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   Table of Contents - Current issue
July-September 2019
Volume 40 | Issue 3
Page Nos. 319-460

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Risk reduction strategies in BRCA patients: An Indian perspective Highly accessed article p. 319
Amit S Parasnis
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Swallowing endoscopy in oncology p. 321
Nilanjan Bhowmick
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Do mass media in health awareness make a palpable impact on cessation of smokeless tobacco use? Highly accessed article p. 323
Hitesh R Singhavi, Pankaj Chaturvedi
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Cutaneous malignant melanoma and targeted therapy based on the biomarkers p. 325
Jayabal Pandiaraja
Malignant melanoma is the most aggressive form of cutaneous malignancy. It accounts for more than 75% of cancer-related deaths among cutaneous malignancies. It accounts for <5% of cutaneous malignancy. Numerous biomarkers are used in malignant melanoma with varying clinical applications, including diagnostic purposes, prognosis, therapeutic purpose, and targeted therapy against melanoma. Systemic chemotherapy in malignant melanoma has little benefit compared to immunotherapy and targeted therapy. The observed overall survival with systemic chemotherapy is much less compared with targeted therapy in advanced or metastatic melanoma. Various targeted therapies are currently used in melanoma treatment including BRAF inhibitors such as vemurafenib and dabrafenib; MEK inhibitors such as trametinib; anti-CTLA-4 antibodies such as ipilimumab; and anti-programmed cell death 1 antibodies such as nivolumab, pembrolizumab, and pidilizumab. This study discusses the role of biomarkers and targeted therapies based on the biomarker.
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Recent advances in the systemic treatment of gastrointestinal malignancy p. 336
Ravi Kumar Paluri, Rojymon Jacob, Anup Kasi
In the following article, practice changing updates on gastrointestinal cancers management have been discussed. For metastatic colorectal cancer with RAS wild-type, fluoropyrimidine plus panitumumab combination has been the preferred maintenance option for patients who have stopped oxaliplatin. The cytoreductive surgery alone showed satisfactory survival outcomes in colorectal cancer patients with peritoneal carcinomatosis. Dose escalation of regorafenib showed better clinical outcomes than the standard dosing regimen. Adjuvant FOLFIRINOX is the new treatment option for selected resected pancreatic cancer patients. Neoadjuvant treatment is the new paradigm for borderline and resectable pancreatic cancer patients. Several options for advanced hepatocellular cancers now available and more clinical studies are required for optimal treatment sequencing. Trifluridine/tipiracil showed improved overall survival in esophageal cancers beyond the second line.
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Response and relapses in pediatric Hodgkin's Lymphoma treated with chemotherapy alone p. 341
Vineeta Gupta, Tej Bali Singh, Sanjeev Kumar Gupta
Aims: The aims of this study were to analyze the sociodemographic profile, disease characteristics, event-free survival (EFS), overall survival (OS), and risk factors for relapse in patients with Hodgkin's lymphoma (HL) treated with only chemotherapy as per unit protocol. Subject and Methods: Case records of children with HL diagnosed and treated at our center between January 2005 and December 2014 were retrospectively analyzed. Results: A total of 90 patients with mean age of 8.13 ± 2.65 years (median age 8 years; range 4.5–15 years) were diagnosed and treated for HL during the study period. Male-to-female ratio was 7.2:1. Almost 12.2% and 87.8% of patients had early and advanced stage disease, respectively. B symptoms were present in 87.8% of patients. Mean duration of symptoms was 9.66 ± 6.30 months (median 8 months; range 2–36 months). Mixed cellularity was the most common histologic type. Multiagent chemotherapy was mainstay of treatment. OS and EFS were 88.8% and 84.5%, respectively. OS in patients with or without bulky disease was 53.3% and 92.2%, respectively. Older age (≥10 years), presence of bulky disease, low hemoglobin (≤7.0 g/dl), and high leukocyte count (≥12000/mm3) at the time of diagnosis, and protocol used (cyclophosphamide, vincristine, procarbazine, and prednisone) were the risk factors for relapse. Conclusions: Our patient population had younger age, advanced disease, more B symptoms, and bulky disease. Still, we achieved good OS and EFS with chemotherapy-alone protocols. Patients with bulky disease had poor OS and EFS. If radiotherapy is included in the protocol for bulky disease, the survival rates can be improved further.
