R. Shetty, K. Akbar, H. Rao, M. Vijayakumar, R. Reddy
Background: Esophageal cancer is one of the common cancer with high mortality. Radical resections offer the best survival. However, traditional radical resection involves thoracotomy, resulting in pulmonary complications. Video-assisted thoracoscopic surgery has overcome this but requires a long learning curve and limitations in certain areas. Robotic-assisted thoracic mobilization has shown promising results. Here, we are sharing initial experience of robotic esophageal mobilization. Aim: The aim of the study is to assess the feasibility, safety, and learning curve of performing robotic esophageal mobilization among patients with esophageal cancers. Materials and Methods: Retrospective review of medical records was conducted for 33 cases who underwent robotic esophageal mobilization in our institute from August 2016 to August 2019. Results: The study population comprised 24 men and 9 women. The mean age of presentation was 55.3 years. Mean operative time was 204 min, and mean thoracic mobilization time was 108 min. The mean lymph node retrieval was 16.6. The postoperative surgical complications were less such as pulmonary complication, i.e., pneumonia in three patients and recurrent nerve palsy, anastomotic leak, and surgical site infection in 1 patient each. There was no procedure-related mortality. Conclusion: Robotic-assisted esophageal mobilization can be safely done without compromising the oncological safety with less postoperative pulmonary complications.
{"title":"Robotic esophageal mobilization: A new norm in the future?","authors":"R. Shetty, K. Akbar, H. Rao, M. Vijayakumar, R. Reddy","doi":"10.4103/oji.oji_33_20","DOIUrl":"https://doi.org/10.4103/oji.oji_33_20","url":null,"abstract":"Background: Esophageal cancer is one of the common cancer with high mortality. Radical resections offer the best survival. However, traditional radical resection involves thoracotomy, resulting in pulmonary complications. Video-assisted thoracoscopic surgery has overcome this but requires a long learning curve and limitations in certain areas. Robotic-assisted thoracic mobilization has shown promising results. Here, we are sharing initial experience of robotic esophageal mobilization. Aim: The aim of the study is to assess the feasibility, safety, and learning curve of performing robotic esophageal mobilization among patients with esophageal cancers. Materials and Methods: Retrospective review of medical records was conducted for 33 cases who underwent robotic esophageal mobilization in our institute from August 2016 to August 2019. Results: The study population comprised 24 men and 9 women. The mean age of presentation was 55.3 years. Mean operative time was 204 min, and mean thoracic mobilization time was 108 min. The mean lymph node retrieval was 16.6. The postoperative surgical complications were less such as pulmonary complication, i.e., pneumonia in three patients and recurrent nerve palsy, anastomotic leak, and surgical site infection in 1 patient each. There was no procedure-related mortality. Conclusion: Robotic-assisted esophageal mobilization can be safely done without compromising the oncological safety with less postoperative pulmonary complications.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122284497","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}
The incidence of renal cell carcinoma (RCC) is around 3% of all cancers. Venous tumor thrombus (VTT) formation and migration are unique aspects of RCC with an incidence of 4%–10%. Venous extension into the renal vein, inferior vena cava, and cardiac extension have been well documented in RCC. Various surgical approaches, including a cardiopulmonary bypass for tumor embolus extraction, may be needed. However, VTT extending into the lumbar vein at the initial presentation is very rare. We hereby report such rarity of RCC presentation of VTT involving renal vein and lumbar vein in a 50-year-old male.
