Asian Pacific Journal of Cancer Care

Radiation-Induced Hypothyroidism in Post-Mastectomy Patients: A Prospective Cohort Study

Satya Shankar Harsh — 2024-10-05

Purpose: Our study aims to assess the incidence of radiotherapy-induced hypothyroidism in breast cancer patients and correlate it with the mean dose to the thyroid.

Method: Out of 75 patients, who were treated under 3-dimensional conformal radiotherapy field in field {3D CRT(FiF)} by conventional Radiotherapy to post-modified radical mastectomy (MRM) chest wall, a dosing regimen of 200cGy per fraction for a total 5000cGy at our center in the year 2016, 63 patients were randomized and investigated. All patients were treated by Linear accelerator, varian, with the Eclipse version 13.6 treatment planning system. All information on radiotherapy used for each patient was extracted from the Eclipse treatment planning system. All patients were followed up for 7 years after Radiotherapy. TSH and freeT4 levels were measured. The Chi-square test was used to compare the outcome of the disease in terms of nominal and rank qualitative variables. Student t-test was used to compare in terms of quantitative variables.

Result: After 7 years since the radiotherapy, according to the results, a total of 10 out of 63, {15.87% (P = 0.008)} of patients had hypothyroidism, of which 11.11% (7 out of 63) were clinical, and 4.76% (3 out of 63) were subclinical. Dmean > 21 Gy compared with Dmean ≤ 21 Gy was associated with a significantly higher incidence of radiation-induced hypothyroidism (RHT) at 7 years after radiotherapy (3.17% vs. 12.7%, P<0.001).

Conclusion: We recommend that the Dmean of the thyroid should be kept lower than 21Gy for post-modified radical mastectomy radiotherapy to decrease the incidence of radiation-induced hypothyroidism. Further investigations in larger cohorts are required to confirm our results.

Pattern of Recurrence and Metastatic Disease in Post Operative Postradiotherapy Patients of Squamous Cell Carcinoma of Oral Cavity

Shruti Paliwal — 2024-10-05

Objective: Oral cavity is one of the common site of cancer in head and neck. They have high cure rate but locoregional failure seen in some cases at primary, nodal or metastatic site. We retrospectively analysed treatment results of oral cavity cancer in our institute and intented to define the prevalence and pattern of failure.

Materials and Methods: It is a prospective cohort study. 179 cases of post operative oral cavity cancer between January 2019 to December 2021, who took radiotherapy or chemoradiotherapy treatment in our institute were studied. 79 patients had loss of follow up during and after treatment. Results of study excluded these patients.

Results: Median follow up was 24 months (8-40 months). Treatment failure after radiotherapy or chemoradiotherapy at primary site and at nodal site was 22 % and 2 % respectively. In 8% cases recurrence was present at both primary and nodal site. Metastasis at extra nodal site occurred in 4% cases (3% in liver, 1% in bone).

Conclusion: Operated case of oral cavity cancer when treated with radiotherapy or chemoradiotherapy has very high cure rate and few locoregional failures at primary and nodal site and rarely at distant site. Recurrence most commonly seen in advanced disease. Therefore, advanced disease patients should be treated with more aggressive treatment to achieve higher cure rate in oral cavity cancer patients. Disease free survival and overall survival was better in early stage than in advanced stage. Node positive disease had more risk of recurrence and metastasis.

Outcomes of Palliative RT to Liver in Liver Metastases

Shiv Shankar Jhanwar — 2024-10-05

Introduction: Various techniques are available to treat and alleviate pain and other symptoms in liver metastasis (LM) or advanced hepatocellular carcinoma (HCC) patients. One of such technique is the external beam radiotherapy to whole liver. This study aimed to evaluate the feasibility, efficacy, tolerability and patient’s reaction to external beam radiotherapy (EBRT) in palliation of symptoms and quality of life (QoL) LM patients or HCC patients.

Material and Method: A total of 50 patient of either liver metastasis or HCC were included and planned on single 8Gy/fraction to whole liver radiotherapy. Ultrasonographic guided marking of liver was done prior to treatment and pretreatment dexamethasone and antiemetic was given. Evaluation was done at 1 week and 1 month after the end of treatment.

