Oncology Department Research Articles

Integration of Telemedicine Consultation Into a Tertiary Radiation Oncology Department: Predictors of Use, Treatment Yield, and Effects on Patient Population.

The COVID-19 pandemic led to rapid expansion of telemedicine. The implications of telemedicine have not been rigorously studied in radiation oncology, a procedural specialty. This study aimed to evaluate the characteristics of in-person patients (IPPs) and virtual patients (VPs) who presented to a large cancer center before and during the pandemic and to understand variables affecting likelihood of receiving radiotherapy (yield) at our institution. A total of 17,915 patients presenting for new consultation between 2019 and 2021 were included, stratified by prepandemic and pandemic periods starting March 24, 2020. Telemedicine visits included video and telephone calls. Area deprivation indices (ADIs) were also compared. The overall population was 56% male and 93% White with mean age of 63 years. During the pandemic, VPs accounted for 21% of visits, were on average younger than their in-person (IP) counterparts (63.3 years IP v 62.4 VP), and lived further away from clinic (215 miles IP v 402 VP). Among treated VPs, living closer to clinic was associated with higher yield (odds ratio [OR], 0.95; P < .001). This was also seen among IPPs who received treatment (OR, 0.96; P < .001); however, the average distance from clinic was significantly lower for IPPs than VPs (205 miles IP v 349 VP). Specialized radiotherapy (proton and brachytherapy) was used more in VPs. IPPs had higher ADI than VPs. Among VPs, those treated had higher ADI (P < .001). Patient characteristics and yield were significantly different between IPPs and VPs. Telemedicine increased reach to patients further away from clinic, including from rural or health care-deprived areas, allowing access to specialized radiation oncology care. Telemedicine has the potential to increase the reach of other technical and procedural specialties.

CONTRIBUTION OF COMPUTED TOMOGRAPHY IN THE ASSESSMENT OF THE EXTENT OF BLADDER CANCER AT THE MOTHER-CHILD UNIVERSITY HOSPITAL CENTER LE LUXEMBOURG

Objective: Our study aimed to study the contribution of CT scanning in the assessment of the spread of bladder cancers at the Medical Imaging Department of the Mother-Child University Hospital Center Luxembourg. Methodology: Descriptive cross-sectional study carried out at the Mother-Child University Hospital Center Luxembourg, in the Medical Imaging department in collaboration with the Medical Oncology department. It included 91 cases of bladder tumors over a 38-month period from January 1, 2020 to February 28, 2023. Results : We collected 91 cases of bladder tumors, the average age of occurrence was 55.86 years, with extremes of 21 and 80 years. The male gender was predominant with a sex ratio of 1.46. The Bambara ethnic group was the most represented with 41.8%. The dominant profession was that of housewives with a rate of 36.3%. A history of urinary bilharzia was found in 30.8% of our patients. On CT, the masses had a hypodense appearance in 81.3% and 5.5% were calcified the contours were irregular in 57.1% of cases and budding in 41.8% of cases. The masses presented heterogeneous enhancement in 59.3% of cases after PDC injection and the long axis measurement varied from 11 to 116 mm with an average of 37.35 mm. Squamous cell carcinoma was the most common histological type with 60.4%, followed by urothelial carcinoma (35.2%). Locoregional invasion was mainly perivesical fat in 24.2% of cases, the prostate in 16.5% of cases and the cervix in 13.2% of cases. Distant metastases were present in 45.1% of patients with a pulmonary predominance, i.e. 22% of cases. Stages T4 and T3 were the most represented with 42.9% and 35.2% of cases respectively. Stage N2 represented 31.9% of cases and stage N1 represented 16.5% of cases. Conclusion : Bladder cancers are more common in men than in women. Urinary schistosomiasis is the predominant risk factor in endemic countries. Locoregional invasion is more frequent and predominates at the perivesical fat level. Pulmonary metastases are more common.

Comparative evaluation of robot-assisted, laparoscopic and open surgical interventions in the combined treatment of stomach cancer

