Indian Journal of Cancer
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   Table of Contents - Current issue
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July-September 2016
Volume 53 | Issue 3
Page Nos. 345-469

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MOLECULAR ONCOLOGY: ORIGINAL ARTICLES  

Epidermal growth factor receptor expression in gastric tumors and its relationship with the germline polymorphisms − 216 G>T, −191 C>A, (CA) n IVS1, and R521K Highly accessed article p. 345
JH Torres-Jasso, AR Bustos-Carpinteyro, JR Garcia-Gonzalez, J Peregrina-Sandoval, JA Cruz-Ramos, E Santiago-Luna, JY Sanchez-Lopez
DOI:10.4103/0019-509X.200648  PMID:28244453
BACKGROUND: Gastric cancer (GC) is the third worldwide leading cause of cancer-related death affecting both sexes. The aberrant expression of epidermal growth factor receptor (EGFR) gene has been detected in many human epithelial malignancies and linked to advanced disease, more aggressive phenotype, and poor prognosis. AIMS: To analyze the relation that the expression of EGFR in gastric tumors holds with pathological characteristics and with the germline polymorphisms −216 G>T, −191 C>A, (CA) n IVS1, and R521K. MATERIALS AND METHODS: We studied 22 biopsies from gastric tumors obtained by endoscopy. EGFR expression was determined by relative quantification real-time polymerase chain reaction with the glyceraldehyde-3-phosphate dehydrogenase reference gene (as for messenger RNA [mRNA]) and by immunohistochemistry (IHC) (as for protein). EGFR germline polymorphisms were analyzed by sequencing, GeneScan, and restriction fragment length polymorphisms. RESULTS: EGFR mRNA expression was increased (>2-fold) in 13.6% of GC cases, decreased (<0.5-fold) in 68.2%, and normal in 18.2%; overexpression was related to well-differentiated gastric tumors, whereas underexpression was linked to moderate or poorly differentiated gastric tumors (P < 0.001). EGFR protein expression was high (IHC 2+ and 3+) in 29.4% of gastric tumors and was normal or low (score 0 to 1+) in 70.6% cases. EGFR expression, in both mRNA and protein, was not related to any EGFR polymorphism (P > 0.05). CONCLUSIONS: Most gastric tumors showed low EGFR expression (mRNA and protein), whereas EGFR overexpression was related to well-differentiated gastric tumors. Furthermore, germinal polymorphisms −216, −191, (CA) n IVS1, and R521K were not related to EGFR expression (mRNA or protein).
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Applicability of a single 5 color cytoplasmic markers tube as primary panel for immunophenotyping of acute leukemia: A Gujarat Cancer and Research Institute experience p. 349
BP Parikh, SP Patel, BN Raiya, HH Vora, DH Jetly
DOI:10.4103/0019-509X.200659  PMID:28244454
INTRODUCTION: Flow cytometry is highly sensitive for detection and quantitative analysis of surface and intracellular antigens in malignant hemopoietic cells. Immunophenotyping is a routine practice for classification and lineage assignment of acute leukemia. In the present study, our aim is to identify the role of a single 5 color, CD45, myeloperoxidase (MPO), cCD79a, cCD3, and Tdt, cytoplasmic markers combination as a primary tube. We compared with final diagnosis on the basis of morphology, cytochemistry, and primary and secondary panels of immunophenotyping and also with other study. MATERIALS AND METHODS: We have included 455 new cases of acute leukemias with applied primary and secondary panels of markers for immunophenotyping. We analyzed sensitivity and specificity of different subsets with combination of positive and negative markers. RESULTS: MPO was positive in 61.4% of acute myeloid leukemia (AML) cases. All 184 (100%) cases of the AML were negative for cCD3 and cCD79a co-expression. cCD79a expression was highly sensitive as 98.5% B-acute lymphoblastic leukemia (B-ALL) expressed it. cCD3 expression was detected in 100% cases of T-ALL, and its co-expression was not seen in B-ALL and AML. CONCLUSION: Our study indicates that there was very good correlation of 5-color cytoplasmic tube-based diagnosis versus final diagnosis based on morphology, cytochemistry, and flow cytometry. We can use this 5-color cytoplasmic tube method to make immunophenotyping cost-effective.
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BREAST CANCER: ORIGINAL ARTICLE Top

Epidemiological and survival analysis of triple-negative breast cancer cases in a retrospective multicenter study p. 353
R Sarin, L Khandrika, RNM Hanitha, A Avula, M Batra, S Kaul, H Raj, S Shivkumar, S Gupta, E Khan, TPS Bhandari, SVSS Prasad, VA Reddy, G Swarnalata, M Bakre, S Chatterjee, J Jain
DOI:10.4103/0019-509X.200682  PMID:28244455
INTRODUCTION: This is a retrospective study with data collected from breast cancer cases from five major Apollo Hospitals across India, as part of a biobanking process. One aspect of our study focused specifically on data from triple-negative breast cancer (TNBC) cases. The aim of this study was to analyze epidemiology, treatment options, and survival of the patients with TNBC. Our goal was to draw conclusions on the preponderance of the disease and also to understand the outcomes using the existing therapy options. MATERIALS AND METHODS: Data were collected after due ethical clearances and were coded with regard to patient identifiers to protect patient privacy. Data were not only from the various departments of the respective hospitals and the treating physicians but also from the follow-up made by hospital staff and social workers. RESULTS: About 20% of all cases of breast cancer comprised TNBC. Although the disease is generally thought to be an early onset disease, there was no major difference in the median age of diagnosis of TNBC compared to other breast cancer cases. More than 85% of the TNBC cases were of early stage disease with <4% of the cases of metastatic cancer. Data on follow-up were somewhat sporadic as a good number of cases were lost to follow-up, but from the available data, recurrence rate was about 11%. Death, when it occurred, was mostly in the early periods of treatment with 35% of the events occurring before 3 years. The overall survival rates beyond 3 years were more than 86%. CONCLUSIONS: Data and sample collection are an ongoing process, so we expect this data set to be enriched with more cases and longer duration of follow-up in a year. Preliminary analysis sheds light on the potential of such a collection both for understanding the epidemiology of the disease and also for conducting future studies with an eye toward improving treatment outcomes.
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LETTER TO THE EDITOR Top

The male breast cancer: Epidemiological data from the North of Peru p. 359
G Flores-Trujillo, E Serrano-LaBarrera
DOI:10.4103/0019-509X.200652  PMID:28244456
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BREAST CANCER: ORIGINAL ARTICLES Top

