Journal of cancer research and therapeutics最新文献

Abstract: Head and neck adenoid cystic carcinoma (ACC) is a common malignancy often associated with an aggressive clinical course and a wide array of gene mutations. This systematic review aimed to determine the prevalence of these mutations and their association with prognosis and recurrence in ACC. A search of the scientific literature was carried out from inception till 31 July 2024 in the electronic databases - PubMed, EMBASE, Scopus, Web of Science, Ovid/MEDLINE, and Science direct following specific eligibility criteria. The methodological quality of the included studies was assessed using the Newcastle-Ottawa tool. 31 studies were included, and numerous genes like MYB, NOTCH, TP53, PIK3CA, ARID1A, KDM6A, RAS, SPEN, and many more were identified and were related to poor prognosis. Identification of different genes using wide NGS panels and combination of molecular techniques becomes necessary as multiple genes might be involved in ACC pathogenesis and subsequent targeted therapies can be designed.

Background: Hypofractionated Radiotherapy has replaced Conventional Radiotherapy in Carcinoma Breast. This study aimed to assess locoregional failure, disease-free survival, and overall survival in patients treated over 5 years in our institution.

Materials and methods: A total of 453 patients with carcinoma of the breast eligible for whole breast radiotherapy were assessed from January 2018 to December 2023. Two-dimensional Radiotherapy was given via Telecobalt or LINAC. Demographic, disease, and treatment-related data were analyzed.

Results: Median follow-up was 2.75 years (Range 0.3-5.2 years). Breast-conserving surgery and modified radical mastectomy were done in 21.81% and 78.18% of patients respectively. Neoadjuvant chemotherapy was given in 55.2% of cases. Pathologically, 54.2% of patients had Stage IIB-IIIB and 45.7% had I-IIA.70.84% were given 42 Gy/15 # and the rest of them were given either 41.6 Gy/16 # or 40 Gy/15 #. Percentages of acute skin toxicities Grade I, II, and chronic were observed in 23.11%, 3.97%, and 5.07%, respectively. There were a total of 16 locoregional recurrences and 27 cases of distant metastasis in 5 years. Overall survival and disease-free survival after 5 years were 94.2% and 90.5%, respectively.

Conclusion: Hypofractionated radiotherapy is a safe and efficacious choice for radical treatment of carcinoma breast patients post-surgery. It provides superlative results in concern to disease-free survival and overall survival with minimal acute and chronic toxicities.

Background: Preoperative chemoradiotherapy and subsequent surgery is the standard of care for locally advanced rectal cancer. This has resulted in good local control, but without a significant survival benefit. Multiple randomised trials have utilised total neoadjuvant therapy (TNT) to improve survival outcomes. However, clinical experience in India is limited.

Methods: Patients with cT3/4 or N + rectal adenocarcinoma with ECOG 0-1 were included. Treatment course comprised Short-course radiotherapy (25 Gy in 5 fractions over 1 week), followed by 6 cycles of chemotherapy (Inj. oxaliplatin 130 mg/m2 on D1 and Tab capecitabine 1000 mg/m2 BID from D1-14, q21 days). Following the completion of neoadjuvant treatment, patients were assessed for surgery. Surgery involved Total Mesorectal Excision.

Results: 32 patients were enrolled. Males comprised 66% of the population, and the median age was 42 years. 75% of patients had distal rectal tumours. 18.8% were signet ring cell carcinoma (SRC). 43.8% of patients had mesorectal fascia involvement and lateral lymph nodes (LLN) were present in 28% patients. All patients completed the full course of TNT. 84.4% patients underwent definitive surgery. Pathological complete response was reported in 37% patients, with R0 resection in 96%. Sphincter preservation could be achieved in 29.2% of distal tumours. The incidence of acute grade 3 or higher adverse events was 40.6%, the most common being diarrhoea (15.6%), followed by anaemia (9.4%). Post-operative complications were seen in 22.2% of patients, the most frequent being delayed wound healing. The incidence of Clavien-Dindo grade IV complications was 3.7%. At a median follow-up of 2 years, OS and PFS were 75% and 59.4%, respectively. Absence of LLN and non-SRC histology was associated with significantly higher PFS and OS.

Conclusion: The TNT protocol we followed was well tolerated in our patient population. Excellent tumour and nodal regression rates were seen. It can be considered a viable alternative to preoperative conventional chemoradiation, particularly in a resource-limited setting. However, this treatment strategy was not optimal for patients with high-risk features such as the presence of LLNs and SRC histology.

