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   Table of Contents - Current issue
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October-December 2020
Volume 57 | Issue 4
Page Nos. 367-509

Online since Saturday, October 17, 2020

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EDITORIAL  

Dispelling myths about unmarried patients with cancer Highly accessed article p. 367
Joan DelFattore
DOI:10.4103/ijc.IJC_110_20  
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REVIEW ARTICLE Top

Grossing and reporting of squamous cell carcinoma of oral cavity—An evidence-based approach p. 378
KR Anila, Cessal T Kainickal, Shaji Thomas, K Jayasree
DOI:10.4103/ijc.IJC_667_20  
The grossing of radical surgery specimens of the head and neck region is extremely challenging due to the complicated anatomy with the inclusion of various tissues such as mucosa, soft-tissue, bone, skin, etc., in the specimen. Also, essential/core data provided in the histopathology report significantly influence further treatment decisions taken. The eighth edition of the cancer staging manual of the American Joint Committee on Cancer has brought about major changes in reporting of squamous cell carcinoma of the oral cavity. Though pathologists in oncology centers who routinely handle such specimens are aware of these updates and the impact of their report on patient management, this may not be true for other peripheral centers that may be handling these specimens. Lack of awareness can lead to a compromised report which will adversely affect patient management. This article attempts to discuss the salient features to be noted in grossing and reporting of squamous cell carcinoma of the oral cavity and the rationale behind this.
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HEAD AND NECK CANCER Top

Is 9-field IMRT superior to 7-field IMRT in the treatment of nasopharyngeal carcinoma? p. 388
Mohamed S Ibrahim, Ehab M Attalla, Mostafa El Naggar, Wael M Elshemey
DOI:10.4103/ijc.IJC_555_18  
Background: To evaluate the pros and cons of 9-field intensity modulated radiotherapy (IMRT) compared to 7-field IMRT in the treatment of nasopharyngeal carcinoma (NPC). Methods: Ten NPC patients were treated with 7F-IMRT and 9F-IMRT. A dose prescription of 70 Gy was delivered in 35 fractions to gross planning target volume (PTV1). Plan verification was performed via 2D-array and film dosimetry. Dose-Volume Histogram (DVH) parameters were used to evaluate the quality of IMRT plans. Results: Dose data for the investigated planning techniques obeyed the Radiation Therapy Oncology Group (RTOG) protocol no. 0615. The dose delivered to PTV1 and organs-at-risk (OARs) for 9F-IMRT was significantly better than 7F-IMRT, except for OARs which were at a distance from PTV1, such as eyes, optical nerves, and chiasma. Ninety five percent of PTV1 was covered by more than 95% of the prescribed dose (67.75 ± 1.1 Gy and 68.57 ± 1.2 Gy for 7F-IMRT and 9F-IMRT, respectively). The maximum dose to 1% of brainstem was 50.06 ± 2.7 Gy and 47.75 ± 2.6 Gy for 7F-IMRT and 9F-IMRT, respectively. Dose verification showed good agreement with treatment planning system with a maximum deviation for 2D-array of 2.16% ± 0.86 and 1.73% ± 0.33 for 7F-IMRT and 9F-IMRT, respectively. Similarly, radiochromic film reported maximum dose deviations of 3.38% ± 1.68 and 2.77% ± 1.3, respectively. Conclusion: 9F-IMRT provides better homogenous dose to PTV1 and more sparing of OARs over 7F-IMRT for NPC patients, except for OARs which are are a distance from PTV1.
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Should we consider thyroid gland as an organ at risk in carcinoma breast patients receiving adjuvant radiation by conformal technique? A single institute dosimetric study p. 393
Adilakshmi Madisetty, Aparna Suryadevara, Sanjeeva K Chinta, Srinivas Vuppu, Venkata R R Marella
DOI:10.4103/ijc.IJC_607_18  
Background: The most common malignancy among Indian women is carcinoma of the breast. In the management of breast cancer (BC), radiation therapy (RT) is given to breast or chest wall and supraclavicular lymph nodal (SCLN) area, with at least part of the thyroid receiving RT dose.There is an increased incidence of hypothyroidism (HT) among BC patients after RT involving the SCLN area. Moreover, the incidence of HT in India is higher than in the West. The aim of our study is to dosimetrically evaluate the thyroid doses during RT for BC. Methods: This is a single institute prospective study (n = 131). Radiation was planned by three-dimensional conformal radiation therapy (3D-CRT) technique and dose-volume parameters for thyroid gland were noted. Results: The median thyroid gland volume was 7.4 cc. The median of the mean dose to thyroid gland was 2068 cGy, V10 was 42%, and V40 was 33%. In other studies, BC patients with smaller thyroid gland were more prone to HT (volume <8 cc). In our study, we have seen that the median thyroid volume was 7.4 cc. Conclusion: Our study showed a lower mean dose to the thyroid gland and smaller volume thyroid glands than in the literature. As the incidence of HT is higher in India, compared to the west and our patients had small volume thyroid glands, they could be at higher risk of developing HT RT. So BC patients should be monitored for HT and should be given a dose constraint while planning RT.
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Long-term outcomes of differentiated thyroid cancers with tracheal invasion: A 15-year experience p. 398
Yogesh Tiwari, Arvind Krishnamurthy
DOI:10.4103/ijc.IJC_456_19  PMID:32675437
Background: Tracheal invasion is reported to occur in approximately one-third of the patients of locally advanced thyroid cancers. There is a paucity of data in literature with regard to the long-term outcomes of thyroid cancers with tracheal invasion. Methods: A total of 37 patients from our tertiary care center underwent radical surgery for tracheal involvement for differentiated thyroid cancers between the years 2002 and 2016. The variables pertaining to the demographics, clinical presentation, imaging, operative details and histopathology reports were captured from the patient's case records and analyzed. Results: Among the 37 patients, there were 21 males and 16 females. Majority of the patients (56.8%) were >55 years of age. Surgery (tracheal resection) was performed in the primary setting in 29 patients, whereas it was performed in a recurrent setting in 8 patients. As per the Shin classification, 3 patients belonged to Shin stage 1, 3 to Shin stage 2, 16 patients to Shin stage 3 and 15 patients to Shin stage 4. There was no 30 day postoperative mortality in our cohort. The median follow-up of our cohort was 175 months. The 5-, 10-, and the 15-year overall survivals of the entire cohort were 81.7%, 47.8%, and 35.9%, respectively. Conclusion: Our series shows favorable long-term oncological outcomes of selected patients of thyroid cancers with tracheal resection and adds to the limited long-term data available in literature.
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GENITOURINARY ONCOLOGY Top

