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   2017| January-March  | Volume 13 | Issue 1  
    Online since May 16, 2017

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Colorectal cancer presenting as bone metastasis
MC Suresh Babu, Sunny Garg, KC Lakshmaiah, K Govind Babu, Rekha V Kumar, D Loknatha, Linu Jacob Abraham, LK Rajeev, KN Lokesh, AH Rudresha, Suparna Ajit Rao
January-March 2017, 13(1):80-83
DOI:10.4103/0973-1482.181177  PMID:28508837
Introduction: Bone metastasis is a rare site of metastasis, seen in only 3.7–11% of clinical cases. Isolated bone involvement has been reported very rarely in literature. Moreover, the patients who have bone metastasis at presentation are even rare. Objectives: To discuss the demographic characteristics, carcinoembryonic antigen (CEA) levels, pattern of bone involvement, and their correlation with survival in patients of colorectal cancer that have bone metastasis at the time of presentation. Materials and Methods: Retrospectively, tumor registry was analyzed for the cases of colorectal cancer presenting with bone metastasis between 2008 and 2013. Survival curves were generated by Kaplan–Meier method and analyzed using the log-rank test. Results: Ten such patients were identified (male:female = 7:3) of the total 410 patients. Median age was 41 years (22–50 years). All patients were <50 years of age. Median CEA level was 147.5 (45–840). Three patients had bone-only metastasis. Most common metastatic site involved was liver (six patients) and lungs (three patients). The most common sites of bone metastasis were vertebra and pelvis (4 each). Chemotherapy was given in seven patients. Median overall survival was 5.5 months (2–36 months). It was higher in males, in those with bone-only involvement and those without liver involvement. Vertebral involvement, pelvic involvement, CEA levels, and chemotherapy did not show any significant survival implication. Conclusions: In this study, the patients of colorectal cancer presenting with bone metastasis were of male sex and younger age. The factors that were associated with reduced survival were extraosseous and liver involvement.
  13,624 248 10
Multiple primary malignant neoplasms: A 10-year experience at a single institution from Turkey
Durmus Etiz, Evrim Metcalfe, Melek Akcay
January-March 2017, 13(1):16-20
DOI:10.4103/0973-1482.183219  PMID:28508827
Purpose: The development of improved diagnostic techniques, increased survival, and life expectancy of cancer patients have all contributed to the higher frequency of multiple primary malignant neoplasms (MPMN). MPMN can be divided into two main categories: Synchronous MPMN (sMPMN) and metachronous MPMN (mMPMN). Materials and Methods: 122 patients with MPMN analyzed retrospectively who were admitted to the Radiation Oncology Department of Eskisehir Osmangazi University Medical Faculty from January 2004 to December 2013. The patient characteristics and relation with overall survival (OS) were examined. Results: The overall incidence of MPMN was found 1.2% in our institution. The median age was 59 (range: 29–80) years. Male:female ratio was 54.5:45.5%, and mMPMN:sMPMN ratio was 69.9:30.1%. The most common 3 cancers were head and neck (22%), breast (20%), and gastrointestinal (20%) for first primary; and gastrointestinal (22%), lung (19%), gynecologic tumors (15%) for second primary cancers, respectively. The median OS in patients with sMPMN and mMPMN were 30 (3–105) and 91 (4–493) months. 2, 3, and 5 years OS of patients with sMPMN were 86%, 75%, 63%, and with mMPMN were 92%, 88%, 80%, respectively (P < 0.005). Conclusion: OS was found longer in female patients with sMPMN (P < 0.05), and in all group with mMPMN (P < 0.005).
  6,498 462 7
Application of National Cancer Institute recommended terminology in breast cytology
P Arul, Suresh Masilamani
January-March 2017, 13(1):91-96
DOI:10.4103/0973-1482.199452  PMID:28508839
Background: There is a lack of uniformity with regard to the reporting terminology used in breast cytology by pathologists worldwide, resulting in miscommunication of results among health-care providers. Aim: The present study was aimed to assess the accuracy of fine-needle aspiration cytology (FNAC) in the evaluation of breast lesions using the National Cancer Institute (NCI) recommended terminology. Materials and Methods: In this prospective study, a total number of 523 breast FNACs were categorized according to the NCI guidelines. Of these, 286 (54.7%) had histopathological follow-up, and their FNAC diagnoses were compared. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) along with 95% confidence interval (95% CI) and accuracy of FNAC were calculated. Results: Among 286 FNAC cases, 4 were unsatisfactory (C1), 188 were benign (C2), 11 were atypical, probably benign (C3), 21 were suspicious, favor malignancy (C4), and 62 were malignant (C5). On histopathological examination of categories C2 and C3 (total of 199 cases), 193 were confirmed as benign (true negative) and remaining 6 cases were turned out to malignant (false negative). Among categories C4 and C5 (total of 83 cases), 81 were confirmed as malignant (true positive) and remaining 2 were turned out to be benign (false positive). The sensitivity, specificity, PPV, NPV, and accuracy of FNAC were 93.1% (95% CI, 88.2%–95%), 99% (95% CI, 96.8%–99.8%), 97.6% (95% CI, 92.5%–99.6%), 97% (95% CI, 94.9%–97.8%), and 97.2%, respectively. Conclusion: Our study concluded that FNAC reporting using NCI guidelines highly correlated with the histopathological diagnosis.
