Indian Journal of Cancer Education and Research

Introduction: Cancer is a leading cause of morbidity and mortality worldwide. The head and neck cancers form the seventh most common cancer and a major health problem worldwide. Aims: To compare and contrast the role of Granulocyte Colony Stimulating Factor (GCSF) given during weekends in reducing the incidence of oral mucositis in Head and Neck cancer patients receiving concurrent chemoradiotherapy with weekly cisplatin. Materials and methods: This was a prospective two arm comparative study done in the Department of Radiotherapy, Total 70 patients of locally advanced head and neck squamous cell cancers who underwent treatment from the Department of Radiation Oncology from January 2015 to September 2016 were enrolled in the study. Results: Onset of mucositis in control group patients at 8th fraction & 10th fraction were 20% and 51% respectively. Majority of patients (51%) in control group developed mucositis in 10th fraction whereas majority of patients (63%) in study group developed mucositis in 13th fraction. This difference in the onset of mucositis was statistically significant with chi-square p-value of 0.000. This clearly indicates GCSF postpones the onset of radiation induced mucositis. Conclusion: Usefulness of G-CSF in reducing the onset as well as severity of chemoradiation induced mucositis in patients receiving radiation to head and neck cancers.

Keywords: Granulocyte Colony Stimulating Factor; Oral Mucositis; Concurrent chemoradiotherapy.

Anal melanoma is an uncommon and very aggressive cancer. Different surgical techniques have been used to manage this disease with no clear favour of one approach over the another. We saw one patient with a mass in anal region whose upper limit could not be reached on per rectal examination. Investigations and histopathology suggested it to be a locally advanced lesion with metastasis in liver. Extensive surgery was performed and then patient was adviced chemotherapy but he did not took the treatment and was lost to follow up. We present this case because of rarity of the lesion and established form of treatment except role of surgery in early cases.

Keywords: Malignant Melanoma; Anal canal; Treatment

Carcinoma esophagus is a disease of late age with very few cases reported in world literature of its occurrence in young age. The exact cause of this disease in teenagers is not known, but the treatment remains the same. We cam across one such case of a 12-year-old girl with squamous cell carcinoma Grade I of esophagus. The case is reported due to its rarity.

Keywords: Young age; Carcinoma esophagus; Squamous cell carcinoma.

Aim: Breast cancer is the most common cancer among women worldwide and also in India. Patients with same diagnosis have different clinical outcomes and prognosis. This study aimed to evaluate molecular classification in Indian population along with various parameters like tumor grade, tumor histology, age, site, menopausal status and metastasis at the time of presentation. Methods: In this retrospective, single institutional study, we included 429 patients, who underwent immunohistochemistry (IHC) markers for ER, PR, HER2 and further subclassified as per molecular classification into subtypes and their relation with other parameters was studied. Results: This study revealed 39.62% Luminal A, 16.31% Luminal B, 27.03% Basal and 17.01% Her 2 Enriched subtypes with less hormone positivity in Indian population. Conclusion: Our results of molecular classification are consistent with other Indian studies but quite different from western studies. Triple negative breast cancer is slightly more in Indian population going towards poor prognosis and increased probability of metastasis.

Keywords: Breast; Epidemiology; Receptor; IHC; Central India.

Background: Acute myeloid leukemia is a heterogenous clonal disorder of hematopoietic progenitor cells with different molecular genetic abnormalities, clinical characteristics and variable outcomes with currently available treatment. Aim of the study is to analyse the clinical profile & outcomes of AML, an institutional experience where BMT facility is not available. Aims: Clinical profile and outcomes of Acute myeloid leukemia is evaluated. Material and Methods: Retrospective chart review of 51 patients diagnosed of AML with clinical and therapeutic data analysed. Results: 51 patients were analysed (males 30, females 21) with a male predominance. 90% (46/51) of patients were in the age group of <60 yrs & nearly 40% (20/51) were 15–30 yrs which is significant. M2 was the most common FAB subtype with 23/51 (45%) cases and most common presentation is fever. The observed average baseline parameters were: Hb of 6–8 gr% with 30% showed <6 gr%,TLC >15,000 in 90% of cases which confer poor outcomes (60% cases – >50,000 and 30% – >1 lakh). The average platelet count was 20,000–40,000 (25% cases – <20,000). Most patients had a baseline blasts% of >70. The average number of transfusions required during induction were in the range of (PRBCs-4–6, RDPs-20–30, SDPs-2–4 & overall 25–35). Among 51 patients, approxly 75% (38/51) were treated with intensive chemotherapy and 13 were on BSC. Remission rate was found to be 42% (16/38) in patients who received induction chemotherapy while >95% of them relapsed. As most of the patients were not on follow up or died, no follow up data was found to calculate the survivals. Conclusions: AML is an aggressive malignancy with poor outcomes and high relapse rates, especially without BMT. Supportive care constitutes a major component of management. As most of the patients were presenting very late and in poor PS (bad parameters at baseline) early aggressive treatment with strong supportive care improve the cure rates and survival.

