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   2022| January-March  | Volume 18 | Issue 1  
    Online since March 30, 2022

 
 
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ORIGINAL ARTICLES
Evaluation of field-in-field, three-field, and four-field techniques for treatment planning of radiotherapy of pancreatic cancer
Mohamad Pursamimi, Mahdi Ghorbani, Wrya Parwaie, Ahmad Shakeri, Ali Soleimani Meigooni
January-March 2022, 18(1):190-199
DOI:10.4103/jcrt.JCRT_181_20  PMID:35381783
Background: Pancreatic adenocarcinoma is a lethal condition with poor outcomes by various treatment modalities and an increasing incidence. Aim: The aim of this study is to evaluate the advantages of field-in-field (FIF) versus three-field and four-field radiation treatment planning techniques in three-dimensional treatment of patients with pancreatic cancer. Materials and Methods: The evaluations of these planning techniques were performed in terms of physical and biological criteria. Radiotherapy treatment data of 20 patients with pancreatic cancer were selected and evaluated for FIF, three-field, and four-field treatment techniques. The patients were treated by 6 MV photon beam of a medical linac, and these three treatment planning techniques were evaluated for all the 20 patients. The plans were compared based on dose distribution in the target volume, monitor unit (MU), and dose to organs at risk (OARs). Results: The results have shown that, with assuming the same prescribed dose to planned target volume, FIF plans have some advantages over three-field and four-field treatment plans, based on MU values, V20 Gy in the right lung, V20 Gy in the left lung, Dmean in the left kidney, Dmean in the liver, and Dmean in the spinal cord. Based on the obtained results, the use of FIF technique reduces MUs compared to the three-field and four-field techniques. Conclusion: Having a less MU for performing treatment reduces scattered radiation and therefore reduces the risk of secondary cancer in normal tissues. In addition, the use of FIF technique has advantage of less radiation dose to some OARs.
  3,013 79 -
REVIEW ARTICLES
The golden spice curcumin in cancer: A perspective on finalized clinical trials during the last 10 years
Ayse Kubra Karaboga Arslan, Ebru Uzunhisarcıklı, Mükerrem Betül Yerer, Anupam Bishayee
January-March 2022, 18(1):19-26
DOI:10.4103/jcrt.JCRT_1017_20  PMID:35381757
Curcumin, the key bioactive phytochemical present in turmeric (Curcuma longa L.), is the most studied natural compound in cancer. Preclinical studies (in vitro and in vitro) and clinical trials have demonstrated curcumin's effectiveness as an anti-inflammatory agent. The existing evidence supports that curcumin inhibits the proliferation of many types of cancer cells and can play an important role in cancer therapy. This study analyses the existing evidence in the literature on finalized clinical trials (2010–2020) related to the effect of curcumin and turmeric-derived products that focused on different types of cancers, such as chronic myeloid leukemia, multiple myeloma, prostate, colorectal and pancreatic cancer as well as cancer therapy-related complications, including oral mucositis and radiation dermatitis. Original English language articles and clinical trials published between 2010 and 2020 were searched using mainstream scholarly databases, such as PubMed, ScienceDirect, Google Scholar, and ClinicalTrials.gov. The keywords, such as “curcumin,” “turmeric,” “cancer,” “anti-inflammatory,” and “clinical trials,” were used in various combinations. A total of 21 clinical trials were selected, reviewed, and included in this study. Sixteen out of 21 clinical trials were associated with the effectiveness of curcumin or turmeric on various types of cancer, and the other five clinical trials were related to the evaluation of the efficacy of curcumin or turmeric in relieving the side effects of cancer chemotherapy and radiotherapy. The emerging data from the clinical trials confirm that curcumin has the potential for cancer prevention and intervention. However, it is not yet clear whether long-term curcumin supplementation has similar benefits.
  1,666 248 -
EDITORIAL
Steps to improve cancer treatment facilities especially radiotherapy infrastructure in India
Manoj Gupta, Kishore Singh
January-March 2022, 18(1):1-4
DOI:10.4103/jcrt.jcrt_2383_21  PMID:35381755
  1,041 672 -
ORIGINAL ARTICLES
Treatment outcomes and prognostic factors in locally advanced non-small cell lung cancer – An experience from normal India
Arun Thimmarayappa, Sushmita Pathy, Prabhat Singh Malik, Supriya Mallick, Ashish Dutt Upadhyay
January-March 2022, 18(1):27-32
DOI:10.4103/jcrt.jcrt_1855_20  PMID:35381758
Context: Chemoradiation is the standard of care in locally advanced non-small cell lung cancer (LA-NSCLC). Clinical presentation, disease course, and available treatment options are challenges to overcome. Little is known about the ideal timing and interaction of the two modalities, its relevance in day-to-day decision-making and the treatment outcome. Aims: The study evaluates the demographic profile, treatment pattern, outcome, and radiotherapy (RT) practice and patient care of LA-NSCLC at a tertiary cancer center. Setting and Design: This is a retrospective study from a tertiary cancer centre. Archives of patients of LA-NSCLC treated between June 2016 and June 2018 were included in our study. Materials and Methods: Clinical, demographic characteristics, treatment patterns, and outcomes were recorded. RT practice and patient care process including the integration of RT with other specialties, waiting time, and compliance to treatment were documented and analyzed. Statistical Analysis: Overall survival (OS) and progression-free survival (PFS) were the primary endpoints of the study. Log-rank test was used for univariate analysis for the factors on OS, and Cox's proportional hazards model was used for multivariate analysis for cofactors on OS. Results: Two hundred and thirty-two patients of lung cancer were treated during the study period. Fifty-four patients were squamous cell carcinoma, 108 were adenocarcinoma, and 12 were others. Out of 59 patients of LA-NSCLC, 34 underwent definitive chemoradiation. The median follow-up was 11 months (0.7–29), median overall treatment time was 44 days, median PFS was 8.9 months (range: 1.6–28.6), and median OS was 9.4 months (1.7–44.8). Time to start any oncological intervention was 1 month (0.1–4.3) and time to start RT was 2.1 months (0.1–5.4). Adherence to treatment was 91.2%. Age ≥65 and performance status ≥2 were significant for OS on univariate analysis and none on multivariate analysis. Conclusions: One-third of the cases of NSCLC present in LA stage and a third are suitable for definitive chemoradiation and only 20% undergo the planned treatment.
  1,490 197 -
Evaluation of cytotoxic effects of fungal origin nanosilver particles on oral cancer cell lines: An in vitro study
Kiran R Halkai, Rahul Halkai, Supriya Patil, Jameela Alawadi, Wafa Saeed Alawadhi, Narender Reddy Marukala, Nassreen Hassan Mohammad Albar, Shreeshail Indi
January-March 2022, 18(1):240-244
DOI:10.4103/jcrt.JCRT_1308_20  PMID:35381790
Background: Oral cancer is often associated with poor prognosis and it is found that conventional treatment options cause severe side effects, adjacent tissue disfigurement, and loss of function. Recently, silver nanoparticles (AgNPs) paved their path for cancer treatment. Aim: This study aimed to investigate cytotoxic effects of fungal procured AgNPs on oral squamous cell carcinoma (SCC-9) cell line using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Methodology: The silver nanoparticles were biosynthesized using the fungi Fusarium semitectum. Cell lines were cultured in a 1:1 ratio of Dulbecco's Modified Eagle's medium and Ham's F12 medium and subcultured in a T-75 cm2 flask. Cell count was adjusted to 1 × 105 cells/ml; 50,000 cells/well were seeded into a 96 well plate and incubated at 37°C, for 24 h in 5% CO2 humidified conditions. AgNPs (1.75–50 μl/ml) were added to the plates and further incubated at 37°C for another 24 h. Medium containing cells without AgNPs were used as a control group. Later, 20 μl of MTT was added to each well and incubated for 6 h at above-mentioned conditions. About 0.1 mL of Dulbecco's Modified Eagle's Medium solution was added to each well to solubilize formazan. The absorbance was measured using a Tecan reader at 540 nm. The experiment was repeated thrice independently. The percentage (%) inhibition of growth and the AgNP's concentration that prevents the cell growth by 50% (IC50) were determined. Results: Significant dose-dependent inhibition of the growth of SCC-9 cell lines was seen and IC50 was found at 12 μl/ml concentration of AgNPs. Conclusion: Biosynthesized AgNPs of fungal origin exhibit effective anticancer properties against the SCC-9 cell line.
  1,039 56 -
CASE REPORTS
Giant cell tumor of hyoid bone: Diagnostic dilemma with a novel management
Ameya Bihani, Shivakumar Thiagarajan, Devendra Chaukar, Anil K D'Cruz
January-March 2022, 18(1):282-285
DOI:10.4103/jcrt.JCRT_205_19  PMID:35381802
Giant cell tumor of bone (GCTB) is locally aggressive tumor occurring in the epiphysis of long bones. GCTBs are uncommon tumors in the head-and-neck region and rarely involve hyoid bone. We report a case of GCTB of hyoid bone. The patient presented with swelling in left submandibular region. The tumor was surgically excised after initial denosumab therapy. Despite adequate resection and rehabilitation, he was tube dependent. Subsequently it was found that the patient had a coexisting myotonic dystrophy, unknown to exist with GCTB of hyoid. Eventually, the patient succumbed to respiratory failure secondary to myotonic dystrophy. GCTB hyoid is a rare presentation posing a diagnostic dilemma. Ours is the first case to report the use of denosumab for GCT in head-and-neck region. Myotonic dystrophy Type I and GCTB are both known to result from abnormality of closely situated foci on chromosome 19.
  1,016 35 -
REVIEW ARTICLES
Managing brain tumors in pregnancy: The oncologist's struggle with maternal-fetal conflict
Shikha Goyal, Arun Yadav, Renu Madan, Aarti Chitkara, Ranjit Singh, Divya Khosla, Narendra Kumar
January-March 2022, 18(1):5-18
DOI:10.4103/jcrt.JCRT_1343_20  PMID:35381756
The diagnosis of malignancy, particularly brain tumors, in pregnancy is uncommon but poses a complex dilemma for the management of both the patient and her fetus, as the interplay of disease with the physiological state of pregnancy affects both outcomes. The routine evaluations (symptomatology, imaging, and hormonal assessments) and treatments (surgery, radiation therapy, and chemotherapy) that are commonplace in brain tumor management may need to be omitted or modified keeping in mind the risk to offspring. Multidisciplinary care and extensive prenatal and perinatal counseling and monitoring are essential. In this review, we discuss the available data addressing these issues and factors which may affect considerations of therapeutic abortions, changes in surgical or medical practices, and outcomes thereof.
  881 152 -
ORIGINAL ARTICLES
The effect of medicarpin on PTEN/AKT signal pathway in head and neck squamous cell carcinoma
Aysel Kalayci Yiğin, Huseyin Donmez, Mustafa Hitit, Sena Seven, Nadire Eser, Ercan Kurar, Mehmet Seven
January-March 2022, 18(1):180-184
DOI:10.4103/jcrt.jcrt_641_21  PMID:35381781
Background/Aim: We aimed to investigate the in vitro modulating effects of medicarpin on the PI3K/AKT signal pathway gene expressions in head and neck squamous cell carcinoma (HNSCC). Materials and Methods: The effect of medicarpin on PTEN and other associated genes in the PTEN/AKT signal pathway was investigated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, real-time quantitative polymerase chain reaction, and Western blot analysis in the SCCL-MT1 (HNSCC) and control (HEK-293) cell lines. Results: The IC50 dose was 80 μM as a result of medicarpin treatment on HNSCC cells (P = 0.0006). It was found that PTEN and AKT gene expressions increased after the medicarpin administration while PDK1 gene expression was decreased in SCCL-MT1 cells (P = 0.0002, P = 0.0003, and P = 0.05, respectively). Protein expression results showed that medicarpin-treated cells significantly increased in pAKT (P = 0.024), pPTEN (P = 0.032), and decreased pPDK1 (P = 0.059) in SCCL-MT1. Conclusions: Our data show that medicarpin modulates HNSCC cells by increasing the PTEN and decreasing PDK1 expressions. PDK1 gene expression effects mTOR pathway which may increase AKT gene. Our study suggests that both medicarpin extracts combination with the HNSCC drug may be more effective in cancer treatment. Future prospective studies that integrate molecular and pharmacogenetic studies are crucial for revealing the mechanism and preventive medical efforts.
