Asian Pacific Journal of Cancer Care

Recent Scenario of Male Breast Cancer in a Tertiary Care Centre

Saima Ambareen — 2024-01-02

Background: Breast cancer in males is a rare disease with an estimated incidence of 0.5-1% of all breast cancer cases. However recent data show that incidence is slowly rising but epidemiological data regarding Male Breast Cancer is little as compared to Female Breast Cancer due to the rarity of this disease. It is mostly seen in elderly men in the 6^th or 7^th decade of life. They usually present at an advanced stage with a poor prognosis as compared to FBC. This study is aimed to analyze the epidemiologic, and clinicopathological behavior of male breast cancer patients.
Methods: This work is the prospective work of 11 male breast cancer patients who were presented in department of General Surgery Rims, Ranchi during a period of 1 year. Data regarding clinical history, examination findings, family history, stage of the disease, histopathological examination and hormonal status were evaluated.
Results: Results showed that male breast cancer occurs later in life with median age being 58.5 years. The average diagnosis delay was 6.6 months. Out of eleven patients, eight of them had involvement of the left breast while the other three had involvement of right side of breast. Invasive ductal carcinoma was the histological type found in nine cases. Ten patients presented an advanced stage of T4 while one patient presented at T3. Hormone receptors were positive in 81.8% cases.
Conclusion: To conclude male breast cancer is a rare disease with multiple and varied risk factors. It is similar in clinical, histological and prognostic characteristic to breast cancer in women but also has varied characteristics. We suggest that for early diagnosis and enhanced prognosis, teaching self-breast examination in males, screening mammography and testing for familial predisposition shall be helpful in high risk groups. Therefore, there is a requirement for more free awareness public programmes to educate males about breast cancer and promote its early detection.

Comparison of Palliative Fractionated Radiotherapy to Thorax in Non-small Cell Lung Carcinoma: A Prospective Comparative Study

Mayur Khandelwal — 2024-01-02

Background: Most patients of lung carcinoma come into the OPD with advance disease and with moderate to severe symptoms. Palliative Radiotherapy to chest can relieve symptoms arising due to intrathoracic pathology. Timing and fractionation schedule is very important for symptomatic relief and response. Time to come the effect of RT is 3 months. The aim of this study is to investigate survival after PTR and evaluate symptomatic relief and adverse effects of RT.
Methods: Patients with non-small-cell lung cancer (NSCLC) planned for PTR in the period of January 2022 to October 2022 at ATRCTRI Bikaner (Rajasthan). We noted pathology, tumor, node, and metastasis (TNM) classification of malignant tumors, stage, indication, starting date, schedule for PTR, completed yes/no, performance status (PS) and time of death.
Results: Out of total 86 patients 12 patients did not complete RT. Rest 74 patients who received PTR included in the study, 30 patients (40%) died within 30 days and 15 patients died within 3 months of treatment. Only 20 patients remained alive at 6 months. More Symptomatic relief seen with 20 Gy in 5 fractions. More Survival seen with PS 1-2 and 30Gy/10fraction. Dyspnea, hemoptysis, and SVC syndrome were the most frequent indications for PTR in our study. Almost every patient noted for >1 indication. Fractionated schedule 30Gy/10F used more frequently in good PS patients.
Conclusions: Our study shows that a significant number of patients who received PTR died before they could achieve optimal effect of the treatment. PS and histology were significant prognostic factors favoring PS 1-2 and squamous cell carcinoma. Based on our study, we suggest that patients with PS 1-2 should be considered for fractionated PTR whereas patients with PS ≥ 2 should be considered for comparatively shorter fractionation size or best supportive palliative care.

Compare Two Different Fractionated Regimes of HDR Intracavitary Brachytherapy after Concomitant Chemoradiation in Carcinoma Cervix: A Prospective Study