Results: After the whole liver radiotherapy, significant improvement was reported in the bilirubin level (68%), pain level (75.5%), and nausea (32%). Talking about the quality of life, the radiotherapy was reported to found potentially effective in enhancing the quality of life among the patients. Greatest percentage improvementwas reported for pain (75.6%), Global health status (39.6%), physical functioning (32.4%), rolefunctioning (36%), social functioning (36%) and appetite loss (30.6%).

Quality of Life in Women with Gynecological Cancers: A Study in Tertiary Care Hospital of Pakistan

FalakNaz Naz Dahar — 2024-10-05

Background: Patient survival has been improved in gynecological cancer due to recent advances in diagnosis and treatment modalities. However longer survival time makes quality of life an even more challenging aspect of care. The aim of study was cross sectional evaluation of the quality of life in Gynecological cancer survivors completing at least 5 years of follow-up after treatment.

Materials and Methods: In this prospective, single-center study, 162 women were interviewed at least 3 months after completion of treatment and no longer than 5 years. Data was collected on validated questionnaire i.e. EORTC QLQ-C30 from all participants & specific questionnaires specific to cancers i.e. OV28, CX24 & EN24.

Results: The study population comprised of 25 (15.4%), 82 (50.6%) and 55 (34%) women with Cervical, endometrial, and Ovarian cancer, respectively. Average Quality of life was found to be 77.93±16.65. Mean Quality of life was reported as 74.67 in cervical cancer, 77.34 in endometrial cancer & 80.30 in ovarian cancer respectively. Similarly, five functional scales like physical (PF), role (RF), emotional (EF), cognitive (CF) and social (SF) were estimated within the mean range of 80 to 90. Fatigue & insomnia were the most common symptoms reported. Sexual functioning was the main concern among patients included in the study. Other than that, musculoskeletal pain and lymphedema were the main issues reported by patients of endometrial cancer.

Conclusion: Study Participants showed overall a good quality of life. However, certain concerns related to sexual quality of life, and chronic lymphedema need special attention to improve quality of care.

Clinico-Epidemiological Profile and Treatment Outcome of Small Cell Lung Carcinoma: A Retrospective Study from a Tertiary Cancer Centre in Northeast India

Chayanika Dutta — 2024-10-05

Background: Small cell lung cancer (SCLC) accounts for 12-15% of all lung cancers and is associated with poor outcomes. This study aimed to understand the clinico-epidemiological profile and outcomes of SCLC in the North-East Indian population.

Methods: A retrospective analysis was performed on medical records of patients with SCLC who were diagnosed, treated, and followed up at the Department of Medical Oncology, Dr. B. Borooah Cancer Institute, during the period from January 2016 to December 2021.

Results: A total of 70 patients were evaluated, with a median age of 62 years, and 82.8% were male. The majority of patients (72.8%) were diagnosed with extensive-stage (ES) disease. Common symptoms included cough (61.4%), chest pain (45.7%), and breathing difficulty (44.2%). The most commonly used chemotherapy regimen was etoposide-platinum. Overall survival (OS) for all patients was 6.1 months. Three-year OS was significantly better in patients with limited-stage (LS) disease (16.4 months vs. 4.3 months in LS vs. ES disease, p<0.05). Median progression-free survival (mPFS) for all patients was 4 months. Survival rates at 6, 12, 24, and 36 months were 45.7%, 18.5%, 5.7%, and 1.4%, respectively. Median OS was significantly correlated with the number of metastatic sites (8.6 months with <3 organ involvement vs. 1.9 months with ≥3 organ involvement; p<0.0001). Patients who received combined modality treatment had better survival than those treated with chemotherapy alone (10.7 months in chemo-radiotherapy vs. 3 months in chemotherapy alone, p<0.001).

Conclusion: SCLC remains a highly aggressive disease with poor survival. Advanced-stage presentation with distant organ metastasis is the most important factor associated with poor survival in patients with SCLC1

Transfusion Practice Patterns in Cancer Patients with Anemia: A Retrospective Study from a Single Oncology Center in Najran, Saudi Arabia

Ahmed Badheeb — 2024-10-05

Background: Recent studies support the safety of restrictive pretransfusion hemoglobulin thresholds (≤7-8 g/dL) for adult cancer patients on chemotherapy. However, the restrictive transfusion strategies role in decreasing inappropriate red blood cell (RBC) transfusion practice in Saudi Arabia is not yet understood. This study aims to evaluate transfusion practices among oncologic patients at Najran Oncologic Center, Saudi Arabia.

