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April-June 2019
Volume 8 | Issue 2
Page Nos. 73-136

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REVIEW ARTICLE  

First-line management of metastatic non-small cell lung cancer: An Indian perspective Highly accessed article p. 73
Nikhil Suresh Ghadyalpatil, Avinash Pandey, Iyer Krishnamani, Chilukuri Srinivas, Shabnam J Rafiq, Sachin S Hingmire, Nagarjuna Maturu, Ragotham Reddy, Kiran K Kumar, K Sreekanth, Bharath Chandra Gurram, PM Parikh
DOI:10.4103/sajc.sajc_294_18  PMID:31069181
Lung cancer has been the most common cancer in the world for several decades. The non-small cell lung cancer (NSCLC) constitutes approximately about 80% of the total cases of lung cancer. Therapeutic interventions in NSCLC have shifted to the target-based approach from histology-based approach, and this has completely changed the face of the management of NSCLC. Developing countries, such as India, have very limited data compiled about the prevalence and treatment practices of lung cancer, despite a large burden of the disease. However, in recent times, there has been a lot of data generated in this regard. This article is an attempt to collate and shine light on the available data for the first-line treatment of NSCLC in India keeping in mind the current standards of care in this area.
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LETTERS TO THE EDITOR Top

Immunotherapy-induced interstitial lung disease: Cases report Highly accessed article p. 79
Waseem Abbas, Ranga Raju Rao, Vineet Govinda Gupta, Swati Popli
DOI:10.4103/sajc.sajc_23_19  PMID:31069182
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ORIGINAL ARTICLES: BREAST CANCER Top

Reproductive factors and breast cancer risk: A meta-analysis of case–control studies in Indian women p. 80
Gayatri Vishwakarma, Harrison Ndetan, Durgesh Nandini Das, Garima Gupta, Moushumi Suryavanshi, Anurag Mehta, Karan P Singh
DOI:10.4103/sajc.sajc_317_18  PMID:31069183
Background/Objective: India is the world's most biodiverse region and is undergoing a period of dramatic social and economic change. Due to population's explosion, climate change and lax implementation of environmental policies, the incidence of breast cancer is increasing. From population-based cancer registry data, breast cancer is the most common cancer in women in urban registries where it constitutes more than 30% of all cancers in females. We conducted a meta-analysis of all breast cancer case–control studies conducted in India during 1991–2018 to find pooled estimates of odds ratio (OR). Materials and Methods: Eligible studies were identified through a comprehensive literature search of PubMed, EMBASE, and HINARI databases from 1991 to January 2018. This analysis included 24 observational studies out of 34 that reported the case–control distribution of reproductive factors, body mass index (BMI) and type of residence. The analysis was performed using RevMan 5.3 (Review Manager, 2017) applying the random-effects model. Results: A total of 21,511 patients (9889 cases and 11,622 controls) were analyzed, resulting in statistically significant association between breast cancer and the following reproductive factors: never breastfeed (OR: 3.69; 95% confidence interval [CI]: 1.70, 8.01), menopausal age >50 years (OR: 2.88; 95% CI: 1.85, 3.85), menarche age <13 years (OR: 1.83; 95% CI: 1.34, 2.51), null parity (OR: 1.58; 95% CI: 1.21, 2.06), postmenopause (OR: 1.35; 95% CI: 1.13, 1.62), and age at the 1st pregnancy >25 years (OR: 1.57; 95% CI: 1.37, 1.80). Family history (FH) of breast cancer (OR: 5.33; 95% CI: 2.89, 9.82), obesity (OR: 1.19; 95% CI: 1.00, 1.42), and urban residence (OR: 1.22; 95% CI: 1.03, 1.44) were also found to be significant risk factors. Conclusion: The results of this meta-analysis are indicative of significant associations between reproductive factors and breast cancer risk, profoundly so among women experiencing menopause after the age of 50, women who never breastfeed and FH of breast cancer.