{"title":"A rare case of renal cell carcinoma with venous tumor thrombus involving lumbar vein","authors":"Abhay Mahajan, Bhushan Dodia, Prashant Darakh","doi":"10.4103/oji.oji_19_20","DOIUrl":"https://doi.org/10.4103/oji.oji_19_20","url":null,"abstract":"The incidence of renal cell carcinoma (RCC) is around 3% of all cancers. Venous tumor thrombus (VTT) formation and migration are unique aspects of RCC with an incidence of 4%–10%. Venous extension into the renal vein, inferior vena cava, and cardiac extension have been well documented in RCC. Various surgical approaches, including a cardiopulmonary bypass for tumor embolus extraction, may be needed. However, VTT extending into the lumbar vein at the initial presentation is very rare. We hereby report such rarity of RCC presentation of VTT involving renal vein and lumbar vein in a 50-year-old male.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114342582","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}
C. Waghmare, V. Jain, Arya Bhanu, Padmini H. Nirmal
Aim: The study aimed to evaluate radically treated breast cancer patient's (RTBCP) perception about routine physical follow up visit (RPFUV). Materials and Methods: RTBCP who had completed treatment at least 1 year before and attended radiation oncology department for RPFUV from August 2018 to May 2019 were evaluated for the study. Patients of both sex and all age group who were declared disease free and ready to give informed written consent for the study were interviewed before and after briefing session. The briefing session included explanation of natural history of disease, long-term treatment side effects, alarming symptoms of disease recurrence, and coping up strategies. Data were collected, compiled, and analyzed using descriptive statistics. Results: One hundred and one radically treated eligible breast cancer patients were interviewed. The median age was 51 years. The female-to-male sex ratio was 100:1. Majority of the patients were Stage II (57.43%) and 67.33% of patients were from the middle socioeconomic group. The average investigation and travel cost per visit excluding food, stay, and care's cost per patient was Rs. 765(±343) and Rs. 483.7 (±400.67), respectively. Majority of the patients (63.37%) feel stressed when they plan for RPFUV. Before briefing sessions, 57.43% of patients agreed to follow-up with a local physician or telephonic follow-up. Whereas, after briefing sessions, 62.38% of patients agreed for the same. Conclusion: Routine physical follow-up visits cause psychological and financial burden on patients. There is a need to practice an alternative to routine physical follow-up visits in RTBCP along with patient's education to further improve posttreatment quality of life.
{"title":"Radically treated breast cancer patient's perception about routine physical follow-up visit","authors":"C. Waghmare, V. Jain, Arya Bhanu, Padmini H. Nirmal","doi":"10.4103/oji.oji_37_20","DOIUrl":"https://doi.org/10.4103/oji.oji_37_20","url":null,"abstract":"Aim: The study aimed to evaluate radically treated breast cancer patient's (RTBCP) perception about routine physical follow up visit (RPFUV). Materials and Methods: RTBCP who had completed treatment at least 1 year before and attended radiation oncology department for RPFUV from August 2018 to May 2019 were evaluated for the study. Patients of both sex and all age group who were declared disease free and ready to give informed written consent for the study were interviewed before and after briefing session. The briefing session included explanation of natural history of disease, long-term treatment side effects, alarming symptoms of disease recurrence, and coping up strategies. Data were collected, compiled, and analyzed using descriptive statistics. Results: One hundred and one radically treated eligible breast cancer patients were interviewed. The median age was 51 years. The female-to-male sex ratio was 100:1. Majority of the patients were Stage II (57.43%) and 67.33% of patients were from the middle socioeconomic group. The average investigation and travel cost per visit excluding food, stay, and care's cost per patient was Rs. 765(±343) and Rs. 483.7 (±400.67), respectively. Majority of the patients (63.37%) feel stressed when they plan for RPFUV. Before briefing sessions, 57.43% of patients agreed to follow-up with a local physician or telephonic follow-up. Whereas, after briefing sessions, 62.38% of patients agreed for the same. Conclusion: Routine physical follow-up visits cause psychological and financial burden on patients. There is a need to practice an alternative to routine physical follow-up visits in RTBCP along with patient's education to further improve posttreatment quality of life.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116542583","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}
Amit Sreen, R. Anadure, H. Singh, Rohit Sharma, A. Garg
Aim: Gallbladder carcinoma (GBC) is a common cancer in women in North India. This prospective observational study aimed at systematically studying the clinical features, treatment response, and survival pattern of GBC patients, in a North Indian population. Materials and Methods: The clinical profile, staging of disease, and treatment outcomes of 116 consecutive patients with histologically confirmed GBC, presenting to a tertiary care hospital in Lucknow from June 2013 to August 2015, with a follow-up period of 2 years till August 2017, were studied. Data were captured on a predesigned study proforma and analyzed with appropriate statistical tools. Results: The median age at presentation was 60 years and 67 patients had coexisting gall stones. Patients were divided into three treatment groups for the analysis. Group A comprised patients who underwent radical cholecystectomy followed by adjuvant chemotherapy. Group B included patients who received the best supportive care and Group C consisted of patients who received palliative chemotherapy. The median overall survival (mOS) was 16, 2, and 9 months for Group A, B, and C patients, respectively. The mOS was 8 months for all patients, irrespective of treatment groups. On univariate analysis, factors having an adverse impact on mOS included obstructive jaundice, elevated liver enzymes, treatment groups, and advanced stage of disease. On multivariate analysis, only factor found significantly associated with mOS was treatment group (P < 0.05). Conclusions: GBC was found to be the second most common malignancy among females in our hospital registry with a uniformly poor prognosis. Patients receiving radical surgery and adjuvant chemotherapy were the longest survivors in this study. Better screening and early diagnosis are the cornerstones of improving outcomes in this aggressive malignancy.
