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July-September 2016
Volume 12 | Issue 3
Page Nos. 1107-1213

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EDITORIAL  

Big data in radiation oncology Highly accessed article p. 1107
Nagraj Huilgol
DOI:10.4103/0973-1482.194598  PMID:28054518
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REVIEW ARTICLES Top

Radioiodine as an adjuvant therapy and its role in follow-up of differentiated thyroid cancer Highly accessed article p. 1109
S Padma, P Shanmuga Sundaram
DOI:10.4103/0973-1482.163677  PMID:28054519
Papillary and follicular cancers of thyroid are the most common varieties of differentiated thyroid cancers exhibiting excellent long-term prognosis when carefully managed. Being a slow-growing malignancy, guidelines exist on the staging, preoperative risk stratification, and management of these cancers to increase the overall survival of these patients. Radioactive iodine has a central role in differentiated thyroid malignancies. It has the same physical properties as stable iodine, thus both normal and malignant thyrocytes cannot differentiate radioactive from stable iodine. Differentiated thyroid carcinoma (DTC) cells concentrate cytocidal amounts of Iodine -131 (131 I) by trapping (the function of the sodium iodine symporter, or NIS) and organifying the iodide ion to produce levothyroxine and triiodothyronine. We shall discuss the role of radioiodine in the management and followup of DTC patients.
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Management of the neck in early oral cancers: Is the verdict out? p. 1114
Vishal U. S. Rao, Prashant H Patil, BV Rajaram
DOI:10.4103/0973-1482.164705  PMID:28054520
The management of patients with the clinically negative neck (N0) in early oral cancers awaits a clear mandate despite growing evidence favoring elective neck dissection. Having a general policy of operating all N0 neck may indeed increase the number of unnecessary neck dissection in the true pathological N0 necks, a more commonly encountered scenario. This controversy needs to be looked beyond statistical evidence to address a larger question to “does the neck truly harbor disease,” thus, refining the early age old debate. This article highlights the feasibility of wait and watch policy, while elaborating a stringent algorithm to judiciously select patients in whom the neck may be safely observed.
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ORIGINAL ARTICLES Top

