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DIAGNOSTIC DILEMMA
Pulmonary tuberculosis as differential diagnosis of lung cancer
MLB Bhatt, Surya Kant, Ravi Bhaskar
July-September 2012, 1(1):36-42
DOI:10.4103/2278-330X.96507  PMID:24455507
Patients with lung cancer are often misdiagnosed as pulmonary tuberculosis leading to delay in the correct diagnosis as well as exposure to inappropriate medication. Several factors are responsible for this situation in developing countries, including lack of awareness, inadequate infrastructure and socio-economic factors. This article outlines the differences between the two diseases as well as features that would make a clinician suspect the right diagnosis early.
  19,255 1,324 9
CASE REPORTS
Primary malignant melanoma of the vagina: A case report and review of literature
Snehamay Chaudhuri, Diptimay Das, Soham Chowdhury, Anjan Das Gupta
January-March 2013, 2(1):4-4
DOI:10.4103/2278-330X.105861  PMID:24455530
A 60 year old woman presented in gynecology department with bleeding per vagina and subsequently histotpathologically, it was diagnosed as malignant melanoma of the vagina. She underwent excision biopsy. On metastatic work-up, Positron emission tomography (PET) scan proved that she had distant metastasis and received palliative radiotherapy and chemotherapy, with temozolamide. She is alive after one year.
  16,053 371 3
MINI SYMPOSIUM ON SUPPORTIVE CARE - ORIGINAL ARTICLES
The role of honey in healing of bedsores in cancer patients
Aramita Saha, Subrata Chattopadhyay, Md. Azam , Prabir Kr Sur
October-December 2012, 1(2):66-71
DOI:10.4103/2278-330X.103714  PMID:24455516
Bacground: Honey was used to treat infected wounds as long as 2000 years before bacteria were discovered. It has been reported to have inhibitory action to around 50 species of bacteria and fungi (aspergillus, penicillium). Usually, Metronidazole powder is used in our palliative clinic for wound healing due to low cost & effectivity. Honey is cheap, easily available ingredient with high astringent activity. Objective: Objectives of the study were to find out the effectiveness of Honey in terms of rate of wound healing & pain control in bedsores of cancer patients. Materials and Methods: 40 cancer patients with bedsore wounds were randomly assigned (1:1 ratio i.e. 20 in each arm) for Study Arm (Honey plus Metronidazole powder) and Control Arm (only Metronidazole powder), attending Palliative clinic of our department in between July 2010 to September 2011.Washing of the wound with normal saline done daily before application of above medicaments. Change of posture & soft bed were encouraged in both groups. A pre designed interview proforma, standardised Bates Jensen Wound Assessment Tool and Visual Analogue Pain assessment scale were used to collect and assess data. Results: There was significant difference in wound healing status (F value = 6.523; Critical Difference =14.03, P<0.05) from day 10 and pain reduction also (F value = 6.638 and Critical Difference = 1.667, P<0.05) from day 7 in study arm. Conclusion: Application of honey dressing provides a better wound healing, rapid pain relief in cancer patients with bedsores in palliative settings.