  937 42 -
Molecular profiling of oral squamous cell carcinoma associated with oral submucous fibrosis
Sheetal Choudhari, Sneha Masne, Prachi Bhandare, Snehal Dhumal
January-March 2022, 18(1):55-65
DOI:10.4103/jcrt.JCRT_508_20  PMID:35381762
Context: Areca nut, a causative factor for oral submucous fibrosis (OSMF), is identified as a Group 1 human carcinogen. Oral squamous cell carcinoma (OSCC) associated with OSMF is now one of the most common malignancies in South and Southeast Asian countries. Aim: The present study was aimed to have clarity whether OSCC associated with OSMF is a pathologically different disease having different prognosis. Settings and Design: The difference between OSCC associated with OSMF and OSCC not associated with OSMF was studied in relation to expression of molecular markers, Ki-67, a proliferative and prognostic marker for OSCC and matrixmetalloproteinase-9 (MMP-9), and alpha smooth muscle actin (α-SMA), markers for invasiveness. Subjects and Methods: Expression was analyzed immunohistochemically using paraffin-embedded tissues from ten normal oral mucosa (Group I), thirty OSCC associated with OSMF (Group II), and thirty OSCC not associated with OSMF (Group III). Results: Group II showed OSCC occurring at younger age with more cases of well-differentiated OSCC. It also showed lower expression of Ki-67, MMP-9, and α-SMA as compared to Group III, and the difference was statistically significant. In addition, statistically significant low expression of markers was found in well and moderate grades of Group II as compared to those of Group III. Conclusion: OSCC associated with OSMF may have better prognosis and survival rate as it is found to occur at younger age with better grade of tumor differentiation and less expression of molecular markers Ki-67, MMP-9 and α-SMA. Thus, OSCC associated with OSMF can be considered a different disease pathologically and biologically. In-depth analysis of this molecular profiling can help to establish diagnostic, prognostic and therapeutic modalities for this unique malignancy.
  515 61 -
Serum zinc status and the development of mucositis and dermatitis in head-and-neck cancer patients undergoing curative radiotherapy: A pilot study
Suresh Rao, Faizan Kalekhan, Sanath Kumar Hegde, Pratima Rao, Sucharita Suresh, Manjeshwar Shrinath Baliga
January-March 2022, 18(1):42-48
DOI:10.4103/jcrt.JCRT_344_20  PMID:35381760
Background: Radiation-induced mucositis and dermatitis are severe side effects and compromise the health of the head-and-neck cancer patient undergoing treatment. Zinc supplementation during the course of the treatment is shown to have protective effects against both radiation-induced mucositis and dermatitis. The aim of this study was to understand whether the level of serum zinc has an effect on the development of mucositis and dermatitis. Materials and Methods: This was noninterventional study where the levels of serum zinc were ascertained before the start of treatment by spectrophotometric methods. The patients were treated every day with no more than one fraction of 2 Gy per day, five times a week without any intended gaps for a planned target dose of 60–70 Gy (6–7 consecutive weeks). The patients were assessed for radiation-induced dermatitis and mucositis in accordance with the standard guidelines. The association between the levels of serum zinc with the development of different grades of mucositis and dermatitis (on the day of development) was ascertained using the Pearson correlation coefficient (r). A statistical value of P < 0.05 was considered to be statistically significant. Results: A total of 52 consecutive patients satisfying the inclusion criteria were enrolled. The results indicate that serum zinc levels showed a significant correlation (r = 0.29; P < 0.038) for Grade 1, while it was insignificant for Grades 2 and 3. For dermatitis, a significant correlation for all the grades (Grade 1 [r = 0.28; P < 0.043]; Grade 2 [r = 0.39; P < 0.006]; and Grade 3 [r = 0.49; P < 0.047]) was observed. Conclusions: For the first time, the results of this pilot study indicate that the serum level of zinc had an inverse association with the early development of mucositis and dermatitis, with better effects seen in dermatitis where it was also effective in Grades 2 and 3.
  478 66 -
CASE REPORTS
Gastric immature teratoma arising from the lesser curvature of the stomach: A rare case report
Madhu Kumar, Akanksha Singh, Damini Singh
January-March 2022, 18(1):308-311
DOI:10.4103/jcrt.JCRT_870_20  PMID:35381809
Immature gastric teratoma is an uncommon germ cell tumor of the stomach. A 6-month-old male child was born through full-term vaginal delivery. After 1 month presented with a history of abdominal distension and palpable mass along with a history of Malena for the past 10 days. Computed tomography scan showed the presence of a large well-defined multilobulated solid cystic lesion with multiple calcifications in the abdominopelvic region. Radiological findings were suggestive of germ cell tumors. The exploratory laparotomy findings showed a large tumor mass with variegated consistency arising from the lesser curvature of the posterior wall of the stomach. The total excision of mass and primary closure of the gastric wall was done. Histopathology of excised specimens showed immature teratoma of the stomach. The child is still on follow-up regularly visited as outpatient, doing well day-to-day activity. We report a very rare case of immature gastric teratoma in an infant on the basis of clinicoradiological and pathological findings.
  510 30 -
ORIGINAL ARTICLES
Detection of Helicobacter pylori in oral squamous cell carcinoma using modified Giemsa stain: A new diagnostic approach
Rucha D Gore, Sangeeta J Palaskar, Rasika B Pawar, Shreeedhar D Khule
January-March 2022, 18(1):72-75
DOI:10.4103/jcrt.JCRT_562_17  PMID:35381764
Context: Oral squamous cell carcinoma (OSCC) is the sixth most common cancer worldwide. It is mainly known to be caused by tobacco in various forms and also due to viral, fungal infection and poor oral hygiene, etc. Poor oral hygiene leads to colonization of pathogenic bacteria including Helicobacter pylori. It seems that the presence of H. pylori might be a risk factor for developing oral cancer. The successful attempt was made to detect H. pylori in diagnosed specimens of OSCC using Warthin–starry and Giemsa stains in our department. The modified Giemsa stain is the method of choice because it is sensitive, cheap, easy to perform, faster, and reproducible. Aim: The aim of this study is to detect H. pylori in various grades of OSCC using modified Giemsa stain. Subjects and Methods: Thirty cases of various grades of OSCC were selected from the archives of the department. Five-micrometer-thick paraffin-embedded tissue sections of these cases were taken and stained with modified Giemsa and were studied under ×100 magnification. Results: All the tissue sections studied were positive for H. pylori bacteria. Conclusions: Our study showed a significant presence of H. pylori in histological sections of OSCC, and it seems likely that the presence of H. pylori might be a risk factor for the developing oral lesions such as oral cancer. Early detection and eradication of H. pylori in the oral cavity, especially in high-risk patients, might prevent its harmful consequences.
  456 83 -
A metagenomic assessment of gut microbiota in Indian colon cancer patients
V Deepak Bamola, Rajkishor Kapardar, Banwari Lal, Atul Sharma, Rama Chaudhry
January-March 2022, 18(1):96-102
DOI:10.4103/0973-1482.341139  PMID:35381769
Background: Gut microbiota plays an important role in the development of different diseases including colorectal cancer. The geography, lifestyle, and dietary habits of Indians are different from Western world, thus microbiome studies of Western population could not be extrapolated to their Indian counterparts. Method: Therefore, we have conducted a study on gut microbiota in Indian healthy subjects and patients of colon cancer using 16S ribosomal RNA Amplicon sequencing. Operational taxonomic units were calculated for different bacterial taxon including phylum, class, order, family, and genus level. Results: Observed results indicated a considerable difference in the bacterial diversity in both the groups. Phylum Firmicutes was significantly dominated in both the groups followed by Bacteroidetes, Actinobacteria, and Proteobacteria which clearly indicates the dominance of phylum Firmicutes in Indian population. Phylum Firmicutes and Actinobacteria were significantly abundant in the healthy group while phylum Bacteroidetes in the colon cancer group. Bacterial genera Megamonas, Megasphaera, Mitsuokella, and Streptococcus were significantly abundant in the healthy group and Veillonella, Prevotella, and Eubacterium in the colon cancer group. Bacterial genus Bradyrhizobium was present in the healthy group and Alistipes, Coprococcus, Dorea, and Rhodococcus were present in the colon cancer group but absent in the healthy group. Conclusion: There was a considerable difference in bacterial diversity in both the study groups indicating dysbiosis in the colon cancer group.
  454 78 -
CASE REPORTS
Erythroderma: An unusual manifestation of imatinib – A rare case report
Pritam Kataria, Apurva Patel, Pradip Kendre, Nahush Tahiliani, Tushar Mule, Murtaza Bohra
January-March 2022, 18(1):253-256
DOI:10.4103/jcrt.JCRT_306_18  PMID:35381793
Imatinib is a tyrosine kinase inhibitor that selectively inhibits several protein tyrosine kinases which is central to the pathogenesis of human cancer. It forms the first-line treatment for chronic myeloid leukemia (CML) and gastrointestinal stromal tumors. Usually, the drug is well-tolerated with relatively few side effects. Adverse effects most commonly associated with imatinib include mild-to-moderate edema, nausea and vomiting, diarrhea, muscle cramps, and cutaneous reactions. Other side effects such as the elevation of hepatic transaminase and myelosuppression occur less frequently and resolve with interruption of imatinib therapy. Skin rash is one of the most common adverse effects of imatinib incidence of which range from 7% to 88.9%. Exfoliative dermatitis, i.e., erythroderma has been very rarely reported with this drug. We here report a rare case of erythroderma in a patient with CML on imatinib 400 mg/day therapy within 3 months of starting the treatment.