  6,611 261 4
Genomic aberrations in non- small cell lung cancer and their impact on treatment outcome
Amrallah A Mohammed, Hani El-Tanni, Mohammed A Alsakkaf, Ahmad A Mirza, Tariq Al-Malki Atiah, Arwa Al-Malki Atiah
January-March 2017, 13(1):9-15
DOI:10.4103/0973-1482.180605  PMID:28508826
The therapeutic options of nonsmall cell lung cancer (NSCLC) therapy has been changed since the first discovery of activating epidermal growth factor receptor (EGFR) mutations and the development of specific EGFR tyrosine kinase inhibitors, which resulted in the evolution of “personalized medicine.” There are a considerable number of genomic aberrations in NSCLC serving as potential predictive biomarkers and drug targets and still more. We summarized the molecular pathways, potential targets, and possible impact on disease outcome in NSCLC.
  6,028 237 -
Recurrent osteosarcoma with calcified liver metastases: Uncommon development of a common disease
Shikha Goyal, Pramod K Julka
January-March 2017, 13(1):139-141
DOI:10.4103/0973-1482.148672  PMID:28508848
Osteosarcoma is the commonest primary malignant bone tumor. Since bones lack a lymphatic system, metastatic spread in these tumors is exclusively hematogenous, the commonest sites being lungs and bone. We report a case of osteosarcoma humerus which recurred locally after primary therapy consisting of neoadjuvant chemotherapy and limb salvage surgery, who developed calcified liver metastases in addition to local and pulmonary relapse. Liver, though a common site of hematogenous spread in most solid tumors, has rarely been reported to be involved in metastatic osteosarcomas.
  5,357 171 5
Transcoelomic spread and ovarian seeding during ovulation: A possible pathogenesis of Krukenberg tumor
Bikash Shah, Wen-Hao Tang, Shammi Karn
January-March 2017, 13(1):152-153
DOI:10.4103/0973-1482.206234  PMID:28508852
  5,343 170 2
Assessment of three-dimensional setup errors in image-guided pelvic radiotherapy for uterine and cervical cancer using kilovoltage cone-beam computed tomography and its effect on planning target volume margins
Nidhi Patni, Nagarjuna Burela, Rajesh Pasricha, Jaishree Goyal, Tej Prakash Soni, T Senthil Kumar, T Natarajan
January-March 2017, 13(1):131-136
DOI:10.4103/0973-1482.199451  PMID:28508846
Purpose: To achieve the best possible therapeutic ratio using high-precision techniques (image-guided radiation therapy/volumetric modulated arc therapy [IGRT/VMAT]) of external beam radiation therapy in cases of carcinoma cervix using kilovoltage cone-beam computed tomography (kV-CBCT). Materials and Methods: One hundred and five patients of gynecological malignancies who were treated with IGRT (IGRT/VMAT) were included in the study. CBCT was done once a week for intensity-modulated radiation therapy and daily in IGRT/VMAT. These images were registered with the planning CT scan images and translational errors were applied and recorded. In all, 2078 CBCT images were studied. The margins of planning target volume were calculated from the variations in the setup. Results: The setup variation was 5.8, 10.3, and 5.6 mm in anteroposterior, superoinferior, and mediolateral direction. This allowed adequate dose delivery to the clinical target volume and the sparing of organ at risks. Conclusion: Daily kV-CBCT is a satisfactory method of accurate patient positioning in treating gynecological cancers with high-precision techniques. This resulted in avoiding geographic miss.
  5,158 333 5
Dosimetric comparison of head and neck cancer patients planned with multivendor volumetric modulated arc therapy technology
Murugesan Kathirvel, Vellaiyan Subramani, VS Subramanian, Shanmugam Thirumalai Swamy, Gandhi Arun, Subramanian Kala
January-March 2017, 13(1):122-130
DOI:10.4103/0973-1482.203600  PMID:28508845
Aim: Purpose of this study is to dosimetrically compare head and neck (H and N) cancer patients planned with multivendor volumetric modulated arc therapy (VMAT) technology. VMAT treatment planning can be done using biological (treatment planning system [TPSB]: Monaco) or physical (TPSP: Eclipse)-based cost function optimization techniques. Planning and dosimetric comparisons were done in both techniques for H and N cases. Materials and Methods: Twenty H and N patients were retrospectively selected for this study. VMAT plans were generated using TPSP (V11.0) and TPSB (V3.0) TPS. A total dose of 66 Gy (planning target volume 1 [PTV1]) and 60 Gy (PTV2) were prescribed to primary and nodal target volumes. Clinical planning objectives were achieved by both the optimization techniques. Dosimetric parameters were calculated for PTVs, and quantitative analyses were performed for critical organs. Monitor units were compared between two TPSs, and gamma analysis was performed between I'matriXX measured and TPS calculated. Results: Clinically, acceptable VMAT plans showed comparable dose distributions between TPSB and TPSP optimization techniques. Comparison of mean dose, homogeneity index, and conformity index for PTV1 showed no statistical difference (P - 0.922, 0.096, and 0.097); however, in PTV2 statistically significant difference was observed (P - 0.024, 0.008, and 0.002) between TPSB and TPSP. TPSB optimization showed statistically significant superiority for spinal cord and brainstem (D1% P - 0.0078, 0.00002) whereas improved parotid sparing was observed in TPSP optimization (mean dose P - 0.00205). Gamma analysis illustrated that both systems could produce clinically deliverable plans. Conclusion: VMAT plans by TPSP and TPSB offered clinically acceptable dose distributions. TPSB-based optimization showed enhanced sparing of serial organs whereas TPSP-based optimization showed superior sparing of parallel organs.