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ORIGINAL ARTICLES: GI CANCERS Top

Modified Epirubicin, cisplatin, and 5-FU regimen as first-line chemotherapy in metastatic gastric or gastroesophageal junction adenocarcinoma: A Phase II study p. 85
K Govind Babu, Tamojit Chaudhuri, KC Lakshmaiah, Lokanatha Dasappa, Linu Abraham Jacob, MC Suresh Babu, AH Rudresha, KN Lokesh, LK Rajeev
DOI:10.4103/sajc.sajc_146_18  PMID:31069184
Background: Epirubicin, cisplatin, and 5-FU (ECF) is one of the most commonly used first-line chemotherapy regimens in metastatic gastric cancer. However, due to protracted infusion schedule, need for special infusion pumps, and catheter-related complications, the practical utility and acceptability of standard ECF regimen are limited, particularly in resource-constrained settings including India. Materials and Methods: In the present study, we have used a more convenient modification of the standard ECF protocol (using 5 days intravenous infusion of 5-FU at a dose of 750 mg/m2/day, given over 6 h through a peripheral venous line), in Indian patients with metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma. The primary endpoint was overall survival (OS). The secondary endpoints were overall response rate (ORR), progression-free survival (PFS), and toxicity profile. Results: Between January 2014 and December 2017, 107 patients were assigned and treated with this modified ECF regimen. The median age was 52 years (range, 34–62); 66.3% were males and 36.5% of the patients had ≥ 3 metastatic disease site involvement at baseline. Dose reductions due to toxicity were required in 14.9% of the patients. The ORR was 32.7%; median PFS and OS were 5.9 months (95% confidence interval [CI]: 4.7–6.9) and 10.4 months (95% CI: 8.4–11.8), respectively. Both the hematological and nonhematological toxicities were manageable, and there was no toxicity-related death. The most frequent Grade 3–4 adverse events were neutropenia (18.7%), febrile neutropenia (13.1%), mucositis (5.6%), and diarrhea (5.6%). Conclusions: In the present study, the modified ECF regimen demonstrated significant efficacy with an acceptable toxicity profile in Indian patients with metastatic gastric and GEJ adenocarcinoma. The survival outcomes of this modified schedule were comparable with those of the standard ECF regimen, as reported earlier. Clearly, this modified and more convenient ECF protocol should be explored and validated through large prospective randomized trials.
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Modified Heidelberg technique of pancreatic anastomosis postpancreaticoduodenectomy – 10 years of experience p. 88
Ramachandra Chowdappa, Ajeet Ramamani Tiwari, Namrata Ranganath, Rekha V Kumar
DOI:10.4103/sajc.sajc_241_18  PMID:31069185
Context: Pancreatic fistula has forever been a dreaded complication after pancreatic anastomosis (PA). We present a retrospective analysis of 10 years of experience with the Modified Heidelberg technique (MHT) that has been recently described. Aim: The aim of the study is to establish postoperative pancreatic fistula (POPF) rates after MHT. Settings and Design: This is a retrospective observational study carried out at a tertiary cancer center in South India in the Department of Surgical Oncology. Subjects and Methods: Two hundred and eight consecutive patients who underwent pancreaticoduodenectomy (PD) and PA with MHT for a variety of proximal pancreatic lesions from January 2008 to February 2018 were included in this study. The incidence of POPF was recorded by the International Study Group on Pancreatic Fistula 2005 and 2016 definitions. Statistical Analysis Used: Epidemiological and clinical data are expressed in ratios and percentage and presented in table format. Results: Between January 2008 and March 2016, 186 patients underwent PD, and MHT was used for PA. Five (2.7%) patients developed Grade A POPF whereas Grades B and C were seen in three (1.6%) patients each with one death. Between April 2016 and February 2018, 22 patients underwent PD. Two patients (9%) had biochemical leak whereas none of them developed clinically relevant POPF. No deaths were recorded in this period. Overall, Grade B and Grade C POPF rates were 1.4% each, whereas 30-day mortality was 0.4%. Conclusions: Results of this study indicate that MHT is a safe, reliable, easy to learn, and adopt technique of pancreatic reconstruction after PD.