Mayur Khandelwal — 2024-01-02

Background: Cervical cancer is the common cancer cause of death among women in developing countries. High Dose Rate (HDR) intracavitary brachytherapy that is given with or sequential after EBRT, is an integral component in the treatment of carcinoma of the cervix. In recent years, High Dose Rate (HDR) brachytherapy in combination with External Beam Radiotherapy (EBRT) has been popular in the management of carcinoma of the cervix.
Objectives: To evaluate treatment response post 3 and 6 months after treatment completion and treatment-related toxicities during treatment in weekly v/s biweekly HDR intracavitary brachytherapy after concomitant chemoradiation in squamous cell carcinoma cervix patients.
Methods: A total of 60 cervical cancer patients fulfilling the inclusion criteria were selected. Patients were randomly assigned to the weekly and Biweekly HDR ICBT using the chit-box method with replacement. Arm A (Study arm): 30 patients with concurrent EBRT (50 Gy/25 fractions with 2 Gy per fraction) with weekly cisplatin (35 mg/m²) followed by HDR-ICBT 5 Gy * 5 fractions biweekly after completion of EBRT. Arm B (Control arm): 30 patients with concurrent EBRT (50 Gy/25 fractions with 2 Gy per fraction) with weekly cisplatin (35 mg/ m²) followed by HDR - ICBT 7.5 Gy * 3 fractions weekly after completion of EBRT.
Results: Patients were assessed at 3 and 6 months to determine the local disease response and the incidence of any toxicities assessed during the treatment. All responses were graded as either CR (complete response), PR (partial response), SD (stable disease), or PD (progressive disease). 30 patients were assessed for therapy response using the WHO criteria. At 3 months arm A showed 86% CR and arm B showed 90% CR. 2 patients in arm A and 1 patient in arm B had PR. In both arms 2 patients had progressive disease. At 6 months 1 patient in both arms who had progressive disease converted into partial response after taking post RT chemotherapy.
Conclusions: To sum up, brachytherapy is a vital aspect of the process of treating cervical cancer. Several centers have experimented with various doses and fractionation regimes. Patients in the current trial reported no safety concerns or intolerability issues across any treatment protocol. Arm A had treatment completion before arm B with comparable disease response and toxicities. Therefore, the choice of treatment plan depends on the individual patient’s circumstances and the institution’s demands. nonetheless, longer follow-ups and a bigger patient sample are needed for a solid evaluation of disease response and toxicity.

Hereditary Colorectal Cancer in Brunei Darussalam

Muhammad Hazman Awang Josli — 2024-01-02

Introduction: Hereditary colorectal cancers (CRC) are associated with early age of disease onset and high risks of developing other cancers. In this study, we estimate the prevalence of hereditary CRC over a 6-year period, and report the socio-demographics and clinical profile of patients in Brunei Darussalam.
Methods: A retrospective study of data from 146 patients diagnosed with CRC from January 2017 to December 2022 was obtained from The Brunei Cancer Centre. Suspected or confirmed hereditary CRC patients were flagged from the 146 cases based on microsatellite instability (MSI) assay testing, immunohistochemistry (IHC) four-panel staining on mismatch repair (MMR) genes MLH1, MSH2, MSH6, and PMS2, and BRAFV600E test results.
Results: Among the 146 patients with CRC, 41.7% (n=61) patients underwent MSI testing where 7.5% (n=11) reported high instability in their microsatellite assay (MSI-H), of which 2 were associated with Lynch syndrome. Among the 11 patients with “suspected” or “confirmed” hereditary colorectal cancer, majority presented with abdominal pain prior to diagnosis (81.8%; n=9), Stage 2 cancer (36.4%; n=4), moderately differentiated tumour (72.7%; n=8), tumour located in caecum (36.4%; n=4) and all patients had surgery as first-line management, with more than half receiving chemotherapy (54.5%; n=6).
Conclusion: 7.5% of patients of CRC cases seen at a tertiary cancer centre over a 6-year period was found to have “suspected” or “confirmed” hereditary CRC. The lack of genetic testing performed in local settings may indicate that the actual prevalence may be higher.

Reoperative Thyroid Bed Surgery: An Evaluation of Complications and Outcomes

Sandeep Vijay — 2024-01-02

Introduction: Secondary surgeries for thyroid cancers are conventionally associated with long term morbidities. This study was conducted to assess the efficacy of our Institutional Surgical Protocol while dealing with such cases, through the complications and levels of disease clearance achieved.
Methods: It was a retrospective observational study; patients who underwent reoperative thyroid surgery from January 2020 to January 2023 were included. All patients were operated as per the Institutional Policy.
Results: 25 patients were included in the study. Secondary surgeries included Central Neck Dissection with Lateral Neck Dissection (40%), Revision thyroidectomy (24%) and Completion thyroidectomy (12%). The pathological diagnoses of the patients were mainly Well differentiated Thyroid cancers like Papillary Carcinoma (72%) and Follicular Carcinoma (12%). Complications following Secondary surgery included Permanent Hypoparathyroidism (4%) and Permanent Vocal cord palsy (4%). Literature shows an incidence of 5-10% and 0-5% respectively. In 60% of patients, there was no uptake in the Postop Iodine scan which displayed complete disease removal.
Conclusion: Our Institutional Protocol results in a significant reduction in post op complications as compared to literature. Adequate disease clearance is ascertained by the lack of uptake in the Postop Iodine Scan.