Incidence and pattern of bone metastases at presentation in Indian carcinoma breast patients p. 360
SM Doddala, A Suryadevara, SK Chinta, AL Madisetty
DOI:10.4103/0019-509X.200655  PMID:28244457
BACKGROUND: Breast cancer (BC) is the most common female cancer and frequently metastases to the bones. Breast cancer among Indian women occurs a decade earlier and more aggressive than the western population. Screening guidelines are based on western studies. The aim of our study is to assess the role of Technitium99m bone scan (TBS) in screening Indian EBC patients at presentation. We also looked at the pattern of BM in all stages of BC. METHODS: Patients with BC who had TBS at presentation from January 2012 to September 2015 were included in the study. RESULTS: Bone metastases were seen in 23.42% (241/1029). Of these, 10.06% (31/308) EBC, 25.60% (169/660) locally advanced BC (LABC) and 63.93% (39/61) of metastatic BC (MBC) patients had BM. Most common sites of BM were spine and pelvis. In long bone and sternum, proximal part was commonly involved. CONCLUSION: The incidence of BM in Indian BC patients at presentation is higher than western population. The incidence of BM per stage is similar to west. So TBS should be done in LABC and symptomatic EBC. There is high incidence of BM to spine and pelvis. In pelvis, SI joints and ilium and in long bones and sternum, proximal parts were commonly involved.
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The pattern of invasive lobular carcinoma in the patients diagnosed with breast cancer from Balochistan p. 363
AH Baloch, AN Khosa, N Bangulzai, H Sadia, M Ahmed, F Khan, M Jan, M Tareen, MH Kakar, J Shuja, HK Naseeb, J Ahmad
DOI:10.4103/0019-509X.200672  PMID:28244458
Introduction: Invasive lobular carcinoma (ILC) is the second most common type of breast cancer accounting for 5%–15% of all the breast cancer cases. The present study was performed on 171 breast cancer patients from Balochistan registered in CENAR (Center for Nuclear Medicine and Radiotherapy), Quetta. Materials and Methods: Written consent was obtained from the patients. The history of the disease was taken from the patients, and the patients' enrollment files were retrieved. Results: Of the 171 patients, 5 (2.96%) were diagnosed with ILC with tumor Grade II, and stage of the cancer reported was Grade III in all the 5 patients affected with ILC. Conclusion: ILC is the second most common type of breast cancer diagnosed with comparatively lower grade but almost reported infiltrating.
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LETTER TO THE EDITOR Top

Utility of driver mutation p. 365
V Sharma, VM Patil, V Noronha, A Joshi, K Prabhash
DOI:10.4103/0019-509X.200665  PMID:28244459
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BREAST CANCER: ORIGINAL ARTICLE Top

Alteration in steroid hormone and Her-2/neu receptor status following neoadjuvant chemotherapy in locally advanced breast cancer: Experience at a tertiary care centre in India p. 366
P Ramteke, V Seenu, R Prashad, SD Gupta, V Iyer, SVS Deo, A Gogia, S Mathur
DOI:10.4103/0019-509X.200669  PMID:28244460
CONTEXT: Use of neoadjuvant chemotherapy (NACT) in locally advanced breast cancer (LABC) enables tumor reduction and conservative surgery. It is proposed in some studies that there may be an alteration in the hormonal receptor (HR) status and human epidermal growth factor receptor 2 (Her-2)/neu immune-expression following NACT. AIMS: To study the status of estrogen receptor (ER), progesterone receptor (PR), and Her-2/neu receptor before and after NACT in LABC. MATERIALS AND METHODS: HR and Her-2/neu status were evaluated by immunohistochemistry on 100 core needle biopsy of primary tumors and surgical specimens after receiving NACT (NACT group); fifty patients without NACT served as non-NACT group, and discordance was compared between the two groups. RESULTS: In the NACT group, discordance of 17%, 13%, and 11% was noted in ER, PR, and Her-2/neu status, while in non-NACT group, discordance seen in ER, PR, and Her-2/neu was 8%, 8%, and 4%, respectively. CONCLUSIONS: There was a significant alteration in ER and Her-2/neu status from the core biopsy to the treated resected tumor in the study group. As these changes may impact treatment, HR and Her-2/neu expression reanalysis in final surgical specimens is recommended.
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HEAD AND NECK CANCER: ORIGINAL ARTICLE Top

Induction chemotherapy with cisplatin and ifosfamide in locally advanced inoperable squamous cell carcinoma of the head and neck: A single-institution experience p. 372
S Zaheer, SA Siddiqui, M Akram, SA Hasan
DOI:10.4103/0019-509X.200661  PMID:28244461
BACKGROUND: Induction chemotherapy (ICT) in patients with head and neck cancer has been studied since a long time. The addition of taxanes to the cisplatin and 5-fluorouracil (5FU) (PF) regimen results in superior antitumor activity. We did this study to see the response and toxicity of ICT with cisplatin and ifosfamide followed by concurrent chemoradiotherapy (CRT) in locally advanced, unresectable squamous cell carcinoma of head and neck (SCCHN). AIMS: The aim of this study was to see the results of ICT using cisplatin and ifosfamide regimen in locally advanced unresectable SCCHN in terms of acute and chronic toxicity and response to treatment. MATERIALS AND METHODS: Patients with Stage III and IV, nonmetastatic SCCHN were enrolled in the study. They were given two cycles of ICT with cisplatin and ifosfamide followed by CRT. RESULTS: After ICT, the overall response rate (ORR) was 75.0% at the primary site and 70.0% at the nodal site. ORR for combined primary and nodal disease was observed to be 67.5%. The complete response (CR) and partial response (PR) for combined primary and nodal site were seen in 4 (10.0%) and 23 (57.5%) patients. Of 32 patients who received CRT after ICT, CR was 53.1% and PR was 31.3%. Mucositis, skin reaction, and pharyngeal and laryngeal toxicities were the most common but tolerable. CONCLUSION: ICT with cisplatin and ifosfamide gives comparable results to the standard paclitaxel, PF regimen. We conclude that this combination regimen for ICT is not only an economical alternative of taxol-based regimen but also well tolerated by the patients.
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LETTER TO THE EDITOR Top

Seminoma of solitary testis: A case report p. 376
I Rana, A Lukram
DOI:10.4103/0019-509X.200667  PMID:28244462
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HEAD AND NECK CANCER: ORIGINAL ARTICLE Top

