Journal of cancer research and therapeutics最新文献

Purpose/objective: Endometrial carcinoma (EC) is the third most common gynecological malignancy in India. Recent PORTEC-3 analysis emphasized the role of central histopathological review. We aimed to retrospectively analyze the demographic and histopathological characteristics of EC patients treated at our institute and assess the impact of the central histopathological review on management and also analyze clinical outcomes in this cohort of patients.

Materials and methods: Data of 75 EC patients treated at our center between 2013 and 2022 were retrieved from our departmental archives. Patients were analyzed for demographic details, histopathological findings, details of surgery and histopathology (HPE), results of a review of HPE, adjuvant treatment details, and clinical outcomes. All patients with HPE outside of our institute were reviewed at our center prior to initiation of treatment. In cases of discordance, patients were discussed in the multidisciplinary tumor board for the final treatment decisions. Patients were staged as per International Federation of Gynaecology and Obstetrics 2018.

Result: The median age was 57 years (range: 37-74 years). Twenty-seven patients with HPE reported from the outside center were reviewed at our institute and changes were observed in 26 patients (96.3%). HPE review changes were observed in terms of histological grade, histological type, myometrial invasion, and lymph node involvement in five (18.5%), three (11.1%), seven (25.9%), and three (42.8%), respectively. HPE review leads to changes in the management of 19/26 patients. Stage distribution was I: II: III in 48 (64%): 9 (13.3%): 18 (24%) patients, respectively. The median external beam radiotherapy dose was 50 Gray (range: 45-50.4 Gray at 1.8-2 Gray per fraction). The median brachytherapy dose for patients treated with brachytherapy alone was 7 Gray each for three sessions and in combination with EBRT was 6 Gray each in two sessions. At a median follow-up of 51 months (range: 6-116 months), seven (9.3%) patients developed distant metastasis, two (2.7%) patients had local plus distant metastasis, and two (2.7%) patients had local recurrence. The overall survival and disease-free survival rates at 3 years were 93.5% and 86.7%, respectively.

Conclusion: EC patients treated at our center have excellent local control rates with a combination of external beam radiotherapy and brachytherapy. The central histopathological review may result in changes impacting patient management and should be routinely done prior to initiation of treatment in EC.

Abstract: Sweet syndrome is a rare, etiologically unknown dermatosis that can be idiopathic or associated with certain clinical conditions. Among these conditions are infections, autoimmune diseases, inflammatory bowel diseases, vaccinations, the use of medications, and neoplasias. Hematological neoplasias, particularly acute myeloid leukemia, are the most commonly described; however, the condition may also be related to solid tumors, being those of the genitourinary tract the most associated with the syndrome. Drug-induced Sweet syndrome has also been reported; however, it is rarely seen. We report a case of 59 years old male patient with a diagnosis of carcinoma urinary bladder, who developed skin eruption after infusion of the first cycle of chemotherapy (gemcitabine and cisplatin) and resolved after treatment with steroids. The diagnosis of Sweet syndrome was confirmed only after skin biopsy, cultures and laboratory investigations. Malignancy as the cause of skin eruptions was eliminated by the fact that it occurred only after infusion of chemotherapy and the tumor was still there in the bladder, and skin eruptions did not occur after stopping steroids.

Introduction: Deep inspiratory breath hold is one of the techniques for reducing the heart doses for left breast cancers. This study was conducted to confirm use of physical parameters from DIBH simulation CT scan like DIBH amplitude alongside several novel parameters to predict the heart dose reduction.

Materials and methods: Segmentation and planning of radiation to the left breast on the free breathing (FB) and DIBH simulation scan was performed for 50 left-sided breast cancer patients treated with DIBH technique. Physical parameters, namely DIBH amplitude, anterior sternal displacement, diaphragmatic excursion, ratio of lung volume (cc) in DIBH scan to lung volume in FB scan (cc), and delta heart volume in field (DHVIF), were extracted and were compared with magnitude of heart dose reduction (mean heart dose, V30Gy, and D5%).

Results: Forty-eight (96%) patients achieved reduction in the mean heart dose with DIBH technique, while all patients had reduction in V30Gy. The median reduction was 41%, 89.7%, and 63% in the mean dose, V30Gy, and D5%, respectively. While DIBH did not correlate with heart dose reduction, ratio of lung volumes and DHVIF showed a strong positive correlation with heart dose reduction (P < 0.05). Sternal displacement correlated weakly with heart dose reduction but strongly with DHVIF, demonstrating to be an indirect predictor.