Clinicopathological Evaluation of Extragonadal Germ Cell Tumors - A Retrospective Study from a Regional Cancer Center in India

Sindhu Ramamurthy — 2024-01-02

Introduction: Extragonadal germ cell tumors (EGGCTs) are tumors arising at extragonadal ana-tomical locations. The biological behavior and prognosis of these tumors differ from their gonadal counterparts. Our study aims to analyze their histological subtypes, the outcome, and the prognosis of these lesions at various age groups.
Material and Methods: We carried out a retrospective analysis of all patients with EGGCTs diag-nosed from January 2017 to December 2019.
Results: Our study included 61 cases of EGGCTs. These cases were divided into neonatal (birth to six months), prepubertal (more than six months to 12 years), and post-pubertal group (>12 years). The most frequently affected group was prepubertal (44.2%). The age ranged from birth to 45 years with a male-to-female ratio of 1:1.03. The frequently involved site was sacrococcyx (36%) followed by mediastinum (31.1%). The common histologic subtype was mature teratoma (39.3%), followed by yolk sac tumor (YST) (18%), mixed germ cell tumor (18%), immature teratoma (14.7%), and germinoma (9.8%). Four cases of teratoma had somatic malignancies. There were 48 stage I, 8 stage II, and 2 stage III tumors. Statistical analysis revealed a significant association of age group concerning primary site (p=0.004), histological type (p=0.002), and clinical stage (p=0.034). In a median follow-up of 30 months, an Overall Survival (OS) of 93.2% and Event Free Survival (EFS) of 90.4% were noted across all age groups. OS of 100% (neon tal), 96% (prepubertal) and 88.0% (post-pubertal) revealing a declining trend (p=0.324) with increasing age was noted. The important prognostic factors include histological subtype (mixed germ cell tumors and teratomas with somatic malignancies had reduced overall survival) and stage (I vs II and III) for OS and stage alone for EFS (P<0.0001).
Conclusion: Our study highlights the clinicopathological characteristics, prognostic parameters, and the outcome of GCTs occurring at extragonadal sites and emphasizes the role of pathologists in the detailed reporting of these lesions.

Radiotherapy Planning in Synchronous Bilateral Breast Cancer Irradiation: A Dosimetric Study

Niketa Thakur — 2024-02-10

Background: The large radiation field and surrounding normal structures make treatment planning and dose delivery of synchronous bilateral breast cancer (SBBC) much more difficult than it is for unilateral breast cancer. Intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) can produce acceptable normal tissue sparing while improving target dose coverage compared to 3D-CRT. With this context in mind, we carried out a study to examine the dosimetric variations of IMRT and VMAT techniques using a single isocenter for planning cases of SBBC.
Patients and methods: Five patients were considered for this study. All the patients had undergone bilateral mastectomy. Dose prescribed was 50 Gy in 25 fractions. VMAT and IMRT plans were created for each patient. All the plans made were mono-isocentric. Dosimetric data of the target and organs at risk (OAR) were compared.
Results: There is a trend towards better PTV coverage using VMAT compared to IMRT (V95 IMRT=94.8720, V95 VMAT=95.8740; P=0.316). VMAT plans significantly improved the dose homogeneity as V105% decreased from 2.886% to 0.312% using VMAT plans (P=0.001). IMRT plans showed trend towards higher lung Dmean and V20Gy than VMAT plans. The irradiation dose to the heart was significantly higher in the IMRT plan than VMAT plan, resulting in Dmean of 15.836 Gy vs 13.580 Gy (P=0.026), V25Gy of 16.498% vs 13.832% (P=0.046) and V30 Gy of 9.774% vs 7.022% (P= 0.043).
Conclusion: The single isocentric VMAT technique can be performed conveniently in SBBC. It improves target volume coverage with optimal normal tissue sparing. It is a feasible approach while planning synchronous bilateral breast irradiation.

