Pub Date : 2023-01-01DOI: 10.4103/crst.crst_263_23
Amit Gupta, Krithika Rangarajan
We read with great interest the original study, “Artificial intelligence-based prediction of oral mucositis in patients with head-and-neck cancer: A prospective observational study utilizing a thermographic approach” by Thukral et al., recently published in the Cancer Research, Statistics, and Treatment journal.[1] In this cross-sectional study, the authors described a convolutional neural network-based deep learning algorithm for classifying thermographic images of patients with head-and-neck cancer undergoing radiotherapy according to the absence or presence of early oral mucositis changes. The authors demonstrated a high accuracy (82.05%) of the proposed model for the classification of the testing dataset. We have a few comments to make regarding this study. Radiation-induced oral mucositis is a frequent complication of radiotherapy in patients with head-and-neck cancers, which can vary greatly in severity from mild erythema and pain to extremely debilitating oral ulcers precluding any per-oral alimentation.[2] The management is mainly symptomatic and may necessitate invasive means of alimentation along with interruption of radiation therapy.[3] Although the exact pathogenesis of radiation-induced oral mucositis is still poorly understood, good oral health, adequate nutritional status, and advanced modulated radiotherapy regimens have been shown to have a prophylactic effect.[4] In particular, alimentation via percutaneous endoscopic gastrostomy (PEG) early in the course of radiotherapy has been shown to prevent higher grades of radiation-induced oral mucositis and consequent interruption of therapy.[4] In this regard, the true predictive application of artificial intelligence lies in identifying those patients with head-and-neck cancer who are more likely to develop higher grades of radiation-induced oral mucositis with continued radiotherapy treatment and thus are candidates for more aggressive prophylactic measures like PEG or de-intensification of therapy. Although the study by Thukral et al.[1] showed an excellent diagnostic performance of the deep learning algorithm for the detection of early oral mucositis changes on thermography images, there were some important drawbacks. Being a cross-sectional study, the subsequent development of higher grades of radiation-induced oral mucositis with higher cumulative radiation doses could not be studied. The authors did not consider the duration, regimen, planning, and dose of radiotherapy following which the patients were evaluated. The relatively small sample size made the deep learning algorithm prone to overfitting. It is important to avoid using different images from the same patient in both the training and testing datasets—the study methodology did not mention this. The validation of the deep learning algorithm should have been done by testing on patient data collected in the natural course of their disease rather than collated enriched data. Finally, we would like to recommend that the rese
{"title":"Deep learning for prediction of radiation-induced oral mucositis: Need for longitudinal studies","authors":"Amit Gupta, Krithika Rangarajan","doi":"10.4103/crst.crst_263_23","DOIUrl":"https://doi.org/10.4103/crst.crst_263_23","url":null,"abstract":"We read with great interest the original study, “Artificial intelligence-based prediction of oral mucositis in patients with head-and-neck cancer: A prospective observational study utilizing a thermographic approach” by Thukral et al., recently published in the Cancer Research, Statistics, and Treatment journal.[1] In this cross-sectional study, the authors described a convolutional neural network-based deep learning algorithm for classifying thermographic images of patients with head-and-neck cancer undergoing radiotherapy according to the absence or presence of early oral mucositis changes. The authors demonstrated a high accuracy (82.05%) of the proposed model for the classification of the testing dataset. We have a few comments to make regarding this study. Radiation-induced oral mucositis is a frequent complication of radiotherapy in patients with head-and-neck cancers, which can vary greatly in severity from mild erythema and pain to extremely debilitating oral ulcers precluding any per-oral alimentation.[2] The management is mainly symptomatic and may necessitate invasive means of alimentation along with interruption of radiation therapy.[3] Although the exact pathogenesis of radiation-induced oral mucositis is still poorly understood, good oral health, adequate nutritional status, and advanced modulated radiotherapy regimens have been shown to have a prophylactic effect.[4] In particular, alimentation via percutaneous endoscopic gastrostomy (PEG) early in the course of radiotherapy has been shown to prevent higher grades of radiation-induced oral mucositis and consequent interruption of therapy.[4] In this regard, the true predictive application of artificial intelligence lies in identifying those patients with head-and-neck cancer who are more likely to develop higher grades of radiation-induced oral mucositis with continued radiotherapy treatment and thus are candidates for more aggressive prophylactic measures like PEG or de-intensification of therapy. Although the study by Thukral et al.