Samarium-153-(4-[((bis (phosphonomethyl)) carbamoyl) methyl]-7,10-bis (carboxymethyl)-1,4,7,10-tetraazacyclododec-1-yl) acetic acid: A novel agent for bone pain palliation therapy p. 1117
Hassan Yousefnia, Razieh Enayati, Mohammad Hosntalab, Samaneh Zolghadri, Ali Bahrami-Samani
DOI:10.4103/0973-1482.197534  PMID:28054521
Aim: Various phosphonate ligands labeled with β-emitting radionuclides have shown good efficacy for bone pain palliation. In this study, a new agent for bone pain palliation has been developed. Materials and Methods: Samarium-153-(4-[((bis(phosphonomethyl))carbamoyl)methyl]-7,10-bis (carboxymethyl)-1,4,7,10-tetraazacyclododec-1-yl) acetic acid (153Sm-BPAMD) complex was prepared using BPAMD ligand and samarium-153 chloride. The effect of various parameters on the labeling yield of 153Sm-BPAMD including ligand concentration, pH, temperature, and reaction time were studied. Production of 153Sm was performed at a research reactor using 152Sm (n, γ)153Sm nuclear reaction. The radiochemical purity of the radiolabeled complex was checked by instant thin layer chromatography. Stability studies of the complex in the final preparation and the presence of human serum were performed up to 48 h. Partition coefficient and hydroxyapatite (HA) binding of the complex were investigated and biodistribution studies using single photon emission computed tomography (SPECT) and scarification were performed after injection of the complex to wild-type mice. Results: 153Sm-BPAMD was prepared in a high radiochemical purity >98% and specific activity of 267 GBq/mmol at the optimal conditions. The complex demonstrated significant stability at the room temperature and in human serum at least for 48 h. HA binding assay demonstrated that at the amount of more than 5 mg, approximately, all radiolabeled complex was bind to HA. At the pH 7.4, log Po/w was − 1.86 ± 0.02. Both SPECT and scarification showed major accumulation of the labeled compound in the bone tissue. Conclusions: The results show that 153Sm-BPAMD has interesting characteristics as an agent for bone pain palliation, however, further biological studies in other mammals are still needed.
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Clinicopathological correlation of skin tumors: A dermatologist's perspective p. 1124
Namitha Chathra, Ramesh Bhat
DOI:10.4103/0973-1482.194601  PMID:28054522
Background: Tumors of the skin may be encountered by a dermatologist either as presenting complaints or as incidental findings. Certain tumors are easily recognized clinically, while others can only be diagnosed by histopathology. Aims and Objectives: To analyze the pattern of skin tumors through clinical and histopathological correlation and to assess the role of a dermatologist in the treatment of tumors. Materials and Methods: A retrospective analysis of histopathologically-diagnosed skin tumors seen in dermatology outpatient department from May 2011 to June 2013. Results: Forty cases of skin tumors were histopathologically reported during the period under review. Out of this, nine cases were malignant, the nonmelanoma to melanoma ratio being 8:1. Conclusion: Dermatologists are recommended to monitor closely the changing pigmented or hyperkeratotic lesions and poorly healing ulcers to facilitate early diagnosis and effective management.
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Efficacy of icotinib versus traditional chemotherapy as first-line treatment for preventing brain metastasis from advanced lung adenocarcinoma in patients with epidermal growth factor receptor-sensitive mutation p. 1127
Xiao Zhao, Guangqin Zhu, Huoming Chen, Ping Yang, Fang Li, Nan Du
DOI:10.4103/0973-1482.194599  PMID:28054523
Objective: This study aimed to investigate the potential use of icotinib as first-line treatment to prevent brain metastasis from advanced lung adenocarcinoma. Materials and Methods: This investigation was designed as a retrospective nonrandomized controlled study. Enrolled patients received either icotinib or traditional chemotherapy as their first-line treatment. The therapeutic efficacy was compared among patients with advanced. (stages IIIB and IV) lung adenocarcinoma with epidermal growth factor receptor (EGFR)-sensitive mutation. The primary endpoint was the cumulative incidence of brain metastasis, whereas, the secondary endpoint was overall survival(OS). Death without brain metastasis was considered a competitive risk to calculate the cumulative risk of brain metastasis. Survival analysis was conducted using the Kaplan–Meier method and statistical significance was determined using the log-rank test. Results: The present study included 396 patients with 131 in the icotinib group and 265 in the chemotherapy group. Among those with EGFR-sensitive mutation, the cumulative risk of brain metastasis was lower in the icotinib group than in the chemotherapy group. However, no significant difference in OS was observed between the two groups. Conclusion: Icotinib can effectively reduce the incidence of brain metastasis and therefore improve prognosis in advanced lung adenocarcinoma patients with EGFR.sensitive mutation.