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Depression among women diagnosed with breast cancer: A study from North India p. 347
Monika Thakur, Bandna Gupta, Rohitash Kumar, Anand Kumar Mishra, Sameer Gupta, Sujita Kumar Kar
Introduction: Major depressive disorder is a major mental health problem and is the fourth most important cause of loss of disability-adjusted life years worldwide. Aim: The study aimed to assess the association of depression among women diagnosed with breast cancer. Methodology: A descriptive, cross-sectional study was done on 102 females diagnosed with breast cancer. Women were recruited using purposive sampling technique. Patients were evaluated on Mini International Neuropsychiatric Interview Version 6.0.0 to screen other psychiatric comorbidities. Hamilton depression 17-item, rating scale was used to measure severity of depression. Results: The prevalence of depression was 47.05% in women diagnosed with breast cancer. Majority of the patients (54.1%) had mild depression. Correlations of clinical and Sociodemographic variables with parameters of depression were not significant. Conclusions: Depression is commonly associated psychiatric morbidity in patients diagnosed with breast cancer. The severity of depression is independent of the sociodemographic and clinical variables of patients with breast cancer.
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A prospective randomized comparison of concurrent chemoradiation with neoadjuvant and adjuvant chemotherapy with concurrent chemoradiation alone for locally advanced carcinoma cervix p. 353
Rahul Singh, M LB Bhatt, Rajendra Kumar, Kirti Srivastava, RK Grover, Pragya Shukla, Vijay P Raturi, Roopali , Jalaj Gaur, Mandira Saha, Dewesh Kishan
Aims: The aim of this study was to compare concurrent chemoradiation along with neoadjuvant and adjuvant chemotherapy versus concurrent chemoradiation alone in locally advanced cervical cancer regarding treatment response and toxicities. Subjects and Methods: A randomized control study was done on 116 patients with locally advanced carcinoma cervix (Stage IIB to IIIB) registered between January 2014 and February 2015. Patients were randomly divided to receive either one cycle of cisplatin/5-fluorouracil neoadjuvant chemotherapy and two cycles of the same adjuvant chemotherapy with concurrent chemoradiation with weekly cisplatin (Arm A) or only concurrent chemoradiation (Arm B). All patients received three fractions of high-dose-rate intracavitary brachytherapy after completion of the external radiation. Results: A higher proportion of the patients of chemotherapy arm achieved complete response (94%) as compared to the nonchemotherapy arm (56%), and this was statistically significant. There was a trend toward more treatment-related acute toxicity with chemotherapy. Conclusions: These results have corroborated the view that if neoadjuvant and adjuvant chemotherapies are added to concurrent chemoradiation, it could further the effects of concurrent chemoradiation for patients with locally advanced cancer of the uterine cervix.
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Vulval cancer: When should i stop resecting? Identifying the factors that predict recurrence p. 358
Sarah Louise Platt, Claire Louise Newton, Pauline J Humphrey, Joya P Pawade, Vivek V Nama
Context: Vulval cancer surgery has become more conservative and it is important to understand whether resection margins alone influence recurrence rates or whether other prognostic factors should be considered when planning treatment. Aims: The aim of this study is to define factors that predict vulval cancer recurrence, enabling development of a recurrence prediction model. Settings and Design: This was a Aretrospective descriptive analysis of new vulval squamous cell carcinoma cases in a gynecological oncology center (January 1, 2007 to December 31, 2013). Subjects and Methods: Analysis of tumor characteristics and treatments. Patient outcomes were recorded, identifying recurrences, and subsequent interventions. Statistical Analysis Used: Univariable and multivariable logistic regression tools applied to determine recurrence risk factors. Results: Seventy patients underwent primary vulval surgery. Bilateral groin node dissection was performed in 26/70 (37.1%) cases and unilateral groin node dissection in 9/70 (12.9%) cases. 57/70 (82%) cases had a negative vulval resection margin, with 67% <8-mm margin. 18/70 (26%) patients underwent adjuvant treatment. Overall recurrence rate of 21/70 (30%): 14/70 locally and 7/70 at the groin. Median survival was 84.2 months and median disease-free interval was 19.1 months. Factors that were statistically significant in predicting recurrence were positive groin histology, lymphovascular space invasion (LVSI), and disease stage. Conclusions: We reported a reduction in the size of tumor-free margins at primary excision. The recurrence rate of 30% is within the previously reported range, suggesting that factors aside from resection margin (LVSI, stage, and groin node involvement) are also important in predicting recurrence. These factors should be incorporated into a prediction model when planning adjuvant treatment.