Materials and Methods: A retrospective chart review study between January 1, 2020, and December 31, 2022, involving 59 adult cancer patients presented to King Khaled Hospital in Najran, Saudi Arabia. Clinical variables for prescribing RBC transfusions based on liberal (> 7 g/dL) or restricted (Hb < 7 g/dL) baseline hemoglobin levels and number of transfused RBCs were investigated in univariate analysis.

Results: The mean age was 65.0 ±10.2 years, and most cases were male (n=40, 67.8%). The common primary tumor location was colorectal cancers (n=27, 45.8%), and most cases were in metastatic stages (n=44, 74.6%). The majority of cases (n=36, 61.0%) had severe anemia (Hb < 7 g/dL) at admission. The mean number of RBC units received was 4.9 ±2.4 RBC. Variables associated with restricted prescribing RBC transfusions were male gender (OR: 3.21; 95% CI: 1.05-10.33, p= 0.044), high ECOG-PS status (OR: 2.95; 95% CI: 1.01-9.03, p=0.048), cardiac disease history (OR: 2.05; 95% CI: 0.69-6.44, p= 0.009), and platinum-based chemotherapy (OR: 233.33; 95% CI: 33.12-5054.45, p <0.001). However, survival status was higher among patients with restrictive strategy (OR: 0.25; 95% CI: 0.08-0.73, p= 0.025). Factors associated with an increased number of transfused RBCs were male gender (OR:1.43; 95% CI: 1.07-1.93, p= 0.012), platinum-based chemotherapy (OR:1.55; 95% CI: 1.18-2.15, p= 0.004), history of bleeding (OR: 1.31, 95% CI: 1.02-1.73, p= 0.032), and history of cardiac disease (OR: 1.31 (1.02-1.73; p= 0.002).

Conclusion: The study concluded that factors like male gender, platinum-based chemotherapy, bleeding history, and concurrent cardiac disease were associated with an increased number of RBC transfusions. In addition to that, we found a clear adherence to the clinical practice guidelines among the transfused patients. The study suggests an etiology-based approach to cancer-related anemia and transfusions, enabling clinicians to plan safe, targeted therapy and improve patients’ quality of life by synchronizing chemotherapy efficacy.

Radiation Induced Thyroid Gland Changes in Nasopharyngeal Carcinoma Patient after Chemoradiotherapy in DR Sardjito Public Hospital

Sagung Rai Indrasari — 2024-10-16

Objective: The objective of this study was to determine the volumetric change in thyroid gland in nasopharyngeal carcinoma patients after undergoing chemoradiotherapy that could alter thyroid gland function. Furthermore, this study correlates the mean dose effect towards the decrease in thyroid volume to predict the outcoming clinical signs of radiation induced hypothyroidism (RHT).

Methods: This study consists of a cross sectional retrospective evaluation of multiplanar image that comprised three planes of axial, coronal, and sagittal of all NPC patients who underwent chemoradiotherapy and received a computed tomography (CT) imaging before and three months after completing treatment to the evaluate the alteration of thyroid volume.

Result: A significant decreased in thyroid volume between pre and 3 months post chemoradiotherapy was obtained in the result with p value < 0.001, along with the mean dose of 58 Gray effect towards the decreased thyroid volume with p value = 0.005.

Conclusion: Our study demonstrated that reduction in thyroid volume may be seen as early as 3 months after chemoradiotherapy in nasopharyngeal carcinoma that correlates with mean dose effect towards the thyroid volume. This volume changes also accompanied by the alleviation of free T3 and free T4 before and after chemoradiotherapy. Therefore, efforts should be made to do an early evaluation of radiation induced hypothyroidism (RHT). Early treatment and additional evaluation might be considered to enhanced the quality of life of the nasopharyngeal carcinoma patient. Highlights/Key points: Significant decreased in thyroid volume and its function among NPC patients evaluated by CT imaging and thyroid panel. Correlation of the mean dose volume effect towards the decrease in thyroid volume. Prediction of the outcoming clinical signs of radiation-induced hypothyroidism in NPC patients after chemoradiotherapy.