Keywords: AML (Acute myeloid leukemia); Clinical profile; BMT (Bone marrow transplant).

Introduction: Adjuvant chemotherapy is considered the standard of care for patients with colorectal cancer after curative resection. Studies on adjuvant and metastatic colorectal cancer showed FOLFOX4 and CAPEOX are equal in efficacy (Progression free survival (PFS), OS) but differ in terms of Toxicity and Compliance. Aims: The present study is aimed to compare the toxicity and compliance between FOLFOX4 and CAPEOX in adjuvant and metastatic colorectal cancer. Materials and Methods: Prospective randomized comparative study of patients with adjuvant and metastatic colorectal cancer who are histopathologically confirmed colorectal malignancy with high risk Stage II, Stage III, Stage IV Colorectal cancer. Results: The baseline characteristics between the two groups were comparable in almost all aspects. Incidence of grade 3 (41.4% v 7%) and grade 4 (20.7% v 0%) neutropenia were higher with FOLFOX4 arm as compared to the CAPOX arm which showed a statistical significance (p=0.000). As compared to the FOLFOX4 arm, CAPOX arm showed a higher incidence of grade 2 (51.2% v 0%) and grade 3 (27.9% v 0%) hand foot syndrome (HFS) which is statistically significant (p=0.000). Dose limiting toxicities (DLTs) were seen with 95.3% patients in the CAPOX arm and 96.6% patients in the FOLFOX4 arm. Patients in the CAPOX arm showed a higher compliance rates (CAPOX 60.5%, FOLFOX4 31%) than patients in the FOLFOX4 arm with a statistical significance (p=0.014). Conclusion: The overall grade 3 and 4 toxicity is significant with FOLFOX4 arm as compared to CAPOX arm. CAPOX arm isassociated with a higher incidence of grade 2 & 3 hand foot syndrome (HFS), Patients who received CAPOX showed a better compliance to treatment as compared to patients who received FOLFOX4.

Keywords: Infusional 5-Floro Uracil (FOLFOX4); Capecitabine (CAPOX); Colorectal cancer (CRC).

Introduction: Cervical cancer is the fourth most common cancer in women, and the seventh overall, Use of IMRT in pelvic malignancies has shown reduced radiation exposure to adjacent bowel and bladder. IMRT is superior to conventional techniques in normal tissue sparing for the treatment of cervical cancer. Aims: To assess and compare the acute toxicities of Conventional RT with concurrent chemotherapy & IMRT with concurrent chemotherapy. Material and Methods: This Prospective randomised study was conducted in the Department of Radiation Oncology for a period of 2 years in 120 patients, who satisfied the eligibility criteria with 60 patients in each group, A and B. 1 patient in Group A and 3 patients in Group B defaulted during External Beam Radiotherapy. 116 patients were evaluated at the end of study, 59 in IMRT arm (Group A) and 57 in Conventional RT arm (Group B). Results: All the patients in the study were of squamous histology with moderately differentiated being the most common grade in the groups, 61.7% in Group A and 48.3% in Group B. 98.3% patients in Group A and 95% patients in Group B completed the planned treatment. Out of those who completed treatment, 72.9% patients in Group A and 73.7% patients in Group B completed it in ≤ 56 days. The cause of treatment delay was acute toxicity in 31.3% of patients in Group A and 20% of patients in Group B. The most common acute toxicity seen was upper gastrointestinal toxicity seen in the form of nausea and vomiting. Complete response at first follow up was seen in 81% patients in Group A and 75.4% patients in Group B. After completion of study, locoregional control was seen in 89.8% patients in Group A and 87.6% patients in Group B. Locoregional failure was seen in 6.8% patients in Group A and 5.3%patients in Group B. Distant metastasis was seen in 3.4% patients in Group A and 5.3% patients in Group B. Conclusions: Toxicity between the two modalities was comparable with advantage of IMRT in reducing the acute lower gastrointestinal toxicity. The loco-regional control was comparative in both groups.