Comparative Dosimetric Analysis of conventional 3DCRT and VMAT for Head and Neck Cancer

Shubhangi Thanvi — 2024-02-10

Introduction: Advancements in radiation oncology improve the outlook for patients with head and neck cancer which allowed to escalate the dose of radiation to tumours while minimizing the dose to surrounding healthy tissues. This study aims comparison of radiotherapy treatment planning of 3 DCRT and VMAT for head and neck cancer.
Methods: Prospective study conducted on fifty patients of head and neck cancer in which 25 patients were treated with 3 DCRT and 25 patients treated with VMAT. Both plans were evaluated to compare the efficiency of VMAT and 3 DCRT dosimetrically in terms of PTV volume, homogeneity index, conformity index and doses to organs at risk.
Results: Dose D98% for PTV66 was 59.39 Gy and 51.82 for VMAT and 3DCRT respectively. Conformity index was 1.0816 and 1.4472 for VMAT and 3DCRT plans respectively and the difference was statistically significant. Homogeneity index was 0.1473 for VMAT and 0.2997 for 3DCRT which proves that VMAT was more homogeneous. OARs sparing was also better with VMAT compared to 3DCRT especially the OARs which were very close to target volume especially parotid glands, Brainstem and optic nerve.
Conclusion: Compared to 3DCRT plans, VMAT plan produced significantly better target coverage, homogeneous as well as dose conformity. Doses to organs at risk such as spinal cord and parotid glands were also reduced. Besides, the delivery of VMAT treatment was more efficient.

Incidence, Severity and Clinical Correlation of Oxaliplatin Induced Neuropathy in Patients with Colorectal Cancer: A Single Institutional Experience

Sreya Mallik — 2024-02-10

Background: Colorectal cancer is the third most commonly diagnosed cancer worldwide, and its incidence is increasing in developing countries. Chemotherapy plays a significant role in the treatment of locally advanced and metastatic colorectal cancer. Oxaliplatin has remained the backbone of the treatment of colorectal carcinoma. The primary dose-limiting toxicity of oxaliplatin is neuropathy, which can reduce compliance during therapy and impair daily living activities. With limited data regarding the occurrence of oxaliplatin-induced peripheral neuropathy (OIPN) in the Indian population, we aimed to determine the incidence and severity of oxaliplatin-induced neurotoxicity and its clinical correlation with various clinical parameters in patients with colorectal carcinoma in a cancer care centre from North-East India.
Material and Methods: A prospective observational analysis was performed on all histologically confirmed cases of colorectal adenocarcinoma who received oxaliplatin-based chemotherapy either in an adjuvant setting or first-line palliative setting at Dr. B. Borooah Cancer Institute between April 2019 to March 2020.
Results: Our study evaluated 76 patients with colorectal carcinoma with a mean age of 54.07 ± 10 years. The majority (65.8%) of the patients had adenocarcinoma of the colon, and 34.2% had rectal adenocarcinoma. Twenty-three (30.3%) patients presented with metastatic disease. Oxaliplatin-based chemotherapy regimens were either CAPOX (72.4%) or FOLFOX (27.6%). Acute OIPN was observed in 59 patients (77.6%), and the most common symptom was cold-induced perioral paraesthesia. The most frequent grade for acute OIPN was grade II (30.3%). Chronic OIPN was seen in 47 (61.8%) patients, with the majority developing grade II neuropathy and was manifested mainly after 4^th cycle of chemotherapy. The incidence of OIPN was higher in the patients aged ≥60 years, with a cumulative oxaliplatin dose of > 1000 mg/m² and baseline low serum magnesium or calcium level.
Conclusion: Oxaliplatin is one of the essential chemotherapy drugs used in colorectal cancer with significant dose-limiting toxicity of peripheral neuropathy. Well-timed identification of neuropathic symptoms can increase treatment adherence and improve the patient’s quality of life.

Clinical Characteristics and Treatment Outcome of Waldenstrom Macroglobulinemia: Experience from a Tertiary Cancer Centre