Anesthesia concerns in prostate brachytherapy: An institutional experience p. 411
Vinod Kumar, Deepti Ahuja, Nishkarsh Gupta, Sachidanand J Bharati, Rakesh Garg, Seema Mishra, KP Haresh, Subhash Gupta, Sushma Bhatnagar
DOI:10.4103/ijc.IJC_666_18  
Background: Prostate cancer is a common cancer found in men worldwide. Brachytherapy is an established modality used for the treatment of these patients. Although anesthetic management of such patients is challenging but the ideal anesthetic technique has not yet been established. Our study aims to identify the most efficacious anesthetic technique for perioperative management of prostate cancer patients undergoing brachytherapy. Methods: Retrospective analysis of ten patients who underwent 16 brachytherapy sessions under combined spinal epidural (CSE) anesthesia between April 2016 and December 2016 was done. The data were collected, tabulated using MS Excel, and statistically analyzed with EPI Info 6 and SPSS-16 statistical software (SPSS Inc. Chicago, USA) to draw relative conclusions. Results: The median peak sensory dermatome level achieved was T6 and the median maximum motor block achieved was grade 2. The mean (± standard deviation (SD)) time to sensory regression to T10 (range T5-T8) dermatome was found to be 118.00 ± 47.110 (range = 0-238) minutes. Despite the presence of co-morbidities, minor intraoperative complications were observed only in two patients. The postoperative numerical rating scale (NRS) was less than 4 in all patients during the first 24 hours. None of our patients complained of nausea, vomiting, pruritus and respiratory depression. The mean (± SD) patient satisfaction score was 44.40 ± 0.871 (range : 1-5) at the end of 24 hours. Conclusions: CSE anesthesia is a safe and effective technique for anesthetic management of patients undergoing prostate brachytherapy.
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Outcomes of locally advanced cervical cancer presenting with obstructive uropathy: An institutional audit p. 416
Rohan Salunkhe, Supriya Chopra, Suyash Kulkarni, Nitin Shetty, Reena Engineer, Umesh Mahantshetty, Jaya Ghosh, Sudeep Gupta, Shyam Kishore Shrivastava
DOI:10.4103/ijc.IJC_704_18  
Background: There is paucity of outcome data of patients with cervical cancer presenting with malignant obstructive uropathy. The present retrospective study describes outcomes of patients with cervical cancer who presented with obstructive uropathy at the time of diagnosis and underwent urinary diversion with percutaneous nephrostomy (PCN) before/during treatment. Methods: Patients who underwent PCN from January 2010 to June 2015 were included. Intent of treatment (radical or palliative) was decided within multidisciplinary team depending on disease stage, Karnofsky performance status (KPS), and degree of renal derangement. Treatment and outcome details were retrieved from electronic records. Time to normalization of creatinine, feasibility of delivering planned treatment, and overall survival (OS) were determined. Impact of various prognostic factors on outcomes was determined using univariate or multivariate analysis. Results: After PCN and double-J stenting, 50% were eligible for (chemo) radiation. All radically treated patients (26/52) received brachytherapy. The median EQD2 to point A was 78 Gy (72–84 Gy). The median OS was 10 (0.5–60) months. Patients who completed chemoradiation had median OS of 31 months. Those receiving radical radiation and palliative radiation had median OS of 11 and 6 months, respectively. On univariate analysis, smaller tumor size (p = 0.03), high KPS (P = 0.04), and radical intent of treatment (P = 0.05) predicted for OS. Conclusion: Patients presenting with obstructive uropathy have median OS less than a year despite urinary diversion. Select cohort with good performance status, small tumor size, and serum creatinine of ≤3 mg/dL may be selected for diversion procedures and potential radical treatment.
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BREAST CANCER Top