  7,608 1,136 1
MINI SYMPOSIUM - RT DOSIMETRY AND FRACTIONATION: ORIGINAL ARTICLES
Dose prediction accuracy of anisotropic analytical algorithm and pencil beam convolution algorithm beyond high density heterogeneity interface
Suresh B Rana
January-March 2013, 2(1):26-30
DOI:10.4103/2278-330X.105888  PMID:24455541
Purpose: It is well known that photon beam radiation therapy requires dose calculation algorithms. The objective of this study was to measure and assess the ability of pencil beam convolution (PBC) and anisotropic analytical algorithm (AAA) to predict doses beyond high density heterogeneity. Materials and Methods: An inhomogeneous phantom of five layers was created in Eclipse planning system (version 8.6.15). Each layer of phantom was assigned in terms of water (first or top), air (second), water (third), bone (fourth), and water (fifth or bottom) medium. Depth doses in water (bottom medium) were calculated for 100 monitor units (MUs) with 6 Megavoltage (MV) photon beam for different field sizes using AAA and PBC with heterogeneity correction. Combinations of solid water, Poly Vinyl Chloride (PVC), and Styrofoam were then manufactured to mimic phantoms and doses for 100 MUs were acquired with cylindrical ionization chamber at selected depths beyond high density heterogeneity interface. The measured and calculated depth doses were then compared. Results: AAA's values had better agreement with measurements at all measured depths. Dose overestimation by AAA (up to 5.3%) and by PBC (up to 6.7%) was found to be higher in proximity to the high-density heterogeneity interface, and the dose discrepancies were more pronounced for larger field sizes. The errors in dose estimation by AAA and PBC may be due to improper beam modeling of primary beam attenuation or lateral scatter contributions or combination of both in heterogeneous media that include low and high density materials. Conclusions: AAA is more accurate than PBC for dose calculations in treating deep-seated tumor beyond high-density heterogeneity interface.
  5,869 1,086 6
ONCOLOGY PEARLS
A systematic approach to diagnosis of cystic brain lesions
Vibhor Sharma, Kumar Prabhash, Vanita Noronha, Nidhi Tandon, Amit Joshi
April-June 2013, 2(2):98-101
DOI:10.4103/2278-330X.110509  PMID:24455569
Brain metastasis is the most common intracranial tumor in adults. The incidence of brain metastasis is rising with the increase in survival of cancer patients. Magnetic resonance imaging with contrast enhancement is the imaging procedure of choice to diagnose and characterize brain metastases. Multiple lesions with marked vasogenic edema and mass effect are typically seen in patients with brain metastases. The classical appearance of a metastasis is a solid enhancing mass with well-defined margins and extensive edema. Occasionally, central necrosis produces a ring enhancing mass. Here, we report a case of Non Small Cell Lung Cancer with multiple ring enhancing lesions in brain, and the approach to diagnosis of such patients.
  5,177 919 2
LETTERS TO EDITOR
Revision of Prasad's social classification and provision of an online tool for real-time updating
Rahul Sharma
July-September 2013, 2(3):157-157
DOI:10.4103/2278-330X.114142  PMID:24455606
  4,322 630 3
DRUG REVIEW
Crizotinib: A comprehensive review
Arvind Sahu, Kumar Prabhash, Vanita Noronha, Amit Joshi, Saral Desai
April-June 2013, 2(2):91-97
DOI:10.4103/2278-330X.110506  PMID:24455567
Anaplastic lymphoma kinase (ALK) gene rearrangements are present in a small subset of non-small-cell lung cancers. ALK-positivity confers sensitivity to small-molecule ALK kinase inhibitors, such as crizotinib. The integration of crizotinib into standard treatment practice in NSCLC will rest on the widespread implementation of an effective screening system for newly diagnosed patients with NSCLC which is flexible enough to incorporate new targets as treatments are developed for them. Phase I and II studies of crizotinib in ALK-positive lung cancer have demonstrated significant activity and impressive clinical benefit, which led to its early approval by USFDA in 2011. Although crizotinib induces remissions and extends the lives of patients, there have been reports of emerging resistance to Crizotinib therapy. In this review, we discuss the history, mechanism of action, uses, adverse effects, dose modifications and future challenges and opportunities for patients with ALK-positive lung cancers.
  3,616 979 16
REGIONAL ARTICLE
Oncology in Nepal
Madan K Piya, Sandhya C Acharya
July-September 2012, 1(1):5-8
DOI:10.4103/2278-330X.96490  PMID:24455501
Nepal being a developing country is lagging behind in almost all its healthcare services and hence Oncology is also in its primitive stages. In this review, effort is being made to outline the historical perspectives regarding evolution of Oncology in Nepal, with a brief overview of cancer scenario in the country. This review also highlights the challenges, constraints and successes that are associated in initiation and nurturing of Oncology in developing countries. It also emphasizes the history, current status, challenges of academic training in oncology and also portrays the effort of various national and international organisations and government trying to achieve recent advancements and expensive modern technology.
