Journal of cancer research and therapeutics最新文献

Abstract: Among women, cervical cancer continues to be a significant cause of cancer-related death, especially in low- and middle-income nations. Brachytherapy (BT), which provides excellent tumor dose delivery while preserving surrounding tissues, is an essential part of the treatment for locally advanced cervical cancer. Anatomical issues, such as large cervical fibroids, may complicate the placement of the intracavitary brachytherapy (ICBT) applicator. We describe a 74-year-old woman whose stage IIIB cervical cancer was complicated by a large cervical fibroid, which presented a significant BT issue. The successful management of this case, which involved careful uterine sounding and tandem placement under general anesthesia using transrectal and transabdominal ultrasound guidance, and the patient's completion of three high-dose-rate ICBT sessions with favorable outcomes, is a testament to the expertise and dedication of the medical professionals involved. This case underscores the importance of their specialized skills, image-guided techniques, and meticulous planning in overcoming anatomical barriers and ensuring effective BT delivery in complex cervical cancer cases.

Abstract: Home-based palliative care offers a compassionate way to support terminally ill patients in familiar settings, but its implementation in resource-limited environments is challenging. We share our experience with a 35-year-old man with advanced squamous cell carcinoma of the tongue, previously treated with radiotherapy and brachytherapy, who presented with metastatic pleural effusion and severe respiratory distress. Despite comprehensive symptom management in the palliative care ward-including opioid titration, nerve blocks, and psychological support-his wife faced substantial barriers to providing home care. Financial hardship, lack of family support, and living on a third floor hindered timely crisis management. Although we trained the caregiver, resource limitations led to complications like empyema and sepsis, necessitating readmission. The patient passed away after 5 weeks. This case emphasizes the need for systemic investment in caregiver training, community support, and healthcare infrastructure to address the multifaceted challenges of home-based palliative care in resource-constrained settings.

Abstract: Chemotherapy extravasation is a serious iatrogenic complication, especially with vesicant agents such as epirubicin. In severe cases, it can lead to extensive tissue necrosis and compartment syndrome. While surgical intervention is the mainstay treatment for acute complications, novel adjuncts like platelet-rich plasma (PRP) may support wound healing in the recovery phase. A 66-year-old woman with a history of non-Hodgkin's lymphoma developed swelling, bullae, and pain in her right hand following intravenous epirubicin infusion. Compartment syndrome was suspected, and emergency fasciotomy with debridement was performed. Despite initial surgical and medical management, delayed wound healing and recurrent necrosis were observed. Autologous PRP mixed with mupirocin was applied topically twice daily. Accelerated granulation, epithelialization, and functional recovery of the hand were noted within days of PRP initiation. This case illustrates the regenerative potential of PRP in promoting wound healing following chemotherapeutic tissue injury. Its application in extravasation wounds remains rare in the literature, and this report adds to growing interest in PRP as a safe and potentially effective adjunctive therapy in complex oncologic wounds.

Abstract: Gastro-esophageal Stromal Tumor (GIST) is the type of mesenchymal tumor that arises from specialized cells called interstitial cells of Cajal (ICC) or their precursors. The most common site is stomach (60%-70%) followed by small intestine (20%-30%). Esophageal GISTs comprises 0.7% of all GISTs, making them incredibly rare. Treatment options for esophageal GISTs typically involve a multidisciplinary approach and depend on the several factors, including the tumor size, location, and the presence of metastasis. The primary treatment for localized esophageal GISTs is surgical removal, often involving a partial or complete esophagectomy. In some cases, targeted therapy with drugs such as imatinib may be used before or after surgery to shrink the tumor or prevent its recurrence. We report a case of middle-aged man, who presented with dysphagia and was diagnosed as gastrointestinal stromal tumor of lower thoracic esophagus, positive for c-kit, and SMA, and negative for desmin. Patient was treated with targeted therapy and surgery that resulted in excellent outcome with prolonged survival. Although esophageal GIST is a rare scenario, outcome in this subset of patients can be improved with the use of targeted therapy that hasten the symptomatic relief and adds to survival benefit.

Background: Total neoadjuvant treatment has revolutionized the treatment algorithm in the management of locally advanced rectal carcinoma (LARC). This increase in the lifespan should be translated into an improved quality of life (QOL) so as to have a holistic treatment approach.