Introduction. Gastric cancer ranks fifth in incidence and fourth in mortality among all oncological diseases worldwide. According to recent clinical data, for stage cT2N0 and beyond, a combined approach using various schemes and regimens of anticancer drug therapy is recommended. Currently, indications for the use of minimally invasive techniques in the surgical treatment of locally advanced gastric cancer are not defined. Research objective. Comparative assessment of the immediate outcomes of robot-assisted, laparoscopic, and open surgical interventions in patients with gastric cancer of different localizations who underwent neoadjuvant polychemotherapy. Materials and methods. The study is based on a retrospective analysis of 81 medical histories of patients with locally advanced gastric cancer of different localizations operated on from 2018 to 2022 in the Department of Abdominal Oncology of City Hospital №40 in St. Petersburg. All patients underwent preoperative cycles of anticancer drug treatment within perioperative polychemotherapy schemes: FLOT – 64 (79%) patients, mFOLFOX6 – 9 (11.1%) patients, and FLOT+Тrastuzumab – 8 (9.9%) patients. Laparoscopic, traditional open, and robot-assisted surgical interventions were performed using the da Vinci surgical system. Results. Thirty-seven (45.7%) robot-assisted operations were performed, (22/27.2% – distal subtotal resections of the stomach (DSRS), 15/18.5% – gastrectomies (GE), 19 (23.5%) laparoscopic (11/13.6% – LDSRS, 8/9.9% – LGE), and 25 (30.9%) operations via laparotomy (9/11.1% – DSRS, 16/19.7% – GE). All patients underwent D2 and D2+ lymphadenectomy. Statistically significant differences were noted in groups for parameters such as operative intervention time, intraoperative blood loss, and length of hospital stay. Open surgical intervention group had significantly higher blood loss volume – median 275 (90.00; 300) ml (p&lt;0.001) and postoperative hospital stay duration – median 10.00 (9.00–14.00) days (p=0.017). Operation time was significantly shorter compared to minimally invasive interventions – median 150.00 (97.50–210.00) minutes for distal resections and 150.00 (96.25–207.50) minutes for GE (p&lt;0.005). There were no statistically significant differences in complication rates (p&gt;0.05) and the number of removed lymph nodes (p=0.334). However, the percentage of early postoperative complications, including lethal outcomes, was higher in the open intervention group (n=4/16%) compared to laparoscopic (n=2/10.5%) and robot-assisted (n=2/5.4%). The overall frequency of postoperative complications IIIA–V according to the Clavien-Dindo classification was 9.9%. One (1.2%) case had a lethal outcome after open gastrectomy. Histological examination showed no tumor growth in the resection margins (R0) for all patients. Complete regression of the gastric tumor (CAP-0) was noted in one case (1.23%) after combined treatment. Nearly complete response to therapy was observed in 13 cases (16%) (CAP-1), partial response in 28 cases (34.6%) (CAP-2), and no response to neoadjuvant therapy in 39 cases (48.1%) (CAP-3). Conclusions. Minimally invasive surgical interventions in the combined treatment of locally advanced gastric cancer are feasible, safe, and oncologically justified. Robot-assisted surgery demonstrates advantages over open and laparoscopic surgery in parameters such as intraoperative blood loss, number of removed lymph nodes, activation and hospitalization periods.

Post molar choriocarcinoma with solitary renal metastasis in the absence of primary uterine tumor: a case report and review of the literature

BackgroundChoriocarcinoma is a rare and highly malignant form of gestational trophoblastic disease that may develop following pregnancy, abortion, or a hydatiform mole. Renal metastatic involvement by post molar choriocarcinoma is even rarer. In this case report, we describe a unique case of post molar choriocarcinoma with a solitary renal metastasis in the absence of a primary uterine tumor and metastases in other sites, which presented with urological symptoms and spontaneous renal hemorrhage.Case presentationA 41-year-old Persian woman with history of complete hydatiform mole presented with severe flank pain, nausea, vomiting, gross hematuria, and vaginal bleeding. Laboratory tests demonstrated a serum beta human chorionic gonadotropin hormone level of 60,000 mIU/mL. Imaging studies showed a lesion at the lower pole of the left kidney with active bleeding surrounded by hematoma, as well as an empty uterine cavity. Additionally, bilateral pleural effusion was detected without any lesion within the lungs. Subsequently, the patient underwent laparotomy, partial nephrectomy, and left para-ovarian cystectomy. Endometrial curettage was also carried out. The histopathology report revealed choriocarcinoma renal metastasis with high expression of beta human chorionic gonadotropin, cytokeratin 7, and Ki 67. Moreover, there were no malignant cells in the endometrial curettage specimens, and a corpus luteum cyst was found within the para-ovarian cyst. Further investigations revealed that the pleural effusion was free of malignant cells, and there was no evidence of metastatic lesions in the brain. As a result, the patient was referred to the oncology department to receive chemotherapy, and the beta human chorionic gonadotropin levels dropped to 5 mIU/mL after receiving courses of a standard regimen of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine/oncovin over 3 weeks. Finally, monthly measurements of beta human chorionic gonadotropin levels for 6 months indicated that levels have constantly remained within normal ranges, showing no evidence of recurrence or new metastasis.ConclusionsUrological symptoms such as hematuria or spontaneous renal hemorrhage might be the only presentation of post molar choriocarcinoma with renal involvement. Thus, it can be beneficial to measure serum beta human chorionic gonadotropin levels among females of childbearing age who present with unexplained urological symptoms, especially if there is a history of prior hydatiform mole.

