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2015| July-September | Volume 36 | Issue 3
Online since
October 7, 2015
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REVIEW ARTICLE
Neoadjuvant chemotherapy in oral cancers: Selecting the right patients
S Vishak, Bharath Rangarajan, Vikram D Kekatpure
July-September 2015, 36(3):148-153
DOI
:10.4103/0971-5851.166716
PMID
:26855522
The standard of care treatment for oral squamous cell carcinoma (OSCC) at present, consist of surgical resection followed by adjuvant radiotherapy and chemotherapy as indicated. Despite recent advances the overall prognosis remains guarded. Role of neoadjuvant chemotherapy is being explored with premise of reducing extent of surgical resection, improving loco-regional control and decreasing distant metastasis, thereby improving treatment outcomes by decreasing mortality and morbidity. However, indications of neoadjuvant chemotherapy in oral cancers are not clearly defined. Majority of studies have failed to demonstrate a significant benefit of neoadjuvant chemotherapy in terms of loco regional control and overall survival in resectable OSCC. In a select subset of patients with locally very advanced and unresectable OSCC, neoadjuvant chemotherapy has been shown to cause tumor shrinkage and improve resectability. These hypothesis generating findings of reduction in distant metastasis, improved resectability and functional outcome, however need further validation. In summary, the role of neoadjuvant chemotherapy for OSCC remains investigational and has a limited role outside clinical trial.
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POSITION PAPER
Indian Council of Medical Research consensus document for the management of tongue cancer
Anil K D'Cruz, Shilpi Sharma, Jaiprakash P Agarwal, Alok Thakar, Ashraf Teli, Supreeta Arya, Chirag Desai, Pankaj Chaturvedi, Paul Sebastian, Bipin T Verghese, Shubhada Kane, V Sucharita, Tanvir Kaur, DK Shukla, Goura Kishor Rath
July-September 2015, 36(3):140-145
DOI
:10.4103/0971-5851.166712
PMID
:26855520
The document is based on consensus among the experts and best available evidence pertaining to Indian population and is meant for practice in India.
Early diagnosis is imperative in improving outcomes and preserving quality of life. High index of suspicion is to be maintained for leukoplakia (high risk site).
Evaluation of a patient with newly diagnosed tongue cancer should include essential tests: Magnetic resonance imaging (MRI) is investigative modality of choice when indicated. Computed tomography (CT) scan is an option when MRI is unavailable. In early lesions when imaging is not warranted ultrasound may help guide management of the neck.
Early stage cancers (stage I & II) require single modality treatment - either surgery or radiotherapy. Surgery is preferred. Adjuvant radiotherapy is indicated for T3/T4 cancers, presence of high risk features [lymphovascular emboli (LVE), perineural invasion (PNI), poorly differentiated, node +,close margins). Adjuvant chemoradiation (CTRT) is indicated for positive margins and extranodal disease.
Locally advanced operable cancers (stage III & IVA) require combined multimodality treatment - surgery + adjuvant treatment. Adjuvant treatment is indicated in all and in the presence of high risk features as described above.
Locally advanced inoperable cancers (stage IVB) are treated with palliative chemo-radiotherapy, chemotherapy, radiotherapy, or symptomatic treatment depending upon the performance status. Select cases may be considered for neoadjuvant chemotherapy followed by surgical salvage.
Metastatic disease (stage IVC) should be treated with a goal for palliation. Chemotherapy may be offered to patients with good performance status. Local treatment in the form of radiotherapy may be added for palliation of symptoms.
Intense follow-up every 3 months is required for initial 2 years as most recurrences occur in the first 24 months. After 2
nd
year follow up is done at 4-6 months interval. At each follow up screening for local/ regional recurrence and second primary is done. Imaging is done only when indicated.
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ORIGINAL ARTICLES
Epidemiological review of laryngeal cancer: An Indian perspective
Saurabh Bobdey, Aanchal Jain, Ganesh Balasubramanium
July-September 2015, 36(3):154-160
DOI
:10.4103/0971-5851.166721
PMID
:26855523
Background:
Laryngeal cancer is one of the 10 leading causes of cancer in Indian men. The association of laryngeal cancer and tobacco smoking is well-established, but the peculiarities such as wide variation of disease distribution and survival, role of tobacco chewing, indoor air pollution, and dietary factors in laryngeal cancer causation needs to be understood. In this study, we review the descriptive and observational epidemiology of laryngeal cancer in India.