Assessment of toxicities and outcomes in patients with breast cancer treated with hypofractionated radiotherapy p. 423
M Sindhu, Monica Malik, Syed F Ahmed, Deepthi Valiyaveettil
DOI:10.4103/ijc.IJC_670_18  
Background: Hypofractionation is now becoming the standard of care in breast irradiation. The aim of this study was to assess the toxicities and outcomes in patients with breast cancer treated with hypofractionated radiotherapy (HFRT). Methods: Patients with localized breast cancer who received adjuvant HFRT between 2013 and 2015 with a minimum follow-up of 6 months following radiation were included in this prospective study. Late toxicities were assessed using CTCAE v 4 and included chest/breast pain, limb pain, limb edema, skin pigmentation, skin fibrosis, and shoulder movement restriction. Outcomes assessed included locoregional control, disease-free survival, and overall survival. Statistical analysis was done using Microsoft Excel and SPSS v22. Results: A total of 81 patients fulfilled the inclusion criteria, of which 19 patients had died during follow-up. Regional nodal irradiation was done in 63 (77.8%) patients using the same hypofractionated schedule of 40 Gy in 15 fractions. Late toxicities were assessed for 62 patients. The median follow-up following the course of hypofractionated radiation was 45 months (range 14 - 65 months). Late toxicities were assessed for 62 patients. Grade 1/2 chest/breast pain, limb pain, limb edema, skin pigmentation, skin fibrosis, and shoulder movement restriction were seen in 11%, 12%, 7%, 6%, 8%, and 11% of cases, respectively. Distant recurrences were seen in 8% of cases, and there were no locoregional recurrences. Five-year overall survival was 76.5%. Conclusion: HFRT to whole breast or chest wall and the regional nodal areas was well-tolerated with acceptable rates of late toxicities on follow-up.
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Study of pathological complete response rate with neoadjuvant concurrent chemoradiation with paclitaxel in locally advanced breast cancer Highly accessed article p. 428
Priya Iyer, Venkatraman Radhakrishnan, Ananthi Balasubramanian, V Sridevi, Arvind Krishnamurthy, Manikandan Dhanushkodi, Shirley Sundersingh, Selvaluxmy Ganesarajah
DOI:10.4103/ijc.IJC_524_19  PMID:32675440
Background: Neoadjuvant concurrent chemoradiation (CTRT) is not widely practiced in breast cancers. The current study presents our experience with the use of neoadjuvant CTRT in patients with locally advanced breast cancers (LABC) treated at our center. Methods: The study included all consecutive female patients with inoperable stage III LABC treated at Cancer Institute (W.I.A), Chennai, India, from December 2015 to September 2016. Data were collected retrospectively from the patients' case records. The impact of neoadjuvant CTRT on the pathological complete response (pCR) and survival was analyzed. Neoadjuvant chemotherapy consisted of 4 cycles of adriamycin and cyclophosphamide given either before or after 4 cycles of paclitaxel. All chemotherapy cycles were given once in 3 weeks. Concurrent radiotherapy was incorporated with 2 cycles of paclitaxel. Results: The study included 100 patients with a median age of 49 years, among whom 9 (9%) had IIIA disease, 73 (73%) IIIB, and 18 (18%) had IIIC disease. The hormone receptor-positive disease was observed in 36 (36%) patients, triple-negative in 24 (24%), and Her2/neu positive disease in 40 (40%) patients. All patients were operable after completing the planned neoadjuvant treatments. Ninety-one out of 100 (91%) patients underwent modified radical mastectomy whereas 9 (9%) did not consent for surgery. Among the patients who underwent MRM, 34/91 (37.7%) patients had a pCR. Moreover, pCR was observed in 12/22 (54.5%) patients with triple-negative disease, 10/34 (29.4%) patients with hormone receptor-positive disease, and 12/35 (34.2%) patients with Her2/neu positive disease (P = 0.19). Most common morbidity observed was grade 3 skin reactions. The 2-year event-free survival and overall survival for the entire cohort was 73.1% and 88%, respectively. Conclusion: Neoadjuvant CTRT is associated with a higher pCR rate than what has been reported with neoadjuvant chemotherapy alone. Further prospective studies are required to confirm our findings.
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MCQS Top