Geetha Narayanan — 2024-03-13

Background: Waldenstroms macroglobulinemia (WM) or Lymphoplasmacytic lymphoma is a rare B cell lymphoproliferative malignancy characterized by serum monoclonal immunoglobulin M (IgM) protein and lymphoplasmacytic infiltration in the bone marrow. Patients usually present in their seventh decade with symptoms related to the infiltration of the marrow or the effects of monoclonal IgM in the blood.
Objective: Was to study the clinical characteristics and treatment outcome of patients diagnosed with WM.
Materials and Methods: This is a retrospective analysis of 26 cases of WM treated at a tertiary cancer centre.
Results: WM constituted 0.68% of our nonHodgkin’s lymphoma. The median age at presentation was 67 years with a male to female ratio of 2:1. Four patients had lymphadenopathy, six had splenomegaly and four patients had evidence of hyper viscosity. All patients had IgM paraproteinemia, the M band was IgM-kappa in 19 patients and IgM-lambda in seven patients. All patients had a histopathological confirmation. According to IPSS-WM, 12 patients each were in the intermediate and high risk group and 2 in the low risk group. Among the 26 patients, 20 patients received upfront treatment and four patients were kept under observation. The indications for treatment were cytopenia in ten patients, constitutional symptoms in five, hyper viscosity in four and symptomatic lymphadenopathy in one patient. Sixteen patients received rituximab-based chemotherapy. Four patients with features with hyper viscosity underwent plasmapheresis. The three year progression free survival and overall survival were 69.4% and 78 % respectivel.
Conclusions: WM is a low grade B cell lymphoproliferative disorder having an indolent course and do not require treatment for prolonged period. Diagnosis is challenging due to lack of distinct diagnostic features. Rituximab containing regimens are the standard of care. Newer targeted treatment options may improve the outcome of this incurable disease.

Comparative Study of 3D Conformal Radiation Therapy by 3 Fields v/s 5 Fields Treatment Planning Techniques for Head and Neck Cancer

Dharampal Jakhar — 2024-03-13

Purpose: The purpose of this study was to compare conventional 3 field versus 5 field treatment planning techniques during 3-dimensional conformal radiotherapy(3D-CRT) in respect of OAR, PTV coverage, treatment response & toxicities in head and neck Cancer.
Materials and methods: This study included 50 biopsy proven and registered patients of head and neck cancer. Twenty five patients randomized to each arm. Arm A- 3D- conformal radiotherapy by 3 field delivery technique. Arm B--3D- conformal radiotherapy by 5 field delivery technique. All patients were irradiated on linear accelerator with concurrent chemotherapy in form of 3 weekly Cisplatin. Target volumes and normal structures were manually contoured on the axial slices of the planning CT scan. Patients were evaluated at end of treatment, 1^st, 3^rd & 6^th months follow up visits.
Results: At the end of treatment 22 (88%) patient in 3 field and 23 (92%) patients in 5 field had complete response. At 6 months complete response was 76% and 80 % in Arm A and B respectively (p value=0.6836). Grade 3^rd xerostomia was seen 12% Vs 4% in Arm A and B respectively ( p value= 0.92 ) Mean V95 was 90.93 for conventional 3 field technique and 93.28 with 5 field technique ( p value=0.08).
Conclusion: 5 field 3D-CRT technique can be used to spare parotid and other OAR and better PTV coverage specially in larynx carcinoma , patient with N2 or less nodal involvement and not involving higher neck node level.

Comparative Dosimetric Analysis of IMRT and VMAT in Head and Neck Cancers

Trilok Rawal — 2024-03-13

Purpose: The aim of study was to dosimetrically evaluate and compare IMRT and VMAT plans for irradiation of local head and neck cancers focusing on target coverage, conformity index, homogeneity index and dose perceived by the organs at risk (OAR).
Methods: Prospective study conducted on 50 patients selected randomly and divided in two groups in which one group receive IMRT plan and another received VMAT plan.
Results: PTV coverage was similar for both the techniques. The conformity index was higher for VMAT in comparison to IMRT which is statistically significant. The homogeneity index was also better in VMAT plans as compared to IMRT except for higher PTV volume where IMRT had better plans. The mean dose to parotid were significantly lesser in parotid glands in VMAT plans. Also, the point max dose to spinal cord, brainstem, vestibulocochlear nerve was lesser. There was no significant difference in dose received by spinal cord in both arms.
Conclusion: VMAT provides better dose conformity, more homogenous target coverage and OAR sparing in comparison to IMRT.

The Outcome of Anaplastic Glioma Treated at a Tertiary Cancer Care Institute in South Asia

