Lakshmaiah Chinnagiriyappa Kuntegowdanahalli

Epidemiology and outcomes of nasopharyngeal carcinoma: Experience from a regional cancer center in Southern India

Context: Nasopharyngeal carcinoma (NPC) is a rare head and neck cancer with significant geographical variation. There are limited data on epidemiology and outcomes of NPC reported from Southern India. Settings and Design: Retrospective analysis. Materials and Methods: We analyzed our hospital data between January 2005 and December 2011 with NPC and analyzed their demographic parameters and outcomes with therapy. Results: A total 143 cases of NPC were identified. Median age at presentation was 35 years with male predominance. Majority (84%) of the cases had the WHO Type 3 histology. Nodal metastasis at presentation was seen in 90% of the cases, majority being bilateral. Distant metastasis was seen in 16% of the cases, most commonly at bone, lung, and liver. Concurrent chemoradiation with weekly cisplatin was offered to 84.7% of localized disease while 80% of these also received adjuvant chemotherapy. Complete remission and partial remission were achieved in 66.1% and 15.2% of the cases, respectively. Weekly cisplatin was well tolerated with Grade 3–4 toxicity seen in 22% of cases. At a median follow-up of 20 months, 2-year progression-free survival and overall survival were 67.2% and 79.5%, respectively. Statistical Analysis Used: SPSS software version 20. Conclusion: NPC is a rare head and neck malignancy in Southern India, presenting with advanced stage and more propensity to distant metastasis. It has good outcomes to concurrent chemoradiation with weekly schedule of cisplatin being well-tolerated regime. Further prospective studies to test this schedule and other novel agents in this potentially curable malignancy are warranted.

Prognostic significance of bone only metastasis compared to visceral metastasis in patients with carcinoma cervix treated with platinum-based chemotherapy

Context: Carcinoma cervix is a leading cause of cancer in Indian females where 15%–60% of the cases eventually metastasize. Bone only metastasis is rare, and data on its response and survival with systemic therapy as compared to other visceral metastasis are limited. Settings and Design: The study design was a retrospective analysis. Materials and Methods: We retrospectively analyzed our data between May 2013 and April 2015 to identify the cases of bone only metastasis and visceral metastasis and tried to analyze their outcomes with paclitaxel- and carboplatin-based chemotherapy and bisphosphonates (for bone metastasis only). Results: Totally, 12 cases with bone only metastasis (Group 1) and 43 cases with visceral metastasis (Group 2) were identified. Most common sites of bone metastasis were vertebrae (66.67%) and pelvis (25%) while that of visceral metastasis was liver (44.18%) and lung (34.88%). Only 33.33% and 34.88% of cases in Group 1 and Group 2, respectively, could complete all six cycles of chemotherapy. Overall, response rates were 41.67% and 30.32% in Group 1 and Group 2, respectively. Median progression-free survival and overall survival (OS) were 10 months and 14 months, respectively, in Group 1 as compared to 4 months and 9 months, respectively, in Group 2. The difference in survival was statistically significant. Statistical Analysis Used: It was carried out by SPSS software version 20. Conclusion: Bone only metastasis is a rare and distinct entity with favorable outcomes as compared to visceral metastasis. However, disease remains aggressive and poor OS emphasizing the need of further research.

Can the Use of Bone Marrow Parameters Improve the Efficacy of Risk Prediction Scores in Chronic Myeloid Leukemia in Imatinib Era

Micro‐Abstract The development of various risk scores for chronic myeloid leukemia prognostication and, thus, intensification of treatment has been an area of research. Our data have confirmed that using bone marrow parameters instead of conventional peripheral blood parameters improved the efficacy of the Sokal and European Treatment and Outcome Study risk scores. Introduction: Many attempts have been made to develop risk prediction scores for chronic myeloid leukemia in chronic phase (CML‐CP) to identify the subgroup with a poorer response to therapy to enable early intensification of treatment. Because the bone marrow (BM) provides a more sensitive reflection of the disease process, we hypothesized that using BM parameters in the Sokal and European Treatment and Outcome Study (EUTOS) risk scores could improve their efficacy in an imatinib‐treated population. Materials and Methods: We analyzed cases of CML‐CP for their response and survival outcomes with imatinib using risk groupings determined by the Sokal and EUTOS scores using peripheral blood (PB) or BM parameters (Sokal‐PB, Sokal‐BM, EUTOS‐PB, and EUTOS‐BM). Results: A total of 371 cases were analyzed. The concordance for risk groups was greater for the EUTOS scores (81.9%) than for the Sokal scores (68.1%) using PB versus BM parameters. For all 4 risk scores, the predictive efficacy was statistically significant. EUTOS‐PB and EUTOS‐BM could better prognosticate for progression‐free survival (PFS) and overall survival (OS) between the low‐ and high‐risk groups (P < .0001). However, with the Sokal risk score, the use of BM parameters improved the prognostic capacity for PFS between the low‐ and intermediate‐risk groups, with a statistically significant difference (P = .025), but not for OS (P = .88). Conclusion: The use of BM parameters, a simple method that is feasible in routine clinical practice could improve the prognostic efficacy of the Sokal score for PFS but not for OS in low‐ and intermediate‐risk groups. Further research to improve the sensitivity of risk scores for CML‐CP prognosis and attempts at risk‐directed therapy is warranted.