MCQs on “Study of pathological complete response rate with neoadjuvant concurrent chemoradiation with paclitaxel in locally advanced breast cancer” p. 435
HS Darling, Pradeep Jaiswal, Nishant Lohia, Nishant Tiwari
DOI:10.4103/ijc.IJC_1079_20  
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THORACIC ONCOLOGY Top

Determining whether multiple needles are necessary in interstitial brachytherapy for thoracic tumors: A dosimetry analysis p. 437
Bo Yang, Xiaoyang Sun, Haowen Pang, Jingbo Wu
DOI:10.4103/ijc.IJC_693_18  
Background: In interstitial brachytherapy, needles must be inserted in a regular, parallel arrangement to ensure a uniform target dose distribution and conformal distribution to the target. It is generally difficult to achieve this in thoracic tumors because of obstruction by the ribs. Furthermore, insertion of multiple needles may cause the patient considerable harm and could expose him/her to additional risks. Thus, we propose the single-dwell-position method, discuss its applicability, and compare it with the actual multiple-needle method using dosimetry. The aim of this study was to evaluate the necessity for multiple needles with irregular alignment in interstitial brachytherapy for thoracic tumors. Methods: Twelve patients' interstitial brachytherapy plans were reviewed. The single-dwell-position interstitial brachytherapy plans, wherein one needle was hypothetically inserted, were compared with the actual multiple-needle plans. Dose parameters, including clinical target volume (CTV) and volumes of the lung, spinal cord, heart, and ribs, were compared. We also evaluated the correlation between CTV size and dose difference in the lungs. The nonparametric Wilcoxon test was used. Results: There were no statistically significant differences in the doses achieved with the single-dwell-position plans and actual multiple-needle plans. The correlation between the CTV size and dose difference in the lungs was weak. Conclusions: Irregularly arranged multiple-needle interstitial brachytherapy does not provide superior doses to the lung, heart, spinal cord, or ribs compared with single-dwell-position plans. If regular arrangement of multiple needles is difficult to achieve, the multiple-needle scheme is not the only viable option.
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TOBACCO Top

