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   2022| July-September  | Volume 18 | Issue 4  
    Online since September 22, 2022

 
 
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REVIEW ARTICLES
Gastric cancer in Jammu and Kashmir, India: A review of genetic perspectives
Ruchi Shah, Puja G Khaitan, Tej K Pandita, Adnan Rafiq, Deepak Abrol, Jyotsna Suri, Sandeep Kaul, Rakesh Kumar, Swarkar Sharma
July-September 2022, 18(4):873-879
DOI:10.4103/jcrt.JCRT_12_19  PMID:33533734
Gastric Carcinoma (GC) is one of the most common malignancies, which accounts for 6.8% of total cancer population worldwide. In India, the northeastern region has the highest gastric cancer incidence, and the Kashmir Valley has a very high incidence of gastric cancer as compared to other parts of Northern India. It exceeds 40% of total cancers with an incidence rate of 3–6-fold higher than other metro cities of India. Gastric cancer is a heterogeneous disease where most of the cases are sporadic, and <15% are due to obvious familial clustering. The heterogeneous nature of the disease can be associated with differences in genetic makeup of an individual. A better understanding of genetic predisposition toward GC will be helpful in promoting personalized medicine. The aim of this review is to analyze the development and progression of GC and to explore the genetic perspectives of the disease with special emphasis on Jammu and Kashmir, India.
  4,715 340 -
CASE REPORTS
Trastuzumab and thyroid dysfunction: An association to be aware of
Rodrigo Sánchez-Bayona, Maria Angeles Garcia del Barrio, Estibaliz Alegre, Oscar A Fernandez-Hidalgo, Marta Santisteban Eslava
July-September 2022, 18(4):1183-1185
DOI:10.4103/jcrt.JCRT_66_19  PMID:36149184
The incidence of autoimmune thyroid disorders is higher among women with breast cancer (BC) than in other solid malignancies, while it has not a prognostic impact. Trastuzumab (T) is a humanized monoclonal antibody approved for human epidermal growth factor receptor 2 (HER2)-positive BC in the neoadjuvant, adjuvant, and metastatic scenarios. Since 2014, subcutaneous (SC) T has been employed with the same efficacy as the intravenous formulation together with an easier way of administration. To date, autoimmune thyroiditis has been linked rarely to the use of intravenous T, and no cases have been related to the SC presentation. We report two cases of HER2-positive early BC patients who developed hypothyroidism during maintenance therapy with SC T that required levothyroxine supplementation. SC T includes recombinant human hyaluronidase to facilitate tissue penetration of the drug. This enzyme may alter the thyroid gland stroma and facilitate the development of thyroid disorders. Thyroid function tests are recommended in patients on SC T.
  4,403 109 -
ORIGINAL ARTICLES
Calcitriol potentially alters HeLa cell viability via inhibition of autophagy
Iwan Setiawan, Ronny Lesmana, Hanna Goenawan, Dodi Suardi, Vesara Ardhe Gatera, Rizky Abdulah, Raden Tina Dewi Judistiani, Unang Supratman, Budi Setiabudiawan
July-September 2022, 18(4):1144-1151
DOI:10.4103/jcrt.JCRT_82_20  PMID:36149174
Objective: This study was conducted to evaluate the effect of Calcitriol on cellular death in HeLa cells via autophagy and turn over due to mitochondria homeostasis. Methods: HeLa cell lines were grown in 24-well plates and treated with Calcitriol at varying doses (0.013 μM-0.325 μM) for varying time periods (2, 6, 12, and 18 h). Cell proteins were extracted with scrapers and lysed using RIPA buffer. Western blots were performed for proteins involved with autophagy (Lc3, p62), signaling (mTOR, PI3K, HIF1α), mitochondria (PGC1α, COX4, and Tom 20), and apoptosis (Caspase 3, Caspase 9, and PARP). Protein carbonyl levels were determined by measuring the indirect ROS level. An inhibition study using L-mimosine was performed to analyze the significance of HIF1α. Results: Calcitriol treatment induced cytotoxicity in a dose- and time-dependent manner and caused growth arrest in HeLa cells. The PI3K-AKT-mTOR pathway was activated, leading to inhibition of autophagy and alterations in mitochondria biogenesis homeostasis. Treatment with Calcitriol produced protein carbonyl levels similar to those in the cisplatin-treated and control groups. Increased ROS levels may cause toxicity and induce cell death specifically in cancer cells but not in normal cells. The inhibition of HIF1α partially rescued the HeLa cells from the toxic effects of Calcitriol treatment. Conclusion: We suggest that Calcitriol may shut down mitochondrial homeostasis in HeLa cells by inducing the PI3K-AKT-mTOR pathway and inhibiting autophagy, which leads to cell death.
  3,210 77 -
Cancer resilience in parents of children with cancer; the role of general health and self-efficacy on resiliency
Narges Mohammadsalehi, Azadeh Asgarian, Marzieh Ghasemi, Abolfazl Mohammadbeigi
July-September 2022, 18(4):1119-1123
DOI:10.4103/jcrt.JCRT_464_19  PMID:36149170
Introduction: Cancer in children affect their parents to some stress and worries during treatment process. This study aimed to assess the parental adjustment on the resiliency of parents of children with cancer and its relationship with social support, self-efficacy, and general health. Materials and Methods: In a cross-sectional study, 107 parents of children with cancer were selected by convenience sampling method from the Oncology Departments of Qom Hospitals, Iran. Standard questionnaires including Phillips Social Support, Corner Davidson Resilience, Sheerer Self-Efficacy Inventory, and General Health Questionnaire (GHQ-28) were used for data collection. Pearson's correlation coefficient, Chi–square test, t-test, and multivariate linear regression were used for data analysis in SPSS software. Results: A significant correlation was observed between cancer resilience and social support score (r = 0.285). Multivariate regression model Showed that social support was the most important predictor of cancer resilience (β =0.723, P = 0.045). In addition, self efficacy (β =0.356, P = 0.005) showed a direct relationship with cancer resilience. Nevertheless, an inverse association (β = -0.351, P = 0.025) was observed between GHQ score and cancer resilience in parents of children with cancer. Conclusion: Cancer resilience in families of children with cancer is significantly associated with higher social support, more self-efficacy, and better general health. Interventional programs aimed at increasing family resilience and reducing stress by increasing the social support and self-efficacy in patients' families are helpful and necessary.
  2,838 44 -
Efficacy of vorinostat-sensitized intraperitoneal radioimmunotherapy with 64Cu-labeled cetuximab against peritoneal dissemination of gastric cancer in a mouse model
Tomoko Tachibana, Yukie Yoshii, Hiroki Matsumoto, Ming-Rong Zhang, Kotaro Nagatsu, Fukiko Hihara, Chika Igarashi, Aya Sugyo, Atsushi B Tsuji, Tatsuya Higashi
July-September 2022, 18(4):907-914
DOI:10.4103/jcrt.JCRT_124_20  PMID:36149139
Background: Gastric cancer is a common cause of cancer-related death worldwide, and peritoneal dissemination is the most frequent metastatic pattern of gastric cancer. However, the treatment of this disease condition remains difficult. It has been demonstrated that intraperitoneal radioimmunotherapy (ipRIT) with 64Cu-labeled cetuximab (anti-epidermal growth factor receptor antibody; 64Cu-cetuximab) is a potential treatment for peritoneal dissemination of gastrointestinal cancer in vivo. Recent preclinical and clinical studies have also shown that a histone deacetylase inhibitor, vorinostat, effectively sensitized gastrointestinal cancer to external radiation. Aim: In the present study, we examined the efficacy of the combined use of vorinostat, as a radiosensitizer during ipRIT with 64Cu-cetuximab in a peritoneal dissemination mouse model with human gastric cancer NUGC4 cells stably expressing red fluorescent protein. Methods: The mouse model was treated by ipRIT with 64Cu-cetuximab plus vorinostat, each single treatment, or saline (control). Side effects, including hematological and biochemical parameters, were evaluated in similarly treated, tumor-free mice. Results: Coadministration of ipRIT with 64Cu-cetuximab + vorinostat significantly prolonged survival compared to control and each single treatment. No significant toxicity signals were observed in all treatment groups. Conclusions: Our data suggest that vorinostat is a potentially effective radiosensitizer for use during the treatment of peritoneal dissemination of gastric cancer by ipRIT with 64Cu-cetuximab.
  2,484 55 -
Hepatitis B in hepatocellular carcinoma patients and its correlation with alpha-fetoprotein and liver enzymes
Richa Surit, Ravi Shekhar, Dinesh Kumar Sinha, Sanjeet Kumar Singh, Uday Kumar, Nidhi Prasad
July-September 2022, 18(4):903-906
DOI:10.4103/jcrt.JCRT_239_19  PMID:36149138
Background: Hepatocellular carcinoma (HCC) in India ranges from 0.7 to 7.5 for men and 0.2 to 2.2 for women, per 100,000 population per year. The major risk factors for the development of HCC are infection with hepatitis B virus (HBV), hepatitis C virus, and cirrhosis of liver. Alpha-fetoprotein (AFP) and liver enzymes are widely used by clinicians for diagnostic purpose in HCC. Aims and Objective: This study was conducted in HCC patients related to HBV infection and to assess the significance of AFP and liver enzymes in it. Materials and Methods: Blood samples of 68 patients were taken. The samples were analyzed for AFP and liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], and alkaline phosphatase [ALP]). Liver enzymes were estimated by auto analyzer OLYMPUS AU400. AFP was analyzed by chemiluminescence immunoassay. Results: The mean values of AFP in serum hepatitis B surface antigen (HBsAg) negative and positive patients ranges from 22745.4 to 23269.3 ng/ml with P = 0.921. The mean value of ALP in HbsAg-negative patients was 418 U/ml, whereas in positive patients, it was 310 U/ml. Both the groups did not show any significant changes in AFP levels. The ALP showed slight rise in negative group. The other parameters did not show significant rise in all patients. Conclusion: These values suggest that there was no significant influence of viral etiology on AFP and liver enzymes level in HCC patients.
  2,243 87 -
BRIEF COMMUNICATIONS
Combination intraoral radiation mouthguard-positioning stent
Zain Uddin Ahmed, Joseph D Randazzo, Joseph M Huryn, Evan B Rosen
July-September 2022, 18(4):1162-1164
DOI:10.4103/jcrt.JCRT_825_19  PMID:36149177
The sequelae of head-and-neck radiation may include hyposalivation, dysgeusia, trismus, mucositis, and osteoradionecrosis. A mouthguard used during radiation therapy can mitigate the effects of backscatter radiation from dental restorations. In addition, an intraoral positioning stent can assist in repositioning oral structures, such as the tongue, away from the field of radiation during treatment, thereby limiting dose delivery. The purpose of this article is to provide a technique to fabricate a combination prosthesis, which functions to reposition oral structures as well as mitigate the effects of backscatter from dental restorations during head-and-neck radiation therapy.
  1,950 80 -
CASE REPORTS
Quadruple metachronous primary cancer in a single patient: A rare case report
Tauseef Ali, Aafreen Khan, Vivek Kathed, Shalu Verma, Anil Sarolkar, Virendra Bhandari
July-September 2022, 18(4):1199-1201
DOI:10.4103/jcrt.JCRT_484_19  PMID:36149189
Multiple primary cancer is a condition where multiple occurrences of different malignancies occur in the same individual. As there is a rise in the long-term survival of patients, multiple primary cancer is now not a rare entity. To see four different tumors in the same patient is very rare, and here, we report the case of a 60-year-old female patient with quadruple primary cancer of bilateral breast, esophagus, and sarcoma of the leg.