  426 94 -
ORIGINAL ARTICLES
Clinical response of carboplatin-based chemotherapy and its association to genetic polymorphism in lung cancer patients from North India – A clinical pharmacogenomics study
Ritambhara , Sonia Tiwari, Sivakumar Vijayaraghavalu, Maqsood A Siddiqui, Abdulaziz A Al-Khedhairy, Munish Kumar
January-March 2022, 18(1):109-118
DOI:10.4103/jcrt.JCRT_925_20  PMID:35381771
Purpose: Lung cancer mostly diagnosed at advanced inoperable stages; thereby, the chemo-, radiation-, targeted or immune-therapy alone or in combination remains the treatment of choice. In chemotherapy, platinum-based compounds such as cisplatin and carboplatin and third-generation drugs such as docetaxel, paclitaxel, gemcitabine, and vinorelbine are widely used. The beneficial therapeutic outcome of the chemotherapy alone or in combination with radiation (chemoradiation) and/or development of drug resistance depends on the inter-individual genetic differences. Hence, this study was carried out to find gene biomarker that could be useful in the diagnosis of the disease and to predict the outcome of chemo/chemoradiation therapy in ethnic North Indian population. Materials and Methods: In this clinical study, lung cancer (n = 52) patients from North Indian population were recruited. All the patients were treated with carboplatin target area under curve-5 in combination with third-generation drugs (gemcitabine 1.2 mg/m2; paclitaxel 175 mg/m2; and etopside 100 mg/m2) and radiation therapy. The genomic DNA was isolated from the blood sample and performed polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism. Results: We found hazard ratio to be significantly higher for XPDLys751Gln (hazard ratio [HR] =2.11, 95% confidence interval [CI]: 0.98–4.53, P = 0.056) and IL1 β511C/T (HR = 9.9, 95% CI: 2.55–38.40, P = 0.001). GSTT1 null (HR = 0.39, 95%CI: 0.18-0.84, P = 0.017) genotype has better response to chemotherapy. Generalized multidimensional reduction model suggested that IL1RN (cross-validation consistency [CVC] =10/10, P = 0.054) and XRCC1399Gln, GSTM1 (CVC = 10/10, P = 0.001) as best predicted model in lung cancer patients to the treatment response. Conclusion: Genetic polymorphisms and single nucleotide polymorphisms in DNA repair gene (XRCC1, XPD) and drug-metabolizing gene (GSTM1 and GSTT1) could serve as genetic biomarkers in lung cancer patients treated with the above indicated chemotherapy. Based on genotype and chemotherapy treatments, the toxicity effects can be minimized, this will help in the development of personalized medicine in future with better efficacy.
  432 79 -
Significance of HIF-1α and CD105 in establishing oral squamous cell carcinoma associated with oral submucous fibrosis a distinct clinicopathological entity
Alka Harish Hande, Minal S Chaudhary, Amol R Gadbail, Madhuri N Gawande, Swati K Patil, Prajakta R Zade, Preethi N Sharma, Shradha G Jaiswal, Archana M Sonone
January-March 2022, 18(1):33-41
DOI:10.4103/jcrt.JCRT_591_20  PMID:35381759
Context: Oral squamous cell carcinoma associated with oral submucous fibrosis (OSCC with OSMF) is clinicopathologically a distinct entity. However, scientific proof in view of assessment of biomarkers of hypoxia and neoangiogenesis to differentiate them are lacking. The expression of hypoxia-inducible factor 1-α (HIF-1α) and CD105 in OSCC with and without OSMF possibly will be explicated along these lines. Aim: This study aims to evaluate the molecular basis of hypoxia and neoangiogenesis in terms of immunohistochemical expression of HIF-1α and CD105 in OSCC with and without OSMF cases. Settings and Design: A retrospective cohort. Subjects and Methods: The study comprise of 203 histopathologically diagnosed surgically operated cases of OSCC retrieved from the departmental archives. The OSCC cases were subgrouped into two, OSCC with OSMF (Group I) and OSCC without OSMF (Group II). The evaluation of hypoxia and angiogenesis was carried out by immunohistochemical markers, HIF-1α and CD105. MVD is the parameter of angiogenesis expressed by CD105. Statistical Analysis Used: Differences in CD105, and HIF-1α immunoreactivity between study groups were done using descriptive statistics using “Kruskal–Wallis test,” “Mann-Whitney test.” Statistical significance was set at P < 0.05. Results: On comparison of MVD in Group I and II, statistically significant difference was found in MVD (8.88 ± 3.41, 16.13 ± 5.86, P = 0.0001). The HIF1-α expression was less in Group I (6.85 ± 2.62) as compare to Group II (7.22 ± 3.08) but the difference was statistically nonsignificant (P = 0.35). Conclusions: The OSCC with OSMF is not only clinicopathologically distinct entity of OSCC but also diverse in its molecular pathogenesis as explicited by distinct expression of HIF-1 α and CD105.
  438 64 -
Tumor infiltrating lymphocytes in head and neck squamous cell carcinoma – Evaluation and clinical impact
Senjuti Dasgupta, Sudipta Chakrabarti, Asit Ranjan Deb
January-March 2022, 18(1):49-54
DOI:10.4103/jcrt.JCRT_830_20  PMID:35381761
Background: Head-and-neck squamous cell carcinomas (HNSCCs) are one of the most common malignancies worldwide. Emerging evidence reveals that tumor-infiltrating lymphocytes (TIL) provide valuable prognostic information in various malignancies, including HNSCC. Aims and Objectives: The present study aimed to evaluate a simple yet accurate method of counting TILs in HNSCCs. It was also done to determine if there is any correlation between different clinicopathological parameters of HNSCC and TIL counts. Materials and Methods: A retrospective institutional-based, observational study was undertaken for 1 year. Patients with histologically proven HNSCCs were included. All clinicopathological parameters were noted, and evaluation of TIL was meticulously done both in the stromal and intratumoral regions for each case. Standard statistical methods were employed for data analysis. Results: The present study included 81 patients, among which 51 (63%) were male and the rest (30, 37%) were female. The mean age of the patients was 55.3 ± 10.5 years. Most tumors were located in the oral cavity (73, 90.1%). The most common histologic type was moderately differentiated (MD) squamous cell carcinoma (SCC) (50 cases, 61.7%). Stromal TIL score was high in 45 cases (55.6%). In 69 cases (85.2%), the intratumoral TIL level was low. A statistically significant correlation was found between TIL levels (both stromal and intratumoral TIL) and tumor differentiation, pT stage, and lymphovascular invasion. The correlation between intratumoral TIL level, age of patients, and pN stage was also statistically significant. Conclusion: TIL evaluation is an inexpensive, simple, and reproducible method, which furnishes relevant prognostic data. It has the potential for consideration of its inclusion in routine histopathological reports of HNSCCs.
  424 67 -
Clinical outcome of intensity-modulated radiotherapy versus two-dimensional conventional radiotherapy in locally advanced nasopharyngeal carcinoma: Comparative study at SKIMS Tertiary Care Institute
Kaneez Fatima, Asifa Andleeb, Mushtaq Ahmad Sofi, Malik Tariq Rasool, Afroz Fir, Shahida Nasreen, Nazir Ahmad Dar
January-March 2022, 18(1):133-139
DOI:10.4103/jcrt.jcrt_169_21  PMID:35381774
Background: The management of nasopharyngeal cancer (NPC) at present is based primarily on radiotherapy, but the technique by which radiation therapy is delivered is different such as intensity-modulated radiotherapy (IMRT) and two-dimensional conventional radiotherapy (2D-CRT). Materials and Methods: In our study, IMRT and 2D-CRT were compared for their treatment outcome in locally advanced nasopharyngeal carcinoma (NPC) patients. Patients with Stage II to IVA nasopharyngeal cancer (NPC) as per the American Joint Committee on Cancer 7th and 8th edition 2017 treated with IMRT (n = 30) and 2D-CRT (n = 30) between October 2016 and October 2020 were retrospectively analyzed. We matched our patients by using the propensity-score matching method. OS was the primary endpoint of our study. The secondary endpoints were local relapse-free survival (LRFS), regional relapse-free survival (RRFS), disease-free survival (DFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). Acute and late radiation toxicities between IMRT and 2D-CRT were also compared. Results: In the propensity-matched cohort of 60 patients, 30 patients received 2D-CRT and 30 patients received IMRT. Compared with the treatment of 2D-CRT, the IMRT group is associated with a better 3-year OS (70% vs. 85% P = 0.045), LRFS (78% vs. 96% P = 0.047), RRFS (78% vs. 95% P = 0.015), DFS (80% vs. 95% P = 0.034), and PFS (84% vs. 90% P = 0.024), while as DMFS (85% vs. 85% P = 0.147) were comparable in both the groups. IMRT was also associated with a lower incidence of late toxicities such as xerostomia and trismus. Conclusion: Our study demonstrates that IMRT yields better long-term overall survival and local control including LRFS, RRFS, DFS, and PFS. In addition, late toxicities induced by irradiation in nasopharyngeal carcinoma (NPC) are lower with IMRT. IMRT may be an effective treatment in nasopharyngeal cancer (NPC) as compared to 2D-CRT, but further studies are needed to establish the association.
  448 43 -
CASE REPORTS
Post hysterectomy mesonephric carcinoma: A case report and literature review
Sanjay Kumar, Sucheta , Bharti Saklani, Archana , Raman Kapil, Rajeev Sen
January-March 2022, 18(1):277-279
DOI:10.4103/jcrt.JCRT_168_19  PMID:35381800
Mesonephric carcinoma is a rare type of carcinoma seen in the female genital tract. It arises from the mesonephric remnants situated in the broad ligament, lateral wall of the cervix, vagina, and uterine corpus. Very few cases of mesonephric carcinoma have been reported so far in the literature. The sites mentioned in various literatures include the cervix, vagina, or uterus, but we could not find any literature that mentions posthysterectomy vault as a site for mesonephric carcinoma. Here, we report a case of 40-years-old hysterectomised female who presented in the hospital with nodular growth on the vault and complaints of bleeding per vaginum. Microscopy of the lesion did not show typical morphology of mesonephric carcinoma, but immunohistochemistry played a vital role in the diagnosis of this rare tumor.
  449 31 -
ORIGINAL ARTICLES
Radiotherapy for locally advanced unresectable gallbladder cancer - A way forward: Comparative study of chemotherapy versus chemoradiotherapy
Shwetabh Sinha, Reena Engineer, Vikas Ostwal, Anant Ramaswamy, Supriya Chopra, Nitin Shetty
January-March 2022, 18(1):147-151
DOI:10.4103/jcrt.JCRT_1568_20  PMID:35381776
Background: For nonmetastatic locally advanced gallbladder cancer (LAGBC) which remains unresectable and nonmetastatic after chemotherapy, there is no consensus on whether to continue chemotherapy or add local radiotherapy (RT) for improving outcomes. Materials and Methods: Forty-five patients of surgically unresectable nonmetastatic LAGBC were analyzed. Twenty patients did not receive RT (no RT cohort) and received only chemotherapy, while 25 patients received RT (RT cohort) with conformal techniques along with concurrent gemcitabine-based chemotherapy. No RT and RT cohorts were compared for disease-related outcomes and toxicities. Results: Median follow-up of the entire cohort was 11.5 months. Two-year progression-free survival (18.6% vs. 0%, P = 0.0001) and overall survival (37.3% vs. 5%, P = 0.0001) were significantly better in the RT cohort as compared to a no RT cohort. More number of patients had locoregional progression in the no RT cohort (85% vs. 32%, P = 0.0002). Radiation-induced acute and late gastrointestinal toxicity ≥ RTOG Grade 3 were seen in one and two patients, respectively. Conclusion: Addition of local RT to chemotherapy improves the survival outcomes and can be considered as a definite treatment modality for nonmetastatic LAGBC patients not amenable to surgery who have responded to chemotherapy.
  414 60 -
CASE REPORTS
Gnathic variant of primary adenoid cystic carcinoma: A unique case report
Sayani Shome, Aishika Mallick, Sanchita Kundu, Swagata Gayen
January-March 2022, 18(1):286-290
DOI:10.4103/jcrt.JCRT_56_20  PMID:35381803
Adenoid Cystic Carcinoma (AdCC) is an uncommon malignant epithelial salivary gland neoplasm, which is indolent yet persistent. Intraosseous /central variant of AdCC of the jaw is poorly understood owing to its innocuous clinical presentation thus posing a diagnostic challenge. AdCC is characterized by perineural invasion, late distant metastasis and a high recurrence rate , thus having a major effect on the mortality and morbidity rate. It is often diagnosed at an advanced stage which is chiefly achieved through histological examination and complete clinic-radiological work up. A clinical case of an intraosseous variant of AdCC, involving the mandible of a 49 year old male patient is discussed herewith, encompassing the entire spectrum of clinicopathological, radiological and treatment modalities rendered.