PREDICTIVE MODELS FOR ASSESSING RISKS OF POSTOPERATIVE CARDIAC AND RESPIRATORY COMPLICATIONS IN PATIENTS WITH LUNG CANCER

The aim of the study is to identify risk factors for the development of postoperative cardiac and respiratory complications in patients after lobectomy and to develop nomograms to predict such complications.&#x0D; Materials and Methods. From January 2020 to August 2023, 411 lobectomies were performed in patients with non-small cell lung cancer in the surgical department of thoracic oncology, Regional Clinical Oncology Dispensary (Ulyanovsk). The present study included 162 patients according to the designed enrolment criteria. The authors identified statistically significant risk factors for the development of severe cardiac and respiratory complications after lobectomy with systematic lymph node dissection.&#x0D; Results. Due to insufficient data cardinality, artificial data with a similar distribution were synthesized using the MICE method (multivariate imputation by chained equations). The sample is divided into training (n=1258) and validation (n=342) datasets at a ratio 80 to 20. Final testing of the initial data was carried out (n=162).&#x0D; Logistic regression for respiratory complications: respiratory complications = 23.4232 – 0.7427 × stair climbing test – 0.0259 × shuttle walking test. Based on these data, a nomogram was constructed to predict the development of respiratory complications. Error matrix characteristics: accuracy – 0.95; sensitivity – 0.86; specificity – 0.97; positive predictive value – 0.86; negative predictive value – 0.97.&#x0D; Logistic regression for cardiac complications: cardiac complications = 11.1147 – 0.1247 × stair climbing test – 0.1651 × ejection fraction + 0.1568 × BMI + 1.133 × hypertension. Based on these data, a nomogram was constructed to predict cardiac complications. Error matrix characteristics: accuracy – 0.91; sensitive-&#x0D; ty – 0.63; specificity – 0.98; positive predictive value – 0.9; negative predictive value – 0.92. &#x0D; Conclusions. The developed prognostic models allow us to determine the risk group among patients who are planning a lobectomy for lung cancer at the preoperative stage. It also allows us to ensure high-quality prevention for these complications in patients at high risk.

Primary breast sarcomas: A 13 case-series study treated in university hospital in central Tunisia over a 25-year period.

To retrospectively study the therapeutic modalities of primary breast sarcomas in view of the data of a local Tunisian experience. It is a monocentric, descriptive, retrospective study including 13 cases of primary breast sarcoma treated over a period of 25 years (1995-2020) in the oncological radiotherapy department of a university hospital in Sousse, Tunisia. In our study, 13 cases of non-metastatic breast sarcomas that has been identified, divided into ten cases of phyllodes sarcomas and three cases of non-phyllodes sarcomas.Surgically, all our patients had a mastectomy. Among them, seven underwent a lymph node procedure: five underwent axillary lymph node dissection, and two others had primary axillary lymph node biopsy. For the adjuvant treatment, all the patients included in our study received radiotherapy and seven received chemotherapy. Local recurrence occurred on the operative scar in one patient after completion of radiation therapy. Metastatic relapse was described in five patients. The time to onset of metastases varied between two months and five years. Nevertheless, a complete remission was noted in 6 patients with a follow-up varying from four years to 20 years. Two patients were lost to follow-up. Breast sarcomas remain a very rare entity of aggressive tumors.The therapeutic approach is poorly codified. For this reason, the therapeutic decision should always be discussed in a multidisciplinary assessment.

Dynamic Treatment Strategy of Chinese Medicine for Metastatic Colorectal Cancer Based on Machine Learning Algorithm.

To establish the dynamic treatment strategy of Chinese medicine (CM) for metastatic colorectal cancer (mCRC) by machine learning algorithm, in order to provide a reference for the selection of CM treatment strategies for mCRC. From the outpatient cases of mCRC in the Department of Oncology at Xiyuan Hospital, China Academy of Chinese Medical Sciences, 197 cases that met the inclusion criteria were screened. According to different CM intervention strategies, the patients were divided into 3 groups: CM treatment alone, equal emphasis on Chinese and Western medicine treatment (CM combined with local treatment of tumors, oral chemotherapy, or targeted drugs), and CM assisted Western medicine treatment (CM combined with intravenous regimen of Western medicine). The survival time of patients undergoing CM intervention was taken as the final evaluation index. Factors affecting the choice of CM intervention scheme were screened as decision variables. The dynamic CM intervention and treatment strategy for mCRC was explored based on the cost-sensitive classification learning algorithm for survival (CSCLSurv). Patients' survival was estimated using the Kaplan-Meier method, and the survival time of patients who received the model-recommended treatment plan were compared with those who received actual treatment plan. Using the survival time of patients undergoing CM intervention as the evaluation index, a dynamic CM intervention therapy strategy for mCRC was established based on CSCLSurv. Different CM intervention strategies for mCRC can be selected according to dynamic decision variables, such as gender, age, Eastern Cooperative Oncology Group score, tumor site, metastatic site, genotyping, and the stage of Western medicine treatment at the patient's first visit. The median survival time of patients who received the model-recommended treatment plan was 35 months, while those who receive the actual treatment plan was 26.0 months (P=0.06). The dynamic treatment strategy of CM, based on CSCLSurv for mCRC, plays a certain role in providing clinical hints in CM. It can be further improved in future prospective studies with larger sample sizes.

