V. Perumareddy, Rashmi Shivananjappa, Geeta Sn, R. Tiwari, S. Mandal
Background The percentage of pelvic lymph node (LN) positivity in cervical cancer patients varies from 19% in early stages to 68% in advanced cases. Thirty-three percent of patients will develop recurrence within 2 years following therapy, and 5-year relative survival for patients with affected regional LNs is 57%. Hence, pelvic LNs need to be included in the definitive plan of radiation treatment for better disease control and longer survival. With conventional radiation therapy, dose escalation was not possible because of small bowel constraints. With higher conformity of intensity-modulated radiotherapy technique, doses to pelvic and abdominal organs can be minimized. The added advantage of simultaneous integrated boost (SIB) is that high dose per fraction is delivered to the gross disease and low dose to the microscopic disease, thereby reducing the total treatment time and improving the therapeutic ratio. Materials and Methods Forty-one patients presenting to the Department of Radiation Oncology, between January 2016 and June 2017, with newly biopsy-proven carcinoma cervix Stage IB to IVA were enrolled in the study, and all the investigations were performed. The radiation dose was delivered using volumetric modulated arc therapy plan according to the dose of 5,000 cGy in 25 fractions to the whole pelvis and 5,500 cGy in 25 fractions to the involved nodes at 220 cGy per fraction using SIB along with weekly cisplatin at 40 mg/m2. After completion of external beam radiation, all the patients received three fractions of brachytherapy to a total dose of 21 Gy. Acute toxicities were assessed using Radiation Therapy Oncology Group criteria. At 3 months after completion of treatment, all the patients were followed up with diffusion-weighted magnetic resonance imaging of abdomen and pelvis to assess the response after 3 months. Results Of 41 carcinoma cervix patients with significantly positive LNs treated with SIB VMAT, 9.8% of the patients (4 patients) had residual nodal disease and 87.8% of the patients (36 patients) had a complete response, and 19.5% (8 patients) had residual disease of primary and 78% (32 patients) had a complete response at 3 months after completion of treatment with only grade I and grade II toxicities. Conclusion Treatment with SIB VMAT in carcinoma cervix patients with significant pelvic LNs shows a very good response with acceptable acute toxicities. But longer follow-up period is required to see if this response translates into better disease-free survival and overall survival.
{"title":"Indian Data on the Response of Positive Pelvic Lymph Nodes in Carcinoma Cervix Patients Treated with Simultaneous Integrated Boost Using Volumetric Modulated Arc Radiation Therapy","authors":"V. Perumareddy, Rashmi Shivananjappa, Geeta Sn, R. Tiwari, S. Mandal","doi":"10.1055/s-0042-1751120","DOIUrl":"https://doi.org/10.1055/s-0042-1751120","url":null,"abstract":"\u0000 Background The percentage of pelvic lymph node (LN) positivity in cervical cancer patients varies from 19% in early stages to 68% in advanced cases. Thirty-three percent of patients will develop recurrence within 2 years following therapy, and 5-year relative survival for patients with affected regional LNs is 57%. Hence, pelvic LNs need to be included in the definitive plan of radiation treatment for better disease control and longer survival. With conventional radiation therapy, dose escalation was not possible because of small bowel constraints. With higher conformity of intensity-modulated radiotherapy technique, doses to pelvic and abdominal organs can be minimized. The added advantage of simultaneous integrated boost (SIB) is that high dose per fraction is delivered to the gross disease and low dose to the microscopic disease, thereby reducing the total treatment time and improving the therapeutic ratio.\u0000 Materials and Methods Forty-one patients presenting to the Department of Radiation Oncology, between January 2016 and June 2017, with newly biopsy-proven carcinoma cervix Stage IB to IVA were enrolled in the study, and all the investigations were performed. The radiation dose was delivered using volumetric modulated arc therapy plan according to the dose of 5,000 cGy in 25 fractions to the whole pelvis and 5,500 cGy in 25 fractions to the involved nodes at 220 cGy per fraction using SIB along with weekly cisplatin at 40 mg/m2. After completion of external beam radiation, all the patients received three fractions of brachytherapy to a total dose of 21 Gy. Acute toxicities were assessed using Radiation Therapy Oncology Group criteria. At 3 months after completion of treatment, all the patients were followed up with diffusion-weighted magnetic resonance imaging of abdomen and pelvis to assess the response after 3 months.\u0000 Results Of 41 carcinoma cervix patients with significantly positive LNs treated with SIB VMAT, 9.8% of the patients (4 patients) had residual nodal disease and 87.8% of the patients (36 patients) had a complete response, and 19.5% (8 patients) had residual disease of primary and 78% (32 patients) had a complete response at 3 months after completion of treatment with only grade I and grade II toxicities.\u0000 Conclusion Treatment with SIB VMAT in carcinoma cervix patients with significant pelvic LNs shows a very good response with acceptable acute toxicities. But longer follow-up period is required to see if this response translates into better disease-free survival and overall survival.","PeriodicalId":31357,"journal":{"name":"Asian Journal of Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43799870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Siddhesh Rajendra Tryambake, J. Gawande, R. Wategaonkar