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Nanothermia: A heterogenic heating approach p. 1132
Szasz Oliver, Szasz Andras
DOI:10.4103/0973-1482.197568  PMID:28054524
Aim of Study: The aim of the study is to show the possible differences on the same temperature and treatment time as control parameter of the variety of local hyperthermia techniques, pointing the possible differences in the local and systemic actions. Materials and Methods: Debate about the apparent locality of malignancy and the problems of the local treatment. Results: Consider the physiological feedback mechanisms, the spread of temperature, and the time which has active role in the spreading. Conclusion: Points that the clinical results depend not only on the temperature but also on the technical solution of the heat delivery.
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Questionnaire survey to assess the pattern and characteristics of cell-phone usage among Indian oncologists p. 1138
Anusheel Munshi, Debanarayan Dutta, Pramod Tike, Jai Prakash Agarwal
DOI:10.4103/0973-1482.164704  PMID:28054525
Purpose: Obtain baseline data of cell-phone usage in the medical (MO), surgical (SO) and radiation (RO) oncology community practicing in India. Materials and Methods: Indigenously prepared cell-phone usage related questionnaire was used in the present study after approval by the Institutional Ethics/Scientific Committees. The questionnaire had 41 items and was made to assess the cell-phone usage parameters, utility in clinical practice, awareness, and to compare parameters between oncology specialties. Between November 2009 and January 2010, the questionnaire was sent as an E-mail attachment to 200 oncologists in India. Results: In all, 123 responses were received (61% responders); 84 (68.3%) were RO. The median age of responders was 35 years. Overall, 80% felt handicapped without cell-phone. The Mean cell-phone score, an index to assess overall usefulness over a score of 1–10, was 6.46 (median 7, standard deviation 1.709). There was no significant difference between RO, MO and SO in duration of usage (P = 0.235), number of cell-phones (P = 0.496), call duration per day (P = 0.490) and dependence on cell-phone (P = 0.574). Age of starting cell-phone usage was earlier in RO (P = 0.086). Professional usage was significantly more by MO and SO compared to RO (P < 0.001); however, the former were less aware of any potential cell-phone hazards compared to RO (P < 0.007). Conclusion: The results of the first such questionnaire based study have been presented. Most oncologists consider cell-phones a useful tool in patient care. More RO are aware of potential cell-phone hazards compared to non-RO's.
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Cellular and spectroscopic characterization of cancer stem cell-like cells derived from A549 lung carcinoma p. 1144
Murali M. S. Balla, Raghumani S Ningthoujam, Mukesh Kumar, Jayant R Bandekar, Badri N Pandey
DOI:10.4103/0973-1482.171365  PMID:28054526
Background: Cancer stem cells (CSCs) are increasingly being realized to play a significant role in the mechanism of chemo-, radio-resistance, and metastasis of cancer. However, studies for spectral markers of CSCs using Fourier transform infrared (FT-IR) and circular dichroism (CD) spectroscopy are limited in the literature. Materials and Methods: In the present study, CSCs obtained from single cell assay of human lung adenocarcinoma (A549) cells were characterized using CD44+/CD24−/low phenotype expression, Hoechst 33342 dye efflux assay, and expression of stemness genes. Spectral changes in cancer cells and clones enriched with CSCs were studied by FT-IR and CD spectroscopy. Results: The changes in FT-IR spectra of clones enriched with CSCs showed the difference in the secondary protein structure as compared to nonstem cancer cells. Moreover, A549 clone cells showed higher C-O band of carbohydrates and deoxyribose ring vibrations of Z-form of DNA. These results were further corroborated with CD spectroscopy that showed increased alpha helix proteins and difference in DNA conformation in clones enriched with CSCs. FT-IR studies also showed higher imidazole-metal interactions in clones enriched with CSCs. These results are in agreement with higher activity of one of the metalloproteins that is, superoxide dismutase in clones enriched with CSCs and their increased radioresistance. Conclusions and General Significance: Overall, these observations provide novel FT-IR and CD spectroscopy signatures in A549 clones enriched with CSCs, which may have implications in the quantifying magnitude of CSCs as prognostic markers in cancer therapy.