  4,121 465 4
EDITORIAL
A fresh look at oncology facts on south central Asia and SAARC countries
Vanita Noronha, Ugyen Tsomo, Arif Jamshed, MA Hai, Sarath Wattegama, RP Baral, Madan Piya, Kumar Prabhash
July-September 2012, 1(1):1-4
DOI:10.4103/2278-330X.96489  PMID:24455500
  3,476 551 14
REVIEW ARTICLES
Challenges in launching multinational oncology clinical trials in India
Kamal S Saini, Gaurav Agarwal, Ramesh Jagannathan, Otto Metzger-Filho, Monika L Saini, Khurshid Mistry, Raghib Ali, Sudeep Gupta
January-March 2013, 2(1):44-49
DOI:10.4103/2278-330X.105896  PMID:24455545
In the recent past, there has been an impressive growth in the number of clinical trials launched worldwide, including India. Participation in well-designed oncology clinical trials is of advantage to Indian healthcare system in general, and cancer patients in particular. However, the number of clinical trials being run in India is not commensurate with the cancer burden prevailing in the country. In this article, the authors investigate the reasons for this discrepancy, highlight critical bottlenecks, and propose ways to ameliorate the situation.
  3,643 370 1
REVIEW ARTICLE
Positron emission tomography-computed tomography in the management of lung cancer: An update
Punit Sharma, Harmandeep Singh, Sandip Basu, Rakesh Kumar
July-September 2013, 2(3):171-178
DOI:10.4103/2278-330X.114148  PMID:24455612
This communication presents an update on the current role of positron emission tomography-computed tomography (PET-CT) in the various clinical decision-making steps in lung carcinoma. The modality has been reported to be useful in characterizing solitary pulmonary nodules, improving lung cancer staging, especially for the detection of nodal and metastatic site involvement, guiding therapy, monitoring treatment response, and predicting outcome in non-small cell lung carcinoma (NSCLC). Its role has been more extensively evaluated in NSCLC than small cell lung carcinoma (SCLC). Limitations in FDG PET-CT are encountered in cases of tumor histotypes characterized by low glucose uptake (mucinous forms, bronchioalveolar carcinoma, neuroendocrine tumors), in the assessment of brain metastases (high physiologic 18F-FDG uptake in the brain) and in cases presenting with associated inflammation. The future potentials of newer PET tracers beyond FDG are enumerated. An evolving area is PET-guided assessment of targeted therapy (e.g., EGFR and EGFR tyrosine kinase overexpression) in tumors which have significant potential for drug development.
  3,285 593 4
POSITION PAPER
Skin markings methods and guidelines: A reality in image guidance radiotherapy era
Shrinivas Rathod, Anusheel Munshi, Jaiprakash Agarwal
July-September 2012, 1(1):27-29
DOI:10.4103/2278-330X.96502  PMID:24455505
Preparation of site of radiation delivery is an important process in radiation treatment planning and plays a crucial role during a course of radiotherapy to achieve reproducibility of set-up and accuracy of treatment delivery. The preparation of treatment area is done by markings of field center, field edge or other reference point of planned field. Both non-invasive (marker pen, henna) and invasive methods (tattoo) are available for marking with limitations of each. Tattoo with a needle pricked at angle of 30° to 1-2 mm depth to create tattoo 2-3 mm diameter in size is an ideal procedure. Visibility, permanent nature, social-religious belief, and mobility of skin are one of the main concerns about tattoo. Tattoo removal can be done performed if desirable by patients by various modern ways, which will be esthetically available. Dermabrasion, cryotherapy, surgery, QSRL (Q-switched ruby laser) are common methods of tattoo removal. Esthetic dissatisfaction, allergy, dermatoses, keloids, infection, fanning/fading of tattoo are associated problems. In IMRT and IGRT treatment, delivery dependence on tattoo in reduced and use of surrogate markers including particularly for bony set-up and implanted markers (e.g. gold seeds) for tumor localization and treatment verification is increasing. However, these are complex procedures and require an expertise. Ease of set-up and less time required for tattooing are one of the main advantages of tattoo as compared to external or internal marker set-up. Tattoo still remains a crucial method of positioning, especially in developing countries and in palliative treatment settings.