{"title":"A study on the clinical profile and treatment outcomes in gallbladder carcinoma from Northern India","authors":"Amit Sreen, R. Anadure, H. Singh, Rohit Sharma, A. Garg","doi":"10.4103/oji.oji_39_20","DOIUrl":"https://doi.org/10.4103/oji.oji_39_20","url":null,"abstract":"Aim: Gallbladder carcinoma (GBC) is a common cancer in women in North India. This prospective observational study aimed at systematically studying the clinical features, treatment response, and survival pattern of GBC patients, in a North Indian population. Materials and Methods: The clinical profile, staging of disease, and treatment outcomes of 116 consecutive patients with histologically confirmed GBC, presenting to a tertiary care hospital in Lucknow from June 2013 to August 2015, with a follow-up period of 2 years till August 2017, were studied. Data were captured on a predesigned study proforma and analyzed with appropriate statistical tools. Results: The median age at presentation was 60 years and 67 patients had coexisting gall stones. Patients were divided into three treatment groups for the analysis. Group A comprised patients who underwent radical cholecystectomy followed by adjuvant chemotherapy. Group B included patients who received the best supportive care and Group C consisted of patients who received palliative chemotherapy. The median overall survival (mOS) was 16, 2, and 9 months for Group A, B, and C patients, respectively. The mOS was 8 months for all patients, irrespective of treatment groups. On univariate analysis, factors having an adverse impact on mOS included obstructive jaundice, elevated liver enzymes, treatment groups, and advanced stage of disease. On multivariate analysis, only factor found significantly associated with mOS was treatment group (P < 0.05). Conclusions: GBC was found to be the second most common malignancy among females in our hospital registry with a uniformly poor prognosis. Patients receiving radical surgery and adjuvant chemotherapy were the longest survivors in this study. Better screening and early diagnosis are the cornerstones of improving outcomes in this aggressive malignancy.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128702150","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}
R. Grover, Preeti Negi, P. Kingsley, A. Varghese, U. George
Background: Treatment-related swallowing dysfunction still represents a significant clinical issue affecting the quality of life of head and neck cancer (HNC) patients following radiation therapy (RT) or chemoradiation therapy (CRT). Aim: The aim of the study was to evaluate the incidence of swallowing dysfunction following RT or CRT by fiberoptic endoscopic evaluation of swallowing (FEES) and to analyze the FEES findings in reference to patient-, tumor- and treatment-related factors. Materials and Methods: This prospective study included histopathological-proven HNC patients undergoing objective swallowing assessment by FEES at baseline, 3 months, and 6 months after receiving RT or CRT from December 2013 to November 2014. The parameters used to represent swallowing dysfunction included pooling of secretions, laryngeal penetration, aspiration, laryngopharynx reflux, and nasopharyngeal reflux. Results: A total of 34 patients undergoing a swallowing assessment schedule were analyzed. At 3-month assessment, we found swallowing dysfunction in 38.2% of cases which was more frequent in patients with oral cavity and hypopharyngeal primaries than other primary sites of HNC (P = 0.013). There was a higher chance of swallowing dysfunction among locally advanced HNC patients than early-staged patients, particularly at 3-month assessment although statistically insignificant (41.3% vs. 20%). The most frequently noted swallowing dysfunction was pooling of secretions in the vallecula and pyriform fossa. At 3 months following RT/CRT, there was an increase in the incidence of swallowing dysfunction (38.2% of patients) which subsequently decreased by 6 months (20.6% of patients). Conclusions: It is imperative to pick up the observations pointing toward the development of future swallowing dysfunction among HNC patients following RT/CRT by performing FEES, thereby reducing mortality associated with silent aspiration.