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Systemic chemotherapy and short-course radiation in metastatic rectal cancers: A feasible paradigm in unresectable and potentially resectable cancers p. 92
Vikas Ostwal, Akhil Kapoor, Reena Engineer, Avanish Saklani, Ashwin deSouza, Prachi Patil, Supreeta Arya, Suman Kumar Ankathi, Supriya Chopra, Mangesh Patil, Shanu Jain, Anant Ramaswamy
DOI:10.4103/sajc.sajc_174_18  PMID:31069186
Background: The optimal use and sequencing of short-course radiotherapy (SCRT) in metastatic rectal cancers (mRCs) are not well established. Materials and Methods: We retrospectively reviewed the records of mRC patients receiving SCRT followed by palliative chemotherapy between January 1, 2013, and December 31, 2016, in Tata Memorial Hospital. Patients were classified as having “potentially resectable” disease (local and metastatic) or “unresectable” disease at baseline based on prespecified criteria. Results: A total of 105 consecutive patients were available for analysis. The median age of patients was 48 years (range: 16–62 years), and 57.1% were male patients. Signet ring histology was seen in 13.3% of patients. The most common site of metastases was liver limited (29.5%), nonloco-regional nodes (12.4%), and lung limited metastases (9.5%). Chemotherapeutic regimens administered were capecitabine-oxaliplatin (70.5%), modified 5 fluorouracil (5 FU)-leucovorin-irinotecan-oxaliplatin (10.5%), and modified 5 FU-leucovorin-irinotecan (8.6%). Targeted therapy accompanying chemotherapy was administered in 27.6% of patients. About 42.1% of patients with potentially resectable disease and 11.1% with the unresectable disease at baseline underwent curative-intent resection of the primary and address of metastatic sites. With a median follow-up 18.2 months, median overall survival (OS) was 15.7 months (95% confidence interval: 10.42–20.99). Patients classified as potentially resectable had a median OS of 32.62 months while patients initially classified as unresectable had a median OS of 13.04 months (P = 0.016). The presence of signet ring morphology predicted for inferior mOS (P = 0.021). Conclusions: SCRT followed by systemic therapy in mRC is a feasible, efficacious paradigm for maximizing palliation, and achieving objective responses. The classification of patients based on resectability was predictive of actual resection rates as well as outcomes. Signet ring mRC show inferior outcomes in this cohort of patients.
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Efficacy of preoperative chemoradiotherapy in downstaging rectal cancer and its impact on the long-term outcome p. 98
Janaki Gururajachar Manur, Rahil Bharatbhai Patel, Sathish Chandramouli
DOI:10.4103/sajc.sajc_203_17  PMID:31069187
Introduction: Response to preoperative chemoradiation (PRTCT) for rectal cancer predicts the long-term outcome. Context: Tertiary care hospital. Aims: The aim is to study the factors affecting the response to chemoradiation. Settings and Design: Retrospective. Materials and Methods: Twenty-three patients of rectal cancer undergoing PRTCT followed by surgery and adjuvant chemotherapy were followed up for 20–56 months. Postoperative response, tumor downstaging and nodal downstaging were correlated with the disease status. Results: Tumor downstaging was seen in 11 (50%) and nodal downstaging in 12 (63.15%) patients. Nodal downstaging was statistically significant with P = 0.004. Pathological complete response (PCR) was seen in one patient and partial response (PR) in 17 patients. Thirteen (72.2% of patients) were alive and disease free and the negative nodal status correlated with long-term control with P = 0.04. Conclusion: Most patients of rectal cancer show PR to PRTCT, and the benefit is more for node-positive patients. Nodal PCR is associated with a higher chance of long-term disease control.