  3,311 473 3
MINI SYMPOSIUM - FNAC VERSUS CORE BIOPSY: ORIGINAL ARTICLE
Computed tomogram guided fine-needle aspiration cytology of lung mass with histological correlation: A study in Eastern India
Santosh Kumar Mondal, Dipanwita Nag, Rama Das, Palash Kumar Mandal, Pranab Kr Biswas, Manish Osta
January-March 2013, 2(1):14-18
DOI:10.4103/2278-330X.105881  PMID:24455536
Background: Fine-needle aspiration cytology (FNAC) is an important and useful investigation, and is considered next to imaging in the rapid diagnosis of pulmonary mass lesion for the last few decades. Aims: To assess the role of Computed Tomogram (CT) guided FNAC in pulmonary mass lesions; to analyze the results; and to compare with histopathological findings. Materials and Methods: The clinical, radiological, and cytological data of 130 patients were prospectively studied who underwent CT guided FNAC from October 2009 through September 2011. Thereafter these patients underwent bronchoscopic/trucut biopsy/lobectomy, whatever clinically indicated. Smears and tissue sections were evaluated simultaneously to reach at a definite diagnosis. Results: Out of 130 cases, we found adequate FNAC smear and histopathology reports only in 124 cases. The age range varied from 35 to 73 years with the peak in the fifth to sixth decades. The benign lesions were 10 (8.07%) and malignant lesions were114 (91.93%) shown by cytology. The most common tumor was adenocarcinoma (51.72%) followed by squamous cell carcinoma (22.41%) and small cell carcinoma 6.89%. Diagnostic accuracy of CT guided FNAC was 95%. Post procedural complications such as hemorrhage and chest pain were minimal and were noted only in three cases. Conclusion: CT guided FNAC of pulmonary masses provides simple, easy, and reliable method for reaching rapid tissue diagnosis with minimal complication.
  3,353 408 2
REVIEW ARTICLES
Overview of recent developments in chronic lymphocytic leukemia
Preetesh Jain, Kanti R Rai
October-December 2012, 1(2):84-89
DOI:10.4103/2278-330X.103721  PMID:24455520
Multiple advances have been made in our understanding of pathobiology of chronic lymphocytic leukemia (CLL). These developments in the laboratory include new prognostic markers, risk stratification of the disease and newer therapeutic agents in CLL. These advances in CLL have come a long way in the past three decades since the development of Rai and Binet clinical staging systems. Important strides in the pathobiology, from defining mutational status of IGHV, to B-cell receptor (BCR) signaling pathways and CLL microenvironment have made a major difference in our understanding of this disease. Mutational status of immunoglobulin heavy chain genes (IGHV), CD38 and Zap-70, chromosomal aberrations and newer mutations, are the most clinically relevant prognostic markers. Chemoimmunotherapy (CIT) has become the treatment of choice for young and fit CLL patients. Various inhibitors of BCR signaling pathways and immunomodulatory drugs have shown efficacy in clinical trials. The most recent advance is the use of chimeric antigen receptor therapy (CAR) based on autologous T-lymphocytes. Nevertheless, CLL remains an incurable disease today. Coordinated developments between laboratory and clinic will hopefully translate into a cure for CLL. This short review focuses on advances in prognostication and therapy in CLL.