Experience of pediatric palliative care among children with cancer in a tertiary care hospital in Bangladesh

Background: Palliative care is a holistic approach which can improve patients and their family’s quality of life through the prevention and relief of physical symptoms as well as support for emotional, social and spiritual suffering. Despite the substantial need for palliative care there is very limited access in Bangladesh, with only a few palliative care services focused on children including several hospital-based services as well as home and hospice-based services, within the capital city of Dhaka. The aim of the study was to evaluate the effect of pediatric palliative care on quality of life in children with cancer. Methods: This was an institutional based descriptive study conducted in the department of pediatric hematology and oncology and pediatric palliative care unit, Dhaka medical college hospital, Dhaka, from May to August 2023. A total of thirty child and parent pairs were taken as the study population according to inclusion and exclusion criteria. Outcome was evaluated by the CPOS-2 questionnaires for symptom and Lanskys performance status scale for assessment of activity level. Results: The median age of the children were 5.7 years where 70.0% were male. The duration of disease of the patients was up to 6 months in 63.3% cases. One third of the patients had ALL, 13.3% had NHL, and 10.0% had Ewing sarcoma while another 10.0% having neuroblastoma. Conclusions: There is significant improvement in the quality of life of pediatric cancer patients and their parents, as well as the enhanced performance status of patients with cancer after receiving pediatric palliative care.

“Examining the link between tooth agenesis and papillary thyroid cancer: is there a risk factor?” Observational study

BackgroundMutations in one or multiple genes can lead to hypodontia and its characteristic features. Numerous studies have shown a strong genetic influence on the occurrence of hypodontia, and identified several genes, including AXIN2, EDA, FGF3, FGFR2, FGFR10, WNT10A, MSX1, and PAX9, that are directly associated with dental agenesis and carcinogenesis. The objective of this study was to investigate the occurrence and pattern of tooth agenesis, microdontia, and palatally displaced canine (PDC) in women diagnosed with papillary thyroid cancer (PTC), compared to a control group of women without any malignancy or thyroid disease.Materials and methodsThis case–control study was carried at the Department of Orthodontics, School of Dental Medicine University of Zagreb, and Department of Oncology and Nuclear Medicine Sestre Milosrdnice University Hospital Centre. The study involved a clinical examination and evaluation of dental status, panoramic X-ray analysis, and assessment of medical and family history of 116 female patients aged 20–40 with PTC, as well as 424 females in the control group who were of similar age.ResultsThe prevalence of hypodontia, microdontia, and PDC was statistically higher in women with PTC than in the control group. The prevalence rate of hypodontia was 11.3% in the experimental group and 3.5% in the control group. The experimental group showed a higher occurrence of missing upper lateral incisors, lower left central incisors, and all the third molars (except the upper left) compared to the control group. Women with PTC showed the prevalence of PDC significantly higher than the control group (3.5%, 0.7%, p = 0.002). The probability of hypodontia as a clinical finding increases 2.6 times, and microdontia occurs 7.7 times more frequently in women with PTC.ConclusionOur study suggests a possible link between odontogenesis and PTC. The absence of permanent teeth may increase the likelihood of PTC in women. Leveraging the age-7 orthopantomogram to identify women at high risk for PTC within a critical early detection window could significantly improve oral health outcomes and PTC prognosis through proactive interventions.

Satisfaction levels and associated influencing factors among inpatients and outpatients with breast cancer at a tertiary health facility in Ghana.

To uncover variables linked to breast cancer patient satisfaction in order to improve policy choices and actions for breast cancer care in Ghana. We employed a cross-sectional design using a quantitative approach. The Radiotherapy, Oncology and Surgery Departments of the Korle Bu Teaching Hospital, Accra. Inpatient and outpatient breast cancer patients. The level of inpatient and outpatient satisfaction was measured using descriptive and inferential statistical analyses. The Shapiro-Wilk test was employed to assess normality, while the Heckman selection model assessed significance with outcomes of interest. A total of 636 participants, with a mean age of 52.64±14.07 years, were recruited. The measured inpatient and outpatient levels of satisfaction out of 100 were 74.06±7.41 and 49.99±1.00 respectively, while the self-reported satisfaction levels out of 5 were 4.22±0.63 and 4.11±0.85 respectively. The level of inpatient satisfaction was significantly influenced by age, marital status, income level, and number of previous facilities visited (p<0.05). Outpatient satisfaction level was significantly associated with place of residence and income level (p<0.05). The study offers insight into the satisfaction levels of breast cancer patients receiving inpatient and outpatient services at the largest tertiary referral centre and teaching hospital in Ghana, as well as the factors influencing attendance and satisfaction levels. Understanding and improving breast cancer patients' levels of satisfaction is a way that providers can safeguard their emotional well-being. Improvement in patient satisfaction at our institution among outpatients is an area for future growth. Gardner-Holt Women's Health Grant program, Centre for Global Surgery 2021.