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Temperature increase induced by modulated electrohyperthermia (oncothermia®) in the anesthetized pig liver p. 1153
Lajos Balogh, András Polyák, Zita Pöstényi, Veronika Kovács-Haász, Miklós Gyöngy, Julianna Thuróczy
DOI:10.4103/0973-1482.197561  PMID:28054527
Aim of Study: Is to show the intrahepatic temperature development in anesthetized pig. Materials and Methods: Temperature development in the liver of anesthetized pig is measured to study the thermal effects of capacitive coupled energy transfer. The treatment was made by modulated electrohyperthermia (mEHT, trade name: oncothermia ®), controlled by a fluoroptical temperature sensing positioned by the ultrasound-guided process. Various fits of coupling were studied. Results: The intrahepatic temperature at the end of the treatment ranged 40.5–44.8°C, while the skin temperature ranged 36.8–41.8°C depending on the coupling arrangement. Conclusion: mEHT is a feasible method to deliver deep heat to the liver of an anesthetized pig.
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Brain metastasis from nonnasopharyngeal head and neck squamous cell carcinoma: A case series and review of literature p. 1160
Sarbani Ghosh-Laskar, Jai Prakash Agarwal, Prahlad H Yathiraj, Prasad Tanawade, Rajendra Panday, Tejpal Gupta, Ashwini Budrukkar, Vedang Murthy
DOI:10.4103/0973-1482.184525  PMID:28054528
Background: Brain metastasis from primary head and neck squamous cell carcinoma (HNSCC) is infrequent and probably under-reported thereby leading to paucity of information. Methods: Archives of two institutes in India were studied from 2005 to 2013 and relevant information regarding patient demographics, treatment details, and follow-up was obtained for patients having brain metastasis (BM) from HNSCC. Data were analyzed using SPSS software version 20 (IBM Corporation, NY, USA). Results: Metastasis to the brain was detected in 17 patients with an HNSCC primary. The median age for diagnosis of index primary was 55 years (range (R) - 32–71 years) with 88% (15/17) being male. Oral cavity was the most common site of primary disease with 35% (6/17) followed by larynx (24%), oropharynx (18%), and hypopharynx (18%). The median stage at presentation was IVA (47%) and two (12%) were metastatic to the brain at presentation. Human papillomavirus analysis was not available for any of the patients. Neurological symptoms were complained of in 94% patients. The median BM-free-interval was 15 months (R - 1–67 months, SE ± 5.2). While 88% had multiple brain metastases, 82% also had extracranial metastasis and in 53% of patients, the index primary was not controlled. The median overall survival of all patients after the development of BM was 2 months (R - 0.5–6 months, SE ± 0.4). Conclusion: BM in HNSCC is mostly multiple, associated with extracranial metastasis and can occur in patients without locoregional relapse or residual disease and carries a dismal outcome.
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A retrospective analysis of patients with head and neck cancer treated with radiation, hyperthermia, and cetuximab: A brief report of outcome p. 1164
Nagraj G Huilgol
DOI:10.4103/0973-1482.194600  PMID:28054529
Purpose: Advanced head and neck cancer continues to have a dismal outcome. Chemoradiation remains the current standard of care. Chemoradiation has not achieved the desired increase in survival in locally advanced head and neck cancer. This is a retrospective analysis of six patients treated with hyperthermia, radiation therapy, and cetuximab. We wished to determine if this combination treatment would further improve the outcome. Materials and Methods: Six patients with squamous cell cancer of the head and neck region were treated with hyperthermia, cetuximab, and radiation therapy. The end points assessed were acute toxicity and immediate response. Results: All the six patients received the planned doses of cetuximab and radiation therapy. Two patients did not complete the planned hyperthermia sessions. All patients developed mucositis and acneiform rashes. None had thermal burns. One hundred percent complete response was observed in all the patients. Conclusion: Addition of hyperthermia to cetuximab and radiation therapy is feasible and shows impressive response rates with manageable toxicity profile. Further studies evaluating the same are needed to confirm these findings.
