|WOMEN'S CANCER INITIATIVE ANNUAL CONFERENCE 2021
|Year : 2021 | Volume
| Issue : 6 | Page : 1-16
Oral presentation at the women's cancer initiative annual conference 2021
|Date of Web Publication||16-Jan-2022|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Oral presentation at the women's cancer initiative annual conference 2021. Indian J Cancer 2021;58, Suppl S2:1-16
| » Clinical Outcomes of Stage I-III Hormone Receptor-Positive, Her2 Negative Breast Cancer: A Single Institution Study|| |
Arun M, Asha Arjunan, Priya Balakrishnan
Background: This study was aimed to assess the clinical outcomes of stage I-III hormone receptor-positive, HER2 negative breast cancer with respect to overall survival (OS), disease-free survival (DFS), locoregional recurrence, and other prognostic factors.
Methods: This was a retrospective analysis of 694 patients registered at Regional Cancer Centre, Trivandrum (RCC) and diagnosed with Stage I-III hormone receptor-positive and HER2 negative breast cancer from 1st January 2011 to 31st December 2013. OS and DFS were estimated using the Kaplan-Meier method and the survival curves thus obtained were compared with the log-rank test. Univariate analysis was done using Chi-square and Fisher's exact tests. Multivariate analysis using the Cox-regression model was performed to determine the impact of various patient, tumor, and treatment-related factors on outcome. All statistical tests were two-sided, and p ≤0.05 was considered to be statistically significant. Analyses were performed with SPSS version 11.0.
Result: The median follow-up of the study population was 88 months (28 - 118 months).75% of patients were positive for both estrogen receptor (ER) and progesterone receptor (PR), 16% were ER+/PR-, and 9% were ER-/PR+. The OS of the study population at 5 years and 6 years was 89 % and 86 % respectively, while the DFS at 5 years and 6 years was 83.8 % and 83.2 % respectively. The median and mean time to relapse were 12.5 and 23.3 months respectively. The median and mean time from relapse to death were 7 months and 13.7 months respectively. The locoregional recurrence rate was 1 %. The most common site of distant relapse was visceral, followed by bone metastasis. The 5 year OS was 90.2%, 86.3%, and 84.4 % respectively for ER+/PR+, ER+/PR- and ER-/PR+ molecular subtypes. On multivariate analysis, higher nodal stage and endocrine therapy duration of fewer than 5 years were associated with a significantly increased hazard ratio for risk of death.
Conclusions: The survival rates for hormone receptor-positive HER2 negative breast cancer in this study were similar to several series from literature. Survival rates were better for the ER+PR+ subtype when compared to single receptor-positive breast cancer; however, this was not statistically significant.
| » Audit of Male Breast Cancer Patients at A Tertiary Care Academic University Hospital in India|| |
Deep Chakrabarti, Arunima Ghosh, Divya Kukreja, Abigail Veravolu Resu, Mranalini Verma, Madan Lal Brahma Bhatt
Background: Male breast cancer is a rare disease accounting for less than 1 % of all breast cancer cases worldwide. Most of our knowledge about them is based on retrospective datasets.
Methods: This retrospective cohort study included all patients of invasive male breast cancer treated at the radiotherapy department of a tertiary care academic university hospital in India between 2012 and 2020. Records were identified from a prospectively maintained database. Clinicopathological parameters, treatment details, recurrence patterns, and survival were determined.
Result: Twenty-three patients were included. The median age was 55 years. Most patients were UICC TNM composite stage III (74%) and node-positive (78%) with Scarff-Bloom-Richardson grade II (52%). One patient presented with metastatic disease upfront. Sixteen patients (70%) were estrogen receptor (ER) positive. Lymphovascular space invasion (LVSI) and perineural invasion (PNI) were present in 65% and 26% patients respectively. The most common chemotherapy timing was adjuvant (61%), and the most commonly used regimen consisted of a triplet of 5-fluorouracil, an anthracycline (doxorubicin or epirubicin), and cyclophosphamide (FAC or FEC, 57%). Twenty-two patients underwent surgery (two lumpectomies, one wide local excision, 17 mastectomies) and subsequent radiotherapy to a dose of 42.6 Gy in 16 fractions. At a median follow up of 53 months (95% CI 47-67 months), three patients had died. Nine patients had local or distant failures (four bone metastases, one lung metastasis, four locoregional recurrences). The five-year disease-free survival (DFS) was 59%, disease-specific survival (DSS) was 96%, and overall survival (OS) was 96% (12 cases censored for OS).
Conclusions: Our reported cohort shows that most male breast cancer patients present with advanced stages, and most are node-positive with a high incidence of ER-positive disease and LVSI. Even with a relatively high incidence of bone metastasis, good five-year DFS, DSS, and OS are expected.
| » Single Centre Experience of Phyllodes Tumour of Breast: Unmet Need for Standardised Care Delivery|| |
Preeti Vijayakumaran, Swapnil Patel, Anuj Singh, Durgatosh Pandey
Background: Phyllodes tumor, earlier known as cystosarcoma phyllodes are a rare group of fibroepithelial tumors which constitute less than 1% of all breast neoplasms. Surgery is the mainstay of management, extent varying as per histology. The current study was undertaken to identify the magnitude of a seemingly uncommon problem, with varying management practices across institutions.
Methods: Retrospective analysis of prospectively maintained institutional database identified 92 patients, who presented to a tertiary care centre with a histopathological diagnosis of phyllodes tumor, from April 2018 – August 2021.
Result: A total of 92 patients with a clinico-radiological suspicion or a histopathological diagnosis of phyllodes tumor were studied. Of these, 14 patients who eventually had invasive ductal adenocarcinoma on the final histopathology were excluded from further analyses. Amongst the remaining 78 patients, final histology distribution included 23 (29%) benign phyllodes, 10 (12.8%) borderline phyllodes, 23 (29%) malignant phyllodes, 8 (10%) spindle cell sarcoma and 14(17.7%) pleomorphic and other high grade sarcomas. Median age of patients was 42 years, with a median age of 38 and 42 years for borderline and malignant subgroup, respectively. 55 patients (70.5%) presented per-primum and 23 (29.5%) had recurrent disease. Amongst patients presenting with recurrent disease, histology most commonly consisted of malignant (14), followed by borderline (6) and benign phyllodes (3). Preoperative core biopsy finding was correlated with the final histopathological diagnosis and a positive correlation was noted in 74.
Conclusions: Clinical and histological suspicion is of utmost importance in planning appropriate management. There is an unmet need amongst the surgeons and pathologist with regards to identification of phyllodes in the spectrum of breast malignancies. Appropriate and timely administration of adjuvant treatment can help significantly improvise treatment outcomes.
| » Metastatic Behavior of Breast Cancer in Step with Hormonal and Her 2 Status|| |
Rajesh Kori, Akshay Singh, Jay Prakash Sahu, Veenita Yogi, OP Singh, HU Ghori, Payal Gupta, Sachet Saxena
Background: Breast cancer is a utmost public health trouble for women throughout the world. According to facts based totally on contemporary developments from the most cancers reviews through Indian Council of Medical Research (ICMR), breast cancer in female is estimated to make a contribution 2,00,000 (14.8%) of the total cancer burden (1). Metastasis ailment remains the underlying cause of loss of life in the majority of breast cancer patients who succumb to their sickness. The distant organs to which breast most cancers preferentially metastasized, of which bone, liver, lung and brain are among the most common sites, are of scientific and organic importance and are closely related to the patients survival consequences. Factors influencing development of breast cancer metastasis largely encompass tumor size, histology grade, lymphovascular spread, nodal involvement and receptors status. The skeleton is amongst the most regularly located sites for approximately 50% of sufferers with breast cancers. It has been documented that patients with estrogen receptors (ER)- positive and progesterone receptor (PR)- positive tumors are greater probably to have bone metastasis, whereas sufferers with HER2- enriched, so-called triple-negative (ER-, PR-, and HER2-negative) breast cancer (TNBC) have a predilection for visceral metastasis, inclusive of to the brain. Metastases are the main reason of loss of life in breast cancer. The genuine mechanism of metastasis deveis nonetheless not well understood.
