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   Table of Contents - Current issue
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April-June 2021
Volume 58 | Issue 2
Page Nos. 155-314

Online since Monday, June 7, 2021

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EDITORIAL  

Papillary microcarcinoma—Management issues p. 155
Ashok R Shaha, R Michael Tuttle
DOI:10.4103/ijc.IJC_281_21  PMID:34100408
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REVIEW ARTICLE Top

Nondisclosure of a cancer diagnosis and prognosis: Recommendations for future research and practice Highly accessed article p. 158
Mahati Chittem, Sravannthi Maya, Shweta Chawak
DOI:10.4103/ijc.IJC_740_19  PMID:32594077
Nondisclosure of a cancer diagnosis and prognosis is a common practice in many family-centric cultures wherein cancer is viewed negatively, resulting in family carers opposing truthful communication to patients. Oncologists comply with this request for diagnosis and/or prognosis nondisclosure owing to the cultural milieu, often choosing to describe the disease in less threatening terms such as “tumor” or “fever.” This review provides a snapshot of existing research exploring diagnosis and prognosis disclosure and nondisclosure from the perspectives of the oncologists, family carers, and the patient with a particular focus on the psychological outcomes for patients who are aware versus not aware of their diagnosis and/or prognosis. Further, this review makes recommendations for future research and practice in cancer diagnosis and prognosis communication in India (e.g., communication skills training for family carers and healthcare providers).
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AUDIT Top

An audit of the editorial process at the Indian Journal of Cancer: Lessons learned, and how to improve chances of acceptance of your paper p. 165
Georgiaria J Fernandes, Sanjay A Pai
DOI:10.4103/ijc.IJC_1319_20  PMID:34100409
Background: The editors of the Indian Journal of Cancer (IJC) have not, so far, objectively analyzed the editorial processes involving author, referee, and editor data of the journal. Hence, we aimed at doing so in this audit. Methods: We retrospectively analyzed manuscripts submitted to the IJC from April 1, 2020, to May 31, 2020, for data related to the peer-review process. Microsoft Excel was used to enter the retrieved information and to carry out the statistical analysis. Results: Three hundred and nineteen manuscripts were submitted during the study period. Of these, three were excluded from the study. Of the 316, 79 (25%) were articles on laboratory medicine; 182 (57.6%) were original articles. About half of the submitted manuscripts (166, 52.5%) were desk-rejected. Of the remaining 149 manuscripts, 105 did not follow the instructions to contributors (ITC) and required a median number of two revisions (range = 1–5) to satisfy the ITC. To review 107 manuscripts, 536 external referees were invited; of them 306 did not respond, 79 declined the invitation, and 151 accepted the invitation. Of these 151, 132 reverted with comments. Of the 200 Indians who were invited as referees, 118 (59%) accepted the invitation, whereas of the 336 non-Indian referees, only 33 (9.8%) did. Of the 107 Indian and 25 non-Indian referees who sent their comments, 86 (80.4%) and 19 (88%), respectively, offered useful comments. The median number of days to decision: for desk-rejection was 1 day (range = 0 – 42) days, for rejection after peer-review was 67 (range = 4 – 309) days, and for acceptance was 133.5 (range = 42 – 305) days. Decision has not yet been taken for 14 manuscripts. Conclusion: The study provides evidence that it is difficult to get referees. Also, a significant number of authors do not read or follow the ITC. We suggest that the time taken for a decision can be appreciably improved if these issues are addressed.
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GYNECOLOGIC CANCER Top