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Does fall in serum glutathione predict the long-term outcome to concurrent chemoradiation for cervical cancer patients? p. 1167
Manjunath Gudibande Narasappa, Janaki Manur Gururajachar, Vasudha Kambam Chokkanna, Mohankumar Somashekar
DOI:10.4103/0973-1482.197562  PMID:28054530
Background: Wide variations are seen in clinical practice with respect to response to concurrent chemo radiation among cervical cancer patients. Fall in serum glutathione (GSH) level directly correlates with early response to treatment. Whether this early response translates to a better long term outcome is the subject of this prospective study. Materials and Methods: Thirty eight women with cervical cancer were treated with concurrent chemo radiation followed by brachytherapy. Serum GSH was measured before and after two fractions of radiation and first chemotherapy. Patients were followed for a median follow up of four years. Fall in GSH was correlated with response at six weeks and disease status at four years. Results: Median fall in serum GSH was 171.16 µg per ml. Fall in GSH was 170.42, 103.54 and 37.25 µg per ml (P value of <0.0001, 0.05 and 0.18) in patients showing complete response, partial response and no response respectively. Among 26 patients who had no disease at six weeks, 22 women remained disease free at four years (P < 0.0001), two recurred (P < 0.05) and two died of other causes respectively. Non bulky tumours and patients more than 50 years of age showed a fall of 190.69, 265.17 µg per ml respectively. Conclusion: Greater fall in serum GSH predicts better early response as well as long term disease control.
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Diagnostic value of core biopsy histology and cytology sampling of mediastinal lymph nodes using 21-gauge EBUS-TBNA needle p. 1172
Preyas J Vaidya, Avinandan Saha, Arvind H Kate, Kamlesh Pandey, Vinod B Chavhan, Joerg D Leuppi, Prashant N Chhajed
DOI:10.4103/0973-1482.197535  PMID:28054531
Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the initial modality of choice in sampling mediastinal lymphadenopathy. It is possible to obtain both cytological and histological samples using both 21-gauge and 22-gauge EBUS-TBNA needles. The current study was undertaken to compare the diagnostic yield of cytology and histology samples obtained by the same EBUS-TBNA 21-gauge needle. Patients and Methods: One hundred sixty-six consecutive patients who underwent EBUS-TBNA with a 21-gauge EBUS-TBNA needle over a period of 3 years were included in this retrospective analysis. The diagnostic yields of EBUS-TBNA histology (EBUS-TBNA-H) and EBUS-TBNA cytology (EBUS-TBNA-C) specimens were compared using the McNemar test. Results: The overall sensitivity and specificity of EBUS-TBNA were 89% and 100%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of EBUS-TBNA were 100% and 53%, respectively. The overall sensitivity and specificity of EBUS-TBNA-H were 85% and 100%, respectively. The PPV and NPV of EBUS-TBNA-H were 100% and 43%, respectively. The overall sensitivity and specificity of EBUS-TBNA-C were 65% and 100%, respectively. The PPV and NPV of EBUS-TBNA-C were 100% and 14%, respectively. The diagnostic yield of EBUS-TBNA-H over EBUS-TBNA-C was statistically significant (P < 0.0001). Conclusion: EBUS-TBNA-H with 21-gauge needle significantly improves the diagnostic yield of EBUS-TBNA. EBUS-TBNA-H improves the NPV of EBUS-TBNA. The combination of EBUS-TBNA-H and EBUS-TBNA-C improves the overall diagnostic yield of EBUS-TBNA.
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Polymorphisms of glucose-regulated protein 78 and clinical relevance of neuroblastoma: Risk and prognosis p. 1178
Jiao Zhang, Jiaxiang Wang, Qiuliang Liu, Jingyao Gao, Qi Wang
DOI:10.4103/0973-1482.193119  PMID:28054532
Background: Neuroblastoma (NB) is the most common extracranial solid tumor in childhood. Glucose/regulated protein 78 (GRP78) is a stress-associated protein. It has been reported that overexpression of GRP78 occurs in various human cancers, and GRP78 polymorphisms have effect on the expression of GRP78 with possible function of predicting clinical outcome. Upregulation of GRP78 has been detected in NB. However, little is known about the relationship of GRP78 polymorphisms and the susceptibility of NB. Aim: To investigate whether GRP78 polymorphisms were associated with the risk and clinical characteristics of NB. Materials and Methods: Two GRP78 polymorphisms rs391957 (C>T) and rs430397 (G>A) were detected in 105 