  4,703 215 2
Randomized controlled Phase III study comparing hepatic arterial infusion with systemic chemotherapy after curative resection for liver metastasis of colorectal carcinoma: JFMC 29–0003
Mitsuo Kusano, Michitaka Honda, Koji Okabayashi, Koho Akimaru, Syuichi Kino, Yasushige Tsuji, Masashi Watanabe, Satoshi Suzuki, Takaki Yoshikawa, Junichi Sakamoto, Koji Oba, Shigetoyo Saji
January-March 2017, 13(1):84-90
DOI:10.4103/0973-1482.184524  PMID:28508838
Background: The feasibility and efficacy of adjuvant hepatic arterial infusion (HAI) in preventing the development of liver metastases in patients with advanced colon carcinoma have not been validated. The aim of this randomized controlled study was to compare the feasibility of HAI and the protective effect against liver metastasis after curative resection to those of systemic chemotherapy. Methods: Between July 2000 and June 2003, 91 patients were enrolled. Patients were randomly assigned to receive 5-fluorouracil (5-FU) via continuous venous infusion (CVI) or intra-hepatic arterial weekly high-dose 5-FU (WHF). The primary endpoint was overall survival (OS). Results: In the WHF group, the cumulative failure rate of hepatic arterial catheterization was 16.7% at 6 months. The occurrence of grade 3 adverse events was comparable between the groups. The 5-year OS rates were 59.0% in the CVI group and 34.9% in the WHF group (P = 0.164). CVI tended to show a protective effect against liver metastasis regarding the 5-year liver-specific cumulative recurrence rate: CVI, 45.0% vs. WHF, 68.3%; P = 0.037). Conclusion: HAI therapy has a certain protective effect against liver metastasis after curative resection in patients with colorectal cancer. However, this therapy did not contribute to any marked improvement in their overall survival.
  4,736 150 4
Sialadenoma papilliferum: A rare case report and review of literature
S Sunil, Sharlene Sara Babu, Sathibhai Panicker, Nithin Pratap
January-March 2017, 13(1):148-151
DOI:10.4103/0973-1482.187300  PMID:28508851
Sialadenoma papilliferum (SP) classified under the ductal papillomas by the WHO is a rare benign tumor of minor salivary glands. It is a rare lesion of salivary glands predominantly affecting the minor glands. It has characteristic exophytic and endophytic clinical growth pattern. Histopathologically, it is characterized by papillary projections supported by fibrovascular connective tissue core and infiltrated with mixed inflammatory cells. The ductal lining epithelium of double-layered cells of luminal layer of tall columnar cells and a basilar layer of small cuboidal cells shows additional papillary projections into the lumen. We report a case of SP of mid palate.
  4,660 206 1
A dosimetric analysis of cardiac dose with or without active breath coordinator moderate deep inspiratory breath hold in left sided breast cancer radiotherapy
Beena Kunheri, Sanketh Kotne, Sneha S Nair, Dinesh Makuny
January-March 2017, 13(1):56-61
DOI:10.4103/jcrt.JCRT_1414_16  PMID:28508834
Background and Aim: Cardiac toxicity is a major concern for left breast tangential field irradiation. The left ventricle and left anterior descending (LAD) artery are suggested to be radiosensitive and radiation to these structures leads to late lethal cardiotoxicity. Moderate deep inspiration breath hold (mDIBH) during radiation treatment delivery helps in reducing the cardiac dose. This study compares dosimetric parameters of heart with and without active breath coordinator (ABC) mDIBH during tangential field breast cancer radiation. Study Type: This is a dosimetric comparative study. Materials and Methods: Forty-five consecutive patients with left-sided breast cancer who underwent breast-conserving surgery and adjuvant tangential field and radiotherapy with ABC mDIBH between November 2013 and September 2015 in our center were analyzed in this study. The ABC device was used for respiratory control and patients who could hold their breath for 20–30 s were considered for radiation with ABC mDIBH. Simulation scans of both free breathing (FB) and ABC mDIBH were done. Tangent field treatment plans with a dose prescription of 40 Gy/15 Fr were generated for each patient, in both scans. Target coverage, dose to the heart, LAD, and the left lung were documented with dose-volume histograms. Results: Statistical Package for the Social Sciences, version 20 software, was used for analysis and the level of significance was set at P < 0.05. Mean heart dose was 308.5cGy with FB and 159cGy with ABC (P < 0.0001). Mean dose to the LAD was reduced by 53.81% (1320.64 cGy vs. 606.56 cGy, P < 0.001). Target coverage was equal in both the plans. Conclusion: We report that the use of ABC mDIBH technique resulted in a significant reduction in cardiac dose and hence can be considered as a promising tool for cardiac sparing.
