Primary tumors of the central nervous system are relatively uncommon, comprising only 1%–2% of all neoplasms. However, they constitute the second most common type of malignancy in children (after leukemia) and the leading cause of cancer-related morbidity and mortality in children and young adults worldwide. Globally, there is substantial variability with nearly five-fold difference in incidence between various parts of the world. Brain tumors are quite heterogeneous with regard to histology, biological behavior, and prognosis mandating multidisciplinary therapeutic decision-making. This retrospective audit of all consecutive patients registered in a single calendar year (2013) in the neuro-oncology disease management group at Tata Memorial Centre is reflective of the ground reality and fair representation of outcomes in routine neuro-oncologic practice.

INTRODUCTION: The stage at diagnosis of renal cell cancer (RCC) in developed countries is lower due to increased utilization of routine health checkups by patients compared to developed countries. This study aims to determine the sociodemographic and clinical distribution of RCC in patients presenting to Tata Memorial Hospital (TMH). SUBJECTS AND METHODS: We performed a retrospective audit of all patients presenting to TMH with a diagnosis of RCC. Data were retrieved from our electronic medical record system from January 1, 2013 to December 31, 2013. The survival analysis was done by Kaplan–Meir analysis method of estimating survival. Log-rank test of comparison was applied to estimate the difference in the survival among the different stages of renal cancer. RESULTS: Of the 35,197 new registered patients at TMH, 338 were diagnosed with RCC. Most patients were in the 50–60 years age group, with 56.6 years being the median age at presentation. Among patients treated at TMH, 84 underwent surgery and tyrosine kinase inhibitor was given in 55 (16%) patients. The patients' characteristics, clinical characteristics of RCC, treatment modalities offered, and survival of patients treated for RCC are presented in this paper. CONCLUSION: In the absence of robust Indian data on RCC, this audit provides baseline information on epidemiology, stage at presentation, and outcomes of RCC at our center compared with the West.

AIM: Tata Memorial Hospital is one of the high-volume tertiary care referral centers for gastric cancer (GC) in India. We aimed to analyze the outcomes after surgery for GC. PATIENTS AND METHODS: Data were collected from the prospective database maintained by the Gastrointestinal and Hepato-Pancreato-Biliary Division of the Department of Surgical Oncology at Tata Memorial Hospital, Mumbai, Maharashtra, India. All consecutive patients who underwent curative resection for adenocarcinoma of the stomach from January 2010 to December 2015 were included. RESULTS: A total of 580 patients underwent curative resection for adenocarcinoma of the stomach in the above mentioned time span. Distal tumors were more common and the tumor epicenter was at the distal body/antrum in 435 (75%) patients. One hundred eighty-two (31.3%) patients underwent upfront surgery and 398 patients (68.6%) were operated after receiving neoadjuvant chemotherapy. Surgical procedures included 371 distal/subtotal gastrectomies, 78 proximal, and 131 total gastrectomies. Overall median blood loss was 500 mL and intraoperative blood transfusion was required only in 10.5%. Median hospital stay was 8 days (range, 3–44). Postoperative major morbidity (Clavein–Dindo grade III/IV) was 8.9% and mortality was 1.5%. Median lymph node yield was 18 (range, 2–76). When perioperative outcomes were compared in the initial half of the study period (Period 1, 2010–2012) versus the later half (Period 2, 2013–2015), the median lymph node yield was found to be better in the later half (17 vs. 19) along with reduction in the median hospital stay (16 vs. 11 days). At a median follow-up of 36 months (range, 3–225 months), overall 5-year survival was 51.9%. The disease-free survival at 5 years was 46.9%. CONCLUSION: Results from our study indicate that, with increasing hospital volumes, the median lymph node yield after D2 gastrectomy improves and the median hospital stay is reduced. Surgery for GCs in high-volume centers might result in improved perioperative outcomes.