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Study of the use of traditional, complementary, and alternative medicine in Indian cancer patients p. 365
Nishitha Shetty, Paraashar Ravindranath Rai, Arpitha Shetty
Objectives: The use of alternative forms of medicine is well known in India, especially amongst cancer patients but there are very few studies that have investigated its usage and benefits. A study was conducted to determine the prevalence of the use of Traditional medicine, Complementary and Alternative Medicine (CAM) by cancer patients visiting a cancer care center. This study laid an emphasis on the predictors of use of CAM. Materials and Methods: This is an observational study conducted from March 2017 to May 2017 at a tertiary cancer care center. After obtaining informed consent, patients were handed a questionnaire and their responses were analyzed. Data analysis tools of Microsoft Office Excel 2007 were used for statistics. Results: A total of 407 patients took part in the study. The prevalence of traditional medicine and CAM was found to be 23.5% (96 patients). The mean duration of CAM use was 4.8 months (0.25 months–48 months). About 77% of the users had an education level below the upper primary level, of which 30.02% were illiterate. About 62.5% of the users were below poverty line. Nearly, 41.7% of the patients had not received any allopathic treatment before starting traditional medicine and CAM and did so for a mean duration of 4 months. About 53% of the patients who received some form of traditional medicine and CAM claim to have experienced some symptomatic benefits from its use. Nearly, 68.75% of the users were simultaneously receiving conventional anticancer therapy. Traditional medicine and CAM use was disclosed to the treating physician by 55% of the patients. Conclusion: Traditional medicine and CAM use have been shown to have a high prevalence among the less-educated and the economically backward sections of the society. There is not sufficient data to support the effectiveness and safety of traditional medicine and CAM. physicians have to acknowledge the increasing incidence of traditional medicine and CAM use in the population and actively inquire and educate the patients on its use.
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Clinicopathological profile of head and neck squamous cell carcinoma p. 369
Senjuti Dasgupta, Sudipta Chakrabarti, Asit Ranjan Deb
Background: Head and neck squamous cell carcinoma (HNSCC) constitutes one of the most common malignancies in the world. The geographic location influences the etiologic factors and site of tumor. Aims and Objectives: The present study was carried out to illustrate the clinicopathologic profiles of HNSCC patients since data regarding these tumors from eastern region of India are scarce. Materials and Methods: A prospective study was undertaken for 2 years in which patients with histologically proven HNSCC were included. The clinicopathologic features of each case were analyzed. Results: A total of 108 cases were included in the study, among which 79 (73.15%) were male and 29 (26.85%) were female. Mean age of the patients was 53.21 (±12.17) years. The most common risk factor was smoking (63 cases, 58.33%) followed by tobacco or betel nut chewing (41 cases, 37.96%). The common patterns of presentation included ulcerated lesion (51 cases, 47.22%), whitish lesion (28 cases, 25.93%), and hoarseness of voice (11 cases, 10.19%). The most common sites involved were buccal mucosa (36 cases, 33.33%) and dorsal surface of the tongue (26 cases, 24.07%). The most common site for exophytic tumors was buccal mucosa (9 out of 23, 39.13%) and that for ulceroproliferative lesions was tongue (9 out of 17, 52.04%). Microscopically, well-differentiated (Grade I) tumors were most common (67 cases, 62.04%) followed by moderately differentiated (Grade II) tumors (38 cases, 35.19%). A statistically significant correlation was obtained between anatomic site and grade of the tumor. Conclusion: Patients of HNSCC from the eastern region of India have distinctive features with regard to macroscopic appearance and microscopic grade of their tumors.