  4,234 284 12
Evaluation of role of alpha-methyl acyl-coenzyme A racemase/P504S and high molecular weight cytokeratin in diagnosing prostatic lesions
Deepika Jain, Sumiti Gupta, Nisha Marwah, Rajnish Kalra, Veena Gupta, Meenu Gill, Nikita Jain, Shubha Lal, Rajeev Sen
January-March 2017, 13(1):21-25
DOI:10.4103/0973-1482.206239  PMID:28508828
Background: In recent years basal cell markers (high molecular weight cytokeratin [HMWCK]) and prostate biomarker alpha-methyl acyl-coenzyme A racemase (AMACR) have been used as adjuvant to morphology in diagnostically challenging cases with a very high sensitivity and specificity. This has increased the diagnostic accuracy of prostate cancer worldwide. Materials and Methods: In this prospective study, total of 50 cases including 37 cases of malignant lesions and 13 cases of benign lesions of the prostate were taken. Tumor grade was determined according to Gleason's grading system. AMACR and HMWCK expressions were determined by immunohistochemical staining. The obtained results were analyzed and evaluated using Chi-square statistical test (SPSS version 20). Results: AMACR was not expressed in any of the 13 cases of benign lesions of the prostate while in malignant lesions of prostate it was expressed in 33 of 37 (89.18%) cases. All 4 (100%) cases of well-differentiated carcinoma were positive for AMACR expression. 21 of 25 (84%) moderately differentiated and all 10 (100%) cases of poorly differentiated tumors were positive for AMACR. There was statistically significant difference in expression of AMACR between benign and malignant lesions of the prostate, indicated byP = 0.001. In benign lesions, HMWCK was expressed in all the 13 (100%) cases while in malignant lesions of prostate it was not expressed in any of the (0%) case. All 13 benign lesions were positive for HMWCK only. AMACR expression was not seen in any of the benign lesion. Out of 37 malignant cases, 4 cases were negative for both, 33 cases were positive only for AMACR, but no case was positive only for HMWCK. Conclusions: As an adjunct to biopsy, AMACR and HMWCK have value for resolving diagnostically challenging cases.
  3,813 228 -
The association between rs1972820 and the risk of breast cancer in Isfahan population
Narges Zabihi, Samira Sadeghi, Hossein Tabatabaeian, Kamran Ghaedi, Mansoureh Azadeh, Mohammad Fazilati
January-March 2017, 13(1):26-32
DOI:10.4103/0973-1482.183202  PMID:28508829
Context: A number of single nucleotide polymorphisms (SNPs) in ERBB4 gene have been linked to increase the risk of breast cancer. However, no study has been dedicated to analyze the significance of microRNA-related SNP rs1972820, located in ERBB4 3'-untranslated region (UTR), in breast tumors. Aims: Here, we investigated the frequency and association between rs1972820 and breast cancer. Subjects and Methods: The rs1972820 genotypes in 182 samples were collected from 96 healthy people, and 86 breast cancer patients were determined using tetra-primer amplification refractory mutation system-polymerase chain reaction. The frequency of genotypes was analyzed to find the association between rs1972820 and breast cancer risk. Statistical Analysis Used: Conditional logistic regression, odds ratios (ORs), the associated 95% confidence intervals (CIs), and Armitage's test were used in this study. Results: In silico analysis suggested that rs1972820 located in the 3'UTR of ERBB4 gene affects the binding affinity of miR-3144-3p a potential oncomiRNA. Statistical analysis showed a significant association between SNP rs1972820 G allele and reduced breast cancer risk, odds ratio = 0.443 (95% CI: 0.196–0.998). Conclusions: rs1972820 SNP allele is significantly associated with the reduced risk of breast cancer and could be considered as a potential marker for breast cancer predisposition in population of Isfahan.
  3,623 274 8
ABCs of RhoGTPases indicating potential role as oncotargets
Indira Bora, Neeta Shrivastava
January-March 2017, 13(1):2-8
DOI:10.4103/0973-1482.204878  PMID:28508825
RhoGTPases also known as molecular switches represent a family of GTP-binding proteins. They shuttle between “On” and “Off” states. In the “On” state, they activate plethora of molecules. These proteins perform a wide variety of functions involving cytoskeletal modeling, cell motility, migration, and mitosis. Members of this family are referred as master regulators of many cellular activities. Due to wide variety of portfolios attributed to RhoGTPases, their misbehavior leads to initiation and also progression of metastatic cancers. Many members of this family have been reported to be differentially regulated leading to spread of malignant cells from one site to other. These wandering cells find a comfortable site in accordance to Paget's soil and seed hypothesis and form secondary lesions. Out of multiple members of this family, RhoA and RhoC are important factors. RhoA is supposed to increase tumor proliferation when overexpressed while RhoC is responsible for tumor initiation. We searched publications on RhoGTPases, their functions and contribution in cancer development and metastasis on World Wide Web and PubMed. This review focuses on the role of Rac and Rho small GTPases in cell motility and granting the opportunistic motile behavior of aggressive cancer cells. To condense knowledge from existing literature about the roles played by these molecular switches, their structural and functional ramifications are introduced in the beginning followed by an account on their wrong behavior that leads to oncogenesis and oncoprogression. This piece of work highlights members of RhoGTPases as viable oncotargets.
  3,507 156 2
A3 adenosine receptor agonist induce G1 cell cycle arrest via Cyclin D and cyclin-dependent kinase 4 pathways in OVCAR-3 and Caov-4 cell lines
Hamid Reza Joshaghani, Seyyed Mehdi Jafari, Mahmoud Aghaei, Mojtaba Panjehpour, Hamideh Abedi
January-March 2017, 13(1):107-112
DOI:10.4103/0973-1482.199381  PMID:28508842
Aim of the Study: The cell cycle, a vital process that involves in cells' growth and division, lies at the heart of cancer. It has been shown that IB-MECA, an A3 adenosine receptor agonist inhibits the proliferation of cancer cells by inducing cell cycle arrest in several tumors. In this study, we evaluated the role of IB-MECA inhibition in cell cycle progression in ovarian cancer cells. Materials and Methods: Cell viability was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay in Caov-4 and OVCAR-3. Analysis of cell cycle distribution was carried out by flow cytometry. To determine the mechanisms of IB-MECA-mediated induction of cell cycle arrest, the expression of cell cycle regulatory proteins Cyclin D1 and cyclin-dependent kinase 4 (CDK4) was evaluated. Results: Our results showed that IB-MECA significantly reduced cell viability in a dose-dependent manner. Moreover, our results indicated that a low concentration of IB-MECA induced G1 cell cycle arrest. Reduction of Cyclin D1 and CDK4 protein levels was also observed after treating cancer cells with IB-MECA. Conclusion: This study demonstrated that IB-MECA induces G1 phase cell cycle arrest through Cyclin D1/CDK4-mediated pathway in ovarian cancer cells.
