BACKGROUND: Buccal mucosa cancer involving masticator space is classified as very advanced local disease (T4b). The local recurrence rate is very high due to poor understanding of the extent of tumor spread in masticator space and technically difficult surgical clearance. The objective of this study is to understand the extent of tumor spread in masticator space to form basis for appropriate surgical resection. MATERIALS AND METHODS: All consecutive patients with T4b-buccal cancer underwent compartment resection, with complete anatomical removal of involved soft-tissue structures. Specimens were systematically studied to understand the extent of invasion of various structures. The findings of clinical history, imaging and pathologic evaluation were compared and the results were evaluated. RESULTS: A total of 45 patients with advanced buccal cancer (T4b) were included in this study. The skin, mandible and lymph nodes were involved in 30, 24 and 17 cases respectively. The pterygoid muscles were involved in 34 cases (medial-pterygoid in 12 and both pterygoids in 22 cases) and masseter-muscle in 32 cases. Average distance for soft-tissue margins after compartment surgery was 2 cm and the margins were positive in 3 cases. The group with involvement of medial pterygoid muscle had safest margin with compartment surgery while it was also possible to achieve negative margins for group involving lateral pterygoid muscle and plates.The involvement of pterygomaxillary fissure was area of concern and margin was positive in 2 cases with one patient developing local recurrence with intracranial extension. At 21 months median follow-up (13-35 months), 38 patients were alive without disease while two developed local recurrence at the skull base.CONCLUSIONS: T4b buccal cancers have significant soft-tissue involvement in the masticator space. En bloc removal of all soft-tissues in masticator space is advocated to remove tumor contained within space. The compartment surgery provides an opportunity to achieve negative margins for cancers actually contained within masticator space.It is inappropriate to club all patients with masticator space involvement in one group.

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The purpose of this study is to determine the influence of bladder and bowel preparation protocols on the dose-volume histograms (DVHs) of these organs using the cone beam computed tomography (CBCT)-based intensity modulated radiotherapy (IMRT) treatment planning for prostate cancer patients. The pelvic DVHs of 12 prostate cancer patients were studied using CBCT images obtained immediately before each treatment. Six patients had bladder and bowel preparation protocol whilst the other six patients were the control group. Contoured bladder and rectal volumes on CBCT images were compared with planning computed tomography. All patients were treated with IMRT with 7800 cGy in 39 fractions over 8 weeks. Compared with the patient with bladder preparation protocol, patients without bladder preparation instruction had higher bladder volume and dose variation. The maximum variation in bladder volume was as high as 98% in the control group. Without bowel preparation protocol, the rectal volumes were more variability. Owing to changes in rectal filling on the day of treatment, the maximum variation in rectal volume was as high as + 96%. With bowel preparation protocol, the maximum rectum volume variations were less than 25%. The changes in prostate target dose compared with planning dose were minimal as would be expected from positioning with daily image guidance and gold seed implanted.

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BACKGROUND: Carcinoma of buccal mucosa is the most common cancer of the oral cavity in India. Treatment of oral cancer poses unique reconstructive challenges, owing to the dynamic architecture of the oral cavity. Despite current progress in various treatment modalities, over the past 50 years survival rates have not improved drastically. Although, philosophy on treatment of buccal mucosa carcinoma remains well-established, due to the relative paucity of reported data, retrospective reviews of institutional experiences are of prime importance. This study provides a detailed insight on this site specific cancer of the oral cavity in the Indian population. AIM: The aim of this study is to analyze our experience with the management of carcinoma of buccal mucosa; associated clinical presentation, outcomes and prognostic factors. SETTINGS AND DESIGN: A retrospective chart review was performed of all cases of primary buccal mucosa carcinoma treated surgically between years 2008 and 2012 in SDM Craniofacial Unit, Karnataka, India. MATERIALS AND METHODS: All cases were analyzed based on patient characteristics, clinical presentation, surgical and adjuvant therapy rendered and treatment outcomes. A retrospective chart review was carried out using the hospital's data base for the same. STATISTICAL ANALYSIS USED: Kaplan-Meier methods were used for analyzing disease free survival (DFS). Univariate analysis of prognostic factors was performed with log rank test. RESULTS: The significant variables in univariate analysis were: Overall stage, T-stage (T1/T2 vs. T3/T4) and nodal status (N0 vs. N+). We found that staging, tumor size and nodal status were significant prognostic factors for DFS. CONCLUSION: The strong influence of overall disease stage, tumor size, nodal status, final histopathological report and habits of tobacco/betel quid chewing, on prognosis; emphasizes the importance of early diagnosis and prevention of carcinoma of buccal mucosa in the Indian population.

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CONTEXT: Proliferative verrucous leukoplakia (PVL) is a highly persistent and aggressive oral pre-malignant lesion with an obscure etiopathogenesis and a malignant transformation rate of 85-100%. AIMS: The aim of the present study is to assess the role of Ki-67, p16, CD34, Bcl-2, cyclooxygenase-2 (COX-2) in the spectrum of PVL to ascertain their role in its etiopathogenesis. SETTINGS AND DESIGN: A retrospective chart analysis was carried out on a series of seven confirmed cases of PVL, which were followed-up for 2 years. SUBJECTS AND METHODS: Immunohistochemical appraisal of these cases was carried out by a panel of markers, related to cell proliferation, cell cycle regulation, angiogenesis, apoptosis and inflammation. The expression of these markers was correlated with patients' clinicopathological profile. STATISTICAL ANALYSIS USED: The frequency distribution of the group data was analyzed. RESULTS: The latest labeling index of Ki-67 in our cases ranged from 8.18 to 12.6. p16 was positive in 3/7 cases. Bcl-2 expression was moderately positive in 2/7 cases. All cases were intensely positive for COX-2 staining. Microvascular density assessed by CD34 staining ranged from 11 to 20/high power fields. One case which transformed into squamous cell carcinoma demonstrated increased Ki-67, Bcl-2, COX-2, CD34 expression, but negative p16 and Bcl-2 expression. CONCLUSIONS: Application of these markers in understanding the behavior of PVL suggests that an imbalance between the proliferation apoptosis dynamics of the lesion accompanied by an increase in inflammation and angiogenesis underlie the molecular pathogenesis of the PVL spectrum.

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Phase I metabolic enzyme CYP1A1 plays an important role in xenobiotics metabolism and has been extensively studied as a cancer risk biomarker. CYP1A1 is polymorphic and its four variants, e.g., CYP1A1* 2 A, CYP1A1* 2C, CYP1A1* 3 and CYP1A1* 4 with trivial names m1, m2, m3, and m4 respectively, are most commonly studied for cancer link. Gene- gene interaction studies combining polymorphisms of this enzyme with those of phase II detoxifying enzymes, especially glutathione S- transferases (GSTs) revealed greater risk for cancer susceptibility. Variants of CYP1A1 have also been found to be associated with chemotherapeutic adverse- effects. Results of these studies, however, remained largely contradictory mainly because of lack of statistical power due to involvement of small sample size. Strongly powered experimental designs involving gene- gene, gene- environment interactions are required in order to validate CYP1A1 as reliable cancer- biomarker.