Quality of life in long term survivors of cervical cancer: A cross sectional study p. 171
TS Shylasree, Rohit Ranade, Abhay K Kattepur, Satinder Kaur, Rohit Dusane, Amita Maheshwari, Umesh Mahantshetty, Supriya Chopra, Reena Engineer, Rajendra A Kerkar
DOI:10.4103/ijc.IJC_712_18  PMID:34100410
Background: Quality of life (QOL) is an important parameter to evaluate and modify in patients treated for cervical cancer as long-term survival is excellent in early-stage and reasonably good in locally advanced stage compared to other solid cancers. The aim of the study was the cross sectional evaluation of the quality of life in survivors completing at least 3 years of follow-up after curative therapy for cervical cancer at a tertiary cancer institute. Methods: All patients, following primary curative treatment with no evidence of recurrence and completing at least 3 years follow-up, were assessed for QOL using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-30 and its cervical cancer module (Cx24). Patients were subdivided based on the modality of treatment. Analysis was done using Kruskal-Wallis and Mann-Whitney U test. Results: One hundred seven patients were analyzed out of the 113 patients initially included. Treated patients showed good global QOL (mean value: 84.07) and functional scores (covering all domains). In the cervical cancer module, sexual activity, sexual enjoyment, and sexual function were low in the majority of the respondents. Chronic lymphedema, symptom experience, and sexual worry were significant across all the treatment arms. Conclusion: Cervical cancer survivors have an overall good QOL. However, certain concerns related to the sexual quality of life, symptom experience, and chronic lymphedema need to be addressed appropriately.
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Adjuvant chemotherapy in uterine carcinosarcoma: Comparison of a doublet and a triplet chemotherapeutic regimen p. 179
Udip Maheshwari, Suhas K Rajappa, Vineet Talwar, Varun Goel, Prasanta K Dash, Manish Sharma, Pankaj Goyal, Parveen Jain, Venkata P B Koyyala, Dinesh C Doval
DOI:10.4103/ijc.IJC_57_19  PMID:33753600
Background: Uterine carcinosarcoma (UCS) is a rare and aggressive malignancy, and there are no existing standard guidelines for adjuvant therapy. Doublet chemotherapy regimens are most favored in adjuvant setting; however, given the early chances of distant recurrences, does a triple-drug adjuvant chemotherapy improve disease-free survival (DFS), remains to be seen. Our aim of the study is to compare and review different adjuvant regimens used in UCS. Methods: Retrospective chart analysis included 37 optimally staged UCS patients. Each of them had either received paclitaxel plus carboplatin (PC) or paclitaxel, ifosfamide, and cisplatin (TIP). A toxicity analysis was charted as per common terminology criteria for adverse events (CTCAE) 4 criteria. A survival analysis was done by the Kaplan-Meier method, and log-rank test was used for comparison of two variables. Results: Incidence of UCS was 4.1% and mean age (standard deviation) was 58.73 ± 6.3 (range 42 - 71) years. TIP and PC chemotherapies were given to 22 and 15 patients, respectively. Five-year DFS and overall survival for TIP versus PC were 38.2% versus 35.9% (P = 0.118) and 49% versus 50.3% (P = 0.306), respectively, and for Stage I, II versus Stage III was 78.8% versus 12.7%(P = 0.001) and 92.3% versus 34.2% (P = 0.002), respectively. However, in advanced disease (Stage III), there is a trend toward DFS advantage of triple-drug adjuvant regimen (Hazards ratio (HR) = 0.35, 95% confidence interval (CI) = 0.12–1.07). Grade 3 and 4 toxicities were seen in 54.5% patients of TIP chemotherapy group and in 13.3% patients of the PC chemotherapy (P = 0.012). Conclusion: Triple-drug adjuvant chemotherapy (TIP) confers no survival advantage over doublet chemotherapy (PC), and in turn, increases the grade 3/4 toxicity in the adjuvant setting of optimally staged UCS patients.
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PEDIATRIC CANCER Top