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Is high altitude an emergent occupational hazard for primary malignant brain tumors in young adults? A hypothesis p. 374
Neelam Sharma, Abhishek Purkayastha, Tejas Pandya
Introduction: Brain cancer accounts for approximately 1.4% of all cancers and 2.3% of all cancer-related deaths. Although relatively rare, the associated morbidity and mortality affecting young- and middle-aged individuals has a major bearing on the death-adjusted life years compared to other malignancies. Over the years, we have observed an increase in the incidence of primary malignant brain tumors (PMBTs) in young adults. This observational analysis is to study the prevalence and pattern of brain tumors in young population and find out any occupational correlation. Materials and Methods: The data were obtained from our tertiary care cancer institute's malignant diseases treatment center registry from January 2008 to January 2018. A total of 416 cases of PMBT were included in this study. Results: Our analysis suggested an overall male predominance with most PMBTs occurring at ages of 20–49 years. The glial tumors constituted 94.3% while other histology identified were gliosarcoma (1) gliomatosis cerebri (1), hemangiopericytoma (3), and pineal tumors (3). In our institute, PMBT constituted 1% of all cancers while 2/416 patients had secondary glioblastoma multiforme with 40% showing positivity for O-6-methylguanine-DNA-methyltransferase promoter methylation. Conclusions: Most patients belonged to a very young age group without any significant family history. A probable hypothesis could be excessive cosmic radiation exposure to persons staying at high altitude areas due to occupational exigencies for which in-depth case–control epidemiological studies are required to reach any conclusion.
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FoxO3a gene down-regulation in pathogenesis of pediatric acute lymphoblastic leukemia p. 381
Malihe Mirzaie, Mahboobeh Nasiri, Mehran Karimi, Majid Yavarian, Arghavan Kavosi
Introduction: Acute lymphoblastic leukemia (ALL) is the most common malignancy found in the pediatrics with the peak prevalence between the ages of 2 and 5 years. The constitutive activation of PI3K/AKT pathway inhibits the tumor-suppressor role of FoxO3a (a member of the forkhead class O [FoxO] transcription factor family) in a variety of cancers and leads to tumorigenesis. This study aims to investigate the expression of FoxO3a in three different stages of pediatric ALL in mRNA level. Subjects and Methods: In this case-control study, 70 patients with childhood ALL and 70 healthy age- and gender-matched as the control group were enrolled. Real-time quantitative RT-polymerase chain reaction (qRT-PCR) was used to detect the mRNA expression level of FoxO3a in children with different stages of ALL and healthy children as a control group. Results: Data showed that the expression of FoxO3a mRNA was lower in newly diagnosed ALL patients compared to controls (P < 0.0001), maintenance (P = 0.0342), and relapse (P = 0.0006) groups, while no difference was observed between other groups. In addition, T-ALL patients showed decreased expression of FoxO3a compared to Pre-B ALL ones (P < 0.0001). Conclusion: The study results suggest that FoxO3a plays a tumor-suppressor role in ALL. Thus, its up-regulation seems to be a plausible therapeutic strategy for this type of tumor.
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Evaluation of pulmonary infiltrate in febrile neutropenic patients of hematologic malignancies p. 386
Chandan K Das, Ajay Gogia, Lalit Kumar, Atul Sharma, Sanjay Thulkar, Immaculata Xess, Karan Madan
Background: Pulmonary infection is the major risk during neutropenia induced by chemotherapy as well as stem cell transplantation. In spite of potent new-generation antifungal and broad-spectrum antibiotics, one-third of patients usually die from infectious complications. Early diagnosis and prompt administration of appropriate therapy improve the survival. Materials and Methods: We prospectively carried out the study to identify the infectious etiology of pulmonary infiltrates in febrile neutropenia patients by imaging and bronchoscopy. Bacterial culture, fungal culture, galactomannan and molecular diagnosis for pneumocystis, and other infectious agent were carried out in the bronchoalveolar lavage (BAL) fluid and blood. Results: A total of 27 patients were evaluated. Half of the patients belonged to acute leukemia (46%). We had a diagnostic yield of 65% with the most common isolates being Gram-negative bacteria and Aspergillus species. Conclusion: Gram-negative organisms were the predominant infectious agents of pulmonary infection. Our finding emphasizes the importance of BAL in evaluating pulmonary infiltrates in neutropenic patients with hematological malignancies.