Materials and Methods:
MEDLINE and Web of science electronic database was searched from January 1995 to December 2013, using the using keywords "laryngeal cancer, laryngeal cancer outcome, epidemiology, etiological factor and their corresponding Mesh terms were used in combination like OR, AND." Two authors independently selected studies published in English and conducted in India. A total of 15 studies were found to be relevant and eligible for this review.
Results:
In India, laryngeal cancer contributes to approximately 3-6% of all cancers in men. The age-adjusted incidence rate of cancer larynx in males varies widely among registries, highest is 8.18 per 100,000 in Kamprup Urban District and the lowest is 1.26 per 100,000 in Nagaland. The 5-year survival for laryngeal cancer in India is approximately 28%. Indian studies show tobacco, alcohol, long-term exposure to indoor air pollution, spicy food, and nonvegetarian diet as risk factors for laryngeal cancer.
Conclusion:
There is wide regional variation in the incidence of laryngeal cancer in India. Survival rates of laryngeal carcinoma are much lower as compared to other Asian countries. Studies conducted in India to identify important risk factors of laryngeal cancer are very limited, especially on diet and indoor air pollution. Hence, more research is required for identifying the etiological factors and development of scientifically sound laryngeal cancer prevention programs.
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EDITORIAL COMMENTARY
Commentary on Elective versus therapeutic neck dissection in node-negative oral cancer
Moni Abraham Kuriakose
July-September 2015, 36(3):137-139
DOI
:10.4103/0971-5851.166675
PMID
:26855519
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ORIGINAL ARTICLES
Smokeless tobacco use in Urban Indian women: Prevalence and predictors
Gauravi A Mishra, Sheetal V Kulkarni, Subhadra D Gupta, Surendra S Shastri
July-September 2015, 36(3):176-182
DOI
:10.4103/0971-5851.166739
PMID
:26681842
Context:
India is the second largest consumer of tobacco. Tobacco consumption in nonsmoking forms is culturally accepted even among women.
Aims:
This study aimed at understanding the patterns and predictors of smokeless tobacco (SLT) use among the urban low-socioeconomic women in Mumbai, India.
Materials and Methods:
This is a cross-sectional community-based survey of tobacco usage among women residing in seven low-socioeconomic communities in suburbs of Mumbai, India. Staff for the study was recruited, trained, clusters selected, accurately mapped, households identified, meetings held with community leaders, and household surveys conducted. Women using tobacco were invited to participate in the detailed survey and interviewed to document the various sociodemographic factors and in depth information on tobacco use. The data were computerized and analyzed.
Results:
About 22.30% of the total female population consumed tobacco, mainly in the smokeless forms, with only 0.50% of the tobacco users using smoked tobacco. Masheri was the most common form of tobacco used, followed by chewing tobacco. The median frequency of use of different tobacco products varied from 2 to 4 per day. The mean age at initiation of tobacco was 26.23 years. According to the results of univariate and multivariate logistic regression analysis, illiterate women, with advancing age, belonging to Hindu, Muslim, or Buddhist communities, who were either manual laborers or housewives, divorced or separated, and speaking Marathi were at higher risk of being tobacco user.
Conclusion:
Patterns and predictors of SLT use among women have been identified in the present study. This will guide in planning prevention and control strategies.
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Metronomic chemotherapy in platinum-insensitive failures and/or early failures postmultimodality management in oral cancers
Vijay M Patil, Vanita Noronha, Amit Joshi, Rakesh Pinninti, Sachin Dhumal, Atanu Bhattacharjee, Kumar Prabhash
July-September 2015, 36(3):161-165
DOI
:10.4103/0971-5851.166725
PMID
:26855524
Purpose:
Oral cancer patients with platinum-resistant disease and or early failures have limited treatment options. This analysis was planned to study the efficacy of metronomic chemotherapy in this group of patients.
Materials and Methods:
This was a retrospective analysis of oral cancer patients who had squamous cell carcinoma and had an early failure and/or platinum-insensitive failure. Early failure was defined as a failure either within 1-month of adjuvant radiotherapy or within 6 months of chemoradiation (CTRT). A sample size of 100 patients was selected for this study. If ≥39 of 100 patients would have survived at 6 months with metronomic chemotherapy, then additional studies would be warranted.