Methods: The sources of study was routine outpatients and inpatients visiting the Department of Radiation Oncology, Gandhi Medical College Bhopal. From January 2016 TO December 2018. The patients statistics and pathologic features of the primary tumor were recorded, including the patients age at diagnosis, tumor type, histologic grade and ER, PR and HER2 status. The detailed case history of the patient was recorded for the further investigations and the treatment as per required. Clinical prognosis and staging used to be carried out as per the necessities given in TNM staging, in particular based totally on AJCC system. After histopathological affirmation the patients have been blanketed in the study. The ER and PR expression repute used to be examined by means of the use of achievable of immunohistochemistry (IHC), and HER2 protein overexpression and /or gene amplification used to be as soon as evaluated thru way of IHC. Those with locoregional recurrence or lymph node had been excluded. A complete of 221 instances had been identified.
Result: The study was conducted on total of 221 patients of breast cancer with mean age of 48.21±11.4 years (ranging from 22 to 80 years). Majority of patients with breast cancer belonged to 31 to 60 years of age (84.15) whereas only 5% patients belonged to less than 30 years of age. Bilateral breast was involved in 0.9.
Conclusions: Breast most cancers stays a huge burden in current society, requiring in addition search for to apprehend the underlying mechanism that stress metastases and how to intention it. It is divided into several groups according to IHC: luminal A/B, TNBC, triple positive breast cancer, HER2-enriched and basal like. Subtypes had been related to considerable distinction in pattern of distant spread. Bone is the most predominant site of metastases followed by liver and lung. Luminal subtype having greater propensity for visceral metastases whereas TNBC predominantly show bone metastases.
| » Prevalence of BRCA Mutations Among High Risk Breast Cancer Patients in Eastern India|| |
Spoorthy Kolluri, Soumya Surath Panda, Sindhu Kilaru, Suma D, Lalatendu Moharana, Ghanshyam Biswas
Background: The prevalence of BRCA mutation among breast cancer patients seems to be variable according to geographic area, race, hormone status varying between 9 to 15
Methods: This is a cross sectional, non interventional, single center study conducted between June 2020 to July 2020. All eligible breast cancer patients who presented to us during this duration were enrolled in the study. This included patients with age at or below 45 years, any age with strong family history, age at or less than 60 years with TNBC, male breast cancer were included in the study in accordance with NCCN guidelines. However, we did include patients with TNBC histology even above 60 years of age if the patients consented to testing. Germline BRCA testing was done from a peripheral blood sample. If an eligible patient was unwilling for testing then the reason for the same was noted.
Result: 40 eligible breast cancer patients between the ages of 27 to 72 years were enrolled in the study. There were 39 female and 1 male patients. 5(14.28%) patients tested positive fore BRCA gene. Among the positive reports, 3(8.57%) were BRCA1 positive and 2(5.71%) was BRCA2 positive. 3(8.57%) patients had VUS,1 in BRCA1 and 2 in BRCA2. Among these, 1 patient tested positive for BRCA2 and was also VUS for BRCA2. All the patients who tested positive for BRCA mutation were Triple Negative Breast Cancer. Also, all the patients who tested positive were over the age of 45 with 2 above the age of 60. Among the entire population 4(10%) had positive family history of relevant cancers. Among those with positive family history only 1(2.86%) patient tested positive for BRCA mutation. 5(12.5%) patients refused testing. The reasons for refusal being social stigma and financial constraints. 2 patients in the study group took PARPi after disease progression to metastatic disease.
Conclusions: The incidence of BRCA mutations in our center is high at 14.28%. All the patients who tested positive were of the triple negative histology suggesting this to be a high risk group. Family history did not play a significant role in determining the positivity rate as only one of the patients who had mutations had significant family history. Hence family history may not be an adequate criteria to test for BRCA mutations in the population. Rather histology should be taken into account to look for eligible candidates for testing. The patients who tested positive in our study were older with 2 patients over the age of 60 years. Hence, we might conclude that BRCA testing can be considered in older women outside the age criteria especially in triple negative histology. We have also noticed that social stigma around genetic diseases along with financial constraints to be a factor for inadequate testing in our region. We understand that this is a small sample size and may not be representative of the diverse population in India.
| » Breast Cancer Care in a Tertiary Hospital in Kerala: Is Practice Concordant with National Guidelines?|| |
Ramakrishna Kamath, Anjali Krishna, Anjitha Asok, Ajay Sasidharan, Sruthi K, Nikhil Haridas, Misha JC Babu, Mala Mathur Sharma, Wesley Jose, Debnarayan Dutta, Pavithran K, Vijaykumar DK
Background: The National Cancer Grid (NCG) of India had published clinical practice guidelines for breast cancer care in 2017 that are relevant in the Indian context. This analysis aims to evaluate the concordance of breast cancer management with the guidelines for patients treated in the year 2020.
Methods: All patients who had surgery for breast cancer at a single centre in the calendar year 2020 were included. Concordance was checked for six indicators selected from the NCG guideline. The indicators were (1) use of sentinel lymph node (SLN) biopsy in cN0 patients; (2) lymph node harvest of greater than 10 nodes in SLNB positive and those without SLNB; (3) HER2 FISH testing in patients with HER2(2+) on IHC; (4) adjuvant radiotherapy in all BCS and patients with T4 or more than 3 nodes positive; (5) anthracycline-taxane chemotherapy in all node-positive breast cancer; and (6) adjuvant trastuzumab in HER2 3+ or HER2 FISH Positive. The final concordance of each indicator was compared to the concordance in previously published data of patients treated in 2014-15 and tested for significance using the Chi-square test.
Result: A total of 314 women underwent surgery for breast cancer in the calendar year 2020. Concordance data was unavailable in 5 patients who were lost to follow up for different indicators. Sentinel lymph node biopsy, lymph node harvest of 10 or more nodes, HER2 FISH testing, chemotherapy, radiotherapy, and trastuzumab were indicated in 189(60.1%), 186(59.2%), 246(78.3%), 205(65.2%), 16(5%) and 80(25.4%) patients respectively. Sentinel lymph node biopsy (SLNB) was performed in 186 out of 189(98.4%). Reasons for non-concordance included cardiac comorbidity, previous excision of primary tumour and no axillary uptake of blue dye. Out of 186 patients with a positive SLNB or without SLNB 155(83.3%) had a lymph node harvest of 10 or more. Reasons for poor nodal harvest included false-negative sentinel node in frozen section, post neoadjuvant chemotherapy and unknown reasons. HER2 FISH testing was performed in 15 of 16 (94%) patients with 2+ HER2-positive on immunohistochemistry. One patient was lost to follow up and FISH testing could not be done. A total of 223(91%), 194(95%), and 67(84%) received chemotherapy, radiotherapy and trastuzumab. Reasons for non-concordance for adjuvant therapy included financial constraints, patient refusal of treatment, loss to follow up and comorbidity. Compared to concordance rates for patients treated in 2014-15, only one out of the six indicators (lymph node harvest of 10 or more) did not show significant improvement (p=0.33) [Table 1].
Conclusions: The concordance of breast cancer care management with NCG guidelines is high and has significantly improved in the year 2020 compared to patients treated in 2014-15. Probable factors for the increased concordance could be: increased awareness, multidisciplinary tumour board discussions, affordability of testing and targeted therapy, and improvement in diagnostic and treatment techniques.
| » Palliative Radiotherapy for Fungating Lesions in Metastatic Breast Cancers – A Single Institution Experience|| |
Divya Kukreja, Anjali Diwakar, Mansi Shukla, Deep Chakrabarti, Mranalini Verma, ML Bhatt
Background: In developing countries patients with advanced or metastatic breast cancers may present with skin involvement or fungating lesions associated with pain, bleeding and foul-smelling discharge which may hamper their quality of life (QoL). Palliative radiotherapy can be used to alleviate symptoms in this group of patients and improve their QoL.