  2,867 563 -
MINI SYMPOSIUM - RT DOSIMETRY AND FRACTIONATION: ORIGINAL ARTICLES
Different fractionation schedules of radiotherapy in locally advanced head and neck malignancy: A prospective randomized study to compare the results of treatment and toxicities of different protocols
Dipanjan Majumder, Kakali Choudhury, Pabitra Das, Suvrokanti Kundu, Debabrata Mitra
January-March 2013, 2(1):31-35
DOI:10.4103/2278-330X.105890  PMID:24455542
Context: Altered fractionated radiotherapy may have better result than conventional radiotherapy and concomitant chemoradiotherapy to treat locally advanced head and neck cancers. Aims: Evaluation of the response and toxicities in different fractionated radiotherapy schedules in locally advanced head and neck cancer. Materials and Methods: Sixty four histologically proved patients of locally advanced head and neck cancer were included in the study according to protocol and were randomized into three arms. Arm A (n = 21) received 66 Gy in 33 fractions (5 fractions/week from Monday to Friday) single fraction daily in 6½ weeks along with concomitant chemotherapy (injection Cisplatin 30 mg/m 2 intravenous once weekly) for 6 weeks. Arm B (n = 21) received 66 Gy in 33 fractions (6 fractions per week) single fraction daily in 5½ weeks, and arm C ( n = 22) received late hyperfractionation after 3 weeks; 30 Gy in 15 fractions in 3 weeks followed by 1.4 Gy twice daily (time gap between 2 fractions were 6 hours) for 15 days with a total of 72 Gy in 6 weeks. Response to treatment, compliance, and toxicities were compared in all the three arms. Statistical Analysis Used: Frequency table and chi square tests done. Results: Baseline data were comparable in all the three arms. Complete response in arm A, arm B, and arm C were 15%, 26.315%, and 23.81%, respectively ( P = 0.339). Grade 1 Neutropenia in arm A was 15%, arm B was 26.32%, and arm C was nil (P = 0.0486). Conclusion: Altered fractionation and concurrent chemoradiation showed similar response with comparable acute toxicities except nutropenia, which was significantly higher in arm B.
  3,074 295 3
THE GREAT DEBATE: FOR HPV VACCINE IN CERVICAL CANCER
Efficacy and safety of human papillomavirus vaccine for primary prevention of cervical cancer: A review of evidence from phase III trials and national programs
Partha Basu, Dipanwita Banerjee, Priyanka Singh, Chandrani Bhattacharya, Jaydip Biswas
October-December 2013, 2(4):187-192
DOI:10.4103/2278-330X.119877  PMID:24455618
The Human Papillomavirus (HPV) vaccines have been widely introduced in the national immunization programs in most of the medium and high income countries following endorsement from national and international advisory bodies. HPV vaccine is unique and its introduction is challenging in many ways - it is the first vaccine developed to prevent any cancer, the vaccine is gender specific, it targets adolescent females who are difficult to reach by any health intervention programs. It is not unusual for such a vaccine to face scepticism and reservations not only from lay public but also from professionals in spite of the clinical trial results convincingly and consistently proving their efficacy and safety. Over the last few years millions of doses of the HPV vaccine have been administered round the world and the efficacy and safety data have started coming from the real life programs. A comprehensive cervical cancer control program involving HPV vaccination of the adolescent girls and screening of the adult women has been proved to be the most cost-effective approach to reduce the burden of cervical cancer. The present article discusses the justification of HPV vaccination in the backdrop of natural history of cervical cancer, the mechanism of action of the vaccines, efficacy and safety data from phase III randomized controlled trials as well as from the national immunization programs of various countries.
