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Indian Journal of Medical and Paediatric Oncology
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SCIENTIFIC ABSTRACTS
Year : 2012  |  Volume : 33  |  Issue : 4  |  Page : 0  

Scientific Abstracts


Date of Web Publication13-Feb-2013

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How to cite this article:
. Scientific Abstracts. Indian J Med Paediatr Oncol 2012;33:0

How to cite this URL:
. Scientific Abstracts. Indian J Med Paediatr Oncol [serial online] 2012 [cited 2019 Jul 22];33:0. Available from: http://www.ijmpo.org/text.asp?2012/33/4/0/107111

Scientific Abstracts

O-1

Effects of imatinib therapy on serum calcium, phosphate and magnesium levels and correlation with musculo-skeletal symptoms in chronic myeloid leukemia patients

Coca Pragnya, Thota Narender Kumar, Gundeti Sadashivudu, Linga Vijay Gandhi, Srinivas Lakshmi, Digumarti Raghunadharao

Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India

Aim: To study the effects of imatinib therapy on serum levels of calcium, phosphate and magnesium and co-relate these levels with musculo-skeletal symptoms. Materials and Methods: Treatment naïve chronic myeloid leukemia (CML) patients on imatinib were prospectively studied. All patients were followed up every 15 days for 3 months. Serum calcium, phosphate and magnesium levels were obtained at baseline, and 3 months of imatinib therapy or whenever the patient complained of musculoskeletal symptoms, whichever was earlier. Results: From August 2010 to November 2011, 87 patients with newly diagnosed CML were enrolled into the study. Sixty seven (77%) patients complained of musculoskeletal symptoms. Median time to development of musculo-skeletal complaints was 1 month (range 0.25 to 3 months) [Table 1]. Symptoms were not significantly associated with changes in calcium or phosphate levels. Conclusion: Imatinib causes hypocalcemia and hypophosphatemia in a proportion of patients but these changes were not significantly associated with musculo-skeletal symptoms.

O-2

Is there a role of induction chemotherapy in T4b stage carcinomas of oral cavity?

Vijay Maruti Patil, Vanita Noronha, Amit Joshi, Seema Gulia, Bharatsinha Bhosale, Vamshi Krishna Muddu, Supreeta Arya 1 , Shashikant Juvekar 1 , Pankaj Chatturvedi 2 , Devendra Arvind Chaukar 2 , Prathamesh Pai 2 , Anil D'cruz 2 , Kumar Prabhash

Departments of Medical Oncology, 1 Radio-Diagnosis, and 2 Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

Objective: To study the safety and efficacy of induction chemotherapy in T4b oral cavity cancers. Efficacy was evaluated in terms of achievement of resectability. Materials and Methods: It is a retrospective analysis of prospectively collected data of T4b oral cavity cancer patients who were offered induction chemotherapy and then assessed for resectability, at the end of 2 cycles of chemotherapy. Induction chemotherapy was given with either a 3 drug combination of cisplatin, 5 FU and Docetaxel or a 2 drug combination of Platinum or Taxane. The response rates on the basis of axial imaging are reported, which was performed at the end of 2 cycles. Toxicity in (accordance with CTCAE vs. 4.02) was noted. These patients were assessed for resectability in a joint clinic. Results: Hundred and ten patients received chemotherapy. Median age was 41.5 years (range 25-66 years). Ninety three (84.5%) patients had primary in buccal mucosa. The anatomical space involvement, which upstaged the patient to T4b was involvement of masticator space in 102 (92.7%) and involvement of pterygoid plates in the rest. Twenty one (20%) of our patient received 3 drug regimen while rest received 2 drug regimen. The treatment regimen included docetaxel in 40 patients (36.36%). Induction was completed by 100 patients (90.9%). The causes of discontinuation of NACT were progression of disease (6 patients), abandonment (3 patients) and toxicity (1 patient). Radiological response assessment was done in 100 patients. Partial response was achieved in 28 patients, stable disease in 49 patients and progression was noted in 23 patients. Resectability was achieved in 34 (30.9%) of 110 patients. On univariate analysis, involvement restricted to the lower part of masticator space without extension to infratemporal space, use of a 3 drug regimen and use of docetaxel containing regimen were important factors in achieving resectability. On logistic regression multivariate analysis for achievement of resectability, the only independent predictor of achieving resectability were, use of 3 drug regimens and use of regimen containing docetaxel. Febrile neutropenia was seen in 14 patients (12.72%) and grade 3-4 GI toxicity was seen in 13 patients (11.1%). On univariate analysis, use of 3 drug and docetaxel containing regimen lead to more hematological toxicity. Conclusion: Use of induction chemotherapy is safe and can achieve resectability in 30.9% of our T4b patients.



O-3

Mantle cell lymphoma: The profile and outcome from a tertiary care center in south India


Lokesh KN, Lakshmaiah KC, Suresh TM, Govinda Babu, Lokanatha D, Rao C 1 , Linu AJ, Rajeev LK

Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India

Background: The objective was to determine the clinical, hematologic profile and outcome of mantle cell lymphoma (MCL) at our center. Materials and Methods: This is a retrospective study of 60 cases of MCL diagnosed by biopsy and IHC (cyclin D1 positive). Results: The median age was 55 (40-72) years. Male:female ratio was 9:1. The common presenting feature was Lymphadenopathy (73.3%). Gastrointestinal tract (15%) was the most common extranodal site. B symptoms were present in 43.3%. Most of them were in good performance status 83.3%, hepatomegaly in 36%, and splenomegaly in 46.6%. The median uric acid 4.7 (3.3-12.1) mg/dl and LDH 489 (212-1829) u/l. Ten cases were Blastoid variant and 1 was Pleomorphic. On M-IPI 48.4% were in low, 31.6% intermediate and 20% in high risk. 56.6% had stage IV disease with bone marrow involved in 51.6%. Thirty three patients received treatment either COP or CHOP or RCHOP with overall response rate of 100%, 87.5% and 90.9% respectively. Kaplan meier survival analysis was done. With a median follow up of 24 months, the PFS was 60%, 58.3% and OS was 86.6%, 66.6% for CHOP and RCHOP respectively. Parameters associated with a short survival were poor PS, splenomegaly, B symptoms, high leukocyte count, high LDH level, blastic variant and high risk MIPI. Conclusion: MCL presented predominantly with advanced stage and extranodal involvement. The major challenges for future clinical trials are to define the risk groups better and to target these subsets individually, to achieve long-term meaningful survival.