Conclusions: Physical parameters like anterior sternal displacement, ratio of lung volumes of DIBH to FB, and possibly diaphragmatic movement can predict the dose reduction before the dose calculations by the physicist. These parameters can be used to construct a model to predict heart dose reduction.

Background: This study reports the psychometric properties of OUTPASAT-35RT questionnaire from a large Indian cancer cohort treated with ambulatory radiotherapy (RT) at a tertiary-care comprehensive cancer center.

Materials and methods: Adults with a pathologically proven diagnosis of cancer undergoing fractionated RT (≥10 fractions) with the ability to read and understand English, Hindi, or Marathi were accrued after written informed consent. Patients were administered a language-appropriate version of OUTPATSAT-35RT along with European Organization for Research and Treatment of Cancer (EORTC) generic quality-of-life questionnaire (QLQ-C30) at conclusion of RT (±3 days). Psychometric properties of OUTPATSAT-35RT were analyzed.

Results: A total of 314 patients were accrued between 2018 and 2020. A negligible floor effect (<2%) but a high ceiling effect (>15%) was observed for OUTPATSAT-35RT. Multi-trait analysis revealed satisfactory validity and reliability of the questionnaire. Pearson's correlation coefficient (PCC) of individual item score with own scale was >0.4 suggesting good convergent validity. Discriminant validity was satisfactory as the PCC with its own scale/own domain was greater than with other scales of the same domain and other domains of OUTPATSAT-35RT, respectively. Correlation of scales of OUTPATSAT-35RT with scales of QLQ-C30 demonstrated acceptable divergent validity (all values of PCC <0.3). Cronbach's alpha was >0.7 suggesting good internal consistency. Test-retest reliability was good with intra-class coefficient being >0.7. Economic status was the only socio-demographic factor correlating significantly with OUTPATSAT-35RT scores; satisfaction of patients with the delivery of care increased with increasing family income.

Conclusion: The psychometric properties of OUTPATSAT-35RT were found to be acceptable and satisfactory during validation testing in a large Indian cohort.

Background: Esophageal cancer (EC) is an extremely aggressive tumor with one of the highest geographic, ethnic, and gender variations. Various factors including tobacco consumption, unhealthy diet, and socioeconomic status have been implicated in the etiology of EC. Despite the advent of modern treatments, the prognosis of EC is dismal. This study has been undertaken to review the clinical and pathologic profiles, treatment approach, and survival pattern in patients with EC in a tertiary care hospital in northeast India.

Materials and methods: A retrospective descriptive study was done with 179 EC patients presented to our department between January 2013 and December 2020. Statistical analysis was done by using IBM Statistical Package for the Social Sciences version 21. P- value <0.05 was considered significant.

Results: The majority of the patients presented in the sixth decade of life from rural areas with male to female ratio of 3.7:1. Dysphagia was the most common presenting feature. High incidence of tobacco and alcohol use was found. Mid-esophagus is the most common site and squamous cell carcinoma is the most common type. Fifty-two (29.1%) and 71 (39.6%) patients presented in stages III and IV, respectively. Twenty-four (13.4%) patients presented with metastatic disease, the lung being the most common site. Patients were treated with surgery, chemotherapy, radiotherapy, or combination of any of these. Overall median survival for the EC patients was 6 months. Patients treated with concurrent chemoradiation had better survival.

Conclusion: EC is a serious malignancy with a dismal prognosis due to the advanced stage at presentation. Larger clinical trials using new therapeutic strategies are the need of the hour.

Introduction: Concurrent Chemoradiation is the standard of care in the treatment of unresectable locally advanced head and neck cancer. Some of the acute side effects seen after or alongside the head and neck radiotherapy include dermatitis, mucositis, xerostomia, dysphagia and swallowing dysfunction. Evolving data demonstrate that acute toxicities may persist long-term and develop into late effects. In addition, late effects may manifest months or years after completion of therapy, persisting for years or even lifelong, far longer than previously believed. When severe, late effects may profoundly affect function and quality of life. The present study was conducted to analyze the spectrum of late radiation toxicities in head and neck cancer patients treated with radical external beam radiation therapy and to determine its prevalence and severity.

