Goura Kishor Rath

Does chemotherapy improve survival in gall bladder cancer

4202 Background: Carcinoma of gall bladder is 4th commonest cancer in females in Northern India. Incidence is 5.5/1,00,000 women. Surgery is only modality for cure. Majority of patients present in advanced inoperable stage where median survival is between 3-6 months and treatment options are analgesics, biliary stents, or palliative chemotherapy. Oxaliplatin, has demonstrated some activity in advanced adenocarcinoma of gall bladder (Proc Am Soc Clin Oncol 2002:21; 142b). To assess the impact of chemotherapy (5 FU, FA with or without Oxalipaltin) on survival this study was undertaken. MATERIAL AND METHODS 109 gall bladder cancer patients were seen from November 2000 to September 2003. Median age was 50 years, 72 were females (males to females ratio 1:2). Pain was the commonest presenting symptom seen in 96 ( 88%) patients, 55 ( 51%) patients had gall bladder stones, and 80 ( 72%) patients had metastaic disease. TREATMENT 50 patients received only analgesics, simple cholecystectomy was done in 16, radical cholecystectomy in 15, and 13 patients received adjuvant radiotherapy without or with (9 patients) FUFA. Oxaliplatin based palliative chemotherapy (FOLFOX or Oxaliplatin FUFA as reported earlier ASCO 2002:21; 142b or Oxaliplatin and Capecitabine) were used in 21 patients, and 5 patients received FUFA. RESULTS Median survival for whole group was 5 months ( range 0-34 months). Any form of anti cancer treatment improved survival. Median survival for patients who received no treatment versus palliative chemotherapy versus surgery followed by adjuvant treatment was 3, 5, and 10 months respectively ( p=0.0000). Median survival for patients who received any form of chemotherapy versus no chemotherapy was 10 versus 4 months ( p=0.03). Overall responses in Oxaliplatin based group were 24% including 1 CR ( another 20% had disease stabilization). Median survival was 10 months in patients who received FOLFOX. CONCLUSIONS This study reveals that patients receiving chemotherapy adjuvant or palliative had superior survival compared to others. Oxaliplatin based chemotherapy FOLFOX in particular may be superior to others as palliative chemotherapy. However, this must be tested in randomized controlled trial. No significant financial relationships to disclose.

Atypical teratoid rhabdoid tumor of the brain: case series and review of literature

IntroductionIntracranial atypical teratoid rhabdoid tumor is an uncommon malignancy with a dismal outcome. Commonly misdiagnosed over the decades as primitive neuroectodermal tumor of the brain, it has dramatically different biological behavior.DiscussionWe herein report a case series of five patients diagnosed and treated as atypical teratoid rhabdoid tumor of the brain in a major cancer center in north India. We have also analyzed the clinical, histopathological, and radiological features and the therapeutic options of this enigmatic tumor.

Spinal intradural primary germ cell tumour—review of literature and case report

BackgroundPrimary spinal cord germ cell tumour is a rare tumour. We herein review the tumour characteristics, associated risk factors, treatment policy, and patterns of failure of primary intradural germ cell tumour.MethodWe conducted a PUBMED search using a combination of keywords such as “spinal germ cell tumor,” “germinoma,” “extradural,” “intradural,” “intramedullary,” “extramedullary,” and identified 19 cases of primary spinal germ cell tumour. Clinical features, pathologic characteristics, and treatment details of these patients including status at follow-up were noted from respective case reports. We also describe a case of a young Indian patient of intradural extramedullary germ cell tumour treated with a combination of surgery, chemotherapy, and radiotherapy.FindingsThe median age at presentation was 24 years. The most common location of the tumour was thoracic (40%). β-HCG overproduction was noted in 40% of the patients. Most patients were treated with a combination of surgery, radiation therapy, and systemic chemotherapy. Median follow-up was 16.5 months. Recurrence was observed in 10% of the patients, all in β-HCG over-producing tumours. The illustrative case was a 28-year male, presenting with pain in lower back and both lower limbs for 2 months. Magnetic resonance imaging spine showed an inhomogeneous hyperintense soft tissue mass at L2-L4 spinal level. He was treated with complete surgical excision and four cycles of chemotherapy with BEP regimen following a histological diagnosis of non-seminomatous germ cell tumour. Palliative irradiation to the lumbar spine was given on progression at 3 months. The patient eventually succumbed to his condition, due to compressive transverse myelitis possibly due to cervical cord metastasis.ConclusionLimited surgery followed by upfront radiation therapy and adjuvant chemotherapy is the optimal management of this rare group of tumour. Omission of radiation therapy from the treatment armamentarium might engender local recurrence and spinal dissemination at first failure.

