Neeti Sharma

Neurofibromatosis with chronic myeloid leukemia in an elderly male: An unusual association

Neurofibromatosis is a genetic disorder of neural crest-derived cells that predominantly affect growth and development of neural tissues. We report a case of 64-year-old patient, had several soft tissue cutaneous nodules (neurofibroma) on the body including the face, head, and neck, extremities and multiple hyperpigmented macules on trunk and back (Café-au-lait pigmentation), who was accidentally diagnosed as chronic myeloid leukemia, on routine investigation for surgical management. He did not have any systemic manifestation either of diseases.

Malignant phyllodes tumor with chondro and osteosarcomatous differentiation and secondaries in lungs

Phyllodes tumor is a rare breast tumor, with neoplastic epithelial and stromal components for 10 cm in size and firm in consistency. She underwent left mastectomy. The histopathology revealed a malignant phyllodes tumor with sarcomatous stromal overgrowth and heterogeneous chondro and osteosarcomatous differentiation. At 2 months after surgery, she reported to us with secondaries in bilateral lungs. We planned palliative chemotherapy in view of good general condition of the patient and lung metastasis. Chemotherapy included ifosfamide, adriamycin and cisplatin as per standard regimen every 3 weekly. After three cycles, her lung metastasis cleared completely. It was planned to continue same chemotherapy for six cycles.

Is There Hope For Breast Cancer Patients Without Surgery??: An Institutional Retrospective Disease Free Survival Study.

Background: Recently incidence of carcinoma breast has increased many folds and surpassed cervical malignancy. Management of breast carcinoma has multi modality treatment. One or the other modality, sometimes surgery is not acceptable for patients due to many reasons. Material and method: In retrospective disease free survival study, a group of disease free patients were found who had refused for surgery and were treated by chemoradiotherapy alone. Results: Among the 25 patients, 17 patients (68%) were treated more than 10 years back, 5 patients (20%) 6 years back and 3 patients (12%) 2 years back. All these patients were disease free for above post treatment periods till april 2017. Conclusion: Hope should not be lost for those in whom surgery is not done, this method of alone chemoradiotherapy may also yield acceptable results in terms of survival, disease free survival and cosmetic effects in some patients.

Age wise distribution of colorectal cancer: An institutional observational study

Background: Overall, the incidence of colorectal cancer appears to be stable or diminishing. However, based on our regional cancer institute’s datas, we have observed the increasing incidence of colorectal cancer in patients ≤40 age. The aim of this study was to verify the rising trend, clinico-pathological features and survival in colorectal cancer in patients ≤40,in comparison to patients >40 age. Materials and methods: A retrospective study was conducted to review all patients≤ 40 age and more than 40 year of age separatly with a diagnosis of colorectal cancer from January 2004 to December 2012. Results: Young patients were 24.17% of total 1096 colorectal cases. In young patients 60.37% were male and 39.63% were female. 9% young had family history & only 8% had history of alcohol intake. Onset of symptoms to reaching diagnosis period is longer in younger patients.(Range 3 months to 1 year in young, while 1 months to 6 months in older). Higher pathological T stage was seen in the younger age group when compared with patients above 40 years. Also the younger age group showed more advanced N stage when compared with patients above 40 years. With final TNM staging, in younger age group 66% were in stage IV and 30% were in stage III. Eighty percent of all young cancer deaths were within 22 months (from 8months to 22 months). Conclusion: Above results show the aggressive nature and late diagnosis of carcinoma colorectal in young. These data highlight a need for thorough evaluation of young with colorectal symptoms and in high risk population, also life style modification agenda by Govt .or non Govt. organization.

Superiority of Concurrent Chemo Radiation Over Sequential Chemo Radiotherapy for Palliation of Dysphagia in Carcinoma Esophagus, A Reterospective Study

Aim: Positive results of many Trials have incorporated concurrent and sequential chemo radiotherapy in treatment of inoperable carcinoma esophagus. But concurrent chemo radiation therapy is similar to that achieved by surgery alone. The main plea of concurrent chemoradiation in esophageal cancers is early regression and palliation of dysphagia for long time. The aim of this study to analyse the modalities of treatment available for palliation of dysphagia in carcinoma esophagus and determine the most effective option among them. Materials and Methods: Between September 2011 to December 2013,50 patients of esophageal cancers were treated in our institute, 25 patients in sequential and 25 in concurrent chemo radiotherapy arm. Swallowing function was assessed in these patients by the use of a swallowing-function scoring system. Results: Assessment of response in two arms were done for grade of dysphagia palliation, Complete Response at 6 months and toxicity. Dysphagia scores improved in 88% in study arm and 64% in control arm. In study arm 28% male and 52% female patients, while in control arm 40 % male and 28% female patients presented with CR in primary tumor and mediastinal lymph node. There was statistical significant difference in toxicities of TLC and ANC between both arms. Grade 2 and 3 toxicities were 40% and 4% for TLC and were 28% and 0% for ANC in study and control arm respectively (p = 0.013 ,p=.014). This may be due to concurrent use of chemotherapy with radiation in study arm that also showed synergism for toxicity of TLC and ANC. Conclusion: Concurrent Chemo Radiotherapy is a more aggressive approach for dysphagia control, which is beneficial for those patients with good performance status .This approach is used as an alternative to stenting. This combination is more effective than neoadjuvant chemoradiation for improving dysphagia scores and QoL in inoperable esophageal cancers .