Pediatric nasopharyngeal carcinoma: Experience from a tertiary cancer center in India p. 377
V Radhakrishnan, P Kumar, S Totadri, P Ganesan, G Selvaluxmy, T Ganesan, M Dhanushkodi, T Sagar
DOI:10.4103/0019-509X.200663  PMID:28244463
BACKGROUND: Pediatric nasopharyngeal carcinomas (NPCs) are rare tumors. There is paucity of data on outcomes in pediatric NPC from developing countries. AIM: The present study was conducted to ascertain the outcomes of children with NPC at our center. SETTINGS AND DESIGN: A retrospective analysis of case records of pediatric NPC patients treated at our hospital was performed. PATIENTS AND METHODS: We analyzed the outcomes of 37 consecutive patients <18 years of age with pediatric NPC treated between 2000 and 2015. Patients were treated with concurrent chemoradiotherapy (CTRT) with cisplatin and 5-fluorouracil (5-FU) or CTRT with cisplatin, followed by adjuvant chemotherapy with cisplatin and 5-FU. STATISTICAL ANALYSIS: Survival was analyzed using Kaplan–Meier method, and log rank test was used to compare variables. RESULTS: The median duration of follow-up was 36.6 months. The median age of the patients was 15 years, and 22/37 (59%) patients were male. The most common presenting complaint was neck mass (70%), followed by nasal bleeding (16%). The distribution of Stage I, II, III, and IV patients was 1/37 (3%), 2/37 (6%), 13/37 (35%), and 21/37 (57%), respectively. Distant metastasis at presentation was seen in 3/37 patients. Complete response was seen in 32/37 (86%) patients. The 3-year event-free survival (EFS) for the entire cohort of patients was 60.1%. No significant difference in EFS was observed with age, gender, stage, use of 5-FU with CTRT, and nutritional status. CONCLUSION: Majority of patients with pediatric NPC present with advanced stage disease at our center. No difference in outcomes was seen with the two schedules of CTRT. Local control could be achieved in majority of patients; however, distant metastasis was the most common reason for relapse.
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LETTER TO THE EDITOR Top

Pigmented basal cell carcinoma: A rare case report p. 380
K Singh, A Sharma, T Chatterjee
DOI:10.4103/0019-509X.200673  PMID:28244464
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HEAD AND NECK CANCER: ORIGINAL ARTICLES Top