  413 33 -
ORIGINAL ARTICLES
Can a signature molecular-profile define disparate survival in BRAF-positive Gliosarcoma and identify novel targets for therapeutic intervention?
Puneet Gandhi, Richa Khare, Nitin Garg, Jharna Mishra
January-March 2022, 18(1):224-230
DOI:10.4103/jcrt.jcrt_1900_20  PMID:35381788
Purpose: Gliosarcoma (GS) has a low incidence but is aggressively invasive, with poor-survival. Even though GS is recognized as a different subgroup from glioblastoma (GB), there is no molecular panel available to define its clinical outcome. The objective was to identify the molecular imprint of GS in terms of expression of human telomerase reverse transcriptase (hTERT), high mobility group A1 (HMGA-1), kinesin superfamily protein-14 (KIF-14), epidermal growth factor receptor (EGFR) markers with reference to disparate prognosis and identify plausible targets for intervention. Materials and Methods: We retrieved 9-GS samples from a cohort of 57-GB patients during a 36 months study period and compared them with 10 molecularly typed GB-samples and 15 controls. Conventional-immunohistochemistry (IHC) was used for histopathology of GS and immunofluorescence-IHC was performed for quantification of identified marker-panel. Statistical tools for non-parametric data were used for inferring results. Results: GS was confirmed by reticulin-staining and positivity for glial fibrillary acidic protein, Vimentin, smooth muscle actin. Immune-reactivity for BRAF-V600Ewas present in both glial and sarcomatous cells and negative expression of isocitrate dehydrogenase, ATRX, TP53.Comparison between GS, GB, and control tissues showed that the expression of markers reached significance (P < 0.0001), without the influence of confounders. Significant correlation of EGFR was found with hTERT (r = 0.77), HMGA-1 (r = 0.72), KIF-14 (r = 0.82) suggesting that their combined analysis can define prognosis. To establish the diagnostic accuracy (threshold ≥80% specificity), AUC for EGFR was 0.78 (>3.95), KIF-14 0.97 (>7.45), hTERT 0.63 (>23.86), and HMGA-1 0.53 (>15.45). Conclusion: This is the first evidence-based investigation presenting differential expression of proliferation and stemness markers hTERT, HMGA-1, KIF-14 in-correlation with EGFR, indicating a plausible-association between survival and disease-progression in individual GS-cases. It can serve as a model for further studies in this glioma-subgroup and the designing of a target panel for personalized treatment.
  376 36 -
BRIEF COMMUNICATIONS
Anorectal malignant amelanotic melanoma: Report of a rare aggressive primary tumor
Musharraf Husain, Tajamul Rashid, Mir Mujtaba Ahmad, Mohammad Jaseem Hassan
January-March 2022, 18(1):249-252
DOI:10.4103/jcrt.JCRT_461_20  PMID:35381792
Malignant melanoma of the anorectal region is a very rare aggressive malignant neoplasm and it constitutes 1% of all malignant lesions of this area. About 70% of these lesions are pigmented, whereas 30% are amelanotic. Demonstration of immune markers of melanoma by immunohistochemistry (IHC) is required for confirming the diagnosis of amelanotic malignant melanoma. Here, we report a case of anorectal malignant amelanotic melanoma in a 65-year-old male with no medical comorbidities, who presented with chief complaints of bleeding per rectum associated with prolapsing mass per rectum of 7 months duration. On external examination and proctoscopy, three prolapsed pedunculated fungating masses were seen externally protruding out of the rectum approximately 4 cm from the anal verge. Contrast-enhanced computed tomography of the whole abdomen and pelvis was suggestive of moderately enhancing lobulated anorectal mass with large polypoidal intraluminal component arising from anorectal walls and extension into mid-lower rectum with liver and locoregional lymph nodes metastasis. The patient was taken up for palliative local excision. Per-operatively, three large irregular highly vascular pedunculated rectal growth was seen. The growth was excised and sent for histopathological examination. Microscopic examination of mass show spindle-to-ovoid tumor cells with hyperchromatic central to eccentric nuclei arranged in intersecting fascicles with a focal alveolar pattern. The large number of atypical mitotic figures (40-50/10 High Power Field (HPF)) was seen along with areas of necrosis and the presence of few bizarre binucleated and multinucleated giant cells. A differential diagnosis of malignant amelanotic melanoma was given along with undifferentiated carcinoma, gastrointestinal stromal tumor , and Non-Hodgkin's lymphoma. On IHC, the tumor cells were reactive for HMB45, S-100, and SOX-10. Thus a diagnosis of malignant amelanotic melanoma was confirmed. The patient had symptomatic improvement.
  366 39 -
LETTERS TO THE EDITOR
“Likely to be missed if unsuspected”: FIP1L1-PDGFRA positive myeloid neoplasm in a patient with nodal T-lineage lymphoblastic lymphoma
Praveen Sharma, Niranjan Shiwaji Khaire, Sreejesh Sreedharanunni, Pankaj Malhotra, Neelam Varma
January-March 2022, 18(1):316-317
DOI:10.4103/jcrt.JCRT_940_19  PMID:35381811
  342 47 -
CASE REPORTS
Acute myeloid leukemia presenting in a human immunodeficiency virus-positive patient
Shano Naseem, Pooja Murgai, Neelam Varma, Subhash Varma
January-March 2022, 18(1):297-300
DOI:10.4103/jcrt.JCRT_992_19  PMID:35381806
We report a case of AML in a 29-year-old HIV-positive female on anti-retroviral therapy. She presented with bicytopenia, fever and easy fatiquability. Bone marrow examination revealed 77% blasts, which on flow cytometric immunophenotyping showed positivity for myeloid lineage markers and were negative for monocytic and lymphoid lineage markers. Although rare, AML is seen in HIV patients, therefore, in presence of persistent cytopenias, detailed hematological evaluation should be done so as to not miss/delay the AML diagnosis.
  356 23 -
ORIGINAL ARTICLES
Is fractionated robotic stereotactic body radiosurgery optional salvage treatment for the re-irradiation of locally recurrent nasopharyngeal carcinoma?
Ozlem Yetmen Dogan, Gokhan Yaprak, Hazan Ozyurt, Beyhan Ceylaner Bicakci, Fatih Demircioglu, Emriye Algul, Naciye Isik
January-March 2022, 18(1):66-71
DOI:10.4103/jcrt.JCRT_114_20  PMID:35381763
Purpose: Recurrent nasopharyngeal carcinoma (NPC) after previous radiation therapy is a significant problem. This study was to determine the potential benefits from re-irradiation by fractionated stereotactic body radiotherapy (FSRT) on survival benefits and effects of severe late toxicities. Materials and Methods: Between 2009 and 2018, treatment outcomes were evaluated retrospectively in 26 patients with locally recurrent NPC treated using FSRT with CyberKnife. Five patients who had metastatic disease and one who had second recurrence were excluded from the study, and the remaining 20 patients were analyzed. The median age was 52 years (range, 28–80 years); re-treatment T stage was as follows: 6 (30%) – T2, 5 (25%) – T3, and 9 (45%) – T4. The median time from initial RT to recurrence was 22 months (range, 8–159 months). The median re-irradiation FSRT dose was 30 Gy in 5 fractions. Results: The median follow-up was 44 months; the overall survival (OS), local failure-free survival, and disease progression-free survival rates at 3 years were 89%, 73%, and 53%, respectively. All patients were evaluated for response after treatment: 9 (45%) had complete, 3 (15%) had partial, and 6 (30%) had no response. Univariate analysis demonstrated that higher cumulative total radiotherapy dose, gross tumor volume, and recurrent time interval were prognostic factors for local failure-free survival. The recurrent time interval was also an independent factor for progression-free survival and OS. The incidence of temporal lobe necrosis and trismus was 10% and 20%, respectively. One patient had Grade 5 toxicity to treatment-related bleeding. Conclusion: Tumor dose coverage is important for treating recurrent NPC, and treatment-related mortality was vascular in nature. FSRT is a promising treatment modality for recurrent NPC.
  332 42 -
CASE REPORTS
Urachal adenocarcinoma: A case report and review of the literature
Zeynep Gural, Serap Yücel, Sedenay Oskeroğlu, Fulya Ağaoğlu
January-March 2022, 18(1):291-293
DOI:10.4103/jcrt.JCRT_28_20  PMID:35381804
The urachus is a canal between the allantois and the early fetal bladder. Urachal carcinoma is a rare and aggressive type of bladder cancer. This cancer usually presents at an advanced stage. We report a 70-year-old patient with malignant transformation of urachal cyst several years later. The patient was treated with partial cystectomy and adjuvant radiotherapy. A review of the published literature is also presented.
  318 53 -
ORIGINAL ARTICLES
Knowledge, attitude, and practice of radiation oncologists during COVID-19 pandemic
Aarathi Ardha, Nanuvala Prathyusha, Bijjal Atreya, D Asha, Sanjeeva Kumari
January-March 2022, 18(1):214-219
DOI:10.4103/jcrt.JCRT_1671_20  PMID:35381786
Background: Cancer care hospitals are taking measures to reduce the spread of COVID-19. Doctors and health-care workers might be suffering from burnout. Measures taken to reduce overcrowding in hospitals might be making access to essential cancer care difficult. The study aims to understand changes in practice, levels of burnout, and other psychological aspects in radiation oncologists working in a regional cancer center during the COVID-19 pandemic. Methods: Data were collected through online Google Forms. The participants who were included in the study were doctors working in the department of radiation oncology. A 25min survey consisting of multiplechoice questions related to the changes at work during COVID19, and standardized questionnaires assessing fear of Covid 19 and burnout. The Oldenburg Burnout Inventory (OLBI) was used in this study to assess burnout. The Fear of COVID-19 Scale was used to assess fear induced by the COVID-19 pandemic. Results and Conclusion: Out of 71 professionals who participated in this study, most of them belonged to the category of residents (84.5%) and the rest were consultants (15.5%). Rescheduling of the patients' radiation treatment to convenient time slots to avoid overcrowding, preferring hypofractionated radiotherapy, and the use of telephonic consultations to prioritize outpatient appointments were the most commonly used measures. The results have shown that 62% of the doctors have experienced symptoms of exhaustion and disengagement, indicating a presence of burnout. However, aspects related to fear of COVID have been revealed to be less prevalent among the participants.
  332 39 -
CASE REPORTS
Cryoablation treatment of oral and maxillofacial tumors: Five case reports
Xiao Li, Ya-Wen Wang, En-Bo Wang, Yuan-Shui Liu
January-March 2022, 18(1):257-259
DOI:10.4103/jcrt.JCRT_982_20  PMID:35381794
Oral and maxillofacial anatomy and function are important and complex. They are involved in facial expressions, chewing, language, breathing, and other functions. It is therefore important to choose the optimal treatment plan for oral and maxillofacial tumors. For patients with who cannot tolerate surgery or who refuse surgery or radiotherapy can be treated with cryoablation. Cryoablation can maintain local tissue integrity and organ function and protect facial integrity. It is a repeatable treatment that, if necessary, can be followed by traditional antineoplastic therapies. This study introduces five cases with severe basic diseases who cannot tolerate or have refused surgery or radiotherapy. The patients were diagnosed as having oral and maxillofacial tumors. These patients experienced painful local swelling or breaking of the tumor. All patients received cryoablation combined with other treatments. Local control of the tumors and improved function and quality of life were achieved. In clinical work, for patients with severe basic diseases who cannot tolerate or refuse surgery or radiotherapy, cryoablation has unique advantages, and this approach is expected to become a widely used treatment for oral and maxillofacial tumors.