Materials and methods: This is a prospective study of LARC patients (n = 39) undergoing total neoadjuvant therapy (TNT): SCRT 25Gy/5# followed by 6 cycles of NACT followed by surgery. QOL was analyzed at 3 months and 6 months post-treatment using the EORTC QLQ C30 and CR29 questionnaire. Wilcoxon signed rank test was used to analyze mean scores of Health-Related Quality of life (HRQL) between 3 and 6 months as Global Health Status, five functional scales (physical, role, emotional, cognitive, social functioning), and symptoms scales.

Results: Global health status showed a statistically significant difference (P = 0.001) along with a minor clinical improvement. Under functional items, physical functioning (P < 0.01), role functioning (P = 0.03), emotional functioning (P = 0.01), and social functioning (P = 0.01) all showed statistically significant differences with clinical improvement. For the symptom scales, most of them showed a statistically significant difference and a clinical reduction of scores.

Conclusion: TNT has become the new standard of care in LARC. This study shows a statistical and clinical improvement in global health status with the improvement in functional status of QOL. There is also a statistically significant decrease in symptom scales, which is corroborated by clinical improvement. TNT improves both the survival and the QOL, thus making it a comprehensive treatment option for LARC.

Abstract: Paraneoplastic syndromes encompass an enigmatic spectrum of clinical manifestations precipitated by various malignancies but not attributable to direct tumor invasion, metastatic dissemination, or hormone secretion from the affected organ. In ovarian cancer, a notably heterogeneous malignancy with a predilection for presentation at the advanced stage, paraneoplastic manifestations may arise from multiple organ systems, thereby complicating diagnosis, altering clinical trajectories, and exerting profound impact on both short- and long-term patient outcomes. These phenomena, observed across both epithelial and nonepithelial ovarian tumors, are often mediated through immune cross-reactivity, ectopic hormone secretion, or cytokine dysregulation. Notable manifestations include neurological syndromes, such as cerebellar degeneration, anti-N-methyl-D-aspartate receptor encephalitis, and metabolic disturbances like hypercalcemia, Cushing's syndrome, and thromboembolic states. Despite significant advancements, the diverse clinical presentations of paraneoplastic syndromes continue to pose substantial diagnostic ambiguities, with challenges in surgical planning and operative intricacies. This narrative review aims to elucidate an expansive analysis of the extant data on epidemiological patterns of ovarian cancer-associated paraneoplastic syndromes, their underlying molecular and immunological drivers, and management strategies. The review utilized extensive search across PubMed, EMBASE, Medline, Scopus, and Cochrane Library databases from January 2000 to March 2024. Inclusion criteria included peer-reviewed studies reporting ovarian cancer patients with clinically confirmed paraneoplastic syndromes, definite investigations, and clinical outcomes. Furthermore, it emphasizes the critical importance of multidisciplinary approaches to deliver holistic perioperative care, while addressing the systemic perturbations induced by paraneoplastic processes.

Abstract: Total skin electron beam therapy (TSET) is the specialized and effective therapy for mycosis fungoides and Sézary syndrome. The Stanford TSET technique, which is the one most often used, requires the patient to remain standing for an extended time. Here, we report on the invention of a device to assist in patient positioning for TSET and how the device is used in clinical care. Our novel device comprises supports for the patient's head and upper limbs plus a bicycle-style saddle seat. We used the device during delivery of TSET for Sézary syndrome in a 30-year-old woman. Radiation was delivered from six angles every 2 days (three angles daily) by the Stanford technique using 6 MeV, 2 Gy per fraction, for a total of 12 Gy every 2 days. The total treatment time each day was about 1 hour. During the first 5 days of treatment, the patient required breaks during irradiation because of general malaise and nausea caused by chemotherapy. At each treatment session, glass dosimeters were used to measure the delivered doses to the parietal, bilateral axillary, anterior chest, bilateral medial thigh, and bilateral plantar areas. Glass dosimeter measurements showed underdoses in the medial thigh dose on both sides, thereby suggesting scattering and attenuation caused by the saddle seat. However, the patient experienced great relief from being able to straddle the seat, given her debilitated physical condition and the imposed blindness from lead contact lenses that she wore to protect her corneas. The patient's risk of falling was ameliorated, and she underwent treatment in safety. Our novel device to support a patient in debilitated physical condition receiving TSET carries a risk of dose reduction to the medial thigh, but the risk of falling is significantly reduced.