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CONTEXT AND AIM: The prognosis of primary gliosarcoma (PGS) remains dismal with current treatment modalities. We analyzed the outcome of PGS patients treated with concurrent and adjuvant temozolomide (TMZ). SETTINGS AND DESIGN: Retrospective single institutional analysis. MATERIALS AND METHODS: We retrospectively evaluated 27 patients of PGS treated with radiotherapy (RT) and TMZ during 2007-2012. STATISTICAL ANALYSIS USED: Overall survival (OS) was estimated by the use of Kaplan Meier method and toxicities were evaluate using common terminology criteria for adverse events version 2.0 (National Cancer Institute, USA). RESULTS: Median age at presentation and Karnofsky performance status was 45 years and 90 respectively and male: female ratio was 20:7. Patients received adjuvant RT to a total dose of 60 Gy at 2 Gy/fraction. All patients except 5 received adjuvant TMZ to a median number of 6 cycles. Grade 2 and 3 hematological toxicity was seen in 8% and 4% of patients respectively during concurrent RT. During adjuvant chemotherapy, 13.6% had Grade 3 thrombocytopenia and 9.5% had Grade 3 neutropenia. Median OS was 16.7 months (1 year and 2 year actuarial OS was 70.8% and 32.6% respectively). Adjuvant TMZ was associated with a better survival (median survival 21.21 vs. 11.93 months; P = 0.0046) on univariate analysis and also on multivariate analysis (hazard ratio 1.82, 95% confidence interval: 1.503-25.58; P = 0.012). CONCLUSIONS: The results of our study, largest series of patients with PGS treated with concurrent and adjuvant TMZ shows an impressive survival with acceptable toxicity. We suggest TMZ be included in the “standard of care” for this tumor.

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BACKGROUND: Oral squamous cell carcinoma (OSCC) ranks as one of the most common types of cancer and oral potentially malignant lesions (OPMLs) provides with an overall increased risk for development of carcinoma. As podoplanin expression is attracting interest as a marker for cancer diagnosis and prognosis, this study assesses the role of podoplanin expression in such lesions. MATERIALS AND METHODS: Podoplanin expression and lymphatic vessel density (LVD) was determined using D2-40, a marker for podoplanin, in 70 diagnosed cases of potentially malignant lesions and OSCC. RESULTS: Normal epithelium showed negligible podoplanin expression, whereas the expression extended predominantly at the basal layer and the suprabasal layer or above at one or multiple areas in potentially malignant lesions. Podoplanin expression in OSCC showed two different patterns-diffuse and focal. A statistically significant increase in mean LVD was seen from normal epithelium to potentially malignant lesions (P < 0.001) and to OSCC (P < 0.022) while a non-significant increase was seen (P < 0.594) between OPMLs and OSCC. Overall no significant correlation was found between D2-40 epithelial positivity and LVD (P = 0.122). CONCLUSION: This study suggests the utility of podoplanin as a biomarker for cancer risk assessment as it detects the early changes and thus provides an additional value beyond current clinical and histopathological evaluations. Hence, podoplanin is suggested to be a marker of tumor initiation and to a lesser extent of tumor progression.

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INTRODUCTION: We report our cohort of oral squamous cell carcinoma (OSCC) patients with or without predisposing habits in glossal and extraglossal sites. MATERIALS AND METHODS: A retrospective analysis of OSCC cases over a period of 13.75 years from the archives of Ragas Dental College and Hospital, Chennai, India. Demographic details, site, details of habits, and grade of OSCC were retrieved. Social Package for Social Service version 17.0 was used to analyze the data. Descriptive statistics, Chi-square test, and comparison of mean were employed appropriately. RESULTS: There were 151 OSCC cases, of which 60.9% (92/151) were males, 21.2% (32/151) were aged ≤40 years and 27.82% (42/151) occurred in the tongue. The glossal to extraglossal site ratio was 1:2.6. Predisposing habits were present in 52.4% of glossal OSCC and 82.6% with extra-glossal sites (P = 0.000). Besides tobacco, exclusive areca nut chewing was observed in 15.23% (23/151) patients. Thirty-nine (25.8%) belonged to non-tobacco, non-areca nut, non-alcohol (NTND) group with male to female ratio was1:3. DISCUSSION: In our cohort, 112 of 151 OSCC (74.8%) had at least one predisposing habit. Chewing of areca nut alone was a predisposing habit by itself. In addition, there was a small, subset of cases that were not associated with history of any habits. This study brings to focus the subsets of OSCC predisposed by areca nut and NTND, that needs to be studied further.

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BACKGROUND: Oral tyrosine kinase inhibitor (gefitinib and erlotinib) have been used in the palliative treatment of head and neck cancers with limited success. In this report, we aim to quantify the symptomatic benefit, progression-free survival (PFS) and overall survival (OS) when erlotinib is given as second-line treatment in Head and neck cancers. METHODS: This was a post-hoc retrospective analysis of a randomized study comparing metronomic chemotherapy with cisplatin. A patient who progressed on chemotherapy and had a PS0-2 were offered second-line chemotherapy. Patients who had received erlotinib (150 mg PO OD) as second line treatment were selected for this analysis. Erlotinib was discontinued in case of either progression of disease or if the patient had intolerable side effects. Patient were monitored 1-week after the start of erlotinib and subsequently at monthly intervals. The toxicity was recorded in accordance with CTCAE version 4.02 (NCI,USA) and the response were graded in accordance with RECIST version 1.1. All of these patients were followed-up till death. RESULTS: Twenty-three patients were identified. The median age of these patients at the start of the second line was 47 years (interquartile range 40.5–51.75 years). The primary site of distribution was oral cavity primary in 17 patients (77.3%) and nonoral cavity primary in 05 (22.7%) patients. The immediate last chemotherapy regimen received was cisplatin in 9 patients (40.9%) and metronomic chemotherapy in 13 patients (59.1%). Symptomatic benefits post second-line erlotinib was seen in 18 patients (81.8%). The most common adverse events (any grade) seen were anemia in 20 patients (90.9%), rash in 10 patients (45.5%) and diarrhea in 7 patients (31.8%).The best radiological response documented were a partial response in 04 patients (19.2%). The median estimated PFS and OS were 110 days (95% confidence interval [CI]: 61–175 days) and 156 days (95% CI: 126–185 days) respectively. CONCLUSION: Erlotinib single agent has promising activity in the second line and needs to be explored in future studies.