Introduction Immune checkpoint inhibitors (ICIs) are rapidly being utilized as treatment option either alone or in combination with chemotherapy in most of the solid tumors. Objectives Our single-center retrospective study aimed to present our experience with the effectiveness and safety of these agents in Indian set of patients with various advanced solid tumors. Material and Methods Twenty-five adult patients with stage IV solid tumors of varying sites treated with ICIs at Aditya Birla Memorial Hospital, Pune, Maharashtra, India, between October 2017 and September 2020 were included in the study. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR), disease control rate (DCR), and toxicity profiles were evaluated. All statistical calculations were performed using IBM SPSS version 25. Results Total of 25 patients (median age 61) was evaluated. Histological evaluation revealed adenocarcinoma (48%), squamous cell carcinoma (40%), and one each (4%) of others. Eastern Cooperative Oncology Group performance status score was I in 16 (64%) and II in 9 (36%) patients. Average of 10 cycles ICIs were received by each patient. Majority were males with 11 (44%) having some comorbidities. Lung (48%) was the most common primary followed by head and neck cancers (32%). Most (76%) were treated with nivolumab, followed by pembrolizumab (20%) while only one patient was given atezolizumab. Median follow-up was 18 months. Median OS was 24 months (95% confidence interval [CI]: 9–NA) and 2-year OS rate in the study was 38.4% (95% CI: 18.8–78.3), while median PFS was 9 months (95% CI: 6–NA) and 1-year PFS rate was 22.3% (95% CI: 9.7–51.2). One patient (4%) had complete response, 6 (24%) had partial response while 12 (48%) had stable disease response at first follow-up. Mean and median time to progression were 5.7 and 9 months, respectively. ORR was 28% (95% CI: 12.07–49.4) while the DCR was 76% (95% CI: 54.87–90.64). PS II patients were associated with significantly poor median OS and PFS. There was no significant difference in survival with respect to age, gender, site, histology, and comorbidities; however, 4/25 patients had undergone biomarker assessment and were associated with a trend toward better median PFS (8 vs. 11 months, hazard ratio 0.53, 95% CI: 0.12–2.34, p = 0.38). Two of 25 patients developed autoimmune conditions namely ophthalmoplegia and hypothyroidism each. Fatigue (36%) and nausea (12%) were the most common toxicities. Conclusion Real-world data from our study depicts our own experience with ICIs to suggest that these agents are well-tolerated and equally effective in Indian set of patients with advanced metastatic solid tumors. ICIs could be safely used even in patients with PS II and biomarker assessment in adjunction needs to be encouraged wherever feasible for better patient selection, prognostication, and clinical outcomes.
{"title":"Retrospective Study of Clinical Outcomes and Toxicity Profile in Patients Treated with Immune Checkpoint Inhibitors","authors":"Siddhesh Rajendra Tryambake, J. Gawande, R. Wategaonkar","doi":"10.1055/s-0042-1751116","DOIUrl":"https://doi.org/10.1055/s-0042-1751116","url":null,"abstract":"\u0000 Introduction Immune checkpoint inhibitors (ICIs) are rapidly being utilized as treatment option either alone or in combination with chemotherapy in most of the solid tumors.\u0000 Objectives Our single-center retrospective study aimed to present our experience with the effectiveness and safety of these agents in Indian set of patients with various advanced solid tumors.\u0000 Material and Methods Twenty-five adult patients with stage IV solid tumors of varying sites treated with ICIs at Aditya Birla Memorial Hospital, Pune, Maharashtra, India, between October 2017 and September 2020 were included in the study. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR), disease control rate (DCR), and toxicity profiles were evaluated. All statistical calculations were performed using IBM SPSS version 25.\u0000 Results Total of 25 patients (median age 61) was evaluated. Histological evaluation revealed adenocarcinoma (48%), squamous cell carcinoma (40%), and one each (4%) of others. Eastern Cooperative Oncology Group performance status score was I in 16 (64%) and II in 9 (36%) patients. Average of 10 cycles ICIs were received by each patient. Majority were males with 11 (44%) having some comorbidities. Lung (48%) was the most common primary followed by head and neck cancers (32%). Most (76%) were treated with nivolumab, followed by pembrolizumab (20%) while only one patient was given atezolizumab. Median follow-up was 18 months. Median OS was 24 months (95% confidence interval [CI]: 9–NA) and 2-year OS rate in the study was 38.4% (95% CI: 18.8–78.3), while median PFS was 9 months (95% CI: 6–NA) and 1-year PFS rate was 22.3% (95% CI: 9.7–51.2). One patient (4%) had complete response, 6 (24%) had partial response while 12 (48%) had stable disease response at first follow-up. Mean and median time to progression were 5.7 and 9 months, respectively. ORR was 28% (95% CI: 12.07–49.4) while the DCR was 76% (95% CI: 54.87–90.64). PS II patients were associated with significantly poor median OS and PFS. There was no significant difference in survival with respect to age, gender, site, histology, and comorbidities; however, 4/25 patients had undergone biomarker assessment and were associated with a trend toward better median PFS (8 vs. 11 months, hazard ratio 0.53, 95% CI: 0.12–2.34, p = 0.38). Two of 25 patients developed autoimmune conditions namely ophthalmoplegia and hypothyroidism each. Fatigue (36%) and nausea (12%) were the most common toxicities.