Evaluation of serum procalcitonin, serum interleukin-6, and interleukin-8 as predictors of serious infection in children with febrile neutropenia and cancer p. 185
Arathi Srinivasan, Nuthan Kumar, Julius X Scott
DOI:10.4103/ijc.IJC_808_18  PMID:33402576
Background: Early diagnosis of sepsis in children with febrile neutropenia remains difficult owing to non-specific clinical and laboratory signs of infection. There is a need to assess the utility of inflammatory markers in clinical risk assessment for their ability to discriminate between low-risk and high-risk neutropenic patients since presently there is insufficient data to recommend their routine use. Methods: This is a prospective study of children on therapy admitted with febrile neutropenia and sampled for serum procalcitonin (PCT), interleukin-6 (IL-6), and interleukin-8 (IL-8) at admission. The febrile neutropenia episodes were categorized into two groups - Group I: no focus of infection and Group II: clinically/microbiologically documented infection. Statistical analyses for comparison were performed using Z-test and receiver operating curves at various cut-off levels. Results: A total of 46 episodes of febrile neutropenia in 33 children were analyzed. In total, 76% were categorized as group I and 24% as group II. The mean value of PCT in group II was higher (28.07 ng/mL) than group I (1.03 ng/mL) though there was no significant statistical difference. At a cut-off level of 2 ng/mL for PCT, sensitivity of 63%, specificity of 91%, positive predictive values (PPV) of 70%, and negative predictive value (NPV) of 88% were observed. There was no significant difference in the IL-6 and IL-8 levels between both the groups. However, at an optimal cut-off value of 50 pg/mL, IL-6 had an NPV of 80% and at a cut-off level of 130 pg/mL, IL-8 had an NPV of 73%, however, with low sensitivity and specificity. Conclusion: IL-6, IL-8, and PCT can be utilized to define a group of patients with a low risk of sepsis in view of their favorable NPV. The use of these biomarkers together can facilitate early discharge from the hospital, and the use of oral antimicrobial therapy, in turn, reducing the cost of supportive therapy in a developing country.
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Nutritional status in children with acute lymphoblastic leukemia, and its correlation with severe infection p. 190
Rimjhim Sonowal, Vineeta Gupta
DOI:10.4103/ijc.IJC_110_19  PMID:33402560
Background: Undernutrition is a common childhood problem in India which may contribute to higher risk of infection and lower survival rate in children with acute lymphoblastic leukemia (ALL). Methods: In our study, we retrospectively included patients of age group 1-15 years who were treated for ALL and survived induction. Data on weight, height and serum albumin levels recorded at the time of diagnosis of the patients were used in this study. For defining acute undernutrition we used weight-for-height, weight-for-age criteria for children ≤5 years and body mass index for age >5 years. We correlated nutritional status of the patients with severe infection and mortality percentage. Results: There were 101 patients with male:female ratio of 2.4:1. Forty-four children were ≤5 years and 57 children were >5 years of age. It was found that 74 children had B-cell ALL and 17 children had T-cell ALL; 54 patients were stratified as high-risk and 47 as standard-risk. In all, 52.5% patients had acute undernutrition at diagnosis. In ALL patients with acute undernutrition, severe infection was found to be 10.8% higher than ALL patients with normal nutrition which was statistically insignificant. Male children and children with serum albumin level <3.5 g/dL in the acute undernutrition group had higher risk of infection. Mortality percentage of patients with baseline acute undernutrition was found to be higher by 11% than normal nutrition group (P-value = 0.21). Conclusion: Our study highlights the magnitude of undernutrition at diagnosis in ALL patients in a tertiary care centre. It also correlates nutritional status with severe infection and mortality in follow-up.
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BREAST CANCER Top

Evaluation of breathing-adapted radiation therapy for right-sided early stage breast cancer patients p. 195
Selcuk Demiral, Omer Sager, Ferrat Dincoglan, Bora Uysal, Hakan Gamsiz, Yelda Elcim, Bahar Dirican, Murat Beyzadeoglu
DOI:10.4103/ijc.IJC_140_19  PMID:33402561
Background: Adverse effects of breast irradiation have been an important concern given the increased survival of early stage breast cancer (ESBC) patients with more effective treatments. However, there is paucity of data on the utility of Active Breathing Control (ABC) technique for right-sided ESBC patients. In this study, we assessed the incorporation of ABC into adjuvant Radiation Therapy (RT) of right-sided ESBC patients and report our dosimetric results. Methods: Thirty-six patients receiving whole breast irradiation followed by a sequential tumor bed boost were included in the study. All patients received field-in-field intensity modulated radiation therapy with incorporation of active breathing control-moderate deep inspiration breath-hold (ABC-mDIBH) after breast conserving surgery. Dose–volume parameters in both plans with and without ABC-mDIBH were compared using Mann-Whitney U test. Results: Mean lung dose decreased from 7 Gy to 5.2 Gy (26% reduction) for the total lung (p < 0.001) and from 12.6 to 9.4 Gy (25% reduction) for the ipsilateral lung (p < 0.001). Mean dose decreased from 4.6 Gy to 1.7 Gy (58% reduction) for liver (p < 0.001) and 1.7 Gy to 1.4 Gy (16% reduction) for the heart (p < 0.001). Conclusion: Our study revealed that incorporation of ABC-mDIBH into adjuvant RT of right-sided ESBC patients results in significantly improved critical organ sparing.
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A descriptive study on prevalence of arm/shoulder problems and its impact on quality of life in breast cancer survivors p. 201
Priyansh Jariwala, Navneet Kaur
DOI:10.4103/ijc.IJC_22_19  PMID:33402566
Background: Surgery for breast cancer and adjuvant radiotherapy are frequently associated with impairment of arm/shoulder function and development of lymphedema. However, most of the studies in Indian breast cancer survivors (BCSs) have focused on the development of lymphedema even though restriction of shoulder movement and pain are even more prevalent and adversely affect the quality of life (QOL). Hence, this study was conducted with the objectives to (1) study the prevalence of arm/shoulder problems (ASPs) including restricted shoulder mobility (ROM), lymphedema and arm/shoulder pain (2) assessment of the QOL in BCSs (3) to study the impact of ASPs on QOL. Methods: This descriptive study was conducted on BCSs at an academic center in Delhi These patients underwent a mastectomy and axillary lymph node dissection with adjuvant therapies and were within 6 months to 5 years of follow-up. Assessment of ASPs was done using Kwan's arm problem scale (KAPS), and survivors with scores of more than 21.5 were considered to have significant ASPs. Assessment of shoulder movements was done by using a goniometer, lymphedema by measuring arm circumference at multiple points and arm/shoulder pain by using a numerical pain rating scale (NPRS). QOL was assessed using short form (SF-36) questionnaire. Results: A total of 212 BCSs were studied with a mean duration of follow-up of 2.7 years (range = 6 months - 60 months). The prevalence of ASPs was 49% on KAPS. Prevalence of ROM, lymphedema, and arm/shoulder pain was found to be 51%, 27%, and 12% respectively. Patients with ASPs had poorer QOL scores on SF-36, significantly affecting both physical and mental component summary score. Among ASPs, worst scores were reported for limb swelling. Conclusion: There is a high prevalence of ASPs in BCSs. Survivorship care plans should appropriately address these issues.
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MCQS Top