  3,381 189 6
Morbidity of central compartment clearance: Comparison of lesser versus complete clearance in patients with thyroid cancer
Gouri Pantvaidya, Rakesh Katna, Anuja Deshmukh, Deepa Nair, Anil D'Cruz
January-March 2017, 13(1):102-106
DOI:10.4103/0973-1482.199378  PMID:28508841
Background: Extent of central compartment neck dissection (CCND) in thyroid cancers has been a debate because of associated morbidity. There have been attempts to reduce the extent of surgery in an attempt to decrease morbidity. Patients and Methods: We analyzed the morbidity of CCND from our prospectively maintained surgical morbidity database. CCND was divided into bilateral complete clearance (BCC) and less than complete clearance (LCC). LCC was performed for clinicoradiologically node negative patients. Rates of hypocalcemia and recurrent laryngeal nerve (RLN) palsy rates were compared for LCC versus BCC. We also classified procedures performed in the central neck according to the extent of dissection. Results: Of 153 evaluable patients, BCC was performed in 43.8% and LCC in 56.2%. Rate of postoperative hypocalcemia was 40.2% in BCC group versus 17.4% in LCC group. We had an overall RLN palsy rate of 7.4%. There was no significant difference in RLN palsy rates between the groups. Conclusion: Lesser extent of dissection in central compartment reduces postoperative hypocalcemia but has no influence on RLN palsy rates.
  2,949 187 2
Beneficial influence of ellagic acid on biochemical indexes associated with experimentally induced colon carcinogenesis
Umesalma Syed, Sudhandiran Ganapasam
January-March 2017, 13(1):62-68
DOI:10.4103/0973-1482.172715  PMID:28508835
Objective: To elucidate the key biochemical indexes associated with 1, 2-dimethylhydrazine (DMH)-induced colon carcinogenesis and the modulatory efficacy of a dietary polyphenol, ellagic acid (EA). Materials and Methods: Wistar rats were chosen to study objective, and were divided into 4 groups; Group 1-control rats; Group 2-rats received EA (60 mg/kg body weight/day, orally); rats in Group 3-induced with DMH (20 mg/kg body weight) subcutaneously for 15 weeks; DMH-induced Group 4 rats were initiated with EA treatment. We examined key citric acid cycle enzymes such as isocitrate dehydrogenase, alpha-ketoglutarate dehydrogenase, succinate dehydrogenase, malate dehydrogenase and the activities of respiratory chain enzymes NADH dehydrogenase and Cytochrome-C-oxidase and membrane-bound enzyme profiles (Na +/K + ATPase, Ca 2+ ATPase and Mg 2+ ATPase), activities of lysosomal proteases such as β-D-glucuronidase, β-galactosidase and N-acety-β-D-glucosaminidase and cellular thiols (oxidized glutathione, protein thiols, and total thiols). Results: It was found that administration of DMH to rats decreased both mitochondrial and membrane-bound enzymes activities, increased activities of lysosomal enzymes and further modulates cellular thiols levels. Treatment with EA significantly restored the mitochondrial and ATPases levels and further reduced lysosomal enzymes to near normalcy thereby restoring harmful effects induced by DMH. Conclusion: EA treatment was able to effectively restore the detrimental effects induced by DMH, which proves the chemoprotective function of EA against DMH-induced experimental colon carcinogenesis.
  2,851 180 6
Acoustic analysis of voice in nonlaryngeal head and neck cancer patients post chemoradiotherapy
Nikhila Radhakrishna, BK Yamini, Amrut Sadashiv Kadam, N Shivashankar, Chendil Vishwanathan, Rajesh Javarappa
January-March 2017, 13(1):113-117
DOI:10.4103/0973-1482.199386  PMID:28508843
Background: Concurrent chemoradiotherapy (CCRT) used for definitive management of locally advanced head and neck squamous cell carcinoma (HNSCC) allows organ preservation at the cost of preservation of function. Vocal cords, being within the field of irradiation, undergo acute and chronic changes which adversely impacts the patients' voice. Aims: To assess the acute changes in the acoustic characteristics of voice post-CCRT in patients with nonlaryngeal HNSCC. Materials and Methods: Thirty patients with HNSCC treated with CCRT, a total dose of 66–70 Gy/33–35 fractions at five fractions/week, with weekly cisplatin. Acoustic analysis (AA) and laryngoscopic examination performed at baseline, 6 weeks, and 3 months post-CCRT. Statistical analysis of the parameters using ANOVA and Student's t-test was performed. Results: Of the thirty patients, 26 patients completed CCRT. At 6 weeks post-CCRT, among 14/26 patients, most (11/14 [78.57%]) developed Grade III toxicity. On AA, both increase and decrease in mean F0 from baseline was observed. An increase (P < 0.05) in each, i.e., jitter, shimmer, and noise to harmonics ratio (NHR) were recorded. At 3 months post-CCRT, among 8/14 available, most (6/8 [75%]) showed Grade II toxicity. The mean F0 reduced for both genders; jitter and shimmer, and NHR values maintained an increase (P > 0.05). Conclusions: Periodic AA allows quantification of voice changes and mapping of vocal toxicity induced by CCRT.