Abstract: Sebaceous carcinoma at the extraocular sites is an extremely rare tumor. This is the case report of sebaceous carcinoma of the scalp in a 35-year-old male presenting with a fungating cauliflower-like mass on the scalp. There is no standardized treatment for such presentation, which is why it is important to highlight such rare cases, for optimizing treatment plans in the future. A 35-year-old male presented with a fungating, disfiguring lesion on the scalp, which started as a small lesion 3-4 years ago. The patient took ayurvedic treatment, followed by four surgical excisions at other facilities, which did not provide relief. Besides mild discomfort and social embarrassment, the patient did not report any symptoms. The past medical, social, and family history of the patient were unremarkable. At the presentation, the patient looked pale and had edema in the left ankle. On examination, multiple mobile subcentimeter lymph nodes were noted in the head and neck region. The lab assessments revealed hemoglobin of 4.2 g/dL. The patient was admitted and transfused with four units of packed red blood cells. CT scan of the brain showed an irregular mass in the parietal, frontal, and occipital region, causing lytic erosion of the high parietal bone and infiltrating the adjacent dura. Histopathological report revealed the lesion to be sebaceous carcinoma. PET-CT scan showed increased fluorodeoxyglucose uptake in the head, neck, and lungs. The case was discussed in a multidisciplinary tumor board, and radiation was planned. Radiotherapy effectively reduced the size of the tumor, making surgical intervention feasible. This case emphasizes the importance of individualized treatment and thorough evaluation with a multidisciplinary approach for appropriate treatment planning.

Background: The thyroid gland is a richly vascularized organ, yet it is a rare site for metastasis. Metastasis can sometimes mimic certain primary thyroid malignancies morphologically, thus making the diagnosis and management decision a challenge. The present multi-institutional study highlights these challenges with an aim to discuss the diagnostic approach in such scenarios.

Material and methods: A retrospective multi-institutional study conducted in three high-patient input tertiary care centers from north India. Clinically proven cases of metastasis to the thyroid gland were retrieved and relevant slides were reviewed.

Result: A total of 16 cases of thyroid gland metastasis were included, which constituted 3.8% of all thyroid malignancy and 0.7% of all thyroid resection specimens. Synchronous metastasis was encountered in 43.7% of the cases. Lung was the most common primary site of metastasis with squamous cell carcinoma being the most common morphological variant. Thyroglobulin, TTF-1, calcitonin, CK7, CK20, and Ki 67 were the most commonly used immunohistochemical markers. Two interesting cases with metastasis from carcinoma cervix and leiomyosarcoma uterus were also documented. Follow-up details were available on ten cases of which nine had died due to complications related to metastasis.

Conclusion: Metastasis to the thyroid gland is an exceedingly rare phenomenon and can be difficult to differentiate from primary thyroid malignancy based on clinical presentation especially when the primary site is unknown. The cytomorphological features may also be diagnostically challenging. Detailed clinical and radiological information combined with astute analysis of morphological features as well as the judicious application of immunomarker panels may be valuable. Patient prognosis and management are greatly influenced by early diagnosis and differentiating metastasis from primary malignancies.

Abstract: The effect of single-nucleotide polymorphisms (SNPs) in Cyclin Dependent Kinase Inhibitor 1A (CDKN1A C/A), Mouse Double Minute 2 (MDM2), 309 T/G methylenetetrahydrofolate reductase (MTHFR) 677 C/T, MTHFR 1298 A/C, and Methionine synthase (MTR) 2756 A/G has been investigated in retinoblastoma (RB) with inconsistent results. Therefore, this study aims to conduct a meta-analysis and explore the overall role of these genetic variants with retinoblastoma risk. Literature search was done using PubMed, EMBASE, Cochrane Library, Google, Dogpile, and CBM all studies evaluating the association between CDKN1A or p21 C/A, MDM2 309 T/G, MTHFR 677 C/T, MTHFR 1298 A/C, and MTR 2756 A/G polymorphism and RB risk were included. A total of 1773 patients and 2474 controls were included. To understand these polymorphisms' role in RB risk, pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random or fixed effects model. P values < 0.05 were considered statistically significant. Funnel plots were used to assess publication bias. Our meta-analysis showed a significant association between RB susceptibility to CDKN1A dominant model (OR = 1.518, 95% CI = 1.003-2.298, P = 0.048), MDM2 dominant model (OR = 0.700, 95% CI = 0.542-0.903, P = 0.006) and MTR 2756 A/G all models that is allele model (OR = 4.680, 95% CI = 1.992-10.993, P = 0.000), dominant model (OR = 2.044, 95% CI = 1.511-2.765, P = 0.000), and recessive model (OR = 0.283, 95% CI = 0.122-0.656, P = 0.003). The present meta-analysis suggested that MTR 2756 A/G, MDM2 309 T/G, and CDKN1A polymorphism are associated with the risk of RB.