MCQs on “A descriptive study on prevalence of arm/shoulder problems and its impact on quality of life in breast cancer survivors” p. 207
HS Darling, Pradeep Jaiswal, Nishant Lohia, Nishant R Tiwari
DOI:10.4103/ijc.ijc_508_21  PMID:34100411
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NEURO-ONCOLOGY Top

Factors affecting survival in glioblastoma patients below and above 65 years of age: A retrospective observational study p. 210
Berrin B Yavuz, Gul Kanyilmaz, Meryem Aktan
DOI:10.4103/ijc.IJC_36_19  PMID:33402568
Background: The purpose of this study is to identify the differences with respect to survival and prognostic factors in a comparison between radiotherapy-receiving glioblastoma (GBM) patients above and below 65 years of age. Methods: The results of 157 patients with GBM were analyzed retrospectively. Patients were divided into two groups as those below and above 65 years of age. A comparison was drawn with respect to each group's demographic characteristics, treatment methods, and findings. Results: Out of a total of 157 patients, 53 patients (33.8%) were above 65 years of age. Karnofsky performance status (KPS) was weaker among older patients (P = 0.002). On the other hand, with respect to radiotherapy dose, among older patient group, greater hypofractionation and whole-brain radiotherapy was applied (P = 0.003) compared with younger patients. The survival rates for 1, 2, and 5 years among patients aged <65 years were 63%, 30%, and 3%, respectively, and in patients aged ≥65 years were 43%, 13%, and 0%, respectively. In univariate analyses, a comparison between patients below and above 65 years of age revealed that values higher than 80 KPS (P = 0.002), applying total excision (P < 0.001), receiving concurrent chemotherapy (P = 0.004), receiving conventional radiotherapy (P < 0.001), and adjuvant chemotherapy (P < 0.001) were effective factors on overall survival rates. Conclusion: In the patient group above 65 years of age, the patient should be attentively selected before opting for a specific treatment, age alone should not be the sole determinant factor. Rather, by considering the KPS scores, potential aggressive treatment options should also be applied.
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COLORECTAL CANCER Top