{"title":"Swallowing dysfunction after head-and-neck irradiation – Is it worth the fiberoptic endoscopic evaluation of swallowing?","authors":"R. Grover, Preeti Negi, P. Kingsley, A. Varghese, U. George","doi":"10.4103/oji.oji_42_20","DOIUrl":"https://doi.org/10.4103/oji.oji_42_20","url":null,"abstract":"Background: Treatment-related swallowing dysfunction still represents a significant clinical issue affecting the quality of life of head and neck cancer (HNC) patients following radiation therapy (RT) or chemoradiation therapy (CRT). Aim: The aim of the study was to evaluate the incidence of swallowing dysfunction following RT or CRT by fiberoptic endoscopic evaluation of swallowing (FEES) and to analyze the FEES findings in reference to patient-, tumor- and treatment-related factors. Materials and Methods: This prospective study included histopathological-proven HNC patients undergoing objective swallowing assessment by FEES at baseline, 3 months, and 6 months after receiving RT or CRT from December 2013 to November 2014. The parameters used to represent swallowing dysfunction included pooling of secretions, laryngeal penetration, aspiration, laryngopharynx reflux, and nasopharyngeal reflux. Results: A total of 34 patients undergoing a swallowing assessment schedule were analyzed. At 3-month assessment, we found swallowing dysfunction in 38.2% of cases which was more frequent in patients with oral cavity and hypopharyngeal primaries than other primary sites of HNC (P = 0.013). There was a higher chance of swallowing dysfunction among locally advanced HNC patients than early-staged patients, particularly at 3-month assessment although statistically insignificant (41.3% vs. 20%). The most frequently noted swallowing dysfunction was pooling of secretions in the vallecula and pyriform fossa. At 3 months following RT/CRT, there was an increase in the incidence of swallowing dysfunction (38.2% of patients) which subsequently decreased by 6 months (20.6% of patients). Conclusions: It is imperative to pick up the observations pointing toward the development of future swallowing dysfunction among HNC patients following RT/CRT by performing FEES, thereby reducing mortality associated with silent aspiration.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128724505","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}
Groin node metastases are predominantly seen in primary malignancies of infradiaphragmatic location. However, sparse cases of inguinal metastases from tumors above the diaphragm have been reported in the medical literature. Here, we report a case of small-cell carcinoma of the lung with metastatic inguinal lymph node at the initial presentation in a 57-year-old man. The case was diagnosed and managed congruously as per the stage of the disease, which was metastatic. However, the patient was died due to disease progression after 8 months of diagnosis. This case edifies to a clinical oncologist's knowledge that patients with commodious and disseminated malignancies of supradiaphragmatic location may present with lymph nodes in the inguinal region.
{"title":"Small-cell carcinoma of the lung with inguinal lymph node metastasis at initial presentation","authors":"S. Thakur, P. Vias, M. Gupta","doi":"10.4103/oji.oji_40_19","DOIUrl":"https://doi.org/10.4103/oji.oji_40_19","url":null,"abstract":"Groin node metastases are predominantly seen in primary malignancies of infradiaphragmatic location. However, sparse cases of inguinal metastases from tumors above the diaphragm have been reported in the medical literature. Here, we report a case of small-cell carcinoma of the lung with metastatic inguinal lymph node at the initial presentation in a 57-year-old man. The case was diagnosed and managed congruously as per the stage of the disease, which was metastatic. However, the patient was died due to disease progression after 8 months of diagnosis. This case edifies to a clinical oncologist's knowledge that patients with commodious and disseminated malignancies of supradiaphragmatic location may present with lymph nodes in the inguinal region.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128555378","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}
H. Rao, R. Shetty, K. Akbar, K. Mahesh, J. Dixit, M. Vijayakumar, S. Gopinathan, N. Mohammed
Background: With the introduction of the concept of sentinel lymph node biopsy (SLNB), the surgical management of the axilla has undergone a paradigm change in clinically node-negative early breast cancer, and complete axillary dissection is avoided if the sentinel lymph node (SLN) is negative for metastasis. Aim: The purpose of this study was to identify the reliability, accuracy, and safety of using methylene blue dye (MBD) in SLNB for early-stage carcinoma of the breast. Materials and Methods: A prospective study was conducted among 151 early breast carcinoma patients (T1/2N0M0) from December 2012 to February 2016. Intraoperative identification of the SLN was done by injecting 5 ml of 1% MBD into the subareolar region of the breast. All the blue-stained lymph nodes were then surgically excised and sent for frozen section examination. Results: The mean age of presentation was 54.10 years. Thirty out of 151 cases had SLN metastasis and 115 cases were negative for malignancy on the frozen section. On the final histopathological examination, 36 cases had metastasis and 115 cases were negative for malignancy. The false-negative rate was 5%. No patients developed anaphylactic/allergic or any type of skin reaction following MBD injection. The accuracy, positive predictive value, and negative predictive value of sentinel node identification using MBD were 96.02%, 100%, and 95.04%, respectively. After a mean follow-up of 10 months, no patient was found to be with ipsilateral axillary or supraclavicular recurrence. Conclusion: The use of MBD in SLNB for the diagnosis of axillary metastasis is reliable, accurate, and safe.