\u0000 Conclusion Real-world data from our study depicts our own experience with ICIs to suggest that these agents are well-tolerated and equally effective in Indian set of patients with advanced metastatic solid tumors. ICIs could be safely used even in patients with PS II and biomarker assessment in adjunction needs to be encouraged wherever feasible for better patient selection, prognostication, and clinical outcomes.","PeriodicalId":31357,"journal":{"name":"Asian Journal of Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44615047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives Bortezomib vial-sharing is commonly employed to maximize the treatment of patients with multiple myeloma (MM) in resource-limited setting. This strategy minimizes delays in treatment but reduces the dose of bortezomib received by the patient. Herein, we aimed to determine the treatment patterns and outcomes in Filipino patients with MM who received reduced-dose bortezomib. Methods The records of 47 adult patients with MM, seen at our institution from 2016 to 2019 and treated with reduced-dose bortezomib, were retrospectively reviewed. Results The median age of the patients at diagnosis was 55 years; 59.6% were male. VCD (bortezomib, cyclophosphamide, dexamethasone) regimen was the most commonly used (70.7%) bortezomib-based treatment. Among the newly diagnosed patients, bortezomib-based treatment afforded an overall response rate of 79.3%. The median overall survival was not reached. Univariate analysis showed that the hemoglobin level affected response while age, hemoglobin and calcium levels, the choice of induction regimen, and the depth of response all had an impact on survival. Conclusion This study is the first to investigate the real-world outcomes of reduced-dose bortezomib in MM treatment and may provide initial evidence that bortezomib vial-sharing is an acceptable strategy in the treatment of MM in resource-limited setting.
{"title":"Treatment Outcomes with Reduced-Dose Bortezomib in Adult Patients with Multiple Myeloma: A Single-Center Experience","authors":"Jeremiah R. Vallente, C. F. N. Cortez, M. Mirasol","doi":"10.1055/s-0042-1751118","DOIUrl":"https://doi.org/10.1055/s-0042-1751118","url":null,"abstract":"\u0000 Objectives Bortezomib vial-sharing is commonly employed to maximize the treatment of patients with multiple myeloma (MM) in resource-limited setting. This strategy minimizes delays in treatment but reduces the dose of bortezomib received by the patient. Herein, we aimed to determine the treatment patterns and outcomes in Filipino patients with MM who received reduced-dose bortezomib.\u0000 Methods The records of 47 adult patients with MM, seen at our institution from 2016 to 2019 and treated with reduced-dose bortezomib, were retrospectively reviewed.\u0000 Results The median age of the patients at diagnosis was 55 years; 59.6% were male. VCD (bortezomib, cyclophosphamide, dexamethasone) regimen was the most commonly used (70.7%) bortezomib-based treatment. Among the newly diagnosed patients, bortezomib-based treatment afforded an overall response rate of 79.3%. The median overall survival was not reached. Univariate analysis showed that the hemoglobin level affected response while age, hemoglobin and calcium levels, the choice of induction regimen, and the depth of response all had an impact on survival.\u0000 Conclusion This study is the first to investigate the real-world outcomes of reduced-dose bortezomib in MM treatment and may provide initial evidence that bortezomib vial-sharing is an acceptable strategy in the treatment of MM in resource-limited setting.","PeriodicalId":31357,"journal":{"name":"Asian Journal of Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47024347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Malignant pericardial effusion (MPE) is a rare presentation in cancer, associated with high morbidity and mortality. Pericardial effusion may cause cardiac tamponade and sudden death without timely intervention. Management of MPE in rural setting during coronavirus disease 2019 (COVID-19) pandemic would require a multidisciplinary team in a center with expertise and could be a challenge in rural India with limited resources. Methods Here we present a case of MPE of unknown origin in a 40-year-old woman, complicated by COVID-19 infection, which was successfully managed in a rural health setting in southern India. Results She was subjected to prompt pericardiocentesis to relieve symptoms and dose-dense palliative chemotherapy followed by metronomic chemotherapy and pro-anakoinosis therapy during COVID-19 home isolation. She currently has no evidence of disease and is tolerating treatment well. Conclusion Complex oncological emergencies like MPE of unknown origin can be managed in rural setting in India, with a slight modification of existing facility resulting in successful outcomes. This case of MPE in a 40-year-old lady is a glaring example of how the same can be achieved. Principle of pro-anakoinosis can be of value not only during pandemics and lockdowns but also otherwise, the feasibility of which has to be elucidated in larger studies.
