anemia (6%), and thrombocytopenia (4%). Dose modifications in TAS-102 were required in 20% of patients, though this did not entail permanent cessation of TAS-102 in any patient. The presence of a resected primary was prognostic for improved OS ( p  < 0.001), while signet ring histology predicted inferior OS ( p  < 0.001).

Conclusion: The combination of TAS-102 and bevacizumab is an efficacious and safe therapeutic option in patients with mCRC who have received at least two lines of prior systemic therapy. There were no requirements for cessation of the combination in the current study, underlying the well-tolerated nature of the combination.

Complete mesocolic excision (CME) for colorectal cancer builds on the success of total mesorectal excision (TME), the international gold standard for rectal cancer. In TME, removal of the primary tumor along with associated mesocolon and accompanying structures as single intact specimen allows in toto excision of all structures that could potentially lead to dissemination. Recent meta-analysis has confirmed that CME results in better disease-free survival (DFS) and overall survival (OS) rates. CME can be done in three ways-open, laparoscopic, and robotic-assisted. We conducted a survey to identify the real-world situation with the use of CME by surgical oncologists. A total of 116 responders shared their experiences and thoughts. The benefit of CME was primarily thought to be for both OS and DFS by 78/116 (67%). The majority of CMEs are being conducted by the open method (74/116; 64%). A total of 52/116 (45%) were of the opinion that 6 to 10 surgeries constitute the learning curve for new surgeons for this technique. Based on our survey results, as well as two recently published systematic reviews and meta-analysis, it is time to consider CME as one of the standards of care in colorectal surgery.

The majority of patients with colorectal cancer (CRC) will ultimately develop metastasis. Identifying specific molecular characteristics in them can help optimize their management in a personalized manner. This requires a noninvasive method for frequent sampling. Liquid biopsy provides such an option that is gaining increasing importance in most tumor types. We present the current status of liquid biopsy in CRC with respect to early diagnosis in high-risk population, screening, follow-up of patients on treatment, early identification of progression, and value of serial sampling. We will also discuss the potential for liquid biopsy to help identify changes related to microbiota, specific tumor-causing bacteria, and testing for ribonucleic acid associated with exosomes.

Introduction: Metastatic CRC is considered as a heterogenous disease. Its management is therefore complex and dynamic. In order the give a ready reference to community oncologists, we developed this real world recommendations.

Methods: A group of experts with academic background and real world experience in mCRC got together. We reviewed the current literature and the insights gained from our real world experience. Based on the same we put together these recommendations.

Recommendations results: Molecular testing should be done wherever possible. Most of these patients will be treated with a palliative approach. Doublet chemotherapy is a long-standing standard of care. Triplet therapy may be offered where a more aggressive approach is indicated. Combination with anti -vascular endothelial growth factor antibodies and/or anti EGFR antibodies is also considered standard. In the first-line setting, pembrolizumab can be used for patients with mCRC and microsatellite instability-high or deficient mismatch repair tumours; Left and right sided tumours are distinct entities. Combination of chemotherapy and targeted therapy is used as per individual patient and tumour characteristics.Oligometastatic disease can be approached with potentially curative intent. Cytoreductive surgery plus chemotherapy can be offered to selected patients with peritoneal only metastases. Stereotactic body radiation therapy can be used as local therapy for patients with oligometastatic liver only disease who cannot be taken up for surgery. New strategies include induction-maintenance chemotherapy and perioperative chemotherapy. All drugs/ regimen included as standard of care in the first line can also be used in subsequent lines. Specific targetable driver mutation tumours can be treated accordingly with their complementary biological therapy.

Conclusion: Multidisciplinary team management and shared decision making are possible when patient and caregivers choose to become active participants.

Introduction: Locally advanced colorectal cancer management remains a challenge due to multiple reasons. Some of the major ones include the changes following the use of neoadjuvant radiotherapy and systemic anticancer treatment and previous abdominal surgery (including defunctioning stoma and related changes) and the proximity of structures close to the cancer. Robotic colorectal surgery for malignancy is rapidly evolving as a surgical technique in the management of colorectal cancers but its role in the management of locally advanced disease is not defined.

Methods: This is a retrospective analysis of robotic colorectal surgery performed and captured in a prospective database. Patients who underwent multivisceral robotic colorectal surgery from 2012 to 2022 were included in this study. Robotic colorectal surgeries without multivisceral resections were excluded.

Results: A total of 24 patients underwent robotic multivisceral resection (RMVR). This included 6 males and 17 females. The 17 females underwent posterior clearance, 5 males underwent abdominoperineal resection with seminal vesicle excision, and 1 male underwent total pelvic exenteration. Of the patients, 22 had neoadjuvant pelvic radiotherapy. Sixteen (66.7%) had past lower abdominal surgery (stoma). Preoperative tumor staging was T3 or T4 in 90%, and 80% had R0 resection. The median lymph node harvest was 15 (range 4-31). There was zero need for conversion to open surgery and zero 90-day mortality.

Conclusion: RMVR is a safe approach for locally advanced colorectal cancer, with acceptable surgical clearance.

Objectives: This retrospective study aims to elucidate the clinical associations of HPV-16, HPV-18, and p16 expression with clinicopathological parameters, risk behaviors, and survival outcomes in head and neck cancer patients from the western Indian population.

Methods: Clinical data of total 92 enrolled HNC patients diagnosed between years 2021 and 2023 were retrospectively collected from medical records. Formalin-fixed, paraffin-embedded blocks of all enrolled patients were collected whose p16 expression by immunohistochemistry tests were already performed. HPV-16 and HPV-18 infection was studied by real-time polymerase chain reaction. Associations between viral status, p16 expression, clinicopathological parameters, risk behaviors, and survival outcomes were assessed using SPSS statistical software version 20. p -Value ≤0.05 was considered to be statistically significant.

Results: Among the 92 enrolled HNC patients, HPV-16 infection was detected in only 12 (13%) patients, with the remaining 80 (87%) testing negative. No HPV-18 infections were observed in any patient. Additionally, p16 expression was positive in only 13 (14%) patients, while 79 (86%) showed negative expression. A statistically significant correlation was found between metastasis involvement and positive HPV-16 infection ( p  < 0.001), with all HPV-16-positive cases exhibiting metastasis. A trend was also noted between the base of tongue and other clinical site subtypes with positive HPV-16 infection ( p  = 0.063). However, no other clinicopathological or risk behaviors showed significant associations with HPV-16 infection and p16 expression. Overall survival analysis revealed that neither HPV-16 infection nor p16 expression served as significant prognosticators in the HNC patient cohort ( p  > 0.05).

Conclusion: This study provides comprehensive insights into the clinical relevance of HPV-16, HPV-18 infections, and p16 expression in HNC among the western Indian population. Understanding the associations between HPV-16, HPV-18, and p16 expression with clinicopathological parameters and survival outcomes may aid in optimizing patient management strategies, including personalized treatment approaches and targeted interventions. Further prospective studies are warranted to validate these findings and explore potential therapeutic implications.