Quantitative detection of SRY-Box 21 (SOX21) gene promoter methylation as a stool-based noninvasive biomarker for early diagnosis of colorectal cancer by MethyLight method p. 217
Keivan Moradi, Esmaeil Babaei, Mohammad Ali Hosseinpour Feizi, Reza Safaralizadeh, Nayebali Rezvani
DOI:10.4103/ijc.IJC_37_19  PMID:33402569
Background: In recent years, the study of potential epigenetic biomarkers in feces has been an attractive research approach for the noninvasive diagnosis of colorectal cancer (CRC). The aim of this study was to evaluate the stool-based DNA methylation potential of SRY-Box 21 (SOX21) gene promoter as an appropriate candidate biomarker for differentiating CRC patients and healthy individuals for the first time. Methods: The MethyLight method was performed to analyze the methylation status of SOX21 gene promoter in fecal samples from 40 patients with CRC and 40 healthy controls. In addition, the diagnostic efficiency of measuring the hypermethylated SOX21 gene in the feces to the fecal occult blood test (FOBT) was compared. Results: The percentage of methylated reference (PMR) values in the stool of CRC patients (median 1.44) was higher than those of healthy individuals (median 0.00) (P < 0.001). A sensitivity of 72.5% and specificity of 100% were obtained for SOX21 gene promoter methylation status and 29 of the patients were considered as positive in methylation status. There was no significant association between PMR values and demographic/clinicopathological features (P > 0.05). Conclusion: The results of the present study demonstrated that the stool-based assay of SOX21 gene promoter methylation has a relatively high sensitivity and specificity and it may serve as a noninvasive biomarker for early detection of CRC. However, more studies with a wide range of samples are required to further confirm the role of hypermethylation of SOX21 in the early CRC diagnosis.
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Robotic-assisted versus conventional laparoscopic surgery for colorectal cancer: Short-term outcomes at a single center p. 225
Dong-ping Hu, Xiao-long Zhu, He Wang, Wen-han Liu, Yao-chun Lv, Xin-long Shi, Li-li Feng, Wei-sheng Zhang, Xiong-Fei Yang
DOI:10.4103/ijc.IJC_86_19  PMID:33753624
Background: The robotic technique has been established as an alternative approach to laparoscopy for colorectal surgery. The aim of this study was to compare the short-term outcomes of robot-assisted and laparoscopic surgery in colorectal cancer. Methods: The cases of robot-assisted or laparoscopic colorectal resection were collected retrospectively between July 2015 and September 2018. We evaluated patient demographics, perioperative characteristics, and pathologic examinations. Short-term outcomes included time to passage of flatus and length of postoperative hospital stay. Results: A total of 580 patients were included in the study. There were 271 patients in the robotic colorectal surgery (RCS) group and 309 in the laparoscopic colorectal surgery (LCS) group. The time to passage of flatus in the RCS group was 3.62 days shorter than the LCS group. The total costs were increased by 2,258.8 USD in the RCS group compared to the LCS group (P < 0.001). Conclusion: The present study suggests that colorectal cancer robotic surgery was more beneficial to patients because of a shorter postoperative recovery time of bowel function and shorter hospital stays
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PHARMACOLOGY Top

The efficacy and safety of onartuzumab in patients with solid cancers: A meta-analysis of randomized trials p. 232
Bum Jun Kim, Dalyong Kim, Jung Han Kim, Hyeong Su Kim, Hyun Joo Jang
DOI:10.4103/ijc.IJC_797_18  PMID:33402588
Background: Onartuzumab, a humanized monovalent monoclonal antibody to the MET protein, has been tested in various cancers. We conducted a meta-analysis of randomized phase II and III clinical trials to investigate the efficacy and safety of onartuzumab in solid cancers. Methods: We searched PubMed, PMC, EMBASE, and the Cochrane library databases. We included randomized phase II or III trials that evaluated the additional benefits of onartuzumab in comparison with the standard treatments. Data on progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were pooled and analyzed. Results: From nine studies, a total of 2,138 patients were included in the meta-analysis. The addition of onartuzumab to the standard treatment resulted in no improvement of PFS (hazard ratio (HR) = 1.00 [95% confidence interval (CI), 0.90–1.11], P = 0.93) and OS (HR = 1.08 [95% CI, 0.94–1.23], P = 0.29). In the subgroup analysis with patients with non-small-cell lung cancer (NSCLC), onartuzumab was not associated with a significant improvement of OS (HR = 1.12 [95% CI, 0.93–1.34], P = 0.23) and PFS (HR = 1.05 [95% CI, 0.91–1.21], P = 0.52). With respect to AEs, onartuzumab increased the incidence of hypoalbuminemia (odds ratio (OR) = 14.8 [95% CI, 3.49–62.71], P < 0.001), peripheral edema (OR = 6.52 [95% CI, 3.60–11.81], P < 0.001), neutropenia (OR = 1.36 [95% CI, 1.03–1.79], P = 0.03), thrombocytopenia (OR = 1.98 [95% CI, 1.03–3.81], P = 0.04), and venous thrombotic events (OR = 3.05 [95% CI, 1.39–6.71], P = 0.006). Conclusion: This meta-analysis indicates that the addition of onartuzumab to the standard treatments had no definite survival benefit with increased severe toxicities in patients with solid cancer.
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LUNG CANCER Top