Prognostic factors effective on survival of patients with glioblastoma: Anadolu Medical Center experience p. 382
M Guden, HB Ayata, C Ceylan, A Kilic, K Engin
DOI:10.4103/0019-509X.200664  PMID:28244465
AIM: The aim of this study is to offer survival following radiation therapy using intensity-modulated radiotherapy or volumetric arc therapy with temozolomide in patients with glioblastoma. MATERIALS AND METHODS: Ninety-two previously treated patients with high-grade glioma (World Health Organization [WHO] grade IV) were studied in Anadolu Medical Center, Department of Radiation Oncology, between January 2006 and July 2015. The diagnosis was established by pathology in all cases. The median age was 59 years (range, 19–86 years). The median tumor diameter was 45 mm, and the rate of the multicentric tumors was 16.3%. The location of the tumor was temporal in 33.7%, parietal in 14.1%, frontal in 23.9%, occipital in 9.8%, and others in 18.5%. The gross total and subtotal resection were performed in 60.9% of the patients, partial resection in 26.1%, and only stereotactic biopsy in 13.0% of the patients. RESULTS: The median overall survival (OS) was 33.01 ± 4.76 months (95% confidence interval 25.64–40.38 months). 1, 2, and 5 years OS was 74.3%, 44.3%, and 31.8%, respectively. The median progression-free survival (PFS) was 27.36 ± 3.87 months (95% confidence interval 19.82–34.89 months). 1, 2, and 5 years PFS was 62.7%, 32.6%, and 27.2%, respectively. On univariate analysis, gender, extent of surgery, tumor size, Karnofsky performance status, and tumor suppressor gene (P53) were significant predictors of OS and PFS. On multivariate analysis, gender (PFS: P = 0.006, OS: P = 0.003), extent of surgery (PFS: P = 0.004, OS: P = 0.012), P53 (PFS: P = 0.003, OS: P = 0.021), and size of tumor (PFS: P = 0.005, OS: 0.012) remained significantly associated with PFS and OS. There is no statistically significant in OS and PFS between female and male (OS: log-rank: 0.79 P = 0.375, PFS: log-rank: 0.54 P = 0.465). PSF and OS were not significantly significant with total/near total resection compared with partial resection (PSF: P = 0.46 log-rank = 0.54, OS: P = 0.340 log-rank = 0.91). Patients with P53 <50% value and patients with P53 >50% value were compared and results were not found statistically significant (PSF: P = 0.917 log-rank = 0.01, OS: P = 0.892 log-rank = 0.02). For patients with tumor size <0 mm, small tumor size did not improve the PSF and OS (PSF: P = 0.291 log-rank = 1.11, OS: P = 0.288 log-rank = 1.13). CONCLUSION: Ninety-two previously treated patients with high-grade glioma (WHO Grade IV) were evaluated with multivariate analysis. Gender, extent of surgery, P53, and tumor size were found as prognostic factors affecting on survival.
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Human papillomavirus/p16 positive head and neck cancer in India: Prevalence, clinical impact, and influence of tobacco use p. 387
V Murthy, M Swain, T Teni, S Pawar, P Kalkar, A Patil, A Chande, S Ghonge, SG Laskar, T Gupta, A Budrukkar, J Agrawal
DOI:10.4103/0019-509X.200668  PMID:28244466
BACKGROUND: Limited data are available on the prevalence and prognostic significance of human papillomavirus (HPV) in squamous cell carcinoma of head and neck (SCCHN) in the Indian population. AIM: The present study aimed to determine the prevalence of HPV and p16 in an Indian cohort of SCCHN and assess their correlation and influence of tobacco use on patient outcomes. MATERIALS AND METHODS: The p16 and HPV status of 170 patients of SCCHN treated with curative chemoradiotherapy was determined using immunohistochemistry and polymerase chain reaction, respectively, and further correlated with their demographic characteristics. In addition, genotyping of HPV-positive samples was performed. Survival outcomes were analyzed and compared for both p16 positive (p16 +ve) and p16 negative (p16 −ve) population. The influence of tobacco use on outcomes was assessed. RESULTS: p16 expression was observed in 20% (34/170) cases whereas HPV positivity was detected in 39.4% (67/170) of SCCHN patients with HPV16 being the most common (91%) subtype. About 73.5% patients were p16 +ve among the tobacco users in this cohort (83.5%). Interestingly, p16 positivity was significantly associated with nonusers of tobacco (P = 0.02) and younger females (P = 0.06). The p16 +ve and p16 −ve groups did not exhibit a significant difference in the 5-year cause-specific survival (CSS) (79% vs. 72.2%), disease-free survival (DFS) (78.3% vs. 68.3%, P = 0.5), and locoregional control (LRC) (82.2% vs. 71.5%, P = 0.4). However, the outcome analyses in tobacco nonusers revealed a definite large improvement in CSS (P = 0.08) and a trend toward improvement in DFS (P = 0.15) and LRC (P = 0.11) in the p16 +ve versus the p16 −ve groups. CONCLUSION: The low prevalence of p16 positivity (20%) and dual HPV and p16 positivity (38.8%) in the studied Indian cohort indicates the low utility of p16 as a surrogate for HPV in the background of high tobacco burden. The outcomes are largely improved in a small subset of SCCHN cases comprising p16 +ve tobacco nonusers.
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Skin involvement and ipsilateral nodal metastasis as a predictor of contralateral nodal metastasis in buccal mucosa cancers p. 394
M Mair, S Nair, SK Thiagarajan, J Agrawal, D Nair, P Chaturvedi
DOI:10.4103/0019-509X.200674  PMID:28244467
CONTEXT: In view of low incidence of contralateral nodal metastasis and increase in the morbidity, the opposite neck is not routinely addressed. However, contralateral nodal metastasis is seen frequently in a certain group of patients. Identifying those factors associated with higher chances of contralateral nodal metastasis may help in optimizing the treatment. AIMS: The aim of this study was to identify prognostic factors associated with contralateral nodal metastasis in cases of buccal mucosa cancers. SETTINGS AND DESIGN: A retrospective audit of 125 patients with squamous cell carcinoma of buccal mucosa at a tertiary cancer center. SUBJECTS AND METHODS: Those cases in which lesions were reaching or crossing midline were included in this study. All cases underwent surgery as primary modality of treatment and had bilateral neck dissection. STATISTICAL ANALYSIS USED: Chi-square test is used for evaluating the variables predicting contralateral nodal metastasis. Finally, a multivariate analysis was performed using binomial logistic regression to identify those variables that were independently associated with the risk of contralateral nodal metastasis. RESULTS: Among 125 patients, 53 cases were node negative. Ipsilateral nodal metastasis was seen in 44/125 (35.2%) patients, 26/125 (20.8%) had bilateral neck node metastasis, and 2/125 (1.6%) had isolated contralateral nodal metastasis. Among these 28 patients with contralateral nodal metastasis, 26 patients had ipsilateral nodal metastasis. Ipsilateral nodal metastasis and skin involvement were independently predictive of contralateral nodal metastasis. CONCLUSIONS: Contralateral nodal metastasis in the absence of ipsilateral nodal metastasis is very rare and frozen section of ipsilateral neck dissection specimen can be an important pointer for addressing contralateral neck.
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Pediatric head and neck squamous cell carcinoma: A retrospective observational study p. 397
D Sharma, G Singh
DOI:10.4103/0019-509X.200676  PMID:28244468
BACKGROUND: Pediatric head and neck squamous cell carcinoma is very rare. Limited data are available in English literature on this issue due to paucity of cases. Hence, we retrieved data of pediatric head and neck cancer in younger age group (≤20 years of age) for evaluation of clinicopathological characteristics, treatment, and outcome of this emerging issue. MATERIALS AND METHODS: A retrospective observational study was conducted from January 2011 to December 2015 in our Department of Radiotherapy. A total of nine patients of age 20 years or younger were identified during this period for analysis in this study. Various parameters such as age, clinical features, clinical stage, and the treatment received by the patients were recorded and analyzed for outcome. RESULTS and DISCUSSION: Median age of presentation was 19 years with male:female ratio 8:1. The most common subsite involved was tongue > buccal mucosa > tonsil > retromolar trigone. Surgery was preferred treatment modality followed by adjuvant therapy (radiotherapy/chemotherapy). Complete response was shown in 62% cases. Disease progression was found in 25% of cases. On median follow-up of 8 months, 25% of patients had developed local recurrence, none showed metastatic disease. CONCLUSION: The rarity of these tumors inevitably results in a paucity of high-level evidence to guide treatment. It has a high impact on the quality of life, cosmetic outcomes, and secondary malignancies may develop with increased survival. More clinical studies to be conducted to establish etiopathological characteristic and treatment guidelines in this issue.
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Squamous cell carcinoma of the oral cavity and oropharynx in young adults p. 399
D Sharma, G Singh
DOI:10.4103/0019-509X.200681  PMID:28244469
BACKGROUND: Head and neck squamous cell carcinoma (SCC) is a disease of older age group predominately in the sixth and eighth decades of life. The incidence of oral SCC (young age <40 years) varies between 0.4% and 3.9%. There has been increasing trend in younger age group worldwide as well as in India as reported by many studies. AIM: The aim of the present study was to compare the clinicopathological profile, treatment, and outcomes of SCC of oral cavity and oropharyngeal cancer in the young age group of <40 years old. MATERIALS AND METHODS: This retrospective observational study was done by retriving data of selected cohort from 2013 to 2015. Patients were divided into 2 groups: Group 1 (10–30 years) and Group 2 (31–40 years) for comparison. SPSS Version 16 software was used for statistical analysis. RESULTS: Cohort of 217 patients was analyzed. The male:female ratio was 11:1. The most frequent site of primary tumor was tongue > buccal mucosa. The primary site of cancer as oropharynx was present in 3 (5.17%) and 22 (13.83%) patients, respectively, in two groups. Mean overall survival (OS) in two groups was 22.53 and 25.14 months, respectively (P = 0.119). The median disease-free survival (DFS) in two groups was 7 and 8 months, respectively. CONCLUSION: The present study showed that the incidence of oropharyngeal cancer increases with age, but the behavior is more aggressive in a younger age group in spite of aggressive treatment, the DFS and OS were not improved in under 30 years group.
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RADIOTHERAPY: ORIGINAL ARTICLES Top