  324 45 -
ERRATUM
Erratum: Hippocampal-sparing radiotherapy and neurocognitive impairment: A systematic literature review
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January-March 2022, 18(1):322-322
DOI:10.4103/0973-1482.342505  PMID:35381815
  330 34 -
CASE REPORTS
Aggressive oral carcinoma cuniculatum: A rare entity
JV Abilasha, Prasanth Thankappan, T Isaac Joseph, D Angelin
January-March 2022, 18(1):266-269
DOI:10.4103/jcrt.JCRT_161_20  PMID:35381797
Oral carcinoma cuniculatum (OCC) is a rare and distinct clinicopathological variant of oral squamous cell carcinoma (OSCC). The term cuniculatum was derived from a Latin word “cuniculus” meaning burrow, because of the “rabbit burrow” appearance. As it invades the underlying tissue, it forms crypts filled with keratin that are essential in distinguishing this neoplasm from other variants of squamous cell carcinoma (SCC). It is a common lesion of the plantar region of the foot but rare in the oral cavity. The first case of OCC was reported in 1977 by Flieger and Owenski in the jaw, with fewer than 50 cases reported in the English literature till date. Tumor cell cannibalism has been reported in various carcinomas such as lung, gallbladder, hepatobiliary, pancreatic, and SCC. Cell cannibalism when it refers to a cancer cell, either within a tumor mass or cell culture, is “a cell that is contained within another bigger cell with a crescent-shaped nucleus.” This report aims to present a rare case of aggressive OCC of the maxillary gingiva with cellular cannibalism and its diverse immunohistochemical expression of E-cadherin, Ki-67, and p53.
  300 54 -
ORIGINAL ARTICLES
Incidence of xerostomia in locally advanced head-and-neck cancers in elderly patients treated with intensity-modulated radiotherapy
Neeraj Jain, Sakshi Jain, Amandeep Kaur, Kanchan Sachdeva, Ramita Sharma, Meena Sudan, Abhimanyu Rakesh, Deepak Abrol
January-March 2022, 18(1):81-83
DOI:10.4103/jcrt.JCRT_37_20  PMID:35381766
Introduction: Dysphagia and xerostomia are the main sequelae of radiotherapy for head and neck cancer (HNC) and the main factors in reducing the longterm patient quality of life. Intensitymodulated radiotherapy (IMRT) uses advanced technology to focus the high radiation doses on the targets and avoid irradiation of noninvolved tissues. Material and Methods: During 2016–2017, 44 patients of locally advanced HNCs were treated with a curative intent with IMRT. They were in the age range of 65–75 years. The median age was 69 years. Thirtyfive patients were male and nine patients were female. Histopathologically, all had squamous cell carcinoma. Stage wise all were T3N2 or more. No concurrent chemotherapy was given. The Eastern Clinical Oncology Group criteria were used for grading the toxicities. Patients were assessed after 4 weeks of completion of treatment. Results and Conclusion: The incidence of mucositis was of Grade 1–2 in 37 patients. Moreover, patients experienced severe mucositis. Six patients had treatment interruptions due to mucositis. Xerostomia was Grade 1–2 in 42 patients and Grade 3 in 2 patients. Dysphagia was Grade 1–2 only. No hematological toxicity was seen. Patients having dysphagia during the treatment were given nasogastric feed. Response wise 14 patients achieved complete response, 28 patients had partial response, and 2 had stable disease. There was no treatmentrelated mortality.
  304 50 -
Tumor control after palliative hypofractionated, “Quad-shot,” external beam radiotherapy followed by brachytherapy: An effective approach in medically compromised and/or elderly patients with cervix cancer
Chairat Lowanich kiattikul, Kailash Narayan, David Bernshaw, Sylvia Van Dyk, Angelo Tzovaras, Ming Yin Lin
January-March 2022, 18(1):173-179
DOI:10.4103/jcrt.JCRT_1346_20  PMID:35381780
Context: Cervix cancer is still a leading cause of death in developing countries. Concurrent chemoradiation (CCRT) over 5 weeks followed by brachytherapy is standard of care in locoregionally advanced cervix cancer. Such prolonged treatment may not be tolerated in medically compromised patients. High-dose interrupted hypofractionated Quad-Shot (QS) radiotherapy with brachytherapy treatment was well tolerated. Aims: This study aims to assess the locoregional tumor control in cervix cancer patients who were treated with QS regimen. Settings and Design: Retrospective. Subjects and Methods: Newly diagnosed histologically confirmed cervix cancer patients who were unfit for conventional CCRT and who were treated with QS protocol between 1999 and 2016 were analyzed. Tumor stage, treatment, and follow-up details were retrieved from an ethics-approved prospective departmental database. Statistical Analysis Used: Descriptive statistics and Kaplan–Meier method were used for estimating survival. Results: Thirty-six patients were available for analysis. The median age was 70.5 (32–92) years. Twenty-two of 36 (61.1%) patients had nodal disease while 33% of all patients had distant metastasis. Of 27 patients who died during follow-up, the local and pelvic control was 75% and 60%, respectively. The median overall survival and progression-free survival were 18.6 months. Grade 3–4 toxicity was observed (16%) in the bowel only. Conclusions: Hypofractionated QS radiotherapy with brachytherapy resulted in an overall 82.1% at least stable disease at the primary site. This treatment regimen was well tolerated and may be considered appropriate for patients who may not be suitable for conventional fully fractionated CCRT.
  308 45 -
CASE REPORTS
Isolated humeral metastasis in cervical cancer: A case report and review of the literature
Alessandro Gioe, Damiano Arciuolo, Vittoria Carbone, Gianfranco Zannoni, Maria Antonietta Gambacorta, Giulio Maccauro, Giovanni Scambia, Giacomo Corrado
January-March 2022, 18(1):273-276
DOI:10.4103/jcrt.JCRT_9_20  PMID:35381799
There are a few reported cases of isolated localized metastasis to bone arising from cancer of uterine cervix in the literature. This is a case of uterine cervix cancer with isolated metastasis to the humerus. A 57-year-old female with a diagnosis of FIGO Stage IIB invasive squamous cell carcinoma of uterine cervix underwent neoadjuvant chemoradiation therapy (CRT) and radical surgery with complete pathological response. Nine months after the surgery, a total body positron emission tomography/computed tomography (PET/CT) scan documented a lesion localized in the proximal part of the right humerus, whereas no evidence of skeletal metastasis found elsewhere. The biopsy from the bone lesion showed a metastatic squamous cell carcinoma of the uterine cervix. A surgical excision of the humeral lesion plus chemotherapy and zoledronic acid was performed. After 9 months, the patient experienced liver metastases and died 2 months later. Bone metastasis is not so infrequent in patients with locally advanced cervical cancer. Total body PET/CT scan should be included in staging work up, and an appropriate treatment should have the primary objective of quality of life preservation.
  307 43 -
ORIGINAL ARTICLES
Preparation and preclinical characterization of 111In-DTPA-Anti-MUC1 as a radioimmunoconjugate for diagnosis of breast cancer by single-photon emission computed tomography
Behrouz Alirezapour, Mahmood Dehghani Ashkezari, Mehdi Memari Fini, Mohammad Javad Rasaee, Javad Mohammadnejad, Malihe Paknejad, Ehsan Maadi, Hassan Yousefnia, Samaneh Zolghadri
January-March 2022, 18(1):158-167
DOI:10.4103/jcrt.JCRT_730_20  PMID:35381778
Context: Targeting MUC1 antigens which are overexpressed in 80% of breast cancers can be widely used in the field of radioimmunoscintigraphy (RIS) of breast cancer. Aims: The aim of this study was to develop a new diagnostic labeled compound for breast cancer RIS. Settings and Design: In this study, an efficient indirect labeling method of PR81 with Indium-111 was developed and preliminary preclinical qualifications were reported. Subjects and Methods: 111In-DTPA-PR81 was prepared and its radiochemical purity and stabilities in human serum and in phosphate-buffered saline (PBS) buffer were surveyed. Furthermore, cellular studies including complex reactivity, binding specificity, cell toxicity, etc., were examined. Finally, biodistribution and scintigraphy of the complex were studied in normal and tumoral animals. Statistical Analysis Used: Statistical analyses were performed using SPSS 10.0. Results: 111In-DTPA-PR81 was prepared with a radiochemical purity of >99% at optimized conditions. Stability studies showed the radiochemical purity of >90% in PBS buffer after 96 h, while the stability in human serum showed decrement to 81% after 96 h. Reactivity of the complex with MUC1 was significantly (P < 0.005) higher than bovine serum albumin (BSA) (about 7–8 times), even though BSA concentration was about twice the MUC1. The binding specificity of the complex to the MUC1 antigen was confirmed by means of immunoreactivity assay. Cell toxicity examination showed no significant lethal effect of the radiolabeled compound on the cells. Biodistribution studies of the complex in normal rats were consistent with the biodistribution of antibodies and high accumulation was observed in the tissues expressing MUC1 antigen. The results of 111In-DTPA-PR81 scintigraphy in tumoral female BALB/c mice at 24 and 48 h after injection showed an increasement of the accumulation in the tumor site. Conclusions: 111In-DTPA-PR81 can be considered as a potential agent for imaging of the MUC1 +breast tumors.
  306 44 -
CASE REPORTS
Choroidal metastasis in pancreatic adenocarcinoma
Ashok Singh, Deepika Malik, Shikha Singh, Virendra J Vyas
January-March 2022, 18(1):263-265
DOI:10.4103/jcrt.JCRT_45_20  PMID:35381796
Pancreatic adenocarcinoma is the seventh largest cause of death from cancer with a death rate of 3.8%. The 5-year survival rate is only 5%. We report A case 28 year old male presented with a 3 week history of pain in upper part of abdomen and dyspepsia of similar duration. After 2 cycles of palliative chemotherapy he presented with diminution of vision in right eye and watering of eye. USG showed retinal detachment with vitreous hemorrhage in the right eye and left eye was normal. On fundoscopy choroidal metastasis was detected as an accidental finding in the right eye. Though Ca Pancreas usually presents in as locally advanced or metastatic disease choroidal metastasis are extremely rare. Despite disappearance of ocular metastasis he had a progressive disease and died of intraparenchymal hemorrhage. Reports of pancreatic cancer with metastasis to the choroid and optic nerve have been rare. There were few reports that demonstrated the significance of a choroidal lesion as the initial clinical sign of pancreatic cancer. This aggressive behavior of the lesion may be an important feature to determine the origin of the tumor. Cancer of the tail of the pancreas is often not detected in the early stages before metastasizing.
  304 42 -
ORIGINAL ARTICLES
Predictive significance of inflammatory indexes in metastatic nonsmall cell lung cancer patients treated with platinum-doublet chemotherapy
Mesut Yilmaz, Ahmet Baran, Merve Korkmaz Yilmaz
January-March 2022, 18(1):220-223
DOI:10.4103/jcrt.jcrt_1902_20  PMID:35381787
Introduction: Lung cancer is the leading cause of cancer-related deaths, worldwide. Despite immune checkpoint inhibitors and targeted therapy have revolutionized the treatment of metastatic nonsmall cell lung cancer (NSCLC), a significant proportion of patients are still treated with platinum-based chemotherapy. It is widely noticed that systemic inflammation plays an important role in the development and progression of many solid tumors. In this study, we aimed to analyze the predictive role of the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and prognostic nutritional index (PNI) in patients with advanced NSCLC treated with first-line platinum-doublet chemotherapy. Methods: We retrospectively collected data of patients treated with first-line therapy for metastatic NSCLC. All patients were treated with first-line platinum-doublet chemotherapy. The patients were grouped based on the median values of SII, PNI, and NLR. The Mann–Whitney U test was used for comparisons between groups. Results: The chemotherapy response rate (RR) was 75% in all patients. RR is statistically significantly lower in high SII, low PNI, and high NLR groups. Conclusions: High inflammatory indexes in metastatic NSCLC patients who were treated with platinum-doublet chemotherapy are related to low chemotherapy RR.