{"title":"Sentinel lymph node mapping in early breast cancer using methylene blue dye","authors":"H. Rao, R. Shetty, K. Akbar, K. Mahesh, J. Dixit, M. Vijayakumar, S. Gopinathan, N. Mohammed","doi":"10.4103/oji.oji_36_20","DOIUrl":"https://doi.org/10.4103/oji.oji_36_20","url":null,"abstract":"Background: With the introduction of the concept of sentinel lymph node biopsy (SLNB), the surgical management of the axilla has undergone a paradigm change in clinically node-negative early breast cancer, and complete axillary dissection is avoided if the sentinel lymph node (SLN) is negative for metastasis. Aim: The purpose of this study was to identify the reliability, accuracy, and safety of using methylene blue dye (MBD) in SLNB for early-stage carcinoma of the breast. Materials and Methods: A prospective study was conducted among 151 early breast carcinoma patients (T1/2N0M0) from December 2012 to February 2016. Intraoperative identification of the SLN was done by injecting 5 ml of 1% MBD into the subareolar region of the breast. All the blue-stained lymph nodes were then surgically excised and sent for frozen section examination. Results: The mean age of presentation was 54.10 years. Thirty out of 151 cases had SLN metastasis and 115 cases were negative for malignancy on the frozen section. On the final histopathological examination, 36 cases had metastasis and 115 cases were negative for malignancy. The false-negative rate was 5%. No patients developed anaphylactic/allergic or any type of skin reaction following MBD injection. The accuracy, positive predictive value, and negative predictive value of sentinel node identification using MBD were 96.02%, 100%, and 95.04%, respectively. After a mean follow-up of 10 months, no patient was found to be with ipsilateral axillary or supraclavicular recurrence. Conclusion: The use of MBD in SLNB for the diagnosis of axillary metastasis is reliable, accurate, and safe.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124225544","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: The elevated neutrophil-to-lymphocyte ratio (NLR) has been identified as a poor prognostic indicator in various malignancies. The progression of malignancies is manifested as alteration in blood counts which can be used as the prognostic markers. Aim: The aim of the present study is to analyze the effect of pretreatment NLR and other hematological variables on progression-free survival (PFS) and overall survival (OS) among cervical cancers patients. Materials and Methods: The present retrospective study enrolled 303 cervical cancer (Stage IIB–IVA) patients treated by radical radiotherapy from January 2016 to December 2018. The pretreatment values of NLR, absolute neutrophil count, and absolute lymphocyte count (ALC) were recorded for each patient and their associations with the clinicopathologic variables, PFS, and OS were analyzed. Results: The optimal cutoff value of NLR was 3.0. The median follow-up period was 19 months. On univariate analysis, PFS rates during the follow-up period were significantly lower in NLR-high versus NLR-low group (P = 0.042) and in low-ALC versus high-ALC group (P = 0.018). Multivariate Cox-proportional hazards model identified NLR and ALC as the strongest prognostic factors for PFS. On univariate analysis, OS was better for patients with the International Federation of Gynecology and Obstetrics Stage IIB versus III–IVA (P = 0.046) and ALC >2000/c.mm versus ≤2000/c.mm (P = 0.050), respectively. None of the hematological variables remained significant for OS on the multivariate analysis. Conclusion: High-NLR is associated with worse survival outcomes in cervical cancer patients. NLR and ALC are the independent prognostic factors for PFS in cervical cancer patients.