Accelerated versus conventional radiation fractionation in early stage carcinoma larynx p. 402
MS Alam, R Perween, SA Siddiqui
DOI:10.4103/0019-509X.200677  PMID:28244470
INTRODUCTION: In our study, we have treated cases of early glottic carcinoma by two different dose-fractionation schedules in relation to overall treatment time. MATERIALS AND METHODS: This is an analysis of 29 patients with invasive, previously untreated T1and T2squamous cell carcinoma of true vocal cord that was treated by radical radiation therapy. DOSE AND FRACTIONATION: All patients were treated with a continuous course of radiation therapy with once-daily fractionation. All the patients were treated 5 days a week from Monday to Friday. The fractionation regime was either: (1) 62.5 Gy/25fractions/5 weeks at 2.5 Gy fractions (Regimen 1), (2) 70 Gy/35 fractions/7 weeks at 2 Gy/fraction (Regimen 2). Regimen 1 included 15/29 patients (51.72%) and Regimen 2 included 14/29 patients (48.27%). Patients were evaluated for: (1) Locoregional control, (2) acute and late radiation toxicities, (3) quality of voice. RESULTS AND OBSERVATION: There was no significant difference in terms of locoregional control rate, acute and late radiation toxicities in both groups. Voice quality during and after radiation was comparable in both arms. CONCLUSION: Use of high dose per fraction schedule with shorter duration of treatment results in comparable local control as well as the quality of voice to the protracted course of radiotherapy without increase in treatment-related toxicities. Shorter overall treatment time can be of great advantage in terms of time, cost, comfort, and acceptability by the patients.
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Does magnetic resonance imaging accurately predict residual disease after unplanned excision of soft-tissue sarcomas? p. 408
S Patkar, A Gulia, S Juvekar, B Rekhi, A Puri
DOI:10.4103/0019-509X.200670  PMID:28244471
BACKGROUND: Often, it is difficult to assess the presence of residual disease after an unplanned excision in soft-tissue sarcomas. Inadequate excision leads to disease recurrence and inferior oncological outcomes while unnecessary excision may lead to additional surgical procedures with inherent morbidity and increased cost of treatment. There is a paucity of literature comparing the preoperative imaging findings with the final histopathology report to accurately assess the presence of residual disease. MATERIALS AND METHODS: The clinical details of 55 patients who had oncological scar excision after unplanned prior excision were retrieved. Histopathological evaluation of scar was compared with presurgery magnetic resonance imaging (MRI) for the presence of residual disease. Sensitivity, specificity, and positive and negative predictive value (NPV) of MRI for detection of residual disease were calculated. RESULTS: On MRI, residual disease was seen in 28 cases, no disease in 24 cases whereas findings of three patients were indeterminate. On final histopathology, residual disease was present in 30 (55%) patients whereas no residual tumor was seen in 25 (45%) patients. Two patients in whom MRI suggested the presence of residual disease had no tumor on final histopathology. No evidence of residual disease was reported in MRI of 24 patients. Of these, twenty patients were confirmed to have no tumor on final histopathology, whereas four patients had a residual tumor. Sensitivity: 86.66%, specificity: 90.90%, positive predictive value (PPV): 92.85%, NPV: 83.33%. CONCLUSION: MRI can aid in preoperative planning by identifying the site and extent of the previous surgery. It has a high PPV (92%) for detection of residual disease. However, a negative scan (NPV 83%) does not reliably exclude the presence of residual disease.
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GYNAE CANCER: ORIGINAL ARTICLES Top

A cohort study of vulvar cancer over a period of 10 years and review of literature p. 412
N Singh, N Negi, K Srivastava, G Agarwal
DOI:10.4103/0019-509X.200656  PMID:28244472
OBJECTIVE: The objective of this study was to study the risk factors, management protocols, and the outcome of vulvar cancer cases over a period of 10 years in a tertiary care hospital. METHODOLOGY: It is a retrospective cohort study. The hospital records of 41 patients with histologically proven vulvar cancer were studied from the Department of Obstetrics and Gynaecology and the Department of Radiotherapy (RT). The presence of risk factors, stage of disease, treatment modalities used, and disease outcomes in terms of survival were studied. The data collected were analyzed and compared with the published literature. RESULTS: The mean age for the diagnosis of vulvar cancer was 52 years and the peak incidence was seen in the age group of 50–70 years. Incidence was significantly more in multiparous (P = 0.001) and postmenopausal women (P = 0.007). An average of 4.1 cases were seen per year. Nearly, 97.56% of the cases were squamous cell carcinomas. Twenty cases belonged to the early stage of the disease (Stage I and II) whereas 21 cases had advanced disease (Stage III and IV). Nearly, 48.78% of the cases were primarily treated with surgery, 26.83% with RT, 7.3% with chemotherapy, and 17.07% with combined chemoradiation. Seventy-eight percent of the surgically treated cases had a mean survival of 5 years. Mean survival of 1 year was recorded in advanced disease cases. Limitation of the study was poor follow-up after treatment. CONCLUSION: Incidence of vulvar cancer is significantly high in multiparous and postmenopausal women. Conservative surgical treatment is the best option in the early stage of the disease (Stage I and II) and gives high survival rates whereas advanced disease treated with chemoradiation has a poor survival.
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Pattern of care in operable endometrial cancer treated at a rural-based tertiary care cancer center p. 416
SB Dessai, D Adrash, M Geetha, S Arvind, J Bipin, S Nayanar, K Sachin, MS Biji, S Balasubramanian
DOI:10.4103/0019-509X.200678  PMID:28244473
PURPOSE: An audit was planned to study the demographics, staging, treatment details, and outcomes of operable endometrial cancers. METHODOLOGY: All operable endometrial cancers treated between January 2009 and October 2014 were included in the study. The details regarding demographics, staging, surgical procedure, pathological staging, adjuvant treatment, and outcomes were extracted from the case records. Descriptive statistics was performed. The time-to-event analysis was done by Kaplan–Meier method. Univariate and multivariate analyses were done for disease-free survival (DFS) and overall survival (OS). RESULTS: There were 55 patients with a median age of 59 years (35–73 years). The Eastern Cooperative Oncology Group performance status was 1 in 52 patients (94.5%) and 2 in 3 patients (5.5%). Forty-nine patients (89.1%) had disease restricted to endometrium while 6 patients (10.9%) had cervical involvement. The surgery done was Type I hysterectomy in 49 patients (89.1%), Type II in 5 patients (9.1%), and Type III in 1 patient (1.8%). Pelvic lymph node dissection was done in all patients while para-aortic (infrahilar) dissection was done in 48 patients (87.3%). The pathological stages were Stage IA in 19 patients, Stage IB in 15 patients, Stage II in 4 patients, Stage IIIA in 3 patients, Stage IIIB in 2 patients, Stage IIIC1 in 5 patients, Stage IIIC2 in 4 patients, and Stage IV in 3 patients. Grade 1 tumors were seen in 23 patients, Grade 2 in 13 patients, and Grade 3 in 19 patients. The histology was endometrioid in 44 patients, serous in 6 patients, clear cell in 3 patients, and others in 2 patients. Adjuvant treatment was received by 40 patients. With a median follow-up of 2.5 years, the 3-year DFS and OS were 78% and 82%, respectively. Age >59 years, Stage III or greater, and Grade 3 tumors were independent prognostic factors adversely affecting both DFS and OS. CONCLUSION: The outcomes in our study are comparable to that seen in Western literature. Elderly status, higher stage, and a poorly differentiated tumor are associated with poor outcomes.
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GENITOURINARY CANCER: ORIGINAL ARTICLES Top