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BACKGROUND: Plethora of information exists in the literature on pathology of the glioma while prevailing research data on quality-of-life (QOL) of glioma patients marks dearth thus demanding more studies. AIMS: In this study, we examined the QOL of different grades of glioma patients among the Chennai population in India. MATERIALS AND METHODS: A total of 162 patients with different grades of glioma enrolled from August 2007 to February 2011, at their first contact to Department of Neurology and Neurosurgery, Government General Hospital, Chennai, India were included and their QOL was assessed by European Organization for Research and Treatment of Cancer Core QOL questionnaire (EORTC QLQc-30), EORTC brain cancer module (QLQ BN-20). RESULTS AND CONCLUSION: Both low and high grade glioma (LGG and HGG) patients had poor mean scores in social functioning (87.0), physical functioning (82.0) and emotional functioning (75.2) and role functioning (58.9). The mean scores on cognitive functioning (61.9) and global QOL (60.3) were better. Age, Karnofsky performance status, World Health Organization grades showed significant associations with all functional scales. The percentage values were higher for symptoms of fatigue (76.9%), pain (71.5%), financial difficulties (77.6%) and appetite loss (38.46%) in both LGG and HGG. Similarly, with respect to QLQ-BN20 domains, HGG patients showed more symptoms than low grade with a significant correlation in communication deficit problems (P = 0.02), headache (P = 0.04), seizures (P < 0.01), hair loss (P < 0.05) than the other symptoms. This initial assessment suggests that an increasing burden of symptoms exists, with poor QOL and survival, which has become a major concern in different grades of glioma patients.

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BACKGROUND: The use of tobacco has been on the rise globally including in India, posing a grave public health problem. Recently, tobacco use through hookah smoking has increased among young adults in India, Middle East, Southwest Asia, Africa, Europe and North America. Hookah prevalence of 0.4-15% has been reported in India. AIM: The aim of the study was to understand perception of hookah use among young adults in Mumbai. MATERIALS AND METHODS: A total of 500 college students, with/without hookah habit, were given a self-administered questionnaire to indicate their perception of hookah use, using yes/no responses. The responses were analyzed in the users/non-users and considered significantly different at P < 0.05. RESULTS: Responses were received from 122 hookah users and 325 non-users. The perception of hookah use between users and non-users and males and females, showed significant differences (P < 0.05), with respect to hookah being injurious to health, causes cancer, is addictive, influence of a close friend, flavors, curiosity toward hookah use and willingness to prepare hookah at home. Whereas, differences in the groups perception of hookah as safer than cigarettes, harmful air quality, ambience, cool look and means of socializing, was not observed. CONCLUSION: The perception of young adults in Mumbai, toward hookah use, indicates an increased trend to use hookah. We recommend deterrents for hookah use by display of health warnings on hookah assembly and the tobacco products, implementation of government policies on hookah and tobacco use and punitive measures for offenders.

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BACKGROUND: In this manuscript, we assessed tumor recurrence and tumor-related mortality in a clinical series of endometrial cancer patients. MATERIALS AND METHODS: A retrospective evaluation of 276 patients (mean age 64 years) with histologically confirmed endometrial cancer treated at a single hospital in Madrid (Spain) was conducted. The median follow-up was estimated using the inverse Kaplan–Meier method. RESULTS: Salient findings were endometrioid carcinoma (84.8% of cases), grade G1 (48.9%) and stages IB (35.1%) and IC (23.2%). Myometrial infiltration >50% was documented in 31.2% of cases and lymphovascular space invasion in 11.9%. After surgery, 52.5% of patients were classified into the low risk group, 21.4% into the intermediate risk group and 26.1% into the high risk group. Tumor recurrence occurred in 14.5% of patients, with an estimated median follow-up of 45 months (95% confidence interval (CI): 41.2–48.8), locoregional recurrence in 42.5% and distant recurrences in 57.5%. Furthermore, 40% of tumor recurrences developed during the first year after primary treatment and 90% over the first 3 years of follow-up. The tumor-related mortality rate was 15.9%. The estimated median follow-up was 46 months (95% CI: 43.0–49.0). Furthermore, 5.07% of death because of tumor developed during the first year after primary treatment and 13.77% over the first 3 years of follow-up. CONCLUSION: The rates of tumor-related death and tumor recurrence in endometrial cancer patients are low, with the highest percentages occurring within 3 years of primary treatment. Most of the recurrences occur outside the pelvis.

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Pan masala (PM) is a mixture of areca nut with slaked lime, catechu and other flavoring agents. It is widely available and used by all the sections of the Indian society. It is genotoxic as it increases sister chromatin exchange and chromatin aberrations. Among humans, it is a leading cause of oral submucous fibrosis that often progresses to oral cancer. Among experimental animals, it leads to neoplastic lesions in lung, liver and stomach. It is hepatotoxic leading to increased level of enzymes, deranged carbohydrate and lipid metabolism. It is harmful to kidneys and testes leading to increased creatinine and sperm deformities respectively. PM is a very harmful substance affecting almost all organ systems, and there is immediate need for a national policy on complete ban on the production, storage, sale and marketing of PM.

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BACKGROUND: Neoadjuvant chemotherapy is being increasingly used in patients with unresectable oral cavity cancers to make them resectable. However, its impact on locoregional treatment delivery in such setting remains poorly studied. AIMS: To evaluate the impact of neoadjuvant chemotherapy on delivery of further locoregional treatment. SETTINGS AND DESIGN: Mono institutional retrospective audit of patients with oral cavity squamous cell cancers treated with neoadjuvant triplet chemotherapy in India. MATERIALS AND METHODS: Patients receiving neoadjuvant chemotherapy (n = 14) from May 2012 to April 2014 were matched 1:2 to patients undergoing upfront surgery (n = 28) based on age (>60 or 60 and less), gender (male or female) and subsite site (tongue and floor of mouth or buccoalveolar complex). Data regarding factors related to the delivery of locoregional treatment and toxicities were compiled. STATISTICAL ANALYSIS: Descriptive analysis in the form of median (range) for continuous variables and frequencies for categorical variables. RESULTS: Patients undergoing neoadjuvant chemotherapy required more extensive resections and had greater operative time (460 vs. 415 min, P < 0.001). A greater incidence of locoregional wound complications was seen as a consequence (57.1% vs. 14.3%, P, 0.01). However, toxicities during radiotherapy were not substantially different between the two groups and compliance to radiation was also similar. Total package time of 100 days or less, was maintained in 90% of patients in both groups. CONCLUSIONS: Delivery of neoadjuvant chemotherapy does not impair the ability to deliver locoregional treatment.

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BACKGROUND: Plasmablastic lymphoma (PBL), a rare non-Hodgkin's lymphoma (NHL) variant specifically associated with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), expresses well-differentiated plasma cell markers like CD138, bright CD38, and MUM1; but not conventional B-cell markers. It occurs at unusual sites like oral cavity and orbit, and has poor survival rates. AIMS: This study serves as a review of a clinical experience with six HIV patients with PBL and observes the spectrum of clinical presentations, histopathologies, and 1-year outcomes in PBL patients. MATERIALS AND METHODS: This review of six PBL patients was conducted at a tertiary care hospital in eastern India using relevant radiological, histopathogical, and immunohistological studies. RESULTS: Incidence of PBL among HIV patients was 0.58% (6/1,028). Mean CD4 count at presentation was 125.5 ± 71.1 cells/μL. Sites of involvement included pleura, lung parenchyma, suprarenal gland, pelvic cavity, and retroorbital space (one each). Immunohistopathology of biopsied sample in each patient revealed PBL (positive plasma cell markers MUM-1/IRF4, CD38, and CD138/syndecan; and negative of B-cell markers CD3, CD20, and CD30). Three (60%) were positive for Epstein Barr virus (EBV) immunoglobulin G (IgG). Five surviving patients received CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) regimen and attained partial remission (PR) after six cycles. Subsequently, three patients were started on EPOCH (etoposide, cyclophosphamide, doxorubicin, vincristine, prednisone) therapy; two attained near total regression after 6 months (four cycles). Overall, four patients remained alive with good quality of life at the end of 1 year of follow-up. CONCLUSION: PBL in HIV occurs at unusual sites with varying aggressivity. This study is too small to comment on the long-term outcomes of PBL in HIV; however, coadministration of antiretroviral therapy (ART) with standard chemotherapy may improve survival.

