South Asian Journal of Cancer最新文献

It is still not possible for all patients with early breast cancer to be cured. Even when they respond well to initial therapy, there exists a substantial risk for recurrence, sometimes after several years. With the availability of cyclin-dependent kinase (CDK) 4/6 inhibitors the role of adjuvant therapy has improved, and so has the chance of cure. These consensus guidelines will ensure that the community oncologist will be able to take the right decision for their patient. The expert committee shares their real-world experience as well as the consensus voting results. Patients eligible for adjuvant therapy with CDK4/6 inhibitors should start that treatment at the earliest. Based on current published data, abemaciclib is the preferred CDK4/6 inhibitor that should be used in eligible patients (unless contraindicated). To ensure optimal dose intensity and adherence to treatment schedule, use of literature and patient information material can improves compliance. Treatment modification requires early reporting of adverse effects, a responsibility of the patient and caregiver (relatives).

Purpose: There is limited evidence for the presentation patterns and outcomes of patients with high-grade gastrointestinal neuroendocrine carcinomas (HG-NEC).

Methods: Patients diagnosed with HG-NEC, defined as having a pathological diagnosis of neuroendocrine cancer with an epicenter of cancer in the gastrointestinal tract and Molecular Immunology Borstel-1 index ≥ 20% between May 2014 and May 2022 were retrospectively analyzed for demographic variables, survivals, and prognostic parameters. The primary endpoint of the study was the estimation of median overall survival (OS) by the Kaplan-Meier method.

Results: A total of 336 patients were included in the analysis, of whom 283 patients (84%) were started on cancer-directed treatment while 53 patients (16%) were planned for best supportive care. The most common sites of the primary were gallbladder (45%), colorectal (19%), and pancreas (13%), with 253 patients (75%) having metastatic NEC. All treated patients received systemic therapy (commonly platinum and etoposide), while 64 patients (23%) underwent resection of the primary. With a median follow-up of 65.4 (45.6 -85.3) months, the median OS of the entire cohort was 15.8 months. The prospective multidisciplinary tumor (MDT) board decision of classifying patients into resectable, unresectable, and metastatic HG-NEC was prognostic for OS (26.8 vs. 21.1 vs. 13.5 months; p  = 0.001). Patients who were able to undergo multimodality therapy (resection and systemic therapy) had improved OS compared with patients on systemic therapy alone (23.1 vs. 14.9 months; p  = 0.003).

Conclusion: A majority of patients with HG-NEC present with advanced disease. An MDT is essential to deciding initial therapeutic strategies in these patients, with patients undergoing resection and systemic therapy having improved OS.

Background: Endocrine abnormalities and metabolic complications remain one of the common late effects after cancer therapy in children. Data on the incidence and pattern of complications would help to guide appropriate monitoring and treatment of childhood cancer survivors.

Methods aims and objectives: Purpose of study is to determine endocrine and metabolic effects in childhood cancer survivors including both hematological malignancies and solid tumors due to cancer per se and treatment-related, including different chemotherapeutic agents and radiotherapy.

Results: Among 97 participants, 84 children (84.5%) had at least one endocrine or metabolic complication; 41 children (42.3%) had more than two endocrine/metabolic complications. Common endocrine complications included precocious puberty (6.2%), short stature (6.2%), and hypothyroidism (5.1%). Among metabolic complications, dyslipidemia was the highest with an incidence of 68%, followed by fasting hyperinsulinism (32%), diastolic hypertension (18.6%), systolic hypertension (11.3%), obesity (8.8%), and metabolic syndrome (8.2%) and impaired fasting glucose (4.1%).Among endocrine complications, there was a significant increase in incidence of hypothyroidism among children receiving radiotherapy (odds ratio [OR]: 7.13, 95% confidence interval [CI]: 1.1-46.2), and among metabolic complications, a significant increase in incidence of metabolic syndrome in children treated with L-asparaginase compared with those not treated with L-asparaginase was observed (OR: 5.61, 95% CI: 1.07-29.5). There was no significant difference between incidence of observed endocrine and metabolic complications based on type of tumor, gender, and puberty status of study participants.

Conclusion: This study suggests that there is significant incidence of endocrine and metabolic complications in childhood cancer survivors, hence timely and appropriate recognition of these complications by appropriate screening recommendations and pursuing further endocrine evaluation rationally is needed.