  274 56 -
Fine needle aspiration cytology of primary thyroid non-hodgkins lymphoma: Experience from a tertiary care center of North India
Meeta Singh, Gunjan Nain, Shyama Jain, Sarika Singh, Vikas Malhotra
January-March 2022, 18(1):185-189
DOI:10.4103/jcrt.JCRT_234_20  PMID:35381782
Presentation: Twelve cases of Primary Thyroid Non-Hodgkin's Lymphoma (PT-NHL) were retrieved from the records suspected or diagnosed as NHL on fine needle aspiration cytology (FNAC) over a period of nine years from 2010-2018. During this period 5236 patients underwent thyroid FNAC;of these 685 cases were diagnosed under Bethesda Caregory V and VI. Thyroid NHL constituted 0.23 % of all thyroid FNA (12/5236 cases)and 1.7% (12/685) of all thyroid malignancies. Patients ranged in age from 40–61 years with Female:Male 7:5. All patients presented with thyroid enlargement (5-14 cms), and were of two months to five years duration. Patients had history of tobacco intake (smoking/chewing)in nine cases (75%). Thyroid function tests showed hypothyroidism in four (33%), positive antithyroid antibodies in three (25%) and; two cases(16.7%) were known cases of Hashimotos thyroiditis with follow up Cytological Findings: Eight cases (66.7%) had monomorphic large cell morphology,other four had mostly intermediate cell types (33.3%). A panel of immunocyto/ histochemistry (ICC/ IHC) showed CD 19 and CD 20 positivity in all cases;sixof these could be correlated on Flow cytometry (FC) with expression of FMC7, CD20, CD19 with kappa light chain restriction (5) and Lambda (1). FC findings corroborated completely with IHC on biopsy sections. The final diagnosis were Diffuse large B cell Lymphoma (DLBCL,8) and MALT- Lymphoma(4). The follow up was available in DLBCL (4) and MALT- Lymphoma (1). CHOP therapy were given in all patients followed by radiotherapy in DLBCL; one patient of DLBCL died following pulmonary complications, rest are well and alive on follow-up. Discussion: PT-NHL is rare in India. DLBCL is the commonest histological type reported. In the present study, tobacco exposure has shown strong association. Combined FNAC-FC provide definitive diagnosis and thus can replace histopathology reducing turn around time. Conclusion: FNAC –FC provides a definitive diagnosis and thus can reduce turnaround time.
  278 51 -
Comparison of albumin adjusted ischemia-modified albumin and total antioxidant status in patients with locally advanced head and neck cancer: A pilot study
R Madhumita, Nivedita Nanda, Pooja Sethi, Jasmine Manna Rani, Chandramouli Natarajan
January-March 2022, 18(1):76-80
DOI:10.4103/jcrt.JCRT_921_20  PMID:35381765
Background: Among all types of cancers in India, head and neck cancer (HNC) accounts for 30%. Oxidative stress (OS) is one of the aetiologies for cancer. However, it is not evaluated for these patients scheduled for anticancer therapy. Therefore, in the present study, we have compared two biochemical markers in HNC patients before therapy to assess their suitability as a marker for ongoing OS in the locally advanced stage of HNC. Materials and Methods: We measured the body mass index (BMI), waist-hip ratio (WHR), blood pressure (BP), albumin, total antioxidant status (TAS), ischemia modified albumin (IMA), and albumin adjusted IMA (AdjIMA) in forty locally advanced squamous cell carcinoma HNC patients and compared with forty healthy individuals of similar age and gender. AdjIMA and TAS were compared by the receiver operating curve. Results: BMI and WHR were significantly lower in HNC patients with no difference in BP parameters. Both IMA and AdjIMA were higher and TAS was lower in HNC patients. TAS was positively associated with BMI and negatively with AdjIMA. Between AdjIMA and TAS, AdjIMA at an optimal cutoff value of 0.23 absorbance unit had higher sensitivity (71%), specificity (65%), and area under the curve (0.710 vs. 0.365). Conclusion: Antioxidant levels are grossly altered in HNC patients. AdjIMA can be considered a better marker for assessing OS in HNC patients than TAS.
  296 29 -
The effect of cancer diagnosis in first-degree relatives on participation of healthy individuals in cancer screening programs and on their attitudes towards healthy lifestyle changes
Oktay Sari, Bora Uysal, Tarık Eren Yilmaz, Ayşe Güniz Çeti, Murat Beyzadeoglu
January-March 2022, 18(1):103-108
DOI:10.4103/jcrt.JCRT_1650_20  PMID:35381770
Background: Ensuring that first-degree relatives of patients diagnosed with cancer are included in the cancer screening programs will reduce the negative effects that may arise both for the individuals having the risk of cancer and for the community. In our study, we aimed to investigate the awareness and attitudes of the first-degree relatives of patients, who have received diagnosis of a cancer, toward cancer screening programs and to determine the risk factors for cancer. Methods: A questionnaire prepared by the researchers was conducted over the relatives of 234 cancer patients for determining their awareness about cancer and their attitudes toward participation in cancer screening programs. The data were analyzed using SPSS 22 software package. Results: 72.6% of the participants never heard about Cancer Early Diagnosis, Screening and Training Center, which has been established to carry out cancer screening programs in Turkey. Approximately half of the female participants did not participate in breast cancer and cervical cancer screenings (54.9% and 51.1%, respectively). The rate of those who had screening tests for colon cancer was less than one-fifth of all participants (19.8%). The above data show the low level of awareness of the participants about cancer. Conclusion: It has been observed that diagnosis of cancer in the first-degree relatives of the participants did not create awareness in these people at a level that would enable them to participate in cancer screening programs and make healthy lifestyle changes.
  266 52 -
CASE REPORTS
A 47-year-old man with rare serous cyst adenocarcinoma of the testis
Zahra Pourvali-Souraki, Ehsan Zaboli, Ghasem Janbabaei, Reza Alizadeh-Navaei
January-March 2022, 18(1):301-304
DOI:10.4103/jcrt.JCRT_1153_19  PMID:35381807
Although papillary serous cyst adenocarcinoma of the ovary is a common tumor, the incidence of ovarian-type papillary serous cyst adenocarcinoma in the testis is rare. Based on medical documents, there are only about 50 cases reported about testicular and paratesticular serous tumors.[1],[2],[3] Herein, we report a case of low-grade serous cyst adenocarcinoma of the testis that did unilateral orchiectomy and then came with retroperitoneal mass and lung metastasis. Chemotherapy was well tolerated, and now, after 1 year, he does not have any complaint.
  283 34 -
ORIGINAL ARTICLES
Evaluation of enzyme-linked immunosorbent assay plasma p16INK4a protein in squamous cell carcinoma in uterine cervix: A case–control study
Kalyani Raju, CV Raghuveer, SR Sheela, Arvind Natarajan, TV Jagadish, BN Sunil, B Sharat
January-March 2022, 18(1):152-157
DOI:10.4103/jcrt.JCRT_1290_20  PMID:35381777
Background: Cervical cancer is one of the common cancers in females. The common method of screening is Pap test which has low sensitivity. Hence, better methods are explored with different biomarkers, of which estimation of P16 protein can be opted in early detection of cervical cancer. Materials and Methods: Seventy cases and seventy controls were considered for the study. Cases were invasive squamous cell carcinoma (SCC) of cervix confirmed by histopathology. Controls were healthy age-matched females. The blood sample of cases and controls was collected in K2 Ethylenediaminetetraacetic acid vacutainer, and the separated plasma was subjected to estimation of P16 protein by quantitative sandwich Enzyme-Linked ImmunoSorbent Assay method. The data were analyzed for the association between p16 protein in plasma in cases and controls. Results: The age among cases and controls ranged from 30 to 80 years. The P16 levels among cases ranged from 3.4 to 19.6 ng/ml with a mean of 7.24 ± 2.35 ng/ml. The plasma P16 level in controls ranged between 0.9 and 9.7 ng/ml with mean of 4.1 ± 2.22 ng/ml. At cutoff more than 4.8 ng/ml in cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 92.86%, 72.86%, 77.4%, 91.1%, and 82.86%, respectively. The specificity increased with increase in plasma p16 levels. The P16 levels were maximum in stage IV disease. Conclusion: This was a pilot study to detect the plasma p16INK4a levels in SCC of cervix. The levels of plasma p16 protein between 3.9 and 5 ng/ml can be considered as the range for the test to be positive. In clinically suspected cases of cervical cancer, levels more than 4.8 ng/ml can be considered for the diagnosis as point of care test.
  288 29 -
Modified neoadjuvant clinicopathological risk stratification as a prognostic score in early and locally advanced triple-negative breast cancer
Biswajit Dubashi, Kirankumar Matta, Smita Kayal, Divya Bala Thumathy, Yadav Nisha, Kadambari Dharanipragada, Karunanithi Gunaseelan, Pampa ch Toi, Prasanth Ganesan
January-March 2022, 18(1):168-172
DOI:10.4103/jcrt.JCRT_986_20  PMID:35381779
Background: Triple-negative subtype is an aggressive breast cancer with inferior survival. Pathological complete remission (pCR) is a good surrogate endpoint for survival among patients receiving neoadjuvant chemotherapy (NACT). We attempted to validate the clinical pathological score (CPS) with a modified risk grouping among Triple-negative breast cancer (TNBC) patients receiving NACT at our center. Methodology: Data of patients with TNBC who underwent NACT between January 2014 to July 2017 were retrospectively analyzed. The composite CPS score included cTN stage and y pTN stage and ranged from 0 to 4. This was calculated using an available online software developed by MD Anderson Center. The score obtained from the calculator was used to develop a risk grouping into low risk (0, 1) and high risk (2, 3, 4). Invasive disease-free survival (iDFS) and locoregional recurrence-free survival (LRFS) were calculated using the Kaplan–Meier method. Results: Seventy-eight patients with TNBC (median age: 45 [24-75]) had received NACT (anthracyclines and taxanes). Early and locally advanced breast cancer constituted 17 (21.8%) and 61 (78.2%), respectively, and 22 (28.2%) achieved pCR. After a median follow-up of 25 months (5–62), 3-year iDFS and OS were 59% and 81%, respectively, for the entire population. The 3-year iDFS in low-risk (n = 18) and high-risk (n = 60) patients was 85% and 51%, respectively (P = 0.03). The 3-year LRFS in low risk and high risk was 93% versus 58% (P = 0.03). The 3-year OS in the low and high risk was 93% and 77%, respectively (P = 0.24, NS). Conclusion: Our study supports the use of the modified neoadjuvant clinicopathological score as a prognostic marker in patients with nonmetastatic triple-negative breast cancer. This needs to be validated in a larger subset of patients.