Management and outcomes of children with rhabdomyosarcoma in a low-to-middle-income country: A first report from Chris Hani Baragwanath Academic Hospital, South Africa

BackgroundStudies done in South Africa show that Rhabdomyosarcomas (RMS) comprises 6 % of childhood malignancies. Very few centres in South Africa (SA) have reported their management and outcomes of children with RMS, and as such, it is difficult to compare outcomes and come up with management protocols befitting our environment. AimTo describe the management and outcomes of children with RMS at Chris Hani Baragwanath Academic Hospital (CHBAH). SettingThe Departments of Paediatric Surgery and Paediatric Oncology. MethodsA retrospective review of clinical records of patients below 18 years of age with RMS, managed from 01 January 2008 to 31 December 2017. ResultsFifty-eight patients had RMS, 77 % embryonal and 21 % alveolar subtypes. Primary tumour site was favourable in 48 %, and unfavourable in 45 %. Thirty-three patients (57%,) had surgery for the primary tumour, whilst 25 patients (43 %) did not have surgery. Post-operative clinical groups were 29 % group I, 9 % group II, 43 % group III, and 19 % group IV. The overall 5-year survival was 55%. Predictors for a good outcome included early disease stage at presentation, favourable site, embryonal subtype, and surgery for the primary tumour. ConclusionThe 5-year survival of 55 % from this study is low when compared to high income countries but is comparable to middle income countries. The main factor contributing to mortality is patients presenting with unresectable advanced disease in unfavourable sites. Surgical resection plays a major role in improving outcomes. Level of evidenceIV

Retrospective descriptive analysis of the demographic and clinicopathological presentation of breast cancer patients in Kasr Al-Ainy Hospital over 5 years

Background Breast cancer is the most common type of cancer and the second leading cause of mortalities among women. Early-stage diagnosis of breast cancer increases the chances of survival, and therefore, reduces mortality rates. A national initiative was implemented in Egypt in 2019 when women above the age of 18 years were granted free screening at 3538 healthcare units, and 114 hospitals nationwide. Objective To describe the sociodemographic factors and clinicopathological presentation of breast cancer among the patients presented to Cairo University Hospital over 5 years. Patients and methods We conducted a descriptive historical study at Kasr Al-Ainy Teaching Hospital of Cairo University, we retrospectively assessed all women with primary breast cancer diagnosed over 5 years during the period from the July 1, 2017 to the July 1, 2022. Data was collected from medical records, operative notes, radiology reports, and pathology reports from the database system of the Oncology Department of Cairo University Hospitals (Kasr Al-Ainy). The patient data is put into a spreadsheet that focuses on the demographic and clinicopathological characteristics of the patients (age, size of the tumor, side of breast affected, histopathology findings, imaging characteristics, immunohistochemistry, and TNM staging of breast cancer). Results We enrolled a total of 509 female patients who were screened for early detection of breast cancer during the past 5 years in general surgery, radio diagnosis, and oncology departments, Kasr Al-Ainy Teaching Hospital; they showed a mean age of 53.7±11.7 years and ranged between 26 and 88 years. In the current study molecular subtyping showed that 24.4% were Luminal A, 34% were Luminal B1, 19.4% were Luminal B2, 9.2% were HER2-enriched and 13% were triple-negative breast cancer subtype. We found that neoadjuvant therapy was prescribed for 190 (37.3%) patients, 36 (19%) of those patients achieved pCR, while the remaining patients had residual disease in the postoperative specimen. Conclusion We concluded that in our center, Egyptian females are diagnosed with breast cancer earlier compared with developed countries; however, the current study reports approximately the same percentages of molecular subtypes, rates of pCR, and metastatic disease at the time of presentation compared with developed countries.

The Safety and Effectiveness of Bevacizumab in Metastatic Colorectal Cancer With Unresectable Metastases: A Real-Life Study From the South of Morocco.