Abstract: Apart from usual occurrence of abscess or appendicitis, carcinoma of appendix is quite rare to occur. Yet, here, we describe a reported case of appendiceal adenocarcinoma that clinically presented as appendicitis in a 60-year-old man. The patient presented with pain in right iliac fossa, which was sudden in onset, nonradiating, and progressively increased in severity with complaints of nausea. He had no history of fever, vomiting, cough, or constipation. Computed tomography revealed a well-defined collection with surrounding fat stranding and peritoneal thickening in right iliac fossa measuring 2.6 * 4.2 * 3.5 cm, volume 20 cc. Appendix was retrocecal and thickened with tip leading to the collection. A few prominent mesenteric lymph nodes were seen in right iliac fossa. These features suggested perforated appendix with abscess formation. An open appendicectomy was done under general anesthesia, and the specimen was sent for histopathological analysis. On a surprise note, the microscopic section of the specimen revealed tumor cells with a conventional glandular appearance favoring a diagnosis of moderately differentiated adenocarcinoma, following which an elective right hemicolectomy was advised. Nonspecific symptoms and difficulties in reaching a diagnosis preoperatively may contribute to underreporting of appendiceal carcinomas. Complete surgical excision and/or chemotherapy may be necessary and help in the better prognosis of the patient.

Background: Refining the overall survival of oral cancer patients has gained traction in the treatment of oral cancer by offering a good quality of life. Restoring the anatomy and function of the glands in the oral cavity has also been an issue of attention. During every neck dissection, the submandibular gland (SMG) is electively removed as a prophylactic measure. The aim of this study was to evaluate the prevalence of SMG involvement in oral cancer patients and to determine the oncological safety of preserving the SMG during neck dissection in patients with oral cancer.

Research design and methods: A total of 215 patients with oral cancer who underwent neck dissection and tumor excision between 2007 and 2018 were included in the study. All data were retrieved from patients treated in a single hospital. Data, including demographics, tumor site, degree of differentiation, involvement of the SMG, Grade of differentiation, and treatment regimens, were collected and evaluated.

Results: Oral cancer was predominant in males, with an increased preponderance amongst the age group of 55 to 65 years. The tongue was the predominant tumor subsite. Only 6.5% of all cases involved the submandibular gland, with the majority of cases involved the floor of the mouth as the primary tumor location, followed by Tongue.

Conclusion: The present study revealed that SMG involvement occurs mostly when the primary tumor site is in close proximity to the gland, such as the floor of the mouth and tongue. However, metastasis to the SMG from other primary sites is very rare. Hence, the decision regarding the excision of the SMG in oral cancer patients should be made during surgery through meticulous frozen section instead of routine excision of the gland during neck dissection. We recommend preserving the SMG in patients with oral malignancies with no compromise in oncological clearance and remaining cautious while dealing with primary subsites, such as the floor of the mouth and tongue, that are in close vicinity to the submandibular gland.

Background: Gall bladder (GB) is a rare site of neuroendocrine carcinoma (NEC). Gallbladder neuroendocrine carcinoma (GB-NEC) comprises only ~0.2% of all gastrointestinal NECs and 4% of all GB cancers. In the published literature, only a few isolated case reports and rare case series of GB-NEC are available. Worldwide, the largest series of GB-NEC reported is of 19 cases from India. In this study, we present clinicopathological features of 56 cases of GB-NEC diagnosed in a tertiary care cancer hospital of northern part of India.

Aims: To study the clinicopathological and immunohistochemical features of GB-NEC from the archives.

Methods: Retrospective data of GB-NEC, diagnosed over 53 months were collected from institutional electronic medical records. Hematoxylin and eosin (H and E) stained slides and corresponding immunohistochemistry slides were reviewed and included in the study. Data was compiled and basic statistical analysis was done.

Results: GB-NEC constituted 3.19% (n = 56/1752) of all GB carcinomas. Histological types of GB-NEC were: small cell NEC (96.4%, n = 54), large cell NEC (n = 1), and NEC with sarcomatous differentiation (n = 1). The diagnosis was ratified by use of combination of two neuroendocrine markers in varying combination comprising of Synaptophysin, chromogranin and INSMI1. Ki-67 index ranged from 50%-80% in 6 cases and more than 80% in 10 cases where count of mitotic figures was limited by extensive areas of necrosis. Follow-up of 6-8 months was available for 22 patients out of which 21 cases were living with disease. Twenty-two patients were treated with palliative chemotherapy.