O-4

Adult acute promyelocytic leukemia - Retrospective analysis


Thota Narender Kumar, Coca Pragnya, Linga Vijay Gandhi, Gundeti Sada Shivudu, Lakshmi Srinivas M, Digumarti Raghunadharao

Department of Medical Oncology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India

Introduction: There is limited data on acute promyelocytic leukemia (APML) from Indian subcontinent on Adult Acute Promyelocytic Leukemia (APML) - Retrospective Analysis based chemotherapy in APML. Materials and Methods: Ninety-two consecutive patients registered at our center between January 2000 and September 2011 were analyzed retrospectively for clinical profile and outcomes. Results: Median age was 32 yrs (19-62) with male to female ratio of 1.16:1. Fever (80%), fatigue (54%) and gum bleeding (52%) were the common symptoms. Gum hypertrophy was seen 33% of patients. Ninety percent of patients had hyper granular variant. Fifty percent were in high risk group. Eighty percent patients (74/92) were started on induction. Pre treatment and early deaths accounted for 10% and 12% respectively. Consolidation was taken by 66.6% (49/74) patients. Around 92% (45/49) attained complete molecular remission (CMR) after consolidation. Of them 64% (29/45) had taken maintenance. At median follow up of 61 months (4-98.5) 47% (35/74) of patients are still alive. Around 15% (7/45) of patient who attained CMR relapsed. Of them 5 are in second CMR. Median overall survival (OS) of 74 patients was 45.5 months. Median OS in patients who completed consolidation was 66.7 months. Median OS and EFS of patients (n=17) with >1 year maintenance was 90.7 months and 68.1 months and patient with <1 year of maintenance (n=12) was 66.83 month and 60 months. Conclusion: Half of our patients are in high risk group. Significant number of pre-treatment and early death occurred. Maintenance therapy altered the survival rates and further studies are required.

O-5

Treatment of MDS with hypomethylating agents: Experience of a tertiary care cancer center


Vikas Goswami, Chandragouda, Sajjan Singh, Mohit Agarwal, Mahanta A, Gupta D, Seth S, Batra U, Bhurani D, Doval DC

Rajiv Gandhi Cancer Institute and Research Centre, Sector V, Rohini, Delhi, India

Introduction: The patients with MDS are elderly, with multiple comorbidities and poor tolerance to therapy. Aberrant methylation is a frequent leukemogenic event in these patients. This represents a potential target for novel hypomethylating agents Azacitidine and Decitabine. There is paucity of data from India. Therefore, we present our experience. Aim: To analyze the efficacy and tolerability of hypomethylating agents in treatment of MDS. Materials and Methods: Patients diagnosed with MDS from year 2008 to 2011, were reviewed for hypomethylating agent used, response, morbidity and outcome. The response assessment was done using modified international working group criteria. Result: During this study period, 41 patients were diagnosed with MDS. Median age at presentation was 71 years (range 55-79 years) and 27 were males. Of these, 27 patients were treated with either Decitabine (n=22) or Azacitidine (n=5). Twenty (74%) patients were of high risk and 7 (26%) were of low risk. The overall response (CR+PR) was seen in 9 (33%) patients. Hematological improvement was seen in 4 (15%) patients. The median time to response was after 3 cycles of treatment. Eleven (41%) patients progressed to AML. The median time to AML progression was 10.2 months. Two (8%) patients were lost to follow up, and 1 died during treatment. These agents were well tolerated. The most common grade ¾ toxicity was hematological toxicity. Neutropenia was seen in 18 patients (66%), thrombocytopenia in 20 patients (74%), anemia in 10 patients (37%), febrile neutropenia in 6 patients (22%). Non hematological toxicities were usually mild and reversible. Toxicity related death occurred in one patient. Conclusion: The good efficacy and manageable toxicity of hypomethylating agents in Indian patients is encouraging, however needs to be confirmed in larger studies.

O-6

Retrospective analysis of germ cell tumor of ovary cases


Akila KB, Kalaiselvi K

Madras Medical College, Tamil Nadu, India

Background: Retrospective analysis of patients with germ cell ovary over 16 years was done to analyze the different mode of presentation, various histological types and their treatment outcome. Materials and Methods: We had 114 cases of germ cell tumor of ovary from year 1993 to 2009 with majority of them between age 21 to 30 (53%). The presenting symptom was pain in 70%. Stage I and III were equally distributed. Most of the patients were treated with fertility sparing surgery and BEP regimen. Results: 70% of the patients had complete response with no major toxicity and are on long term follow up. Conclusions: Mixed germ cell tumor is the commonest type of GCT with 70% of the patients having long term survival.

P-1

To assess the possibility of combining MAb (Nimotuzumab) with concurrent chemoradiation in patients with locally advanced squamous cell carcinoma of head and neck


Kumar Amit, Mishra KC

Meherbai Tata Memorial Hospital, Jamshedpur, Jharkhand, India

Aims: Expression of EGFR seen in most of the cancer of epithelial origin and head and neck region is the leading site. EGFR expression emerges a strong independent prognostic determinant for overall, and disease free survival as well as strong predictor for locoregional relapse. Radiation exposure leads to phosphorylation of EGFR and tumor cell proliferation that could be effectively blocked by the addition of an EGFR - signaling inhibitor. The present study was done to combine the 2 different principles (recommendation) in the treatment of locally advance squamous cell carcinoma of head and neck (SCCHN) - Purely an Indian approach. 1) Radiation with concurrent chemotherapy. 2) Radiation with Monoclonal Antibody against EGFR. We tried to combine concurrent chemoradiation along with monoclonal antibody (nimotuzumab/h-r3: BIOMAb) in patients with SCCHN. Materials and Methods: We conducted this study and enrolled 11 patients of stage III and IV advance SCCHN. Patients were treated with XRT+CDDP+BIOMAb. Primary end points were response rates and safety. RECIST criteria were used for tumor evaluation and CTCAE (v3.0) was for adverse events. Results: 10 patients were evaluable, 6 and 9 months post treatment. 1 patient was discontinued from the treatment, due to diarrhea. None of the patient had Biomab related toxicity. An objective response rate 81% (9 pt.) was achieved with XRT+CDDP+BIOMAb. Conclusion: Present study clearly demonstrates that combining MAb (BIOMAb) with concurrent chemoradiation in treatment of advanced squamous cell carcinoma of head and neck, is worth with acceptable toxicity.