{"title":"A Case of Malignant Pericardial Effusion, Complicated by COVID-19: Challenges and Successful Management in Rural India","authors":"A. Mahantesh, B. Ravikiran, N. Jayashree, M. Anup","doi":"10.1055/s-0042-1750018","DOIUrl":"https://doi.org/10.1055/s-0042-1750018","url":null,"abstract":"\u0000 Background Malignant pericardial effusion (MPE) is a rare presentation in cancer, associated with high morbidity and mortality. Pericardial effusion may cause cardiac tamponade and sudden death without timely intervention. Management of MPE in rural setting during coronavirus disease 2019 (COVID-19) pandemic would require a multidisciplinary team in a center with expertise and could be a challenge in rural India with limited resources.\u0000 Methods Here we present a case of MPE of unknown origin in a 40-year-old woman, complicated by COVID-19 infection, which was successfully managed in a rural health setting in southern India.\u0000 Results She was subjected to prompt pericardiocentesis to relieve symptoms and dose-dense palliative chemotherapy followed by metronomic chemotherapy and pro-anakoinosis therapy during COVID-19 home isolation. She currently has no evidence of disease and is tolerating treatment well.\u0000 Conclusion Complex oncological emergencies like MPE of unknown origin can be managed in rural setting in India, with a slight modification of existing facility resulting in successful outcomes. This case of MPE in a 40-year-old lady is a glaring example of how the same can be achieved. Principle of pro-anakoinosis can be of value not only during pandemics and lockdowns but also otherwise, the feasibility of which has to be elucidated in larger studies.","PeriodicalId":31357,"journal":{"name":"Asian Journal of Oncology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57974185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Thakur, M. Gupta, R. Gupta, Tarunjot Singh, N. Parihar, Asha Ranjan
Purpose In this report we discuss an individually customized surface mold applicator technique to treat a case of early carcinoma penis. This case report is one of its kind which describes the brachytherapy treatment planning based on orthogonal X-ray technique. Material and methods T1N0 disease with squamous cell carcinoma histology involving the foreskin of penis and abutting the glans penis was treated by surface mold applicator technique. Impression of the organ was taken using alginate. Cast was prepared from the impression using Type 4 gypsum. The acrylic mold-based applicator was fabricated on the cast. The catheters were positioned and fixed on the acrylic mold. The organ is placed in the mold-based applicator and the catheters are reconstructed on two-dimensional imaging. The brachytherapy is delivered by the 18-channel high-dose rate Oncentra brachytherapy using Ir192 source. The dose given was 45 Gy in 15 fractions, twice daily more than 6 hours apart. Results Patient was reviewed after 6 weeks for follow-up and there was complete regression of the ulcer. At present, patient is on follow-up for the last 10 months and is now disease-free. Conclusion With judicious patient selection, surface mold brachytherapy is an attractive alternative to the interstitial brachytherapy. It is comfortable for the patient, is easily repeatable, and is time saving in high work load and limited resource settings. Early results with this technique are promising.