Methods: Six patients with WHO PS 1 with metastatic breast carcinoma who had fungating or bleeding lesions over the breast treated between March and July 2020 at a tertiary care academic university hospital in North India were included in this analysis. Their epidemiological, clinical, and pathologic details were recorded. Patients were treated on an Elekta synergy® linear accelerator with photons or electrons as appropriate.
Result: Baseline characteristics are detailed in the table. All six patients treated with palliative radiotherapy were married females with a median (IQR) age of 41 (38-52) years. All patients had T4b, node positive, metastatic, stage IV disease with no family history. Menstrual status: Pre-menopausal: Post-menopausal 5:1. Immunohistochemistry: ER positive: HER2neu positive 2:3. Molecular subtype (St Gallen): Luminal A: Luminal B: Basal: HER2 enriched 1:1:2:2. Out of six patients, three did not receive any systemic therapy. One Patient with Luminal A disease with liver metastases but no visceral crisis was given endocrine therapy with an aromatase inhibitor. One patient with triple negative breast cancer received palliative chemotherapy (Paclitaxel 175mg/m2 and Carboplatin AUC-6 q3weekly for 2 cycles). One patient with HER2 enriched subtype received three cycles of combination systemic therapy (Adriamycin 60mg/m2, Cyclophosphamide 600mg/m2 and Trastuzumab 8mg/kg q3weekly). All patients had complaints of pain and foul-smelling discharge. Five patients had bleeding from ulceration. One patient had presented with myiasis which was cleared before giving radiotherapy. Four out of six patients were treated with electron beam therapy, the energy being decided on the depth of the lesion. Two patients were treated using photons with a bolus placed over the lesion. Radiotherapy was given to a dose of 20 Gray in five daily fractions over one week. All patients had symptom relief in the form of haemostasis, reduction in discharge and size of lesions, with ensuing psychological relief and improved QoL.
Conclusions: Palliative radiotherapy given in advanced or metastatic breast cancers with fungating lesions helps alleviate symptoms of pain, bleeding and foul smelling discharge thereby improving quality of life.
| » Adjuvant Radiotherapy for Breast Cancer Using Volumetric Modulated Arc Therapy: A Dosimetric Comparison With 3dcrt Technique, Report on Toxicity and Quality of Life|| |
Patil Nikunj Rajiv, Krishna Sharan, Shirley Salins, Anshul Singh, Anusha Reddy, Umesh V, Priyanka Augustine
Background: To determine the benefit of VMAT in adjuvant radiotherapy for breast cancers where 3D-CRT was deemed inadequate. Additional objectives were to report the short-term toxicities and the impact on quality of life.
Methods: Patients requiring adjuvant RT to the breast/chest-wall, in whom 3D-CRT plan was considered inadequate by the treating physician, were selected. A dosimetric comparison was done between both techniques. These patients were followed up three monthly after treatment completion to assess the chronic toxicities. An EORTC QLQ- C30 and BR23 questionnaires were filled by the patients before starting radiotherapy and six months post treatment to assess the quality of life. Statistical analysis was using t-test to compare both the techniques. A paired t-test was used to analyse the quality of life and linear regression analysis was done to measure predictors' significance and to calculate the coefficient of determination. The p-value less than 0.05 was considered as statistically significant.
Result: A total of 32 patients were included in the study. The median age was 53 years (Range: 29- 78). 56% underwent Breast conservation surgery, and 81.3% received chemotherapy (either neoadjuvant or adjuvant). VMAT was statistically better than 3DCRT in terms of PTV coverage and Conformity Index (p<0.001). Both plans provided similar Homogeneity. As expected, VMAT was able to limit high doses and 3DCRT was efficient in minimising low dose to Organs-at-risk. V20 ipsilateral lung was lower in VMAT (p<0.001). Contrarily, 3D-CRT was successful in reducing Contralateral lung V20 as well as Dmean. VMAT was also superior in reducing the V25 of heart (p= 0.012). Only one patient developed grade 3 acute dermatitis, and no other grade 3 toxicities were noted. Subcutaneous fibrosis, lymphedema and chronic dermatitis of ≥grade 1 severity were noted in 31.2%, 40.1% & 6.2%, respectively. The global health quality improved significantly at six months following RT, from 29.17 to 96.88 (p<0.001). The overall functional scales improved, but only emotional and cognitive domains showed statistically significant improvement. Though type of surgery and cancer stage appeared to affect functional scores, they were not statistically significant. All symptom scales showed significant improvement over time, except financial burden, which significantly increased (p<0.001). There was improvement in overall symptom scale and body-image perception in BR23 functional scale (p<0.001), but there was little improvement in sexual functioning, sexual enjoyment, and future perspectives.
Conclusions: VMAT can be considered for adjuvant breast RT when 3D-CRT is found to be inadequate. Patients tolerated treatment with acceptable toxicities, with improvement in quality of life at six months following adjuvant treatment, especially in emotional and cognitive functioning domains.
| » Prospective Evaluation of Radiosurgery in Indian Carcinoma Breast Patients with Oligo-Brain Metastasis|| |
Kalavagunta Sruthi, Ramakrishna Kamath, Ajay Sashidharan, Pavithran K, Vijayakumar DK, Wesley M Jose, Annex EH, Debnarayan Dutta
Background: Radiosurgery is the standard of care for oligo brain metastasis. However, in Indian subcontinent whole brain RT is still used for majority of oligo brain metastasis. Present prospective analysis is to evaluate the outcome of SRS in Indian patients with oligo brain metastasis.
Methods: Between May 2017 and July 2021, 111 patients with 206 brain metastases were accrued prospectively and treated with robotic radiosurgery (CK) (M6, Multiplan, VOLO). Patients with small volume oligo brain metastases with good performance status (PS 0-1) and controlled primary were accrued. Frameless stereotactic based immobilization was ensured with a thermoplastic mask, a contrast CT simulation was done with 0.625 mm slices and fused with T1 contrast/T2 Flair MRI images for contouring. PTV margin of 2-3 mm and a dose of 15-30Gy in 1-5 fractions was decided based on the treatment volume. 12Gy normal brain volume and marginal dose was considered for dose prescription. Response to treatment, new brain lesion free survival, overall survival and toxicity profile after SRS was evaluated.
Result: In the entire cohort (n=111 with 206 lesions) [mean age: 57.7 yrs; female: 54%: Breast primary: 31.5% lung primary 42%, single lesions: 65 (59%), mean overall survival was 13.5 months (SD 10.7). More than 6 months, 12 months & 24 months survival was in 77 (75%), 54 (52%) & 17 (16%) respectively. Intracranial recurrence rate was 37% (in-field 16%, out of field in 45% & 39%). Re-SRS was done in 21/34 (61%) patients with recurrence. In 36 oligo brain metastasis patients with breast cancer primary [mean age: 49 years], luminal B were 25%; Her2 enriched 33% and TNBC 36%. 60 lesions [single (53%); 2-3 (28%); >3 (19%)] were treated with SRS [1 fr in 53%; 3-5fr in 47%]. RT dose was <18Gy in 6%; 18-20Gy in 28%; >20Gy in 66%. Mean PTV volume was 23 cc (1.6cc-77.9cc). Mean Gy brain volume was 6% (0-20%); Prescription isodose was 70-80% in 3%; 80-90% in 64%; >90 in 33%; Mean HI was 1.17; CI 1.15, Monitor units 16769 MU; Treatment time 48 min (17-104 min); Number of beams 188 (30-393). Mean brainstem max dose was 562cGy. Six (16%) received previous WBRT and 2 (5%) had surgery. Mean OS was 14.5 months (SD 11.9). More than 6 months, 12 months & 24 months survival was in 29 (80%), 19 (52%) & 7 (19%) respectively. Mean OS in luminal B, Her2 enrich and TNBC was 11.6 (SD 11.4), 17.4 (12.9), 13.7 (12.6) respectively (p-value: NS). Mean OS in breast and lung primary with brain metastasis was 14.5 (11.9) and 12.1 (9.2) (p-value: 0.533) respectively. At last follow up, in breast primary with metastasis patients 13 (36%) had controlled/stable disease, 18 patients had progression of brain metastasis of which 14 patients were retreated. Out of field recurrence was in 7 (19%); In field recurrence in 2 (6%) and both in 10 (28%). SRS was the retreatment modality in 64% while WBRT was used in 36%. Radiation necrosis was seen in 8 patients (22%).