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Pattern of T-cell non-Hodgkin's lymphoma in a tertiary care center in North East India p. 391
Debanwita Mahanta, Jagannath Dev Sharma, Anupam Sarma, Lopamudra Kakoti, Amal Chandra Kataki, Shiraj Ahmed
Context: The non-Hodgkin's lymphomas (NHLs) are lymphoid neoplasms that arise primarily in the lymph nodes. They are classified into B-cell, T-cell, and natural killer cell types and are subtyped on the basis of morphologic and immunohistochemical studies. T-cell neoplasms are clonal tumors of mature and immature T-cells at various stages of differentiation. T-cell lymphoma is common in Asia compared to Europe and America. The pattern and prevalence of T-cell lymphoma in India are, however, different from that of other Asian countries. Aims: The main aim of this study is to analyze the prevalence and pattern of T-cell NHL in North East India, as less number of studies have been carried out in this part of the country. Settings and Design: A 5-year retrospective study (2012–2016) was carried out in our institute, which is a regional cancer center located in North East India. Materials and Methods: Five-year records of previously diagnosed cases were obtained, and then the hematoxylin- and eosin-stained sections and the immunohistochemistry slides were reviewed and studied. Results: A total number of 294 cases of NHL were reviewed in the study period. Seventy-one cases were found to be of T-cell NHL type which comprised 24% of the total NHL. Peripheral T-cell lymphoma not-otherwise specified (PTCL-NOS) (62%) was the most common followed by anaplastic large cell lymphoma (27%). T-lymphoblastic lymphoma (7%) was common in children and young adults. Conclusion: PTCL-(NOS) was found to be the most common T-cell lymphoma. Treatment of most of the cases was by chemotherapy using the cyclophosphamide, doxorubicin, vincristine, and prednisone regimen.
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Utility of neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, mean platelet volume–platelet count ratios: Diagnostic and prognostic markers in patients with hepatocellular carcinoma, prostate carcinoma, stomach carcinoma, and aplastic anemia p. 396
VS Srikanth, M Gopala Krishna Pillai, Cinzia Keechilot, Ashwin Rajkumar, Tushar Tatineni
Introduction: The purpose of the study is to study the potential role of neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and mean platelet volume (MPV)–platelet ratio as diagnostic and prognostic markers in patients with hepatocellular carcinoma (HCC), prostate cancer, stomach cancer, and aplastic anemia. Materials and Methods: We have conducted the present study by screening 208,486 patients who have got admitted during January 2013–June 2017 as in patients in our hospital. The data collected were analyzed for NLR, PLR, and MPV–platelet ratio. Inclusion Criteria: Patients admitted with a diagnosis of HCC, prostate cancer, stomach cancer, and aplastic anemia irrespective of the age and gender. Exclusion Criteria: Patients with multiple malignancies, the presence of secondary infection, and any source of sepsis. SPSS tool was used for statistical analysis. Results: Cost-effective predictive and prognostic biomarkers identified in the study are – NLR for liver cancer, prostate cancer, and stomach cancer; PLR for prostate and stomach cancer; MPV/plate ratio can be used in addition to NLR for liver cancer. These ratios were not significant in aplastic anemia. Conclusion: From our study, we conclude that NLR and PLR are better cost-effective predictor and prognostic markers of HCC, prostate cancer, and stomach cancer. These ratios can be used at the primary health-care level as it can be derived from a simple complete blood count/peripheral smear. Early identification of carcinoma is possible using these potential markers along with the respective clinical presentations and symptoms. These ratios will reduce the financial burden on the patients from rural and low socioeconomic background and will aid in better management of the disease process.
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MUC2 and MUC5AC expression in colon cancer: A preliminary report from South India p. 402
R Jayanth, H Devaraj, R Surendran, Mayank Jain, Jayanthi Venkataraman
Background: There is scanty data from India regarding MUC protein expression from colorectal cancers (CRC) among Indian patients. Aim of the Study: The aim of this study is to assess the alterations in the expression of MUC2 and MUC5AC in 25 patients with CRC by site of the tumor location and differentiation at histology. Materials and Methods: Patients with proven adenocarcinoma of the colon alone were included for the study. Biopsy specimens obtained from tumorous lesions in the colon were classified based on histopathology as well differentiated, moderately, and poorly differentiated adenocarcinoma. Immunohistochemistry was done in the 4 μm thick sections to identify the expression of MUC2 and MUC5AC mucins. Results: MUC2 was uniformly expressed with near similar intensity while MUC5 was moderately (56%) to highly expressed (36%) in mucinous tumors. In nonmucinous tumors, MUC2 was least expressed (68%) with a significant expression on MUC5AC (88%). Except for rectosigmoid growth which had greater expression of MUC5AC (31%), both proximal and distal carcinomas had significant MUC2 and MUC5AC expression. Conclusion: MUC2 and MUC5AC are expressed in colonic cancers, the former showing mildtomoderate expression and the latter moderatetointense expression. The expression is more in mucinous adenocarcinoma.