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OBJECTIVE: To evaluate the features of primary thyroid lymphoma (PTL) by ultrasonography (US) combined with contrast-enhanced ultrasonography (CEUS). MATERIALS AND METHODS: In this retrospective study, 20 patients (8 male and 12 female) with PTL were evaluated by conventional US and among them, 10 patients underwent CEUS examination. The appearance of US features was classified into three types: Diffusive mass type, multiple nodular type and mixed type. The CEUS patterns included diffusive homogeneous enhancement and diffusive heterogeneous enhancement pattern. Parameters of CEUS time-intensive curve were analyzed in primary tumor and involved lymph nodes compared to ipsilateral common carotid artery. RESULTS: Of 20 patients with PTL, 18 presented an enlarging neck mass that grew rapidly with an average duration of 3.2 months, and 17 were associated with Hashimoto's thyroiditis. In conventional US, all patients had marked hypoechoic masses. Among them, 12 patients were diffusive mass type, 6 were multiple nodular type and 2 were mixed type. For CEUS patterns, 8 were diffusive homogeneous enhancement and 2 were diffusive heterogeneous enhancement. Necrosis areas were showed in diffuse heterogeneous pattern which were hardly seen in conventional US. In the quantitative analysis of CEUS parameters, the time to peak of time-intensive curve in the primary tumors or involved lymph nodes was longer than that of the ipsilateral common carotid artery (P = 0.004). CONCLUSION: PTL mainly demonstrated as a diffusive mass type with marked hypoechogenecity on conventional US and diffusive homogeneous enhancement pattern on CEUS. And the heterogeneous enhancement pattern is also helpful for detecting necrosis areas of PTL.

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BACKGROUND: The super family of glutathione S-transferases (GSTs) is composed of multiple isoenzymes with significant evidence of functional polymorphic variation. GSTs detoxify potentially mutagenic and toxic DNA-reactive electrophiles, including metabolites of several chemotherapeutic agents, some of which are suspected human carcinogens. Polymorphisms within the phase II metabolizer enzymes GST T1, GST M1, and GST P1 affect the body's ability to detoxify a range of potential leukemogens encountered in the environment. AIM OF WORK: To address how differences in the human GST isoenzyme expression patterns influence cancer susceptibility, prognosis, and treatment. PATIENTS AND METHODS: A total of 50 patients with acute myeloid leukemia (AML), as well as 50 age and sex matched apparently healthy volunteers were genotyped for GSTP 1, GSTM 1, and GSTT 1 gene polymorphisms using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and conventional polymerase chain reaction (PCR), respectively. RESULTS: For GSTP1 313 A → G (GSTP1 Ile105Val) polymorphism, It was found that the wild genotype (AA) was significantly higher among control subjects (P value = 0.0277), while the frequency of heteromutant genotype (AG) and mutant G allele (AG + GG) was significantly higher among patients (P value = 0.0402, P value = 0.0277, respectively). For GSTM1 and GSTT1gene, we found statistically significantly higher frequency among patients regarding homozygous gene deletion (P value = 0.0005). CONCLUSION: We demonstrated that GSTM1 null or GSTT1 null genotypes may be considered independent risk factors for AML with no impact on prognosis and GSTP1 * 105 genotype is a prognostic factor, adding independent information to the routine laboratory parameters and cytogenetic and molecular alterations of the tumor cells.

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Despite multimodality treatment protocol including surgical resection, radiotherapy, and chemotherapy in patients with glioblastoma multiforme (GBM), most suffer from treatment failure and tumor recurrence within a few months of initial surgery. The effectiveness of temozolomide (TMZ), the most commonly used chemotherapeutic agent, is largely dependent on the methylation status of the promoter of the gene O6-methylguanine-DNA methyltransferase (MGMT) and the integrity of the mismatch repair (MMR) system. Changes in these regulatory mechanisms at the time of recurrence may influence response to therapy. Deciphering the molecular mechanisms of resistance to these drugs may in future lead to improvised patient management. In this article, we provide an update of the spectrum of molecular changes that occur in recurrent GBMs, and thus may have an impact on patient survival and treatment response. For review, electronic search for the keywords “Recurrent GBM”, “Recurrent GBM AND MGMT” “Recurrent glioma AND MGMT”, “Recurrent GBM AND MMR” and “Recurrent glioma AND MMR”, “Recurrent GBM AND MMR” and “Recurrent glioma AND MMR” was done on PubMed and relevant citations were screened including cross-references.

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BACKGROUND: Tobacco smoke has compounds that are known as human carcinogens. With every breath of secondhand smoke we inhale thousands of chemicals. The Government of India in the interest of public health has enacted the Cigarette and Other Tobacco Products Act (COTPA), 2003, which bans smoking in all the public places including hotels and restaurants. The purpose of this study was to observe and record air pollution in smoke free and smoke observed locations and thereby find out whether the owners/managers of hotels, restaurants, and bars comply with rules of COTPA. OBJECTIVES: The objectives of the study were to measure and compare the level of particulate air pollution from secondhand smoke (PM_2.5) in smoking and nonsmoking venues. MATERIALS AND METHODS: The study was conducted from September 2009 to March 2010 in Karnataka, India following a nonrandom sample of 79 locations, which included restaurants, bars, cafes, hotels, and tea stalls in two districts. The concentration of PM_2.5was measured using a TSI SidePak AM510 Personal Aerosol Monitor. RESULTS: In Karnataka out of the 79 hospitality locations, smoking was observed in 58% places and only 28% had displayed the required “No Smoking” signage. Places where indoor smoking was observed had high levels of air pollution with average 135 PM_2.5, which were 3.1 times higher than the average 43 PM_2.5in smoke-free locations and 14 times higher than the World Health Organization (WHO) target air quality guideline for PM_2.5. The average PM_2.5levels in different locations ranged from 11 to 417 μg/m³ and was lower in the case of apparently compliant designated smoking area (DSR). CONCLUSIONS: The patrons and the workers in the hospitality sector continue to be exposed to secondhand smoke despite the enactment of COTPA, which bans smoking in public places. This situation demands stringent measures for effective implementation of the Smoke Free Act and negative response to smoking among civil society.

