Journal of cancer & allied specialties最新文献

Introduction: Pancreaticoduodenectomy (PD) is the only potentially curative treatment for pancreatic head adenocarcinoma. This study aimed to determine the short-term outcomes of PD performed over 1 year at a newly established hepato-pancreatico-biliary unit in Khyber Pakhtunkhwa province of Pakistan.

Material and methods: A retrospective analysis of a prospectively maintained hospital information system (HIS) was undertaken of all patients referred to the unit between May 2021 and August 2022. Data were collected from the medical records of patients in the HIS. Data were analyzed for primary location, age, complications, and operative parameters.

Results: The primary sites of disease were ampulla (n = 18, 52.9%), pancreas (n = 11, 32.4%), and duodenum (n = 5, 14.7%). The median duration of surgery was 7 h. 16 (47.1%) patients required blood transfusion either intraoperatively or in the perioperative period. Patients with pre-operative biliary drainage (PBD) were more likely to have multidrug-resistant positive bile cultures with a P-value of 0.2 (n = 12 [35.3%] vs. n = 5 [14.7%]). Overall morbidity was 38.2%. The most common complications were wound infection (n = 12, 35.3%), delayed gastric emptying (n = 6, 17.6%), and type B pancreatic fistula (n = 3, 8.8%). The complication rate was higher in patients with biliary stenting (n = 11 [32.4%] vs. n = 2 [5.9%]; P = 0.06). The median length of hospital stay for patients without complications was less (6 vs. 12 days; P < 0.001). The complication rate was lower in total laparoscopic PD (TLPD) with P = 0.4 (TLPD: 2.9%, open: 23.5%, laparoscopic assisted: 11.8%). 90-day mortality was zero.

Conclusion: Short-term outcomes for PD in our facility are comparable to high-volume centers. PBD can significantly increase operative time, hospital stay, and morbidity.

Introduction: The Shaukat Khanum Memorial Trust has been operational, since February 1990. The first Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC) started functioning in Lahore on December 29, 1994. SKMCH&RC, Peshawar, started its operation in December 2015. The study aimed to give an overview of the cancer cases registered at SKMCH&RC over 28 years.

Material and methods: This study comprised patient data entered into the hospital information system after registration at the centers affiliated with the trust. The malignancies were stratified according to sex and age category (children [≤18 years] and adults [>18 years]).

Results: Neoplasms of the breast, lower gastrointestinal (GI) tract, and lip and oral cavity were prevalent in all ages and both sexes combined; in adult females, neoplasms of the breast, ovary and uterine adnexa, and lip and oral cavity; in adult males, lower GI system, prostate, and lip and oral cavity; and in children, Hodgkin lymphoma, acute lymphoblastic leukemia, and non-Hodgkin lymphoma were predominant.

Conclusion: Cases registered in a hospital-based registry are important. When combined with information from other facilities, they can estimate population-level statistics. This can improve cancer surveillance in the country for effective disease prevention, control, and management.

Introduction: Indolent non-Hodgkin's lymphomas (NHLs) are a diverse category of malignancies characterized by a chronic relapsing-remitting disease course. In the modern era, patients usually receive a combination of bendamustine plus rituximab as the initial therapy, otherwise known as an R-Benda regimen. While clinical trials have demonstrated R-Benda to be superior to other regimens, our study aims to provide insight into real-world outcomes of R-Benda therapy.

Materials and methods: We conducted a retrospective study for January 2015-July 2022 among patients receiving R-Benda for indolent NHLs at the Aga Khan University Hospital, Karachi, Pakistan. All patients underwent pre- and post-treatment assessment through positron emission tomography scan and computed tomography (CT) imaging. The response to treatment was assessed, and the overall survival (OS) and progression-free survival (PFS) were assessed using a Kaplan-Meier survival analysis.

Results: We enrolled 118 patients, out of which the majority were elderly males (64%). The 2-year follow-up rate was 76.3% (n = 90), and the median follow-up time was 29 months. The most common histopathology encountered was follicular lymphoma (52%) presenting with stage IV disease (56%). Approximately 73% experienced a complete metabolic response to the treatment. Of these, 31.4% subsequently experienced a relapse. In addition, 17.7% of patients underwent a partial response, while 7% had refractory disease. The mean OS was 140 months (95% CI: 120-160), while the lower quartile value was 50 months. On the other hand, the median PFS was 80 months (95% CI: 43-N/A).