NB cases and 145 healthy controls using the polymerase chain reaction fragment length polymorphism technique. Results: Compared with the CC genotype, carriers of CT and TT genotypes of rs391957 polymorphism had higher risks of NB. In NB cases, the variant T allele was significantly associated with tumor International Neuroblastoma Staging System stage (P = 0.027), but not with MYCN amplification (P = 0.056). Compared with the GG genotype, carriers of GA and AA genotypes of rs430397 polymorphism had higher risks of NB. The rs430397 polymorphism was not associated with the clinicopathological characteristics of NB. Conclusion: These data provide the first evidence that GRP78 rs391957 and rs430397 polymorphisms could serve as the markers to predict the risk and poor prognosis of NB.
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Application of accelerated failure time models for breast cancer patients' survival in Kurdistan Province of Iran p. 1184
Asrin Karimi, Ali Delpisheh, Kourosh Sayehmiri
DOI:10.4103/0973-1482.168966  PMID:28054533
Context: Breast cancer is the most common cancer and the second common cause of cancer-induced mortalities in Iranian women. There has been a rapid development in hazard models and survival analysis in the last decade. Aims: The aim of this study was to evaluate the prognostic factors of overall survival (OS) in breast cancer patients using accelerated failure time models (AFT). Setting and Design: This was a retrospective-analytic cohort study. Subjects and Materials: About 313 women with a pathologically proven diagnosis of breast cancer who had been treated during a 7-year period (since January 2006 until March 2014) in Sanandaj City, Kurdistan Province of Iran were recruited. Statistical Analysis Used: Performance among AFT was assessed using the goodness of fit methods. Discrimination among the exponential, Weibull, generalized gamma, log-logistic, and log-normal distributions was done using Akaik information criteria and maximum likelihood. Results: The 5 years OS was 75% (95% CI = 74.57–75.43). The main results in terms of survival were found for the different categories of the clinical stage covariate, tumor metastasis, and relapse of cancer. Survival time in breast cancer patients without tumor metastasis and relapse were 4, 2-fold longer than other patients with metastasis and relapse, respectively. Conclusion: One of the most important undermining prognostic factors in breast cancer is metastasis; hence, knowledge of the mechanisms of metastasis is necessary to prevent it so occurrence and treatment of metastatic breast cancer and ultimately extend the lifetime of patients.
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Long-term outcomes of peripheral blood stem cell transplantation for 38 patients with peripheral T-cell lymphoma p. 1189
Jian Bo, Yu Zhao, Songsong Zhang, Wenrong Hua, Shuhong Wang, Chunji Gao, Quanshun Wang, Honghua Li, Li Yu
DOI:10.4103/0973-1482.189235  PMID:28054534
Objective: In this study, to investigate clinical characteristics, response, outcome, and prognosis of peripheral blood stem cell transplantation (PBSCT) for patients with peripheral T-cell lymphoma (PTCL). Methods: This study retrospectively analyzed the efficacy of PBSCT in 38 patients with PTCL. Kaplan–Meier methods were used in survival analysis, and the Cox regression model was applied in multivariate analysis. There were ten clinical parameters were analyzed. Results: The 2-year overall survival (OS) was 46%, and the 5-year OS was 34% after a median follow-up of 40 months. The patients who received allogeneic PBSCT (allo-PBSCT) had a higher nonrelapse mortality than autologous PBSCT (auto-PBSCT), but they could achieve a longer-term disease-free survival in the former, which OS could achieve 40%. Survival analysis with Kaplan–Meier method showed the pretransplant disease status, B symptoms, serum lactate dehydrogenase (LDH) in early (>275 U/L), Eastern Cooperative Oncology Group (ECOG) score (>1), prognostic index for PTCL score (>2) were all prognostic factors for posttransplant OS. Pretransplant disease status is the only prognostic factor for allo-PBSCT. Conclusion: The key was to reducing transplant-related mortality of allo-PBSCT by reduced-intensity conditioning. Factors such as level of early serum LDH, extranodal involvement, B symptoms, ECOG score, Ann Arbor stage, and pretransplant disease status were all related to the prognosis of patients treated with PBSCT. Allo-PBSCT maybe suggested as the first line therapy for late-stage PTCL patients who could reach treatment remission before transplantation.
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BRIEF COMMUNICATION Top