[1] showed an excellent diagnostic performance of the deep learning algorithm for the detection of early oral mucositis changes on thermography images, there were some important drawbacks. Being a cross-sectional study, the subsequent development of higher grades of radiation-induced oral mucositis with higher cumulative radiation doses could not be studied. The authors did not consider the duration, regimen, planning, and dose of radiotherapy following which the patients were evaluated. The relatively small sample size made the deep learning algorithm prone to overfitting. It is important to avoid using different images from the same patient in both the training and testing datasets—the study methodology did not mention this. The validation of the deep learning algorithm should have been done by testing on patient data collected in the natural course of their disease rather than collated enriched data. Finally, we would like to recommend that the rese","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135784765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shaheena Parveen, Syed Nisar Ahmad, Abdul Wahid Mir, Altaf Hussain Shah, Tariq Abdullah Mir, Zubaida Rasool, Mohamad Younis Bhat, Nazir Ahmad Dar, Gull Mohammad Bhat
ABSTRACT Export Background: The prognosis of patients with hepatocellular carcinoma (HCC) is poor due to its non-specific presentation, underlying liver disease, and advanced stage at presentation. There are limited HCC data from India, and no major studies are available from North India. Objectives: To study the epidemiology, etiological factors, clinical profiles, and treatment patterns of patients with HCC at our center. Materials and Methods: This was a retrospective analysis of prospectively collected data of patients with HCC from January 2016 to December 2020, conducted in the Department of Medical Oncology and Gastroenterology at the Sher-i-Kashmir Institute of Medical Sciences (SKIMS), a tertiary center in North India. Patient data and treatment details were collected and analyzed. Results: We enrolled 127 patients in the study. Males constituted the majority (91; 71.7%), with a mean age of 58 ± 12 years. The majority (100; 78%) of patients had cirrhosis; the common etiological factors included hepatitis B virus infection (30; 23.6%), non-alcoholic steatohepatitis (29; 22.8%), and hepatitis C virus infection (22; 17.3%). Although etiology was unknown in 45 (35.4%) patients, around one-third (36.4%) had diabetes mellitus. Most (91; 71.7%) patients had liver-limited disease and the majority (53; 41.7%) presented with Barcelona Clinic Liver Cancer (BCLC) stage C disease, followed by BCLC A (33; 26%), BCLC B (25; 19.7%), and BCLC D (16; 12.6%). Portal vein thrombosis was noted in 40 (32.3%) patients. Liver-directed therapies, including surgery, ablation, and trans-arterial chemoembolization, were received by 17 (13.4%) patients. The most commonly used systemic treatments were sorafenib (32; 25.2%) and lenvatinib (7; 5.5%), but a substantial number of patients (56/127; 44.1%) either did not adhere to, refused therapy or were given best supportive care. Conclusion: The majority of patients with HCC at our center are males and present at a mean age of 58 years. Hepatitis B virus is the most frequent etiological agent. Patients with HCC present with advanced stage disease and are often not considered suitable for curative intent treatment. Sorafenib is the most commonly administered systemic treatment; however, just under half the patients (44.1%) are either unfit for or refuse treatment.
摘要输出背景:肝细胞癌(HCC)由于其非特异性表现、潜在的肝脏疾病和出现时的晚期，预后较差。来自印度的HCC数据有限，并且没有来自北印度的主要研究。目的:了解我院肝癌患者的流行病学、病因、临床特点及治疗模式。材料和方法:本研究回顾性分析了2016年1月至2020年12月期间在印度北部三级医学中心Sher-i-Kashmir医学科学研究所(SKIMS)肿瘤内科和胃肠病学部门前瞻性收集的HCC患者数据。收集和分析患者资料和治疗细节。结果:我们纳入了127例患者。男性占多数(91人;71.7%)，平均年龄58±12岁。多数(100;78%)患者有肝硬化;常见病因包括乙型肝炎病毒感染(30;23.6%)，非酒精性脂肪性肝炎(29%;22.8%)，丙型肝炎病毒感染(22%;17.3%)。虽然45例(35.4%)患者病因不明，但约三分之一(36.4%)患者患有糖尿病。大多数(91;71.7%)患者有肝局限性疾病，多数(53例;41.7%)表现为巴塞罗那临床肝癌(BCLC) C期，其次是BCLC A期(33;26%)， BCLC b (25%;19.7%)， BCLC D (16;12.6%)。门静脉血栓40例(32.3%)。17例(13.4%)患者接受了肝脏定向治疗，包括手术、消融和经动脉化疗栓塞。最常用的全身治疗是索拉非尼(32;25.2%)和lenvatinib (7%;5.5%)，但有相当数量的患者(56/127;44.1%)不坚持、拒绝治疗或给予最佳支持治疗。结论:我院HCC患者以男性居多，平均年龄58岁。乙型肝炎病毒是最常见的病原。HCC患者表现为晚期疾病，通常不被认为适合治愈性治疗。索拉非尼是最常用的全身治疗;然而，不到一半的患者(44.1%)不适合或拒绝治疗。
{"title":"Etiology, clinical profile, and treatment pattern of hepatocellular carcinoma at a tertiary care center in North India: A retrospective observational study","authors":"Shaheena Parveen, Syed Nisar Ahmad, Abdul Wahid Mir, Altaf Hussain Shah, Tariq Abdullah Mir, Zubaida Rasool, Mohamad Younis Bhat, Nazir Ahmad Dar, Gull Mohammad Bhat","doi":"10.4103/crst.crst_37_23","DOIUrl":"https://doi.org/10.4103/crst.crst_37_23","url":null,"abstract":"ABSTRACT Export Background: The prognosis of patients with hepatocellular carcinoma (HCC) is poor due to its non-specific presentation, underlying liver disease, and advanced stage at presentation. There are limited HCC data from India, and no major studies are available from North India. Objectives: To study the epidemiology, etiological factors, clinical profiles, and treatment patterns of patients with HCC at our center. Materials and Methods: This was a retrospective analysis of prospectively collected data of patients with HCC from January 2016 to December 2020, conducted in