INTRODUCTION: The Pediatric Hematolymphoid Disease Management Group (PHL-DMG) at a tertiary cancer care hospital developed extensive patient support programs to improve retention and outcomes while focusing on protocols adapted to meet patient needs. An audit of measures and outcomes was done for a 7-year period from January 2010 to December 2016. MATERIALS AND METHODS: DMG protocols and patient support activities over the study period were documented and audited. Data was retrieved from internal databases and records. Measures taken and their impact were assessed by descriptive analytical tools. Survival outcomes were calculated using Kaplan–Meier method on SPSS v. 24™ software. RESULTS: Holistic patient support measures were undertaken through a charitable foundation entirely under pediatric oncology. Activities included infrastructure growth, socioeconomic support, provision of accommodation, nutrition, education, and multiple blood component donation drives. Patient registrations increased from 502 in 2009 to 874 in 2016, with the steepest rise in acute lymphoblastic leukemia (ALL) – 330 (2009) to 547 (2016). Treatment refusal and abandonment rates decreased from 32% to 3.4% over the same period, and male to female ratio decreased from 2.56 to 2.28:1. Early mortality in acute myeloid leukemia (AML) fell within 2 years from 26.7% in 2009 to 7%. Five-year overall survival (OS) was 69.5% for all patients registered in 2010, whereas disease-specific 5-year OS was ALL 67.1%, AML 49.3%, chronic myeloid leukemia 100%, Hodgkin lymphoma 90.4%, and non-Hodgkin lymphoma 74.2%. CONCLUSIONS: Holistic patient support-specific activities and adapted protocols made a measurable impact on patient outcomes. High survival outcomes of patients have been achieved despite relatively few receiving salvage therapies or stem cell transplant.

BACKGROUND: Oral cancers are one of the most common cancers in India. Surgery is the main modality of treatment for oral cancer patients. It is important to understand the postoperative morbidity and mortality as it influences patient outcomes. AIM: The aim of this study was to determine oral cancer patients' characteristics, treatment details, 30-day morbidity and mortality, and survival outcomes. SETTINGS AND DESIGN: This was a retrospective analysis of prospectively collected data in a tertiary cancer center. MATERIALS AND METHODS: This study included 850 surgically treated oral cancer cases between January and December 2012. STATISTICAL ANALYSIS: We performed univariate survival analysis by log-rank test, and all significant (P < 0.05) variables underwent multivariate analysis using Cox regression. RESULTS: The median age was 52 years and the male-to-female ratio was 3.4:1. Nearly one-third of the patients received some form of prior treatment. Buccal mucosa (BM) was the most common subsite (64.94%). BM cancers (81.1%) were more likely to present in advanced stage compared to tongue cancers (52%) (P = 0.000). The incidence of postoperative morbidity and mortality was 36.4% and 0.9%, respectively. Complications were higher in cT3-4 (P = 0.000), cN positive (P = 0.000), and those requiring microvascular reconstruction (P = 0.004). The 5-year overall survival of the entire study group was 70.4%. The survival of early and locally advanced stages was 75.1% and 68.4%, respectively. The factors influencing survival were age (>50 years), advanced cT stage, nodal metastasis, overall stage, and presence of orocutaneous fistula. CONCLUSION: The morbidity, mortality, and long-term outcomes of surgically treated oral cancer patients at our center are comparable to those treated in the developed world. Aggressive management of postoperative complications is crucial for early recovery and timely initiation of adjuvant treatment.

BACKGROUND: Total laryngectomy (TL) is a well-established procedure for laryngeal and hypopharyngeal cancers. There is an increasing number of TLs done after organ preservation strategies. AIM: The aim of this study was to report 30-day morbidity and survival outcomes in patients undergoing TL at a tertiary referral center. SETTING AND DESIGN: This was a retrospective review of a prospective database of TL patients operated during 2012–2013. MATERIALS AND METHODS: Patient demographics and other data were captured from the database. Surgical complications were graded as per Clavien–Dindo grading system and were also divided into major and minor as per predecided criteria. Recurrence and survival data were computed using Kaplan–Meier survival curves. RESULTS: A total of 169 patients underwent TL during the study period. About 34% of the patients had received prior radiation therapy. Around 18% of the patients had major complications with a pharyngocutaneous fistula rate of 22.4%. Ninety percent of these were managed conservatively. Though used in a small subset, microvascular reconstruction had the least complication rates. The 3-year disease-free survival and overall survival were 66% and 72%, respectively. There was no difference in survival between per primum and salvage surgery cohorts. CONCLUSION: TL is a safe and oncologically sound procedure in patients with laryngeal and hypopharyngeal cancers. A large proportion of patients still undergo TL as a de novo procedure. This denotes that patients still present with locally advanced cancers which are not amenable to organ preservation.