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Efficacy of a reduced-dose rasburicase: Single-institution experience in India p. 406
KC Lakshmaiah, K Govind Babu, LK Rajeev, D Loknatha, Linu Jacob Abraham, M C Suresh Babu, KN Lokesh, AH Rudresha, Ankit Agarwal
Background: Tumor lysis syndrome (TLS) is an oncological emergency associated with life-threatening metabolic abnormalities. Hyperuricemia is a feature of TLS and is treated with hydration, urine alkalinization, and allopurinol. Rasburicase lowers uric acid (UA) rapidly at the labeled dose of 0.15–0.2 mg/kg/day for 5 days. In a developing country like India where affordability is one major limitation to medical care, the use of rasburicase at the dose recommended by the US Food and Drug Administration (FDA) is not always possible. There is no convincing data suggesting the efficacy of a lower dose of rasburicase (1.5 mg or 3 mg) in the treatment of TLS. We conducted a retrospective study from January 2015 to June 2016 to assess the efficacy of a reduced-dose rasburicase in patients with TLS. Materials and Methods: All the patients with TLS were given rasburicase (single dose of 1.5 mg) on day 1 of chemotherapy. Serum UA, potassium, creatinine, and calcium levels were monitored every 24 h. All the patients who did not achieve normalization of UA with one dose of rasburicase were given another 1.5 mg of rasburicase. Results: Out of 90 patients, 54 patients (60%) had normalization of UA levels after 1.5 mg of rasburicase and 16 (18%) patients required 3 mg of rasburicase for bringing down the UA level to normal. The low serum UA levels were maintained even on the 3rd day of rasburicase. Rasburicase was well tolerated, and there was no death due to TLS. Thirty-one patients (64%) had normalization in the serum creatinine levels after rasburicase. Conclusion: We conclude that a low dose of rasburicase (1.5 mg or 3 mg) is cost effective in reducing serum UA (especially for low-risk and intermediate-risk TLS) and the higher dose as recommended by the US FDA is required only for patients with high-risk TLS.
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Wilm's tumor-collaborative approach is needed to prevent tumor upstaging and radiotherapy delays: A single institutional study p. 409
Shaqul Qamar Wani, Talib Khan, Saiful Yamin Wani, Mohammad Maqbool Lone, Fir Afroz
Context: Successful management of Wilm's tumor (WT) necessitates meticulous attention for proper staging and collaborative effort for its optimal management. Aims: The aim of the study was to observe the patterns of WT. Settings and Design: This study was a single-institutional retrospective study. Subjects and Methods: Twenty-three WT case records were analyzed over 6 years and the data collected were interpreted as number, percent, mean ± and standard deviation with regard to clinicodemographic aspects, staging, and diagnostic modality and treatment options. Results: Mean age was 3.97 ± 2.67 years with maximum number in the 2–5-year age group. Males slightly dominated the number, and majority cases were from the rural area. The major clinical presentation was abdominal mass followed by abdominal pain, fever, vomiting, hematuria, and urinary retention. Left laterality was common and single bilateral WT was seen. Majority of tumors were >10 cm in their largest dimensions. Most WT presented in Stage III followed by Stage I and IV. One was a recurrent tumor. Conclusion: WT was usually diagnosed at the locally advanced or metastatic stages; hence, the comprehensive collaborative approach will help to manage the patients optimally and avoid tumor upstaging and radiotherapy delays. Besides awareness at community level is needed to pick up the disease at the earlier stage to have a better outcome in the form of disease control and disease-free survival.