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Saree cancer: A case report p. 101
Chitrawati Bal Gargade, Abhay Yashwant Desai
DOI:10.4103/sajc.sajc_16_16  PMID:31069188
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ORIGINAL ARTICLE: GYNAECOLOGICAL CANCER Top

Evaluation of cytology as secondary triage in visual inspection after application of 4% acetic acid-based cervical cancer screening program p. 102
Gauravi A Mishra, Sharmila A Pimple, Subhadra D Gupta
DOI:10.4103/sajc.sajc_50_18  PMID:31069189
Context (Background): Visual-based screening techniques are low cost and have good sensitivity. Hence, they appear promising for primary screening in low-resource settings. However, to reduce referrals for diagnostic colposcopy, there is need to triage these screen-positive women with test with good specificity. Aims: The study aims to evaluate the performance of cytology as triage for visual inspection after application of 4% acetic acid (VIA) screen-positive women. Settings and Design: Community-based cervical cancer screening using VIA was implemented among socioeconomically disadvantaged women in Mumbai, India. Methods: Cytology was performed on screen-positive women. All primarily screen-positive women underwent colposcopy. Directed biopsies were obtained among women with positive findings on colposcopy. The gold standard used for final disease status was histopathology or negative colposcopy. Statistical Analysis Used: Test characteristics of cytology as triage test. Results: Among the 138,383 population, 16,424 eligible women were screened with VIA. 785 (4.78%) women were VIA positive and 580 women participated in triage with cytology. The sensitivity and specificity of cytology at threshold of atypical squamous cells of undetermined significance in detecting ≥cervical intraepithelial neoplasia (CIN) 2 were 75.0 and 94.7, respectively. The positive and negative predictive values of cytology as triage test were 23.1 and 99.4, respectively, and the false positivity and false negativity rates were 5.34 and 25.0, respectively. Conclusion: Cytology triage with VIA can reduce referrals for colposcopy to 4.97% of original referrals but may miss around 25%, of high-grade CIN. The substantial reduction in referrals has special implication for low-resource settings, wherein compliance to referral and availability of diagnostic facilities are poor.
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Chronic myeloid leukemia with a rare fusion transcript, b2a3 (e13a3) BCR–ABL1: A report of four cases from India p. 107
Sudha Sazawal, Sunita Chhikara, Kanwaljeet Singh, Rekha Chaubey, Manoranjan Mahapatra, Tulika Seth, Renu Saxena
DOI:10.4103/sajc.sajc_158_18  PMID:31069190
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ORIGINAL ARTICLES: HEAD AND NECK CANCER Top

Efficacy and safety of concurrent chemoradiotherapy with or without Nimotuzumab in unresectable locally advanced squamous cell carcinoma of head and neck: Prospective comparative study - ESCORT-N study p. 108
Ashok Kumar, Nilotpal Chakravarty, Sharad Bhatnagar, GS Chowdhary
DOI:10.4103/sajc.sajc_38_18  PMID:31069191
Background: Nimotuzumab is an anti-epidermal growth factor receptor monoclonal antibody which can be added to chemoradiotherapy (CRT) to improve efficacy for management of locally advanced squamous cell carcinoma of the head and neck (LASCCHN). We prospectively evaluated the efficacy and safety of nimotuzumab with CRT for LASCCHN and compared with CRT alone. Materials and Methods: In this prospective study, 29 LASCCHN (Stage III–IVb) patients received Nimotuzumab plus CRT or CRT alone. Treatment included six cycles of cisplatin (40–50 mg/week) or carboplatin (area under the curve-based), nimotuzumab (200 mg/week), and radiotherapy (60–70 Gy). Tumor response was evaluated as per response evaluation criteria in solid tumors criteria. MoS was estimated using the Kaplan–Meier method. Toxicity and adverse events (AE's) were assessed as per CTCAE v 4.0. Results: At 24 weeks after completion of treatment, the tumor response rate (complete response, partial response, stable disease) was 53.3% and 35.7% favoring nimotuzumab arm while progression of disease was 40% and 35.7% in Nimotuzumab plus CRT and CRT groups, respectively. However, the objective response rate was 57% and 30% in favor of nimotuzumab arm. At median follow-up of 45.5 months, MoS was 33 months in Nimotuzumab plus CRT and 27 months in CRT group. The 5-year survival rate was 33.3% in Nimotuzumab plus CRT versus 7.1% in CRT group. Nimotuzumab was observed to be safe with no additional AE's such as hypersensitivity, hypomagnesemia, and allergic reaction was reported. Conclusion: Addition of Nimotuzumab to standard CRT showed improved survival rate in unresectable, LASCCHN patients without producing additional toxicity.