The longest tumor diameter in one dimension as a predictor for skeletal metastasis in renal cell carcinoma p. 420
AND Dwivedi, A Srinivasan, S Kumar, S Trivedi, VK Shukla, RC Shukla
DOI:10.4103/0019-509X.200649  PMID:28244474
INTRODUCTION: Renal cell carcinoma (RCC) comprises a diverse group of malignant neoplasms that have multifarious histopathological features and biological behavior. One-third of RCC patients develops skeletal metastasis with a poor 5-year survival rate. Data explaining how some of these tumors show sooner bony metastasis than expected is sparse. The objective of this study was to identify whether tumor size can act as a predictor of bony metastases among patients of RCC. MATERIALS AND METHODS: We retrospectively reviewed contrast enhanced computed tomography (CECT) scan and clinical records of 66 patients with RCC, who fulfilled specified inclusion criteria. Patients who had bony metastasis at the time of presentation were selected as case and those without skeletal metastasis were referred to as controls. Receiver operating characteristic (ROC) curve analysis was used to determine the appropriate cut-off value for tumor size, which was measured as the longest tumor diameter (LTD) in one-dimensional (1D). RESULTS: Of the 66 patients selected, 30% developed bone metastasis. The tumor size of RCCs significantly correlated with the presence of skeletal metastasis in our study. None of the patients with 1D LTD <4.8 cm on CECT were found to have skeletal metastasis. ROC analysis revealed that the accuracy of the LTD in predicting bone metastasis was high with an area under ROC curve of 0.823. A cut-off value of 7.5 cm had a sensitivity of 78.9% and specificity of 80.9%. CONCLUSION: The 1D LTD with a cut-off value of 7.5 cm, at the time of presentation is an important predictor of skeletal metastasis. The result of this study may have role in triage of patients into a subgroup which mandates more aggressive treatment and monitoring.
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Efficacy and safety of sorafenib in advanced renal cell cancer and validation of Heng criteria p. 423
A Joshi, A Ramaswamy, V Noronha, VM Patil, A Chandrasekharan, A Goel, A Sahu, N Sable, A Agrawal, S Menon, K Prabhash
DOI:10.4103/0019-509X.200662  PMID:28244475
INTRODUCTION: Sorafenib is an established upfront treatment option for metastatic RCC (mRCC). There is no published literature regarding its performance in Indian Patients. We present an analysis of Sorafenib use in our institute and attempt to validate the Heng criteria as a prognostic score in these patients. MATERIALS AND METHODS: Patients who received Sorafenib as first line treatment for advanced RCC from June 2012 to December 2015 were prognosticated by Heng criteria and retrospectively analysed for baseline demographics, toxicity, response and outcomes. RESULTS: 82 patients (65 males, 17 females) with a median age of 57 years were included for final analysis. Median ECOG PS was 1, 95.2 % of the patients had Stage IV disease and clear cell was the predominant histology (79.4%). 23.2%, 42.7% and 34.1% of patients were classified as low, intermediate and high risk by Heng's criteria, respectively. Dose reduction was required in 24.4% of patients, while 14.6% required permanent cessation of Sorafenib due to intolerable or recurrent side effects. Common adverse events included HFS (68.2%), mucositis (35.3%), fatigue (35.3%), rash (32.9%) and hypertension (25.6%). Response rate observed was 18.2%, while clinical benefit rate was 57.2% in the 57 patients where response was evaluable. Median progression free survival was 7.75 months (5.45-10.05) and median overall survival (OS) was 12.18 months (9.61 – 14.76). Median OS was 19.6, 16.1 and 10.3 months respectively for low, intermediate and high risk patients by Heng criteria and the criteria was statistically discriminatory for the 3 groups for OS (p=0.045, chi-square test). CONCLUSION: Sorafenib is a viable upfront treatment option for metastatic RCC in Indian patients with acceptable PFS, although a high incidence of HFS, mucositis and rash is observed. The Heng score has discriminatory value in mRCC with Sorafenib and can be considered for routine use in the clinic.
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Incidence of prostate cancer at a single tertiary care center in North Karnataka p. 429
SC Ghagane, RB Nerli, MB Hiremath, AT Wagh, PV Magdum
DOI:10.4103/0019-509X.200671  PMID:28244476
CONTEXT: Prostate cancer (PC) remains one of the most common cancers affecting men today. Thus, understanding the prevalence, disease characteristics, and changing demographics of Indian PC patients has emerged as an important aspect of study. AIMS: We aimed to present the case series of PC patients from single tertiary care center in North Karnataka. SETTINGS AND DESIGN: The study designed over a period of 8 years from 2007 to 2015 was conducted in the Department of Urology, KLES Dr. Prabhakar Kore Hospital, Belagavi, Karnataka. MATERIALS AND METHODS: A total of 471 newly diagnosed patients with PC from 2007 to 2015 were included in the study. Sociodemographic, clinical characteristics, radiological and histopathological findings of all patients were collected and analyzed for the risk of PC. STATISTICAL ANALYSIS USED: The statistical analysis used in this study was IBM SPSS Statistics software Inc., version 20.0. RESULTS: A total of 471 patients were diagnosed with PC, the mean age at presentation was 70 years, and mean prostate-specific antigen (PSA) level was 37.71 ng/mL. Digital rectal examination (DRE) was abnormal in 87.5% of 471 cases. Significant correlation was observed between PSA level and DRE (P = 0.0005), correlation of PSA and Gleason's score was P = 0.0006, and histopathological results showed high risk in patients (P = 0.0001). CONCLUSIONS: This is the first hospital-based study of PC incidence with clinical and histopathological features. PC remains an important public health problem with increasing incidence and significant burden on health-care resources in India.
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MENTAL HEALTH IN CANCER: ORIGINAL ARTICLES Top