Conclusions: Radiosurgery is effective in Indian breast cancer patients with oligo brain metastasis. Overall survival after SRS is similar with the western published data. Re-SRS rate is high in patients with small volume recurrence.
| » Dosimetric Variation in Target Volumes and Organs at Risk in Interval Imaging During Adjuvant Image Guided Intensity-Modulated Proton Therapy for Breast Cancer|| |
Nagarjuna Burela, Sapna Nangia, Noufal MP, Kartikeswar Patro, Dayananda Sharma, Minnal MS, Manoj Wakde, Utpal Gaikwad
Background: To investigate variation in dose distribution of targets and organs at risk using bone anatomy registration strategy for breast cancer treated with intensity-modulated proton therapy.
Methods: Ten dose distributions were computed in 4 patients who received IMPT post lumpectomy. Quality Assurance computed tomography (QACT) scans were done periodically after every five fractions. The targets and organs at risk, including cardiac substructures, were recontoured on verification CTs, original proton therapy plans overlaid and evaluated. For each patient, the original plan (Plan-O) and verification plan (Plan-Q) on QACT were calculated using the bony alignment technique. A subvolume-Breast Near Skin (1cm rim of anterior breast close to the skin) was created to help ascertain CTV underdosing.
Result: For Plan-O and Plan-Q, the median CTV Breast D98 was 99.6% (99.2-99.8%) and 98.75% (98.6-99.3%), respectively; CTV Boost D98 was 99.65% (99.5-99.7%) and 99.2% (97.5-99.5%). Similarly, Breast Near Skin D95 was 70.1% (69.7-74.9%) and 72.45% (69.9-75.8%). The OAR doses (Plan-O vs Plan Q) - mean heart doses 0.77Gy vs 0.82Gy, ipsilateral lung mean 7.9 vs 7Gy, V 5Gy 41% vs 35.1%, mean of LAD max 7.8Gy vs 10.6Gy and mean of RCA max was 4.1 vs 4.7Gy.
Conclusions: With the bony alignment, acceptable dosimetric reproducibility of coverage of target and sparing of OARs, respectively was achieved, except in the case of LAD. Further study is warranted to determine the variation of dose to cardiac substructures.
| » Prevalance of Risk Factors of Breast Cancer in Young Indian Women|| |
Nishtha, Navneet Kaur
Background: Breast cancer incidence is increasing at an alarming rate in the Indian subcontinent and statistics reveal the most rapid rise in age standardized rates in the women in 2nd and 3rd decade. The rising trend of BC in the developing world is usually attributed to westernization of the lifestyle However whether same hypothesis hold true for younger women with breast cancer has not been tested in any study so far. Hence, our study was conducted with the aim to study profile of various established and suspected risk factors for breast cancer among young women age ≤40 years.
Methods: The study was conducted from September, 2018 to April, 2020 at Department of Surgery, GTB Hospital, Delhi. 279 participants, with 139 biopsy proven patients as cases and 150 age matched controls were subjected to a predetermined questionnaire comprising of clinical history with risk factor profile and physical examination. Data was analyzed using SPSS Statistical software with power of study 80 % and P-value of <0.05 as statistically significant.
Result: Mean age group of cases was 37.39 ± 5.31 years. Amongst the established risk factors analyzed, only history of breastfeeding was found protective, with p value < 0.03 and prevalence of 76.5% in cases and 86% in controls. Early menarche was seen in 7.4% of cases, nulliparity in 6.6% and 2.2% had delayed pregnancy. 6.6% women had history of benign breast disease and biopsy for same. All established risk factors analyzed had low prevalence in both groups, with no statistical difference. 8.8.
Conclusions: While most studies in India have chosen a selected few established risk factors, our study attempted to include almost all of them to emphasize that none of them have relevance in our women except breastfeeding which too is protective. Data on Indian women is insubstantial to conclude that known risk factors are solely responsible for rise of breast cancer in our young population.
| » Dose Dense Neoadjuvant Chemotherapy in Triple Negative Non Metastatic Breast Cancer: A Real World Experience|| |
Prathyush Vundemodalu, Amit Rauthan, Poonam Patil, Rajashree, Chinnujomi
Background: Triple negative breast cancer (TNBC) is characterized by aggressive behaviour and poor prognosis. Dose dense neoadjuvant chemotherapy especially in triple negative breast cancer patients has the advantage of early control of micrometastasis, early completion of systemic treatment, improved surgical outcomes and provides an opportunity of risk adapted therapy. It also helps in improving pathological complete response rates which can translate into improved overall survival. This study aims to look at outcomes, safety and toxicity profile of dose dense neoadjuvant chemotherapy in non metastatic triple negative breast cancer in an Indian setting.
Methods: We retrospectively analysed 62 patients with biopsy proven non metastatic triple negative breast cancer from January 2016 to January 2021 receiving dose dense neoadjuvant chemotherapy, followed by surgery and radiation as indicated. The disease free survival (DFS) and overall survival (OS) were estimated using the keplen-meier curve.
Result: Out of 62 patients, 41 (66%) were premenopausal and 21 (34%) were postmenopausal. 28 (45%) had stage II and 34 (55%) had stage III disease. The median age was 45 (range from 26-75). 36 (58%) received 4 cycles of AC (adriamycin with cyclophosphamide) followed by 4 paclitaxel 2 weekly, 23 (37%) had received 4 AC followed by weekly paclitaxel for 12 weeks and 3 (5%) have received 4 FEC 2 weekly followed by 4 paclitaxel. Among 62 patients, 11 patients (17%) had neutropenia but severe grade 3 neutropenia causing delay in chemotherapy was seen in 5 (8%) of patients. Anaemia requiring blood transfusions was seen in 4 (6.4%) of patients. Neuropathy was seen in 9 (14%) of patients. 60 (97%) of the patients completed full course of chemotherapy. 30 patients (48%) underwent breast conservation therapy and 32 (52%) underwent modified radical mastectomy. 28 (45%) out of 62 had achieved pathological complete response (pCR). Out of these 28 patients, only 2 have developed recurrence. At time of analysis, median disease free survival (DFS) and overall survival (OS) was not reached. The DFS at 1 year was 88%, 2 years was 79% and 5 years was 71% respectively. The OS was 95% at 2 years and 81% at 5 years.
Conclusions: Our real world experience showed that neoadjuvant dose dense chemotherapy in TNBC patients is a safe and effective approach. All the recurrences in our patients occurred in the first 3 years, after which there were no recurrences seen. The patients who achieved pCR had a longer DFS that those without pCR. Neo-adjuvant dose dense chemotherapy should be a standard approach for all triple negative non-metastatic breast cancers.
| » Clinical Outcome of Triple Negative Breast Cancer Patients Treated in A Tertiary Care Centre|| |
Megha Prem Paramban, T Ajayakumar, Vishnu Asokan
Background: Triple negative breast cancer (TNBC) accounts for approximately 15% of breast cancer cases which is associated with aggressive clinical behaviour and poor prognosis. Study objective was to assess the 5 year overall survival and disease free survival of TNBC patients treated in the year 2014 and 2015 with follow up of 60 months at Tertiary Cancer Care Centre, Government Medical College Calicut.
Methods: 97 patients with stages 1-3 TNBC were retrospectively studied. Treatment and follow up data was gathered from the master file of each patient from the OPD. All metastatic cases at presentation, male breast cancers, patients lost on follow up were excluded from the study. Survival estimates and additional association analyses were performed using the Kaplan–Meier method and log rank test.