  2,790 187 -
Role of aquaporins in oral cancer
Mamatha G. S. Reddy, Elizabeth Dony
January-March 2017, 13(1):137-138
DOI:10.4103/0973-1482.204848  PMID:28508847
Aquaporins (AQP) are the membrane proteins involved in the transport of water and some neutral solutes. Thirteen types of AQP are identified in various human tissues. The expression of AQP's has been studied in various tumors among one is oral cancer. These molecules are involved in cell proliferation, migration, and metastasis. AQP target inhibitors act directly or indirectly through focal adhesion kinase-mitogen-activated protein kinase signaling pathway and shown promising results along with anti-cancer drugs. However, further researches were required to verify the efficiency and safety of these AQPs-target inhibitors in clinical therapy.
  2,796 174 3
Disease characteristics and treatment attributes of patients admitted to the oncology ward of a tertiary care government hospital
Virender Suhag, BS Sunita, Pankaj Vats, Arti Sarin, AK Singh, Mayuri Jain
January-March 2017, 13(1):44-50
DOI:10.4103/jcrt.JCRT_1283_16  PMID:28508832
Background: The burden of oncology patients in the most developing countries including India has witnessed a steady, progressive, and significant upward trend attributed mainly to increased life span, availability of better imaging modalities, increased awareness, and lifestyle and environmental changes. The management of such patients in government setup often presents lots of challenges such as advanced stage of presentation, existence of medical comorbid conditions, scarcity of beds, and long multimodal treatment often complicated with therapy-induced toxicities. Materials and Methods: A prospective study was undertaken in a Radiation Oncology ward catering to male patients over 6-month duration in a superspecialty hospital of defense services. The clinical, pathological, and treatment-related attributes were recorded. Wherever possible, the clinical course of stay, complications during admission, and the response to primary management were studied. Results: A total of 570 patients were admitted for 6-month duration. Of these patients, 240 were transferred in from other peripheral service hospitals while the remaining were admitted directly from this hospital or transferred from various wards of this hospital. The mean age of the patients was 46.5 years. Most common histology was squamous cell carcinoma. The most common site of primary was head and neck, followed closely by central nervous system tumors and gastrointestinal tract. A total of 185 patients were fresh cases admitted for workup and complete duration of definitive management (of which 82 received concurrent chemoradiation), 280 patients were for follow-up, 70 patients were admitted briefly for supportive care during a while on chemoradiation, and 15 patients were admitted for administrative reasons. Fifty-eight patients developed Grade II and onward therapy-induced hematological, gastrointestinal, cutaneous complications, and 14 patients suffered from febrile neutropenia. Thirty patients developed other significant complications warranting cross-referrals to other specialists. One hundred and thirty patients underwent more than one imaging modalities (contrast-enhanced computed tomography, magnetic resonance imaging, bone scan, and positron emission tomography-computed tomography). The duration of stay varied from 3 to 64 days, with an average duration of 38 days. There were 18 deaths during the study period. Conclusion: The course of hospitalization for oncology cases is often prolonged and complicated by significant complications, warranting aggressive supportive care by various concerned specialists. These patients often require multiple imaging for primary and metastatic workup. There is a need for judicious selection of patients meriting admission for optimum utilization of existing resources.
  2,839 126 -
Tabulated square-shaped source model for linear accelerator electron beam simulation
Navid Khaledi, Mahmood Reza Aghamiri, Hossein Aslian, Ahmad Ameri
January-March 2017, 13(1):69-79
DOI:10.4103/0973-1482.206235  PMID:28508836
Context: Using this source model, the Monte Carlo (MC) computation becomes much faster for electron beams. Aims: The aim of this study was to present a source model that makes linear accelerator (LINAC) electron beam geometry simulation less complex. Settings and Design: In this study, a tabulated square-shaped source with transversal and axial distribution biasing and semi-Gaussian spectrum was investigated. Subjects and Methods: A low energy photon spectrum was added to the semi-Gaussian beam to correct the bremsstrahlung X-ray contamination. After running the MC code multiple times and optimizing all spectrums for four electron energies in three different medical LINACs (Elekta, Siemens, and Varian), the characteristics of a beam passing through a 10 cm × 10 cm applicator were obtained. The percentage depth dose and dose profiles at two different depths were measured and simulated. Results: The maximum difference between simulated and measured percentage of depth doses and dose profiles was 1.8% and 4%, respectively. The low energy electron and photon spectrum and the Gaussian spectrum peak energy and associated full width at half of maximum and transversal distribution weightings were obtained for each electron beam. The proposed method yielded a maximum computation time 702 times faster than a complete head simulation. Conclusions: Our study demonstrates that there was an excellent agreement between the results of our proposed model and measured data; furthermore, an optimum calculation speed was achieved because there was no need to define geometry and materials in the LINAC head.