BACKGROUND: Renal cell carcinoma (RCC) is highly resistant to systemic chemotherapy, and historically a poor prognosis for metastatic disease has been reported, with a 5-year survival rate of <10%. Significant advances have been made in the last decade since the introduction of different tyrosine kinase inhibitors (TKIs) such as sunitinib, pazopanib, and sorafenib. Unfortunately, even though the TKIs have been used for a long time, there are very few published data regarding the experience of TKI therapy in metastatic RCC (mRCC) from India. MATERIALS AND METHODS: This is a single institutional review of mRCC patients treated between January 2012 and July 2017. Patients who received at least 1 month of first-line TKIs were included for analysis of response rates, toxicity, survival outcomes, and prognostic factors. RESULTS: Of the 40 mRCC patients, 31 (77.5%) were males. Median age at diagnosis was 58 years (range: 38–80 years). The most common site of metastasis was lungs (n = 24) followed by bone (n = 19) and liver (n = 7). Three patients had favorable risk disease, whereas 25 had intermediate risk and 12 had poor risk disease according to the MSKCC risk criteria. First-line TKI therapy used was sunitinib in 24, pazopanib in 11, and sorafenib in 5 patients. Toxicities of TKIs were Grade 1 or 2 in 13 patients and Grade 3 or 4 in 9 patients; the most common being fatigue, followed by hand-foot syndrome, skin rash, mucositis, and hypertension. Overall, 29 patients (72.5%) had disease control (complete responses in 1, partial responses in 10, and stable disease in 18 patients), whereas 11 had progression of disease at initial evaluation. At a median follow-up of 16 months (range: 2–38 months), median progression-free survival (PFS) was 10.8 months and median overall survival was 19.1 months. CONCLUSIONS: Sunitinib and pazopanib are viable first-line options for mRCC and showed a comparable PFS in Indian patients. Careful patient selection, tailoring of TKI doses, and careful toxicity management are essential for optimum therapy.

BACKGROUND: After failing oxaliplatin-based first-line chemotherapy (CT), approximately 4%–21% of patients with metastatic colorectal cancer (mCRC) respond to irinotecan-based second-line treatment. Earlier studies have demonstrated that arsenic trioxide (ATO) can significantly resensitize resistant colon cancer to 5-fluorouracil (5-FU) by downregulating thymidylate synthase (TS). We hypothesized that a combination of ATO with infusional 5-FU, leucovorin, and irinotecan (FOLFIRI) regimen in mCRC patients refractory to first-line FOLFOX/CAPOX could further improve the outcome of second-line CT. MATERIALS AND METHODS: Patients were administered ATO 0.15 mg/kg/day on days 1–2 along with FOLFIRI regimen at standard doses every 2 weeks, until disease progression, unacceptable toxicity, or patients' refusal. Responses to CT were reported according to RECIST 1.1. Adverse events were classified based on CTCAE version 4.0. RESULTS: Between September 2016 and July 2017, 17 patients with refractory mCRC were treated with this investigational combination. The median age was 49 years; 13 males and 4 females; ECOG PS 0–1/2, 14/3. The most common site of metastases was liver (n = 11) followed by peritoneum (n = 7) and number of involved metastatic sites 1–2/≥3, 9/8. After 6 cycles of CT, overall response rate and disease control rate were 17.6% and 82.4%, respectively (complete remission = 0, partial remission = 3 patients, stable disease = 11 patients). Median progression-free survival was 5.3 months (95% confidence interval [CI]: 4.3–7.0) and median overall survival was 9 months (95% CI: 7.4–10.5) from the initiation of ATO plus FOLFIRI. The toxicities were as follows: Grade 1/2 toxicity: fatigue (7 patients), constipation (2), and nausea and vomiting (2); Grade 3 toxicity: fatigue (3), neutropenia (2), febrile neutropenia (1), diarrhea (2), and QTc prolongation (1). No patient experienced Grade 4 toxicities. CONCLUSIONS: The addition of ATO to FOLFIRI regimen as second-line CT in patients with refractory mCRC offered an encouraging antitumor effect at the cost of manageable toxicity.