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AIM: Breastlight is a new product to improve breast health awareness of women. However, its accuracy in detection of breast lesions (BLs) is unknown. The aim of this study was to determine the Breastlight accuracy in detection of BLs. MATERIALS AND METHODS: From July 2011 to September 2013, a total of 500 women referred to mammography unit in Yazd, Iran for screening were recruited to the study. The sensitivity and specificity of Breast light was measured with clinical breast examination (CBE), mammography and sonography. Sonographic and mammography examinations were performed according to breast density among women in two groups of younger (n = 105) and older (n = 395) than 30 years. RESULTS: The results have shown a statistically significant positive correlation between Breastlight, CBE, sonography, and mammography in detection of BLs. Breastlight significantly detected 60.3%, 35.8%, and 59% of lesions which were detected by mammography, CBE, and sonography, respectively. Its sensitivity varied significantly with breast density. Comparing the sensitivity of Breastlight among women younger and older than 30 years indicated that the Breastlight had a higher sensitivity for women older than 30 years. The greatest and lowest portion of positive predictive value occurred with CBE (94.7%) and mammography (91.1%). As well, its greatest and lowest portion of negative predictive value occurred with CBE (65.6%) and sonography (29.7%). CONCLUSION: The results of this study showed that the efficacy of Breastlight in detection of breast changes as domestic apparatus was appropriate. However, it is recommended further studies to evaluate the Breastlight efficacy and accuracy in detection of the BLs.

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BACKGROUND: The morbidity and mortality caused by breast cancer can be decreased by early detection with breast self-examination (BSE). The objective of this study was to determine the prevalence and the factors determining the practice of BSE. MATERIALS AND METHODS: The study was conducted on 140 women aged above 18 years who presented consecutively in a General Outpatient's clinic in a tertiary hospital in Nigeria. This was the baseline study from an intervention study which looked at the effect of demonstration of BSE on improving Clinical Breast Examination (CBE) among two groups of respondents. Structured questionnaires were validated and administered by an interviewer and the data were analyzed using Statistical Package for Social Sciences (SPSS) version 12. RESULTS: The overall self-reported prevalence of BSE practice was 62.1% among the respondents. Older women (16, 76.2%), married women (63, 65.6%) and women with tertiary education (51, 68.9%) had the highest prevalence of BSE practice. Prevalence rate was highest for civil servant (25, 78.1%), P = 0.04. The practice of BSE was higher among women with a previous history of breast disease (15, 68.2%) and in respondents with a family history of breast disease (7, 63.6%), Only 11 (12.6%) performed BSE as per guidelines, which was once in a month. CONCLUSION: The prevalence of BSE was found to be high, especially in those with tertiary education and in those with a past personal or family history of breast disease. In resource-constrained countries, BSE is a screening tool that can be employed to help reduce the breast cancer burden because routine mammography screening is not yet feasible. Women need to be informed about the when and how to perform BSE.

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BACKGROUND: Male breast cancer (MBC) is a rare disease and accounts for 1% of all breast cancers. There is limited data on MBC from India. The aim of our study was to assess clinico-pathological parameters and outcome in MBC patients. MATERIALS AND METHODS: This analysis was carried out in 76 patients of MBC who were registered at Institute Rotary Cancer Hospital of All India Institute Of Medical Sciences between 1996 and 2012. Patients' records were retrospective reviewed and data obtained from the computer database using International Classification of Diseases code (C-50). RESULTS: The median age was 59 years (range: 28-80). The median duration of symptoms was 11 months (range: 0.5-40). Breast lump was the most common presenting symptom (left > right side). American Joint Committee on Cancer (7^th edition) stage distribution was Stage I-2.6%, Stage II-13.1%, Stage III-59.3% and Stage IV-25%. Modified radical mastectomy was the commonest surgical procedure. Moreover, 30% of tumors were high-grade and 70% had pathological node positive disease. Estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (HER2)/neu positivity was 80% and 28%, respectively. Triple negative breast cancer constituted 19% of cases. With a median follow-up of 36 months, 3 years relapse free survival and overall survival was 60% and 80%. Advanced stage and visceral metastasis at baseline predicted poor outcome. CONCLUSION: MBC constituted 0.8% at our institute. Our study population had a longer time to presentation, advanced disease at presentation, more HER2/neu positivity and triple negativity higher than the available literature.

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BACKGROUND: To compare dosimetric parameters of intensity-modulated radiation therapy (IMRT) with 3D conformal radiotherapy (3DCRT) in post-operative patients of vulvar cancer and to assess clinical outcome and toxicity with IMRT. MATERIALS AND METHODS: A total of 8 post-operative patients of vulvar cancer were treated with IMRT. All patients were also planned by 3DCRT for comparison with IMRT. The two plans were compared in terms of conformity index, homogeneity index, tumor control probability (TCP) and normal tissue complication probability (NTCP) for the planning target volume and organs at risk (OAR). RESULTS: IMRT resulted in significantly lesser doses to rectum, bladder, bowel and femoral head as compared with 3DCRT plans. Mean conformity and homogeneity indices were better and within range with IMRT. The TCP was comparable between the two treatment plans and NTCP for rectum, bladder, bowel and femoral head was significantly less with IMRT as compared with 3DCRT. Treatment was well-tolerated and none of the patients developed Grade 3 or higher toxicity. CONCLUSION: IMRT yielded superior plans with respect to target coverage, homogeneity and conformality while lowering dose to adjacent OAR as compared with 3DCRT. Thus, IMRT offers a reduction in NTCP while maintaining TCP.

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CONTEXT: Recently, there has been considerable interest in the role of radical prostatectomy (RP) in men with high-risk prostate cancer. AIMS: The objective of our study is to report the outcome of upfront RP in our patients with high-risk prostate cancer (Stage ≥ cT2c, a pre-operative serum prostate specific antigen >20 ng/ml or a biopsy Gleason score [GS] 8-10). SUBJECTS AND METHODS: From 1996 to 2010, 208 patients of prostate cancer (high risk category D'Amico's criteria) underwent open RP with bilateral pelvic lymphadenectomy. STATISTICAL ANALYSIS USED: The data was statistically analyzed using Kaplan Meier method and log rank test to calculate progression free, metastasis free survival (MFS) and cancer specific survival (CSS). Furthermore multivariate analysis (MVA) was carried out using SPSS 14 software. (IBM company). RESULTS: At 7 and 10 years, prostate cancer-specific survival (PCSS) was found to be 79.7% and 65%, respectively, biochemical recurrence free survival (BRFS) was 42.4% and 36.7%, respectively and the MFS was 71.1% and 64.4% respectively. High GS was highly predictable of PCSS, BRFS and MFS. Node positivity was the single poor risk factor on MVA whereas biopsy GS, pStage (P = 0.016) and seminal vesicle invasion (P = 0.045) had statistical significance in predicting the MFS. CONCLUSIONS: RP provides accurate pathologic staging of patients with high risk prostate cancer, allows better stratification of patients for further adjuvant therapy and either as an initial approach or part of a multimodal regimen, can provide durable local control and provides excellent CSS.

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OBJECTIVE: We present our data comparing retrospectively the efficacy of abiraterone and cabazitaxel in patients who progress after docetaxel treatment. PATIENTS AND METHODS: The study included 56 patients diagnosed with hormone-refractory metastatic prostate cancer who were previously treated with abiraterone therapy at four oncology centers in Turkey. RESULTS: With abiraterone, the patients had a median progression-free survival (PFS) of 5.9 months (95% confidence interval (CI) for hazard ratio (HR) (4.4–7.4)) and an overall survival of 13.4 months (95% CI for HR (5.5–21.3)). When we compared the disease-free survival (DFS) of reference patients treated with cabazitaxel as a second-line treatment with those receiving second-line abiraterone therapy, there was no significant difference. (PFS = 5.9 months with cabazitaxel vs. 6.7 months with abiraterone, P = 0.213). CONCLUSION: This study has shown that in our experience abiraterone acetate is an effective agent in metastatic castration-resistant prostate cancer (mCRPC) regardless of the line of treatment.