Preparedness of primary health care providers for tobacco cessation — Experiences from a non-communicable disease training program p. 443
Arun M Kokane, Arun Mitra
DOI:10.4103/ijc.IJC_696_18  
Background: Tobacco use can lead to tobacco/nicotine dependence and serious health problems. Quitting smoking significantly reduces the risk of developing smoking-related diseases. In a low resource setting like India, the role of primary healthcare providers in tobacco cessation is immense. The current study was conducted with the objective of evaluating the preparedness, knowledge and attitude of the primary healthcare providers in tobacco cessation. Methods: A cross-sectional study involving 289 trainees taking part in a non-communicable disease training in the calendar year 2015, held at All India Institute of Medical Sciences, Bhopal were interviewed with a close-ended questionnaire on the demographic profile of participants, their preparedness, and current knowledge and attitude related with tobacco cessation activities. Results: Among the 289 trainees, majority of the study participants were staff nurses (54.7%) and medical officers (41.2%) with a mean (± Standard Deviation, range) age of 35 (±10, 22-63) years predominantly from district and sub-district hospitals (52.9%). In total, 86.9% counsel their patients regarding tobacco cessation and 13.1% use nicotine replacement therapy in aiding tobacco cessation. 174 (60.2%) participants received on-job training of various duration on tobacco control, and 96 (33.2%) did not receive any training. Preparedness toward tobacco cessation was present in 15.01% (41) of the study participants. Conclusion: The study reveals that the majority of the healthcare providers were not prepared, and only half of the participants had favorable attitudes and practices of delivering tobacco cessation activities.
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HEMATOLYMPHOID MALIGNANCY Top

Early death in acute promyelocytic leukemia: Evidence from a rural cancer center p. 451
Krishna Reddy Golamari, Anupama Mikkilineni, Sitalatha Chappidi
DOI:10.4103/ijc.IJC_177_19  
Background: Early death is still the characteristic feature of acute promyelocytic leukemia (APL) despite the advances in the treatment regimen. Analyzing the incidence of early death would prove beneficial as no much substantial information is available pertaining to the rural population. The present study analyzed the incidence of APL-associated early death, its clinical characteristics, and outcome among acute myeloid leukemia patients. Methods: This retrospective study included patients catering to the rural areas of Vijayawada (Andhra Pradesh, India) from January 2013 to June 2017. Chi-square test, Fisher's exact test, independent sample median test, and Kaplan–Meier test for probability of survival were used. Results: Of the 204 acute myeloid cases, 24% cases (median age = 30 years; range=8 to 68 years) were identified as APL. Early death rate was 34.6%, who expired within 30 days from diagnosis with 65% suffering high disease risk. The median time from admission to death was 2 days (range 0–18). Cause of early death was majorly due to hemorrhage (64%). Moreover, 47.1% of early death patients received no prior antileukemic treatment. The overall 5-year cumulative disease-free survival rate among patients with APL was 76% where high disease risk patients had the least disease-free survival (65%–75%), whereas intermediate and low-risk patients had >80% and 100% disease-free survival rate, respectively. Conclusion: Early diagnosis and timely intervention might help to prevent early death as our findings clearly indicate poor awareness of disease and lack of early intervention among the rural population.
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RADIATION ONCOLOGY Top