  2,813 134 1
Dual phase cone-beam computed tomography in detecting <3 cm hepatocellular carcinomas during transarterial chemoembolization
Xiaodong Wang, Hooman Yarmohammadi, Guang Cao, Xinqiang Ji, Jungang Hu, Hirad Yarmohammadi, Hui Chen, Xu Zhu, Renjie Yang, Stephen B Solomon
January-March 2017, 13(1):38-43
DOI:10.4103/0973-1482.206242  PMID:28508831
Objective: The objective of this study was to evaluate the sensitivity of dual phase cone-beam computed tomography (CBCT) in detecting small (<3 cm in diameter) hepatocellular carcinoma (HCC) tumors during transarterial chemoembolization (TACE). Materials and Methods: Twenty-two consecutive patients with unresectable small HCCs in whom TACE was performed were retrospectively evaluated. Contrast CT or contrast magnetic resonance imaging (MRI) was performed in all patients within 1 month prior to the procedure. Dual phase CBCT was performed prior to TACE and lipiodol-CBCT was performed after treatment. The sensitivity of dual phase CBCT in detecting small HCCs was compared to hepatic angiography, contrast enhanced CT and MRI. Results: Seventy HCC tumors with sizes of <3 cm were detected in 22 patients. Dual phase CBCT depicted 67 small tumors either on arterial or venous phase and was significantly more sensitive compared to hepatic angiography, contrast CT, or MRI (95.7%, 65.7%, and 71.4%, respectively; P < 0.001). Conclusions: Dual phase CBCT is significantly more sensitive than hepatic angiography, contrast enhanced CT, and MRI in detecting smaller than 3 cm HCC tumors and can be a helpful modality in making accurate planning for treatment of HCC.
  2,711 131 6
Coexistence of hard palate carcinoma with tuberculosis: A rarity
SK Verma, Anand Srivastava, Karthik Nagaraju, Ashwini Kumar Mishra, MM Goel
January-March 2017, 13(1):142-144
DOI:10.4103/0973-1482.174538  PMID:28508849
Coexistence of tuberculosis (TB) and palatal malignancy is a rare phenomenon and it has never been reported. Here, we present a case of hard palate carcinoma with TB in a 60-year-old male patient who was successfully managed by three pronged approaches by combining antitubercular therapy with chemotherapy and radiotherapy.
  2,717 111 -
Dosimetric verification of dose calculation algorithm in the lung during total marrow irradiation using helical tomotherapy
Ewelina Konstanty, Julian Malicki, Katarzyna Łagodowska, Anna Kowalik
January-March 2017, 13(1):33-37
DOI:10.4103/jcrt.JCRT_980_15  PMID:28508830
Introduction: Treatment of proliferative diseases of the hematopoietic system involves, in most cases, chemotherapy combined with radiation therapy, which is intended to provide adequate immunosuppressant. Conventionally, total body irradiation (TBI) was used; however, total marrow irradiation (TMI) performed with helical tomotherapy (HT) has been proposed as an alternative, with the aim of delivering the highest dose in the target area (skeleton bone). Purpose: The purpose of this study is to evaluate the accuracy of the dose calculation algorithm for the lung in TMI delivered with HT. Methods: Thermoluminescent detectors (TLD-100 Harshaw) were used to measure delivered doses. Doses were calculated for 95 selected points in the central lung (53 TLDs) and near the rib bones (42 TLDs) in the anthropomorphic phantom. A total of 12 Gy were delivered (6 fractions of 2 Gy/fraction). Results: HT-TMI technique reduces the dose delivered to the lungs in a phantom model to levels that are much lower than those reported for TBI delivered by a conventional linear accelerator. The mean calculated lung dose was 5.6 Gy versus a mean measured dose of 5.7 ± 2.4 Gy. The maximum and minimum measured doses were, respectively, 11.3 Gy (chest wall) and 2.8 Gy (central lung). At most of the 95 points, the measured dose was lower than the calculated dose, with the largest differences observed in the region located between the target volume and the adjacent lung tissue. The mean measured dose was lower than the calculated dose in both primary locations: −3.7% in the 42 rib-adjacent detectors and −3.0% in the 53 central lung TLDs. Conclusion: Our study has shown that the measured doses may be lower than those calculated by the HT-TMI calculation algorithm. Although these differences between calculated and measured doses are not clinically relevant, this finding merits further investigation.
  2,682 137 2
Evaluation of the effect of temperature variation on response of PRESAGE® dosimeter
Bagher Farhood, Davood Khezerloo, Tohid Morteza Zadeh, Hassan Ali Nedaie, Daryoosh Hamrahi, Najimeh Khezerloo
January-March 2017, 13(1):118-121
DOI:10.4103/0973-1482.199389  PMID:28508844
Introduction: Many factors, such as PRESAGE ® composition, dose rate, energy, and type of radiation, temperature, etc., may effect on PRESAGE ® dosimeter response. The aim of this study was investigating the effect of temperature variation on response of PRESAGE ® solid dosimeter. Materials and Methods: In this study, a PRESAGE ® solid detector was fabricated. Ninety-four percent weight polyurethane, 5% weight carbon tetrachloride, and 1% weight leucomalachite green were used. Radiological and physical characteristics of PRESAGEs ®, such as mass density, electron density, and effective number atomic were obtained and compared with water. Response of PRESAGE ® dosimeter in temperatures −4, 10, 25, 35, 45, 55, 65, 75, 85, and 90°C was evaluated. In addition, the absorption peak at various temperatures was investigated. Results: The results showed that the absorption peak at different temperatures was in the range of 630–635 nm. For temperatures below 75°C, the results indicated that temperature variation has no effect on the response of PRESAGE ® dosimeter whereas at the temperatures >75°C, temperature variation has an effect on PRESAGE ® dosimeter response. Conclusion: The finding showed that temperature changes have not impact on the absorption peak. In addition, the results related to the effect of temperature variation on the response of PRESAGE ® dosimeter showed that in the range of clinical applications (temperatures below 75°C), temperature variation has no effect on PRESAGE ® dosimeter response.