Result: 97 patients details were analyzed. The mean age of the study population was 50.8 years. Most of the patients were postmenopausal and parous. Majority of the patients had tumor size more than 3 cm and node negative. Among the node positive patients 25.8% were N1, 12.4 % were N2 and 9.3% were N3. 37% patients were LVI negative. Most of the patients were stage 2 (64.9%) followed by stage 3(27.8%). 89.7 % underwent MRM. 62.9% received radiation treatment, among them majority conventional fractionation. The mean DFS of the study population was 49.24 months. 5 year OS was 53.4 months. 2 patients developed locoregional failure, one in the axilla and other in chest wall. 21 had distant metastasis with most common site being bone followed by brain. On univariate analysis, higher stage, LVI, and nodal burden were associated with poor DFS and OS.
Conclusions: 5 year OS was 76.29%. Advanced disease exhibited by stage, node positivity, nodal status, LVI were found to be statistically significant factors associated with poor DFS and OS in TNBC patient.
| » Atijivita (A Mobile App) Study Protocol: A Randomised Controlled Trial to Evaluate a Mobile App for Improving Health Related Quality of Life of Patients with Breast Cancer|| |
Maninder Deep Kaur, Budhi Singh Yadav, Divya Dahiya, Sukhpal Kaur, Akhilesh Sharma, Sushmita Ghoshal
Introduction: Evidence has shown that breast cancer self management support from mobile app can improve the QoL of patients. This protocol explains the methods for development of mobile application and to evaluate its effectiveness vs. routine care.
Materials & Methods: This is a 24-week two arm prospective randomized open blinded end point single centre study. A total of 170 breast cancer patients will be allocated 1:1 to receive either routine care or mobile app in PGIMER, India. Patients will complete a baseline assessment and after that at 3 months and 6 months assessment will be done. The Primary outcome is the change in the score of EORTC QLQ- 30 and BR-23 questionnaires from baseline to 6 months. A mobile app was developed after extensive review of literature, guidance from the experts and after assessing the needs of the breast cancer survivors (BCSs). By assessing the needs of the BCSs we found that fatigue, lymphedema and sexual problems (loss of interest in sex, vaginal dryness) were the most common problems that BCSs faced following treatment. A mobile app was developed mainly focusing on these problems. The content of the app included four important sections [Table 1].
Results: All statistical analyses will be completed using the IBM SPSS Version 25 statistical software package with a 5% level of significance (two sided). Mann Whitney test will be applied to compare distribution between two groups. Logistic regression will be used as multivariate analysis to calculate adjusted odds ratio with after adjusting confounding variables.
Discussion: The application is currently under trial. If this application is found effective, it will be freely available in play store for more usability
| » Review Article on Association of Breast Cancer Surgery with Quality of Life and Psychosocial Well-Being in Young Breast Cancer Survivors|| |
Prachi Kalra, Rakesh Dhankhar, Vivek Kaushal
Background: Breast cancer is one of the leading cause of cancer in females worldwide. A newly diagnosed young female can undergo breast conservative surgery (BCS) or unilateral/bilateral mastectomy with reconstruction depending the clinical staging of the disease. Many young females with breast cancer choose bilateral mastectomy (BM), because of less known short-term and long-term physical and psychosocial well-being outcomes following surgery. Many studies compare body image outcomes among Breast Reconstruction, BCS, and Mastectomy groups have reported non-significant findings. This review article focuses on evaluating the association of different treatment modalities with quality of life (QOL) and psychosocial outcomes following diagnosis in young breast cancer survivors.
Methods: Literature was reviewed and compared regarding evaluation of QOL and psychosocial outcomes following diagnosis in young breast cancer patients. Following are the various tools used in literature. QOL was evaluated with help of Cancer Rehabilitation Evaluation System Short Form (CARES-SF). The physical subscale includes a range of functional issues assessing difficulties with performing physical tasks and pain. Sexual health was assessed with the CARES-SF sexual subscale, which includes 3 items evaluating sexual attractiveness, interest, and frequency. The 3-item body image subscale from the full (139 item) CARES was also included.1 For each CARES item, respondents rate on a 0 to 4 scale how they have felt over the past few weeks; scores for each subscale are calculated from the mean of ratings for each individual item and range from 0 to 4, with higher scores indicative of more problems. Anxiety and Depression Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Hospital Anxiety and Depression Scale scores range from 0 to 21, with scores 0 to 7 considered ''normal,'' scores 8 to 10 considered ''borderline abnormal,'' and scores of at least 11 considered ''abnormal.2. A meta-analysis was done in breast cancer survivors, primary objective was QOL included physical health, social health, emotional health, and global health while secondary outcomes included body image and sexual well-being. This was conducted with the help of questionnaires of interest. This study showed female opting for Breast Reconstruction (BR) or BCS are likely to report fairly better QOL outcomes than Mastectomy. But due to some discrepancy observed in BR versus BCS outcomes, developing a unified questionnaire includes both breast/surgery-specific and generic QOL domains is needed.
Result: All cancer-specific QOL domains, including CARES physical function, body image and sexuality showed improvement over follow-up for all surgeries. Pairwise comparisons demonstrated that women who had Breast Conservative Surgery (BCS) vs bilateral mastectomy (BM) without reconstruction had significant poor physical functioning. With worse body image, worse sexual health. Discomfort in going for work, attending public gathering because of low self esteem. Mental health concerns like anxiety, poor self worth and depression to name a few. Various comparison groups were evaluated like BCS vs unilateral mastectomy (UM) with/without reconstruction, UM vs BM with/without reconstruction. All showed that patients who underwent BM without reconstruction showed poorer score in CARES physical function.
Conclusions: This article comprehensive information about how variable parameters of Quality of life and psychosocial health are affected both in the short and long term in young women who undergo breast cancer surgery. Understanding various outcomes of different treatment modalities may be useful to newly diagnosed young females making informed decisions and should be communicated well by clinicians during the decision process. In this analysis of QOL and psychosocial wellbeing of young females following breast cancer surgery, it is affirmative physical and psychosocial health improve over time. However, overall quality of life was poorer in patients undergoing extensive surgery compared to females who undergo less surgery with anxiety, sexuality and body image issues. Thus importance of pre surgical counselling and post surgical psychosocial support by the family and society holds great importance in lives of cancer survivors. This article comprehensive information about how variable parameters of Quality of life and psychosocial health are affected both in the short and long term in young women who undergo breast cancer surgery. Understanding various outcomes of different treatment modalities may be useful to newly diagnosed young females making informed decisions and should be communicated well by clinicians during the decision process. In this analysis of QOL and psychosocial wellbeing of young females following breast cancer surgery, it is affirmative physical and psychosocial health improve over time. However, overall quality of life was poorer in patients undergoing extensive surgery compared to females who undergo less surgery with anxiety, sexuality and body image issues. Thus importance of pre surgical counselling and post surgical psychosocial support by the family and society holds great importance in lives of cancer survivors.
| » Improving Knowledge on Sex and Sexuality among Young Women with Cancer - Findings from A Qualitative Pilot Study in Mumbai, India|| |
Sameena Mehboob Bilgi, Tabassum Wadasadawala, Supriya Chopra, Archana Vishaye, Priti Mane, Urmila Jaykar, Leena Walvankar, Sunita Jadhav, Vidhi Agrawal, Ruksheda Syeda, Nirjari Dalal, Sudeep Gupta
Background: Cancer treatment has an impact on sexual health. Literature suggests that breast and gynaecology cancer patient concerns revolve around body image, fertility preservation/reproductivity health. Although some treatment-related sexual adverse effects are short-term, many survivors face long-term effects such as treatment-induced menopause and significant surgical disfigurement. There is a need to understand the patient's perspective about strategies to deal with loss of intimacy along with the health care provider's focus on issues related to contraception and fertility. Therefore, with the increase in the number of young women cancer survivors, it is essential to address their sexual health concerns in order to improve their overall sexual quality of life.