S100A2: A potential biomarker to differentiate malignant from tuberculous pleural effusion p. 241
Ting Wang, Ning Wang, Linpei Zhang, Yuchun Liu, Asmitananda Thakur
DOI:10.4103/ijc.IJC_149_19  PMID:33402562
Background: S100 calcium binding protein A2 (S100A2)—which has been testified to have an abnormal expression in non-small cell lung cancer (NSCLC)—is considered as an effective biomarker in the diagnosis and prognosis of this malignancy. In this study, we detected the S100A2 levels in pleural effusion, aiming to evaluate its potential value in differentiating malignant pleural effusion (MPE) from tuberculous pleural effusion (TPE). Methods: We collected pleural effusion from 104 NSCLC patients with MPE and 96 tubercular pleurisy cases. Enzyme-linked immunosorbent assay (ELISA) was performed to measure the levels of S100A2 in these samples. Meanwhile, the serum S100A2 levels were also examined in same subjects. The data concerning the expression of those commonly-used markers, including CEA, CYFRA211 and NSE, were obtained from medical records. Results: Like other classified biomarkers, S100A2 had an over-expression in both pleural effusion and sera of the NSCLC patients compared with controls (P = 0.000), though having a lower P value. Receiver operating characteristic (ROC) analysis showed that the levels of S100A2 in pleural effusion (PE) could distinguish MPE from tuberculous pleurisy (Area Under the Receiver Operating Characteristic Curve (AUC) = 0.887), and its diagnostic value in hydrothorax was obviously higher than in serum (AUC = 0.709). Conclusion: Our results indicate that levels of S100A2 are significantly elevated in MPE, and that S100A2 may serve as a diagnostic biomarker for NSCLC patients with MPE. In further studies, we will validate our findings with a larger sample population.
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RADIOLOGY Top

Why is it important to report early possible COVID-19 PET/CT findings in cancer patients? Explaining with a case series p. 248
Duygu Tekin, Emine Budak, Banu Yoldas, Adnan Budak
DOI:10.4103/ijc.IJC_645_20  PMID:34100412
Background: Coronavirus disease-2019 (COVID-19) causing a pandemic mostly results in mild symptoms; however, it can evolve into serious complications. It is emphasized that if the term from the recent anticancer treatment to the diagnosis of COVID-19 was short, the probability of serious events increased in cancer patients. Therefore, early detection of COVID-19 and prevention of serious events is very important. We aimed to investigate whether it is possible to detect COVID-19 early by positron emission tomography (PET)/computed tomography (CT). Methods: We retrospectively evaluated the images and clinical findings of patients who underwent PET/CT due to malignancy and whose COVID-19 polymerase chain reaction (PCR) test were detected positive subsequently. Results: Eight cancer patients with positive COVID-19 PCR tests were included in the study. PET/CT revealed subpleural ground-glass opacities (GGOs) showing mild fluorodeoxyglucose (FDG) uptake that could be compatible with COVID-19 in 4 of 8 patients. The number of affected lobes ranged from 1-4. All patients were diagnosed with COVID-19 by PCR test when symptoms and/or lung findings worsened on the days after PET/CT. The time interval between the last anticancer treatment and COVID-19 diagnosis in five patients was ≤7 days. During the follow-up, six of the cases (75%) needed mechanical ventilation and died later. Conclusion: COVID-19 may be recognised early by detecting incidental findings in PET/CT, especially in asymptomatic cancer patients. Potential complications may be prevented by early diagnosis and anticancer therapy changes. Therefore, possible COVID-19 findings in PET/CT should be reported and the patient should be referred to relevant clinician.
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CASE REPORTS Top