  272 45 -
An audit of Grade III or more skin reactions in consecutively assessed patients at a modern radiation oncology center
Vikas Kumar Pandey, Anusheel Munshi, Bidhu Kalyan Mohanti, Kanika Bansal, Khushboo Rastogi, Tharmarnadar Ganesh, Rohit Singh Chauhan, Bhavini Chaudhari, Pramod Pandey
January-March 2022, 18(1):84-88
DOI:10.4103/jcrt.JCRT_611_20  PMID:35381767
Purpose: Radiation dermatitis is most common and debilitating side effects of radiotherapy leading to treatment interruption, thereby compromising the local control, and effecting quality of life. With the invent of modern imaging and recent advances in megavoltage radiotherapy, radiation-related side effects have reduced. In this audit, we report the risk factors associated with Grade III dermatitis in modern centers. Materials and Methods: We analyzed 172 patients treated with volume modulated arc therapy (VMAT) and static field intensity-modulated radiotherapy (SFIMRT) at our center. All head and neck, breast, gynecological, GU malignancies, and sarcoma patients treated with a dose of >45 Gy from April 2018 to December 2019 were included in the study. On couch, treatment verification was done with cone-beam computer tomography (CBCT). Slice-by-slice verification of planning target volume (PTV) with CBCT was done in the first three fractions and weekly thereafter. Skin evaluation was done using CTCAE v. 5. Statistical analysis was done using SPSS v. 22. Results: Of the 172 patients treated with VMAT and SFIMRT, 15 patients (8.7%) had Grade III dermatitis. Grade III dermatitis was mostly seen in breast cancer followed by head-and-neck patients. More reactions were observed in patients with advanced stage disease. Treatment verification is important at the later course of treatment, especially in head-and-neck cases where the treatment volume is large and PTV may extend outside skin. Contributing factors of radiation dermatitis at modern radiotherapy center are gene mutation, use of concurrent chemoradiotherapy, and bolus. Conclusion: We hereby conclude that PTV mismatch in weekly treatment verification, genetic mutations, concurrent chemo-radiotherapy, use of thermoplastic mask, and bolus are the contributing factors for Grade III dermatitis in modern radiotherapy centers.
  286 30 -
CASE REPORTS
Paroxysmal nocturnal hemoglobinuria clone in a patient with acute promyelocytic leukemia
Balraj Singh, Nazia Khan, Parminder Kaur, Michael Maroules
January-March 2022, 18(1):294-296
DOI:10.4103/jcrt.JCRT_1176_19  PMID:35381805
Acute promyelocytic leukemia (APL) is a unique subtype of acute myeloid leukemia (AML), which presents with a distinct coagulopathy. Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired hemolytic anemia which is clonal in nature due to somatic mutation. PNH may evolve to aplastic anemia, and more rarely, to a myelodysplastic syndrome or to AML. The literature review showed that AML is derived from the PNH clone as the leukemic cells lack the expression of glycosylphosphatidylinositol-linked proteins and PNH phenotype disappeared with the onset of acute leukemia. Herein, we report an unusual presentation of the coexistence of two clonal disorders PNH and APL. Our case contributes to the literature that AML in the setting of PNH is a separate disorder.
  278 37 -
Primary intramedullary spinal gliosarcoma: An unusual presentation
Snigdha Hazra, Sayan Kundu, Bodhisattwa Dutta, Asit Ranjan Deb
January-March 2022, 18(1):270-272
DOI:10.4103/jcrt.JCRT_182_20  PMID:35381798
Gliosarcoma is a biphasic central nervous system malignancy composed of glial and mesenchymal components. It is recognized as a rare variant of glioblastoma with unique histology, immunostaining properties, and natural history. Although usually described to primarily involve the brain, a search of the published literature revealed four reported cases of gliosarcoma arising in the spinal cord. This report describes the case of a 35-year-old woman with progressive back pain with loss of sensation and power of both lower limbs. Magnetic resonance imaging showed an intramedullary unifocal space-occupying lesion in her thoracolumbar spinal cord. Subtotal resection and subsequent histopathological and immunohistochemical studies confirmed the diagnosis of gliosarcoma of the spinal cord. This report further establishes the clinical entity of primary spinal gliosarcoma and proposes the need to consider this possibility among the differential diagnoses of a space-occupying spinal lesion.
  285 27 -
Challenging case of a re-irradiation in a dorsal spine primitive neuroectodermal tumor: Role of modern image-guided pencil beam proton therapy
Utpal Gaikwad, Satadru Biswas, Dayananda Shamurailatpam, Kartikeshwar Patro, Mayur Sawant, Rakesh Jalali
January-March 2022, 18(1):312-315
DOI:10.4103/jcrt.JCRT_515_20  PMID:35381810
Extradural primary primitive neuroectodermal tumor (PNET) is a rare aggressive disease mostly occurring in young adults. We present a locally recurrent case of dorsal PNET in the fifth decade of life after a prolonged disease-free interval of 10 years. The patient received radiation therapy in fairly large fields twice in his lifetime and was planned for third-time radiation to a few overlapping paraspinal areas over a period of three decades. Keeping in mind previous irradiations, possible target volume in proximity to organs at risk (OARs) patient was planned for consolidtive radiation using the most conformal technique available, which is proton beam therapy with image guided pencil beam scanning technique. Special dose constraints for the spinal cord and other OARs were set, and proton therapy plan was generated at our institute. When compared with parallelly generated intensity-modulated radiation therapy plan with the same dose prescription and dose constraints using helical tomotherapy, intensity-modulated proton therapy plan showed superior dosimetric benefit in terms of coverage and significant sparing of OARs.
  284 23 -
ORIGINAL ARTICLES
Increased psychomotor retardation and tension as short-term neuropsychiatric adverse events of immune checkpoint inhibitors: A prospective cohort study
Rami Bou Khalil, Anthony Kassab, Georges Costa, Fady Gh Haddad, Sami Richa, Joseph Kattan
January-March 2022, 18(1):140-146
DOI:10.4103/jcrt.JCRT_1088_20  PMID:35381775
Introduction: Patients undergoing cancer treatment as well as cancer survivors commonly describe behavioral alterations. As a matter of fact, neuropsychiatric adverse events (NPAEs) have been extensively described with older immunotherapies, especially with interferon alfa. However, there are little data investigating the NPAEs of immune checkpoint inhibitors (ICIs). Therefore, the aim of this study is to evaluate the safety profile of ICI in terms of NPAEs. Materials and Methods: This is a prospective, interventional, self-controlled study. Participants receiving ICIs as unique therapy, between February and December 2019, were evaluated at the beginning of their treatment protocol, at 1 month and finally at 3 months. During the three evaluations, disease and patients' characteristics were assessed, as well as NPAEs using the Brief Psychiatric Rating Scale (BPRS) questionnaire, the psychological stress due to cancer's burden using the Herth hope index, and the performance status (PS) using the Eastern Cooperative Oncology Group (ECOG) score. Results: Forty-four patients were enrolled, of whom 24 patients completed their three evaluation visits. No changes in BPRS total score were found throughout the study period. However, two subscores of the BPRS, “motor retardation” (P = 0.008) and “tension” or “nervousness” (P = 0.002), increased starting the 1st month of treatment. Moreover, age (r = 0.426, P = 0.038) and the baseline PS (P = 0.027) were the main risk factors of such manifestations. Conclusion: This study suggests that ICI could be responsible for motor retardation and increased tension starting the 1st month of treatment, with higher ECOG score and older age being the main risk factors.
  269 38 -
Detection of differential expression of miRNAs in computerized tomography-guided lung biopsy
Anjana Singh, Ravi Kant, Soumyadeep Nandi, Nuzhat Husain, Manisha Naithani, Anissa Atif Mirza, Tajindra Singh Saluja, Kamini Srivastava, Ved Prakash, Satyendra Kumar Singh
January-March 2022, 18(1):231-239
DOI:10.4103/jcrt.jcrt_749_21  PMID:35381789
Aims: Nonsmall-cell lung carcinoma comprises 85% of lung malignancies and is usually associated with a poor prognosis due to diagnosis at advanced stages. Molecular diagnosis of computerized tomography (CT)-guided biopsy has the potential to identify subtypes of lung carcinoma like adenocarcinoma (AC) and squamous cell carcinoma (SCC) along with its molecular stratification. This approach will help predict the genetic signature of lung cancer in individual patients. Subjects and Methods: Histopathologically proved a CT-guided biopsy sample of lung cancer cases was used to screen for the expression of microRNA (miRNA) earlier quantitated in blood plasma. Primers against hsa-miR2114, hsa-miR2115, hsa-miR2116, hsa-miR2117, hsa-miR449c, and hsa-miR548q with control RNU6 were used to screen 30 AC, 30 SCC, 5 nonspecific granulomatous inflammation, and 8 control samples. Reverse transcription polymerase chain reaction (RT-PCR) data revealed expression of hsa-miR2114 and hsa-miR548q in AC as well as SCC. Results: RT-PCR data revealed that the expression of hsa-miR2116 and hsa-miR449c was found upregulated in AC while hsa-miR2117 was expressed in SCC cases. Bioinformatic analysis revealed that genes, where these miRNAs are located, were also upregulated while targets of these miRNAs were downregulated. Conclusions: miRNAs expression pattern in the CT-guided biopsy samples can be used as a potential tool to differentially diagnose lung cancer subtypes. The expression pattern of miRNAs matches very well in blood plasma and tissue samples, albeit levels were very low in the earlier case than later. This approach can also be used for screening mutations and other molecular markers in a personalized manner for the management of lung cancer patients.
  278 28 -
Evaluation of metastatic neck nodes search for primary and subsequent management
Ashutosh Gupta, Inderpal Singh, Meenu Gupta, Isha Puri
January-March 2022, 18(1):119-123
DOI:10.4103/jcrt.JCRT_1083_20  PMID:35381772
Background: Cancers in the head-and-neck region are the sixth most common cancers worldwide with an increasing incidence in developing countries. Methods: This study was carried out in the department of ENT and head-and-neck surgery in collaboration with the department of radiotherapy for a period of 1 year extending from May 01, 2014, to April 30, 2015. A total of 48 cases of metastatic secondary nodes were included in the study. Results: The male-to-female ratio in the present study was 4.33:1. Maximum number of patients were seen in the seventh decade. The youngest patient was a female 30 years old and the oldest was a male of 80 years. About 95.84% of primary tumors were squamous cell carcinomas and 40.47% of the patients of head-and-neck cancer with metastatic lymph nodes had well-differentiated squamous cell carcinomas. Majority of cases presented with N2 nodes, while N1 nodes were highest in cases of carcinomas larynx. Conclusions: Metastatic neck disease is a major problem in patients with head-and-neck cancer. The therapeutic goal includes not only known disease but also the elimination of possible subclinical disease. The judicious use of moderate doses of irradiation and modified surgical procedures should be used in specific clinical situations to significantly decrease neck recurrences while eliminating morbidity.