A Prospective Interventional Study to Compare Induction Chemotherapy Followed by Definitive Chemoradiation Versus Definitive Chemoradiation in Locally Advanced Carcinoma Cervix Patients

Naresh Kumar Saini — 2024-10-16

Background: Cervical cancer is the fourth most commonly diagnosed cancer and the fourth leading cause of cancer death in women worldwide. Every year in India, 1,23,907 women are diagnosed with cervical cancer and 77,348 die from the disease. In India majority of patients of carcinoma cervix presented in locally advanced stage. Chemoradiation followed by brachytherapy is the standard of care for management of locally advanced cervical cancer but failure to control systemic disease occurs in one third of patients. Neoadjuvant chemotherapy, however, has been tested in various studies in cervical cancer for many years without success. In this study, we compared induction chemotherapy with 3weekly paclitaxel and cisplatin followed by chemo-radiation versus definitive chemo radiation.

Materials and Methods: In this study 100 histopathologically proven squamous cell carcinoma cervix, locally advanced patients were included,the study group (n=50) received induction chemotherapy followed by definitive chemoradiation while the control group (n=50) received definitive chemoradiation.

Results: The median age was 51 years (Range 32 – 65 years). Majority of patients was FIGO stage IIB (23%), IIIB (61%). In study arm 42 patients (84%) had complete response, and 7 patients (14%) had partial response. In control group 40 patients (80%) had complete response and 8 patients (16%) had partial response. Overall response rate was 98% in study group and 96% in control group. (p value=0.991, statistically insignificant). Grade 2 and 3 haematological toxicities were higher in study group as compare to control group. Among gastrointestinal toxicities (nausea, vomiting and diarrhea) grade 1 toxicity in study group and grade 2 toxicity in control group was slightly higher. (statistically insignificant).

Conclusion: Induction chemotherapy with paclitaxel and cisplatin prior to standard chemoradiation provides similar results to chemoradiation alone with respect to response to treatment. Complete response rate was better achieved in study arm. In developing countries like India with limited resources and increasing cancer patient’s burden, induction chemotherapy followed by chemoradiation can be an alternative to standard care without compromising outcome and with manageable toxicities.

Study of the Excess Cost Associated with Drug Wastage Due to Limited Vial Size Options of the Intravenous Drugs for Anti-cancer Treatment, Among Patients Receiving Such Treatment at Tata Memorial Hospital

Atul Tiwari — 2024-10-21

Aims and Objectives: To evaluate the drug wastage and additional costs (in INR) resulting from leftover or unused drugs due to limited vial strength options, and to propose vial size recommendations to pharmaceutical companies tailored to Indian requirements.

Material and Methods: A total of 500 adult patients attending daycare oncology were prospectively evaluated. Mean, median, mode and left over or unused drug dose for each chemotherapy drugs were calculated. The economic loss estimation was done considering the unit cost for the drug.

Result: The overall drug wastage for 500 prescriptions was 57,836 mg, accounting for 8.67% of the total prescribed dose. This resulted in an economic loss of 1,02,562 INR, which is 6.26% of the total cost. The highest proportions of drug wastage were observed for vincristine (28.72%), etoposide (23.20%), bleomycin (18.5%), pemetrexed (17.10%), nab-paclitaxel (16.37%), vinblastine (14.70%), Adriamycin (11.76%), and carboplatin (11.36%). The maximum economic loss was attributed to carboplatin (19.66%), nab-paclitaxel (17%), etoposide (14.5%), oxaliplatin (9.45%), and pemetrexed (7%). In combination chemotherapy regimens, gemcitabine-cisplatin-nab-paclitaxel (18.52%), pemetrexed-carboplatin (11.82%), and carboplatin-etoposide (8.97%) were responsible for the highest monetary losses due to drug wastage.

Conclusion: Drug wastage due to oversized chemotherapy vials imposes significant financial and environmental burdens. We recommend offering additional vial size options for carboplatin, etoposide, gemcitabine, nab-paclitaxel, irinotecan, vincristine, and 5-FU. We hope this will reduce drug wastage to below 1-2%.

Perception and Belief of Dietary Intake among Newly Diagnosed with Gynaecologic Cancer in Malaysia: A Qualitative Study

Chiou Yi Ho — 2024-11-23

Background: Gynaecologic cancers (GC) experience unintentional weight loss and inadequate oral intake even before treatment. Cancer patients are at risk of accessing inaccurate advice and misleading information due to the prevalence of misinformation regarding nutrition and cancer in the media. This study aimed to obtain a comprehensive understanding of the perception and belief of dietary intake among newly diagnosed with GC in Malaysia.