the Department of Medical Oncology and Gastroenterology at the Sher-i-Kashmir Institute of Medical Sciences (SKIMS), a tertiary center in North India. Patient data and treatment details were collected and analyzed. Results: We enrolled 127 patients in the study. Males constituted the majority (91; 71.7%), with a mean age of 58 ± 12 years. The majority (100; 78%) of patients had cirrhosis; the common etiological factors included hepatitis B virus infection (30; 23.6%), non-alcoholic steatohepatitis (29; 22.8%), and hepatitis C virus infection (22; 17.3%). Although etiology was unknown in 45 (35.4%) patients, around one-third (36.4%) had diabetes mellitus. Most (91; 71.7%) patients had liver-limited disease and the majority (53; 41.7%) presented with Barcelona Clinic Liver Cancer (BCLC) stage C disease, followed by BCLC A (33; 26%), BCLC B (25; 19.7%), and BCLC D (16; 12.6%). Portal vein thrombosis was noted in 40 (32.3%) patients. Liver-directed therapies, including surgery, ablation, and trans-arterial chemoembolization, were received by 17 (13.4%) patients. The most commonly used systemic treatments were sorafenib (32; 25.2%) and lenvatinib (7; 5.5%), but a substantial number of patients (56/127; 44.1%) either did not adhere to, refused therapy or were given best supportive care. Conclusion: The majority of patients with HCC at our center are males and present at a mean age of 58 years. Hepatitis B virus is the most frequent etiological agent. Patients with HCC present with advanced stage disease and are often not considered suitable for curative intent treatment. Sorafenib is the most commonly administered systemic treatment; however, just under half the patients (44.1%) are either unfit for or refuse treatment.","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135784770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kundan S. Chufal, Irfan Ahmad, Alexis A. Miller, Atul Tyagi, Preetha Umesh, Rahul L. Chowdhary, Muhammed I. Sharief, Munish Gairola
Advances in the treatment of breast cancer have resulted in a consistent trend toward improved outcomes worldwide. From the perspective of low- and middle-income countries (LMIC) these improved outcomes offer hope despite an increase in the incidence of breast cancer.[1] However, a substantial proportion of women treated with adjuvant radiotherapy in LMICs are at risk of developing late radiation-induced cardiac morbidity owing to the lack of appropriate radiotherapy infrastructure.[2] This risk is reflected in a higher heart mean dose (Dmean) in Asian LMICs over the last two decades and compounded by an overall higher proportion of the global burden of cardiovascular diseases.[3,4] After accounting for reporting bias, the actual heart Dmean is likely higher in routine community practice and, disconcertingly, remains unknown in those treated on Cobalt-60 (Co60) machines. Measures can be instituted to reduce the heart Dmean with increasing levels of available resources in LMICs, namely: (a) adopting hypofractionated treatment schedules; (b) avoiding internal mammary nodal irradiation in early breast cancer (EBC) when using Co60 machines; (c) excluding ribs and intercostal muscles during target delineation; (d) preferring forward-planned approaches (with breath control), and; (e) reserving inverse-planned approaches for patients with unfavorable anatomy (and/or unsuitable for breath control).[5-7] In a recent survey of more than 2000 radiation oncologists worldwide, the lowest adoption of hypofractionated treatment schedules in breast cancer was in LMICs.[8] The advantage of shorter fractionation schedules in resource constrained LMICs is obvious, yet a third of the respondents voiced concerns regarding late toxicity. The results of hypofractionated trials (most allowed Co60 treatment) should allay this concern. The anticipated effect of hypofractionated radiotherapy on cardiac function is lower than conventional fractionation, owing to a reduced heart Dmean after Equivalent Dose in 2 Gy (EQD2) conversion.[9] Dosimetric studies have demonstrated that unless the α/β ratio of the heart is lower than 1.5, almost all hypofractionated schedules have a lower EQD2 Dmean compared to conventional fractionation.[9] Acknowledging the limitations of dosimetric modeling in predicting complex cardiac events, we endorse prospective data collection on cardiac outcomes. Yet the current generation of trials in radiation oncology with cardiac-specific outcomes are designed to assess the efficacy of conventionally fractionated Proton Beam Therapy (PBT), a technology that can potentially reduce heart Dmean to near-zero, but in LMICs, this will benefit only those with financial resources.[10] Treating internal mammary nodes (IMC) to replicate the positive results of elective regional nodal irradiation (RNI) trials with Co60 machines should be reconsidered. Since a linear relationship exists between heart Dmean and the risk of major cardiac events at 10 years, the Co60 t
