Journal of cancer research and therapeutics最新文献

Abstract: EGFR gene mutations are the second most common oncogenic driver of tumorigenesis in non-small cell lung cancer (NSCLC). Exon 19 deletions and L858R point mutation are strong predictors of response to TKIs, whereas rare EGFR mutations are generally associated with suboptimal TKIs response. Notably, rare mutations G719X and S768I can co-exist as complex mutations within the same tumor. In this context, we report a case of a 55-year-old female patient with left lower lobe lung adenocarcinoma along with metastases in the liver, skull, and bony pelvis. Histopathological examination of the right iliac bone confirmed the moderately differentiated metastatic adenocarcinoma. Findings of this report present the rare EGFR double mutations (G719X + S768I), along with concurrent ROS1positivity, which can directly affect treatment choices. There is ongoing debate about the optimal choice of TKI for the rare EGFR mutations, but earlier reports indicate that these mutations may respond more favorably to second-generation TKIs compared to first-generation. This report underscores the significance of thorough molecular profiling in NSCLC.

Background: Head and neck cancer (HNC) is a major global health concern. Despite advances in treatment, the outcome is poor due to locoregional failure. Enhancer of zeste homolog 2 (EZH2), an epigenetic modifier, plays a role in cancer development by promoting growth, invasion, and dissemination of tumor cells. This study aims to investigate the correlation between EZH2 expression and the response to chemoradiation (CRT) in patients with locally advanced, inoperable oral cavity and oropharyngeal squamous cell cancers.

Methods: Fifty patients were prospectively included in this study. All of the patients received definitive CRT. A second biopsy was retrieved between the third and fourth fractions of radiotherapy (RT). Immunohistochemistry (IHC) was performed on pre-RT and postthird fraction biopsy samples to evaluate EZH2 status. The IHC score was calculated based on EZH2 intensity and the percentage of positive cells. A score of 4 or more indicated high expression. After 12 weeks of treatment completion, the response was assessed and correlated with EZH2 status, and the statistical analysis was done.

Results: The EZH2 score was significantly higher in tumor tissue than in normal tissue samples (P value: 0.001). High expression of EZH2 was found in 78% of pre-RT and 81% of postthird fraction tumor samples. High expression of EZH2 did not show a statistically significant correlation with response to CRT (P value: 0.809). However, the EZH2 score increased significantly in the postthird fraction samples of patients who did not achieve a complete response (P value: 0.03).

Conclusion: The study indicates that EZH2 can be a valuable predictive marker in HNC. Anti-EZH2 therapy should be explored to improve the treatment outcomes in patients with high expression of EZH2.

Introduction: Primary retroperitoneal masses are neoplasms that originate within the retroperitoneal space, independent of any retroperitoneal organs. Although rare, they present significant diagnostic and therapeutic challenges.

Materials and methods: This study was performed in the Department of Pathology and Lab Medicine at AIIMS Raipur over a period of 2 years. It included both retrospective and prospective cases. Relevant clinical details and radiological investigations were reviewed. Histopathological findings and results from ancillary studies were analyzed and correlated with the clinical data.

Results: The study reported 15 cases of primary retroperitoneal masses, with a higher occurrence in males. Most patients were in their 50s to 60s. Both benign and malignant neoplasms were observed. Three uncommon cases included one extra-skeletal osteosarcoma and two extra-skeletal Ewing sarcomas.

Conclusion: Retroperitoneal tumors present diagnostic challenges and therapeutic complexities due to their rarity, often late presentation, and anatomical location near vital structures in the retroperitoneal space. Accurate diagnosis is crucial for appropriate management and prognostication.

Introduction: There is significant variation in normal tissue toxicity and outcomes in terms of tumor response among patients with the same tumor, node, metastasis (TNM) stage and treatment. The aim of the study was to analyze various patient, tumor, and treatment parameters and evaluate their impact on acute treatment toxicities, as well as the treatment responses in adult head and neck cancer patients.

Materials and methods: This prospective observational study was conducted between November 2021 and April 2023 at a tertiary cancer care center in South India. For the acute toxicity, data from 108 patients were available for analysis. For the clinical outcome, data from 86 patients were available for analysis.

Results: Low hemoglobin levels were predictive of both acute severe dermatitis (<11.15 g/dL; P value of 0.02) and severe mucositis (<11.45 g/dL, P value of 0.01). Other factors associated with severe dermatitis included low serum albumin, high lactate dehydrogenase to albumin ratio, high lean body mass, and elevated body mass index. The use of concurrent chemotherapy and triweekly chemotherapy was independently associated with a higher incidence of severe neutropenia when compared to no chemotherapy or weekly chemotherapy. Low skeletal muscle index, smaller gross tumor volume, and a shorter overall radiotherapy completion time were statistically significant factors correlated with a higher percentage of complete responses.