  2,576 668 10
MINI SYMPOSIUM - FNAC VERSUS CORE BIOPSY: ORIGINAL ARTICLE
Anterior mediastinal masses: A study of 50 cases by fine needle aspiration cytology and core needle biopsy as a diagnostic procedure
Jitendra G Nasit, Maulin Patel, Biren Parikh, Manoj Shah, Kajal Davara
January-March 2013, 2(1):7-13
DOI:10.4103/2278-330X.105872  PMID:24455533
Background: Mediastinal tumors are an uncommon abnormalities found in clinical practice. Anterior mediastinum is the common site and tissue diagnoses of anterior mediastinal masses (AMMs) are very important for correct therapeutic decision. Objective: We evaluate the different malignant AMMs in various age groups and the sensitivity of fine needle aspiration cytology (FNAC) and core needle biopsy (CNB). Cytology smears are reviewed with particular emphasis on pitfalls in the cytological diagnosis. Materials and Methods: This was a prospective study of 50 patients who were consulted for AMMs and underwent FNAC and CNB under guidance of ultrasound or computed tomography (CT) scan from 2006 to 2011. Cytology smears and histological sections were evaluated in all patients. Results: Among 50 cases, 36 were male and 14 were female. Most AMMs (52%) were identified in the fifth and sixth decades of life. Metastatic carcinoma and nonHodgkin's lymphoma are the common AMMs. Adequate tissue material was obtained in 49 of 50 cases by CNB. Of these 49 patients, 35 (71.42%) cases were diagnosed correctly by FNAC, whereas 14 (28.57%) cases were not diagnosed definitely by FNAC. The sensitivity of CNB for AMMs was 97.95%, significantly higher than FNAC (71.42%) ( P < 0.05). CNB had statistically significant higher diagnostic rate than FNAC in the noncarcinoma group (100% versus 62.96%) ( P < 0.05). There is no significant difference of CNB and FNAC in carcinoma group ( P > 0.05). Diagnostic rate of FNAC was higher for carcinomatous lesions (81.81%) than for noncarcinomatous lesions (62.96%). Conclusion: Ultrasound or CT scan-guided CNB in combination with FNAC are safe, minimally invasive, and cost-effective procedure, which can provide a precise diagnosis in the AMMs, and may obviate the need for invasive surgical approach. FNAC usually suffice for carcinomatous lesions but CNB should be performed whenever the diagnosis of carcinoma is equivocal or noncarcinoma lesions are suspected.
  2,758 394 7
THROUGH THE MICROSCOPE: ORIGINAL ARTICLES
Immunohistochemistry: A diagnostic aid in differentiating primary epithelial ovarian tumors and tumors metastatic to the ovary
Divya Kriplani, Mandakini M Patel
October-December 2013, 2(4):254-258
DOI:10.4103/2278-330X.119888  PMID:24455652
Introduction: Among cancers of the female genital tract, the incidence of ovarian cancer ranks below only carcinoma of the cervix and the endometrium. Recent years have witnessed significant development in the use of immunohistochemistry in diagnostic ovarian pathology. Materials and Methods: We received 95 specimens and biopsies of primary ovarian neoplasms and neoplasms metastatic to the ovary in a period of 2 years. Of these 30 cases were of the primary surface epithelial neoplasms and seven of metastatic tumors. Discussion: The most common tumors metastasizing to the ovary originate from the gastrointestinal tract followed by the endometrium. We used a panel of six markers including cytokeratin-7 (CK7), CK20, carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), estrogen receptor (ER) and Wilms' tumor 1 (WT1) to help classify various surface epithelial tumors as well as to differentiate them from tumors metastatic to the ovary. Conclusion: CK7 is the most helpful marker to differentiate primary ovarian carcinoma from metastatic colorectal carcinoma of the ovary. Nearly, 96% of ovarian adenocarcinomas were positive for CK7 in contrast to metastatic colorectal, which showed only 25% positivity. We also found that CK7, CK20 and CEA are useful markers to differentiate primary serous tumors from primary mucinous tumors; however, these are less helpful in differentiating ovarian mucinous adenocarcinomas from colorectal adenocarcinomas metastasizing to the ovaries. WT1 helps in typing primary surface epithelial tumors of the ovary and is also significant in determining whether a serous carcinoma within the ovary is primary or metastatic.