Methods: An intervention was designed and delivered to 26 young (breast and gynaecology) cancer patients focused on improving knowledge about sex and sexuality through psycho- educational group therapy sessions. The sessions were facilitated by a team of trained psychologist, social worker, and clinician. They were conducted on a virtual platform i.e., zoom.
The topics of the sessions are mentioned below: -
- Improve Communication Skills on Sexuality
- Improve Body Image Issues
- Education on Sexual Health
- Partner Engagement
Result: The participants were young women with breast (18) and gynaecology (8) cancer from low income backgrounds belonging to various states of India. The age group of the participants were between 26 to 45 years. Pre and post intervention survey were carried out. Pre intervention survey revealed around 69% of the participants had faced challenges in communicating with their husband regarding intimacy, where as 70% had body image issues, 16% were aware about the importance of sexual health. Post intervention session evaluation suggested that around 88% participants mentioned that they were able to initiate communication with their husbands, about 95% of the patients reported that they were able to understand and deal with their body image issues, 100% participants became aware that intimacy and sexual health play an important role in their lives.
Conclusions: Findings clearly indicate that sexuality, intimacy, and body image issues were common among young women cancer patients. The study reinforces the need for inclusion of sex and sexual health communication as an essential component in routine cancer care for improving quality of sexual health and there by overall health of young women with cancer.
| » Prevalence of Anxiety and Depression Amongst First Time Outpatients Attending Breast Services|| |
Sridhar Suresh, Shilpa Rao
Objective: Studies show that anxiety and depression are very common across patients presenting to outpatient services for medical illnesses. We expect similar or even higher scores in patients with breast complaints, owing to vitality of breast as an organ in terms of sexuality, identity and confidence.
We have conducted a pilot study to determine prevalence of anxiety and depression in patients presenting to the Breast Services of a tertiary care center in Western India. We also assessed the associated factors predicting the risk of anxiety and depression.
Materials and Methods: A descriptive, cross-sectional study was conducted on 192 consenting patients who attended the Breast Services for any breast related complaints.
Data were collected by face-to-face interviews using GAD-7 and PHQ-9 questionnaires. Important demographic characteristics were also noted. Results were analyzed using Kruskal Wallis and Mann Whitney U tests.
Results: As per the cut off points of anxiety and depression employed by the questionnaires, a high percentage of the Breast Services patients were at risk for psychiatric disorder with prevalence of 46.4% for anxiety and 29.7% for depression.
Conclusion: There is a high prevalence of anxiety and depression among Breast Services patients. Younger age, unmarried or single women, higher education and working status can be predicting factors associated with depression and anxiety
| » Bone Related Quality of Life in Postmenopausal Women with Early and Locally Advanced Breast Cancer on Chemotherapy|| |
Yadav Nisha, Biswajit Dubashi, Zachariah Bobby, Jaya Prakash Sahoo, Smita Kayal, Ramesh Ananthakrishnan, Prasanth Ganesan
Background: Chemotherapy cytotoxicity adversely affects bone homeostasis resulting in a significant reduction in bone mineral density which may probably result in poor quality of life. There are limited studies looking at the bone-specific quality of life in this subgroup of patients. This study aimed to assess the impact of chemotherapy on the quality of life specific to bone health during chemotherapy among postmenopausal women with non-metastatic breast cancer.
Methods: Seventy-two newly diagnosed postmenopausal women with early and locally advanced breast cancer aged 42 to 65 years planned for anthracycline and taxane-based chemotherapy (FEC x 3cycles followed by Docetaxel x 4 cycles) were recruited prospectively during the study period (2018-2021). Bone mineral density (BMD) was measured by Dual-energy X-ray absorptiometry (Hologic Discovery Wi) before and after completion of chemotherapy. Patients with osteoporosis (T- score ≤ - 2.5 SD) at diagnosis were excluded. Quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO-31) tool was used to assess the patient's health-related osteoporosis-specific quality of life before the start of chemotherapy and the end of chemotherapy. The QUALEFFO–31 is an osteoporosis-specific quality-of-life questionnaire. The Tamil version of the QUALEFFO–31 questionnaires has been validated. QUALEFFO–31 questionnaire has three domains (31 questionnaires in total). These include pain domain (4 questions), physical function (18 questions), and mental function (9 questions). Each domain's score is calculated as an average value of all the answered items linearly transformed on a scale of 0-100. The total QALEFFO score is calculated as a sum of all answers to items and then linearly transformed on a scale of 0-100. The worse the QOL condition is, the higher the score gets. The differences in the QUALEFFO-31 and BMD were analyzed by paired t-test. P <0>
Result: The median age of the study group was 53 (42-65) years. Early and locally advanced breast cancers were 16 (22.2%) and 56 (77.8%), respectively. Hormone receptor-positive breast cancer was seen in 39 (54.2%) patients. Out of 72 patients at diagnosis, 55 (76.4%) were osteopenia, and 17 (23.6%) were normal. There was no pathological fracture observed at baseline. In our study, at a diagnosis, the mean score functions were pain (13.2±5.3), mental (41.6±13.5), and physical (18.7±4.2), respectively, as described in [Table 1]. A significant worsening was seen in the overall pain, physical and mental functions at six months compared to the baseline (p = 0.001), which indicated worse quality of life in terms of bone health. There was significant worsening of BMD at the lumbar spine, neck of the femur and total hip were -3.0±2.9, -3.1±3.9, and -2.3±2.5.
Conclusions: Our study suggests that there is a worsening of bone health in women who receive chemotherapy in terms of worsening bone mineral density and bone-related quality of life. There is a definite case for using bone-directed therapy along with chemotherapy to improve overall bone health.
| » Assessment of Anxiety, Stress and Depression in Patients of Breast Carcinoma Receiving Hormonal Therapy During 10 Year Followup|| |
Shylini P, Amrut S Kadam
Objective: Assessment of
- Acute Stress Disorder
- Depression in patients during followup for breast cancer while on hormonal therapy
- Study groups-Breast carcinoma patients who underwent surgery and radiotherapy with or without chemotherapy on hormonal therapy during regularly scheduled follow up for 10yrs without any psychiatric comorbidities.
- Breast cancer patients are assessed about anxiety, stress, and depression during followup while on hormonal therapy using different questionnaire. Patients were assessed on 5 continuous followup anytime during 10yrs of hormonal therapy.
- Acute Stress disorder is assessed 2 days after routine checkup for metastasis and recurrence using Impact of event scale-Revised, which is a standard questionnaire to assess traumatic experience within past 7 days. (10). It consists of 22 questions and has scores of 0-4, is used to assess Hyperarousal, Intrusion and avoidance.
- Depression and anxiety can be analysed by Hospital Anxiety and Depression Scale (HADS-D). Each item in this scale is scored from 0-3 and that means a person can score between 0-21 for either anxiety or depression, so data we get is ordinal as its based on a scale.
Result: Out of 100 patients included in the study, 80% were above 50 yrs and 91 belonged to lower socioeconomic status and 52% was illiterate. 7% had family history of malignancy. 64% patients had locally advanced breast cancer and 100% of study population underwent Modified radical mastectomy as surgical modality. 38% of study population received neoadjuvant chemotherapy and 56% received adjuvant chemotherapy. All patients had received adjuvant radiotherapy and is on hormonal therapy. Anxiety was graded using questionnaire from 0-21, 5% of patients didn't have anxiety, 10% had borderline anxiety and 85% had anxiety during each visits for routine checkup. Depression was graded using questionnaire from 0-21, 20% of patients had Depression during first 6 months of followup and patients on followup post 5 yrs of locoregional treatment did not have depression. 42.5% had ASD of score 20, 17.5% had score 24, 15% had score 18, 12.5% had score 16, 7.5% had score 22 and score of 14 and 0 were in score of 2.5. 10 had stress due to clinical examination, 90 patients had stress while investigations for metastasis or recurrence is done like bone scan, chest xray, mammography, ultrasound abdomen and pelvis or PETCT.