Conclusion: Various patient, tumor, and treatment-related factors significantly influence the severity of toxicities and treatment response outcomes in head and neck cancer patients undergoing definitive radiotherapy/chemoradiotherapy.

Objective: Whole-body diffusion-weighted (DW) magnetic resonance imaging (MRI) in lymphoma patients and its comparison with 18F fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT).

Materials and methods: This prospective study was performed on 33 patients with histopathologically proven lymphoma. Fifteen patients were diagnosed with Hodgkin's lymphoma (HL), and 18 patients had non-Hodgkin's lymphoma (NHL). All patients underwent PET-CT followed by DWI-MRI, and the performance of DWI-MRI was compared with PET-CT, taking PET-CT as the gold standard.

Results: Agreement on staging between DWI-MRI and PET-CT was found in 30 out of 33 patients. The overall sensitivity, specificity, area under the curve (AUC), positive predictive value, negative predictive value, and diagnostic accuracy of MRI were 87%, 100%, 0.93, 100%, 96%, and 96.7%, respectively, taking 18F-FDG/PET as the reference standard.

Conclusion: Whole-body DWI-MRI is a highly sensitive method for lymphoma staging. It has excellent agreement with 18-FDG-PET/CT and is a great alternative for managing lymphoma patients without using ionizing radiation or an intravenous contrast agent.

Background: Squamous Cell Carcinoma (SCC) of the oral cavity is the most common malignancy of the head and neck region and is known for its aggressive behavior with a high rates of recurrence and metastasis.

Materials and methods: A total of 73 patients of surgically resected cases of oral squamous cell carcinoma from January 2021 to December 2021 with or without adjuvant therapy were included. Worst Pattern of Invasion (WPOI) and Tumor budding (TB) were evaluated on routine hematoxylin and eosin-stained sections and these were correlated with clinicopathological parameters. Statistical analysis was conducted by using Chi-square test and multivariate logistic regression model. A P value < .05 considered significant.

Result: The mean age was 44 ± 12.57 and M: F of 6.3:1. Most of the tumors were located on buccal mucosa (47.9%) and tongue (32.8%). Lip, alveolus and floor of the mouth were the other sites involved constituting 9.5% (n = 7), 6.8% (n = 5) and 2.7% (n = 2), respectively. Both WPOI and TB in oral squamous cell carcinoma (OSCC) was found to be significantly associated with stage of the tumor and metastasis to lymph node with P value <0.5. Depth of invasion >1 cm was found in 64.3% of the cases (n = 47), which was found to be significantly associated with WPOI (P = 0.004) and TB (P = 0.04). We also found a significant association of TB with Perineural invasion (PNI) (0.003). A significant association of WPOI and TB with a P value of 0.012 was also found. On multivariate analysis the lymph node metastasis was found to be significantly associated with high WPOI (IV, V) and PNI.

Conclusion: Both WPOI and TB are found to be significantly associated with the clinicopathological factors like stage, Depth of invasion (DOI), and metastatic lymph nodes. They are highly reproducible and can be easily evaluated on routine H and E sections, thus proving to be cost effective in a resource poor setting. They can be used as independent prognostic markers in OSCC and thus help in deciding the treatment plan for the patients.

Background: The aim of total neoadjuvant therapy (TNT), which includes neoadjuvant radiation therapy followed by neo-adjuvant chemotherapy (NACT) and surgery, is to improve systemic control rates, while maintaining loco-regional control for locally advanced rectal cancers (LARC). We investigated this approach of TNT with short course radiotherapy (SCRT).

Methods: In this single-arm prospective interventional study, 25 LARC patients were enrolled and treated with SCRT of 25 Gray in five fractions over 1 week followed by NACT (oxaliplatin and capecitabine) for six cycles, followed by definitive surgery with total mesorectal excision (TME). The end point was to evaluate pathological complete response (pCR), acute toxicity (measured using Common Terminology Criteria for Adverse Events version 5.0), and loco-regional control (LRC).

Results: Male: Female ratio was 17:8 and median age was 47 years. The clinical stages were T2: T3: T4 and N0: N1: N2 in 3: 20: 2 and 5: 8: 12 patients, respectively. Twenty (80%) of the 25 patients that were recruited underwent the entire course of treatment. Two patients defaulted, one expired, and two achieved clinical complete response (cCR) and did not agree to surgery. The median follow-up period was 15.5 months (8.8 to 18.2 months). 1/25 patients (4%) experienced grade 3 gastrointestinal toxicity during SCRT. Seven (30%) out of twenty-three patients receiving NACT developed Grade 3 toxicity. Six (30%) out of 12 patients undergoing surgery achieved pCR. Two patients developed loco-regional relapse and crude LRC rate for the entire cohort of enrolled patient at 1-year was 86.95%.

Conclusion: The TNT approach with SCRT demonstrated favorable pathological complete response (pCR) rates, acceptable toxicity, and excellent short-term locoregional control.