  2,495 554 3
LETTERS TO EDITOR
Lung cancer and Hepatitis C virus
Rajendra Prasad, Nuzhat Husain, Saurabh Karmakar, Sanjay Verma
April-June 2013, 2(2):86-86
DOI:10.4103/2278-330X.110500  PMID:24455565
  1,959 1,077 -
CASE REPORTS
Xanthogranulomatous pyelonephritis: Rare presentation of a rare disease
Saifullah Khalid, Sufian Zaheer, Samreen Zaheer, Ibne Ahmad, Mohd Khalid
January-March 2013, 2(1):4-4
DOI:10.4103/2278-330X.105863  PMID:24455529
Xanthogranulomatous pyelonephritis is a rare chronic renal infection of unknown pathogenesis characterized by replacement of renal parenchyma by lipid filled macrophages frequently associated with an enlarged, non-functioning kidney and an obstructing calculus. We report a case of a 45 year old non diabetic female who presented with gradually enlarging renal mass with extensive retroperitoneal involvement and a non-functioning kidney with no evidence of obstructing stone or fat density and simulating malignancy. She was diagnosed as stage III Xanthogranulomatous pyelonephritis and managed with radical nephrectomy with favourable outcome.
  2,760 263 3
REVIEW ARTICLES
Issues in current management of chronic myeloid leukemia: Importance of molecular monitoring on long term outcome
Hari Menon
January-March 2013, 2(1):38-43
DOI:10.4103/2278-330X.105893  PMID:24455544
Monitoring of CML patients while on therapy is vitally important and ENL has come up with specific guidelines for the same. Since we are currently talking about operational cure, this review shall focus on evaluating the emerging data to optimize response. This requires attention to all outstanding controversial issues. Only careful, accurate and regular monitoring with specific attention to grey areas will help us select first line therapy, decide when to discontinue TKIs and also move to second line TKIs in a timely manner.
  2,542 401 2
THE SKILLFUL SCALPEL: ORIGINAL ARTICLES
Dermatofibrosarcoma protuberans: Role of wide local excision
Raashid Hamid, Aadil Hafeez, Ashraf M Darzi, Inam Zaroo, Habib Owais, Afrozah Akhter
October-December 2013, 2(4):232-238
DOI:10.4103/2278-330X.119926  PMID:24455646
Objectives: The main objective of the present study was to study the outcome of surgical treatment of dermatofibrosarcoma protuberans. Materials and Methods: This study included 45 patients both retrospective and prospective from December 1995 to December 2010. Results: Out of 45 patients, 30 were males and 15 females with the male to female ratio of 2:1. Mean age of presentation was 38.4 + 13.2 years. Commonest mode of presentation was raised firm multinodular lesion with fixity to overlying skin. Site distribution was 42.22% trunk, 57.88% extremities and head and neck. None of the patients had lymph node involvement All patients underwent wide local excision. On histological examination, 8 patients had positive margins. Overall recurrence rate was 22.22%. (please clarify what is the difference between the rate of recurrence following surgery and the overall recurrence rate) Only 2 patients developed metastasis to lungs in the course of their follow-up. Out of 45 patients, 35 remained recurrence free over a varying period of 5 months to 13 years (mean 68 months). Ten patients developed one or more local recurrences. Average time from initial treatment to recurrence was 32 months. All patients with recurrent tumors were subjected to salvage treatment, i.e., re-excision. Average recurrence-free period was 36 + 44 months within a mean follow-up of 68 months. Conclusion: Because of the potential of local recurrence, therapy for DFSP should be directed toward adequate local excision of the primary lesion. Minimal resection should include a surrounding margin, comprising 3-cm margin of normal skin and removal of underlying deep fascia. Compromising on margins invites higher chances of local recurrence.