  1,876 46 -
ORIGINAL ARTICLES
Effectiveness and cost-effectiveness of trastuzumab emtansine in women with HER2-positive locally advanced or metastatic breast cancer: A systematic review and meta-analysis
Yingchih Yeh, Chiehfeng Chen, Yu Ko
July-September 2022, 18(4):1061-1072
DOI:10.4103/jcrt.jcrt_1095_21  PMID:36149162
Background: Trastuzumab emtansine (T-DM1) is a human epidermal growth factor receptor-2 targeted antibody-drug conjugate that contains a monoclonal antibody, trastuzumab, covalently linked to DM1, a small molecule cytotoxin. Methods: We conducted a systematic review and meta-analysis of published trials to examine the efficacy and safety of T-DM1 for patients with HER2-positive metastatic breast cancer. In addition, we systematically reviewed existing economic evaluations of T-DM1. An electronic literature search of online databases (Medline, CENTRAL, and Embase) was performed. Randomized controlled trials that compared T-DM1 with other active treatment agents were eligible for inclusion. In addition, studies that involved T-DM1 as one of the treatment comparators in an economic evaluation were included. Four trials with a total of 2462 participants were included in this meta-analysis. Results: Pooled results showed T-DM1 substantially improved overall survival (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.67–0.85; I2 = 0%) and progression-free survival (HR, 0.67; 95% CI, 0.52–0.85; I2 = 75%). In addition, T-DM1 showed greater association with severe thrombocytopenia and liver dysfunction than other regimens, but a lower rate of neutropenia, leukopenia, febrile neutropenia, asthenia, and diarrhea. All four trials included in the meta-analysis overall had a low risk of bias. Two cost-utility analyses involving T-DM1 were identified, and the overall quality was high. Conclusions: T-DM1 is effective for the treatment of patients with HER2-positive metastatic breast cancer, and it demonstrates a tolerable safety profile compared with other active controls. Little evidence was available regarding the cost-effectiveness of T-DM1 so no conclusions can be drawn.
  1,727 116 -
Can dual staining with p16 and Ki67 be biomarkers of epithelial dysplasia in oral lesions?
Anju Bharti, Sumaira Qayoom, Riddhi Jaiswal, Preeti Agarwal, RK Singh, SP Agarwal, Shalini Bhalla, Annu Makker, Madhu Mati Goel
July-September 2022, 18(4):1003-1008
DOI:10.4103/jcrt.JCRT_40_20  PMID:36149153
Background: Oral carcinogenesis is a multistage process with epithelial dysplasia as a premalignant condition. There is a significant inter-observer variation in diagnosing and grading the oral epithelial dysplasia. As human papillomavirus (HPV) is believed to have à strong relationship with oral carcinogenesis, using P16 as a biomarker may help in identifying the cells which may be undergoing the malignant transformation. However, due to the low specificity of P16, dual staining test P16INK4/Ki67 might be a better promising marker for identifying the transformed cells. This study was designed to evaluate the dual expression of P16 and Ki67 as a promising biomarker for dysplasia and their correlation with clinicopathological factors. Materials and Methods: Immunohistochemical analysis for p16 and ki67 was performed on 30 premalignant oral lesions and 36 oral squamous cell carcinoma (OSCC) by dual staining using the CINtec PLUS kit. Results: CINtec positivity was observed only in leukoplakia with dysplasia (46.7%) and squamous cell carcinoma (25%). None of the cases of leukoplakia without dysplasia or oral submucosal fibrosis stained positive for CINtec plus staining. In leukoplakia with dysplasia, there was no significant association with any of the clinicopathological parameters studied. In OSCC cases, alcohol intake showed statistically significant association with CINtec positivity. Conclusion: P16INK4/Ki67 assessment by dual staining is a promising biomarker for identifying dysplasia in cases with diagnostic dilemmas.
  1,583 47 -
Induction of apoptosis and suppression of Ras gene expression in MCF human breast cancer cells
Sadegh Saremi, Maryam Kolahi, Mohammad Reza Tabandeh, Mahmoud Hashemitabar
July-September 2022, 18(4):1052-1060
DOI:10.4103/jcrt.JCRT_624_20  PMID:36149161
Breast cancer is the leading invasive cancer in women globally. This study aimed at evaluating the anti-apoptotic activity of p-Coumaric acid (PCA) on MCF-7 breast cancer cell line. Experiments were conducted in which the MCF-7 cell line was treated with PCA. which showed decreased cell viability, increased lactate dehydrogenase activity, and caspase-3 activation. The results were evaluated with real-time polymerase chain reaction which revealed that PCA reduced the amount of H-Ras and K-Ras transcript in MCF-7 breast cancer cells. In the presence of PCA there was a significant increase in the levels of mRNA gene Bax and late apoptotic cells which was dose dependent. It also retarded the relative expression of antiapoptotic gene, Bcl2 in treated cells. The results suggest that PCA exhibits anti-cancer properties against MCF-7 cells. PCA inhibited the growth of MCF7 cell. The optimum concentration of PCA was 75–150 mM. PCA can inhibit the growth of MCF-7 cells by reducing Ras expression and inducing cell apoptosis. Our results suggest that PCA could prove valuable in the search for possible inhibitors of Ras oncogene functionality and gain further support for its potential utilization in the treatment of patients with breast cancer. PCA is safe and could complement current treatments employed for the disease.
  1,522 53 -
Expected rate of liver fluke-related cholangiocarcinoma in endemic area of liver fluke with antiparasitic drug distribution program for disease control in Thailand
Viroj Wiwanitkit
July-September 2022, 18(4):927-930
DOI:10.4103/jcrt.JCRT_783_19  PMID:36149142
Objective: Parasitic-induced cancer is an important problem in tropical oncology. Liver fluke-related biliary tract cancer of cholangiocarcinoma is an important kind of endemic cancer in Southeast Asia. This cancer is related to the liver fluke infection. The local public health policies for disease control include antiparasitic drug, praziquantel, distributing aiming at getting rid of risk factor, and opisthorchiasis. In the present report, the authors reappraise on the local epidemiological data on liver fluke infection among the local people in endemic area Thailand under antiparasitic drug distribution program for further assessment for expected rate of cholangiocarcinoma. Materials and Methods: The present study is a clinical mathematical modeling study. First, the retrospective reappraisal on the available local data on liver fluke infection among the local people in endemic area of Thailand, a tropical country in Indochina, with a different history of previous exposure to antiparasitic drug is done. Then, a mathematical model based on predictive modeling and probability assignment technique is developed for the assessment of estimated rate of cholangiocarcinoma. Results: According to the present study, the expected rate of liver fluke-related cholangiocarcinoma is equal to 0.0564%. There is a strong relationship between expected rate of liver fluke-related cholangiocarcinoma and number of previous exposure to praziquantel (r = 0.99, P = 0.02). Conclusion: According to the study, the high expected rare of cholangiocarcinoma is observed despite the use of general antiparasitic drug distribution policy. It implies finding for new adjusted public health manipulation for disease prevention and management.
  1,520 48 -
Exploring quality of life among head-and-neck cancer patients in Western India using European organization for research and treatment of cancer questionnaires
Sujal Parkar, Abhishek Sharma, Mihir Shah
July-September 2022, 18(4):990-996
DOI:10.4103/jcrt.JCRT_450_20  PMID:36149151
Background:Head-and-neck cancers (HNCs) are one of the major public health problems for both patients and the health-care providers in India. The clinical manifestations of HNC and its treatment can lead to negative effects on the quality of life (QoL) of the patient. The study is aimed to explore the QoL using the European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaires among HNC patients in Western part of India. Materials and Methods: A cross-sectional prospective study was conducted among 400 HNC patients attending the tertiary cancer center. The QoL was assessed by using the EORTC core questionnaire (EORTC QLQ-C30) and EORTC head- and neck-specific questionnaire (EORTC QLQ-H and N35). The data were explored using means, standard deviation, medians, ranges, and proportions. Results:All the 400 patients had completed the questionnaire having a compliance rate of 100%. There was no missing data at the item level for the EORTC QLQ-C30 questionnaire. While the missing items for EORTC QLQ-H and N35 were: problems while swallowing food, problems with teeth, and sexuality. The mean functional score ranged from 74.22 to 93.49 for EORTC QLQ-C30. The mean symptoms score was found in the range from 3.25 to 81.50 for EORTC QLQ-H and N35. Conclusion: Both questionnaires were comprehensive and well accepted by the patients. These questionnaires provided the information-related disease-specific QoL data, which otherwise is often missed. Health-care providers should not only focus on the clinical effects of treatment but also on QoL issues because it will improve overall patient care and survival.
  1,525 39 -
CASE REPORTS
Anal cancer with isolated ischial fossa lymph node metastases: A rare entity in the oligometastatic dilemma
Issa Mohamad, Ramiz Abuhijlih, Mousa Alkaldi, Akram Al-Ibraheem, Sami Khatib, Fawzi Abuhijla
July-September 2022, 18(4):1202-1204
DOI:10.4103/jcrt.JCRT_1158_19  PMID:36149190
Carcinoma of the anal canal is relatively rare cancer with a low propensity for metastasis. A literature review identifies two cases with ischial fossa metastases from anal cancer. The authors present the case of a 62-year-old male with moderately differentiated squamous cell carcinoma of the anal canal who presented with isolated ischial fossa lymph node (LN) confirmed by fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography and pelvic magnetic resonance imaging. The patient was treated with concurrent chemoradiation. Ischial fossa LN was included in the high-dose radiation volume. Posttreatment imaging showed complete clinical response. This case highlights a rare metastatic site from anal cancer treated successfully with primary chemoradiation and shows an example of tailored treatment approach of oligometastatic disease from anal cancer.
  1,508 38 -
Diffuse-type giant cell tumor: Pigmented villonodular synovitis of patellar fat pad
Erdem Degirmenci, Abdullah Alper Sahin, Yunus Emre Bulum, Mehmet Gamsizkan, Zafer Orhan
July-September 2022, 18(4):1189-1191
DOI:10.4103/jcrt.JCRT_387_19  PMID:36149186
Pigmented villonodular synovitis (PVNS) is a rare, relatively benign intra-articular lesion characterized by slowly progressing proliferation of the synovial tissue. It is most commonly observed in the knee joint. Localized and diffuse types are two types of PVNS depending on the synovial involvement. Arthroscopic and excisional resections are recommended as the treatment methods for the PVNS. Radiotherapy or chemotherapy can be adjuvant therapeutic options for the widespread masses. In this study, we presented a case of diffuse PVNS originating from the patellar fat pad.
  1,472 38 -
ORIGINAL ARTICLES
Extranodal natural-killer/T-cell lymphoma, nasal type: An immunomorphological study from a regional cancer institute in India
Mohit Agrawal, G Champaka, Usha Amirtham, Linu Abraham Jacob, CS Premalata
July-September 2022, 18(4):1137-1143
DOI:10.4103/jcrt.JCRT_226_20  PMID:36149173
Introduction: Extranodal natural-killer/T-cell lymphoma, nasal type (ENKTL), is a rare, aggressive, predominantly extranodal non-Hodgkin lymphoma (NHL) of putative natural-killer (NK) cell and rarely T-cell origin, always associated with Epstein–Barr virus (EBV) infection and characterized by highly distinctive histopathological features with predilection for the upper aerodigestive tract. While the nasal cavity is the prototypical site, less frequently extranasal ENKTL can also occur. The objective of this case series is to study the immunomorphological features of ENKTL from a tertiary cancer centre as the data are sparse from India despite it being a distinct entity with characteristic clinicopathological features. Methods: We identified 11 cases of ENKTL from the departmental archives between January 2015 and June 2018. The clinicopathological and immunohistochemistry (IHC) findings of these tumors were analyzed. EBV encoded RNA (EBER) in situ hybridization (EBER-ISH) for EBV was done in eight cases. Results: The disease was more common in males (male: female ratio 1.8:1) with the mean age of 45 years (range 31–65 years). Sinonasal region was the most common site with 9 cases and skin and penis were involved in one case each. The patient with penile involvement on further investigations was found to have occult nasal involvement, Histomorphological features such as angiocentricity/angioinvasion was seen in seven cases (63.6%) and significant necrosis was present in all 11 cases (100%). All cases were uniformly positive for cytoplasmic CD3 and CD56 with high Ki67 proliferating index and EBER-ISH test for EBV was positive in all the eight cases. Conclusion: ENKTL is an aggressive NHL and should be differentiated from other T- and B-cell lymphomas as the prognosis and therapy differ. Nasal biopsies showing predominant necrosis and atypical lymphoid cells with angiocentricity must raise the suspicion of ENKTL and should be confirmed by immunomorphological and molecular studies.