{"title":"A practical and practicable framework for implementing cardiac-sparing radiotherapy techniques in breast cancer","authors":"Kundan S. Chufal, Irfan Ahmad, Alexis A. Miller, Atul Tyagi, Preetha Umesh, Rahul L. Chowdhary, Muhammed I. Sharief, Munish Gairola","doi":"10.4103/crst.crst_33_23","DOIUrl":"https://doi.org/10.4103/crst.crst_33_23","url":null,"abstract":"Advances in the treatment of breast cancer have resulted in a consistent trend toward improved outcomes worldwide. From the perspective of low- and middle-income countries (LMIC) these improved outcomes offer hope despite an increase in the incidence of breast cancer.[1] However, a substantial proportion of women treated with adjuvant radiotherapy in LMICs are at risk of developing late radiation-induced cardiac morbidity owing to the lack of appropriate radiotherapy infrastructure.[2] This risk is reflected in a higher heart mean dose (Dmean) in Asian LMICs over the last two decades and compounded by an overall higher proportion of the global burden of cardiovascular diseases.[3,4] After accounting for reporting bias, the actual heart Dmean is likely higher in routine community practice and, disconcertingly, remains unknown in those treated on Cobalt-60 (Co60) machines. Measures can be instituted to reduce the heart Dmean with increasing levels of available resources in LMICs, namely: (a) adopting hypofractionated treatment schedules; (b) avoiding internal mammary nodal irradiation in early breast cancer (EBC) when using Co60 machines; (c) excluding ribs and intercostal muscles during target delineation; (d) preferring forward-planned approaches (with breath control), and; (e) reserving inverse-planned approaches for patients with unfavorable anatomy (and/or unsuitable for breath control).[5-7] In a recent survey of more than 2000 radiation oncologists worldwide, the lowest adoption of hypofractionated treatment schedules in breast cancer was in LMICs.[8] The advantage of shorter fractionation schedules in resource constrained LMICs is obvious, yet a third of the respondents voiced concerns regarding late toxicity. The results of hypofractionated trials (most allowed Co60 treatment) should allay this concern. The anticipated effect of hypofractionated radiotherapy on cardiac function is lower than conventional fractionation, owing to a reduced heart Dmean after Equivalent Dose in 2 Gy (EQD2) conversion.[9] Dosimetric studies have demonstrated that unless the α/β ratio of the heart is lower than 1.5, almost all hypofractionated schedules have a lower EQD2 Dmean compared to conventional fractionation.[9] Acknowledging the limitations of dosimetric modeling in predicting complex cardiac events, we endorse prospective data collection on cardiac outcomes. Yet the current generation of trials in radiation oncology with cardiac-specific outcomes are designed to assess the efficacy of conventionally fractionated Proton Beam Therapy (PBT), a technology that can potentially reduce heart Dmean to near-zero, but in LMICs, this will benefit only those with financial resources.[10] Treating internal mammary nodes (IMC) to replicate the positive results of elective regional nodal irradiation (RNI) trials with Co60 machines should be reconsidered. Since a linear relationship exists between heart Dmean and the risk of major cardiac events at 10 years, the Co60 t","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135700462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We sincerely appreciate the thoughtful comments made by Reddy[1] in his correspondence regarding our study, “The impact of pathological complete response on survival in patients with breast cancer and occurrence in different intrinsic subtypes: A retrospective observational study.”[2] We are pleased to address the points raised in the letter. Ghosh and Ganguly[3] aptly emphasized the multifaceted nature of the pathological complete response (pCR) as a surrogate marker for survival outcomes in neoadjuvant clinical trials. We concur that pCR may not serve as an absolute predictor of long-term survival, as evidenced by the contrasting findings in previous studies,[4] including those highlighted by Conforti et al.[5] and Cortazar et al.[6] Our study sought to contribute to this ongoing discourse by evaluating the correlation of pCR with outcomes within the context of different intrinsic subtypes of breast cancer while evaluating our own practice at the same time. Ghosh and Ganguly[3] pointed out the potential influence of differing neoadjuvant chemotherapy regimens on the attainment of pCR. As rightly pointed out by Reddy,[1] including patients who received more than or at least six cycles of neoadjuvant chemotherapy would have been more prudent, and we intend to re-look at our data from this new perspective. This could have been the reason behind the modest pCR rate of 16.7% achieved in our study.[2] Additionally, the absence of data regarding adjuvant treatment and subsequent lines of therapy is noted, and this could certainly have played a role in influencing survival outcomes. However, we would like to point out that the compliance of our patients to anti-HER2 therapy in the adjuvant setting was better than that observed in the neoadjuvant setting. We are gratified by the inclusion of insights from the CREATE-X[7] and KATHERINE trials,[8] which underscore the evolving landscape of pCR’s predictive potential. The results from these trials support the notion that pCR can guide treatment modifications and lead to improved outcomes. Results from these trials are now being incorporated regularly in clinical practice; this study was an eye-opener for us, and it will hopefully motivate others as well. In conclusion, we concur with Ghosh and Ganguly’s[3] assertion that while the role of pCR as a survival marker in clinical trials remains debated, it does hold significant prognostic value for individuals.[9] We extend our gratitude to them for enriching the discourse surrounding our study and the broader understanding of the implications of achieving pCR and also to Reddy for his insights.[1] Further data from real-world settings will undoubtedly shed more light on the intricate interplay between pCR, treatment strategies, and patient outcomes. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
