Oncology Journal of India

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Background: Lymph node yield (LNY), number of lymph nodes recovered after neck dissection has been identified as a prognostic indicator for several cancers of non-head and neck sites as well as head-and-neck squamous cell carcinoma (HNSCC). Accurate estimation of LNY has been less evaluated in Indian settings. The purpose of this study was to estimate LNY in HNSCC patients, and to find out their association with clinicopathological factors. Materials and Methods: This was a single-center prospective study conducted on patients diagnosed with HNSCC who had undergone neck dissection with or without primary surgery. Grossing of all surgical specimens was done by guidelines under the College of American Pathologists (November 2021). LNY with their association with other clinic-pathological parameters were analyzed using SPSS software version 21.0. Results: A total of 2692 lymph nodes yielded from 112 samples of neck dissection with the mean LNY of 24.02 ± 9.69. A total of 192 lymph nodes were found to be positive with the mean lymph node ratio of 0.07 ± 2.96. Modified radical neck dissection versus selective node dissection performed cases, poor differentiation of tumor, higher tumor stage, more tumor thickness, and positive nodes for metastasis of squamous cell carcinoma were factors that contributed to higher mean LNY over 24. Conclusions: In an Indian setting, the mean LNY for HNSCC patients undergoing lymph node dissection is 24.02 and the factors such as node positivity, tumor differentiation, tumor stage, and higher tumor thickness affect the estimation of LNY.

Background: Gallbladder cancer (GBC) has a high incidence rate in the Indo-Gangetic belt and is usually presented in the unresectable advanced or metastatic stage. In this study, we evaluated the response rate and toxicities of the gemcitabine plus capecitabine (GEM-CAP)-based combination chemotherapy in unresectable or metastatic GBC patients. Subjects and Methods: This was an investigator-initiated, single-arm, prospective study conducted on unresectable or metastatic GBC patients at Jaipur, India, for 1 year. All the patients received a GEM-CAP combination chemotherapy regimen which consisted of gemcitabine 1000 mg/m² intravenously over 30 min on days 1 and 8 and capecitabine at 800 mg/m² orally twice a day for 14 days, administered every 21 days. The response was evaluated in terms of overall response rate (ORR), tumor control rate (TCR), and progression-free survival (PFS). Both quantitative and qualitative toxicities were assessed. Results: A total of 35 patients were enrolled, of which 3 patients were excluded due to treatment interruption. The mean age of patients was 55 (32–80) years, with the majority being female (77.14%), having an ECOG score of 1 (71.43%), and with Stage IVB disease (77.14%). The ORR was 25%, TCR was 50%, and median PFS was 4 months. Major toxicities noted were Grade I and II hematological and nonhematological toxicities, which were managed adequately. Conclusion: The combination therapy of gemcitabine and capecitabine is reasonable, feasible, and well-tolerated approach for the treatment of unresectable advanced and metastatic GBC patients, a disease that had limited treatment options.

Objective: The aim of this study was to evaluate if addition of metoclopramide to the triplet antiemetic therapy is superior to the triplet antiemetic therapy for prevention of delayed chemotherapy-induced nausea and vomiting. Materials and Methods: A randomized single-blind trial was performed on 200 chemotherapy-naïve breast cancer patients who have to receive anthracycline-based highly emetogenic chemotherapy (HEC). The patients were randomized to study arm (n = 100) and control arm (n = 100). Triplet antiemetic therapy (fosaprepitant on day 1, 5-HT3 antagonist on day 1, and dexamethasone for days 1–4) was used in both the arms and metoclopramide (day 1–5) was added to the study arm. Response to antiemetic prophylaxis was assessed in terms of “complete response (CR),” “only nausea,” and “both nausea and vomiting.” CR is defined as no nausea, no vomiting, and no rescue medication during the overall phase (days 1–5). Nausea/vomiting was detected by using the Visual Analog Scale and its impact on quality of life was determined by using the Functional Living Index Emesis (FLIE) score. Results: The demographical and clinical features were similar in both the groups. Majority of patients in both the arms presented with Eastern Cooperative Oncology Group PS 0, Stage III, and positive hormone receptor status. CR was observed more in the study arm than that of the control arm (51% vs. 37%; P = 0.046). The mean total FLIE score was 29.23 in the study arm and 31.16 in the control arm (P = 0.036). Conclusion: This study resulted in a significant CR and clinically relevant improvement in FLIE score for addition of metoclopramide to triple antiemetic prophylaxis. Therefore, a quadruple antiemetic combination including metoclopramide might be an antiemetic prophylaxis option for breast cancer patients receiving anthracycline-based HEC for better compliance to treatment.

Primary pancreatic lymphoma is an extremely rare entity presenting 2.0% of extranodal malignant lymphomas and 0.5% of all pancreatic masses. We present the case of primary pancreatic Hodgkin's lymphoma in a 62-year-old male, who presented with right hypochondrial pain, nausea, vomiting, yellowish discoloration of skin and sclera, accompanied by generalized itching for 3 weeks without any significant loss of appetite and weight loss. Endoscopic ultrasound (EUS) showed a reddish bulge in the head of the pancreas due to the growth. EUS-guided biopsy revealed extensive infiltration by dyscohesive lymphoid cells with classic morphology of mononuclear Reed–Sternberg cells, in a background of lymphocytes and eosinophils. This rare report will be of significant diagnostic help to clinicians and pathologists in accurately diagnosing such cases as there is a high likelihood of misinterpreting these as pancreatic adenocarcinoma, which may impact patient management and survival.

Primary neuroendocrine tumors of the thymus (NETTs) are rare neoplasms and are biologically aggressive. These are more frequently seen in the third to fifth decade of life. Endocrinopathies such as Cushing's syndrome, acromegaly, or multiple endocrine neoplasia-1 are associated in 50% of cases. These tumors usually present with the invasion of surrounding mediastinal structures. The long-term outcome of NETT is poor due to high risk of recurrence or metastasis. Prognosis depends on the stage, invasion, resection, and possible association of endocrinopathies. We present this case of a 17-year-old male clinically diagnosed as Cushing's syndrome with hypothyroidism, without adrenal mass but with anterior mediastinal mass, and it histologically turned out to be carcinoid of the thymus. Although thymic carcinoids are known to present with Cushing's syndrome, we have not come across with its association of hypothyroidism. Total thymectomy was performed for the case. The patient is on regular follow-up for the past 3 years, he is totally asymptomatic and not on any medication.

Online since 19^th May, 2017