  1,408 55 -
CASE REPORTS
Mucinous carcinoma of the gallbladder- two rare case reports
Mitakshara Sharma, Ashutosh Rath, Reena Tomar, Nita Khurana, Deepak Ghuliani
July-September 2022, 18(4):1192-1194
DOI:10.4103/jcrt.JCRT_646_19  PMID:36149187
Gallbladder carcinomas are uncommon with female predominance in the sixth or seventh decades. Mucinous carcinomas of the gallbladder are rare with few cases documented in the literature. We present two cases of mucinous carcinoma of the gallbladder one of which was incidentally detected. The first case is a 65-year-old female who was diagnosed clinically with a suspected case of carcinoma of the gallbladder with the help of contrast-enhanced computed tomography. Microscopy showed extensive areas of mucin pools (>90% of the tumor), atypical cells in three-dimensional clusters, and scattered singly in the mucin pools. Immunohistochemistry revealed a strong expression of MUC2 by the tumor cells. The second case is a 60-year-old female who was diagnosed clinically with a case of chronic cholecystitis; however, the cholecystectomy specimen showed a mucinous growth in the fundus and body of the gallbladder, microscopy of which showed extensive mucin pools (>90% of the tumor) along with scattered signet-ring cells. Both the cases were reported as mucinous carcinoma of the gallbladder. Mucinous carcinoma of the gallbladder exhibit more aggressive behavior than conventional gallbladder carcinomas. Documentation of these rare cases will encourage further research to find out their true incidence and adequate management of the patient.
  1,401 44 -
Fibromatosis mimicking relapse of a neuroendocrine tumor at 68Ga-DOTATOC positron-emission tomography/computed tomography
Elena Trevisi, Ivan Facilissimo, Stefano Taraglio, Maria Pia Brizzi
July-September 2022, 18(4):1171-1173
DOI:10.4103/jcrt.JCRT_802_19  PMID:36149180
Mesenteric fibromatosis (desmoid tumor) is a locally aggressive fibroblastic lesion, characterized by a high recurrence rate that makes treatment challenging. Currently, there is no evidence-based treatment approach. We report the case of a female patient with a history of neuroendocrine tumor, who underwent 68Ga-DOTATOC positron-emission tomography/computed tomography (PET/CT), showing increased focal abdominal uptake suggestive of disease relapse. Histological examination revealed typical findings of fibromatosis. These findings indicate the expression of staining for somatostatin receptors (SSTRs) on fibromatosis cell surface and suggest to include fibromatosis among the potential causes of false-positive results at 68Ga PET/CT. Moreover, SSTRs expressed in desmoid tumors could be further investigated as a therapeutic target.
  1,395 48 -
ORIGINAL ARTICLES
Assessment of preoperative thyroglobulin levels in papillary thyroid cancer
Mehmet Ali Melik, Ilyas Baskonus, Latif Yilmaz
July-September 2022, 18(4):1042-1044
DOI:10.4103/jcrt.JCRT_1268_20  PMID:36149159
Background: The papillary thyroid cancers (PTCs) are the most common cancer of endocrine cancers. The primary treatment is surgery, and the prognosis is mostly well. In spite of many methods for the early diagnosis, the simpler and noninvasive methods are being sought. The aim of this study is to find out whether the value of thyroglobulin (Tg) is related with PTC. Materials and Methods: Prospectively; we measured the preoperative Tg value of 203 (159 females and 44 males) patients who underwent a total thyroidectomy with various indications in General Surgery Department of Gaziantep University. Tg values of 61 patients with benign lesions and 142 patients with PTC were compared. Results: In the patients with PTC, the mean preoperative Tg value was 105.05 ng/ml and 76.80 ng/ml in the benign patients. According to receiver operating characteristic analysis, the cutoff point was determined 102 ng/ml. There was a statistically significant difference in preoperative Tg values between benign group and PTC (P < 0.05). Conclusion: Patients with a preoperative Tg values above 102 ng/mL may more likely to have PTC. It is thought that Tg levels may be accepted as a criterion for distinguish malignant/benign situations that should be supported with new studies.
  1,349 54 -
Inter-fractional entrance dose monitoring as quality assurance using Gafchromic EBT3 film
Sun Young Moon, Yunhui Jo, Jaehyeon Seo, Dongho Shin, Myonggeun Yoon
July-September 2022, 18(4):1152-1158
DOI:10.4103/jcrt.JCRT_8_20  PMID:36149175
Introduction: This study describes a simple method of inter-fractional photon beam monitoring to measure the entrance dose of radiation treatment using Gafchromic EBT3 film. Materials and Methods: The film was placed at the center of a 1-cm thick phantom shaped like a block tray and fixed on the accessory tray of the gantry. The entrance dose was measured following the placement of the film in the accessory tray. The dose distribution calculated with the treatment planning system was compared with the dose distribution on the irradiated EBT3 films. The effectiveness of this methodology, as determined by gamma passing rates, was evaluated for the 22 fields of eight three-dimensional conformal radiotherapy (3D-CRT) plans and the 41 fields of nine intensity-modulated radiotherapy (RT) plans. The plans for three-dimensional conformal RT included treatments of the rectum, liver, breast, and head and neck, whereas the plans for intensity-modulated RT included treatments of the liver, brain, and lung. Results: The gamma passing rates for 3D-CRT ranged from 96.4% to 99.5%, with the mean gamma passing rate for 22 fields being 98.0%. The gamma passing rate for intensity-modulated RT ranged from 96.1% to 98.9%, with the mean gamma passing rate for 41 fields being 97.7%. All gamma indices were over the 95% tolerance level. Conclusions: The methodology described in this study, based on Gafchromic EBT3 film, can be utilized for inter-fractional entrance dose monitoring as quality assurance during RT. Clinical application of this method to patients can verify the accuracy of beam delivery in the treatment room.
  1,343 35 -
Effect of TENS and stabilization exercises on pelvic pain in pelvic cancer survivors following multimodal treatment: A clinical trial
Oshin Diana Mathias, Renu B Pattanshetty
July-September 2022, 18(4):1124-1128
DOI:10.4103/jcrt.JCRT_1157_19  PMID:36149171
Background: Pelvic floor muscle (PFM) dysfunction and pain are common complications seen in pelvic cancers including the gynecological and genitourinary systems before and after treatments such as chemotherapy, radiotherapy, and surgeries and may contribute to significant morbidity as the survival rates increase in these patients. Objective: The objective of the clinical trial was to evaluate the effect of transcutaneous electrical nerve stimulation (TENS) and stabilization exercises on pelvic pain in pelvic cancer survivors following multimodal treatment. Materials and Methods: Thirty-one patients including both male and female adults treated for pelvic cancers were recruited in the study. Outcome measures in terms of pain were assessed at baseline and at the end of the study by the visual analog scale and genitourinary pain index (GUPI) scale, abdominal muscle strength by pressure biofeedback unit for transverse abdominal (TrA) muscle, and quality of life (QOL) by functional assessment of cancer therapy general questionnaire. Pelvic stabilization exercises and TENS were administered once daily approximately 30 min during the acute hospitalization. Results: Pelvic stabilization exercises and TENS demonstrated to be effective in ameliorating pelvic pain (P < 0.001) and improving in the GUPI scores of pain, incontinence, increasing strength of TrA musculature (P < 0.001), and improving overall QOL (P < 0.005). Conclusion: The trial suggests that a combination of pelvic stabilization exercises and conventional TENS may be used as a strategic tool to reduce pain and improve PFM strength after multimodal treatments in pelvic cancer survivors in the clinical setup of an Indian Scenario.
  1,287 29 -
CASE REPORTS
Primary leiomyosarcoma kidney – A rare entity with a diagnostic challenge
Dimple Chaudhary, Ashutosh Rath, Shramana Mandal, Nita Khurana, PN Agarwal
July-September 2022, 18(4):1186-1188
DOI:10.4103/jcrt.JCRT_107_19  PMID:36149185
Primary leiomyosarcoma kidney is a rare tumor with an aggressive nature. Leiomyosarcoma is one of the common histologic types of the sarcomas, comprising 60% of all sarcomas. Sarcomatoid renal cell carcinoma is a close differential of renal leiomyosarcoma as both tumors have spindle-shaped cells. The former has a more pleomorphic character with nuclear grade four, which can be differentiated on the basis of immunohistochemistry. Hence, the diagnosis of primary renal leiomyosarcoma poses a diagnostic challenge. One such case of renal leiomyosarcoma in a 45-year-old male is being discussed here.
  1,216 45 -
ORIGINAL ARTICLES
A 10-year registry-based incidence, mortality, and survival analysis of colorectal cancer in Northern Malaysia
Ibtisam Ismail, Huan Keat Chan, Soelar Shahrul Aiman, Abu Hassan Muhammad Radzi
July-September 2022, 18(4):931-938
DOI:10.4103/jcrt.JCRT_544_20  PMID:36149143
Introduction: Colorectal cancer (CRC) is the third most common cancer globally. This study aimed to determine the incidence, mortality, and survival rates of CRC in northern Malaysia over the last decade. Materials and Methods: This was a registry-based, cross-sectional study. All the CRC patients seeking treatment from any of the 21 hospitals located in northern Malaysia between 2008 and 2017 were included in this study. Both the incidence and mortality rates were expressed as the number of cases per 100,000. The time series analysis was performed to assess the changes in the age-standardized incidence and mortality rates (ASIR and ASMR) of CRC, while the Cox regression analysis was used to detect the differences in the mortality risk between subgroups of CRC patients. Results: Of the 5746 CRC patients identified, approximately 40% were diagnosed only at Stages III and IV of the disease. Although the ASIR of CRC was stable and narrowly ranged from 17.03 to 20.01 per 100,000 (P = 0.775), the ASMR of CRC significantly reduced from 12.73 per 100,000 in 2008 to 2.99 per 100,000 in 2017 (P < 0.001). Besides increasing with age and the severity of the disease, the mortality risk was significantly higher in men (adjusted hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 1.02, 1.17) and the Malay ethnic group (adjusted HR: 1.33; 95% CI, 1.08, 1.64). Conclusion: While efforts had been made to promote the timely treatment of CRC, it is encouraging to note a downtrend in its mortality rate. However, there is still a need to upscale the CRC screening going forward.
  1,189 51 -
Evaluating the relationship between dosimetric parameters and esophagitis in patients who experienced radiotherapy in the cervicothoracic region
Zahra Siavashpour, Nazanin Rabiee, Mohsen Bakhshandeh, Amir Anvari, Farid Zayeri
July-September 2022, 18(4):1009-1015
DOI:10.4103/jcrt.JCRT_91_20  PMID:36149154
Purpose: Prescribing radiotherapy or concurrent chemoradiation for cervicothoracic cancers inevitably leads to esophagitis. The purpose of the current study was to evaluate the correlation between the dose–volume parameters and the esophagitis in patients who received radiotherapy in the cervicothoracic region. Materials and Methods: Forty cancerous patients whose radiotherapy fields were in the cervicothoracic region have been rolled. The correlation between the dosimetric and clinical factors with esophagitis was analyzed through binary logistic regression model and Pearson correlation tests and was quantified with receiver operating characteristic curve. Results: The patients participating in the study were selected from breast (6 cases), lymphoma (7 cases), and head-neck (27 cases) patients with prescription doses of 36–72 Gy. Increasing esophagus mean dose resulted in an increase of acute esophagitis significantly (P = 0.05). Furthermore, by one-gray increase in the esophagus median dose, the possibility of esophagitis increased by 9.3% (P = 0.02). To prevent acute esophagitis (Grade ≥2), D50 should be kept below 7 Gy. To limit acute esophagitis, V40 should be kept below 19% (P = 0.04). Conclusions: Based on the correlation analysis of the current study, concurrent chemoradiotherapy, DMean, D50, D80, and V40 are known as reliable predictive dosimetric parameters of acute esophagitis incidence in patients who experienced radiotherapy in the cervicothoracic region.