{"title":"Authors’ reply to Reddy","authors":"Anupama Radhakrishnan, Pritha Roy, Krishnangshu B. Choudhury, Ritam Joarder, Partha Dasgupta","doi":"10.4103/crst.crst_274_23","DOIUrl":"https://doi.org/10.4103/crst.crst_274_23","url":null,"abstract":"We sincerely appreciate the thoughtful comments made by Reddy[1] in his correspondence regarding our study, “The impact of pathological complete response on survival in patients with breast cancer and occurrence in different intrinsic subtypes: A retrospective observational study.”[2] We are pleased to address the points raised in the letter. Ghosh and Ganguly[3] aptly emphasized the multifaceted nature of the pathological complete response (pCR) as a surrogate marker for survival outcomes in neoadjuvant clinical trials. We concur that pCR may not serve as an absolute predictor of long-term survival, as evidenced by the contrasting findings in previous studies,[4] including those highlighted by Conforti et al.[5] and Cortazar et al.[6] Our study sought to contribute to this ongoing discourse by evaluating the correlation of pCR with outcomes within the context of different intrinsic subtypes of breast cancer while evaluating our own practice at the same time. Ghosh and Ganguly[3] pointed out the potential influence of differing neoadjuvant chemotherapy regimens on the attainment of pCR. As rightly pointed out by Reddy,[1] including patients who received more than or at least six cycles of neoadjuvant chemotherapy would have been more prudent, and we intend to re-look at our data from this new perspective. This could have been the reason behind the modest pCR rate of 16.7% achieved in our study.[2] Additionally, the absence of data regarding adjuvant treatment and subsequent lines of therapy is noted, and this could certainly have played a role in influencing survival outcomes. However, we would like to point out that the compliance of our patients to anti-HER2 therapy in the adjuvant setting was better than that observed in the neoadjuvant setting. We are gratified by the inclusion of insights from the CREATE-X[7] and KATHERINE trials,[8] which underscore the evolving landscape of pCR’s predictive potential. The results from these trials support the notion that pCR can guide treatment modifications and lead to improved outcomes. Results from these trials are now being incorporated regularly in clinical practice; this study was an eye-opener for us, and it will hopefully motivate others as well. In conclusion, we concur with Ghosh and Ganguly’s[3] assertion that while the role of pCR as a survival marker in clinical trials remains debated, it does hold significant prognostic value for individuals.[9] We extend our gratitude to them for enriching the discourse surrounding our study and the broader understanding of the implications of achieving pCR and also to Reddy for his insights.[1] Further data from real-world settings will undoubtedly shed more light on the intricate interplay between pCR, treatment strategies, and patient outcomes. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"105 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135700834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/crst.crst_271_23
Rekha Gupta, Satyajeet Soni, Hemant Malhotra
We read with deep interest the review article published in the previous issue of Cancer Research Statistics and Treatment authored by Ulhaq et al.[1] We feel that this manuscript is of utmost importance for practicing oncologists and the journal needs to be congratulated for selecting this for publication to highlight this issue. After more than three decades of practicing oncology in the country, the senior writer of this letter is acutely aware of the lack of knowledge among treating clinicians and the extreme dearth of trained genetic counselors. Hereditary cancer contributes 5–10% of the overall cancer incidence. Early diagnosis and treatment are the most successful tools in cancer management for a higher survival rate. This principle can be applied to hereditary cancer families by identifying high-risk individuals and putting them on surveillance. Genetic counseling is the first step in this process. Pivotal steps have been discussed in the article.[1] Developing genetic counseling units with specialization in oncology is an important step towards generating awareness about hereditary cancer syndromes. As multiple family members are at risk of developing cancer, multiple lives can be saved by providing surveillance and prevention to such families. Counseling and offering genetic testing based on the next-generation sequencing (NGS) and multiplex ligation-dependent probe amplification (MLPA) techniques is at the heart of this concept of prevention, early diagnosis, and treatment. A few important issues were not highlighted in this article.