Indian Journal of Cancer Education and Research

Primary breast lymphoma is a rare entity comprising 0.4-0.5% of all breast neoplasms. Diffuse large B-cell 
lymphoma is the most common identifiable type of primary breast lymphoma with the usual presentation being that 
of a painless palpable mass similar to breast carcinoma. A confirmed diagnosis is based on initial biopsy findings or 
post-operative histopathology and immunohistochemistry (IHC) reports. The treatment options vary from surgical 
interventions to chemotherapy and/or radiotherapy. However, there is no uptodate standard treatment guidelines 
present. In view of this rarity, we herein report a case of a 25 year-old young woman who presented with primary 
breast lymphoma of DLBCL variety.

Pseudomyxoma peritoni is treatable with newer surgical modalities like cytoreductive surgery and hyperthermic 
intraperitoneal chemotherapy (HIPEC), and the anesthetic management can be challenging. In our case, the 
perioperative management was further complicated by the presence of Sjogren’s syndrome which has its own 
anesthetic implications. This may be the first reported case of anesthetic management of HIPEC in a patient having 
Sjogren’s syndrome along with its perioperative considerations include fluid management, stable hemodynamics, 
thermoregulation, electrolyte balance, intraoperative massive fluid shifts, ventilatory management, avoidance of 
renal toxicity and suppression of cytokines release plays a major role in the management in this patient.

Lung cancer is the second most common cancer, accounting for about one out of five malignancies in men 
and one out of nine in women. Unfortunately, over the past several years, while the incidence of lung cancer has 
gradually declined in men, it has been rising alarmingly in women. In 1940 only seven women in 100,000 developed 
the disease; today the rate is 42 in 100,000. And all the evidence points to smoking as the cause.
The majority (85%) of cases of lung cancer are due to long term tobacco smoking. About 10–15% of cases occur in 
people who have never smoked. These cases are often caused by a combination of genetic factors and exposure to 
radon gas, asbestos, second hand smoke, or other forms of air pollution.

Cystic lesion of bone can occur in any bone at any age/sex. and often are asymptomatic or may easily be 
confused with other bone lesions. Many of them typically resolve after skeletal maturity but some can result in 
pathologic fractures or local recurrence. In some lesions the danger of biopsy or other surgery may outweigh any 
benefit. So precise diagnosis is needed to prevent over/under treatment of lesions.
Keywords: Cyst of bone; Simple bone cyst; Aneurismal bone cyst; Intra-osseous ganglion cyst; Subchondral cyst.
Key Message: Not all bone cysts require treatment, in some lesions the danger of biopsy or other surgery may 
outweigh any benefit as they are painful/ fast growing / large /cause a fracture. Specific treatments are determined 
based on size of the cyst, strength of the bone, medical history, extent of the disease, activity level and the symptoms 
an individual is experiencing, and tolerance for specific medications, procedures, or therapies.

Squamous cell carcinoma is one of the most prevalent skin cancers, and it can appear in any burn scar. Its 
incidence ranges from 2% to 6%. A local fasciocutaneous advancement perforator flap based on the underlying 
perforator is known as a Keystone flap.1
 A transposition flap is raised from a laxity area, lifted over neighbouring 
tissue, and transplanted into a surgical wound. To mobilise and move tissue from a region of laxity to an area of 
necessity, adjacent laxity is used.2
 Delaying the conversion of the keystone flap to a transposition flap in our study 
resulted in good survival and a positive outcome.

Background: Chemotherapy induced nausea and vomiting is a debilitating effect of the chemotherapy drugs 
administered to patients with malignancy and deteriorates the quality of life of the patients. The antiemetic drugs 
that are commonly prescribed for controlling CINV are 5-HT3 RA, NK1RA, Dexamethasone, Olanzapine and 
Metoclopramide. These drugs are used either in combinations or alone for treating CINV.
Objective: The purpose of this review is to analyze the various treatment modalities for CINV and to identify the 
suitable antiemetic agents for nausea and emesis caused by various chemotherapy agents.
Methods: We systematically reviewed randomized controlled trials (RCTs) in adult patients undergoing 
chemotherapy treatment and are at risk of CINV, extracting and synthesizing data from eligible articles on study 
design, randomization, withdrawal, blinding, type of analysis, duration, and names and doses of drugs. The primary 
outcome measure was complete response (no emesis and no administration of rescue medication) in preventing 
CINV in acute and delayed phases and secondary outcome was incidence of TRAEs.
Findings: This review included seventeen RCTs among which eleven were blinded and six were open label studies. 
Four studies evaluated the effectiveness of olanzapine in preventing CINV in which one of the study compared 
efficacy of olanzapine and metoclopramide for the treatment of breakthrough emesis. One of the study compared 
the efficacy of granisetron as transdermal delivery system with ondansetron in preventing CINV and concluded that 
granisetron transdermal system was non inferior to ondansetron in controlling CINV. Three studies investigated the 
change in the prevention of CINV on single day administration of dexamethasone with multiple day administration 
of dexamethasone. All the three studies reported that single day administration of dexamethasone was similar 
in efficacy to multiple day dosing. Two studies investigated the efficacy of rolapitant in which one of the study 
concluded that addition of rolapitant to antiemetic treatment regimen consisting of granisetron and dexamethasone 
significantly improved CINV compared with treatment regimen without rolapitant. Three studies evaluated the 
efficacy of NEPA which is a combination of Netupitant (NK1 RA) and Palonosetron (5HT3 RA)among which one 
study concluded that NEPA was superior to Palonosetron and in another NEPA was compared with palonosetron 
and aprepitant and concluded that NEPA was similar to them in controlling CINV. One study evaluated the efficacy 
of fosaprepitant, a prodrug of aprepitant compared to aprepitant and concluded that single dose fosaprepitant was 
non inferior to multiple day administration of aprepitant. Two studies evaluated fosnetupitant in which one study 
compared the efficacy of fosnetupitant at the dose of 81 mg and 235 mg and concluded that dose of 235 mg was 
superior to 81 mg of fosnetupitant. The other study compared the safety profile of fosnetupitant to fosaprepitant 
How to cite this article:
John Stephen Raj, S Monisha, MG Rajanandh, et. al./ A Systematic Review of the Management of Chemotherapy-Induced Nausea 
and Vomiting/Indian J Canc Educ Res 2022;10(2):65-79.
and concluded that both were similar.
Conclusion: Antiemetic triplet treatment 
regimen for CINV consisting of 5HT3 RA, NK1 RA 
and dexamethasone was found to be effective in 
this review but the quality of some of the evidence 
of the studies included in this review contains high 
risk of bias and is not completely reliable. Hence 
we recommend that future trials be conducted 
with minimum risk of bias to ensure high quality 
of evidence.

Complex wounds pattern has initiated efforts to create new and innovative techniques in tissue regeneration. 
Multidisciplinary team has effectively adapted advanced reconstructive techniques merged with regenerative 
medicine modalities to improve outcomes incomplex reconstruction. These treatments combine traditional 
reconstruction measures with regenerative medicine applications and has been termed ‘Hybrid reconstruction 
ladder’. This review article gives an overview about hybrid reconstruction ladder in management of squamous cell 
carcinoma.