Indian Journal of Cancer Education and Research

  At diagnosis approximately 45% of renal cell carcinoma presents with localized disease, 25% with locally advanced disease and 20-30% with metastatic disease. Mostly these tumors metastasize to lung, soft tissue, bone, liver and brain. Vagina is very unusal site of metastasis from RCC. The aim of presenting this case is the rarity of this type of presentation and to give emphasis that targeted therapy provides an extended survival along with improving quality of life of patient. 

Keywords: Renal Cell Carcinoma, Vaginal Metastasis, Targeted Therapy

  Flavonoids, naturally occurring polyphenolic compounds comprises of more than 4000 members. Being edible in nature they became an integral part of human diet. Flavonoids act as potent inhibitor of various types of cancer on virtue of their ability to induce anticancer activities. Flavonoids induces anti-inflammatory, anti-angiogenic, apoptotic activities and also leads to inhibition of invasion and metastasis including cell cycle arrest. Multiple drug resistance is the major principal mechanism via which one amongst the most dreadful disease named as cancer acquires resistance. Several ATP-binding cassette (ABC) transporters causes multidrug resistance in cancer cells. Flavonoids target the ABC transporters and help the cells in restoration of drug sensitivity in multiple drug resistant cancer cells. Flavonoids are capable of mediating both hormone dependent and hormone independent action against various types of cancer including breast and prostate cancer. The present review article describes the potent role of flavonoids as an anti-cancer agent as it possess a mark impact in controlling breast and prostate cancerand an efficient agent to overcome issues of multiple drug resistance. Further in vivo studies of these bioactive compounds become essential so that flavonoids can be used as a potent therapeutic drug of wonder to treat various types of cancers. 

Keywords: Cancer; Drug Resistance; Flavonoids; Neuroprotectant 

  Introduction: The cancer of uterine cervix is one of the leading sites of primary cancers in women around the world. External beam radiotherapy along with Brachytherapy may be routinely administered to cervical cancer patients – stages I B2 to IVA in a curative fashion. Proctitis, a radiotherapy associated toxicity in pelvic irradiation is the main cause of treatment interruptions and discontinuation of treatment. Aim: To evaluate any relationship between the severity of acute gastrointestinal mucositis and the time of radiation during a day with respect to circadian rhythm in patients of cervical carcinoma on pelvic EBRT. Materials and methods: Prospective randomized 2 arm comparative study. Total of 50 patients were included in the study. Patients with squamous cell carcinoma of the uterine cervix stages IB2 to IVA were randomly allocated to 2 groups-group A and group B. Group A patients received radiation in the morning (8.00-10.00AM) and patients in group B received radiation in the evening (6.00-8.00PM) Each patient was informed about the technique and informed consent was obtained. All patients underwent CT-simulation and 3D conformal treatment planning. Results: Incidence and severity of intestinal mucositis is more in the morning arm than in the evening arm. There is no difference in the tumour response rates between the morning and evening arm. Haematological toxicity showed very high significant occurrence (p < 0.001) in the CRT arm compared to ART arm. Nausea, dermatological side effects, fever, vaginal discharge and bladder irritation showed no statistically significant difference.

Conclusion: The final conclusion of this study is there is more incidence and severity of intestinal mucositis in patients receiving RT in the morning indirectly indicating the role of circadian cycle which is most active during early hours on the cell cycle  

Keywords: Cervical Carcinoma; Radiotherapy.  

  Aim: To spare the contralateral submandibular gland in head and neck cancers using IMRT and to compare them with the contralateral unspared group of head and neck cancers also on IMRT but in whom sparing of cSMG is not possible because of various factors and to access xerostomia outcomes in these two groups. Materials and methods: It is a prospective and comparative intent to reduce toxicity levels in 30 patients presented to our hospital of locally advanced head and neck cancers and treated with IMRT and concurrent chemotherapy and their follow-up. All patients with stage I, II / IV Head and Neck cancers to be treated with bilateral head and neck IMRT. Appropriately selected patients with favourable primary tumor characteristics and no definite contralateral neck disease treated with cSMG- sparing. 

Results: Post treatment after 2 months where a score of 2 was seen in 13.3% of patients in the cSMG sparing was done against 30% of the control group. At the end of 4 and 6 months from commencement of treatment were 3.3% and 3.3% respectively in the study group and,16%  and 6.6% in the control group. The difference at 2 and 4 months was clinically significant but statistically could not be proved. This significant difference was observed due to the lower dryness felt by the patients at rest in the cSMG spared arm. Pre irradiation MR sialography with secretion stimulation could not help predict severity of radiation induced xerostomia. Whereas post irradiated MR imaging revealed submandibular gland secretion response in submandibular gland spared arm and revealed that submandibular gland secretion response is most influential to radiation induced xerostomia grading clinically whereas statistical significance could not beproved. This difference was seen when grade 2 and 3 response was seen in base liner SG vs post RT rSG in  both IMRT (36% and 30%) and conventional arms (43% and 40%respectively).

Conclusions: The useof IMRT with daily imaging and time required for careful selection of patients and properexecution of the treatment may lead to questions regarding the time and the costrequired for execution of this type of planning. 