[1] One important issue in the Indian scenario is pre-symptomatic carrier detection in a young person and marriage-related issues,[2] and the reproductive implications of this diagnosis. Such individuals carry a lifetime risk of cancer, and their offspring will harbor the mutation in 50% of cases. Genetic counseling must be offered to such reproductive couples. Preimplantation genetic diagnosis (PGD) can be offered to couples who are conceiving through in vitro fertilization (IVF). The second important issue is the psychological stress of receiving a pre-symptomatic diagnosis. These newly diagnosed pre-symptomatic carriers are young individuals who are on the verge of their careers and starting their reproductive lives. We need a team of support groups, counselors, and psychologists to take care of the pre-symptomatic diagnosis hurdles amidst job security, insurance policy, etc. The authors, even though they claim to have written an India-specific article, have missed out on at least three major publications in the field from India which significantly add to the knowledge on the subject.[3-5] The cost of testing and surveillance also needs to be considered by the individual patient/person. Now, with a large industrial house with deep pockets, entering the field of genetic testing and promising comprehensive genetic profiling at less than `15,000, a whole set of new and unknown issues are bound to arise, and
我们怀着浓厚的兴趣阅读了Ulhaq等人在上期《癌症研究统计与治疗》(Cancer Research Statistics and Treatment)上发表的综述文章。[1]我们认为这篇论文对肿瘤执业医师来说是极其重要的，我们需要祝贺该杂志选择发表这篇文章来突出这一问题。在国内从事肿瘤治疗三十多年后，这封信的资深作者敏锐地意识到治疗临床医生缺乏知识，训练有素的遗传咨询师极度缺乏。遗传性癌症占癌症总发病率的5-10%。早期诊断和治疗是提高生存率的最成功的癌症管理工具。这一原则可以通过识别高风险个体并对其进行监视来应用于遗传性癌症家族。遗传咨询是这个过程的第一步。本文讨论了关键步骤。[1]发展具有肿瘤学专业的遗传咨询单位是提高对遗传性癌症综合征认识的重要一步。由于多个家庭成员都有患癌症的危险，因此，通过对这些家庭进行监测和预防，可以挽救多个生命。咨询和提供基于下一代测序(NGS)和多重连接依赖探针扩增(MLPA)技术的基因检测是这一预防、早期诊断和治疗概念的核心。本文没有强调几个重要问题。[1]在印度的情况下，一个重要的问题是在年轻人中发现症状前的携带者和与婚姻相关的问题，[2]以及这种诊断对生殖的影响。这样的人一生都有患癌症的风险，他们的后代在50%的情况下会携带这种突变。必须向这些生育的夫妇提供遗传咨询。胚胎植入前遗传学诊断(PGD)可以提供给通过体外受精(IVF)怀孕的夫妇。第二个重要的问题是接受症状前诊断的心理压力。这些新诊断的症状前携带者是处于职业生涯边缘并开始生育生活的年轻人。我们需要一个由支持小组、咨询师和心理学家组成的团队来处理在工作保障、保险政策等方面的症状前诊断障碍。尽管作者声称他们写的是一篇针对印度的文章，但他们至少错过了印度在该领域的三个主要出版物，这些出版物大大增加了对该主题的了解。[3-5]检测和监测的成本也需要按患者个体来考虑。现在，随着一家财力雄厚的大型工业公司，以低于1.5万美元的价格进入基因检测和有前景的全面基因分析领域，一系列新的和未知的问题必然会出现，迫切需要技术意识和专业知识来解决这个问题。肿瘤科缺乏训练有素的遗传咨询师。测试前和测试后的咨询是非常重要的。通常情况下，我们处理不满意的病人和/或他们的家人，当面对遗传异常标记为不确定意义的变异(VOUS)，而没有做充分的预检测咨询。保证书是不可操作的。不能提供预防癌症的医疗/手术干预。在系谱分析中，根据家庭成员的风险状况进行筛查。然而，VOUS变异可以根据其他受影响和未受影响的家庭成员的检测结果重新分类。随着时间的推移，新的信息被添加到文献中，也可以提供数据的重新分析。如果在报告中确定了致病性或可能致病性变异，则可采取行动，并可提供家庭成员筛查。成为变异携带者的家庭成员需要心理支持，并需要进行癌症监测。测试呈阴性的人就放心了。他们可以成为家庭的积极支柱。我们很幸运，我们中心有一位训练有素的医学遗传学家和一个成熟的医学遗传学部门。然而，大多数中心的情况并非如此乐观。我们强烈建议在所有大型综合癌症治疗中心配备训练有素的遗传咨询师。在此之前，治疗肿瘤的医生必须振作起来，接受这一领域的培训，并承担起为患者提供遗传咨询的责任。财政支持及赞助无。利益冲突没有利益冲突。
{"title":"Genetic counseling for hereditary cancers: Not everybody’s cup of tea!","authors":"Rekha Gupta, Satyajeet Soni, Hemant Malhotra","doi":"10.4103/crst.crst_271_23","DOIUrl":"https://doi.org/10.4103/crst.crst_271_23","url":null,"abstract":"We read with deep interest the review article published in the previous issue of Cancer Research Statistics and Treatment authored by Ulhaq et al.[1] We feel that this manuscript is of utmost importance for practicing oncologists and the journal needs to be congratulated for selecting this for publication to highlight this issue. After more than three decades of practicing oncology in the country, the senior writer of this letter is acutely aware of the lack of knowledge among treating clinicians and the extreme dearth of trained genetic counselors. Hereditary cancer contributes 5–10% of the overall cancer incidence. Early diagnosis and treatment are the most successful tools in cancer management for a higher survival rate. This principle can be applied to hereditary cancer families by identifying high-risk individuals and putting them on surveillance. Genetic counseling is the first step in this process. Pivotal steps have been discussed in the article.[1] Developing genetic counseling units with specialization in oncology is an important step towards generating awareness about hereditary cancer syndromes. As multiple family members are at risk of developing cancer, multiple lives can be saved by providing surveillance and prevention to such families. Counseling and offering genetic testing based on the next-generation sequencing (NGS) and multiplex ligation-dependent probe amplification (MLPA) techniques is at the heart of this concept of prevention, early diagnosis, and treatment. A few important issues were not highlighted in this article.[1] One important issue in the Indian scenario is pre-symptomatic carrier detection in a young person and marriage-related issues,[2] and the reproductive implications of this diagnosis. Such individuals carry a lifetime risk of cancer, and their offspring will harbor the mutation in 50% of cases. Genetic counseling must be offered to such reproductive couples. Preimplantation genetic diagnosis (PGD) can be offered to couples who are conceiving through in vitro fertilization (IVF). The second important issue is the psychological stress of receiving a pre-symptomatic diagnosis. These newly diagnosed pre-symptomatic carriers are young individuals who are on the verge of their careers and starting their reproductive lives. We need a team of support groups, counselors, and psychologists to take care of the pre-symptomatic diagnosis hurdles amidst job security, insurance policy, etc. The authors, even though they claim to have written an India-specific article, have missed out on at least three major publications in the field from India which significantly add to the knowledge on the subject.