  1,196 38 -
Expression of epithelial–mesenchymal transition biomarkers: Discoidin domain receptor 2, Snail-1, and Ovol-2 as predictors of clinical outcome in patients with epithelial ovarian carcinoma
Ola A Harb, Mariem A Elfeky, Wafaa El-Beshbishi, Ahmed A Obaya, Wael M Abdallah, Amr Ibrahim, Amr A Awd, Ahmed Embaby
July-September 2022, 18(4):1073-1082
DOI:10.4103/jcrt.JCRT_605_19  PMID:36149163
Context: Discoidin domain receptor 2 (DDR-2), which belongs to the receptor tyrosine kinase family, Snail-1, which is a member of zinc-finger transcription factor family, and Ovol-2, which is a member of Ovol family, are incriminated in epithelial–mesenchymal transition (EMT) during cancer progression. Aim: In the current study, we aim to clarify the extent to which EMT biomarkers, DDR-2, Snail-1, and Ovol-2 expression, are involved in the progression of EOC aiming at identification of novel markers for predicting the prognosis of EOC patients. Settings and Design: This was a prospective cohort that was performed in the Faculty of Medicine, Zagazig University. Materials and Methods: We evaluated DDR-2, Snail-1, and Ovol-2 expression in 60 patients of EOC using immunohistochemistry. We followed our patients for about 36 months and analyzed the relationship between markers expression and the prognosis of patients. Statistical Analysis Used: SPSS program (Statistical Package for the Social Sciences). Results: High expression of both DDR-2 and Snail-1 was related to higher grade (P = 0.006) and advanced FIGO stage of the tumor (P < 0.001). Ovol-2 high expression was associated with lower grade of the tumor (P = 0.002) and early stage of the tumor (P < 0.001). High Ovol-2 and low DDR2 and Snail-1 expression were strongly correlated with better response to therapy (P = 0.003 and 0.005, respectively) and increased 3-year survival rates (P < 0.001). Conclusion: DDR-2 and Snail-1 are markers of poor prognosis in EOC while Ovol-2 is a marker of good prognosis.
  1,178 36 -
Immunohistochemical subtyping of diffuse large B-cell lymphoma into germinal center B-cell and activated B-cell subtype, along with correlation of the subtypes with extranodal involvement, serum lactate dehydrogenase, and positron emission tomography scan-based response assessment to chemotherapy
Aarti Tyagi, Andleeb Abrari, Anuj Khurana, Shantanu Tyagi
July-September 2022, 18(4):1129-1136
DOI:10.4103/jcrt.JCRT_842_20  PMID:36149172
Context: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma in Indian population and is divided into the prognostically important subtypes, germinal center B-cell (GCB) and activated B-cell-like (ABC), using immunohistochemistry-based algorithm. Aim: The present study aims to evaluate the influence of immunohistochemical derived DLBCL subtype, GCB or ABC on prognostically significant variables – extranodal involvement and serum lactate dehydrogenase (LDH) level at presentation, and response to chemotherapy assessed on pre- and posttreatment fluorodeoxyglucose-positron emission tomography study. Settings and Design: This was a retro-prospective, 2-year observational study at a tertiary health-care center, New Delhi. Subjects and Methods: The study population includes a total 236 cases of DLBCL. According to the Hans algorithm, DLBCL cases were allocated to the GCB and ABC subgroups. Statistical Analysis Used: For comparison of mean values, independent t-test and analysis of variance were used. For this purpose, we used SPSS 20.0 software. P < 0.05 was considered as statistically significant. Results: Ninety-eight patients (41.5%) had GCB immunophenotype and 138 patients (58.5%) were ABC. A significant difference was observed between mean baseline level of LDH between GCB and ABC subtypes (P < 0.05). The proportion of cases with extranodal involvement was comparatively higher in ABC subtype (P < 0.05). Association between response to chemotherapy with DLBCL immunophenotypes was found to be highly significant (P < 0.00). The response rates were much better in GCB subtype. Conclusions: The mean baseline level of LDH is significantly higher in ABC subtype. The proportion of cases with extranodal involvement was comparatively higher in ABC and shows poor response to chemotherapy as compared to GCB. Baseline LDH level was found to be important prognostic marker in the DLBCL.
  1,158 45 -
Osteoradionecrosis of the jaws: A retrospective cohort study
Kanchan P Dholam, Madhura R Sharma, Sandeep V Gurav, Gurkaran Preet Singh, Karthik M Sadashiva, Sarbani Ghosh Laskar
July-September 2022, 18(4):1016-1022
DOI:10.4103/jcrt.JCRT_248_20  PMID:36149155
Introduction: Radiotherapy (RT) combined with chemotherapy and surgery is the indicated treatment for head and neck cancers. Even with the advent of modern technological advances in RT and improved oral hygiene awareness, osteoradionecrosis (ORN) still remains as one of the most debilitating side effects of RT. Methodology: This is a retrospective review assessing 72 patients aged over 18 years of age reporting in the Dental Department, for treatment of ORN from April 2010 to July 2019. Each patient was clinically examined and treated according to standard protocol. The stage of ORN was noted at the diagnosis and at follow-up. The demographic data, the tumor characteristics, and the treatment of patients were evaluated using descriptive statistics. Results: At the time of diagnosis, 84.7% of the study population was found to have Epstein Type II chronic persistent nonprogressive lesions and 11.1% of the cohort had Type III active progressive lesions. Statistically significant correlation (P = 0.00) was found for ORN grade at diagnosis and at follow-up. ORN being a chronic pathology, stabilization of the disease was observed in 72.3% of cases. The resolution of the necrotic lesion and down staging of the disease was seen only in 2.8% of patients. Conclusion: ORN is mainly a chronic long standing pathology which is difficult to treat completely. Stabilization of symptoms and preventing further spread of the necrotic lesion should be the ultimate aim of the treatment to improve the quality of life of the patients.
  1,154 48 -
CASE REPORTS
Choroid, a unique site for metastasis in Marjolin's ulcer
Amit Bagur Lokesh, Rakesh Kumar, N Saheer, Amar Bhatnagar
July-September 2022, 18(4):1174-1176
DOI:10.4103/jcrt.JCRT_617_19  PMID:36149181
Marjolin is an aggressive malignancy, which shows initial local aggression, followed by the rapid regional and distant dissemination during the latter part of its growth. Metastasis to the uveal tract, although infrequent, is usually secondary to the malignancies of the breast and lung. Marjolin's ulcer metastasizing to choroid is quite rare and unheard of. We intend to report one such case here. Here, we present a case report of a 55-year-old male, who developed Marjolin's ulcer over a previously injured left lower limb. He developed recurrence and re-recurrences requiring multiple surgeries, radiation, and chemotherapy cycles. He eventually developed disseminated systemic metastases. Over the course of his disease, he reported eye symptoms of pain, blurring of vision, and field defect in the left eye. On further evaluation with imaging and fundoscopy, a metastatic deposit was identified in the choroid of the left eye. Metastasis to the uveal tract is an unusual unreported event in the disease progression of Marjolin's ulcer. The treatment is usually palliative. It heralds the terminal stage of the disease, with inevitable death.
  1,130 52 -
ORIGINAL ARTICLES
The predictive value of depth of invasion and tumor size on risk of neck node metastasis in squamous cell carcinoma of the oral cavity: A prospective study
Naresh Kumar Jangir, Akash Singh, Preeti Jain, Shruti Khemka
July-September 2022, 18(4):977-983
DOI:10.4103/jcrt.JCRT_783_20  PMID:36149149
Background: Tumor depth is a reliable parameter to predict nodal metastasis in oral cancers; therefore, the authors embarked upon a prospective observational study to define the relationship between the tumor depth and the risk of cervical lymph node involvement as well to determine the optimal tumor depth cutoff point for nodal metastasis. Aims: The aim was to study the predictive value of depth of invasion (DOI) and tumor size on risk of cervical node metastasis in squamous cell carcinoma of the oral cavity. Materials and Methods: Biopsy-proven Stage I–Stage III oral cavity squamous cell carcinoma patients were included in this prospective, observational study. Various histopathological characteristics (DOI, tumor size, lympho-vascular invasion [LVI], perineural spread, and grade of differentiation) were analyzed to predict the cervical node metastasis. Statistical Analysis Used: The impact of the clinical and histopathological parameters of primary tumor on cervical lymph node metastasis was analyzed by univariate as well as multivariate logistic regression analyses using NCSS 12 version 12.0.5 statistical software. Results: The independent predictors of cervical lymph node metastasis were DOI (P = 0.0014) and LVI (P = 0.0414). The incidence of cervical metastasis increased markedly when the DOI was over 5 mm, and it was a statistically significant (P < 0001) association. Conclusions: DOI is a significant predictor of cervical nodal metastasis and tumor depth 5 mm can be considered as a cutoff value in staging and management of early oral squamous cell carcinoma.
  1,065 40 -
Plasma miR-183-5p in colorectal cancer patients as potential predictive lymph node metastasis marker
Fatemeh Sanjabi, Reza Nekouian, Abolfazl Akbari, Rezvan Mirzaei, Azam Fattahi
July-September 2022, 18(4):921-926
DOI:10.4103/jcrt.JCRT_174_20  PMID:36149141
Background: Lymph node metastasis (LNM) is a point that often, treatment is not effective in colorectal cancer (CRC). Clinical and pathologic markers of prognosis help clinicians in selecting patients for adjuvant therapy after surgical resection in CRC. MiR-183-5p has been demonstrated to play as an oncogene in CRC, although its biological role still remains unclear. The aim of this study was to evaluate the expression of miR-183-5p in CRC and its potential relevance to clinicopathological characteristics as a prognostic biomarker. Materials and Methods: In this case–control study, 33 CRC plasma samples at stage I-II-III, as well as plasma samples from 13 healthy controls, were collected. The relative expression levels of miR-183-5p in cancer and the normal samples were measured by quantitative real-time PCR. We analyzed their correlation with clinicopathological parameters and prognostic value. Results: Our results indicated that miR-183-5p was significantly overexpressed in CRC samples compared to healthy controls (P < 0.001) from a cutoff value of 3.9 with a sensitivity of 89% and a specificity of 91% and an AUC value of 0.74. Further analysis showed that a high plasma expression level of miR-183-5p was significantly associated with LNM and higher tumor/node/metastases stage (III) (P-value < 0.001). Conclusion: In conclusion, the overexpression of miR-183-5p is highly related to advanced clinical stage, LNM and poor prognosis of CRC, indicating that miR-183-5p may serve as a predictive biomarker for the prognosis or the aggressiveness of CRC.
  1,052 38 -
CASE REPORTS
Epiganthus presenting as respiratory distress in a male neonate: A rare case report
Naveen Kumar, Charanjeet Ahluwalia, Gaurav Singla, Swati Singla
July-September 2022, 18(4):1177-1179
DOI:10.4103/jcrt.JCRT_888_19  PMID:36149182
An epignathus is an extremely rare form of oropharyngeal teratoma that arises from the oral cavity, most commonly from the palate and is associated with a high mortality secondary to airway obstruction in the neonatal period. It predominantly occurs in females. Here, we are presenting a case of giant epignathus in a male baby with associated cleft palate.