Keywords: Cancer; Submandibular; Xerostomia; Radiotherapy.    

  Head and Neck Squamous Cell Carcinoma (HNSCC), have an unsatisfactory prognosis despite intensive local treatment. Single institution retrospective study of 60 patients, who were treated with induction chemotherapy followed by Concurrent chemo radiation for period between January 2012 to December 2012 to understand utility of Induction Chemotherapy (IC), response rates and outcome analysis of patients with locally advanced and non-metastatic HNSCC. 38 out of 60 patients (63.3%) received all 3 planned IC cycles and 15 (25%) patients completed only 2 out of 3 cycles and rest of patients defaulted during course of chemotherapy. Only 32 patients had clinical benefit (CBR 38%), 12 patients had CR (20%), 11 patients had PR (18%), and SD in 9 patients (15%) on IC therapy. 20 (33.33%) patients received subsequent radiation treatment following IC. Among 20 patients who received subsequent radiation treatment, 17 were treated with radical intent and 3 with  palliative intent. Remaining 40 (66.67%) failed to receive any further treatment. At last only 12 out of 17 patients received concurrent chemo radiotherapy following Induction chemotherapy and five disease free survival  rate was 46%. Induction chemotherapy is almost always associated with poor patient compliance to planned definitive treatment in developing country. Innovative and individualized approach for patient compliance is required. Periodic assessment of induction chemotherapy response, target therapies and early initiation of radiation therapy in non-responder should be the cornerstone of future strategy. 

Keywords: Concurrent Chemoradiation; Induction Chemotherapy; Locally Advanced Head and Neck Squamous Cell Cancer; Treatment Outcomes; Response Rate.

  Aim: The present study was carried out to analyze the  various patient related (e.g. age, sex, performance status), disease related (white blood cell count, cytogenetic and molecular mutational status)and treatment related (delay in treatment initiation and response to induction chemotherapy)variables as predictors of outcome in acute myeloid leukemia (AML) patients presenting to a tertiary care center in North India. Materials and Methods: Thedata of all newly diagnosed de-novo AML patients who presented to our center from January 2015 to December 2017 and opted for chemotherapy was correlated with treatment outcome. Results: Sixty eight patients underwent induction chemotherapy during the study period. Sixteen (23.5%), 49 (72.1%) and 3 (4.4%) were in the favorable, intermediate and adverse risk groups, respectively. Fifteen (22%), 8 (11.7%) and 11 (16.1%) patients were positive for AML-ETO, NPM1, FLT3 mutations (3 patients had FLT3 D835 mutations), respectively. Exon 17 c-kit mutations were seen in 10 (14.7%) patients. We did not observe any exon 8 c-kit mutations in our cohort of patients. Biallelic CEBPA mutations were seen in 6 patients (8.8%). Following induction chemotherapy, 26 (38.2%) patients attained complete remission (CR), 20 (29.4%) achieved incomplete CR (platelet count<100 x 109/L) and 22 (32.4%) were refractory to induction therapy. There were only 3 (4.4%)  induction deaths.High TLC was associated with FLT3 mutations (p=0.03) and presence of extra medullary disease correlated with AML-ETO (p=0.02) and c-KIT mutations (p=0.02). There was statistically significant correlation of FLT3-ITD mutation positive patients with risk of relapse (p= 0.001). The 2 yr Overall survival (OS) and Event free survival (EFS) were 39.6% and 22.8%,
respectively. In a multivariate analysis, the performance  status (PS) and post induction remission status independently predicted survival.

Conclusion: Thus our data highlights that PS and post induction remission status translates into better OS. 

Keywords: Acute Myeloid Leukemia; Induction Chemotherapy; Molecular Mutations; Prognosis, Survival.
  

  Introduction: The failure of testicular descent or cryptorchidism is the most common defect in newborn boys. Cryptorchidism is an established risk factor for infertility and testicular germ cell tumors (TGCT). About 10% of all cases of testicular germ cell tumors (TGCT) occur in men with a history of cryptorchidism. The common type of TGCT in cryptorchid testes is seminoma, believed to be derived from pluripotent prenatal germ cells. We report our series of patients with cryptorchidism presenting with TGCT in this study. Materials & Methods: We retrospectively reviewed our hospital medical records for patients presenting with testicular tumor in an undescended testis. The age, presenting symptoms, examination  ndings, blood biochemistry reports, imaging records were examined, and noted. The histopathology reports were reviewed. Treatment records, including operative notes were examined in detail and analyzed. Results: During the study period Jan 2001 to  Dec 2015 a total of  ve patients presented with testicular tumor in an undescended testis. Mean age of patients at presentation was 38.33±0.95 years (29-47 range). The most common presenting symptom was a painless mass in the groin or lower abdomen.

Conclusions: Very little is known about mechanisms of TGCT tumourigenesis. Painless enlargement of a mass in the groin, or an abdominal mass is the most common mode of presentation in these patients. Pain in the region of the mass remains the second most common symptom. Most of the patients present with a locally advanced or metastatic disease and need to be treated with multimodal treatment options.  

Keywords: Undescended testes; testicular tumors; seminoma; orchidopexy; intra-abdominal testis.