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Effectiveness and tolerability of nimotuzumab in unresectable, locally advanced/metastatic esophageal cancer: Indian hospital-based retrospective evidence p. 112
Sundaram Subramanian, Nithya Sridharan, V Balasundaram, Sameer Chaudhari
DOI:10.4103/sajc.sajc_89_18  PMID:31069192
Context: Epidermal growth factor receptor (EGFR) is overly expressed in esophageal squamous cell carcinoma (ESCC) and is important prognostic and predictive biomarker. Nimotuzumab is a humanized anti-EGFR monoclonal antibody and has documented promising clinical outcomes and survival rates in various solid tumors with high EGFR expression. Aims: Attempt to fill gap on paucity of data in India on the efficacy of Nimotuzumab in the treatment of locally advanced/metastatic ESCC. Settings and Design: Hospital records of 15 patients with unresectable, locally advanced/metastatic esophageal cancers, histologically confirmed squamous cell carcinoma being treated with Nimotuzumab along with standard treatments from October 2006 to November 2016 were retrospectively analyzed. Subjects and Methods: The tumor response rate and overall survival (OS) were analyzed. All patients were assessed for toxicity and adverse events (AEs) as per Common Terminology Criteria for Adverse Events (CTCAE) v4. Results: Majority had lower thoracic esophageal cancer. Tumor response rate observed was as follows 33% had a complete response, 67% had a partial response, and objective response rate was 100%. Survival rate at 1-, 3-, and 5-year was 58.33%, 29.17%, and 29.17%, respectively. Median OS was 26.8 months (95% confidence interval, 2.63–not reached). No Grade III or Grade IV AEs were observed. No added toxicity was observed due to nimotuzumab.Conclusions: Nimotuzumab combined with standard treatment in locally advanced/metastatic ESCC improved the survival rate and achieved a better tumor response rate without accumulation of toxicity and was well tolerated.
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Oral cancer incidence trends in Delhi (1990–2014): An alarming scenario p. 116
Anshuman Kumar, Gourav Popli, Sujeet Bhat, Sumedha Mohan, Avinash Sowdepalli, Kiran Kumari
DOI:10.4103/sajc.sajc_209_18  PMID:31069193
Background: Oral cancer ranks in the top three of all cancers in India, which accounts for over 30% of all cancers reported in the country, and oral cancer control is quickly becoming a global health priority. We have conducted an age period analysis of oral cancer incidence trends using the Population-Based Cancer Registry (PBCR) data in Delhi over a 24-year period (1990–2014) to address the trends of one of the leading cancer sites in Delhi. Materials and Methods: The data of oral cancer proportion and incidence for the year 1990–2014 were taken from Delhi PBCR which records cancer cases from more than 180 government and 250 private facilities. The data were segregated by sex, age, and anatomical site and were analyzed to calculate age-specific incidence rates and expressed in cases per 100,000 persons/year. Results: The highest incidence for both genders was seen in the age group 50–59 years and the lowest incidence for both genders was in youngest age group (<20 years) for all the years from 1990 to 2014. The relative proportion of oral cancer among all types of cancer in Delhi has shown alarming rise from the year 2003 onward. Conclusion: Increasing relative proportion of oral cancer can be implicated in increased consumption of gutkha chewers in the last decade of the 20th Century. As access to health-care services and cancer-related awareness is highly variable in India, more in-depth analysis of the incidence of oral cancer in rural regions will be required.