{"title":"Step-by-Step Guide to Surface Mold Applicator-Based Brachytherapy in a Case of Early Carcinoma Penis: An Organ-Preserving Approach","authors":"P. Thakur, M. Gupta, R. Gupta, Tarunjot Singh, N. Parihar, Asha Ranjan","doi":"10.1055/s-0042-1751113","DOIUrl":"https://doi.org/10.1055/s-0042-1751113","url":null,"abstract":"\u0000 Purpose In this report we discuss an individually customized surface mold applicator technique to treat a case of early carcinoma penis. This case report is one of its kind which describes the brachytherapy treatment planning based on orthogonal X-ray technique.\u0000 Material and methods T1N0 disease with squamous cell carcinoma histology involving the foreskin of penis and abutting the glans penis was treated by surface mold applicator technique. Impression of the organ was taken using alginate. Cast was prepared from the impression using Type 4 gypsum. The acrylic mold-based applicator was fabricated on the cast. The catheters were positioned and fixed on the acrylic mold. The organ is placed in the mold-based applicator and the catheters are reconstructed on two-dimensional imaging. The brachytherapy is delivered by the 18-channel high-dose rate Oncentra brachytherapy using Ir192 source. The dose given was 45 Gy in 15 fractions, twice daily more than 6 hours apart.\u0000 Results Patient was reviewed after 6 weeks for follow-up and there was complete regression of the ulcer. At present, patient is on follow-up for the last 10 months and is now disease-free.\u0000 Conclusion With judicious patient selection, surface mold brachytherapy is an attractive alternative to the interstitial brachytherapy. It is comfortable for the patient, is easily repeatable, and is time saving in high work load and limited resource settings. Early results with this technique are promising.","PeriodicalId":31357,"journal":{"name":"Asian Journal of Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47729454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose Most of the intramedullary spinal cord lesions have a component of insidious myelopathic changes at the time of diagnosis. Among the spinal cord lesions, intramedullary neoplasms are rare (25%). They represent 4 to 10% of all central nervous system tumors. But due to involvement of tracts, they are associated with significant neurological symptoms. Their imaging features can help early diagnosis and predict prognosis. We aim to narrow down differential diagnoses of intramedullary lesions based on imaging findings. Materials and Methods This retrospective study included 40 patients as a sample that underwent magnetic resonance imaging spine at our institution (on 3T machine). Patient population had varied clinical complaints, ranging from headache, nausea, vomiting, motor weakness, bladder and bowel involvement, progressive paraparesis to paraplegia. Lesions were evaluated site, size, margin, associated cysts, signal intensity, enhancement, and associated syringohydromyelia. Results This study obtained majority of the lesions to be ependymoma (15) and astrocytoma (11), followed by infection (4), hemangioblastoma (3), and metastasis (2). Five patients were either lost to follow-up or not operated on. Conclusion Most of the intramedullary lesions were malignant and were showing postcontrast enhancement. Ependymomas were more frequently present in cervical region, central in location with well-defined margins and focal postcontrast enhancement. Among the total of 15 ependymomas, three cases were associated with neurofibromatosis-2. Ependymomas were more frequently associated with syringohydromyelia and peripheral hemorrhage (cap sign). Astrocytoma was more frequently seen in children, thoracic and eccentric in location with ill-defined margins. Enhancement in astrocytoma was dependent on the grade of tumor. Metastasis was a differential, with imaging characteristics dependent on type of primary. Intramedullary granuloma due to infection can also be confusing mimics of neoplasm. High-velocity signal loss due to flow voids is seen in the hemangioblastomas.
{"title":"Imaging Features of Intramedullary Spinal Cord Lesions with Histopathological Correlation","authors":"Bhanupriya Singh, Abhishek Chauhan, G. Raj","doi":"10.1055/s-0042-1750792","DOIUrl":"https://doi.org/10.1055/s-0042-1750792","url":null,"abstract":"\u0000 Purpose Most of the intramedullary spinal cord lesions have a component of insidious myelopathic changes at the time of diagnosis. Among the spinal cord lesions, intramedullary neoplasms are rare (25%). They represent 4 to 10% of all central nervous system tumors. But due to involvement of tracts, they are associated with significant neurological symptoms. Their imaging features can help early diagnosis and predict prognosis. We aim to narrow down differential diagnoses of intramedullary lesions based on imaging findings.\u0000 Materials and Methods This retrospective study included 40 patients as a sample that underwent magnetic resonance imaging spine at our institution (on 3T machine). Patient population had varied clinical complaints, ranging from headache, nausea, vomiting, motor weakness, bladder and bowel involvement, progressive paraparesis to paraplegia. Lesions were evaluated site, size, margin, associated cysts, signal intensity, enhancement, and associated syringohydromyelia.\u0000 Results This study obtained majority of the lesions to be ependymoma (15) and astrocytoma (11), followed by infection (4), hemangioblastoma (3), and metastasis (2). Five patients were either lost to follow-up or not operated on.