Introduction: Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm of antigen-presenting cells within the reticuloendothelial system primarily originating in lymph nodes, but in almost one-third of the patients, extranodal sites are involved including oral cavity, tonsil, gastrointestinal tract, soft tissue, and breast. The thyroid gland is an extremely rare location for FDCS and very few cases are reported in the literature.

Case report: Here, we present a 39-year-old man who presented with a swelling in the neck for 3 months and difficulty in breathing for 15 days. Following left hemi-thyroidectomy, histopathologically and immunohistologically, he was diagnosed as FDCS of thyroid arising in Castleman's disease. He received adjuvant radiation treatment. The patient had favorable prognosis with no evidence of disease for 6 years after treatment till date.

Conclusion: The aim of this report was to present the rare site of FDCS arising in the thyroid gland, the vital role of immunohistochemistry in diagnosis, and effectiveness of multimodality treatment for favorable prognosis.

One year of adjuvant trastuzumab is the standard of care for HER2-positive breast cancer. In low-middle income countries, delivery of 1-year trastuzumab is challenging due to significant financial burden. Evidence for shorter durations of adjuvant trastuzumab is gaining popularity in this regard. In this study, we compared the effectiveness and safety of 1 year versus shorter durations of adjuvant trastuzumab practiced in our center. In total, 312 patients were included in this analysis. The median age was 52 years. More than two-thirds of patients (67.6%) had stage 2 disease and majority were hormone-receptor-positive (62.5%). The median follow-up duration was 50 months. The 4-year disease-free survival was 97.3%. The 4-year disease-free survival for shorter durations of adjuvant trastuzumab was 98% compared with 96.7% in 1-year trastuzumab therapy group. In univariate analysis, stage at diagnosis was the only factor which had statistically significant association with disease-free survival. In multivariate analysis, none of the variables were found to be predictive of survival. Two patients (0.6%) had significant left ventricular ejection fraction decline. Shorter durations of adjuvant trastuzumab have comparable 4-year disease-free survival to standard 1-year therapy and is an alternative adjuvant treatment option for HER2-positive breast cancer patients in resource-limited settings.

Rhabdomyosarcoma (RMS) is a malignant, soft tissue neoplasm consisting of cells derived from the primitive mesenchyme that exhibit a profound tendency to myogenesis. Historically, the spindle cell and sclerosing variants were subcategorized under embryonal type RMS. Spindle cell/sclerosing RMS (S-ScRMS) was recently recognized in 2013 by the World Health Organization as a stand-alone entity. Current data support that certain S-ScRMS cases have a more aggressive clinical course with a reduction of long-term survival, and those found in the head and neck region often exhibit extensive local recurrence. Here, we highlight an aggressive clinical course of S-ScRMS by presenting a case of a 7-year-old male child who presented with complaints of swelling in left cheek since 15 to 20 days. It was associated with pain. He was diagnosed as S-ScRMS and received chemotherapy but the disease was aggressive and progressed on chemotherapy. He received radiation but still the disease was inoperable, hence was kept on supportive care.

Objective: Peripheral T cell lymphomas-not otherwise specified (PTCL-NOS) are a heterogeneous group of mature T cell lymphomas that do not belong to any specified subtype. Gene expression profiling has revealed two biological variants of PTCL-NOS, PTCLGATA3 and PTCLTBX21. This study aims to subclassify PTCL-NOS using immunohistochemistry (IHC) and to establish its implication in prognosis.

Methods: A descriptive study was done using 39 morphologically and immunohistochemically diagnosed cases of PTCL diagnosed over a 10-year period, 2013 to 2022. The additional IHC markers used were GATA3 and CCR4 for PTCLGATA3 and TBX21 and CXCR3 for PTCLTBX21. All cases had a minimum follow-up of 6 months.

Results: After subclassification of PTCL-NOS ( n  = 39), 44% were PTCLGATA3 subtype. This subtype showed monomorphic morphology and a high ki67 index, and was found to a have worse outcome. In comparison, PTCLTBX21 showed heterogeneous morphology and a low ki67 index.

Conclusion: Subcategorization of PTCL-NOS based on the IHC markers helps in the stratification of this disease. This will also identify cases with more aggressive behavior at the time of diagnosis.

Background: Nonpalpable breast lesions pose a challenge in their early diagnosis. Image-guided biopsy is preferred in these cases so that a pathological diagnosis of breast carcinoma is reached timely for a better prognosis as the disease has an increased chance of successful outcome with early identification and treatment.