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Smokeless tobacco warnings in Indian mass media: Intention and attempts to quit p. 413
Zachary J Madewell, Claire A Kolaja
Introduction: In India, over 200 million people use smokeless tobacco (SLT), which increases the risk of cancers. Studies have demonstrated mass media campaigns effectively reduce smoking tobacco prevalence, but few have assessed their impact on SLT cessation. Objectives: This study used data from the Global Adult Tobacco Surveys (GATS) in 2009–2010 and 2016–2017 to examine associations between SLT health warnings in mass media, and intention and attempts to quit using SLT. We also compared the proportion of SLT users who noticed mass media warnings between 2009–2010 and 2016–2017. Materials and Methods: Over 16,000 and 15,000 current SLT users from the GATS-1 and GATS-2, respectively, were used for analysis. Weighted logistic regression models were used to analyze associations between noticed health warnings on SLT packages, newspapers/magazines, television, radio, billboards, cinemas, internet, vehicles, and walls, and intention and attempts to quit SLT. Results: In final models, the odds of intention and attempts to quit were highest among those who noticed warnings in newspapers/magazines (adjusted odds ratio [AOR]: 1.50; 95% confidence interval [CI]: 1.30–1.74) and the internet (AOR: 1.60; 95% CI: 1.12–2.29), respectively. Warnings on SLT packages, television, billboards, radio, vehicles, and walls were also associated with increased cessation behavior. More noticed warnings on SLT packages, television, billboards, and newspapers/magazines in GATS-2 than GATS-1, but fewer heard radio warnings. Conclusions: Among Indian SLT users, we found evidence that SLT warnings in mass media may promote cessation behavior. Health warnings in mass media could play an important role in the overall strategy to reduce the morbidity and mortality associated with SLT use.
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Overview and principles of scientific writing p. 420
Amrita Prayag
Scientific writing in English started in the 14th century. Human beings have been able to communicate for thousands of years. Yet scientific communication as it is today is relatively new. It was only 300 years ago that the first journals were published. Writing is the most vital means for communicating scientific work. It helps document and communicate ideas, activities and findings to others. Good writing can be beneficial to scientists in a number of ways. In this article we have discussed the basic overview and principles of scientific writing.
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High-dose methotrexate p. 424
Manikandan Dhanushkodi
High-dose methotrexate (HDMTX) is defined as methotrexate dose of ≥500 mg/m2. It is used in the treatment of acute lymphoblastic leukemia, osteosarcoma, and primary central nervous system lymphoma. Administration mandates adequate hydration; urine alkalinization; leucovorin rescue, monitoring of urine output, serum creatinine, and methotrexate levels. Delayed methotrexate clearance is managed by increasing hydration and leucovorin dose. Glucarpidase is the antidote for patients with renal toxicity. Studies from India have shown that HDMTX can be administered without monitoring of methotrexate levels with strict monitoring of urine pH, urine output, and serum creatinine and extended hydration and leucovorin doses.
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Hodgkin's lymphoma of the stomach: A rare entity p. 427
M C Suresh Babu, AG F Thottian, RK Sai, CS Premalata, Dasappa Lokanatha, LA Jacob, KN Lokesh, AH Rudresha, LK Rajeev, S Saldanha
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Origami in oncology: Coping with children p. 430
Nidhi Patni, Sanjeev Patni, Ajay Bapna, Lalitmohan Sharma, Upendra Sharma
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A man with pulmonary and bilateral adrenal lesions p. 432
Lokesh Kumar Rawat, Sunita Khandelwal, Hemant Dadhich
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Commentary on oncotype Dx p. 434
Prashant Mehta, Atul Batra, Amol Patel
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Pediatric primary pleural synovial sarcoma: A unique case report with brief review of literature p. 435
Anant Vatsayan, Ajay Gupta, Sharazad Saab, Agne Petrosiute
Synovial sarcoma (SS) primary to the pleura is an extremely rare tumor. So far, only nine cases have been reported in pediatric patients. However, none of these patients was found to have a conglomeration of tumors. Here, we report a case of 16-year-old female with monophasic SS and synchronous occurrence of left paraspinal ganglioneuroma and a right paraovarian cystadenoma. A next-generation sequencing genetic panel revealed a novel variant of unknown significance in the MET gene. The occurrence of multiple different tumors in a young patient with a novel genetic variant in a known oncogene (MET) may suggest a possibility of a hitherto unknown cancer predisposition syndrome. We also present a brief review of primary pleural SS reported in pediatric patients.