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Burden of acute toxicities in head-and-neck radiation therapy: A single-institutional experience p. 120
Sandeep Muzumder, Nirmala Srikantia, Avinash H Udayashankar, Prashanth Bhat Kainthaje, MG John Sebastian
DOI:10.4103/sajc.sajc_264_17  PMID:31069194
Introduction: Combined modality therapy is the standard of care in locally advanced head-and-neck cancer (HNC). The incidence of acute toxicities increases with additional therapy. The present study investigated the incidence and patterns of mucositis, dysphagia, aspiration, feeding tube use, admission for supportive care, and treatment compliance in patients with HNC treated curatively with radiation therapy (RT) with or without chemotherapy. Methods and Material: A retrospective review of 164 consecutive HNC patients treated with RT at St. John's Medical College Hospital, Bengaluru, from January 2013 to June 2017 was done. Results: A total of 148 HNC patients were treated with a curative intent and 122 (82.4%) were locally advanced HNC. Combined Modality treatment was received by 119 (80.4%) patients. Eighty-four (56.7%) patients were treated by concurrent chemo-radiation. IMRT technique was used in 125 (84.5%) patients. The incidence of grade 3-4 mucositis, dysphagia and aspiration was 25%, 46%, and 10%, respectively. Nasogastric tube feeding was necessitated in 18.9% (n=28) and 27% (n = 40) required inpatient admission for supportive care. Twenty-nine (19.6%) patients did not complete planned RT dose and 46 (31%) patients had unscheduled RT break (>2days). Fifty-six (66.7%) patients did not receive planned chemotherapy. Conclusions: Acute toxicity due to RT in HNC remains a challenge despite using modern techniques. A significant proportion of patients require supportive therapy for more than 12 weeks and did not complete the scheduled treatment.
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Correlating the treatment outcome with tumor staging, grading, and various treatment modalities in patients with esthesioneuroblastoma p. 124
Shuchita Singh, Lavleen Singh, Richa Ranjan, Manoj Kumar Singh, Alok Thakar, Suresh Chandra Sharma
DOI:10.4103/sajc.sajc_273_18  PMID:31069195
Objective: Although till date no management protocol for esthesioneuroblastoma (ENB) has been standardized due to tumor rarity, still multimodality approach shows better treatment outcomes as compared to surgery alone. The objective of this study was to analyze the clinicopathological spectrum of ENB and to correlate treatment response with tumor staging, histopathological grading, and various treatment modalities. Materials and Methods: Twenty-one consecutive patients with biopsy-proven ENB were studied and evaluated for response to treatment in the form of complete tumor resolution. Results were analyzed and correlated with stage and grade of tumor and form of therapy received. Results: There was male preponderance (3.2:1) with age ranging between 7 and 63 years (median of 25 years). Survival rates significantly dropped with increasing tumor stage (63.6% in stages A and B vs. 30% in stages C and D) and grade (100% in Grades 1 and 2 vs. 31.25% in Grades 3 and 4). The recurrence rate was 80% in surgery alone group, which came down to 43.7% if surgery was supplemented with other modalities. In cases where multimodality treatment plan was used, endoscopic procedures fared equally as open surgical procedures. Conclusion: Hyam's grade and Kadish stage are important prognostic indicators of treatment outcome, with survival rates dropping with increasing tumor stage and grade. Multimodality treatment protocols have improved the disease outcome, making endoscopic surgery equivalent to radical surgeries regarding result outcomes and giving other advantages such as better cosmesis, less treatment-related morbidities, decreased hospital stay, and better cost-effectiveness.