BACKGROUND: Activation of Wnt/β-catenin pathway has been implicated as a mechanism of oncogenesis of hepatocellular carcinoma (HCC). CTNNB1 mutation, which encodes for β-catenin, has been found to be the most common underlying genetic alteration. In this study, we evaluated the frequency of aberrant β-catenin expression in our cohort of HCC cases and explored its correlation with clinicopathologic features. METHODS: Fifty-three cases of histologically proven HCC were included in this study. Nuclear expression (with or without cytoplasmic staining) in >5% tumor cells was regarded as positive for β-catenin. Comparison with clinicopathologic features of β-catenin-negative HCC cases (controls) was also done. RESULTS: Nuclear β-catenin positivity was seen in 20 (37.7%) HCC cases. Median age was 60.5 years, and male-to-female ratio was 5.7:1. Alpha-fetoprotein (AFP) levels were normal in half of the patients (P = 0.03). Approximately 36.8% of hepatitis B virus-related, 50% of hepatitis C virus-related, and 35% of viral marker-negative HCC were positive for β-catenin. Median tumor size was 8.7 cm. Majority (53%) of β-catenin-positive HCCs were unicentric, and a significant proportion (65%) displayed a well-differentiated histology (P = 0.11). No specific histological type was associated with β-catenin positivity. Although not statistically significant, more patients (57%) with β-catenin-positive HCCs developed recurrence or progressive disease than β-catenin-negative patients (35%). CONCLUSIONS: Aberrant β-catenin expression was seen in a substantial proportion of our HCC cases. β-catenin-positive HCC was associated with normal AFP levels, unicentric tumors, well-differentiated histology, and an unfavorable outcome.

CONTEXT: Tumor budding (TBud) is recognized as a poor prognostic marker in colorectal cancer (CRC) with important treatment implications in Stage II cancers and malignant polyps. There are multiple propositions for bud count reporting but without an uniformly accepted system. The International TBud consensus conference (ITBCC) proposed mandatory reporting of budding on the single worst ×20 high power field (0.785 mm² area) with a 3-tier scoring system (low/intermediate/high for 0–4, 5–9, and ≥10 buds/×20 field). AIMS: Due to the lack of availability of ×20 objective, we aimed to validate a simple ×40 field count (0.236 mm² area) for wider applicability. METHODS: Bud count was done on hematoxylin and eosin-stained slides of 92 archived cases of colon cancer on the worst ×20 and ×40 fields (0.95 mm² and 0.236 mm² area) (hotspot method). Count for 0.785 mm² area was calculated using ITBCC normalization factor of 1.2. Interobserver variability between two observers was assessed. Score groups for ×20 field and proposed score groups for 40× field (low/intermediate/high for 0–1, 2–4 and ≥5 buds) were compared with disease-free survival. RESULTS: High bud score was seen in 20.6% and 31.5% cases, respectively, using the ×20 and ×40 methods. High interobserver concordance was noted (ICC 0.95). Both the ITBCC bud score and our proposed 40× scoring correlated significantly with prognosis (P = 0.030, log-rank test). CONCLUSIONS: In centers lacking 20× objective, we propose using the worst 40× hotspot method for reporting of budding for all CRCs as a simple, reproducible and prognostically significant scoring system.