Masquerader in oncology: IgG4-related kidney disease presenting as right upper ureteric mass p. 259
Abhishek Laddha, Ginil K Pooleri, Amrutha Thomas, MR Bindhu, Appu Thomas
DOI:10.4103/ijc.IJC_402_19  PMID:33753597
Immunoglobulin G4-related disease (IgG4-RD) is a systemic immune-mediated fibroinflammatory condition that can mimic several diseases and can present as a malignant tumor. We present a case of a 53-year-old woman who presented with a right upper ureteric mass. On pathologic evaluation, a diagnosis of IgG4-RD was made. In the absence of preoperative biopsy and other clinical manifestations, preoperative clinical diagnosis remains challenging and high index of suspicion and accurate pathological evaluation may help in avoiding misdiagnosis.
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Primary retroperitoneal serous adenocarcinoma: A case report of rare malignancy with literature review p. 262
Thin Thin Win, Saint Nway Aye, Nurul Shuhada Abdul Hamad, Sharifah Emilia Tuan Sharif
DOI:10.4103/ijc.IJC_528_19  PMID:33402586
The primary retroperitoneal serous adenocarcinoma (PRSAC) is a rare malignant tumor of the retroperitoneum. It shares the same pathological and biological behavior with ovarian serous carcinoma. Most of the cases develop as peritoneal adenocarcinoma and rarely occur in the retroperitoneum. It is reported as serous surface papillary carcinoma of the peritoneum and extraovarian peritoneal serous papillary carcinoma. We present a case of PRSAC in a 60-year-old woman. Only 11 cases of PRSAC have been reported from 1983 to 2019. Histopathological features with immunohistochemical expressions are important to diagnose PRSAC. The outcome and survival mainly depend on the possibility of surgical resection. Molecular genetics of PRSAC should also be studied in relation with its ovarian counterpart.
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Mesenteric leiomyosarcoma in a pregnant woman: A case report and review of literature p. 267
Sanjay P Deshmukh, Minish Jain, Taher Chharchhodawala
DOI:10.4103/ijc.IJC_705_19  PMID:33753608
We herein describe a case of primary leiomyosarcoma of descending mesocolon mesentery in a pregnant woman. A 31-year-old woman was referred to our clinic for the presence of a suspicious mass (solid heterogenous lesion with lobulated margins) detected during routine obstetric ultrasonography (USG), growing throughout her term. Imaging in her third trimester showed a considerable increase in the size of the mass and was suspected to be malignancy of uterine origin. Tru-cut biopsy performed post-partum indicated leiomyosarcoma. She underwent neoadjuvant chemotherapy with six cycles of dacarbazine and doxorubicin with partial response. Subsequently, she underwent surgery, and the tumor was found to be present in sigmoid colon mesentery extending in retroperitoneum involving 5 cm of ureter. The mass was resected along with part of the colon and ureter that was involved by disease. Patient had uneventful recovery post-surgery. Considering moderate response to chemotherapy and discussion in tumor board, she was not given adjuvant chemotherapy. At follow-up of 15 months, the patient is disease-free with a normal, healthy baby.
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Metastases from renal cell carcinoma—Report of three unpredictable cases and literature review p. 273
Kiran P Malhotra, Anurag Gupta, Saumya Shukla, Gaurav R Agarwal, Hardeep S Malhotra
DOI:10.4103/ijc.IJC_160_20  PMID:34100413
The capacity to metastasize after long periods of discovery and resection of the primary renal lesion or to present as metastasis with undisclosed primary lesions grant renal cell carcinomas (RCC) a formidable and unpredictable behavior. We report three unusual cases of metastasis from RCC. The first patient presented with metastatic clear cell adenocarcinoma in the right shoulder muscles, with unknown primary and revealed an undetected clear cell right RCC on radiology. The second patient presented with a hemorrhagic nasal metastasis of RCC. A history of nephrectomy for RCC, 10 years prior to the development of nasal metastasis was elicited. The third patient presented with axillary and later abdominal wall metastasis of papillary RCC. He had a history of RCC 3 years prior to the discovery of metastasis. RCC has the propensity to appear as a metastatic carcinoma with unknown primary, requiring exclusion of several diagnostic pathologic entities. The appearance of metastasis many years after disease quiescence is challenging and clinicians need to be sensitized to the need for long-term surveillance in RCC. Though the prognosis remains poor, immune checkpoint inhibitors are currently the modalities of choice in such cases.
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Secretory carcinoma of salivary gland origin: A recently established masquerader p. 278
Shilpi Budhiraja, Rajeev Kumar, Gaurav Khanna, Prem Sagar, Sudhir Arava, Adarsh Barwad, Asit Ranjan Mridha
DOI:10.4103/ijc.IJC_274_20  PMID:34100414
Secretory carcinoma (SC) of the salivary gland is considered to be a low-intermediate grade tumor with the potential of locally aggressive behavior. This tumor is similar both genetically (ETV6-NTRK3 fusion) and histologically to secretory carcinoma of the breast. We intent to share our experience of four cases of SC in terms of clinical behavior, pathological features, and treatment outcome. Medical records of four cases of SC were retrieved and analyzed for clinical presentation, surgical treatment, and outcome. Pathological data was reanalyzed along with immunohistochemistry. Out of the four identified SC cases, three were men. Two lesions originated from the parotid gland and two from minor salivary glands. Two of these cases exhibited features of locally aggressive pattern. SC of salivary gland origin has distinct histological and immunohistochemical features apart from the characteristic genetic translocation and fusion. Surgery with or without adjuvant radiotherapy is the treatment of choice. To establish the biological behavior of this tumor, larger case series with long-term follow-up is desirable.
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PERSPECTIVE Top