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LETTERS TO THE EDITOR Top

Metastasizing Pleomporphic Adenoma - Case reports and review of literature p. 126
Suresh Mani, Sukamal Das, Regi Thomas, Rajiv C Michael
DOI:10.4103/sajc.sajc_19_19  PMID:31069196
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ORIGINAL ARTICLES: HEMATOLYMPHOID MALIGNANCIES Top

Influence of JAK2V617F allele burden on clinical phenotype of polycythemia vera patients: A study from India p. 127
Sudha Sazawal, Kanwaljeet Singh, Sunita Chhikara, Rekha Chaubey, Manoranjan Mahapatra, Renu Saxena
DOI:10.4103/sajc.sajc_161_18  PMID:31069197
Background: Elevated JAK2V617F allele burden is associated with enhanced expression of downstream target genes in Philadelphia negative chronic myeloproliferative neoplasms (CMPNs) which include PV, ET & PMF. Previous studies have shown the impact of JAK2V617F allele burden on clinical phenotype of CMPNs. However, there is no data from India regarding the association between JAK2V617F allele burden and clinical phenotype in PV. Aims/Settings and Design: We aimed to investigate the effect of allele burden on clinical phenotype in 90 JAK2V617F positive PV patients and to see its influence on disease related complications. Material and Methods: Allele burden of 90 JAK2V617F positive PV patients was quantified by Real-time polymerase chain reaction (RQ-PCR). Results: 74/90 (82.22%) were males and 16/90 (17.78%) were females (median 45 years, range 35-78). Patients with age >50 years had significantly higher JAK2V617F allele burden (median 40.15%, range 0.49–91.62 %) than patients with ≤ 50 years age (median 48.59 %, range 0.56–86.74 %; P < 0.032). Patients with splenomegaly had significantly higher JAK2V617F allele burden (mean 50.24%, range 6.91–84.17%) than patients without splenomegaly (mean 33.82 %, range 0.49–71.83 %; P < 0.017). Patients with higher allele burden (median 57.20, range 43.4–72.03%) had significantly raised thrombotic events than the patients with lower allele burden (median 37.38, range 0.49–84.17%; P < 0.043). 49/90 (54%) were homozygous and 41/90 (46%) were heterozygous. Conclusions: Higher JAK2V617F allele burden showed association with increased age, splenomegaly and thrombotic events. Thus, it may be considered for prognostication and setting up the treatment protocol in PV patients.
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ORIGINAL ARTICLES: SUPPORTIVE CARE AND OTHERS Top

Predictors of adverse drug reactions in geriatric patients: An exploratory study among cancer patients p. 130
S George Sneha, Kalpana Simhadri, Viswam K Subeesh, S Varghese Sneha
DOI:10.4103/sajc.sajc_218_18  PMID:31069198
Objectives: The objective of this study was to study the predictors of adverse drug reactions (ADRs) among geriatric patients in the Department of Medical Oncology. Methods: A hospital-based prospective observational study was carried out among 153 inpatients in the Department of Medical Oncology for 6 months. Patients above 60 years of age with a confirmed history of malignancy were included in the study. The potential risk factors for ADR were defined in relation to the patient and chemotherapeutic regimen and relationship between them was assessed by univariate and multivariate logistic regression analysis. Results: Among 153 patients, 94 (64.43%) experienced ADRs. The mean ADR per patient was 0.88 ± 1.2. The common ADRs found were alopecia (30.18%) and diarrhea (28.68%). Risk estimates revealed that there was a significant association between smokers (odds ratio [OR] = 10.326; 95% confidence interval [CI] 2.345–45.47, P = 0.001), alcoholics (OR = 10.897; 95% CI 2.479–47.902, P = 0.001), increasing age (OR = 2.22; 95% CI 1.698–2.909, P = 0.001), overweight (OR = 16.68; 95% CI 2.179–127.741, P = 0.001), and male participants (OR = 0.143; 95% CI 0.05–0.390 P = 0.001) with the development of ADRs. The risk of carboplatin (OR = 13.359; 95% CI 3.056–58.406 P = 0.001) and 5-fluorouracil (OR = 1.938 95% CI 1.266–2.935 P = 0.001) use and occurrence of ADRs were also found to be high. Conclusion: The study findings showed that smoking, alcohol consumption, age more than 70 years, and overweight had a high risk for developing ADRs in geriatric patients who underwent chemotherapy. The independent risk factors identified should be targeted for preventive measures to improve anticancer agent prescription and reduce the risk of ADRs.
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Case report on stereotactic body radiation therapy for locally recurrent renal cell carcinoma after partial nephrectomy in a patient with single kidney p. 135
Kaushik Jagannath Kataki, Ajinkya Gupte, Ram Madhavan, K Beena, Debnarayan Dutta, Raghavendra Holla, Manoj Kalita
DOI:10.4103/sajc.sajc_7_19  PMID:31069199
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