P-2

A survey of knowledge and practice of oncologists in use of anti-EGFR drugs in lung cancer


Krishnamani KV, Vijay Gandhi Linga, Sadashivudu Gundeti, Raghunadharao Digumarti

Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India

The use of TKIs in NSCLC is not uniform amongst oncologists. 84 medical, surgical and radiation oncologists were given a questionnaire to assess their knowledge and practice in use of TKI in lung cancer. All participants in this survey prescribed TKIs to their patients. 59 (70%) participants tested for EGFR mutations among patients on TKIs. Number of participants prescribing TKI only for adenocarcinomas was 54 (64%). Those prescribing TKI for non-adenocarcinomas numbered 30 (36%). In the survey, 66 (79%) doctors prescribed TKI in a relapse setting. To elderly patients and those sick at presentation 79 (94%) physicians would prescribe TKIs. 34 (40%) participants favored continuing TKI, until progression. Side effects due to TKIs would prompt physicians to modify dose occasionally in 65 (77%) cases and frequently in 14 (17%) cases. Testing for EGFR mutations in patients on TKIs is not uniform among oncologists with 70% testing for the mutation, only 64% participants used TKIs in adenocarcinomas. TKIs were used more often (79%) in a relapse setting. 77% oncologists would occasionally modify dose due to side effects of TKIs. Use of TKIs in lung cancer based on approved guidelines is recommended.

P-3

Ewing's sarcoma of the cranium-clinical profile of two cases


Krishnamani KV, Vijay Gandhi Linga, Sadashivudu Gundeti, Raghunadharao Digumarti

Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India

Introduction: Primary Ewing's sarcoma of the cranium is extremely rare. Only small case series have been reported in literature. We report two cases of primary Ewing's sarcoma of the cranium. Case 1: A 10-year-old boy presented with protrusion of both eyes and nasal stuffiness. CT scan brain was suggestive of a lesion in the anterior cranial fossa involving basofrontal region extending into ethmoidal sinus, left and right orbit, bilateral maxillary sinus and nasopharynx. Histopathology was suggestive of Ewing's sarcoma. CD 99 was positive. Staging work up was negative for metastases. The tumor was near totally excised. Adjuvant chemotherapy with VAC+ IE was given. The boy is asymptomatic and on follow up for 3 months. Case 2: An 11-year-old girl presented with a swelling in the right parieto-occipital region. Initial biopsy was reported as pyogenic granuloma. The lesion grew in size within a span of 6 months. MRI brain was suggestive of extra-axial lesion over bilateral parietal region hypointense on T1 and heterogeneous on T2 with pressure effect over posterior parietal lobe. Histopathology was suggestive of Ewing's sarcoma- NSE+, CD99+ and LCA- negative. Staging work up was negative for metastases. Adjuvant chemotherapy was given. This girl is on regular follow up for 4 months with no recurrence. Conclusion: Primary Ewing's sarcoma of the cranium is a rare disease. This disease has a good prognosis with multimodality treatment. In one of the largest follow up data of 14 patients, 8 patients (57.1%) survived 5 years or longer with multi modality treatment including surgery, chemotherapy and radiotherapy. These cases also illustrate that multi-disciplinary approach in patients with Ewing's sarcoma of the cranium can have a good outcome. A 10-year-old boy presented with protrusion of both eyes of 4 days duration and nasal stuffiness of 2 days duration. He was evaluated in Neurosurgery department. CT scan Brain was suggestive of well defined hyperdense lesion noted in the anterior cranial fossa involving basofrontal region extending into ethmoidal sinus, left and right orbit, bilateral maxillary sinus and nasopharynx. FNAC was suggestive of suspicious carcinoma. He underwent transcranial and transnasal bifrontal craniotomy and with near total excision of tumor. Histopathology was suggestive of Ewing's sarcoma/PNET. Staging work up with bone scan, CECT chest and bone marrow was normal. It was planned to treat him with VAC + IE based chemotherapy.

P-4

Iimatinib related skin toxicities in CML patients - An analysis


Krishnamani KV, Karthikaraya Linga, Vijay Gandhi Linga, Sadashivudu Gundeti, Raghunadharao Digumarti

Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India

Introduction: Cutaneous reactions to Imatinib are common and occur in 9.5% to 69% of patients. Most cutaneous eruptions caused by Imatinib do not necessitate discontinuance of Imatinib and are usually self limited, despite continued treatment. Aims and Objectives: To estimate the prevalence of skin toxicity in patients of CML on Imatinib mesylate. Materials and Methods: All patients of CML on Imatinib mesylate coming to the OPD for treatment and follow-up were included in the study. CTC version 4 was used for skin toxicity and grading. Results: Total numbers of patients studied were 104. Of these, 62 (59.6%) were male and 42 (40.4%) were female. The age group of the studied population was between 14 and 60 years of age. Number of patients in chronic phase, accelerated and blast crisis phase were 78 (75%), 22 (21.2%) and 4 (3.8%) respectively. Hypo-pigmentation was seen in 68 patients (65.3%) (grade 1-50 and grade 2-18). Hyper-pigmentation was observed in 50 patients (48%) (grade 1-12, grade 2-38). 48 patients (46%) developed periorbital edema. Nail discoloration was observed in 10 patients (9.6%) and pruritis and hyperhydrosis were seen in 5 patients each (4.8%). No skin lesions were seen in 11 patients (10.5%). Conclusions: Cutaneous reactions to Imatinib occurred in 89.4% patients in our study. Pigmentation disorders were most common in our population of patients. Hypo-pigmentation, hyper-pigmentation and periorbital edema was seen in 65%, 48% and 46% patients respectively. Compared to other studies reported in literature incidence of pruritis and periorbital edema was less in our study. All the reactions were self- limited. None required temporary withdrawal or discontinuation of the drug.

P-5

Signet ring cell carcinoma of the urachus in a young male


Pragnya

Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India

Urachal mucinous adenocarcinoma is a rare tumor and represents less than 1% of all bladder tumors. We present a case report of a 27-year-old man, who presented with dysuria and hematuria. Imaging studies revealed a mass in the dome of the bladder. Transurethral biopsy was suggestive of mucinous adenocarcinoma. He underwent radical cystoprostatectomy and pelvic lymphadenectomy. Postoperatively, he received chemotherapy with capecitabine and oxaliplatin.