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INTRODUCTION: Bortezomib is a novel proteasome inhibitor in myeloma. There is a paucity of data from India regarding the efficacy and tolerance to bortezomib. MATERIALS AND METHODS: All patients with newly diagnosed multiple myeloma from January 2008 to December 2011 treated with bortezomib as the first-line therapy were studied in a retrospective analysis. The primary end point was the overall rate of response. Secondary end points were the progression free survival (PFS), reversibility of renal compromise and safety of bortezomib. RESULTS: Our study included 41 patients with newly diagnosed myeloma. The overall response to bortezomib was 88.5% (complete response [CR] 31.4%, very good partial response 34.2%, partial response [PR] 22.8%). A renal response (CR renal, PR renal or Minimal Response renal combined) was documented 96.2% patients with initial renal impairment. The median time to the first renal response was 21 days. 17 patients (41.4%) had severe toxicity (Grade 3 and 4). Bortezomib induced peripheral neuropathy (BIPN) was the most common toxicity seen (53.6%) and the most common cause for discontinuation of therapy. At a median follow-up of 9 months, median PFS was not reached. DISCUSSION: The results obtained in our study are comparable with those of established studies on bortezomib. Our patient population has similar responses and renal reversibility patterns. However, they are at an increased susceptibility to BIPN, leading to discontinuation of therapy. CONCLUSION: Bortezomib as first-line therapy has a good efficacy and safety.

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BACKGROUND: The B cell lymphoma-2 gene is a proto-oncogene whose protein product inhibits apoptosis. Its role is associated with keeping cells alive, but not by stimulating them to proliferation, as other proto-oncogenes do. Increased expression of protein product of Bcl-2 gene appears in the early phase of carcinogenesis leading to apoptosis impairment and in consequence to the progression of neoplastic changes. OBJECTIVE: To evaluate and compare the expression of Bcl-2 protein in oral epithelial dysplasia and oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Sixty cases of formalin-fixed paraffin-embedded archival specimens comprising of 30 cases of leukoplakia with oral epithelial dysplasia and 30 cases of OSCC were taken for immunohistochemical analysis using monoclonal antibody against anti-human Bcl-2 oncoprotein. RESULTS: Immunostaining for Bcl-2 protein was identified in basal and parabasal layers as granular cytoplasmic staining in oral epithelial dysplasia. In OSCC, Bcl-2 immunoreactivity was most prominent in the peripheral cells of the infiltrating tumor islands which diminished toward the center in well-differentiated and moderately differentiated OSCC, whereas stronger and more diffuse expression of Bcl-2 oncoprotein was seen in poorly differentiated OSCC. Overall positivity of 26.7% (8/30) was observed in oral epithelial dysplasia and 30% (9/30) in OSCC in this study. INTERPRETATION AND CONCLUSION: Altered expression of Bcl-2 oncoprotein may be an early molecular event which leads to prolonged cell survival, increased chances of accumulation of genetic alterations, and subsequent increase in malignant transformation potential.

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BACKGROUND: Medulloblastoma is an embryonal tumor with aggressive behavior and is more commonly seen in children than adults. The aim of this study was to determine the epidemiological patterns of medulloblastoma in a tertiary care center in Southern India. MATERIALS AND METHODS: It is a retrospective study, in which the records of all the clinically diagnosed medulloblastoma cases in the last 10 years (2002-2012) were analyzed. RESULTS: A total of 58 cases were found, with the mean age at diagnosis being 10 years. There was a slight predilection for the male sex (58.62%). The first presenting symptom was mostly related to raise intracranial pressure and the mean duration of symptoms was 200 days. Nearly, 89.6% of patients were in Stage 0 and had a central tumor location. Multimodality treatment included surgery followed by craniospinal irradiation up to 36 gray followed by posterior fossa boost up to 54 gray. Median radiation therapy duration was 6.5 weeks and concurrent single agent vincristine was the most common chemotherapy used. Most of the patients showed only a partial response to treatment, mainly because of large tumors at presentation, which could be attributed to the lack of awareness, delayed medical attention and poor follow-up. CONCLUSION: Early diagnosis and treatment is the key to management of medulloblastoma, which still needs to be achieved. Bulky tumors have a poor outcome, efforts should be aimed at complete surgery and giving risk stratification based treatment. Resources need to be allocated to make more conformal methods of radiotherapy available, which will decrease the growth abnormalities and cognitive impairments.

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BACKGROUND AND OBJECTIVE: Neurocytoma (NC) is a rare benign neuronal tumor. A complete excision remains curative for most of these tumors, but atypical histology and extra-ventricular location often necessitates adjuvant therapy. We intended to explore the clinico-pathological features and treatment outcome in patients of NC in our institute. MATERIALS AND METHODS: Medical records were reviewed and data collected on NC over a 6-year period (2006-2012) from the departmental archives. Disease free survival (DFS) was analyzed by Kaplan-Meier method. RESULTS: A total of 18 patients met the study criteria. Fourteen patients had intra-ventricular neurocytoma (IVNC), right lateral ventricle being the most common site of origin. Gross total resection and near total resection were achieved in eight cases each whereas tumor decompression and biopsy could be done in two cases. On post-operative histopathological examination, eight patients were found to have atypical NC while 10 patients had typical NC. All patients underwent adjuvant radiation. The median dose of post-operative radiation was 56 Gy. All patients were alive at their final follow-up. One patient had both clinical and radiological evidence of local relapse. In the evaluable patients (n = 18), after a median follow-up of 35 months the DFS rate at 2 years and 3 years are 100% and 83% respectively. CONCLUSION: Use of adjuvant radiation to a total dose of 56 Gy enhances the local control and achieves superior survival in patients of NC. Use of 3D conformal planning techniques may help us to achieve better therapeutic ratio in patients with NC.

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INTRODUCTION: Tobacco use among school children is becoming a serious problem indeveloping countries. The early age of initiation underscores the urgent need to intervene and protect this vulnerable group from becoming victims of this addiction. AIM: To assess the knowledge, attitudes, and practices about tobacco use among 13-15 year old school children of Bangalore City. MATERIALS AND METHODS: A cross-sectional study was designed and data on tobacco usage was collected from 1288 students aged 13-15 years studying in six government and private schools of Bangalore using a self-administered closed ended questionnaire. Data was analyzed using SPSS 15.0 and descriptive statistics was applied. Chi-square tests were used to determine the significant differences in the variables of interest. RESULTS: Out of 1288 children, 1281 (99.5%) children had heard about tobacco and 1162 (90.2%) students knew the harmful effects of tobacco. Only 28 (2.2%) had used tobacco products. Peer pressure was the main reason for tobacco use among children and age was not a barrier in buying tobacco products. Television (58%) was the main source of information for tobacco products followed by newspapers (26%) and movies (16%). CONCLUSION: It is encouraging to find that majority of the 13-15 year old children surveyed in the present study did not use tobacco and were aware of the health risks associated with tobacco use. This calls for the school authorities to be included in stricter implementation and monitoring of the implementation of legislation. Regular and systematic education programs catering to teachers, children, and also their parents should be undertaken.