{"title":"Prognostic significance of neutrophil lymphocyte ratio in patients of carcinoma cervix treated with radiotherapy","authors":"B. Ali Azher, Niketa Thakur, Sonal Patel","doi":"10.4103/oji.oji_20_20","DOIUrl":"https://doi.org/10.4103/oji.oji_20_20","url":null,"abstract":"Background: The elevated neutrophil-to-lymphocyte ratio (NLR) has been identified as a poor prognostic indicator in various malignancies. The progression of malignancies is manifested as alteration in blood counts which can be used as the prognostic markers. Aim: The aim of the present study is to analyze the effect of pretreatment NLR and other hematological variables on progression-free survival (PFS) and overall survival (OS) among cervical cancers patients. Materials and Methods: The present retrospective study enrolled 303 cervical cancer (Stage IIB–IVA) patients treated by radical radiotherapy from January 2016 to December 2018. The pretreatment values of NLR, absolute neutrophil count, and absolute lymphocyte count (ALC) were recorded for each patient and their associations with the clinicopathologic variables, PFS, and OS were analyzed. Results: The optimal cutoff value of NLR was 3.0. The median follow-up period was 19 months. On univariate analysis, PFS rates during the follow-up period were significantly lower in NLR-high versus NLR-low group (P = 0.042) and in low-ALC versus high-ALC group (P = 0.018). Multivariate Cox-proportional hazards model identified NLR and ALC as the strongest prognostic factors for PFS. On univariate analysis, OS was better for patients with the International Federation of Gynecology and Obstetrics Stage IIB versus III–IVA (P = 0.046) and ALC >2000/c.mm versus ≤2000/c.mm (P = 0.050), respectively. None of the hematological variables remained significant for OS on the multivariate analysis. Conclusion: High-NLR is associated with worse survival outcomes in cervical cancer patients. NLR and ALC are the independent prognostic factors for PFS in cervical cancer patients.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127217897","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}
The biological heterogeneity of breast cancer accounts for variations in natural course of disease and differences in response to various therapeutic modalities. These variations pose as major challenges in clinical management of patient. The quest for markers that would accurately define prognosis and response to particular therapeutic modality has led us to the molecular makeup of these tumors. The technique of gene expression profiling has been pivotal in this regard. With the study of thousands of genes simultaneously in breast cancer patients, a molecular classification of breast carcinoma was proposed in the early 21st century. High-throughput commercial assays proved to be useful in predicting prognosis for the patients but are expensive. Classification of breast cancers using immunohistochemistry that can be used as a surrogate of this molecular classification is inexpensive, easier, and more convenient to use. However, the accuracy of this classification is closely dependent on accurate immunohistochemical measurement of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki67. The initial surrogate classification has undergone revisions to make it more relevant in the 13th St Gallen International Breast Conference. Newer molecular subtypes such as claudin low have also been identified but are included in the basal-like subtype in surrogate classification due to its triple-negative nature. The utility of the surrogate classification in the Indian setting is immense due to limited access to molecular techniques. This review covers in detail the evolution, prognostic, and therapeutic implications of the surrogate molecular classification of breast cancers.