Arunkumar Madukkarai Natarajan — 2024-03-13

Objective: Anaplastic glioma is a highly aggressive brain tumor that often occurs in young adults. There is a lack of data from India on anaplastic gliomas. This study aims to evaluate the prognostic factors of anaplastic glioma and correlate them with the outcome.
Materials and Methods: This is a retrospective observational study of 57 patients with anaplastic glioma treated from 1996 to 2015 in a cancer institute in Chennai. We captured data from the cancer institute’s hospital-based electronic health record tumor registry and correlated factors including age, sex, histology, site of disease, type of surgery, adjuvant treatment, and radiation treatment technique with outcome. For the calculation of progression-free survival (PFS) and Overall Survival (OS), we used Statistical Package for Social Science (SPSS) software.
Result: This analysis included fifty-seven patients, with a median follow-up of 34 months. The median progression-free survival (PFS) and overall survival (OS) were 28 and 41 months, respectively. On univariate analysis, factors associated with improved survival include Anaplastic Oligodendroglioma histology (HR-0.43, CI-0.22-0.80, P=0.006), Frontal lobe location (HR-1.96, CI-1.07-3.58, P=0.025) Gross total resection (HR-1.94, CI-1.03-3.64, P=0.034), and addition of Temozolamide (HR-2.09, CI-1.14-3.84, P=0.014). On multivariate analysis Anaplastic Oligodendroglioma histology, (HR-0.49,CI-0.25-0.95,P=0.037), Frontal lobe (HR-2.14,CI-1.12-4.07,P=0.021), Gross total resection (HR-2.89,CI-1.47-5.69,P=0.002) and addition of Temozolamide (HR-2.02,CI-1.07-3.81,P=0.029) remained significant factors for improved OS.
Conclusion: Among the various clinical and treatment-related prognostic factors, our study revealed that anaplastic oligodendroglioma histology, frontal lobe location, gross total resection, and addition of temozolomide chemotherapy to radiation showed improved outcomes.

A Prospective Comparative Study of Sensorineural Hearing Loss in Patients of Head and Neck Cancers Treated with 2-D RT vs 3-D CRT

Prem Kumar — 2024-03-13

Background: SNHL is disabling for the patient, since it has a chronic and often Progressive natural history. sensorineural hearing loss is irreversible, whereas conductive hearing loss (as often found after radiotherapy) is mainly reversible.
Material and Methods: This prospective randomized study was conducted in Department of Radiation Oncology, S P medical college Bikaner, Rajasthan. The study was done from November 2020 to October 2021. After taking informed consent total of 50 patients of biopsy proven squamous cell carcinoma of head and neck region randomly distributed among Group A who received 2D RT (2Gy/Fr in 30 to 35 fractions for 6 to 7 weeks) and Group B who received 3D CRT (2Gy/fr) in 30 to 35 fractions for 6 to 7 weeks).
Result: After completion of treatment SNHL assessment was done in patients treated with conventional and conformal radiotherapy which was for speech frequency 15% and 8 % respectively and for high frequency was 45% and 28% respectively. After 3 month of completion SNHL for speech frequency 27.5% and 12% respectively and for high frequency was 62.5% and 32% respectively.
Conclusion: High-frequency hearing loss can have a significant impact on quality of life because it affects speech discrimination, conventional radiotherapy experienced greater hearing loss as compared of conformal.

Exploring Malnutrition Risk in Cancer Chemotherapy Patients: An Assessment of Associated Factors in a Tertiary Care Cancer Center

G Hari Prakash — 2024-03-13

Objectives: This study aimed to assess the risk of malnutrition in cancer chemotherapy patients and identify the associated factors.
Materials and Methods: It is a cross-sectional study. Purposive sampling was used to collect data from a tertiary care cancer centre. The study collected data from 101 participants and used a malnutrition screening tool (MST) to assess the risk of malnutrition.
Results: The majority of participants in the study were female (61.4%) and in the 3^rd or 4^th stage of cancer (57.4% and 41.6%, respectively). Of the participants, 63.4% experienced weight loss without trying chemotherapy, and 60.4% were at risk for malnutrition. Cancer stage was associated with malnutrition risk, but other clinical variables were not.
Conclusion: Malnutrition is a significant issue among cancer chemotherapy patients in the study’s population. The findings of this study can be used to develop interventions to prevent and manage malnutrition in patients with cancer and improve the effectiveness of cancer treatment in the Indian population.