Objective: The study aims at evaluating the role of stereotactic core needle biopsy (CNB) and percutaneous ultrasound-guided core needle biopsy (US-CNB) in diagnosing suspicious nonpalpable breast lesions.

Methods: Our study included 35 patients with nonpalpable breast lesions and having a Breast Imaging Reporting and Data System (BI-RADS) risk assessment category IV or V on mammography or sonography. These 35 lesions were subjected to percutaneous image-guided (stereotactic or US) biopsy for histopathological analysis.

Results: Out of a total of 35 cases, 17 were pathologically malignant (48.6%), with the most common subtype being invasive ductal carcinoma (82.3%). Twenty-nine cases underwent US-CNB, 16 (55.1%) of which were malignant and 13 (44.8%) were benign on histopathological evaluation (HPE). The remaining six cases, which on mammography showed no mass but suspicious malignant calcification only, were subjected to stereotactic CNB, out of which one (16.6%) was malignant and five (83.3%) were benign on HPE. Hence, the lesions visible on sonography were more likely to be malignant.

Conclusion: Sonography and mammography play a complimentary role in detecting breast carcinoma. Percutaneous biopsy under image guidance can be used as an accurate diagnostic alternative to open surgical excisional biopsy to avoid diagnostic delay.

Objectives: Fever is a known complication in pediatric cancer patients when on chemotherapy for which prompt initiation of empiric antibiotics is the single most important life-saving intervention. Nearly two-thirds of all children are treated without identifying the source of fever. Molecular diagnostics can improve management of febrile episodes and reduce unnecessary antibiotic use. The purpose of our study was to evaluate the pathogenic etiology of febrile episodes and analyze their clinical characteristics.

Materials and methods: We conducted a prospective observational study at our tertiary care institution from January 2019 to March 2020, to identify the etiology of febrile episodes with or without neutropenia in pediatric cancer patients and to study their clinical outcomes.

Results: Forty febrile episodes were observed among 27 patients over a period of 15 months. The mean age group was 5 years. In 28 febrile episodes without a focus (70%), a respiratory organism (virus, bacteria, or coinfection) was detected. Rhinovirus was the most common single respiratory isolate (47.36%), followed by Streptococcus pneumoniae (21.05%) and six episodes had multiple viral isolates (21.42%). There was no prolonged hospitalization, need for intensive care unit or oxygen requirement, or mortality. The most common antibiotic used in empiric management was piperacillin-tazobactam. Aminoglycosides were added when there was a clinical suspicion of resistant organism.

Conclusion: Around 70% of febrile episodes without a focus or documented infection in cancer children had a respiratory pathogen identified in nasopharyngeal swab. Molecular diagnostics greatly enhances diagnostic sensitivity and thereby individualizes the management of febrile illness in these children.

Introduction: Lymph nodes, lung, liver, bone, and brain are the commonest metastatic sites for malignancies arising in various body sites. Gastrointestinal (GI) tract is a very uncommon metastatic site and the present study describes the single-center experience of GI metastases from non-GI malignancies.

Aims and objectives: To study the spectrum of metastatic tumors to GI tract and elucidate their clinicopathological characteristics.

Materials and methods: This was a retrospective study done on cases diagnosed from 2015 to 2023 at our institute. All cases of non-GI malignancies metastatic to hollow GI tract were included. Cases with GI primary, hematological malignancies, cases with exclusive serosal deposits, and direct invasion of a GI organ from an adjacent primary tumor were excluded. Apart from hematoxylin & eosin (H&E)-stained slides, immunohistochemistry findings of these were reviewed.

Results: Thirty-six patients were histologically proven GI metastases from non-GI malignancies diagnosed during the study period. Most cases were seen in 5th to 7th decade with a significant female preponderance (M:F of 1:8). The commonest metastatic GI sites were small bowel ( n  = 11), sigmoid colon ( n  = 9), and rectum ( n  = 7), followed by stomach ( n  = 3), appendix ( n  = 3), gall bladder ( n  = 2), and ampulla ( n  = 1). Stricture, perforation, and nodular mucosa were the most common endoscopic findings. The most common primary malignancies in females were ovarian serous carcinoma ( n =21) followed by squamous cell carcinoma (SCC) of cervix ( n  = 8). In males, there was no site preference, and the primary sites included prostate, lung, kidney, and oral mucosa.

Conclusion: The study highlights the rare occurrence of GI metastases from non-GI malignancies. Females are at greater risk of such metastases primarily from ovarian serous carcinoma and cervical SCCs.