  2,719 217 5
QUEST FOR AN ANTIDOTE TO RADIATION TOXICITY - ORIGINAL ARTICLES
Role of oral glutamine in alleviation and prevention of radiation-induced oral mucositis: A prospective randomized study
Subrata Chattopadhyay, Aramita Saha, Mohammad Azam, Anindya Mukherjee, Prabir Kumar Sur
January-March 2014, 3(1):8-12
DOI:10.4103/2278-330X.126501  PMID:24665438
Background: Oral mucositis is the most frequently occurring painful and dose-limiting side-effect of radiation of the head and neck region. Few studies demonstrated that oral glutamine suspension may significantly reduce the duration and severity of objective oral mucositis during radiotherapy. Materials and Methods: A randomized, prospective single institutional case control study was performed between April 2012 and November 2012 comparing the influence of oral glutamine on radiation induced mucositis in head and neck malignancy patients. Seventy biopsy proven patients with head and neck cancer receiving primary or adjuvant radiation therapy were randomized to receive either oral glutamine suspension daily 2h before radiation in the study arm (10 g in 1000 ml of water) (n = 35) or nothing before radiation; control arm (n = 35). Results and Analysis: Total 32 patients (91.43%) in the glutamine arm and total 34 patients (97.15%) developed mucositis. Grade 3 mucositis (14.29%) and grade 4 mucositis (2.86%) in the study arm (who received oral glutamine) were significantly less (P = 0.02 and P = 0.04, respectively) in the glutamine arm. The mean duration of grade 3 or worse mucositis (grade 3 and grade 4) was significantly less (6.6 days vs. 9.2 days) in study arm with P < 0.001. Mean time of onset of mucositis was significantly delayed in patients who took glutamine in comparison to control arm with P < 0.001. Conclusion: Glutamine delays oral mucositis in the head neck cancer patients. Moreover, it reduces the frequency and duration of grade 3 and grade 4 mucositis.
  2,076 844 13
REVIEW ARTICLE
Management of relapsed-refractory diffuse large B cell lymphoma
Lalit S Raut, Prantar P Chakrabarti
January-March 2014, 3(1):66-70
DOI:10.4103/2278-330X.126531  PMID:24665451
Relapsed-Refractory Diffuse Large B Cell Lymphoma (RR DLBCL), which accounts for approximately one-third of patients with DLBCL, remains a major cause of morbidity and mortality. Managing RR DLBCL continues to be a challenge to the treating hemato-oncologist. Salvage high-dose chemotherapy followed by autologous stem cell transplantation is the standard of care for chemosensitive relapses in DLBCL. Various salvage regimens are available, but the quest for an optimal regimen continues. The addition of rituximab to the salvage regimen has improved the outcome of RR DLBCL. Several pertinent issues regarding the management of RR DLBCL are discussed in this short review.
  2,118 716 7
REVIEW ARTICLES
Role of bacteria in oral carcinogenesis
R Rajeev, Kanaram Choudhary, Swagatika Panda, Neha Gandhi
October-December 2012, 1(2):78-83
DOI:10.4103/2278-330X.103719  PMID:24455519
Oral cancer is the most common cancer diagnosed in Indian men and is the leading cause of cancer deaths. It is considered as a multistep and multifactorial disease. Besides accumulation of genetic mutations, numerous other carcinogens are involved. In this category, viral and chemical carcinogens are well studied and documented. However, in the oral cavity, the role of microbiota in carcinogenesis is not known. Microbial populations on mouth mucosa differ between healthy and malignant sites, and certain oral bacterial species have been linked with malignancies, but the evidence is still weak in this respect. Nevertheless, oral microorganisms inevitably up-regulate cytokines and other inflammatory mediators that affect the complex metabolic pathways, and may thus be involved in carcinogenesis. Poor oral health associates statistically with prevalence of many types of cancer such as pancreatic and gastrointestinal cancer. This review presents possible carcinogenesis pathway involved in bacterial carcinogenesis, commonly implicated bacteria in oral carcinogenesis, and their role in cancer therapeutics as well.
  2,201 555 2
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