[3-5] The cost of testing and surveillance also needs to be considered by the individual patient/person. Now, with a large industrial house with deep pockets, entering the field of genetic testing and promising comprehensive genetic profiling at less than `15,000, a whole set of new and unknown issues are bound to arise, and ","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"278 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135700841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/crst.crst_103_23
Sunny Chi Lik Au
Cancers and tumors are a challenge to face, a foe to fight; Oncologists and their teams, a path to trace, a hope in sight. Within the eye, a tumor grows; A silent threat that nobody knows. The news, sometimes, is hard to take; The doctor often wonders what steps to make. A biopsy, the doctor takes a deep breath, then says with care; For the patient, to balance the bills of death, it’s hard to bear. The biopsy shows something we cannot ignore; And we know we must “buy-a-see” for something more. Denial and anger, at first, do show; Acceptance and appreciation, with time, do grow. Take the oncology journey, one step at a time; We know that we have the strength to climb. Oncology as a team, with knowledge and care; Gives patients the strength, the flight to bear. The road is long, and the journey is tough; The team works together to show they are enough. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
{"title":"Intraocular tumors and biopsy (buy-a-see)","authors":"Sunny Chi Lik Au","doi":"10.4103/crst.crst_103_23","DOIUrl":"https://doi.org/10.4103/crst.crst_103_23","url":null,"abstract":"Cancers and tumors are a challenge to face, a foe to fight; Oncologists and their teams, a path to trace, a hope in sight. Within the eye, a tumor grows; A silent threat that nobody knows. The news, sometimes, is hard to take; The doctor often wonders what steps to make. A biopsy, the doctor takes a deep breath, then says with care; For the patient, to balance the bills of death, it’s hard to bear. The biopsy shows something we cannot ignore; And we know we must “buy-a-see” for something more. Denial and anger, at first, do show; Acceptance and appreciation, with time, do grow. Take the oncology journey, one step at a time; We know that we have the strength to climb. Oncology as a team, with knowledge and care; Gives patients the strength, the flight to bear. The road is long, and the journey is tough; The team works together to show they are enough. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135701146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prachi Bhatia, Madhura R. Sharma, G. Singh, S. Gurav
{"title":"Authors' reply to Thavarool et al.","authors":"Prachi Bhatia, Madhura R. Sharma, G. Singh, S. Gurav","doi":"10.4103/crst.crst_85_23","DOIUrl":"https://doi.org/10.4103/crst.crst_85_23","url":null,"abstract":"","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"8 1","pages":"138 - 139"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87320669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/crst.crst_237_22
Mehdi Mahmoodkhani, Mehdi Shafiei, M. Sharifi, A. Naeimi, D. Tehrani
Background: Extramedullary tumors account for a small percentage of all the tumors of the central nervous system and spine. Objectives: We aimed to determine the demographic characteristics and outcomes of treatment of patients with surgically resected extramedullary spinal tumors who visited medical centers in Isfahan, Iran. Materials and Methods: This descriptive study was conducted in Alzahra and Kashani medical centers in Isfahan, Iran, between 2013 and 2021. Patients with extramedullary spinal tumors who underwent surgery were included. Data collected included the pain score as measured on the visual analog scale (VAS) for pain severity, and the patients' neurological and functional status before and after treatment, as assessed on the McCormick scale. Results: We enrolled 94 patients in the study. The most common extramedullary spinal tumors were nerve sheath tumors in 32 (34.1%) patients, meningiomas in 27 (28.8%), and metastases in 22 (23.4%). The median follow-up was 3.60 ± 2.33 years. Pain was reported by 89 (94.7%) patients, which remained unresolved in 11 (13.5%) even after treatment; 18 (19.1%) patients died, among whom 8 (44.4%) had metastatic disease. As per the McCormick scale, 35 of 62 patients (46.1%) had a complete recovery following the various treatments including surgery, chemotherapy, and radiotherapy in the follow-up. Conclusion: There is an analogous distribution of extramedullary spinal tumors in Iranian patients compared to global data. In Iran, nerve sheath tumors and meningiomas are the most common extramedullary tumor types, and pain is the most common initial manifestation of these tumors. Surgical intervention in patients with extramedullary tumors usually leads to complete recovery based on the McCormick scale and reduction of pain symptoms as per the pain–VAS.