P-6

Primary plasma cell leukemia in a 25-year-old woman


Geetha Koora, Krishna Mani, Raghunadharao D

Post Graduate, Gandhi Medical College, Hyderabad and Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India

Introduction: Primary plasma cell leukemia (PPL) is a rare plasma cell dyscracia characterized by malignant proliferation of plasma cells in the bone marrow and peripheral blood. Kyle's criteria (absolute plasma cell count >2000/cmm or >20% of differential count) is used to establish diagnosis. The common age of presentation is 53-57yrs, and it is rare in young individuals. We report a 25-year-old woman diagnosed with plasma cell leukemia. Case Report: A 25-year-old woman, with no co-morbidities, presented with a history of fever, cough with whitish expectoration and easy fatigability of a week. The hemogram elsewhere showed pancytopenia. A bone marrow aspiration (BMA) revealed atypical mono-nuclear cells. She was referred to our hospital for further management. On examination, ECOG performance status was 2, she was pale with no palpable peripheral lymphadenopathy. Chest and abdominal examination revealed bilateral coarse crepitations and hepatosplenomegaly. Hemoglobin was 6.7 g/dl. Her peripheral smear was suggestive of lymphoproliferative disease. The BMA suggested possibilities of a lymphoplasmacytic lymphoma, plasma cell neoplasm or a plasmacytoid lymphoma in leukemic phase. Flow cytometry was consistent with plasma cell neoplasm (CD-38+, CD56- and CD19-). Her serum free light chain assay showed kappa light chains of 1530 mg/dl, lambda light chains of 24 mg/dl, with a kappa/lambda ratio 63.7 (0.25-1.65 normal range). Beta 2 micro globulin was 6290 ng/ml (normal 800-2200 ng/ml). Serum protein electrophoresis showed a dense M-spike in the gamma region. Immunofixation showed it to be IgG Kappa. Skeletal survey revealed lytic lesions in skull. Chest X-ray was suggestive of fractured left 4 th rib, cardiomegaly, and bronchopneumonia. The serum creatinine was 1.3 mg/dl and calcium was 9.0 mg/dl. She was started on a bortezomib based induction regimen. Conclusion: PPL is a disease of old age, rarely reported in young individuals. Diagnosing morphologically may be difficult, as in this case; flow cytometry can reveal the correct diagnosis.

P-7

Ewing's family tumor: The prognostic value of initial tumor size on an intensive protocol


Prakash G Chitalkar, Rajeeb K Deo, Pawan Gupta, Pushpinder Gulia, Sanjeev Joshi, Neetu Singhal

Department of Oncology, Asian Institute of Medical Sciences, Faridabad, Haryana, India

Ewing's family tumors (EFT) is highly curable neoplasm in children and young adults (CYAS). Initial tumor size, serum LDH and the EWS/LW1 mutation are known prognostic factors; and low volume disease is known to result in higher response rates and longer survival times. In a community oncology centre, longer system intervals results in higher percentage of high volume disease at presentation. Twelve CYAS with non metastatic EFT were managed on the intensive EFT 2001 protocol. The patients characteristics studied were - age, site, size (volume), involvement of neurovascular structures, bone marrow involvement and molecular finding. Tumor volume was measured in non-metastatic tumors by tri-dimensional volume. All patients were treated on the intensive EFT 2001 protocol. Four achieved complete responses and eight partial responses. Multivariate analysis determined that initial disease volume (<100 cc) did not correlate with response status. However, progression free survival and overall survival correlated with initial disease volume (P value <0.05). Initial disease volume is a prognostic factor in Ewing's family Tumor.

P-8

Incidence of EGFR mutations in non-squamous non-small cell lung cancer in Indian population: A tertiary care centre experience


Rajesh Kota, Gullipalli Muralidhar, Sadashivudu Gundeti, Vijay Gandhi Linga, Lakshmi Srinivas Maddali, Raghunadharao Digumarti

Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India

Epidermal growth factor receptor (EGFR) is one of the targeted molecular markers in many cancers including lung malignancy. Genetic modifications such as deletions, insertions and single nucleotide polymorphisms in the tyrosine kinase domain of EGFR is a common feature observed in most lung cancers. However, the prevalence of mutation varies among ethnicity, grade, age and gender. We report the incidence of EGFR mutations in cell non-squamous non-small lung cancer (NS-NSCLC) patients using DNA obtained from samples, such as biopsy/fine needle aspiration/pleural fluid, from a tertiary care centre. DNA from 40 NS-NSCLC (adenocarcinoma-33, poorly differentiated-2, bronchoalveolar-2, large cell-1, adenosquamous-1 and NSCLC-1) tissue samples was analyzed for EGFR mutations for exon 18, through 21. Mutations were detected in 27.5% (11/40) of the study population. Among the mutant positive cases, most common mutation was deletions in exon 19 (73%). Adenocarcinoma was the only histology observed among all the mutation positive cases in our study. 40% of females (8/20) harbored any one type of EGFR mutation, none of them were smokers. Two out of three males among whom the mutation was positive were smokers. The study suggests significant prevalence of EGFR positivity in NS-NSCLC in Indian sub-population and provides opportunities for targeted therapies for this group.

P-9

Issues of Imatinib and fertility outcome in CML


Vamshi Krishna Reddy G, Maddi Rahul N, Linga Vijay G, Gundeti Sadashivudu, Lakshmi M, Leela Digumarti 1 , Raghunadharao Digumarti

Department of Medical Oncology, Nizam's Institute of Medical Sciences, 1 Obstetrics and Gynaecology, St. Theresa Hospital, Hyderabad, India

Purpose: The use of Imatinib (IM) now offers most patients with chronic myelogenous leukemia (CML) lengthy remissions and the hope of normal life expectancy. Majority of our CML patients are in the reproductive age group, and these improved survivals have resulted in issues relating to fertility and procreation. There is limited literature about the effect of Imatinib on fertility outcome. Materials and Methods: The records of all patients with CML treated with IM were reviewed. We report the experience on 38 pregnancies, involving 31 patients (20 women and 11 men) who conceived on IM. 4 males and 3 females conceived twice on IM. Results: The fertility outcome is shown in [Table 1] and [Table 2]. Conclusion: IM at higher dose appears to increase the risk of intrauterine deaths. IM at standard dose of 400 mg does not appear to increase the incidence of congenital malformations or fetal outcome.

P-10

Retrospective analysis of prognostic factors and outcomes in small cell lung cancer


Thota Narender Kumar, Gundeti Sadashivudu, Coca Pragnya, Linga Vijay Gandhi, Lakshmi Srinivas M, Digumarti Raghunadharao

Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India

Introduction: Small cell lung cancer (SCLC) accounts for about 14-18% of all lung cancers. There has not been much improvement in outcomes over the last few decades. Myriad of papers are published on predictive factors and outcomes. Scarce data is available from Indian subcontinent. Materials and Methods: We retrospectively analyzed all the records of SCLC from Jan 1995 through June 2011 for clinical profile, prognostic factors and outcome. Results: [Table 1] one forty patients were analysed. Median age was 56 yrs (18 - 75). Male patients accounted for 93.6% (M: F 14.6:1). Cough (85%), dyspnea (77%) and chest pain (56%) were the common symptoms. 60% patient presented with extensive disease. Conclusion: Cumulative symptoms, stage and performance status are the predictors of Overall survival, but only stage predicted the progression free survival.