Incorporation of Multidisciplinary Tumour Board (MTB) Practice on Cancer Patient Care: Experiences of a Comprehensive Cancer Care Hospital in the Eastern India

Mandira Saha — 2024-03-13

Aims/objectives: A multidisciplinary tumor board (MTB) is a crucial aspect of comprehensive cancer care, providing evidence-based treatment for patients. The aim of this analysis was to assess the importance of MTB in comprehensive cancer care and its impact on cancer patients’ management and treatment compliance.
Method: One-year audit of the patients discussed on the tumor board of a private comprehensive cancer care hospital between September 2020 and August 2021. The data were collected before, during, and after each MTB meeting.
Result: A study of 800 cases discussed on the tumor board in one year. Approximately 60% of cases were presented by surgical oncology, 21% by medical oncology, and the rest by other departments. The median age of patients was 56 years. This audit revealed that the most common tumor was head and neck cancer (28.5%), followed by gastro-intestinal and breast cancer (55.2%). The most common treatment plan was surgical management (57.6%), followed by systemic therapy (45%), radiotherapy (32.1%), and palliative care (14.5%). Treatment compliance was over 50%, and after one year, 52.87% of patients were still alive. The audit revealed that more than 20% of the data was missing.
Conclusion: The difficult management of advanced-stage disease is improved, and treatment compliance is increased, through MTB practice. The demographics of cancer in this region of the country were also displayed by this audit. In the future, a prospective trial with a larger patient population, comprehensive follow-up information, and fewer missing data points should be used to evaluate the true impact of multidisciplinary care.

Yoga as a Comprehensive Therapy for Elevating Cancer-Related Fatigue: A Comprehensive Review

Anantha Krishna B S — 2024-02-10

Objective: This comprehensive review aims to explore the efficacy of yoga as a comprehensive therapy for alleviating cancer-related fatigue. The objective is to delve into the biological mechanisms, psychological effects, and clinical evidence underpinning the impact of yoga on fatigue in cancer patients.
Methods: A systematic literature search was conducted across various databases, including PubMed, Google Scholar, and relevant journals. The review encompasses studies focusing on the intersection of yoga and cancer-related fatigue.
Results: The review provides a thorough examination of how yoga serves as a comprehensive therapy for cancer-related fatigue. Biological mechanisms, including neuroendocrine modulation, immune system influence, and inflammation regulation, are discussed. Psychological mechanisms, such as stress reduction and mood improvement, are explored. The analysis includes a diverse range of clinical evidence, incorporating randomized controlled trials and observational studies.
Conclusion: In conclusion, this comprehensive review consolidates evidence supporting yoga as a holistic intervention for elevating cancer-related fatigue. By addressing both the biological and psychological dimensions, the review underscores the potential of yoga in offering a comprehensive approach to alleviate fatigue in the context of cancer care.

Comprehensive Analysis of Biomarkers in Vulvar Cancer-Unveiling the Role of EGFR, GLUT1, MUC1, MRP1, P16, PD-L1, and P53: A Review

M. Siva Charani — 2024-02-10

Vulvar cancer remains a significant health concern for women worldwide, it provides a comprehensive overview of biomarkers in vulvar cancer, focusing on the significance of EGFR, GLUT1, MUC1, and MRP1. It explores their prognostic value, pathophysiology and delves into the intricate landscape of P16, PD-L1, and P53 biomarkers. The article aims to elucidate the roles of these biomarkers in predicting outcomes, offering insights into their potential as prognostic indicators for vulvar cancer. This analysis contributes to the evolving understanding of molecular markers in the context of vulvar cancer prognosis and informs future research directions in the field.

Mycosis Fungoides: The Great Masquerader – Trilogy Case Series

Shipla Roy — 2024-01-02

Mycosis fungoides, also known as granuloma fungoides or Alibert-Bazin syndrome, is the most common form of primary cutaneous T-cell lymphoma. In the early course of the disease, the skin lesions have significant overlap with many other primary cutaneous disorders like psoriasis, eczema, and tinea infections. Hence, early suspicion, prompt diagnosis by histopathological and immunohistochemical analysis, and regular follow-up are of utmost importance. Here we present a trilogy of cases of mycosis fungoides with varied skin lesions.

Juvenile Myelomonocytic Leukemia – Experience from a Tertiary Care Hospital in Eastern India

Kaustav Ghosh — 2024-01-02

Background: Juvenile myelomonocytic leukemia (JMML), previously known as juvenile chronic myeloid leukaemia, is a rare, unique, and aggressive myeloproliferative neoplasm of early childhood. Making a diagnosis of JMML is challenging because of the overlapping clinical and haematological features with other myeloproliferative neoplasms (MPN). However, some unique features like monocytosis, the absence of BCR-ABL translocation, and the presence of specific mutations (PTPN-11, K-RAS, N-RAS, CBL, or NF1) clinch the correct diagnosis.
Methods: A prospective analysis of six JMML patients with variable clinical features treated with injection azacytidine as frontline therapy during the study period of 2 years.
Results: The median age was 4.5 years with male:female ratio 2:4. Pallor and splenomegaly were the most common presenting signs. Four patients (66.67%) achieved complete remission (CR), two patients (33.33%) had partial remission (PR), and one patient (16.67%) had progressive disease (PD). The overall survival rate was 66.67% (four out of six), and the mortality rate was 33.33%.
Conclusion: Azacitidine is an effective treatment option as upfront therapy for JMML, especially in resource poor developing countries.