Granulocytic sarcoma masquerading as Ewing's sarcoma: A diagnostic dilemma

An eleven-year-old boy presented with a swelling in his left elbow. Radiologically the features were that of an Ewings sarcoma involving the ulna. Histopathology showed small round cell tumor strongly positive for Monoclonal Imperial Cancer research fund 2 (MIC2) antigen. Similar cells in the bone marrow were involved with MIC2 positivity. The patient developed skin lesions, which on biopsy were found to be chloromas. The initial biopsies were reevaluated with special stains revealing granulocytic sarcomas in acute myeloid leukemia masquerading as Ewings due to its MIC2 positivity. The possibility of myeloid neoplasms should be considered routinely with known MIC2 positive round cell tumors.

Concurrent Chemoradiation for Cancer of the Cervix: Results of a Multi-Institutional Study From the Setting of a Developing Country (India)

Purpose The primary output of hospital-based cancer registries is data on cancer stage and treatment-based survival that can be used to evaluate patient care, but because there are many challenges in obtaining follow-up details, a separate study on patterns of care and patterns of survival for patients at selected sites was initiated under the National Cancer Registry Programme of India. This article presents the results for cervical cancer. Patients and Methods A standardized patient information form was used to record patient information, and data were entered into a central repository—the National Centre for Disease Informatics and Research. The study patients were from 12 institutions and were diagnosed between January 1, 2006, and December 31, 2008. Patterns of treatment were assessed for 7,336 patients, and patterns of survival were determined for 2,669 patients from six institutions, at least 70% of whom had data regarding follow-up as of December 31, 2012. Results Of 7,336 patients, 55.5% received optimal radiotherapy (RT). In all, 80.9% of patients had locally advanced cancers (stage IIB to IVA), 51.1% received RT alone, and 44.4% received concurrent chemoradiation (RTCT). In 1,753 patients with locally advanced cancers, significantly better survival was observed with RTCT than with RT alone (5-year cumulative survival, 70.2% v 47.3%; hazard ratio, 0.48; 95% CI, 0.41 to 0.56). Conclusion A conservative estimate indicates that, on an annual basis, 38,771 patients with cervical cancers in India alone do not get the benefit of RTCT and thus they have poorer survival. There is a need to reiterate the National Cancer Institutes alert that advised supplementing chemotherapy to radiation for locally advanced cancer of the cervix in the context of the developing world, where 84.3% of cancers of the cervix occur.

National cancer control and registration program in India.

Indian Journal of Medical and Paediatric Oncology | Oct-Dec 2014 | Vol 35 | Issue 4 Cancer has emerged as a major public health concern in India. 12.5 lakh new cases are diagnosed every year and around 28 lakh cases of cancers are prevalent at any given point of time. It also claims lives of about 6.8 lakh patients per year.[1] According to the World Health Organization (WHO), death from cancer cases in India is projected to rise to 13.1 million by the year 2030. The burden of cancer is expected to further increase due to increase in life expectancy, demographic transitions and the effects of tobacco and other risk factors. As per latest data of India from GLOBOCAN 2012,[1] top three cancers in female are breast, cervix uteri and colo-rectum and in male are oral cavity, lung and stomach. Most cancer cases in India are associated with tobacco use, infections, and other avoidable causes. Social factors, especially inequalities, are major determinants of India’s cancer burden,[2] with poorer people more likely to die from cancer before the age of 70 years than those who are more affluent. National Cancer Registry Programme (NCRP) data of Indian Council of Medical Research (ICMR)[3] suggest a wide demographic variation in incidence of cancer. While Aizwal district has an age-adjusted incidence rate (AARs) of 273.4, the rural registry of Barshi in Maharashtra has an AAR of 51.8. These data reflect the impact of environmental and cultural factors on the incidence of cancer. In urban registries like Delhi, Mumbai and Thiruvananthapuram, breast cancer is the most common cancer in women[4] and in registries such as Barshi, Aizwal and Guwahati, cervical cancer is most common in women. Cancer of the stomach and liver are among the most common malignancies in Mizoram and carcinoma of the gall bladder figures among the top five cancers in some registries such as Delhi and Dibrugarh.