\u0000 Conclusion Most of the intramedullary lesions were malignant and were showing postcontrast enhancement. Ependymomas were more frequently present in cervical region, central in location with well-defined margins and focal postcontrast enhancement. Among the total of 15 ependymomas, three cases were associated with neurofibromatosis-2. Ependymomas were more frequently associated with syringohydromyelia and peripheral hemorrhage (cap sign). Astrocytoma was more frequently seen in children, thoracic and eccentric in location with ill-defined margins. Enhancement in astrocytoma was dependent on the grade of tumor. Metastasis was a differential, with imaging characteristics dependent on type of primary. Intramedullary granuloma due to infection can also be confusing mimics of neoplasm. High-velocity signal loss due to flow voids is seen in the hemangioblastomas.","PeriodicalId":31357,"journal":{"name":"Asian Journal of Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48265359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Waseem Abbas, Archit Pandit, V. Goel, Anjali Aggarwal, R. Acharya
Preoperative chemotherapy and preoperative chemoradiation, both improve survival for locally advanced esophageal cancer proven in randomized trials and metanalysis. Limited data are available comparing these preoperative therapies especially in non-gastroesophageal junction squamous cell cancer of esophagus. In this retrospective analysis, 69 eligible patients of locally advanced esophageal cancer, who underwent preoperative chemoradiation followed by surgery or chemotherapy followed by surgery at our center were analyzed. The end points of study were overall survival, disease free survival, and histopathological response. Three weekly paclitaxel and carboplatin was used as neoadjuvant chemotherapy and weekly paclitaxel and carboplatin were used with radiation as per standard protocol. Median follow-up time was 35 months for surviving patients. Median overall survival was 44 months (95% CI 27.2–62.7) in chemoradiation group and it was not reached in the chemotherapy arm (p-value −0.832). The median disease-free survival for patients who underwent preoperative chemoradiation was 41 months and 34 months in preoperative chemotherapy group (p-value −0.812). Seven of 41 patients (17.1%) in chemoradiation group were circumferential resection margin (CRM) positive as compared with six of 28 (21.4%) in chemotherapy group (p = 0.650). A pathological complete response was seen in 13 (31.7%) patients in chemoradiation group and seven (21.4) patients in chemotherapy group. There was no survival advantage for preoperative chemoradiotherapy compared with preoperative chemotherapy in patients with predominant esophageal squamous cell carcinoma of locally advanced esophageal cancer. Despite the non-significant improvement from preoperative chemoradiation with respect to CRM positivity and pathological complete response rates, there was no difference in overall survival or disease-free survival.
{"title":"Preoperative Chemoradiation versus Chemotherapy in Locally Advanced Resectable Esophageal Cancer: A Retrospective Study","authors":"Waseem Abbas, Archit Pandit, V. Goel, Anjali Aggarwal, R. Acharya","doi":"10.1055/s-0042-1750199","DOIUrl":"https://doi.org/10.1055/s-0042-1750199","url":null,"abstract":"Preoperative chemotherapy and preoperative chemoradiation, both improve survival for locally advanced esophageal cancer proven in randomized trials and metanalysis. Limited data are available comparing these preoperative therapies especially in non-gastroesophageal junction squamous cell cancer of esophagus. In this retrospective analysis, 69 eligible patients of locally advanced esophageal cancer, who underwent preoperative chemoradiation followed by surgery or chemotherapy followed by surgery at our center were analyzed. The end points of study were overall survival, disease free survival, and histopathological response. Three weekly paclitaxel and carboplatin was used as neoadjuvant chemotherapy and weekly paclitaxel and carboplatin were used with radiation as per standard protocol. Median follow-up time was 35 months for surviving patients. Median overall survival was 44 months (95% CI 27.2–62.7) in chemoradiation group and it was not reached in the chemotherapy arm (p-value −0.832). The median disease-free survival for patients who underwent preoperative chemoradiation was 41 months and 34 months in preoperative chemotherapy group (p-value −0.812). Seven of 41 patients (17.1%) in chemoradiation group were circumferential resection margin (CRM) positive as compared with six of 28 (21.4%) in chemotherapy group (p = 0.650). A pathological complete response was seen in 13 (31.7%) patients in chemoradiation group and seven (21.4) patients in chemotherapy group. There was no survival advantage for preoperative chemoradiotherapy compared with preoperative chemotherapy in patients with predominant esophageal squamous cell carcinoma of locally advanced esophageal cancer. Despite the non-significant improvement from preoperative chemoradiation with respect to CRM positivity and pathological complete response rates, there was no difference in overall survival or disease-free survival.","PeriodicalId":31357,"journal":{"name":"Asian Journal of Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42781301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ramya Venugopal, S. S., R. Tiwari, G. Narayanan, B. Vishwanathan