Conclusions: The diagnosis of cancer causes stress on any individual which relates both to symptoms of disease and to the psychological meaning attached to cancer. The patients ability to manage these stresses depends on the prior level of emotional adjustment, threat the cancer posses to attainment of age appropriate goals (e.g. career, starting a family, retirement), the presence of emotionally supportive person in the environment and variable determined by the disease itself (disability symptoms, site of cancer, treatment required, presence of pain, and prognosis). Advanced cancer patients who are depressed may also have physical symptoms which are difficult to palliate and these symptoms improve as their depression is treated. Diagnosing psychological problems during the course of treatment, will help in improving the outcome of treatment. Depressive and anxiety spectrum should be taken into serious consideration since they have increasing disability on health scores. Acute stress disorder, anxiety, depression due to routine followup in breast cancer patients are underreported, so their early diagnosis and management will improve the outcome and quality of life in them.
| » Patient Reported Outcomes (Pros) Among Indian Breast Cancer Survivors Using the 'Breast-Q' Questionnaire|| |
Khizer Doctor Ganju, Shilpa Rao, Amit Bondve
Background: The dramatic improvement of oncologic outcomes in breast cancer over the years, has simultaneously seen a growing emphasis being placed on preserving the quality of life among breast cancer survivors. The 'BREAST-Q' questionnaire provides a validated, standardised tool for assessing patient reported outcomes (PROs) in a structured, objective manner, and has repeatedly demonstrated the superiority of breast conservation (BCT) over mastectomy. However, due to limited studies of the 'BREAST-Q' in the Indian subpopulation, an objective comparison of PROs between BCT and mastectomy in this setting has not yet been done. We aim to assess PROs between patients having undergone BCT and mastectomy for breast cancer at our multidisciplinary Breast Clinic using the 'BREAST-Q'.
Methods: Patients who underwent Mastectomy and BCT at our Breast Clinic from 2010 to 2019 were invited to participate and complete the pre and postoperative mastectomy and BCT modules of the 'BREAST-Q 2.0', and the scores compared to assess the PROs between these two cohorts. This included patients that were offered NACT to downstage the tumour.
Result: 35 patients in either group were administered the 'BREAST-Q 2.0'. Patients in the BCT group reported significantly better satisfaction with the appearance of their breasts [77.42 (3.93) vs 50.37 (6.33); p = 0.00001], better physical [88.02 (9.3) vs 72.4 (6.57); p = 0.00001], better psychosocial [91.57 (6.18) vs 68.71 (4.81); p = 0.00001], and better sexual well- being [86.43 (6.48) vs 45.51 (5.10); p = 0.00001], than those in the mastectomy group. Both groups reported similar distress from adverse effects of radiation [16.48 (1.06) vs 16.8 (0.86); p = 0.207].
Conclusions: Indian breast cancer survivors having undergone BCT report a having a better quality of life than those having undergone a mastectomy, much like their western counterparts. In a multidisciplinary setting, breast conservation, effective communication, and counselling support should be prioritised to ensure the best possible outcomes.
| » Impact of Nationwide Lockdown on Breast Cancer Care During Covid-19 Pandemic: A Retrospective Analysis from Central India|| |
Jay Prakash Sahu, Rajesh Kori, Akshay Singh, HU Ghori, OP Singh, Veenita Yogi
Background: As per GLOBOCAN 2020 breast cancer is most common cancer in India accounts for 13.5% cases of all cancers and it's also the most common cause of death due to cancer, responsible for 10.6% of deaths. (4) Due to lockdown after covid 19 outbreak patients were unable to reach to tertiary centres for treatment and many of them presented with advanced stage and lost follow up before taking complete treatment. The management of patients with breast cancer has been impaired, resulting in delayed diagnosis, chemotherapy, and surgery. Timelines from surgery to adjuvant chemotherapy has been increased (5,6). The main objective of this retrospective analytical study was to evaluate the impact of COVID-19 in terms of delay in diagnosis, stage at presentation, metastasis, treatment received by patients, outcome of the treatment and follow up.
Methods: A retrospective analytical study was conducted at the Department of Radiation Oncology, Gandhi Medical College, Bhopal, (M.P.). The details of 75 females with histopathologically confirmed breast cancer who presented during 24th March 2020 – 30th June 2021 (duration 15 months), including age of the patient, duration between onset of symptoms and diagnosis, stage at presentation, histopathology, hormonal status, number of neoadjuvant chemotherapy surgery, adjuvant chemotherapy, radiotherapy, response of treatment by using RECIST 1.1 criteria and follow up were collected and the data was analyzed by SPSS Version 20.
Result: The study included data of 75 females with histopathologically confirmed breast cancer presented during 24th March 2020 – 30th June 2021.The mean age of presentation was 50.08 + 11.8 years with majority of the patients belong to age group of 51-60 years (32.0 %).The duration between onset and diagnosis was < 1 month in 2.7% patients,1-6 months in 33.3%,6-12 months in 45.3% patients and more than 12 months in 18.7%.The histopathology shows majority of the patients presented with invasive ductal carcinoma grade III.1.3% patients presented with TNM stage IA ,2.7% with stage IIB, 17.3% with IIIA,17.3% with IIIB, 33.3% with IIIC and 28% with stage IV, majority of patients (51%) presented with locally advanced stage. Among the patients with metastasis, bone metastasis was most common (9.3%). Out of 33 patients who received neoadjuvant chemotherapy only 48.4% patients completed all cycles of chemotherapy and out of 40 patients who received adjuvant chemotherapy only 55.0% patients completed all cycles of chemotherapy. Response assessment showed that 28.0% patients had partial response, 41.3% patients had complete response,22.7% had progressive disease and 8.0% patients lost follow up just after diagnosis. The mean follow up was 4.93 + 3.06 months. About 34.7% were still on follow up whereas 56% were lost to follow up and 9.3
Conclusions: The coronavirus pandemic has had significant impact on breast cancer patients in terms of duration between onset and diagnosis, stage and metastasis at presentation and default to follow up resulting in detrimental effect on breast cancer prognosis and response to treatment.
| » Impact of Covid 19 Pandemic on the Quality of Life (QOL) of Breast Cancer Patients|| |
Tintu MV, Senthil Kumar
Background: Covid 19 pandemic created chaos and challenges in all fields of life. Oncology community is one of the most affected field because of interruptions in chemotherapy, radiotherapy schedule, cancellation or delay in surgeries and rescheduling of regular oncological evaluations. Apart from this, everywhere it is projecting that cancer patients are more vulnerable for getting covid 19 and its complications. This study is conducted to evaluate how this fear of getting covid 19 and consequences of delay in cancer care affecting their quality of life.
Methods: We included all breast cancer patients registered in our hospital during period from January 2019 to December 2020, irrespective of their age, comorbidities, stage of disease, histology. A survey (online via telephonic contact, WhatsApp chat, Facebook and offline by providing questionnaire to those who come on OPD) focusing on treatment interruptions and quality of life was conducted on month of February 2021. The COVID-19 Concern Survey combined questions to assess participant demographics and cancer history, cancer- directed treatment during the COVID-19 pandemic, and QOL. The quality of life was measured with the Cancer Worry Scale and Hospital Anxiety and Depression Scale.
Result: From hospital database collected details of 62 patients registered during this period and were able to contact 53 patients (85.48%). Median age was 55years. At time of survey, 45 patients (84.9%) were on active treatment. Total of 39 (73.58%) patients experienced delay in some component of their cancer care. 44.12% patients experienced delay in scheduled surgery, 53.84% patient there was delay in scheduled chemotherapy and for 40% patients delay in starting chemotherapy, for 3 patients delay in hormone therapy initiation, 10 patients experienced delay in planned imaging. On univariate analysis, age less than 60 years, being scheduled for cancer treatment or cancer surgery, delay in oncology care were all associated with higher levels of cancer worry, anxiety and depression.