Conclusions: GB-NEC is a rare and aggressive malignancy with poor prognosis due to advanced clinical stage of presentation and limited availability of treatment options.

Abstract: Schwannomas are solid, well-encapsulated masses that develop eccentrically toward the nerve from that they originate. They typically affect the head and neck and involve Schwann cells surrounding autonomic, peripheral, and cranial nerves. Intraoral schwannoma is most affected by the tongue, with 54% male preponderance. The most common neural tumors in the oral cavity include neurofibroma, schwannoma, and malignant peripheral nerve sheath tumor (MPNST). CD56 is more specific in schwannomas than neurofibromas, with CD56 expressed strongly in 90% of schwannomas and negative in 86% of neurofibromas. Schwannoma has various histological variants, including ancient schwannoma, Cellular schwannoma, epithelioid schwannoma, Microcystic/reticular variant, Neuroblastoma-like variant, and plexiform schwannoma. CD56, when combined with S-100 and calretinin, can help diagnose peripheral nerve sheath tumors like schwannomas and neurofibromas. Surgical excision with nerve preservation is typically curative, but size and location may affect the surgical strategy. Schwannoma management aims to remove the capsule, minimize malignant emergence, and make the prognosis favorable.

Introduction: Radiation therapy plays a crucial role in the management of pediatric cancer. With recent advancements in treatment techniques and radiation delivery, stricter immobilization is required. However, achieving this in pediatric patients is challenging and often necessitates daily anesthesia. In this study, we present an audit of pediatric patients who underwent radiation therapy under anesthesia, highlighting associated complications and providing a roadmap for resource allocation.

Materials and methods: We collected data on pediatric patients who required radiotherapy under anesthesia, including demographic details, tumor characteristics, anesthesia specifics, observed complications, and any treatment gaps. Descriptive statistics were used to analyze demographic, tumor, and treatment characteristics. Univariate and multivariate analyses were performed to identify correlations with various variables.

Results: From January 2021 to December 2023, 67 patients were scheduled for radiotherapy with daily anesthesia. The median age of the patients was 4 years (interquartile range: 2-5 years). Of these, 34 patients required anesthesia for the entire course of treatment, 22 patients needed anesthesia for part of the treatment, and seven patients did not require anesthesia after the simulation. Overall, anesthesia was needed for 59.12% of sessions. Complications occurred in 66 sessions (8.2%) involving 26 patients. Treatment had to be paused in eight cases, with a median delay of 8 days. The treatment compliance rate was 96.9%. An age of <3 years was significantly associated with the need for anesthesia during radiation. The complication rate was notably higher in patients who required anesthesia for the entire course of radiotherapy.

Conclusion: While the use of anesthesia ensures proper immobilization during radiation treatment for pediatric patients, it carries the risk of complications. Therefore, it is essential to continuously explore and support efforts to allow patients to undergo radiation without the need for anesthesia.

Background: Locally advanced pancreatic cancer (LAPC) is currently treated with chemotherapy (CT) alone or CT combined with radiation therapy (RT) (CT+RT). There is no robust evidence supporting one over the other. The present study compares the two treatment modalities in terms of their survival outcomes and safety profile.

Methods: The retrospective study includes 29 nonmetastatic, unresectable, LAPC patients who were treated with CT+RT (21 patients) or CT alone (8 patients) during November 2019 to September 2023. CT consisted of FOLFIRINOX or Gemcitabine-based regimens. CT+RT patients were treated with conventional (50.4 Gy/28fr) as well as hypofractionated RT dose schedules (39 Gy/13fr, 25 Gy/5fr, and 42 Gy/6fr). The primary endpoint of the study was the median overall survival (OS), and the secondary endpoints were the median progression-free survival (PFS) and acute and late radiation-induced toxicities.

Results: At a median follow-up of 24 months, patients of CT+RT group had prolonged survival compared to patients of CT alone group with median OS of 20 months versus 7 months (P = 0.0032) and median PFS of 15 months versus 5 months (P = 0.029). The majority of toxicities in CT+RT group were Grade 1-2 around 79%. However, Grade 3 or more late event was seen only in 1 (5%) patient.

Conclusion: Incorporating radiation therapy along with CT should be the standard approach for unresectable LAPC patients improving survival with acceptable toxicities.