Cancer in children: The tip of the iceberg p. 285
Venkatraman Radhakrishnan
DOI:10.4103/ijc.IJC_787_20  PMID:34100415
Pediatric cancer outcomes have improved dramatically in high-income countries (HICs) with more than 80% of patients surviving. This has been achieved through early diagnosis, the formation of collaborative research groups, and government policies. However, most children with cancer in low and middle-income countries (LMICs) do not survive due to multiple factors including lack of resources, manpower, and national level pediatric cancer policy. If we need to improve the overall outcome of children with cancer then we need to focus our attention on children in LMICs as they constitute 80% of the worldwide disease burden. This article looks at the burden of pediatric cancer, examines pediatric oncology policy paralysis, and offers possible solutions for improving care for children with cancer.
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VIEWPOINT Top

Integrating psycho-oncology services in cancer care in India p. 290
Bincy Mathew, Bidhu Kalyan Mohanti, Saipriya Tewari, Anusheel Munshi
DOI:10.4103/ijc.IJC_217_20  PMID:33402596
Psychological distress is often an under-diagnosed problem in cancer care. Addressing psychosocial issues would enhance treatment compliance, physician–patient relationship, treatment efficacy and quality of life. This article emphasizes the importance of integrating psycho-oncology services in cancer care and attempts to define the various roles that a psycho-oncologist can play across the entire trajectory. It also highlights the indispensable role played by the oncologists' referrals in maximizing the benefits of psycho-oncology services received by patients and their caregivers.
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IMAGES IN ONCOLOGY Top

An unusual case of ectopic thyroid tissue in an adrenal gland presenting as a cyst p. 294
Shreya Bramhe, Shashi Dhawan, Neeraj Dhamija
DOI:10.4103/ijc.IJC_181_20  PMID:34100416
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LETTERS TO THE EDITOR Top

Frozen in time, thawed to life – A case of fertility preservation in a patient with breast carcinoma p. 296
Chithira Pulimoottil Vignarajan, Keerthana Rajasekharan, Neena Malhotra
DOI:10.4103/ijc.IJC_865_19  PMID:33753618
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Laboratory findings and treatment in non-small cell lung cancer (NSCLC): Single-center report p. 299
Chhavi Rajvanshi, Aseem K Tiwari, Swati Pabbi, Geet Aggarwal, Simmi Mehra, Rajni Chauhan, Dheeraj Gautam, Ashok Kumar Vaid
DOI:10.4103/ijc.IJC_926_19  PMID:34100417
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An atypical case of primary pulmonary peripheral T-cell lymphoma misdiagnosed as a pulmonary infectious disease: A case report and literature review p. 302
Liyong Shi, Yiming Zeng, Huihuang Lin, Xiaoyang Chen
DOI:10.4103/ijc.IJC_987_19  PMID:33753623
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Mimicker of malignancy, malakoplakia presenting as PI-RADS 5 lesion in mp-MRI—A case report p. 307
Abhishek Laddha, Ginil Kumar Pooleri, MR Bindhu, Appu Thomas
DOI:10.4103/ijc.IJC_164_20  PMID:34100418
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OBITUARY Top

Dr. V. Shanta: A cancer crusader with a mission of service above self Highly accessed article p. 310
Arvind Krishnamurthy
DOI:10.4103/ijc.IJC_178_21  
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NEWS Top

News from the world of oncology p. 312

DOI:10.4103/ijc.ijc_560_21  
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