  1,042 44 -
LETTERS TO THE EDITOR
Synchronous benign Brenner's tumor of the ovary with leiomyoma and endometrial adenocarcinoma in a postmenopausal female
Jude Ogechukwu Okoye
July-September 2022, 18(4):1208-1209
DOI:10.4103/jcrt.JCRT_831_19  PMID:36149192
  1,030 43 -
REVIEW ARTICLES
Malignant gastrointestinal neuroectodermal tumor: A case-based review of literature
Pritinanda Mishra, Dipanwita Biswas, Sandeep Abhijit Pattnaik, Susama Patra, Dilip Kumar Muduly, Vigneshwaran Balasubiramaniyan, Amit Kumar Adhya
July-September 2022, 18(4):885-897
DOI:10.4103/jcrt.JCRT_829_19  PMID:36149136
Malignant gastrointestinal (GI) neuroectodermal tumor is an extremely rare entity that was first described by Zambrano et al. in 2003 as “clear cell sarcoma (CCS)-like tumor of the GI tract.” It shares some of the histopathological features of CCS but lacks the immunohistochemical (IHC) reactivity for melanocytic markers. Most mesenchymal neoplasms of the GI tract belong to the category of GI stromal tumors and are characterized by the IHC expression of c-KIT. In cases, without detectable KIT receptor expression, several differential diagnoses have to be taken into consideration. In this article, we describe such a case and present a review of all the reported cases till date. We also present the current available knowledge on its pathology and molecular genetics along with the limitations in its diagnosis. Here, we report a case of a 32-year-old man with a tumor of the small bowel composed of polygonal tumor cells arranged in solid nests, alveolar pattern, and pseudopapillary and admixed with numerous osteoclast-like multinucleated giant cells. Immunohistochemically, the tumor cells strongly expressed S-100 protein only. HMB-45, melan-A, CD117, cytokeratin, desmin, smooth muscle actin, and CD-34 were absent. Ki-67 index was 15%. The diagnosis was further confirmed by fluorescence in situ hybridization (FISH) demonstrating the presence of EWSR1 (22q12) translocation. A final diagnosis of malignant gastroneuroectodermal tumor was rendered. The patient is disease-free for 20 months of postsurgery. The diagnosis of this entity should be considered in the presence of S-100-positivity and multinucleated osteoclastic giant cells and the absence of melanocytic differentiation in a tumor arising from GI tract. Further confirmation can be done by performing FISH analysis.
  933 60 -
ORIGINAL ARTICLES
A comparative study of gemcitabine and cisplatin versus oral capecitabine alone in metastatic gallbladder cancer
Deepak Kumar, Neeraj Rastogi, Sushma Agarwal, Shagun Mishra, Shaleen Kumar, Punita Lal, Shalini Singh, Sunil Choudhary
July-September 2022, 18(4):939-945
DOI:10.4103/jcrt.JCRT_896_19  PMID:36149144
Aims: There is no consensus for palliative chemotherapy regimen in metastatic gallbladder cancer. We did a retrospective study to compare the treatment outcome in patients of metastatic gallbladder cancer treated with either gemcitabine + cisplatin (regimen A) or oral capecitabine (regimen B) alone. Subjects and Methods: A total of 67 patients between January 2015 and September 15 treated with either regimen A or regimen B were retrospectively evaluated. Statistical analysis was done in June 2019. Kaplan–Meir and Log rank test were used to compare survival between two arms. Results: Out of 67 patients, 31/67 (46%) received regimen A, and 36/67 (54%) received regimen B. Male to female ratio was 1:3. About 42% patients in regimen A and 20% in regimen B required palliative stenting. Median number of chemotherapy cycles was 4 in both regimen A (range 1->6) and regimen B (range 1->6). Patients receiving 3 cycles and 6 cycles of chemotherapy in regimen A and regimen B was 68% and 31% versus 70% and 63%, respectively (P = 0.86). Response assessment as any response (complete response + partial response + disease was stable) after 3 cycles and 6 cycles was 71% and 57% (P = 0.20), 44% and 39% (P = 0.29), in regimen A and B, respectively. Median survival was 23 weeks (range 2–106 weeks) in regimen A and 15 weeks (range 4–83 weeks) in regimen B (P = 0.40). Conclusions: The present study shows gemcitabine and cisplatin has nonsignificant better survival compared to oral capecitabine. However, oral capecitabine is more convenient and easy to administer. Studies with larger sample size are needed to further establish the standard chemotherapy guidelines.
  945 42 -
Higher order genes interaction in DNA repair and cytokine genes polymorphism and risk to lung cancer in North Indians
Ritambhara , Rishabh Kumar, Maneesh Kumar Gupta, Priyanka Gautam, Sonia Tiwari, Sivakumar Vijayraghavalu, Girish C Shukla, Munish Kumar
July-September 2022, 18(4):953-963
DOI:10.4103/jcrt.JCRT_51_20  PMID:36149146
Context: Lung cancer pathological process involves cumulative effects exerted by gene polymorphism(s), epigenetic modifications, and alterations in DNA repair machinery. Further, DNA damage due to oxidative stress, chronic inflammation, and the interplay between genetic and environmental factors is also an etiologic milieu of this malignant disease. Aims: The present study aims to assess the prognostic value of DNA repair, cytokines, and GST gene polymorphism in lung cancer patients who had not received any neoadjuvant therapy. Materials and Methods: In this case–control study, 127 cases and 120 controls were enrolled. DNA from the blood samples of both patients and controls was used to genotype XRCC1Arg399Gln, XPDLys751Gln, and interleukin-1 (IL-1β) genes by polymerase chain reaction (PCR)-restriction fragment length polymorphism method, whereas multiplex PCR was performed to genotype GSTT1 and GSTM1. Results: Binary logistic regression analysis showed that XRCC1Arg399Gln-mutant genotype (Gln/Gln, odds ratio [OR] = 4.6, 95% confidence interval [CI]: 2.2–9.6) and GSTT1 null (OR = 2.7, 95% CI: 1.6–4.5) were linked to cancer susceptibility. Generalized multidimensional reduction analysis of higher order gene–gene interaction using cross-validation testing (CVT) accuracy showed that GSTT1 (CVT 0.62, P = 0.001), XPD751 and IL- (CVT 0.6, P = 0.001), and XRCC1399, XPD751, and interleukin-1 receptor antagonists (IL-1RN) (CVT 0.98, P = 0.001) were single-, two-, and three-factor best model predicted, respectively, for lung cancer risk. Classification and regression tree analysis results showed that terminal nodes which contain XRCC1399-mutant genotype (AA) had increased the risk to lung cancer. Conclusion: The present study demonstrated that XRCC1399 (Gln/Gln), GSTT1, and IL-1RN allele I, I/II served as the risk genotypes. These genes could serve as the biomarkers to predict lung cancer risk.
  929 54 -
Laparoscopic-assisted surgery versus open surgery for transverse colon cancer: A multicenter retrospective study
Hiroshi Tamagawa, Masakatsu Numata, Toru Aoyama, Keisuke Kazama, Yukio Maezawa, Yosuke Atsumi, Kentaro Hara, Kazuki Kano, Keisuke Komori, Shinnosuke Kawahara, Norio Yukawa, Sho Sawazaki, Hiroyuki Saeki, Teni Godai, Yasushi Rino, Munetaka Masuda
July-September 2022, 18(4):898-902
DOI:10.4103/jcrt.JCRT_946_20  PMID:36149137
Introduction: Previous randomized controlled trials demonstrated similar oncological outcomes between laparoscopic-assisted (LA) and open (OP) colectomy; however, patients with transverse colon cancer were not analyzed. The aim of this study was to confirm the oncological safety and the advantages of the short- and long-term results of LA surgery for transverse colon cancer in comparison to OP surgery. Materials and Methods: The study data were retrospectively collected from the databases of four hospitals. Patients with transverse colon cancer who underwent LA or OP R0 or R1 resection were registered. Results: Among the 204 patients, 149 underwent OP colectomy and 55 underwent LA colectomy. The median follow-up period was 43 months. The rate of conversion to OP resection was 7.3%. The 5-year overall survival rate of the LA group was higher than that of the OP surgery group for all-stage patients (97.5% vs. 91.1%, P = 0.108), and it was similar in Stage II and Stage III patients (94.1% vs. 94.2%, P = 0.510). The LA group had significantly lower blood loss and a significantly longer operative time in comparison to the OP surgery group. Furthermore, the postoperative hospital stay was significantly shorter (9 vs. 13 days, P = 0.001) and the incidence of Grade ≥III complications was lower in the LA group (3.7% vs. 14.8%, P = 0.031). Conclusion: We concluded that LA surgery for transverse colon cancer is oncologically safe and yields better short-term results in comparison to OP surgery.
  856 62 -
Correlation of the activities of antioxidant enzymes superoxide dismutase and glutathione reductase with micronuclei counts among areca nut chewers of Manipuri population using exfoliative cytology: A preliminary study
Ngairangbam Sanjeeta, Sumita Banerjee, Saikat Mukherjee, T Premlata Devi, DB Nandini, P Aparnadevi
July-September 2022, 18(4):984-989
DOI:10.4103/jcrt.JCRT_1227_20  PMID:36149150
Context: Areca nut (AN) is a potent cytotoxic and genotoxic agent. Oxidative stress-induced by chewing of AN can cause DNA damage leading to nuclear anomalies such as micronuclei (MN) and also alters antioxidant defense mechanisms, leading to genomic instabilities and the development of oral cancer. Aims: The aim of this study is to study the correlation between the levels of glutathione reductase (GR) and superoxide dismutase (SOD) in exfoliated buccal mucosal cells and the genotoxicity levels (MN count) in chronic AN chewers. Materials and Methods: The present study was conducted with the approval of the Research Ethics Board in 60 individuals; 40 cases (Group I–20 raw AN chewers, Group II–20 dried areca with tobacco chewers), and 20 controls as Group III in the age group of 18–68 years who attended the outpatient department of our college. Estimation of SOD and GR and MN assessment was done using buccal exfoliated cells. Statistical Analysis Used: Statistical analysis was performed using the Student's t-test and one-way ANOVA. Results: Antioxidant levels were found to be significantly reduced in both Group I and Group II in comparison to the control group. Group II showed significantly reduced level of GR in comparison to Group I. The MN count was significantly increased in Group II in comparison to Group I. The MN counts showed an inverse correlation to the activities of the antioxidant enzymes. Greater activities of antioxidant enzymes correlated with decreased MN counts. Conclusions: Detection of MN in AN chewers with or without tobacco can be a useful biomarker for clinical screening procedures that may be used as a risk marker for oral cancer. It is important to increase the awareness programs to educate the public about the deleterious effects of AN chewing, emphasize on early intervention of AN chewing habit and thus prevent the development of oral cancer.
  877 41 -
CASE REPORTS
Multiple muscle involvement in relapsed multiple myeloma: A rare case
Muzeyyen Aslaner AK, Rabiye Uslu Erdemir
July-September 2022, 18(4):1165-1167
DOI:10.4103/jcrt.jcrt_156_22  PMID:36149178
Although extramedullary involvement in multiple myeloma (MM) emerges in various organs, muscle involvement is rarely seen and is associated with poor prognosis. It is aimed to discuss the treatment strategy in such a rare case with multiple muscle involvement in relapsed MM. Because the response to treatment is short-lived and the prognosis is poor in extramedullary involvement, effective and dynamic treatment methods for bridging should be used for clinical trials and hematopoietic stem cell transplantation.
  848 46 -
ORIGINAL ARTICLES
The relationship between adjuvant chemotherapy and thiol-disulfide compounds
Pınar Akyol, Didem Şener Dede, Burak Bilgin, Arife Ulaş, Mehmet Ali Nahit Şendur, Muhammed Bülent Akıncı, Salih Başer, Cihan Erol, Mutlu Hızal, Bülent Yalçın
July-September 2022, 18(4):1114-1118
DOI:10.4103/jcrt.JCRT_32_20  PMID:36149169
Aim: Thiols are the organic compounds of the antioxidant system. There is limited data in the literature concerning chemotherapy (CT) in cancer and thiol balance. In this study, we aimed to evaluate the possible changes of thiol/disulfide levels with the recurrent CT cycles and type of cancer. Materials and Methods: The 40 healthy individuals and 40 patients who had been newly diagnosed with early-stage breast, ovary and endometrium cancer receiving adjuvant CT. Blood samples were taken from all patients three times as basal and after the first and second CT sessions. Results: We compared preadjuvant treatment levels of thiol and disulfide parameters in the patients group with the control group. The median of native thiol and total thiol was found to be higher in the control group than in the study group (P < 0.001). In addition, disulfide/native thiol and disulfide/total thiol rates were found to be higher in the patient group (P = 0.001). When we look at the comparison before and after CT in the patient group, disulfide/native thiol and disulfide/total thiol rates, which represent increased oxidative stress (OS) levels were found to be higher after CT than before CT measurement (P < 0.016). Discussion: This is the first study, which has researched the relationship between cancer type and thiol compounds and changes of thiol compounds during CT therapy, by using the method designed by Erel and Neşelioğlu. In this study, we found that pre-CT thiol disulfide balance in cancer patients shifted toward disulfide direction and OS levels may increase after repetitive CT sessions.