BACKGROUND: The management of locally advanced carcinomas of the esophagus and esophagogastric junction has undergone a major evolution over the past two decades with the widespread use of combined modality therapy. Although many Indian centers practice the combined modality therapy with neoadjuvant chemoradiation (nCRT), published data are sparse. OBJECTIVES: The objective of this study was to study the safety and efficacy of nCRT in patients with locally advanced resectable carcinoma of the esophagus. MATERIALS AND METHODS: Prospective single-arm study of the first fifty patients enrolled over 3 years (2014–2016). RESULTS: The median age was 51 years (M:F = 3:2), 90% of the patients had squamous cell carcinomas, and 69% had lower-third lesions. All accrued patients completed the intended dose of radiation; however, approximately 20% had a treatment delay, which was duly gap corrected. Importantly, there were no treatment-related toxic deaths. Eleven patients could not undergo surgery following nCRT (two patients defaulted, two were deemed medically unfit, and seven (14%) patients had disease progression on imaging). Thirty-nine (78%) patients were planned for definitive surgery; however, a further 7 (14%) were found to be inoperable intraoperatively. Thirty-two patients successfully completed their definitive surgical procedures with R0 resections, of which 19 patients (38%) had a pathological complete response (pCR). There was no postoperative 90-day mortality in our study cohort. Analysis of prognostic factors that predicted a response showed that patients who had adenocarcinoma and with circumferential lesions responded poorly. CONCLUSION: nCRT appears to be a safe and a reasonably well-tolerated option in carefully selected patients with resectable locally advanced esophageal cancers. Although our data are not mature to analyze the survival outcomes with a pCR rate of 38%, it suggests nCRT to be a promising option in the management of locally advanced resectable esophageal cancers.

PURPOSE: The objective of this study was to assess response to neoadjuvant chemotherapy in molecular subtypes of breast cancer. METHODS: This study included 60 patients with locally advanced and metastatic breast cancer. The authors excluded patients who already underwent mastectomy or were given any chemotherapy/radiotherapy. They analyzed the clinical and immunohistochemical characteristics using core biopsy specimens to determine their correlations with response to chemotherapy. RESULTS: A clinical complete response was observed in 19 patients (31.7%), a clinical partial response in 30 patients (50%), clinical stable disease in 8 patients (13.3%), and progressive disease in 3 patients (5%). A pathologic complete response (pCR) was observed in 7 (21.87%) of 32 patients who underwent surgery. High Ki-67 was associated with human epidermal growth factor receptor 2 (HER2)-positive status (P = 0.027) and triple-negative breast cancer (TNBC) (P = 0.006). Multiple logistic regression analysis showed that pCR was correlated with HER2 status (odds ratio 26.589, confidence interval [CI] =1.606–44.190), P = 0.022. Of the seven patients found to have pCR, six patients (85.7%) were treated with taxol-containing regimen. The other parameters that were correlated with pCR are TNBC and estrogen receptor/progesterone receptor status. Tumor size, Ki-67 value, and grade of the tumor were not correlated with clinical response. CONCLUSION: Molecular subtype in breast cancer is an effective factor for predicting response to neoadjuvant chemotherapy. HER2-positive status was associated with high Ki-67 and high clinical and pathological response rate. Taxol needs to be added in neoadjuvant chemotherapy to improve pCR. Luminal subtypes respond poorly to chemotherapy.