  2,564 144 1
Radiation-induced non-targeted effect in vivo: Evaluation of cyclooygenase-2 and endothelin-1 gene expression in rat heart tissues
Reza Fardid, Masoud Najafi, Ashkan Salajegheh, Elahe Kazemi, Abolhasan Rezaeyan
January-March 2017, 13(1):51-55
DOI:10.4103/0973-1482.203601  PMID:28508833
Aim: In this study, we investigated expression levels of cyclooxygenase-2 (COX-2) and endothelin-1 (ET-1) genes after pelvis and heart irradiation in a rat model. These factors are involved in heart diseases (HDs). Materials and Methods: We used seven groups, including two groups of pelvic irradiation, two groups of whole body irradiation, two groups of heart irradiation, and one control nonirradiated group. Pelvis irradiations were conducted at a 2 cm × 2 cm in the pelvis area. Irradiation condition conducted using 1.25 MeV cobalt-60 gamma-rays (30 cGy/min). The changes at ET-1 and COX-2 gene expressions in heart tissue after pelvis and heart irradiation were measured and compared to the control and whole body irradiation groups at 24 h and 72 h after the exposure. Results: In heart irradiation groups, 3-fold up-regulation of both ET-1 and COX-2 was observed. In pelvis irradiation groups, 3-fold up-regulation of ET-1 was seen, but not significant changes in COX-2 gene expression have observed at distant heart tissues after pelvis irradiation. Conclusion: This study reveals that nontargeted effect induced by radiation may be considered as an important phenomenon for induction of HD after radiotherapy.
  2,504 133 5
Retraction: Evaluation and identification of factors related to KRAS and BRAF gene mutations in colorectal cancer: A meta analysis

January-March 2017, 13(1):156-156
DOI:10.4103/0973-1482.206243  PMID:28508855
  2,241 186 -
Accelerated fraction radiation therapy versus concurrent chemoradiation therapy for locally advanced head and neck cancers: Is there evidence of equivalent effect?
Snehal Bhupendra Shah, Devendra Arvind Chaukar, Priya Ranganathan
January-March 2017, 13(1):153-154
DOI:10.4103/0973-1482.184520  PMID:28508853
  2,313 93 -
Comparison of beam hardening effect of physical and enhanced dynamic wedges at bladder inhomogeneity using EBT3 film dosimeter
Ghazale Geraily, Nooshin Sharafi, Alireza Shirazi, Mahbod Esfehani, Maryam Masoudifar, Blookat Eftekhar Rajab
January-March 2017, 13(1):97-101
DOI:10.4103/0973-1482.206244  PMID:28508840
Introduction: Using physical wedges (PWs) to modify dose distribution and more homogeneous target coverage is a well-established technique. However, there are many problems with PWs known as beam hardening, which made them problematic. This can be overcome by dynamic wedges which do not filter beam. Comparison of physical properties of physical and enhanced dynamic wedges (EDWs) restricted to homogeneous medium. Hence, the main aim of this study is to compare dosimetric properties of physical and EDWs at bladder inhomogeneous phantom as a most common case implementing wedges. Materials and Methods: An inhomogeneous pelvic phantom with homogeneities of uterus, femur, soft tissue, rectum, and bladder was designed. Eclipse treatment planning system with the aim of bladder target was used for calculations. All dose distributions were measured with EBT3 films. Results: Comparison between beam profiles of physical and EDWs at wedged and nonwedged directions shows a greater difference at near inhomogeneous soft tissue interface and also at heel side of wedges. Conclusion: Little difference observed between dose distribution of physical and EDWs shows neglectable effect of beam hardening produced by PW compared to EDW at inhomogeneous medium. Furthermore, EBT3 films present good feature to measure dose distributions at EDW fields.
  2,099 102 -
Anaplastic hemangiopericytoma of eyelid: An unusual location
Pradeep Ventrapati, Sushmita Pathy, Ajeet Kumar Gandhi, Seema Kashyap
January-March 2017, 13(1):145-147
DOI:10.4103/0973-1482.206240  PMID:28508850
Hemangiopericytomas (HPCs) are rare soft tissue tumors. The eyelid is a very uncommon site for these tumors, and an anaplastic variant of HPC in the eyelid has not been reported before. A 44-year-old male presented with complaints of slowly progressive, painless swelling on the inner aspect of the left upper eyelid for 9 months. He underwent local excision of the swelling and histopathology revealed a WHO Grade III anaplastic HPC. Whole body 18 F-fluorodeoxyglucose positron emission tomography-computed tomography done postoperatively did not show any evidence of local or distant disease. The patient was planned for adjuvant radiotherapy of 60 Gy in 30 fractions over 6 weeks in view of high grade of histopathology and doubtful margins. He is disease free at the time of the last follow-up. To the best of our knowledge, this is the first case of anaplastic HPC of eyelid being reported in English literature.
  1,922 73 -
Erratum: Effects of food insecurity on the women esophageal cancer in the Zanjan Province

January-March 2017, 13(1):155-155
DOI:10.4103/0973-1482.191054  PMID:28508854
  1,874 74 -
From the editor
Kishore Singh
January-March 2017, 13(1):1-1
DOI:10.4103/jcrt.JCRT_384_17  PMID:28508824
  1,656 115 -