  268 35 -
Interaction between peritumoral reactivity and histomorphological pattern of lymph node reactivity in oral squamous cell carcinoma: A host immune status indicator
Archana Bhatta, Rachna Rath, Surya Narayan Das, Sudha Smruti Mishra, Debashis Sethi
January-March 2022, 18(1):124-132
DOI:10.4103/jcrt.JCRT_1685_20  PMID:35381773
Background: The invasive tumor front (ITF) of oral squamous cell carcinoma (OSCC) and the reactive changes in regional lymph nodes (RLNs) are believed to carry integral prognostic information about the tumor's invasive capacity and insight into host immune response, respectively. Aim: This study aims to evaluate the reactivity patterns of RLNs in relation to the tumor stage, grade and various histopathological parameters at the ITF of primary tumor, in an attempt to elucidate the nature of host-immune response to tumor. Materials and Methods: Pattern of invasion (POI) using Bryne's criteria, peritumoral inflammation, and status of connective tissue (CT) stroma of 50 OSCC cases, that underwent selective neck dissection were assessed at the ITF. Immunoreactivity patterns in corresponding 450 RLNs were assessed as proposed by Tsakraklides and Ioachim. Further, 97 metastatic lymph nodes (LNs) were evaluated for degree and pattern of tumor invasion. The datasets were subjected to the Chi-square analysis. Results: There was statistically significant association (P = 0.001) of Type III and Type IV POI as well as mild peritumoral inflammation (P = 0.024) with the advanced stages of OSCC as compared to early stages. Significant association was observed between LN reactivity pattern and tumor stage (P = 0.05), with metastatic nodes exhibiting germinal center predominance (97.9%) and lymphocyte predominance (69.1%) largely observed in nonmetastatic nodes. Majority of metastatic nodes showed Grade 3 invasion (54.7%) in the form of large islands (57.7%), whereas two (2.1%) nodes were totally effaced by tumor metastasis. Statistical significance was observed between CT stroma at ITF and degree of tumor invasion in metastatic LN (P = 0.001). POI also showed significant correlation with peritumoral inflammation (P = 0.002), CT stroma (P = 0.02), and LN reactivity pattern (P = 0.03). Conclusion: This study supports the presence of a strong immunological host-tumor relationship.
  258 41 -
Monte Carlo simulation for assessing absorbed dose effects of low-dose β-radiation (90Sr/90Y) on cytotoxicity and apoptotic death in K562 cells
Zeynab Alizadeh, Rasoul Khodabakhsh, Mehdi Mohammadzadeh, Yaghub Pazhang, Seyed Mostafa Mohammadi
January-March 2022, 18(1):200-208
DOI:10.4103/jcrt.JCRT_909_20  PMID:35381784
Objective: Most studies suggest that dose-specific radiation regimens are essential for optimal induction of cancer cell response. This study focused on determining β-radiation-absorbed dose (rad) effects on the cell viability, cytotoxicity, hypersensitivity, and cell death of K562 cells using experimental methods and Monte Carlo simulation (MCS). Materials and Methods: The K562 cells were cultured and irradiated with β-particles emitted from a strontium source in vitro, with the estimated daily activity of 1.238 μCi. The treated cells were radiated at least three times every day for 3 consecutive days. The cell viability and apoptosis were investigated in treated cells by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, DNA electrophoresis, Hoechst dye, and inverted microscope. The average absorbed doses were obtained by MCS (MCNPX code). To verify simulation and experimental results, we used a Geiger–Muller counter and estimated a scaling factor. Results: The cytotoxic effects and cell death were induced in the treated groups via rad in a time-dependent manner. The highest apoptotic and cytotoxic effects were observed in cells after irradiation with β-particles for 120 min per day in 3 consecutive days. rads were determined using MCNPX code and cell survival rates were significantly reduced during irradiation periods. No significant hyper-radiosensitivity was found based on experimental and theoretical results. Conclusion: Despite the difficult calculation of the rad in the target cells and the scant information in this field, fortunately we have achieved significant theoretical data consistent with the experimental results. Our findings also introduced MCS as a better choice for evaluating of rad effects under different cellular conditions with high accuracy.
  270 21 -
Stem gene expression in breast tumors during chemotherapy: Connection with the main clinical and morphological factors and the disease outcome
Marina K Ibragimova, Matvey M Tsyganov, Irina V Deryusheva, Elena M Slonimskaya, Nikolai V Litviakov
January-March 2022, 18(1):89-95
DOI:10.4103/jcrt.JCRT_1331_20  PMID:35381768
Introduction: In this research, we studied how the expression of 14 stem genes (TERT; OCT3; SMO; MYC; SNAI2; MOB3B; KLF4; BMI1; VIM; FLT3; LAT; SMAD2; LMNB2; KLF1), as well as the TGF-β1 cytokine gene and its TGFBR1 receptor in breast tumors before and after NAC is associated with clinical and morphological parameters and the disease outcome. Materials and Methods: The study included 82 patients with the morphologically verified diagnosis of T1-4N0-3M0 breast cancer (stages IIA — IIIB). The material was paired biopsy samples of tumor and surgical material for each patient. The stem genes expression was analyzed via qPCR. Results: As a result, we found that increased level of stem genes expression in breast tumors is associated with lymphogenic metastasis, young age, small tumor size, expression of estrogen and progesterone receptors, and the luminal B molecular subtype. NAC stimulates the expression of 7 out of 16 stem genes. Patients who further developed hematogenic metastases have twice as many hyperexpressed stem genes in their tumors before the treatment and after NAC than patients with no hematogenic metastases. The expression level of three genes - OCT3, LAT, and LMNB2 - in a residual tumor allows us to predict metastasis-free survival of patients with breast cancer of various molecular subtypes with a 79% accuracy. Conclusion: Thus, stem genes hyperexpression is associated with tumor progression.
  250 40 -
LETTERS TO THE EDITOR
DNA base excision repair gene variants and susceptibility to ovarian cancer
Sora Yasri, Viroj Wiwanitkit
January-March 2022, 18(1):321-321
DOI:10.4103/jcrt.JCRT_26_20  PMID:35381814
  266 23 -
BRIEF COMMUNICATIONS
How prepared the radiotherapy centers are to deal with COVID-19 pandemic? A nationwide survey from 46 cancer centers across India
Sandip Kumar Barik, Binod Kumar Behera, Saroj Kumar Das Majumdar, Dillip Kumar Parida
January-March 2022, 18(1):245-248
DOI:10.4103/jcrt.JCRT_1525_20  PMID:35381791
Managing of radiotherapy department in many cancer centers in India has become very challenging during the COVID-19 pandemic. A radiotherapy center has to deal with multiple problems such as long treatment duration of each patient, high caseload on each radiotherapy machine, a limited number of qualified technical staff available, and equipment maintenance. For the department's smooth running, both the patient and healthcare worker must be safe from contacting COVID-19. A robust and planned strategy is required for prevention, screening, and awareness among all. To access our preparedness and evolve by gaining from other radiotherapy centers, a study was conducted using questionnaires and responses collected from different cancer centers in India.
  242 25 -
CASE REPORTS
Radiation-induced synchronous mandibular osteosarcoma and papillary thyroid carcinoma: A disguised conundrum
Neha Kumari, Kinjal Shankar Majumdar, Shahab Ali Usmani, Satya Prakash Agarwal
January-March 2022, 18(1):305-307
DOI:10.4103/jcrt.JCRT_366_20  PMID:35381808
With substantial improvement in survival in cancer patients, the risk of radiation-induced malignancy in previously irradiated areas is increasingly possible. Both radiation-induced sarcomas and papillary thyroid carcinomas (PTCs) are well documented in literature. However, radiation-induced synchronous malignancies are rare, are often misdiagnosed, and presents with diagnostic and therapeutic challenges due to paucity of literature and lack of available guidelines. Here, we report a case of radiation-induced synchronous mandibular osteosarcoma and PTC in a previously treated carcinoma of base tongue with concurrent chemoradiation. He initially presented with an oral cavity mass, and during the course of the treatment was incidentally diagnosed with a synchronous PTC. It also establishes the indolent course of PTC, which often goes undiagnosed till the presentation with regional nodal metastasis. This report, to the best of our knowledge, is the first reported case of synchronous radiation-induced OSM and PTC.
  230 27 -
Early detection of isolated pleural metastasis from carcinoma pyriform fossa: Can it be steered away from doom?
Bhanu Vashistha, Palak Garg, Preety Negi, Pamela Alice Kingsley
January-March 2022, 18(1):280-281
DOI:10.4103/jcrt.JCRT_1739_20  PMID:35381801
Isolated pleural metastasis from carcinoma of the pyriform fossa is a rare phenomenon. Literature search revealed pleural metastasis from head-and-neck cancer is in itself rare and carries a grave prognosis. Isolated pleural metastasis with local control in the primary and regional site with no other documented distant metastatic disease is again rarely encountered. We report this case as detection of pleural-based metastasis early in the course of disease and intervention can result in better outcome.
  226 24 -
LETTERS TO THE EDITOR
When to use dual staining in cervical cancer screening?
Wiebren A. A. Tjalma
January-March 2022, 18(1):318-319
DOI:10.4103/jcrt.JCRT_731_18  PMID:35381812
  212 34 -
ORIGINAL ARTICLES
Spectrum of pediatric kidney tumours with special references to WT1 immunostain at a tertiary care hospital
Chhanda Das, Madhumita Mukhopadhyay, Namrata Maity, Tamanna Parvin, Biswanath Mukhopadhyay, Brati Mukhopadhyay
January-March 2022, 18(1):209-213
DOI:10.4103/jcrt.JCRT_436_19  PMID:35381785
Context or Background: Pediatric renal tumours are the second most common solid tumours in children. The most common in this group is Wilms tumour with mesoblastic nephroma being the 2nd most common tumour in children, younger than 3 months. Aims and Objectives: The present study was conducted to study the epidemiological occurrence of pediatric renal tumours at a tertiary care hospital and to study the diagnostic efficacy of WT1 immunostaining in distinguishing Wilms tumour from other types of renal tumours. Materials and Methods: It was a single institution-based prospective and observational study conducted for 2 years (from October 2013 to September 2015) in the department of pathology in our hospital. A total of 50 cases were enrolled in this study all were below 15 years of age. Results: Nephroblastoma or Wilms tumour was found to be the most common type, occurring in 66% cases. Fourteen out of 33 cases of Wilms tumour showed triphasic components (blastemal, epithelial, and stromal) with Blastemal type Wilms being the second most common (11 cases). WT1 immunostaining was positive in 93.9% cases of nephroblastoma. The highest amount of nuclear positivity noted in blastemal cells followed by epithelial cells. Rhabdomyoblastic differentiation and regressive variant showed nonspecific cytoplasmic staining. Cystic partially differentiated nephroblastoma and diffuse anaplasia type Wilms tumour showed nuclear staining in blastemal cells. Conclusion: The expression of WT1 immunostain was found to be diagnostically significant in differentiating Wilms tumour from other renal tumours.
  218 26 -
CASE REPORTS
Highly aggressive gastric adenocarcinoma with multiple skin nodule and supraclavicular node in a 19-year-old patient: A rare presentation in such young age
Deepak Raj Sonkar, Arun Kumar Rathi, Savita Arora, Mohammad Azam, Kumar Prabhat, Kishore Singh
January-March 2022, 18(1):260-262
DOI:10.4103/jcrt.JCRT_528_19  PMID:35381795
Although gastric adenocarcinoma is common in middle- and old-aged population, it is rare in young people. Development of cutaneous metastasis during presentation is even rarer in any age group. We report the case of a 19-year young man with gastric adenocarcinoma who had multiple skin nodules over the trunk during presentation. Fine-needle aspiration cytology of the nodule revealed it to be metastasis from gastric adenocarcinoma. Cutaneous metastasis may be the first presentation of internal malignancies even with a short history of disease in young patients. Atypical presentation of a malignancy in atypical age group must be evaluated with prompt assessment, active intervention, and close follow-up.
  194 27 -
LETTERS TO THE EDITOR
New Wuhan coronavirus: Any carcinogenicity property?
Beuy Joob, Viroj Wiwanitkit
January-March 2022, 18(1):320-320
DOI:10.4103/jcrt.JCRT_57_20  PMID:35381813
  190 19 -