Association of comorbidities with breast cancer: An observational study

Background: The aim of this study was to describe the prevalence of comorbidity in newly diagnosed female breast cancer patients in north-west India. The second end point of the study was compliance for multimodality treatment. Comorbidity assessed by counting the number of coexisting diseases diagnosed in a cancer patient or by using a comorbidity index that combines the number and severity of the diseases. The most widely used index is the Charlson Comorbidity Index (CCI). Materials and Methods: The data of female patients with breast cancer were recorded, having comorbidities during the cancer registration or comorbidities diagnosed during the treatment at the host institute between January and December 2012. The patients were distributed on the basis of physical parameters such as age, stage, tumor grade, hormone receptor status, ECOG status at diagnosis and CCI. Scores of CCI are summed to provide a total score to predict mortality. Results: During the period of January to December 2012, 156 biopsy-proven breast cancer patients were included in the study. During this period, female breast cancer patients enrolled were 13.94% out of total patient enrollment. The most prevalent comorbidities associated with breast cancer are hypertension (21.8%), chronic obstructive pulmonary disease (COPD) (19.9%), rheumatologic disease (18.6%), and diabetes mellitus (16.7%), all four conditions have been reported in around 75% of the cases. The planning of multimodality management in comorbidity arm was significantly lower (P > 0.01) as compared to patients without comorbidity. Conclusions: The planning of multimodality management in comorbidity arm was significantly lower as compared to patients without comorbidity. Because of the comorbid condition, the definitive treatment of breast cancer was not given so this will also affect the treatment of breast cancer. When the CCI score increases with an increase in the number of comorbidities will decrease survival.

Maintenance gemcitabine versus best supportive care following platinum-paclitaxel chemotherapy for patients with advanced nonsmall cell lung cancer

Background: Approximately two-thirds of all patients with newly diagnosed nonsmall cell lung cancer (NSCLC) have advanced disease (Stage IIIB or IV) that is only amenable to palliative chemotherapy. Switch maintenance therapy with a different active agent aims to hit clonal variants resistant to the first-line therapy before they have had time to increase in number. Based on this, we conducted a randomized Phase III study to compare gemcitabine (Gem) versus best supportive care (BSC) as maintenance therapy. Methods: Between July 2011 and January 2012, chemo-naive patients with Stage IIIB/IV NSCLC were initially treated with six cycles of cisplatin (40 mg/m2 day 1, 2) and paclitaxel (175 mg/m2 day 1) every 3 weeks. Subsequently, nonprogressors were randomized 1:1 to receive maintenance G (1000 mg/m2 on days 1 and 8 every 3 weeks) or BSC alone till disease progression. The primary endpoint was a comparison of overall survival (OS) between two arms, and the secondary endpoint was progression-free survival (PFS). Results: Exactly 134 patients were enrolled (median age: 50 years, males 76.8%, Stage IV disease 50.7%, Eastern Cooperative Oncology Group performance status 0/1: 67.9%). Following 6 cycles of initial therapy, the Response Rate (RR) was 35.1% (Complete Response (CR) 3%, Partial Response (PR) 32.1%), and 38.8% had stable disease. Ninety-nine nonprogressors were randomized to receive Gem (n = 50) or BSC (n = 49). The median OS for Gem was 10 months (95% confidence interval [CI]: 9.2–10.7) and 8 months (95% CI: 6.7–9.2) for BSC, with a hazard ratio (HR) 0.64 (95% CI: 0.51–0.77, P = 0.002). The median PFS was 9 months (95% CI: 8.1–9.9) for G versus 7 months (95% CI: 6.3–7.7) for BSC, with a HR 0.67 (95% CI: 0.50–0.84, P = 0.009). Maintenance therapy was tolerated well despite a higher incidence of grade 3/4 toxicity (anemia 12% vs. 8.1%; neutropenia 18% vs. 4.1%; thrombocytopenia 14% vs. 2%; and fatigue 8% vs. 2%). Conclusion: Switch maintenance therapy with gemcitabine, following initial platinum-based doublet chemotherapy in advanced NSCLC can produce significantly longer PFS and OS compared to BSC alone at the cost of higher grade 3/4 hematological toxicities.