P-11

Weekly cisplatin versus three weekly cisplatin plus 5 fluorouracil for chemoradiation in cervical cancer


Nithya S, Kalaichelvi K 1 , Rajasekharan PN 2 , Vijayalakshmi N 3

Madras Medical College, Chennai, 1 Institute of Obstetrics and Gynecology, 2 Madurai Medical College, 3 Institute of Obstetrics and Gynecology, India

Background: The aim of this study is to compare weekly cisplatin with 3 weekly cisplatin plus 5 Fluorouracil (5FU) concurrent with radiation in cervical cancer. Materials and Methods: Patients with stages IB - IIIB cervical cancer (n=182) selected for chemoradiation were randomized to weekly cisplatin 40 mg/m 2 (arm1, n=90) or 3 weekly cisplatin 70 mg/m 2 and 5FU 1000 mg/m 2 (arm2, n=92) during radiation. Both arms were compared in terms of toxicity, response rates and 2 years survival. Results: Arm2 showed better complete response (CR) rates (94% vs. 76% P<0.0001), quicker response (CR in <12 weeks: 65% vs. 22% P<0.0001) and significantly better 2 years progression free survival (PFS) (45% vs. 19%, P=0.04). Earlier response significantly correlated with better PFS (P=0.02). Arm1 had more grade 3-4 toxicity (31% vs. 8% P<0.0001). Conclusion: Chemoradiation with 3 weekly cisplatin and 5FU is associated with better response rates, lesser toxicity and better PFS in cervical cancer.





P-12

Primary synovial sarcoma in right atrium: A rare case report

Premkumar Devadoss, Ravi CR, Lakshiminarasimhan S, Balaji J

Department of Medical Oncology, Madras Medical College, Chennai, Tamil Nadu, India

Primary synovial sarcoma of mediastinum is a rare malignancy and also, this tumor arising from the right atrium, is even rarer. So far, only very few cases have been reported. A 35-year-old male presented with palpitation and chest pain of 6 months duration. Echocardiogram revealed a mass measuring 6.3×3.3 cm arising from the septal leaflet of the tricuspid valve extending in to the right ventricle and right ventricular outflow tract, suggesting a clinical diagnosis of right atrial myxoma. Hence, the patient was taken for surgery. Surgical excision in toto was done. Post-operative surgical pathology was reported as Botyroid type of Rhabdomyosarcoma. Slide review and Immunohistochemistry proved to be synovial sarcoma. Based on these reports, the patient was started on chemotherapy (VAC regimen). The patient has so far completed 4 cycles of chemotherapy. Currently he is still under treatment.

P-13

Multidrug resistance gene expression in acute myeloid leukemia and its response to induction chemotherapy


Sangeeta Jiwatani, Ms Sailaja Kagita, Raghunadharao D

Department of Medical Oncology, NIMS, Hyderabad, India

Aims and Objectives: The aim is to study the expression of multidrug resistance gene (MDR1) expression in acute myeloid leukemia (AML) patients and correlate with clinical and hematological findings, and, response to induction chemotherapy. Materials and Methods: A group of 33 AML patients with pre and post treatment samples were included in the study. Quantitative RT-PCR was used to measure the mRNA expression levels of MDR1, by TaqMan chemistry on an ABI Step One Real-Time PCR machine (Applied Biosystems), using Actin as an endogenous reference gene. For this analysis, a value over 30% expression of MDR1 was considered positive. The median age at presentation was 32 years (range 17-52 years). The male to female ratio was equal. Results: Analysis revealed that the expression level of MDR1 gene was significantly higher in pretreated cases, when compared to post treated cases (P<0.0001). MDR1 expression was found to be significantly higher in males (P<0.0001) compared to females. Before treatment, 27.27% (9/33) of the patients showed positive MDR1 expression and 72.72% (24/33) of them had negative MDR1 expression. After induction therapy, 30.30% (10/33) of the patients showed positive expression and 69.69% (23/33) had negative expression. Conclusion: When MDR1 expression with respect to response status was considered, no variation was observed in patients with complete remission, while patients with persistent disease showed higher MDR1 expression levels after induction therapy (P<0.0001). Financial Assistance: Department of Biotechnology (INDIGO Project) and Mr. Mathew Kuncheria (Philanthropist).

P-14

Second cancers in CML


Maddi Rahul Narayan, Vamshi Krishna Reddy G, Thota N Kumar, Coca Pragnya, Linga V Gandhi, Gundeti Sadashivudu, Maddali L Srinivas, Digumarti Raghunadharao

Department of Medical Oncology, Nizams Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India

Introduction: Long term side effects of imatinib mesylate (IM) are not well known, especially 2 nd cancers. To the best of our knowledge, there is no Indian data. Two previous reports suggested an unexpected increased incidence of cancers among patients treated with IM after failure to IFN. We analyzed the patients for second cancer on IM from year 2001 to year 2011. Material and Methods: We analyzed the patients for second cancer on IM from year 2001 to year 2011. Results: Of the 2,230 CML patients reviewed, 8 patients developed second cancers. 5 were males. 4 of the 5 men were smokers. Median dose of IM was 400 mg. Median age at diagnosis of CML was 59 years. The second cancers diagnosed included cancer of the esophagus, stomach, rectum, kidney, prostate, cervix, tongue and hodgkin lymphoma (HL) (mixed cellularity). Adenocarcinoma and squamous cell carcinoma were most common histologies. Median time from CML diagnosis to second cancer was 13 months. Median time on treatment with TKI until second cancer was 12.5 months. Median follow up time after diagnosis of second cancer was 15.5 months. Only one (HL) out of 8 patients is alive, till date. 6 out of 7 patients died from their second cancer. 1 patient died due to an acute exacerbation of COPD. In terms of CML, 3 patients were in CCR, 1 in CHR, 2 in Chronic phase, 1 in partial response and 1 in blast crisis at the time of last follow up. Conclusion: In conclusion, second cancers occur in a small percentage of patients receiving therapy with IM for CML and are the cause of death in these patients.

P-15

Mucosal melanoma (ORO-pharynx): A rare presentation


Rajkumar R, Ravi CR, Lakshminarasimhan, Balaji J

Department of Medical Oncology, Madras Medical College, Chennai, Tamil Nadu, India

We report a case of 65-year-old female, who presented with a proliferative growth left tonsillar area of 3 months duration and found to be progressive resulting in mechanical obstructive symptoms of dysphagia and dysphonia. She was found to have left upper deep cervical lymph nodes on examination. Examination of oropharynx showed mass of size 5 cms, in the left tonsillar area. Vdl scopy confirmed it. Her USG abdomen, CT scan chest, CT scan abdomen were normal. Histopathology was consistent with malignant melanoma. Patient underwent surgical excision of the left tonsillar fossa mass, in order to relive the obstructive symptoms. Patient was given 3 cycles of injection cisplatin and dacarbazine. Patient is on regular follow up without any local or distant recurrence. This case is presented for its rarity, since mucosal melanomas on the tonsillar fossa is rare among the oropharyngeal melanomas.