Conclusions: Covid 19 significantly had an impact on quality of life of these breast cancer patients. Since covid 19 is still continuing in our country, there will be high chances for delay in cancer care for future patients also. There is a need to address this psychological issues and methods to deliver oncology care without much delay even in background of issues created by covid 19 is needed. Proper allocation of resources and collaboration with other departments especially surgical and psychiatry and psychology is indeed the need of hour.
| » An Audit of Efficacy and Toxicity of Neoadj Paclitaxel and Trastuzumab in Her-2 Positive Locally Advanced Breast Cancer|| |
Vinin NV, Joneetha Jones, Geetha M
Background: In Her 2 positive LABC, chemotherapy combined with targeted therapy is given as neoadjuvant and as adjuvant treatment. In our centre Neoadjuvant chemotherapy for LABC is given with a combination of Paclitaxel and Trastuzumab. Hence with this study we intented to know the efficacy of this Neoadjuvant regimen for Her2 positive LABC.
Methods: In this retrospective study, we studied Her 2 positive LABC patients who received Neoadjuvant chemotherapy (NACT) with weekly Paclitaxel and Trastuzumab from the period January 1st, 2013 to December 31st, 2018. Demographic details, toxicities during NACT, pathological response to NACT, adjuvant chemotherapy details and the clinical condition of patient on follow up visits were also noted from case sheet.
Result: Total of 105 patient details were analysed. Grade III/IV toxicities were seen in 8 patients. 99 patients underwent Modified radical mastectomy and the rest 5 patients underwent Breast conservation surgery. Pathological complete response (p CR) was seen in 40 (38 %) patients and rest had partial response (p PR). Overall survival at 1 year, 2 years, 3 years and 5 years were 96.2%, 91.3%, 86.6% and 81.4% respectively. Overall DFS at 1 year, 2 years, 3years were 87.4%, 84.3% and 82.1 % respectively. DFS in pCR group at 1 year was 92.3% and it was same at 2years and 3 years, while in p PR group at 1year, 2 years and 3 years were 84.1%, 80.9% and 75.3% respectively.
Conclusions: Neoadjuvant weekly Paclitaxel and trastuzumab combination was well tolerated and resulted in excellent pathological response. DFS and OS was good in the entire patient group and there was significantly better survival in p CR group of patients. This study shows that p CR translates to better DFS and OS.
| » Comparative Study of Dose-Dense Weekly Paclitaxel in Combination with Carbolatin Versus Conventional 3 Weekly Paclitaxel and Carboplatin in Terms of Efficacy, Tolerance and Toxicity in Neoadjuvant Treatment of Ovarian Cancer|| |
Vijayeta Ray, Shahid Ali Siddiqui
Aims and Objectives: Comparative study to find out efficacy, tolerance and adverse reactions of dose dense weekly paclitaxel and carboplatin versus conventional 3 weekly paclitaxel and carboplatin in neoadjuvant treatment of ovarian cancer in terms of:
- Response to therapy
- Acute toxicities
- Late toxicities
Materials and Methods: It is a prospective randomized trial conducted on outdoor and indoor patients of Department of Radiotherapy and Clinical Oncology, JNMCH, AMU, ALIGARH enrolled during the period of October 2018 to July 2020.
Control arm - received Carboplatin administered at a dose of AUC 5 based on the Calvert formula18 or AUC 6 based on a calculated creatinine clearance. Paclitaxel was administered at the dose of 175 mg/m2. The regimen was repeated every 21 days.
Study arm - received Paclitaxel administered at dose of 80mg/m2 weekly with Carboplatin administered at an AUC of 5 three weekly.
Results: The efficacy of NAC was evaluated at only one point, because surgery was performed immediately if chemotherapy was found to be effective. Most of the patients were of more than 60 years and belonged to the post-menopausal age group with good ECOG status. In the study arm, maximum patients presented with FIGO stage 3(46%) or stage 2(27%) disease, while in the control arm it was stage 3 disease (40%) followed by stage 1c (30%). Maximum detected histology of tumour was serous type in both the arms.
Complete response was seen in 72.9% of study arm and 30% of control arm patients.13.6% patients in the study arm and 35% in the control arm showed partial response. While 4.5% of study arm and 20% of control arm patients showed progressive disease. Stable disease was seen in 9% of study arm and 15% of control arm patients. The result was significant at p=0.04.
The mean duration of neoadjuvant treatment was 136.81 days and 139.75days respectively in study and control groups. All patients in both the arms showed a treatment delay with 36.4% showing a delay in treatment within 1 week and 63.6% a delay of more than 1 week in study arm . In the conventional arm the same were 30% and 70% respectively. The mean time to surgery in the study arm was 70.09 days and 69.9days in control arm.
Acute toxicities during treatment were also assessed. 77% patients in the study arm and 85% of control arm manifested grade 1 anemia; 18% and 15% patients respectively having grade 2 and an average 9% of only study arm having grade 3 anemia. Neutropenia, which was mostly grade 1, was seen in average 9% patients of study arm and 5% of control arm. Also 9% patients in study arm and 5% patient in control arm manifested grade 1 thrombocytopenia. Grade 1 myalgia manifested in 45% and 30% respectively of study and control patients, the same for grade 2 dysesthesia being 14% and 5%.
Conclusion: We concluded that weekly dose dense paclitaxel with carboplatin is an effective and feasible treatment option in neoadjuvant setting in patients with advanced ovarian cancer with good response rates and acceptable toxicities.
| » KI-67 As an Early Predictor of Response to Pre-Operative Chemotherapy in Carcinoma Breast: A Retrospective Analysis|| |
Salman Khurshid Shah, Geeta SN, Shashidhar, Veda Varshne, Aditya Nadella
Background: Human Ki-67 protein expression is strictly associated with cell proliferation. The presence of Ki-67 protein during all active phases of the cell cycle (G(1), S, G(2), and mitosis), except resting cells (G(0)), makes it ideal to assess the proliferative quotient of a given cell population. Ki-67 protein is well characterized on the molecular level and is extensively used as a proliferation marker; however the functional and prognostic significance is yet to be conclusively determined.
While the nature of Ki-67 may suggest it to be a possible bad prognostic factor, the same properties, it can be suggested, could make it a positive predictive factor response to chemotherapy.
Ki-67 is often evaluated in breast cancers. The management and prognosis in Ca breast, coincidentally is intertwined with neoadjuvant chemotherapy in most cases.
Neoadjuvant chemotherapy acts by reducing the size of the primary, allowing less morbid surgery, possible breast conservation and clearer margins while also taking care of possible systemic load of disease
The objective of this study is to determine if Ki -67 values can be used as an early predictor of response to neoadjuvant chemotherapy, providing the treating oncologists with a clearer picture of the path ahead, and the patient with a better understanding of their condition and expectations.
Methods: The study included retrospectively analyzed data from 150 patients of carcinoma breast who underwent surgery after neoadjuvant chemotherapy between 2015-2021. The clinical, histopathological and immunohistochemical characteristics were analyzed using core biopsy specimens taken before neoadjuvant chemotherapy. This data was then reviewed to determine their correlations with response to chemotherapy.
Result: A pathologically complete response (pCR) was seen in 41 patients. (27%). A partial response was seen in 90 patients (60%). 19 patients had stable disease post neoadjuvant chemotherapy (13%). Ki-67 proved to be an independent factor in determining response to neoadjuvant chemotherapy. A high Ki-67 value (>25%) was observed to be a significant predictive factor for response to chemotherapy predominantly in hormone negative and Her2 positive patients.
Conclusions: The study suggests that Ki-67 may be a strong, independent and effective factor for determining the response to neoadjuvant chemotherapy upfront with reasonable accuracy. A high KI-67 can indicate a higher likelihood of pathologically complete response (pCR) at the time of surgery, providing a more realistic picture of probability of breast conservation and/or possible need for adjuvant radiation.