Methods: We conducted in-depth qualitative interviews with 12 GC respondents from three major ethnicities and continued until the saturation point was reached. A semi-structured interview guide is employed. The interviews were audio recorded and verbally transcribed. Thematic analysis with theoretical saturation was applied to data analysis.

Results: The majority of patients interviewed reported that they made dietary modifications following their GC diagnosis, such as healthy eating, and began taking supplements. Their belief and perception of dietary intake were influenced by the impact of diagnosis, uncertainty, and fear of cancer progression and empowerment through nutrition. The cultural influence and access to resources and information might affect their dietary intake. There was evidence of navigating information overload from various sources after newly diagnosed GC. They felt a dilemma in food choices, balancing emotional and nutritional needs. The multidisciplinary support systems and healthcare delivery approach were useful.

Discussion and conclusion: The perception and belief of dietary intake among newly diagnosed with GC in Malaysia is diverse and can vary greatly depending on individual experiences, beliefs, and situations. They may attempt to restore some control over their health in the face of a cancer diagnosis. All respondents admitted that they changed to a healthy diet after being diagnosed with GC. The healthcare profession might benefit from current qualitative research to better understand more patients and increase the quality of oncology dietetic service and decision-making. Hence, effective dietary interventions and support strategies could be established for this population.

Prospective Observational Study on Esophagitis in Breast Cancer Patients with Supraclavicular Nodal Irradiation - A Common Predicament

Gyanendra Kumar Patro — 2024-11-23

Background: The present study aimed to assess the dosimetric parameters that may be associated with oesophagitis in patients with breast cancer undergoing three-dimensional radiotherapy.

Methods: A single-arm study was conducted on 25 breast cancer patients. Enrolled patients received 40.05Gy in 15 fractions to the chest wall and supraclavicular nodes with 3DCRT. Toxicity grading was examined once a week to assess the onset of grade 2 esophagitis in respective patients. Analyzed parameters incorporate mean oesophageal dose and maximum doses to the esophagus, esophagus volume, and oesophageal length within the supraclavicular nodal PTV treatment area.

Results: The mean age was 43.48 years and Grade 2 oesophagitis was noted in 13 of the 25 patients (52%). The onset of oesophagitis was significantly associated with the oesophageal length associated with the treating area (p= 0.04). The laterality of disease did not show a significant relation (p=0.93). For the commencement of grade 2 oesophagitis, odds ratios were 2.33 (95% CI=1.1-3.89, p=0.02) for a mean esophageal dose ≥12Gy and 2.5 (95% CI=1.2-5.18, p=0.04) for ≥ 4.5 cm of esophagus length within supraclavicular nodal PTV area.

Conclusion: In patients receiving radiation to the supraclavicular area, the mean oesophageal radiation dose and oesophageal length included in the treatment area correlate with the development of acute oesophagitis, which can be minimized by reducing those two parameters.

Exploring Multiple Primary Malignancies: An Institutional Experience with Dual Malignancy Cases

Kiran PK — 2024-11-23

Objective: To determine the incidence, clinical characteristics, and survival outcomes of patients with multiple primary malignancies at a tertiary care cancer centre.

Methods: A retrospective analysis of 28 patients (11 males, 17 females) with histologically confirmed multiple primary malignancies was conducted from 2020 to 2022. Data on demographic characteristics, tumour sites, histopathology, staging, and survival were collected. Kaplan-Meier method was used for survival analysis with log-rank tests for group comparisons.

Results: The incidence of multiple primary malignancies was 0.73%. Metachronous tumours (67.9%) were more common than synchronous tumours (32.1%). Breast cancer was the most frequent primary (32.1%) and secondary (28.6%) malignancy. Mean survival time significantly differed between males (198.0 months, 95% CI: 76.8-122.4) and females (125.2 months, 95% CI: 88.5-162.0, p=0.093). Advanced stage presentation was common, with 42% of primary and 25% of secondary tumours diagnosed at stage III. The event-free survival was higher for metachronous than synchronous malignancies (log-rank p<0.05). Among patients, 28.6% had a positive family history, and 17.9% reported substance addiction.