Combined prednisolone and pirfenidone in bleomycin-induced lung disease p. 1198
Preyas J Vaidya, HS Sandeepa, Tejinder Singh, SK Susheel Kumar, Rajat Bhargava, Gopal Ramakrishnan, Prashant N Chhajed
DOI:10.4103/0973-1482.197530  PMID:28054535
Bleomycin is a cytostatic drug commonly employed in the treatment of Hodgkin's disease, seminomas, and choriocarcinoma. Bleomycin may induce a chronic pulmonary inflammation that may progress to fibrosis. So far, only corticosteroids have been used in the treatment of bleomycin-induced lung disease with variable results. Pirfenidone is an antifibrotic drug that has been approved for the treatment of idiopathic pulmonary fibrosis. We report two cases of bleomycin-induced lung disease treated successfully with pirfenidone and oral corticosteroids.
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CORRESPONDENCE Top

Spectrum of complex chromosomal aberrations in a myelodysplastic syndrome and a brief review p. 1203
Bani Bandana Ganguly, Tuphan Kanti Dolai, Rajib De, Nitin N Kadam
DOI:10.4103/0973-1482.197563  PMID:28054536
Myelodysplastic syndrome (MDS) is a heterogeneous premalignant condition characterized by cytopenia, ineffective hematopoiesis, dysplastic marrow, and risk of progression to acute myeloid leukemia. Cytogenetic abnormalities, including del(3q/5q/7q/11q/12p/20q), monosomy 5/7, trisomy 8/19, i(17q), and -Y, are the indicators of diagnosis and risk stratification. The present case with bicytopenia detected with highly complex chromosome rearrangements with variability in numerical and structural combinations. Chromosome analysis was carried out following unstimulated marrow culture and G-banding. In addition to known MDS-aberrations, der(9p), der(12) dic(12;?19), +15, −18, and ring and marker chromosomes were recorded having, at least, nine abnormal chromosomes/cell. To our knowledge, this is the first case with all MDS-aberrations in one single individual. The case has been discussed in relevance to current MDS research. In the present case, i(17q)/-17, der(12p), del(5q26), del(7q36), and del(20q11) indicate possible alterations in TP53, ETV6, IDH2, EZH2, and SRSF2 genes, which are responsible for pathomechanism, genetic instability, clonal evolution, and advancement of disease condition.
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BOOK REVIEW Top

The Unquiet Mind Cancer: The Metaethical Quandary of Therapies p. 1207
Rohit Manchanda
DOI:10.4103/0973-1482.197529  PMID:28054537
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ERRATUM Top

Erratum: Evaluation of anaplastic lymphoma kinase expression in nonsmall cell lung cancer; a tissue microarray analysis p. 1209

DOI:10.4103/0973-1482.197537  PMID:28054538
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Erratum: The postoperative complication for adenocarcinoma of esophagogastric junction p. 1210

DOI:10.4103/0973-1482.197538  PMID:28054539
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Erratum: Herceptin as a single agent in the treatment of patients with metastatic breast cancer p. 1211

DOI:10.4103/0973-1482.197539  PMID:28054540
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Erratum: Application of intelligent algorithm in the optimization of novel protein regulatory pathway: Mechanism of action of gastric carcinoma protein p42.3 p. 1212

DOI:10.4103/0973-1482.197540  PMID:28054541
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Erratum: The pleiotropic effects and therapeutic potential of the hydroxy-methyl-glutaryl-CoA reductase inhibitors in malignancies: A comprehensive review p. 1213

DOI:10.4103/0973-1482.197541  PMID:28054542
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