P-16

Case report of triple negative breast cancer presenting as a metastatic maculo erythematous lesions without systemic spread


Ravi Mohan P, Narasinga Rao 1 , Rao NRK 2

RIMS Hospital, Srikakulam, 1 Andhra Medical College, 2 Chaitanya Medical Center, Visakhapatnam, Andhra Pradesh, India

Case Report: A 51-year-old post menopausal female, a non diabetic and a non hypertensive,a Triple negative Carcinoma of Breast staged as T2 N1 Mo, underwent MRM followed by FAC X 6 cycles followed by RT, completed in June 2008 elsewhere. Patient developed skin nodule below the right mastectomy scar without any metastatic disease elsewhere, for which was given electrons at Apollo Hospital, Hyderabad in June 2010 with good clinical response. Patient developed macular skin lesions on the anterior abdominal wall in September 2010. Patient was given 6 cycles of Gemcetabine and Carboplatin with stable disease. Patient developed macular rash over the back in June 2011, a biopsy was reported as infiltrating poorly differentiated carcinoma compatible with earlier pathology report, for which capecetabine was given with partial response. There was no metastatic disease elsewhere. We are reporting the peculiarity in this case of the triple negative breast cancer presenting with skin only metastasis presenting as maculo - erythematous lesion without systemic metastasis. Discussion: A literature search revealed that the rarity of triple negative carcinoma of breast presenting as a skin only metastasis without any systemic visceral or bone metastasis with poor response to treatment.

P-17

L-asparaginase induced cerebral sinus venous thrombosis in an adult with acute lymphoblastic leukemia


Lakshmi Chaithanya R, Raghunadharao D 1

Madras Medical College, Chennai, 1 Madurai Medical College, Madras, Tamil Nadu, India

Introduction: L-asparaginase forms an important component of remission induction therapy of acute lymphoblastic leukemia (ALL). It is well tolerated in children than in adults. Cerebral sinus venous thrombosis (CSVT) is one of the serious complications of L-asparaginase. The estimated risk of thrombosis is 5%. It is more common in adult males. Most of the thrombotic events occur during remission induction phase, seldom during the repeat induction phase or maintenance treatment. Case Report: We report a case of a 36-year-old man with newly diagnosed Acute Lymphoblastic Leukemia on repeat induction phase with the MCP 841 protocol. On day 23, patient complained of headache, seizures and altered sensorium. Brain imaging with MRI and MRV was suggestive of venous infarct in right temporal lobe and cerebral sinus venous thrombosis. Coagulation profile was abnormal (PT - 32 sec, APTT - 51.3 sec). Antiepileptics were initiated. Anticoagulation was started with low molecular weight heparin and later was replaced by Acitrom. Patient recovered gradually thereafter. Conclusion: We conclude that diagnosis of CSVT in leukemic patients being treated with L-asparaginase requires a high index of clinical suspicion especially in patients presenting with new onset seizures. Early diagnosis demands a low threshold for imaging and MRI should be preferred over CT. Identification of relevant findings such as venous infarct, absent flow in dural sinuses on CT or MR Venography enables proper diagnosis and management.

P-18

Clinical and histological profile of lung cancer - 7 year experience


Muralidhar G, Rajesh K, Narendra T, Sadashivudu G, Vijay Gandhi L, Lakshmi Srinivas M, Raghunadharao D

Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India

Aim of the study: To study the clinical manifestations, histology, and staging of patients with lung cancer. Materials and Methods: A retrospective analysis was done to analyze the data of 760 lung cancer patients treated over 7 years in NIMS under the Department of Medical Oncology. Patients were categorized according to age, gender, symptoms, duration of symptoms, smoking, performance status (PS), stage, metastatic sites, diagnostic methods, and histology. Results: The median age was 57 years (range, 16-88) and male to female ratio was 4:1. 504 (66%) were smokers. The median duration of symptoms before presentation was 2 months (range 0-36) and 10% of them had antituberculosis treatment. The most common symptoms was cough (74%) followed by breathlessness (54%), chest pain (40%), weight loss (25%), hemoptysis (18%) and hoarseness (11%). Most patients (52%) presented with PS>1. Most common histology was adenocarcinoma (40%) but squamous carcinoma comprised of only 12%. Around 20% patients had the non-small lung cancer - unclassified. The small lung cancer was seen in 80 (11%) of patients. More than 85% of patients presented in advanced stage (lllA, lllB and lV). FNAC of the lung mass was the most common diagnostic modality. Opposite lung was most common metastasis (41%), followed by bone (35%). Conclusions: Demographic data was similar to other Indian and western studies. Adenocarcinoma was the most common histology and most of them are in advanced stage.

P-19

Primary mediastinal synovial sarcoma: A case report and review of the literature


Sathiyamoorthy PN, Ravi CR, Lakshiminarasimhan S, Balaji J

Department of Medical Oncology, Madras Medical College, Chennai, Tamil Nadu, India

Primary mediastinal synovial sarcoma is a rare malignancy with only a few cases reported so far. A 32-year-old woman was admitted for cough, chest pain and breathlessness. Chest radiography showed homogenous opacity in the middle and lower zone of left lung. Computed tomography (CT) revealed a large heterogeneous mass in the left hemithorax involving posterior mediastinum, loculated pleural effusion and few soft tissue density nodules in both the lungs. Left lung mass first described as a resolving hematoma. Ultrasound guided percutaneous needle biopsy suggestive of hematoma/Leiomyosarcoma. The diagnosis of synovial sarcoma was established by thoracotomy and excision of posterior mediastinal mass. The pathological and immunohistochemical analyses confirmed the diagnosis of a monophasic spindle cell synovial sarcoma. PET-CT scan revealed multiple lung nodules in the both lungs. The patient completed three cycles palliative chemotherapy (VAC chemotherapy regimen) in our hospital and the disease remains static.