Keywords: Cervical cancer: Intensity Modulated Radiotherapy; External Beam Radiotherapy.

Objective: To evaluate the diagnostic success and rates of complications of computed tomography (CT)-guided percutaneous biopsy of bone lesions suspected for malignancy. Materials and methods: The one-year prospective study considered 20 cases undergoing CT-guided percutaneous biopsies of bone lesions. All the specimens were obtained with either 11 gauge or 18-gauge needles for bone biopsy and soft tissue biopsy, respectively. The data related to demographics, lesions and histopathological results were collected and analyzed. The biopsy findings were corroborated with the final diagnosis of the clinicians to verify the accuracy of the procedure. The percentage of diagnostic positive yield with CT-guided percutaneous biopsy was analyzed for all the selected cases. Results: The mean age of the study participants was 45.0 ± 28 years and 55% of them were men. Based on the biopsy findings, 12 subjects were diagnosed with primary tumors (60%) and 3 with metastasis (15%). The result was inconclusive for 5 (25%) subjects. Long bones (35%) were found to be the most common site for bone metastasis followed by spine (30%) and hip (25%). Complications were not encountered in any of the cases. Corroboration of the biopsy findings demonstrated that CT-guided percutaneous biopsy was 95% accurate in diagnosing the bone lesions. Conclusion: CT-guided percutaneous biopsy is a safe and effective procedure for the diagnosis of suspicious bone lesions.

Keywords: CT; Percutaneous; Biopsy; bone lesions; Malignancy; Cancer

Introduction: Breast cancer poses a major health concern due to its burden on women worldwide being the most common cancer. Postmastectomy radiation therapy (PMRT) forms an integral component in both breast conservation and patients to reduce the loco-regional recurrence and mortality rate. Aim: This study was done to analyze the dosimetric parameters to skin over tangential field with and without thermoplastic sheet and with additional bolus in postmastectomy breast cancer patients. Material and methods: This study conducted from January 2017 to June 2018 in 20 postmastectomy recruited patients treated by radiotherapy using field-in-field (FIF) by three dimensional conformal radiotherapy (3D-CRT) technique along with planning by tangential fields and application of thermoplastic sheet was used togenerate plans for the patients in all the three arms with same location chosen for all the depth dose profiles and compared for the dosimetric parameters. Results: The PTV coverage was significantly higher in plans with thermoplastic sheet with additional bolus followed by higher in plans for thermoplastic sheet (p-value <0.001) than in without thermoplastic sheet. The hot spot in the plans with thermoplastic sheet was significantly lesser (p-value <0.001) as compared to that in the other two plans. The depth differences for both 90% and 95% doses in the two plans of with and without thermoplastic sheet was statistically highly significant (p-value <0.001). The mean dose at 0.1 cm from the skin surface in the arm with thermoplastic sheet was significantly higher (p-value < 0.001) than without the thermoplastic sheet. In all the plans with thermoplastic sheet with additional bolus whole skin in the treatment area was well covered with 100% dose. Conclusion: Thermoplastic sheet itself acts as a bolus to the chest wall surface for treatment planning ensuring homogenous dose distribution by achieving the required dose on surface along with adequate coverage of dermal lymphatics and postmastectomy scar thus reflecting an effective treatment response with minimal morbidityin patients of carcinoma of breast.Treating the patient without bolus on chest wall reduces the surface dose which is much smaller than that with bolus leading to a limited dose rate, thus a small thickness of the bolus material will lead to a significant increase in the surface dose. 

Keywords: Breast cancer; Postmastectomy radiotherapy (PMRT); Thermoplastic sheet; Skin dose; Bolus material; Surface dose.

Chemotherapy induced thrombocytopaenia is difficult to manage due to limited number of therapies available. A clinical experiment using Carica papaya leaf extract helped to overcome the low platelet count in 3 to 4 days. New agents for correcting thrombocytopaenia take 3 weeks to correct the platelet count. The Carica papaya leaf extract contains large amounts of ascorbic acid (Vitamin C) and Calcium which are essential not only for proplatelet production but also for normal platelet function.

Keywords: Thrombopoiesis; Chemotherapy; Thrombocytopaenia; Carica Papaya Leaf.