  827 46 -
Micronucleus assay in the exfoliated cells of buccal mucosa of gasoline station workers in Tehran
Fatemeh Shahsavari, Sina Mikaeli, Maedeh Ghorbanpour
July-September 2022, 18(4):1030-1035
DOI:10.4103/jcrt.JCRT_875_20  PMID:36149157
Objectives: One of the most critical landmarks of DNA damage is the micronucleus assay. Enumeration of micronuclei contributes to the early diagnosis of precancerous lesions and cancers; however, there are few studies on the frequency of micronucleus in gasoline station workers. To the best of our knowledge, no study has addressed this issue in Iran. The present study aimed to determine the role of working in the gasoline stations of Tehran city on micronucleus frequency in buccal mucosa. Materials and Methods: In this historical cohort study, buccal mucosa samples were collected from 110 individuals working at gasoline stations and 100 unemployed persons using wet tongue depressors. After Papanicolaou staining, the percentage of cells containing micronucleus as well as the mean number of micronucleus in the micronucleated cells was reported. Student's t-test, Mann–Whitney test, and regression analyses were used to specify the effect of other variables on the frequency and mean number of micronucleus per cell. Results: The mean frequency of micronucleus in the case and control group was 29.8 ± 8.2 and 9.3 ± 3.2, respectively, which was statistically significant (P = 0.0001). Furthermore, the mean number of micronucleus in the micronucleated cells of buccal mucosa was significantly higher in individuals who were exposed to gasoline than the control group (P = 0.0001). Conclusion: The results indicated that exposure to gasoline could increase the frequency of micronucleus. It was also revealed that cigarette and hookah smoking and alcohol consumption, together with working in gasoline stations, increase micronucleus abundance, implying the cumulative carcinogenic effect of these factors.
  806 32 -
Comparative evaluation of immunohistochemical expression of MCM2 and Ki67 in oral epithelial dysplasia and oral squamous cell carcinoma
Sushmita Swain, Roquaiya Nishat, Sujatha Ramachandran, Malvika Raghuvanshi, Shyam Sundar Behura, Harish Kumar
July-September 2022, 18(4):997-1002
DOI:10.4103/jcrt.JCRT_10_20  PMID:36149152
Aim and Objectives: The aim and objective of the study were to evaluate the immunohistochemical expression of proliferative markers, Ki67, and MCM2 in oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC), to compare the relationship of their staining patterns, and to look for correlation between them, if any. Materials and Methods: Thirty archival paraffin-embedded tissue blocks of previously diagnosed cases of OED, OSCC each, and 10 normal oral mucosa were used in the study. Immunohistochemical staining for MCM2 and Ki67 markers was done and the slides were individually evaluated for MCM2 and Ki67 expression, with immunopositivity determined on the basis of dark brown staining of the nucleus. The number of positively stained nuclei was counted in 10 representative areas and the data were charted and statistically analyzed. Results: The overall mean expression of both the proteins increased progressively from normal mucosa to OED to OSCC. In normal mucosa, all positively stained nuclei were seen in the basal compartment of the epithelium, while in dysplastic cases, expression was seen toward the surface of squamous epithelium. In OSCC, the frequency of expression of MCM2 and Ki-67 proteins showed an inverse correlation with the degree of tumor differentiation. In well-differentiated cases, the positivity of either marker was restricted to the outermost layer of the tumor cells. In moderately differentiated cases, an expression of Ki-67 was more diffuse in inner layers, whereas the MCM2 antigen was found to be more intense and diffuse in both the inner and outer layers. Whereas in poorly differentiated SCC, positive expression was seen in most of the tumor cells, the mean expression of MCM2 was found to be higher than that of Ki67 in all cases. Conclusion: MCM2, as a proliferation marker, is superior to Ki67 as it indicates the capacity of proliferation and the ability of DNA replication of a cell.
  771 43 -
Hepatosplenic T-cell lymphoma diagnosed using flow cytometry. A single-center study of 12 cases from North India
Khaliqur Rahman, Tanvi Gupta, Ruchi Gupta, Lakshita Singh, Dinesh Chandra, Manoj Kumar Sarkar, Manish Kumar Singh, Sanjeev Kumar, Soniya Nityanand
July-September 2022, 18(4):1093-1097
DOI:10.4103/jcrt.JCRT_877_19  PMID:36149166
Background: Hepatosplenic T-cell lymphoma (HSTCL) is a rare fatal T-cell neoplasm with unique clinical and laboratory features. There is, however, significant morphological and immunophenotypic heterogeneity which may lead to diagnostic dilemma. Aims and Objectives: The study was aimed to study the prevalence and clinic-pathological spectrum of this rare variant of T cell lymphoma in the Indian subcontinent. Material and Methods: A retrospective analysis of all consecutive cases of HSTCL diagnosed over a period of 6 years was carried out. The clinical and laboratory parameters of all these patient were reviewed and analysed. Results: A total of 12 cases of HSTCL were diagnosed during this period which accounted for 1.76% of all non-Hodgkin's lymphomas (NHLs) and 9.1% of all T-cell NHLs. The median (range) age of presentation was 23 (16–30) years.Leukocytosis, peripheral blood (PB) involvement, and a blastic morphology were noted in 41%, 67%, and 58% of the cases, respectively. FCI proved these cells to have a mature, dual-negative (CD4−/CD8−) T-cell phenotype with a gamma–delta T-cell receptor restriction. Frequent loss of CD5 expression (84%) was also noted. These patients invariably had a fatal outcome and majority died within a year of diagnosis. Conclusion: The incidence of leukocytosis and a blastoid morphology is quite frequent in HSTCL. Hence, a differential diagnosis of HSTCL should always be considered in young patients presenting with splenomegaly and exhibiting atypical lymphoid/blastoid cells in the PB or a marrow. An FCI can readily diagnose and differentiate them from an acute lymphoblastic leukemia/lymphoma.
  782 30 -
REVIEW ARTICLES
Desmoid tumor of Meckel's diverticulum presenting as intestinal obstruction: A rare case report with literature review
Aditya Vijay Mundada, Darshana Tote, Anup Zade
July-September 2022, 18(4):880-884
DOI:10.4103/jcrt.JCRT_582_20  PMID:36149135
Meckel's diverticulum (MD) is among the many known congenital malformations of intestine. It is seen in approximately 2% of the population. Desmoid tumors are unusual. They are unique, well-differentiated, and fast-growing musculoaponeurotic fibromatosis tumors, contemplated as Grade 1 fibro sarcoma. They offer exclusive management challenges to surgeons. The most common presentation of desmoid tumors is of painless masses with sluggish growth. Rarely, they may present as intestinal obstruction leading to surgical emergency. We present the only case in history till date along with review of the relevant literature of a 65-year-old gentleman who presented to us with features of intestinal obstruction who successfully underwent elective segmental resection of ileum containing MD with its desmoid tumor. A multimodality approach is needed to tackle such kind of diseases with a team comprising oncosurgeons, oncophysicians, and radiation oncologist to design a standard treatment protocol.
  756 56 -
ORIGINAL ARTICLES
Characterization of genetic polymorphisms in oral cancer-related genes pertaining to oxidative stress, carcinogen detoxifying, and DNA repair: A case–control study
Neville Hoshedar Tata, Ashok Kshirsagar, Nitin Nangare
July-September 2022, 18(4):1023-1029
DOI:10.4103/jcrt.JCRT_1057_20  PMID:36149156
Background: The genetic polymorphism in the DNA repair and maintenance genes leads to mutations and deregulated growth hormones which have implications in cancer. Apart from identified carcinogens such as tobacco, specific genetic polymorphisms correspond to an individual's risk of oral cancer. The current study aims at identification of differences in genetic polymorphisms in subjects with and without oral cancer in Karad, India. Aim/Objectives: The aim of the study was to characterize genetic polymorphisms in oral cancer-related genes pertaining to oxidative stress, carcinogen detoxifying, and DNA repair. Methodology: A hospital-based case–control was conducted with 150 subjects sorted into cases (n = 75) and controls (n = 75). The polymerase chain reaction-based restriction fragment length polymorphism assay was used to genotype the polymorphisms of selected DNA repair, detoxifying, and oxidative stress-related genes. Results: In the cases group, among the DNA repair set, Gene-1 (XRCC1), Gene-3 (XRCC3), Xeroderma Pigmentosum Group-D gene (XPD), and human 8-oxoguanine DNA glycosylase (hOGG1) showed significant genetic polymorphism. Similarly, the genetic polymorphism in the carcinogen detoxifying genes-n-acetyl transferase, GSTP1, and oxidative stress-related gene catalase were noted. Statistical Analysis: The Cramer's V/odds ratio was applied to estimate the association of genetic risk factors with oral cancer. Conclusion: The polymorphisms of XRCC1, XRCC3, XPD, and hOGG1 genes were associated with a higher susceptibility to oral cancer as compared to controls. This information may be a useful novel marker in oral oncology for primary prevention and intervention.
  719 41 -
Significance of platelet parameters in squamous cell carcinoma of oral cavity – A case-control study
Ankit Anand, Kalyani Raju, SM Azeem Mohiyuddin
July-September 2022, 18(4):1036-1041
DOI:10.4103/jcrt.jcrt_786_21  PMID:36149158
Introduction: Tumor microenvironment plays an important role in cancer progression. Platelets are one of the components of the tumor environment shown to have a role in cancer survival and progression. Materials and Methods: Ninety-six cases of squamous cell carcinoma (SCC) cases of the oral cavity and 96 age/sex-matched healthy controls were considered for the study. Data regarding platelet count, platelet distribution width (PDW), mean platelet volume (MPV), Platelet-Large Cell Ratio (P-LCR), Plateletcrit (PCT), platelet/neutrophil ratio (PNR), platelet/lymphocyte ratio (PLR), and Platelet/Monocyte Ratio (PNR) from automated hematology analyzer records and clinicopathological data from the Department of Pathology were captured. These data were compared between cases and controls and also with tumor size, tumor grade, lymph node status, and tumour node metastasis (TNM) stage of cases. Results: Mean ± standard deviation for platelet count, PDW, MPV, P-LCR, PCT, PNR, PLR and PMR among cases were 315.03 ± 98.26, 10.94 ± 1.66, 9.91 ± 0.77, 23.52 ± 5.64, 0.31 ± 0.086, 62.55 ± 31.51, 149.34 ± 61.32, and 498.67 ± 194.91, respectively, and among controls were 287.88 ± 74.11, 10.84 ± 1.18, 9.89 ± 0.72, 23.45 ± 4.55, 0.29 ± 0.061, 60.27 ± 21.02, 138.71 ± 49.28, and 497.64 ± 172.28, respectively. The association between means of platelet count, PDW, P-LCR, and PCT among cases and controls were statistically significant (P = 0.020, 0.006, 0.030, and 0.000, respectively). No statistically significant association was found between means of platelet count, PDW, MPV, P-LCR, PCT, PNR, PLR, and PMR versus tumor size, lymph node status, and tumor grades. The association between the means of PCT/PMR and TNM Stages I and II were statistically significant (P = 0.029 and 0.016, respectively). Conclusions: Platelet count, morphology, and functions are altered in oral SCC. Platelet activation plays an important role in oral cancer. PCT and PMR can be used to predict the progress of oral SCC as a cost-effective inflammatory marker.
  569 43 -
LETTERS TO THE EDITOR
Metabolic syndrome: A patient-related prognostic factor for cancer?