Introduction Advanced radiation therapy delivery techniques require greater understanding of various planning sequences and methods. The aim of this study is to determine a class solution that finds the best possible technique to deliver for stereotactic radiosurgery between dynamic conformal arc (DCA) techniques using various options such as DCA, DCA + SSO (segment shape optimization), and DCA + SSO + VDR (variable dose rate) using noncoplanar beam arrangement and volumetric modulated arc therapy (VMAT) using coplanar beams. Materials and Methods In this dosimetric study, 11 brain cases were retrospectively planned for various techniques and analyzed for the Paddick conformity index (CI), Radiation Therapy Oncology Group homogeneity index (HI), Paddick gradient index (GI), treatment time in terms of monitor units (MU) and normal brain dose (V12Gy). The paired t-test was performed to know the statistical significance between the techniques. Results In terms of CI, GI, and control of the normal brain dose, the VMAT plan was superior to other techniques. But, HI was found to be better with DCA. Above all, VMAT delivered higher MU than any other technique. The p-values between DCA + SSO and DCA, DCA + SSO + VDR and DCA + SSO, and VMAT and DCA + SSO + VDR are as follows: CI: 0.0004, 0.015, and 0.03; GI: 0.03, 0.33, and 0.29; HI: 0.008, 0.04, and 0.06; V12 Gy of normal brain: 0.1, 0.01, 0.38. VMAT requires approximately 41 ± 17% more MU than DCA + SSO + VDR. Conclusion VMAT using coplanar beams is preferable among all the techniques, considering the dosimetric parameters studied. If VMAT is not available in the facility, DCA + SSO + VDR technique using non coplanar beams can be used to deliver SRS treatment.
{"title":"The Optimal Choice of Technique for Stereotactic Radiosurgery—A LINAC-Based Dosimetric Study between DCA, DCA-SSO, DCA-SSO-VDR, and VMAT","authors":"Ramya Venugopal, S. S., R. Tiwari, G. Narayanan, B. Vishwanathan","doi":"10.1055/s-0042-1751117","DOIUrl":"https://doi.org/10.1055/s-0042-1751117","url":null,"abstract":"\u0000 Introduction Advanced radiation therapy delivery techniques require greater understanding of various planning sequences and methods. The aim of this study is to determine a class solution that finds the best possible technique to deliver for stereotactic radiosurgery between dynamic conformal arc (DCA) techniques using various options such as DCA, DCA + SSO (segment shape optimization), and DCA + SSO + VDR (variable dose rate) using noncoplanar beam arrangement and volumetric modulated arc therapy (VMAT) using coplanar beams.\u0000 Materials and Methods In this dosimetric study, 11 brain cases were retrospectively planned for various techniques and analyzed for the Paddick conformity index (CI), Radiation Therapy Oncology Group homogeneity index (HI), Paddick gradient index (GI), treatment time in terms of monitor units (MU) and normal brain dose (V12Gy). The paired t-test was performed to know the statistical significance between the techniques.\u0000 Results In terms of CI, GI, and control of the normal brain dose, the VMAT plan was superior to other techniques. But, HI was found to be better with DCA. Above all, VMAT delivered higher MU than any other technique. The p-values between DCA + SSO and DCA, DCA + SSO + VDR and DCA + SSO, and VMAT and DCA + SSO + VDR are as follows: CI: 0.0004, 0.015, and 0.03; GI: 0.03, 0.33, and 0.29; HI: 0.008, 0.04, and 0.06; V12 Gy of normal brain: 0.1, 0.01, 0.38. VMAT requires approximately 41 ± 17% more MU than DCA + SSO + VDR.\u0000 Conclusion VMAT using coplanar beams is preferable among all the techniques, considering the dosimetric parameters studied. If VMAT is not available in the facility, DCA + SSO + VDR technique using non coplanar beams can be used to deliver SRS treatment.","PeriodicalId":31357,"journal":{"name":"Asian Journal of Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48715916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective The aim of this study was to evaluate risk of ovarian malignancy algorithm (ROMA) in premenopausal patients with ovarian masses. Materials and Methods A mixed observational study was conducted in the Department of Obstetrics and Gynecology at Lilavati Hospital and Research Centre, Mumbai, from the month of June 2017 to March 2018. In this study, premenopausal females with ovarian masses, satisfying the inclusion criteria, were evaluated for the purpose of preoperative analysis. Results In premenopausal females, ROMA less than 11.4% is normal and more than or equal to 1.4% is increased. Considering histopathology reports as the gold standard, significant association was present between ROMA score and premenopausal status. Conclusion ROMA includes two recognized markers that are being used in the current scenario for the purpose of preoperative risk assessment of ovarian cancer, cancer antigen 125 (CA125), and human epididymis protein 4 (HE4). CA125 has been shown to be elevated in most ovarian cancer cells but has a low specificity for ovarian malignancies. HE4 is a recently developed biomarker that is elevated in ovarian cancers, as well as few other cancers, and has been shown to have higher specificity than CA125. Combining CA125 and HE4 provides a relatively more accurate prediction of malignancy than either test alone. ROMA culminates the benefits of the combined CA125 and HE4 biomarkers along with menopausal status to help assign a numeric risk stratification of malignancy in cases of ovarian tumors.