Conclusion: Our study demonstrated that patients on R-Benda had good clinical outcomes, with the vast majority living beyond 50 months. Moreover, 76.1% had no disease progression for the first 2 years. It adds to the existing body of literature that demonstrates that in real-world experience, the outcomes of R-Benda treatment are better than those reported by earlier randomized-control trials.

Introduction: It is uncommon for breast cancer and non-Hodgkin lymphoma to present simultaneously. An increase in the rate of simultaneous malignancy identification has resulted from adopting more sensitive staging imaging techniques.

Case description: Here, we describe a patient who was diagnosed with axillary diffuse large B cell lymphoma (DLBCL) in a cancer hospital during a staging work-up for suspected breast cancer. Breast cancer was staged as Stage IIA and DLBCL as Stage IE. She was given three cycles of rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisolone (R-CHOP) protocol. Interim positron emission tomography scan showed a complete metabolic response (Deauville score 2). She was given one more cycle of R-CHOP. Then, she had right breast-conserving surgery with axillary lymph node dissection in August 2023. Histopathology report showed residual disease with ductal carcinoma in situ. She was recommended weekly paclitaxel for 12 cycles and trastuzumab and pertuzumab for 1 year. She is currently having her adjuvant systemic therapy, after which she will be planned for local radiation. Endocrine treatment will be started once chemotherapy is completed.

Practical implications: Complete baseline work-up per standard protocols/guidelines should be done in each malignancy. Biopsy of metastatic sites should be done wherever possible. All histopathologies should be reviewed thoroughly before treatment initiation, as they may significantly alter patient management.

Introduction: This investigation assessed the clinical characteristics of patients who received care through telemedicine and the clinical impact telemedicine service had on breast cancer patients in a low-income country.

Materials and methods: This natural experimental study assessed the impact of telemedicine service on cancer outcomes among breast cancer patients at Shaukat Khanum Memorial Trust (SKMT), Pakistan, between January 1st, 2018, to December 31st, 2022. The study group (hybrid group) consisted of patients that had both face-to-face and telemedicine appointments, and the control group (physical group) included patients with only face-to-face encounters.

Results: A total of 3,205 patients were included in the analysis. Among those included in the analysis, 3,188 (99.5 %) were females, and the mean age of the cohort was 48.10 ± 11.94 years. Statistically significant differences were observed between the two groups in age, demographic distribution, disease stage, average number of emergency room visits, mean length of stay in the Intensive care unit, and the final patient status (alive at the end of observation period). However, the binary logistic regression model (forward-LR) suggested that the final patient outcome was related to disease relapse, COVID-19 infection, and age.

Conclusion: Telemedicine clinics, when conducted in parallel with physical clinics (hybrid setup), are safe and have a clinical impact similar to having just physical encounters among breast cancer patients in a low-income country.

Introduction: The oncological safety of a submental (SM) flap is thought to be controversial. The objective of our study was to validate our previous study regarding the oncological safety of SM flaps in oral cavity reconstruction.

Materials and methods: An electronic database was searched from 2015 to 2021 for all head-and-neck tumor patients, where reconstruction was performed using a SM flap.

Results: Eighty-eight oral cavity squamous cell carcinoma patients, among whom 71 were males (81.8%), with a mean age of 55.3 years (range: 25-79 years), were retrieved from the database. The sites of involvement were 37 buccal mucosa, 27 lower alveolus, and 24 tongues. The mean follow-up was 33.5 months. The SM flap reconstruction was done for 88 patients; 3 had complete loss of flap, 17 had incomplete loss/partial necrosis, and 68 patients had uneventful recovery of the flap. We had 16 patients with local recurrence. Of these, 4 (4.5%) patients had clear margins and no lymphadenopathy at the level I at the final histopathology report.

Conclusion: This study provides validation of the oncological safety of the SM flap and establishes that nodal positivity at level I alone does not contribute to recurrence at the primary site.

Introduction: Primary spinal malignant melanoma (PSMM) of extramedullary intradural origin is a rare malignant condition with limited current literature regarding its clinical course, magnetic resonance imaging (MRI) findings, treatment strategies, and outcomes.

Case discussion: This is a case report of a patient with PSMM who was treated with surgery followed by radiotherapy for his residual disease in Shaukat Khanum Memorial Trust, Pakistan. The clinical and radiological findings of this case were retrospectively analyzed using the Hospital Information System.

Practical implementations: PSMM of extramedullary intradural origin is a rare malignant tumor that shows characteristic findings on MRI. Surgical resection is the preferred treatment, and radiotherapy is useful for residual disease.