Assessing radiation oncology research needs in India: Results of a physician survey p. 457
Rohini Kishor Bhatia, Supriya Sastri (Chopra), Vijay Anand Reddy Palkonda, GV Giri, Surendranath Senapati, Ramesh S Bilimagga, Manjeet Chadha, Akila N Viswanathan, Surbhi Grover
DOI:10.4103/ijc.IJC_518_19  PMID:32769296
Background: In India, where the annual incidence of cancer is projected to reach 1.7 million by 2020, the need for clinical research to establish the most effective, resource-guided, and evidence-based care is paramount. In this study, we sought to better understand the research training needs of radiation oncologists in India. Methods: A 12 item questionnaire was developed to assess research training needs and was distributed at the research methods course jointly organized by Indian College of Radiation Oncology, the American Brachytherapy Society, and Education Committee of the American Society of Therapeutic Radiation Oncology during the Indian Cancer Congress, 2017. Results: Of 100 participants who received the questionnaire, 63% responded. Ninety percent (56/63) were Radiation Oncologists. Forty-two percent (26/63) of respondents had previously conducted research. A longer length of practice (>10 years) was significantly associated with conducting research (odds ratio (OR) 6.99, P = 0.031) and having formal research training trended toward significance (OR 3.03, P = 0.058). The most common reason for not conducting research was “lack of training” (41%, 14/34). The most common types of research conducted were Audits and Retrospective studies (62%, 16/26), followed by a Phase I/II/III Trial (46%, 10/26). Having formal research training was a significant factor associated with writing a protocol (OR 5.53, P = 0.016). Limited training in research methods (54%, 13/24) and lack of mentorship (42%, 10/24) were cited as reasons for not developing a protocol. Ninety-seven percent (57/59) of respondents were interested in a didactic session on research, specifically focusing on biostatistics. Conclusions: With research training and mentorship, there is a greater likelihood that concepts and written protocols will translate into successfully completed studies in radiation therapy.
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CASE REPORTS Top

Double trouble: Extrauterine epithelioid trophoblastic tumor with uterine choriocarcinoma - An autopsy report p. 463
Kusum Jashnani, Alshifa Yagana, Niraj Mahajan
DOI:10.4103/ijc.IJC_220_19  
Gestational trophoblastic tumors (GTTs) include choriocarcinoma, epithelioid trophoblastic tumor, and placental site trophoblastic tumor. The occurrence of mixed GTT is rare. We report such a case in a 24-year-old woman who presented with menorrhagia since 2 months and obstetric history of two abortions, one of which was a molar pregnancy. She was undergoing evaluation for carcinoma cervix and treatment for pulmonary tuberculosis from another hospital when she was admitted at our institute for further workup and treatment. However, she succumbed and an autopsy was performed. Histologic evaluation after the autopsy revealed uterine choriocarcinoma with metastatic epithelioid trophoblastic tumor (ETT) in the lung and spleen.
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5-Fluorouracil induced extravasation injury p. 467
Sangana Sunitha Reddy, Shalaka Somayaji, Mamatha Krishna Murthy, Vinayak V Maka
DOI:10.4103/ijc.IJC_281_19  PMID:32769297
Antineoplastic drugs based on their ability to cause local damage are classified as irritants, vesicants, and non-vesicants. Previous literature has reported higher rate of vesicants induced extravasation (EV) compared to irritants. We report the first case of irritant, 5-fluorouracil causing grade III EV in 55-year-old woman. The patient was diagnosed with esophageal squamous cell carcinoma. Docetaxel, Cisplatin, and 5-Fluorouracil (DCF) chemotherapy regimen was planned and administered through peripheral venous access. Patient experienced grade 3 extravasation in her 3rd cycle following 5-fluorouracil (5-FU) administration. The suspected drug was withdrawn immediately and discontinued from the 4th cycle of the regimen. The patient completely recovered from the symptoms of pain and erythema in the next cycle and care was taken not to infuse drug in the same site again. Since there is no appropriate antidote available to manage this condition, measures need to be taken to identify the predisposing factors for EV and prevent them.
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Rhabdoid melanoma: A diagnostic ordeal p. 473
Anurag Mehta, Abhimanyu Sharma, Garima Gupta
DOI:10.4103/ijc.IJC_536_19  
A 64-year-old man presented with multiple, bilateral pulmonary nodules, considered clinically to be intrapulmonary metastasis from lung carcinoma. On histopathologic examination, a tumor with a solid growth pattern and rhabdoid neoplastic morphology was seen. Initially, a diagnosis of nonsmall cell carcinoma of lung was considered but the immunophenotype was not supportive. Further, extensive immunohistochemistry revealed SOX10, Melan-A, and HMB45 expression in the absence of S-100. Strong globular cytoplasmic staining for vimentin, SMA, Desmin, and WT1 were observed. A final diagnosis of rhabdoid melanoma was made. The immunoprofile of our case was unique from previously described rhabdoid melanoma in English literature. The globular staining for intermediate filaments such as desmin and SMA is a novel finding. The strong WT1 intracytoplasmic staining reported previously was also observed in this case, with intense globular characteristics.
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VIEW POINT Top