{"title":"A Study to Evaluate Risk of Ovarian Malignancy Algorithm (ROMA) in Patients with Ovarian Masses","authors":"Asna Aafreen, Aprajita Pankaj, Apoorv Pankaj","doi":"10.1055/s-0042-1751119","DOIUrl":"https://doi.org/10.1055/s-0042-1751119","url":null,"abstract":"\u0000 Objective The aim of this study was to evaluate risk of ovarian malignancy algorithm (ROMA) in premenopausal patients with ovarian masses.\u0000 Materials and Methods A mixed observational study was conducted in the Department of Obstetrics and Gynecology at Lilavati Hospital and Research Centre, Mumbai, from the month of June 2017 to March 2018. In this study, premenopausal females with ovarian masses, satisfying the inclusion criteria, were evaluated for the purpose of preoperative analysis.\u0000 Results In premenopausal females, ROMA less than 11.4% is normal and more than or equal to 1.4% is increased. Considering histopathology reports as the gold standard, significant association was present between ROMA score and premenopausal status.\u0000 Conclusion ROMA includes two recognized markers that are being used in the current scenario for the purpose of preoperative risk assessment of ovarian cancer, cancer antigen 125 (CA125), and human epididymis protein 4 (HE4). CA125 has been shown to be elevated in most ovarian cancer cells but has a low specificity for ovarian malignancies. HE4 is a recently developed biomarker that is elevated in ovarian cancers, as well as few other cancers, and has been shown to have higher specificity than CA125. Combining CA125 and HE4 provides a relatively more accurate prediction of malignancy than either test alone. ROMA culminates the benefits of the combined CA125 and HE4 biomarkers along with menopausal status to help assign a numeric risk stratification of malignancy in cases of ovarian tumors.","PeriodicalId":31357,"journal":{"name":"Asian Journal of Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42530563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dermatofibrosarcoma protuberans (DFSP) is an uncommon, painless, slow-growth, superficial soft tissue malignant sarcoma corresponding to less than 0.1% of all malignancies. The primary treatment for DFSP is surgical excision, which is wide local excision (WLE) with tumor-free margins, Mohs micrographic surgery (MMS), and partial or total amputation. The goal of surgical excision is to achieve negative resection margins, thus reducing the local recurrence rate. These three cases reported large dermatofibrosarcoma, which began as a small nodule and progressed within approximately a year and were treated subsequently with wide excisions surgery. The unique and challenging part for most surgeons is removing the mass with a concentric excision due to its specific growth pattern. To achieve negative resection margins, the width of the tumor-free margins and infiltrating depth are two essential factors to be considered for complete excision for both WLE and MMS surgical techniques. Adjuvant therapy, including radiotherapy and targeted therapy, is reserved for unresectable, advanced stage, or recurrent tumors.
{"title":"Dermatofibrosarcoma: Case Report Series","authors":"I. B. Suryawisesa, Oki P. Gotama","doi":"10.1055/s-0042-1751121","DOIUrl":"https://doi.org/10.1055/s-0042-1751121","url":null,"abstract":"Dermatofibrosarcoma protuberans (DFSP) is an uncommon, painless, slow-growth, superficial soft tissue malignant sarcoma corresponding to less than 0.1% of all malignancies. The primary treatment for DFSP is surgical excision, which is wide local excision (WLE) with tumor-free margins, Mohs micrographic surgery (MMS), and partial or total amputation. The goal of surgical excision is to achieve negative resection margins, thus reducing the local recurrence rate. These three cases reported large dermatofibrosarcoma, which began as a small nodule and progressed within approximately a year and were treated subsequently with wide excisions surgery. The unique and challenging part for most surgeons is removing the mass with a concentric excision due to its specific growth pattern. To achieve negative resection margins, the width of the tumor-free margins and infiltrating depth are two essential factors to be considered for complete excision for both WLE and MMS surgical techniques. Adjuvant therapy, including radiotherapy and targeted therapy, is reserved for unresectable, advanced stage, or recurrent tumors.","PeriodicalId":31357,"journal":{"name":"Asian Journal of Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43306290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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