Priscila da Silva Mendonça, Ana Patrícia Nogueira Aguiar, Ronald Feitosa Pinheiro, Sílvia Maria Meira Magalhães
July-September 2022, 18(4):1210-1211
DOI:10.4103/jcrt.JCRT_323_19  PMID:36149193
  574 33 -
ORIGINAL ARTICLES
Use of methylene blue dye for sentinel lymph node mapping in early-stage gynecological cancers – An option for low resource settings
Nisha Singh, Shuchi Agrawal
July-September 2022, 18(4):1088-1092
DOI:10.4103/jcrt.jcrt_746_21  PMID:36149165
Context: Sentinel lymph node (SLN) mapping is a standard of care in gynecological cancers but with limited resources and equipment, intraoperative use of methylene blue for SLN mapping may be more useful. Aims: To authenticate the use of methylene blue dye for intraoperative SLN mapping in cases of early-stage gynecological cancers. Settings and Design: This pilot study was conducted in a tertiary care teaching hospital. Subjects and Methods: The cases included 14 cervical, 4 endometrial, 1 vulvar, and 1 synchronous cervical-vulvar cancer wherein 21 SLN mappings were done. Four ml of methylene blue was injected submucosally in the cervix in cervical and endometrial cancer. It was injected around the tumor in vulvar cancer. The pelvic lymphatic drainage area was examined in cervical and endometrial cancer while inguinofemoral area was examined in vulvar cancer for any blue LNs. Histopathological examination results were compared for the presence of metastasis in stained and unstained LNs. Statistical Analysis Used: The observations were presented as numbers and percentages. Results: The SLN mappings showed a detection rate of 76%. The mean number of LNs removed in each case was 10.3 with an average of 2.4 stained and 7.6 unstained LNs. SLN was most commonly found among right external iliac nodes. All stained and unstained nodes among the 16 SLN detections did not show any histological evidence of metastasis suggesting a negative predictive value of 100%. Conclusions: Methylene blue is an efficient, feasible, and safe dye for SLN mapping in early-stage gynecological cancer.
  496 25 -
Development of in-house heterogeneous thorax phantom and evaluation of pretreatment patient-specific transit dosimetry for intensity-modulated radiotherapy and volumetric modulated arc therapy plans
Priyusha Bagdare
July-September 2022, 18(4):1098-1104
DOI:10.4103/jcrt.jcrt_843_21  PMID:36149167
Background: Patient-specific dosimetry before patient treatment plays a crucial role in radiotherapy (RT) treatment. Absolute point dosimetry and relative dosimetry using homogeneous phantom are the regular methods which are employed for dose verification in RT department. However, this method does not imitate the realistic radiation interaction taking place inside the patient's body as it is heterogeneous in nature. Hence, to perform the relative dosimetry inside the heterogeneous medium which can very well replicate the actual patient scenario, in the present work, we studied the radiological properties of in-house developed heterogeneous thorax phantom (HTP) phantom for different photon energies. And in the second part, we performed the patient-specific relative transit dosimetry by using the design cost-effective HTP. Materials and Methods: HTP was constructed with porous sawdust of pinewood of density 0.24 g/cm3, honeybee's wax of density 0.86 g/cm3, and rib cage of density 1.84 g/cm3 to mimic the actual human thorax. To assess the radiological properties of designed HTP, the mean depth of central axis isodose curves was measured on computed tomography images of homogeneous slab phantom (HSP), actual patient, and on HTP. To evaluate the performance of treatment planning system (TPS), quality assurance (QA) plans of 30 patients were generated on HTP, and the two-dimensional dose fluence calculated by TPS was compared with that of the acquired dose fluence on a linear accelerator. Global γ index passing criteria (dose difference of 3% and distance-to-agreement of 3 mm) were used to evaluate the closeness between the calculated and measured fluence maps. Results: The depth of various isodose lines along the central axis was found to be similar in HTP and actual patients as compared to HSP for different photon energies using varied gantry angles. The γ values for relative exit dosimetry were found to be <1 for >97% of data set points and the correlation factor r was found to be positive ≤1 for all QA plans which indicates the good correlation between calculated and acquired dose fluence. Conclusions: In-house developed HTP is a cost-effective phantom which resembles with that of the human thorax in terms of its radiological properties. Moreover, it can be a better QA medium for pretreatment plan verification of the actual patients.
  430 27 -
CASE REPORTS
Mucinous spindle and tubular renal cell cancer: A rare variant of renal cell cancer
Malay Bajpai, S Pooja, Mayurika Tyagi, Abhishek Pathre
July-September 2022, 18(4):1168-1170
DOI:10.4103/jcrt.jcrt_99_21  PMID:36149179
In the World Health Organization classification system, mucinous tubular and spindle cell carcinoma of the kidney (MTSCC-K) has been described as a rare pathologic subtype of renal cell cancer. This tumor is supposed to have good prognosis, though follow-up data are limited due to rarity of tumor. MTSCC-K is a rare variant of renal cell carcinoma with female predominance and favorable prognosis. We report our experience with a case of mucinous tubular spindle cell carcinoma involving the kidney. A 61-year-old female presented with a palpable left renal lump of 12 cm in size. Computed axial tomography scan revealed a well-circumscribed mass of 11 cm involving the lower pole of the left kidney. She underwent left open radical nephrectomy. The cut section revealed a well-circumscribed tumor with yellowish-white variegated areas measuring 11 cm × 8 cm × 7 cm. Histopathological diagnosis of mucinous tubular spindle cell carcinoma of the kidney was given, and the patient responded well after the treatment. An accurate diagnosis may have an impact on prognostication of tumor and understanding the biology of the tumor. Thus, the clinicians should be aware of this rare disease for prompt diagnosis.
  404 24 -
ORIGINAL ARTICLES
Cyclin-dependent kinase inhibitor p21 and proliferative marker ki67 in colonic carcinoma
Sanjay Kumar, Neha Singh, Sant Prakash Kataria, Shruti Kandoi, Meena Verma, Rajeev Sen
July-September 2022, 18(4):915-920
DOI:10.4103/jcrt.jcrt_712_21  PMID:36149140
Objective: Tumor grade employed for colorectal cancer has long been based on the degree of differentiation, which is difficult to judge objectively. The aim of this study was to assess the immunohistochemical expression of p21 and ki67 and their correlation with the histological grading of colorectal carcinoma. Materials and Methods: A total of 45 biopsy specimens of colorectal cancer were pathologically reviewed and correlation of grade and differentiation of tumor was performed with immunostaining. Results: Ki 67 and p21 markers showed inverse relationship. An inverse relationship of p21 was found with tumor grade, differentiation, Dukes staging and lymph node status, whereas no correlation could be found between these parameters and ki67 expression. Conclusion: We found that p21 can be used to assess the grading and metastatic potential of colorectal carcinoma whereas increased Ki67 expression can help us in the diagnosis of malignancy.
  357 40 -
CASE REPORTS
Carcinoma of the pyriform sinus with mediastinal metastasis successfully treated with chemoradiotherapy in resource-constraint setup
Pallavi Kalbande, Pournima Kale, Aarathi Ardha
July-September 2022, 18(4):1195-1198
DOI:10.4103/jcrt.JCRT_1667_20  PMID:36149188
Squamous cell carcinoma (SCC) of the pyriform sinus with metastatic mediastinal mass is staged as IVC and routinely treated with palliative intent. Here, we report a case cured with radical chemoradiotherapy without CT simulator, lead cutouts, and advanced techniques such as three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, image-guided radiotherapy, and volumetric modulated arc therapy or stereotactic body radiotherapy. A 67-year-old male presented with SCC of the right pyriform sinus with mediastinal metastasis (Stage IVC). He was started with palliative chemotherapy afferent, but he could not tolerate it. Further, he was treated with radical chemoradiotherapy to dose of 60/30# to primary + neck with 6 MV photons and 50 Gy/25# to the anterior mediastinal lesion using 18 Mev electrons. Complete response to the treatment was achieved. At the close follow-up of 58 months, the patient is disease-free and follow-up is still ongoing. Limited metastatic disease can be completely cured using multimodality treatment using simple traditional 2D techniques, though optimal dose escalation becomes a limitation. Some variants of SCC do respond well even at suboptimal radiotherapy doses, so personalized treatment can be considered in such patients.
  361 30 -
ORIGINAL ARTICLES
Validation of a simple technique for accurate treatment delivery for bilateral breast irradiation using the electronic portal imaging device
Debojoyti Dhar, Suman Mallik, Jyotirup Goswami
July-September 2022, 18(4):1159-1161
DOI:10.4103/jcrt.jcrt_1271_21  PMID:36149176
Background and Aims: While bilateral breast cancer is rare, the challenge for the radiation oncologist is to limit the dose to multiple important organs-at-risk and reducing the chance of overlapping tangential fields to limit hotspots. In this study, we present a simple technique to verify the setup accuracy of breast tangential fields using the electronic portal imaging device (EPID) for bilateral breast cancer. Patients and Methods: A 74-year-old female, with bilateral breast cancers, right staged as T1N0M0 and the left T2N1M0, received postoperative radiotherapy following bilateral breast conservative surgery. Standard CT-based simulation and target delineation were done, followed by treatment planning using classical field arrangements with two separate isocenters, one for each breast (keeping identical anteroposterior and superior-inferior coordinates). The planned doses were 45 Gy/25 # for whole breasts, plus tumor bed boost of 15 Gy/6 # and 50 Gy/25 # to left supraclavicular fossa. After setting up the patient, two small lead wires were placed at the medial borders of medial tangents (as seen on light fields) of each breast (longer one for left), followed by EPID imaging (dual exposure: One lateral tangent field image and other larger to include lead wires) of respective contralateral lateral tangential fields to verify that there was no actual overlapping with the opposite medial tangential field, as indicated by the lead wires. Conclusion: The study has validated a simple EPID-based technique for routine use in the field matching for radiotherapy of bilateral breast cancer.
  350 30 -
CASE REPORTS
Acute myeloid leukemia and myelofibrosis: Simultaneous transformation of essential thrombocythemia during treatment with hydroxyurea
Swarna Sri Nalluru, Orhan Efe, Yayan Chen, Nitin Trivedi
July-September 2022, 18(4):1180-1182
DOI:10.4103/jcrt.JCRT_1107_19  PMID:36149183
Essential thrombocytosis (ET) is usually an indolent disease but can uncommonly evolve into acute myeloid leukemia (AML) with a grim prognosis of 2–7 months. Studies report a lower incidence of leukemic transformation when compared to fibrotic transformation. The risk of transformation depends on the age, duration of disease, and tumor biology. Hydroxyurea, a cytoreductive agent, is generally associated with minimal adverse reactions; however, there are conflicting data on its effect on leukogenecity. We describe a rare case of a 79-year-old female developing disseminated intravascular coagulation due to the transformation of ET to both AML and myelofibrosis while being treated with hydroxyurea for 8 years.
  276 39 -
ORIGINAL ARTICLES
Clinical impact of extended field radiation therapy in Stage III carcinoma cervix versus conventional field techniques: A comparative study
Prateek Daga, HS Kumar, Neeti Sharma, Shankar Lal Jakhar, Kamlesh Kumar Harsh, Saroj Dhaka
July-September 2022, 18(4):1083-1087
DOI:10.4103/jcrt.jcrt_597_21  PMID:36149164
Aim: The aim of the study was to examine tumor control and clinical outcomes of extended field irradiation and compare it with those treated with conventional field in same disease profile and also to determine toxicities associated with radiation treatment. Methods: This study included 50 biopsy-proven and registered International Federation of Gynecology and Obstetrics Stage III cases of carcinoma cervix treated with concurrent computed tomography (injection cisplatin 40 mg/m2 weekly) + external beam radiotherapy (EBRT) upto 50 Gy + high-dose-rate intracavitary brachytherapy (ICBT) (22.5 Gy). Twenty-five patients were randomized to each arm. Arm A: Conventional field EBRT 50 Gy with concurrent weekly chemotherapy followed by ICBT. Arm B: Extended field EBRT 50 Gy with concurrent weekly chemotherapy followed by ICBT. Results: At 12-month follow-up, 43 patients (86%) had attained CR. Overall, seven patients (14%) were in noncomplete response (CR) group (non-CR = patients with partial response, stable disease, or progressive disease). The non-CR rate was 16% for Arm A and 20% for Arm B. Among seven patients of non-CR group, six had local disease and one had failure at distant site. Five (10%) patients died in this study, 2 (8%) in Arm A and 3 (12%) patients in Arm B. Residual disease was seen in 2 (4%) patients. Grade III diarrhea was seen in eight patients (16%), 3 in Arm A (12%) and 5 in Arm B (20%). Fifteen patients (30%) developed Grade III skin toxicity. Seven patients in Arm A (28%) and 8 patients (32%) in Arm B developed Grade III toxicity. Twenty-five (50%) cases presented with varying stages of vaginal adhesions and stenosis. Conclusion: Majority of patients achieved CR with minimal acute and late toxicities with similar results in both arms. No patient had pelvic or para-aortic metastasis until recent follow-up.