Results:
The ECOG PS was 0-1 in 92 patients and 2 in 8 patients. The subsite of primary was buccal mucosa in 38 patients (38%), anterior two-third tongue (oral tongue) in 51 patients (51%), and alveolus in 11 patients (11%). The median estimated overall survival was 110 days (95% confidence interval [CI]: 85-134 days). The proportion of patients surviving at 6 months was 26.4% (95% CI: 17.9-35.6).
Conclusion:
Metronomic combination of methotrexate and celecoxib failed to meet its prespecified efficacy limit and should not be used in these patients as routine.
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CONFERENCE REVIEW
Breast and gastrointestinal cancer updates from ASCO 2015
Shaheenah Dawood
July-September 2015, 36(3):189-192
DOI
:10.4103/0971-5851.166757
PMID
:26855529
This review focuses on the updates presented at the ASCO 2015 symposium in breast and gastrointestinal malignancies. Some were practice changing while others gave us an exciting glimpse into what's to come in the very near future. Immunotherapy was the buzz word this year with data presented on every tumor site. Data on the efficacy of anti PD-1 agents in colorectal, hepatocellular and gastric cancer were presented. In breast cancer we saw data on a new and exciting therapeutic target in the form of androgen receptor among triple receptor negative breast tumors presented. Positive results of the PALOMA 3 trial were presented that has given women with hormone receptor positive metastatic breast cancer another therapeutic option. Furthermore data on strategies to further improve anti her2 therapy, optimizing of chemotherapy in the early and advanced stage and various strategies to improve endocrine therapy among patients with breast cancer were presented.
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ORIGINAL ARTICLES
Adenoid cystic carcinoma of head and neck: A single institutional analysis of 66 patients treated with multi-modality approach
Ajeet Kumar Gandhi, Soumyajit Roy, Ahitagni Biswas, Suman Bhasker, Atul Sharma, Alok Thakar, Bidhu Kalyan Mohanti
July-September 2015, 36(3):166-171
DOI
:10.4103/0971-5851.166729
PMID
:26855525
Background:
Adenoid cystic carcinoma (ACC) accounts for 1% of all head and neck (HN) cancers.
Materials and Methods:
Demographic, clinical, treatment, and survival details of 66 patients were collected (1995-2011) and analyzed. Disease-free survival (DFS) was estimated by Kaplan-Meier method.
Results:
Primary disease sites were sinonasal (
n
= 27), salivary gland (
n
= 30), and others (
n
= 9). Median follow-up was 23 months (range: 12-211 months). Estimated DFS at 2- and 5-year were 75% and 67.2%, respectively. On univariate analysis, intra-cranial extension (ICE) (hazard ratio [HR]: 3.59,
P
= 0.0071), lymph node involvement (HR: 4.05,
P
= 0.0065), treatment modality (others vs. surgery plus adjuvant radiotherapy, HR: 2.39,
P
= 0.0286) and T stage (T3/4 vs. T1/2, HR: 3.27,
P
= 0.007) had significant impact on DFS. Lymph node involvement (
P
= 0.038) and ICE (
P
= 0.038) continued to have significant impact on DFS on multivariate analysis.
Conclusion:
Surgery followed by adjuvant radiotherapy remains the treatment of choice for HN ACC. Lymph node involvement and ICE confer poor prognosis.
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COMMENTS AND CONTROVERSY
Clinical trials in oncology: Has India come of age?
Subhash Desai, Abhishek Mahajan
July-September 2015, 36(3):146-147
DOI
:10.4103/0971-5851.166714
PMID
:26855521
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ORIGINAL ARTICLES
Neoadjuvant chemotherapy in technically unresectable carcinoma of external auditory canal
Amit Joshi, Nidhi Tandon, Vanita Noronha, Sachin Dhumal, Vijay Patil, Supreeta Arya, Shashikant Juvekar, Jaiprakash Agarwal, Anil DCruz, Prathmesh Pai, Kumar Prabhash
July-September 2015, 36(3):172-175
DOI
:10.4103/0971-5851.166734
PMID
:26855526
Background:
Carcinoma of external auditory canal (EAC) is a very rare malignancy with surgical resection as the main modality of treatment. The outcomes with nonsurgical modalities are very dismal. We present a retrospective analysis of 4 patients evaluating the role of neoadjuvant chemotherapy in technically unresectable cancers.