Conclusion: Multiple primary malignancies show distinct patterns in incidence, tumour site distribution, and survival outcomes, with metachronous presentations and breast cancer predominance being key characteristics in our population.

Elevated FISH Her-2/neu Amplification in ER Positive, IHC Her-2 Equivocal Invasive Breast Cancer Patients of North-East India

Priyanki Baruah — 2024-12-16

Background: Breast cancer management of Her-2 equivocal breast cancer patients requires assessment by fluorescent in situ hybridization (FISH) for Her-2/neu amplification. Assessment of FISH Her-2/neu amplification status in IHC Her-2 equivocal invasive breast cancer patients of North-East India.

Methods: One hundred sixty-two (n=162) IHC Her-2 equivocal (2+) breast cancer patients were analysed by FISH for Her-2/neu amplification using PathVysion Her-2/neu DNA probe kit. The interpretation of FISH Her-2/neu amplification was based on ASCO/CAP 2018 guidelines.

Results: FISH Her-2/neu amplification was detected in 59.26% (n=96) patients and 40.74% (n=66) patients had no amplification. There were 160 female and 2 male patients. ER-positive patients were 68.51% (n=111) and PR-positive were 54.93% (n=89). “ER+/PR+” status was found in 54.93% (n=89) patients whereas “ER-/PR-’’ in 31.48% (n=51) patients. Significant association was observed between histological grade and FISH Her-2/neu amplification (p=0.036). ER-positive patients had also shown significant association with FISH Her-2/neu amplification (p=0.039). ER+/PR+ patients had shown a trend for higher likelihood of FISH Her-2/neu amplification (p=0.053). There were no significant association observed between FISH Her-2/neu amplification with age (p=0.625), lymph node positivity (p=0.642), laterality (p=0.367), histopathology (p=0.226) and PR-positivity (p=0.199).

Conclusion: FISH Her-2/neu amplification in IHC Her-2 equivocal breast cancer patients of North-East India was found to be significantly associated with ER-positive status and histological grade. ER+/PR+ patients have also an enhanced likelihood of FISH Her-2/neu amplification.

Narrow Band Imaging in Laryngeal Lesions:A Valuable Tool in Decision Making

Deepa Swaminathan — 2024-12-16

Objective: To assess the efficacy of Narrow band Imaging (NBI) in detecting laryngeal malignancies by statistical analysis.

Methods: This prospective, observational study was conducted from 1^st September 2022 to 31^st December 2023. All patients above 18 years, who were scheduled to undergo nasopharyngolaryngoscopy with biopsy for laryngeal lesions, were included. Total 84 patients were included who were divided into two groups, Group A- with no previous treatment, Group B- with previous radiation to the larynx. They underwent routine white light endoscopy followed by NBI and grading was determined. Suspicious areas were biopsied and sent for histopathology. Based on the final report, the diagnostic accuracy was assessed using area under the curve (AUC) in ROC curve, sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy.

Results: Group A included 54 patients. Thirty-five had a clearly malignant lesion on WLE, however NBI showed Grade IV IPCL pattern in three. The final histopathology in them showed squamous cell carcinoma (p value 0.019). One patient had vocal cord leukoplakia on WLE which showed Grade IV NBI pattern. The histopathology showed early squamous cell carcinoma. The remaining 18 had equivocal lesions on WLE with six showing Grade V NBI pattern. The final histopathology showed squamous cell carcinoma in five and moderate dysplasia in one (p value 0.574). Statistical analysis in Group A showed WLE had a sensitivity of 80.49% whereas NBI had 82.93 %. Specificity of WLE was 71.43% and NBI was 69.23%. Group B included 30 patients. Nineteen had malignant lesions on WLE. Of them 2 had Grade IV NBI pattern and one of them showed squamous cell carcinoma in histopathology (p value 1.000). Eleven patients had equivocal lesions in WLE and NBI in 6 showed Grade V pattern. Of these, four showed squamous cell carcinoma on histopathology, one had sarcoma and one showed mild to moderate dysplasia (p value 0.261). Statistical analysis showed WLE had a sensitivity of 69.23% while NBI had 88%. Specificity of WLE was 75% while NBI had 80%.