{"title":"Surrogate molecular classification of breast carcinoma: A classification in need or a dilemma indeed","authors":"K. Dewan, A. Mandal","doi":"10.4103/oji.oji_46_19","DOIUrl":"https://doi.org/10.4103/oji.oji_46_19","url":null,"abstract":"The biological heterogeneity of breast cancer accounts for variations in natural course of disease and differences in response to various therapeutic modalities. These variations pose as major challenges in clinical management of patient. The quest for markers that would accurately define prognosis and response to particular therapeutic modality has led us to the molecular makeup of these tumors. The technique of gene expression profiling has been pivotal in this regard. With the study of thousands of genes simultaneously in breast cancer patients, a molecular classification of breast carcinoma was proposed in the early 21st century. High-throughput commercial assays proved to be useful in predicting prognosis for the patients but are expensive. Classification of breast cancers using immunohistochemistry that can be used as a surrogate of this molecular classification is inexpensive, easier, and more convenient to use. However, the accuracy of this classification is closely dependent on accurate immunohistochemical measurement of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki67. The initial surrogate classification has undergone revisions to make it more relevant in the 13th St Gallen International Breast Conference. Newer molecular subtypes such as claudin low have also been identified but are included in the basal-like subtype in surrogate classification due to its triple-negative nature. The utility of the surrogate classification in the Indian setting is immense due to limited access to molecular techniques. This review covers in detail the evolution, prognostic, and therapeutic implications of the surrogate molecular classification of breast cancers.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115068940","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}
S. Kandasamy, V. Neelakandan, Seenisamy Ramapandian, M. Sinnatamby, Muniyappan Kannan
Introduction: The two mechanisms, optical and radiation fields, operate individually and independently in a Linear Accelerator and cause changes with respect to each other. The standard method for performing the quality assurance (QA) test in radiotherapy involves the irradiation of a radiographic film. In this study, we made an attempt to examine how we could maximize the benefit from an impending filmless environment in the radiotherapy QA program. Aim: The aim is to study the feasibility of using computed radiographs (CRs) in the radiotherapy QA program. Materials and Methods: In this study, the QA tests were performed in Linear accelerators Clinac 600c and Clinac iX, both from Varian Medical Systems, Palo Alto, CA, which was commissioned during September 2004 and July 2011, respectively, were used. Optical and radiation field congruence, radiation isocenter for the gantry, collimator, and couch rotational axis verification, in two linear accelerators were done using gafchromic (EBT3) films and CRs. The standard Gafchromic® EBT3 film, utilized for routine QA were used. The errors estimated were compared and analyzed. Results: The mean error estimated in the QA with both linear accelerators using both QA tools (CR and Film) ranged between 0.053 mm and 0.069 mm, and the standard deviation was estimated to be within 0.062-0.164 mm. Conclusion: The results infer that the QA done with CR is in good agreement with the film. This study poses new challenges to the researchers, task groups, and the regulatory bodies to estimate the frequency of QAs for the newer and the older machines and also, the onset of frequent QAs, once the machine becomes older.
{"title":"Application of computed radiography in the quality assurance of linear accelerators in radiotherapy","authors":"S. Kandasamy, V. Neelakandan, Seenisamy Ramapandian, M. Sinnatamby, Muniyappan Kannan","doi":"10.4103/oji.oji_34_20","DOIUrl":"https://doi.org/10.4103/oji.oji_34_20","url":null,"abstract":"Introduction: The two mechanisms, optical and radiation fields, operate individually and independently in a Linear Accelerator and cause changes with respect to each other. The standard method for performing the quality assurance (QA) test in radiotherapy involves the irradiation of a radiographic film. In this study, we made an attempt to examine how we could maximize the benefit from an impending filmless environment in the radiotherapy QA program. Aim: The aim is to study the feasibility of using computed radiographs (CRs) in the radiotherapy QA program. Materials and Methods: In this study, the QA tests were performed in Linear accelerators Clinac 600c and Clinac iX, both from Varian Medical Systems, Palo Alto, CA, which was commissioned during September 2004 and July 2011, respectively, were used. Optical and radiation field congruence, radiation isocenter for the gantry, collimator, and couch rotational axis verification, in two linear accelerators were done using gafchromic (EBT3) films and CRs. The standard Gafchromic® EBT3 film, utilized for routine QA were used. The errors estimated were compared and analyzed. Results: The mean error estimated in the QA with both linear accelerators using both QA tools (CR and Film) ranged between 0.053 mm and 0.069 mm, and the standard deviation was estimated to be within 0.062-0.164 mm. Conclusion: The results infer that the QA done with CR is in good agreement with the film. This study poses new challenges to the researchers, task groups, and the regulatory bodies to estimate the frequency of QAs for the newer and the older machines and also, the onset of frequent QAs, once the machine becomes older.","PeriodicalId":431823,"journal":{"name":"Oncology Journal of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131961040","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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