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INTRODUCTION: Tobacco use is responsible for a considerable number of morbidity and mortality in the world. Annually 14,000 deaths are attributed to tobacco use in Nepal. Despite having social acceptability of tobacco in Nepalese society, little has been known about tobacco use among rural women. The aim of this study was to report the prevalence of and examine the factors associated with tobacco consumption among women of reproductive age in a rural community of Dailekh district of Nepal. MATERIALS AND METHODS: It was descriptive, cross-sectional study carried out among women of reproductive age in the rural community of Dailekh district. A random sampling was used to obtain 110 women aged 15-49 years. RESULTS: More than two in five were tobacco user and among them 4 in 5 used smoked form of tobacco. This study showed early initiation of tobacco using habit (mean: 14.96 year) where 92% of participants initiated <19 years. Influencing factors for initiation of tobacco use was peer's pressure (95.8%), and respondents reported that they used tobacco to reduce stress (37.5%). CONCLUSION: Tobacco using pattern was high in reproductive age group women. Knowledge and perceptions on tobacco use were poor. Hence, an effective and appropriate community based awareness programs are required to discourage the use of tobacco.

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INTRODUCTION: Mammography is not a popular screening tool for deducting breast cancer in India although regular screening is associated with reduced mortality from breast cancer. OBJECTIVE: The objective of this study is to find out knowledge, experiences and barriers to mammography among working women of Delhi. MATERIALS AND METHODS: Cross-sectional descriptive study was conducted from October 2012 to March 2013 among working women from Delhi, India. The study was conducted as a part of ongoing training workshops organized for women on early detection of breast cancer. Total of eight such programs were organized and were attended by a total of 439 women. Each participant got a self-administered questionnaire to fill. Data was entered in Microsoft Excel and analysis was done using Statistical product and service solutions (SPSS) version 21 (IBM). RESULTS: A total of 439 participants were included in the study. 230 (52.4%) of the women were more than 40 years of age. Only four participants (1%) had not heard about the term mammography before. Less than half (45.1%) of the participants knew correctly the purpose of a mammogram. Only 11.8% of the women knew correctly about the age of getting the first baseline mammogram. Knowledge of frequency of getting the mammogram was also low only 95 (21.6%) correctly knew about it. Only 59 (11.9%) correctly responded that one needs to go to an imaging facility located either in a hospital or elsewhere to get mammogram done. Main experience shared by the women regarding mammography was that 42 (95.45%) did not know anything about the procedure when they went for this investigation. Out of a total of 230 women over 40 years of age only 38 (16.5%) had ever got a mammogram carried out. There is a statistically significant association between education status and practice of mammography (P < 0.05). There were 18 women with family history of breast cancer out, of which 10 (55.5%) had got mammography carried out. 192 out of 230 (83.5%) women over 40 years of age had never got a mammogram done. Main reason 74 (38.5%) cited for this was that they did not know/were not aware they were supposed to go for mammography. CONCLUSION: As knowledge and utilization of mammography is low among women, there is a need to have a multipronged strategy to inform women about mammography and bring about a behavioral change along with having a formal national level screening guidelines for breast cancer early detection.

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CONTEXT: Introduction of trastuzumab, a recombinant monoclonal antibody against the extracellular domain of HER-2, is a cornerstone in the treatment of HER-2+ breast carcinoma. However, many cancers that have an initial response to trastuzumab will progress some time later. After progression on trastuzumab-based first-line treatment, there are several options. Although TDM-1 (Trastuzumab emtansine) has prolonged progression-free survival (PFS) and overall survival in patients previously treated with trastuzumab and taxane, it is still not available in Turkey. Patients may be switched to lapatinib (an oral tyrosine kinase inhibitor targeting both HER-1 and HER-2), or they may re-challenge with trastuzumab. There is no clear definition of the patients who should be switched to lapatinib. AIM: In this study, we investigated the factors predicting the efficacy of lapatinib. SUBJECTS AND METHODS: Totally, 94 patients treated with lapatinib for metastatic breast carcinoma was included in our study. Retrospective data including pathology, treatments and treatment results, metastatic sites, and laboratory tests were collected. RESULTS: Progression-free survival was 9.1 months. Histologic subtypes other than invasive ductal carcinoma and liver metastasis were inversely related with PFS. Overall survival was 22.1 months, and patients with histologic subtypes other than invasive ductal carcinoma and who progress with brain metastasis had a worse prognosis. CONCLUSION: Clinicians should give attention to histologic subtype and metastatic sites when choosing patients for lapatinib treatment.

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BACKGROUND: Hypofractionated radiotherapy in the radical treatment of localized prostate cancer has potential biological advantages relative to conventional fractionation. We report prospectively collected toxicity data from a cohort of patients treated with a 3D conformal technique (3DCRT). MATERIALS AND METHODS: 90 patients receiving curative intent hypofractionated radiotherapy with 57Gy in 19 daily fractions over 3.8 weeks were evaluated prospectively for the development of radiation related toxicity over a 3 year period. RESULTS: All patients completed treatment. Maximal acute toxicity experienced was 58.6, 10 and 1.1% for grade 1, 2 and 3 genitourinary (GU) toxicity respectively and 75.6, 9 and 0% for gastrointestinal (GI) toxicity. For late toxicity the three year actuarial rates of grade 1, 2 and 3 GU and GI toxicity respectively were 47.3, 2.4 and 0%; and 40, 9.3 and 4.7%. There were no grade 4 or worse acute or late toxicities. 97.6% of evaluable patients remained free of biochemical failure 36 months post radiotherapy. CONCLUSIONS: A 57Gy in 19 daily fraction radiotherapy schedule using 3D conformal radiotherapy for the definitive treatment of localized prostate cancer has acceptable early and late toxicity.

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INTRODUCTION: Carcinoma endometrium carries an excellent prognosis when diagnosed early. But controversies exist in the management of Ca endometrium confined to the uterus as to whether a complete surgical staging including lymph node dissection is needed always. This may increase unnecessary surgical morbidity for some. On the other hand, if not done it fails to recognize a subset of patients who require adjuvant treatment, thus affecting the outcome. Hence it is very important to categorize the patients to assess the need of complete surgical staging. AIM: The aim of the following study is to identify the risk factors influencing the upstaging of disease in clinicoradiologically stage 1 carcinoma endometrium. MATERIALS AND METHODS: A retrospective database evaluation of all cases of clinicoradiologically stage 1 carcinoma endometrium from January 2009 to September 2012. STATISTICAL ANALYSIS: Done using the statistical software SPSS − version 16 for windows (SPSS Inc. 233 South Wacker Drive, 11^th Floor Chicago, IL 60606-6412) Independent samples test (t-test for equality of means) were done and (two-tailed) P < 0.05 − were significant. RESULTS: Carcinoma endometrium patients with grade 1, no or < 50% myometrial involvement, <2 cm size and no isthmus involvement had low risk of upstaging. CONCLUSION: Significant upstaging is seen in the present study with per-operative staging procedures. Until the standardization of magnetic resonance imaging (MRI) techniques and reporting, or until a more sensitive non-invasive technique is devised, staging lymphadenectomy appears to be invaluable in risk assessment and prognosis.