Conclusion: We found that NBI in post irradiation setting, showed higher sensitivity and specificity. Hence it can aid in early detection of recurrent lesions that may otherwise be masked by treatment related changes.

Adrenal Myelolipoma with Synchronous Ipsilateral Clear Cell Type Renal Cell Carcinoma: A Case Report with Review of Literature

Mahamaya Sharma — 2024-10-05

Adrenal myelolipomas, typically benign and nonfunctional, are uncommon tumors found incidentally in the adrenal gland, unlike the more prevalent renal cell carcinoma in the kidney. The occurrence of synchronous renal cell carcinoma with adrenal myelolipomas is exceptionally rare, with only a few sporadic case reports documented in the literature spanning over six decades. Here, we present a case of a 67-year-old obese male who complained of colicky left upper abdominal pain, accompanied by a significant medical history of type 2 diabetes and hypertension. Ultrasonography revealed a large space-occupying lesion in the middle pole of the left kidney. Subsequently, left radical nephrectomy and adrenalectomy were performed, and the specimens were sent for histopathological examination, confirming the diagnosis of adrenal myelolipoma with synchronous renal cell carcinoma

Review on Histopathological Techniques in Cervical Cancer Screening

Matthias Solomon Gamde — 2024-11-23

Histopathological techniques remain the basis for cervical cancer care by making diagnosis and model treatment options to improve patient outcomes. It involves the examination of cervical tissue samples to establish a diagnosis, grade precancerous lesions, and stage invasive cancer that guide treatment options. We examined published reports and provided updated information on histopathological techniques in cervical cancer screening using the PRISMA guidelines for review. Histopathology examination is used to confirm precancerous lesions and stage invasive cancer. Accumulated data obtained also informs healthcare providers about the severity of the lesions, allowing decisions for personalized treatment plans and prognosis. While cytology screening is an important tool for cervical cancer screening, histopathological techniques are indispensable to confirm the diagnosis and determine appropriate treatments. Therefore, it is essential to continue streamlining the techniques and scoring patterns to guarantee for their reliability in various contexts.

Dissecting the Tumor Microenvironment (TME) to Decipher New Immunotherapy Targets by Using Artificial Intelligence

Mohd Umar Rehmani — 2024-11-23

Cancer remains one of the leading causes of death worldwide, second only to cardiovascular diseases. Standard cancer treatments, such as chemotherapy, radiation, and surgery, are effective for primary tumors but often fail to eliminate disseminated tumor cells responsible for metastasis. This limitation underscores the necessity for advanced therapeutic strategies, leading to the rise of immunotherapy, which leverages the immune system to combat cancer. Despite its promise, immunotherapy faces challenges, including variable patient responses and immune-related toxicities, complicating the prediction of treatment efficacy. Here, artificial intelligence (AI) emerges as a vital tool that can enhance the precision and effectiveness of immunotherapy by analyzing the intricate tumor microenvironment (TME). This paper explores the limitations of current immunotherapies and examines how AI can address these challenges. It discusses the TME’s role in shaping immune responses, highlighting how understanding its complexities can improve predictive power and treatment outcomes. Furthermore, we address the limitations of AI in cancer research and propose future directions for its integration into clinical practice, with the potential to revolutionize personalized cancer therapy and improve overall patient care.

Bioactive Peptides: A Complementary Approach for Cancer Therapy

Nazanin Khademi — 2024-12-16

Background: The relentless pursuit of effective cancer treatments has led researchers to explore bioactive peptides as a complementary approach to cancer therapy. These peptides, which can be of natural or synthetic origin, are not only identified as potent therapeutic agents but also exhibit significant diagnostic capabilities. The review aims to summarize the properties, classification, and mechanisms of action of these natural peptides on different cancer cell lines, suggesting their potential as safer and more effective cancer treatments.

Objective: To provide an in-depth exploration of bioactive peptides derived from natural sources, revealing their anticancer properties and theoretical models that explain their actions. The review also addresses the complexities of ACP production and classification and sheds light on their potential as less harmful and more precise alternatives to conventional cancer therapies.

Method: The review includes a comprehensive analysis of the literature on bioactive peptides, focusing on their origin, properties, classification, and mechanisms of action. It examines various theories that explain the effect of bioactive peptides on cancer cells and discusses the natural sources of these peptides, their production processes, and classification into different types of ACPs.