Prevalence of depression and anxiety disorder in cancer patients: An institutional experience p. 432
A Shankar, C Dracham, S Ghoshal, S Grover
DOI:10.4103/0019-509X.200651  PMID:28244477
AIM: This study aimed to screen the patients with various malignancies for the presence of depressive disorders and anxiety disorder using standardized rating scales. MATERIALS AND METHODS: Five hundred and thirty-four (n = 534) patients attending the radiotherapy outpatient services completed the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 (GAD-7) Questionnaire. RESULTS: About half (n = 248; 46.4%) of the patients had psychiatric morbidity either in the form of depressive disorder or in the form of GAD. Higher stage of malignancy (from early, advanced to metastasis) was associated with higher prevalence of depressive disorder and GAD. The presence of psychiatric morbidity, especially anxiety disorder, was associated with being from low socioeconomic status. CONCLUSION: The present study suggests that psychiatric morbidity in the form of depressive and anxiety disorders is very common among patients with malignancies. Accordingly, there is a need for close liaison between oncologists and mental health professionals to improve the outcome of patients with various malignancies.
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A study on suicide among Indians living with cancer during 2001–2014 p. 435
Anusa Arunachalam Mohandoss, Rooban Thavarajah
DOI:10.4103/0019-509X.200654  PMID:28244478
BACKGROUND: A small subset of Indian people living/diagnosed with cancer commits suicide. The prevalence and changing trends in such cancer-related suicides are not much reported in literature. An attempt is made to address this subset of suicides during 2001–2014. MATERIALS AND METHODS: Data for this study were collected from the Indian National Crime Bureau Record, cancer registry publication in open domain, and published literature. Trends in the number of suicides associated with state, age groups, genders, and years were the only available parameters. Using these data, descriptive statistics of the rate of suicides, linear trend with age groups, gender, and geographical divisions are presented. RESULTS: During the study period of 14 years, 1,721,946 suicides with an average of 122,996 suicides per year were observed. One in five suicides was related to illness. In total, a sum of 10,421 cancer-related suicides were noted accounting a mean of 744 suicides per year. Males were commonly involved than females. The commonly involved age group was 45–59 years. Southern parts of India had more instances of cancer-related suicides. Among Indian states, West Bengal reported the highest of such instances. DISCUSSION: Suicide trends among Indians living with cancer during 2001–2014 are presented. The possible causes behind this phenomenon and implications are presented. The effect of changes in the trends in terms of geographical distribution, age group distribution, and gender dynamics is presented and discussed in this context. CONCLUSION: Suicide among PLWC is a multi-dimensional, complex phenomenon, orchestrated by several factors, including mental health. The nascent field of psycho-oncology in India needs to explore this through large scale validated studies.
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INFECTION IN CANCER: REVIEW ARTICLE Top

Cancer and cure: A critical analysis p. 441
PS Roy, BJ Saikia
DOI:10.4103/0019-509X.200658  PMID:28244479
Cancer is one of the most dreaded diseases of the 20th century and spreading further with continuance and increasing incidence in the 21st century. The situation is so alarming that every fourth person is having a lifetime risk of cancer. India registers more than 11 lakh new cases of cancer every year, whereas, this figure is above 14 million worldwide. Is cancer curable? The short answer to this question is “Yes.” In fact, all cancers are curable if they are caught early enough. Cancer cells continue to grow unless one of four things occur: (1) The cancerous mass is removed surgically; (2) using chemotherapy or another type of cancer-specific medication, such as hormonal therapy; (3) using radiation therapy; or (4) the cancer cells shrink and disappear on their own.
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INFECTION IN CANCER: ORIGINAL ARTICLES Top

Efficacy and safety analysis of rituximab combined with chemotherapy in the treatment of B-cell lymphoma patients complicated with hepatitis B virus infection p. 443
S Wang, Z Zhang, H Cai, Y Wang
DOI:10.4103/0019-509X.200679  PMID:28244480
BACKGROUND: Lymphoma combined with hepatitis B infection occupies a relatively higher incidence in China than that of in Europe and America. AIMS: To observe the efficacy and safety of rituximab in combination with chemotherapy in patients with B-cell non-Hodgkin's lymphoma (NHL) and hepatitis B virus (HBV) infection. METHODS: Ninety-two B-cell lymphoma patients with HBV infection in Sichuan Cancer Hospital from January 2009 to October 2015 were divided into two groups. Patients in Group A (n = 33) were treated with rituximab combined with chemotherapy, while Group B (n = 59) accepted chemotherapy alone. RESULTS: The effective rate (complete response + partial response) was 69.7% in Group A and 44.1% in Group B with significantly statistical difference (P = 0.018). Some of the patients got different grades of hepatic function damage during the period of chemotherapy, but there was no statistically significant difference between these two groups (P = 0.071). CONCLUSIONS: For CD20-positive NHL patients complicated with HBV infection, rituximab combined with chemotherapy modality is effective. The promise efficacy of this regimen could be achieved relying on controllable safety based on antiviral treatment.
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Epidemiology and resistance pattern of bacterial isolates among cancer patients in a Tertiary Care Oncology Centre in North India p. 448
U Batra, P Goyal, P Jain, A Upadhyay, N Sachdeva, M Agarwal, D Bhurani, V Talwar, SK Gupta, DC Doval
DOI:10.4103/0019-509X.200647  PMID:28244481
OBJECTIVES: To examine the epidemiology of microbiologically documented bacterial infection and the resistance pattern, among cancer patients undergoing treatment at RGCIRC, Delhi. DESIGN AND SETTING: Retrospective observational study in which culture reports obtained over 1 year in 2013, were analyzed. RESULTS: 13329 cultures were obtained over 1 year in 2013 and were analyzed. 23.6 % samples showed positive culture with majority being gram negative isolates (67.9 %). E. coli was the commonest gram negative isolate (49.4%) followed by klebsella (29.7%) and Staph. aureus was the commonest gram positive isolate. There was high incidence of ESBL in blood and urine (87.2% & 88.5%) and BLBLI were also high (78% & 83.9%). Carbapenem resistance was comparatively low (10%) and colistin sensitivity was quiet high (> 95%). CONCLUSIONS: Prevalence of MRSA and VRE in our institute is very less, whereas prevalence of ESBLs and BLBLI isolates amongst gram negative infections is around 80%. Gram negative isolates had poor sensitivity to cephalosporins and fluoroquinolones.
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The microbial etiology and antimicrobial susceptibility of bloodstream infections in patients with cancer at a private tertiary care hospital in Mumbai, India p. 452
T Singhal, S Shah, R Naik
DOI:10.4103/0019-509X.200650  PMID:28244482
BACKGROUND: Knowledge of the etiology and antimicrobial susceptibility of blood stream infections in patients with cancer is crucial to design empirical therapy regimes. METHODS: This is a prospective observational study at a tertiary care private hospital in Mumbai, India from Nov 2009 - Dec 2014. RESULTS: A total of 62 episodes of blood stream infections in 57 patients with cancer were recorded during the study period. Analysis was limited to 52 isolates from 49 episodes in 45 patients. Gram negative pathogens caused 77% of these infections; commonest pathogens were E. coli and Klebsiella. High prevalence of antimicrobial resistance was noted. Susceptibility in E. coli, Klebsiella, Acinetobacter and Pseudomonas to 3rd generation cephalosporins, beta lactam beta lactamase inhibitor combinations, carbapenems and amikacin was 4%, 56.5%, 70% and 86% respectively. CONCLUSION: The high rates of antimicrobial resistance in gram negative isolates is alarming.
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Weekly cisplatin (30–40 mg/m2) as radiosensitizer: Is it high or moderate emetic agent? p. 454
A Karpe, VM Patil, A Joshi, V Noronha, S Gupta, A Ramaswamy, A Sahu, V Doshi, T Gupta, S Rath, S Banavali, K Prabhash
DOI:10.4103/0019-509X.200666  PMID:28244483
PURPOSE: The American Society of Clinical Oncology (ASCO) guideline recommends a high antiemetic prophylaxis for any dose of cisplatin. This hypothesis was tested by us in this analysis of solid tumor patients who received weekly cisplatin as a radiosensitizer in a dose range of 30–40 mg/m2. METHODS: This was a retrospective analysis of 181 solid tumor patients who received weekly cisplatin (in the dose range of 30–40 mg/m2) as a radiosensitizer between July 2015 and August 2015. The antiemetic prophylaxis schedule provided was classified as optimal (if a high antiemetic prophylaxis was provided) or suboptimal (if a nonhigh antiemetic prophylaxis was provided). The incidence of acute, delayed and breakthrough vomiting after chemotherapy was noted. SPSS version 20 was used for analysis. Fisher's exact test was used to determine the association between antiemetic schedule (suboptimal vs. optimal) and postchemotherapy emesis. RESULTS: In the present study, of 181 patients, only 25 patients (13.8%) received optimal antiemetic prophylaxis while the remaining 156 (86.2%) received suboptimal prophylaxis. In the cohort of patients with suboptimal prophylaxis, dexamethasone was omitted in all patients (100%) while NK receptor antagonist was omitted in 76 patients (48.7%). The rate of vomiting was lower in patients receiving optimal prophylaxis as compared to that in patients receiving suboptimal prophylaxis (12% vs. 39.75%; P - 0.005). CONCLUSION: Omission of dexamethasone followed by aprepitant was the main reason for suboptimal prophylaxis. High antiemetic prophylaxis in accordance with ASCO guidelines overall decreased the risk of emesis in patients receiving CTRT with weekly cisplatin in the dose range of 30–40 mg/m2.
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Spectrum of cancer in adolescents and young adult: An epidemiological and clinicopathological evaluation p. 457
D Sharma, G Singh
DOI:10.4103/0019-509X.200680  PMID:28244484
INTRODUCTION: Changing scenario of cancer in adolescents and young adult (AYA) age group becomes an emerging and alarming problem. The age span that falls under the AYA umbrella, i.e., 15–29 years, is broad and having unique characteristic as compared to older and pediatric cohort. Only a few data are available in English literature about this age group where the spectrum of cancer varies accordingly as the function of age. OBJECTIVE: The aim of this study was to evaluate the incidence and pattern of tumor in adolescents and young age group. MATERIALS AND METHODS: A retrospective observational study was done at a tertiary care center. Medical records of patients aged 15–29 years registered from 2011 to 2015 were retrieved for analysis. RESULTS: Incidence rate of malignancy in AYA age is 5.71% in this observational study. Male:female ratio was 1.81:1. Most common cancer in this age group was head and neck cancer > central nervous system > gastrointestinal tract in the entire cohort. CONCLUSION: The malignancy spectrum, their subtypes, and demographic distribution in the AYA cohort have diversity among different cancer centers within India as well as in different countries across the world.
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LETTER TO THE EDITOR Top