{"title":"Extramedullary spinal tumors: Cross-sectional study of the demographic characteristics and treatment outcomes of surgically treated patients from Isfahan (Iran)","authors":"Mehdi Mahmoodkhani, Mehdi Shafiei, M. Sharifi, A. Naeimi, D. Tehrani","doi":"10.4103/crst.crst_237_22","DOIUrl":"https://doi.org/10.4103/crst.crst_237_22","url":null,"abstract":"Background: Extramedullary tumors account for a small percentage of all the tumors of the central nervous system and spine. Objectives: We aimed to determine the demographic characteristics and outcomes of treatment of patients with surgically resected extramedullary spinal tumors who visited medical centers in Isfahan, Iran. Materials and Methods: This descriptive study was conducted in Alzahra and Kashani medical centers in Isfahan, Iran, between 2013 and 2021. Patients with extramedullary spinal tumors who underwent surgery were included. Data collected included the pain score as measured on the visual analog scale (VAS) for pain severity, and the patients' neurological and functional status before and after treatment, as assessed on the McCormick scale. Results: We enrolled 94 patients in the study. The most common extramedullary spinal tumors were nerve sheath tumors in 32 (34.1%) patients, meningiomas in 27 (28.8%), and metastases in 22 (23.4%). The median follow-up was 3.60 ± 2.33 years. Pain was reported by 89 (94.7%) patients, which remained unresolved in 11 (13.5%) even after treatment; 18 (19.1%) patients died, among whom 8 (44.4%) had metastatic disease. As per the McCormick scale, 35 of 62 patients (46.1%) had a complete recovery following the various treatments including surgery, chemotherapy, and radiotherapy in the follow-up. Conclusion: There is an analogous distribution of extramedullary spinal tumors in Iranian patients compared to global data. In Iran, nerve sheath tumors and meningiomas are the most common extramedullary tumor types, and pain is the most common initial manifestation of these tumors. Surgical intervention in patients with extramedullary tumors usually leads to complete recovery based on the McCormick scale and reduction of pain symptoms as per the pain–VAS.","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"30 1","pages":"26 - 31"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86916774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vivek Srigadha, K. Prabhash, V. Noronha, A. Joshi, V. Patil, N. Menon, A. Singh, M. Shah
Cabozantinib is a tyrosine kinase inhibitor that has been approved as therapy for several solid tumors, including metastatic renal cell carcinoma, hepatocellular carcinoma, and differentiated thyroid cancer. To prepare this review, we comprehensively searched various websites, including the United States Food and Drug Administration, the European Medicine Agency Drug Manual, PubMed, Science Direct, and UpToDate using the search terms, “cabozantinib,” “renal cell carcinoma,” “hepatocellular carcinoma,” “differentiated thyroid cancer,” and “medullary thyroid cancer.” We shortlisted all the full-text articles published between 2011 and 2022. Out of a total of 788 manuscripts identified, we included 52. This review of cabozantinib details the pharmacodynamics, pharmacokinetics, clinical indications, adverse effects, safety, and the key research trials that investigated the use of cabozantinib. We have discussed the available clinical trial data and real-world outcomes, both with respect to the efficacy and safety of cabozantinib.
{"title":"Cabozantinib: A narrative drug review","authors":"Vivek Srigadha, K. Prabhash, V. Noronha, A. Joshi, V. Patil, N. Menon, A. Singh, M. Shah","doi":"10.4103/crst.crst_9_23","DOIUrl":"https://doi.org/10.4103/crst.crst_9_23","url":null,"abstract":"Cabozantinib is a tyrosine kinase inhibitor that has been approved as therapy for several solid tumors, including metastatic renal cell carcinoma, hepatocellular carcinoma, and differentiated thyroid cancer. To prepare this review, we comprehensively searched various websites, including the United States Food and Drug Administration, the European Medicine Agency Drug Manual, PubMed, Science Direct, and UpToDate using the search terms, “cabozantinib,” “renal cell carcinoma,” “hepatocellular carcinoma,” “differentiated thyroid cancer,” and “medullary thyroid cancer.” We shortlisted all the full-text articles published between 2011 and 2022. Out of a total of 788 manuscripts identified, we included 52. This review of cabozantinib details the pharmacodynamics, pharmacokinetics, clinical indications, adverse effects, safety, and the key research trials that investigated the use of cabozantinib. We have discussed the available clinical trial data and real-world outcomes, both with respect to the efficacy and safety of cabozantinib.","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":"20 1","pages":"74 - 87"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80428320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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