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   Table of Contents - Current issue
January-April 2022
Volume 6 | Issue 1
Page Nos. 1-35

Online since Wednesday, April 20, 2022

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Extraosseous ewing sarcoma: Experience from a tertiary cancer institute in South India p. 1
Ram Krishna Sai, KN Lokesh, Lokanatha Dasappa, M C Suresh Babu, LK Rajeev, Linu Abraham Jacob
Background: Extraosseous Ewing sarcoma (EOES) is the rare soft-tissue counterpart of Ewing sarcoma (ES) of bone. However, studies on clinical behavior and outcome of EOES are scarce. In this retrospective study, we described the pattern of clinicodemographic characteristics, treatment, and outcomes of EOES and explored predictors of outcomes. Materials and Methods: A total of 46 diagnosed EOES patients were treated at our institute from September 2017 to January 2020. The detailed data were retrieved from hospital records and were analyzed. Progression-free survival (PFS) was estimated by the method of Kaplan and Meier curve. Comparison of different parameters for PFS was calculated by using log-rank test. Results: The mean age at diagnosis was 29.6 years with a male-to-female ratio of 1.4:1. The most common primary site of location for EOES was lower limb (n = 14), followed by retroperitoneum (n = 13) and trunk (n = 10). Seven (15.2%) patients presented with upfront metastasis and the rest 39 cases were nonmetastatic. Treatment outcome was evaluated in 43 patients (38 nonmetastatic and 5 metastatic) in terms of median PFS (mPFS). Extremity EOES in comparison to nonextremity (axial) EOES (P = 0.030) and localized versus upfront metastatic EOES (P = 0.001) had better mPFS. The localized EOES patients who received surgical treatment approach had higher mPFS than those who received nonsurgical treatment (18 months versus 14 months; P = 0.009). EOES patients with subcutaneous (SC) lesions had a trend of higher mPFS than other patients (19 months versus 15 months; P = 0.055). We did not find any difference in mPFS for gender and size of the tumor at presentation. Conclusions: Lower limb and retroperitoneum are the common primary sites of presentation for EOES. EOES patients with extremity location, SC lesion in comparison to deeper presentation, upfront nonmetastatic, and those receiving surgical treatment approach performed better.
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Combined peripheral neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as a predictive biomarker for pathological complete response after neoadjuvant chemotherapy in triple-negative breast cancer patients p. 8
Pooja Babbar, AH Rudresha, Lokanatha Dasappa, Linu Jacob Abraham, M C Suresh Babu, KN Lokesh, LK Rajeev, Smitha C Saldanha, GH Abhilash, Amit Pandey
Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have recently been used as prognostic markers in several tumors particularly more studied in gastrointestinal cancers. Impact of these markers on breast cancer is less studied. We evaluated the correlation of pretreatment NLR and PLR with pathological complete response (pCR) rate to neoadjuvant chemotherapy (NACT) treatment in triple-negative breast cancer (TNBC) patients in addition to analyze the association of these parameters with other clinicopathological parameters. Materials and Methods: Seventy-four early or locally advanced TNBC patients who received NACT and subsequent breast surgery from January 2018 to December 2020 were analyzed. Complete blood profiles done within 1 week of start of NACT were recorded and NLR and PLR were calculated. Pathological responses to NACT after surgery were recorded. The correlation of NLR and PLR with pCR rate and other clinicopathological parameters were evaluated. Results: The median age of presentation was 47 years. Eighteen patients (24.3%) had achieved pCR in this study. The pCR rate was higher in patients with low pre-treatment NLR (≤2.2) versus high NLR (>2.2) (P = 0.038) and low pre-treatment PLR (≤195.8) versus high PLR (>195.8) (P = 0.039). Both the pretreatment NLR and PLR values had no significant association with other clinicopathological profiles such as age, menopausal status, histopathological types and grade of differentiation, and initial clinical stage whereas there is an increase trend of ≤50 years of age group presentation in low NLR/PLR patients. On multivariate analysis, pre-NACT NLR and PLR were found to be independent predictive biomarker for pCR in TNBC patients. Conclusion: The study observed that the pre-NACT NLR and PLR are an indicator of pCR to NACT in TNBC unfolding its potential in future as a cost-effective prognostic and predictive biomarker.
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Axitinib in management of renal cell carcinoma: Indian perspective p. 14
Sagar Bhimrao Bhagat, Amit Y Jadhav, Saiprasad V Patil, Hanmant Venkatrao Barkate
Background: Renal cell carcinoma (RCC) is the most common type of kidney cancer. Despite the availability of several tyrosine kinase inhibitors (TKI) and immunotherapies in India, the placing and sequencing of molecules in the management of RCC remains a source of dispute. The purpose of this qualitative survey was to get insight on the positioning of TKIs, specifically Axitinib, in the treatment of RCC. Methodology: This was a cross-sectional, questionnaire-based survey conducted across India among Medical Oncologist involved in the management of metastatic RCC. The questionnaire consists of 15 questions that were validated by a senior oncologist. The responses to the question were compiled in Microsoft Excel version 2018 and analyzed. Results: Total 51 oncologists completed this questionnaire. Majority preferred the International Metastatic RCC Database consortium risk stratification criteria. In favourable risk category sunitinib was preferred while in intermediate/poor risk patient's axitinib plus pembrolizumab was preferred by majority. Pazopanib and axitinib was favoured in patients with advanced age and comorbidities. Axitinib was the choice in patients who had good response to 1st line therapy and who have visceral metastasis. Majority of oncologists endorsed the use of axitinib in elderly with comorbid patients because of its favourable efficacy and tolerability. Conclusion: Axitinib is preferred choice in metastatic RCC patients who have responded well to TKIs in the first line, in elderly patients with associated comorbidities, in patients with renal impairment and in patients with poor performance status. It is a well-tolerated drug with minimal adverse effects which are transient in nature.