  226 38 -
A mathematical model to predict the different isodose volumes using TRAK value in HDR intracavitary brachytherapy for revised Manchester and ICRU-89 based Point A plans using computer tomography images
Ankur Mourya, Sunil Choudhary, Neeraj Sharma, Uday Pratap Shahi, Gaganpreet Singh, Satyajit Pradhan, Lalit Mohan Aggarwal
July-September 2022, 18(4):1105-1113
DOI:10.4103/jcrt.jcrt_47_21  PMID:36149168
Purpose: To find out the simple relationship between Total Reference Air Kerma (TRAK) and various isodose volumes. Calculated isodose volumes were compared with experimental data for revised Manchester and International Commission on Radiation Units and measurements (ICRU)-89 Point A-based treatment plans. The accuracy of the formula was compared with the results of other relationships available in the literature. Materials and Methods: Dosimetric data from 62 intracavitary brachytherapy (ICBT) treatment plans of 31 patients with cervical cancer were studied. Each patient had treatment plans normalized to revised Manchester and ICRU-89 Points A (Aflange and Aicru89). For each treatment plan, TRAK values, V350, V700, V1050, and V1400 were obtained. The modeling curve was plotted between Isodose volume (Vd) and the ratio of d/TRAK obtained from Aflange plans to get a mathematical relation. The results of this formula were compared with the experimental data and outcomes of other formulas available in the literature. A paired-sample t-test was performed to assess the statistical significance. Results: In the case of revised Manchester-based Aflange normalization plans, the mean isodose volume of V350, V700, V1050, and V1400 were 285.98 ± 32.3 cm3, 101.96 ± 10.63 cm3, 52.71 ± 4.72 cm3, and 31.44 ± 2.33 cm3 respectively. Likewise, for ICRU-89 based Aicru89 normalization plans, the mean isodose volumes of V350, V700, V1050, and V1400 were 304.11 ± 26.17 cm3, 108.88 ± 8.29 cm3, 56.62 ± 3.69 cm3 and 34 ± 2.23 cm3 respectively. The mean difference was significant. The Mathematical relationship developed was [INLINE:1]. No correlation was found between TRAK and D0.1cm3,D2cm3 for organs at risk. Conclusions: The developed formula calculated isodose volumes within the accuracy of ± 3% in ICBT plans.
  216 38 -
The role of metabolic tumor parameters predicting cervical lymph node metastasis in patients with head and neck squamous cell carcinoma
Sibel Goksel, Ozlem C Erdivanli, Ogun Bulbul, Engin Dursun
July-September 2022, 18(4):1045-1051
DOI:10.4103/jcrt.jcrt_2294_21  PMID:36149160
Purpose: This study aimed to investigate the contribution of metabolic positron emission tomography/computed tomography (PET/CT) parameters of the primary tumor in predicting regional lymph node metastasis (LNM) at initial staging in patients with head and neck squamous cell carcinoma (HNSCC). Methods: A total of 114 patients diagnosed with HNSCC and who underwent PET/CT scanning for staging were included in the study between May 2014 and December 2020. Predictive values of maximum standardized uptake value (SUVmax), maximum standardized uptake ratio (SURmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor in the prediction of cervical LNM were evaluated with logistic regression. Results: The patients were diagnosed with cancer of the larynx (46.5%), oropharynx (9.6%), nasopharynx (22.8%), hypopharynx (4.4%), and oral cavity (16.7%). All metabolic parameters of the primary tumor were significantly different between patients with positive and negative LNM (all P < 0.001). MTV (P = 0.022) and TLG (P = 0.007) were significantly higher in patients with contralateral LNM. MTV value of the primary tumor was found as the single significant predictor of regional LNM in patients with HNSCC (OR = 23.17, P < 0.001 vs. OR = 31.1, P < 0.001, respectively) in univariate and multivariate logistic regression analyses. The sensitivity, specificity, and accuracy of MTV were 89%, 80%, and 86%, respectively. Conclusion: MTV of the primary tumor can predict regional LNM and guide the selection of the treatment modalities and clinical decisions in patients with HNSCC at initial staging.
  208 42 -
Assessment of combined modality therapy for non-small-cell lung carcinoma: A simulation study concerning concurrent chemo-brachytherapy
Hadi Rezaei, Hesameddin Mostaghimi, Ali Reza Mehdizadeh
July-September 2022, 18(4):946-952
DOI:10.4103/jcrt.JCRT_689_20  PMID:36149145
Although surgery is the treatment of choice for early-stage non-small-cell lung carcinoma, almost two-thirds of patients do not have acceptable pulmonary function for extensive surgeries. The alternative approach for this large group of patients is sublobar resection along with low-dose-rate (LDR) brachytherapy (BT). However, patients with resected lungs have a high risk of recurrence and are often treated with platinum-based (Pt-based) chemotherapy (CT). In this study, we aimed to evaluate the absorbed doses of lung and other thoracic organs, considering concurrent chemo-BT with LDR sources in two modalities: conventional vs. unconventional Pt-based CT. We used the MCNPX code for simulations and to obtain the lung absorbed dose, dose enhancement factor (DEF), and Pt threshold concentration for the abovementioned modalities. Our results indicate that DEF correlates directly with Pt concentration at prescription point and is inversely correlated with depth. Dose enhancement for conventional CT concurrent with BT is <2%, while it is >2% in case of unconventional Pt-based CT wherein the Pt concentration exceeds 0.2 mg/g lung tissue. Also, the absorbed dose of healthy thoracic organs decreased by 2–11% in the latter approach. In conclusion, the concurrent chemo-BT in the lung environment could enhance the therapeutic doses merely by using unconventional CT methods, while lung Pt accumulation exceeds 0.2 mg/g.
  216 30 -
CASE REPORTS
A rare localization of a common disease: Primary uterine Non-Hodgkin lymphoma mimicking leiomyosarcoma
Sibel Goksel, Elanur Karaman, Pinar Karacin, Şafak Ersöz
July-September 2022, 18(4):1205-1207
DOI:10.4103/jcrt.jcrt_435_22  PMID:36149191
Genitourinary system lymphomas comprise a small part of extra-nodal lymphomas (ENLs). ENLs of uterine origin are extremely rare and are often confused with gynecological malignancies. We present an 80-year-old female patient diagnosed with diffuse large B-cell lymphoma (DLBCL) with a single focus of the uterus. The patient's only complaint was abnormal uterine bleeding. Magnetic resonance imaging revealed an intramural-subserous-submucous multiple mass lesion with minimal contrast enhancement mimicking leiomyosarcoma. Diffuse pathological 18F-fluorodeoxyglucose uptake was detected in the entire uterus corpus and cervix on positron emission tomography/computed tomography (PET/CT) scanning. The pathology of the endocervical and endometrial curettage material obtained was DLBCL; the patient was diagnosed with ENL, and a single focus was the uterus. ENLs should be considered in the differential diagnosis of gynecological malignancies in patients with abnormal uterine bleeding. PET/CT is crucial in showing metabolically active spread areas in these patients.
  208 36 -
ORIGINAL ARTICLES
Tumor regression during radiotherapy as a predictor of response in locally advanced nonsmall cell carcinoma
Arun Thimmarayappa, Nidhun V Ashok, Rambha Pandey, Anant Mohan, Seema Sharma, Shivam Pandey
July-September 2022, 18(4):964-970
DOI:10.4103/jcrt.jcrt_265_21  PMID:36149147
Aims: To compare the predicted response with observed response to treatment by measuring gross tumor volume-primary (GTVp) using onboard kilovoltage (kV) cone-beam computed tomography (CBCT), to analyze the serial tumor volumes during radiotherapy (RT) with serial tumor volumes during follow-up, and to identify the variables associated with survival outcomes. Materials and Methods: Between June 2017 and December 2019, 23 patients of histologically proven locally advanced nonsmall cell lung cancer (LA-NSCLC) received definitive chemoradiation. Serial kV-CBCT images X-ray volume imaging (XVI) were generated weekly for image guidance and were used to generate serial GTVp. Posttreatment follow-up images were used to generate follow-up GTVp. Relative volume regression (VR) during RT and relative response assessment (RA) during follow-up were defined from Avg Vol, of planning CT. The predicted progression model was generated from VR and analyzed against observed progression events. Regression–response model was generated to analyze VR against RA. Results: The median XVI vol1, XVI vol2, and XVI vol3 were 78.123, 56.571, and 48.513 cc during the 2nd, 4th, and 6th weeks of RT, respectively. The median VR0 was 11.777% in the 2nd-week, VR1 was 20.959% in the 4th week, and 33.661% in the 6th week. The predicted responders and progression using the VR were similar to the observed response during the follow-up. The prediction of both RA0 and RA1 obtained from VR2 was statistically significant. Predication of RA0 from VR1 tended towards significant (P=0.084). VR2 was statistically significant in predicting RA2 (P = 0.04). The median progression-free survival (PFS) was not reached and the median overall survival (OS) was 24.2 months (95% confidence interval, 20.3–28.2 months). There was no statistically significant difference in PFS and OS between Avg Vol ≤ 99.5 cc and > 99.5 cc or other clinical parameters. Conclusions: Tumor regression during RT is a potential predictor of response in LA-NSCLC. kV-CBCT is a strong tool in assessing tumor regression during RT.
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Necrosis onstaging 18F FDG PET/CT is associated with worse progression-free survival in patients with stage IIIB non-small cell lung cancer
Gulnihan Eren, Osman Kupik
July-September 2022, 18(4):971-976
DOI:10.4103/jcrt.jcrt_1215_21  PMID:36149148
Objective: The presence of pathological necrosis in the tumor is known to be a factor indicating worse survival. Our study defined necrosis in staging 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with stage IIIB non-small-cell lung cancer (NSCLC) to investigate whether this is a poor prognostic marker. Methodology: A total of 77 patients with NSCLC were evaluated. To evaluate necrosis on 18F FDG PET/CT, we drew a region of interest (ROI) in the area showing visually very low/or no FDG uptake on PET and PET/CT fusion images. If SUVmax was less than blood pool SUVmax and showed significantly less attenuation [10 to 30 Hounsfield units (HUs)] than surrounding tissue on low-dose correlative CT with non-intravenous contrast, we defined it as necrotic (PETNECROSIS). We evaluated the relationship of SUVmax, tumor size, and PETNECROSIS with progression-free survival (PFS) using a Cox proportional hazard regression model. Results: A PFS analysis was performed on 16 patients treated with standard chemoradiotherapy (CRT) regimen. Tumor size ≤42 mm versus >42 mm (P = 0.044, HR: 6.103, 95 CI%: 1.053–35.358) and PETNECROSİS presence/absence (P = 0.027, HR: 6.719, 95 CI%: 1.245–36.264) were independent predictors for PFS. Patients with tumor size ≤42 mm and PETNECROSİS absence were associated with higher 1-year PFS rate than patients with tumor size >42 mm and PETNECROSİS presence (86% vs. 63.5% P = 0.005 and 87.5% vs. 29%, P = 0.001, respectively). Conclusion: PETNECROSİS is helpful to distinguish the patients who would suffer worse survival in stage IIIB NSCLC.
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