BACKGROUND: Triple-negative breast cancers (TNBCs) are known for early age at presentation, large tumor sizes, and overall poor prognosis. However, Indian studies are scarce with limited follow-up data. Hence, the present study is aimed at characterizing nonmetastatic TNBC patients in our population and comparing their outcome with non-TNBC subset. METHODOLOGY: This is a retrospective observational study of nonmetastatic breast cancer patients accrued over 14 years. The demographic, clinical, and pathological profiles of TNBCs and their patterns of recurrences and survivals were compared to that of non-TNBC. Overall and disease-free survival (DFSs) were calculated from the time of initiation of therapy to the occurrence of event, i.e., death or recurrence. RESULTS: TNBC constituted 21.8% of all patients. Patients with triple-negative subtype were significantly younger and more likely to be premenopausal. Higher proportion of TNBC presented in locally advanced stage and had a higher proportion of node-positive patients compared to their non-TNBC counterparts. Although taxane-based neoadjuvant therapy was associated with significantly higher pathological complete responses, recurrences occurred earlier in TNBC. Even though inferior overall and DFSs were encountered in TNBC, statistical significance could not be derived. CONCLUSIONS: TNBCs are a subset of tumors with a poorly understood tumor biology and behavior. Despite being labeled as having an aggressive tumor biology and behavior, not many differences are seen in their clinical outcomes when they present as locally advanced cases.

INTRODUCTION: The present study for biosimilar trastuzumab was a multicentric, randomized, two-arm parallel-group, comparative phase III study in patients with metastatic breast cancer. MATERIALS AND METHODS: Stage I of the study was conducted among 42 participants with equal distribution in the study and reference arm. After a loading dose of 8 mg/kg trastuzumab was administered intravenously on day 1 of the first cycle; serum samples were obtained at 0, 1.5 (end of IP infusion), 3, 6, 8, 24, 96, 168, and 336 h after the first infusion for the first cycle only. C_max and AUC_0–336 were calculated for a single dose. Stage II enrolled a total of 106 patients across 20 centers who were randomized to receive biosimilar trastuzumab (study trastuzumab) or the reference trastuzumab with paclitaxel. The primary endpoint of the objective response rate (ORR) was analyzed after last the dosed participant had completed 25-week evaluation. The secondary outcome measures included time to tumor progression, progression-free survival and overall survival at week 48, and safety evaluation. RESULTS: For reference and study trastuzumab products, mean C_max of 229.02 and 210.68 μg/mL and AUC_0–336 of 24298.29 and 25809.33 (μg × h/mL), respectively, were obtained. The efficacy results demonstrated that study trastuzumab and reference trastuzumab had comparable ORR (48.44% vs. 44.44%). The proportions of participants showing complete response and partial response in each arm were found to be comparable. There were 56 (68.29%) participants in the study arm and 13 (59.09%) participants in the reference arm who had at least one adverse event during the study. Immunogenicity assessment also revealed no participants with positive antibody titer in any of the study arms. CONCLUSION: The pharmacokinetics, overall response rate at 25 weeks, and safety of the biosimilar trastuzumab was comparable to the reference trastuzumab.

BACKGROUND: Anastomosis in gastrointestinal (GI) surgery is a commonly performed procedure. Irrelevant various methods of intestinal anastomosis were followed – recent advance is the use of a stapler as a device for GI anastomosis. Due to the use of staplers, technical failures are a rarity, anastomosis is more consistent and can be used at difficult locations. MATERIALS AND METHODS: Between 2008 and August 2016, 75 patients with esophagus or gastroesophageal junction carcinoma underwent curative intent resection either via a right posterolateral thoracotomy (TTE) or transhiatal esophagectomy or video-assisted thoracoscopic surgery with linear stapler anastomosis. RESULTS: The average follow-up was approximately 9 months. Anastomotic leakage was observed in three patients. On follow-up, two patients presented with difficulty in swallowing, and on upper GI endoscopy, they were found to have anastomotic site stricture. There was no perioperative mortality. CONCLUSION: The linear-stapled esophagogastric anastomosis is a safe and effective anastomotic technique, which can decrease the rate of leak, postoperative dysphagia, and anastomotic stricture. As in this technique only two linear staplers are used in comparison to other techniques where three or more staplers are used, it is also cost-effective. The procedure deserves more attention and further application.