Osseous Hodgkin's lymphoma—review of literature and report of an unusual case presenting as a large ulcerofungating sternal mass

Osseous involvement in Hodgkins lymphoma is uncommon. The most common location is vertebral, primarily in the thoracolumbar region, followed by pelvis, ribs, femur, sternum, clavicle and skull in decreasing incidence. We herein illustrate the salient features of the disease citing a case of a disseminated Hodgkins lymphoma presenting as a large ulcerofungating sternal mass mimicking chronic tubercular osteomyelitis. The case report highlights the importance of clinical suspicion of unusual presentation of lymphohematopoietic tumors of the bone especially in developing countries, where chronic granulomatous disease is preponderant.

Primary orbital calcified synovial sarcoma: A case report

A 32-year-old woman presented with a progressively increasing recurrent swelling of the left eye. An orbital tumor was detected and histologically classified as a synovial sarcoma, confirmed by immunohistochemistry and electron microscopy. Isolated cases of synovial sarcoma have been reported in the retroperitoneum, mediastinum, pharynx and orofacial region. However, the orbit is an extremely rare site. The authors report a case of recurrent primary orbital calcified synovial sarcoma in a young lady treated with surgery and radiotherapy.

A study on the tumor volume computation between different 3D treatment planning systems in radiotherapy.

BACKGROUND Tumor volume plays a crucial role in the survival and local control of the patients treated with radiotherapy. The dose volume histogram also depends on the accuracy of the tumor delineation. AIMS The main aim is to study the variation observed in the computation of the target volume with different treatment planning systems and treatment sites. MATERIALS AND METHODS Sixty patients of different treatment sites which include brain, retinoblastoma, head and neck, lung, gall bladder, liver, anal canal etc, were selected for this study. The tumor volume was delineated on the Eclipse treatment planning systems and CT datasets and DICOM-RT structure sets were transferred to Pinnacle, Oncentra, Plato, Precise, Ergo++, and Tomocon contouring workstations. The recomputed volume from these planning systems was compared with the reference volume obtained from Eclipse. Similarly, the accuracy in generating PTV from CTV was also assessed with different planning systems for 5 and 10 mm. STATISTICAL ANALYSIS USED SPSS 10.0 was used for analysis. RESULTS The overall comparison of the volume with different planning systems showed that Pinnacle calculated relatively larger volume followed by Plato as compared to Eclipse, whereas TOMOCON, Ergo ++, and Oncentra showed reduced volume. As far as the variation in CTV to PTV volume is concerned, pinnacle showed a relatively higher volume as compared to the Eclipse planning systems. CONCLUSION The study shows that all the treatment planning systems showed variation in computing the tumor volume and the CTV to PTV generation also varied with the planning systems.

Primary amelanotic melanoma of the breast: combating a rare cancer

BackgroundMalignant melanoma is the foremost cause of metastasis to the breast from extramammary solid neoplasm. However primary melanoma of the breast is a distinct rarity. Primary melanoma involves the skin and less commonly the glandular parenchyma of the breast.MethodWe herein describe a case of primary amelanotic melanoma of the breast parenchyma in a 32-year-old female managed with a combination of surgery, adjuvant radiotherapy and immunotherapy.ConclusionThis case report aims to increase awareness of unusual neoplasms of the breast which might require a different surgical and adjuvant therapeutic approach.