Materials and methods: This prospective observational study was conducted in the Department of Radiotherapy, Christian Medical College and Hospital, Ludhiana. In all patients with a histopathological diagnosis of head and neck carcinoma who have received radical radiation therapy alone or definitive chemoradiation as part of cancer-directed therapy.

Results: Salivary gland toxicity was the most common toxicity encountered in head and neck cancer survivors resulting in dysphagia followed by dental caries, subcutaneous late effects and dysphagia. As expected, the spectrum of side effects correlated with the primary site, stage of disease and ECOG performance status.

Conclusion: Technological advancement in radiation planning and equipment has resulted in a reduction in the most feared side effects of radiation which has led to improvement in the quality of life of the survivors. As no technology can entirely protect normal tissues from irradiation, utmost care should be taken to minimize the radiation dose received by normal tissues by following preventive and supportive measures.

Introduction: Radiotherapy alone or in combination with chemotherapy is an effective and standard treatment of head and neck carcinoma. Oral mucositis is an unavoidable consequence of chemoradiation which is seen in almost all the patients. This painful condition leads to deterioration of the quality of life and thus interferes with the overall outcome of cancer therapy. As no study has been conducted in an Indian context, we conducted this study for better identification of factors influencing the occurrence and severity of oral mucositis in this patient population.

Objectives: Evaluation of the factors influencing the occurrence, severity, and resolution of radiation induced oral mucositis (RIOM) in patients with head and neck cancer. The relationship between RIOM and treatment volume (TV) and mean dose to oral mucosa were also explored.

Methods: This prospective study was conducted in patients with a histopathological diagnosis of head and neck carcinoma treated with radiation and chemoradiation. The patient, tumor, and treatment-related factors influencing RIOM were evaluated.

Results: Univariate logistic regression analysis of correlated factors with acute radiation oral mucositis revealed TV in phase one (up to 40 Gy) having P value of 0.029 with odds ratio of 1.008. Spearman rank correlation coefficient demonstrated significant positive correlation between oral mucosa dose and TV in all three phases of radiation.

Conclusion: Our study concluded that the most important factor influencing RIOM is TV during phase one of radiation. We found positive correlation between TV and oral mucosa dose through all the phases of radiation treatment.

Abstract: Mandibular defects requiring reconstructions may result from mandibular resections due to benign or malignant lesions. Prosthesis-based rehabilitation of such cases represents a challenge due to various anatomical and functional limitations. Here we present a novel design for the fabrication of a swing lock denture utilizing a simplified hinge and magnets for a patient who had undergone hemimandibulectomy.

Background: Fine-needle aspiration cytology (FNAC) for salivary gland tumors can be challenging to due to the diversity of lesions and cytomorphological convergence between the tumors. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was hence developed and introduced to provide enhanced communication in salivary gland cytopathology. To evaluate the diagnostic utility and validity of MSRSGC in combination with ancillary radiological investigations, we aim to find correlation between Milan system and the radiological impression comparing with final histopathological diagnosis.

Aims and objective: Correlate the Milan category with the radiological and final histopathological diagnosis of salivary gland lesions. Review the FNAC diagnosis of salivary gland lesions and identify cytomorphological predictors of malignancy. Correlate the FNAC and the radiological diagnosis with final diagnosis in histopathology.

Material and methods: A five year retrospective study, comprising fifty four cases of salivary gland FNAC were included in the study.

Results: Majority of the cases belong to Milan VI-Malignant followed by Milan IVa-Benign and rest of cases were among other categories. The sensitivity, specificity, positive predictive value, and negative predictive value of adjuvant radiological diagnosis in differentiating benign and malignant salivary gland lesions was found to be 80%, 62.5%, 72.7%, and 71.4%, respectively. We could observe that the concurrent radiological assessment along with Milan system of reporting in salivary gland FNAC especially under suspicious categories (Milan Category IVb as well as Milan Category V) is a useful and sensitive predictor of malignancy.

Conclusion: A correlation with any form of ancillary radiological assessment is a helpful adjuvant with Milan system to derive a relatable diagnosis in salivary gland neoplasm especially those in categories describing the suspicious entities.