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Effectiveness of posters in enhancement of knowledge about cancer among outpatients and caregivers: A quasi-experimental study p. 20
Sadhana Sudhir Kulkarni, Bhavna Pramod Joshi, Prabha Pandurang Nayak, Vasanti Prabhakar Kelkar
Introduction: Noncommunicable diseases are posing serious public health threats in developed as well as developing countries. Cancer has become one of the leading health problems. The lack of knowledge about cancer in the general public is a major hurdle in its prevention, early detection, and treatment. Out of various media, display of posters is a simple and cost-effective way of mass education. Hence, the effectiveness of posters in imparting knowledge regarding cancer needs to be evaluated. Materials and Methods: After ethical clearance, a quasi-experimental study was undertaken among 314 outpatients and caregivers in waiting area of outpatient department of a tertiary health-care institute. Individuals aged 18 years and above, who could read, write, and understand Marathi language, participated in the study. Written informed consent was obtained. Each of the participants was asked to fill a pretested, structured questionnaire before their entry into display area of posters. Self-paced observation of posters was allowed, after which posttest questionnaire was administered. Totally 255 completely filled forms were considered for analysis. Data were analyzed using SPSS v25.0, and Chi-square values were calculated. Results: Of the 255 participants, 175 (68.6%) were males and 80 (31.3%) were females. The number of correct responses marked increased in posttest as compared to pretest for all 13 items. The difference was found to be statistically highly significant (P ≤ 0.0001) for 9 and significant (P = 0.012, 0.005) for 2 of the total 13 items in the questionnaire. Conclusions: This study provides evidence that posters can be used as an effective tool for health communication regarding cancer among outpatients and caregivers in outpatient department.
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Giant clear cell renal cell carcinoma: An extremely rare and surgically challenging tumor p. 25
Prem Kumar, Deepak Kumar Gupta, Pankaj Kumar, Somesh Janoria, Pranjal Prem
Renal cell carcinoma is the most common renal cancer occurring in the sixth and seventh decades of life. Most of the renal cell carcinomas are detected incidentally at an early stage. It is rare to find a giant renal cell carcinoma. Most of the giant renal cell carcinomas reported were of chromophobe or sarcomatoid variety. Giant renal clear cell carcinoma is extremely rare. In this case report, we are presenting the largest giant renal clear cell carcinoma ever reported from the Indian subcontinent.
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ROS1 rearranged pulmonary sarcomatoid carcinoma: A rare clinical presentation p. 28
H J Gayathri Devi, AS Arjun, Vinayak Maka
Pulmonary sarcomatoid carcinoma (PSC) is a rare type of non-small cell lung cancer which contains poorly differentiated cells and sarcoma or sarcomatoid components (spindle and/or giant cells). Most of the cases are peripherally located and usually present as a large lung mass. We report a case of PSC in a 42-year-old male with massive pleural effusion as initial presentation. Therapeutic pleurocentesis showed exudative lymphocyte predominant pleural fluid. The diagnosis of PSC could be arrived at with medical thoracoscopy, biopsy and immunohistochemical staining. The next generation sequencing assay of gene panel revealed ROS1 positive status. The patient responded well to crizotinib, till the last follow-up of 21 months from the start of treatment.
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Primary small-cell neuroendocrine carcinoma of the gallbladder with bone metastasis: A rare presentation p. 32
Abhishek Anand, Mohammad Ali, Sumaira Qayoom, Geeta Singh
Primary small-cell neuroendocrine carcinomas (NEC) of the gallbladder (GB) are rare with aggressive behavior. It has high malignancy potential with a low survival rate. In this case report, we present a case of primary small-cell NEC of GB in a 43-year-old female who presented with complaints of constipation, upper abdominal pain, and poor oral intake which was identified as a GB mass with liver nodularity on ultrasonography. It was subsequently diagnosed as a case of primary small-cell NEC of GB with liver and bone metastasis on contrast-enhanced computed tomography and core needle biopsy obtained from the left iliac bone. In view of severe jaundice, endoscopic retrograde cholangiopancreatography dilatation and stenting was done followed by palliative chemotherapy and radiotherapy. This case is unique in presenting with liver and bone metastases both instead of only liver metastasis as is commonly seen. Moreover, a sample for histopathological diagnosis was also obtained from a bony site rather than the liver as is the norm.
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Erratum: Bacterial vaginosis and its association with human papilloma virus and increased risk of cervical intraepithelial lesions: An experience from Eastern India p. 35

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