INTRODUCTION: Gallbladder cancer (GBC) falls into the top ten leading cancer sites in urban Delhi. The incidence of GBC in females is more than that among males worldwide. The present study evaluates the temporal variation of GBC incidence in an urban Delhi population. MATERIALS AND METHODS: The 25-year GBC incidence data were obtained from Population-Based Cancer Registry (PBCR) of Delhi which covered nearly 97.5% of the population and 75% of Delhi. We applied joinpoint regression method to determine the trend of GBC incidence from 1988 to 2012. The estimated cumulative risk (0–74) and lifetime risk of developing GBC were also calculated. RESULTS: GBC contributed 6% of total cancer cases in Delhi during the year 2012. In the past 25 years, 12,410 GBC cases (4010 males and 8400 females) were registered and contributed approximately 3% of male cancer cases and 6.5% of female cancer cases. The median age at diagnosis of GBC was 60.13 years and 57.22 years in males and females, respectively. Joinpoint analysis showed an overall increasing trend of age-adjusted rates of GBC incidence over 25 years. In females, a downward trend was observed during 1992–2004, whereas in males, the trend remained consistent during 1991–2005; however, thereafter, it started significant increasing for both the genders. Age-specific trend of GBC also reflects an increasing trend among males and females after 2004. CONCLUSION: The total and age-specific GBC cases have show an increasing trend in the past 25 years in urban Delhi. Stringent steps are required to control the modifiable risk factors for reducing the incidence of GBC in Delhi. In addition, individuals should also practice a healthy lifestyle to reduce the likelihood of GBC as well as other diseases.

BACKGROUND: A small proportion of Non-Small Cell Lung Cancers (NSCLC) are detected with Anaplastic Lymphoma Kinase (ALK) mutation by immunohistochemistry (IHC) but are negative by Fluorescence in situ Hybridization (FISH). Data on responses and outcome of this subset of patients when treated with crizotinib is limited. We analyzed the outcomes of such patients who received crizotinib. PATIENTS AND METHODS: Demographics, treatment details, response to treatment, date of progression and date of death were collected for patients who were IHC positive and FISH negative for ALK mutation from a prospectively maintained database. Depending upon feasibility, patients received either platinum based doublet chemotherapy or the ALK inhibitor crizotinib as first line therapy. Outcomes were compared to our previously published historical cohort of FISH positive patients who were treated with crizotinib. RESULTS: Thirteen patients were detected to be IHC+/FISH- and out of these seven received crizotinib. Objective response rate for crizotinib was 57.15% with an estimated mean PFS of 9.6 months (95% CI 3.8 -15.5 months). The difference in ORR of ALK IHC+/FISH- when compared to our historical cohort of ALK FISH positive treated with crizotinib was not statistically significant (57.15% vs 69.8%; P = 0.265). Estimated mean and median PFS was similar between the two cohorts (median PFS 6.0 months vs 14 months; mean PFS 9.6 months versus 14.7 months; P = 0.467). CONCLUSION: NSCLCs positive for ALK mutation by IHC but not detected by FISH show good response to crizotinib and merit treatment with the same.

BACKGROUND: Incidental gallbladder cancer (iGBC) is on the rise world over. This may be a good scenario as we get to treat GBC in early stages. However, there is a practice of diagnosing patients based on clinicoradiological findings alone and subjecting them to a radical surgical procedure. This approach over-treats patient and has important implications for resource utilization. METHODS: We performed a retrospective analysis of 284 consecutive patients undergoing upfront surgery for suspected GBC from January 2010 to December 2016. The study cohort was divided into two groups, group A – benign (n = 138, 48.6%) and group B – malignant (n = 146, 51.4%). Both groups were compared with respect to demographic characteristics, tumor marker levels, clinicoradiological features, and perioperative outcomes. RESULTS: Approximately 48.6% patients with clinicoradiological suspicion of GBC turned out to be benign on final histology as confirmed on frozen section evaluation (FS). Only 2 patients who were reported benign on FS required revision surgery for malignancy in the final histopathology report. Demographic and clinicoradiological characteristics in both groups were comparable. However, there was a significant difference in blood loss, postoperative hospital stay, and complications between the two groups (P < 0.005). CONCLUSION: Every other patient who presented to a tertiary cancer center with high index suspicion for malignancy, based on clinicoradiological findings, turned out to be benign on final histology. This emphasizes the fact that, as a norm, for radiologically suspected gallbladder malignancy, we need to have a confirmed histological diagnosis at least during surgery before proceeding to radical resection.