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Metaplastic carcinoma of breast: Case series with cytohistological correlation p. 440
Neelam Sood, Sanjay Gupta, Soin Navmeet
Metaplastic carcinoma of breast (MCB) is a rare breast malignancy. It is important to differentiate metaplastic carcinoma from malignant phyllodes and primary breast sarcomas because of their differing biological behavior and prognosis. We report four cases of MCB diagnosed over the past 15 years. Retrospective review of patient records in a tertiary care setting to retrieve cases diagnosed as MCB. Patient records of the past 15 years (2002–2015) were retrieved. Four histopathologically diagnosed cases of metaplastic carcinoma out of a total of 880 archived cases of breast carcinoma were studied along with their cytopathology. Immunohistochemistry was performed on sections. MCB comprised 0.45% of all breast malignancies. The four cases of MCB included MCB with chondroid metaplasia, spindle cell carcinoma, adenosquamous carcinoma, and carcinosarcoma. All the tumors were invariably triple negative (estrogen receptor, progesterone receptor, and Her2/Neu negative) and expression of other epithelial and mesenchymal markers was variable. MCB is a rare breast malignancy. Differential diagnosis is related to the presence of heterologous elements and degree of atypia seen in the lesion. It is important to be aware of this entity as it carries a poor prognosis.
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Occam's razor versus Hickam's dictum: An unusual cause of acute renal failure in pediatric solid malignancy p. 445
Deepam Pushpam, Abhishek Raj, Atul Batra, Sameer Bakhshi
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Transitional cell carcinoma of lacrimal sac presenting as a massive swelling and dacryohemorrhea p. 447
Abhishek Purkayastha, Neelam Sharma, Arvind Kumar Tyagi, Anushree Vartak, Pramod Solanki
Transitional cell carcinomas (TCCs) of lacrimal sac are extremely uncommon neoplasms with high degree of invasiveness, local recurrence, and distant metastasis despite an aggressive treatment. They generally present with epiphora and lacrimal mass lesion but rarely dacryohemorrhea or bloody tears. We hereby report a 50-year-old female who presented with complaints of epiphora, blood in tears, and a progressive swelling measuring 8 cm × 5 cm over left lacrimal sac site. Biopsy from the swelling revealed TCC of lacrimal sac. Radiographic imaging showed a localized mass lesion lacrimal sac eroding adjacent structures, left orbital extension, and left cervical lymphadenopathy without any intracranial extension or distant metastasis. She underwent wide local excision of the primary lesion with left orbital exenteration, left partial maxillectomy, left anterior ethmoidectomy, and left forehead flap reconstruction followed by adjuvant conformal radiotherapy to local site to a dose of 60 Gy and ipsilateral neck to 50 Gy. Combined modality therapy showed satisfactory cosmesis and overall improved functionality on her first review at 6 weeks, however she lost to further follow-up. A thorough review of literature reveals that our case may be one of the largest TCC of lacrimal sac ever reported and the third case to present with dacryohemorrhea in world literature till date.
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Retroperitoneal ganglioneuroblastoma presenting as chronic diarrhea and refractory hypokalemia in a child p. 451
Venkateswari Ramesh, Janani Sankar, Geetha Jayapathy, Mahitha Velusamy
Neuroblastoma is the most common extracranial solid tumor in children. Neuroblastoma presenting with diarrhea as the predominant symptom is rare and can be a diagnostic challenge to the paediatrician. We present a twenty months old child with Retroperitoneal Ganglioneuroblastoma who presented with chronic diarrhea and refractory hypokalemia. Tumor removal resulted in cessation of diarrhea and correction of hypokalemia.
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CD4+/CD8- T cell large granular lymphocytic leukemia: A rare entity p. 453
Ashish Gupta, Anurag Bansal, Alok Kumar
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Concurrent squamous-cell carcinoma esophagus and atypical carcinoid tumor: A rare case report and review of literature p. 456
Amitabh Kumar Upadhyay, Pankaj Goyal, Nidhi Gupta, Rakesh Kumar Gupta, Sandeep Kukkar
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