P-20

Clinico-pathological profile of non-hodgkin's lymphoma in a university cancer centre


Kannan T, Sudheer Reddy K

Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Background: The incidence NHL is on the upsurge with the current Figures standing at 5-6 per 1 lakh population in urban registries. The current study analysis the demographic and clinicopathological profile of NHL in a university cancer center. Materials and Methods: A retrospective analysis of NHL patients from 2006 to 2011 was done. Patients were staged according to Ann-Arbor staging system. Clinical details of all the patients were analyzed. Results: In our study median age was 54 years. Male: Female ratio was 1.8:1. Extra-nodal disease was present in 29%. B-symptoms were present in 54%. B-Cell lymphomas constitute 77% of which 35% were DLBCL type. Most common extra-nodal site was GIT (13.5%). 42% were in stage IV. 23% were in high risk as per IPI. Conclusion: Clinicopathological profile in our series is similar to global trends. IPI predicted the survival rates.

P-21

Left thalamic peduncular germinoma: A rare case report


Syed Ismail N, Ravi CR, Lakshiminarasimhan S, Balaji J

Department of Medical Oncology, Madras Medical College, Chennai, Tamil Nadu, India

Thalamic peduncular germinoma is a rare malignancy with only a few cases reported so far. A 9-year-old boy presented with complaints of weakness in right upper limb and lower limb, head ache and vomiting over 8 months. Clinically, patient had right hemiparesis and right upper motor neuron facial palsy. The patient was evaluated with C.T brain and reported as left thalamic peduncular germinoma. Stereotactic biopsy done on 12 January 2011 was reported as germinoma. The patient received radiotherapy to primary tumor. After completion of radiotherapy, the patient had improvement in the right hemiparesis. The post radio therapy, C.T brain revealed residual lesion in the left thalamic peduncular region. Serum β HCG was found to be elevated (218 IU/ml) and the other tumor markers remained within normal limits. Hence, the patient was planned for chemotherapy four cycles.(chemo regime was inj. Cisplatin 20 mg D1-D5, Etoposide 100 mg D1-D3 and Ifosfamide 1gram D1-D3 for every 28 days cycle). He received first cycle chemotherapy on 26 August 2011 and was discharged from the hospital with good performance status. The patient was lost for follow up since then.

P-22

Weekly chemotherapy as induction chemotherapy in locally advanced head and neck cancer for patients with poor PS and ineligible for 3 weekly maximum tolerable dose chemotherapy


Partha S Roy, Vanita Noronha, Amit Joshi, Vijay Patil, Vamshi Krishna Muddu, Anil D'cruz 1, Kumar Prabhash

Department of Medical Oncology, 1 Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

Objective: To study the safety and efficacy of weekly chemotherapy as Induction chemotherapy in locally advanced head and neck cancers. Materials and Methods: It is a retrospective analysis on use of weekly chemotherapy as Induction chemotherapy in locally advanced head and neck cancer patients. Induction chemotherapy was given with either a 2 drug combination of paclitaxel (80 mg/m 2 ) and platinum (either 30 mg/m2 of cisplatin or carboplatin AUC 2) or single drug paclitaxel (80 mg/m2). The decision to give weekly induction chemotherapy was given on the basis of poor performance status or uncontrolled cardiac co-morbidities. The response rates and toxicity (accordance with CTCAE vs. 4.02) are reported. Results: Eight patients were considered for such therapy. Out of 8 patients, 7 patients had ECOG performance status (PS) of 2 and 1 patient had PS, but other 1 patient had uncontrolled hypertension and history of ischemic heart disease. The median age is 55 to 50 years (35-70). There were 3 patients with primary in oral cavity, 3 with laryngopharyngeal primaries, 1 with a primary in maxilla and 1 with unknown primary with neck node. The stage grouping was stage III in one, stage IVa in 3 patients and rest were stage IVb. Median BMI was 18 kg/m2 (14-25), median hemoglobin was 11.05 (9.8-11.5 mg/dl) and median albumin was 3.5 (3.2-4.4 mg/dl). Cardiac co-morbidities were present in 6 patients. Two patients were HCV positive and one was HIV positive. 7 out of 8 patients took chemotherapy. The median number of planned weekly cycles was 6. Chemotherapy was completed by all patients. Partial response was achieved in 5 patients, stable disease in 1 and progressive disease in 1 patient. Grade 3-4 neutropenia was seen in 2 patients, febrile neutropenia in 2 patients, grade 4 diarrhea in one and electrolyte disturbance in 1 patient. Two patients required admission for toxicity. There was no mortality related to toxicity. Conclusion: Use of induction chemotherapy with weekly regimen is effective. It may be possible to use this regimen in patients, who can not tolerate a 3 weekly chemotherapy with acceptable toxicity. This regimen needs to be evaluated in bigger sample size and longer follow up.

P-23

A study of EGFR mutation in non-smoker NSCLC: Striking disparity between north and south India patients


Minhas S, Patil S 1 , Pungliya M 2 , Soumittra N 3 , Shashidhara HP 4 , Veena 4 , Aggarwal S 5

Sir Ganga Ram Hospital, 1 HCG, Bangalore, 2 AyuGen Biosciences Pvt Ltd, Pune, 3 Vision Research Foundation, Chennai, 4 Consultant Medical Oncologist, Sir Ganga Ram Hospital, New Delhi, HCG, Bangalore, AyuGen Biosciences Pvt Ltd, Pune,Vision Research Foundation, Chennai, Tamil Nadu, India

Introduction: There is a high incidence of EGFR mutation in non-smokers with adenocarcinoma of lung- 70% the southeast Asia and 15% in Caucasians. There is no study in an Indian population yet. Materials and Methods: 55 cases of non-smoker advanced adenocarcinoma of lung were enrolled in this study, after June 2008 in a retrospective fashion. 26 patients were enrolled from Sir Ganga Ram Hospital, Delhi in north India and 29 from HCG, Bangalore in south India. Assessment of mutation status was possible in 49 cases. ARMS technique was used to study the EGFR mutation. Results: A total 27, out of 49 cases were positive for EGFR mutation - 7/21 (33%) from north India and 20/28 (65%) from south India. The commonest mutation was del exon 19 (62%), followed by L858R exon 21 (25%), G719X exon 18 (7%) and insertion exon 20 (3%). Patients were treated either with gefitinib or chemotherapy. 8/12 (83%) patients treated with gefitinib upfront responded. Overall survival (OS) was not reached at a follow up of 11 months in EGFR mutation carriers. Only 2/27 patients died. OS was reached at 10 months in patients with no EGFR mutation. 10/22 of these patients died. Conclusions: The study brings about striking differences in the incidence of EGFR mutation in non-smoker NSCLC cases between north and south India. This could be due to ethnic issues. There is a need to continue to this study in these patient populations.