Background Colorectal cancer constitutes a significant public health challenge, despite remarkable strides made in the last two decades, particularly in the medical management of metastatic stages. Notable progress has been achieved through targeted therapies such as anti-epidermal growth factor receptors or anti-angiogenic antibodies, as well as advancements in surgical approaches for hepatic metastases. This study seeks to assess the efficacy and safety of bevacizumab plus chemotherapy in individuals with metastatic colorectal cancer. Methodology This is an observational, cross-sectional, retrospective study of all patients who were followed up for metastatic colorectal cancer with unresectable metastases and were treated with bevacizumab in combination with standard chemotherapy from January 2010 until December 2019 in the medical oncology department of the Centre Hospitalier Universitaire (CHU) Souss-Massa of Agadir. Results Of the total 162 cases, 117 (72%) had metastatic disease, and 45 (28%) progressed to metastatic disease after initial treatment. The median age of the patients was 55 years (range = 23-79 years) with a sex ratio of 1.1 (M/F). The tumor was located in the left colon in 135 (83.3%)patients. The results represented adenocarcinoma in 137 (84.6)cases and mucinous subtype in 23 (14.19) cases. The three most common sites of metastasis were the liver (99, 61.1), peritoneum (67, 41.3), and lung (33, 20.3). In the first line, allpatients received bi-chemotherapy plus bevacizumab, i.e., fluorouracil, oxaliplatin, and leucovorin in 34 (20.9%) patients; capecitabine plus oxaliplatin in 88 (54.3%) patients; leucovorin, fluorouracil, and irinotecan in 17 (10.4%) patients; andcapecitabine plusirinotecan in 23 (14.1%) patients. Response after first-line treatment was progression in 74 (45.7) cases, stability in 42 (25.9) cases, partial response in 35(21.6) cases, and complete response in 11 (6.8) cases. Nine (6%) patients were able to benefit from surgical resection of metastatic lesions. Overall, 77 (47%)patients received second-line chemotherapy, i.e., 5-FU with irinotecan in 40 (51.8%)cases or with oxaliplatin in 30(38.8%) cases. Two patients developed undesirable side effects under bevacizumab (hypertension). The median progression-free survival and median overall survival of the study cohort were 9 months and 14 months, respectively. Nevertheless, patients who underwent primary tumor resection (p = 0.048), those with right‑sided tumors (p = 0.022), those who received a higher number of treatment cycles (p = 0.020), and those who received maintenance treatment (p = 0.001) had a longer median overall survival. Conclusions Chemotherapy combination with bevacizumab is considered as the cornerstone of metastatic colorectal cancer treatment in our region. With the new healthcare and social security systems, easier access to expensive treatments and molecular pathology tests is currently available. It is important to highlight that real-world data can offer valuable insights into the daily clinical practice of medical oncology.

Clinical Profile of Male Patients Presenting with Breast Cancer in Kashmir Valley

Abstract Introduction Breast cancer is a rare disease in males with unknown etiology and variable rate of incidence among different ethnic and geographical groups. Objectives This article studies the clinical profile of male breast cancer in Kashmir Valley of India Materials and Methods This study was a retrospective study conducted at a superspecialty hospital (Government Medical College Srinagar) in the department of medical oncology over a period of 4 years from January 2017 to October 2021. All male patients who presented with a histopathology-proven diagnosis of breast cancer were included and studied. Results A total of 8 male patients with breast cancer were studied. The median age at diagnosis was 55 years. Most of the patients were from rural background. The most common presenting symptom was breast lump followed by ulceration. The most common location of the tumor was retroareolar. Infiltrating ductal carcinoma (100%) was the only subtype present in our patients. Locally advanced disease accounted for most of the cases. Among stage IV patients two had bone as the metastatic site and one patient had in addition lung metastasis. Immunohistochemistry analysis revealed that all patients (100%) were hormone receptor positive with only one patient being triple positive (12.5%). None of the patients had triple negative disease in our study. In our study 6 patients were treated with multimodalities (surgery, chemo, radiation, and targeted agents). Conclusion Male breast cancer is a well-recognized entity and the gender gap of disease need to be abolished. Awareness among masses and training of general practitioners is needed to pick cases at early stage.

Preliminary results of hypofractionated radiotherapy in breast cancer in Chandigarh, India: single-centre, non-inferiority, open-label, randomised, phase 3 trial

Globally, most of the randomised trials with hypofractionation in patients with breast cancer have used 3-dimensional conformal radiotherapy technique (3D-CRT). As facilities for 3D-CRT technique may not be available in low-resource settings, there is a need to see if hypofractionation is feasible and safe with 2-dimensional (2-D) technique. In this study, we compared a 3-week radiation schedule with a 2-week schedule of hypofractionated radiotherapy in patients with breast cancer with 2-D technique. The current study was an open-label, randomised, phase 3 trial. Patients with breast cancer, stage I-III, post mastectomy or after breast conservative surgery who needed adjuvant locoregional radiotherapy were randomised in the Department of Radiotherapy & Oncology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India; to 34Gy in 10 fractions over 2 weeks (2-week arm) or 35Gy in 15 fractions over 3 weeks to the chest wall and 40Gy/15#/3wks to breast and supraclavicular fossa (3-week arm). Boost dose when indicated was 8-10Gy/2-4#/2-4 days in both the arms. Patients were planned on a 2-dimensional (2D) simulator with 2 tangential fields to breast/chest wall and incident supraclavicular fossa field. Acute toxicity was assessed using the Radiation Therapy Oncology Group (RTOG) grading scale. Assessments were carried out weekly during radiotherapy and at 4 weeks after treatment by the physician. Cosmetic outcome was assessed using the Harvard/National Surgical Adjuvant Breast and Bowel Project (NSABP)/RTOG scale. The toxicity rates between the two arms were compared using Fisher's exact tests. The trial was approved by institutional ethics committee and registered with ClinicalTrials.gov, number NCT04075058. This study included 1121 eligible patients from June 2015 to December 2020. Median follow-up was 35 months (6-84 months). Mean age was 48 years (24-75 years). The patient characteristics were comparable between the two arms except for more mastectomies in the 3-week arm and more node-positive patients in the 2-week arm. There were more oestrogen receptor-positive tumors in the 3-week arm. Acute skin toxicities were comparable between the two arms. Grade 2 and 3 skin toxicity was 100 (18%) and 82 (15%); and 16 (3%) and 12 (2%) in the 3-week and 2-week arm (p=0.21), respectively. Cosmetic outcome was assessed as Excellent or Good for 89% of patients in the 3-week arm as compared to 94% in the 2-week arm (p=0.004). The two radiation schedules were comparable in terms of acute skin toxicity. The cosmetic outcome was better with the 2-week schedule. The preliminary findings indicate 2-week radiotherapy schedule with 2-D technique was better than the 3-week schedule in patients with breast cancer. However, disease outcomes and late-term toxicities need to be further checked. This study was funded by Science and Engineering Research Board (SERB), India.

Kenneth Dawson Bagshawe. 17 August 1925—27 December 2022

Kenneth Bagshawe was a physician, a scientist and an architect of modern oncology. He was first to show that combination chemotherapy can cure a non-haematological cancer, choriocarcinoma. He demonstrated how a tumour marker in blood and urine can give a quantitative representation of the total amount of tumour, providing a monitor of response to treatment or relapse and an indicator of prognosis. He enhanced understanding and treatment of gestational trophoblastic diseases (GTD), a group of which choriocarcinoma is the most lethal member. The most common form of GTD is hydatidiform mole and he developed a national system for management, resulting in a cure rate of virtually 100%. For choriocarcinoma, the figure is today approaching 98%. His system is used in many countries, and over several decades has contributed to the cure and preservation of fertility in hundreds of thousands of women who previously had little or no hope. He used the same principles to treat testicular and ovarian germ cell tumours, again achieving high levels of cure in patients whose disease had spread and would previously have been fatal. He innovated throughout his career, seeking improved tumour specificity in diagnosis and treatment of GTD and inventing antibody-directed enzyme prodrug therapy for more common cancers. He founded the first department of oncology in the UK and devoted much time to developing the speciality, directing research funding organizations and supporting the development of the speciality worldwide. He was a dedicated, original and hugely productive pioneer of oncology.

Oncological Surgical Wound Care: A Comparison of Theruptor NXT Non-adherent Dressing and the Current Standard of Care.

Background Oncological surgeries pose an elevated risk of surgical site infections (SSIs) due to their complexity and various associated treatments, impacting patient outcomes and healthcare costs. This has prompted a focus on advanced wound dressings that provide microbial protection, exudate absorption, and improved product performance, enhancing patient satisfaction. Our study aimed tocompare the efficacy and safety of Theruptor NXT with the current standard of care (SOC) practice involving cotton/povidone/micropore dressings in the postoperative wound management of oncological surgeries. Methodology A total of 102 patients who underwent oncological surgeries in the Department of Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India between May and September 2023 were randomized to Theruptor NXT and SOC dressing groups (51 patients each). The incidence of SSIs, wound pain score, cosmetic appearance of the wound, and adverse events were assessed in the two groups at various intervals, i.e., post-surgery day 2 ± 1, day of discharge, and post-surgery day 30 ± 7. Further, the subject satisfaction and product usage were evaluated on post-surgery day 2 ± 1. Results The baseline characteristics were found to be comparable in both groups, i.e., Theruptor NXT and SOC groups. Further, the SSI rates, scar outcomes, and physiological parameters were also similar between the Theruptor NXT and SOC groups, indicating a similar safety profile of both dressings (p > 0.05). However, the product usage assessment revealed statistically significant differences, favoring Theruptor NXT in terms of superior ease of application, stretchability, exudate management, breathability, and non-adherence properties (p < 0.05). Conclusions Our findings suggest that Theruptor NXT wound dressing is a promising, effective, and user-friendly alternative to SOC wound dressing in diverse clinical settings.

Study of diagnostic accuracy of non-aspiration cytology in solid tumors

Fine needle aspiration cytology (FNAC) is widely accepted as a primary method for the diagnosis of thyroid lesions. An alternative to FNAC is fine-needle sampling without aspiration (FNNAC). FNAC is easy to perform, quickly and has a high degree of sensitivity and specificity and avoid unnecessary surgery. Hence the present study was performed to study the diagnostic accuracy of FNNAC with FNAC technique in solid tumors.: An observational study was carried out on 325 patients with swellings in the breast, thyroid, and soft tissues and enlarged lymph nodes in the Department of surgical oncology, Regional Cancer Centre, Government Coimbatore Medical college hospital, Coimbatore, India. A single pathologist was responsible for all cytological and histological reports. Slides of both approaches were analysed and compared using Mair et al grading methodology, which depends on five factors. The number of smears with superior quality and diagnostic accuracy is compared and analysed statistically using the 'z' test for two proportions.: FNNAC produced better smears with less haemorrhage in vascular organs like the thyroid. FNAC performed better in breast fibrous lesions such as fibroadenoma and phyllodes tumour. For malignant lumps of breast and lymph nodes, FNAC yields better material than FNNAC.: The current research shows that FNNAC is the superior approach for highly vascular organs such as the thyroid because it yields high-quality smears with less blood admixtures. Although FNAC smears were more often diagnostic, they typically yielded acceptable rather than excellent grade smears.

Engaging patients in designing a transmural allied health pathway: A qualitative exploration of hospital-to-home transitions.

The transition from hospital to home is often suboptimal, resulting in patients not receiving the necessary allied healthcare after discharge. This may, in turn, lead to delayed recovery, a higher number of readmissions, more emergency department visits and an increase in mortality and healthcare costs. This study aimed to gain insight into patients' experiences, perceptions, and needs regarding hospital-to-home transition, focusing on allied healthcare as a first step towards the development of a transitional integrated allied healthcare pathway for patients with complex care needs after hospital discharge. We conducted semistructured interviews with patients. Participants were recruited from universities and general hospitals in the Amsterdam region between May and July 2023. They were eligible if they (1) were discharged from the hospital minimally 3 and maximally 12 months after admission to an oncologic surgery department, internal medicine department, intensive care unit, or trauma centre, (2) received hospital-based care from at least one allied healthcare provider, who visited the patient at least twice during hospital admission, (3) spoke Dutch or English and (4) were 18 years or older. Interviews were audio-recorded and transcribed verbatim. We performed a thematic analysis of the interview data. Nineteen patients were interviewed. Three themes emerged from the analysis. 'Allied healthcare support during transition' depicts patients' positive experiences when they felt supported by allied health professionals during the hospital-to-home transition. 'Patient and family involvement' illustrates how much patients value the involvement of their family members during discharge planning. 'Information recall and processing' portrays the challenges of understanding and remembering overwhelming amounts of information, sometimes unclear and provided at the wrong moment. Overall, patients' experiences of transitional care were positive when they were involved in the discharge process. Negative experiences occurred when their preferences for postdischarge communication were ignored. This study suggests that allied health professionals need to continuously collaborate and communicate with each other to provide patients and their families with the personalized support they need. To provide high-quality and person-centred care, it is essential to consider how, when, and what information to provide to patients and their families to allow them to contribute to their recovery actively. The interview guide for this manuscript was developed with the assistance of patients, who reviewed it and provided us with feedback. Furthermore, patients provided us with their valuable lived experiences by participating in the interviews conducted for this study.

Risk factors analysis and the establishment of nomogram prediction model for PICC-related venous thrombosis in patients with lymphoma: a double-center cohort-based case-control study.

The objective of this study is to examine the risk factors associated with the occurrence of PICC-Related Venous Thrombosis (PICC-RVTE) in individuals diagnosed with lymphoma, as well as to develop a predictive risk nomogram model. A total of 215 patients with lymphoma treated at Yunnan Provincial Tumor Hospital from January 2017 to December 2020 were retrospectively evaluated as the training cohort; 90 patients with lymphoma treated at the Department of Oncology of the First People's Hospital of Anning, Affiliated to Kunming University of Science and Technology during the January 2021 to September 2023 were evaluated as the validation cohort. Independent influencing factors were analyzed by logistic regression, a nomogram was developed and validated, and the model was evaluated using internal and external data cohorts for validation. A total of 305 lymphoma patients were selected and 35 (11.48%) PICC-RVTE occurred, the median time was 13 days. The incidence within 1-2week was 65.71%. Multivariate analysis suggested that the activity amount, thrombosis history(within the last 12 months), ATIII, Total cholesterol and D-dimer levels were independently associated with PICC-RVTE, and a nomogram was constructed based on the multivariate analysis. ROC analysis indicated good discrimination in the training set (area under the curve [AUC] = 0.907, 95%CI:0.850-0.964) and the testing set (AUC = 0.896, 95%CI: 0.782-1.000) for the PICC-RVTE nomogram. The calibration curves showed good calibration abilities, and the decision curves indicated the clinical usefulness of the prediction nomograms. Patients should be advised to undergo color Doppler ultrasound system testing within two week after the implantation of a PICC catheter to detect PICC-RVTE at an early stage. The validated nomogram can be used to predict the risk of catheter-related thrombosis (CRT) in patients with lymphoma who received at least one chemotherapy after PICC catheterization, no bleeding tendency, no recent history of anticoagulant exposure and no severe heart, lung, renal insufficiency. This model has the potential to assist clinicians in formulating individualized treatment strategies for each patient.