Materials
and
Methods:
This is a retrospective analysis of 4 patients from our institute from 2010 to 2014 with carcinoma EAC who were deemed unfit for surgery due to extensive disease involving occipital bone with soft tissue infiltration (
n
= 2), temporal dura (
n
= 1), left temporal lobe, and extensive soft tissue involvement (
n
= 1). All these patients received neoadjuvant chemotherapy with docetaxel, cisplatin and 5 fluorouracil (
n
= 3) and paclitaxel and cisplatin (
n
= 1).
Results:
Response evaluation showed a partial response (PR) in 3 and stable disease (SD) in 1 patient by Response Evaluation Criteria in Solid Tumors criteria. All 3 patients who received 3 drug chemotherapy had PR while 1 patient who received 2 drug chemotherapy had SD. Two of these patients underwent surgery, and other 2 underwent definitive chemoradiation. One of 3 patients who achieved PR underwent surgical resection; the other 2 remained unresectable in view of the persistent intradural extension and infratemporal fossa involvement. One patient who had SD could undergo surgery in view of clearance of infraatemporal fossa. Recent follow-up shows that 3 out of these 4 patients are alive.
Conclusion:
This indicates that there may be a role of induction chemotherapy in converting potentially unresectable tumors to resectable disease that could produce better outcomes in carcinoma EAC.
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Clinicopathological pattern of cranial unifocal Langerhans cell histiocytosis: A study at medical college hospital
Salma Bhat, Parvez Nazir, Humaira Bashir, Ruby Reshi, Sheema Sheikh, Rohi Wani
July-September 2015, 36(3):183-185
DOI
:10.4103/0971-5851.166744
PMID
:26855527
Background:
Eosinophilic granuloma (EG) of bone refers to a generally benign form of Langerhans cell histiocytosis localized to the bone. Patients may present with a solitary lesion (monostotic) or multiple sites of involvement (polyostotic).
Materials and Methods:
This study was done to evaluate the clinicopathological pattern of 6 cases of EGs of the skull diagnosed at a tertiary care hospital. All patients of EG were included with the help of medical records over a 5-year period that is, November 2009 to November 2014. They all had been preoperatively evaluated by skull X-ray and computed tomography. To rule out a multifocal disease scintigraphy was performed in all cases preoperatively. Surgical excision was performed, and EG was diagnosed on histopathology and immunohistochemistry.
Results:
There was a male predominance. Parietal bone was the most common affected bone. Total excision of the lesion was performed in all cases. No patient received postoperative radiotherapy. The follow-up period ranged from 6 months to 3 years. No tumor recurrence was noted.
Conclusion:
With an unknown etiology, nonspecific clinical and radiological findings with diagnosis possible only on histopathological examination, EG needs to be considered in the differential diagnosis as a skull mass, especially in children.
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INDIA’S FIGHT AGAINST CANCER
Institutional external peer review: A unique National Cancer Grid initiative
D Raghunadharao, Ravi Kannan, Chitra Hingnekar, DK Vijaykumar, CS Mani, Sarbani Ghosh-Laskar, Sumeet Gujral, Suresh Chaudhari, Sukdev Nayak, Rajesh Dikshit, Rajendra A Badwe, CS Pramesh, on behalf of the National Cancer Grid
July-September 2015, 36(3):186-188
DOI
:10.4103/0971-5851.166753
PMID
:26855528
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IMAGES IN ONCOLOGY
Juxtaoral organ of Chievitz: A histopathological masquerade
Vijay Wadhwan, Arvind Venkatesh, Pooja Aggarwal, Vandana Reddy, Preeti Sharma
July-September 2015, 36(3):193-193
DOI
:10.4103/0971-5851.166762
PMID
:26855530
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903
169
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Giant mediastinal carcinoid
Sabita Jiwnani, George Karimundackal, CS Pramesh
July-September 2015, 36(3):194-194
DOI
:10.4103/0971-5851.166764
PMID
:26855531
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645
131
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© Indian Journal of Medical and Paediatric Oncology | Published by Wolters Kluwer -
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Online since 1
st
June, 2009