A tale of two springs Highly accessed article p. 478
Savita Butola
DOI:10.4103/ijc.IJC_614_19  
Palliative care, which is more than just terminal care, is still unknown in most parts of India. This narrative highlights how early integration of palliative medicine can help the patient and their family to make the most of their time together. Besides, excellent clinical acumen is required while looking after the sickest and the most critical patients, proper communication skills, and an ethical and holistic approach enables a good doctor-patient relationship. Good pain relief, symptom control, attention to nursing issues, providing information sensitively to empower patients and families for joint decision making, and advance care planning can help bring about a decent death and bereavement. Healing is brought about not only for the caregivers but also for the healthcare professionals.
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Metronomic chemotherapy for scheduling oral cancer surgery during the COVID-19 pandemic p. 481
Shiv Rajan, Vijay Kumar, Naseem Akhtar, Sameer Gupta, Arun Chaturvedi
DOI:10.4103/ijc.IJC_553_20  
Worldwide, hospitals are facing problems in managing cancer patients during the ongoing COVID-19 pandemic. Given the immense cancer burden of oral cancer in India, scheduling surgeries are becoming increasingly difficult. Upfront surgeries are recommended for curative treatment of oral cancers and postponing them raises the fear of progression. Metronomic chemotherapy can be considered during the waiting period given its potential oncological benefits and ease of administration without much toxicity.
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PERSPECTIVE Top

Impact of COVID-19 on cancer screening by Non-Government Organizations and the way forward p. 485
Chethana Thirthahalli, Punith Shetty
DOI:10.4103/ijc.IJC_465_20  
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LETTERS TO THE EDITOR Top

Breast cancer associated with paraneoplastic cerebellar degeneration: A case series p. 487
Ilavarasi Vanidassane, Ajay Gogia, Vinod Raina, Priya Tiwari
DOI:10.4103/ijc.IJC_132_19  
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Multiple myeloma presenting with diffuse ulcers and necrotic toe p. 489
Fatemeh Nejatifar, Zahra Mohebbi, Asghar Hajiabbasi, Rambod Mozafari, Hamed Sotoude
DOI:10.4103/ijc.IJC_227_19  
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Feasibility of using pemetrexed as a salvage regimen in heavily pre-treated patients with ovarian cancer: A retrospective review p. 491
Peter Dottino, Matthew Dashkoff, Ann Marie Beddoe
DOI:10.4103/ijc.IJC_284_19  
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Renal hypodysplasia with epididymis-like tubules presenting as renal cancer: An unusual finding at nephron-sparing surgery p. 494
Subhash C Yadav, Santosh Menon, Sangeeta Desai, Palak Popat
DOI:10.4103/ijc.IJC_324_19  
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Instagram or mammogram: What are Indian women more aware of? p. 498
Suhani , Ajit S Oberoi
DOI:10.4103/ijc.IJC_555_19  PMID:32594070
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Use of protective partition during extubation in the COVID-19 pandemic p. 500
Sumitra G Bakshi, Bhakti Trivedi, Vijaya P Patil
DOI:10.4103/ijc.IJC_453_20  
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COMMENTARY Top

Barrier devices for aerosol-generating procedure during COVID-19 pandemic p. 502
Vinod Kumar, Nishkarsh Gupta
DOI:10.4103/ijc.IJC_702_20  
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IMAGE Top

Not all blast flags in hematology analysers are leukemia - think malaria! Highly accessed article p. 505
Jayashree D Kulkarni, Rajesh Singh, PS Pramod
DOI:10.4103/ijc.IJC_790_19  PMID:31736472
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NEWS Top

News from the world of oncology p. 507

DOI:10.4103/ijc.IJC_1105_20  
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  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow