Cancer Center In South India Research Articles

Efficacy and Safety Profile of Different Schedules of Adjuvant Trastuzumab Therapy among Patients with HER2-Positive Breast Cancer: Real-World Experience from a Tertiary Cancer Center in South India

One year of adjuvant trastuzumab is the standard of care for HER2-positive breast cancer. In low–middle income countries, delivery of 1-year trastuzumab is challenging due to significant financial burden. Evidence for shorter durations of adjuvant trastuzumab is gaining popularity in this regard. In this study, we compared the effectiveness and safety of 1 year versus shorter durations of adjuvant trastuzumab practiced in our center. In total, 312 patients were included in this analysis. The median age was 52 years. More than two-thirds of patients (67.6%) had stage 2 disease and majority were hormone-receptor-positive (62.5%). The median follow-up duration was 50 months. The 4-year disease-free survival was 97.3%. The 4-year disease-free survival for shorter durations of adjuvant trastuzumab was 98% compared with 96.7% in 1-year trastuzumab therapy group. In univariate analysis, stage at diagnosis was the only factor which had statistically significant association with disease-free survival. In multivariate analysis, none of the variables were found to be predictive of survival. Two patients (0.6%) had significant left ventricular ejection fraction decline.Shorter durations of adjuvant trastuzumab have comparable 4-year disease-free survival to standard 1-year therapy and is an alternative adjuvant treatment option for HER2-positive breast cancer patients in resource-limited settings.

Primary Thyroid Malignancies in Children and Adolescents - A Retrospective Analysis from a Tertiary Cancer Centre in South India

Primary Thyroid Malignancies in Children and Adolescents - A Retrospective Analysis from a Tertiary Cancer Centre in South India

EP.12A.37 Erlotinib: A Beacon of Hope in EGFR TKI-Progressed Lung Cancer, A Real-World Experience from a Tertiary Care Cancer Centre in South India

EP.12A.37 Erlotinib: A Beacon of Hope in EGFR TKI-Progressed Lung Cancer, A Real-World Experience from a Tertiary Care Cancer Centre in South India

Real-world data on the pattern of recurrence of colorectal cancer at a tertiary cancer center in South India: A retrospective observational study

Real-world data on the pattern of recurrence of colorectal cancer at a tertiary cancer center in South India: A retrospective observational study

Clinico-Pathological Challenges in Managing Rare Cancers of the Vulva: Experience at a Tertiary Cancer Center in South India

Clinico-Pathological Challenges in Managing Rare Cancers of the Vulva: Experience at a Tertiary Cancer Center in South India

An Analysis of Socio-Demographic and Haematologic Profiles of Platelet Donors at a Tertiary Cancer Centre in South India

An Analysis of Socio-Demographic and Haematologic Profiles of Platelet Donors at a Tertiary Cancer Centre in South India

COVID-19 Impact on Newly Diagnosed Breast Cancers at Regional Cancer Centre, Thiruvananthapuram-An Audit.

Geethu Babu The coronavirus pandemic has created havoc in every aspect of life including cancer care and was declared a pandemic. This audit was conducted to study the impact of the pandemic on diagnosis and treatment of newly diagnosed breast cancer patients at a tertiary cancer center in South India. A total of 1,647 patients who registered at Regional Cancer Centre (RCC), Thiruvananthapuram, Kerala, India for breast cancer during the period April 1, 2020, to September 30, 2020 (COVID-19 period) as well as April 1, 2019, to September 30, 2019 (pre-COVID-19 period) were included in the study. Data regarding the geographic distribution, stage at presentation, time factors for reporting for care, diagnosis, and treatment, referral for care elsewhere were collected and analyzed. The study was approved by the Institutional Review Board. Means and ranges were calculated for continuous type variables, and numbers and percentages for categorical variables. To determine whether there were significant differences between the two groups, independent t -test was used for continuous variables and chi-square test for categorical type of variables. A notable reduction (36%) in newly diagnosed breast cancer patients was seen in 2020 when compared with 2019. There was a significant difference in the geographic distribution of patients in both cohorts ( p = 0.001) and a notable reduction in the number of patients reporting to RCC for treatment from the northern districts of Kerala (81%) and outside Kerala (89.5%). There was no significant difference in the time (in weeks) since symptom onset and reporting to hospital or the clinical stage at diagnosis between the groups. Also, coronavirus disease 2019 (COVID-19) did not seem to negatively impact time intervals between date of registration and pathological diagnosis or start of primary treatment. More patients received neoadjuvant systemic therapy during 2020 compared with 2019, and this difference was statistically significant ( p = 0.004). There was no difference in the type of surgery (breast-conserving surgery vs. modified radical mastectomy). The results demonstrate that COVID-19 did not appear to negatively impact the diagnosis and treatment of newly diagnosed breast cancer patients. However, this is largely attributable to the significantly less number of patients who registered, for whom the departments were able to maintain timely cancer care despite the difficult pandemic times. Significantly more patients received neoadjuvant systemic therapy in 2020.

Real-world data on the pattern of recurrence of colorectal cancer at a tertiary cancer center in South India: A retrospective observational study

Background: Recurrent colorectal cancer may be amenable to curative treatment. As the debate on the ideal set of investigations and frequency of follow-up continues, it is important to review the pattern of recurrence in the real-world setting, which could help tailor future follow-up strategies. Objectives: Our primary objective was to study the varying clinical presentations and patterns of recurrence of colorectal cancer. The secondary objectives were to study the site of recurrence, method of diagnosis of recurrence, incidence of second primary colorectal cancer, and salvage rates after recurrence of colorectal cancer. Material and Methods: We reviewed the data of patients who were treated from January 2010 to December 2016 at the Malabar Cancer Center, a tertiary cancer center in Kerala, India. We recorded the clinicopathologic details of patients who were treated with curative intent and had serologic (carcinoembryonic antigen [CEA] elevation), clinical, or radiological evidence of disease recurrence. We also studied the timing and anatomical location of recurrence, symptoms, and the method by which the recurrence was diagnosed. Results: We included 675 patients in the study. There were 324 (48%) female patients; the median age was 55 years (interquartile range [IQR], 47.2-65). The primary diagnosis was colon cancer in 326 (48.3%) and rectal in 349 (51.7%) patients. Multimodality therapy was administered to 393 (58.2%) patients in the form of surgery with or adjuvant neoadjuvant chemoradiation adjuvant radiation, or neoadjuvant short-course radiation with neoadjuvant and adjuvant chemotherapy. Recurrences occurred in 109 (16.1%) patients, only 50 (45.9%) of whom were symptomatic. Recurrences were diagnosed by CEA elevation in 65 (59.6%), imaging in 12 (11%), clinical examination in 4 (3.7%), and colonoscopy in 1 (0.9%) patient. The median time to recurrence was 17 months (95% CI, 14-22). Local and distant recurrences occurred in 29 (4.2%) and 80 (11.9%) patients, respectively; 22 (27.5%) patients developed multisite distant recurrences. Recurrences occurred within the first 5 years of completion of therapy in 96 (88.1%) cases. Twelve (11%) patients received salvage therapy with curative intent. Six patients (0.9%) had a metachronous colorectal primary tumors. Conclusions: Colorectal cancer recurs most commonly in the first 5 years after therapy. Multisite distant recurrence and isolated liver metastases predominate. Recurrences are often asymptomatic and most commonly manifest as elevated CEA. Regular clinical evaluation, CEA testing, colonoscopy, and symptom-based cross-sectional imaging detect up to three-quarters of patients with recurrences, but the overall salvageability remains low.

Unravelling the Enigma of Inflammatory Myofibroblastic Tumours: A Cross-sectional Study from a Regional Cancer Centre, Karnataka, India

Introduction: Inflammatory Myofibroblastic Tumour (IMT) is an unusual neoplasm with intermediate malignant potential, which rarely metastasises. IMT occurs in various anatomical sites, and the initial descriptions were primarily centered on its manifestation in the lungs. Although the age range is broad, IMT is most common in the first three decades of life, with a slight female predominance. Recent data and Anaplastic Lymphoma Kinase (ALK) gene aberrations confirm a neoplastic process for these lesions. Aim: To study the clinicopathological features of IMTs in a regional cancer centre in South India. Materials and Methods: A cross-sectional study included 17 cases of IMT over six years, from May 2014 to May 2020, at Memorial Kidwai Memorial Institute of Oncology (KMIO), Bengaluru, Karnataka, India. The clinicopathologic and immunophenotypic features were analysed on needle biopsies and resected specimens. Correlation between the expression of ALK-1 and histological patterns, mimickers, metastasis, and prognosis were described. Results were analysed using Microsoft Excel 2019 and Medcalc calculator. Results: Seventeen cases of IMTs were included in this study, out of which two were in the lung, and the rest were extrapulmonary. Sixteen cases were unifocal on presentation; however, one IMT of extremity showed evidence of secondaries on bone scan. The mean age at presentation was 33.47 years, and the maleto-female ratio was 1:1.12. Among the seventeen cases, sites are as follows: one each in the retroperitoneum, liver, soft-tissue (extremity), two each in the breast, lung, female genital tract, urinary bladder, and three each in the head and neck region (maxilla, trachea, and alveolus) and mesentery. Microscopically, IMTs showed various histological patterns. Immunostaining for ALK-1 was positive in seven out of seventeen cases, and the rest were diagnosed by excluding closer mimickers. Conclusion: The present study provides crucial insights into the clinicopathological features of IMTs. Immunohistochemistry (IHC) is an essential diagnostic tool that helps accurately differentiate IMT from its mimickers by identifying ALK protein expression. This distinction is essential for guiding targeted therapy in recurrent or metastatic cases.

The Impact and Prognostic Significance of Extra-Nodal Extension in Clinically N0 Oral Cancer: A Prospective Clinical Study.

Oral cavity squamous cell carcinoma (OCSCC) demonstrates a high propensity to metastasize to regional lymph nodes. Despite technological and scientific advances, identification of pathological adverse features preoperatively remains elusive. This study intended to identify the true occurrence of extra-nodal extension (ENE) in clinically and radiologically N0 OCSCC patients and to investigate its impact and prognostic significance. A prospective, single-centre, non-randomized study was conducted at a tertiary cancer centre in South India to include all untreated operable patients of OCSCC without clinical, radiological, or cytological evidence of nodal metastasis (cN0). All the patients underwent tumor resection surgery with neck dissection and received adjuvant therapy when indicated. Patients were followed up and neck dissection specimens were histopathologically analyzed. The primary outcome was to assess the presence of ENE in cN0 OCSCC patients and its extent. The secondary outcomes were 2-year disease-free survival (DFS) and tumor characteristics. A total of 237 patients with operable OCSCC were evaluated. Out of these, 80 patients who were clinically and radiologically N0 were included in the study and they underwent tumor resection surgery and neck dissection. The final histopathological evaluation revealed that 21.25% of patients (n = 17) had metastatic neck disease and 7.5% of patients (n = 6) had ENE, and all were reported as microscopic ENE. Within the node-positive group, the 2-year DFS for patients with and without ENE were 50% and 90.9%, respectively (p = 0.0362). The results suggest that ENE remains a strong predictor of adverse outcomes, recurrence, and survival in oral cancer patients.

An Overview of Psychological Analysis of Breast Cancer Patients undergoing Modified Radical Mastectomy and Breast Conservation Surgery and its impact on Objectified Body Consciousness at a Tertiary Care Cancer Centre in South India

BackgroundBreast cancer is the most common cancer among females, and surgery plays a central role in its treatment. Surgical treatments may have a negative psychological impact on women's mental health regarding their body image. The purpose of this study was to compare the psychological health insights pertaining to objectified body consciousness scores before and after the surgery and also to observe whether these scores were comparable across the surgery types. Materials and MethodsThis retrospective analysis of prospectively maintained data included 706 breast carcinoma patients who underwent either Breast Conservation Surgery or Modified Radical Mastectomy at tertiary care Cancer Centre, between the years 2020 to 2021. A validated questionnaire of Objectified Body Consciousness was used to obtain responses at diagnosis and at 6 months postsurgery and final scores were calculated for both instances. Two sample t-tests/analysis of variance and Chi-square tests were used to compare continuous and categorical variables respectively. ResultsOut of total 706 breast cancer patients, 402 patients underwent Breast Conservation Surgery and 304 underwent Modified radical mastectomy procedure. A statistically significant change was seen in the mean Objectified Body Consciousness Score (14.22 ± 15.44) for all patients when compared preoperatively(72.72 ± 11.38) and postoperatively(60.15 ± 17.58). This change was higher in the Modified Radical Mastectomy group(29.38 ± 11.53). Also, statistically significant rise in scores was seen with increasing age. ConclusionWe could affirmatively conclude in our study that younger breast cancer patients and all patients who underwent a Modified Radical Mastectomy, had more psychological apprehension with the body image postsurgery, signifying these groups should be encouraged by healthcare professionals to reach out for counselling at the earliest.

Factors associated with knowledge of diagnosis, prognosis & distress in cancer patients receiving palliative care - A retrospective cohort analysis.

Demographic attributes of cancer patients are associated with the awareness of diagnosis, the prognosis of cancer and their associated psychological distress. This study was aimed to assess the knowledge of diagnosis, prognosis and psychological distress among patients reporting to the pain and palliative care department in a tertiary cancer hospital, south India. Data of all patients visiting the palliative care outpatient department of a tertiary cancer centre in south India between January and June 2018 were included in the study (n=754). A structured pro forma was used to collect information on the sociodemographic details and clinical aspects and a distress thermometer was used to assess the level of distress. Information, thus collected, were analysed using descriptive statistics and logistic regression. Around 16.2 per cent of the patients were unaware of their diagnosis while two third (68%) were unaware of the prognosis. More than half of the patients reported significant distress (54.1%). Gender, education, not working and being diagnosed with head-and-neck cancers were associated with knowledge of diagnosis, while educational level predicted the knowledge of prognosis. Younger age group, head-and-neck cancer, haematology cancer, state of being unaware of diagnosis and prognosis were found to be associated with distress. Higher educational levels and better socio-economic status increase the likelihood of patients being aware of their diagnosis and prognosis. Being unaware of the prognosis remains associated with the higher level of distress.

Significance of tumor-infiltrating lymphocytes in tumor regression in breast cancer: A study in a tertiary care cancer center in South India.

Tumor immunology plays a significant role in predicting tumor biology and how a tumor is going to respond to neoadjuvant chemotherapy (NACT). Tumor-infiltrating lymphocytes (TILs) are the easiest and by far the cheapest method of assessing tumor immunity. Many studies have suggested that TILs play an important role in tumor regression in breast cancer. The aim of the current study was to determine significance of TILs in tumor regression in breast cancer. Patients with newly diagnosed and histologically proven breast cancer who were treated with both NACT and surgery in our institute were included in the study. TILs were assessed both before and after NACT, and were correlated with the relative amount of tumor regression and molecular subtypes based on the immunohistochemistry profile. The study included 43 specimens of carcinoma breast in females. 42 cases were diagnosed with invasive carcinoma, no special type (NST), and one with lobular carcinoma. Pathological complete remission (pCR) was noted in 6 cases, partial remission (PRe) in 12 cases, and no response in 25 cases. TILs were noted before and after NACT in all cases and were correlated with other clinicopathological parameters. The present study highlights that TILs play a vital role in tumor regression and can be included in routine reporting. It can provide an insight into tumor biology.

B-Cell Prolymphocytic Leukemia: Clinical Profile and Treatment Outcomes at a Tertiary Cancer Center in South India

Introduction: B-cell prolymphocytic leukemia (B-PLL) is a rare lymphoid malignancy considered to have an aggressive course. At diagnosis, most patients have prominent splenomegaly, minor involvement of lymph nodes, and marked leukocytosis with a predominance of prolymphocytes. It is usually treated on similar lines as chronic lymphocytic leukemia. Objectives: The objective of this study was to study the clinicopathological profile and treatment outcomes of B-PLL patients treated at a tertiary cancer center in South India. Materials and Methods: In this retrospective study, the patients diagnosed with B-PLL from August 2020 to July 2022 were included and reviewed for clinical characteristics, pathological findings, and treatment outcomes. The patient's data were collected from hospital medical records and analyzed. Results: Five patients were diagnosed as B-PLL over a period of 2 years. The median age at diagnosis was 52 years. In this series, all the patients presented with high white blood cell (WBC) count ≥50,000 WBC per microliter and splenomegaly was seen in 80%, including massive splenomegaly in 60% of patients. Three patients were treated with bendamustine–rituximab regimen, one patient received single-agent bendamustine, and rest one patient died of tumor lysis syndrome before chemotherapy. Three patients demonstrated partial remission during interim evaluation and rest two patients died of their disease. Conclusion: B-PLL demonstrates a spectrum of clinical features with variation in the extent of the splenomegaly, leukocyte counts, and aggressiveness. This study shows a plethora of clinical features ranging from slowly progressive to rapidly fatal disease.

The LapPath study: Comparison of pathologic outcomes of laparoscopic versus open rectal cancer surgery—A retrospective analysis from a tertiary cancer center in South India

The LapPath study: Comparison of pathologic outcomes of laparoscopic versus open rectal cancer surgery—A retrospective analysis from a tertiary cancer center in South India

Impact of Anterior Commissure Involvement and Frozen Guided Resections on Oncological Outcomes after Laser Cordectomy in Early Glottic Cancers – A 10-year Retrospective Analysis from a Tertiary Care Cancer Center in India

Background: Early glottic cancers can be treated using different options such as transoral laser microsurgery (TLM), open partial laryngectomy (OPL), and radiation therapy (RT). TLM provides similar oncological benefits to OPL in a few subsets of patients, and the quality of voice is comparable to RT, while hospitalization time is reduced. Resection by laser microsurgery of early glottic cancer with anterior commissure involvement (ACI) is more challenging mainly due to difficulty in adequate exposure. The frozen section is reliable in TLM for determining the extent of resection and the real depth which may be masked on videoscopy. Materials and Methods: This study is a retrospective analysis of patients with early glottic cancer (Tis, T1) who underwent TLM in a tertiary cancer center in South India from January 1, 2012, to December 31, 2019. All patients were identified from the hospital registry. Results: The study included 89 patients, and the median follow-up was 54 months. Out of 89 patients, 14 patients had local recurrence which was managed with salvage TLM/salvage RT/salvage laryngectomy. There were three patients with nondisease-specific deaths. Among the study population, the laryngeal preservation rate was 96.6%, the cause-specific survival rate was 100%, and the overall survival rate was 97.7%. The 3-year disease-free survival rate was 84.4%. ACI and frozen margin positivity were statistically significant poor prognostic factors. Conclusion: TLM is a safe and effective treatment of early glottic carcinoma. Apart from tumor (T) staging, ACI and frozen positivity were negative predictive factors. The results suggest the need to consider ACI in the T staging of glottic tumors. Frozen positivity helps us in re-excision but signifies that the disease is deeply infiltrative or aggressive and a vigilant follow-up is required for these patients.

Clinical profiles and outcomes of young versus elderly patients with multiple myeloma: A retrospective observational study from a tertiary cancer center in South India

Clinical profiles and outcomes of young versus elderly patients with multiple myeloma: A retrospective observational study from a tertiary cancer center in South India

The prevalence and correlates of comorbidities among patients with cancer attending a tertiary care cancer center in South India: An analytical cross-sectional study.

Comorbidities in patients with cancer can affect treatment, and should, therefore, be prioritized and managed. Our primary aim was to assess the prevalence of comorbidities among patients with cancer. The secondary objective was to identify the association of comorbidities with various sociodemographic and clinical variables. This was a cross-sectional study conducted between December 2019 and March 2020 among patients with cancer, seeking treatment at Malabar Cancer Center, in Kannur District of northern Kerala in South India. Semi-structured interviews were conducted, and comorbidities were assessed using the Charlson Comorbidity Index. The anthropometric measurements were recorded using a standardized instrument and protocol. We enrolled 242 patients in this study. There were 148 (61.2%) female patients; 106 (43.8%) were aged between 41 and 50 years. Cancers of the head-and-neck and breast accounted for the majority of cases (23.1% each, n = 56), followed by the digestive system (18.6%, n = 45) and female reproductive system (11.2%, n = 27). The most common primary cancers in the head-and-neck, digestive, and female reproductive systems were oral, colorectal, and cervical, respectively. The prevalence of comorbidities among patients with cancer was 70.2% (n = 170). Common comorbidities were hypertension (n = 82 ; 33.9%), arthritis (n = 57; 23.6%), and diabetes (n = 53; 21.6%). After controlling for potential confounders, the factors noted to be independently associated with the presence of comorbidities were advanced age, family history of comorbidity, normal weight or underweight, and cancer treatment for more than 6 months' duration. The high prevalence of comorbidities among patients with cancer suggests the need for an integrated system of care and management as the comorbidities affect the overall management of cancer treatment and care.

Prognostic relevance of pre-treatment inflammatory biomarkers along with other clinicopathological and treatment factors in oral cavity cancers.

Inflammation has traditionally been considered to be one of the hallmarks of cancer, and systemic inflammatory responses have a prognostic value in many solid cancers. The use of inflammation-based prognostic markers along with traditional clinicopathological prognostic markers in oral cavity cancers has not been studied well. This is a retrospective study from a prospectively maintained database of patients with oral cancers who were managed in a regional cancer center in south India. The study included patients with squamous cell carcinoma of the oral cavity who were treated with curative intent from January to December 2016. Three hundred sixty-one patients met the eligibility criteria and were included in the study. The median age of our patient cohort was 45 years; the male-to-female ratio was 3.7:1. All of the patients underwent curative treatments after a multi-disciplinary board concurrence. Advanced T stage, patients with buccal mucosal cancers and patients who received upfront non-surgical treatments have poorer survival outcomes. The clinicopathological variables that predicted a poorer overall survival in the cohort of patients treated with upfront surgery were advanced T Stage, higher grade, presence of perineural invasion, a higher inflammatory maker, and combination of platelet and neutrophil lymphocyte ratio (COP-NLR). Our unique study of oral cavity cancer patients with a primary aim of exploring the prognostic significance of the pre-treatment inflammatory markers gave very interesting results. The prognostic significance of COP-NLR and other inflammatory markers in oral cancers need to be further explored. More importantly, our study has clearly reiterated that meaningful long-term survival outcomes in oral cavity cancers can only be achieved with the incorporation of upfront surgery.

Profile of patients of colon cancers treated without any targeted therapies and comparison of treatment outcome between left- and right-sided tumors: A retrospective study from a tertiary cancer center in South India

Introduction: Left- and right-sided colon cancers differ in pathology, tumor biology, and response to therapies. In our country, most of the patients with carcinoma of colon, do not afford targeted therapies and are treated with chemotherapy only, for their metastatic diseases. Aims: The present study aimed to find out differences in terms of survival outcomes between right- and left-sided colon carcinoma patients who were treated without any targeted therapy or immunotherapy. Materials and Methods: Retrospectively, data of patients of carcinoma colon who were diagnosed and treated in between January 2010 and August 2017 were collected. The different clinicopathological and survival parameters were compared between right-sided and left-sided colon carcinoma patients using Kaplan–Meier models, unadjusted Cox regression models, and Cox models stratified by stage. Results: Mean disease-free survival (DFS) for Stage I, II, and III patients was 37.9 months, 33.7 months, and 28.9 months, respectively, and mean progression-free survival (PFS) in 1st line for metastatic disease was 8.1 months. Mean PFS for metastatic diseases in 1st line was not different significantly between left- and right-sided tumors (left vs. right: 8.1 months vs. 8.5 months, P = 0.72). For nonmetastatic disease, mean overall survival (OS) was significantly better in left-sided tumors (left vs. right: 46.2 months vs. 39.6 months, P = 0.019). Those with metastatic disease at presentation, OS did not vary with side (left vs. right: 24.5 months vs. 24.2 months, P = 0.89). Among the patients, who had undergone curative surgery, either upfront or after conversion chemotherapy, left-sided tumors were found to have higher mean DFS and OS (left vs. right, DFS: 31.2 months vs. 20.4 months, P = 0.006, hazard ratio [HR] = 0.54, 95% confidence interval [CI]: [0.38–0.77]; OS: 46.4 months vs. 39.6 months, HR = 0.51, 95% CI = [0.31–0.84], P = 0.008). Conclusion: Patients with left-sided nonmetastatic tumors or metastatic tumors that could undergo curative surgery had higher DFS and OS. Among the patients who did not undergo curative surgery, and were treated with chemotherapy alone, PFS and OS were similar for tumors of both sides. With only chemotherapy without any targeted agents for the metastatic disease, there was no difference in survival with the side.