Prognostic and predictive implications of Sokal, Euro and EUTOS scores in chronic myeloid leukaemia in the imatinib era-experience from a tertiary oncology centre in Southern India.

Chronic myeloid leukaemia (CML) is a myeloproliferative disorder. Over the years many prognostic models have been developed to better risk stratify this disease at baseline. Sokal, Euro, and EUTOS scores were developed in varied populations initially receiving various therapies. Here we try to identify their predictive and prognostic implication in a larger population of Indian patients with CML-CP (chronic phase) in the imatinib era.

An unusual presentation of cardiac metastasis in breast cancer

Metastatic disease to the heart is a rare phenomenon. In this case report, we describe an unusual case of metastasis of breast cancer to the left side of the heart in an elderly lady, with its intracardiac location detected by means of transthoracic echocardiography. This is one of the few described case reports of breast cancer metastasizing to the left ventricle of the heart.

Clinical profile, treatment, and outcomes of patients with mantle cell lymphoma treated in a tertiary care center in South India

Introduction: Mantle cell lymphoma has an aggressive course, with unfavorable outcomes. Subjects and Methods: A retrospective analysis was undertaken and 77 cases were identified between 2009 and 2014. Results: Median age was 55 years with a male to female ratio of 6:1. Patients with pure nodal disease at presentation were fewer than with extranodal disease (53.2%). Most common extranodal site was bone marrow. A number of patients with low-, low-intermediate, high-intermediate, and high-risk International Prognostic Index (IPI) scores were 6, 24, 22, and 25. Treatment consisted of cyclophosphamide,hydroxydaunorubicin, oncovin, prednisolone (CHOP) or R-CHOP regimens. Median survival was 21 months. Median overall survival with early and advanced disease was 31 and 18 months (P = 0.02). Patients who received R-CHOP survived better than those given CHOP, 30 and 16 months (P = 0.0002). There was no difference in survival with respect to age, gender, extranodal, or bone marrow involvement. Conclusions: Most patients presented with extranodal disease, advanced stage, and high IPI. Although rituximab has improved survival, intensive chemotherapy would be required to improve survival.

Gemcitabine-induced supraventricular tachycardia: A rare manifestation

Gemcitabine is a cytotoxic drug with superior toxicity profile and widely used in the management of various solid malignancies. The common side effects associated with gemcitabine are myelosuppression, diarrhea, and flu-like symptoms. Cardiac side effects due to gemcitabine are very rare. We present a case of an elderly female aged 69 years, diagnosed to have metastatic carcinoma gallbladder, and without any cardiac risk factors, who developed supraventricular tachycardia 3 days after gemcitabine infusion. We emphasize the need for careful and routine cardiac monitoring in an elderly patient who develops symptoms of tachyarrhythmia when on gemcitabine therapy.

Breast cancer as second malignant neoplasm after acute myeloid leukemia: A rare occurrence

Cancer survivors after successful treatment of hematological and lymphoid malignancies are at an increased risk for second malignant neoplasms. As the overall survival has increased in these cancers, solid tumors are emerging as a serious long-term complication. In this article, we describe such a rare occurrence, in literature, of breast cancer after the treatment of acute myeloid leukemia.

Hairy cell leukemia - clinical profile and treatment outcome from a Tertiary Regional Cancer Institute in South India

Background: Hairy cell leukemia (HCL) is an indolent neoplasm of small mature B lymphoid cells. It is characterized by pancytopenia, splenomegaly, bone marrow fibrosis, and presence of atypical lymphoid cells with hairy projections in peripheral blood, bone marrow and spleen. HCL is potentially curable and treatment with purine analog cladribine induces complete remission (CR). Materials and Methods: This is a retrospective analysis of 10 HCL cases diagnosed in the Department of Medical Oncology at a Tertiary Regional Cancer Institute, South India, over 7 years. The clinical features, laboratory parameters, bone marrow findings, cytochemistry, immunophenotyping, and outcome with treatment were studied. Results: Among 8 cases of HCL who were treated with cladribine, 7 achieved remission and 1 succumbed to infection during course of treatment. Median overall survival in these 7 cases was 61 months. Conclusion: HCL is a chronic lymphoproliferative neoplasm with potentially curative treatment. Cladribine is treatment of choice and majority of patients achieve long-lasting CR. Upon relapse, these patients can be successfully salvaged with cladribine retreatment.