OBJECTIVE: Carbapenems are one of the last therapeutic options to treat various bacterial infections including multidrug resistant (MDR) nosocomial infections. However, excessive and inappropriate prescription of this drug has recently led to an epidemic rise in carbapenem resistance. Optimizing antibiotic utilization and exploring alternate options can be a potential way to control carbapenem resistance. The aim of this study was to assess the clinical efficacy of novel antibiotic adjuvant entity (ceftriaxone + sulbactam + ethylenediaminetetraacetic acid [EDTA] [CSE-1034]) in the treatment of various nosocomial infections. METHODS: Older patients suffering from hospital-acquired pneumonia, ventilator-associated pneumonia, and complicated urinary tract infections who received CSE-1034 as empirical therapy were evaluated. CSE-1034 therapy was initiated empirically and continued based on the results of culture sensitivity and clinical outcome. RESULTS: In total, 59 culture-positive patients with mean age of 57 ± 19 years were evaluated in this retrospective study. Escherichia coli was the most predominant pathogen isolated, followed by Acinetobacter baumannii, Klebsiella pneumonia, and Pseudomonas aeruginosa. Microbial sensitivity analysis has shown that isolates from all patients exhibited resistance to multiple classes of antibiotics. Isolated pathogens from 78% were sensitive to meropenem, 86% to CSE-1034, and 100% to colistin except Proteus species. Overall assessment of clinical outcome has shown that 83% cases were cured with CSE-1034 monotherapy, 12% with CSE-1034 and colistin combination therapy, and 5% were cured with alternate meropenem therapy. CONCLUSION: From this study, it can be concluded that ceftriaxone + sulbactam + EDTA alone or in combination with colistin can be an effective empiric treatment of various MDR nosocomial infections and can serve as an effective alternative to carbapenems.

Chylothorax is an uncommon complication in children. Although surgery and trauma are the most common causes encountered, hematological as well as solid malignancies can present with chylothorax. This study aimed to describe the presentation and management of malignant chylothorax in children. This is a case series from a pediatric hematology-oncology unit. Chylothorax was diagnosed by demonstrating high triglyceride content in the pleural fluid and a low cholesterol concentration in relation to the serum cholesterol. Cytology for malignant cells and investigations for tuberculosis were performed in all patients. Initial management included placement of an intercostal tube and administration of a fat-free diet with the addition of medium-chain triglycerides. Appropriate treatment of the underlying malignancy was initiated simultaneously. Three children with diagnoses of Stage IV neuroblastoma, lymphoblastic lymphoma, and Hodgkin lymphoma developed chylothorax. Malignant cytology was positive in the patient with T-NHL. All patients were found to have associated hypoproteinemia and hypoalbuminemia. The chylothorax resolved with conservative measures in two patients. It remained intractable in the child with T-NHL, in whom the lymphoma was refractory to chemotherapy. Chylothorax is a rare but challenging complication that can accompany childhood malignancies. Surgical interventions, radiotherapy, and pleurodesis are alternatives if the chylothorax is refractory to medical management.

Eccrine spiradenoma is one of the rare adnexal tumors with eccrine differentiation; however, it is considered to have apocrine differentiation. Around 50 cases of eccrine spiradenoma have been reported in the literature. Due to vascularity and painful symptoms, it is often confused with the painful lesions of skin such as glomus tumor and angioleiomyoma. Surgical excision is considered the gold standard for the treatment of these cases, with low rates of recurrence. Here, we present a 52-year-old male who presented with a nodular lesion in the left side of chest for the past 4 years. Surgical excision was performed and the tissue was sent for histopathological examination. Eccrine Spiradenoma may present congenitally or spontaneously as tumor of the sweat glands with unclear etiology. Early accurate diagnosis is very important in preventing chances of recurrence and more importantly identifying onset of malignant transformation.