Sensorineural deafness: An uncommon irreversible adverse effect of bortezomib p. 459
Parameswaran Anoop, Channappa N Patil, Vaishnavi S Joshi, Poonam Maurya, Pradeep Hosamani
DOI:10.4103/0019-509X.200675  PMID:28244485
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INFECTION IN CANCER: ORIGINAL ARTICLES Top

Eribulin in heavily pretreated metastatic breast cancer: A tertiary care center experience from India p. 460
J Bajpai, A Ramaswamy, S Gupta, J Ghosh, S Gulia
DOI:10.4103/0019-509X.200653  PMID:28244486
INTRODUCTION: Heavily pretreated metastatic breast cancer (MBC) remains a major therapeutic challenge with limited treatment options this. Eribulin, an anti-microtubule agent, has been recently approved for this indication. There are sparse data from the Asian region for eribulin and merits exploration. MATERIALS AND METHODS: This was a single institution retrospective analysis of MBC patients treated with eribulin from 2013 to 2014. These patients had received at least 2 lines of prior therapy for metastatic disease. Patients received standard doses of eribulin and were monitored for toxicity and responses. RESULTS: Eighteen patients were included in this analysis. They had received a median of 6 lines of therapy previously (including adjuvant treatment) and had significant visceral involvement (median 3 organs). A median of 4 cycles of eribulin was delivered. There were no complete responses; partial responses were seen in 33% (6/18), stable disease status in 28% (5/18) patients, and progressive disease on eribulin in 39% (7/18) patients. The median progression-free survival was 15 weeks (3.5 months), and median overall survival was 27 weeks (6.2 months). Significant Grade 3/4 toxicities seen included peripheral neuropathy in 28% (5/18) and neutropenia in 28% (5/18) of patients while dose reductions were required in 22% (4/18) of patients. CONCLUSION: Eribulin offers a viable, well-tolerated regimen that provides meaningful clinical benefit in Indian patients with MBC.
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Everolimus in heavily pretreated metastatic breast cancer: Is real world experience different? p. 464
J Bajpai, A Ramaswamy, S Gupta, J Ghosh, S Gulia
DOI:10.4103/0019-509X.200657  PMID:28244487
BACKGROUND: Drugs targeting mammalian target of rapamycin signaling pathway have been recently approved for treatment of hormone receptor (HR) positive metastatic breast cancer (MBC). However, there is lack of real world data from India on the use of this therapeutic strategy. MATERIALS AND METHODS: A retrospective analysis of MBC patients who had recurrence or progression while receiving aromatase inhibitors (AI's) and further treated with everolimus and either tamoxifen/AI/fulvestrant between March 2012 and June 2014, was undertaken. RESULTS: There were 41 patients with median age 55 years, 73% with visceral metastasis, and 73% with ≥2 sites of metastases. Thirty (73%) patients had received 3 prior lines of therapy including AI (100%), tamoxifen (94%), fulvestrant (39%), and chemotherapy (100%) while the remaining had received <3 lines of prior therapy. The commonest Grade 3/4 adverse events were stomatitis (19%), hyperglycemia (new/worsening, 17%), fatigue (14.5%), nonneutropenic infections (14%), anemia (12%) and pneumonitis (7%). Everolimus dose reductions were required in 31% patients. There were 30% partial responses, 38% prolonged disease stabilizations and 32% disease progression as best responses to everolimus. The median progression-free survival was 22 weeks (5 months). CONCLUSIONS: Everolimus based treatment has meaningful activity in heavily pretreated patients with HR-positive MBC but is associated with considerable toxicity and requirement for dose adjustment.
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VIEW POINT Top

Immune checkpoint inhibitors for Indian patients: A note of caution p. 468
A Venniyoor
DOI:10.4103/0019-509X.200660  PMID:28244488
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