Findings: The review identifies a range of bioactive peptides with anticancer properties from various sources, including animals, plants, fungi, and marine organisms. These peptides act through diverse mechanisms, such as membrane disruption, apoptosis induction, and immune system modulation. The review provides a detailed account of the peptides’ effects on different cancer cell lines and their potential therapeutic applications.

Discussion and Conclusion: The review concludes that bioactive peptides offer a promising avenue for cancer therapy, with the potential to revolutionize treatment landscapes. It emphasizes the need for further research to fully realize the therapeutic potential of these peptides and their role in the future of cancer treatment. The review also highlights the importance of understanding the structure-function relationship of bioactive peptides to enhance their therapeutic efficacy and reduce systemic toxicity.

Tackling the Rare: Thymoma and T-Cell Acute Lymphoblastic Leukemia Coexistence

Maryam Imran — 2024-10-05

Thymomas are rare tumors arising from thymic epithelial cells, while T-cell acute lymphoblastic leukemia (T-ALL) is a rare hematologic malignancy. The co-occurrence of these entities within the same patient is exceedingly rare and presents unique diagnostic and therapeutic challenges. We present a case of a 29-year-old male with a history of thymoma complicated by T-ALL. The patient was first presented with symptoms of superior vena cava obstruction syndrome, which led to thymoma diagnosis. Subsequent progression of symptoms and investigations revealed the presence of T-ALL. The patient was managed with chemotherapy, radiotherapy, and supportive care, with a favorable response. This case highlights the importance of considering rare malignancies in the differential diagnosis, the challenges of managing concurrent rare malignancies, and the need for multidisciplinary approaches in such cases. Further research is warranted to better understand the underlying mechanisms and optimal management strategies for these rare coexisting malignancies.

Prostatic Leiomyosarcoma: Case Report

Rohit Saini — 2024-12-16

Leiomyosarcoma of prostate is one of the rarest malignancies which is encountered in oncology practice. Symptomatically patients present with obstructive urinary complaints with no specific tumour marker or PSA abnormal value. Due to the limited number of cases till now no specific guidelines for treatment, diagnosis is available. Mostly treated on experience based on other prostate malignancy and sarcoma of other sites. Here we are reporting a case of primary prostatic leiomyosarcoma of a 17-year-old male and challenges regarding his diagnosis and treatment.

Precision in Delivery: The Critical Role of Daily Imaging in Radiotherapy for Nasopharyngeal Cancer with VMAT Technique

Papu Das — 2024-11-23

Nasopharyngeal cancer (NPC) presents unique challenges in radiotherapy due to its complex anatomical location and proximity to critical structures. Volumetric Modulated Arc Therapy (VMAT) has emerged as a highly effective technique, offering precise dose distribution to the target volume and spearing of surrounding normal tissues and organ at risks (OARs). The integration of daily imaging in the treatment of NPC with VMAT is pivotal in enhancing treatment accuracy, patient safety and overall clinical outcomes. Daily imaging, utilizing technologies such as cone beam computed tomography (CBCT) and kilovoltage (KV) or megavoltage (MV) imaging plays a crucial role in verifying patient positioning and adapting to anatomical changes. This practice ensures that the radiation is delivered accurately to the target area while minimizing exposure to adjacent healthy tissues and OARs. By facilitating real-time adjustments, daily imaging allows for reduced safety margins around the tumor, thus optimizing the therapeutic ratio. Furthermore, daily imaging contributes to adaptive radiotherapy by monitoring tumor shrinkage and shifts in patient anatomy over the treatment course. This adaptability is essential for maintaining dose precision, particularly in the nasopharyngeal region where minor deviations can significantly impact treatment efficacy and toxicity. Clinical studies have consistently demonstrated that the use of daily imaging in VMAT for NPC leads to improved treatment accuracy, reduced recurrence rates and better preservation of critical structures. The ability to detect and correct for set-up errors and anatomical variations on a daily basis significantly enhances the overall treatment quality. In conclusion, daily imaging is indispensable in the management of nasopharyngeal cancer treated with VMAT. It not only ensures precise delivery of radiation therapy but also enhances patient outcomes by allowing for real-time adjustments and reducing unnecessary radiation exposure. As technological advancements continue, the role of daily imaging in radiotherapy will likely become even more integral, further improving the effectiveness and safety of cancer treatments.