Introduction: The recommended treatment method for bone sarcoma is wide local excision and reconstruction to preserve limb function. Established methods of reconstruction are mega prosthesis or biological reconstruction. This study aimed to determine the complications and functional outcomes associated with limb salvage surgery using liquid nitrogen-treated bone.

Materials and methods: We retrospectively observed the short-term outcome of limb salvage surgeries where liquid nitrogen bone was used for reconstruction. A total of 15 patients underwent reconstruction with liquid nitrogen auto graft from January 2018 to December 2020. We used the free freezing method of liquid nitrogen treatment after wide local excision of sarcoma. We observed short-term outcomes after liquid nitrogen-treated bone reconstruction in limb salvage surgery. Survival of the auto grafts was recorded using the Kaplan-Meier method with a 95% confidence interval.

Results: The mean follow-up was 19.83 ± 4.5 months. The mean musculoskeletal tumor society score was 62.4 ± 7.9%, while the average Toronto extremity score was 59.6 ± 5.7%. Three patients died during the study duration due to visceral metastasis. Skin necrosis and wound breakdown were major complications in 9 (60%) patients. Deep infection was observed in 4 (26.7%). Similarly, 4 (26.7%) patients had non-union at either the proximal or distal osteotomy site, while the average time of bone union in the rest of the patients was 6.3 ± 1.7 months. A total of 6 (40%) patients underwent reoperation after liquid nitrogen treatment, either due to infection or non-union at the osteotomy site. Recurrence was observed in 3 (20%) of patients.

Conclusion: We observed a high complication rate with liquid nitrogen-treated autograft reconstruction. Vascularized fibula with liquid nitrogen-treated autograft or endoprosthesis should be encouraged.

Introduction: Due to the radiation-sparing effects on salivary gland acini, changes in the composition of the oral microbiome may be a driver for improved outcomes in patients receiving proton radiation, with potentially worse outcomes in patients exposed to photon radiation therapy. To date, a head-to-head comparison of oral microbiome changes at a metagenomic level with longitudinal sampling has yet to be performed in these patient cohorts.

Methods and materials: To comparatively analyze oral microbiome shifts during head and neck radiation therapy, a prospective pilot cohort study was performed at the Maryland Proton Treatment Center and the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center. A longitudinal metagenomic comparative analysis of oral microbiome shifts was performed at three time points (pre-radiation, during radiation, and immediately post-radiation). Head and neck cancer patients receiving proton radiation (n = 4) were compared to photon radiation (n = 4). Additional control groups included healthy age- and sex-matched controls (n = 5), head and neck cancer patients who never received radiation therapy (n = 8), and patients with oral inflammatory disease (n = 3).

Results: Photon therapy patients presented with lower microbial alpha diversity at all timepoints, and there was a trend towards reduced species richness as compared with proton therapy. Healthy controls and proton patients exhibited overall higher and similar diversity. A more dysbiotic state was observed in patients receiving photon therapy as compared to proton therapy, in which oral microbial homeostasis was maintained. Mucositis was observed in 3/4 photon patients and was not observed in any proton patients during radiation therapy. The bacterial de novo pyrimidine biosynthesis pathway and the nitrate reduction V pathway were comparatively higher following photon exposure. These functional changes in bacterial metabolism may suggest that photon exposure produces a more permissive environment for the proliferation of pathogenic bacteria.

Conclusion: Oral microbiome dysbiosis in patients receiving photon radiation may be associated with increased mucositis occurrence. Proton radiation therapy for head and neck cancer demonstrates a safer side effect profile in terms of oral complications, oral microbiome dysbiosis, and functional metabolic status.

Introduction: Wilms tumor is the most common renal malignancy in children. The occurrence of Wilms tumor with various congenital genitourinary anomalies has been reported, particularly in horseshoe kidneys, hypospadias, disorder of sexual development, and double collecting system. However, Wilms tumor with crossed renal ectopia is a rare finding.

Case description: We are reporting a case report of Wilms tumor in a 3-year-old girl who presented with a huge left flank mass with cross-fused renal ectopia. After the initial workup and triphasic computed tomography scan of the chest, abdomen, and pelvis for confirmation of diagnosis and metastasis, the patient underwent image-guided tissue biopsy, followed by neoadjuvant chemotherapy, left radical nephrectomy with separation of fused right ectopic renal moiety, and adjuvant chemoradiation.

Practical implication: This report shows an association of Wilms tumor with cross-fused renal ectopia, a rare combination. Unusual findings on imaging with unilateral flank mass should be considered as part of the differential diagnosis for this rare finding. Adjuvant chemotherapy and modern imaging helped delineate the anatomy and ease the surgery for safe resection, improving the overall outcome.