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INTRODUCTION: There is limited data from India regarding elderly non-Hodgkin's lymphomas (NHL) patients. Hence, this audit was planned to study the clinic-pathological features and treatment outcomes in elderly NHL patients. METHODS: Retrospective analysis of all NHL patients above age of 59 years treated at the author's institute, between December 2010 and December 2013 was done. Case records were reviewed for baseline details, staging details, prognostic factors, treatment delivered, response, toxicity and efficacy. SPSS version 16 (IBM, Newyork) was used for analysis. Descriptive statistics was performed. Kaplan–Meir survival analysis was done for estimation of progression-free survival (PFS) and overall survival (OS). Univariate analysis was done for identifying factors affecting PFS and OS. RESULTS: Out of 141 NHL patients, 67 patients were identified subjected to the inclusion criteria. The median age was 68 years (60–92). Majority were B-cell NHL (86.6%). The commonest subtype in B-cell was diffuse large B-cell lymphoma (55.2%). Fifty-four patients took treatment. The treatment intent was curative in 41 patients (61.2%). Among the patients receiving curative treatment, 16 patients couldn't receive treatment in accordance with NCCN guidelines due to financial issues. Two years PFS was 55%. Two years PFS for B-cell NHL and T-cell NHL were 55% and 50% respectively (P = 0.982). Two years PFS for standard Rx and nonstandard Rx were 62% and 50% respectively, but it didn't reach statistical significance (P = 0.537). Two years OS for the entire cohort was 84%. CONCLUSION: Standard treatment in accordance with guidelines can be delivered in elderly patients irrespective of age. There is a need for creating financial assistance for patients, so that potentially curative treatments are not denied.

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BACKGROUND: Lymphomas are one of the commonest childhood malignancies. Due to varied clinical features many patients are misdiagnosed and treated for other diseases. It is imperative to keep health workers informed about the current trend of lymphomas in northeastern Nigeria to facilitate prompt diagnosis and treatment. OBJECTIVE: To evaluate the extent of lymphomas at presentation and to define the pattern of presentation in relation to gender and site. MATERIALS AND METHODS: Retrospective analysis of cases of lymphomas over a 15 year period was conducted. Structured questionnaires were used to document demographic characteristics and clinical features. The non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL) cases were categorized using standard classification schemes. Data were analyzed using the Statistical Package for Social Sciences (SPSS) software version 16, Illinois, Chicago, USA. Spearman's correlation and Student's t-test were applied where appropriate. A P value < 0.05 was considered significant. RESULTS: Fifty cases of lymphoma, 10 (20%) belong to HL and 40 (80%) belong to NHL. Lymphoma is common in male, though the male to female preponderance was not significant in both the cases (P = 0.107 and 0.320, respectively). Maxilla was the commonest site of primary malignancy (36%) and late presentation of patients were observed. New trend was noticed, the NHL patients present commonly with severe symptoms than HL (P = 0.038). HL was dominated by lymphocytic predominant type, while NHL was dominated by the small non cleaved cells (Burkitt's) lymphoma (70%). CONCLUSION: Childhood lymphoma in northeastern Nigeria has a slight shift in varied clinical presentation in favor of NHL. Patients in this study had late presentation.

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CONTEXT: The distribution of different types of lymphoma varies across geographic regions. AIMS: The present study was done to understand the occurrence of nodal lymphomas in a referral hospital of Mangalore city. SETTINGS AND DESIGN: Descriptive study. SETTING: The present study was conducted on 95 lymph node biopsy specimens, received in a referral hospital of Mangalore city. MATERIALS AND METHODS: All cases of nodal lymphoma diagnosed between January 2007 and June 2010 in a referral hospital of Mangalore were selected for the study. The patients age and clinical details were obtained. Immunophenotyping was done for all cases of NHL and selected cases of HL. IPI score for NHL was noted and correlated with the outcome. STATISTICAL ANALYSIS USED: Chi square test was used. RESULTS: Out of the total 95 cases of nodal lymphoma 37 (39%) were HL while 58 (61%) were NHL. Classical HL was diagnosed in 35 cases (37%) while 2 cases (2%) were diagnosed NLPHL. B cell lymphoma formed 72% of NHL. Follicular lymphoma accounted for 28% of all NHL. T cell lymphoma formed 28% of NHL. CONCLUSIONS: In conclusion the following points are significant about the distribution of lymphomas in a referral hospital of Mangalore city. The incidence of NSHL is higher while national data suggests MCHL as the most common subtype. The incidence of FL as well as T cell NHL is much higher when compared to national incidence. The epidemiological factors for this high frequency (either genetic or environmental) needs to be studied further.

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BACKGROUND: Dendritic cell (DC)-based immunotherapy has the potential to induce an antitumor response within the immunologically privileged brain. AIMS: The aim of this study was to evaluate the short-term effect of DC vaccine therapy on lymphocyte subsets in patients with refractory primary brain tumor. MATERIALS AND METHODS: Eighteen cases with refractory primary brain tumor who refused any treatment against tumor within 6 months of the therapy, were referred to one medicine center, from January 2011 to October 2012. All patients received 1 × 10⁷ tumor lysate–pulsed DC vaccinations both intradermal injection and intravenous infusion 3 times/week. RESULTS: There were increases of lymphocytes CD8+ (P = 0.002) and CD56+ (P = 4.207E-10), but no change of lymphocytes CD3+ (P = 0.651). Six patients were positive response of delayed-type hypersensitivity. There were improving of appetite in 14 cases and increasing of physical strength 17 cases. CONCLUSIONS: DC vaccine has the potential for inducing an immune cytotoxic effect directed toward tumor cells.

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BACKGROUND: National Tobacco Control Programme was launched in India in year 2007-08. It was realized that community health workers can play an important role of agents for positive change to bring down the tobacco morbidity and mortality in the country. Keeping this in view, a health worker guide was developed by the Government of India, Ministry of Health and Family Welfare (GOI) in collaboration with The Union South-East Asia (The Union) in the year 2010. The guide provides the information needed by the most basic level of health workers to effectively address the problem of tobacco use in the community. A modular training was conducted in two jurisdictions in India (namely, Chandigarh and Hamirpur (Himachal Pradesh)) to assess the usefulness of the guide as training material for community health workers in undertaking tobacco control activities at community and village levels. MATERIALS AND METHODS: A total of 271 participants were trained, which included 133 from Chandigarh and 138 from Hamirpur. The pre and post-training assessment of knowledge of health worker was done. RESULTS: There was marked increase in post-test scores as compared to the pretest scores. The health workers scoring more than 60% increased from 40% in the pretest to over 80% in the post-test. Only three workers had a post-test score of less than 30% against 54 workers in the pretest. CONCLUSION: The understanding on tobacco control had increased significantly after the training in each group. It is strongly recommended that such training should be replicated to all community health workers across all the states in India.

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