Loss of Blood Group Antigens in Haematolymphoid Malignancy: A Case Series from a Cancer Institute from North East India

Ranjita Sarma — 2024-03-13

Introduction: Altered expression of blood group antigens has been reported to be associated with both solid as well as haematological malignancies. This usually results from genetic mutation leading to incomplete as well as abnormal synthesis of antigens. Transitional loss of RBC antigens especially from ABO system is most commonly found in haematological malignancies causing blood group discrepancies and followed by reversal to its historical blood group during remission. Loss of A, B antigens has also been associated to play a role in lung, bladder and colon cancers. However not much data is available regarding haematological malignancies.
Methods and Methodology: Retrospective review of blood group discrepancy (Forward group) in patients admitted for haematolymphoid malignancy at our institute was done during a period of 3.5 years (13/3/2020 till 12/9/2023). Blood grouping done by Column agglutination test were repeated by conventional tube method. Further confirmation of the group was done by saliva test and adsorption elution test as indicated. The detail history of the patient was collected from the hospital records and analysed.
Results: A total of 7 patients presented with either loss or decrease in antigen expression. Most common diagnosis was Acute Myeloid Leukaemia (AML) with FLT3 mutation and most common antigen affected was A.
Conclusion: Haematolymphoid malignancies has been associated with loss of blood group antigens causing group discrepancy. Blood transfusion is an integral part of the supportive care in these patients. Hence, proper work up of blood group discrepancy cases should be done and recorded so as to prevent delay in blood transfusion.

A Rare Soft Tissue Tumor Confused Radiologically with Chondroma; Extraskeletal Osteosarcoma

Sevda Dalar — 2024-01-02

Extraskeletal osteosarcoma is a malignant chondro-osseous neoplasia that is not associated with the skeletal system. It accounts for less than 1% of all soft tissue sarcomas. We report a case of a 60-year-old male with an isolated primary subcutaneous tumor in the dorsal aspect of his left foot. The lesion was initially considered an extraskeletal chondroma radiologically. After imaging; surgical excision and pathological analysis the diagnosis of extraskeletal osteosarcoma was made. This report includes the clinical and pathological findings of extraskeletal osteosarcoma in this case.

Intracranial Hemangiopericytoma- A Case Report

Mayur Khandelwal — 2024-01-02

Intracranial hemangiopericytomas are rare vascular tumours, account for less than 1% of all primary tumours of the central nervous system. This tumour usually found outside of CNS i.e., lower extremities and retroperitoneum. Treatment is surgery followed by radiotherapy to decrease chances of recurrences. This is a case report of a young female diagnosed with intracranial hemangiopericytoma in 2021 at our hospital-Acharya Tulsi Regional Cancer Institute, Bikaner.

Perinephric and Ovarian Metastasis from Advanced Urothelial Carcinoma Bladder: Case Report of a Rare Dismal Disease

Poorva Vias — 2024-01-02

Background: Metastatic urothelial carcinoma bladder at the time of diagnosis is a rare entity with lymph nodes, bones, lung and liver as common metastatic sites. Sometimes metastasis can be seen in various atypical sites.
Case Presentation: Unusual location of metastasis can be seen in perinephric region, renal fascia and ovaries as seen in the described case. Primary urothelial carcinoma of ovary needs to be differentiated from the metastasis. There are no standard lines of management and the treatment needs to be individualised. Prognosis of metastatic urothelial carcinoma remains fatal with a limited life expectancy.
Conclusion: We present a case of metastatic urothelial carcinoma bladder with metastasis to perinephric region and ovaries with her course of treatment.

Sarcomatoid Malignant Pleural Mesothelioma: A Case Report

Divya Sharma — 2024-02-10

Mesothelioma is a rare neoplasm and found 1 case/ million / year. It develops mainly in individuals over 60 year of age. Main risk factor is asbestos exposure. Other risk factors include: - Simian virus 40, ERIONITE fibre exposure, radiation induced. This is a case report of a 70-year-old female diagnosed with Mesothelioma of Sarcomatoid type by IHC markers.