P-24

Small cell carcinoma of gall bladder: Report of two cases


Anupam Mahanta, Vikas Goswami, Chandragouda, Kumardeep, Ullas Batra, Doval DC

Rajiv Gandhi Cancer Institute and Research Centre, Sector-V Rohini, Delhi, India

Background: Gallbladder neuroendocrine tumors (GB-NETs) represent only 0.5% of all NETs and have an aggressive behavior. Approximately 40 cases of small cell carcinoma of GB reported in the literature. Herein, we report two cases of small cell carcinoma GB diagnosed and treated at our institute. Materials and Methods: First case presented with metastatic disease and was treated with palliative chemotherapy and radiation therapy. Second patient underwent radical cholecystectomy followed by 6 cycles of adjuvant chemotherapy. Etoposide and platinum based chemotherapy was given in both cases. Results: Both patients tolerated treatment well and are currently on follow up for last 3 and 2 months, respectively. Conclusion: Small cell carcinoma of GB requires a multidisciplinary approach with wide surgical resection and chemotherapy. The natural history of the disease is characterized by extensive local invasion and early metastases. Careful follow up with CT-Scan is mandatory to facilitate early detection of recurrence. Etoposide and platinium based chemotherapy seems to be a reasonable choice but is with out a well defined standard of care protocol.

P-25

Information systems in cancer - An update


Kannan T, Nagarajasri BH

SVIMS University, Sri Venkateswara University

Background: Internet plays a vital role in the present era. Recent trends in information systems have strengthened the cancer management strategies. Information resources assist to understand disease diagnosis and management options and to make it simple, evidence based and structured. Materials and Methods: Search of various information resources on cancer was done and presented. Such information was collected from offline sources like books, journals, brochures, libraries and search engines on the internet like PubMed, Oncolink, MD consult, Science Direct, Google scholar, Wikipedias, Podcosts, Blogs and Social networking. Using these resources effectively and they should be analyzed. Results: In this paper, we collect and present the information tools from various sources including the internet to assist to the medical professionals, patients, lay persons and support groups. Appropriate infrastructure should be made available with adequate funds for maintenance.

P-26

Renal cell carcinoma - A university hospital scenario


Kannan T, Venkata Sampath V

Sri Venkateswara Institute of Medical Sciences, Triupati, Andhra Pradesh, India

Background: Globally, the incidence of renal cell carcinoma (RCC) is increasing, with myriad presentations. This study analyzes the patterns of clinical behavior of renal cell carcinoma in a university hospital. Mateirals and Methods: Retrospective analysis of 5 years data were analyzed with reference to various clinical parameters. Results and Conclusions: In our study, the median ages for Years 2007, 2008, 2009, 2010 and 2011 were 64, 62.5, 60, 52, and 42 respectively. Male and female ratio was 1.6. Stage IV was 21%. Presenting symptoms were Loin pain 51%, Hematuria 35%, Mass in the loin 19%. Bilateral RCC was seen in 3 cases; Dual malignancy was seen in 2 cases; Adrenal invasion was seen in 3 cases; lung was the commonest metastatic site.

P-27

Sunitinib in metastatic renal cell carcimoma: A single-centre experience


Vamshi Krishna M, Kumar Prabhash, Vanita Noronha, Amit Joshi, Bharatsinha Bhosle, Ravi T, Vijay Patil, Hari Menon, Sudeep Gupta, Banavali SD, Ganesh Bakshi, Tangaonkar HB

Tata Memorial Hospital, Mumbai, Maharashtra, India

Background: Historically, metastatic renal cell carcinoma has had poor prognosis; the outcomes have improved with the Introduction of tyrosine-kinase inhibitors like sunitinib. There is no reported literature from India on the use of sunitinib in metastatic renal cell carcinoma. We present an analysis of sunitinib in our patients. Materials and Methods: An unselected population of patients with metastatic or relapsed metastatic renal cell carcinoma receiving sunitinib was analyzed with respect to response, toxicity and outcomes. Results: 59 patients (51 males and 8 females) with a median age of 55 years were analyzed. Lungs and the skeletal system was the commonest site of metastases. The patients received a median number of 4 cycles, with 23 patients requiring dose- modification and 12 discontinuing therapy due to toxicity. Overall, 38 patients (65%) had CR, PR or SD, while 14 had progression or death at initial evaluation. The median PFS was 11.4 months and overall survival was 22.6 months. Hand-foot syndrome, fatigue, mucositis, Conclusions: Sunitinib is a viable option for the treatment of metastatic renal cell carcimoma and shows a comparable PFS in Indian patients. Though toxicity remains a concern, most of the adverse effects can be managed conservatively. Careful patient selection, tailoring the dose of therapy, adequate counseling and careful follow-up is essential for optimum therapy.

P-28

A rare case of paediatric blastic plasmacytoid dendritic cell neoplasm in long term remission


Unnikrishnan Vineetha, Lakshmaiah KC, Premlata CS 1 , Gajula Mehar Kumar, Suresh TM, Loknath D, Govind Babu, Jacob Linu

Departments of Medical Oncology and 1 Pathology, Kidwai Memorial Institute of Oncology, M.H. Marigowda Road, Bangalore, Karnataka, India

Background: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an extremely rare subtype of acute leukemia, characterized by the clonal proliferation of immature precursors of plasmacytoid dendritic cells with a propensity for skin involvement and rapid systemic dissemination. In adults, the disease follows an aggressive course with a poor outcome and a median survival of only 14 months. Due to its rarity and only recent recognition as a distinct clinicopathological entity, there was no standardized therapy. Conclusions: Experience in children with this disease is limited. Here, we report the case of a 15-year-old girl with BPDCN, who had a good response to chemotherapy based on an acute lymphoblastic leukemia regimen with sustained complete remission, 26 months after diagnosis.

P-29

Renal cell carcinoma - A university hospital scenario


T Kannan, Venkata Sampath V

Sri Venkateswara Institute of Medical Sciences, Triupati, Andhra Pradesh, India

Background: Globally the incidence of renal cell carcinoma (RCC) is increasing, with myriad presentations. This study analyzes the patterns of clinical behavior of renal cell carcinoma in a university hospital. Materials and Methods: Retrospective analysis of 5 years data were analyzed with reference to various clinical parameters. Results: In our study 52 patients were studied, the median ages for years 2007, 2008, 2009, 2010 and 2011 were 64, 62.5, 60, 52, and 42, respectively. Male and Female ratio was 1.6. Stage IV was 21%. Presenting symptoms were Loin pain 51%, Hematuria 35%, Mass in the loin 19%. Bilateral RCC was seen in 3 cases; Dual malignancy was seen in 2 cases; Adrenal invasion was seen in 3 cases; lung was the commonest metastatic site. Conclusions: There is an up trend in incidence, stage and a downtrend in age of presentation the reasons for which needs further study.




 

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